Shivering following retrobulbar block

A case of a severe but brief period of shivering following a retrobulbar block (RBB) is presented. The shivering occurred within two minutes after completion of the RBB and subsided gradually within five minutes, without specific treatment. The patient remained conscious during the episode of shivering. The shivering was so abrupt and severe as to be misjudged as a seizure, but its onset appeared to be slower than a seizure. The mechanism of shivering appeared to be the central spread of local anaesthetic solution into the brain stem, along the optic nerve. Shivering may be a warning sign of brain stem anaesthesia and demands special care to anticipate life-threatening complications.

Histiocytic medullary reticulosis: radiologic diagnosis of splenic infarction--a case report

A case of histiocytic medullary reticulosis with splenic infaraction from a 23-year-old male is presented. Radiologic findings on selective spleen scintigraphy and abdominal CT are described. Selective spleen scintigraphy showed huge, multilobulated spleen with numerous photon-deficient areas in it and peripherally. Abdominal CT showed large peripheral band-like low density and infiltrative lesion in spleen with accompanying intraabdominal lymphadenopathy. Histoligical features were consistent with HMR in spleen and liver specimens.

HLA and Graves' disease in Koreans

The HLA-A, B, C and DR antigen distribution in 128 Korean patients with Graves' disease was compared with that in 220 controls. The frequency of HLA-B13, DR5 and DRw8 (relative risk 3.8, 4.4, and 2.3, respectively) was significantly increased in patients with Graves' disease. There was no significant correlation between the presence of these HLA antigens and the clinical features.

Changes of serum angiotensin-converting enzyme activity during treatment of patients with Graves' disease

Serum angiotensin-converting enzyme activity was measured spectrophotometrically, and serum thyrotropin-binding-inhibitory immunoglobulin (TBII) activity was measured by radioreceptor assay in normal subjects and in patients with Graves’ disease serially before and during treatment, and these activities were compared with each other and with thyroid hormone levels in various thyroid functional status. Correlation between serum angiotensin-converting enzyme activity and serum thyroid hormone level was pursued with relation to the changes of thyroid functional status in patients with Graves’ disease during treatment.

Serum angiotensin-converting enzyme activity was significantly elevated in patients with hyperthyroid Graves’ disease before the start of treatment (35 ± 13 nmol/min/ml, n=50), and not in patients with Graves’ disease, euthyroid state during treatment with antithyroid drugs or radioactive iodine (23 ± 9 nmol/min/ml, n=12), but decreased significantly in patients with Graves’ disease, hypothyroid state transiently during treatment (15 ± 4 nmol/min/ml, n=12), respectively in comparison with normal control subjects. Serum angiotensin-converting enzyme activity was positively correlated with the log value of serum T3 concentration (r=0.62, p<0.001, n=95), and with the log value of free thyroxine index (r=0.66, p<0.001, n=91) but not statistically significantly with serum TBII activity. Serum angiotensin-converting enzyme activity was followed in 11 patients with initially increased activity and the activity decreased in proportion to serum thyroid hormone level during treatment, irrespective of treatment modality. It is suggested that thyroid hormones play a role in the increase and decrease of serum angiotensin-converting enzyme activity directly or indirectly influencing the peripheral tissues (probably reticuloendothelial cells or peripheral endothelial cells) in patients with Graves’ disease.

The prevalence of antithyroid autoantibodies in normal Korean population--age, sex distribution and its relation to thyroid function

The prevalence of antithyroid autoantibodies and the relationship between the presence of autoantibodies and thyroid functions were studied in 848 apparently normal Korean adults with tanned red cell agglutination technique. Results are summarized as follows: 1) The prevalence of antimicrosimal antibody (MCHA) and antithyroglobulin antibody (TGHA) were 4.4% and 1.9% in 458 males, and 12.4% and 5.0% in 390 females, respectively. Both autoantibodies were more prevalent in female (p<0.001, p<0.01). 2) The age-specific prevalence of MCHA was 4.0% in their twenties, 10.1% in their thirties, 12.5% in their forties, 12.0% in their fifties, 8.3% over sixty, and those of TGHA were 2.0% in their twenties, 3.0% in their thirties, 7.0% in their forties, 4.2% in their fifties, 2.5% in subjects over sixty, respectively. Both showed maximal values around forty and fifty and tended to be lower thereafter. 3) Mean T3, T4 and TSH values of high titer group (⩾1:1002) (n=32) were 125 ± 20.6 ng/dl, 9.1 ± 1.7μ g/dl and 4.0 ± 1.8 uU/ml, and those of low titer group (<1:1002) (n=44) were 134 ± 24.3 ng/dl, 9.6 ± 1.7 ug/dl and 3.2 ± 1.2 νU/ml. T3 was lower and TSH, higher in high titer group than in low titer group (p<0.05, p<0.05), and no significant difference was observed in T4 level (p<0.1). In conclusion, the prevalence of MCHA and TGHA were higher in apparently normal females than in males with their peaks around forty and fifty, being lower thereafter, and antithyroid autoantibody of high titer (⩾1:1002) was related to alteration of thyroid functions suggesting the existence of “subclinical autoimmune thyroiditis” state.

