Management of unstable angina

One-hundred and seven patients with unstable angina were treated between 1981 and 1987. Platelet dysfunction and elevation of fibrinogen was observed. The efficacy of aspirin, dipyridamole and heparin on coagulation profile is compared. Left main disease was seen in 11.4 per cent. Left anterior descending was occluded in 90.7 per cent. Aortocoronary bypass graft using saphenous vein graft was carried out on all patients. On an average, each patients received 3.5 grafts. Emergency surgery was done in nineteen. Associated ventricular aneurysm was resected in nine. Thirteen patients died. Operative mortality decreased to nil in 1986–1987. Perioperative infarction was seen in five patients. Clinical improvement was seen in 80.3 per cent and 48.9 per cent were asymptomatic. Actuarial survival was 92 per cent after six years. Postoperative coronary angiography in 28 patients showed patency of grafts in 18, partial patency in six and occlusion in four. Aspirin was found useful after surgery to relieve angina. Spiroergometry and Thallium²⁰¹ scintigraphy was useful to assess medical and surgical treatment.     

Orally active beta-lactam inhibitors of human leukocyte elastase-1. Activity of 3,3-diethyl-2-azetidinones.

A thorough analysis of the mechanism of inhibition of human leukocyte elastase (HLE) by a monocyclic beta-lactam and the mechanism of beta-lactam hydrolysis led to the preparation of potent and highly stable inhibitors of HLE. This work led to the identification of 4-[(4-carboxyphenyl)-oxy]-3,3-diethyl-1- [[(phenylmethyl)amino]carbonyl]-2-azetidinone (2) as the first orally active inhibitor of human leukocyte elastase (HLE). Analogs of 2 with different substituents on the urea N were synthesized and evaluated for their activity in vitro against HLE as well as in vivo in a hamster lung hemorrhage model. Compounds with a methyl or a methoxy group in the para position of the benzene ring were very potent in both assays. The results are discussed on the basis of the proposed model for the binding of this class of inhibitors to HLE and a possible mechanism of inhibition is presented.     

Incidence of three sexually transmitted diseases during a safer sex promotion program for HIV-infected women

Promotion of safer sex practices typically includes education, skills building, and condom distribution. To evaluate the impact of such promotions and describe risk factors for sexually transmitted disease (STD), a retrospective review of 741 sexually active HIV-infected women was conducted. The cohort was African-American (82%), at least 22 years of age (81%), acquired HIV through sex (36%), had a CD₄ count above 200/ mm³ (76%), and had a history of substance (alcohol or drug) use (38%). Those with incident STD (14.7%) were more likely to be under 22 years of age, to have a history of substance use, and to have an STD at entry. Traditional methods of promoting safer sex practices should be enhanced by other options such as regular screening, partner treatment, and the use of microbicides and other female-controlled methods. Received from the Department of Medicine, Louisiana State University, New Orleans.     

Free‐breathing cardiac MR with a fixed navigator efficiency using adaptive gating window size

A respiratory navigator with a fixed acceptance gating window is commonly used to reduce respiratory motion artifacts in cardiac MR. This approach prolongs the scan time and occasionally yields an incomplete dataset due to respiratory drifts. To address this issue, we propose an adaptive gating window approach in which the size and position of the gating window are changed adaptively during the acquisition based on the individual's breathing pattern. The adaptive gating window tracks the breathing pattern of the subject throughout the scan and adapts the size and position of the gating window such that the gating efficiency is always fixed at a constant value. To investigate the image quality and acquisition time, free breathing cardiac MRI, including both targeted coronary MRI and late gadolinium enhancement imaging, was performed in 67 subjects using the proposed navigator technique. Targeted coronary MRI was acquired from eleven healthy adult subjects using both the conventional and proposed adaptive gating window techniques. Fifty‐six patients referred for cardiac MRI were also imaged using late gadolinium enhancement with the proposed adaptive gating window technique. Subjective and objective image assessments were used to evaluate the proposed method. The results demonstrate that the proposed technique allows free‐breathing cardiac MRI in a relatively fixed time without compromising imaging quality due to respiratory motion artifacts. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

