Antibodies to human platelet antigens form a significant proportion of platelet antibodies detected in Indian patients with refractoriness to platelet transfusions.

BACKGROUND: The transfusion of platelets is an important therapeutic strategy in bleeding patients with thrombocytopenia. However, some chronically transfused patients fail to achieve the appropriate platelet count increment following transfusion due to the presence of platelet alloantibodies. OBJECTIVES: The aims of this research were to study the prevalence of platelet alloimmunisation and to characterise the platelet-reactive (PR) antibodies in haematology patients refractory to platelet transfusions in an Indian setting. PATIENTS AND METHODS: A total of 80 patients with a prior history of multiple transfusions (minimum of five cellular transfusions) were included in the study if they did not achieve an adequate corrected count increment within 24 h of the platelet transfusion. Patients with non-immunological causes of platelet refractoriness were excluded from the study. The test was performed on a blood sample of 4 mL of Ethylenediaminetetraacetic acid (EDTA) blood sample in which plasma was separated and stored at -80 °C and underwent batch testing in PAK-2LE. RESULTS: The overall prevalence of platelet alloimmunisation in our study was 60%. Of the 48 patients who were detected to have platelet antibodies, the combination of anti-human leucocyte antigen (HLA) and platelet-specific (PS) antibodies together constituted the majority of 54·2%. The overall prevalence of anti-HLA antibodies was 51·25% and of PS antibodies was 41·25% in the total study population of 80. CONCLUSION: The overall prevalence of PS antibodies in our study was greater than that reported by other groups in India and other countries. This needs to be considered, particularly in the management of patients refractory to platelet transfusions, where HLA-matched platelets constitute current best practice.

The development of criteria for evaluating psychiatric education programs.

During the last year, the Psychiatry Education Branch of the National Institute of Mental Health undertook an exhaustive review of 530 training proposals from 205 institutions. The scope of such an endeavor, as well as the desire to maintain peer review, necessitated the recruitment of 90 outside consultants. The need for consistency of judgment among a large group of site visitors gave rise to a document that detailed points of concern in the evaluation of psychiatric training programs. Broader dissemination of this document might be useful in a program's self-evaluation, and might further its understanding of the site-visit process. The result of many such evaluations should be the improvement of psychiatric education throughout the country.

Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction.

Seven of 48 patients (14.6%) with acute myocardial infarction who were given 2.4 g of magnesium sulfate as a single intravenous dose had potentially lethal arrhythmias during the first 24 hours after admission, whereas 16 (34.8%) of 46 patients receiving placebo had similar arrhythmias. In addition, 14 of these 16 patients in the placebo group had their first arrhythmia (in the intensive coronary-care unit) within two hours after the start of the study, whereas in the magnesium-treated group, there were no such arrhythmias until some four hours later. The higher the lymphocyte potassium concentration, the greater the reduction in the incidence of arrhythmias. Serum magnesium levels increased by 16.5% and lymphocyte magnesium concentrations by 72% in the magnesium treated group. Intravenous magnesium reduces the incidence of serious arrhythmias after acute myocardial infarction.

Intracellular cations and diuretic therapy following acute myocardial infarction.

In a controlled, prospective, randomized study of the effects of diuretic therapy on serum, lymphocyte, and erythrocyte potassium, magnesium, and calcium concentrations, 155 patients were followed up for six months after experiencing acute myocardial infarction. Of these, 48 patients received furosemide and potassium; 37 patients received hydrochlorothiazide and amiloride hydrochloride; and 70 patients did not require diuretics. Lymphocyte and erythrocyte cation concentrations were all statistically significantly lower in the furosemide-treated patients when compared with the patients in the nondiuretic-therapy group or the hydrochlorothiazide-amiloride-treated group, with no change in serum levels. Since the combination of low intracellular potassium and magnesium concentrations in patients with recent myocardial infarction may be of importance in the cause of arrhythmias, we suggest that potassium- (and magnesium-) sparing diuretics be used in the treatment of patients, when necessary, unless their diuretic needs cannot be met by such agents.

Characteristics of psychiatric residency programs and quality of education.

