Alexithymia: relationship to personality disorders

Previous studies suggested an association of alexithymia with other personality models, as well as with various psychiatric syndromes. However, with regard to current diagnostic systems, the clinical validity of alexithymia remains to be established. In a sample of 182 psychiatric outpatients, the lifetime prevalence of DSM-III-R axis I disorders was determined by Structured Clinical Interview for DSM-III-R (SCID) interviews. In addition, DSM-III-R personality disorders were assessed using the Personality Diagnostic Questionnaire-Revised (PDQ-R). On the Toronto Alexithymia Scale (TAS), 17% of the sample scored in the alexithymic range. A series of stepwise multiple regression analyses were performed, exhibiting no relationship between alexithymia and any of the DSM-III-R axis I lifetime diagnoses. In contrast, schizotypal, dependent, and avoidant personality dimensions, as well as a lack of histrionic features, emerged as significant predictors of alexithymia, which further supports the conceptualization of alexithymia as a personality dimension.

Perceptual ranking versus visual evoked potentials for different local features in texture segregation

PURPOSE

To validate recent reports of specific visual evoked potentials associated with preattentive texture segregation (tsVEPs) and to quantitatively compare perceptual segregation strength and tsVEP amplitudes across different local features.

METHODS

Four local features were selected: crossed vs noncrossed, line segments differing in orientation by 90 degrees, U-shapes differing in orientation by 90 degrees, and U-shapes differing in orientation by 180 degrees. The two variants of each local feature were spatially arranged in a checkerboard pattern; for the first three features this led to pop-out of a "preattentive checkerboard." In seven subjects, perceptual segregation strength was assessed using ranking, and tsVEPs were recorded in these and three additional subjects.

RESULTS

Statistically significant tsVEPs were obtained for the features crossed vs noncrossed and 90 degrees-line segments. Ranking results and tsVEP amplitudes were highly correlated (P < 0.001); the order of perceptual ranking and the order of tsVEP amplitudes were identical; 180 degrees-U-shapes had lowest ranking, mean tsVEP amplitude was 0.1 microV, close to noise. Line segments had maximal ranking, tsVEP amplitude was 1.5 microV.

CONCLUSIONS

The results suggest that tsVEPs quantitatively reflect the activity of cortical mechanisms involved in texture segregation across various features.

Different organization of the tRNA-gene-associated repetitive element, DRE, in NC4-derived strains and in other wild-type Dictyostelium discoideum strains

The retrotransposon DRE (Dictyostelium repetitive element) was discovered in the course of an extensive study concerning the genomic organization of tRNA genes in the NC4-derived strains AX2 and AX3 of the cellular slime mold Dictyostelium discoideum. As a striking feature, DRE was found exclusively in a constant orientation and at a constant distance upstream from different tRNA genes. About 150-200 DRE with intact 5'-terminal-repeat structures are present in NC4-derived strains. These strains were termed high-copy DRE strains (HCD strains) as opposed to low-copy DRE strains (LCD strains) such as the wild-type D. discoideum isolates DD61, WS380B, OHIO and V12. LCD strains contain only 3-15 DRE with intact 5'-terminal-repeat-structures. However, in addition to these few intact elements, many 5'-truncated DRE elements are present in LCD strains. In HCD strains, most DRE show typical structural characteristics of retrotransposons containing terminal repeats at both ends, which seems to be one prerequisite for active transposition. In LCD strains, however, most DRE elements are 5'-truncated, which is a common feature of eukaryotic LINE elements. Despite their truncated 5'-ends, DRE in LCD strains retain unique integration specificities, i.e. they are always found position-specifically and orientation-specifically integrated in front of tRNA genes, flanked by a 12-16-bp target-site duplication.

Elicitor-Induced Changes in Ca2+ Influx, K+ Efflux, and 4-Hydroxybenzoic Acid Synthesis in Protoplasts of Daucus carota L

Suspension-cultured carrot cells (Daucus carota) and their protoplasts respond to a fungal elicitor prepared from the culture medium of Pythium aphanidermatum by accumulating 4-hydroxybenzoic acid (4-HBA). Protoplasts release the compound into the culture medium. Using 45CaCl2 as a tracer, we were able to demonstrate that the secretion of 4-HBA is preceded by a rapid increase in the Ca2+ influx and a concomitant K+ efflux. If the increased Ca2+ influx was prevented by ethyleneglycol-bis([beta]-aminoethylether)-N,N[prime]-tetraacetic acid, 4-HBA synthesis was inhibited by 70%. These results are discussed with regard to signal transduction from the plasma membrane to the nucleus of carrot protoplasts.

