Duodenal ulcer healing on 2 g of sucralfate daily at bedtime compared to 1 g four times daily

Seventy-seven patients with endoscopically verified duodenal ulcers were randomized to treatment with either 2 g sucralfate daily at bedtime or 1 g sucralfate q.d.s. in a controlled double-blind comparative study. After a 4-week treatment period, the healing rate was 68% for the former and 69% for the latter treatment.     

Thrombin Inhibitory Activity of Fractions Obtained by Gel Filtration of Antithrombin III Deficient Plasma

Two fractions with thrombin inhibitory activity of a progressive type were obtained by gel filtration of plasma from patients with congenital deficiency of antithrombin III and from normal controls. The fractions corresponded to α₂-macroglobulin and antithrombin III. The thrombin inhibitory activity of the α₂-macroglobulin of the patients was not lower than normal.     

Effect of alveolar hypoxia on segmental pulmonary vascular resistance and lung fluid balance in dogs

In a biventricular bypass preparation with constant-flow perfusion, pulmonary arterial pressure (P_pa), average pulmonary capillary pressure (P_pc), venous pressure (P_v), extravascular lung water volume (EVW_d) and capillary permeability-surface area product for urea (PS) were determined in control animals and in animals subjected to alveolar hypoxia. During hypoxia, P_pa increased in a biphasic manner, the site of hypoxic pulmonary vasoconstriction being located in the arterial upstream segment. At baseline, P_pc values were identical in control and experimental animals (3.4 ± 0.4 vs. 3.6 ± 0.2 mmHg). During 150 min of airway hypoxia, the rise in P_pc (5.1 ± 0.3mmHg) did not exceed the rise in P_pc (4.9 ± 0.5mmHg) recorded in control animals at same time interval during normoxic ventilation. EVW_d increased during hypoxia to values significantly higher than those obtained in control animals (0.559 ± 0.036 vs. 0.466 ± 0.027 mL water g^?1 lung). PS remained unchanged at baseline level throughout experiments in both groups of animals. Present data suggest that lung oedema formation during alveolar hypoxia may be caused by increased transcapillary fluid loss preferentially through transcellular hydraulic pathways in capillary endothelial cells.     

Deep vein thrombosis: a 7-year follow-up study

Abstract. Objectives. To study the sequelae of deep venous thrombosis (DVT) in terms of symptoms and objective signs of deep venous insufficiency (DVI) and their relationship to the initial extension of DVT, and to assess the control legs in the same way. Design. Follow-up study after an average of 89 (range 79–102) months. Setting. Out-patient clinic, University Hospital, Oslo. Subjects. Seventy-six patients with DVT 7 years previously. At follow-up 41 patients were dead and 10 were not available for restudy, thus twenty-five patients were studied in all. Main outcome measures. Symptom rating. Objective verification of DVI by invasive pressure recordings (DVI-I) and by the Doppler ultrasound technique (DVI-D). Results. At follow-up, 42% of the patients had symptoms, half of these severe, while 68% had DVI. Eighty-two per cent of symptomatic patients and 60% of the asymptomatic patients had DVI. There were no more symptoms in proximal than in distal DVT, but slightly more DVI. Control legs had neither symptoms nor DVI. Conclusions. Seven years after DVT few patients had severe symptoms, although objective signs of DVI were common. Symptoms were no more frequent after proximal than after distal DVT. We found no symptoms or DVI in control legs.     

Long-term anticoagulant therapy in cerebrovascular disease: does bleeding outweigh the benefit?

Abstract. Objective . The aim of the present study was to determine the risk of major haemorrhagic complications, stroke and other cardiovascular events, and mortality during long-term anticoagulant therapy (ACT) in patients with cerebrovascular disease not included in any prospective trials. Design . The data were collected retrospectively. Setting . All patients with symptomatic cerebrovascular disease discharged from the Stroke Unit, Aker University Hospital, Oslo, with ACT (warfarin) during 1983 through to 1986 were included. Subjects . The material consists of 161 patients with a mean age of 67.8 (range 40–90) years. The reason for initiating ACT was frequent transient ischaemic attacks (TIAs) in 52 patients, stroke in progression (SIP) in 33 patients, and probable embolic stroke in 76 patients. International normalized ratio (INR) of 4.2–2.8 was aimed at. Main outcome measures . Major haemorrhagic complications, recurrent stroke and survival was determined for the total material, and in the subgroups non-valvular atrial fibrillation (NVAF, n = 49), TIAs, and SIP. Results . The mean duration of ACT was 21.1 (range 0.5–60.2) months with a total of 282.9 patient-years. The rate of major (including fatal) haemorrhagic complications was 4.6% per year, and the rate of fatal haemorrhagic complications was 1.4% per year. The complication rates in the subgroups of patients did not differ significantly from that in the total material. Only two out of the 13 major haemorrhagic complications occurred during the initial 6 months of ACT. No strokes occurred in the TIA subgroup. The rate of recurrent stroke (excluding intracranial haemorrhage) was 3.9% per year for all patients, 4.7% per year for the patients with NVAF, and 4.2% per year for the patients with SIP. Conclusions . The total results suggest a positive net effect of ACT in patients with NVAF and TIAs. Without comparable data, no definite conclusions concerning the effect of ACT on patients with SIP can be drawn. The rate of bleeding complications was similar to that in other studied materials and is not negligible. In patients with SIP and TIAs, ACT beyond 6 months should probably only be continued if aspirin is not tolerated or has proven ineffective in the particular patient.     

