Management of superficial vein thrombosis and thrombophlebitis: status and expert opinion document.

Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb, Lipohep, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.

Modulation of Fusicoccin-Binding Protein Activity in Mung Bean (Vigna radiata L.) Hypocotyls by Tissue Maturation and by Fusicoccin.

The phytotoxin fusicoccin (FC), after binding to a plasma membrane-localized receptor, causes higher plant cells to excrete protons. Ligand-binding analysis has been used to show that the plasma membrane of mung bean (Vigna radiata L.) hypocotyls contains both high-affinity (HA) and low-affinity (LA) binding sites for FC. The effect of tissue maturation on these sites was determined on isolated membrane vesicles from the meristematic region (hook) and the elongation zone and from mature hypocotyl tissues. In the meristematic region the HA:LA ratio was 1:20. As hypocotyl tissues matured, the site density of HA increased and there was no change in LA density, so that the HA:LA ratio increased to 1:2 in maturet issues. FC-induced proton excretion correlates with the HA density, not the LA density. When sections isolated from each region were incubated with FC prior to isolation of membranes, there was an apparent conversion of LA to HA sites during the first 90 min in all regions. During the next 1 to 3 h there was a further 2.5- to 3- fold increase in binding sites in all regions, accompanied by a slight decline in dissociation constant. The increase in binding sites, but not the apparent conversion of LA to HA, was partly blocked by cycloheximide. These data suggest that FC alters FC-binding protein activity in two ways: first, by causing an increase in affinity for FC of preexisting LA receptors, and second by inducing the synthesis of additional FC receptors. This apparent up-regulation of a phytotoxin receptor by its ligand in plants has not previously been reported.

Modulation of platinum-induced toxicities and therapeutic index: mechanistic insights and first- and second-generation protecting agents.

Platinum-type drugs have proven to be valuable in the treatment of a variety of solid tumors, beginning with the commercial approval of cisplatin 18 years ago. There are several clinically important toxicities commonly associated with the administration of these drugs. Despite the extensive use of cisplatin and carboplatin, the fundamental chemical transformations and mechanisms that underlie their antitumor and toxic effects have not been fully characterized. Several first-generation protective thiols have been clinically studied in an attempt to reduce the toxicity of platinum-type drugs; while some of these agents appear to protect against certain toxicities, nearly all platinum-protecting drugs have their own intrinsic toxicities, which can be additive to the toxicity of platinum-type drugs. Tumor protection by platinum-protecting drugs is an additional untoward effect that is associated with certain types of agents and must be addressed with care. Recent advances in theoretical and laboratory methods and the use of supercomputers have extended our understanding of the possible major mechanisms underlying platinum drug antitumor activity and toxicity; we present strong evidence that there are two classes of chemical species of platinum drug. One class appears to predominantly account for the antitumor activity, and the other class of chemical species produces many of the toxic effects of platinum drugs. We have discovered a new nontoxic, second-generation platinum-protecting agent, known as BNP7787, which appears to selectively inactivate and eliminate toxic platinum species. BNP7787 has recently entered phase I clinical testing in cancer patients.

What happened to the "n" of sink? Children's spellings of final consonant clusters.

Children's spellings provide a window on their representations of spoken words. These representations may not always match those assumed by the conventional orthography. We examined one specific case in which this may be true, that of CVCC (consonant-vowel-consonant-consonant) syllables. In three experiments, first graders often produced spellings such as "sach" for the nonword [symbol: see text] and "pit" for the nonword /pIlt/. We suggest that many children consider these syllables to contain three phonemes instead of four phonemes. Rather than treating the postvocalic nasal or liquid as a separate phoneme, children consider it an attribute of the vowel. This suggestion was supported by the results of a phoneme counting test in which children often used three tokens for syllables such as [symbol: see text] and /pIlt/. The results suggest that, in addition to difficulties in gaining access to phonemes, nonstandard phonemic representations may be a stumbling block in the acquisition of alphabetic literacy.

Noninvasive imaging for deep venous thrombosis.

In 96 patients, 127 extremities were identified by duplex ultrasonography as having acute deep venous thrombosis. The majority of these patients were found to have factors that predisposed them to thrombi formation. Doppler examination correlated with the duplex results in 77 extremities (61 percent). Two factors were identified that led to discrepancies between the results of these two modalities: (1) Thrombi that were more proximally located and totally occlusive were more likely to result in abnormal Doppler results than those that were not. (2) Doppler examination of the deep venous system of the lower extremities, although more accurate than clinical evaluation, was of insufficient accuracy to make correct decisions regarding the need for anticoagulation.

Details of a canine venous insufficiency model.

