ABNORMAL PROTEOLYSIS IN SICK NEWBORNS

ABSTRACT: Henriksson, P. and Ekelund, H. (Department of Paediatrics, University of Lund, Allmänna Sjukhuset, Malmö, Sweden). Abnormal proteolysis in sick newborns. Acta Paediatr Scand, 64:327, 1975–87 newborn infants were studied on their first day of life for defects in the coagulation and fibrinolytic systems. The infants were divided into two diagnostic groups, one with IRDS, the other with mixed neonatal disorders. Factor V, fibrinogen and fibrin/fibrinogen degradation products (FDP) were abnormal more often than any of the other factors examined. The presence or absence of "multiple defects" appeared to depend on the severity of the illness and its ultimate course. Thus 28% of the surviving infants or 85% of those who died had "multiple defects". The pattern of abnormalities did not differ between the infants with IRDS and those with mixed disorders. The "multiple defects" are ascribed to the following mechanisms: (1) impaired synthesis due to vitamin K deficiency and/or liver damage, (2) abnormal proteolytic activity stimulated by tissue damage and causing (a) an activation of the coagulation process (b) activation of the fibrinolytic system, or (c) of both the coagulation and the fibrinolytic systems. Differentiation between these pathways to defective haemostasis are important when deciding upon therapeutic measures in addition to the basic treatment.     

The Effect of Intravenous Injection of Purified Human Tissue Thromboplastin in Rats

As a background for the development and testing of phospholipase C in the therapy of post-traumatic and post-surgical intravascular coagulation, highly purified tissue thromboplastin was injected i.v. into rats. The levels of factor V, VII, VIII and blood platelets and the activity of the intrinsic coagulation pathway in general (the cephalin test) were followed. Histological examination of pulmonary, kidney and liver tissue was carried out. The dose-response was highly dependent on the injection rate. A marked activation of factor VII and a fall in the activities of factors V and VIII as well as in thrombocyte counts were observed. Very few or no thrombi were seen beyond the pulmonary circulation. The main changes (fibrin-containing thrombi and platelet aggregates) were observed in the lungs during the first 15 min after injection. After 15 min virtually no thrombi or platelet aggregates could be detected. The effect of tissue thromboplastin was counteracted by large doses of antithrombin III.     

Propafenone versus Disopyramide for Treatment of Chronic Symptomatic Ventricular Arrhythmias

ABSTRACT The efficacy and safety of propafenone, 150 mg four times daily, were compared with those of disopyramide, 100 mg four times daily, in a randomized single-blind, cross-over study in 38 patients with symptomatic premature ventricular complexes (PVCs). The 24-hour ambulatory ECG, employed for assessing antiarrhythmic efficacy, was analyzed blindly. The median reduction in the number of PVCs was higher with propafenone than with disopyramide (91.4% vs. 63.5%, respectively, p<0.01). A reduction of at least 80% was achieved by propafenone in 22 (59%) and by disopyramide in 16 patients (43%) (NS). Ventricular tachycardias (VTs) were abolished by propafenone in eight out of 11, and by disopyramide in five out of nine patients with VTs (NS) A possible proarrhythmic effect was seen in three patients during disopyramide and in one patient during propafenone treatment. Micturition disturbances (p<0.001) and a dry mouth (p<0.01) were more commonly associated with disopyramide than with propafenone. In conclusion, in the given dosages, propafenone was superior to disopyramide in suppressing PVCs and had fewer side-effects.     

HEART RATE AND ARTERIAL BLOOD PRESSURE DURING DIFFERENT FORMS OF INDUCTION OF ANAESTHESIA IN PATIENTS WITH MITRAL STENOSIS AND CONSTRICTIVE PERICARDITIS

Twenty-four patients about to undergo surgery for mitral stenosisor constxictive pericarditis were studied by recording intra-arterialblood pressure and heart rate continuously during the inductionperiod. In two groups of patients, narcosis was induced withthiopentone or hexobarbitone. In the third group, inductiontook place with nitrous oxide. The investigation shows that:(1) A significant increase in blood pressure occurred duringintubation in all three groups, and was most marked in the thiopentonegroup. The blood pressure returned to the initial values inthe thiopentone and nitrous oxide groups. Pronounced hypotensionappeared in the hexobarbitone group. (2) A significant increasein heart rate during intubation occurred only in the barbiturategroups. Bradycardia appeared in the hexobarbitone group. ^*Present addresses; Anaesthesia Department, East Hospital, Universityof Gothenburg, Sweden. Present addresses; Anaesthesia Department, County Hospital,Skellefteft, Sweden.     

