Thrombelastographic measures of clot propagation: a comparison of alpha with the maximum rate of thrombus generation.

The alpha angle alpha (degrees) is a thrombelastographic measure of clot propagation. A parametric measurement of clot propagation [maximum rate of thrombus generation (MRTG), dynes/cm2 per s], however, has recently been utilized. Thus, the relationship of changes in alpha with changes in MRTG were determined. alpha and MRTG values obtained from 859 thrombelastograms was collected from nine studies. Data were analyzed and the relationship between alpha and MRTG defined with commercially available software. Additional comparisons were made retrospectively from whole-blood and plasma data obtained from 33 normal individuals. Data from the nine studies demonstrated that MRTG increased in an exponential fashion compared with increases in alpha (R2 = 0.88, P < 0.001). Whole-blood alpha values were in the range 66.7-74.7 whereas MRTG values were 5.5-10.8, and plasma alpha values were 65.1-77.9 with corresponding MRTG values of 3.5-12.0. Assessment of clot propagation utilizing MRTG provides a more parametric evaluation than the determination of alpha. While normal alpha values may vary by only 12-20%, MRTG values vary by approximately 200-300%. The MRTG should be progressively utilized to a greater extent in both laboratory and clinical settings to parametrically quantify clot growth kinetics with thrombelastography.     

Postantibiotic effect of clarithromycin alone and combined with ethambutol against Mycobacterium avium complex.

The postantibiotic effect (PAE) of clarithromycin alone and in combination with ethambutol was determined for two clinical blood isolates of Mycobacterium avium complex. An average PAE, ranging from 5.5 to 18.0 h, was noted for each isolate at each clarithromycin concentration except when isolate B was exposed to clarithromycin at the MIC. The addition of ethambutol did not enhance the PAE observed with clarithromycin alone. The clinical implications of the PAE of clarithromycin for M. avium complex remain to be determined.     

A study comparing biopharmaceutic characteristics of four once daily controlled release diltiazem preparations

Summary— In the present study we have compared the steady state biopharmaceutic characteristics of four diltiazem once daily controlled release capsules: Mono-Tildiem LP 300® (300 mg), Adizem® XL (300 mg)¹, Cardizem® (300 mg) and Dilacor® (240 mg). Sixteen healthy male volunteers (aged 22.9 ± 3.3 years, range 19–31 years) completed an open label, multiple oral dose, randomized, four-period crossover study without a washout period in between. The volunteers received each diltiazem formulation once daily for four days. Trough diltiazem and metabolites plasma concentrations were determined on days 3 and 4. The 24-h plasma concentration-time profiles were assessed after the dose on day 4 of each period. The following steady state pharmacokinetic parameters for diltiazem were calculated: the minimum plasma concentration (c_min), the maximum plasma concentration (c_max), the time to reach that concentration (t_max), the time interval during which the plasma concentration exceeds 50% of c_max (t₅₀), the area under the plasma concentration-time curve (AUC_72–96) and the peak-to-trough fluctuation (PTF). For the metabolites of diltiazem, N-mono-desmethyl-diltiazem (NDM) and desacetyldiltiazem (DAD), AUC_72–96 (AUC_NDM and AUC_DAD) and the ratio metabolite/parent compound were calculated. Steady state was achieved on day 3. Except one, all controlled release formulations have satisfactory controlled release properties allowing once daily administration. However, significant (P < 0.05) differences were found between the pharmacokinetic characteristics which do not allow exchange of the various formulations. Concentrations well below 50 ng·mL^-1 in the morning hours were observed for Dilacor® (240 mg) and Adizem® XL (300 mg), which could be a disadvantage of these formulations as it is well-known that ischaemic events occur at a higher rate during that part of the day. The plasma concentration profiles of NDM and DAD, the major circulating metabolites, parallel the plasma concentration profiles for the parent compound. From a clinical point of view, all treatments were well tolerated.     

Platelet 3H-imipramine binding during recovery from depression.

Decreased binding of tritiated imipramine to platelets has been considered to be a potential biological marker of depression. However, it has been unclear how binding values alter during treatment and recovery. This study investigated imipramine binding parameters and depressive symptoms in 25 patients suffering from major depression at entry to the study and 1, 3 and 6 months later. Although the initial Bmax values were significantly lower in the depressed patients than in healthy subjects, it was not possible to establish a clear relationship between recovery from depression and Bmax. The power of this study to detect an effect of at least 10% of the variance in Bmax due to factors related to recovery from depression was 0.78.     

WHO SPEAKS? WHO LISTENS? DIFFERENT VOICES AND DIFFERENT SEXUALITIES

ABSTRACT Psychoanalytic theories of sexuality have regarded homosexuality as a symptom of arrested sexual development. Such theorizing fails to acknowledge the prejudicial values that underpin it. The work of the philosopher, Michel Foucault, can offer psychotherapists new possibilities of considering sexual orientation that do not presuppose a split between the psychic and the socio-political. The complexity and diversity of lesbian roles, identities, experiences and cultures are particularly highlighted by Audre Lorde (a Black lesbian feminist theorist). The two cases illustrate how a Foucauldian analysis, combined with a psychoanalytic approach, can enable us to respond more sensitively to questions of identity in our work with patients.     

Disseminated migratory osteoporosis: an unusual pattern of osteoporosis

Regional migratory osteoporosis (RMO) is a well-defined clinical entity, consisting of migratory osteoporosis involving the lower extremities with associated radiographic changes. Idiopathic osteoporosis (IO) is considered to be a separate and distinct entity, occurring in young adults and consisting of axial osteoporosis and back pain. We describe a patient who had hybrid characteristics, both clinically and radiographically, and include iliac-crest biopsy histologic correlation. We believe that this pattern of osteoporosis in many ways resembles RMO, but with severe axial involvement; hence the term disseminated migratory osteoporosis.