Assessment of hypercoagulability in patients with cancer using the Sonoclot Analyzer and thromboelastography.

Patients with cancer have an increased incidence of thrombosis and abnormal haemostasis detectable by sophisticated laboratory tests. Whether abnormalities in such highly sensitive assays is clinically relevant to bleeding or thrombosis is not clear. The thromboelastograph (TEG) and Sonoclot analyzers assess the coagulation process in whole blood and may therefore be physiologically more relevant than assays of isolated haemostatic components. Blood was collected from healthy volunteers and patients with breast cancer, colorectal cancer or benign disease and tested in the TEG and Sonoclot. Results in the cancer group were compared to appropriately sex-matched controls. The TEG parameters R (P < 0.02), angle (P < 0.05) and MA (P < 0.001) were abnormal in colorectal cancer; up to 8/17 (47%) patients being assessed as hypercoagulable. R (P < 0.05), angle (P = 0.05) and MA (P < 0.001) were abnormal in breast cancer; 2/21 (9%) patients having abnormal results. In the Sonoclot Analyzer, 11/17 (64%) patients with colorectal cancer had a significant increase in clot rate (P < 0.001) while 2/17 had a decreased SonACT time (P = 0.05). 4/21 (19%) breast cancer patients had a significant increase in clot rate (P < 0.001) and the SonACT was shortened (P = 0.05). Platelets and fibrinogen levels were generally normal and only one patient had clinical evidence of thrombosis. There were no significant coagulation changes in patients with benign colon or breast disease. In conclusion, hypercoagulability was detected in a high proportion of breast and colorectal cancer patients by both techniques. The clot rates of the TEG and Sonoclot were significantly correlated but the latter was abnormal in a greater proportion of cancer patients.

An assessment of disability rating scales used in multiple sclerosis.

Twenty patients with clinically definite, stable multiple sclerosis were examined independently by three of us at the same visit and given scores on the Ambulation Index, Expanded Disability Status Scale, and Kurtzke Functional System scales. Observer error accounted for 12% to 55% of the variation observed between individual Kurtzke Functional System scores, 17.1% of the variation observed between the patients' Expanded Disability Status Scale scores, and only 3.9% of the variation between Ambulation Index scores. The implications of these findings for the choice of scales in clinical trials are described.

The response to isoniazid of action tremor in multiple sclerosis and its assessment using polarised light goniometry.

Isonicotinic acid hydrazide (isoniazid) was evaluated in five patients as a treatment for the control of severe cerebellar action tremor occurring in multiple sclerosis. Oral doses of isoniazid BPC were increased every 2 weeks from 300 mg to 1200 mg daily over an 8 week period. Four patients reported considerable symptomatic benefit at doses ranging from 600 mg to 900 mg daily. Polarised light goniometry demonstrated a two to three-fold reduction of tremor in these patients when standard methods of clinical assessment showed only marginal improvement.