Splenic dynamics of indium-111 labeled platelets in idiopathic thrombocytopenic purpura.

Splenic dynamics of 111In-labeled platelets and platelet-associated IgG in 33 patients with idiopathic thrombocytopenic purpura (ITP) were studied. Two half-lives were calculated for the biexponential splenic time-activity curve after i.v. injection of 111In-labeled platelets. There was no difference in the mean half-life of the rapid component of the splenic curve (ST1) when patients with negative or slightly positive platelet suspension immunofluorescence test (PSIFT) were compared to those with strongly positive PSIFT (3.0 +/- 0.7 min vs. 3.6 +/- 0.4, p greater than 0.05). Mean half-life of the slow component of the splenic curve (ST2) was found to be longer in patients with a strongly positive than a negative or weakly positive PSIFT (26 +/- 5 min vs. 13.2 +/- 1.0 min, p less than 0.01). It seems that determination of the two components of the splenic time-activity curve provides a useful method for studying platelet kinetics in ITP.

The Finnish leukaemia group: levamisole in maintenance therapy of acute myeloid leukemia in adults.

The Finnish Leukaemia Group has carried out a randomized, multicenter trial to study the effect of levamisole on the remission maintained with 6-mercaptopurine and methotrexate in acute myeloid leukaemia in adults. Levamisole was given on 3 consecutive days every 2 weeks. Twenty-five patients received only chemotherapy, while 26 patients received levamisole as well. The patients receiving levamisole showed significantly better remission duration than those given only chemotherapy (P = 0.033, Mantel's summary chi 2-text). There are four long term survivors in the levamisole group versus none in the chemotherapy group. The remissions have lasted 48-75 months.

Plasma beta-thromboglobulin in severe infection.

The plasma concentration of beta-thromboglobulin was serially measured in nine patients with septicemia, ten patients with pneumonia and five thrombo- and granulocytopenic patients with acute leukemia. Six patients with septicemia out of the eight studied on days 1-3 and all eight patients studied 7-14 days after onset had an abnormal high beta-thromboglobulin level. One patient with pneumonia out of six studied on days 1-3 and six out of nine studied on 7-14 days after onset had an abnormal high value. A rising trend in plasma beta-thromboglobulin with the highest mean levels at one to two weeks after onset was common to both groups. Positive ethanol gelation, increased level of fibrin/fibrinogen degradation products, decreased antithrombin III, increased FVIII complex and disproportionate ratio of FVIII:C to FVIIIR:Ag were common in both groups in the early stages of the disease. All the five patients with leukemia had a lower than normal beta-thromboglobulin level throughout the study but showed in the coagulation parameters changes similar to those observed in the other groups. Judging from the commonness of abnormal beta-thromboglobulin values in the two first patient groups, low grade platelet activation is a normal response in severe infection.

Plasma beta-thromboglobulin in acute myocardial infarction.

Serial measurements of plasma beta-thromboglobulin concentration were made in 25 patients with acute myocardial infarction. The beta-thromboglobulin level was elevated in 18 patients on the day of presentation and the mean beta-thromboglobulin of the patients (83 ng/ml) differed significantly from the normal mean (26 ng/ml; p less than 0.001). When grouped according to the clinical severity, the most severely affected patients had the highest values (mean 128 ng/ml; n = 11). Two patients with a mild or moderate clinical course had a normal beta-thromboglobulin level throughout the study. The patients showed a distinct pattern in the evolution of the plasma beta-thromboglobulin values. The initial elevation was followed by a decrease in beta-thromboglobulin levels (mean 37 ng/ml on day 3), when only the severely affected patients differed from the normals. The beta-thromboglobulin level started to increase thereafter, reaching in many cases the highest and in some cases the only abnormally high values at the end of the second week (mean 75 ng/ml) in the survivors. The levels were mostly normal again 4-6 months after the infarction.

Thromboprophylaxis with low molecular weight heparin (dalteparin) in pregnancy.

Venous thromboembolism remains an important cause of maternal mortality. For women at risk during pregnancy, the recommended venous thromboembolismprophylaxis is unfractionated heparin. Low molecular weight heparins, such as dalteparin, also may be suitable, but randomised trials have not been performed. Pregnant women (105) with confirmed previous or current thromboembolism were randomised to receive either unfractionated heparin twice daily (mean 20569 IU/day) or dalteparin once daily (mean 4631 IU anti-factor Xa units/day) subcutaneously for thromboprophylaxis during pregnancy and postpartum period. Recurrence of venous thromboembolism and safety of treatments were assessed. Dalteparin administered once daily was safe and effective in thromboprophylaxis during pregnancy and postpartum.

Low platelet arachidonic acid in young patients with brain infarction.

Fatty acid patterns of plasma and platelet lipids, platelet aggregation and thromboxane A2 (TxA2) production were studied in young patients (n = 12) with brain infarction and in healthy controls (n = 13). Platelet arachidonic acid content was significantly reduced in the stroke patients, but in vitro platelet aggregation was similar in the two groups. A low dose of acetosalicylic acid (ASA) (100 mg) suppressed thromboxane production and normalized the platelet arachidonic acid values. The low arachidonic acid in platelets is probably due to its increased consumption, indicating platelet activation in vivo.

Dietary intervention in breast cancer patients: effects on dietary habits and nutrient intake.

Effects of dietary intervention on dietary habits and nutrient levels were studied in 240 women aged 50-65 years who had been operated for a stage I-II breast cancer. Following surgery the women who had participated in a dietary history interview were randomly assigned to one of two groups. The intervention group (n = 121) received individual dietary counselling aimed at reducing dietary fat intake to 20-25 per cent of energy (E per cent) while increasing intake of carbohydrates. No dietary advice was given to women assigned to the control group (n = 119). There was no significant difference between the groups in terms of base-line nutrient intake except for a higher energy intake in the control group (P less than 0.05). Sixty-three (52 per cent) of the women in the intervention group and 106 (89 per cent) of the women in the control group completed the 2-year follow-up. Energy intake decreased after 2 years in both groups and the difference between the groups remained (P less than 0.01). Total fat intake decreased in the intervention group by 12.9-23.3 E per cent after 2 years and by 3.1 E per cent in the control group. The intake of carbohydrates increased from 46.2 to 57.2 E per cent in the intervention group and from 46.2 to 48.9 E per cent in the control group. The study shows that dietary habits and intake of nutrients can be altered through dietary counselling to breast cancer patients, and that such changes are long lasting.