"Naturally-occurring" anti-K1: possible association with mycobacterium infection

We report a case of "naturally-occurring" (nonred blood cell stimulated) anti-K1. The patient had never received a blood transfusion. Red blood cell antibody screening panels showed agglutination with K:1 red blood cells at room temperature and not in the anti-globulin test. Testing with 2-mercaptoethanol showed the antibody to be IgM. The antibody is "naturally-occurring" and may be associated with pulmonary tuberculosis.     

Radioimmunoassay of "pregnancy-specific"-beta 1-glycoprotein (SP1).

A radioimmunoassay for SP1 ("pregnancy-specific" beta 1-glycoprotein) is described in which a sensitivity of 0.1 microgram/L was achieved by use of an antiserum with Ka approximately equal to 1.7 x 10(11) L/mol and delayed addition of a 125I-SP1 tracer (specific acty, 25 Ci/g) that was stable for use in the assay for at least six to seven weeks. We also report an additional anti-SP1 serum, from an early bleeding, that displayed "apparent positive cooperativity" in the IgG but not the IgM fraction.     

"PMN-elastase assay": enzyme immunoassay for human polymorphonuclear elastase complexed with alpha 1-proteinase inhibitor

A solid phase, enzyme-linked immunoassay is described for the quantitative determination of the complex of human granulocyte elastase (EC 3.4.21.37) with alpha 1-proteinase inhibitor. The assay employs antibody-coated test tubes and it is suitable for routine use in clinical chemistry laboratories. Data for sample stability and test characteristics are given. A reference range of 20-180 micrograms/l elastase in plasma was determined. The diagnostic significance of granulocyte elastase levels in plasma in inflammatory diseases is discussed.     

Switching from transdermal drugs: an observational "N of 1" study of fentanyl and buprenorphine

The aim of this study was to confirm that the concomitant presence of transdermal fentanyl (TTS FE) and buprenorphine (TTS BU) may be feasible without important consequences, using doses presumed to be equianalgesic. A prospective "N of 1" study was carried out in a sample of volunteers with cancer pain receiving stable doses of TTS FE or TTS BU, with adequate pain and symptom control. In the study design, each patient provided data before and after a switch from one opioid to the other and then back to the previous one. Sixteen patients receiving daily stable doses of 0.6 or 1.2mg of TTS FE were switched to TTS BU using an FE-BU ratio of 0.6-0.8. After three days, the TTS BU patch was removed and TTS FE patch was placed for another three days. Six patients receiving TTS BU were switched to TTS FE and then rotated back to TTS BU with the same dosing considerations. No statistical differences in changes in pain and symptom intensity during switching and between the two different sequences were observed. No significant changes in rescue doses of oral morphine were reported at the same intervals. Cancer patients receiving stable doses of TTS FE or TTS BU can be safely switched to the alternative transdermal opioid. Further studies should be performed to gather data about the use of TTS BU with other opioids, at different doses, and in different clinical conditions.     

Autoantibody "subspecificity" in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups

OBJECTIVE: Autoimmune thyroid disease (AIT), celiac disease, and Addison's disease are characterized by the presence of autoantibodies: thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in AIT, tissue transglutaminase antibody (TTGAb) in celiac disease, and 21-hydroxylase antibody (21-OHAb) in Addison's disease. The objective of this study was to define the prevalence of these autoantibodies and clinical disease in a population with type 1 diabetes. RESEARCH DESIGN AND METHODS: We screened 814 individuals with type 1 diabetes for TPOAb, TGAb, TTGAb, and 21-OHAb. Clinical disease was defined by chart review. Factors related to the presence of autoimmunity and clinical disease including age at onset of type 1 diabetes, duration of diabetes, age at screening, sex, and the presence of autoantibodies were reviewed. RESULTS: The most common autoantibodies expressed were TPOAb and/or TGAb (29%), followed by TTGAb (10.1%) and 21-OHAb (1.6%). Specific HLA DR/DQ genotypes were associated with the highest risk for expression of 21-OHAb (DRB1*0404-DQ8, DR3-DQ2) and TTGAb (DR3-DQ2- DR3-DQ2). The expression of thyroid autoantibodies was related to 21-OHAb but not to TTGAb. The presence of autoantibodies was associated with and predictive of disease. CONCLUSIONS: In this large cohort of individuals with type 1 diabetes, the expression of organ-specific autoantibodies was very high. The grouping of autoantibody expression suggests common factors contributing to the clustering.     

误服"消渴丸"致低血糖昏迷1例

患者男，１８岁。于１９９７年５月３１日凌晨３时许因抽搐、昏迷２小时急诊入院。患者口渴、小便频数，误认为是“消渴病”，自购消渴丸服用［３０ｇ瓶装，每丸含格列本脲（优降糖）０．２５ｍｇ］，每天服４次，每次５丸，３天共６０粒，服下优降糖总量１５ｍｇ，服药期...     

Recent advances in nuclear cardiology. 1. "Hot-spot" and "cold-spot" myocardial scintigraphy

Nuclear cardiology is a comparatively new field of cardiovascular medicine in which technologic advances have provided relatively noninvasive means of evaluating cardiovascular abnormalities. The purpose of this two-part review is to emphasize some important recent advances and to place in perspective the advantages and disadvantages of those new techniques that are particularly useful clinically.