Nucleotide sequence of a putative succinate dehydrogenase operon in Thermoplasma acidophilum

28 amino acids from the N-terminal region of a putative terminal oxidase from the archaebacterium Thermoplasma acidophilum were determined by Edman degradation. On basis of this amino acid sequence a degenerated oligonucleotide was synthesized and used as a radioactive probe for Southern blot analysis of EcoRI digested genomic DNA. A 2.3 kb EcoRI fragment strongly hybridized to the probe and size selected genomic library from genomic DNA was constructed. Several clones scored positive by screening the library with the degenerated oligonucleotide, from which only one clone contained a EcoRI DNA fragment encoding the 28 amino acid sequence determined by protein sequencing. Sequence analysis revealed the presence of three genes in the typical arrangement of an operon. The first gene codes for a protein containing 11 cystein residues in an arrangement typical for Fe/S proteins. Protein sequence comparison revealed significant homologies to the fumarate reductase and succinate dehydrogenase of other bacteria. The two other genes encode small hydrophobic proteins probably serving as membrane anchor for the Thermoplasma acidophilum succinate dehydrogenase.

Pattern electroretinogram and computerized optic nerve-head analysis in glaucoma suspects

Both the pattern electroretinogram (PERG) and computerized disc analysis have been shown to detect early stages of glaucomatous optic nerve disease. As these two methods tap different domains (PERG reflects ganglion cell function, whereas disc analysis yields morphometric measures), we set out to compare their results in the same eyes. We recorded the PERG and optic disc parameters in 114 eyes of 58 ocular hypertensive patients. In addition, 51 eyes (26 patients) were monitored over a follow-up period of more than 6 months using the optic nerve-head analyzer. We found: (1) that a reduction in PERG amplitude was significantly correlated with increasing loss of neuroretinal rim area (P < or = 0.01), (2) that 9 of 11 eyes with a significant (P < 0.1) decrease in neuroretinal rim area over time had a reduced PERG, and (3) no significant correlation between PERG and optic disc area or between PERG and rim area. Our data show a high agreement between PERG amplitude and computerized disc analysis. This encourages the hope that it will be possible to detect glaucoma damage before appreciable visual field defects ensue.

[In incipient glaucoma the pattern electroretinogram displays diffuse, retinal damage]

The pattern electroretinogram (PERG), a noninvasive tool to measure the activity of retinal ganglion cells, shows changes in early glaucoma. We wanted to investigate whether or not the PERG is preferentially affected when the Bjerrum area is stimulated. We recorded the PERG from 17 eyes in 17 patients with initial stages of visual field defects due to open-angle glaucoma and from 10 eyes in 10 normal subjects. Counter-phasing checkerboard patterns were used as visual stimuli with a check size of 0.8 degrees at 16 reversals/s and 98% contrast. Three visual field extents were stimulated: (1) full screen (31 degrees x 27 degrees), (2) central stimulation with a diameter of 14 degrees, (3) peripheral stimulation = full screen with central mask of 14 degrees in diameter. The latter stimulus covers the regions where traditionally glaucomatous defects are expected early. In glaucoma patients, there was a significant decrease in the PERG amplitude compared to normals. This reduction was very similar for all three stimuli (42%, 52% and 47%, respectively). Thus, the PERG amplitude is reduced to a similar degree both in regions of the visual field where early damage is found (Bjerrum area) and in the central area. This result suggests that in early glaucoma there is focal as well as diffuse retinal damage.

[The Freiburg Vision Test. A computer-assisted procedure with sequential strategy]

Single Landolt Cs were presented in one of four positions on a monitor. Subjects responded by pressing one of four buttons (forced choice). A computer selected the size of the Landolt Cs on a logarithmic scale using the "Best PEST" algorithm (Best Parameter Estimation by Sequential Testing), a modern procedure to measure psychophysical thresholds. For comparison, conventional measurements according to DIN 58220 (Deutsche Industrie Norm) were performed with Landolt Cs projected in eight positions, using three out of five correct responses as the threshold criterion. Examination of 23 patients (most of them with senile cataract) did not show any significant difference between the two tests in either visual acuity or reproducibility on two consecutive days. The coefficients of variation between sessions were 22% for the Freiburg test and 26% for the DIN test and 18% between the two tests, pooled over two sessions. The Freiburg acuity test thus appears to be numerically equivalent to the DIN 58220 procedure. In addition, it has a number of advantages: (1) examiner-dependent variability is reduced; therefore, the test can be used by inexperienced examiners; (2) the forced choice technique is used rigorously; (3) mistakes in confounding oblique directions are largely avoided; (4) the procedure is about twice as fast.

