Coagulation abnormalities in 22 cats with naturally occurring liver disease

Twenty-two cats with liver disease were evaluated for coagulation abnormalities including alterations in prothrombin time, activated partial thromboplastin time, thrombin time, factor VII activity, and platelet count. The purpose of the study was to determine the prevalence of coagulation abnormalities in this population of cats, classify abnormalities according to underlying pathogenesis, and determine if serum biochemical parameters typically used as indicators of liver disease showed any correlation with the coagulation abnormalities present. Study results indicated that at least 1 coagulation abnormality was present in 82% of the cats. Prolongation of prothrombin time was most common (16/22 cats) and factor VII activity was below reference range (< 60%) in 15 cats. When classified according to underlying pathogenesis, vitamin K deficiency was the most common abnormality found (11/22). Other abnormalities were less common and included hepatic synthetic failure (3/22), indeterminate (3/22), and disseminated intravascular coagulation (1/22). Increase in alkaline phosphatase (ALP) activity was the only biochemical abnormality that showed statistically significant correlation with coagulation abnormalities (P = .023). Cats with marked increases in ALP activity were more likely to have coagulation abnormalities than those with only mild increases in ALP activity.

Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment

PURPOSE

We investigated safety and efficacy outcome pertaining to the Mentor Alpha-1, 3-piece inflatable penile prosthesis for impotence treatment.

MATERIALS AND METHODS

A 2-phase, multi-institutional, large scale retrospective study, with independently analyzed medical record (phase I) and questionnaire (phase II) data from consecutive eligible patients of 7 physician investigators was performed from March to October 1993.

RESULTS

In phase I there were no morbidities of any type in 394 of the 434 patients (90.8%) (mean age 61 years, range 24 to 88) who underwent Alpha-1 implantation (mean followup 22.2 months, range 0.67 to 44.5). The risk of prosthesis malfunction (fluid leak and auto-inflation) was 2.5%. No cylinder aneurysms were reported. A total of 93.1% of Alpha-1 devices was free from explantation (4.4%) or revision surgery (2.5%) for approximately 2 years from the original implant date. Kaplan-Meier actuarial analyses revealed that cumulative survival of the Alpha-1 prostheses at 12, 24 and 36 months was 98 +/- 1%, 93 +/- 2% and 85 +/- 7% until device malfunction, and 91 +/- 2% 83 +/- 4% and 75 +/- 7% until surgical intervention (revision or explantation). In phase II 89% of the men claimed fulfilled expectations with the Alpha-1 prosthesis as impotence treatment. Satisfaction responses 80% or greater were noted with regard to intercourse ability and confidence, and device rigidity and function. Implantation did not result in greater than 80% satisfaction in partner relationships or feelings (as judged by the patient), social or work confidence, or intercourse frequency. Factors adversely affecting satisfaction included partner feelings of dissatisfaction (as judged by the patient), specific physician investigators and need for explantation/revision surgery.

CONCLUSIONS

In 1 of the largest multi-institutional implant outcome studies thus far performed, safety and efficacy data concerning the Alpha-1 contemporary inflatable device were found markedly improved over earlier inflatable prostheses and now compare favorably with historical data from noninflatable rod type devices.

Plasma von Willebrand factor antigen concentration as a predictor of von Willebrand's disease status in German Wirehaired Pointers

OBJECTIVE

To evaluate the use of plasma von Willebrand's factor (vWF) concentration as a screening test for inherited von Willebrand's disease (vWD) in German Wirehaired Pointers (GWHP).

DESIGN

Prospective study.

SAMPLE POPULATION

Plasma samples from 467 GWHP.

PROCEDURE

Plasma vWF concentrations were measured as vWF antigen (vWF:Ag), using ELISA, and test values were used to estimate prevalence of vWD in GWHP and predict parental vWD status. Test results of progeny from matings of carrier and noncarrier parents were then compared with the predicted outcome of such matings.

RESULTS

376 (81%) GWHP were classified as vWD noncarriers, 58 (12%) as carriers, and 5 (1%) as affected with vWD. An additional 28 (6%) GWHP could not be classified on the basis of plasma vWF:Ag concentration. The observed outcome of tests of 213 pups was not significantly different from that predicted on the basis of parental vWF:Ag concentration. The predictive value of a positive test result (vWF: Ag% < 50) for identifying vWD carriers was 0.89.

