Search

Introduction: Thyroid storm (TS) is a rare, but critical illness that can cause multiorgan failure and carries a high risk of mortality. We describe a case of refractory TS successfully treated with SPAD. Case: A 48 y/o lady was evaluated for sustained ventricular tachycardia (SVT) in the setting of newly diagnosed thyroid storm. She received a left ventricular assist device (LVAD) 4 years ago for cardiomyopathy (EF< 20%). Exam: SVT and florid CHF. Biochemical evaluation following amiodarone infusion for 18 hours: TSH < 0.05 (0.4 - 4 UIU/ml), FT4 7.87(0.76-1.46ng/dl), TT3 181 (60-180 ng/dl). TPO, TRAB and TSI antibodies were negative. Thyroid sonogram showed heterogeneous normal sized gland, no nodules or hyper vascularity. She received methimazole (MMI) 60 mg orally twice daily, Lugol’s iodine 10 drops orally three times daily and hydrocortisone 100mg intravenously 3 times daily. Beta-blockers were deferred due to cardiogenic shock. Amiodarone (400 mg orally twice daily)) was continued for ongoing episodes of SVT. She developed shock liver limiting the continuation of maximum doses of MMI. Continuous veno-venous hemofiltration (CVVH) was initiated for anuric renal failure. She required ventilator and pressor support on day 7 (D7) of hospitalization as urgent preparations were being made for LVAD exchange (given LVAD malfunction). TFts obtained on D7 showed a suboptimal response to maximal therapy: FT4 3.86, TT3 146. She underwent emergent SPAD using modified CVVH with dialysate containing 4% human albumin for 12 hrs. pre-operatively. It led to a fall in the FT4 to 1.71 and TT3 to 90. She received a new LVAD without further episodes of SVT. TFTs subsequent to 8 additional sessions of SPAD (as a bridge to definitive thyroidectomy) were as follows: FT4 1.56, TT3 76, thereby allowing for a dose reduction in MMI. Thyroidectomy was considered but deferred since the family opted for comfort measures when the patient developed cardiac tamponade Conclusions: TS can be recalcitrant to therapy with MMI, beta blockade, cold iodine and steroids. Adjunct therapy such as lithium, cholestyramine, and plasmapheresis, in addition to conventional therapy may have limited benefit, and comes with potential side effects. SPAD offers a safe and effective therapeutic alternative for refractory TS that can be performed continuously for a sustained response. In our case, with SPAD, thyroid hormones dropped to permissible levels, thus allowing for successful completion of emergent high risk cardiac surgery. Additionally, SPAD may provide a window for definitive surgical intervention and should be considered in refractory TS.

Alcoholism is one of the most common psychosocial disorders, affecting approximately 10% of the general population. The impact of alcoholism on the care of patients with other medical illnesses has not been addressed in many of these populations, including patients with end-stage renal disease (ESRD) undergoing hemodialysis. We set out to determine the prevalence of alcoholism in an urban hemodialysis population and ascertain whether alcoholism had an effect on compliance in this population. One hundred sixty-three urban hemodialysis patients were screened using the Michigan Alcoholism Screening Test (MAST), a 25-item questionnaire that has been validated in multiple trials. Forty-five patients (27.6%) scored 5 or greater on the MAST. The MAST-positive subjects were younger (age, 55 +/- 15 years versus 64 +/- 13 years) and tended to be men (58% versus 43%). There was no significant difference in the incidence of diabetic kidney disease; however, there were significantly more human immunodeficiency virus (HIV)-positive patients in the MAST-positive group. The dietary compliance measures of predialysis potassium or phosphorus levels did not differ between the two groups. A trend toward lower serum albumin level was evident in the men in the MAST-positive group (3.75 +/- 0.57 versus 3.91 +/- 0.30 g/dL; P = 0.0212). In conclusion, there is a high prevalence of alcoholism in the urban dialysis population. Alcoholic patients with ESRD are younger and tend to be men. HIV-positive patients with ESRD have a high prevalence of concomitant alcoholism. Compliance indicators of predialysis potassium and phosphorus levels are not affected. However, nutritional status, measured by serum albumin level, tends to be poorer in the alcoholic group.