Predictive value of the pattern electroretinogram in high-risk ocular hypertension

PURPOSE

The pattern electroretinogram (PERG) is reduced in early glaucoma and in some eyes with ocular hypertension (OHT). This study was designed to test the ability of the PERG to predict the development of visual field loss in OHT eyes.

METHODS

In 29 eyes of 18 patients with high-risk OHT, the visual fields were tested, and the PERG was recorded using counterphasing checkerboard patterns at check sizes of 0.8 degrees and 15 degrees at 16 reversals/sec. The visual fields were retested 11-31 mo later. Initially, 12 eyes had pathologic PERG recordings.

RESULTS

During the observation period, visual field loss developed in five eyes. All these eyes had a pathologic PERG recorded during the first visit. Of the eyes that had a normal PERG, none had field changes.

CONCLUSIONS

Within the reservations of the limited sample size and follow-up interval, these findings suggest that the PERG can be used to discriminate between patients with OHT who will develop visual field loss and those who will not.

Psychiatric and psychometric issues in acné excoriée

Psychiatric and psychometric issues were assessed in 12 acné excoriée patients. Two patients exhibited a DSM-III-R dysthymia and 2 patients a DSM-III-R personality disorder, which were considered as associated comorbidities. Most patients reported concern for being unattractive and a compulsive urge to manipulate their skin. However, 8 out 12 patients did not fulfill criteria for any DSM-III-R disorder. In particular, we could not find evidence for the assumption of underlying obsessive-compulsive disorders or body image disorders in acné excoriée.

Retinal and cortical activity in human subjects during color flicker fusion

Pattern electroretinograms (PERG) and cortical visually evoked potentials (VEP) were simultaneously recorded from 7 visually normal and 1 protanopic subjects. Stimuli were color checkerboards (0.5 degrees check size), phase-reversing at 17 Hz (i.e. 34 reversals/sec). Using a stepwise sweep procedure, the luminance of the red (lambda peak = 550 nm) and green (lambda peak = 630 nm) checks varied in 11 steps in opposite directions from 0 to 30 cd/m2, embracing the subjective equiluminance point. For normal subjects at subjective equiluminance, the VEP amplitude dropped sharply down to 13 +/- 2% of the value at pure luminance contrast. The PERG, however, was only reduced to 56 +/- 10% at this point, an attenuation 4 times less than that of the VEP. In contrast to normal subjects, in the protanopic subject the PERG was sharply reduced at equiluminance, parallel to the VEP. This would be expected when L-cones are missing. Assuming that the PERG reflects the activity of the retinal ganglion cells, our findings suggest that human retinal ganglion cells respond well under the condition of equiluminant flicker fusion, which is in agreement with recent single-cell studies in the monkey. Consequently, the temporal low-pass filter, which mediates color-flicker fusion, would seem to lie central to the retinal ganglion cells.

Electrophysiological correlates of texture segregation in the human visual evoked potential

We investigated whether the visual evoked potential (VEP) reflects cortical processing associated with preattentive texture segregation. On a visual display unit we presented stimuli with various arrangements of oriented line segments that either led to the appearance of a "preattentive" checkerboard or did not. Two presentation modes were used (pattern onset at 1 Hz and rapid pattern change at 4.3 Hz), while luminance (57 cd/m2) and contrast (92%) of the line segments remained constant. VEPs were recorded in 7 human subjects. The VEP was analyzed as a linear combination of putative components, which are evoked by either local pattern, quasi-local orientation contrast or global preattentive structure. In the transient VEP, we found a negativity over the posterior pole at a latency between 161 and 225 msec (FWHM) in the linear combination designed to extract segregation-specific components. Peak amplitude reached 3.1 +/- 0.8 microV (mean +/- SEM) at 199 msec. This negative peak appeared only for textures containing orientation contrast. Steady-state analysis of the rapid presentation also revealed a significant component (P = 0.002) associated with texture segregation. These potentials either represent processing of orientation contrast or global processing of texture segregation. The results suggest that specific surface potentials, differing from cognitive potentials, can be derived which are associated with preattentive processing.