CLINICAL IMPLICATIONS

Plasma vWF:Ag concentration was an effective predictor of genetic status for the vWD trait, and for the outcome of matings between carriers and noncarriers of vWD in this study of GWHP.

Severe, recessive von Willebrand's disease in German Wirehaired Pointers

OBJECTIVE

To characterize the biochemical and genetic basis of a clinically severe form of von Willebrand's disease (vWD) in German Wirehaired Pointers.

DESIGN

Case series.

SAMPLE POPULATION

Plasma samples from 335 German Wirehaired Pointers (8 clinically affected).

PROCEDURE

Plasma samples were evaluated, using an ELISA, to determine von Willebrand factor (vWF) antigen concentration. Additional studies performed on samples from clinically affected dogs included coagulation screening tests, factor VIII coagulant activity assays, and immunoelectrophoresis to determine vWF multimeric composition.

RESULTS

Mucosal bleeding and bleeding at sites of cutaneous injury were observed in affected dogs by 6 months old. Plasma vWF antigen concentration was markedly reduced, and there was a lack of high molecular weight vWF multimers; findings compatible with type-II vWD. Inheritance and expression pattern of vWD in this breed was most compatible with that of an autosomal recessive trait.

CLINICAL IMPLICATIONS

Von Willebrand's disease should be included in the differential diagnoses of bleeding diatheses in German Wirehaired Pointers, with definitive diagnosis confirmed on the basis of canine-specific vWF assays.

Isolation and characterization of canine factor IX

Canine plasma factor IX was purified to homogeneity by a combination of barium citrate precipitation and three-step column chromatographies of DEAE sepharose, heparin agarose and a monoclonal antifactor IX antibody-linked agarose. Canine factor IX has an apparent molecular size of 61 kDa, which is slightly smaller than that of human factor IX, as determined by denatured polyacrylamide gel electrophoresis. Its amino acid composition, amino-terminal and carboxyterminal amino acid sequences agreed well with those predicted from the reported cDNA. Unlike purified human factor IX, canine factor IX preparation often showed a discrete smaller molecular species (approximately 50 kDa) which was generated by a specific proteolytic cleavage between Arg310 and Val311. When purified canine factor IX was utilized as a standard for enzyme linked immunosorbent assay, the concentration of canine factor IX in the pooled normal dog plasma was determined to be 5.3 micrograms/ml with 11.2% carbohydrate content (or 4.7 micrograms/ml for its polypeptide chain moiety). Concentration of plasma factor IX antigen was measured in six severely affected, unrelated hemophilia B dogs. Four had factor IX antigen of less than 1% of the normal, and two had undetectable levels. The latter two had gross molecular abnormalities in their factor IX genes. Three obligate carrier females had variable but proportionately reduced factor IX antigen and factor IX coagulant activity levels. These results provide a quantitative method for measuring canine factor IX antigen which is a prerequisite for studying hemostasis and development of gene transfer approaches in the canine model of hemophilia B.

Working as a volunteer nurse/midwife in Pakistan

The contrast in health and life-style between Pakistan and the UK is very great. Working in a country with one of the highest birth and fertility rates in the world, coupled with poverty and an under-developed health care system stretched the authors initiative and resourcefulness in dealing with difficult situations.

