Coronary Artery Thrombosis Developing during Angiography

ABSTRACT A case of coronary thrombosis developing during coronary arteriography is described. In spite of obstruction of a main coronary artery, only a small myocardial infarction developed. Increased coagulability probably contributed to the thrombus formation.     

ISOLATION OF CYTOMEGALOVIRUS FROM THE BLOOD LEUCOCYTES OF A PATIENT WITH POST-TRANSFUSION MONONUCLEOSIS

Cytomegaloviæmia was demonstrated in an adult female patient who was suffering an episode of post-transfusion mononucleosis, as a consequence of the administration of a large volume of fresh blood. The primary nature of this infection was confirmed by demonstration of a complement-fixing antibody rise during the course of the illness to a final titre of 1 : 512. The virus was isolated from unpurified blood leucocytes, and again one week later from purified blood lymphocytes. Although a newly acquired infection with cytomegalovirus (CMV) has been demonstrated in this case, its ætiological role cannot be confidently assessed. The likely source of the virus is regarded as being one or more of the blood donors, and the possibility of a primary infection or a reactivation of a latent infection has been considered. Antibody titrations were carried out on eight sets of stored sera from patients with post-transfusion mononucleosis. Four of these showed a significant rise in antibody titre and only one set gave negative results. These results are consistent with the CMV infection having occurred in seven of these patients at the time of their episode of pest-transfusion mononucleosis. The suggestion is made that a revision of the criteria for the utilization of fresh blood for certain groups of patients may become necessary.     

PREMEDICATION WITH SLOW RELEASE MORPHINE (MST) AND ADJUVANTS

Sixty-one women undergoing major gynaecological surgery receivedslow release morphine (MST) 60 mg, with placebo, hyoscine 0.6mg or diazepam 10 mg, by mouth 2 h before sugery. Plasma morphineconcentrations reached a steady level usually within 3 h afteradministration of MST, and did not increase after surgery unlesssupplementary opioid was given. Hyoscine delayed morphine absorption.Before operation no fewer than 50% of patients were sedatedafter MST alone, but this increased to 85% after MST and diazepam.Similarly, only the combination MST and diazepam produced anxiolysis.Postoperative mood was unhappier after MST and hyoscine. Emesisoccurred in 40–57% of patients, and was not reduced byhyoscine. Therefore premedication with MST alone did not producereliable sedation or anxiolysis. A combination of hyoscine andMST premedication cannot be recommended, as it did not producesedation, anxiolysis or antiemesis and may have delayed morphineabsorption.     

Synthesis of side-chain to side-chain cyclized peptide analogs on solid supports

Cyclic peptide structures of the type -Lys-R₁—R_n-Glu- can be synthesized on the Merrifield resin by assembling the peptide chain using Nα-Fmoc-amino acids and Boc and tert.-butyl protection for the side-chains of Lys and Glu, respectively. If residues R₁ to R_n contain side-chain functional groups, TFA-resistant protection is required. After TFA treatment cyclization on the resin can be performed with appropriate coupling reagents. The formation of such cyclic structures may be preceded or followed by peptide chain assembly using Nα-Boc-amino acids and the entire peptide chain containing the cyclic portion is finally cleaved by HF treatment. Using this principle we synthesized the following opioid peptide related cyclic analogs: H-Tyr-d -Lys-Gly-Phe-Glu-NH₂ (I), H-Tyr-Lys-Gly-Phe-Glu-NH₂ (II), H-Tyr-d -Lys-Phe-Glu-NH₂ (III), H-Tyr-d -Glu-Gly-Phe-Lys-NH₂ (IV), H-Tyr-d -Glu-Phe-Lys-NH₂ (V), H-Tyr-d -Orn-Gly-Glu-NH₂ (VI) and H-Tyr-d -Ala-Lys-Phe-Glu-NH₂ (VII). Cyclic monomers were obtained in all cases, as demonstrated by mass spectrometry. Analysis of side-products revealed a slow-down of the HF deprotection of O-benzylated tyrosine as a consequence of hydrophobic interactions as well as the formation of a side-chain-linked antiparallel cyclic dimer in the case of compound VI. In conclusion, the described method permits the convenient preparation of peptide analogs cyclized via amide bond formation between side-chain amino and carboxyl groups in reasonable yield.     

