Echocardiographic abnormalities and anticardiolipin antibodies in Egyptian patients with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is an inflammatory disease characterized by deposition of autoantibodies and pathogenic immune complexes in cells and tissues causing lesions. Cardiac involvement in patients with SLE has been described since the early 20th century. Echo-cardiography is time main instrument for investigating the anatomical and functional involvement of the heart in the great majority of systemic diseases. Antiphospholipid syndrome is an autoimmune disease characterized by antiphospholipid antibodies and at least one clinical manifestation, the most common being venous or arterial thrombosis and recurrent fetal loss. Anticardiolipin IgG antibodies have been linked to several cardiac manifestations in patients with SLE. -to study the cardiac abnormalities in Egyptian patients with SLE, to determine its relation to other clinical features of SLE and its association with anticardiolipin antibodies [IgG]. This study involved thirty patients with SLE. Patients were classified into two groups according to having any abnormal finding on echocardiography into Echo positive patients [23 patients] and echo negative patients [7 patients]. Patients were also classified into two groups according to ACL IgG seropositivity into Group I: ACL positive patients [18 patients] and Group II. ACL negative patients [12 patients]. Group I with ACL +ve were further classified according to ACL titer of antibodies into: Group IA: with high titer [10 patients] and Group IB: with low titer [8 patients]. The study involved also a control group of 15 age and sex matched apparently healthy individuals. For each one detection of anticardiolipin antibodies IgG, transthoracic echocardiography in addition to liver and renal function tests were done. Results were subjected for statistical analysis. This study revealed that cardiac involvement in SLE is very common and it is not related to other clinical features of lupus, age, disease duration or to activity of disease. 23 patients had echocardiographic abnormalities [76.60%], 11 patients had pericardial effusion [36.60%], 1 patient had LV diastolic dysfunction [3.3%], 3 patients had LV systolic dysfunction [10%], 3 patients had Pulmonary hypertension [10%] and 16 patients had Valvular abnormalities [53.30%]. The valvular abnormalities were affecting the mitral valve in 16 patients [53.3%], aortic valve in 2 patients [6.6%] and tricuspid valve in 7 patients [23.3%]. No pulmonary valve affection was detected. Valvular involvement - especially regurgitation and thickening of the mitral valve - is the most encountered forum of heart disease in SLE followed by pericardial effusion. Comparative study between anticardiolipin positive and negative groups regarding echocardiographic abnormalities showed no statistical significance [P > 0.05]. ACL shows a tendency towards a statistical significance with MV thickening [P = 0.06]. Comparative study between patients of ACL +ve SLE patients according to titer of anticardiolipin antibodies IgG revealed statistically significant difference between both groups as regards BUN, PTT creatinine clearance, SLAM score and number of valve regurgitation in each patient [P < 0.05] as well as echo abnormalities in general [P < 0.05]. Cardiac involvement in SLE specially valvular affection followed by pericardial effusion - is very common although, clinical involvement is not very common and it is not related to other clinical features of lupus. ACL IgG antibodies play a role in the pathogenesis of the severity of cardiac affection in general and valvular lesions in particular and in time pathogenesis of lupus nephropathy

Avoidance of external laryngeal nerve injury during thyroidectomy

100 patients suffering from simple multinodular goitre [78 females and 22 males] with mean age of [32.8Y] were classified into two equal groups 50 patients each. In the first group the superior thyroid vessels were ligated as mass ligation with in the upper pole. In the second group, the superior thyroid vessels were ligated individually with identification of external laryngeal nerve whenever possible. The voice function was tested pre -and 3 months postoperatively in both groups. There was preservation of the voice function in the second group with some aspects of deterioration of voice function in the first group. So, individual ligation of superior thyroid vessels and identification of external laryngeal nerve if possible, is a good method for preservation of voice functions after thyroidectomy operations

Gas chromatographic peak enhancement problem and solution

The peak enhancement of Bentazon [3-isopropyl-1 H-2,1,3-benzothiazin-4 [3H]-one-2,2-dioxide]; the active ingredient of Basagam herbicide; and its metabolites in fortified samples have been studied using capillary gas chromatography [GC] with a thermionic specific detector [TSD], flame photometric detector [FPD] and mass selective detector. [MSD]. The enhancement problem which was connected with the infection of samples and standards in methanol was eliminated by using non-polar solvent for GC infection

Anticardiolipin antibodies, hemolytic anemia and thrombocytopenia in systemic lupus erythematosus

29 patients with SLE [27 females and 2 males], mean age [26.5 years]. 11 of these patients had autoimmune hemolytic anemia [AIHA] and 18 SLE patients without AIHA [control patients]. Anticardiolipin [ACL] antibodies IgG and IgM levels were measured by ELISA. Elevated IgM ACL antibodies were seen in 7 [63.6%] of 11 patients with AIHA and 2 [11.1%] of 18 control SLE patients [P <0.01]. There was no significant difference in IgG ACL antibodies levels between the two groups. Thrombocytopenia was present in 7 [63.6%] of 11 patients with AIHA and 4 [22.2%] of 18 control SLE patients [P <0.05]. Elevated IgG ACL antibodies were found in 3 [75%] of 4 control SLE patients with thrombocytopenia, [P <0.05] while IgM ACL antibodies were not detected in these patients. It was concluded that in patients with SLE and autoimmune hemolytic anemia, there is a high prevalence of both thrombocytopenia and IgM ACL antibodies which may act as anti- erythrocyte autoantibodies. Also, there is an association between IgG ACL antibodies and presence of thrombocytopenia in SLE. These antibodies may play a direct role in mediating platelet destruction

primary antiphospholipid syndrome, clinical and serological study

The aim of this study was to analyze the clinical and serological features in a series of patients with primary antiphospholipid syndrome [PAPS]. 12 patients were reported. The antiphospholipid antibodies were determined with the following techniques: IgG and IgM anticardiolipin antibodies by ELISA, lupus anticoagulant by Exner test. The results showed that the mean age of the patients was 32.5 years with a female/male ratio of 2: 1. The most frequently observed clinical manifestations were deep venous thrombosis [DVTs], 6 patients [50%]. Arterial occlusions were less frequent, 4 patients [33%], recurrent fetal losses in 4 patients [33%]. Thrombocytopenia was detected in 5 patients [42%], antinuclear antibodies in 3 patients [25%]. Antiphospholipid antibody study demonstrated the presence of anticardiolipin antibodies in 10 patients [83%], lupus anticoagulant in 4 patients [33%]. It was concluded that the primary antiphospholipid syndrome may exist as a distinct clinical entity and all younger patients presenting with thrombotic events, fetal losses and/or thrombocytopenia without evidence of a well defined disease, should be tested for antiphospholipid antibodies in order to rule out this syndrome