Apoptosis after stent implantation compared with balloon angioplasty in rabbits. Role of macrophages

Both cell proliferation and apoptosis (programmed cell death) are supposed to play a role in restenosis after angioplasty. We studied these processes in smooth muscle cells (SMCs) and macrophages 1, 4, and 12 weeks after balloon angioplasty or Palmaz-Schatz stent implantation in rabbit iliac arteries. Proliferating cells were visualized by immunostaining with antibodies directed against proliferating cell nuclear antigen. Apoptotic cells were detected using the TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick and labeling) technique, propidium iodide staining, and transmission electron microscopy. At all time points, the neointimal cross-sectional area of the arteries was twofold to fourfold greater after stent implantation than after balloon angioplasty. The total number of neointimal cells was similar 1 and 12 weeks after both interventions. The neointimal cell density, however, decreased by 58% between the 1st and the 12th week after stent implantation compared with a 20% decrease after balloon angioplasty (P < .01). Stent implantation induced more cell proliferation but also more apoptosis in the media than balloon angioplasty after 1 and 4 weeks. In addition, stent implantation caused more macrophage accumulation and apoptosis in the neointima, but cell proliferation rates did not differ significantly in comparison with balloon angioplasty. The higher rate of apoptosis in the neointima 1 week after stent implantation compared with balloon angioplasty is due to an increased rate of SMC and macrophage death. Macrophage accumulation and apoptosis in the early phase after stent implantation appear to play a role in extracellular matrix secretion, which increases neointima formation after 4 and 12 weeks compared with balloon angioplasty in this model.

Suitability of preadmission blood samples for pretransfusion testing in elective surgery

BACKGROUND

North American transfusion guidelines do not stipulate a time limit between drawing the specimen for pretransfusion testing and giving the transfusion to patients who have not received a transfusion or been pregnant in the preceding 3 months. British guidelines suggest that separated plasma and serum can be stored at -30 degrees C for up to 6 months, but they draw attention to the paucity of evidence concerning the use of stored samples. In Australia, transfusion guidelines recommend a maximum of 10 days' validity for pretransfusion specimens, which requires the patient to present for pretransfusion testing within 10 days of admission or to undergo retesting after admission, which in turn necessitates additional time in the hospital before operation. The study was performed to document the safety of using for pretransfusion testing a blood sample collected more than 10 days before surgery.

STUDY DESIGN AND METHODS

Samples from 500 patients scheduled for elective surgery who had not been pregnant or received a transfusion in the previous 3 months were separately tested in blood group and antibody screens at an interval from 11 to 335 days before admission and again on admission.

RESULTS

No clinically significant change was detected in the red cell antibody status of the paired samples of any patient.

CONCLUSION

For patients who have not been transfused or pregnant in the previous 3 months, it is safe to crossmatch blood for transfusion by using a sample collected well in advance of elective surgery and stored at -30 degrees C.

A novel form of hereditary sideroblastic anaemia with macrocytosis

We describe a pedigree with maternally inherited sideroblastic anaemia in which the red cells are dimorphic with a raised MCV. To our knowledge, this form of hereditary sideroblastic anaemia (HSA) has not been reported previously. 16 members of the family were investigated, revealing eight affected members. Two further family members were not tested but were presumed affected on the histories available. The proband, born in 1967, presented during pregnancy with a macrocytic anaemia (Hb 7.0 g/dl, MCV 106 fl) and a dimorphic red cell picture. Post partum, a bone marrow biopsy showed hypercellularity, mild dyserythropoiesis and ring sideroblasts. Cytogenetics were normal. Other causes of macrocytosis were excluded. Six other family members (three female, three male) have similar findings. There is no evidence of paternal transmission. An additional female relative who presented in 1992 with refractory anaemia with excess blasts in transformation and a dimorphic blood film, died from progression to AML. Affected members show a raised metal-free red cell protoporphyrin level suggestive of a defect at the level of Fe2+ incorporation into protoporphyrin. We propose that this form of HSA is due to a mitochondrial mutation. A search for deletions or point mutations in the mitochondrial DNA is currently underway.

Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. Countrywide Integrated Non-Communicable Diseases Intervention

The main goal of the preventive intervention study in one community of the German CINDI (Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO) area was to improve cardiovascular health by reducing the risk factors smoking, hypertension, obesity, hypercholesterolaemia, and by changing sedentary lifestyle. The intervention was performed by using the special "Three-Level-Strategy", which is characterised by activities of primary care physicians in the usual consulting hour (1st level), with patient groups in their practices (2nd level), and at community level (3rd level) where a special work group and a co-ordinating general practice are co-operating. To evaluate the occurrence of the risk factors in practice and the local population, four cross-sectional random samples (N(total) = 4881) were carried out in seven practices from 1992 to 1995. On the community level, 23 special exercise-based health groups (N(total) = 600) were established and were investigated by means of a questionnaire, related to behaviour and health beliefs. A "Local Health Information System" facilitated the evaluation, the management of the data, and the organisation of the health programme. The results of the practice samples showed a significant reduction of smoking (-17.8%) and hypertension (-31.5%) (p < 0.01). The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants (83.8%). The participants considerably improved their health behaviour: 82% discussed health in their family, 37.3% stated an increase of healthy nutrition, 52% of relaxation; 86.2% intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings. We conclude that the practice-based "Three-Level-Strategy" provides a strong support for successful long-term prevention of cardiovascular risk, particularly, when exercise-based health training sessions are performed in order to change sedentary lifestyle. When organised on community level, they might have a positive impact on the health behaviour of the whole community. Physical activity can be used as a "prodrug" for health promotion in a holistic way.

Modified low density lipoprotein delivers substrate for ceramide formation and stimulates the sphingomyelin-ceramide pathway in human macrophages

Exposure of human blood monocytes derived macrophages to modified (oxidized or acetylated) LDL induced a approximately 40% elevation (60 pmol/10(6) cells) of the endogenous level of the sphingolipid ceramide. A rise of both neutral and acidic SMase activity was found after treatment with oxidized LDL (250 and 80%), while addition of acLDL stimulated only the neutral enzyme (280%). Sphingo(phospho)lipids from LDL were transferred to the cell membrane and distributed into intracellular compartments as observed with acLDL containing BODIPY-FL-C5-SM. Quantitation of ceramide after the addition of [3H-N-acetyl]- or BODIPY-FL-C5-SM-labeled modified LDL (27 microg/ml) to the cell culture medium indicated that approximately 210 pmol CA/10(6) cells was generated from exogenous (ox/acLDL) SM. These results demonstrate a stimulation of the sphingomyelin-ceramide pathway by modified LDL utilizing primarily exogenous (LDL-derived) substrate and suggest that the effects of modified LDL are at least partially due to an increased level of the messenger ceramide.

Improved quality of life in patients with generalized cardiovascular metabolic disease on a prepared diet

