Alteration in thyroid functions and nuclear T3 receptors [Nt3R] pinding capacity in chronic nonthyroidal illnesses

This study was carried out on 30 chronically ill patients and 10 normal control subjects. 10 patients were with chronic liver disease, 10 with chronic renal failure [CRF] and 10 were diabetics on insulin therapy. Thyroid functions and NT3R were measured by radioimmunoassay [R.I.A.]. The main objective of this study was to examine if changes in nuclear binding capacity for T3 might explain the maintenance of clinical euthyroidism during chronic illness. Hepatic and renal patients had significant decrease in T3 and a significant increase in TSH, whereas no significant changes in T4 could be detected, a condition known as low T3 syndrome. In diabetics, a non-significant decrease in T3 and T4 was observed together with a slightly significant increase in TSH. Binding of lymphocyte nuclei to [125I] T3 in hepatic and renal patients revealed decreased binding sites and increased binding capacity which could be explained as a compensated hypometabolic state which might be achieved by increased binding capacity for NT3R. In diabetics binding sites were increased while binding capacity were decreased. The explanation for these diverse hormonal changes may be related to the stress situation as a whole rather than to a particular disease. Moreover, these changes represent a beneficial adaptive homeostatic mechanism, and alteration by therapy with thyroid hormones in such cases interrupt physiological adaptive changes and is not recommended

Discrete versus diffuse coronary artery stenosis clinical, angiographic and echo-doppler studies

Forty subjects were admitted to catheterization laboratory at Ain Shams University Hospital with typical and atypical chest pain. According to the coronary angiogram, 30 patients had coronary artery disease [CAD]. These patients were further classified CAD [19 patients] and diffuse CAD [11 patients]. There was no statistically significant difference between the two groups with regard to age, sex, duration of the disease, symptoms or functional class. The diffuse CAD group had significantly higher prevalence of diabetes mellitus [P > 0.01] than the discrete CAD group. On the other hand, the discrete CAD group had a significantly higher prevalence of anterior myocardial infraction [P < 0.05]. Coronary angiographic data revealed that in the discrete CAD group lesions tended to occur more frequently in the proximal segments whereas diffuse CAD had both proximal and distal segements involvement and a significantly higher [P < 0.01] mean coronary severity score. Echocardiographic and Doppler data revealed that diffuse CAD group had a significantly [P > 0.05] higher wall motion score [WMS] and none significantly difference in ejection fraction [EF] than the discrete group. The diastolic function was impaired in the CAD patients. The diffuse CAD group had a highly significantly increase in A wave and A/E ratio [P < 0.01] and a significant lower acceleration and deceleration than discrete CAD group. So, our results indicated that the diastolic dysfunction is inter-related to the severity and extent of CAD lesions. Therefore, the diagnosis of diffuse rather than discrete CAD which is an angiographic diagnosis, could not be predicated from the clinical data alone. Moreover, CAD patients were not prone to more adverse effects on the ventricular function apart from some impairment of left ventricular [LV] diastolic function as detected by pulsed wave Doppler ultrasound

High density lipoprotein subfractions and apolipoprotein-A1[Apo-A1] In chronic hemodialysis patients

Cholesterol content in high density lipoprotein [HDL] subfractions and the serum concentration of opoprotein A-1 [Apo-A1] have been studied in 32 patients at the end stage of chronic renal failure [CRF] undergoing haemodialysis. High density lipoprotein-cholesterol [HDL-C] subfractions were significantly decreased in the patient's group compared to the control group. However, serum concentrations of Apo-A1 were not significantly different. The raised Apo-A1/HDL2 cholesterol ratio in the patients group suggests the existence of qualitative changes in HDL subfractions in patients with CRF receiving haemodialysis. The abnormalities in the relative composition of HDL subfractions could play an important role as a cardiovascular risk factor in patients with CRF undergoing haemodialysis