TRYPTOPHAN METABOLISM IN ALCOHOLISM. TRYPTOPHAN BUT NOT EXCITATORY AMINO ACID AVAILABILITY TO THE BRAIN IS INCREASED BEFORE THE APPEARANCE OF THE ALCOHOL-WITHDRAWAL SYNDROME IN MEN

Tryptophan (Trp) metabolism and disposition and excitatory andother amino acid concentrations were determined in alcohol-dependentsubjects in relation to the alcohol-withdrawal syndrome (AWS).Parameters were examined in 12 alcohol-dependent male subjects,undergoing elective upper digestive tract tumour resection,and 12 age-, gender-, and medication-matched controls on threeoccasions: pre-operatively, post-operatively, and immediatelybefore (i.e. within 24 h of) the appearance of the AWS. No significantdifferences were observed between controls and alcoholic subjectson the first or second of these occasions. On the third occasion,within 24 h of the appearance of the AWS, alcoholics showeda dramatic elevation (117%) in free serum Tip concentrationand a consequent increase (111%) in the ratio of [free Trp]/[competingamino acids], which is an accurate predictor of Trp entry intothe brain. Increases were also observed on this third occasionin concentrations of total Trp (49%), cortisol (123%), and norharman(137%). Concentrations of glutamate, glycine, aspartate, serine,and taurine did not differ significantly within or between thecontrol and alcohol-dependent groups of subjects on any of thethree occasions. The possible significance of the Trp and relatedmetabolic changes in relation to the behavioural features ofthe AWS is discussed.     

One-year Sequential Follow-up of Venous Emptying Rate and Leg Temperature Profiles after Acute Deep Vein Thrombosis

Abstract. In order to study the natural course of venous flow and temperature reaction in the legs after symptomatic first episode of deep vein thrombosis (DVT), 65 patients (57 with proximal DVT) without further thromboembolic complications during the observation period were followed for 1 year by repeated plethysmography (PG) and thermography (TG). Regarding the non-invasive parameters substantial individual variations were observed during the observation period. After 1 year pathologic PG and TG were still demonstrated in 39% (I_μ (95%) = /0.43±0.05/) and 65% (I_μ (95%) = /1.18±0.11/), respectively, of the patients after proximal DVT. Only a minority of the patients were normalized permanently in both PG and TG during the first year. The high frequency of remaining venous obstruction and especially, persistent thermoactivity is notable and may be of clinical importance.     

Activities of glycolytic and citric acid cycle enzymes in oral leukoplakia

abstract — Biopsies of homogeneous leukoplakias and non-involved oral mucosa were obtained from the same patient, and buccal mucosa samples were obtained from individuals free of oral mucous membrane disease. Activities of glucose-6-phosphate dehydrogenase (G6PDH), pyruvate kinase (PK), glycerol-3-phosphate dehydrogenase (G3PDH), NAD and NADP dependent isocitrate dehydrogenases (ICDH) were quantitated in microdissected specimens of the superficial third of the epithelium. ICDH (NAD) was measured photo-kinetically with the aid of a bioluminescent system. The remaining enzymes were assayed according to the techniques developed by l owry and co-workers. The activities of G6PDH and G3PDH in non-involved mucosa of leukoplakia patients were double those of mucosa from healthy controls. The activities of PK and ICDH (NAD and NADP) in these two groups of lesion-free mucosa were similar. Non-involved mucosa differed from leukoplakias with respect to the two ICDH's. In hyperorthokeratinized leukoplakias, NAD and NADP dependent ICDH activities were decreased by 59% and 37%, respectively. The values for the two ICDH's in hyperparakeratinized lesions lay between the levels of activity in noninvolved mucosa and hyperorthokeratotic leukoplakias but did not differ significantly from either.     

Treatment of Oral Theophylline Poisoning

ABSTRACT Two patients, 15 and 20 years old, were admitted after an overdose of theophylline in a slow-release preparation. The gradual occurrence of clinical symptoms reflected the slow gastrointestinal absorption of the drug, and therefore active treatment was not started until 10 and 12 hours after intake, respectively. Peak s-concentrations were 275 and 1295 μmol/l, respectively. One patient was treated with hemoperfusion only, whereas the more severely intoxicated patient was treated with combined hemoperfusion and hemodialysis. Only about 0.2 g theophylline was eliminated by hemodialysis in this patient compared to a calculated amount of 6.9 g by hemoperfusion. Severely theophylline-intoxicated patients should be treated with supportive therapy and hemoperfusion.