THE IMPROVED DEMONSTRATION OF CIRCULATING ANTIBODIES IN HEMOLYTIC ANEMIA BY THE USE OF A BOVINE ALBUMIN MEDIUM

1. Bovine albumin solution as a testing and diluting medium was used for thedetection of abnormal iso-antibodies in the serum of various cases of hemolyticanemia.

2. Five patients with idiopathic acquired hemolytic anemia all showed a warmagglutinin, although in 4 of these patients antibody could not be detected by use ofthe standard saline technic. Higher titres than in salt sDlution were always obtained in the albumin medium. Three patients with congenital spherocytic anemianot in crisis, 2 patients with severe Mediterranean anemia, and 2 with sickle cellanemia failed to show antibody. In the crisis of 1 case of congenital spherocyticanemia an autohemolysin was temporarily found with the use of bovine albumin.Other cases of acquired hemolytic anemia (chemical, symptomatic, hypersplenic)failed to show antibody. Detection of antibody was of distinct value in the diagnosis of acquired hemolytic anemia of the "idiopathic" type. Its continuedpresence in such a case after splenectomy rendered the prognosis doubtful.

3. In the further differentiation of various types of familial and acquired cases,use was made of the red cell survival time. Parallel determinations of the survivaltime and of iso-antibodies showed a distinct correlation. Use of the anti-humanglobulin rabbit serum test to detect iso-antibody adsorbed to the red cell is citedas of further diagnostic aid.

     

AN INVESTIGATION INTO THE PROBLEMS OF EASY CHAIRS USED BY THE ARTHRITIC AND THE ELDERLY

Groups such as the arthritic and the elderly are particularlysusceptible to seating problems. An extensive questionnaireto determine the nature and extent of seating difficulties wasgiven to patients at rheumatology clinics and members of daycentres for the elderly in Leeds. Forty-two per cent of subjectshad some degree of difficulty in rising from their easy chairat home and of these 18% either experienced great difficultyor could not rise unaided. Only 13% had chairs designed to aidrising (e.g. high chair) and 40% of subjects thought their chaircould be improved. Thirty-four per cent said that their easychair caused them pain or discomfort. Information about subjects'body dimensions and their easy chair dimensions was also collected.Further research based on the survey results is planned in orderto develop criteria for the design of easy chairs for the arthriticand the elderly. ^*Based on a paper presented at the Annual Provincial Meetingof the Royal Society of Medicine, Section of Rheumatology andRehabilitation, the British Association of Rheumatology andRehabilitation, Nottingham, 25 and 26 september 1980     

AN IMPROVED METHOD FOR THE RADIOIMMUNOASSAY OF FREE-THYROXINE IN SERUM DIALYSATES

A convenient, sensitive radioimmunoassay of free thyroxine in serum dialysates is described. The method utilizes a solid phase separation system (pre-formed double antibody) and a relatively short incubation period (220 min) with a staggered addition of tracer. Blanks were low and consistent. The normal range for non-pregnant euthyroid samples (n= 59) was 11–23 pmol/1. Third trimester pregnancy samples were mostly within the normal range but at the lower end. Patients on T4 replacement showed a much wider variation in free T4 levels with many samples in the hyperthyroid region. Some hypothyroid samples had undetectable free T4 levels and hyperthyroid samples were frequently greater than 80 pmol/l.     

对长期用生长抑素激动剂治疗肢端肥大症停药后生长激素分泌和胆囊收缩功能的观察

为了探索克服长效生长抑素激动剂ＳＭＳ２０１－９９５治疗肢端肥大症（肢大）引起胆囊结石的方法，我们前瞻性地观察了１４例经ＳＭＳ治疗的肢大患者于停用ＳＭＳ后生长激素分泌轴系变化及胆囊病变的恢复情况。结果：停用ＳＭＳ后第１周，周围血中生长激素基础值及５小时生长激素谱中生长激素平均水平均显著低于用药前水平，分别为用药前生长激素水平的３６％和２４％。在停药后２周未，则生长激素基础值和５小时生长激素谱平均水平分别为用药前的６０％和５６％。在６例没有形成胆囊结石的肢大患者中，胆囊相对收缩率在停药后１周内恢复正常，在８例已形成胆囊结石的肢大患者中，３例在停药后２周内胆囊收缩功能恢复正常，４例在停药后１月内排尽胆囊结石。我们的结果显示，采取ＳＭＳ间歇给药的方法对预防ＳＭＳ治疗诱发胆囊结石形成可能有益。     

