Moderate Clinical Symptoms Research Articles

Differences in the interaction of acetylcholine receptor antibodies with receptor from normal, denervated and myasthenic human muscle.

The interaction of acetylcholine receptor antibodies with different kinds of human skeletal muscle receptor was investigated. The reaction of most receptor antibodies was strongest with receptor from a patient with myasthenia gravis and with receptor from denervated muscle. Results obtained with these receptors were well correlated. The binding of most receptor antibodies to receptor from functionally normal muscle was much weaker and also qualitatively different. In a few patients with moderate and severe clinical symptoms the existence of acetylcholine receptor antibodies was revealed only by their reaction with receptor from myasthenic muscle. One patient had a clone of receptor antibodies reacting exclusively with receptor from her own muscle.

Study on the pathogenicity of ostertagiosis due to Ostertagia circumcincta in sheep, in Iraq

The response of Awassi sheep to Ostertagia circumcincta, the most prevalent ovine strongylid species in Iraq, was studied. A dose of 100000 larvae of O. circumcincta (Iraqi strain) induced moderate clinical symptoms of ostertagiosis. These symptoms were correlated with elevated pH of the abomasal fluid and increased plasma pepsinogen levels. There was no evidence of larval inhibition since the majority of the fourth stage larvae (L 4) continued their development. No appreciable loss of worm population was observed and most of the parasites survived and exhibited a prolific egg-laying potential six moths after initial infection. Assessments of the pathophysiological changes were performed and correlated with parasitological and clinical observations. The Awassi breed of sheep, the most prevalent in the Arab Middle East, seems to be more susceptible to ostertagiosis than other breeds and there was no spontaneous self-cure in this breed.

Diagnosis and Management of Postoperative Pericardial Effusions and Late Cardiac Tamponade Following Open-Heart Surgery

The clinical and laboratory findings of 28 patients identified as having late pericardial effusions were examined. Eleven of these patients were asymptomatic; 9 patients had moderate symptoms including fatigue, malaise, weight gain, and dyspnea on exertion, and 8 patients with similar symptoms had evidence of cardiac tamponade. Ten patients underwent right heart catheterization in the intensive care unit; normal hemodynamics were confirmed in 4 and cardiac tamponade in 6 patients. Pericardiocentesis was effective in decompressing cardiac tamponade in 7 of 8 patients. One patient required operative subxiphoid drainage after unsuccessful pericardiocentesis. In addition, 5 patients with moderate clinical symptoms and pericardial effusions, who did not have cardiac tamponade, underwent pericardiocentesis because of a need for chronic anticoagulant therapy. The remaining patients were managed successfully by observation, discontinuation of warfarin when possible, fluid restriction, and diuretic therapy. All but 1 patient was symptomatically improved. A diagnostic and therapeutic schema is presented as an aid to early recognition of this troublesome and potentially lethal complication.

Plasma levels of zimelidine and norzimelidine in endogenous depression.

A new serotonin uptake inhibitor zimelidine was studied in 16 endogenously depressed inpatients, who received 150 mg/kg orally during 3--6 weeks in a phase II-type study. Plasma concentrations of zimelidine and its main metabolite norzimelidine were determined twice a week. Ten patients obtained a well-defined steady-state plasma level within 1--2 weeks, while three patients still had increasing concentrations of both substances or only norzimelidine within the investigation period. In two patients, biochemical affection of the liver could be demonstrated during the treatment; one associated with moderate clinical symptoms (dizziness and fever), the other without clinical symptoms. Both patients recovered upon cessation of the zimelidine treatment. In the former patient, very high concentrations of zimelidine at the time of hepatic symptoms were demonstrated, while the latter patient was within the average concentration range. Other adverse reactions were mild and few, particularly with respect to anticholinergic effects. With the applied, probably suboptimal, dosage the therapeutic response was only satisfactory in five cases.

Clinical and manometric investigations of the lower esophageal sphincter and its reactivity to pentagastrin in patients with hiatus hernia. LES-pentagastrin-test.

After a careful clinical investigation (anamnesis, analysis of stomach secretion, X-ray tests, esophagoscopy with biopsies) of 45 patients with axial hiatus hernia and 20 healthy volunteers with no radiological signs of reflux, manometric analysis of the lower esophageal sphincter (LES) was performed. The manometric tests applied were: (1) 3-point manometry for measuring the reflexive pressure increase in the LES after abdominal compression and (2) the continuous withdrawal method before and after intravenous injection of 0.6 µg/kg pentagastrin (LES pentagastrin test). According to the results obtained by all methods applied, the patients with hiatus hernia could be divided into two groups. Group I consists of 12 patients with moderate clinical symptoms and essentially normal pressures and reactions of the LES. Group II comprises 33 patients with more severe symptomatology such as X-ray evidence of reflux (33), stenosis (3) or esophagitis of the lower esophagus (17), hyperacidity of the stomach (5), insufficient reaction of the LES to abdominal compression (29), reduced maximum pressure in the LES and an abnormally low response of the LES to intravenous pentagastrin (19). Essentially by means of the results of the LES pentagastrin test, group II could by subdivided into group IIA, with a normal, and group IIB with significantly reduced pentagastrin response. There was a good correlation between the reduced pentagastrin response and the exhibition of more severe symptoms of the other parameters tested. Thus, it could be shown that the LES-pentagastrin test could contribute to a further differentiation, which is important in respect to the therapeutic consequences and assist in a better understanding of the pathophysiological basis of the disease.

Tests of “Hepatic Function” in Portal Cirrhosis

Summary Hepatic function was measured in 50 patients with portal cirrhosis of the liver. Twenty healthy persons were studied similarly as a control group. The cases of portal cirrhosis were classified arbitrarily into three groups on the basis of clinical severity: I) 14 patients without symptoms, latent cirrhosis; II) 23 with moderate clinical symptoms of hepatic failure; and III) 13 individuals severely ill and deeply jaundiced. Marked differences were found corresponding, in general, with the clinical severity of illness. In the group without symptoms attributable to the liver per se, parenchymal function was not significantly changed when compared with the normal group, whereas markedly abnormal and significant deviations were encountered in severely ill patients with hepatic failure and deep jaundice. Hepatic function was studied at intervals in 32 patients with symptoms of portal cirrhosis treated medically for periods less than four months to two and a half years. Pronounced improvement in hepatic function was noted in all patients who continued under medical treatment for longer than four months. The serum bilirubin, the cholesterol cholesterol-ester ratio, the total plasma proteins, the plasma albumin, the urinary urobilinogen and the elimination of hippuric acid roughly paralleled the clinical course. The bromsulfalein excretion test remained abnormal longer than other tests of hepatic function and abnormal values were obtained in 7 of 15 patients so studied. The variations in cephalin cholesterol flocculation, thymol turbidity and alkaline phosphatase did not parallel the clinical course.