Decreased collagen-induced platelet aggregation and increased platelet arginine levels in migraine: a possible link with the NO pathway

We studied whole blood platelet aggregation induced by collagen, platelet activating factor (PAF) and measured basal platelet L-arginine (L-arg) levels, as an indirect index of the nitric oxide (NO) pathway in migraine. Migraine, both with and without aura groups, showed a reduced aggregation to collagen, but not to PAF, compared with control subjects. Platelet L-arg levels were significantly increased in migraine with aura sufferers, whereas the plasma levels were in the same range in migraineurs and controls. Platelet hyperesponsiveness to collagen stimulation in migraine may be linked to an increased availability of the amino acid precursor and an abnormal NO synthesis.     

Informed consent for intravenous contrast-enhanced radiography: a national survey of practice and opinion

A detailed questionnaire regarding the obtaining of patient consent for the administration of intravenous contrast agents was sent to 3845 radiologists in those hospitals across the United States having more than 100 beds. The results represent the current community practice and opinion of the 1547 radiologists (40%) who answered. They showed that 66% of respondents obtained no type of informed consent before injecting intravenous contrast agents. Half of those who did obtain consent did not inform their patients of possible specific major adverse reactions. Half of those who did not obtain consent believed the risk of adverse reaction was remote. Another 40% believed the consent procedure might heighten anxiety and, therefore, increase the risk of reaction. Obtaining informed consent, however, was not significantly associated with an increased incidence of major reactions. Since 8% of the respondents indicated some involvement in malpractice lawsuits regarding the question of informed consent for various procedures, the obtaining of informed consent might lessen the risk of exposure to malpractice litigation. Additional results showed that written consent did not appear to lessen the number of studies performed and that it offered more specific information to the patient regarding complications. Finally, most radiologists (80%) requested a specific policy regarding informed consent from at least one of the following organizations: the American College of Radiology (ACR) (96%), the Radiological Society of North America (RSNA) (26%), state chapters of the ACR (15%).     

SOME EFFECTS OF PROTEOLYTIC INHIBITORS ON TISSUE INJURY AND SYSTEMIC ANAPHYLAXIS

A study was made of the development of various forms of local and systemic injury in animals treated with inhibitors of proteolytic activity. The agents used were tosylarginine methyl ester (TAME), epsilon aminocaproic acid (EACA), and soybean trypsin inhibitor (SBTI). 1. Hemorrhagic necrosis in the skin of the rabbit following intradermal epinephrine in combination with bacterial endotoxin (either intravenous or local) was clearly suppressed by EACA, TAME, and SBTI, given systemically. Tosylarginine (TA) was ineffective. 2. No effect was observed on the classical Shwartzman reaction, the local Arthus phenomenon, or inflammation induced by xylene. 3. The lethal effects of systemic anaphylaxis in the mouse, acute endotoxemia in the rat and mouse, and drum shock in the rat are suppressed by EACA and TAME. 4. There was no effect on the generalized Shwartzman phenomenon in the rabbit and on anaphylaxis in the guinea pig. 5. The effects of EACA or TAME on the injury reactions under investigation were not due to a pharmacological or chemical action on vascular behavior per se. 6. The data provide corroborative evidence for a proteolytic step in injury phenomena which may be mediated through some common activation system. 7. The working hypothesis is advanced that local or systemic stress through the release of epinephrine may result in an increase of a circulating activator of proteolysis and that this in turn may give rise to the release of vasoactive substances,—possibly histamine, serotonin, or a polypeptide.     

Heartburn in pregnancy

Summary Half of pregnant women have heartburn during pregnancy. Most primaparas and some multiparas are spontaneously relieved in the last weeks as the uterus descends, but all are invariably relieved immediately after delivery. The heartburn is a newly experienced burning sensation of variable severity in the throat or substernal region, frequently radiating from one area to the other.One-third of the women developed heartburn in the first 4 months of pregnancy; this appeared to be associated with psychic factors and was particularly resistant to antacid therapy. A neuromuscular mechanism is an attractive but unproved explanation. The character of heartburn in late pregnancy is different; clinical and objective evidence suggests that acid reflux is a mechanism, and antacids are effective. There is no evidence suggesting that neuromuscular dysfunction of the esophagus is involved.The authors wish to thank Drs. Lee Buxton and C. Davis of Yale's Department of Obstetrics and Gynecology for their cooperation and advice during the study reported here.The research described in this article was supported in part by grants C-2578. A-1785, and A-3473 from the U. S. Public Health Service and the Norwich chapter of the Connecticut Heart Association.     

Measuring feminine gender identity in homosexual males

The appropriateness of measuring femininity in homosexual males by means of the usual masculinity-femininity tests is questioned. It is felt that what was called by earlier observers femininity or effeminacy in males was mainly or solely feminine gender identity (F.G.I.), whereas the masculinity-femininity tests currently used in measuring femininity with males embrace a wider area of differences between males and females than that of gender identity proper. An attempt was made to arrive at a more appropriate scale by first assembling a nucleus of F.G.I. items of high clinical face validity which later could be extended by adding items strongly correlated with this nucleus. The degree of F.G.I. was assessed by means of this scale in transsexual and nontranssexual androphiles (homosexual males who erotically prefer mature partners) and heterosexual control subjects. Results showed that transsexual and heterosexual males were discriminated by F.G.I. scores without any overlap, while nontranssexual androphiles' scores overlapped heavily with those of the controls and only slightly with those of the transsexual males.This study was supported by a grant from the Clarke Institute of Psychiatry Research Fund.