Includes bibliographical references (p. 266-278). Number of sources in the bibliography: 178 Thesis (Ph. D.) -- University of Cyprus, Faculty of Pure and Applied Sciences, Department of Chemistry, September 2005. The University of Cyprus Library holds the printed form of the thesis. Σε αυτή την διατριβή επιχειρούμε να κατανοήσουμε τους μηχανισμούς των ειδικών επιδράσεων απλών ανιόντων σε φυσικοχημικά και βιολογικά συστήματα. Για τον σκοπό αυτό μελετήθηκαν οι επιδράσεις διαφόρων αλάτων του νατρίου με μονοσθενή ανιόντα (NaX) που ανήκουν στη σειρά Hofmeister χρησιμοποιώντας τρία πρότυπα συστήματα: (α) Μονοστοιβάδες φωσφολιπιδίων στην διεπιφάνεια νερού-αέρα. (β) Διπλοστοιβάδες φωσφολιπιδίων διεσπαρμένες σε περίσσεια νερού. (γ) Μικκύλια φωσφολιπιδίων. Για τον σχηματισμό των μονοστοιβάδων και των διπλοστοιβάδων χρησιμοποιήθηκε το διπολικό φωσφολιπίδιο 1,2-Dipalmitoyl-sn-Glycero-3-Phosphocholine (DPPC), ενώ για τον σχηματισμό μικκυλίων χρησιμοποιήθηκε το συγγενές λιπίδιο Dodecylphosphocholine (DPC). Τα άλατα που χρησιμοποιήθηκαν στην μελέτη αυτή είναι: NaCl, NaBr, NaNO3, NaI, NaBF4, NaClO4 και NaSCN. Η φασική συμπεριφορά και η δομή των μονοστοιβάδων του DPPC στην διεπιφάνεια ηλεκτρολύτη-αέρα μελετήθηκαν με ισόθερμες π - Α, με μικροσκοπία γωνίας Brewster (BAM), με περίθλαση ακτινών X υπό μικρή γωνία (GIXD) και με υπέρυθρη φασματοσκοπία ανάκλασης-απορρόφησης (IRRAS). Στην παρουσία αλάτων σημειώθηκε σημαντική αύξηση της επιφανειακής πίεσης σε σταθερή επιφάνεια ανά μόριο, υποδεικνύοντας σταθεροποίηση της υγρής-εκτεταμένης φάσης της μονοστοιβάδας. Αυτή η αύξηση εξαρτάται από το είδος του ανιόντος και την συγκέντρωση του ηλεκτρολύτη. Τα πειράματα περίθλασης ακτινών X και υπέρυθρης φασματοσκοπίας έδειξαν ότι δεν αλλάζει σημαντικά η δομή της μονοστοιβάδας (παράμετροι πλέγματος) και η μέση διαμόρφωση των λιπιδίων παρουσία ανιόντων στο υπόστρωμα. Η επίδραση των αλάτων νατρίου (NaX) στην υγρή φυλλώδη φάση Lα των διπλοστοιβάδων DPPC μελετήθηκε με σκέδαση ακτινών Χ (SAXS) σε συνδυασμό με επιβολή ωσμωτικής πίεσης (OS). Από τα πειράματα διαπιστώθηκε ότι σε σταθερή ωσμωτική πίεση η απόσταση των διπλοστοιβάδων αυξάνει στην παρουσία αλάτων και η αύξηση αυτή εξαρτάται από το είδος του ανιόντος και τη συγκέντρωση του άλατος, με το ανιόν SCN- να εμφανίζει τη μεγαλύτερη επίδραση. Οι ιδιότητες των μικκυλίων του επιφανειοενεργού DPC στην παρουσία των διαφόρων ανιόντων Hofmeister μελετήθηκαν χρησιμοποιώντας δυναμική σκέδαση φωτός (DLS). Οι φυσικοχημικές ιδιότητες των μικκυλίων DPC επηρεάζονται από το είδος και τη συγκέντρωση του ανιόντος. Η επίδραση των ανιόντων ακολουθεί τη σειρά Hofmeister. Για τον υπολογισμό σταθερών πρόσδεσης των ανιόντων στις διάφορες λιπιδικές γεωμετρίες πραγματοποιήθηκε θεωρητική προσαρμογή στα πειραματικά αποτελέσματα με κατάλληλα θεωρητικά πρότυπα. Τα αποτελέσματα δείχνουν ότι μοντέλα, τα οποία βασίζονται στη χημική προσρόφηση των ανιόντων στις κεφαλές των λιπιδικών μορίων, δεν μπορούν να εξηγήσουν τα πειραματικά αποτελέσματα. Αντίθετα τα πειραματικά αποτελέσματα των