Learning "what" and "how" in a human motor task

We studied the development of implicit and of verbally declared knowledge for normal human subjects who learned an unfamiliar motor task in one learning session. The exploratory nature of motor learning and a special period for optimizing skill were followed in real time. Subjects understood the goal for task success, but they had to learn a motor strategy of what pattern of serial movements to make and the tactics of how much to scale their amplitudes and timing. We compared the time course for acquiring tactical skill with that for acquiring knowledge of strategy and of tactics, and their necessary cues. Implicit and declarative knowledge were distinguished from one another by correlating subjects' verbal self-reports with movement kinematics and their results. Implicit generation of the correct strategy and of the tactics developed in an exploratory manner from the beginning of the learning session. Implicit strategy learning soon gave way to conscious efforts, but tactical learning remained implicit until its first unambiguous verbal declaration (with one exception). First strategy declarations were voiced before those for tactics, during trial-and-error learning that did not require task success, and referred to reversing the direction of hand movements (one exception). In contrast, first declarations of tactics almost always required actual or imminent success, referred to when direction was to be reversed, and it was achieved near the top of a sigmoid learning curve that rose to tactical skill (with one exception). During the sigmoid rise, movement amplitudes and timing were optimized in a distinct manner, although tactics usually adapted thereafter to movements of more moderate speed that could still be successful.

A subgenomic RNA associated with cherry leafroll virus infections

Cherry leafroll nepovirus (CLRV) genomic RNA 1 (8 kb) and genomic RNA 2 (7 kb) have 3' polyadenylate tracts and, extending 5' from the polyadenylate, nearly identical sequences of 1.6 kb termed the 3' common region. We observed RNAs 1 and 2 and a third RNA of 1.5 kb in nucleic acid extracts of CLRV-infected Nicotiana tabacum suspension cell protoplasts and Chenopodium quinoa plants, using a hybridization probe complementary to 1 kb of the 3' common region. The third RNA was partially purified by preparative gel electrophoresis and chromatography on an oligodeoxythymidylate column. Analyses of transcripts primed by a complementary oligodeoxyribonucleotide and of cDNA clones revealed that the third RNA corresponds to the 3' 1500 nucleotide residues of RNA 1. Hence we designate the newly characterized RNA as RNA 1A. RNA 1A was not detected as encapsidated RNA in extracts of either protoplasts or C. quinoa plants. The amount of accumulated RNA 1A declined between 24 and 48 hr after inoculation of protoplasts with CLRV virions, although CLRV RNAs 1 and 2 continued to accumulate. Other results were not consistent with cleaved RNA 1 being the origin of RNA 1A. RNA 1A has the properties of a subgenomic RNA, presumably synthesized from negative-sense RNA 1 as template.

Amylase secretion by cultured porcine parotid cells

The similarity of porcine and human physiology and the availability of slaughterhouse tissues suggests the use of porcine parotid cells as a model for amylase secretion. A procedure is described for the isolation of porcine parotid cells by collagenase-P/dispase digestion of the tissue. The preparation consisted of individual cells and small aggregates that were maintained in primary culture, during which the cells formed aggregates that firmly attached to the plastic substrate. The amylase content of the cultured cells remained adequate for assay of secretory activity during culture for one week after isolation. Depending upon variations in experimental treatments, the cultured cells secreted approx. 35-65% of cellular amylase in response to a carbachol challenge. The cells were slightly responsive to long exposures to isoproterenol, and were unresponsive to nicotine, elevated extracellular K+ or substance P. Secretion induced by carbachol required extracellular Ca2+, was inhibited by atropine and occurred with a nearly linear response over a 30-min period. The Ca2+ ionophore A23187 was also a potent secretagogue for amylase secretion, producing levels of secretion equal to that induced by carbachol. The ease of preparation and the retention of amylase during primary culture suggests that the preparation will be useful in studies on muscarinic receptor-mediated control of amylase secretion.

Transient gene expression of antisense RNA and coat protein-encoding sequences reduced accumulation of cherry leafroll virus in tobacco protoplasts

Cherry leafroll nepovirus (CLRV) is the causative agent of blackline disease, which results in a fatal necrosis of the graft union of English walnut scion on certain rootstocks. Tobacco suspension cell protoplasts were electroporated with plasmid constructions, bearing or not bearing RNA-derived sequences, and, subsequently, were electroporated with CLRV virions or virion RNA Replication of CLRV in protoplasts was demonstrated by accumulation of both positive- and negative-sense CLRV genomic RNAs 1 and 2, capsid antigen, and virions. Three plasmids were tested for antiviral action. These have inserts that were derived from the coat protein gene, inserted in both orientations, and from the 3' terminal sequence that is nearly identical in RNA 1 and RNA 2, oriented for expression of antisense RNA. Plasmids were introduced into protoplasts 12 hr prior to introducing the virions or virion RNA. CLRV accumulation was reduced significantly by prior electroporation of plasmids intended to express coat protein or 3' antisense RNA, but not by electroporation of plasmid without insert or plasmid with coat protein encoding sequences in the antisense orientation. These results demonstrate the utility of transient expression in a protoplast system for comparing the efficacy of a variety of virus-derived and other sequences for their potential application in virus control strategies.