Albino-type misrouting of the optic nerve fibers not found in dissociated vertical deviation

It has been suggested that albinolike misrouting of the visual pathway occurs in patients with dissociated vertical deviation (DVD). We re-examined this contention in ten DVD patients using visually evoked potentials. Full-field monocular pattern-onset checkerboard stimulation was employed. The visually evoked potentials were recorded simultaneously from both occipital lobes. Their differential activity during stimulation of the right eye was compared with that obtained during stimulation of the left. We found no predominance of crossed projection in any of the DVD cases. The results in nine normal subjects were similar. In 13 albino patients, however, there was a relative positivity in the contralateral hemisphere about 100 ms after pattern-onset, which reconfirmed predominance of the crossed projection. Possible artifacts are discussed that may have led to the assumption of misrouting in DVD in two previous reports.

Influence of mood on visually evoked potentials: a prospective longitudinal study

Anecdotal observations have suggested that individual differences in mood state could be one reason for the variability of visually evoked potentials (VEP). Therefore, we designed a longitudinal study, in which VEP amplitude was measured and psychological dimensions were assessed. All subjects completed a 'mood state questionnaire' before each session. The results from the VEP measurement and from the mood questionnaire varied widely between subjects. The intraindividual reproducibility, however, was high in 15 of 20 subjects, even over 4 weeks. In some cases we found intraindividual variability of VEP amplitude to be highly correlated with some factors derived from the mood state questionnaire. An overall analysis of covariance and variance (ANCOVA) showed a significant negative correlation between VEP amplitude and the mood factor 'Tiredness' and a significant positive correlation between VEP amplitude and 'Activity'.

Structure of the small nuclear RNP particle U1: identification of the two structural protuberances with RNP-antigens A and 70K

We have investigated the structure of the small nuclear RNP (snRNP) U1 by combining EM of complete and partially protein-deficient particles with immunoelectron microscopy employing mAbs against known components of the U1 snRNP. It was found that the two main protuberances of this particle can be identified with the U1-specific proteins A and 70K. The 70K protuberance is the one lying closer to the 5' terminus of the snRNA, as identified by its 5'-terminal m3G cap. The round-shaped main body of U1 snRNP represents its core RNP domain containing the common snRNP proteins. Functional implications of these results are discussed. Our results may also point to the physical basis for the production of autoantibodies directed against specific groups of snRNP proteins. The physical grouping of the common proteins (Sm epitopes) and the specific proteins (RNP epitopes) could result in one or the other being presented to the immune system as is the case in patients suffering from SLE or MCTD, respectively.

Transfer RNA genes from Dictyostelium discoideum are frequently associated with repetitive elements and contain consensus boxes in their 5' and 3'-flanking regions

A total of 68 different tRNA genes from the cellular slime mold Dictyostelium discoideum have been isolated and characterized. Although these tRNA genes show features common to typical nuclear tRNA genes from other organisms, several unique characteristics are apparent: (1) the 5'-proximal flanking region is very similar for most of the tRNA genes; (2) more than 80% of the tRNA genes contain an "ex-B motif" within their 3'-flanking region, which strongly resembles characteristics of the consensus sequence of a T-stem/T-loop region (B-box) of a tRNA gene; (3) probably more than 50% of the tRNA genes in certain D. discoideum strains are associated with a retrotransposon, termed DRE (Dictyostelium repetitive element), or with a transposon, termed Tdd-3 (Transposon Dictyostelium discoideum). DRE always occurs 50 (+/- 3) nucleotides upstream and Tdd-3 always occurs 100 (+/- 20) nucleotides downstream from the tRNA gene. D. discoideum tRNA genes are organized in multicopy gene families consisting of 5 to 20 individual genes. Members of a particular gene family are identical within the mature tRNA coding region while flanking sequences are idiosyncratic.

