The effects of streptokinase and hydroxyethyl starch on in vitro clot disruption by ultrasound.

BACKGROUND: In vitro studies showed that low-frequency ultrasound (US) causes blood clot dissolution. This effect is augmented with thrombolytics, microbubbles and microparticles. However, in animal models of transcutaneous delivery, US alone is not effective, probably due to attenuation of US energy by overlying skin. When combined with thrombolytics or microbubbles, transcutaneous US is highly effective. PURPOSE: To assess the synergistic effect of low-intensity low-frequency US and saline, hydroxyethyl starch (HAES) (a non-gas filled microparticle containing solution), streptokinase (STK), and their combination on blood clot disruption. METHODS: Human blood clots from 4 healthy donors, 2-4 hours old, were immersed for 0, 15, or 30 min in 37 degrees C in 10 ml of the above-mentioned solutions, and then were randomized to 10 sec of 20 kHz US or no US. The % difference in weight was calculated. RESULTS: Immersion for 30 min without US resulted in 13.8 +/- 1.2% clot lysis in saline, and 22.0 +/- 1.3%, 21.7 +/- 2.1%, and 23.2 +/- 1.9% in STK, HAES, and STK + HAES, respectively (p = 0.002). US augmented clot lysis in all groups and at all time points. With low-intensity US, HAES was not better than saline. However, the combination of HAES + STK with US resulted in larger clot disruption at 15 sec incubation time (46.7 +/- 3.2%) than with saline (29.6 +/- 2.1%), HAES (29.6 +/- 2.5%), and STK (32.8 +/- 3.6%) (p < 0.001). CONCLUSION: low-frequency, low-intensity US combined with HAES and STK resulted in greater clot disruption at short incubation times. This combination may assist in achieving faster reperfusion in in vivo models.

[Patient education of the depressed patient and his family]. / L'information du déprimé et de son entourage.

The information available to the patient and to his family today pose new conditions for the care of the depressed; it facilitates the acceptance of the illness and of its effects, it is indispensable for the therapeutic relationship as well as for the effective observance by the patient of his treatment, and thus contributes to the improvement of the quality of life of the depressed. Certain rules must be observed in the transmission of this information: it must be accessible and understandable to everyone, it must be concise, it must be repeated and revised according to circumstances, it must discourage self-diagnosis and self-prescription by the patient. This information is to be transmitted chiefly by the doctor and the pharmacist. The depressed may also appeal to complementary sources of informations: books, journals and more rarely scientific publications. Patients' associations provide another potential source for the dissemination of information. Their chief objective is to provide this information not only to the patients and their immediate entourage, but also to the population at large.

[Chronic depression and its treatment]. / Les dépressions chroniques et leurs traitements.

Can depression still be defined today as a transient abnormal state which is reversible with treatment? Chronic depression affects about one out of five depressed subjects. The progression to chronicity has a multifactorial determinism; it includes sociodemographic, medical and psychopathological parameters. These depressions are sometimes difficult to diagnose, all the more as there are no definitely established nosographic criteria. One usually considered is the persistence over more than two years of depressive symptoms and/or of socioprofessional dysfunctions. First-line treatment is based on uninterrupted prescription of a well-tolerated antidepressant for over two years, with dosage maintained at the acute phase level. In the event of a failure, there is as yet no well-defined alternative therapy. Because of their socioprofessional repercussions, chronic depressions may become a significant public health issue. They need imperiously that prospective long-term evaluation studies be implemented.

Congenital dislocation of the hip and computerised axial tomography.

CT scans of 18 hips with typical congenital dislocation have been studied in 16 children. These show that the common position of dislocation is lateral, superior and slightly anterior, and that a "false acetabulum" can be distinguished even in young children. A defect in the posterior ischium causing distortion of the acetabulum was also present in most cases. The cartilage and the acetabular contents were well shown. Positions of reduction and the anteversion of the acetabulum and the femoral neck were studied. Hypotheses are presented on the mode of dislocation and on the cause of the pathological changes.