Thrombophilia and pregnancy outcomes

Pregnancy complications are still a challenge for physicians, because knowledge of pathomechanisms and prophylactic measures is still limited. In recent years thrombophilia as a risk factor for pregnancy complications has gained much attention in the scientific community. To study the rate of thrombophillia gene in cases with recurrent abortion. In the period between January 2006 and May 2007, 40 consecutive patients with a history of recurrent failed IVF and abortion, defined as fetal loss before 16 weeks' gestational age, were screened by the following tests: Molecular diagnosis of 11 thromobophilia gene mutation, ACL IgG and IgM. PtC, PtS. ATIII and Lupus anticoagulants. 40 patients were included in this study and the following data was recorded: All cases were negative to protein C, S and anti T Ill. One case showed positive anti cardiolipin Ig M-3 cases positive for Lupus anticoagulant, all the cases were positive for multiple thrombophillia genes. The observed rate of successful pregnancies of women treated with aspirin, who had mild thrombophilia and a history of a single abortion, is much lower than it would haye been expected from patient treated with combined therapy

Plasma level of soluble thrombomodulin in acute myocardial infarction and acute ischemic stroke in type 2 diabetes mellitus

The present study was carried out on 40 patients with acute myocardial infarction [AMI] or acute ischemic stroke [AIS]. The patients were divided into four groups [each group comprised ten patients]: Group I included nondiabetic patients with AMI, group II included diabetic patients with AMI, group III included nondiabetic patients with AIS and group IV included diabetic patients with AIS. In addition, ten healthy subjects were taken as a control group. Mean plasma soluble thrombomodulin [sTM] level was significantly lower in patients with AMI [group I + group II] [3.88 ng/ml + 3.8] and in patients with AIS [group III + IV] [3.75 ng/ml + 2.8] compared with the control group [6.64 ng/ml + 2.33] with no significant difference between patients with AMI and AIS. Acute myocardial infarction [AMI] and acute ischemic stroke [AIS] were associated with decreased plasma sTM, reflecting the decreased expression of endothelial TM, thus disturbing the balance between procoagulant and anticoagulant factors towards a pro-coagulant state. In patients with AIS, diabetics have lower plasma sTM than non-diabetics

Biological significance of stem cells [CD34 +] and vascular endothelial growth factor [VEGF] in the peripheral blood of patients with acute myocardial infarction

Reports on stem cell transplantation-an innovative approach to repair damaged myocardium following acute myocardial infarction [AMI]-have raised the question of a possible spontaneous mobilization of corresponding stem cells from the bone marrow of ischemic patients. Exposed to vascular endothelial-derived growth factor [VEGF], such cells would differentiate into myocardial cells within the infarcting myocardium, thus hopefully initiating the reparative process. The present work assessed the prevalence of marrow derived stem cells expressed in term of percent of CD34 + cells in the peripheral blood of patients sustaining AMI, as well as the serum level of VEGF needed for their differentiation into cardiac myocytes. We studied 21 male patients with AMI [mean age 52.5 +/- 8.9 years]. Myocardial infarction was anterior in 10 and inferior in 11 patients. Eleven healthy males [mean age 53.9 +/- 9.4 years] served as controls. Following admission, all patients and controls were subjected to clinical examination including 12-lead ECG with routine laboratory evaluation comprising total and differential CBC, hepatic and renal functions, as well as relevant cardiac serum enzymes with the latter repeatedly measured every 8 hours to detect the highest peak of CK. Specific laboratory measurements included flowcytometric analysis of peripheral blood mononuclear cells to detect CD34 + population and serum VEGF level by ETA on admission, 3 day, and prior to discharge. Comparing the mean percent values of CD34 + cells on admission [7.02 +/- 3.08], ischemic patients exhibited insignificantly higher levels of CD34 on the 3rd day [8.57 +/- 3.5] as well as on discharge [8.45 +/- 3.5]. The above mentioned values were also insignificantly different from samples withdrawn from control subjects [8.84 +/- 3.4]. However, CD34 cell population was positively correlated with the extent of myocardial damage expressed in terms of peak CK. Thus with an arbitrary limit of >/= 30% rise in CD34, two patients subgroups could be stratified, with 12 patients having >/= 30% rise in CD 34, exhibiting a peak CK of 2498.6 IU/L, and 9 patients showing < 30% rise in CD34 presenting a peak CK of 1312.9 IU/L. However this relationship was not of statistical significance. Serum VEGF surprisingly showed a trend towards decrease rather than increase when compared to control subjects [1.23 +/- 0.99 versus 2.79 +/- 1.67 respectively, p = 0.001], with the decline maintained over the 3rd day and prior to discharge in most patients, raising the issue of increased consumption during the process of stem cell differentiation. Acute myocardial infarction apparently initiated a series of molecular and biological events whereby continued mobilization of bone marrow stem cells [expressed by continuing rise of CD34 marker] was triggered. Subsequent homing into myocardium lead to continuous consumption of VEGF needed for their differentiation into cardiac myocytes. This phenomenon could be part of a spontaneous reparative process potentially raising hopes of therapeutic applications

Evaluation of two types of fibrin sealants as a haemostatic agent in the management of hepatic injuries: an experimental comparative study in an animal model

The present study was carried out on 40 female albino rabbits [1 kilogram in weight] in the animal laboratory of the National Cancer Institute. General anaesthesia was administered to all rabbits. The abdomen was entered through an upper midline incision and the liver was exposed. The scalpel was used to inflict a 2 cm long wound in the liver parenchyma deep enough but short of the posterior Glisson's capsule. The rabbits were divided into 2 equal Groups; in group [1] fibrin glue made from platelets and bovine thrombin was applied to the hepatic tear; while in group [2] fibrin glue made from platelets and human thrombin was applied to the liver tear. The time needed to achieve haemostasis was recorded in each group. Both types of fibrin sealants were successful to achieve haemostasis well as healing of the liver tear. However, the time needed to achieve haemostasis was significantly shorter in group [1] [bovine thrombin group]. It was concluded that both agents could be an attractive solution in the management of hepatic injuries especially in the modern era of surgical laparoscopy