Early post-transplant lymphoproliferative disease following heart transplantation in the absence of lymphocytolytic induction therapy.

We report a case of post-transplant lymphoproliferative disease presenting as a disseminated polymorphous B-cell lymphoma involving the cardiac allograft 3 months following transplantation in a recipient who did not receive anti-lymphocyte induction immunosuppression. In situ hybridization for the lytic Epstein-Barr virus marker NOT I was positive within a lymphocytic infiltrate on endomyocardial biopsy. Our case is the third of early post-transplant lymphoproliferative disease (within 6 months of transplantation) involving the heart allograft in the absence of anti-lymphocyte induction immunosuppression. Post-transplant lymphoproliferative disease of the heart allograft should be considered in the presence of an atypical cardiac lymphocytic infiltrate, with possible differentiation from allograft rejection using in situ hybridization for Epstein-Barr virus.

Changes in lipoprotein(a) concentration after orthotopic heart transplantation.

BACKGROUND: Elevated concentrations of lipoprotein(a) have been considered an important risk factor in the development of premature cardiovascular disease and have been proposed as a risk factor in the development of accelerated cardiac allograft vasculopathy after orthotopic heart transplantation. METHODS: We prospectively measured lipoprotein(a), fasting cholesterol, and triglyceride concentrations before (n = 38), 6 months (n = 38), and 1 year (n = 21) after orthotopic heart transplantation. The mean age of the patients was 52 +/- 2 years. Eighty-seven percent of the patients were men, 82% were white, and 61% had ischemic cardiomyopathy. RESULTS: Mean lipoprotein(a) concentration was lower 6 months after transplantation than it was before the operation (23 +/- 3 mg/dL vs 17 +/- 3 mg/dL; P =.014) and remained low 1 year after transplantation (23 +/- 3 mg/dL vs 18 +/- 4 mg/dL; P = not significant). In contrast, mean cholesterol concentration was higher 6 months after transplantation (171 +/- 8 mg/dL vs 221 +/- 8 mg/dL; P <.001) and 1 year (171 +/- 8 mg/dL vs 205 +/- 10 mg/dL; P <.01) than it was before transplantation. Triglyceride concentration was higher 1 year after transplantation than it was before the operation (146 +/- 13 mg/dL vs 184 +/- 20 mg/dL; P =.017). CONCLUSIONS: Lipoprotein(a) concentrations decrease during the 6 months after transplantation and stay low for at least 1 year after the operation. Additional studies are needed to ascertain the effect these changes in lipoprotein(a) concentration on the development of cardiac allograft vasculopathy.

Eye tracking in normals: spem asymmetries and association with schizotypy.

SPEM was recorded electro-oculographically during visual tracking of sinusoidal targets oscillating at .4 and .8 cycles per second in one hundred nineteen undergraduates. The logarithms of median root mean square values were used to assess tracking accuracy for leftward and rightward halfcycles of tracking. Over the entire sample, there was a significant superiority of rightward over leftward tracking, which, given evidence for the ipsilateral mediation of SPEM at the cortical level, suggests a right hemisphere predominance in the control of SPEM in normal subjects. Individual tracking asymmetry was associated with overall tracking accuracy such that subjects with relatively deficient leftward tracking and those with a larger absolute magnitude of asymmetry had poorer overall tracking. High scores on an MMPI schizotypy measure (Sum 2-7-8-0) were significantly related to poorer overall SPEM accuracy, individual tracking asymmetry, the absolute magnitude of tracking asymmetry, and phase lag, though the subjects' sex, handedness, and crossed hand-foot dominance were found to affect the relationships between schizotypy and tracking accuracy. These findings suggest that although control of SPEM may be predominantly right hemispheric, in some persons with a vulnerability to schizophrenia spectrum disorders, expressed as poorer overall SPEM accuracy and high schizotypy scores, left hemisphere-mediated (leftward) SPEM may be particularly impaired.

Lipoprotein(a) levels and heart transplantation atherosclerosis.

BACKGROUND: Elevated serum lipoprotein(a) [Lp(a)] levels are associated with the development of native coronary atherosclerosis. The association between increased levels of Lp(a) and the development of accelerated cardiac allograft vasculopathy (ACAV) in patients who have undergone orthotopic heart transplantation has not been firmly established. METHODS AND RESULTS: We studied 74 consecutive heart transplant recipients with at least 1 year survival to determine the relation between Lp(a) and the presence of ACAV. Recipient and donor clinical and laboratory parameters, including mean serum Lp(a) levels, were obtained. ACAV was defined angiographically as > or =30% stenosis in one or more epicardial arteries. ACAV 1 year after heart transplantation was angiographically present in 26 (35%) patients. Mean donor age (36 +/- 13 years [ACAV (+)] vs 28 +/- 10 years, [ACAV (-)]; p = 0.004) and mean serum triglyceride levels 6 months after transplantation (286 +/- 275 mg/dl [ACAV (+)] vs 169 +/- 85 mg/dl [ACAV (-)]; p = 0.025) were univariate predictors of ACAV. No significant difference in mean serum Lp(a) levels was observed (20 +/- 19 mg/dl [ACAV (+)] vs 30 +/- 30 mg/dl [ACAV (-)]; p = NS). Donor age was the single greatest independent predictor of ACAV by multivariate logistic regression (p = 0.02). CONCLUSIONS: Lp(a) does not appear to be a risk factor for the development of ACAV 1 year after heart transplantation. Further studies are needed to define the influence of serum Lp(a) on the development of cardiovascular disease after orthotopic heart transplantation.

Lateral preference and neuropsychological correlates of schizotypy.

A battery of 11 schizotypy questionnaires was administered to 316 male undergraduates. The scores of the 266 white subjects were subjected to a principal components analysis, and 73 subjects scoring at the upper and lower ends of the factor score distribution based on the first unrotated component were recalled for neuropsychological testing. The battery of neuropsychological tests consisted of four tests of motoric performance, four subtests from the Wechsler Adult Intelligence Scale-Revised, the conjugate lateral eye movement test, and a lateral preference questionnaire. Subjects high on schizotypy did not differ from low scorers on overall neuropsychological performance or performance asymmetries. High scorers did show a sinistral shift in hand and foot preference and more crossed dominance compared with controls. Asians scored significantly higher than whites on several schizotypy scales, raising the question of a possible ethnic bias in these measures.