Current dietary recommendation for cardiovascular disease risk reduction and recommended dietary allowances (RDAs) were used to develop a nutritionally complete prepackaged prepared meal plan specifically designed to reduce the risk of cardiovascular disease. In the current study we tested patient acceptance of the diet as defined by measures of quality of life. In a randomized, parallel-design, multicenter clinical trial, 77 persons with hypertension, diabetes mellitus, dyslipidemia, or a combination of two or more of these conditions were recruited and randomly assigned to either a prepared meal plan (n = 39) or a comparable self-selected diet (n = 38) for 10 wk. The prepared meal plan met both the RDAs for all essential micronutrients and the dietary recommendations of national health organizations for macronutrients, cholesterol, sodium, and fiber. The prescribed self-selected diet was matched for macronutrients. Quality of life, as measured by a battery of instruments, was the major endpoint. Individuals consuming the prepared meal plan had significant improvements in mental health (P < 0.01), general perceived health (P < 0.005), daily activities (P < 0.05), work performance (P < 0.005), affect (P < 0.01), and nutritional health perceptions (P < 0.001), and reductions in nutrition hassles based on a standardized questionnaire (P < 0.001). The self-selected-diet group had significant improvements in nutritional health perceptions (P < 0.001) and affect (P < 0.001). There were significant improvements in weight (P < 0.001), blood pressure (P < 0.001), cholesterol (P < 0.002), low-density lipoproteins (P < 0.001), glucose (P < 0.014), and glycated hemoglobin (Hb A(1c) (P < 0.004) that were comparable in both groups. In summary, this study shows that a nutritionally complete diet, whether prepackaged or self-selected, improves multiple risk factors for cardiovascular disease. The prepackaged prepared meal plan had the added benefit of a greater improvement in quality of life.

The significance of subnormal serum vitamin B12 concentration in older people: a case control study

OBJECTIVES

To determine the clinical significance of subnormal serum vitamin B12 concentration in older people by comparing the hematological, neurological, and biochemical findings in patients with subnormal serum B12 with a control group with normal B12 levels.

DESIGN

Clinical and laboratory assessment of hospital patients selected to represent a wide range of serum B12 levels.

SETTING

Patients in the medical wards of two hospitals, one a general hospital and the other a geriatric hospital.

PARTICIPANTS

Ninety-four older patients, 43 with subnormal (< 150 pmol/L) and 51 with normal serum B12 concentrations.

MEASUREMENTS

Mini-Mental State Examination, neurological score, full blood examination, mean neutrophil lobe count; serum B12, holotranscobalamin II, total homocysteine, folate, creatinine and gastrin red folate; parietal cell antibodies, intrinsic factor antibodies.

RESULTS

Of all the measurements, only mean neutrophil lobe count and mean serum total homocysteine were significantly different in the low serum B12 compared with the control group. There was a significant correlation between serum B12 and homocysteine levels. Eighty-eight percent of patients in the test group compared with 76% in the control group showed at least one of the following; elevated serum total homocysteine, neutrophil hypersegmentation, or elevated MCV. This overlap was much reduced when patients with borderline values for serum B12 (150-250 pmol/L) were included in the low B12 group. Most of the older subjects had little or no B12 on transcobalamin II, irrespective of the serum B12 level.

CONCLUSION

Almost 90% of older patients with serum B12 < 150 pmol/L show evidence of tissue vitamin B12 deficiency. Deficiency becomes manifest in older patients at relatively higher concentrations of serum B12 than in younger subjects, possibly because of lower levels of holotranscobalamin II in the older patients.

Myocardial contrast echocardiography for assessment of papaverine vasodilator response in patients with angiographically normal coronary arteries and in patients after orthotopic heart transplantation

Myocardial contrast echocardiography has the potential for assessing changes in regional myocardial perfusion. We used this method to compare papaverine vasodilator response in 10 patients after orthotopic heart transplantation without acute rejection of left ventricular hypertrophy (HTX) and in 15 patients with angiographically normal coronary arteries (control group). Injections of 2 ml of sonicated iopromid (9 paired injections in HTX and 24 paired injections in the control group) were performed before and after intracoronary application of papaverine (8 or 10 mg) into the left or right coronary artery. From regional time-intensity curves, alpha (variable of curve width), area under the curve (area), peak contrast intensity (Imax) and contrast decay half-time (T1/2) were derived by from a gamma variate function. T1/2 increased from 4.2 +/- 1.2 to 7.2 +/- 4.0 s (p < 0.01) after papaverine in HTX compared to a change from 4.8 +/- 1.0 to 6.0 +/- 1.7 s (p < 0.001) in normal subjects. Alpha decreased in HTX from 0.44 +/- 0.15 to 0.27 +/- 0.10 s-1 (p < 0.01) after intracoronary papaverine injection. In the control group alpha was 0.37 +/- 0.08 s-1 at rest compared to 0.30 +/- 0.08 s-1 at hyperemic conditions (p < 0.002). Area increased in HTX from 444 +/- 261 to 910 +/- 732 U.s (p < 0.01) and in normal subjects from 352 +/- 171 to 585 +/- 262 U.s (p < 0.001). Hyperemic to baseline flow ratios for area varied from 0.9 to 3.8 (mean 2.17 +/- 1.11) in HTX compared to 1.76 +/- 0.52 (1.03 to 2.71) in normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Etofibrate suppresses neointima formation of the ballooned common carotid artery of rats

