Use of the platelet reactivity index by Grotemeyer, platelet function analyzer, and retention test Homburg to monitor therapy with antiplatelet drugs

In 1974, Wu and Hoak described a method for determining circulating platelet aggregates. This method was modified by Grotemeyer in 1983. The platelet reactivity index (PR) is based on the ratio of platelet aggregates in blood samples obtained in different buffer solutions. Platelet aggregates are resolved when blood is sampled in EDTA-buffer, but remain fixed when EDTA-formalin-buffer is used. Generally, the PR is preferred, because in vitro manipulations of platelets are not necessary, and the results are calculated. PR values above 1.05 are suspicious for elevated platelet aggregation. PR values above 1.2 indicate pathological changes in platelet aggregation. The PR is inexpensive (4.0 euro dollars) and rapid to perform. PR values were used successfully to identify nonresponders to secondary prophylaxis with acetylsalicylic acid (ASA), that is, patients suffering from stroke (33%) and patients after cardiac ischemia (18%). Furthermore, elevated PR values correlated significantly with the incidence of arterial thromboembolic complications. The PR correlated well in our prospective study with values received from the retention test Homburg (RT-H) and the platelet function analyzer (PFA-100). The data indicate that the values of the PR seem to be highly predictive for the evaluation of the ASA therapy. However, the PR is not feasible for the determination of the ASA overdosage.     

Resolution of a giant atrial thrombus following anticoagulation therapy

We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy, repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant therapy.     

Ectopic Adrenal Tissue in the Inguinal Region in Children

Adrenal rests are common in children and are most often found as bright yellow, retroperitoneal nodules from the diaphragm to the pelvis. They are usually incidental findings during surgery. In a 12-month period, 268 children, 18 days to 15 years (mean 3.2 years) of age, underwent 304 operations for common inguinoscrotal disorders at the Department of Pediatric Surgery, Erciyes University Medical School. There were 252 males and 16 females, (M/F 15.7:1). Ectopic adrenal tissue was found in nine males (3%). This report concerns the incidence and structure of aberrant adrenal tissue found in children during inguinoscrotal operations, including its embryology, histology, and clinical implications.     

<Emphasis Type="Bold">18th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), Crete,Greece—June 9–11, 2011</Emphasis>

Abstracts

18th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), Crete, Greece—June 9–11, 2011     

Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction

Recent evidence suggests that postischemic myocardial dysfunction (“stunning”) may be mediated by oxygen free radicals. Various studies have reported the beneficial effects of antioxidants in ischemia–reperfusion injury. The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment on oxidative stress, infarct size, and left ventricular (LV) function, as adjunct therapy in myocardial infarction (MI). Patients with acute MI received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with streptokinase. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. At admission, plasma MDA levels were not different between the groups. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with streptokinase significantly diminished oxidative stress and improved LV function in patients with acute MI. These encouraging results would justify the performance of a larger controlled study.     

Small arterial elasticity predicts the extent of coronary artery disease: Relationship with serum uric acid

BackgroundArterial elasticity has been previously linked to atherosclerotic vascular disease states. Serum uric acid level has been recently associated with increased arterial stiffness, but to what extent serum uric acid reflects angiographic coronary artery status and vessel compliance remains to be established. In this study we aimed to evaluate the association of arterial elasticity indexes, serum uric acid and the presence and extent of angiographic coronary artery disease (CAD) in patients with chronic stable angina.MethodsOne hundred and eight consecutive patients attending for elective coronary angiography were investigated. The severity of CAD was expressed using the Gensini score. Quantitative analysis of the arterial elasticity was performed by applanation tonometry. Serum uric acid was measured in all participants. Stepwise multiple linear regression analysis was used to identify the independent correlates of the Gensini score.ResultsAfter adjustment for age, gender, common cardiac risk factors and cardiovascular drugs, small artery elasticity index (SAEI) (p < 0.001) and serum uric acid (p < 0.001) were independently correlated with the severity of CAD. Stepwise multiple linear regression analysis was also used to identify independent correlates of the SAEI. Serum uric acid emerged as the only independent correlate of SAEI (p < 0.001).ConclusionsSAEI independently reflects the extent of CAD in patients with chronic stable angina. This relationship is chiefly mediated by serum uric acid. Our data add to the growing evidence that serum uric acid may be a marker of arterial stiffness and atherosclerotic burden.     

A simple and practical agglutination assay for the detection of human anti-mouse antibodies

BACKGROUND AND OBJECTIVES: Human anti-mouse antibodies (HAMAs) are relatively common in human serum and may interfere with therapeutic and diagnostic mouse monoclonal antibodies (MoAbs). We developed a simple particle agglutination test (PaGIA) for the detection of HAMAs. DESIGN AND METHODS: Red-dyed high density particles were coated with monoclonal mouse IgG. These particles were incubated in the reaction chamber of a gel-card together with serum samples obtained from healthy blood donors (n=32), and patients with clinically proven autoimmune thrombocytopenia (AITP; n=26). Positive reactions were defined by a layer of particles on top of the gel or agglutinated particles dispersed throughout the gel matrix. Furthermore, MoAb-coated particles were subjected to flow cytometry and the results were compared with the new HAMA PaGIA. RESULTS: HAMAs were detectable in 33% of serum samples tested (n=58). Results from flow cytometric analysis revealed a high parallel to those obtained by the PaGIA. Interestingly, we observed an increased incidence of HAMAs in AITP patients (42%) compared to healthy blood donors (26%). INTERPRETATION AND CONCLUSION: The new HAMA PaGIA allows a specific and easy, rapid detection of HAMAs and is suitable for large scale testing.     

An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy

Clinical Rheumatology - The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and...     

Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds

Summary.  One of the applications for circular external fixators is the treatment of large-bone defects which may be difficult to manage with conventional methods. Successful results have been reported with the use of circular external fixators, particularly in the treatment of infected tibial pseudoarthroses and those with bone loss. In this study, a total of 43 cases with tibial bone defects (18 infected) as a result of high-velocity gun-shot injuries were treated with circular external fixators between January 1, 1988 and December 31, 1995. The mean follow-up period was 50 months (range: 28–98 months) after the removal of the Ilizarov device. Satisfactory union was obtained in 40 cases without any major complication or additional surgical intervention, in spite of the large and in some cases infected defects. We conclude that this is a safe method for the treatment of infected or noninfected tibial bone defects.

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Résumé.  Une des applications des fixateurs externes circulaires (FEC) est le traitement des pertes de substance osseuse qu’on ne peut pas traiter facilement avec les méthodes classiques. Des auteurs rapportent les résultats de traitement dans des cas de pseudarthrose infectée du tibia. Ils rapportent les résultats de 48 perte de substance du tibia secondaire à des blessures par arme à feu. 18 d’entre-eux étaient infectés. Le délai d’observation moyen était de 50 mois (28–98 mois) après ablation de l’appareil d’Ilizarov. Dans 40 cas, il n’y as pas eu de complication majeure ni de nécessité d’intervention chirurgicale complémentaire. En conclusion, c’est une bonne méthode pour traiter les pertes de substance osseuse du tibia infecté ou non.

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Accepted: 30 April 1998