This is the second in a series of articles looking at how to manage change in general practice Countesthorpe, Leicestershire
Little is known about hepatic T lymphocyte subpopulations in the human liver. The aim of this study was to document the various subpopulations present in the liver and compare them to peripheral T lymphocytes in the same patients. Normal hepatic tissue was obained at time of transplant from five patients, and a single cell suspension of lymphocytes were prepared by standard methods. Ceils were stained with monoclonal antibodies specific for CD8ct and CD8B chains, CD4, CD8, CD3, o~BTCR, and ySTCR, and analyzed by two and three colour flow cytometry. Of the hepatic CD3+ cells, 71% were CD8+ and 25% were CD4+, with a CD4/CD8 ratio of 1:3 in contrast to the peripheral CD4/CD8 ratio of 2:1.18% of the hepatic CD3+ cells expressed ySTCR. Significantly, CD8~ct accounted for 27% [mean] of the total hepatic CD8+ population. Conclusion: There is now evidence that the adult human gut can support extrathymic T cell differentation. A significant population of hepatic CD8txct cells would suggest that the liver is also a site of extrathymic differentiation, which may have important implications for the understanding of autoimmunity and graft tolerance.
Three dimensional body surface maps provide more information on the gee-spatial distribution of cardiac elactrieal activity. It is hypo thesised that this information could facilitate the diagnosis of acute MI in early cases where standard methods are equivocal. To date these techniques have been confined to the laboratory and have yet to find clinical application. An important first step is the assessment of their diagnostic value among patients with established MI.All 82 consecutive patients admitted to the RVH cardiac unit with first presentation ofchastpaln suggestive of MI were mapped at 24 hours using a Corazonix BSM-32 predieter which measured QRS and STT iso-lntegrals using 32 leads. Of the 82 patients, 57 (69.5%) had an initial diagnostic ECG with subsequent confirmatory enzyme elevation. A further 25 (30.5%) presented with nondiagnostic ECG f'mdings. Fifteen of this group had an MI as confirmed by an increase in cardiac enzymes. For comparative purposes, 54 consols were recruited and mapped, all with normal ECG and no IHD risk factors. A series of discriminant function analyses were performed to assess sensitivity and specificity. Using a subset of the 32 QRS and the 32 STT iso-integralmeasurements, selected by a stepwise forward algorithm, a sensitivity of 94.7% (54/57) and a specificity of 90.7% (49/54) was obtained. When all measurements were analysed together, better results were obtained: sensitivity 10070 (57]57) and specificity 96.3 (42/ 54). In further multivariate analysis, map topography differed significantly (p<< 0.01) between males and females. Separating the data according to sex and using all QRS and sTr iso-integral measurements, 100% specificity and sensitivity resulted. Despite these findings, each of the derived discriminam functions had difficulty in classifying the 25 cases belonging to the possible MI group. The best results obtainable were: a sensitivity of 60% and a specificity of 60%. This suggests that further analysis is required to identify the topography of these patients. MYOGLOBULIN RELEASE AS AN INDICATOR OF REPERFUSION FOLLOWING THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTIONF. Lavin, M. Keane, A. Forde, P, Shah, F. Gannon, K. Daly. Department of Cardiology, University College Hospital, Galway. National Diagnostics Unit, University College, Galway.Myoglobulin (ME) coneentratien time curves were studied as an index of successful reperfusion in acute myocardial infarctien and compared to standard non-invasive indices of reperfusiontime to peak CPK, rapid-ST segment normalization, reperfusion arrhythmias. 18 patients with clinical and electrocardiographic evidence of acute myocardial infarction were studied, of which 12 received thrombulytic therapy. Six patients who received thrombolysis showed signs of early reperfusion -Group A, six patients did not reperfuse -Group B, six did not get thrombolysis -Group C. Group A were shown subsequently angiographically to have patent infarct related arteries. Blood samples were obtained on admission (O hrs.), hourly up to8 hrs. and 8 ho...
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