ABSTRACT
Resistant Graves' disease in pregnancy is a rare entity. The clinical situation poses immense difficulty to the treating endocrinologist and obstetrician in optimizing maternal and fetal heath. No guidelines till date are available to manage resistant Grave's disease in pregnancy. We hereby present a case series on resistant Grave's in pregnancy and our institute experience in managing this rare and challenging clinical entity. Definitive management is total thyroidectomy in second trimester. Higher doses of ATDs and betablockers may have its fetopathic effects. Use of immunosuppressive agents are not advised in pregnancy to suppress the TRAb titre. Steroid therapy may be used as an adjuvant to permissible doses of anti-thyroid medications to curb the thyrotoxicosis in pregnancy. An alternate fetal friendly ATD is not available to add on to existing ATDs. TRAb estimation in maternal blood is mandatory. Mothers need frequent monitoring of cardiac status and need to avoid factors that can cause cardiac decompensation. Fetal surveillance includes growth monitoring and biophysical profile at nearby intervals, helps to ascertain the effects of excess thyroid hormones, TRAb and anti-thyroid drugs. Immediate neonatal cord blood screening for thyroid abnormalities is necessary. Maternal and fetal management in such a clinical situation is multidisciplinary.
ABSTRACT
The activity of the neutral, Mg2+-stimulated sphingomyelinase of cultured neuroblastoma cells (N1E-115) is enriched in the plasma membrane fraction and is reduced following treatment of intact or broken cells with trypsin, alpha-chymotrypsin, papain, and protease. Two protease-sensitive enzymes of the cell interior (lactate dehydrogenase and NADPH-cytochrome c reductase) are not affected by protease treatment of intact cells. These results indicate that the neutral, Mg2+-stimulated sphingomyelinase is oriented externally on the plasma membrane of the cultured neuroblastoma cell.
Subject(s)
Cell Membrane/enzymology , Neuroblastoma/enzymology , Phosphoric Diester Hydrolases/metabolism , Sphingomyelin Phosphodiesterase/metabolism , Animals , Cell Line , Chymotrypsin/pharmacology , L-Lactate Dehydrogenase/antagonists & inhibitors , Magnesium/pharmacology , Mice , NADPH-Ferrihemoprotein Reductase/antagonists & inhibitors , Papain/pharmacology , Peptide Hydrolases/pharmacology , Sphingomyelin Phosphodiesterase/antagonists & inhibitors , Trypsin/pharmacologyABSTRACT
The activities of some enzymes increase during the development of the cellular slime mould, Dictyostelium discoideum. Because optimal specific activity is attained by eachenzyme at a specific developmental stage, development can be followed as a function of enzyme activity. The activity of one of these enzymes, alkaline phosphatase, increases markedly during the late stages of development, making it a potentially useful marker for terminal differentiation. It has been suggested that this increase in activity is due to de novo enzyme synthesis because the increase in activity does not occur in the presence of inhibitors of RNA and protein synthesis. However, we present evidence here of reversible heat activation of membrane-bound alkaline phosphatase which suggests that the increase in alkaline phosphatase activity may be due to an unmasking of pre-existing enzyme by a novel membrane regulatory mechanism.