The inhibition of neointima formation by drugs is a major goal to prevent restenosis following angioplasty. In the present study, the effect of etofibrate on blood lipids and vessels wall was investigated using a balloon injury rat model. Two weeks after ballooning the common carotid artery neointima formation was quantified by morphometric measurement of the neointimal area and cellularity in vessel cross sections, and by fluorometric evaluation of the DNA content. Etofibrate (160 mg/kg/day) had no effect on plasma triglyceride levels, but reduced serum cholesterol by about 25%. The injury-induced increase of both the neointimal area and the DNA-content was significantly inhibited by 47% (P < 0.005) and 34% (P < 0.05), respectively, in the drug-treated animals in comparison to the untreated control rats. The ratio of neointima and media was significantly (P < 0.001) reduced from 152.9 +/- 11.6% (controls) to 82.84 +/- 12.59% in the etofibrate-treated group. The cellularity (numerical profile and volume density of nuclei) in the neointima was similar in both groups. In conclusion, injury-induced neointima formation is reduced in etofibrate-treated animals, which could be due to an inhibition of smooth muscle cell proliferation.

Hypercholesterolemia increases manganese superoxide dismutase immunoreactive macrophages in myocardium

The effect of hypercholesterolemia on manganese superoxide dismutase (MnSOD)-containing macrophages was investigated in male New Zealand white rabbits. Macrophages from control animals, which were marked with the RAM-11 antibody, demonstrated co-localization with MnSOD immunoreactivity, e.g. in the peri- and paravascular space within the myocardium, but not in the bone marrow. In rabbits fed a 0.5% cholesterol-enriched diet for 42 days, a significant increase (P < 0.01) of MnSOD-immunoreactive macrophages within the myocardium was found concomitant to the drastic elevation of serum cholesterol level. In the bone marrow, MnSOD immunoreactivity did not change after cholesterol feeding. Thus in cholesterol-fed rabbits, the increase of MnSOD-containing macrophages seems to parallel that of lipoproteins. MnSOD is considered as being protective against the cytotoxic effects of those superoxide anions, possibly generated in macrophages, which are involved in the metabolism of modified lipoproteins.

Low-dose radioactive endovascular stents prevent smooth muscle cell proliferation and neointimal hyperplasia in rabbits

BACKGROUND

Restenosis induced by smooth muscle cell (SMC) migration and proliferation and neointimal thickening limits the clinical success of balloon angioplasty and stent implantation. In this study, the long-term effect of endovascular irradiation via low-dose radioactive stents on neointima formation was compared with conventional stent implantation in a rabbit model.