As part of the fiscal year 1975 NIMH review of all psychiatric education grants, 144 basic residency training programs were thoroughly examined. In order to generate hypotheses about factors related to quality, the authors divided these grants into those given high priority rankings, those ranked in the middle, and those disapproved. Faculty and trainee characteristics, aspects of the service system, and organizational, educational, and evaluation factors were strongly related to quality. In general, good programs had a primary theoretical orientation with a tolerance for diversity, were not administratively responsible for community mental health centers but had strong community service ties, and tended to be in university settings. The authors point out the need to determine psychiatry's role vis-à-vis primary care and to develop a clear understanding of the place psychiatry will have in the health and mental health systems.

Magnesium levels in patients with chronic ischemic heart disease.

Serum magnesium was measured in 89 control subjects ages 19 to 86 years and in 64 patients (ages 35 to 82 years) who had suffered from acute myocardial infarction at least 6 months previously. No differences were found in the serum magnesium levels due to age or sex nor was there any statistical difference between the mean levels in the two groups. It is concluded that the level of serum magnesium is not associated with the presence or absence of clinically evident ischemic heart disease.

The effect of chromium on established atherosclerotic plaques in rabbits.

Twenty-three rabbits were fed for 8 weeks with standard diet to which was added a 1.5% cholesterol supplement. After this the cholesterol supplement was discontinued, but 11 rabbits received a daily intraperitoneal injection of 20 micrograms of potassium chromate while the remaining 12 received distilled water. The aortas were examined after a further 30 weeks; their mean weight per unit length was 1.27 g (SE +/- 0.17) in the control group and 0.81 g (SE +/- 0.08) in the chromium treated group (t = 2.36; P < 0.05). The percentage area of intimal surface covered by plaques was 94.8% (SE +/- 1.7) and 62.6% (SE +/- 10.4), respectively (t = 3.53; P < 0.005), and the total cholesterol content per unit length of aorta was 729 mg/100 ml (SE +/- 44.0) and 457.8 mg/100 ml (SE +/- 117.1), respectively (t = 23; P < 0.05). The results show a significant effect of chromium on the regression of cholesterol-induced atherosclerotic plaques in rabbits.

The effect of chromium on cholesterol-induced atherosclerosis in rabbits.

Rabbits fed on a 1% cholesterol diet for 30 days were injected daily with potassium chromate for a further 60 days. A 50% reduction in aortic intimal plaque area and in aortic total cholesterol content was observed. Control rabbits treated with chromium showed a significant increase in the chromium concentration of their aortas, liver and kidneys but not of the myocardium. Cholesterol-fed rabbits treated with chromium showed a significant increase in chromium concentrations in the liver and kidneys only. Serum cholesterol levels were consistently lower in the chromium-treated animals, although the differences did not reach significant levels.

The action of chromium on serum lipids and on atherosclerosis in cholesterol-fed rabbits.

Eight rabbits, fed on a 1% cholesterol diet for 30 days, were injected daily with potassium chromate for a further 60 days. A 50% reduction in aortic intimal plaque area and in aortic total cholesterol content was observed. However, although levels of serum cholesterol and triglycerides were consistently lower and levels of high density lipoprotein fractions consistently higher in the chromium-treated as compared to the control rabbits, these differences did not reach statistical significance. A further 6 rabbits were injected with potassium chromate and fed on a 1% cholesterol diet for 12 weeks. Mean aortic cholesterol content (+/-SEM) was 40.23 mg/10 cm aortic length (+/-7.50) as compared to 66.24 mg/10 cm (+/- 7.89) in a control group (P less than 0.05), whereas the area of aortic intima covered by macroscopic plaques was 67.5% (+/-2.79) and 81.1% (+/-3.14) (P less than 0.01) respectively.

Serum, lymphocyte, and erythrocyte potassium, magnesium, and calcium concentrations and their relation to tachyarrhythmias in patients with acute myocardial infarction.

