Donor intracranial bleeding is associated with advanced transplant coronary vasculopathy: evidence from intravascular ultrasound

OBJECTIVES: We evaluated the impact of spontaneous intracranial bleeding (ICB) in the donor on transplant coronary vasculopathy using serial intravascular ultrasound examinations. MATERIALS AND METHODS: Between January 1995 and December 2000, 72 recipients underwent cardiac transplantation from donors who had experienced spontaneous ICB (ICB group). Their findings using serial intravascular ultrasound analysis at baseline (within 1 month) and 1 year after transplantation were compared with 90 recipients who had undergone transplantation from trauma donors (trauma group). RESULTS: Compared with the Trauma group, the ICB group showed increased coronary intimal thickness (0.55 +/- 0.33 vs 0.39 +/- 0.3 mm; P = .034), plaque volume (3.84 +/- 2.5 vs 2.28 +/- 1.65 mm(3); P = .015) and plaque burden (7.4 vs 2%) at 1 year after transplantation. CONCLUSIONS: Donor spontaneous ICB is associated with significantly increased coronary vasculopathy.     

Enhanced proliferation, attachment and osteopontin expression by porcine periodontal cells exposed to Emdogain

Emdogain^® (EMD) is an enamel matrix derivative extracted from developing porcine teeth with demonstrated periodontal regenerative potential. EMD has been shown to influence a number of properties of periodontal ligament cells including proliferation, cell attachment and matrix synthesis. To date, the effect of EMD on the epithelial cell rests of Malassez (ERM) is unknown.

In this study, periodontal ligament fibroblasts, ERM, alveolar bone cells and gingival fibroblasts were obtained from porcine periodontal ligament, alveolar bone and gingiva. This study investigated, in vitro, the effect of EMD at three concentrations on proliferation, cell attachment and expression of mRNA for two mineralised tissue-related proteins (osteopontin and bone sialoprotein).

As for other periodontal cells, the ERM proliferative response was enhanced by EMD. Attachment assays revealed a highly significant increase for ERM and gingival fibroblasts after EMD treatment at all concentrations. This study has also shown that EMD stimulated expression of osteopontin mRNA by ERM and alveolar bone cells.

The results from this study provide evidence that EMD enhanced cellular events related with proliferation, attachment and osteopontin mRNA expression by porcine periodontal cells, in a manner consistent with its role in periodontal regenerative therapy.     

PIC9 The Economic Impact of a Drug Information Service

OBJECTIVE: A cost-avoidance model was developed to determine potential cost savings (PCS) of a drug information service (DIS) that results from answering a drug information request.
DESIGN: Patient-specific questions received by the drug information service were reviewed and evaluated. A panel determined whether or not appropriate drug therapy would have been employed if the DIS had not been consulted. Potential outcomes of drug information requests were classified using a decision-tree model. A severity rating with potential cost avoidance was then attached to each applicable request to predict PCS of the DIS.
RESULTS: Seventy-seven of the 570 drug information responses in the six-week study period had assessable PCS to the institution. During the study interval, PCS were estimated to be $196,000. Projected to one year, PCS reached $1.7 million. Of the savings noted, most were in the categories of increased monitoring and additional treatment. Annual PCS using a sensitivity analysis ranged from $423,601 to $1,922,560 per year.
CONCLUSIONS: This model demonstrates that the DIS at our institution does provide substantial cost avoidance. This model may be modified to evaluate PCS in other areas of pharmacy practice.     

Complications of epilepsy and a ruptured pyonephrosis: Radiology to the rescue in the Brooks murder case

A woman and her lover were accused of murdering the woman's husband. Five weeks after fracture/dislocations of both shoulders and a central fracture/dislocation of the right hip were diagnosed the woman's husband died of septicaemia consequent on a ruptured infected hydronephrosis. The shoulder and hip injuries and the ruptured hydronephrosis were attributed to a beating with a blunt instrument. A review of the medical records of the deceased, particularly his radiological examinations, led the authors to conclude that his joint injuries and ruptured kidney were not due to the alleged assault. The joint injuries were the consequence of epileptic seizures and the ruptured kidney was also due to natural causes. These medical opinions provided evidence that led to acquittal of the accused.