Severe coagulopathy after a bite of a green bush viper (Atheris squamiger): case report and biochemical analysis of the venom

A 34 year old male bitten by an adult Atheris squamiger snake developed symptoms of nausea, vomiting, diarrhea which were followed by drowsiness and impaired breathing. Local hemorrhage, edema and pain at the bite-site occurred, but no systemic bleeding or hemorrhagic diathesis developed. All clinical and laboratory parameters were in the normal range except for afibrinogenemia, thrombocytopenia and slight proteinuria. Replacement therapy (fibrinogen and platelet concentrates) and treatment of shock stabilized the patient within 2d and coagulation returned to normal. Atheris squamiger venom was subjected to biochemical and biological analysis. The LD50 of the venom was 5 mg/kg (mice, s.c.). It produced local hemorrhage corresponding to about 25% of the activity of puff adder venom (Bitis arietans). In vitro the venom had a fibrinogen-converting activity, it did not activate purified prothrombin but very likely contained a F V and Ca2+-dependent prothrombin activator. The venom exhibited strong platelet-aggregating activity, which was not inhibited by protease inhibitors and by EDTA or EGTA. The venom also aggregated acetylsalicylic acid treated platelets indicating, that the arachidonic acid pathway was not essential for activation. Rat serum rapidly inhibited the platelet-aggregating activity of the venom; human serum, however, had only a partial inhibitory effect. Preliminary experiments showed that platelet-aggregating activity may be separated from fibrinogen-converting activity by anion-exchange chromatography.     

Early management of unstable coronary artery disease. Coronary angiography is the first measure in high-risk patients

Unstable coronary artery disease is currently the major cause of admissions to coronary intensive care units, accounting for 30-40 per cent of cases. The underlying cause is rupture of an atherosclerotic plaque, coronary blood flow being impeded by a superimposed thrombus. New and more effective antithrombotic drugs are becoming increasingly available. Simultaneous early coronary angioplasty, stenting or bypass surgery provide the most effective amelioration of symptoms. Early revascularisation has not hitherto been found to reduce the risk of myocardial infarction or mortality in patients without signs of severe ischaemia. In this large category of cardiac patients, treatment strategy selection is of considerable importance to the effective utilisation of resources.     

Validity of the Wonderlic Personnel Test as a brief IQ measure in psychiatric patients.

100 male psychiatric inpatient referrals (mean age 41.18 yrs) for psychological testing were administered the Wonderlic Personnel Test and the Wechsler Adult Intelligence Scale—Revised (WAIS—R) in a counterbalanced order. In this clinical context, the Wonderlic proved not to be an acceptable alternative to the WAIS—R. The tests correlated only moderately (.75), differed in mean IQ level, and agreed in IQ classification in only 40% of the cases. Efforts to improve these results by devising new IQ correction factors resulted in only slight improvements. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent results in color compositing of three-parameter magnetic resonance scans as a preoperative aid to the management of upper limb sarcomas

The phenomenon of induced tolerance to a normally lethal episode of ischaemia by preconditioning with sub-lethal ischaemia has been linked to induction of the 72 kDa heat-shock protein (HSP72). However, a direct correlation between HSP72 expression and ischaemic preconditioning in vivo has not been proven. Using an in vitro model of ischaemia-related neuronal damage we have investigated whether HSP72 protein expression is temporally correlated with subsequent tolerance to a normally lethal ischaemic episode. Organotypic hippocampal slice cultures were maintained in vitro for 14 days before being exposed to hypoxia for 15-180 min. Periods of hypoxia shorter than 60 min did not produce neuronal damage. No HSP72 immunoreactivity was observed in either untreated cultures or in those exposed to hypoxia for 15 min. Following 30 and 45 min hypoxia a significant induction of HSP72 occurred in neurons of both the CA1 and CA3/4 regions of the pyramidal cell layer. A significant number of microglia were positively stained with HSP72. The peak of HSP72 expression occurred 18 h after the induction of hypoxia but remained significantly elevated for 48 h post-hypoxia. Prolonged hypoxia (60 or 180 min) produced a selective lesion of the CA1 pyramidal cell layer which was not associated with an induction of HSP72. Pre-conditioning with 45 min hypoxia 18 h prior to 180 min hypoxia did not reduce the neuronal damage associated with 180 min hypoxia alone. These data strongly suggest that HSP72 does not directly confer tolerance in this in vitro model of ischaemia-related neuronal death.     

