The effects of diclofenac sodium on thyroid function tests in vivo and in vitro

In order to investigate the effects of the non-steroidal antiinflammatory drug, diclofenac sodium on thyroid function, 8 male and 2 female volunteers were given single dose of 50 mg diclofenac sodium. Ninety minutes after the administration of the drug, the concentrations of total T 3, total T 4 and free T 4 were decreased significantly, but the concentrations of free T 3 and the levels of T 3 uptake, % free T 3 and % free T 4 were increased. When diclofenac sodium was added to serum in vitro, the levels of free T 3, free T 4 and T 3 uptake were increased. These results showed that diclofenac sodium inhibited the binding of T 3 and T 4 competitively to the binding protein. The apparent decline in the concentrations of total T 3 and total T 4 after diclofenac sodium administration suggested that the drug altered distribution and metabolism of T 3 and T 4 mainly by increasing their free forms.     

A microcomputer program for critical evaluation of diagnostic tests

We developed a microcomputer program that provides a Bayesian model of diagnostic performance and a simple decision tree model of clinical utility. We have used this program to review diagnostic performance and clinical utility for proposed new services at our 360-bed university hospital. We believe that significant benefits can be achieved if medical journals report complete data on test performance. First, this allows physicians to perform their own evaluations of diagnostic performance. Second, this allows physicians to evaluate clinical utility using either standard decision trees or decision trees that reflect specific clinical problems.     

Implication on thyroid function tests]

We tried to investigate the present problems, concerning the reference individual and interval in thyroid function tests and find the solutions for them. We are now using healthy adults for the reference individual and interval. Recently, we found the sex-difference and age-related changes for reference individual and interval in free T3 measurement. We raised the questions on whether there are any sex-differences and/or age-related changes or not. Surprisingly, there were almost no detailed data about them especially in Japan. Therefore, we examined the Europe data, and found out some kind of sex-differences and age-related changes. We propose the following examinations using many Japanese population in order to provide a precise and proper reference individual and interval: 1. Whether there are any sex-difference in thyroid function tests? 2. Whether there are age-related change in thyroid function tests, for instance, simply dividing population into the immature, adult and the aged?     

Propositions of interpretative comments for thyroid function tests

In the field of thyroid disease, a number of governmental organisms or professional associations have published practice guidelines containing laboratory-related recommendations, eg the Haute autorité de la santé (HAS), or the American Thyroid Association (ATA). Among the physicians who prescribe thyroid function tests, all have not read and memorized all these recommendations. In order to help them to better integrate these recommendations in their practice, we have composed a thesaurus of ready-made interpretative comments, trying to adapt our proposed comments to each possible combination of results of TSH and/or free T4 and/or free T3. The laboratorians who would prefer to use only the comments based strictly on the recommendations of HAS and/or ATA, will be able to select among our comments what is really validated by these two organizations. In addition, our work aims at enabling the patients who want it, to benefit from written information, which may be complementary to the more often spoken information provided by the clinicians.     

New tests for the assessment of thyroid function in dogs

As the techniques of thyroid imagery are not suitable for use in veterinary practice, laboratory tests are of special interest in the confirmation of thyroid disease. As many thyroidal function tests exist for use in dogs, but all are controversial, we assessed two new tests which have recently been commercially developed: the canine TSH assay and the canine thyroglobulin autoantibody assay. The TSH values assayed with the DPC kit in dogs were usually under 0.55 ng/1. TSH assay could not totally replace thyroid stimulation with T4 measurement in hypothyroidism but permitted distinction between a thyroidal disease (high TSH) and an extrathyroidal disease (low TSH). TSH should be considered as complementary to thyroid stimulation for the determination of hypothyroidal aetiology. TSH measurement could also be used to confirm pituitary aetiology in nanism (TSH undetectable), and to evaluate the therapeutic efficacy of treatments of hypothyroidism with thyroidal aetiology, the dose being suitable when the TSH value returns to normal. The main aetiology of hypothyroidism seemed to be autoimmune lymphocytic thyroiditis. Thyroglobulin autoantibodies were the most frequent autoantibodies found in dogs with thyroiditis. It was not possible to use a commercial canine thyroglobulin autoantibody assay kit to refute or confirm this in a population of dogs with hypothyroidism and high TSH. Further technical developments will be required before the canine thyroglobulin autoantibody immunoassay can be used to diagnose thyroiditis.     

