Heparin versus danaproid for prevention of venous thromboembolism after hip surgery.

PURPOSE: To compare the prevalence of deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), and bleeding complications in patients receiving heparin or danaproid after hemiarthroplasty or osteosynthesis for hip fractures. METHODS: 37 men and 138 women aged 47 to 100 (mean, 80) years underwent either hemiarthroplasty or osteosynthesis for hip fractures; 5 patients with dementia were excluded. All patients received preoperative elastic stocking and postoperative intermittent pneumatic compression. They were divided into 3 groups based on their admission period: controls (n=71), unfractionated heparin (n=44), and danaproid sodium (n=55). Drugs were administered from postoperative day 1 to 7. At day 7, all patients undertook radioisotope venography of the legs and lung perfusion scintigraphy. RESULTS: In the control, heparin, and danaproid groups respectively, the DVT rates were 31%, 9.1%, and 5.5%, and the PTE rates were 5.6%, 4.5%, and 1.8%. Only the DVT rate in the control group was significantly higher than that in the heparin and danaproid groups. In the heparin group, one patient had gastrointestinal bleeding, 5 developed wound haematomas, and one had leakage from the drain site for 2 weeks. CONCLUSION: Danaproid sodium appeared more effective and safer than heparin, with no bleeding complications occurred.

Photodissociation of p-xylene in polar and nonpolar solutions.

The photodissociation of p-xylene at 266 nm in n-heptane and acetonitrile has been studied with use of nanosecond fluorescence and absorption spectroscopy. The p-methylbenzyl radical was identified in n-heptane and acetonitrile by its fluorescence, which was induced by excitation at 308 nm. The p-xylene radical cation was observed in acetonitrile by its absorption. In n-heptane, the decay rate of the S(1) state of p-xylene ((3.2 +/- 0.2) x 10(7) s(-1)) is equal to the growth rate of the p-methylbenzyl radical ((2.7 +/- 0.4) x 10(7) s(-1)), showing that the molecule dissociates via the S(1) state into the radical by C-H bond homolysis (quantum efficiency approximately 5.0 x 10(-3)). In acetonitrile, the formation of the p-xylene radical cation requires two 266 nm photons, and the decay rate of the radical cation ((1.6 +/- 0.2) x 10(6) s(-1)) equals the growth rate of the p-methylbenzyl radical ((2.0 +/- 0.2) x 10(6) s(-1)). This shows that the radical cation dissociates into the radical by deprotonation (quantum efficiency approximately 8.9 x 10(-2)).

[A case of infected subdural hematoma due to Campyrobacter fetus].

A 20-year-old male presented fever, nausea and headache 1 week after eating uncooked liver. On admission, it was revealed he had suffered a closed head injury 3 months before without unconsciousness. On admission, computed tomography scan showed a left chronic subdural hematoma. Gd-DTPA magnetic resonance images revealed unusual enhancement of the capsule and linear enhancement of the subarachnoid space. The patient underwent burr hole irrigation and drainage. The culture of the hematoma content showed Campylobacter fetus. Therefore, the diagnose was infected subdural hematoma. A drainage operation and administration of antibiotics were effective. Our case suggests that enhanced magnetic resonance images are useful for diagnosis and follow-up of infected subdural hematoma.

A low prevalence of coronary heart disease among subjects with increased high-density lipoprotein cholesterol levels, including those with plasma cholesteryl ester transfer protein deficiency.

BACKGROUND: Use of genetic analysis may improve the predictive value of risk factors for disease. A high plasma level of high-density lipoprotein (HDL) cholesterol is a strong negative risk factor for coronary heart disease (CHD). Cholesteryl ester transfer protein (CETP) deficiency causes increased levels of HDL cholesterol. However, recent studies suggest that CETP deficiency is a risk factor for CHD despite elevated HDL cholesterol levels. METHODS: Plasma lipid levels, CHD prevalence, resting electrocardiograms, and common CETP gene mutations were analyzed cross-sectionally in a population of 19,044 male and 29,487 female Japanese subjects (ages 45-79 years). RESULTS: High HDL cholesterol levels (serum HDL cholesterol >/=80 mg/dl, >/=95th percentile) were found in 6 and 5% of Japanese men and women, respectively. In the group with HDL cholesterol >/=80 mg/dl, common CETP gene mutations were identified in 23-24% of men and 31-49% of women. The prevalence of CHD in the group with high HDL cholesterol (>/=80 mg/dl) was low among both men (1.0%) and women (1.3%). There was no difference in CHD prevalence between hyper-HDL-cholesterolemic subjects with and without CETP mutations. CONCLUSIONS: Subjects with very high HDL levels (HDL cholesterol >/=80 mg/dl) as well as mild-to-moderate HDL elevations (60-79 mg/dl) appear to be protected against CHD, whether or not they have CETP deficiency, a genetic cause of elevated HDL.

An iridoid glucoside from dipsacus asperoides.

A new iridoid glucoside, loganic acid-6'-O-beta-D-glucoside, has been isolated from the defatted root of Dipsacus asperoides. Its structure has been elucidated by spectroscopic means as 1S-(1 alpha,4a alpha,6 alpha,7 alpha,7a alpha)-1-[(6-O-beta-D- glucopyranosyl-beta-D-glucopyranosyl)oxyl]1,4a,5,6,7,7a-hexahydro-6-hydr oxy-7- methyl-cyclopenta[c]pyran-4-carboxylic acid.