Usefulness of plasma catecholamines during head-up tilt as a measure of sympathetic activation in vasovagal patients

We purified and characterized a thermophilic beta-galactosidase from Thermus sp. A4 isolated from the Atagawa hot spring (Shizuoka, Japan). The enzyme was monomeric, and its molecular mass was estimated to be 75 kDa by SDS-polyacrylamide gel electrophoresis. The enzyme was extremely thermostable and retained its full activity after incubation at 70 degrees C for 20 h. The Km observed were 5.9 mM for ortho-nitrophenyl beta-D-galactopyranoside and 19 mM for lactose. We cloned and analyzed the complete sequence of the gene encoding this enzyme. It was found to consist of 645 amino acid residues. We propose that this enzyme and seven other unclassified beta-galactosidases are new members of family 42 of the glycosyl hydrolases.     

Hopelessness as a measure of suicidal intent in the depressed elderly.

Suicidal ideation in the elderly has been related to depression, changes in health, and anticipation of a limited future. The present study examined the Hopelessness Scale (HS) and its relation to these factors in a depressed geriatric population. A total of 120 elderly outpatients, who had applied to receive psychotherapy for depression, completed the HS, Beck Depression Inventory (BDI), health ratings, and the Schedule for Affective Disorder and Schizophrenia (SADS) at intake. The HS was found to be internally consistent, and a principal components analysis revealed three distinct factors that were related to hope, feelings of giving up, and future planning. The HS, BDI, and health ratings were predictive of suicidal ideation as measured by specific items in the SADS. The relation among suicidal ideation hopelessness, depression, and health perceptions for the depressed aged are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

SMS text messages as a prosthetic aid in the cognitive rehabilitation of schizophrenia.

Objective: To evaluate the efficacy of short message service (SMS) text messages as a compensatory aid to improve independence in individuals diagnosed with schizophrenia and cognitive deficits. Design: An ABA withdrawal single-case experimental design was used. Eight men diagnosed with schizophrenia took part in the study; all demonstrated memory or planning problems in everyday life. Results: Five participants completed the entire trial. Four were more successful in carrying out daily activities when receiving prompts, whereas 1 did not profit from the intervention. Conclusion: SMS text messages can be effective in compensating for cognitive impairment in some but not all individuals with schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A bronchoscopic aid in the therapy of bronchial asthma patients with a severe course

The body's immunological responses were examined in thyroid damage caused by the incorporation of varying 131I doses. The in-take of 131I in doses of 37, 74, and 148 KBc/g body weight caused reductions in the murine blood concentrations of thyroxin following 30, 60, and 180 days. The blood levels of triiodothyronine decreased 180 days after administration of 131I in a dose of 74 KBc/g body weight and 30, 60, and 180 days after incorporation of the radioisotope in a dose of 148 KBk/g body weight. Decreased concentrations of the both hormones were followed by the suppression of a humoral immune response to sheep red blood cells, diminished cell-mediated immunity in the mixed culture of lymphocytes. The inhibition of immune responses was correlated with the changes in the level of triiodothyronine.     

Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: a ten-year experience

BACKGROUND: The choice between ileal pouch-anal anastomosis (IPAA) and ileorectal anastomosis (IRA) in the treatment of patients with familial adenomatous polyposis remains controversial. The aims of this study were to assess our 10-year experience with proctocolectomy, endoanal mucosectomy, construction of an ileal reservoir pouch, and IPAA in a series of 171 patients with familial adenomatous polyposis and to compare the functional results after IPAA with those after IRA. METHODS: Data from patients treated by IPAA at one institution were prospectively accumulated from October 1983 to October 1993. Medical records of 171 consecutive patients were studied regarding morbidity and functional results. These functional results were compared with those of a series of 23 patients who underwent IRA at the same institution. RESULTS: One patient (0.6%) died after operation. Sixty-two patients (36%) had concomitant colorectal carcinoma, 36 of which tumors were invasive (15 stage A, 13 stage B, and 8 stage C). Forty-six patients (27%) had at least one postoperative complication, with 14 patients requiring reoperation (8%). Twenty-six patients (15%) had obstruction. Seven patients (4%) had pelvic sepsis, and one had transient impotence (0.6%). Only two patients (1%) had a typical episode of pouchitis. The mean follow-up was 29 months (range, 3 to 100 months); 101 patients were monitored for more than 1 year. Little difference was noted between bowel function after IRA and that after IPAA. The mean daytime stool frequency after IPAA was 4.2 with 26% of patients having an average of 1 bowel movement at nighttime, compared with a stool frequency of 3.0 and 13% of patients having night evacuation after IRA. Daytime continence was normal for 98% of patients after IPAA and for all the patients after IRA. Nighttime continence was normal in 96% and 98% of patients, respectively. CONCLUSIONS: Morbidity and functional results after IPAA for familial adenomatous polyposis do not differ from those reported after IRA. For this reason and because of the risk of rectal cancer after ileorectal anastomosis, IPAA with endoanal mucosectomy is our first choice in the treatment of patients with familial adenomatous polyposis.     

Categorizing pain in patients seen in a veterans health administration hospital: Pain as the fifth vital sign.

Previous research has supported the concept of classifying pain intensity into distinct categories (of mild, moderate, and severe) based on the effects of pain on functioning. Such categories, however, have not been studied in samples of veterans. The current study sought to validate the concept of pain intensity classification in a sample of veterans with mixed types of chronic pain. There were 632 veterans referred to a pain program and asked to complete a packet of questionnaires that included a 0 to 10 measure of pain intensity and measures of pain-related interference, depressive symptomatology, and disability. The results indicated that the veterans' ratings of pain at its worst could be classified into the categories of mild, moderate, and severe, with cutpoints of a maximum rating of 3 for mild and 7 for moderate pain. The findings suggest that pain treatment studies of veterans with diverse types of chronic pain should include ratings of pain intensity at its worst that can be reliably classified as mild, moderate, or severe and related to other important outcomes such as daily function and mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desmopressin in the management of nocturia in patients with multiple sclerosis. A double-blind, crossover trial

BACKGROUND: Neurogenic bladder affects up to 80% of patients with multiple sclerosis (MS) and, in 50% of these patients, it is a significant cause of disability. The current management of neurogenic bladder, based on fluid restriction, anticholinergic agents, intermittent self-catheterization, and, in some cases, surgical intervention, often fails to relieve all symptoms. Furthermore, anticholinergic drugs have significant adverse effects and may be medically contraindicated. Nocturia is a particularly disabling symptom of neurogenic bladder; by disrupting sleep patterns, it aggravates the chronic fatigue of MS, imposes serious demands on caregivers, and can lead to institutionalization. To evaluate a novel approach to the symptomatic management of nocturia in patients with MS, we have conducted a trial of desmopressin acetate (1-desamino-8-D-arginine vasopressin), a synthetic analogue of antidiuretic hormone. OBJECTIVE: To evaluate the efficacy and short-term safety of desmopressin therapy in the symptomatic treatment of nocturia in patients with MS. METHODS: Seventeen patients were enrolled in a double-blind, crossover trial of desmopressin administered at bedtime. Patients with both relapsing-remitting and chronic-progressive forms of MS were admitted. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and plasma osmolality were measured twice weekly and urinalyses and urine cultures were performed weekly during the trial. RESULTS: Desmopressin reduced the percentage of nights with nocturia in patients from 97% to 66%. The average number of episodes of nocturia per night in patients decreased from 2.35 to 1.09 and the maximum hours of sleep uninterrupted by nocturia increased from 3.74 to 5.77. These results were highly significant. Four of the 17 patients discontinued participation in the study after developing asymptomatic or minimally symptomatic hyponatremia. CONCLUSIONS: Desmopressin was found effective; no tolerance and only minimal adverse effects have been observed. Our results suggest that desmopressin, either alone or in combination with other therapeutic modalities, is effective in the symptomatic management of nocturia in patients with MS. The only adverse effect attributed to desmopressin was hyponatremia, which occurred in 4 of 17 patients and appeared to be dose related.     

