Prevention of postoperative deep venous thrombosis. Low-dose heparin versus graded pressure stockings

In a prospective, controlled clinical study prevention of postoperative deep venous thrombosis by low-dose heparin (Heparin Leo 5 000 I.U. subcutaneously twice daily) was compared with graded compression stockings (TED stockings, Kendall Co.). One hundred and twelve patients, admitted during a period of one year for elective major surgery, were allocated to one of the two treatment groups. In order to detect deep venous thrombosis the 99mTc-plasmin test was performed before the operative procedure and again 5 days later. Ninety-seven patients completed the study (45 patients in the heparin group and 52 patients in the stocking group). Venous thromboembolism was detected in 4 patients (8.9%) in the heparin group and in 3 patients (5.8%) in the stocking group (p greater than 0.05). In 6 patients the plasmin test was positive and one patient in the heparin group died following pulmonary embolism. It is concluded that graded compression stockings can be used as an alternative to low-dose heparin for prophylaxis against deep venous thrombosis in elective general surgery.     

The anterior cricoid split. Clinical experience with extended indications

A recommended approach to postextubation infant subglottic stenosis secondary to subglottic edema employs the recently described anterior cricoid split (ACS) procedure. This technique provides an expanded subglottic airway with minimal paratracheal dissection and does not require concomitant tracheotomy. We applied this procedure in managing extubation difficulty in pediatric as well as neonatal patients. Five of ten patients in our series did not fulfill the traditional criteria for ACS. Relief of stridor and avoidance of tracheotomy were accomplished in nine of ten patients. One patient in whom mechanical ventilation was reinstituted developed an interesting complication. In properly selected infants with subglottic airway compromise, the ACS appears to be an effective adjunct in facilitating extubation.     

THE ACTIVE SITE OF AN INDUCIBLE ARYLACYLAMIDASE FROM PSEUDOMONAS ACIDOVORANS

Though very effectively ibhibited by both SH-group directed reagents and inhibitors typical for serine hydrolases, the inducible arylacylamidase from Pseudomonas acidovorans is a serine enzyme rather than a sulfhydryl enzyme. The amino acid sequence around the reactive serine residue is Gly-Ser-Ile. The sequence of a larger peptide from the active site is described.     

Evidence for Modulation of Melatonin Secretion in Men With Benign and Malignant Tumors of the Prostate: Relationship With the Pituitary Hormones

The serum levels of the pineal hormone melatonin were determined by radioimmunoassay (RIA) in 4-h intervals throughout a 24-h period in elderly men with different types of prostate tumors: benign prostatic hyperplasia (BPH, n = 13), incidental carcinoma (PCi, n = 5), and nonmetastasizing carcinoma (PC, n = 9), as well as in young men (YM, n = 10). Simultaneously, the pituitary hormones prolactin, growth hormone, luteinizing hormone and follicle-stimulating hormone were measured by RIA. All subjects were untreated and free of serious complaints, and they stayed in the same environment. The data were analyzed by the population mean-cosinor method, and linear correlation coefficients between the five hormones were calculated for each group. Melatonin showed significant circadian rhythms in young men and patients with BPH and PCi but not in patients with PC. Twenty-four-hour mean concentration (mesor) and amplitude were significantly increased in patients with PCi as compared to patients with PC. Prolactin showed significant circadian rhythms in young men and in patients with BPH, whereas patients with PCi and PC appeared to have ultradian variations. Growth hormone did not show significant rhythms in any of the groups; the mesors were elevated in all tumor groups as compared to young men. Gonadotropin mesors were elevated in all tumor patients as compared to young men; rhythms were not detected. Carcinoma patients showed different interhormonal correlations than all other groups. These results indicate that modulation of melatonin secretion, accompanied by changes in the pituitary hormone levels, may be related to development and growth of prostate cancer.     

Long-lasting remission of pulmonary metastases of renal cell cancer under IFN-beta therapy in a patient with multiple sclerosis

BACKGROUND: Immunomodulary therapy based on interferon (IFN)-a has been shown to be effective in a subset of patients with advanced renal cell carcinoma (RCC). IFN-Beta has occasionally been reported to induce remissions in RCC, but is well established in the treatment of multiple sclerosis (MS). There is an ongoing debate whether hyperactivation of the immune system may convey protection against the development of cancer in MS patients. PATIENTS AND METHODS: A 54-year-old female MS patient underwent tumor nephrectomy for RCC in 1994. 1 year later, several bilateral pulmonary metastases were documented by computed tomography and were histologically confirmed thereafter. Therapy with IFN-Beta was started. RESULTS: Soon after initiation of IFN-Beta treatment, the patient achieved an almost complete remission which is still ongoing after 10 years of IFN-Beta therapy. CONCLUSION: To our knowledge, this is the longest remission under IFN-Beta treatment ever reported in an RCC patient. We conclude that IFN-Beta should be particularly considered as a therapeutic option in the rare occasion of metastatic RCC in patients with MS.     

Adding the Female Condom to HIV Prevention Interventions for Women with Severe Mental Illness: A Pilot Test

We evaluated the efficacy of a gender-specific intervention to reduce sexual risk behaviors by introducing female-initiated methods to urban women with severe mental illness. Seventy-nine women received 10 sessions of an HIV prevention intervention or a control intervention. The primary outcome was unprotected oral, anal, or vaginal intercourse, expressed using the Vaginal Episode Equivalent (VEE) score. Knowledge and use of the female condom were also assessed. Women in the HIV prevention intervention showed a three-fold reduction in the VEE score at the 3-month follow-up compared to the control group, but the difference was not significant. These women were significantly more likely to know about female condoms, have inserted one and used it with a sexual partner at the 3-month follow-up and to have inserted it at 6 months compared to controls. The female condom may be a useful addition, for a subset of women with SMI, to comprehensive HIV prevention programs.