Low prevalence of heparin-induced thrombocytopenia after cardiac surgery in Thai patients

Introduction

Heparin induced-thrombocytopenia (HIT) has been well recognized in Western countries. However, there are no data in the Thai population. We therefore investigated the prevalence of anti-platelet factor 4 (PF4)/heparin antibodies, HIT, and its thrombotic complications in Thai patients undergoing cardiac surgery using unfractionated heparin.

Materials and methods

Seventy-three consecutive patients were prospectively enrolled in this study. Blood samples before operation and week 1, week 2, and week 3 after operation were collected from each patient for HIT antibody screening by enzyme-linked immunosorbent assay using IgG antibody specific to the PF4/heparin complex. Positive samples were further analyzed by ¹⁴C-serotonin release assay. Complete blood count was performed daily during the first week, then weekly for 3 weeks.

Results

No patient had detectable anti-PF4/heparin antibodies at baseline. Five patients sero-converted during the course of the study for anti-PF4/heparin IgG: 3 (4.1%) at week 1, 4 (5.5%) at week 2, and 5 (6.8%) at week 3 after surgery. However, none of these patients had anti-PF4/heparin antibodies that resulted in ¹⁴C-serotonin release to be considered clinically significant antibodies. Post-operative thrombocytopenia after the operation was found in 35 patients (47.9%), but was not considered to be caused by HIT. Thromboembolic events occurred in 3 patients (4.1%) during follow up; however, none of these patients had positive PF4/heparin antibody tests.

Conclusions

Our study represents the first study to examine Thai patients exposed to heparin in the context of cardiac surgery. We found a lower prevalence of positive anti-PF4/heparin antibodies and clinical HIT than previously published studies.     

Nonketotic hyperglycinemia in two siblings with neonatal seizures

Seizures are a common problem in neonates. Differential diagnoses include infection, trauma, hypoxia and congenital metabolic disorders. Among these, congenital metabolic disorder is less familiar to general pediatricians. We report two patients with nonketotic hyperglycinemia (NKH), a rare and lethal congenital metabolic disease. Transient hyperammonemia and transient hypouricemia, uncommon features found in NKH, were detected in one patient. High doses of sodium benzoate and dextromethorphan failed to modify the clinical course. Neuropathology denoted characteristic diffuse vacuolization and changes in reactive and gliotic astrocytes. The clinical course, biochemical findings, diagnostic approaches and diagnostic tests are discussed in detail. Recent modalities of treatment are reviewed. Because of its rarity and rapidly progressive course, it maybe underdiagnosed resulting in death before being recognized. Awareness of the possibility of congenital metabolic disorder in early neonatal catastrophe will increase the diagnostic rate.     

Acute pulmonary inflammation induced by lung overloading with selenium particles: leukocyte response and in situ detection of selenium at high resolution

The kinetics of the acute inflammatory response of the lung was triggered in CD-1 mice by a single intratracheal instillation of a large amount of Se (10 mg); it was studied by quantitative cytology of bronchoalveolar lavage samples, light microscopy, and scanning electron microscopy coupled with x-ray elemental microanalysis. Bronchoalveolar lavage leukocytes were mostly neutrophils and increased from 12 to 24 h of Se treatment and decreased at 72 h. Only less than half of the granulocytes showed ingested Se particles; in contrast, virtually all BAL macrophages contained Se particles. Scanning electron microscopy coupled with X-ray elemental microanalysis revealed that the intracellular Se particles were heterogeneous in size (diameters from 0.4 and up to 14 microm), and that Se inclusions were sometimes accumulated at a pole of the cell. At 72 h after instillation of the particles, Se-loaded alveolar macrophages were migrated in the interstitial space of the alveoli. Se-positive regions had a focal distribution in the lung; accumulation of inflammatory cells erased the alveolar architecture of these areas of the deep lung. Our data indicates that Se overloading of the lung results in: (1) an acute inflammatory response that is dominated by neutrophils; (2) early removal of Se done mostly by alveolar macrophages, and (3) formation of focal areas of invasion of the lung parenchyma by inflammatory infiltrates.     

