RESUMO
A product of the arms race during the Cold War, the Russian VX, or VR, is an organophosphorus compound that is a structural isomer of the western VX compound (or A4), with which it shares a very high toxicity. It is much less studied and known than VX because the knowledge of its existence is relatively recent. A very low volatility and high resistance in the environment make it a persistent agent. Poisoning occurs mainly following penetration through skin and mucosa but vapour inhalation is a credible risk in some circumstances. The clinical presentation may be differed by several hours and despite the absence of signs and symptoms, the casualty should not be considered as contamination or intoxication-free. This agent has a long residence time in blood, a characteristics that clearly differentiates it from other compounds such as sarin. The protocols for antidote administration may thus have to be changed accordingly. The fact that VR poisoned individuals will less respond to the current oxime therapy used in France, the 2-PAM and that VR represents a higher threat than VX, being probably possessed by some proliferating states, justify the interest for this toxic product.
Assuntos
Agentes Neurotóxicos/toxicidade , Compostos Organotiofosforados/toxicidade , Animais , Inibidores da Colinesterase/química , Inibidores da Colinesterase/toxicidade , Humanos , Agentes Neurotóxicos/química , Compostos Organotiofosforados/química , Intoxicação/terapia , Federação RussaRESUMO
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant peripheral neuropathy characterized by recurrent isolated nerve palsies, which are precipitated by trivial compression and trauma. Although HNPP has been well-described in literature, it often goes unrecognized. We report a case of HNPP occurring during military training to promote recognition and proper management of this entity.
Assuntos
Artrogripose/diagnóstico , Neuropatia Hereditária Motora e Sensorial/diagnóstico , Militares , Artrogripose/genética , Eletromiografia , Deleção de Genes , Neuropatia Hereditária Motora e Sensorial/genética , Humanos , Masculino , Proteínas da Mielina/genética , Exame Neurológico , Adulto JovemRESUMO
Arsines family includes many compounds with various toxicities. Arsenic trihydride or arsine is the most toxic form of arsenic. Powerful haemolytic gas, it has never been used as a chemical weapon because its toxicity is not immediate and it is non persistent. However, cases of industrial poisoning with arsine are still identified in spite of a strict regulation at work. It is also identified as a potential toxic of chemical terrorism. This agent, of which the mechanism of action is still not well defined, is badly recognized because of intoxications rarity. However, fast detection means are available. Health professionals and especially those who are involved in piratox plan need to learn to recognize arsine intoxication (hematuria, oliguria, haemolytic anemia) in order to provide early, specific treatment and avoid damages.
Assuntos
Intoxicação por Arsênico/terapia , Arsenicais , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/prevenção & controle , Arsenicais/farmacocinética , Humanos , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia , Exposição Ocupacional , Distribuição TecidualRESUMO
This study investigated effects of a high protein (PROT) versus a high carbohydrate (CHO) diet on performance and physiological responses during an ultraendurance climbing race at moderate altitude. On two different periods, in a randomised crossover design, ten climbers (30.0+/-0.9 years) participated in the race (duration 29 h approximately, energy expenditure 43.6+/-1.2 MJ.day (-1)) and were fed either with the PROT (30% protein content) or the CHO diet (68% carbohydrate) each providing 16.74 MJ. Mental performance was assessed by the Stroop test and we estimated maximal voluntary strength of quadriceps muscle. We quantified metabolic and hormonal circulating concentrations. Mental performance was unaffected after the two races, while muscular performance and body weight were decreased (both p<0.01) with no diet effects. Decreases were measured for IGF-I concentration and its binding protein IGFBP-3 (p<0.001), and increases for cortisol and norepinephrine (p<0.01) with no diet effects. Glucose concentration decreased (p<0.05) without diet effects, while amino acids (leucine, isoleucine, valine, and tyrosine) decreased in CHO group (p<0.001). Leptin concentration decreased (p<0.001) without diet effects, whereas total ghrelin increased in CHO group (p<0.01). Our results showed that a high PROT or high CHO intake during physical exertion at moderate altitude maintained mental performance, but did not limit muscle force reduction and body weight loss. There was decreased glucose availability, and hormonal responses indicated both catabolism and extreme energy deficiency induced by exercise with opposite responses of ghrelin and leptin. The ghrelin response was additionally indicative of macronutrient intake during the race.
