Thyroid disease associated with rheumatoid arthritis is not adequately screened with a sensitive chemiluminescence thyrotrophin assay

The objective of this study was to screen for thyroidopathies in patients with rheumatoid arthritis (RA). Screening for thyroid disorders is advocated in patients with autoimmune diseases, and rheumatoid arthritis has been linked to thyroid autoimmune disorders, more particularly Hashimoto's thyroiditis and sometimes Graves' disease. We performed thyroid disease screening in 69 patients with RA free of medication for at least a 2 weeks period, not in remission, and in 65 patients with osteoarthritis (OA). The latter were studied as a control group of non-autoimmune arthritis patients. Basal levels of thyrotrophin (TSH) were measured using a sensitive chemiluminescence serum TSH assay. Serum antithyroperoxidase and antithyroglobulin (anti-Tg) autoantibodies were measured as well. If TSH values were found to be outside the normal limits, serum total thyroxine, total triiodothyronine (T3), resin T3 uptake, the free thyroxine index (FT4I) and free triiodothyronine index (FT3I) were evaluated. Rheumatoid arthritis patients exhibited statistically significant lower mean TSH values as compared to OA patients. However, RA patients with low TSH values did not have elevated FT4I. Previous use of corticosteroids in some of the RA patients may be responsible for these results. The autoantibodies levels did not differ between the two groups. We conclude that thyroid function screening with sensitive TSH assays is not sufficient for assessment of early stages of autoimmune thyroidopathies in patients with RA. Thyroid hormones should also be estimated.     

Rapid tracheal intubation with vecuronium: the priming principle

Following the administration of a single 0.1 mg/kg dose of vecuronium bromide, satisfactory conditions for tracheal intubation developed in 156 +/- 12 s (mean +/- SEM), and the clinical duration of the initial dose was 36 +/- 2 min. When the initial dose of vecuronium was administered in two increments, a 0.015 mg/kg "priming" dose, followed 6 min later by a 0.050 mg/kg "intubating" dose, intubation time decreased to 61 +/- 3 s and clinical duration to 21 +/- 1 min. The priming dose that had no unpleasant effect on premedicated, awake patients could be administered 3-4 min before, and the intubating dose 2 to 3 min after induction of anesthesia. With the described technique, comparable intubating conditions could be obtained just as rapidly with vecuronium as with succinylcholine chloride, without subjecting the patients to the side effects of and the complications occasionally encountered with succinylcholine. An added advantage of the use of a priming dose is that it will reveal undiagnosed, pathologic, or idiopathic increase of sensitivity to nondepolarizing muscle relaxants.     

Surgical treatment of liver injuries by application of Fibrinkleber

The combination of highly concentrated fibrinogen, thrombin, clotting factor XIII, and fibrinolytic inhibitor aprotinin represents a new biological hemostatic, and adhesive system, known as Fibrinkleber. Liver injuries and injuries of parenchymatous organs, with the difficulties inherent in their surgical repair, are a suitable field of application for the new substance. In our experimental work, standardized sharp liver injuries in 29 rabbits were treated only by application of Fibrinkleber. In all cases, this procedure resulted in a complete control of bleeding as well as in a stable and lasting closure of wounds. Five of these animals died from causes unrelated to the liver trauma but rather to parasitosis. During the postoperative observation period, from 2 days to 2 months, microscopic and histological examination showed ideal repair of the glued wounds. In the control group, 5 rabbits were kept without application of Fibrinkleber. Three of the rabbits with liver injuries and all of the control group histological examinations showed separation of the wounds with minimal healing.

