IGg4-related Disease Presenting as Rapidly Progressive Renal Failure and Inguinal Iymphadenopathy.

A 58-year-old man presented with swelling in the left inguinal region and loss of appetite, nausea and azotemia with a serum creatinine of 5.2 mg/dL and urine albumin of 1+ and normal size kidneys with no hematuria. His serum creatinine increased to 9 mg/dL over 1 month, his total proteins were 10.8 and serum albumin was 3.3 g/dL, and lymph node excision biopsy showed fragments of lymphoid tissue with interfollicular areas containing sheets of plasma cells and atretic germinal centers. In view of unexplained renal failure, he underwent renal biopsy, which showed interstitial inflammatory infiltrate composed of lymphocytes and rich in plasma cells with storiform fibrosis and a possibility of IgG4-related renal disease was reported. On further evaluation, serum electrophoresis showed no M band. Serum IgG4 levels were 18.2 g/L (0.03-2 g/L). A diagnosis of IgG4-related renal disease was confirmed.

Copolymers of bipyridinium and metal (Zn & Ni) porphyrin derivatives; theoretical insights and electrochemical activity towards CO2.

This study reports the electropolymerization of novel keto functionalized octaethyl metal porphyrins (Zn2+ and Ni2+) in the presence of 4,4'-bipyridine (4,4'-bpy) as a bridging nucleophile. The polymer films were characterized by electrochemical, spectroscopic (UV-Vis, XPS, FT-IR and Raman spectroscopy) and imaging (AFM and SEM) techniques. The absorption and electronic spectra confirm the presence of both porphyrin and 4,4'-bipyridine units in the film. The surface morphology reveals homogeneous film deposition with average roughness values of approx. 8 nm. The theoretical studies performed offered insights into the interplay of different metal centres (Zn2+ and Ni2+) and the keto functionality of the porphyrin unit in the formation of copolymer films. The electrochemical interaction of polymer films with CO2 suggests a reversible trap and release of CO2 with low energy barriers for both the polymers.

Serum insulin-like growth factor binding protein-1 (IGFBP-1) phosphorylation status in subjects with and without ischaemic heart disease.

BACKGROUND: Insulin-like growth factor binding protein-1 (IGFBP-1) modulates the activity of IGF-I. It exists in serum as phosphorylated and less phosphorylated forms. We wished to measure serum levels of both these forms of IGFBP-1, using a novel assay, in subjects with, or without ischaemic heart disease (IHD). METHODS: We measured serum concentrations of the phosphorylated and less phosphorylated forms of IGFBP-1 in 75 subjects (36 with and 39 without IHD). Two immunoassays were used, one which detects non-, and less-phosphorylated forms (LpIGFBP-1), and another which specifically detects the serine phosphorylated form of IGFBP-1 (pIGFBP-1). RESULTS: LpIGFBP-1 concentrations were significantly higher in subjects without IHD than in those with IHD (5.3+/-0.5 microg/L vs. 2.7+/-0.4 microg/L, p<0.001). pIGFBP-1 levels were also significantly higher in subjects without IHD compared to those with IHD (33.3+/-2.0 microg/L vs. 25.3+/-2.2 microg/L, p<0.01). The correlation between LpIGFBP-1 and pIGFBP-1 for all subjects was (r=0.71, p<0.001). This association was stronger in subjects without IHD (r=0.76, p<0.001) than for those with IHD (r=0.60, p<0.001). A significant negative association was observed between IGF-I and the ratio between the two forms (r=-0.45, p<0.0001). Receiver-Operating Characteristic (ROC) curve showed the highest area under the curve for LpIGFBP-1 (0.75) [95% CI: 0.63-0.86] and optimum cut-off value of 2.83 microg/L with 75% sensitivity and 74% specificity. CONCLUSIONS: We propose that low serum concentrations of IGFBP-1 forms could be a marker of coronary risk, and the LpIGFBP-1:pIGFBP-1 ratio may be an index of biologically active IGF-I.

Biological variation in fasting serum insulin-like growth factor binding protein-1 (IGFBP-1) among individuals with a varying glucose tolerance.

OBJECTIVE: To evaluate the biological variation of serum insulin-like growth factor binding protein-1 (IGFBP-1) in individuals with different degrees of glucose tolerance. RESEARCH DESIGN AND METHODS: IGFBP-1 was measured in 42 fasted subjects with: normal glucose tolerance (NGT=15), impaired fasting glucose (IFG=9), impaired glucose tolerance (IGT=9) and type 2 diabetics (DM=9). Short- and long-term reproducibility was determined for IGFBP-1. RESULTS: The longer-term reproducibility (CV) of serum IGFBP-1 was 20.9%, 29.5%, 33.1% and 48.0% for subjects with NGT, IFG, IGT and DM respectively. The results for the short-term serum IGFBP-1 yielded CVs for these same respective categories of 8.2%, 16.1%, 29.2% and 13.8%. CONCLUSIONS: IGFBP-1 measurement was least variable in NGT individuals over both long-term and short-term intervals and variability increased with deteriorating glucose tolerance. Due to its biological variation, IGFBP-1 serum level is more reliable in normal subjects than in individuals with type 2 diabetes.

Intermittent ovarian and thyroid failure and spontaneous twin pregnancy.

Intermittent failure of two endocrine systems is unusual and presents diagnostic and management challenges. We report a case of a young woman with intermittent thyroid and ovarian failure who had spontaneous twin gestation four years after the diagnosis of premature ovarian failure was made. This case demonstrates coincidental biochemical and clinical thyroid and ovarian failure both of which spontaneously resolved with no treatment, although subsequently irreversible hypothyroidism ensued after the initial recovery. Elevated gonadotrophins with a menopausal pattern on more than one occasion, in an amenorrhoeic patient with menopausal symptoms, usually indicates permanent ovarian failure. This case demonstrates that this may not be true and while this is probably a rare occurrence, clinicians need to be aware of this possibility. It also re-emphasizes the need to consider the clinical picture when interpreting biochemical results.