Aspirin or Coumadin as the Drug of Choice for Valve Replacement with Porcine Bioprosthesis

Eight hundred twenty-four patients who had cardiac valve replacement with a porcine bioprosthesis were given either Coumadin (sodium warfarin) or aspirin. No patient in sinus rhythm no matter what valve or valves were replaced had thromboembolism whether treated with Coumadin (124 patients) or aspirin (260 patients). One hundred fifty-one patients who had mitral valve replacement, were in atrial fibrillation, and were treated with Coumadin had seven embolic events (4.6%), while 135 similar patients treated with aspirin had five embolic events (3.7%). Fifty-one patients who had double-valve replacement, were in atrial fibrillation, and were treated with Coumadin had three embolic episodes (5.9%), while 86 similar patients treated with aspirin had three embolic events (3.5%).No statistical difference was found in the incidence of thromboembolism between similar groups of patients whether treated with Coumadin or aspirin (p > 0.05). Hemorrhagic complications were higher and reached statistical significance (p < 0.001) for the group treated with Coumadin. This study shows that aspirin prevents thromboembolic complications as well as Coumadin in patients having cardiac valve replacement with a bioprosthesis, and results in a lower rate of complications.     

The effect of total enteral tube feeding on the vitamin status of malnourished patients with inflammatory bowel disease

Eight malnourished patients (5 men and 3 women, mean age 26.5 +/- 0.4 years) suffering from Inflammatory Bowel Disease were prospectively included at admission to study the effect on protein-energy and vitamin status of a specially designed enterally tube fed formula diet. Eighty nine healthy individuals (36 men and 53 women, mean age 34 +/- 2 years) were used as controls. All but one patient were on steroids. The mean caloric supply was 58.2 +/- 2.4 kcal/kg/day with a mean nitrogen content of 0.37 +/- 0.02 gN/kg/day. The mean Total Enteral Nutrition period lasted 20.8 +/- 2.3 days (range 12 to 28 days). Fat- and water-soluble vitamins were studied at admission and after the nutritional period. Likewise both the protein-energy nutritional status and the activity of the disease were evaluated. At admission, plasma levels of folate, biotin, beta-carotene and vitamins A, C and E were significantly lower in patients than in controls. Tocopherol/cholesterol ratio, and vitamin B1, B2, B6, and B12 status were normal. At the end, plasma values of folate, biotin and vitamin C remained unchanged. However, the protein-energy nutritional status and the activity of the disease significantly improved. At admission, 4 out of 8 patients were at risk of developing hypovitaminosis for vitamins A, C, biotin, beta-carotene, and folate. At the end, a similar percentage remained at risk for these vitamins except for vitamin A. The content of some vitamins in the best designed formula diets does not meet the needs for patients with Inflammatory Bowel Disease.     

Specific character of movement disorders in children studying string instruments]

Orthopaedic examinations were carried out in 242 children studying string instruments. Various indispositions and deformations of the motor organs were found in 31 children. It has been demonstrated that they were mainly the result of technical errors in holding of the instrument, which caused overloading of the upper extremities and the spine.