METHODS AND RESULTS

Palmaz-Schatz stents were made radioactive in a cyclotron. The stents had a very low activity (maximum, 35 microCi), and thus, manipulation did not require extensive radiation protection. One, 4, 12, and 52 weeks after the implantation of nonradioactive stents and radioactive stents in rabbit iliac arteries, neointimal thickening was analyzed by quantitative histomorphometry. Immunostaining for endothelial cell von Willebrand factor, macrophages, SMC alpha-actin, collagen type I, and proliferating cell nuclear antigen (PCNA) was performed to determine radiation-induced changes in the arterial wall. SMC proliferation was quantified by computer-assisted cell counting of PCNA-immunoreactive cells. Neointima formation was markedly suppressed by the implantation of radioactive stents in a dose-dependent fashion at all observed time points. At peak proliferative activity of SMCs 1 week after nonradioactive stent implantation, 30 +/- 2% of SMCs in the neointima were proliferating, compared with 0.5 +/- 0.1% of SMCs after implantation of stents with an initial activity of 35 microCi (P < .001). The neointima covering radioactive stents was characterized by decreased smooth muscle cellularity and increased extracellular matrix formation. Further, we observed a delayed endothelialization depending on the radiation dose. No difference in vascular thrombosis was found after nonradioactive and radioactive stent implantation.

CONCLUSIONS

The results of this study clearly indicate that low-dose radioactive endovascular stents potently inhibit SMC proliferation and neointimal hyperplasia in rabbits.

Turnover of the D1 protein and of Photosystem II in a Synechocystis 6803 mutant lacking Tyrz

The Photosystem II reaction center is rapidly inactivated by light, particularly at higher light intensity. One of the possible factors causing this phenomenon is the oxidized primary donor, P680(+), which may be harmful to Photosystem II because of its highly oxidizing nature. However, no direct evidence specificially implicating P680(+) in photoinhibition has been obtained yet. To investigate whether P680(+) is harmful to Photosystem II, turnover of the D1 protein and of the Photosystem II reaction center complex were measured in vivo in a mutant of the cyanobacterium Synechocystis sp. PCC 6803, in which the physiological donor to P680(+), Tyrz, was genetically deleted. In this mutant, D1 degradation in the light is an order of magnitude faster than in wild type. The most straightforward explanation of this phenomenon is that accumulation of P680(+) leads to an increased rate of turnover of the Photosystem II reaction center complex, which is compatible with the hypothesis of destructive oxidation by P680(+) that is damaging to the Photosystem II complex.

Influence of surface texture and charge on the biocompatibility of endovascular stents

BACKGROUND

The mechanical behaviour and the surface characteristics of endovascular stents are key factors determining stent patency. In-vitro studies have suggested that surface texture and charge alter the biocompatibility of metallic stents. In this study, the influence of surface texture and charge of metallic stents on thrombosis and neointima formation was evaluated in a rabbit model.

METHODS

Twenty-four stainless steel Palmaz-Schatz stents were coated either by an electrochemical deposition of metal on the stent surface or were coated with a metallic film which was implanted into the stent surface by argon ion bombardment. The coatings consisted of platinum, gold, or copper. Coated and uncoated control stents were implanted in rabbit iliac arteries. As antithrombotic therapy, 500 IU heparin and 60 mg aspirin was given intravenously before stent implantation, followed by 60 mg aspirin intravenously every third day for 4 weeks. Thrombus and neointima formation in arterial cross-sections of 24 coated stents were compared with 19 uncoated stents using quantitative, computer-assisted histomorphometry and transmission electron microscopy.

RESULTS

A higher stent surface porosity and more surface cracks after stent expansion were found after galvanization than after ion implantation. The in-vitro surface potentials of uncoated steel, copper-, and gold-coated or platinized stents were +150, +120, +180, and +180 mV, respectively. Four weeks after implantation, six of 14 galvanized stents, but none of the uncoated or ion bombarded stents, were occluded by a thrombus. Neointimal hyperplasia was increased in stents coated by galvanization compared with stents coated by ion implantation. In both study groups, the most electropositive coating (platinum or gold) induced markedly less neointima formation than the least electropositive (copper).

CONCLUSION

Stent surface texture was the most important factor determining biocompatibility of coated Palmaz-Schatz stents in this study. In contrast to suggestions derived from in-vitro studies, the charge of stents does not seem to play a major role with respect to stent thrombogenicity. Low stent charge correlates with an increased neointima formation.