Toxic effects of selenium inhalation: acute damage of the respiratory system of mice

Accidental inhalation of selenium by humans has been associated with damage of respiratory tissues that is lacking a detailed histological definition. We have investigated the natural history of injury to the tracheal epithelium and lungs induced by a single intratracheal instillation of CD-1 mice with two different doses of dimethyl selenide (0.05 and 0.1 mg Se/kg of body weight). The animals were sacrificed 1, 7, 14, and 28 days after the single selenium treatment. Samples of the trachea and lungs were studied by light microscopy. The tracheal epithelium showed loss of cilia and acute necrosis that was followed by metaplastic transformation. Edema and diffuse alveolar damage was observed in the lungs. Our data suggest that: i) severity of respiratory lesions caused by selenium is dose dependent; ii) selenium causes transient metaplastic transformation of the tracheal epithelium; iii) chronic inflammation and increased thickness of alveolar septa occur in the lungs; iv) 4 weeks after selenium treatment, mice recover from the tracheal injury, whereas no amelioration of pulmonary lesions was observed.     

Total video endoscopic thyroidectomy by an axillary approach

BACKGROUND: A permanent transverse surgical scar is an unavoidable problem after conventional thyroidectomy. Endoscopic thyroidectomy performed via an axillary approach leaves no scarring at the neck and anterior chest wall and so provides an excellent cosmetic result. The axillary scars are usually not seen when the arm is in a normal position. MATERIALS AND METHODS: From April 2001 to February 2003, we used a four-port technique to perform 45 lobectomy and isthmectomy procedures. One 12-mm port for the flexible laparoscope (EL2-TF410, Fuji Photo Optical, Tokyo, Japan) and three additional 5-mm ports for instruments and suction were inserted through the axilla on the side of the nodule. The CO(2 )insufflation pressure was set at 4 mm Hg, and in most cases, a 5-mm Johnson & Johnson Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio, U.S.A.) was used for the dissection. RESULTS: Of 45 procedures, 44 were performed successfully. In one case, conversion to a conventional technique was required. The mean operating time was 131.2 minutes, and the mean blood loss was 51.6 mL. The recurrent laryngeal nerves were clearly identified in every case, and no case of permanent voice change occurred after surgery. In one patient, a 20-mL seroma developed on the 10th postoperative day, which was treated by simple aspiration. One patient experienced a transient voice change. The patients were discharged on average at 2.9 days after the operation. CONCLUSIONS: Endoscopic thyroidectomy by an axillary approach to manage benign thyroid disease is feasible and safe and provides promising cosmetic results. We think that this approach may play an important role in the near future.     

Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

AIM To determine the role of ciprofloxacin in reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP).METHODS A randomized, controlled trial was performed in 48 cholestatic patients at Rajavithi Hospital (Tertiary Referral Center for ERCP 600 cases per year). All the 48 patients received 200 mg ciprofloxacin intravenous injection for 30 min before starting any procedures, and then were randomly divided in two groups. Twenty-two patients in study group continually received ciprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and blood (in cholangitis) and clinical cholangitis were recorded.RESULTS Forty-eight patients were enrolled and divided into continuous ciprofloxacin treatment group (n = 22) and discontinuous ciprofloxacin treatment group (n = 26). During ERCP, stones were found in 22 patients,malignant diseases in 24 patients and other pathologic lesions in 5 patients. One (4.5%) of the 22 patients who received ciprofloxacin and 2 (6.3%) of the 26 patients who discontinued ciprofloxacin after ERCP developed cholangitis (relative risk = 0.71; 95% CI = 0.14-3.65;P = 0.88). Bacterobilia was found in 27 (56.3%) out of 48 patients. E. coli and Streptococcus viridans were the most common organisms.CONCLUSION Continual use of ciprofloxacin in patients with cholestasis after adequate biliary drainage procedures plays no role in reducing cholangitis.     

