Biclonal IgA and IgM gammopathy in lymphocytic lymphoma

We report the case of a 76-year-old white man with a diffuse, well-differentiated lymphocytic lymphoma at the base of his tongue. Although serum electrophoresis, immunoelectrophoresis, and immunofixation showed he had a biclonal IgA kappa and IgM kappa gammopathy, biopsy of the tumor showed a positive immunoperoxidase response only for IgM kappa. The biclonal pattern persisted after chemotherapy, despite shrinkage of the tumor mass. The association of IgA and IgM appears to be the least frequent combination of separate biclonal immunoglobulins, the clinical course of such patients being more often that of lymphoma or macroglobulinemia than of myeloma. However, the symptomatology can be highly variable, as our case uniquely demonstrates.

Biclonal IgA and IgM gammopathy in lymphocytic lymphoma

We report the case of a 76-year-old white man with a diffuse, well-differentiated lymphocytic lymphoma at the base of his tongue. Although serum electrophoresis, immunoelectrophoresis, and immunofixation showed he had a biclonal IgA kappa and IgM kappa gammopathy, biopsy of the tumor showed a positive immunoperoxidase response only for IgM kappa. The biclonal pattern persisted after chemotherapy, despite shrinkage of the tumor mass. The association of IgA and IgM appears to be the least frequent combination of separate biclonal immunoglobulins, the clinical course of such patients being more often that of lymphoma or macroglobulinemia than of myeloma. However, the symptomatology can be highly variable, as our case uniquely demonstrates.

Cyanate binding to the ferric heme octapeptide from cytochrome c. A model for anion binding to high spin ferric hemoproteins

Equilibrium constants for the binding of cyanate to the ferric heme c octapeptide in 50% ethylene glycol, 50% aqueous buffer were measured spectrophotometrically. Equilibrium constants measured at several temperatures from -20 degrees C to 0 degrees C exhibited an apparent van't Hoff relationship yielding thermodynamic values of delta Ho = -1.3 X 10(3) +/- 0.9 X 10(3) J/mol (-3.1 X 10(2) +/- 2 X 10(2) cal/mol), delta So = -3 +/- 3 J/K X mol (-0.6 +/- 0.8 cal/K X mol). The equilibrium constant for cyanate binding at 25 degrees C and pH 7.4 is 1.21 which is approximately 2 to 3 orders of magnitude lower than that observed for cyanate binding to methemoglobin and metmyoglobin. Krel, the ratio of the hemoprotein to model heme octapeptide binding constants, for NCO- is smaller than Krel for N3- suggesting that hydrogen bonding between the terminal ligand atoms and the distal histidine in hemoglobin and myoglobin does not contribute to the increased protein ligand stabilization observed for these anions relative to the model. A donor-acceptor interaction between the distal histidine and the electrophilic middle atoms of these bound ligands is proposed.

Titrimetric determination of ascorbic acid using chloranil

Ascorbic acid is oxidized and quantitatively titrated with chloranil (2,3,5,6-tetrachloro-1,4-benzoquinone) in the presence of hexamethylenetetramine in acetone-water; the end point is determined visually by the appearance of a golden yellow color. Colored solutions are assayed by setting the initial absorbance at 451 nm to zero or the minimum, titrating with chloranil solution, and measuring absorbance after each increment of titrant. A plot of the volume of chloranil added against the absorbance gives a straight line with the volume intercept as the end point. Interference by the thiol group of cysteine, glutathione, etc., is avoided by masking with acrylamide; interference by iron(II) is masked with ammonium thiocyanate and sodium potassium tartrate. Hydrogen sulfite and thiourea (which do not interfere) are added as antioxidants during extraction of ascorbic acid from drugs and fruits.

Intracavitary thrombi in the right heart associated with multiple pulmonary emboli. Report of two patients

Two-dimensional echocardiography identified intracavitary masses in the right heart in two patients presenting with extensive pulmonary embolism. In one, a right ventricular mass was identified which was confirmed at subsequent autopsy to be an organizing thromboembolus. In the second patient, a right atrial mass was identified; it disappeared with thrombolytic therapy which was accompanied by clinical improvement. We demonstrate that intracardiac thrombi associated with pulmonary embolism may be identified noninvasively by two-dimensional echocardiography. We suggest the presence of thrombi may represent a large intravascular thrombus. This recognition may influence therapeutic decisions.

Causes of perioperative myocardial infarction: their identification and prevention

Despite major technical advances in coronary bypass surgery and myocardial preservation, perioperative infarction remains a serious problem. The authors review the pathogenesis of the two different types of myocardial injury, occlusion necrosis and reperfusion necrosis. These two entities can be distinguished clinically by radioisotope scanning. Experimental studies have demonstrated that reperfusion necrosis can be prevented pharmacologically. Since the majority of perioperative infarcts are probably due to reperfusion, the importance of distinguishing between these two entities is evident.

Effect of naproxen on the kinetics of elimination and anticoagulant activity of a single dose or warfarin

The purpose of this investigation was to determine the effect of the nonsteroidal anti-inflammatory drug naproxen on the elimination kinetics and anticoagulant activity of warfarin. Ten healthy men received one oral dose of 50 mg racemic warfarin alone and with naproxen, 375 mg twice daily for 17 days beginning 10 days before warfarin. Naproxen administration caused a small but statistically significant increase in the free fraction of warfarin in serum but had no significant effect on the total clearance, volume of distribution, half-life, and anticoagulant activity of warfarin. Warfarin, on the other hand, apparently enhances the serum protein binding of haproxen. There was substantial intersubject variation but very little intrasubject variation in the anticoagulant effect of warfarin. The intersubject variation of the anticoagulant effect was not related to the elimination kinetics of warfarin.

Effect of naproxen on the steady-state serum concentration and anticoagulant activity of warfarin

The purpose of this investigation was to determine whether the anti-inflammatory drug naproxen interacts with warfarin during prolonged administration of both drugs. Healthy adults received oral doses of warfarin daily for 26 days. Naproxen, 375 mg twice daily, was given from the eleventh through the twentieth days. Naproxen administration had no apparent effect on the steady-state concentrations of free and total (free and protein-bound) warfarin in serum, despite a small but statistically significant increase of the warfarin-free fraction in serum. There was no apparent difference between the prothrombin times (at a constant daily dose of warfarin) observed before, during, and after administration of naproxen.