Cytophilic antithyroglobulin antibody and antibody-dependent monocyte-mediated cytotoxicity in Hashimoto's thyroiditis.

Antithyroglobulin (anti-Tg) antibodies cytophilic for human monocytes were detected in the serum of 30 of 45 patients with Hashimoto's thyroiditis using the passive rosette technique. These antibodies conferred on normal monocytes the ability to form rosettes with Tg-coated erythrocyres (E-Tg) in vitro. The percentage of E-Tg rosette-forming monocytes was correlated with serum anti-Tg antibody titers measured by tanned sheep red cell hemagglutination. Most serum cytophilic activities were recovered in the immunoglobulin G fraction and were not affected by heating to 56 C for 30 min or ultracentrifugation at 105,000 X g for 60 min. Passive E-Tg rosette formation by monocytes was immunologically specific and was inhibited by the addition of small amounts of free Tg into the medium but was not inhibited by the addition of normal human serum. The anti-Tg antibody-armed monocytes became cytotoxic against Tg-coated chicken erythrocytes and lysed target erythrocytes by an extracellular mechanism. It was suggested that monocytes might be armed by cytophilic antibodies in vivo, since monocytes of patients with Hashimoto's thyroiditis showed increased E-Tg binding (rosette formation) relative to monocytes from control subjects. These findings support the possible pathogenetic involvement of monocytes in human autoimmune thyroiditis.

Late patellar tendon ruptures after removal of the central third for anterior cruciate ligament reconstruction. A report of two cases.

Patellar tendon rupture after removal of the central third for ACL reconstruction is a rare complication. Only nine cases have been previously reported, and all of these occurred within the first 10 months after surgery. We report two cases of late patellar tendon ruptures occurring at more than 3 and 6 years, respectively, after surgery. A review of the literature has suggested but not conclusively supported that devascularization, an alteration in tendon healing and remodeling, or injury to the remaining tendon at the time of graft harvest may be possible causes of this rare complication. Biopsy tissue from any future patellar tendon ruptures after removal of its central third could contribute to a better understanding of this anomaly.

Cytophilic anti-thyroglobulin antibody and antibody-dependent macrophage-mediated cytotoxicity in Hashimoto's thyroiditis.

Antibody-dependent macrophage-mediated cytotoxicity was studied to determine the significance of cytophilic anti-thyroglobulin antibody (ATgA) present in the sera of patients with Hashimoto's thyroiditis. Effector cells were normal human monocytes or guinea-pig peritoneal exudate cells, and target cells were human thyroglobulin(Tg)-coated chicken erythrocytes. Cytotoxicity was evaluated by morphological observation and by 51Cr-releasing assay. Normal human monocytes rapidly destroyed ATgA-bound Tg-coated chicken erythrocytes by extracellular cytolysis and by phagocytosis. On the contrary, human monocytes "armed" with cytophilic ATgA destroyed Tg-coated chicken erythrocytes slowly and to a lesser extent, and only by extracellular cytolysis. When normal monocytes or peritoneal exudate cells were incubated with Tg-coated chicken erythrocytes in the presence of the sera of patients with Hashimoto's thyroiditis, phagocytosis occurred rapidly, but extracellular cytolysis developed rather slowly. These data suggest the possibility that human monocytes participate in antibody-dependent cell-mediated cytotoxicity (ADCC) in vivo, which may be an important destructive mechanism in Hashimoto's thyroiditis. It is also possible that ATgA cytophilic for monocytes render non-immune peripheral monocytes cytotoxic against Tg-bearing cells.

Recurrent transient thyrotoxicosis with painless thyroiditis--a case report.

A case of a 40-year-old woman who was suffering from painless thyroiditis with recurrent transient thyrotoxicosis is reported. Acute exacerbations occurred four times during the past ten years, two after delivery and two after catching a cold. Serum thyroid hormones increased, though radioiodine uptake by the thyroid was very low and no inflammatory signs were observed. The histological findings of the thyroid were of atypical thyroiditis and not consistent with either chronic lymphocytic thyroiditis or subacute thyroiditis. Tanned sheep red cell hemagglutination titers for anti-thyroglobulin antibodies (TRC) and for anti-microsomal antibodies (MHA) were negative or low. The disease seems to be rare and the pathophysiology and etiology are discussed.

Thromboembolism after hip surgery. Comparison of screening methods.

Venous thromboembolism is a serious and, often, asymptomatic complication of hip surgery. A reliable screening test is needed to detect thrombi early to prevent death from pulmonary emboli. Noninvasive screening tests were ineffective in our study of 453 patients. We recommend early use of ventilation/perfusion lung scanning in all patients after hip surgery. In those who have positive results, ascending venography can be used to localize the thrombus and anticoagulation therapy can be started early.

[A case report of Swyer-James syndrome].

A 43-year-old man with Swyer-James syndrome (SJS) was reported. The left side of his chest radiograph and computed tomogram was hyperlucent with decreased vascular markings. Pulmonary angiogram and scintigram showed markedly decreased blood flow of the left lung. Statistical study of the patients with SJS in Japan was done.