Bilateral sudden sensorineural hearing loss as a presentation of metastatic adenocarcinoma of unknown primary mimicking cerebellopontine angle tumor on the magnetic resonance image

This report presented a case of sudden profound bilateral sensorineural hearing loss with progressive facial diparesis in a 64-year-old woman. The magnetic resonance imaging (MRI) finding mimicked bilateral masses in the cerebellopontine angle (CPA) in an absence of clinical meningeal or parenchymal involvements at the first presentation. Surgical biopsy and histopathologic finding identified masses secondary to direct invasion of adenocarcinoma of gastrointestinal origin. Many investigations could not discover the primary site of the metastatic adenocarcinoma. Grave prognosis was observed in all cases reported including ours; the patient died 10 weeks after onset of symptoms.     

Relationship between aerobic capacity and cardiovascular disease risk factors in Thai men and women with normolipidemia and dyslipidemia

[Purpose] This research aimed to investigate the relationship between aerobic capacity (VO_2,peak) and cardiovascular risk factors in normolipidemic and dyslipidemic Thai men and women. [Subjects and Methods] We recruited 104 dyslipidemic and 100 healthy participants. Fasting blood samples were analyzed for lipid and blood glucose levels. Anthropometry, blood pressure, and body composition were measured before exercise. Each subject underwent exercise testing to determine VO_{2, peak}. Heart rate (HR) was recorded throughout the exercise test. [Results] Dyslipidemic participants had a lower VO_{2, peak} than normolipidemic participants (p<0.01). In normolipidemic male participants, VO_{2, peak} was positively correlated with high density lipoprotein cholesterol (HDL-C) levels and negatively correlated with low density lipoprotein cholesterol (LDL-C) levels and triglycerides to HDL-cholesterol (TG/HDL-C) ratios; in females, VO_{2, peak} was negatively correlated with age, total cholesterol, and LDL-C. In dyslipidemic males, VO_{2, peak} was positively correlated with HDL-C levels and negatively correlated with age, LDL-C and TG levels, and percent body fat; in females, VO_{2, peak} was positively correlated with resting HR and heart rate recovery and negatively correlated with age, TG/HDL-C, and waist circumference. [Conclusion] There was a relationship between aerobic capacity and cardiovascular disease risk factors in both normolipidemic and dyslipidemic participants. This relationship was affected by gender.Key words: Peak oxygen consumption, Lipid profiles, Heart rate     

Production and characterization of a monoclonal antibody against 28.5 kDa tegument antigen of Fasciola gigantica

A monoclonal antibody (MoAb) against the 28.5 kDa tegumental antigen of Fasciola gigantica was produced by the hybridoma technique using spleen cells from BALB/c mice immunized with the tegumental extract from adult F. gigantica. This MoAb was found to be of the isotype IgG(1), kappa-light chain, and shown by immunoblotting to specifically react with the 28.5 kDa antigen present in the tegument, excretion-secretion material of the adult, whole-body extracts of newly excysted juveniles, 5-week-old juvenile and adult parasites. It did not cross-react with antigens from other trematode parasites, including Schistosoma mansoni, Eurytrema pancreaticum and Paramphistomum spp. Immunolocalization of this antigen by indirect immunofluorescence indicated that it was present as a major component of the adult tegument, particularly in its outer rim, tegumental cells, and their processes. Furthermore, the epithelium linings of the oral sucker, buccal tube, pharynx, caecal bifurcation, both male and female genital canals, which were the continuation of the tegumental-type epithelium, were also positively stained with this MoAb. A similar pattern of immunolocalization, but with weaker staining intensity, was observed in newly excysted, 5- and 7-week-old juveniles. Thus this antigen is expressed in all developmental stages of the parasite, and it could be a strong candidate for immunodiagnosis and vaccine development.