Assuntos
Carboidratos da Dieta/metabolismo , Proteínas Alimentares/metabolismo , Montanhismo/fisiologia , Resistência Física , Adulto , Altitude , Carboidratos da Dieta/administração & dosagem , Proteínas Alimentares/administração & dosagem , Proteínas Alimentares/sangue , Metabolismo Energético , Humanos , Insulina/sangue , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , MasculinoRESUMO
Neuromeningeal tuberculosis is a rare extrapulmonary location in France. Delayed diagnosis can lead to therapeutic failure and severe sequels. However early diagnosis is a major challenge that requires the proper epidemiological, clinical, radiological and biological resources. Problems related to diagnosis of mycobacteria infection and to shortcomings in certain healthcare systems can hinder early diagnosis. The purpose of this review was to describe the diagnostic value of assaying adenosine deaminase activity in cerebrospinal fluid from patients with neuromeningeal tuberculosis. Evidence from studies published over the last 25 years indicate that the sensitivity and specificity of measuring adenosine deaminase activity range from 36 to 92% and 71 to 100% respectively depending of cutoff values used. Before performing this assay, it is necessary to rule out obvious or frequent etiologies such as purulent bacterial meningitis or cryptococcosis in HIV patients. Taken together these studies show that this simple, inexpensive technique is a valuable tool for early diagnosis and management of tuberculosis patients and that it can be easily implemented in hospital labs regardless of technical or financial resources.
Assuntos
Adenosina Desaminase/líquido cefalorraquidiano , Tuberculose Meníngea/diagnóstico , Diagnóstico Precoce , Humanos , Sensibilidade e Especificidade , Tuberculose Meníngea/enzimologiaRESUMO
Thiopurines are frequently used in gastroenterology for Crohn's disease or hemorrhagic rectocolitis. Their metabolism is regulated by a particular enzyme, thiopurine S-methyltransferase or TPMT. There are three ways to evaluate the effectiveness and the risk of side effects associated with this treatment. TPMT activity measurement or genotyping are recommended to decide for treatment, while metabolites determination is a used as marker of monitoring. Phenotypic approach (TPMT activity measurement or metabolites determination) requires delicate techniques and interindividual variations make the interpretation difficult. Genotyping is easier to interpret but cannot exclude some risk of side effects.
Assuntos
Azatioprina/farmacologia , Imunossupressores/farmacologia , Mercaptopurina/farmacologia , Azatioprina/efeitos adversos , Azatioprina/farmacocinética , Genótipo , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Mercaptopurina/efeitos adversos , Mercaptopurina/farmacocinética , Metiltransferases/genética , Metiltransferases/metabolismoRESUMO
BACKGROUND: During the last ten years, consumption of palm wine, a popular traditional alcoholic beverage, seriously increases in Gabon. This sweet beverage seems to be the main alcohol and the most drunken in low socioeconomic population. OBJECTIVE: To have an idea of its composition and toxicity, 21 samples of palm wine were collected in the country and analysed. METHODS: Twenty-one palm wine samples were randomly selected from all over Gabon. Methanol and ethanol concentrations in the samples were measured by gas chromatography. Aromatic hydrocarbons were measured by selected ion monitoring mode in mass spectrometry. Delection of heavy metals was by standard techniques. RESULTS: Gabonese palm wine contained ethanol at a mean concentration of about 60 g*L-1, i.e. 7.5 degrees (volume %), volatile components such as alcohols, aldehydes, carboxylic acids and esters and trace metals. Trace metals were present at low concentrations below internationally recognized maximal limits for alcoholic beverages with less than 2 microg*L-1 for cadmium, less than 10 microg*L-1 for arsenic and for lead 15 samples with concentrations under 10 microg*L-1 and the last six samples with concentrations between 11 and 61 microg*L-1. None of the searched aromatic or chlorinated solvents, indicative of refined fuel or industrial contamination, was detected. CONCLUSION: For the parameters analyzed here, there seems to be no significant difference in constitution between Gabonese wine palm and others kind of palm wine produced in West Africa. This alcohol needs to be more considered by public health authorities and medical teams because of its health and economic consequences.