Renal failure and thyroid function tests: the effects of commencing haemodialysis

Thyroid function tests are often noted to be abnormal in patients with chronic renal failure. We investigated thyroid and pituitary function in six patients with renal failure. In order to study the effects of improvement in the uraemic state on these tests, they were repeated after regular haemodialysis was commenced. Serum thyroxine and free thyroxine levels were at the lower limit of the normal range prior to dialysis and both showed a non-significant increase after regular haemodialysis was started. The TSH response to TRH (TRH test) decreased in five of the six patients after dialysis but this did not achieve statistical significance. The abnormalities in thyroid function tests often observed in clinically euthyroid patients with renal failure do not appear to change significantly after the institution of regular dialysis.     

A blinded, multi-center evaluation of two commercial in vitro tests for latex-specific IgE antibodies.

PURPOSE: To compare the diagnostic value of two commercial in vitro tests for the detection of latex-specific IgE antibodies. METHODS: Serum samples were collected from latex-allergic and nonlatex-allergic individuals. Persons were classified as latex allergic if they had a positive clinical history and a positive skin prick test with a latex extract. Persons with no latex-related symptoms and negative skin tests were classified as nonlatex allergic. The serum samples were tested in a blinded fashion by a laboratory using the CAP (Pharmacia-Upjohn) and AlaSTAT (Diagnostic Products Company) assays. Values of 0.35 kA U/L or greater were considered positive in both tests. RESULTS: The 143 sera studied came from 83-latex allergic and 60 nonallergic persons. The in vitro tests were found to have sensitivities of 79.5% and 73.8%, and specificities of 90.2% and 91.7%, for CAP and AlaSTAT, respectively. The positive predictive values were 91.7% and 92.5%, while the negative predictive values were 76.4% and 71.4% for the CAP and AlaSTAT, respectively. CONCLUSION: In individuals classified by the combination of clinical history and skin test results, both the Pharmacia CAP and the DPC AlaSTAT demonstrated acceptable sensitivities, specificities, and predictive values for detection of antilatex IgE antibodies. These findings suggest that both assays can be useful adjuncts to the diagnosis of latex allergy.     

A critical evaluation of HIPE data

Resource allocation and planning of future services is dependent on current volumes, making it imperative that procedural data is accurately recorded. We sought to evaluate the effectiveness of the information gathered by the Hospital Inpatient Enquiry (HIPE) system in recording such activity. Five index vascular procedures (open/endovascular abdominal aneurysm repair, carotid endarterectomy, lower limb angioplasty/bypass) were chosen to reflect activity. The Economic and Social Research Institute (ESRI), and HIPE databases were interrogated to obtain the regional and hospital specific figures for the years 2005, 2006 and 2009, and then compared with the prospective vascular database in St James's hospital. Data for 2006 (the most recent year available) shows significant discrepancies between the HIPE and vascular database figures for St James's hospital. The HIPE and database figures respectively for; open aneurysm 13/30 (-50%), endovascular aneurysm 39/31 (+25%), carotid 62/48 (+29%), angioplasty 242/111 (+100%) and bypass 24/10 (+100%) These inaccuracies are likely to be magnified on a regional and national level when pooling data.     

Prosthetic heart valve evaluation in vitro: critical aspects of data comparability

The technology of heart valve substitution has considerably improved in the last few years, but its reliability after implantation is still not good enough, hence the need to study new valve design and improve quality testing. Different pulse duplicators are used for heart valve testing, but the results depend very much on the system adopted and the measurement protocol. Tests on two pulse duplicators currently used at the Biomedical Engineering Laboratory at the Istituto Superiore di Sanità, Rome, are reported here. The most significant parameters for valve evaluation were measured following each system's own protocol. Attention was focused on vascular load tuning when setting up the system and on the relationship between drive unit flow waveform and valve regurgitation and energy loss measurements. Standardization criteria must be defined in order to ensure the reliable comparability of in vitro testing results.