In vivo release and turnover of secreted platelet antiheparin proteins in rhesus monkey (Macaca mulatta)

Human and rhesus monkey platelets secrete at least two antiheparin proteins: platelet factor 4 (PF4) and low affinity platelet factor 4 (LA-PF4). Neither of these proteins showed species-related antigenic differences. As determined by radioimmunoassay, the levels of PF4 and LA-PF4 antigen per 10(9) monkey platelets amounted to 10.7 and 20.3 microgram, respectively. One milliliter of monkey plasma prepared from blood collected into an anticoagulant composed of EDTA, prostaglandin E1, and theophylline solution contained 22.4 ng LA-PF4 and 8.0 ng PF4. Concentrations of these two platelet-specific proteins in monkeys closely resembled levels found in human platelets and plasma. Infusion of prostacyclin (PGI2) (100 or 300 ng/kg/min) into monkeys for 15 min resulted in a significant decrease of plasma levels of LA-PF4 antigen and of PF4 by 40%--60% (p < 0.0001). This decrease was related to the inhibitory effect of PGI2 on the secretion of platelets stimulated by a catheter or by venipuncture. Longer infusion of PGI2 did not produce further significant change. The supernate obtained after aggregation of human platelets stimulated by thrombin was injected into monkeys receiving PGI2 infusion. The disappearance of LA-PF4 antigen in monkey plasma followed a biphasic exponential curve with half-lives for the fast and slow components of 8.4 and 63 min. PF4 disappeared faster but followed the same pattern (half-lives for the fast and slow component of 2.1 and 70 min). Analysis of the experimental data suggests that the low levels of secreted platelet proteins in monkey plasma are related to their minimal in vivo release and to their rapid clearance.     

Poly(HEMA)--based embolic material in endovascular surgery of liver

Physico-chemical and medico-biological methods, including hematology and cytology, were used in an evaluation of properties of poly(2-hydroxyethyl methacrylate) (poly(HEMA))-based embolic material indicated in the occlusion of branches of hepatic artery of patients with focal alterations of the liver. The elastographic method helped in predicting mechanical properties of the hydrogel material. Poly(HEMA) was mechanically stable for endovascular applications, exhibited no significant loss in elasticity and possessed consistency resembling the soft tissue of the organism. Analysis of blood in contact with poly(HEMA) hydrogel provided a control of its biological inertness. Recently, 315 patients with focal alterations of the liver, including hemobilic hemorrhages and both primary and metastatic tumors, underwent endovascular occlusion with poly(HEMA) emboli as a pre-surgical step or as a simple occlusive measure. Compared with a direct operation on hemangiomatous injuries in the liver without endovascular occlusion, embolization with poly(HEMA) allowed to reduce 2.5-3 times bleeding in the operational zone. At the same time, the poly(HEMA) embolic material induced activation of general hemostatic reaction in the postembolization period.     

Correction of Lower Limb Deformities Using Ilizarov's Technique

Background

India accounts for approximately 10 million orthopaedically handicapped children and adults with limb deformity. Ilizarov ring fixator could treat most of these deformities.

Methods

Twenty cases of deformities of lower limb managed with Ilizarov technique during period between March 2001 and February 2003 were studied.

Results

55% were in the age group of 11-30 years. Out of the 20 cases studied, 6 were congenital talipes equino varus, 8 were fixed flexion deformity of knee, 4 were equines deformity of the ankle and 2 were malunited fracture shaft of tibia.4 patients who had recurrence were operated for fixed flexion deformity of the knee. The main complication encountered was pin tract infection, which was seen in 15(75%) cases. In 16(80%) cases, the results were excellent with no recurrence of deformity and patients were able to walk independently. In 4 (20%) cases, recurrence was mild to moderate (10 to 20) but all of them were able to ambulate idependently and carry out their routine activities.

Conclusion

Ilizarov ring fixator is a superior compared to conventional methods for correction of deformities of lower limb.Key Words: Ilizarov method, Ligamentotaxis, Distraction     

Efficacy and Toxicity Profile of Methotrexate Chloroquine Combination in Treatment of Active Rheumatoid Arthritis

Background

The present study was conducted to study the efficacy and toxicity profile of methotrexate chloroquine combination in treatment of active rheumatoid arthritis.

Methods

24 patients of rheumatoid arthritis confirming to revised American Rheumatism Association (ARA) criteria were studied prospectively for twenty months. Clinical evaluation was made every 3 months. Clinical disease variables measured at each visit were number of joints with swelling, number of joints with tenderness and pain, duration of morning stiffness and physician and patient assessment of disease activity. Blood counts, liver function tests and other adverse effects due to drugs were monitored every 2 months.

Results

10 patients demonstrated more than 50% improvement. 4 patients withdrew from study, 2 because of excessive nausea and vomiting and 2 because of noncompliance. Other side effects noted were hyperpigmentation, photosensitivity, skin rashes, raised transaminases and stomatitis.

Conclusion

Methotrexate chloroquine combination has good efficacy and toxicity profile. Gastrointestinal side effects are most common and usually responsible for the discontinuation of the drugs.Key Words: Rheumatoid arthritis, Methotrexate, Chloroquine, Efficacy, Toxicity     

The first experience in using sevoflurane

The paper analyzes the first experience in using the halogen-containing anesthetic sevoflurane, which is new for Russia, as an agent for initial narcosis and anesthesia maintenance in adult patients. For induction, delivery of sevoflurane was initiated in a dose of 0.7 r.% through the mask of an anesthetic-respiratory apparatus. After 3-5 breaths, the dose of sevoflurane was increased up to 2 r.%. The time of inhalation to the level of INEEG being achieved 40-45% was 3.2 +/- 0.5 min, while that with propofol was 3.3 +/- 1.0 min. Initial inhalational anesthesia was smooth, which did not exclude a slight short-term motor activity in 2 patients. Sevofluorane has a pronounced hypnotic, but a weak analgesic effect in adults, which requires the co-administration of fentanyl. Sevofluorane will be mostly demanded for initial narcosis and anesthesia maintenance in children and for the induction and maintenance of anesthesia in ambulatory anesthesiology and thriving one-day hospitals. The foregoing does not rule out the use of servofluorane for the induction and maintenance of anesthesia in adults.     

To the effective concentration of xenon

The present literature discusses what effective concentration of xenon may be used to induce adequate anesthesia. To examine the analgesic properties of the substance, 38 patients undergone laparoscopic operations for calculous cholecystitis under informational saturation EEG (INEEG) monitoring were included into this study. All the patients were divided into 3 groups in accordance to the mode of anesthesia maintenance and INEEG monitoring. In Groups 1 and 2, the concentration of xenon was maintained at 70%; INEEG monitoring was made in the of-line mode. In Group 3, the concentration of xenon was gradually decreased from 70% to the minimum value at which the level of INEEG was 40-50%, which corresponds to the adequate depth of anesthesia. The use of 70% xenon concentration and the standard doses offentanyl (3.1 +/- 1.6 microg/kg/h) resulted in excessively deep anesthesia (38 +/- 4% INEEG). Reduction of the dose of fentanyl on an average to 1.5 +/- 0.8 microg/kg/h permitted more adequate anesthesia; however, an excessively deep anesthesia is encountered in 40% of cases, as evidenced by INEEG. The active use of INEEG monitoring in Group 3 makes it possible to perform an adequate anesthesia (46 +/- 4% INEEG) and to determine the xenon concentration necessary for this, which is equivalent to 42 +/- 11% with the dose of fentanyl of 0.9 +/- 0.8 microg/kg/h.