A formula for correcting for the in vitro release of platelet beta-thromboglobulin.

The interpretation of platelet beta-thromboglobulin (BTG) and platelet factor 4 (PF4) levels as indicators of in vivo platelet activation is complicated by the artefactual release of these proteins in vitro. A formula was devised to correct for in vitro platelet activation and release of BTG. Blood was collected from normal volunteers by an ideal method and BTG and PF4 levels determined by radioimmunoassay; these were the reference values. Blood from normal volunteers was activated in vitro by standing at room temperature. The BTG and PF4 released was measured at different time intervals. The relationship between BTG and PF4 released was measured at different time intervals. The relationship between BTG and PF4 was measured mathematically best described by a second degree polynomial function. The true plasma BTG value was then calculated by correcting for in vitro release by the general formula: BTG corrected = BTG measured - BtG for PF4 measured + BtG for PF4 reference The validity of the correction formula was tested in 10 normal subjects and in patients with either recent myocardial infarction(n = 10), familial hypercholesterolaemia(n = 10) or arterial prostheses(n = 14). Correction was adequate in normal subjects if the plasma BTG levels did not exceed 260ng/ml. In patients with a thrombotic tendency, the formula overcorrected for in vitro release. This could be ascribed to increased in vivo PF4 levels in these patients, especially those with prostheses. The reference values for PF4 in these patients, and especially those with vascular prostheses, were also higher than normal. The PF4 measured in their plasma thus reflects both in vivo and in vitro released protein. The hypothesis on which the correction formula was based, is therefore not always applicable. It may be possible to improve the correction by establishing formulae for specific disease groups.

Daily serial evaluation of left ventricular function with equilibrium radionuclide ventriculography following thrombolysis during acute myocardial infarction.

The changes in ventricular function after reperfusion by coronary thrombolysis are important when deciding about further definitive treatment necessary to ensure long-term vessel patency. The purpose of this study was to evaluate the early changes in left ventricular function after reperfusion. Left ventricular function was serially evaluated for 10 days in a group of 18 patients receiving intracoronary thrombolytic therapy for an acute myocardial infarction. Comparison of the global ventricular function in the successfully and unsuccessfully reperfused groups of patients showed significantly better function in the successful group than the unsuccessful group after the first day, which was maintained for the entire study period. Global and regional ventricular function in the successfully reperfused patients showed significant early improvement during the initial 72 h with maintenance of this improvement for the study period of 10 days. In the patients in whom reperfusion was unsuccessful, regional ventricular function showed no change, while the global function declined from day 5 to day 8 of the study period. This study then confirms the significant improvement in ventricular function after successful reperfusion. The time course pattern of the change in ventricular function indicates that the most significant improvement occurs within the first 72 h after reperfusion. These changes are similar to those previously reported in experimental animals.

[Partial ileal bypass for familial hypercholesterolemia]. / Gedeeltelike ileale omleiding vir familiële hipercholesterolemie.

The extent of reduction in cholesterol levels, the maintenance of low levels in the long-term, the morbidity and mortality as well as the acceptance of side-effects of the partial ileal bypass (PIB) is reviewed. The mean reduction in cholesterol levels following PIB was 35.2% in males and 35.8% in female patients. The reduction is significant and it is maintained over a 10-year period. The morbidity and mortality is low and side-effects are well tolerated. Our results indicate that the PIB may play an important role in the cholesterol-lowering armamentarium.

The diagnosis of abdominal injuries in comatose patients.

The clinical course of 95 comatose trauma patients was prospectively evaluated. The role of clinical findings and diagnostic peritoneal lavage (DPL) combined with computed tomography (CT) were assessed in the diagnosis of abdominal injuries. Seven per cent of the patients were comatose due to hypoperfusion, and did not have a primary brain injury. Of the remaining 88 patients, 28% had an associated abdominal injury. Hypotension predicted an associated abdominal injury with an accuracy of 72%, and a haematocrit less than 30% had an accuracy of 82%. Clinical examination was 50% accurate. DPL was 93% accurate, with a false-positive rate of 10%. No abdominal injuries were present in the group in whom the lavage results were negative, while no unnecessary laparotomies were performed in the group with a 4+ or 5+ positive DPL (calorimetric method). In the group with 1+, 2+ and 3+ positive DPL, 3/15 laparotomies (12%) were done for minor abdominal injuries. Minimising unnecessary laparotomies was achieved by utilising CT to determine the nature and extent of the injury. By using DPL as a screening test, and CT to quantify the injury, unnecessary operations can be avoided, and all injuries can still be diagnosed.

