Tej K. Thusoo

Immunological studies in thromboangiitis obliterans (Buerger's disease)

Abstract Immunological studies were carried out in 10 patients of thromboangiitis obliterans (Buergers disease) and compared with controls. Cell mediated and humoral immunities were investigated. Presence of specific cellular immunity against arterial antigen, increased serum immunoglobulins, formation of specific humoral antiarterial antibodies, and demonstration of immune complexes raise the possibility of involvement of autoimmune process in causation of thromboangiitis obliterans.

Autoantibodies in thromboangiitis obliterans (Buerger's disease).

Autoantibodies, organ and non-organ specific, were studied in 10 patients of thromboangiitis obliterans by immunofluorescence technique and compared with age matched controls without peripheral vascular disease and patients of other peripheral vascular diseases. Organ specific autoantibodies (various classes of immunoglobulins IgM, IgG, IgA) and C3 component were observed in the diseased vessels of thromboangiitis obliterans. Antibodies, antiarterial, were present in the sera of these patients. Among the non-organ specific antibodies (ANA and AMA), only ANA were found in the sera of patients. Presence of autoantibodies in patients of thromboangiitis obliterans strongly point out of that probably this disease entity is an autoimmune disorder.

Upper Airway Obstruction in Patients with Goiter Studied by Flow Volume Loops and Effect of Thyroidectomy

The patient with goiter and his or her physician frequently overlook symptoms of upper respiratory obstruction. Conventional radiology is the accepted method for detecting upper airway obstruction in these patients. Flow volume loops provide additional information on airflow dynamics. Twenty-five patients of goiter undergoing surgery were evaluated for upper airway obstruction by symptomatology, conventional radiology, and flow volume loops. Flow volume loops were repeated 1 month after surgery. Ten (40%) patients had mild symptoms on direct questioning. Tracheal deviation, compression, or both were noted in eight (32%) patients on radiology. Flow volume loops detected upper airway obstruction in 15 (60%) patients. Surgery resulted in normalization of all preoperative abnormal curves. The flow volume loop is a simple noninvasive method for detecting upper airway obstruction in patients with goiter. Abnormal upper airway dynamics are present in more patients with goiter than previously recognized, and relief of this obstruction should be an important aspect of thyroid surgery.

Solitary Nodular Goiter

OBJECTIVE To study the cytomorphologic features of solitary nodular goiters (SNG). STUDY DESIGN May-Grunwald-Giemsa-stained smears in 441 SNG diagnosed by ultrasonography and fine needle aspiration (FNA) and found to have optimum cellular material at review were subjected to detailed cytologic assessment. The age of the patients ranged from 11 to 75 years, with a median of 35. Male: female ratio was 69:372. The parameters for cytologic assessment included cellularity, colloid content, acinar formation, papillary formation, intranuclear cytoplasmic inclusions, nuclear grooves, marginal vacuoles, Hurthle cells and various inflammatory cells. Histopathology reports on thyroidectomy specimens were available in 27 cases from two Delhi hospitals. RESULTS Hyperplastic nodules (68 cases) differed significantly from colloid goiters (269 cases) by having more cases with excessive cellularity, acinar formation and marginal vacuoles (P < .001). There was also a significant difference with respect to papillary formation and moderate-to-excessive colloid content (P < .001). As compared to hyperplastic nodules, neoplasms (60 cases) had a significantly higher number of cases with papillary formation, intranuclear inclusions and nuclear grooves but lower number of cases with marginal vacuoles (P < .01-.001). Among neoplasms, usual papillary carcinoma (19 cases) differed from follicular neoplasms (20 cases) with respect to acinar formation, papillary formation and nuclear grooves (P < .001). A significant difference was also observed with respect to colloid content and nuclear inclusions. Follicular variant of papillary carcinomas (FVPC) (10 cases) emerged as a distinct cytologic entity following review and differed from usual papillary carcinomas in having a higher number of cases with acinar formation, tubular formation and marginal vacuoles (P < .01-.001) and lower number of cases with nuclear grooves (P = .05). FVPC also differed from follicular neoplasms with respect to papillary formation, tubular formation, intranuclear inclusions and nuclear grooves (P < .01-.001). Overall cytohistologic agreement was achieved in 24 of 27 (88.9%) cases. CONCLUSION Detailed cytologic assessment of FNA smears-in SNG was helpful in highlighting parameters that differentiate between various types of goiters.

Comparative study of free omental, peritonenal, Dacron velour, and Marlex mesh reinforcement of large-bowel anstomosis

The comparative role of free ometal, peritoneal, Dacron® velour, and Marlex® mesh grafts in reinforcement of an extremely vulnerable experimental model of large-bowel anastomosis was studied in dogs. While both the omentum and peritoneum proved not to be effective in preventing anastomotic leakage, Dacron velour did considerably lower this incidence to within reasonable limits but led to formation of low-grade lymphoma at the reinforcement site in two animals. Only Marlex mesh was found to be highly effective in sealing the suture line, and it is anticipated that, with the usual teachnique of anastomosis, this sealing effect will be foolproof, thereby nullifying any risk of suture-line breakdown

Significance of circulatory immune complexes in thromboangiitis obliterans (Buerger's disease).

Circulatory immune complexes were estimated in the sera of 25 patients and 20 age and sex matched controls by precipitation with 8% polyethylene glycol (PEG). Characterization of the immune complexes, thus obtained, was performed by the double immuno-diffusion method. The mean protein content of the PEG precipitates was significantly higher in the patients of thromboangiitis obliterans than in the controls. The immunoglobulins in the immune complexes were predominantly of mixed type in contrast to mainly single class immunoglobulins in the controls. C3 complement distribution in immune complexes of patients and control sera was 64% and 45% respectively. The immune complexes in patients were found to be biologically active. The mechanism of formation of circulatory immune complexes and their role in the pathogenesis of arteritis in relation to smoking of tobacco has been postulated.