AN ASSESSMENT OF RED CELL SURVIVAL IN IDIOPATHIC UNCONJUGATED HYPERBILIRUBINÆMIA (GILBERT'S SYNDROME) BY THE USE OF RADIOACTIVE DIISOPROPYLFLUOROPHOSPHATE AND CHROMIUM

Red cell survival was determined in 20 patients with idiopathic unconjugated hyperbilirubinæmia without overt signs of hæmolysis (Gilbert's syndrome) by means of a double isotope technique with the use of diisopropylfluorophosphate (DF³²P) and chromium (⁵¹Cr) simultaneously. Red cell life span was significantly reduced in 42% of patients. However, the degree of hæmolysis was not sufficient to produce hyperbilirubinæmia in persons with normal hepatic function. The incidence of familial involvement in patients with reduced red cell survival was not significantly different from that in patients with normal red cell survival. Similarly, there was no difference between the groups with respect to symptomatology, age of onset of jaundice, or results of laboratory investigations. It is concluded that the hyperbilirubinæmia in this syndrome is more likely to be due to a defect in hepatic handling of bilirubin than to compensated hæmolysis. This defect appears to occur whether or not there is a reduced red cell survival. It remains to be shown why some patients with this syndrome have a reduced red cell survival while others do not.     

AN IMPROVED METHOD FOR THE DETECTION OF HETEROZYGOSITY OF CONGENITAL VIRILIZING ADRENAL HYPERPLASIA

A modified short ACTH test for the detection of heterozygote carriers of 21-hydroxylase deficiency (21-OHD) was applied to twenty-one controls and fourteen parents of children with 21-OHD. The following modifications were introduced: (1) Endogenous ACTH was suppressed by dexamethasone administration prior to the test, (2) Plasma 17-hydroxyprogesterone (17-OHP), cortisol (F), progesterone (P), corticosterone (B) and delta 4- androstenedione (A) were measured, (3) Variables studied were the ratio of plasma increments (delta) between precursors and end products, (4) Data were analysed by a step-wise discriminant analysis. Significant alterations in the metabolic pathway of F, B and A were demonstrated. The discriminant analysis showed that the addition of B pathway data did not improve the discrimination potency of the test performed on F pathway data. The combination of variates which provided the best discrimination was the logarithmic sum of delta 170HP/delta F at 15 and 30 min. It led to a 94% correct classification for normals and carriers.     

AN IMPROVED METHOD FOR THE ESTIMATION OF RELATIVE BINDING CONSTANTS OF T4 AND ITS ANALOGUES WITH SERUM PROTEINS

A new method is reported for the determination of the binding constants of homologous ligands relative to that of the parent ligand. The technique minimizes the effects of random and bias errors inherent in absolute methods and obviates the need to quantitate the radiolabelled tracer concentration. In addition, it is likely to be of general applicability for monovalent proteins. The method has been applied in the determination of the binding constant (relative to that of T4) of the T4-analogue tracer used in the Amerlex free T4 radioimmunoassay, in respect of its binding to both T4 binding globulin and prealbumin. The binding constants of the analogue (relative to T4) were approximately 3% for both proteins. These levels were judged unlikely to interfere significantly with the measurement of free T4 in serum samples from patients with very wide variations in concentration of either T4 binding globulin or prealbumin.     

经腹腔镜胆囊一期缝合治疗胆囊息肉

１９９１年３月至１２月，我们应用腹腔镜行胆囊息肉摘除，胆囊一期缝合３２例。其中多发息肉２４例，单发８例。９例合并胆囊结石。手术前用Ｂ超对胆囊定位，做皮肤小切口，穿刺胆囊放入ＯｌｙｍｐｕｓＡ５３０７腹腔镜，取出息肉，电凝止血，标本立即行冰冻检查。冰冻报告为良性，术中胆道造影无梗阻，用４／０无损伤缝线分层缝合胆囊粘膜和浆膜。多数病人仅手术当日需静脉补液治疗，术后第一天即可下地、进食。３２例切口均一期愈合。１６例３个月后随访，胆囊功能正常。     