Adverse effect of warfarin in acute myocardial infarction: increased left ventricular thrombus formation in patients not treated with high-dose heparin

In a prospective non-randomized study, 229 patients with a verfiedfirst acute anterior myocardial infarction (AAMI) underwentechocardiography before discharge in order to study left ventricular(LV) thrombus formation. Antithrombotic therapy was given accordingto the routine of each centre. Patients receiving high-dose heparin had few LV thrombi, irrespectiveof warfarin therapy (6/32 vs 3/25, P ns). In patients not givenheparin, however, a significantly higher prevalence of LV thrombiwas found in a subgroup of patients treated with warfarin ascompared to those who did not receive warfarin (8/13 vs 17/68,P 0.02). A similar, but non-significant difference was observedin patients given low-dose heparin (42% vs 27%, P ns). Withinthe non-heparin and low-dose heparin groups, age, infarct size,occurrence of Q-wave infarction, congestive heart failure andLV wall motion impairment did not differ between those treatedor not treated with warfarin. In conclusion, high-dose heparin seems effective in the preventionof LV thrombosis irrespective of warfarin therapy after AAMI.The start of warfarin therapy in patients not receiving heparinwas, however, associated with an increased prevalence of LVthrombosis.     

Bed rest and increased diuretic treatment in chronic congestive heart failure

To elucidate the effect of bed rest used as an adjunct to increaseddiuretic treatment, twelve patients with chronic congestiveheart failure (CHF) had a 50% increase in loop diuretic dosageand were allocated to either continuous bed rest or bed restduring nights only. The 24-hour bed rest group reduced theirweight significantly (mean±SEM: 2.00±0.79 kg,P<0.001), whereas the night bed rest group had no significantweight reduction (1.10±0.37 kg, 0.1<P<0.2) duringthree days of observation. Furthermore, the 24-hour bed restgroup had a significantly increased diuresis (P<0.05) duringthe first day of the study and a tendency towards increasednatriuresis. The cumulated diureses for the two groups (24-hourbed rest versus night bed rest) during the three days of studywere 7773±700 ml and 5861±909 ml (0.05 <P<0.1),respectively. Plasma concentrations of adrenaline, nor adrenaline,renin and aldosterone were increased, as measured in the supineposition. No significant differences were found between thetwo groups. Plasma concentrations of antidiuretic hormone werewithin normal limits. In conclusion, continuous bed rest isa reasonable adjunct to diuretic treatment in patients withCHF.     

TREATMENT OF IDIOPATHIC AUTOIMMUNE HEMOLYTIC ANEMIA IN CHILDREN Review and Report of Two Fatal Cases in Infancy

Abstract. Report of two cases of severe idiopathic autoimmune hemolytic anemia (AIHA) in infants who underwent splenectomy and received corticosteroids and cyclophosphamide without benefit. One infant, additionally, was treated with thymectomy and azathioprine without influencing his disease. Experience of therapy for childhood AIHA is reviewed. Four children with AIHA have been thymectomized. Two of these failed to benefit from surgery. There have been fifteen previous trials with immunosuppressive agents in childhood AIHA. About 60% of the children so treated (9 of 15) have shown improvement. Additional clinical trials with this agent are warranted.     

The Antithrombotic Effect of Heparin in Deep Venous Thrombosis: Relation to Four Heparin Assays

Abstract In a prospective study, 280 patients with phlebographically proven deep venous thrombosis intravenous heparin infusion; 224 of the patients were subjected to control phlebography after 5–8 days of treatment. Females above 70 years showed least phlebographic improvement despite similar heparin dosage and heparin activity. Heparin activity in daily drawn blood samples was determined by four different assays. Chromogenic substrate (CS) assay (Coatest heparin), activated partial thromboplastin time (Cephotest), and thrombin time with recalcified plasma (CaTT) showed weak but significant correlations with thrombus resolution judged by phlebography (p=0.004, 0.003 and 0.018, respectively). A linear prediction equation showed that the phlebographic result was about equally influenced by the mean dose and by the result of any of the three heparin assays. Thrombin time with citrated plasma showed no correlation. CS assay and CaTT showed significantly lower mean heparin activity in patients with (n=13) than without clinically diagnosed pulmonary embolism (p=0.012 and 0.001, respectively).