μονοστοιβάδων μπορούν να εξηγηθούν πολύ ικανοποιητικά με χρήση ενός εναλλακτικού θεωρητικού μοντέλου που βασίζεται στην κατανομή των ανιόντων μεταξύ του διαλύματος και μιας επιφανειακής λιπιδικής στοιβάδας μέσω του οποίου σταθερές κατανομής των ανιόντων μεταξύ των δύο φάσεων μπορούν να υπολογισθούν. In this thesis, we attempt to understand the mechanisms behind specific anion effects by studying the effects of sodium salts (NaX) of different monovalent anions belonging to the Hofmeister series on three model systems: (a) Langmuir monolayers of phospholipids at the air-water interface, (b) bilayers of phospholipids dispersed in excess water, and (c) micelles of phospholipid compounds. The zwitterionic lipid 1,2-Dipalmitoyl-sn-Glycero-3-Phosphocholine (DPPC) was used to form monolayers and bilayers, and the lipid Dodecylphosphocholine (DPC) was used to form micellar solutions. The salts used were NaCl, NaBr, NaNO3, NaI, NaBF4, NaClO4 and NaSCN. The phase behavior and the morphology and structure of DPPC Langmuir monolayers in the presence of electrolytes in the subphase were studied by π – Α isotherms, Brewster Angle Microscopy (BAM), Grazing Incidence X-ray Diffraction (GIXD) and Infrared Reflection-Absorption Spectroscopy (IRRAS). The presence of salts was found to increase the surface pressure at a fixed area per molecule at the low-pressure part of the isotherm, indicating a stabilization of the liquid-expanded phase of the monolayer. This increase depends on the type of the anion and the electrolyte concentration. X-Ray diffraction and infrared spectroscopy experiments show that the conformation and packing properties (lattice parameters) of the hydrocarbon chains in the presence of salt remain essentially unaffected even at quite high electrolyte concentrations. The effect of the NaX salt solutions on the Lα Phase of DPPC bilayers was investigated using Small-Angle X-Ray Scattering (SAXS) and the Osmotic Stress (OS) technique. It was observed that for the same osmotic pressure the water bilayer separation increases in the presence of salts, depending on the type of the anion and the concentration of the electrolyte used. The effect of the different anions on the bilayer structural parameters follows the Hofmeister series. The micellar properties of the surfactant DPC in the presence of different Hofmeister anions were studied using Dynamic Light Scattering (DLS). The physicochemical parameters of the DPC micelles are all affected by the type and concentration of anion used. In order to obtain “binding constants” of anions on the three lipid models, fitting of the experimental results was carried out with appropriate theoretical models. The fitting results indicate that the experimental data cannot be explained with models based on chemical binding of the anions on the headgroups of the lipid molecules. On the contrary, the monolayer results can be fitted quite well with an ion-partitioning model, which assumes that anions can penetrate a surface lipid layer.