Occurrence of acute megakaryoblastic leukemia in a patient with idiopathic growth hormone deficiency.

We describe a case of a 15 year old boy who developed acute megakaryoblastic leukemia (AMKL) while receiving treatment with human growth hormone (hGH) for idiopathic growth hormone deficiency (GHD). He was diagnosed as having idiopathic GHD and given hGH from December 1991. The examination of his peripheral blood showed mild pancytopenia 2 months before the start of the hGH therapy. Since January 1992, paleness of the skin, general fatigue and fervescence progressed gradually. In February 1992, because of the occurrence of acute leukemia, administration of hGH was discontinued. Judging from the results of surface marker analysis of the blast cells, the patient was diagnosed as having AMKL. He was treated with chemotherapy for acute non-lymphoblastic leukemia from March 1992. A complete remission was obtained after 4 weeks of treatment. The chemotherapy was completed in July 1993. He remains in complete remission 26 months after diagnosis. This case suggests the importance of hematological examination and, when there is any abnormality which is not caused by GHD, such as pancytopenia, more detailed medical examinations (for example bone marrow examination) are necessary.

[Analysis of prevalence over-estimates for tuberculosis in Okayama Prefecture].

In order to clarify the over-estimates in prevalence rates of tuberculosis, patients originally registered as having tuberculosis and later cancelled from the registration due to change of diagnosis were analyzed. The results were as follows: 1) The patients reclassified due to a change in diagnosis accounted for 6.3% of all reclassified patients. Of all the patients cancelled by the change of diagnosis, the proportion diagnosed as having atypical mycobacteriosis was largest. 2) The patients cancelled due to a change in diagnosis accounted for 6.0% of the patients newly registered as having tuberculosis. 3) The prevalences of all tuberculosis, pulmonary tuberculosis, infectious pulmonary tuberculosis and of bacteriologically positive pulmonary tuberculosis were significantly reduced by corrective adjustments. 4) Analysis for method by which diagnosis was obtained showed that there was a larger proportion of those patients who were reclassified due to change in diagnosis who were diagnosed by mass screening, compared to those reclassified due to correction of disease. The prevalence of cavities was less among the former group than the latter.

[Epidemiological study of atypical mycobacteriosis in Okayama prefecture].

In order to understand the epidemiology of atypical mycobacteriosis, patients who were cancelled from registration in tuberculosis surveillance and those who were diagnosed as having atypical mycobacteriosis were compared. The results were as follows in: 1) The proportion of female patients was greater for atypical mycobacteriosis than for tuberculosis. 2) No case of atypical mycobacteriosis resulting from contact infection was detected. Therefore, atypical mycobacteriosis dose not appear to be transmitted by direct person-to-person contact under ordinary conditions. 3) There were fewer cases of atypical mycobacteriosis with cavities than of tuberculosis. 4) There was no correlation between the incidence of atypical mycobacteriosis was higher to tuberculosis incidence. 5) The incidence of atypical mycobacteriosis was higher in the southern part of Okayama prefecture than in the northern part.

[A comparison of pancuronium and vecuronium used during the induction of high-dose fentanyl anesthesia].

Effects on hemodynamics and blood catecholamine levels of pancuronium and vecuronium used during the induction of anesthesia, were studied in patients undergoing coronary artery bypass grafting. Anesthesia was induced out with fentanyl, 70 micrograms.kg-1, and diazepam, 0.2 mg.kg-1, and either pancuronium or vecuronium was administered in a dose of 0.2 mg.kg-1. Control measurements were made before the induction of anesthesia. Hemodynamic parameters and blood levels of norepinephrine (NEP) and epinephrine (EP) were measured three minutes (S1) and ten minutes (S2) after tracheal intubation. The study showed that HR, AP, CI, and coronary perfusing pressure were more stable in the group of patients receiving pancuronium (group P) than in the group receiving vecuronium (group V) during the induction of anesthesia. LVSWI and RVSWI showed a comparable decline in both groups. While NEP was unaffected in group P during the induction of anesthesia, it decreased significantly at S1 and S2, compared with control (S0), in group V. On the other hand, EP decreased significantly at S1 and S2 during the induction of anesthesia in both groups, but group V showed a greater change. The results of this study suggest that pancuronium is more advantageous than vecuronium as a muscle relaxant used during the induction of high-dose fentanyl anesthesia.

Computed tomography in the assessment of pancreatic tumor response after intraoperative radiation therapy.

Computed tomography was used in 7 patients given intraoperative electron beam therapy for advanced carcinoma of the pancreas. The local tumor response was studied quantitatively by defining the tumor contour in consecutive CT scans and then estimating the tumor volume. The maximum diameters of the tumor in 3 planes (X, Y and Z) were also estimated. There was evidence of initial tumor regression in all patients during the first few months after the treatment. No specific behaviour of the diameters in the X, Y and Z planes could be detected. Later on, regrowth of the tumor could sometimes be observed, preferably in one of the 3 planes. On the whole, CT was found to be a useful tool for assessing tumor response to this form of therapy.