Platelet antibodies in bilharzial Hepatosplenomegaly

This study was conducted on forty subjects, thirty male patients with bilharzial hepatosplenomegaly and ten healthy control subjects matched for age and sex. Platelets were studied quantitatively and platelet functions were assessed by bleeding time, clot retraction, platelet adhesion and aggregation. Immunological investigations including determination of serum immunoglobulins [IgG, IgM, and IgA], serum complement [C3c and C4], circulating immune complexes [CICs], as well as clot retraction test for detection of platelet antibodies. There was a significant reduction of platelet count and a negative correlation between the platelet count and the platelet antibodies in patients group. Diminished platelet functions were demonstrated by decreased platelet adhesion, decreased clot retraction, and impaired adenosine diphosphate [ADP] aggregation. No statistical correlation was found between the impairment of aggregation and the degree of inhibition of clot retraction. On the contrary, and inverse correlation was demonstrated between clot retraction and platelet antibodies. Significant higher levels of IgG and IgM in patients' group were detected whereas serum IgA levels showed no statistical difference. Significantly increased levels of serum C3c were demonstrated and there was an inverse correlation between C3c levels and platelet count, however, there was no correlation between serum C3c and platelet antibodies. Serum levels of C4 were not significantly deviated from normal levels. Serum levels of CICs were higher in patients' group and a significant positive correlation was found between these complexes and serum IgG levels. In conclusion, the present study proved the presence of platelet antibodies in patients with bilharzial hepatosplenomegaly. The observed quantitative and qualitative platelet defects in those patients had been correlated to the presence of platelet antibodies and the concomitant immunological disturbances

Prophylactic endoscopic sclerotherapy versus conservative management in patients with non-bleeding oesophageal varices

The present study was performed to evaluate the value of prophylactic sclerotherapy before the first episode of variceal haemorrhage regarding its effect on the incidence of variceal bleeding, hepatic encephalopathy and survival during a follow up period of two years after excluding drop outs. One-hundred patients with liver cirrhosis and varices who had not bled, 50 were treated conservatively and 50 were treated by sclerotherapy. On admission, patients were assigned to one of three categories according to Pugh's classification of severity. It was found that bleeding was not related to the degree of liver illness but rather to variceal grading. Prophylactic sclerotherapy lowered significantly the frequency of variceal bleeding as well as the incidence of encephalopathy. Although total mortality rate was less in the sclerotherapy group [8 percent] than in the conservative group [22 percent], it was not statistically significant. On the other hand, mortality due to bleeding alone has occurred in [6 percent] of the sclerotherapy group and was statistically significant when compared to the conservative group. It can be concluded that prophylactic sclerotherapy is a valuable method as the incidence of variceal bleeding, hepatic encephalopathy as well as mortality were diminished after its usage. Also, it may have a benefit in improving the long-term survival in such patients

Neutrophil granulocyte function in bacterial and protozoal infections

The aim of this study was to assess neutrophil chemotaxis, phagocytosis, neutrophil metabolic changes and killing capacity [neutrophil alkaline phosphatase activity [NAPA], and nitroblue tetrazolium [NBT] reduction test] in bacterial and protozoal infections. Nineteen patients with bacterial urinary tract infection [UTI] [10 cases with Gram negative and 9 cases with Gram- positive], and 16 patients with protozoal infections [10 cases with amoebic liver abscess and 6 cases with intestinal giardiasis] were the material of this study. Ten healthy age matched volunteers were selected as a control. Chemotaxis and NBT reduction were not affected in all patients. Phagocytic activity was significantly increased [p< 0.002] in patients with Gram-positive bacterial infection, while it showed a highly significant increase [p < 0.002] in patients with Gram-negative bacterial infection. In intestinal giardiasis patients phagocytic activity was qualitatively increased, whereas it was increased quantitatively in amoebic liver abscess patients. NAPA was not affected in intestinal giardiasis patients, whereas in amoebic liver abscess patients and bacterial infection patients it was increased. Therefore, to assess neutrophil activity in microbial infections more than one function test is essential and thus when planning for treatment this could be taken into consideration

