Comparison of the effectiveness of venlafaxine in peri- and postmenopausal patients with major depressive disorder.

INTRODUCTION: This study examines the difference in the efficacy and tolerability of an antidepressant inhibiting the reuptake of norepinephrine and serotonin--IRNS--on climacteric patients diagnosed of major depressive disorder, comparing the therapeutic response between perimenopausal and postmenopausal patients. METHODS: Observational, prospective, open-label, multicenter study 24 weeks study. The sample consisted of women between 45 and 55 years diagnosed of major depressive disorder. The study drug was venlafaxine extended release at doses according to the investigator's clinical criteria. The efficacy was assessed using repeated measures of the scales: Hamilton Depression Rating Scale and Blatt-Kupperman Menopausal Index. RESULTS: 36 depressed women were included in the study and 35 completed it. The patient's age range was 47 to 55 years old. Throughout the study, a significant clinical improvement in depressive and hormonal symptoms was seen. The comparison of the pattern of improvement, according to the menstrual status of the patients, showed no significant different between pre and postmenopausal patients. Perimenopausal women reported a higher rate of adverse events. CONCLUSION: The Venlafaxine was effective in treating depressive and hormonal symptoms regardless of the menstrual status of climacteric patients with a slightly worse tolerance in perimenopause.

[The search for clinical markers of abnormal hypercoagulable states among factors that trigger venous thromboembolic disease]. / Búsqueda de marcadores clínicos de hipercoagulabilidad patológica según los factores desencadenantes de enfermedad tromboembólica venosa (ETV).

We proposed to search for markers of hypercoagulable states in function of age, sex or factors that trigger venous thromboembolic disease (VTD) in a group of patients so diagnosed. The following patient data were analyzed: age, sex and triggering factors of VTD categorized as associative-transient, permanent or unknown. In patients under age 55 years of age in whom the triggering factor of VTD was unknown, and in those who had a family and/or personal history of VTD, coagulability was assessed approximately three months after the episode of acute thrombosis and was repeated during follow-up. From April 1993 to July 1996 we saw 297 patients diagnosed of VTD and performed 187 coagulability tests (63%). Eighty-six were normal (46%) and 101 (54%) abnormal. No significant relations were found for age, sex or triggering factors and the results of follow-up coagulability testing. We conclude that factors known to trigger VTD are not the only ones relevant for indicating the need to order the assessment of coagulability, given that the presence of coagulopathy is not confined to patients with supposed clinical markers.

[Abortions caused by anticardiolipin antibodies: prevention by low-dose acetylsalicylic acid]. / Abortos debidos a anticuerpos anticardiolipinas: prevención mediante ácido acetil salicílico a bajas dosis.

BACKGROUND: It is a very well-known fact the relationship between pregnancy with history of fetal losses and positive aCL, and many treatments have been tried in order to prevent it. We present a study about the treatment of these pregnant women with ASA at low doses. PATIENTS AND METHODS: We have followed-up a group of 28 women with previous abortions and positive aCL. They were treated with ASA (50 mg/day) since beginning until end of pregnancy. We measured aCL levels monthly. RESULTS: 24 cases of pregnancy (86%) were successfully, 3 cases were fetal losses and 1 case was a fetal malformation. IgG aCL were positive in 16 patients before treatment, and IgM aCL in 11 cases. One patient had both of them. 18 patients became negative after pregnancy. We have not found any relationship between the level of aCL and fetal losses. CONCLUSIONS: In our study, ASA at low doses (50 mg/day) is a safe and effective treatment in achieving successful pregnancies, and reducing aCL levels in patients with history of fetal losses.

Reversal of severe hepatic veno-occlusive disease by combined plasma exchange and rt-PA treatment.

We report the successful treatment of a case of severe hepatic veno-occlusive disease (VOD) by combined treatment with exchange plasmapheresis and fibrinolysis with rt-PA. Very advanced alterations of hepatic vascular circulation, evaluated by Doppler sonography, reverted to normal after treatment. Severe VOD, defined by McDonald's criteria, produces a mortality of 98%. This case suggests that this new method of combined treatment might contribute to changing the usually bad prognosis of this clinical condition.

Effect of oxidants on proteases of the fibrinolytic system: possible role for methionine residues in the interaction between tissue type plasminogen activator and fibrin.

Evidence has recently been presented that activated macrophages (M phi) express both urinary (u-PA) and tissue type (t-PA) plasminogen activator. Major cell products of M phi and polymorphonuclear neutrophils (PMN) are reactive oxidants of the HOCl/chloramine type. Since PMN and M phi are involved in inflammatory and fibrinolytic processes, we were interested in the interaction of u-PA, t-PA, and plasmin with oxidants of the leukocyte type. The enzymes were treated with chloramine-T, which at pH 8.5 is a selective oxidant for methionine residues. Oxidation by chloramine-T of t-PA abolishes about 40% of both stimulation susceptibility of t-PA by fibrinogen degradation products (FDP) and affinity of t-PA to FDP. However, the plasminogenolytic and amidolytic activity of unstimulated t-PA as well as the plasminogenolytic activity of u-PA and the amidolytic activity of plasmin are not impaired. Identification of the amino acid residues in the t-PA responsible for the interaction with fibrin might be of great importance in order to understand the mechanism of the clot- selectivity of t-PA. The present study gives evidence that fibrin specificity of t-PA partly depends on chloramine oxidizable amino acids, presumably methionine residues. Hence, experimental data on the interaction between t-PA and fibrin, using oxidized and labelled t-PA should be interpreted with caution. It may be suggested that oxidants of the leukocyte type might regulate t-PA activity and selectivity for fibrin.

Single chain-urokinase binds to oxidized fibrin(ogen) derivatives.

Single chain- urokinase (scu-PA), in contrast to two chain urokinase, is a physiological plasminogen activator of fibrin selectivity. The mechanism of selective fibrinolysis of scu- PA has not been clarified up to now. This study has shown that fibrin selectivity might involve oxidative processes. Binding studies with immobilized oxidized fibrinogen degradation products (FDP) demonstrated higher affinity of scu-PA to oxidized than to unmodified FDP. The fibrin(ogen) domain responsible for this oxidant mediated increase of scu-PA affinity is localized in the D-subunit of fibrin(ogen). Thus, experimental data upon the interaction of scu-PA with fibrin(ogen) using oxidized and I- labelled fibrin(ogen) might be interpreted with caution: the oxidized product may behave in a distinct manner than the unoxidized, native, one. Activated leukocytes release large amounts of scu-PA and of oxidants of the chloramine type. The oxidants could contribute significantly to fibrinolysis and proteolysis in areas of inflammation, preparing fibrin for its specific degradation. The present data support the concept of an involvement of oxidative processes in the fibrinolytic pathway.