Platelet aggregation following defibrination with ancrod.

In vitro platelet aggregation was studied in dogs following defibrination with Ancrod. There was marked inhibition of aggregation immediately after defibrination. A gradual return toward normal aggregation was observed over the 96 hours study period, but aggregation was still abnormal at 96 hours after defibrination. There was an inverse and highly significant correlation between aggregation and fibrin degradation product level. Fibrinogen was not measurable after defibrination for the entire study period. Aggregation was thus independent of fibrinogen concentration in this study.

Subcutaneous mastectomy: acute complications and long-term follow-up.

Subcutaneous mastectomy as performed at our institution from 1965 to 1979 was an operation with high morbidity. The risk of complication appears to have been decreased with a two-stage approach. Long-term results were disappointing, with a high incidence of capsular contracture. The incidence of capsular contracture appears to have been reduced by subpectoral placement of the implants. One breast carcinoma occurred 10 years after subcutaneous mastectomy.

Disappearance of the polyurethane cover of the Ashley Natural Y prosthesis.

Polyurethane foam implanted in our patient was neither inert nor permanent. Clinical observations and animal studies suggest that all polyurethanes implanted to date have slowly disintegrated and have been absorbed in tissue. This process takes several years to complete. The exact time sequence and histology are not known.

Prospective trials of dexamethasone and aerosolized gentamicin in the treatment of inhalation injury in the burned patient.

The addition of an inhalation injury to a cutaneous burn results in a significant increase in patient mortality rates, both from early pulmonary edema and, later, Gram-negative pneumonitis. Steroids have been shown to decrease mortality in an inhalation injury model. Aerosolization of gentamicin has been used successfully to treat severe bronchial infections. Therefore, a prospective, randomized trial was undertaken to evaluate both these drugs. Sixty burned patients, with inhalation injury confirmed by bronchoscopy and 133Xenon scan, were studied: 30 patients received either dexamethasone or saline placebo for 3 days; serial pulmonary functions were measured on those able to cooperate; another 30 patients received either aerosolized gentamicin or placebo for 10 days. Both drug-treated groups were comparable to their controls in age and mean burn size. Results of the steroid trial showed no major differences in mortality, pulmonary complications, or changes in pulmonary functions. Results of the gentamicin trial showed no major differences in mortality, time of death, or pulmonary and septic complications between treated and control groups.

Characterization of fragment E from fibrinogen and cross-linked fibrin.

Fragment E, a terminal plasmin digestion product of fibrinogen or fibrin, contains portions of the alpha, beta, and gamma chains linked by disulfide bonds. In this study, Fragment E from fibrinogen and fully cross-linked fibrin were purified by gel filtration of the soluble fraction from heated plasmin digests of either fibrinogen or fibrin or by step-wise chromatography of terminal plasmin digests of fibrinogen or cross-linked fibrin on DEAE-cellulose. Fibrinogen Fragment E and fibrin Fragment E migrated as single bands with identical mobilities on sodium dodecyl sulfate-polyacrylamide gel electrophoresis or on polyacrylamide gel electrophoresis at pH 3.2 or pH 8.6. After reduction by beta-mercaptoethanol, the two Fragment E species had very similar patterns on sodium dodecyl sulfate gel electrophoresis; each contained three subunits which had molecular weights ranging from 5,000 to 12,000. Only the subunit polypeptide derived from the gamma chain in either Fragment E contained carbohydrate. The two Fragment E species had identical sedimentation coefficients and identical molecular weights by equilibrium ultracentrifugation. The amino acid compositions were indistinguishable. Partial NH2-terminal sequence analyses of fibrinogen Fragment E and fibrin E were identical, indicating that plasmin had cleaved the NH2-terminal regions of the Aalpha or alpha and Bbeta or beta chains of both Fragment E Species.