Assuntos
Consumo de Bebidas Alcoólicas/etnologia , Vinho/efeitos adversos , Vinho/análise , Cromatografia Gasosa , Etanol/análise , Gabão/epidemiologia , Humanos , Hidrocarbonetos Aromáticos/análise , Metais Pesados/análise , Metanol/análise , SegurançaRESUMO
Reorganization of hospital or private sector labs is a strong trend. Such process implies consolidation of tests on a minimum of analyzers, harmonization of equipment (limitation of number of suppliers), posts number reduction, and development of powerful software. Increase of productivity needs set up of automation systems, specially at the level of pre-analytical phase, in a way to limit manual steps. At the same moment, quality improvement generates a decreasing TAT (Turn-Around-Time), a strong reduction of errors, a better protection against biological hazards, and standardization of sample management and validation process. After giving some notions about consolidation and integration, our choices for a brand new and innovative solution are explained.
Assuntos
Laboratórios Hospitalares/organização & administração , Automação , Técnicas de Laboratório Clínico , França , Humanos , Controle de QualidadeRESUMO
The disorder now known as metabolic syndrome has been recognized for 50 years, but its multiple definitions have led to some confusion and even doubt about its very nature. Metabolic syndrome is directly linked to the presence of android obesity, which indicates insulin resistance and lies at the root of all risk factors and early indications of type 2 diabetes. It is diagnosed by systematic measurements of waist size and its direct interpretation taking ethnic origin into account. This pragmatic approach avoids the uncertainties generated by differing definitions and is subtler than the presence or absence of metabolic syndrome in a given patient. Drug-free treatment of an android obese patient is inexpensive and effective, but this apparently simple approach masks difficulties of application. However, these are sociological problems.
Assuntos
Pesos e Medidas Corporais , Síndrome Metabólica/epidemiologia , Biomarcadores/sangue , Glicemia/metabolismo , Tamanho Corporal , Humanos , Insulina/sangue , Síndrome Metabólica/diagnóstico , Obesidade/epidemiologia , Reprodutibilidade dos Testes , Triglicerídeos/sangueRESUMO
INTRODUCTION: Selective serotonin reuptake inhibitors (SSRI) are the most common antidepressants prescribed for elderly people. Although they are generally better tolerated than other antidepressant treatment classes, they can be responsible for potentially life-threatening hyponatremia, related to syndrome of inappropriate antidiuretic hormone secretion (SIADH). OBSERVATION: A 64 years-old woman was hospitalized for cognitive function alteration and vomiting after introduction of paroxetine for depressive symptoms. Serum investigations revealed hyponatremia (121 mmol/l) with low plasma osmolarity and normal natriuria consistent with diagnosis of SIADH. Hyponatremia was reversible after paroxetine withdrawal. DISCUSSION: Hyponatremia induced by SIADH is a serious but underestimated complication of SSRI treatment. This complication occurs in the elderly people within the first month of treatment. Monitoring of the serum sodium concentration during the first month of treatment is recommended for older patients.
Assuntos
Hiponatremia/induzido quimicamente , Síndrome de Secreção Inadequada de HAD/diagnóstico , Paroxetina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Transtornos Cognitivos/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
SCOPE: Clinical implications associated with polymorphisms in drug-metabolizing genes involved in the chemotherapy of colorectal cancers (5-flurorouracil, oxaliplatin and irinotecan) are reviewed. CURRENT SITUATION AND SALIENT POINTS: Treatments of colorectal cancers have been greatly improved last years but patients respond differently to identical medication. Genetic polymorphisms are one of the major causes of these individual responses to drugs associated with sometimes severe adverse effects. Pharmacogenetics is based on all polymorphisms that determine genetic human diversity associated with variable response to anticancer drugs. PERSPECTIVES: Morbidity and mortality related to toxicity or inefficacy of these drugs could be reduced by analyzing the pharmacogenetic profile of patients before treatment. Results should be integrated in protocols for monitoring and assessment the dosage of drugs.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Farmacogenética/métodos , Acetilcolinesterase/genética , Antineoplásicos/efeitos adversos , Butirilcolinesterase/genética , Camptotecina/efeitos adversos , Camptotecina/análogos & derivados , Neoplasias Colorretais/enzimologia , Di-Hidrouracila Desidrogenase (NADP)/genética , Humanos , Irinotecano , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Compostos Organoplatínicos/efeitos adversos , Oxaliplatina , Polimorfismo GenéticoRESUMO
INTRODUCTION: End-stage renal failure patients are particularly at risk for tuberculosis, especially for peritoneal tuberculosis. Microbiological diagnosis remains hazardous in many cases. CASE REPORT: We report on a case of peritoneal tuberculosis in an end-stage renal failure patient. The diagnosis was suspected on the basis of adenosine deaminase dosage in peritoneal fluid, allowing an early presumptive treatment and a favourable outcome with a 3 years follow-up. DISCUSSION: The measurement of adenosine deaminase activity in ascites represents a diagnostic advance in tuberculous peritonitis among end-stage renal failure patients.