Appropriateness of transfusions of red cells, platelets and fresh frozen plasma. An audit in a tertiary care teaching hospital

OBJECTIVE

To determine how current hospital practice for transfusions of red cells, platelets and fresh frozen plasma conformed with published criteria.

DESIGN

Elaboration of criteria for transfusion from a review of the current literature; and analysis of the medical records of patients receiving transfusions of red cells (200), platelets (215), and fresh frozen plasma (260) during defined time periods in 1993.

SETTING

A large tertiary care teaching hospital.

OUTCOME MEASURES

Inappropriateness rates for transfusion episodes and numbers of individual units of blood products administered.

RESULTS

Inappropriateness rates for transfusion episodes and numbers of individual units administered were 16% and 10% for red cells, 13% and 11% for platelets, and 24% and 16% for fresh frozen plasma (31% and 21% when transfusions for thrombotic thrombocytopenic purpura were excluded). Red cells and fresh frozen plasma were used inappropriately most frequently in association with a surgical procedure; for platelets, it was their use for bleeding. In many of the transfusions deemed inappropriate, deficiencies of red cells, platelets and/or coagulation factors were documented, but the degree of deficiency did not meet the stringent appropriateness criteria. Twenty-six transfusions were deemed inappropriate because the indication was not documented in the medical record.

CONCLUSIONS

Specific problem areas in which blood product use was inappropriate were identified. Guidelines for transfusion appropriateness, education of hospital staff, and a monitoring system to ensure adherence to the guidelines, are required.

Biochemical indices of vitamin B12 nutrition in pregnant patients with subnormal serum vitamin B12 levels

To determine the significance of the commonly observed fall in serum vitamin B12 levels during pregnancy, serum levels of the B12 metabolites methylmalonic acid (MMA) and homocysteine (Hcy) were measured in a group of 50 pregnant patients with subnormal serum B12 (range 45-199 pg/ml) and the results compared with those of 25 pregnant controls (serum B12(208-580) pg/ml). Mean values for serum MMA and total Hcy in the subnormal B12 group were 445.4 nmol/L and 7.03 mumol/L, respectively, which were not significantly different from the mean MMA of 440.5 nmol/L and Hcy of 6.88 nmol/L in the controls. For the total group of patients, neither serum MMA nor serum Hcy levels correlated with serum B12. One-third of pregnant patients showed elevated serum MMA values, independent of B12 status. Significant elevation of serum Hcy was detected in only two patients, both with subnormal serum B12 and hematological evidence of B12 deficiency. We conclude that the usual fall in serum B12 concentration in pregnancy does not reflect B12 deficiency at the biochemical level. In establishing true B12 deficiency in pregnancy, the serum Hcy level (in the absence of folate deficiency) but not serum MMA, is of value.

Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany

A prospective multicenter study was carried out from October 1 to November 30, 1991, to determine the incidence, severity, and mortality of acute respiratory failure (ARF) in Berlin, Germany, a metropolis with a population of 3.44 million. Adult patients from 72 intensive care units (ICUs) were evaluated. ARF was defined as: (1) intubation and mechanical ventilation (I+MV) > or = 24 h; age > or = 14 yr. Incidence of ARF was assessed as the number of patients fulfilling ARF criteria within the 2-mo study period. Severity of ARF was defined as "no lung injury" (NLI), "mild-to-moderate lung injury" (MMLI), and "severe lung injury" (SLI) according to Murray and coworkers' proposals. Mortality was assessed as number of patients with ARF dying during ICU stay. During the study period, 508 patients were diagnosed as having ARF, representing an incidence of ARF of 88.6 per 100,000/yr. Twenty-four h after I+MV, MMLI occurred in 94% and SLI in 3.6% of the ARF patients. Overall mortality rate was 42.7%. Mortality rate in the NLI group was 36.4%; in patients with MMLI, 40.8%; and in patients with SLI, 58.8%. Our data offer novel information on incidence, severity, and mortality of ARF in a major urban population.