The attitude of South African women to mastectomy for breast cancer.

No previous study has reported on the acceptance of and attitudes towards the treatment of breast cancer among white South African women. The influence of age, social, economic and marital status, occupation, and the effect of knowledge of the disease on the reaction to the possible diagnosis of breast cancer, the attitude to mastectomy, and physical and psychological readjustment after mastectomy were studied in 100 respondents to a questionnaire. The preliminary conclusions from this study are that South African women desire effective treatment of breast cancer, that physical and psychological readjustments are readily made by the majority without major problems, and that reconstructive surgery is not in high demand.

Efficacy of grass-maize pollen oral immunotherapy in patients with seasonal hay-fever: a double-blind study.

Forty patients with a well-documented history of seasonal hay fever and a positive skin-prick test specific to grass pollen, including Bermuda grass and maize pollen (Zea maize), were allocated randomly on a double-blind basis to receive either an oral mixed grass-maize pollen extract or a matched placebo during the 1981/1982 grass pollen season. After 12 months the code was broken and patients on placebo were transferred to active therapy while patients on active therapy continued with maintenance therapy for another 12 months during the 1982/1983 grass pollen season. The assessment of the effect of the orally administered grass-maize pollen extract was on the clinical symptoms. During the first year the patients on active therapy had significantly fewer hay fever symptoms during the summer months compared with the placebo group. During the second study year, with all patients on active therapy, both groups had markedly milder symptoms compared with the placebo group. Side-effects were negligible. This study concludes that oral immunotherapy with grass-maize pollen extract in grass pollen-sensitive seasonal hay fever patients is safe and effective.

Ketanserin in the treatment of hypertension following coronary artery bypass surgery. A preliminary study.

The possible role of 5-hydroxytryptamine (serotonin) in patients developing hypertension following coronary artery bypass surgery was investigated by intravenous administration of ketanserin, a specific 5-hydroxytryptamine-receptor antagonist. Our findings in the preliminary study indicate that 5-hydroxytryptamine might not play a role in the hypertension seen after coronary artery bypass surgery.

Uterine contraction patterns in abruptio placentae.

Tocographic monitoring of 21 patients with grade III abruptio placentae revealed the following: the tocographic pattern can be of diagnostic aid; the tocograph is of no value in measuring progress, because there is no significant change in uterine tone and contraction frequency and amplitude from the time the membranes are ruptured until the delivery of the fetus; and the tocographic patterns in abruptio placentae are probably of diagnostic value as regards the coagulation defect, but further proof of this is necessary.

Efficacy of different antibiotics in the treatment of pelvic inflammatory disease.

A total of 40 patients with acute pelvic inflammatory disease (APID) were studied over a period of 7 months; one aim was to evaluate the use of different antibiotics in treatment. The most important findings were: (i) most patients had a polymicrobial aetiology for their APID; (ii) Chlamydia trachomatis and the anaerobic bacteria were the most common organisms encountered; and (iii) tetracycline plus metronidazole is probably the best combination therapy for APID.

Uterine contraction regularity during labour in White and Black patients.

Irregularity of uterine contractions during labour was compared in 50 White and 50 Black patients. The standard deviation of distances between contractions as seen on cardiotocography and of maximal pressures was used to compare contraction regularity in the two groups of patients. A small standard deviation (SD) indicated regular contractions; a larger SD signified irregular contractions. Mean SDs of peak-to-peak and of base-to-base measurements were both 6,3 mm for White patients and both 7,6 mm for Black patients. The mean SD for maximal uterine pressures was 9,5 mmHg for White patients but 12,7 mmHg for Black patients. All these differences were statistically highly significant, and this implies that uterine contractions are more irregular in Black patients.