This work is a review of the effect of different monovalent anions (belonging to the Hofmeister series) on a single model amphiphile, phosphatidylcholine molecules in contact with water, in three different geometries, Langmuir monolayers, bilayers and micelles, which differ by area per molecule and radius of curvature. The zwitterionic lipids DPPC (1,2-dipalmitoyl-phosphatidylcholine) and DPC (Dodecylphosphocholine) have been used to form the three geometries. The salt solutions used were NaCl, NaBr, NaNO3, NaI, NaBF4, NaClO4 and NaSCN. Various interfacial and bulk experimental techniques were used in order to study the effect of the anions on the amphiphiles in the three geometries. The interfacial techniques used were surface pressure-area isotherms, Brewster angle microscopy (BAM), Grazing incidence X-ray diffraction (GIXD), infrared reflection absorption spectroscopy (IRRAS). The bulk sensitive techniques used were small-angle X-ray scattering (SAXS), osmotic stress (OS) and light scattering. The experimental results obtained from the three model systems indicate that the interfaces become charged through lipid-ion association. The results were fitted with appropriate theoretical models to provide "binding" or "partitioning" constants of anions in the headgroup region of the lipid molecules. The theoretical analysis strongly suggests that the anions do not associate with the lipid molecules through a local chemical reaction, but rather they partition inside the disordered lipid interfaces. © 2007 Elsevier B.V. All rights reserved. 303 1-2 144 158 Cited By :36

Includes bibliographical references (p. 266-278). Number of sources in the bibliography: 178 Thesis (Ph. D.) -- University of Cyprus, Faculty of Pure and Applied Sciences, Department of Chemistry, September 2005. The University of Cyprus Library holds the printed form of the thesis. Σε αυτή την διατριβή επιχειρούμε να κατανοήσουμε τους μηχανισμούς των ειδικών επιδράσεων απλών ανιόντων σε φυσικοχημικά και βιολογικά συστήματα. Για τον σκοπό αυτό μελετήθηκαν οι επιδράσεις διαφόρων αλάτων του νατρίου με μονοσθενή ανιόντα (NaX) που ανήκουν στη σειρά Hofmeister χρησιμοποιώντας τρία πρότυπα συστήματα: (α) Μονοστοιβάδες φωσφολιπιδίων στην διεπιφάνεια νερού-αέρα. (β) Διπλοστοιβάδες φωσφολιπιδίων διεσπαρμένες σε περίσσεια νερού. (γ) Μικκύλια φωσφολιπιδίων. Για τον σχηματισμό των μονοστοιβάδων και των διπλοστοιβάδων χρησιμοποιήθηκε το διπολικό φωσφολιπίδιο 1,2-Dipalmitoyl-sn-Glycero-3-Phosphocholine (DPPC), ενώ για τον σχηματισμό μικκυλίων χρησιμοποιήθηκε το συγγενές λιπίδιο Dodecylphosphocholine (DPC). Τα άλατα που χρησιμοποιήθηκαν στην μελέτη αυτή είναι: NaCl, NaBr, NaNO3, NaI, NaBF4, NaClO4 και NaSCN. Η φασική συμπεριφορά και η δομή των μονοστοιβάδων του DPPC στην διεπιφάνεια ηλεκτρολύτη-αέρα μελετήθηκαν με ισόθερμες π - Α, με μικροσκοπία γωνίας Brewster (BAM), με περίθλαση ακτινών X υπό μικρή γωνία (GIXD) και με υπέρυθρη φασματοσκοπία ανάκλασης-απορρόφησης (IRRAS). Στην παρουσία αλάτων σημειώθηκε σημαντική αύξηση της επιφανειακής πίεσης σε σταθερή επιφάνεια ανά μόριο, υποδεικνύοντας σταθεροποίηση της υγρής-εκτεταμένης φάσης της μονοστοιβάδας. Αυτή η αύξηση εξαρτάται από το είδος του ανιόντος και την συγκέντρωση του ηλεκτρολύτη. Τα πειράματα περίθλασης ακτινών X και υπέρυθρης φασματοσκοπίας έδειξαν ότι δεν αλλάζει σημαντικά η δομή της μονοστοιβάδας (παράμετροι πλέγματος) και η μέση διαμόρφωση των λιπιδίων παρουσία ανιόντων στο υπόστρωμα. Η επίδραση των αλάτων νατρίου (NaX) στην υγρή φυλλώδη φάση Lα των διπλοστοιβάδων DPPC μελετήθηκε με σκέδαση ακτινών Χ (SAXS) σε συνδυασμό με επιβολή ωσμωτικής πίεσης (OS). Από τα πειράματα διαπιστώθηκε ότι σε σταθερή ωσμωτική πίεση η απόσταση των διπλοστοιβάδων αυξάνει στην παρουσία αλάτων και η αύξηση αυτή εξαρτάται από το είδος του ανιόντος και τη συγκέντρωση