Continued study of a chronic deep venous insufficiency (CDVI) model allows optimal comparison with the human condition. This study evaluates the model's long-term stability, its lack of observed clinical effect, and a simulated exercise study as a physiologic estimate of normal hindlimb walking. The time to maximal ankle venous pressure after standing (VFT), and to 90% of the venous refilling time after electrical stimulation, quadripedal, or hindlimb walking (VRT90), and the minimal pressure after exercise (AVP) were measured up to 10 months after CDVI model creation. The animals' intravenous resting pressure was obtained after standing stationary on all four limbs. Analysis of variance was used to determine statistical significance where indicated. VFT, AVP, and VRT90 measurements demonstrated values consistent with CDVI in animals studied up to 10 months after model creation and were statistically different from control limb values (p < or = .002, n = 8). Animals studied during quadripedal walking showed no difference in resting pressure, AVP, and VRT90 between model and control limbs (n = 5). There was no statistical difference in AVP or VRT90 measured under conditions of stimulated exercise or bipedal walking; and both conditions produced hemodynamic changes consistent with CDVI (n = 5). This animal model is a reliable long-term CDVI hemodynamic model. The normal venous hemodynamics recorded during quadripedic walking may explain the lack of clinical sequelae observed in this model. Lastly, the method of simulated exercise used in this study is a reliable test that reflects physiologic measurements obtained during bipedal walking.

The effect of enalapril on leg muscle blood flow in patients with claudication.

In the percent study the authors have demonstrated that the peripheral blood flow and resistance as measured by strain-gauge venous occlusion plethysmography were favourably altered by enalapril. The peripheral blood flow increased significantly and since there was no detectable change in ankle pressure this indicated a decrease in resistance during administration of the drug.

Encapsulated liquid crystal (ELC) thermography in peripheral arterial disease.

The correlation between peripheral pressures and skin temperatures was studied by encapsulated liquid crystal (ELC) plates in 66 patients with peripheral arterial disease. The study was also performed to evaluate the correlation between symptoms and temperature in four symptomatic groups of patients (with claudication, rest pain, ischemic ulcerations or gangrene and chronic ulcerations in diabetic patients). The correlation with temperature and pressure was positive (0.99) and so it was that one between symptoms and temperature. This method may be easily used in patients with peripheral arterial disease to evaluate the perfusion of the extremities and to compare bordering areas. Considering these data different new applications of this technique in peripheral vascular disease diagnosis can be suggested. The elevate velocity of the method (about 5 seconds) reveal also very fast variations of the perfusion and this may be useful to study functional decreases of blood pressure.

[Rheographic studies in the diagnosis of vertebrobasilar syndromes]. / Badania reograficzne w diagnostyce zespolow kregowo-podstawnych.

The authors report the results of investigations of 33 healthy subjects and 33 patients with manifestations of intracranial circulatory disturbances in the vascularization area of the vertebrobasilar system. Type II rheography was used. All curves from the vertebral, vertebromastoid and frontomastoid leads were averaged. No significance of asymmetry between the right and left sides was demonstrated in attempts at differentiation between patients and controls. Mosaicisim of changes of curves during head turning was observed in 15% of controls and 55% of patients.

Children's sensitivity to syllables, onsets, rimes, and phonemes.

It has been argued that children's performance on phonological awareness tasks varies with the linguistic level that is tapped by the task. For example, tasks that involve syllables are thought to be easier than tasks that involve lower-level linguistic units, and tasks that tap the level of onsets are thought to be easier than tasks that require access to single phonemes. In previous research, however, the linguistic status of a unit has often been confounded with its size. Five experiments were carried out in an attempt to disentangle these variables and so to provide a better test of the linguistic status hypothesis. In the first study, preschoolers and kindergartners more readily judged that two stimuli shared a beginning sound when that sound was an onset on its own than when it was part of a cluster onset. In two additional experiments, there was an advantage for syllables over rimes in kindergarten and first-grade children when the shared units occurred in the middle syllables of trisyllabic stimuli. The superiority for syllables was largely masked in two other studies in which the stimuli that shared a unit rhymed. This latter result suggests that children's familiarity with rhyme can override the syllable advantage. Overall, the results support the linguistic status hypothesis by indicating that effects of linguistic level on phonological sensitivity cannot always be reduced to effects of unit size.

Children's sensitivity to syllables, onsets, rimes, and phonemes.

It has been argued that children's performance on phonological awareness tasks varies with the linguistic level that is tapped by the task. For example, tasks that involve syllables are thought to be easier than tasks that involve lower-level linguistic units, and tasks that tap the level of onsets are thought to be easier than tasks that require access to single phonemes. In previous research, however, the linguistic status of a unit has often been confounded with its size. Five experiments were carried out in an attempt to disentangle these variables and so to provide a better test of the linguistic status hypothesis. In the first study, preschoolers and kindergartners more readily judged that two stimuli shared a beginning sound when that sound was an onset on its own than when it was part of a cluster onset. In two additional experiments, there was an advantage for syllables over rimes in kindergarten and first-grade children when the shared units occurred in the middle syllables of trisyllabic stimuli. The superiority for syllables was largely masked in two other studies in which the stimuli that shared a unit rhymed. This latter result suggests that children's familiarity with rhyme can override the syllable advantage. Overall, the results support the linguistic status hypothesis by indicating that effects of linguistic level on phonological sensitivity cannot always be reduced to effects of unit size.