Platelet adhesiveness and fibrinolysis after recent cerebro-vascular accidents and their relationship with subsequent deep venous thrombosis of the legs.

In fifteen patients with a cerebro-vascular accident resulting in an acute hemiplegia there was a subsequent rise in the platelet count and plasma fibrinogen level. There were no significant alterations in platelet adhesiveness, plasminogen activator, plasminogen, FR-antigen and haematocrit. Patients diagnosed as developing deep venous thrombosis with the 125I-fibrinogen technique had a significantly lower platelet adhesiveness and plasminogen level than those who were not.

Fibrinolytic activity in malignant disease.

Resting fibrinolytic activity and fibrinolytic capacity were compared in 31 patients with malignant disease and in 24 control subjects without malignant disease. Patients with malignant disease had a lower mean fibrinolytic activity: this was particularly marked in those with disseminated disease. In contrast, patients with malignant disease had a fibrinolytic capacity which did not differ from that of the control subjects.

Effect of local exercise and vessel occlusion on fibrinolytic activity.

Arterial occlusion of the upper limb did not affect the fibrinolytic activity in the venous blood of that limb; venous occlusion associated with venous distension resulted in a marked rise in activity. Local fibrinolytic activity was increased substantially by active exercise; passive exercise induced a smaller increase. Active exercise undertaken during arterial occlusion did not result in a rise in activator level. It is concluded from these results that blood flow into the venous system rather than accumulation of metabolites is responsible for the increased release of activator into the blood during local exercise and vessel occlusion.

Changes in protease inhibitors after acute myocardial infarction.

Plasma levels of fibrinogen, alpha1-antitrypsin, alpha2-macroglobulin, antithrombin III, and C1 inactivator were measured serially for 10 days in 11 patients after acute myocardial infarction. Both fibrinogen and alpha1-antitrypsin rose markedly to reach peak levels 5-7 days after infarction while C1 inactivator levels rose slowly with the highest observed mean level on the 10th postinfarction day. Neither antithrombin III nor alpha2-macroglobulin changed significantly after myocardial infarction. No relationship between C1 inactivator levels and either fibrinogen or alpha1-antitrypsin was found in a study of 30 patients with a variety of disorders while fibrinogen and alpha1-antitrypsin levels were significantly correlated.

Eicosanoid formation by mammalian intestine. Effects of some intestinal secretagogues.

Intestinal tissues of man, rat, mouse, guinea-pig and rabbit were preincubated with laxatives, homogenised, and incubated with [14C]arachidonic acid. After extraction into chloroform, the eicosanoids were separated by thin layer chromatography. Metabolism of [14C]arachidonic acid into prostaglandins (PGs), and the lipoxygenase products LTB4 and 5-HETE, was stimulated by ricinoleic acid (100 micrograms/ml) or phenolphthalein (100 micrograms/ml), and to a lesser extent by picosulphate (125 micrograms/ml) and sulfosuccinate (200 micrograms/ml). Mannitol (500 micrograms/ml) had no effect. Indomethacin (1 microgram/ml) inhibited the stimulation of PG formation. The dual pathway inhibitor BW755C (1 microgram/ml) reduced the formation of prostaglandins, LTB4 and 5-HETE. In some experiments on rat colon, prostanoids were separated from lipoxygenase products, characterised by their chromatographic mobility and quantitated (relative amounts PGE2 greater than PGF2 alpha greater than TXB2 greater than PGD2). Their formation was enhanced by ricinoleic acid (100 micrograms/ml) and inhibited by either indomethacin or BW 755C (1 microgram/ml). The present results indicate that mammalian isolated gut tissue can convert [14C]arachidonic acid into both cyclo-oxygenase and lipoxygenase products, and support the suggestion that eicosanoids may participate in the laxative effect of some secretagogues.

A comparative trial of large doses of ketoprofen and indomethacin in the treatment of rheumatoid arthritis.

