A case of familial antithrombin III variant complicated by recurrent pulmonary infarction

This paper describes hearing loss and recovery as well as cochlear damage in chicks, after a 200-h exposure to an intense pure tone, and compares the results to similar data following a 48-h exposure to the same sound. The results revealed that the magnitude of initial hearing loss and the rate of recovery were nearly the same for both exposures. The initial cochlear damage produced by the 200-h exposure, however, was less severe than that seen after the 48-h exposure. In addition, new hair cells were observed in the lesion area immediately after the 200-h exposure. However, after the 48-h exposure, they were first identified after several days of recovery. These observations were consistent with the conclusion that cochlear repair began during the longer exposure itself. The fact that hearing loss and recovery was the same for the two exposure conditions, while the level of cochlear damage differed, suggests that functional recovery depended on processes other than the regeneration or repair of hair cells and supporting cells. These other processes are considered.     

Systemic sclerosis complicated by procainamide-induced lupus and antiphospholipid syndrome

In order to estimate the effect of the long term administration of cyclosporine (CsA) on the shape change of erythrocytes, erythrocyte shapes which are observed with a scanning electron microscope were classified according to the nomenclature of Bessis for stomatocyte-echinocyte shape transformation. As a result of observing the erythrocyte shape of fifty-six patients with kidney transplantation treated with CsA, the morphological index of the erythrocytes of patients significantly increased to 0.0835+/-0.0085*** in comparison with 0.0004+/-0.0051 of those from healthy volunteers (control) (***: p<0.001, ANOVA). Such transformations had no relation to the subjects' sex or age. On the other hand, the erythrocytes of patients administered more than 100 ng/ml of CsA and posttransplanted within less than two years were transformed by CsA from the state of discocyte to echinocyte. In rats, the morphological index of erythrocytes of rats treated with 3 mg/kg/d or 5 mg/kg/d of CsA significantly increased in comparison with rats treated with saline (control). Furthermore, the erythrocytes of two patients were observed in terms of shape before the treatment with CsA. In both patients, the echinocyte type of erythrocyte increased by treatment with CsA. In vitro, the morphological index of the erythrocytes incubated with plasma containing CsA significantly increased, to 0.459+/-0.066*** in comparison with 0.064+/-0.029 of the control. It is suggested from these results that CsA treatment induces the echinocyte type of erythrocyte.     

Chronic hepatitis C virus positive hepatitis and antiphospholipid syndrome

The antiphospholipid syndrome, disorder in which venous and arterial thrombosis may occur, has been described in association with systemic lupus erythematosus and later in a great variety of entities, including infectious diseases. It has been described recently a high frequency of antiphospholipid syndrome in patients with chronic hepatitis C. We present a case of cirrhosis with hepatitis C virus markers and criteria for antiphospholipid syndrome, and we review the literature.     

Mesenteric venous thrombosis and antithrombin III deficiency: diagnosis before an acute digestive hemorrhage

Metarhizium anisopliae var. anisopliae (Metschnikov) Sorokin 1883 to our knowledge has never been reported as an agent of human or animal mycosis. This fungus has great importance as an agent of biological control of different pests and mosquito larvae in Colombia. It has been isolated as the aetiological agent of keratomycosis for the first time from the eye of a Colombian male.     

Hereditary antithrombin deficiency and pregnancy. Pregnancy course in six women with known hereditary antithrombin deficiency

Inherited antithrombin (AT) deficiency is a major cause of venous thromboembolism, especially in relation to surgery and pregnancy. We present six AT deficient pregnant women, who successfully delivered seven babies at the Department of Gynaecology/Obstetrics, Aalborg Hospital. From conception, or if possible prior to conception, the women were treated with unfractionated (UFH) or low molecular weight heparin (LMWH) throughout the pregnancy. If the pregnancy was without complication, AT substitution was only used at delivery and for approximately a week post-partum, when warfarin treatment was re-instituted.     

Complex-dependent inhibition of factor VIIa by antithrombin III and heparin

The regulation of the factor VIIa-tissue factor complex is essential for control of the hemostatic response. However, the role of the inhibitor antithrombin III in the regulation of factor VIIa has remained in question. The inhibition of factor VIIa activity by antithrombin III and heparin in the presence and absence of tissue factor was evaluated using the fluorescent substrate m-LGR-nds. Our data show that the activity of recombinant human factor VIIa is inhibited by antithrombin III in the presence of heparin at a rate of 1.7 x 10(2) M-1 s-1. In the presence of tissue factor, the rate constant for this reaction increases to 5.6 x 10(3) M-1 s-1. A 1:1 stoichiometric complex between factor VIIa and antithrombin III, with an apparent molecular weight of 110,000, was detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. A heterogeneous mixture of factor VIIa products with molecular weights between 50,000 and 80,000, most likely representing proteolytically degraded factor VIIa-antithrombin III complexes, was also observed.     