Important semen parameters during postcoital testing.

One hundred and sixty-two females who attended our infertility clinic were selected according to the quality of their cervical mucus. Only mucus of extremely high quality was used in the study to determine the influence of different semen parameters on the postcoital test results. All mucus samples were evaluated 8 h following coitus. The results of the postcoital tests were divided into group I (less than 7 spermatozoa per 400 X magnification) and group II (greater than 7 spermatozoa per 400 X magnification). The results of the statistical analysis indicated the order of importance of the different semen parameters during postcoital testing. By using the stepwise discriminant analyses, it was calculated that the sperm concentration and forward progression rate of the spermatozoa are discriminating factors between the two groups.

The incidence of surgical glove perforation during obstetric and gynaecological surgical procedures.

The increasing prevalence of diseases such as AIDS and hepatitis B makes safe surgical techniques more important than ever before. Intact surgical gloves act as a barrier against these infections and a study was therefore done to determine the incidence of surgical glove perforation during obstetric and gynaecological surgical procedures. Surgical gloves were collected and tested for perforations following 353 consecutive obstetric and gynaecological operations. Forty pairs of new unused surgical gloves were tested for perforations in the same way. Whereas none of the 40 control pairs of gloves was found to be perforated, 22%-24% of used gloves were perforated. The experience of the surgeon had no influence on the incidence of glove perforation (P = 0.997; chi 2-test). Left-hand gloves were more frequently perforated than right-hand gloves, but this difference was not statistically significant (P = 0.075: chi 2-test). These findings must be a source of concern to all those practising obstetrics and gynaecology and measures are therefore suggested to decrease the risk of HIV or hepatitis B transmission during operations.

Cervical intra-epithelial neoplasia and invasive cervical cancer in black and white patients.

The relative incidences of cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer were studied in black and white patients at the academic hospitals of the University of the Orange Free State. A statistically highly significant difference was found between black and white patients, with a higher incidence of invasive cervical cancer than stage III CIN (CIN III) in black patients and a higher incidence of CIN III than invasive cervical cancer in white patients (P = 0.000092; 95% confidence interval -0.355-(-)0.128). The time interval between the peak incidence of CIN III and that of invasive cervical cancer was found to be shorter in black than in white patients. These distressing findings emphasise the urgent need for a national cervical cytological screening programme to decrease the incidence of invasive cervical cancer. This serious yet preventable disease is still very prevalent in South Africa, especially among black women.

Haematological condition of the San (Bushmen) relocated from Namibia to South Africa.

A cross-sectional study was undertaken to assess the haematological condition of the San (Bushmen) relocated from Namibia to South Africa. We studied 238 subjects--145 men and 93 women; none of the women was pregnant. We performed full blood counts and estimations of serum vitamin B12, folate, ferritin and erythrocyte folate concentrations. The mean haemoglobin concentration among the men was 14.7 g/dl and 19 (13%) were anaemic; among the women it was 13.8 g/dl and 18 (19%) were anaemic. Thirteen (9%) of the men and 22 (24%) of the women had low concentrations of serum ferritin, and 38 (26%) of the men and 22 (24%) of the women had erythrocyte folate concentrations of less than 270 nmol/l. Three (2%) men and 4 (4%) women had serum vitamin B12 concentrations of less than 120 pmol/l. Eighty-one (56%) of the men and 76 (82%) of the women had eosinophilia, probably because of parasitic infections. It would appear from this and previous studies that prolonged exposure of these hunter-gatherers to a Western lifestyle has resulted in a high prevalence of anaemia, caused by low iron and folate intakes, complicated by alcohol consumption.

Erythrocyte sedimentation rate in elderly blacks.

This study investigated the erythrocyte sedimentation rate (ESR) in an elderly population with the objective of establishing reference ranges and the diagnostic value of the ESR. Elderly blacks were randomly selected from communities in the Orange Free State. ESR determinations were done according to the Westergren method. Total protein, albumin, immunoglobulin and C-reactive protein (CRP) levels were measured on serum. Results were analysed by means of non-parametric statistical methods. In the group with normal CRP' and immunoglobulin levels it was found that 99% of values were below 44 mm/h for men and 62 mm/h for women. The sensitivity and specificity for these cut-off values (CRP used as 'gold standard') were 33% and 91% respectively for men and 75% and 89% respectively for women.