Human serum vitamin B12 assay methods--a review

The clinical importance of a reliable human serum vitamin B12 assay to aid the diagnosis of pernicious anemia (PA) cannot be overemphasized. Our review of the literature indicates that a reference method for the quantitation of serum vitamin B12 (serum B12) with the required accuracy, precision and rapidity has not been reported to-date. Controversies, debates and criticisms over human serum B12 assays (especially commercial kits) have been common-place. Various methods of quantitation of B12 reviewed in this communication include: microbiological, radioisotopic, high-performance liquid chromatography (HPLC) and the most recent radioimmunoassay (RIA) techniques. This review attempts to provide awareness of the limitations of these methods and establishes the base for eventual development of a B12 reference method in our laboratory.

Malignant hyperthermia: a possible new variant

A young healthy male, who had three consecutive episodes of postoperative hyperthermia was anaesthetized with special precautions to prevent malignant hyperthermia. Despite neuroleptic anaesthesia and dantrolene pretreatment, the patient experienced post-anaesthetic hyperthermia. The patient's clinical picture was almost identical to the symptoms experienced by two of his maternal relatives. All three experienced nausea, vomiting, muscle cramps and high fever which occurred between five to seven hours after general anaesthesia. The serum potassium (K) and creatinine phosphokinase (CPK) levels determined during the hyperthermic episode and on the next day were not elevated. On the basis of the patient's family history, his clinical picture, and his laboratory data, we speculate that this patient might have a form of malignant hyperthermia or a possible new variant.

Comparative studies of Iodo-bead and chloramine-T methods for the radioiodination of human alpha-fetoprotein

Human alpha-fetoprotein (h-AFP) of iodination grade was radiolabeled with Na125I by chloramine-T (conventional method) and by Iodo-bead (solid-phase method) in our laboratory under standard and varied conditions, such as quantity of h-AFP and volume of the reaction mixture. We have slightly modified the chloramine-T method and developed a protocol for the Iodo-bead method of iodination. Our results show that while the chloramine-T method yields radiolabeled h-AFP of apparently 40% higher specific radioactivity (SR) than those of the Iodo-bead method, the latter appears to be a simpler, more controllable and milder method, giving rise to a more stable population of [125I]h-AFP. This is supported by the results of radioactive counting of [125I]h-AFP collected from a Sephadex G-50 column after radioiodination, storage stability and immunoreactivity with anti-h-AFP.

Neurogenic pulmonary edema associated with ruptured spinal cord arteriovenous malformation

A case of neurogenic pulmonary edema (NPE) associated with a ruptured spinal cord arteriovenous malformation (AVM) is presented. The mechanisms involved in the development of NPE are discussed briefly. The possible role of preganglionic sympathetic fibers in the spinal cord in the etiology of NPE is suggested.

Multicystic encephalomalacia due to fetal viral encephalitis

Two children, aged 2 weeks and 2 months, with multicystic encephalomalacia aer described. Although computerized tomography (CT) scan was used for the diagnosis, the value of the simple method of transillumination is stressed. The mother of one child had mumps with meningitis at 26 weeks' gestation. The other child had an echovirus 11 isolated from the cerebrospinal fluid and herpesvirus hominis (HVH) from the skin at 8 weeks. We speculate that the changes in the brains of these babies may be due to the respective viruses causing a fetal encephalitis.

Jack been urease (EC 3.5.1.5). II. The relationship between nickel, enzymatic activity, and the "abnormal" ultraviolet spectrum. The nickel content of jack beans

At low pH, EDTA promotes the loss of the tightly bound nickel ions from jack bean urease. The specific activity of soluble enzyme after partial EDTA-promoted inactivation is a linear function of the nickel content. The results are consistent with the presence of 2.0 nickel ions per 97 000-dalton subunit in pure urease. The time scale for loss of enzymatic activity and nickel under these conditions is similar to that for loss of the "abnormal" tail absorption in the ultraviolet and visible absorption spectrum of urease (including the shoulder at approximately 420 nm). This indicates that nickel in urease is essential for enzymatic activity and establishes that the metal ions are in part responsible for the tail absorption in the ultraviolet spectrum of urease. After partial inactivation in the presence of EDTA either at low pH or in 2.5 M guanidinium chloride at neutral pH, urease did not regain activity in the presence of Ni2+. As yet apourease has not been produced reversibly. Jack bean seeds grown hydroponically without added nickel were low in both urease activity and nickel (10 and 6%, respectively, of parent seeds). Several other metal ions were readily available. This result suggests that metal ions other than nickel cannot substitute for nickel in the formation of normally active urease.

Pertussis and the risk of non-accidental injury

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