Use of the true absorption coefficient as a measure of bioavailability of radiocaesium in ruminants

Limitations of existing methods to describe the bioavailability of dietary radionuclides to ruminants (the transfer coefficient and apparent absorption coefficient) have led to the alternative suggestion of using the true absorption coefficient (A(t)). Various approaches to estimating A(t) for radiocaesium, involving the intravenous administration of a second isotope, are presented and discussed with reference to results from studies in which a range of radiocaesium sources were examined in sheep. Although estimates of A(t) differed between the sources, they were reasonably consistent between measurement techniques. Those methods which involved the estimation of endogenous faecal excretion of radiocaesium could be used with previously contaminated animals and did not require continuous administrations of radiocaesium isotopes, but gave unreliable results for sources of low bioavailability. Methods based on estimating the turnover rate of dietary radiocaesium through blood plasma were sufficiently sensitive to measure A(t) for the range of sources studied. However, they require previously uncontaminated animals and continuous administration of both isotopes for approximately 7 days. Bioavailability is more effectively measured as A(t) than as the transfer or apparent absorption coefficients since A(t) does not incorporate factors relating to the metabolism of radiocaesium in the tissues of the animal. The results of these studies show that differences in transfer coefficients between sheep and cattle and between sheep of differing ages are not due to variation in absorption across the gut. The potential for applying these approaches to other radioactive elements is discussed.     

Infant parasite rates and immunoglobulin M seroprevalence as a measure of exposure to Plasmodium falciparum during a randomized controlled trial of insecticide-treated bed nets on the Kenyan coast

Repeated cross-sectional surveys among infants sleeping under insecticide-treated bed nets (ITBN) and contemporary control infants were used to estimate changes in Plasmodium falciparum exposure due to ITBN use on the Kenyan coast. Presence of P. falciparum parasites or total P. falciparum Immunoglobulin M (IgM) seropositivity were used independently and in combination in a constant risk catalytic conversion model to estimate the force of infection in ITBN and control communities. Such studies during infancy avoid problems of early saturation of prevalence due to high forces of infection and persistence of infection, minimize problems of self-treatment, and can be conducted among large populations covering a wide geographic area. These contrast previous parasitologic studies of ITBN among older children and the traditional entomologic studies of transmission that are logistically demanding. Our investigations demonstrated that parasite prevalence, IgM seropositivity, and the force of transmission were all significantly reduced by 50%. In addition, more infants under ITBN entered their second year of life without previous exposure to P. falciparum than control infants. These effects upon delayed acquisition of effective immunity require careful monitoring during future vector control programs using ITBN.     

Phase II trial of docetaxel: a new, highly effective antineoplastic agent in the management of patients with anthracycline-resistant metastatic breast cancer