Clinical and electrophysiological studies in diabetic peripheral Neuropathy

This work was done to study the clinical sensory findings and to investigate the influence of hyperglycaemia on nerve sensory conduction. A group of 120 maturity-onset diabetic patients [86 females and 34 males] and 30 normal control subjects were studied. The patients were classified into two groups according to whether they had diabetic neuropathy [32 patients] or not had [88 patients]. The modalities of light touch and vibration sense were the most frequently diminished, two-point discrimination was less frequently affected and proprioception was rarely affected. Sensory nerve conduction velocity of median, ulnar and sural nerves, using the antidromic technique, was significantly [P < 0.001] slowed in the diabetic patients compared to controls. Levels of fasting plasma glucose as well as levels of glycosylated haemoglobin, and index of long-term glycaemia, were correlated with slowing of sensory conduction velocity of the tested nerves. These associations could not be explained by patient age or duration of diabetes. These findings suggest that the degree of hyperglycemia of maturity-onest diabetes contributes to the sensory nerve abnormalities in this disease. We can conclude that sensory nerve conduction parameters are the objective criteria for peripheral nerve involvement. It tends to be impaired in diabetics even those without clinical evidence of neuropathy. Moreover, the sensory nerve conduction parameters are probably the most sensitive index of peripheral neuropathy in diabetic patients. The present study also concluded that altered nerve metabolism associated with hyperglycaemia may contribute to the distal sensory polyneuropathy of diabetes. This support the hypothesis for the existence of endoneurial oedema and hydration of peripheral nerves secondary to overactivity of aldolase reductase pathway. These structural changes are recently quantitatively defined by magnetic resonance proton image. This increased level of peripheral nerve water represents a new finding in the development of diabetic neuropathy. Treatment with an aldolase reductase inhibior is a prospect which might halt, if not reverse, the development of diabetic neuropathy

Clinical significance of serum and synovial fluid complement component activities in juvenile rheumatoid arthritis

Functional activity of the total hemolytic complement [CH50] as well as the activity of four of the complement components [C1, C4, C2, and C9] were examined [using the haemolytic assay] both in the synovial fluid and sera from 25 patients with juvenile rheumatoid arthritis [JRA]. The clinical subgroups of the disease were as follows: 12 patients had a polyarticular onset, 10 patients had polyarticular onset; while 3 patients had systemic onset. The incidence of seropositivity in these patients was 32%. Among the seurm four complement component activities measured in this study, C1 was not elevated, C4 and C2 were moderately elevated and C9 was markedly supernormal. The higher C9 activity observed in the patients correlated well with blood sedimentation index. On the other hand, when synovial fluids were examined for CH50 and component activities of complement, the specimens could be divided into two groups according to the level of C4: Group 1 [11 patients] had titres of 10,000 u/ml or less and Group 11 [14 patients] had titres greater than 10,000 u/ml. Group 1 patients tended to be females, to have a significantly older age at onset, and to have polyarticular disease; only three of the eleven patients in group 1 were seronegative. Group 11 tended to have more males, than females, and to contain patients with pauciarticular disease and all were serongeative. The activities of C9 in serum and synovial fluid were highly correlated in the 25 paired specimens. This may indicate that there is an equilibrium between serum and synovial fluid C9 [which is alpha 2-globulin and the smallest protein among the complement components]; and the slope of the regression line of that correlation may represent the state of permeability of synovial membranes in such patients. In conclusion, the whole haemolytic complement activity as well as the complement component activities were depressed in the synovial fluid of patients with JRA, while the serum complement component activities were normal or elevated. Moreover, synovial fluid levels were profoundly depressed irrespective to seropositivity. These changes can result from complement hypercatabolism occurring within the rheumatoid joint space which, therefore, be reflected in normal serum levels of complement components

