Overview of randomized trials of intravenous heparin in patients with acute myocardial infarction treated with thrombolytic therapy

Intravenous heparin is routinely given after thrombolytic therapy for patients with acute myocardial infarction in the United States and in some, but by no means all, other countries. Several trials have documented improved infarct-artery patency in patients treated with heparin; however, none was large enough individually to assess the effect of heparin on clinical outcomes. We performed a systematic overview of the 6 randomized controlled trials (1,735 patients) to summarize the available data concerning the risks and benefits of intravenous heparin versus no heparin after thrombolytic therapy. Mortality before hospital discharge was 5.1% for patients allocated to intravenous heparin compared with 5.6% for controls (relative risk reduction of 9%, odds ratio 0.91, 95% confidence interval 0.59 to 1.39). Similar rates of recurrent ischemia and reinfarction were observed among those allocated to heparin therapy or control. The rates of total stroke, intracranial hemorrhage, and severe bleeding were similar in patients allocated to heparin; however, the risk of any severity of bleeding was significantly higher (22.7% vs 16.2%; odds ratio 1.55, 95% confidence interval 1.21 to 1.98). There was no significant difference in the observed effects of heparin between patients receiving tissue-type plasminogen activator and those receiving streptokinase or anisoylated plasminogen streptokinase activator complex, or between patients who did and did not receive aspirin. The findings of this overview demonstrate that insufficient clinical outcome data are available to support or to refute the routine use of intravenous heparin therapy after thrombolysis. It is not known if these findings are due to lack of statistical power, inappropriate levels of anticoagulation, or lack of benefit of intravenous heparin. Large randomized studies of heparin (and of new antithrombotic regimens) are needed to establish the role of such therapy.     

Religion's role in adjustment to a negative life event: Coping with the loss of a child.

Parents (N?=?124) who had lost an infant to sudden infant death syndrome were interviewed 3 wks and 18 mo postloss. Two components of religion (religious participation and religious importance) were assessed, and their relations with 3 coping-process variables (perceived social support, cognitive processing of the loss, and finding meaning in the death) were examined. Greater religious participation was related to increased perception of social support and greater meaning found in the loss. Importance of religion was positively related to cognitive processing and finding meaning in the death. Furthermore, through these coping-process variables, religious participation and importance were indirectly related to greater well-being and less distress among parents 18 mo after their infants' deaths. Results suggest that further study of the social and cognitive aspects of religion would be profitable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary intrathoracic lymphangioma masquerading as teratoma

Two cases of cystic hygroma arising as a primary lesion in the chest are presented. Because of calcifications discovered on CT and because of the anterior location of the mass in both cases, teratoma was the first diagnostic consideration. However, after surgical removal, histologic study determined that both lesions were cystic hygromas with areas of scattered calcification probably secondary to hemorrhage. These cases are presented because of the remarkable similarity of their imaging features to those of teratoma.     

Methods of measuring susceptibility of anaerobic bacteria to trovafloxacin, including quality control parameters

Three methods approved by the National Committee for Clinical Laboratory Standards for testing the susceptibility of anaerobic bacteria were used to evaluate the fluoroquinolone, trovafloxacin. The methods gave essentially comparable results with 126 anaerobes and with three quality control strains. A collaborative study defined the quality control range for trovafloxacin MICs. Trovafloxacin had good in vitro activity against the more common anaerobes (MIC 90 < = or 2.0 micrograms/ml).     

Are nursing's 'extraordinary' moral standards realistic?

This paper discusses a hypothetical situation, taken from the author's book Nursing Ethics: a principle-based approach, in which a nurse feels pressured into working beyond his official span of duty. The nurse experiences a conflict between a number of obligations; to patients and clients, to his family and to himself. To which should he give greatest weight? Steven Edwards suggests the nurse's decision is a moral one, based on personal standards held by the nurse.     

Acute arthritis of cats associated with feline calicivirus infection

Twelve specific pathogen-free cats were infected either by intra-articular inoculation or by contact exposure to one of two strains of feline calicivirus (FCV), either F65, a field strain originating from an outbreak of lameness in a group of cats, or a vaccine strain. Following either route of exposure, both strains induced signs typical of FCV infection including oral and nasal ulceration, conjunctivitis and ocular discharge. These signs were of equal severity for both virus strains, but overall, following either route of infection, F65 induced more severe disease than the vaccine strain, with marked pyrexia, lethargy and lameness. Vaccine virus only induced a relatively mild lameness following intra-articular inoculation. Gross pathological and histopathological lesions were seen in some of the joints, but again changes were more severe in the F65-exposed cats. Virus was isolated from both normal and affected joints from both groups of F65-exposed cats, and from a joint from each cat inoculated intra-articularly with vaccine virus. Mild transient lameness was also seen in one of two control cats inoculated intra-articularly, but no pathological changes were seen or virus isolated from joints. A cDNA probe used in RNA dot blot hybridisation experiments was found to be specific and more sensitive than virus isolation in detecting FCV in selected tissues. This may be useful in future studies on the pathogenesis of FCV disease and in studies on viral persistence in FCV carriers.     

Tripe palms: a cutaneous paraneoplastic syndrome

Tripe palms is a cutaneous paraneoplastic syndrome. We report a case of tripe palms in a 71-year-old man with non-small cell lung cancer. Approximately 90% of patients with tripe palms have an associated cancer, most commonly involving the lung or the stomach. Any patient with tripe palms must have a complete cancer workup, especially for lung and stomach cancer.     

Explosion risks during the confined storage of bituminous coals : Calculation of gaseous hydrogen accumulation in ship holds

Bituminous coal piles stored in the open air can undergo autocatalytic heating accompanied by the emission of small but appreciable amounts of molecular hydrogen. When the coal is contained in a confined space and the temperature reaches 40°C, accumulation of hydrogen is expected. This process has been observed for a wide variety of bituminous coals. The amount of hydrogen gas expected to accumulate in the air pocket above the coal cargo in ship holds (assuming that the coal's temperature approaches 40°C during the voyage) has been calculated. The results clearly indicate that in most cases the hydrogen concentration will be appreciably above the lower explosion limit in air. Hence when bituminous coals are stored in a confined space (e.g. a ship hold), the explosive risk of hydrogen should be taken into account.