A 4-weeks' double-blind, crossover study in 30 patients with definite or classical rheumatoid arthritis is reported using 300 mg ketoprofen per day and 150 mg indomethacin per day. Both drugs had similar effects upon the patients' subjective improvement of pain. Objectively, the results also suggest that ketoprofen may be more effective in reducing the articular index, i.e. a superior analgesic effect. Further studies are underway to assess the value of ketoprofen administered in high dosage for longer duration.

Mefenamic acid: an under-rated antirheumatic?

A double-blind crossover study was carried out in 18 patients with classical rheumatoid arthritis to assess the effectiveness of mefenamic acid (500 mg t.d.s.) compared with placebo or indomethacin (25 mg q.d.s.). Each treatment was given for 1 week and subjective and objective assessments were carried out at the end of each period. Results showed that both mefenamic acid and indomethacin were significantly better than placebo in most parameters. Although duration of morning stiffness and patient preference favoured indomethacin it was considered that there was no demonstrable difference of any clinical significance between the two active medications.

Comparison of sodium meclofenamate and indomethacin in rheumatoid arthritis.

A double-blind crossover study was conducted in 15 patients with classical definite rheumatoid arthritis to compare the effect of sodium meclofenamate (300 mg daily) with placebo and indomethacin (100 mg daily). Each treatment was administered for 1 week to patients assigned at random to treatment sequences. The active drugs were shown to be significantly superior to placebo. Sodium meclofenamate alone reduced the articular index. Patient preference, however, was in favour of indomethacin.

A robust method for evaluation of NANC transmission in human sigmoid colon muscle in vitro.

INTRODUCTION: Human tissues are notoriously difficult to work with, giving results that are quantitatively variable within and between studies. Hence, previous investigations of nonadrenergic, noncholinergic (NANC) relaxation in human colon muscle report both partial and complete inhibitions of the NANC response by specific competitive inhibitors of nitric oxide (NO) production. We have established a robust and reproducible model to examine the contribution of NO during NANC relaxation assay in human sigmoid colon muscle strips. METHODS: Complete control curves to long-train, stepwise, frequency-dependent, continuous electrical field stimulation (EFS) relaxation using vertical platinum electrodes connected to a biphasic pulse train stimulator generated NANC responses in fresh human sigmoid colon circular muscle strips set up in Bennett baths. A second complete curve was generated on the same strip in the presence of specific drugs to determine the contribution of NO to NANC relaxation. Responses to NO were also generated in muscle strips. Results were fitted to the Hill equation. RESULTS: The first and second frequency-response curves without test drugs could be fitted to the Hill equation, resulting in similar midpoint locations ([f](50)), maximal asymptotes (alpha), and midpoint slope (n) parameters. L-N(G)-nitro-arginine (L-NOARG), TTX, and haemoglobin produced a tonic contraction in the muscle strips. NANC relaxations to EFS were inhibited by L-NOARG (30-37%), TTX (56-62%), and haemoglobin (48-90%). NO relaxations were concentration dependently inhibited by haemoglobin. Haemoglobin was equipotent in mediating tonic contraction and inhibiting NO relaxation. DISCUSSION: We established reproducible assays for human colon muscle strips by the generation of two complete dose-response curves to long-train EFS, thus enabling a "within-preparations" study. The results suggest that NO contributes but is not the sole mediator of relaxations to long-train EFS in human sigmoid colon muscle. Moreover, a basal production of NO may serve to regulate tone of human colonic muscle.

Is vasoactive intestinal peptide an inhibitory transmitter in the circular but not the longitudinal muscle of guinea-pig colon?

Circular muscle strips of guinea-pig isolated colon relaxed with vasoactive intestinal peptide or peptide histidine methionine, whereas the longitudinal muscle contracted. The non-adrenergic-non-cholinergic inhibitory nerves may therefore be different in these two muscle layers.

Hypothalamic-pituitary-adrenal (HPA) axis function in patients receiving long-term intra-articular corticosteroids.