Occurrence of express saccades under isoluminance and low contrast luminance conditions

Saccadic reaction times (SRTs) of three human subjects were analyzed. The gap paradigm was used (i.e. fixation point offset precedes target onset) to obtain high proportions of express saccades (i.e. saccades of extremely short reaction times) in the SRT distributions. In one set of experiments, the luminance of the (red) saccade target was varied from brighter to darker than the (green) background including an isoluminance condition. Express saccades were obtained in response to pure color contrast stimuli with about the same frequency and reaction time as to stimuli with both color and luminance contrast. In a second experiment, the luminance contrast of a white target on a white background was lowered below 10%. Again the number of express saccades was not reduced. Thus, in contrast to other perceptual phenomena the visual neural mechanisms underlying the generation of express saccades are not affected by isoluminance nor low contrast luminance.

The protective effect of cyclosporine against cirrhotic alteration of the liver

We have successfully applied the immunosuppressive drug cyclosporine in patients with primary biliary cirrhosis and in some patients with chronic active hepatitis. After several years of treatment, we have found a histologic remission tendency in cirrhotic alteration of some patients. This observation indicates that cyclosporine could have protective effects against fibrosis or cirrhotic alteration. To clarify this, we treated Sprague-Dawley rats in which the cirrhotic alteration of the liver was induced by injection of 0.5 ml/kg body weight carbon tetrachloride intramuscularly twice a week with cyclosporine (orally); the control animals were given saline solution instead of cyclosporine. After 6 weeks, we examined the liver histologically to determine the grade of fibrosis and cirrhosis and the grade of fatty degeneration; in group 2 we gave 1 mg/kg body weight cyclosporine daily, and in group 3 it was given every second day. We found excellent protective effects of cyclosporine against cirrhotic alteration in both groups compared with the control group. In group 3 only 25% of the animals showed grade 3 fibrosis and cirrhosis; however, the rate in the control animals (group 4) was 64.3%. In the daily application of cyclosporine (group 2) we found reduced effects of the drug compared with group 3. In group 1 we ordered 10 mg/kg body weight cyclosporine, which causes severe hepatotoxicity. In group 5, animals with hepatic damage from carbon tetrachloride were treated from the third week with cyclosporine. The effect of cyclosporine was not as beneficial compared with the groups in which we ordered cyclosporine from the first week. These results suggest excellent anticirrhotic effects of cyclosporine. This drug should be ordered as early as possible in the treatment of chronic hepatic damage and in an adequate minimal dosage.

Colonic fermentation of potato starch after a freeze-thaw cycle

To estimate colonic carbohydrate fermentation following a potato meal, 13 healthy volunteers consumed 375 g potatoes containing 60 g starch on three different occasions in random order: (A) potatoes boiled and consumed fresh at 60 degrees C; (B) potatoes boiled, frozen, thawed and consumed at 20 degrees C; and (C) potatoes boiled, frozen, thawed, reheated to 90 degrees C, and consumed at 60 degrees C. End-expiratory breath hydrogen (H2) was measured every 15 min for 10-14 hr with a selective electrochemical cell. The extent of colonic carbohydrate fermentation (AUC = area under the breath H2 concentration vs time curve) in experiment B was significantly higher (+186%, P less than 0.002) than in experiment A. The breath hydrogen AUC in experiment C was higher than in experiment A (+48%, P less than 0.04) but lower than in experiment B (-94%, P less than 0.003). It is suggested that structural alterations of the starch molecule occur during freezing, thawing, and reheating and alter the availability of carbohydrates for fermentation by colonic anaerobes.

Supercritical fluid chromatography in the routine stability control of antipruritic preparations

A recently developed system for supercritical fluid chromatography (SFC), based on independent flow and pressure control and suitable for packed and capillary columns, was tested on a routine level for the reliable, accurate and precise determination of active pharmaceutical substances in stability control. Only packed columns were used for this analysis. The chromatographic figures of merit and the validation data of the active substance alone and in two different dosage forms (accuracy, 98.8-99.2%; precision, 0.6%; linearity of response, 0.998-0.999) are comparable with the former liquid chromatographic methods. Economical (reduction of analysis time, fewer experimental steps and less sample pre-separation) and ecological (carbon dioxide of organic solvents) advantages make SFC an attractive alternative to liquid chromatography in the determination of crotamiton.

