Clinical and economic effectiveness of an inpatient anticoagulation service.

We conducted a prospective cohort study to evaluate clinical and economic end points achieved by a pharmacist-managed anticoagulation service compared with usual care (50 patients/group). The primary therapeutic end point was the time between starting heparin therapy and surpassing the activated partial thromboplastin time therapeutic threshold. The primary economic end point was the direct variable cost of hospitalization from admission to discharge. No significant differences between groups were noted for the primary therapeutic end point. Total hospital costs were significantly lower for patients receiving pharmacist-managed care than for those receiving usual care ($1594 and $2014, respectively, 1997 dollars, p=0.04). Earlier start of warfarin (p=0.05) and shorter hospital stay (5 and 7 days, p=0.05) were associated with the pharmacist-managed group.

Enhanced platelet aggregation, high homocysteine level, and microvascular disease in diabetic muscle infarctions: implications for therapy.

Muscle infarction is a rare complication in patients with diabetes mellitus, probably because of the rich vascular supply of this tissue. We describe a patient with type 1 diabetes who had infarction of the muscles in her right thigh. We report, for the first time, that the patient, in addition to an advanced microvascular disease in the muscle, had increased plasma total homocysteine levels and increased platelet aggregation. These pathologies might have a synergistic effect on the development of this rare complication and should be treated aggressively to prevent further episodes.

Calcium-induced high molecular weight proteins in the intact rabbit lens.

We have investigated the ability of Ca2+ to induce the formation of high molecular weight (HMW) proteins in the intact lens. Ca2+ cataracts were produced in rabbit lenses by culturing the lenses for either four days in medium containing 20 mM Ca2+ or for three days in medium containing 100 mM Ca2+. Lenses cultured in 20 and 100 mM Ca2+ medium became opaque after 20 hr and contained 30 and 200 times higher levels of Ca2+, respectively, than transparent lenses cultured in medium containing 1 mM Ca2+. Lenses exposed to 100 mM Mg2+ did not lose transparency. The opacification of the lenses extended to a depth of 1 mm into the cortical layer and did not involve the nucleus. No significant differences were found in the concentrations of either soluble or insoluble proteins present in freshly excised lenses and Ca2+ cataracts. Soluble HMW proteins, greater than 1.5 X 10(6) daltons, were in two- and five-fold greater amounts in the 20 and 100 mM Ca2+ cataracts, respectively, compared to controls. HMW protein present in the 100 mM Ca2+ cataract amounted to approximately 3% of the total soluble protein in the lens. The amount of Ca2+ present in the HMW fraction was 1 Ca2+ per 5 X 10(5) daltons, no higher than that present in the unaggregated crystallins. No evidence was found for covalent bonding in the aggregate. Results of polyacrylamide gel electrophoresis and double immunodiffusion indicated the presence of alpha- and beta- but not gamma-crystallin in the HMW protein.(ABSTRACT TRUNCATED AT 250 WORDS)