Assuntos
Adenosina Desaminase/sangue , Falência Renal Crônica/complicações , Peritonite Tuberculosa/diagnóstico , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/enzimologia , Masculino , Pessoa de Meia-Idade , Peritonite Tuberculosa/sangue , Peritonite Tuberculosa/enzimologiaRESUMO
Tuberculosis may affect several organs and its prevalence is continuously increasing. Laboratory diagnosis still remains difficult. Adenosine deaminase (Ada) is an enzyme which contributes to purine metabolism and its presence in lymphocyte, monocyte and macrophage cells is associated with T cells mediated immunity. Many studies have shown the usefulness of Ada determination in various biological fluids for the diagnosis of tuberculosis. In pleural fluid, cutoff vary from 33 to 48 U/L, with sensitivity higher than 80% and specificity near 100%. In peritoneal fluid the cutoff value is 30 U/L. In cerebrospinal fluid, the value of 7 U/L can make discriminate negative and positive cases with a good sensitivity and specificity. The data from the literature show that 50 U/L in pericardic fluid is a reliable threshold for tuberculosis diagnosis. Ada determination in serum is not as relevant as in others fluids because of its low specificity. Ada measurement in biological fluids, easy and not expensive, may be add to other biological tests for tuberculosis diagnosis.
Assuntos
Adenosina Desaminase/análise , Líquidos Corporais/química , Tuberculose/diagnóstico , Humanos , Sensibilidade e Especificidade , Tuberculose/enzimologiaRESUMO
Affinity electrophoresis has been applied to the analysis of the multiple molecular forms of human plasma cholinesterase allozyme U. A water-soluble p-amino-substituted-phenyltrimethylammonium polyacrylamide was synthetized by copolymerization of an unsaturated derivative of the ligand with acrylamide, and entrapped at various concentrations within the matrix of separating gels. Electrophoresis was carried out in these gels, and the relative mobility of the molecular forms of the enzyme was decreased. From the variation of mobility (Rm) as a function of immobilized ligand concentrations, the apparent dissociation constants of monomer (C1), dimer (C3) and tetramer (C4) of phenotype U were calculated. The decrease in mobility was reversed by addition of non-immobilized competitive ligands (N-methylpyridinium and N-methylacridinium). The appearance of the slopes of Rmi-1 vs. concentration does not give sufficient information for determination of the number of anionic binding sites of C4, but the slight curvature of the plots suggests that bivalent or higher interactions occur when the concentration is sufficiently high. For all three size isomers from a critical ligand concentration, a second zone, named B, appears and intensifies rapidly at the expense of the first zone (A) as the immobilized ligand concentration increases. Among several possible explanations of this phenomenon, it is proposed that the ligand induces a conformational isomerization of the enzymes with a change in affinity (KD,B less than KD,A) and that the interconversion process between the two states B in equilibrium A is slow compared with the ligand-association equilibrium dissociation steps.