Electron microscopy of U4/U6 snRNP reveals a Y-shaped U4 and U6 RNA containing domain protruding from the U4 core RNP

We describe the electron microscopic investigation of purified U4/U6 snRNPs from human and murine cells. The U4/U6 snRNP exhibits two morphological features, a main body approximately 8 nm in diameter and a peripheral filamentous domain, 7-10 nm long. Two lines of evidence suggest that the peripheral domain may consist of RNA and to contain U6 RNA as well as the 5' portion of U4 RNA. (a) Separation of the U4/U6 snRNA interaction regions from the core domains by site-directed cleavage of the U4 snRNA with RNase H gave filament-free, globular core snRNP structures. (b) By immuno and DNA-hybridization EM, both the 5' end of U4 and the 3' end of U6 snRNA were located at the distal region of the filamentous domain, furthest from the core. These results, together with our observation that the filamentous U4/U6 domain is often Y shaped, correlate strikingly with the consensus secondary structure proposed by Brow and Guthrie (1988. Nature (Lond.), 334:213-218), where U4 and U6 snRNA are base paired in such a way that two U4/U6 helices together with a stem/loop of U4 snRNA make up a Y-shaped U4/U6 interaction domain.

Protein-RNA interactions in 20S U5 snRNPs

The interaction of the U5-specific polypeptides with U5 snRNA was investigated by comparison of the differential accessibility towards nucleases and dimethylsulfate of defined regions of U5 snRNA in purified 20S and 10S U5 snRNPs. While 20S U5 snRNPs contain eight U5-specific proteins in addition to the common proteins, the 10S U5 snRNPs contain only the latter proteins. The results indicate that only the central part of stem/loop I of U5 snRNA including internal loops IL2 and IL2', contains binding sites for U5-specific proteins, suggesting that several U5-specific proteins may be bound to U5 snRNP via protein-protein interactions. Moreover, they show that the core polypeptides do not interact with stem/loop I.

RNP, Sm and SS-B antigens from calf thymus: molecular stability upon enzymatic digestion

RNP, Sm and SS-B nuclear antigens from calf thymus were studied with respect to the size distribution on sucrose gradients as well as to the molecular integrity and related structural changes when they were subjected to enzymatic digestions under different conditions. Making a difference with RNP particles, the Sm size distribution is concentration dependent, a property in accordance with the complexity of the Sm particles in comparison with the RNPs. The use of combined effects of temperature, endogenous proteases and RNase A, allowed us to gain insight into the limits of stability of the three antigenic particles. Following treatments in the absence of RNAse A, the degradation products (32-38 Kd molecular weight) of the 70 Kd RNP polypeptide remain stable and associated with other molecules within the RNP particle. It was also found that the phosphate groups of the SS-B protein moiety are only accessible to alkaline phosphatase if the RNA of the SS-B particle is degraded by the action of RNAse A.

Usefulness of antithrombotic therapy in resting angina pectoris or non-Q-wave myocardial infarction in preventing death and myocardial infarction (a pilot study from the Antithrombotic Therapy in Acute Coronary Syndromes Study Group)

In a prospective pilot trial of antithrombotic therapy in the acute coronary syndromes (ATACS) of resting and unstable angina pectoris or non-Q-wave myocardial infarction, 3 different antithrombotic regimens in the prevention of recurrent ischemic events were compared for efficacy. Ninety-three patients were randomized to receive aspirin (325 mg/day), or full-dose heparin followed by warfarin, or the combination of aspirin (80 mg/day) plus heparin and then warfarin. Trial antithrombotic therapy was added to standardized antianginal medication and continued for 3 months or until an end point was reached. Analysis, by intention-to-treat, of the 3-month end points, revealed the following: recurrent ischemia occurred in 7 patients (22%) after aspirin, in 6 patients (25%) after heparin and warfarin, and in 16 patients (43%) after aspirin combined with heparin and then warfarin; coronary revascularization occurred in 12 patients (38%) after aspirin, in 12 patients (50%) after heparin and warfarin, and in 22 patients (60%) after aspirin combined with heparin and then warfarin; myocardial infarction occurred in 1 patient (3%) after aspirin, in 3 patients (13%) after heparin and warfarin, and in no patient after aspirin combined with heparin and then warfarin; no deaths occurred after aspirin or after aspirin combined with heparin and then warfarin, but 1 patient (4%) died after warfarin alone; major bleeding occurred in 3 patients (9%) after aspirin, in 2 patients (8%) after heparin and warfarin, and in 3 patients (8%) after aspirin combined with heparin and then warfarin. Recurrent myocardial ischemia occurred at 3 +/- 3 days after randomization.(ABSTRACT TRUNCATED AT 250 WORDS)