Prospective randomized placebo-controlled trial of aprotinin for elective aortic reconstruction

BACKGROUND: The serine protease antagonist, aprotinin, reduces perioperative blood loss in cardiac surgery and orthotopic liver transplantation. A pilot study suggested that the drug may also reduce bleeding during infrarenal aortic replacement; the aim was to confirm or refute this observation with a prospective, randomized, double-blind, placebo-controlled trial. METHODS: Some 136 patients were randomized to receive either aprotinin, given as a loading dose of 2 x 10(6) kallikrein inactivator (KI) units followed by 0.5 x 10(6) KI units/h or equal volumes of 0.9 per cent saline. After 80 patients had been randomized the infusion dose was doubled to ensure that plasma levels were similar to those seen in successful cardiac studies. Blood loss, coagulation and haematological parameters were recorded throughout surgery and for 7 days afterwards. Blood was transfused to maintain the haemoglobin level at 100 g/l. RESULTS: Four patients were withdrawn after randomization when found at laparotomy to be unsuitable for the planned reconstruction. The 30-day mortality rate was 4.5 per cent, with no excess complications in either group. Blood loss collected on swabs was reduced from 480 ml in placebo-treated patients to 379 ml with aprotinin (P = 0.014). Blood loss into suction drains in the first 24 h after operation was reduced from 295 to 205 ml in aprotinin-treated patients (P = 0.002). However, no significant reduction was found in intraoperative or total blood loss, or transfusion requirement. CONCLUSION: The small reduction in blood loss in patients treated with aprotinin demonstrated in this study does not support its use in routine elective aortic surgery.     

T lymphocyte-directed gene therapy for ADA- SCID: initial trial results after 4 years

In 1990, a clinical trial was started using retroviral-mediated transfer of the adenosine deaminase (ADA) gene into the T cells of two children with severe combined immunodeficiency (ADA- SCID). The number of blood T cells normalized as did many cellular and humoral immune responses. Gene treatment ended after 2 years, but integrated vector and ADA gene expression in T cells persisted. Although many components remain to be perfected, it is concluded here that gene therapy can be a safe and effective addition to treatment for some patients with this severe immunodeficiency disease.     

Prolongation of responses in decentralization supersensitivity

In chronically decentralized nictitating membranes of cats the responses to norepinephrine and to acetylcholine were markedly prolonged. The increased duration was not directly related to the increased amplitude of the contractions. It is likely to be due to a change of the muscle itself.     

Concentric rings simulating tinea imbricata in secondary syphilis. A case report

A female patient with secondary syphilis presented with concentric rings of papules simulating tinea imbricata. To avoid the occurrence of "ping-pong" syphilis, it is stressed that both sexual partners should be treated simultaneously.     

Effect of phosphate,calcium, and pH on the dissolution of a phosphate rock in soil

The effect of phosphate (P), calcium (Ca), and pH on the dissolution of Sechura phosphate rock (SPR) in a Typic Dystrochrept was investigated in an incubation study over 90 days. Increasing the P status of the soil had little effect on either the rate or extent of dissolution of SPR, as measured by a single extraction with 0.5M NaOH, or on the amount of plant-available P in the soil as measured by the Bray procedure. This suggests that a reactive PR such as SPR could be effective as a maintenance P fertilizer on soils of medium and high P status.The dissolution of SPR at pH 6.4 was only 4% of total P added, compared to 33.6% of total P added at pH 5.2. Addition of Ca as CaCl₂, at the same rate of Ca as that added in Ca(OH)₂ to raise soil pH from 5.2 to 6.4, reduced the dissolution of SPR to 11% of total P added. The large effect of Ca on the dissolution of SPR contrasts with the small effect of soil P status and probably reflects the fact that the concentration of Ca in the soil solution is generally several orders of magnitude higher than that of P. The results obtained suggest that pH, per se, is of less importance in the dissolution and subsequent plant availability of P from phosphate rock in soil than previously thought.     

Femorotibial and femoroperoneal bypass vein grafts. A 15-year experience

Results with 111 femoral-infrapopliteal vein grafts in 105 patients were subjected to life-table analysis. The overall five-year cumulative graft patency rate of 46% was associated with a 60% limb salvage rate. In cases in which the infrapopliteal graft represented the initial operative procedure, the five-year limb salvage and patency rates (69% and 56%, respectively) were significantly higher (P less than .05) than those achieved with secondary grafts (38% and 22%, respectively). Most limbs (79%) with failed intrapopliteal grafts, without further attempts at reconstruction, required major amputation within six months. The site of the distal anastomosis (anterior tibial, posterior tibial, or peroneal arteries) proved not to be a significant factor in determining long-term limb salvage or graft patency rates. Furthermore, the differences between five-year salvage and patency rates in diabetics (45% and 32%, respectively) and nondiabetics (65% and 53%, respectively) approached but did not reach statistical significance. It is believed these observations support the established but controversial role of infrapopliteal bypass in advanced peripheral occlusive diseases.     

In vivo trigonal measurements and their relationship to competence of the ureterovesical junction

In vivo measurements of the trigone were obtained in 73 children undergoing cystourethroscopy for evaluation of urinary tract infection with and without associated vesicoureteral reflux. These data revealed greater mobility or distensibility of the trigone in children with reflux. In addition, those children with large trigones had shorter submucosal tunnels. Bladder capacity was not statistically different between the 2 groups.