Immunochemical studies of antisera to human fibrinopeptide-B

The immunochemical specificity of rabbit antisera to human fibrinopeptide-B (FPB) has been studied by comparing the relative abilities of FPB and of various proteins and peptides containing the NH2-terminal segment of the B beta-chain of human fibrinogen to inhibit the binding of a radioiodinated FPB derivative by each of seven anti- FPB sera. Anti-FBP sera varied in the extent to which they cross- reacted with fibrinogen, the NH2-terminal disulfide knot of fibrinogen (N-DSK), B beta 1(Pyr)-118(Met), B beta 1(Pyr)-42(Arg), and desarginyl- FPB. Anti-FPB sera have been identified that discriminate effectively between FPB and larger FBP-containing peptides; such antisera can be used to measure FPB in the absence of the larger peptides or to demonstrate the presence of larger peptides such as B beta 1(Pyr)- 42(Arg) in extracts of clinical plasma samples by means of an increase in FPB immunoreactivity following thrombin treatment. One anti-FPB serum has been identified that is capable of detecting desarginyl-FPB, and this antiserum has been used in the development of a radioimmunoassay for desarginyl-FPB. Thus, by precisely defining the specificity of anti-FPB sera, it has been possible to identify antisera that are useful, not only in the measurement of FPB, but also in the detection of other important related molecules, such as B beta 1(Pyr)- 42(Arg) and desarginyl-FPB. The immunochemical detection of these FPB- related peptides should provide useful information concerning the action of proteolytic enzymes, such as plasmin on the NH2-terminal segment of the B beta-chain of fibrinogen, and of carboxypeptidase-B on free FPB, in human plasma.     

Blockade of the alpha3alpha4 N-cholinoreceptors and GluR1 AMPA receptors eliminates clonic-tonic nicotinic and kainate seizures

Monoammonium N-alkyl derivative of decylamine (IEM-1678), which blocks alpha3beta4 N-cholinoreceptors (but does not block GluR1 AMPA receptors), in doses of 1.0 - 3.0 mg/kg produces a 4-fold decrease in the frequency and lethality of nicotinic clonic-tonic seizures. However, even in the maximum dose of 3 mg/kg, IEM-1678 only slightly decreases kainate clonic-tonic seizures. Bis-ammonium compound IEM-1460 (containing adamantyl radical), which blocks both GluR1 AMPA receptors and alpha3beta4 N-cholinoreceptors, in a range of doses 0.1 - 3 mg/kg produces a 5- to 8-fold decrease in the frequency and virtually completely eliminates lethality of both clonic-tonic nicotinic and kainate seizures. Hence, the complete elimination of generalized kainate and nicotinic seizures requires combined blockade GluR1 AMPA and alpha3beta4 N-cholinoreceptors.     

Incidence and predictors of thyroid dysfunction caused by long-term intake of amiodaron

AIM: To analyze occurrence of thyroid dysfunction due to regular long-term intake of amiodaron (for one year), to search for predictors of amiodaron-induced hypothyroidism and thyrotoxicosis. MATERIAL AND METHODS: Sixty two patients with different types of arrhythmia have undergone examination including tests for TTH (once in three months), free T3 and T4 (once in 6 months), ultrasound thyroid investigation, general clinical and physical check-up, resting ECG in 12 leads, echocardiography, chest x-ray, biochemical blood tests, blood count, urinalysis. RESULTS: Amiodaron intake for 1 year was associated with amiodaron-induced thyroid dysfunction in 25% patients: 19.2% developed hypothyroidism, 5.8%--thyrotoxicosis. Organic pathology of cardiovascular system, cardiac failure, left ventricular aneurysms, low global myocardial contractility, organic thyroid pathology, elevated levels of antithyroid antibodies predicted hypothyroidism. Thyrotoxicosis was associated with a young age and male sex. CONCLUSION: Amiodaron may cause thyroid dysfunction in patients with arrhythmia.     

Recurrent laryngeal nerve and voice preservation: routine identification and appropriate assessment �C two important steps in thyroid surgery

INTRODUCTION

The aims of this study were to assess and compare vocal cord functions before and after thyroid surgery after intra-operative identification of recurrent laryngeal nerve.

PATIENTS AND METHODS

Recurrent laryngeal nerve (RLN) is seen intra-operatively in all cases undergoing thyroid surgeries. Vocal cord functions including any voice change were evaluated by indirect laryngoscopy (I/L) and direct laryngoscopy (D/L) before and after surgery.

RESULTS

Prospective study on 100 patients over 18 months with a total of 146 nerves at risk (NAR). Majority were women (n = 86) with mean age of 37.48 years (range, 13–60 years). RLN was seen in all patients and 19 patients complained of some change in quality of their voice after surgery. Evaluation by I/L and D/L at 6 weeks showed recurrent laryngeal nerve palsy (RLNP) in nine (47.36%) and five (26%) of these 19 patients respectively. Analysed according to total NAR, the incidence of voice change and temporary RLN palsy (I/L and D/L) at 6 weeks was still less at 13.01%, 6.16% and 3.42%, respectively. Voice change improved in all cases at 3 months with no RLNP palsy by I/L or D/L. All these 19 patients had undergone difficult or extensive surgery for malignancy, large gland, extratyhroidal spread or fibrosis.

CONCLUSIONS

Despite identification and preservation of RLN, patients can develop postoperative voice change and RLNP although all voice change cannot be attributed to damaged RLN. Proper assessment of vocal cord functions by I/L and D/L laryngoscopy is required to rule out injuries to these nerves. Risk of damage is higher in patients undergoing more difficult surgery.     

Day Care Surgery in Otolaryngology : a three year Prospective Study

Day care surgery is now an integral part of otolaryngology and is widely practised in the West. But in our military setup it still has to gain popularity. A Day Care Surgical Centre was established at Armed Forces Clinic in 1996. In the period May 1998 to Apr 2001, a total of 752 otolaryngology cases were operated at the centre, of which 474 cases were major and 278 cases were minor. All cases were performed under local anaesthesia supplemented by sedation. Strict patient selection criteria were adopted resulting in a low immediate post-operative complication rate (1.46%). None required admission to hospital for the management of complications. The feasibility of performing otolaryngological surgery on a day care basis is demonstrated, especially in nasal and aural cases. The experience gained shows that high medical standards can be achieved with low resource expenditure. Patient selection criteria and guidelines are suggested.Key Words: Day care, Otolaryngology, Surgery