Short-term outcome and predictors of adverse events following pulmonary thromboendarterectomy

Pulmonary complications including hypoxemia, right heart failure, and prolonged ventilation may follow pulmonary thromboendarterectomy (PTE) performed via cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest. Seventeen adult patients have undergone PTE at the University of Maryland Medical System during the preceding 3 years. From these patients, clinical and hemodynamic parameters were tabulated pre-CPB, post-CPB, at admission to the intensive care unit (ICU), and prior to discontinuation of invasive monitoring in the ICU. Data on anthropometric variables, survival, and times of extracorporeal circulation, mechanical ventilation, and hospital stay were also collected. The mean values for pulmonary arterial systolic and diastolic pressures and pulmonary vascular resistance (PVR) decreased significantly from pre-CPB values after PTE (all p < 0.05). Mild mixed acidosis present at ICU admission resolved prior to discharge (p = 0.002). The length of mechanical ventilation time was positively correlated with the absolute post-CPB PVR and negatively correlated with the relative change in central venous pressure (CVP) from pre-CPB to post-CPB values (r = 0.75, p = 0.037). Of the pre-CPB anthropometric variables, only body mass index was significantly higher in nonsurvivors (p = 0.037). Pulmonary artery pressures and vascular resistance fall significantly after PTE. A lower post-CPB PVR and a relatively decreased (i.e., from pre-CPB values) CVP predict reduced length of postoperative ventilation but not of the hospital stay. Mortality appears increased in patients with a large body habitus.     

Myxoma and antiphospholipid antibody syndrome

We report a 26 years old female with a Cerebral Palsy as a consequence of a perinatal vascular accident. She was admitted in August 1996 with a left hemiplegia due to a right M1 median artery thrombotic occlusion, as demonstrated by magnetic resonance imaging angiography. Transesophagical bi-dimensional echocardiography showed a right atrial myxoma and ruled out the persistence of an oval foramen. The study of coagulation disorders lead to the diagnosis of a primary antiphospholipid syndrome. We postulate that interleukin-6 produced by the myxoma could trigger an immunological reaction leading to the primary antiphospholipid syndrome.     

Coexistence of primary antiphospholipid syndrome and protein S deficiency in a Hispanic man with ischemic stroke

Transitional cell papillomas rarely develop in the fossa navicularis of the anterior urethra. We observed such a case of transitional cell papilloma and detected human papillomavirus type 6 (HPV-6) DNA in this papilloma by polymerase chain reaction. To our knowledge this report is the first of HPV-infected transitional papilloma in the anterior urethra.     

Polyarteritis nodosa and the antiphospholipid syndrome

We describe a case of classical polyarteritis nodosa (PAN) with visceral aneurysms presenting with renal infarction and hypertension. The female patient also had all the laboratory features of the antiphospholipid syndrome (APS) and 2 months into her illness developed a large iliofemoral thrombosis. She responded well to immunosuppressive therapy and anti-coagulation. Repeat arteriogram showed regression of the visceral aneurysms. The link between PAN and APS, and the therapeutic dilemma posed by this association, are discussed.     

Massive deep vein thrombosis in a patient with antithrombin III deficiency undergoing ovarian stimulation for in vitro fertilization

OBJECTIVE: To present the first report of a thromboembolic complication in early pregnancy after ovarian hyperstimulation for IVF in a patient with AT III deficiency who was treated successfully and subsequently delivered a healthy male infant at 32 weeks of gestation. DESIGN: Case report. SETTING: Hospital-based clinic for reproductive medicine. PATIENT: A 28-year-old woman who consulted our IVF clinic with a 3.5-year history of primary infertility. INTERVENTIONS: Intravenous heparin therapy. RESULTS: The patient responded adequately to heparin therapy and was discharged home on SC heparin. A primary cesarean section was performed at 32 weeks of gestation because of poor fetal growth and transverse lie. CONCLUSIONS: We stress the importance of obtaining a thorough personal and family history before initiation of ovarian hyperstimulation. Measuring activity of AT III, protein C, and protein S in patients with a suspicious history of thromboembolic episodes occurring at an early age may lead to the implementation of appropriate prophylactic measures, preventing potentially life-threatening complications.