Aortic distensibility and stiffness index measured by magnetic resonance imaging in patients with Marfan's syndrome

OBJECTIVES

To use magnetic resonance imaging to measure the elastic properties of the aorta of adults with Marfan's syndrome and to compare these results with those obtained by echocardiography.

PATIENTS AND METHODS

12 patients with Marfan's syndrome and 12 controls matched for age. Transverse luminal areas of the ascending and descending aorta were measured using electrocardiographic gated magnetic resonance imaging. Echocardiography was used to measure the diameter of the ascending aorta and aortic arch in patients with Marfan's syndrome. Blood pressure was measured during both scans.

RESULTS

In diastole, transverse luminal areas of the ascending and descending aorta were significantly greater in patients with Marfan's syndrome when measured by magnetic resonance imaging and corrected for body surface area; P < 0.02 and P < 0.05 respectively. Patients with Marfan's syndrome had a higher stiffness index (112.77 v 5.78, P < 0.05) and a lower distensibility (0.0066 v 0.0105, P < 0.05) than controls. Results produced by MRI and echocardiography were not significantly different.

CONCLUSIONS

Magnetic resonance imaging gives good quality reproducible images of the ascending and descending aorta. In patients with Marfan's syndrome, aortic distensibility and stiffness index measured by magnetic resonance imaging were abnormal (but did not always relate directly to the size of the aorta.

Development of degenerative spondylosis of the lumbar spine after partial discectomy. Comparison of laminotomy, discectomy, and posterolateral discectomy

STUDY DESIGN

The development of degenerative spondylosis after successful operative decompression of the affected nerve root was prospectively evaluated in a comparative case series of 100 patients with a herniated lumbar nucleus pulposus.

OBJECTIVES

The objective of this study was to compare the relative incidence of degenerative spondyloarthrosis after successful posterior laminotomy and discectomy and posterolateral extradural discectomy for decompression of a compromised lumbar nerve root.

SUMMARY OF BACKGROUND DATA

The relationship between the radiographic appearance of degenerative spondylosis and prior operative procedures has been controversial and at times contradictory. The posterior operative approach with a partial discectomy has been associated with a significant incidence of postoperative degenerative spondylosis and intraneural and perineural fibrosis, complications that may be minimized, or perhaps even eliminated, with the posterolateral evacuation of the offending intervertebral disc fragment.

METHODS

Each patient had: 1) not responded favorably to nonoperative treatment, 2) a persistent radiculopathy, 3) correlative imaging studies with no preoperative spondyloarthrosis and 4) minimum 2-year follow-up. Fifty patients were treated by posterior laminotomy and discectomy and fifty were treated by a posterolateral extradural discectomy. Postoperative spondylosis was graded based on the radiographic presence or absence of osteophytes, the intervertebral disc height, the vertebral body alignment and the facet joint changes.

RESULTS

At an average postoperative follow-up of 65 months, the incidence of a one grade increase in degenerative spondylosis was 80% of the laminotomy and discectomy patients as compared to 39% of the posterolateral discectomy patients.

CONCLUSIONS

The increased incidence of spondyloarthrosis with the posterior approach suggests that minimally invasive posterolateral extradural procedures should be considered for the decompression of a compromised lumbar nerve root.

Factor XI deficiency in Kerry Blue Terriers

A 9-year-old female Kerry Blue Terrier with postoperative hemorrhage and prolonged activated partial thromboplastin and activated clotting times was determined to have factor XI deficiency. Transfusions of fresh-frozen plasma given on 4 consecutive days transiently returned the values for activated clotting time and plasma factor XI activity to within reference range limits and controlled the hemorrhage. Analysis of data from 10 other factor XI-deficient Kerry Blue Terriers with a tendency for mild posttraumatic or postoperative bleeding was suggestive of an autosomal mode of inheritance, with a mild tendency for posttraumatic or postoperative bleeding in homozygous and heterozygous dogs. Factor XI deficiency is the only contact phase protein defect that causes a bleeding disorder in animals, which can be explained by the fact that thrombin is more efficient than factor XIIa in activating factor XI. Factor XIa plays a key role in sustaining coagulation.

Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test

The intracarotid amobarbital test (IAT) examines hemispheric memory and language. We set out to determine whether memory performance on the IAT correlated with seizure relief after anterior temporal lobectomy in 117 patients with refractory epilepsy. The IAT assessed recognition memory performance for nine items with correction for false-positive recognitions. We then compared performance of one hemisphere with that of the other, defining a correctly lateralized memory deficit as worse performance when using the hemisphere containing the operated temporal lobe than when using the other hemisphere. The analysis included concurrent factors that might also affect outcome, such as age at first risk for epilepsy, presence or absence of tumor, and Full Scale IQ. A discriminant function analysis demonstrated that patients with a correctly lateralized memory deficit on the IAT had an increased probability of being seizure-free following surgery after controlling for other predictors. The performance of the nonoperated temporal lobe related to outcome, although less strongly. The magnitude of the difference in performance between the two hemispheres and the performance of the operated hemisphere did not relate to outcome. Patients who became seizure-free had an earlier age at first risk than did those with persistent seizures, and tumor presence weakly correlated with postoperative outcome. IQ did not correlate with outcome. We conclude that the IAT predicts seizure relief after anterior temporal lobectomy independent of other known risk factors we examined.

Lupus-type "anticoagulant" in a dog with hemolysis and thrombosis

A circulating anticoagulant was detected in a 2-year-old Chesapeake Bay Retriever with hemolytic anemia, nephrotic syndrome, thrombocytopenia, polyarthropathy, and pulmonary thromboembolism. A persistent prolongation of the activated partial thromboplastin time (aPTT) was detected, and it did not correct with repeated administration of fresh frozen plasma. The aPTT was still prolonged, with a 1:1 mixture of patient's plasma and normal dog plasma in vitro, suggesting the presence of a circulating inhibitor. Results of assays to characterize the inhibitor were compatible with those described for the lupus anticoagulant in human patients with systemic lupus erythematosus. Paradoxically, patients having the lupus anticoagulant are at increased risk for thrombosis. Pulmonary thromboembolism has been described as a frequent complication of immune-mediated hemolytic anemia in the dog, and the presence of a circulating anticoagulant should be considered as a potential mechanism.

Buccal mucosa bleeding time is prolonged in canine models of primary hemostatic disorders

Bleeding times are reported in many studies using canine models, with a variety of techniques employed to adapt these tests for dogs. We evaluated a canine model of template bleeding time, the buccal mucosa bleeding time (BMBT), by examining the test's sensitivity and specificity for defects of primary hemostasis. We examined thirty-five dogs having defined defects of either primary hemostasis (Types I, II, III von Willebrand's disease, thrombasthenia, thrombopathia) or secondary hemostasis (hemophilia A and B, Factor VII deficiency). Comparisons of BMBT and cuticle bleeding time were made in a subset of these dogs. All dogs having primary hemostatic disorders had long BMBT, and all factor deficient dogs had BMBT within normal range. The BMBT in canine models appears to be a specific and sensitive test of primary hemostasis; suitable for evaluating factors affecting template bleeding time and potential efficacy and thrombogenicity of treatment regimens.

Survey of the Anopheles maculatus complex (Diptera: Culicidae) in peninsular Malaysia by analysis of cuticular lipids

Anopheles maculatus Theobald sensu lato is a species complex now consisting of eight sibling species; An. maculatus is still represented by two cytologically distinct forms; i.e., the widely distributed sensu strictu or B, and E from southern Thailand and adjacent areas in northern Malaysia. Cuticular lipid profiles in conjunction with principal component analysis was used to separate An. maculatus form E from sensu stricto form B in a preliminary survey of the An. maculatus complex at five locations spanning peninsular Malaysia. The relative rank orders, from the areas of the five gas chromatographic peaks used to determine lipid differences for specimens from peninsular Malaysia, matched well with those from cytogenetically identified colony specimens of An. maculatus forms B and E. The two-dimensional principal component pattern of specimens identified as form E was highly clumped, which indicated that very similar cuticular lipids were present within this putative malaria vector. Both forms coexisted in peninsular Malaysia, but form E may be dominant except in the south.