του άλατος, με το ανιόν SCN- να εμφανίζει τη μεγαλύτερη επίδραση. Οι ιδιότητες των μικκυλίων του επιφανειοενεργού DPC στην παρουσία των διαφόρων ανιόντων Hofmeister μελετήθηκαν χρησιμοποιώντας δυναμική σκέδαση φωτός (DLS). Οι φυσικοχημικές ιδιότητες των μικκυλίων DPC επηρεάζονται από το είδος και τη συγκέντρωση του ανιόντος. Η επίδραση των ανιόντων ακολουθεί τη σειρά Hofmeister. Για τον υπολογισμό σταθερών πρόσδεσης των ανιόντων στις διάφορες λιπιδικές γεωμετρίες πραγματοποιήθηκε θεωρητική προσαρμογή στα πειραματικά αποτελέσματα με κατάλληλα θεωρητικά πρότυπα. Τα αποτελέσματα δείχνουν ότι μοντέλα, τα οποία βασίζονται στη χημική προσρόφηση των ανιόντων στις κεφαλές των λιπιδικών μορίων, δεν μπορούν να εξηγήσουν τα πειραματικά αποτελέσματα. Αντίθετα τα πειραματικά αποτελέσματα των μονοστοιβάδων μπορούν να εξηγηθούν πολύ ικανοποιητικά με χρήση ενός εναλλακτικού θεωρητικού μοντέλου που βασίζεται στην κατανομή των ανιόντων μεταξύ του διαλύματος και μιας επιφανειακής λιπιδικής στοιβάδας μέσω του οποίου σταθερές κατανομής των ανιόντων μεταξύ των δύο φάσεων μπορούν να υπολογισθούν. In this thesis, we attempt to understand the mechanisms behind specific anion effects by studying the effects of sodium salts (NaX) of different monovalent anions belonging to the Hofmeister series on three model systems: (a) Langmuir monolayers of phospholipids at the air-water interface, (b) bilayers of phospholipids dispersed in excess water, and (c) micelles of phospholipid compounds. The zwitterionic lipid 1,2-Dipalmitoyl-sn-Glycero-3-Phosphocholine (DPPC) was used to form monolayers and bilayers, and the lipid Dodecylphosphocholine (DPC) was used to form micellar solutions. The salts used were NaCl, NaBr, NaNO3, NaI, NaBF4, NaClO4 and NaSCN. The phase behavior and the morphology and structure of DPPC Langmuir monolayers in the presence of electrolytes in the subphase were studied by π – Α isotherms, Brewster Angle Microscopy (BAM), Grazing Incidence X-ray Diffraction (GIXD) and Infrared Reflection-Absorption Spectroscopy (IRRAS). The presence of salts was found to increase the surface pressure at a fixed area per molecule at the low-pressure part of the isotherm, indicating a stabilization of the liquid-expanded phase of the monolayer. This increase depends on the type of the anion and the electrolyte concentration. X-Ray diffraction and infrared spectroscopy experiments show that the conformation and packing properties (lattice parameters) of the hydrocarbon chains in the presence of salt remain essentially unaffected even at quite high electrolyte concentrations. The effect of the NaX salt solutions on the Lα Phase of DPPC bilayers was investigated using Small-Angle X-Ray Scattering (SAXS) and the Osmotic Stress (OS) technique. It was observed that for the same osmotic pressure the water bilayer separation increases in the presence of salts, depending on the type of the anion and the concentration of the electrolyte used. The effect of the different anions on the bilayer structural parameters follows the Hofmeister series. The micellar properties of the surfactant DPC in the presence of different Hofmeister anions were studied using Dynamic Light Scattering (DLS). The physicochemical parameters of the DPC micelles are all affected by the type and concentration of anion used. In order to obtain “binding constants” of anions on the three lipid models, fitting of the experimental results was carried out with appropriate theoretical models. The fitting results indicate that the experimental data cannot be explained with models based on chemical binding of the anions on the headgroups of the lipid molecules. On the contrary, the monolayer results can be fitted quite well with an ion-partitioning model, which assumes that anions can penetrate a surface lipid layer.

