Evaluation of the Sebia Minicap Flex Piercing capillary electrophoresis for hemoglobinopathy testing.

INTRODUCTION: Capillary zone electrophoresis (CZE) at alkaline pH is one of the techniques used for hemoglobinopathy screening. In this study, an evaluation of the performance of a lower throughput CZE instrument, the Sebia Minicap Flex Piercing system, for this purpose is reported for the first time. METHODS: The analytical performance of the Sebia Minicap Flex Piercing system was evaluated. Furthermore, a method comparison between the Sebia Minicap Flex Piercing and two HPLC methods, that is, the Bio-Rad Variant Classic(™) and the Bio-Rad D-10(™) systems was performed by measuring samples with and without clinically relevant hemoglobin disorders. RESULTS: The analytical performance was acceptable for the determination of HbA, HbA2, HbS, and HbF, with an imprecision ≤2.0%. Method comparison showed a linear correlation for HbA2, HbF, and HbS measurements. Clinical concordance was acceptable when comparing CZE and HPLC. CONCLUSIONS: Lower throughput CZE using the Sebia Minicap Flex Piercing can be used for precise and accurate first line screening and follow-up of hemoglobinopathies.

Aberrant glycated haemoglobin (HbA1c) results leading to haemoglobinopathy diagnosis in four Belgian patients.

INTRODUCTION: We report four cases in which haemoglobinopathy screening was triggered following aberrant HbA1c analysis. Either the HbA1c assay was unable to produce a quantifiable result or it showed the presence of an extra fraction and/or the result was discordant with the clinical context. CASE REPORT: In the reported four patients, all from Caucasian, Belgian descent, Hb analysis was performed using cation-exchange high performance liquid chromatography. If necessary, additional Hb electrophoresis was carried out to establish a preliminary (biochemical) diagnosis. Definitive diagnosis was obtained for every sample through DNA-analysis. Three patients were carriers of Hb J-Toronto and one of Hb Stanleyville-II. DISCUSSION: This report underlines the importance of correct interpretation of HbA1c results to avoid mismanagement of (diabetic) patients. Since neither the RBC indices, the clinical context, nor the ethnicity of these patients was suspicious for an underlying haemoglobinopathy, the aberrant HbA1c result was the only indicator for further investigation. Laboratory personnel and clinicians should be aware of the possibility of uncommon, sometimes clinically unsuspected, Hb variants to cause aberrant HbA1c values, even in populations with low prevalence for haemoglobinopathies. Further analysis should be prompted to obtain definitive diagnosis. Alternative methods for monitoring glycaemic control should be used.

Naproxen sodium: comparative efficacy and tolerability of two dosages for pain after joint surgery.

In a multicenter, randomized, double-blind, parallel trial, the efficacy and tolerability of two regimens of naproxen sodium were compared in a two-day treatment of moderate to severe pain following open surgery of the hip, shoulder, knee, and ankle joints. Of 147 patients enrolled, the data of 99 were valid for efficacy analysis, 45 in the low-dose regimen (day 1, 1,100 mg; day 2, 825 mg) and 54 in the high-dose regimen (1,650 mg/day). At 12 interviews each day, patients evaluated intensity of pain using numerical scales and recorded complaints. At the end of the study, overall efficacy was evaluated. Although there were no statistically significant differences between the two regimens for efficacy or tolerability, the high-dose regimen achieved greater pain relief in patients who had hip or shoulder surgery, suggesting that this regimen had greater cumulative efficacy for these patients.

The intercondylar notch in acute tears of the anterior cruciate ligament: a computer graphics study.

Although the intercondylar notch becomes narrowed with a failed repair of the ACL or with chronic instability of the knee, narrowed intercondylar notches have frequently been observed during arthrotomy for an acute ACL tear in previously uninjured knees. In order to determine whether the structure of the intercondylar notch predisposes a knee to anterior cruciate tears, a computer graphics study was designed. Notch view roentgenograms of 50 patients with an acute ACL injury and 50 "normal" patients without history of significant knee injury were compared. An interactive graphics design station was used to obtain the area of the anterior opening (ANT) and posterior arch (POST) of the intercondylar notch. A "total" (TOTAL) area was obtained by tracing the distal 7.5 cm of the femur. Only the ratios of areas obtained from each roentgenogram were used for comparison because of varying femur sizes among patients and possible slightly varying techniques of taking the notch view roentgenogram itself. The following ratios were developed: ANT/POST, POST/TOTAL, and (POST-ANT)/TOTAL. The difference between the means of the ratio POST/TOTAL for knees with acute ACL tears and those for normal knees was statistically significant (P less than 0.005). This study suggests that a narrowed posterior arch of the intercondylar notch may predispose a knee to ACL tear.

Anterior cruciate ligament arthroplasty.

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes anserine transfers. This coincided with a proposed pathologic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate stabilizations arthroplasties were performed. Patients with less than a 2 year followup were not included in this retrospective study. One hundred nine arthroplasties are reported: 80 isolated ACL tears and 29 multiple ligament injuries. Statistically significant relationships between elapsed time from ACL tear to surgery and meniscal tears, and elapsed time and degenerative changes in the articular surfaces were seen. Surgical technique was arthroplasty, graft harvest, graft placement, graft set, and postoperative care. Functional score followup has occurred for an average of 3 years (range 2 to 5 years). No patient has failed to return to his or her original sport or occupational demands. Pivot shift, disengagement, or spontaneous rupture of the arthroplasty has not occurred postoperatively. Full participation has occurred with bilateral ACL arthroplasties and arthroplasty performed for previous intraarticular augmentation failure. The operative success in the preliminary follow-up period was based on: ligamentous substitution, anatomical placement, femoral intercondylar notch compliance in full range of motion, revascularization of the ligament substitute, and histologic support of the procedure.

[Polyarthritis in leprosy (author's transl)]. / Polyarthrites au cours de la lèpre.

Inflammatory rhumatisms simulating rheumatoid arthritis belong to the manifestations of the reactions of leprosy. Pathology of these arthritis variate with the type of reaction. In the present observations, it must probably be the transition from a tuberculoid leprosy to a lepromatosis form in which the immunological state looks like the lupus one.

Polyarthrites au cours de la lèpre / Polyarthritis in leprosy

Inflammatory rheumatisms simulating rheumatoid arthritis belong to the manifestations of the reactions of leprosy. Pathology of these arthritis variate with the type of reaction. In the present observations, it must probably be the transition from a tuberculoid leprosy to a lepromatosis form in which the immunological state looks like the lupus one.

[Acute nephritis and allergic vasculitis due to phenindione (author's transl)]. / Glomérulonéphrite aiguë et vascularite allergique après traitement a la phénylindanedione.

The authors report a case of acute nephritis which appears during a treatment with phenindione. The nephropathy described after this medication are now well known. Their manifestations are either a proteinuria associated or not with a nephrotic syndrome or an interstitial nephritis whose pronostic is reserved. In this observation the mechanism is different : the lesion is glomerular and complicates an allergic vasculitis which was secondary to the phenindione's therapy. The pronostic was good.