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Resumen Debido a su tamaño y ubicación, el hígado es un órgano muy vulnerable en casos de trauma abdominal. Las heridas hepáticas varían considerablemente y su severidad dépende del tipo y magnitud del trauma. En virtud de la vascularidad del hígado y, según la localización de la herida, el tratamiento del trauma hepático con frecuencia es difícil. La hemorragia resultante y los consiguientes complejos problemas postoperatorios significan un desafío formidable.La combinación de fibrinógeno altamente concentrado, trombina, factor XIII de coagulación y aproptinina, un inhibidor de fibrinolisis, ha venido a representar un nuevo sistema biológico hemostático y adhesivo, el cual se conoce como Fibrinkleber. Las lesiones hepáticas y en general las heridas de los órganos parenquimatosos, por las dificultades que presentan en el momento de la reparación quirúrgica, constituyen un campo propicio para la aplicación de esta nueva sustancia. En nuestro trabajo experimental se trataron heridas hepáticas estandarizadas en 29 conejos mediante la sóla aplicación de Fibrinkleber. Tal procedimiento resultó, en todos los casos, en un completo control del sangrado y en un cierre estable y duradero de las heridas por la firme adherencia de las superficies hepáticas. Cinco de los animales fallecieron por causas no relacionadas con el trauma hepático sino con parasitosis. En el curso del período de observación postoperatoria, desde el segundo día hasta dos meses, los exámenes microscópicos e histológicos mostraron una cicatrización ideal de las heridas así adheridas. En el grupo de control se incluyó a cinco conejos que no recibieron la aplicación de Fibrinkleber. Tres de estos perecieron poco tiempo después de infligida la lesión, y en todos el examen histológico demostró separación de la herida con mínima cicatrización.

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Résumé La combinaison à haute concentration de fibrinogène, de thrombine du facteur XIII et de l'aprotinine (inhibiteur de la fibrinolyse) permet de constituer un agent biologique d'hémostase et de coalescence dénommé Fibrinkleber. Les blessures du foie et plus généralement les blessures des organes parenchymateux dont la cure est difficile à assurer chirurgicalement sont susceptibles d'être traitées efficacement par cette nouvelle substance. A titre expérimental des blessures du foie identiques chez 29 lapins ont été traités uniquement par ce nouvel agent. Dans tous les cas l'hémorragie pu être arrêtée et la coalescence définitive de la plaie pu être obtenue. Cinq des 29 lapins moururent non de leur plaie hépatique mais de parasitose. Pendant la période d'observation postopératoire s'étendant du deuxième jour jusqu'à la fin du deuxième mois l'examen macroscopique et l'examen microscopique permirent de constater la cicatrisation parfaite de la plaie. Un groupe de contrôle comprenant cinq lapins qui présentaient une blessure hépatique de type identique mais traitée sans l'aide de l'agent coagulant et coalescent permit de constater que la plaie persistait et que sa cicatrisation était minime.

     

The IHAT-GUT Iron Supplementation Trial in Rural Gambia: Barriers,Facilitators, and Benefits

Introduction: In most sub-Saharan African countries iron deficiency anaemia remains highly prevalent in children and this has not changed in the last 25 years. Supplementation with iron hydroxide adipate tartrate (IHAT) was being investigated in anaemic children in a phase two clinical trial (termed IHAT-GUT), conducted at the Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM) (abbreviated as MRCG hereof). This qualitative study aimed to explore the personal perceptions of the trial staff in relation to conducting a clinical trial in such settings in order to highlight the health system specific needs and strengths in the rural, resource-poor setting of the Upper River Region in the Gambia. Methods: Individual interviews (n = 17) were conducted with local trial staff of the IHAT-GUT trial. Data were analysed using inductive thematic analysis. Results: Potential barriers and facilitators to conducting this clinical trial were identified at the patient, staff, and trial management levels. Several challenges, such as the rural location and cultural context, were identified but noted as not being long-term inhibitors. Participants believed the facilitators and benefits outnumbered the barriers, and included the impact on education and healthcare, the ambitious and knowledgeable locally recruited staff, and the local partnership. Conclusions: While facilitators and barriers were identified to conducting this clinical trial in a rural, resource-poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. To effectively implement a nutrition intervention, the local health systems and context must be carefully considered through qualitative research beforehand.