In this work we investigated the effect of sodium salts of different monovalent anions belonging to the Hofmeister series on Langmuir monolayers of DPPC (1,2-dipalmitoyl phosphatidylcholine). The salts used were NaCl, NaBr, NaNO3, Nal, NaBF4, NaClO4, and NaSCN. The monolayer phase behavior and the morphology and structure of the lipid phases were studied by surface pressure-area isotherms, Brewster Angle Microscopy (BAM), Grazing Incidence X-ray Diffraction (GIXD), and Infrared Reflection-Absorption Spectroscopy (IRRAS). The presence of electrolytes in the subphase was found to increase the surface pressure at a fixed area per molecule, indicating a stabilization of the liquid-expanded phase of the monolayer. This increase is different for different anions and different electrolyte concentrations. X-ray diffraction and infrared spectroscopy experiments show that moderate concentrations of chaotropic anions, such as I-, do not significantly change the conformation and packing properties of the hydrocarbon chains. The lattice parameters and the ordering of the lipid molecules in the liquid-condensed phase remain essentially unaffected, even at quite high electrolyte concentrations. This finding suggests that anions partition into or bind to the looser liquid-expanded phase, thus providing entropic stabilization of that phase, but do not penetrate into or bind to the domains of the liquid-condensed phase. This intriguing result is discussed in terms of the possible modes of interaction of anions with lipid interfaces. 108 39 15238 15245 Cited By :107

The three main currently proposed approaches for understanding specific ion effects are briefly described. In some experimentally well defined and simplified situations, one can decouple ion specificity effects from all others. Small globular micelles in water/salt mixtures are one of the simple situations where specific ion effects can be distinguished: 'hydrophobic ions' introduced by Hofmeister in the late 19th century, also called 'structure breaking' or 'salting in' ions, which are similar to 'soft ions' in the classification introduced by Pearson, are more strongly adsorbed on the micellar surface than predicted by electrostatics alone. Hence, lateral repulsions between surfactants are increased, resulting in a measurable and calculable decrease of micelle size when adsorbing anions such as bromide replace non-adsorbing anions such as chloride. © 2004 Elsevier Ltd. All rights reserved. 9 1-2 74 80 Cited By :36

78 6 786 788

166 placentae from multiple pregnancies (including three triplets and 17 monochorral) have been studied by injection corrosion technique, using cellulose acetate buterite in acetone, under continuous pressure within physiological limits. It has been shown that vascular anastomoses in twin placentae are usually multiple. The direct type is frequently found in monochorial twin placentae and is mostly arterial or venous in nature. The indirect type is observed more commonly in dichorial twin placentae and is mostly arteriovenous in nature. Both types are almost universally found in monochorial monoamniotic placentae. The presence of direct anastomotic channels has a highly significant association with the incidence of marginal vessels and an exaggeration of parameters of stress to an abnormal quantum – both singly and in combinations of three or more - and is independent of the pattern of branching. In the ontogenetic time-sequence perspective, direct anastomoses, marginal vessels and parameters of stress in a twin placenta can be regarded as different phases of the sequelae of an altered vascular relationship caused by disturbances in the vicinity of the 12th week of gestation. It has been further shown that direct vascular anastomoses are a greater risk to the twins than indirect ones. The importance of early and timely recognition of such channels, by an examination of twin placentae for the presence of marginal vessels, is stressed.

We examine the use of the inverse titration method for determining the ionization constant of weak organic bases when the basic form of the substance is highly insoluble in aqueous solutions. The inverse titration involves progressive dissolution of the precipitate of the insoluble basic form through addition of a strong acid, and determination of the total solubility at each step with a suitable analytical technique. Analysis of the experimental data allows the simultaneous determination of the ionization constant and the solubility of the basic form. We use dibucaine, a local anaesthetic, and analyze its total solubility after each acid addition using UV spectrophotometry. This simple experiment allows the accurate determination of the pKa of the compound at various temperatures, but provides only a rough estimate of the solubility of the basic form.