Surgical glove powder and intraperitoneal adhesion formation. An appeal for the use of powder-free surgical gloves.

Intraperitoneal adhesion formation is a major cause of infertility and/or intestinal obstruction. Among the many well-known aetiological factors responsible for peritoneal inflammatory reaction is surgical glove powder; for example, cornstarch powder. A study was undertaken on 30 rats to determine whether cornstarch powder caused intraperitoneal adhesions. The rats were randomised into two groups under laboratory conditions. Laparotomies were performed on all the rats and trauma inflicted to the right uterine horn. The study group received cornstarch powder suspended in normal physiological salt solution intraperitoneally, and the control group received only normal physiological salt solution. Peritoneal adhesions were evaluated after 2 weeks and statistically analysed with a t-test and 95% confidence intervals. The study group showed a statistically significantly higher incidence of intraperitoneal adhesions (P = 0.0003). It is concluded that cornstarch, as used on surgical gloves, caused peritoneal adhesions and should therefore be removed before surgery. Powder-free gloves are more suitable for preventing adhesion formation.

The prevalence of hepatitis B viral markers in Bloemfontein anaesthetists.

A study was undertaken to determine whether the 48 anaesthetists in Bloemfontein have a higher rate of exposure to hepatitis B virus than comparable groups and whether active immunisation with hepatitis B surface antigen is necessary. Hepatitis B markers were detected by radio-immunoassay and the results analysed statistically. Hepatitis B markers were found in the sera of 36.17% of the anaesthetists and they had an 8-9 times greater prevalence of markers than employees of the local hospitals. Hence anaesthetists run a larger risk of contracting hepatitis B and its complications. It is recommended that non-immune anaesthetists be immunised.

Autonomic neuropathy and atypical myocardial infarction in a diabetic clinic population.

The incidence of autonomic neuropathy in 52 insulin-dependent and 87 non-insulin-dependent diabetic subjects was studied as well as the relationship between the type and duration of diabetes, metabolic control and the association of atypical infarctions with autonomic neuropathy. No statistically significant relationship was found between any parameter and the presence of autonomic neuropathy. Atypical infarctions were not confined to subjects with autonomic neuropathy, but the incidence was considerably higher than that in the general population. Position of the infarction did not determine whether it was silent or not. It is suggested that physicians should be alert to the occurrence of silent infarctions in all diabetics and not only those with clinical evidence of autonomic neuropathy.

Intracoronary thrombolysis and coronary angioplasty for evolving myocardial infarction.

At present experience in South Africa with coronary reperfusion during the acute phase of myocardial infarction is limited. Acute reperfusion of an infarct-related coronary artery was attempted in 55 patients using intracoronary thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA). Intracoronary streptokinase infusion had reopened 25 to 40 totally occluded lesions but usually a residual severe stenosis remained. PTCA was subsequently attempted in 36 severely stenotic coronary arteries and 19 totally occluded coronary arteries. PTCA was successful in 48 of the 55 cases (87%). After 1 week vessel patency was present in 36 of the 39 patients who had early coronary artery re-assessment. Late restenosis occurred in 4 out of 14 cases. There were no procedure-related deaths. Normal global as well as regional left ventricular function was present in 15 cases after 1 week. Emergency PTCA alone or in combination with intracoronary thrombolytic therapy is efficacious in achieving coronary reperfusion. On follow-up, left ventricular function appeared to be well preserved in 27% of patients with patent infarct-related arteries.

The renin-angiotensin-aldosterone system during and after cardiopulmonary bypass.

Renin and aldosterone values were measured in 20 patients undergoing coronary bypass surgery. Renin activity rose to a peak during bypass, falling a little after bypass and surgery. Aldosterone levels rose significantly during bypass, and continued to do so afterwards. This demonstrates a typical physiological stress response, evoking hormonal changes.