Assuntos
Butirilcolinesterase/sangue , Colinesterases/sangue , Acridinas , Sítios de Ligação , Butirilcolinesterase/genética , Butirilcolinesterase/isolamento & purificação , Eletroforese em Gel de Poliacrilamida/métodos , Humanos , Isomerismo , Substâncias Macromoleculares , Fenótipo , Compostos de Piridínio , Compostos de Amônio Quaternário , TemperaturaRESUMO
CONTEXT: The Metabolic syndrome is considered to be an important public health problem, but few epidemiological studies have defined the present situation in France. EPIMIL is a prospective epidemiological study that began on February 1, 2003. SUBJECTS AND METHODS: This study was designed to identify the clinical and laboratory parameters of metabolic syndrome and cardiovascular risk factors in a population of 2045 male military personnel based in the Paris region. The initial 1-year cross-sectional study will be followed by a 10-year follow-up and patient care. RESULTS: The 2045 subjects included 185 (9%) presented at least 3 of the 5 NCEP ATP III criteria defining metabolic syndrome. They were significantly older (42.2 +/- 8.5 yrs) than the other subjects (37.3 +/- 8.7 yrs, P<0.001), had a higher BMI (29.5 +/- 3.4 vs 24.8 +/- 2.9 kg/m2, P<0.001) and a greater body weight at age 20 (75.4 +/- 11 vs 70.4 +/- 8.5 kg, P<0.01). Smoking, little physical activity and family histories of diabetes and arterial hypertension were more frequent in these men. While levels of the cholesterol and CRP us were higher, Lp(a) and homocysteine concentrations were normal. Plasma insulin and BMI (r = 0.456 P<0.0001) and plasma insulin and waist circumference (r = 0.446 P<0.0001) were well correlated. Lastly, plasma insulin, free fatty acids and cardiovascular risk increased steadily with the increase in the number of metabolic syndrome criteria. CONCLUSIONS: These results in a large and particularly uniform population of men show the prevalence of metabolic syndrome in adult men, and demonstrate its link with insulin resistance. Men with several risk factors require specific care, particularly for hypertension and dyslipidemia; the effectiveness of this care will be evaluated during the follow-up period.
Assuntos
Síndrome Metabólica/epidemiologia , Militares/estatística & dados numéricos , Adulto , Albuminúria/epidemiologia , Glicemia/metabolismo , Pressão Sanguínea , Tamanho Corporal , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Triglicerídeos/sangue , Organização Mundial da SaúdeRESUMO
INTRODUCTION: Metabolic syndrome is a cardiovascular risk factors cluster and hyperhomocysteinemia an obvious independant risk factor. OBJECTIVE: To ascertain if hyperhomocysteinemia is associated with the metabolic syndrome. METHODS: "Epimil" is a prospective epidemiologic survey, which began by a cross-sectionnal study of cardiovascular risk factors in a French population, which then will be followed for ten years for supervision and intervention. Initial data collection, blood pressure measurement, ECG and blood samples (biology and DNA) have been performed. For the metabolic syndrome, we used the criterias of the third report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (NCEP ATP III). RESULTS: Out of 2045 men aged from 20 to 58 years (37.7+/-8.7 years), 185 (9%) have metabolic syndrome (at least three criterias), 587 (29%) a blood homocysteine>or=12 micromol/L and 202 (10%)>or=15 micromol/L. Homocysteinemia is 10.97+/-5.01 micromol/L for the whole population and doesn't differ with (11.4+/-6 micromol/L) or without (10.9+/-5 micromol/L) the metabolic syndrome, as does its values distribution. It's not correlate with the body mass index, waist and hip measurements, nor with glycemia, HbA1c, insulin resistance and cardiovascular risk markers (CRPus, microalbuminuria). It weakly correlates with systolic and diastolic blood pressure, creatinine clearance, tobacco use, cholesterolemia, triglycerides and free fatty acids but not with HDL and LDL fractions, nor lipoprotein (a). Among this population, it slightly contributes to the ten years vascular risk evaluated according to Framingham equations or Score system. CONCLUSIONS: Homocysteinemia and the prevalence of hyperhomocysteinemia don't differ with or without the metabolic syndrome and doesn't correlate its main criterias.
Assuntos
Hiper-Homocisteinemia/complicações , Síndrome Metabólica/epidemiologia , Adulto , Glicemia/metabolismo , Pressão Sanguínea , Colesterol/sangue , Estudos Transversais , França/epidemiologia , Homocisteína/sangue , Humanos , Hiper-Homocisteinemia/sangue , Insulina/sangue , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , Fatores de Risco , Triglicerídeos/sangueRESUMO
Mivacurium and succinylcholine are short-acting neuromuscular blocking drugs. The duration of their action depends on their rapid hydrolysis by plasma cholinesterase or butyrylcholinesterase. More than thirty genetic variants of this enzyme have been described but the atypical variant is the most frequently involved in prolonged apnoea following the administration of these two myorelaxants. We present one case of patient who presented a five hours long apnoea associated with null cholinesterase activity and detection of a butyrylcholinesterase silent variant (Sil-1, 1 for 100,000 persons in population) after sequencing.
