Human thrombi contain an abundance of active thrombin.

This study assessed the abundance and activity of thrombin in human thrombi. removed at autopsy or during surgery. Arterial and venous thrombus sections showed thrombin activity by in situ zymography, based on conversion of fibrinogen to fibrin. Hirudin or antibodies to thrombin abolished the activity. Thrombin activity in extracts of 40 thrombi was quantified by cleavage of fibrinogen or small peptide substrates: the results correlated well (r = 0.87, p<0.0001) with a median activity of about 4.5 IU/g of thrombus (wet weight). Activity correlated poorly with total prothrombin (median 27 microg/g) and was inversely related to antithrombin, but not to PAI-1. Zymography showed two major active bands, thrombin at 37 kDa, and a 50 kDa form that probably corresponds to meizothrombin desF1. The abundant local thrombin demonstrated here has implications for thrombus lysis and extension: incomplete lysis and exposure of active thrombin may lead to re-occlusion of vessels.     

‘That thing in his head’: Aboriginal and non-Aboriginal Australian caregiver responses to neurodevelopmental disability diagnoses

Little is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non-Aboriginal caregivers’ experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children’s diagnosis and ongoing management in the context of their family networks and community. In contrast, non-Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers’ engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well-established effects of medical dominance over the process of defining a person’s capacity and status.     

Does idiopathic parkinsonism in Aberdeen follow intrauterine influenza?

A study is presented which fails to replicate a recent report that peak years of birth of patients later developing Parkinson's disease are related to the influenza pandemics of the period 1890-1930. The years of birth of a whole population cohort of 243 patients suffering from Parkinson's disease examined in Aberdeen in 1983 and reexamined in 1986/7 were compared with deaths due to influenza in the City of Aberdeen in the years 1900-1930. Although a significant peak of Parkinson births (compared with the age profile of the Aberdeen population in 1983) occurred in 1902, there appeared to be no systematic relationship between Parkinson births and influenza deaths. In addition, no season of birth effect could be detected in a comparison with 232 matched controls. The presence of peaks of birth years, for whatever aetiological reason, is of significance to epidemiological studies in that prevalence estimates may be influenced by the year of study relative to these mini-cohorts.     

7-Ethoxyresorufin deethylase (EROD) in human liver —The effect of alcoholic liver disease

Summary We have investigated the effect of alcoholic liver disease (ALD) on the metabolism of 7-ethoxycoumarin 0-deethylase in human liver microsomes. EROD activity was significantly reduced in tissue from ALD patients who smoked, compared to smoking controls. A similar trend was seen in non-smokers. These results have implications for the metabolism of environmental carcinogens.     

Paraganglioma of the vagina: report of a case, including immunohistochemical and ultrastructural findings.

Paragangliomas are uncommon neoplasms of the female genital tract, with fewer than 15 reported cases arising from the uterus, ovary, vagina, and cervix. Three of these tumors presented in the vagina. This report describes the authors' experience with a paraganglioma of the vagina in a 24-year-old woman that presented as an asymptomatic mass. The histologic features in the initial biopsy proved again that the paraganglioma may be confused with other vascular neoplasms. The clinical course after the biopsy implied that this neoplasm had been awakened from its functionless dormancy.     

Epidural Anesthesia and Acutely Increased Intracranial Pressure: Lumbar Epidural Space Hydrodynamics in a Porcine Model

Background: The effects of epidural injection on intracranial pressure (ICP), lumbar epidural pressure, cerebral blood flow (CBF), and spinal cord blood flow (SCBF) were studied after acutely increased ICP in swine.

Methods: Twenty pigs, anesthetized with isoflurane and mechanically ventilated to maintain normocarbia, had two Tuohy needles placed in the lumbar epidural space. The ICP, lumbar epidural pressure, heart rate, mean arterial pressure, and central venous pressure were monitored. All animals had a Fogarty catheter placed in the parietal epidural space. Six pigs were randomized to a normal ICP group (group N) and eight pigs to an increased ICP group by inflation of the Fogarty catheter balloon (group R). Each pig had 0.33 ml [centered dot] kg sup -1 of 2.0% carbonated lidocaine injected over 20 s via an epidural needle placed at L3. The ICP and lumbar epidural pressure were then monitored continuously for 30 min. Pressure-time data were fit to traditional compartmental models. Epidural elastance and resistance were calculated using a derivation of the Windkessel theory. An additional six pigs had ICP elevated as in group R and CBF and SCBF measured using radioactive microspheres at five time periods: baseline, 0-60 s, 100-160 s, 200-260 s, and at 30 min after epidural injection.

Results: The animals did not differ with respect to heart rate, central venous pressure, or mean arterial pressure at baseline. The ICP was 10 +/- 2 mmHg in group N, and 24 +/- 2 mmHg after balloon inflation in group R. After epidural injection, peak ICP was significantly greater in group R (76 +/- 22 vs. 54 +/- 17 mmHg) but not different by 30 min (17 +/- 5 vs. 11 +/- 1 mmHg). Epidural elastance in group N was 8.3 +/- 3.1 mmHg [centered dot] ml sup -1 and 12.8 +/- 3.0 mmHg [centered dot] ml sup -1 in group R (P = 0.045). Epidural resistance was 1,330 +/- 590 mmHg [centered dot] s [centered dot] ml sup -1 in group N and 2,220 +/- 600 mmHg [centered dot] s [centered dot] ml sup -1 in group R (P = 0.038). The CBF and SCBF were less than 10% of baseline during the 0- to 60-s time period after epidural injection. Thereafter, CBF and SCBF did not differ from baseline values.     

Is it a Hypo? Knowledge of the Symptoms of Hypoglycaemia in Elderly Diabetic Patients

Knowledge of the symptoms of hypoglycaemia was assessed in 161 elderly diabetic patients using insulin or a sulphonylurea. Nine percent knew no symptoms. Patients on insulin and those with poorer control had significantly greater knowledge (p<0.01). Those reporting episodes of hypoglycaemia had significantly greater knowledge of some symptoms. Knowledge decreased with age, but was not related to sex, duration of diabetes or living alone. Patients and relatives had similar knowledge and education of both needs to be improved.     

Obtaining parental consent--opting in or opting out?

In a population based project aimed at identifying children with specified disabilities within a health region, there was, rightly, concern about the transfer of data on named children across health district boundaries. Two methods of obtaining parental consent for this process were tested. High recruitment rates were achieved using an ''opting out'' approach.