Blood warming: current applications and techniques

Active blood warming is a recent practice and arises out of conflicting needs. On the one hand, the safety and preservation of blood require refrigerated storage and delivery up to the moment of transfusion. On the other hand, modern methods of very rapid transfusion in resuscitation would cause clinically dangerous hypothermia if unmodified, ice-cold blood were to be so transfused. These needs must be reconciled in the interest of adequate patient care--hence the need for blood warming. Nevertheless, blood warming creates risks of its own and should not be used without justifying clinical indications. Within limits that extend somewhat above normal body temperature, the application of heat does no harm to stored RBC, a fact that is not reflected in current standards for blood warmers. Bearing in mind the human tendency to "stretch" standards and the fallibility of mechanical devices, caution is always wise. But perhaps the time has come for reconsideration of the present upper limit of 38 degrees C. Many varieties of blood warmers are available in the US, but none at this time is based on electromagnetic activity. The most common systems now in use are in-line warmers, most of which are not adequate for the type of rapid-transfusion systems currently available. Countercurrent in-line blood warmers and the method of rapid warm saline admixture can both be used successfully for rapid, massive transfusions. Blood warming is seldom necessary or desirable for elective transfusions at conventional rates, even for patients with cold autoagglutinins.     

Red cell tolerance of admixture with heated saline

Red cell stability in the face of thermal stress has been evaluated only in the setting of prolonged incubation. This study was conducted to determine red cell tolerance of rapid mixture with heated saline, which exposes red cells to heat only until thermal equilibration, which is a matter of seconds. Half-units of 35-day-old red cells stored in CPDA-1 were mixed at 6 to 10 degrees C in the blood container with an equal weight of 60, 70, or 80 degrees C saline. This resulted in mean mixture temperatures of 30.9, 37.5, and 42.6 degrees C, respectively. Controls consisted of the same mixture, but with 6 to 10 degrees C saline. The red cells in the mixtures were assessed for osmotic fragility, and the supernatant was examined for plasma hemoglobin and potassium. Neither osmotic fragility curves nor supernatant hemoglobin or potassium changed significantly with saline temperatures of 60 or 70 degrees C. When 80 degrees C saline was used, osmotic fragility, supernatant hemoglobin, and potassium all increased significantly (p less than 0.01) over control values. Red cells tolerate rapid mixture with 70 degrees C saline without hemolysis or change in osmotic fragility.     

The effect of the hurricane Katrina disaster on sexual behavior and access to reproductive care for young women in New Orleans

OBJECTIVE: The Hurricane Katrina disaster caused rapid displacement of over a million persons in metropolitan New Orleans. The purpose of this study was to describe changes in sexual behavior and access to reproductive care pre- and postrapid displacement among a cohort of young women receiving family planning services before displacement. METHODS: Women 16 to 24 years old, who were attending 2 public family planning clinics and enrolled in a vaginal douching prevention study, were located 5 to 6 months after Katrina and interviewed by telephone to elicit information about sexual behavior and access to reproductive care. RESULTS: Women who were located were interviewed (N = 55). Of these, 96% were black, 62% were employed before the disaster, and the mean age was 22.1 (SD 2.1). In the 5 to 6 months after disaster, 86% lived in 3 or more places, 31% had returned to New Orleans, 17% needed health care but could not access it, 40% had not used birth control, and 2 (4%) experienced an unintended pregnancy as a result of lack of access to care. When compared with baseline, after the hurricane, women were less likely to have attended family planning services, to have used birth control, to have >1 sex partner, to have a vaginal odor or discharge. CONCLUSION: Relief efforts for disasters causing rapid displacement of impoverished women should include reproductive care such as provision of contraception, condoms, and STI services, as well as linking women back into care.