Thymopentin (TP-5) potency in vivo is enhanced by slow infusion

The in vivo activity of thymopentin in guinea pigs was assessed electromyographically 18 h after intravenous or subcutaneous injections or infusions ranging over varying periods of time. The lowest threshold dose required to establish a positive effect was obtained with a 30–60 min i.v. infusion (0.38–0.75 μg/kg) and we found that we needed X 5 times this dose with 30 min s.c. infusion, X 10 this dose with 10 min i.v. or s.c. infusion, X 200 this dose with bolus IV injection and X 400 this dose with bolus s.c. injection. The marked increase of potency of thymopentin with infusion should be considered in designing clinical regimens.     

Plasma lipids in kidney transplanted children and adolescents: influence of pubertal development, dietary intake and steroid therapy

Abstract. Plasma triglycerides and/or cholesterol were significantly increased in twenty-four of thirty kidney transplanted children and adolescents with stable renal function, at least one year after the last rejection crisis who received low dose prednisone therapy. The cholesterol increment was related to both low density and high density lipoproteins. However, similar to findings in adult allograft recipients, these increases were very variable: six subjects had normal levels, eight had increased triglycerides, five increased triglycerides and cholesterol, and eleven increased cholesterol. No influence of renal function was found in this series of patients all of whom had plasma creatinine below 160 μmol/1. Subjects who had achieved sexual development had lower cholesterol values. An insignificant difference was observed between patients receiving daily and alternate-day steroid therapy, but a significant negative correlation was found between plasma triglycerides and fractional urinary excretion of 17 OH corticosteroids in the first 6 h after an oral dose of prednisone. Finally, no correlation was found between energy intake and triglycerides; but a significant correlation was observed between protein intake and plasma cholesterol.
In conclusion, some patients show a high level of triglycerides and/or cholesterol after renal transplantation, possibly due to a different individual response to steroid therapy.     

THE CAUSES OF PATIENT DROPOUT FROM PENILE SELF-INJECTION THERAPY FOR IMPOTENCE

PURPOSE: Penile self-injection therapy, a second line treatment for erectile dysfunction, is the most efficacious means of reestablishing functional erections when first line therapies fail and the patient wants to avoid penile prosthesis implantation. Despite high efficacy rates, injection therapy has high dropout rates. To our knowledge studies to date analyzing patient attrition have reviewed small numbers of patients followed for only short periods. We elucidate the main reasons for patient dropout in a large penile self-injection program with long-term followup. MATERIALS AND METHODS: A questionnaire was mailed to 1,424 patients who completed the office training and home use phases of a penile self-injection program. RESULTS: The overall attrition rate was 31% of the 720 men who completed the questionnaire, with a mean followup of 38 months. The main reasons for dropout were cost of therapy, patient and partner problems with the concept of penile injection, lack of partner availability and spontaneous improvement in erections. Lack of efficacy of therapy was the primary reason for only 1 of 7 dropouts. Furthermore, adverse effects of penile injections (priapism, penile nodules, pain) appeared to be only minor contributors to dropout. CONCLUSIONS: To our knowledge this study is the largest published, single center cohort of patients treated with injection and followed for an analysis of dropout rates. Based on study data a reduction in dropout rates may be achieved by keeping the cost of therapy low, and ensuring patient and partner education as well as continued support throughout treatment.     

A Bayesian Meta‐Analysis Comparing AngioJet® Thrombectomy to Percutaneous Coronary Intervention Alone in Acute Myocardial Infarction

Objective: The purpose of this meta‐analysis was to compare outcomes for AngioJet thrombectomy versus percutaneous coronary intervention (PCI) without thrombectomy in acute myocardial infarction (AMI) patients. Background: PCI is the preferred treatment for revascularizing the infarct‐related artery in patients with AMI. There is controversy about the benefits of thrombectomy as an adjunct to PCI. Methods: AMI studies published between January 1, 1999, and March 1, 2007, were used to compare AngioJet thrombectomy plus PCI to PCI alone. Bayesian meta‐analytic estimates were used to estimate the odds ratios (95% CI) for short‐term mortality, major adverse cardiac events (MACE), and final TIMI 3 flow. Results: The AngioJet data included 11 studies and 1,018 patients. The PCI data included 81 studies and 24,076 patients. The AngioJet group included more patients with large thrombus burden, rescue PCI after failed thrombolytic therapy, and longer symptom duration compared to the PCI group. Despite the higher risk profile of AngioJet patients, the groups had similar odds of short‐term mortality, 0.98 (0.53, 1.50), MACE, 1.25 (0.54, 2.40), and final TIMI 3 flow, 1.12 (0.70, 2.27). Conclusion: AngioJet thrombectomy results in clinical and angiographic outcomes that are similar to PCI in lower risk AMI patients. These observations suggest that AngioJet thrombectomy may reduce the additional risk associated with visible thrombus in the infarct‐related lesion.     

A plethysmographic method for demonstrating the response specificity of the oral vascular bed

In this paper, we describe a new method for measuring the oral plethysmogram, and we assess its sensitivity and specificity under differing psychological stimulation. Finger and palate pulse amplitudes and blood pressure were monitored while individuals (N= 13) performed several tasks: mental arithmetic, nausea imagery, fear imagery, and anger imagery. Pulse pressure, having a major effect on pulse amplitude, was partialed out in analyses. Palate pulse amplitude increased significantly in response to the degree to which the individual felt irritated, judged, nauseated, or angry. In contrast, finger pulse amplitude changed significantly only in the arithmetic task and, unlike the palate, showed a decreased amplitude with increased irritation and being judged. Results indicate that the oral plethysmogram can serve as a reliable measure of oral mucosal vasomotor reactivity and that it has a different pattern of response specificity than does the finger.     

Maximal Rate of Tachycardia Development: Sinus Tachycardia with Sudden Exercise vs. Spontaneous Ventricular Tachycardia

In addition to providing basic physiologic information, knowledge of the maximal rate of sinus tachycardia development may be helpful in developing algorithms permitting new generations of antitachycardia pacemakers to distinguish accurately between sinus and ventricular tachycardia. To determine the maximal rate of sinus tachycardia development, 50 normal subjects rushed up 100 stairs as rapidly as possible, with continuous electrocardiographic monitoring. During the first second of exercise, the mean cardiac cycle length shortened from 709 to 570 ms, equivalent to an increase in heart rate from 85 to 105 beats per minute, or 20 beats per minute per second. Thereafter, a more gradual decrease in cycle length occurred. Differences between men and women, smokers and non-smokers, and sedentary compared to active subjects were all insignificant. Analysis of 50 spontaneous episodes of ventricular tachycardia also revealed a sequential but more abrupt decrease in the cycle length during the first second from 757 to 360 ms, equivalent to a rate increase from 79 to 167 beats per minute, or 88 beats per minute per second. After approximately 1 ¹/₄ seconds, the ventricular tachycardia cycle length remained virtually constant. Baseline cycle lengths were similar in the sinus and ventricular tachycardia groups, but differed in all subsequent beats, although overlap for individual subjects did occur.