PURPOSE: To determine the efficacy (objective response rate and duration of response and survival) and toxicity of docetaxel in patients with strictly defined anthracycline-resistant metastatic breast cancer (MBC). PATIENTS AND METHODS: Thirty-five patients with bidimensionally measurable MBC who had progressive disease while receiving anthracycline-containing chemotherapy were registered onto the phase II trial. Docetaxel was administered at a dose of 100 mg/m2 over 1 hour every 21 days. RESULTS: Thirty-four patients were assessable for disease response; 18 (53%; 95% confidence interval [CI], 35% to 70%) achieved a partial response. The median times to disease progression and survival duration were 7.5 and 13.5 months, respectively, for responding patients. The median overall survival duration was 9 months. Two hundred eight cycles (median, five) of docetaxel were administered. Neutropenia with less than 500 cells/microL developed in 31 of 35 patients; it was complicated by fever in 30 (14%) of 208 cycles and in 18 (51%) of 35 patients, including one treatment-related death. Fluid retention was seen in 15 (43%) of 35 patients, including pleural effusions in 11 patients (31%). Moderate skin toxicity, asthenia, and myalgia were observed in 16%, 58%, and 37% of cycles, respectively. CONCLUSION: Docetaxel has the highest reported antitumor activity in anthracycline-resistant MBC. High objective response rates were seen in patients with visceral-dominant involvement, multiple metastatic sites, or extensive previous therapy. Docetaxel is associated with severe but reversible neutropenia, asthenia, and cumulative dose-related fluid retention. Dexamethasone decreased the frequency and severity of skin toxicity and appeared to ameliorate fluid retention.     

Clinical impact of somatostatin receptor scintigraphy in the management of patients with neuroendocrine gastroenteropancreatic tumors

Somatostatin receptor scintigraphy (SRS) has been used for the detection of gastroenteropancreatic (GEP) tumors. This study evaluates the clinical impact of SRS in GEP tumor detection and its therapeutic implications on patient management. METHODS: We prospectively studied 160 patients with biologically and/or histologically proven GEP tumors. Before SRS, patients were classified into three groups: gastrointestinal (Group 1; n = 90) patients without known metastases; (Group 2; n = 59) patients with metastases limited to the liver; (Group 3; n = 11) patients with known extrahepatic metastases. The scintigraphic data were compared to the radiological findings. RESULTS: In Group 1, without known metastases, conventional imaging detected 53 primary sites in 44 patients: SRS was positive in 68% of these sites and discovered 4 additional primary tumors in 3 patients and 16 metastases in 14 patients. Conventional imaging was negative in 46 patients: SRS discovered 47 new sites in 36 patients. In Group 2, SRS confirmed liver metastases in 95% of patients and discovered 45 new sites in 36 of these patients. In Group 3, SRS disclosed 11 new sites in 7 patients. These results modified patient classification in 38 cases (24%). Surgical therapeutic strategy was changed in 40 patients (25%). CONCLUSION: Somatostatin receptor scintigraphy improves tumor detection, has major clinical significance and should be performed systematically for staging and therapeutic decision making in patients with GEP tumors.     

The redox equilibria of copper ions in the molten silicate fluxes as a measure of basicity

The redox equilibria of copper ions in the molten NaO_0.5-SiO₂, NaO_0.5-NaF-SiO₂, NaO_0.5-CaO-SiO₂, CaO-CaF₂-SiO₂, CaO-MgO-SiO₂, and CaO-SiO₂ systems have been measured in order to seek a new measure of flux basicity. The Cu²⁺/Cu⁺ ratio decreases with increasing the content of basic oxide. The correlations between the Cu²⁺/Cu⁺ ratio and other refining indexes, such as carbonate, sulfide, and phosphate capacities, CaO activity, and theoretical optical basicity are discussed.     

Carotid arterial blood flow in the ovine fetus as a continuous measure of cerebral blood flow

Principles derived from a group of 46 ML of the mantle zone are presented: Mantle pattern of a ML and its cytological structure are mostly sufficient for positive basic diagnosis. Diffuse mantle zone ML need detection of BCL-1 and CD5 hyperexpression which are characteristic for small-cell and centrocytoid forms when compared with BCL-2 positive centrofollicular lymphomas. B monocytoid lymphomas from the parafollicular subgroup as well as plasmacytoid ML from the marginal subgroup retain faint BCL-1 positivity but lose CD5 positivity. That may results in attempt of problematic narrowing of mantle zone definition because of existence of the mixed cellularity forms of mantle zone ML. Nodular mantle zone ML are clinically recognized late and are unsensitive to treatment which is opposite to the original idea of their relative benignity. M-coding of mantle zone ML is very defective because the codes do not separate nodular (perifollicular) and diffuse variants.