COMPARATIVE STUDY OF BACTERIAL IDENTIFICATION BY COLORECTAL TISSUE CULTURE AND FLUID CULTURE AFTER COLONOSCOPIC WASHING

Background: Inflammation of the colon is often found during colonoscopy. In order to confirm the pathogenesis of the lesion, bacterial cultures are applied. Biopsied tissue specimens are used for bacterial culture, and fluid culture after colonoscopic washing also has been used for bacterial identification. In the latter method, sterile saline solution is sprayed over the area and then is collected with the fluid. The two methods have not been compared with each other. Methods: The subjects comprised 89 cases with inflammatory lesions detected during colonoscopy. Samples were collected by both methods at the inflammatory site. The bacterial load was semiquantitatively evaluated as 1+, 2+, and 3+. Results: Pathological bacteria were found in nine cases. Vibrio parahaemolyticus was detected in one case only by tissue culture. In the other eight cases, bacteria cultures were positive by both methods. A total of 36 kinds of bacteria constituting the intestinal flora were identified. The detection rate was 83.9% by fluid culture and 70.9% by tissue culture. It was significantly larger by fluid culture than by tissue culture. Bacteria were isolated at a rate of 3.61 species per sample by fluid culture and 3.05 species per sample by tissue culture. The bacterial load per species was a median of 2.00+ by fluid culture and 1.27+ by tissue culture. The number of detected bacterial species and the bacterial load per species were significantly larger by fluid culture than by tissue culture. Conclusion: Fluid culture after colonoscopic washing is recommended to identify intestinal bacteria by culture.     

尿激酶、前列腺素E_1联合溶栓对家兔全身纤溶系统的影响

在家兔髂股动脉血栓模型观察尿激酶（ＵＫ）和前列腺素Ｅ１（ＰＧＥ１）联合溶栓的效果。结果如下：①经导管动脉联合用药（简称联用），优于单用ＵＫ，再通率为１００％。优于常规静脉途径（再通率５０％）；②静脉联用组全身纤溶激活，即总纤溶活力增强，纤溶酶原（ＰＬＧ）和纤维蛋白降解产物（ＦＤＰ）增高。有出血的潜在危险，而动脉联用组全身纤溶改变小于静脉联用及动脉单药（ＵＫ）组。经导管动脉内联合用ＵＫ和ＰＧＥ１是一种疗效高、副作用小的溶栓方法。     

LAPAROSCOPIC WEDGE BIOPSY OF THE LIVER WITH USE OF AN ULTRASONICALLY ACTIVATED SCALPEL

Background: Wedge biopsy of the liver yields more accurate diagnosis of liver diseases than does needle biopsy, but is usually more invasive. We have designed a new method for laparoscopic wedge biopsy under local anesthesia with use of an ultrasonically activated scalpel. Methods: We performed wedge biopsy in seven patients with liver diseases. Under local anesthesia, two trocars punctured the abdomen and the edge of the liver was dissected with the scalpel. We evaluated the differences in operating time, grade of pain during/after the biopsy, changes of laboratory data and changes of body temperature, between seven wedge and 18 needle biopsies. Results: No differences were found in all factors between wedge and needle biopsies. Conclusions: This new method of laparoscopic wedge biopsy under local anesthesia was safe and more useful than needle biopsy. It was also no more invasive than needle biopsy.     

复方海蛇胶囊治疗阿尔茨海默病的临床疗效及安全性观察

目的观察复方海蛇胶囊治疗阿尔茨海默病患者的临床疗效及安全性。方法共30例经临床检测、量表测定符合AD诊断标准的患者,用复方海蛇胶囊药物治疗3个月,以MMSE、ADAS-COG、BBS和ADL检测分数评定疗效。结果MMSE评分在19~24分之间的患者,复方海蛇胶囊治疗前后MMSE评分分别为21.96±1.876和23±2.949,具有显著性差异(P<0.01)。无1例患者出现肝肾功能及心电图异常。结论复方海蛇胶囊对治疗轻度阿尔茨海默病具有一定作用,且药物安全性高,副作用小。