Serum, lymphocyte, and erythrocyte potassium, magnesium, and calcium levels were measured in 215 patients during the five days following acute myocardial infarction. Serum potassium fell from 4.25 +/- 0.05 to 4.08 +/- 0.06 mmol/liter (p less than 0.001), magnesium from 0.93 +/- 0.01 to 0.85 +/- 0.01 mmol/liter (p less than 0.001), and calcium from 2.4 +/- 0.02 to 2.2 +/- 0.08 mmol/liter (p less than 0.001). Lymphocyte potassium increased from 18.1 +/- 1.5 to 51.6 +/- 4.3 pmol/100 cells (p less than 0.001) and magnesium from 2.0 +/- 0.1 to 8.2 +/- 0.8 pmol/100 cells (p less than 0.001), whereas calcium decreased from 2.9 +/- 0.27 to 1.4 +/- 0.25 pmol/100 cells (p less than 0.001). Erythrocyte cations remained constant. There was a larger increase in lymphocyte potassium in patients with tachyarrhythmias than in patients without (70.4 and 46.9 pmol/100 cells, respectively, p less than 0.001), whereas the presence of a high lymphocyte magnesium level was associated with a significant decrease in the development of tachyarrhythmias, despite high potassium concentrations. It is suggested that lymphocyte cation concentrations mirror myocardial interstitial concentrations and that a high interstitial magnesium level has a protective effect on the increased cell excitability due to, and despite, a high interstitial potassium level.

Effects of hydrochlorothiazide, diltiazem and enalapril on mononuclear cell sodium and magnesium levels in systemic hypertension.

Sixteen patients (mean age 68 years) with mild to moderate hypertension were treated with either diltiazem or hydrochlorothiazide for 6 weeks, followed by enalapril for a further 6 weeks. A second group of 40 patients (mean age 71 years) was treated with either hydrochlorothiazide or enalapril for 12 weeks; nonresponders received both drugs for 8 weeks. Treatment with hydrochlorothiazide or enalapril resulted in a lowering of systolic and diastolic blood pressures, but diastolic pressure was lower in patients treated with enalapril (89 +/- 2 and 82 +/- 2 mm Hg, respectively; p less than 0.05). Treatment with diltiazem resulted in a decrease in diastolic pressure only. Treatment with hydrochlorothiazide resulted in a 17% decrease in serum potassium (p less than 0.05), which returned to normal when enalapril was substituted. Hydrochlorothiazide also produced a 23% decrease in mononuclear cell sodium content at 4 weeks (p less than 0.01), with a further 15% decrease at 12 weeks (p less than 0.05). Mononuclear cell potassium and magnesium also decreased at 12 weeks by 18 and 16%, respectively (p less than 0.05). All these effects were reversed when enalapril was substituted. A similar pattern of events was seen with diltiazem, which was again reversed with enalapril. Finally, there was no relation between changes in mononuclear cell sodium or other cation content and changes in blood pressure.

Valvular dysfunction in antiphospholipid syndrome: prevalence, clinical features, and treatment.

Valvular abnormalities develop in 36% and 35% of patients with primary antiphospholipid syndrome (PAPS) and with systemic lupus erythematosus (SLE) respectively, and in 48% of patients with SLE and antiphospholipid antibodies (aPL). Valvulopathy includes leaflet thickening, vegetations, regurgitation, and stenosis. A literature survey shows that significant morbidity from valvular dysfunction, mostly mitral regurgitation leading to congestive heart failure, occurs in 4% and 6% of SLE and PAPS patients, respectively. The pathogenesis of valvulopathy may involve interaction of aPL with antigens on the valve surface, resulting in valvulitis. Current therapy includes symptomatic measures and valve replacement. A novel approach for symptomatic antiphospholipid syndrome (APS) related valvulopathy involves treatment with systemic corticosteroid. We describe four such patients and their dramatic clinical and hemodynamic response to treatment with prednisone when symptomatic measures failed.

Primary lymphosarcoma of the breast: review of the literature on occurrence in elderly patients.

A case of primary lymphocytic lymphosarcoma of the breast in a 74-year-old woman is presented, together with a review of the literature on 23 cases of primary breast lymphosarcoma in patients aged 60 or older. In this age group, simple local excision or mastectomy is probably sufficient.

