Global tests on coagulation and fibrinolysis in systemic and pulmonary circulation accompanying hip arthroplasty with acrylic cement

Sudden cardio-respiratory collapse (CRC) within seconds after implantation of methylmethacrylate cement and femoral prosthesis during hip replacement surgery, accounted at our hospital among 315 patients for a mortality of 0.6%. This prompted our pathophysiological studies concentrating on the critical intraoperative period for this complication. This series of 6 patients with osteoarthrosis was followed with established parameters on coagulation and fibrinolysis in arterial and mixed venous blood withdrawn frequently during and after total hip arthroplasty. The surgical procedure induced activation in both systems as evidenced by a gradual and statistically significant drop in level of blood platelets, fibrinogen, vitamin K dependent clotting factors. At the end of operation soluble fibrin and moderately elevated concentrations of FDP/FRA were demonstrated. The results were similar in corresponding arterial and mixed venous blood specimens. The perioperative changes were not potentiated by the introduction of cement and the implantation of the prosthetic components. The postoperative changes had the same pattern and the same magnitude as those following other types of major surgery. The present results do not indicate marked alterations in coagulation and/or fibrinolysis in the critical period for CRC to develop.     

Hematuria following blunt abdominal trauma. The utility of intravenous pyelography

To clarify the indications for intravenous pyelography (IVP) and nephrotomography (NT) in the evaluation of patients with hematuria following blunt thoracoabdominal trauma, we performed a retrospective analysis of patients admitted during a one-year period who had undergone IVP and NT for suspected renal injury. One hundred thirty-four patients were reviewed, and the findings of IVP and NT correlated with the magnitude of hematuria on urinalysis, associated injuries, management, and outcome. Sixty-two (46%) of 134 patients had fewer than ten red blood cells per high-power field (RBCs/HPF) on urinalysis (group 1), 19 (14%) of 134 patients had 10 to 30 RBCs/HPF (group 2), and 53 (40%) of 134 patients had greater than 30 RBCs/HPF (group 3). Twenty-seven patients had renal injuries detected by IVP and NT, two in group 2 and 25 in group 3. We conclude that IVP and NT should be reserved for patients with greater than 30 RBCs/HPF on admission urinalysis.     

A Community-Based Oral Health Intervention in Navajo Nation Head Start: Participation Factors and Contextual Challenges

Successful interventions require consistent participation by intended recipients. We utilized mixed methods to describe participation of 518 parent–child dyads enrolled in a randomized cluster trial of a 2-year oral health intervention for Head Start (HS) families across Navajo Nation delivered by native Community Oral Health Specialists (COHS). We quantitatively assessed factors that contributed to participation and qualitatively examined barriers and strategies. The intervention offered fluoride varnish (FV) and oral health promotion (OHP) activities for two cohorts (enrolled in 2011, N = 286, or 2012, N = 232) of children in the HS classrooms and OHP for parents outside the classroom. Child participation was good: FV: 79.7 (Cohort 1) and 85.3 % (Cohort 2) received at least 3 of 4 applications; OHP: 74.5 (Cohort 1) and 78.4 % (Cohort 2) attended at least 3 of 5 events. Parent participation was low: 10.5 (Cohort 1) and 29.8 % (Cohort 2) attended at least three of four events. Analysis of survey data found significant effects on parent participation from fewer people in the household, Cohort 2 membership, greater external-locus of control, and a greater perception that barriers existed to following recommended oral health behaviors. Qualitative analysis of reports from native field staff, COHS, community members, and the research team identified barriers (e.g., geographic expanse, constraints of a research trial) and suggested strategies to improve parent participation (e.g., improve communication between COHS and parents/community). Many challenges to participation exist when conducting interventions in rural areas with underserved populations. Working with community partners to inform the development and delivery of interventions is critical.     

Ergebnisse der Sammelforschung über kataleptische Totenstarre

Ohne Zusammenfassung     

Degradation of Human Fibrinogen by Brinastrase®, Trypsin and Chymotrypsin: An Immunological Study

Human fibrinogen is degraded by Brinastrase, trypsin and chymotrypsin and the fibrinogen related antigens (F.R.A.) are characterized by agar and crossed agarose immunoelectrophoresis, using anti-fibrinogen and monospecific anti-D and anti-E serum. D+E-antigenic F.R.A. are not seen during digestion with Brinastraser? or chymotrypsin. D-antigenic fractions with different electrophoretic mobility and of different antigenic potency appear initially during digestion with these enzymes and are degraded into non-antigenic polypeptides during further digestion. Trypsin, however, digests fibrinogen as plasmin, but the D-antigenic fragments, after repeated digestion, lose their antigenic properties. Fragments, immunoelectrophoretically very similar to the plasmin-resistant E-fractions (M.W. around 50, 000), are formed during digestion with Brinastrase, chymotrypsin and trypsin. They are rather resistant to further degradation. Sustained trypsin-digestion results in formation of fragments with partial E-antigenicity and Brinastrase and chymotrypsin produce after sustained and repeated incubation fragments, with significantly increased electrophoretic mobility and decrease in M.W. as estimated by SDS polyacrylamide electrophoresis. Also these fragments, however, retain at least some E-antigenic properties.     

Demonstration of Different D- and E-Antigenic Intermediates During Plasmin Degradation of Non-Stabilized and Stabilized Fibrin Clots

The degradation scheme of stabilized and non-stabilized (solubility criteria) human fibrin clots, as obtained by porcine plasmin and urokinase activation of human plasminogen, is illustrated by crossed immuno-electrophoresis in agarose using antifibrinogen and monospecific anti-D and anti-E serum and is further characterized by Sephadex G 150 filtration and by sodium dodecyl sulphate polyacrylamide electrophoresis. Heat labile E-antigenic fractions exhibiting slow migration in agarose appear early during digestion of fibrin and are especially characteristic for the degradation of stabilized fibrin, whereas only traces are found during degradation of non-stabilized fibrin. They decrease in concentration and disappear as the final E-antigenic fraction with distinct anodic mobility in agarose develops. The intermediary fractions are eluted by Sephadex G 150 filtration before the final plasmin resistant E-fraction. Some of these intermediates may have a molecular weight from more than 50, 000 to around 250, 000, whereas the final E-antigenic plasmin resistant has a molecular weight of 50, 000. The plasmin-resistant heat-labile D-fragments found during digestion of non-stabilized fibrin have a molecular weight of around 100, 000, whereas plasmin-resistant D-antigenic fractions found during degradation of stabilized fibrin have a molecular weight of around 190, 000, all molecular weights approximated (non-reduced freeze dried Sephadex filtrates).