Assuntos
Apneia/induzido quimicamente , Apneia/genética , Colinesterases/genética , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Succinilcolina/efeitos adversos , Idoso , Butirilcolinesterase/sangue , Colinesterases/sangue , Humanos , Masculino , Fenótipo , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Patients suffering from acute renal failure must undergo dialysis to substitute for the kidney's excretory function. Dialysis is a means of exchange between two solutions: blood and a liquid known as dialysate, across a semi-permeable membrane. This membrane permits the passage of water and aqueous solutions of low molecular weight but not that of the aqueous solutions of high molecular weight such as proteins. Dialysed patients are biologically monitored to prevent the various complications arising from blood dialysis, to check the efficacy of the treatment as well as to reduce the risk of morbidity and mortality. Because of the multiple and complex nature of renal functions, biological monitoring of a dialysis patients presents many, often inter-related facets. In addition to the complications inherent in dialysis itself, the dialysed patient is exposed to other causes of mortality or morbidity such as nutritional, hematologic, cardiovascular and infectious problems. Clinicians is confronted by other complications, albeit less common and easier to control, in the form of osteoarticular troubles or even aluminium poisoning. Lastly, biological assessment of the efficacy of purifying processing depends principally on calculating the dose of dialysate and the ureic index of subtraction which, in turn, requires the measurement of uremia.
Assuntos
Monitorização Fisiológica , Diálise Renal/efeitos adversos , Equilíbrio Ácido-Base , Idoso , Alumínio/intoxicação , Doenças Ósseas/diagnóstico , Doenças Ósseas/etiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/etiologia , Feminino , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/etiologia , Humanos , Doenças do Sistema Imunitário/diagnóstico , Doenças do Sistema Imunitário/etiologia , Artropatias/diagnóstico , Artropatias/etiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/etiologia , Modelos Teóricos , Estado Nutricional , Diálise Renal/normas , Fatores de Risco , Fatores de Tempo , Uremia/diagnóstico , Uremia/terapia , Equilíbrio HidroeletrolíticoRESUMO
We report a case of blackwater fever with brown plasma due to the presence of methemalbumin. The discovery of plasma with this color is a rare event at the laboratory. This compound appears during intravascular hemolysis or hemorrhagic pancreatitis when the ability of haptoglobin and hemopexin to bind free hemoglobin has been exceeded. In these cases some of heme is oxidized to hematin and taken up by serum albumin to form an albumin-hematin complex called methemalbumin. The major clinical problem is to evoke the diagnosis of methemalbuminemia and not confuse with methemoglobinemia. In our case, methemalbumin was detected and quantified using a scanning spectrophotometer. Its diagnostic and clinicals consequences are discussed.
Assuntos
Anemia Hemolítica/sangue , Anemia Hemolítica/etiologia , Febre Hemoglobinúrica/sangue , Febre Hemoglobinúrica/complicações , Metemalbumina/metabolismo , Anti-Inflamatórios/uso terapêutico , Febre Hemoglobinúrica/diagnóstico , Febre Hemoglobinúrica/terapia , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Hematócrito , Heme/metabolismo , Hemoglobinas/análise , Humanos , Masculino , Metemalbumina/análise , Metemalbumina/química , Pessoa de Meia-Idade , Plasma/química , Diálise Renal , Albumina Sérica/metabolismo , Espectrofotometria , Esteroides , Trombocitopenia/classificação , Trombocitopenia/etiologiaRESUMO
Cardio-vascular diseases are the most common cause of death in industrialized countries. A new marker has emerged among offending risk factors in the past few years: homocysteine. This sulphured amino-acid is an important intermediate in transsulphuration and remethylation reactions of methionine's metabolism. We proposed to evaluate a home made method of determination for this parameter by high performance liquid chromatography (HPLC) and to compare it to fluorescence polarization immunoassay technique (FPIA) and to gaz phase chromatography (CG-SM). This method associated with good sensibility and precision remain much less expensive than FPIA technique.