An Accelerated Hemostasis Protocol following Transradial Cardiac Catheterization Is Safe and May Shorten Hospital Stay: A Single‐Center Experience

Introduction: Hemostasis following transradial cardiac catheterization is achieved by external pressure application using various devices, TR Band? being one. There is no standardized protocol for the application and removal of such devices. Objective: To assess the safety and feasibility of a more rapid (1 hour) initiation of TR Band? removal ([time to wean] TTW1) compared to a recommended 2 hour protocol (TTW2) in a controlled prospective study. Methods: 100 consecutive outpatients undergoing diagnostic transradial cardiac catheterization prospectively underwent an accelerated initiation of post‐procedure TR Band? removal (TTW1 group). The controls were a random historical cohort of 25 patients who had the conventional 2 hours to wean approach (TTW2). Results: The mean age was 62 years with a mean BMI of 29 kg/m²; 51% were hypertensive and 9% were on warfarin anticoagulation. As defined, the median times to TR Band? weaning were 60 minutes and 120 minutes for TTW1 and TTW2 groups, respectively, p < 0.001. TTW1 patients had more oozing leading to insignificant delay in the weaning process (16% vs 4% in the TTW2 group, p = NS). The total time, however, from TR Band? application to removal was significantly shorter in the TTW1 group compared to TTW2 (median of 120 minutes [mean 127] vs 180 minutes [mean 187], p < 0.001). There were no differences in any prespecified complications. Conclusion: A rapid 1‐hour commencement of TR Band? weaning following transradial diagnostic cardiac catheterization appears to be safe. It shortens the overall device removal time and may shorten hospital stay in day‐case procedures.     

DETECTION OF ABNORMAL E-CADHERIN EXPRESSION BY SIMULATED PROSTATE BIOPSY

Purpose

Sampling error is an inherent problem of prostate biopsy. Consequently the determination of whether a given carcinoma is clinically significant based on biopsy results is problematic. We assess the dimensions of sampling error and, thereby, provide insight into the potential value of prognostic markers applied to needle biopsies.

Materials and Methods

We constructed 3-dimensional computer models of 21 prostatectomy specimens, including outlines of carcinomas, regions of abnormal E-cadherin expression and individual Gleason patterns. The 6 random systematic core biopsy technique and modifications were simulated using a computer algorithm.

Results

In 6 of 21 cases the area of abnormal E-cadherin expression and/or high grade carcinoma was not sampled on 6 random systematic core biopsy. The areas missed were either small or inconsistently under sampled regions of the prostate. Modifying the placement of biopsy needles improved the detection of these features. In addition, percent tumor in the needle appeared to be well correlated to percent tumor in the prostate (r = 0.891, r (²) = 0.642).

Conclusions

To avoid underestimating the aggressiveness of prostatic carcinoma at least 6 biopsies should be taken from each patient. A more extensive sampling is probably not warranted in all patients but it may prove useful in those in whom extent of disease is unclear or whose general health makes treatment decisions difficult. A reliable estimate of tumor volume in the prostatectomy specimen can be made based on relative amount of tumor in the biopsy specimen on an individual basis.     

A more efficient biofeedback procedure for the treatment of nocturnal bruxism

This study describes a novel approach in the use of a conditioning procedure for the treatment of nocturnal bruxism. The effectiveness of the procedure is demonstrated through its application with two nocturnal bruxists in controlled case study designs. Subject 1 received several variations of this procedure and the results indicated that using a loud tone which she manually reset after awakening was the most effective approach to this treatment. The second study was designed to compare the effectiveness of relaxation training to the conditioning technique. Subject 2 failed to show any decrease in her bruxing behaviour when taught relaxation. However, she showed immediate decreases in both frequency and duration of bruxing responses when treated with the biofeedback procedure. The need for future research in this area is discussed with emphasis on the development of low cost, home treatment units.     

LONG-TERM TREATMENT RELATED COMPLICATIONS OF BRACHYTHERAPY FOR EARLY PROSTATE CANCER: A SURVEY OF PATIENTS PREVIOUSLY TREATED

PURPOSE: We determined long-term symptoms in patients after brachytherapy (radioactive seed implantation) for early (nonmetastatic) prostate cancer. MATERIALS AND METHODS: We performed a cross-sectional survey of 105 (80% of those contacted) men treated at least 2 years 9 months (median 5.2 years) previously with brachytherapy alone (72 patients) or brachytherapy plus external beam radiation therapy (33) at a pioneering referral center for ultrasound guided brachytherapy. RESULTS: Median patient age was 70 years at treatment and 75 years when surveyed. Bowel symptoms were uncommon (range 4% to 9%) unless patient had also received external beam radiation therapy. Urinary incontinence occurred in 45% of men, although leakage of more than a few drops, daily leakage and wearing absorptive pads occurred in 11%, 11% and 16%, respectively. Men who underwent documented transurethral prostatic resection were much more likely to report incontinence (83% versus 39%, p = 0.005) and those who underwent implantation less than 5 years earlier were less likely (33% versus 53%, respectively, p = 0.04). Complete impotence was common (50%) but impaired erections were more so (73%). Patients who received combined radiation treatment had more frequent erectile dysfunction. CONCLUSIONS: Long-term bowel symptoms are infrequent after brachytherapy alone. Urinary incontinence is common, although usually only a few drops and not daily. Erectile dysfunction, prevalent in populations of older men, was found in most men. However, because our study design precluded documenting baseline symptoms before treatment and subsequent clinical interventions, the contribution of factors other than brachytherapy is unclear. The morbidity of patients receiving more recent brachytherapy may be less.