The hypothalamic-pituitary-adrenal (HPA) axis function of eight patients with rheumatoid arthritis receiving regular intra-articular methyl prednisolone acetate was studied. Tests of the HPA axis 5-7 weeks after the last injection revealed suppression in two patients. Some patients receiving intra-articular corticosteroids may therefore have abnormal responses to stress.

Peptic ulceration and sigmoid volvulus in India.

The results of surgery in 126 patients with benign peptic ulceration and 57 with sigmoid volvulus presenting at a hospital in N India are discussed. Complications of ulceration, apart from stenosis, were rare and most patients underwent vagotomy and gastroenterostomy. Gangrenous sigmoid volvulus was mainly treated by resection and immediate anastomosis, while non-gangrenous volvulus was treated by colopexy. The aetiology of both conditions is discussed.

Emergency surgery in Ethiopia.

The surgical needs of Ethiopia are not met by traditionally trained surgeons. Ten recently registered doctors were trained for a two-month period in 20 selected lifesaving procedures. Evaluation of their skills one year after their course suggested that they were able to save lives and to use their skills either under supervision or alone. The training of physicians before their appointment to rural areas is a possible solution to the unacceptably high morbidity and mortality from surgical causes in rural Ethiopia.

British surgeons training abroad--an evaluation.

The experience and practice of a surgeon training in Africa is reviewed. Clinical, practical and management skills are invaluable. The value of an elective period in a British training system is suggested.

A novel means of securing a laparoscopic port in the obese patient.

Advanced interventional laparoscopy has necessitated the development of a vast array of new equipment, but inevitably some of this equipment has had to be adapted to specific patient needs. Standard laparoscopic ports may be too short for use in obese patients. We describe a technique using a Portex endotracheal tube as an over-tube, which will overcome this problem.

Endoscopic thoracic sympathectomy in the treatment of upper limb hyperhidrosis.

The technique of endoscopic sympathectomy is described and its value in the treatment of upper limb hyperhidrosis is reported in an initial series of 7 patients (13 sympathectomies). It is recommended as the treatment of choice for this condition.

Survey of methods of treatment of haemorrhoids and complications of injection sclerotherapy.

INTRODUCTION: This study was conducted to survey current practices in the treatment of haemorrhoids (Hs), prevalence of complications associated with injection sclerotherapy (IS) and attitudes to its use to treat anterior Hs. METHODS: Postal questionnaires were sent to 92 consultant surgeons in the South East Thames Region. They were returned anonymously. RESULTS: Seventy questionnaires were returned (76% response rate) and 61 questionnaires were used in the data analysis; 18 from coloproctologists and 43 from non-coloproctologists who treated Hs. First degree Hs were mostly treated with IS alone (76%). Second degree Hs were treated with rubber band ligation (RBL) alone (36%) or a combination of IS and RBL (36%). Third degree Hs were mostly treated with haemorrhoidectomy (76%). Nineteen surgeons (31%) reported complications using IS; 82% of these were urological. Nine surgeons (15%) did not use IS to treat anterior Hs and 10 (16%) advised their trainees not to inject anteriorly. CONCLUSIONS: IS is a common treatment of Hs. Nearly one-third of consultants reported complications, the majority of which were urological and likely to be secondary to IS of anterior Hs. It may be safer to avoid IS of anterior haemorrhoids.

Prevention of haematogenous infection in prosthetic joints.

A survey was conducted to identify the attitude of consultant orthopaedic surgeons and rheumatologists in Scotland, North East England and Ireland, to the prevention of blood-borne infection in prosthetic joints. Of the 61% who completed the questionnaire, 65% gave advice about intercurrent infection, a similar number gave advice about the use of prophylactic antibiotics before certain surgical procedures, with less than half of the patients receiving any written instructions about inter-current infection, and less than a quarter of the patients receiving any written instructions about antibiotic prophylaxis. 36% of the respondents were confused as to what to advise or ignored the problem. The reality of late infection is discussed and a policy to minimise the risk of late infection in prosthetic joints is presented for consideration.