The effects of chromium supplementation on serum glucose and lipids in patients with and without non-insulin-dependent diabetes.

Seventy-six patients with established atherosclerotic disease were treated daily with either 250 micrograms of chromium orally as chromium chloride or a placebo for a period of 7 to 16 months (mean, 11.1 months). Serum chromium increased from 2.69 +/- 0.09 to 12.12 +/- 0.77 nmol/L (mean +/- SE, P less than .005). Serum triglycerides were lower (1.68 +/- 0.11 and 2.10 +/- 0.14 nmol/L, respectively; P less than .02) in the chromium-treated patients than in the patients who received placebo, and serum high-density lipoprotein (HDL) increased (from 0.94 +/- 0.05 to 1.14 +/- 0.07 mmol/L, P less than .005) in the patients who received chromium. There was no change in serum cholesterol or blood glucose during the study.

A routine method for the measurement of the sodium, potassium, magnesium and calcium content of human lymphocytes.

We describe a rapid, single-step procedure for the isolation of human lymphocytes from whole blood, suitable for a routine clinical laboratory. Lymphocyte content of sodium, potassium, magnesium and calcium were measured simultaneously in a group of controls and found to fall within expected ranges. Expression of results per mg protein produced less inter-individual variation than per unit cell. In order to examine another, physiologically different but normal population, women during pregnancy were also studied. The cation content of lymphocytes expressed per mg protein was significantly lower than for controls due to a 44% increase in protein content per cell.

The relationship between beta-endorphin levels and uterine muscle contractions during labor.

Plasma beta-endorphin (BE) levels (8.6 +/- 0.8 pmol/l) (mean +/- SE) were lower in the third trimester than in non-pregnant controls (14.8 +/- 1.1 pmol/l) (P less than 0.001), increased during labor, to 29.3 +/- 4.4 pmol/l (P less than 0.005) and decreased, 72 h after delivery, to 3.5 +/- 0.4 pmol/l (P less than 0.001). BE levels were found to correlate significantly with uterine muscle contraction (r = 0.966, P less than 0.05) and with cervical effacement (r = 0.974, P less than 0.05) during labor.

Fever: genuine or factitious?

Although patients with factitious fever form a small subgroup of all patients investigated for fever of unknown origin, the diagnosis should be kept in mind. If unsuspected, this phenomenon can lead to a multiplicity of laboratory investigations and misuse of hospital beds, as well as to unnecessary risk to the patient.

Differential diagnosis of chest pain. Use of isoenzyme LDH1 level as a criterion.

Changes in level of isoenzyme LDH1 seem to be a valuable criterion in differentiating acute myocardial infarction from active coronary insufficiency without infarction. LDH1 level increases noticeably within 48 hours after onset of pain from acute myocardial infarction but tends to decrease if the pain is due to active coronary insufficiency.

Potassium and magnesium status in ischaemic heart disease.

This paper summarizes the evidence that magnesium and potassium ions play a vital role in the generation of ventricular tachyarrhythmias in patients with acute myocardial infarction. In particular, the protective role of magnesium is stressed. Patients with acute myocardial infarction treated prophylactically with magnesium intravenously for the first 24 hours after admission have a much lower incidence of potentially fatal tachyarrhythmias and a low in-hospital mortality. The role of intracellular cation measurements in defining prognosis after acute myocardial infarction is also discussed as is the effect of diuretic therapy.

A prospective randomized trial of intravenous magnesium versus intravenous propranolol in acute myocardial infarction.

A total of 266 patients entered into a study comparing the effect of intravenous magnesium and propranolol following acute myocardial infarction. Of these, 97 were able to receive either drug and were therefore randomized into the magnesium (n = 51) or propranolol group (n = 46). 88 patients were unable to receive propranolol and formed a third group (NR) while a further 81 patients could not receive either drug and formed a fourth group (N). The study showed that intravenous magnesium was as effective in preventing potentially lethal arrhythmias as propranolol and could be given to some 70 per cent of such patients whereas propranolol could only be given to 36 per cent.