Intra-arterial streptokinase in acute ischaemic stroke. A pilot study

AIMS

To assess the safety and efficacy of the intra-arterial administration of streptokinase within 24 hours of acute ischaemic stroke.

METHODS

Patients who presented to the Austin Hospital casualty department between 3 and 22 hours after an acute stroke were considered for the study. Eligible patients had pretreatment non-contrast computed tomographic scans of the brain to exclude haemorrhage. Streptokinase (250,000 units) was administered directly into the common carotid artery or the cervical portion of the internal carotid artery.

MAIN OUTCOME MEASURES

The incidence of symptomatic and asymptomatic cerebral haemorrhage, haemorrhagic transformation of infarction, angiographic reperfusion, clinical outcome at seven to 10 days and the frequency of other complications.

RESULTS

Thirteen patients were treated over a 16-month period. Major clinical improvement occurred in five patients (39%) at 48 hours. This was associated with angiographically demonstrated recanalisation of a middle cerebral artery occlusion in two patients and partial recanalisation in two others. Significant hypotension in two patients required therapy to be stopped. In five other cases mild hypotension developed but the streptokinase infusion was completed. Haemorrhagic transformation of the infarct occurred in four patients without clinical deterioration.

CONCLUSION

Intra-arterial administration of streptokinase is safe in selected patients with acute ischaemic stroke. The theoretical benefit of an increased local thrombolytic effect and reduced systemic complications, compared with the use of higher intravenous doses, justifies a randomised clinical trial. If therapies such as this are to be successful, rapid referral to an appropriate centre is necessary.

Management of canine von Willebrand's disease

Canine von Willebrand's disease (vWD) is the most common inherited bleeding disorder of purebred dogs. Optimum treatment of affected dogs is influenced by the presence of concurrent disorders, especially thyroid insufficiency, and the nature of hemostatic stress encountered. Blood component therapy, most specifically the use of cryoprecipitate, provides the most effective transfusion support for severely affected dogs.

Effects of verapamil and Bay K 8644 on defibrillation energy requirements in dogs

Antiarrhythmic drugs are often required in patients with implantable cardioverter-defibrillator devices. Prior evidence suggests that drugs modulate defibrillation energy requirements by altering ion channel activity. To evaluate the effects of calcium ion channel activity on internal defibrillation energy requirements, the calcium antagonist verapamil and Bay K 8644, a calcium channel activator, were investigated in 30 open-chest, pentobarbital-anesthetized dogs. Defibrillation energies were applied across two epicardial patch electrodes. The likelihood of successful defibrillation was determined at various shock energy levels, and the 50 and 90% effective energy doses were calculated using nonlinear regression. In saline control experiments (n = 10), the stability of the preparation throughout the 6-h duration of the experiments could be demonstrated. Verapamil administration (n = 10) infused to a mean plasma concentration of 69 ng/ml increased the 50 and 90% effective defibrillation energies by 41 and 43% (p less than 0.05), respectively, and to a mean plasma verapamil concentration of 170 ng/ml by 95 and 75% (p less than 0.01), respectively. The mean cycle length during ventricular fibrillation decreased with verapamil and was inversely related to the change in defibrillation energy requirement. Administration of Bay K 8644 (n = 10) produced a slight increase in the 50% effective defibrillation energy (25%; p less than 0.05) and 90% effective defibrillation energy (17%; n.s.). The electrophysiologic effects of verapamil were neither prevented nor reversed by Bay K 8644. In conclusion, intravenous verapamil administration caused an increase in defibrillation energy requirements, but the mechanism by which verapamil exerted this effect remains unclear. These experimental data suggest that verapamil should be used in patients with automatic implantable cardioverter-defibrillator devices only after individual testing.