Prevention of Platelet Deposition and Thrombus Formationon Hemodialysis Membranes: A Double-Blind Randomized Trial of Aspirin and Dipyridamole

Abstract: A double-blind crossover study comparing low-dose aspirin (ASA) and dipyridamole (DPM) (100 mg ASA+75 mg DPM, t.d.s.), high-dose ASA and DPM (300 mg ASA+75 mg DPM, t.d.s.), and placebo on platelet deposition and thrombus formation on hemodialysis membranes was undertaken in 17 long-term dialysis patients. The high-dose combination significantly reduced the fall in platelet count during dialysis and also significantly increased postdialysis heparin concentrations. Scanning electron microscopy of the Cuprophan membranes showed a reduction in platelet desposition and fibrin formation during both treatment schedules, but this was most marked with the high-dose combination. The results of this study indicate that there is a graded response to combined ASA-DPM treatment and that this can significantly reduce platelet consumption and contact activation of fibrin during hemodialysis with Cuprophan membranes.     

Combining day patient treatment with family work in a child psychiatry clinic

Summary The 81 youngsters who began attending a day treatment programme within a 1-year period were assessed using an interval design. The children ranged in age from 18 months to 16 years and attended with similarly aged children for 1 day a week. The treatment programme combined family therapy with the day unit's milieu therapy and specific individual treatment programmes for the child. The results indicate that the combination of a 1 day a week attendance and family therapy had a significant clinical impact upon the problems. The pattern of improvement observed would suggest that the day-unit attendance made a unique contribution to the overall outcome.     

Effect of intrauterine contraceptive device on uterine haemostasis: a morphological study.

The effect of the intrauterine contraceptive device (IUCD) on uterine haemostasis was studied at various stages of the menstrual cycle in a series of 46 patients by light- and electron-microscopy and by following the distribution of an infusion of 51Cr-labelled autologous platelets. The endometrium in contact with the IUCD in the majority of cases showed grooving with atrophy and mild chronic inflammation in the surrounding tissues. The adjacent stroma also showed increased vascularity and occasional foci of haemorrhage but the increased blood loss associated with the presence of the IUCD could not be attributed to mechanical erosion or stromal blood vessels by the device. During menstruation the presence of an IUCD does not appear to inhibit the formation of fibrin/platelet thrombi although both in control and IUCD patients there was a striking paucity of platelet/fibrin thrombi in circumstances where their formation should be enhanced. In contrast to other workers we have not observed that gaps or breaks in the endothelial lining of endometrial blood vessels occur with any greater frequency in patients fitted with an IUCD. The principal mechanism by which uterine haemostasis is achieved remains to be established.     

Differential glucose uptake in retina- and brain-derived endothelial cells.

Microangiopathy is a systemic complication of diabetes that is especially severe in the retinal microcirculation. The objective of this study was to compare glucose uptake and glucose transporter expression between retinal endothelial cells and the closely related endothelial cells derived from the cerebral microcirculation. Endothelial cells isolated from bovine brain, bovine retinal, and rat heart microvessels were cultured in the presence of control (5 mM) and high levels of (30 mM) d-glucose for 1-5 days. Glucose uptake by cultured endothelial cells was determined by measuring the uptake of [(3)H]deoxy-d-glucose and glucose transporter protein expression was assessed by Western blot. Our results showed that glucose uptake was significantly (P < 0.001) higher in brain- and heart-derived endothelial cells than in retinal endothelial cells at both physiologic and high concentrations of glucose. High levels of glucose caused a significant (P < 0.05) decrease in glucose uptake in brain-derived and heart endothelial cells but had no effect on retinal endothelial cells. Similarly, in response to high glucose levels there was a significant (P < 0.01) down regulation of GLUT-1 in brain-derived endothelial cells but not in retinal endothelial cells. These results suggest that despite a low basal level of glucose uptake the inability of retinal endothelial cells to down regulate glucose uptake in the presence of high glucose levels could make them especially sensitive to the deleterious effects of hyperglycemia in diabetes.