A new method for delivering radioactive cytotoxic agents in solid cancers

PURPOSE

Therapeutic agents such as monoclonal antibodies, radiopharmaceuticals, and radioactive growth factors are limited in effectiveness due to the inability to deposit significant quantities of the agents and for limited periods of time in solid cancer. A new technique based on knowledge of the pathophysiology of solid tumors allows for significant concentration of these agents to accumulate and for a prolonged period of time, thus allowing interaction with the tumor for potentially increased effectiveness.

METHODS AND MATERIALS

Three agents have been studied: 131I antiferritin monoclonal antibody, colloidal 32P chromic phosphate, and 131I transferrin. The time required for maximal tumor uptake was determined in vitro in tissue culture and was 10 min, 25 min, and 40 min, respectively. The new method of in vivo tumor infusion consisted of a direct intratumoral injection of macroaggregated albumin (MAA) 10,000 particles, followed by the radioactive agents under study. Tumors were infused in vivo using the new technique and compared to intratumoral infused controls. In the instance of radiolabeled antiferritin antibody, intraperitoneal administration and intratumoral infusion were compared to the new technique. In the other two instances, intratumoral infusion was compared to the new method.

RESULTS

In all instances the direct vascular blockade caused by MAA led to greater deposition of the agent under study for at least 24 h. These results were clinically applied with MAA followed by 32P colloidal chromic phosphate and were consistent with the experimental findings.

CONCLUSION

A new technique is described that may be carried out in the experimental laboratory and clinic by direct tumor infusion of macroaggregated albumin (MAA), followed by other radioactive agents that will remain localized in solid cancers and will allow for high tumor dose deposition for potentially increased therapeutic efficacy.

Fluoxetine effects on cerebral glucose metabolism

In a counterbalanced, double-blind, placebo-controlled trial, 40 mg of fluoxetine was administered to four healthy adult volunteers (three men, one woman; age range 20-39 years), 90 min before injection of 6-7.5 mCi of [18F]-2-deoxyglucose to measure cerebral metabolic rate of glucose (CMRglu). Subjects were engaged in a visual monitoring task shortly before and during scanning with a PETT-VI tomograph. Global CMRglu did not differ when placebo (8.93 +/- 0.96 mg 100 g-1 min-1) was compared to fluoxetine (8.22 +/- 0.86 mg 100 g-1 min-1; paired t-test = 0.82, df = 3, p < 0.48). However, statistical parametric mapping of differences in CMRglu between placebo and fluoxetine conditions revealed regional effects of fluoxetine shown by decreased metabolism in the amygdaloid complex, hippocampal formation and ventral striatum, and by increased metabolism centered in the right superior parietal lobe (Brodmann area 7). Parametric mapping for use in PET studies of glucose metabolism represents a significant new tool for studying drug effects in humans.

Screening for consumptive coagulopathy in preeclampsia

OBJECTIVE

To identify a practical and cost-effective profile of tests to screen for consumptive coagulopathy in preeclampsia (PE).

METHODS

Retrospective analysis of the results of measurements of platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen and D-dimers in 100 patients presenting with PE uncomplicated by other disease or antepartum hemorrhage. Twenty-four patients had pregnancy-induced hypertension only, and 76 hypertension with proteinuria.

RESULTS

The incidence of abnormal tests on presentation was raised D-dimers 34%, thrombocytopenia 14%, prolonged APTT 12%, prolonged PT 3%, and low fibrinogen 2%. Prolonged APTT without thrombocytopenia occurred in 8% of patients. In 19 patients with elevation of D-dimers alone, only one showed evidence of consumption of coagulation factors on subsequent testing.

CONCLUSIONS

A combination of platelet count and APTT is probably a practical and cost-effective combination to screen for consumptive coagulopathy in PE.