Haemorheological changes in patients with systemic lupus erythematosus do not seem to be related to thrombotic events

Atherothrombotic events are significant factors of mortality and morbidity in patients with systemic lupus erythematosus (SLE). The extent that rheological factors may be involved in these events in these patients has not been established. We measured the following rheological parameters in 86 patients with SLE, of whom 16 had suffered venous and/or arterial thrombotic events, and in 86 healthy controls: fibrinogen (Fbg), plasma viscosity (PV), blood viscosity at 230 s(-1) both at native haematocrit (BVn 230 s(-1) and corrected to 45% (BVc 230 s(-1), erythrocyte aggregation at stasis (AE0) and at 3 s(-1) (AE1), aggregation time (Ta), aggregation index at 10 s (AI10), disaggregation threshold (gammaD), and erythrocyte deformability (ED). In addition glucose, total cholesterol (T-Chol), triglycerides (TG), haematocrit (Hct) and Body Mass Index (BMI) were determined. SLE Disease Activity Index (SLEDAI) was also assessed. The patients showed a significant increase in BMI (P=0.030), TG (P<0.001), PV (P=0.007), AE0 (P=0.005), AE1 (P=0.006), AI10 (P=0.024), gammaD (P=0.001), Fbg (P=0.050); and a significant decrease in Ta (P<0.001), Hct (P<0.001) and BVn 230 s(-1) (P=0.003). When patients with SLEDAI10 were compared, the latter had lower Hct (P=0.041) and lower BVn 230 s(-1) (P=0.017) than those with less SLEDAI. No significant differences were found in any of the parameters analysed on comparing patients who had suffered a thrombotic event with those who had not. Our results suggest that, although patients with SLE have moderate rheological changes, these do not seem to be responsible for the increase in the thrombotic tendency in these patients.     

Anticardiolipin antibodies do not seem to be associated with APC resistance in vivo or in vitro

Anticardiolipin antibodies (aCL) or lupus anticoagulants (LA) have been found to exert an inhibitory action upon the activation and function of protein C, a natural coagulation inhibitor. Recently an in vitro phenomenon called resistance to activated protein C (APC resistance) has been described as the most frequent cause of hereditary thrombophilia. In order to see whether a positive association of APC resistance with aCL exists we examined plasma of 162 consecutive outpatients referred for thrombophilia screening. Further, the IgG fraction was isolated from plasma of two aCL-positive and LA-negative patients and of two aCL-negative healthy subjects by means of protein A affinity chromatography. Each of these isolates was mixed with normal plasma, and the APC resistance was assayed; 25/162 (15.4%) patients had confirmed abnormal APC resistance. Only 1/25 (4.0%) APC resistance-positive patients and 11/137 (8.0%) APC resistance-negative patients had positive IgG- and/or IgM-aCL (p=0.5, nonsignificant). In the in vitro test system the APC resistance ratio remained unaffected after addition of normal IgG or aCL-IgG fraction in the tested normal plasma and did not deviate from the range of buffer controls. These data do not suggest any association of aCL with abnormal APC resistance. aCL-IgG fractions from aCL-positive and LA-negative plasmas do not interfere with the APC resistance test system in vitro in low concentration.     

Preoperative serum levels of c-erbB-2 do not seem to be useful in management of patients with rectal cancer

Background and aim Soluble c-erbB-2 oncoprotein has been proven as a useful marker in the management of breast cancer patients, but its value in diagnostics and follow-up of colorectal cancer patients remains controversial. The aim of this study was to evaluate the usefulness of serum c-erbB-2 monitoring in diagnostics and prediction of disease outcome in rectal cancer patients. Materials and methods Serum samples from 88 patients with rectal adenocarcinoma before surgery and from 41 healthy controls were tested for the presence of c-erbB-2 oncoprotein by ELISA, and the patients were followed up for at least 5 years after the surgery. Results Preoperative serum c-erbB-2 levels were significantly higher in stage IV patients than in healthy controls (P<0.001) and did not show correlation with preoperative CEA levels. Elevated preoperative serum c-erbB-2 levels showed relatively high specificity (88%) and low sensitivity (44%) in the diagnosis of rectal cancer. Elevated preoperative oncoprotein levels were predictive neither for overall survival nor for development of local recurrence/distant metastases. Conclusion Although preoperative serum c-erbB-2 levels were significantly higher in rectal cancer patients than in healthy controls, the soluble c-erbB-2 does not seem to be useful in the diagnosis of rectal cancer due to its low sensitivity. Preoperative serum levels of this oncoprotein were predictive neither for overall survival nor for local recurrence/distant metastases in rectal cancer patients.     

Sustained biochemical remission after interferon treatment may closely be related to the end of treatment biochemical response and associated with a lower incidence of hepatocarcinogenesis

Abstract: Clinical background and incidence of hepatocellular carcinoma (HCC) of patients with chronic hepatitis C who obtained biochemical remission without eradication of virus (biochemical response) after interferon (IFN) treatment was retrospectively analyzed for 755 patients. Annual incidence of HCC was significantly lower in the patients with biochemical response and sustained response than that of the patients that did not show these responses. Logistic regression analysis showed that only the normalization of alanine aminotransferase (ALT) value at the end of IFN treatment was a significant factor for biochemical response. Annual incidence of HCC was significantly lower in the patients who obtained normalization of ALT values at the end of treatment than those who did not. Patients who were younger, who had a lower level of activity and fibrosis indices in histology, higher platelet count, and who were given more higher total dose of IFN were more likely to attain normalization of ALT levels at the end of treatment, and this was related to biochemical response. Low incidence of HCC in patients who obtained normalization of ALT values at the end of treatment was likely because they were in the earlier stage of chronic hepatitis. Active treatment of chronic hepatitis C with interferon in the early phase of the disease may bring about a biochemical response in some patients, even if sustained virological response is not obtained.