Turnover of 57Co-labelled Vitamin B12-Transcobalamin II and Autologous 131I-labelled IgG in a Patient with Antibody to Transcobalamin II

In a pernicious anaemia patient with a circulating antibody to transcobalamin II (TC II), the plasma clearance of radioactive vitamin B₁₂ bound to TC II has been shown to be much slower (plasma half-life 8.2 days) than in control subjects (plasma half-life 0.7 days). Thus, the patient's high serum vitamin B₁₂ binding capacity and elevated serum vitamin B₁₂ are the result of decreased catabolism of TC II due to the presence of antibody. The turnover of the B₁₂-TC II-antibody complex was shorter than that observed for autologous ¹³¹I-labelled IgG (plasma half-life 16.8 days). This difference is most likely due to dissociation of the complex.     

Mixed Carotid Sinus Hypersensitivity: Successful Therapy with Pacing, Ephedrine, and Propranolol

Three forms of carotid sinus hypersensitivity are recognized clinically (cardio-inhibitory, vasodepressor, and mixed). The cardio-inhibitory form has been managed successfully with pacemaker therapy. The vasodepressor element has been difficult to manage clinically whether in its pure form or in combination with the cardio-inhibitory type. We review the various pharmacologic methods previously reported and present our experience with a new pharmacologic alternative, which is the combined use of ephedrine and propranolol to induce unopposed alpha stimulation.     

A Syndrome Resembling Adrenal Cortical Insufficiency Associated with Long Term Busulfan (Myleran) Therapy

Four patients who developed a clinical syndrome characterized by hyperpigmentation of the skin, weakness, fatigue, weight loss, anorexia and nauseawhile on long-term treatment with busulfan were described. The etiology ofthe disorder, although clearly related to the busulfan therapy, is obscure, butmay be related to "dethiolation".

Submitted on June 12, 1961 Accepted on August 4, 1961     

Von Willebrand's disease: indication for combined surgical procedures

The case presented illustrates several important aspects of von Willebrand's disease. Abnormal bleeding after dental extractions may be the first indication that a patient has a bleeding disorder. When replacement therapy is adequate, normal he-most sis can be expected at the same time of surgery and after surgery. Multiple surgical procedures should be done where feasible. Orthopedic surgeons would probably hesitate to work simultaneously with dentists because of the perceived risk of joint infection secondary to bacteremia associated with dental procedures. However, many other procedures can be performed with success, as in the case reported here. Finally, until the time when virus-free therapy (without the need of human donors) is available, the exposure of patients to blood components should be minimized by combining procedures and by using treatments such as Stimate whenever possible.     

Extraction of an Intravascularized Pacemaker Lead—A New Approach to an Unusual Problem

A new catheter approach to removing an intravuacularized, nonfunctional pacemaker lead which was fixed at both distal (right ventricular endocardium) and proximal (brachiocephalic vein/superior vena cava) ends is described. This case also emphasizes the need for removal of an old pacemaker lead that caused bacteremia in a patient with a prosthetic aortic valve even when infection was presumed to be cured.