Infrared laser versus ultrasonic in treatment of painful shoulder

This study was carried out on 60 patients with shoulders painful at rest, and with limitation of all ranges of movement. The patients were divided into three well balanced groups. Each group comprised 20 patients. The first group was a "placebo one". The second and third groups treated with ultrasonic [U.S.] and infrared [I.R.] laser therapy respectively. The severity of the pain and the range of active shoulder joint movements in flexion, abduction, external and internal rotations were done prior to the treatment, three and six months after treatment. Results of this study revealed that the average percentage of shoulder pain improvement after three and six months of teatment in the four shoulder joint movements is better with the use of I.R. laser therapy than U.S. As for the range of shoulder joint movements, it was observed that there was a highly significant improvement in the I.R. Laser group after three and six months of treatment but only after six months in the U.S. group. These finding lead us to conclude that pain relief and maximum functional recovery of shoulder joints are better achieved in patients with painful shoulders who were under I.R. laser therapy than patients under U.S. therapy. It is suggested that the "frozen shoulder" - i.e. pain free shoulder with severe limitation of all movement - is the end result of a neglected painful shoulder and it is essential that painful shoulders be treated as early as possible if normal function is to be restored

Leukocyte migration inhibition in agarose and parietal cell antibody in chronic gastritis

Forty-one patients with chronic gastritis without pernicious anaemia and 12 healthy persons with normal gastric mucosa were examined. Cell-mediated immunity [CMI] against gastric fundal and antral mucosal antigens was studied using the leucocyte migration inhibition agarose test [LMAT], and serum parietal cell antibodies [PCA] were examined by the indirect immunofluorescence method. The LMAT was positive in eight [19.5%] out of 41 patients with gastritis and in none of the healthy subjects. In all these cases migration inhibition appeared with antigen that corresponded to gastric lesion. PCA were present in 11 [26.8%] out of 41 patients with gastritis and in 2 [16.7%] out of 12 healthy persons. No significant relationship was found between the PCA and the result of LMAT. Thus, it is concluded that, there is an evidence that immunological factors may participate in the causation of non-specific chronic gastritis

study of circulating T and B lymphocytes in chronic active hepatitis

The number of circulating lymphocytes as well as B and T lymphocytes was estimated in the blood of 35 patients biopsy-verified chronic active hepatitis [CAH]. The number of total lymphocytes and rosette-forming cells [T lymphocytes] was decreased significantly [P < 0.01 and 0.001, respectively] in the patients' group. The number of IgG-IgA-and IgM-bearing-lymphocytes [B lymphocytes] did not change significantly, while the number of null cells were increased significantly [P < 0.02] in patients versus the control group. It was concluded that the immunological changes observed in the present study in the form of increased number of B lymphocytes, decreased number of T lymphocytes may be an operative mechanism for genesis of CAH through an antibody dependent cellular cytotoxicity mechanism [Type VI hypersensitivity reaction]. Moreover, the increased number of null cells may indicate the presence of killer cells [K cells] with active cytotoxicity directed against hepatocytes leading to hepatocellular necrosis and hepatitis

HLA antigen phenotypes in rheumatic heart disease

The pattern of human leucocyte antigen [HLA] phenotypes [HLA-A, -B and -DR antigens] was typed in 80 upper Egyptian patients with established rheumatic valvular heart disease and the results were compared with those of 200 ethnically similar normal controls. The results of the present study suggested that RHD in population may be influenced by the HLA associated genetic susceptibility. Recent studies have been recently begun to probe the monoclonal technology which revealed the existence of a serologically defined strong genetic marker [B-lymphocyte alloantigen]. The predictive value of this antigen in predicting the risk of various factors of acute rheumatic fever [ARG] and RHD, needs to be evaluated to better recognize and quantitate the different lymphocyte subsets to enable production of selective and effective immunosuppressive therapy [at an earlier stage] of this disabling heart disease