Avoidable Compartment Syndrome! High Index of Suspicion for a Newly Presenting Haemophiliac: A Case Series.

Bleeding disorders can present at any age and vary in their severity. Haemophilia, which is characterised by its x-linked recessive inheritance, can present with a spontaneous mutation and therefore no family history will be evident. Three cases of trauma induced thigh haematomas as an initial presenting feature for people with haemophilia are discussed. The cases highlight the importance of a coagulation screen if the patients bleeding phenotype does not match the injury sustained. An isolated prolonged APTT with no offending anticoagulant cause should always be investigated to look for underlying haemophilia. Interestingly the cases demonstrate the limitations of a coagulation screen. Factor VIII being an acute phase reactant can result in the fact that the initial coagulation screen may be temporarily normal. Therefore, if there is a high index of suspicion for a bleeding disorder, consider repeating the coagulation screen and seeking haematology opinion. Early diagnosis and appropriate specific factor replacement for an injured haemophiliac prevent haematomas expanding thus avoiding potential complications like compartment syndrome or unnecessary surgical input.

Free radical markers in patients with angina pectoris and normal coronary angiograms.

Markers suggestive of enhanced free radical (FR) activity have been demonstrated in patients with chest pain and normal coronary angiograms. This may be of pathogenetic importance because FRs impair vascular relaxation and are generated following episodes of myocardial ischaemia/reperfusion. Fifteen patients with angina pectoris, normal coronary angiograms and either a positive exercise tolerance test and/or abnormal dipyridamole thallium tomogram were studied along with 15 age-, sex- and smoking-matched controls. A peripheral venous blood sample was obtained to measure the following FR markers: malondialdehyde, plasma thiols, red blood cell glutathione and superoxide dismutase. No significant differences were detected in the levels of any of the FR markers between either the group of 15 patients with chest pain and normal angiograms or the subgroup with positive exercise tolerance tests when compared to the controls. There is therefore no evidence of enhanced FR activity in patients with chest pain and normal coronary angiograms in peripheral venous blood samples.

Speciation studies of serum aluminum/citrate complex by liquid chromatography-furnace AAS.

We examined, in chronic-haemodialysis patients, the in vitro effect of citrate on aluminum binding to plasma proteins, desferrioxamine, and other constituents, by gel filtration chromatography. The elution profile of these complexes was studied by equilibrium and fast-protein liquid chromatography. The aluminum distribution was determined by graphite furnace atomic absorption spectrometry. We found that citrate mobilized aluminum from plasma binding sites to form an aluminum-citrate complex, possibly of colloidal nature.

Serum aspartate aminotransferase storage and the effect of pyridoxal phosphate.

The storage stability of the catalytic activity of aspartate aminotransferase (AST) remains the subject of conflicting reports. We reevaluated this issue for total AST activity and for the cytosolic and mitochondrial isoenzymes from human sera stored at room, refrigerator, and freezer temperatures for up to 28 days. We found that these enzymes were stable for catalytic activity and immunologic (mass) measurements up to 24 hours at ambient temperatures and for at least 28 days at 4 degrees, -20 degrees, and -80 degrees C. The addition of exogenous pyridoxal phosphate (0.1 mmol/L) to serum improved stability of AST storage at ambient temperature (22 degrees C) from 1 day to 7 days.

Changes in mass and catalytic activity concentrations of aspartate aminotransferase isoenzymes in serum after a myocardial infarction.

We used an RIA and inhibition of enzyme activity to monitor the changes in mass and catalytic concentrations of the aspartate aminotransferase (EC 2.6.1.1;AST) isoenzymes in serum after myocardial infarction. Cytosolic (c-AST) and mitochondrial (m-AST) forms of AST were present in sera from all 38 of our patients. Although the immunological and catalytic concentrations of both isoenzymes correlated well with the size of the infarct, c-AST gave a better measure than did m-AST. About 20% of the total enzyme activity at peak activity was from the mitochondrial isoenzyme. Both isoenzyme activities peak at very nearly the same time, but m-AST has the longer half-life. Immunological evidence of the mitochondrial isoenzyme can be detected in serum for at least eight days after the infarct. The presence of left ventricular failure produces greater serum isoenzyme activities than in those without failure.

Radioimmunoassay of aspartate aminotransferase isoenzymes in human serum.

We describe the development of a sensitive, specific radioimmunoassay for the cytoplasmic and mitochondrial isoenzymes of human aspartate aminotransferase (L-aspartate:2-oxoglutarate aminotransferase; EC 2.6.1.1). Isoenzymes from human heart tissue were purified to homogeneity and used to raise high-titer antisera in rabbits. We partly purified the antisera by selective column chromatography. The Bolton-Hunter reagent was used to radioiodinate the isoenzymes. The assay requires 100 microL of serum, includes a solid-phase second-antibody separation, and can be completed in less than 3 h. There was no cross reactivity between the two isoenzymes. As little as 5 micrograms (50 pmol) of each aspartate aminotransferase can be measured per liter of serum.

Chemical properties of the principle in C. parvum that produces splenomegaly in mice.

Suspensions of Wellcome C. parvum strain 6134 produce splenomegaly in mice when injected i.p. in amounts as low as 20 microgram. This lymphoreticular stimulatory activity is extremely sensitive to cell breakage and is abolished by heating for 4 h at 100 degrees. Periodate oxidation of the bacteria destroys their capacity to produce splenomegaly and abrogates the agglutination of intact C. parvum by Con A. Mild HCl hydrolysis also abolished the splenomegaly but phenol:chloroform:ether and chloroform:methanol extractions did not. These results suggest that the relevant stimulatory principle in C. parvum is of carbohydrate nature, and most probably present on the surface of the bacterium.