Hydroxyethyl starch induced acquired von Willebrand's disease

Hydroxyethyl starch (HES) (Hespan, DPont) is a widely used synthetic volume expander which in standard doses of up to 1.51 in 24 h has no significant effect on coagulation (Munsch et al. 1988). However, the data sheet states that in large volumes HES may alter the coagulation mechanism. We now report a case of HES induced acquired von Willebrand's disease (vWD) in which severe bleeding occurred.     

Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

The importance of the behavioural state in biophysical assessment of the term human fetus

Summary. We have examined how the different behavioural states exhibited by 78 healthy fetuses at term influence the result of the nonstress test (NST) and biophysical profile score (BPS). In association with state 1F the average recording time to obtain a satisfactory NST and EPS was 27.0 and 26.3 min respectively, and 52.6% and 44.0% respectively failed to achieve a 'normal' result. In contrast, satisfactory results were always obtained in the two active states (2F and 4F), and the average time was 3–5 min. Mature fetuses spend on average one third of the time in state 1F, and knowledge of its characteristics is therefore important, for the interpretation of biophysical tests. Our results suggest that continuation of biophysical recording for at least 40 min is necessary before an unreactive NST or low BPS should be regarded as suspicious. We suggest that interpretation of the NST and BPS should be made in the light of knowledge of normal patterns of behavioural development rather than using an arbitrarily defined scoring system.     

Synthesis of thioredoxin partial sequences on 1,6-hexanedioI diacrylate (HDODA)-cross-linked polystyrene resin

The continued and rapid discoveries of new peptides with interesting biological functions have created an unprecedented demand for the chemical synthesis of peptides required for structure-function correlations. Several strategic improvements have been suggested and tested to meet the demand for peptides in high purity and quantity. This article describes the synthesis of three partial sequences of thioredoxin, a naturally occurring sulfur-reducing protein containing 108 amino acid residues, on a newly developed flexible, cross-linked polystyrene support (2% polystyrene cross-linked with 1,6-hexanediol diacrylate) using the standard solid-phase methodology. The protected peptides were cleaved from the polymeric support by trifluoroacetic acid and purified by chromatography. The free peptides were shown to be homogeneous by high-performance liquid chromatography and were characterized by amino acid analysis and circular dichroism. The circular dichroism measurement revealed that the peptides possess a helical conformation. From the yield and purity of the peptides obtained, it was inferred that the favorable swelling and solvation characteristics of the support facilitated effective synthesis.     

Continuation of normal neurobehavioural development in fetuses with absent umbilical arterial end diastolic velocities

Summary. Detailed serial observations of behaviour were made in four singleton fetuses who were very small for dates and who had persistently absent umbilical artery end diastolic velocities for 2 to 9 weeks duration. All were born preterm for deteriorating maternal disease, and in two there were additional fetal indications for delivery. Behavioural comparison with 45 low risk singleton fetuses, at comparable gestations, revealed no significant differences in the development of behavioural cycles, the proportion of time spent in quiet cycles, or the amount of fetal breathing. None of the fetuses developed an abnormal heart rate pattern. We conclude that prenatal neurobehavioural development may continue apparently unimpaired in the presence of absent umbilical artery end-diastolic velocity of several weeks duration. Long term data of infant outcome are necessary before the clinical significance of this can be assessed.     

Natural Cytotoxicity and Serum Blocking in Malignant Cervical Neoplasia

ABSTRACT: Peripheral blood lymphocytes from 100 patients with various stages and histological types of squamous cell carcinoma of the uterine cervix were assayed for natural killer (NK) cell activity against K562 cells using the single cell cytotoxicity assay in agarose. The effect of autologous serum on NK cell activity and a quantitation of soluble antigen-antibody complexes was also carried out. The cancer patients showed reduced NK activity compared with normal controls, the reduction increasing with tumor load. Another observation was that patients with poorly differentiated tumours showed lower levels of NK activity. Addition of autologous serum resulted in further depression of NK activity in all groups of patients. An increase in circulating immune complexes was also evident in all groups of patients. Here again increase in tumor load and poorly differentiated tumors showed the highest levels. The results point toward a possible disturbance in NK cell activity that could be further depressed by autologous serum factors.     

Antibodies to Endometrial Transferrin and Alpha 2-Heremans Schmidt (HS) Glycoprotein in Patients With Endometriosis

PROBLEM: Identifying the endometrial antigens inciting autoimmunity is important in setting up an antibody assay for a non-invasive diagnosis and clinical monitoring of endometriosis. METHODS: Two-dimensional gel electrophoresis of endometrial extracts, Western blot analysis, passive hemagglutination and enzyme-linked immunosorbent assay (ELISA), amino acid sequencing and molecular studies were done on chosen antigens. Forty-six women with endometriosis, 4 women with uterine leiomyomata, 4 with pelvic adhesions, 3 with repeat Cesarean sections (conditions that coexist with or predispose to endometriosis) and 46 controls participated. RESULTS: Antigens with molecular weights (MW) of 64 kDa [isoelectric point (pI) of 3.5-4.0] and 72 kDa (pI of 4.5) bound to IgG in all patients with endometriosis, but not the controls. Amino acid sequencing of the proteins revealed that they had homology to alpha 2-Heremans Schmidt (HS) glycoprotein (MW: 64 kDa) and transferrin (MW: 72 kDa). Endometriosis patients had significant antibody levels to these two proteins (predictive value of 80–90%). The analysis of patients' endometrial RNA detected the message for alpha 2-HS glycoprotein and transferrin. Albumin (pI 5.5) and collagen (pI 3.5) failed to elicit antibody responses. CONCLUSIONS: Patients with endometriosis have significant antibodies to endometrial transferrin and alpha 2-HS-glycoprotein. We can effectively use an antibody assay using these antigens for diagnosing endometriosis.