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Variations in plasma thyroxine-binding prealbumin (TBPA) were investigated in 15 well-nourished patients who underwent minor orthopaedic surgery and resumed normal oral feeding on the first post-operative day. TBPA fluctuations were analysed together with those of other nutritional and inflammatory markers including albumin (ALB), some acute-phase reactant proteins, C-reactive protein (CRP), orosomucoid also named alpha 1-acid-glycoprotein (alpha 1GP), alpha 1-antitrypsin (alpha 1AT) as well as cortisol and haematocrit. Measurements were conducted the day before operation, after the administration of anaesthesia, 2 h after the patient regained consciousness and then daily for a period of one week (days 1 to 7). Assays showed that TBPA and ALB levels began to decline by day 1 reaching minimum values by day 3 (with 35 and 15 per cent total decreases respectively compared to the initial levels). CRP levels began to rise on day 1 reaching maximum levels by day 2, alpha 1 GP and alpha 1 AT started to increase on day 1 and 2 respectively and displayed maximum concentrations by day 3. Cortisol, on the other hand, showed a rapid, yet short-lived increase after the patient regained consciousness on the day of operation. Haematocrit levels decreased from day 1 to day 3 and these low values were maintained until the end of the study. Aside from cortisol and CRP, the initial levels of the other parameters were not yet restored by day 7. These results show that despite an early return to normal oral feeding in post-operative patients, the commonly observed pattern of variation in TBPA levels persisted, indicating that such a pattern seems to be mainly influenced by stress-induced post-operative responses rather than by nutritional supply.
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Eighteen of 24 patients with rheumatoid arthritis showed intermediate IgG-containing complexes on preparative ultracentrifugation before treatment with D-penicillamine. Serial analyses of these showed strikingly close correlation in reduction of IgG as well as alpha 1-antitrypsin-IgA complexes. Three patients did not respond to treatment clinically, and retained both types of complexes. Complexes virtually disappeared in all responders. Only small changes were found in total IgG or IgM levels and the reduction of IgA levels was moderate, except for one case who developed IgA deficiency. The importance of further analysis of non-responders is stressed.