Spontaneous coronary thrombosis following thrombolytic therapy for acute cardiovascular accident and stroke: a case study

Cardiac complications following stroke or acute cerebrovascular accidents (CVA) are common; however, many of these complications are asymptomatic and do not cause adverse cardiac effects. Symptomatic events (such as acute myocardial infarction after CVA) rarely occur and are often the result of an underlying cardiac embolic source, such as a left ventricular thrombus. We report a case of spontaneous coronary thrombosis following thrombolytic therapy for acute CVA, and discuss the implication that an underlying systemic pro-thrombotic state may predispose individuals to thrombosis in disparate vascular beds.     

severe disease complicated by osteoporosis

In this illustrative case, rheumatoid disease changed an active, self-supporting woman into a disabled, dependent and depressed person. When disease activity is continuous, early efforts to prevent severe deformity take on great urgency. It is also important to alleviate the psychosocial impact of the disease, which may well be more than even a highly motivated patient can handle alone.     

Drug Evaluation in Rheumatoid Arthritis

Pulmonary thromboembolism is an extremely common cause of respiratory distress, unremitting heart failure, and sudden death in elderly persons.     

Milrinone in heart failure. Effects on exercise haemodynamics during short term treatment.

The effects of milrinone, a new bipyridine inotropic agent, on the haemodynamic responses to treadmill exercise were studied in 12 patients with congestive heart failure. Four weeks' treatment with milrinone 20 mg daily produced an improvement in left ventricular function during exercise as reflected by significant increments in cardiac index and stroke volume index without change in pulmonary capillary wedge pressure. Systemic oxygen consumption, measured at submaximal exercise, also increased suggesting that the drug induced rise in stroke output was associated with improved skeletal muscle perfusion. Maximum exercise capacity increased. Importantly, the beneficial effects of milrinone on exercise haemodynamics and exercise tolerance were sustained throughout the four week treatment period. No drug related side effects occurred. After treatment with milrinone was stopped left ventricular function deteriorated to a level slightly, but significantly, worse than that before treatment. These observations indicate a potentially useful role for milrinone in treating heart failure.     

Glycoprotein IIb-IIIa complex and Ca2+ influx into stimulated platelets

Changes in intracellular Ca2+ concentrations [( Ca2+]i) in platelets stimulated with aggregating agents were measured with the fluorescent indicator dye quin 2. Ca2+ influx, but not intracellular mobilization, in response to adenosine diphosphate (ADP), platelet aggregating factor (PAF-acether), and sodium arachidonate was significantly inhibited by monoclonal antibodies against the glycoprotein (GP) IIb-IIIa complex; inhibition of thrombin-stimulated influx was inhibited to a lesser extent and reached statistical significance only at thrombin concentrations of 0.1 U/mL and below. Anti-GP Ib and HLA-ABC monoclonal antibodies had no effect on Ca2+ influx in response to any agonist. Thrombasthenic platelets gave normal [Ca2+]i responses to ADP and thrombin, which were not inhibited by an anti-GP IIb-IIIa antibody. It is suggested that Ca2+ influx in response to weak agonists occurs predominantly via a channel closely adjacent to the GP IIb-IIIa complex, but that higher concentrations of thrombin and A23187 also stimulate influx via another pathway.     

Abnormal clonogenic potential of T cells from multiple myeloma patients

Peripheral blood lymphocytes (PBLs) from multiple myeloma patients are defective in both proportion and absolute numbers of OKT4+ cells and have a normal proportion but reduced absolute number of OKT8+ cells. To assess the functional capabilities of the T cells in myeloma patients, we cloned the T cells in PBLs using limiting dilution conditions in which 100% of OKT4+ and OKT8+ T cells in normal PBLs are able to form a clone. In contrast, the OKT8+ cells from PBLs of five of seven multiple myeloma patients were severely compromised in their clonogenic potential; only 7% to 25% of OKT8+ T cells appeared to give rise to a clone. Clonogenic potential of the OKT4+ cells in patients was more nearly normal. Analysis of two multiple myeloma patients with abnormally low numbers of T cells in PBLs revealed the existence of abnormalities in the progenitors of T cell clones. In both patients, two to three times as many T cell clones were observed as would have been expected based on the number of PBLs cultured at limiting dilution, indicating that OKT4-8- cells in PBLs are capable of giving rise to OKT4+ and, at lower frequency, to OKT8+ clonal progeny in vitro. We conclude that purely quantitative assessment of T cell subsets should be interpreted with caution, since proportionately normal numbers of OKT8+ cells in patient PBLs are seriously compromised in their ability to give rise to clonal progeny in vitro, and since there appears to be a OKT4-8- population of T cells in PBLs that are committed to become OKT4+ or OKT8+ T cells, but are unable to do so in vivo.