A pilot study of antithrombin replacement in intensive care management: the effects on mortality, coagulation and renal function

A prospective, randomized, controlled trial to examine the effects of antithrombin supplementation on mortality, coagulation and renal function has been carried out on 132 intensive care patients. Antithrombin activity was measured in all patients on admission to the intensive care unit (ICU). Patients with an antithrombin activity of less than 70% were randomized to either receive antithrombin replacement or to act as controls. Antithrombin activity was maintained above 70% in the treated patients throughout their stay on ICU. Ninety-three patients had an antithrombin activity of less than 70% and 35 received replacement therapy. Patients with antithrombin activity below 70% remained on the ICU significantly longer and had a significantly higher mortality rate than patients with antithrombin activity above 70%. Antithrombin supplementation neither reduced mortality nor shortened the intensive care stay. Fifty patients with reduced antithrombin activity remained on the ICU for at least 4 days, 25 received antithrombin and 25 acted as controls; coagulation parameters and renal function have been monitored in these patients. Fibrinogen concentration and platelet count were unaffected by antithrombin replacement. Antithrombin supplementation did not appear to reduce the incidence of impaired renal function in sepsis, trauma and postoperative patients. The creatinine clearance fell below 20 ml/min in eight patients in the no-treatment arm while by comparison only three patients in the treatment arm developed impaired renal function. Our study does not demonstrate a clear role for the use of antithrombin supplementation in intensive care, however the finding that antithrombin reduced renal impairment is encouraging and a larger study to confirm this finding is at present underway.

Food craving, mood and the menstrual cycle

Seventy-six women, with a mean age of 35.7 years, who reported premenstrual craving for sweet foods in a retrospective questionnaire, were assessed prospectively with a pre- and post-menstrual eating questionnaire and daily ratings of craving, mood, irritability and breast tenderness over two menstrual cycles. In 72% of these women a perimenstrual pattern of food craving was confirmed. In 13% this craving was confined to the menstrual phase. There was no consistent association between food craving and mood change, either in timing or severity. Women with more severe mood change did not report more severe craving. There was also no association between food craving and cyclical breast tenderness. Perimenstrual food craving, therefore, appears to be a cyclical phenomenon in its own right, of uncertain aetiology and worthy of further study.

Extracts of feverfew inhibit granule secretion in blood platelets and polymorphonuclear leucocytes

Extracts of feverfew (Tanacetum parthenium) inhibited secretory activity in blood platelets and polymorphonuclear leucocytes (PMNs). Release of serotonin from platelets induced by various aggregating agents (adenosine diphosphate, adrenaline, sodium arachidonate, collagen, and U46619) was inhibited. Platelet aggregation was consistently inhibited but thromboxane synthesis was not. Feverfew also inhibited release of vitamin B12-binding protein from PMNs induced by the secretagogues formyl-methionyl-leucyl-phenylalanine, sodium arachidonate, and zymosan-activated serum. Feverfew did not inhibit the secretion induced in platelets or PMNs by the calcium ionophore A23187. The pattern of the effects of the feverfew extracts on platelets is different from that obtained with other inhibitors of platelet aggregation and the effect on PMNs is more pronounced than has been obtained with very high concentrations of non-steroidal anti-inflammatory agents.

Conformational-energy studies of tetrapeptide opiates. Candidate active and inactive conformations

The conformational behavior of four tetrapeptide enkephalin analogues (Tyr-Gly-Gly-Phe-OH, Tyr-Gly-Gly-Phe-NH2, Tyr-D-Ala-Gly-Phe-NH2, and Tyr-D-Ala-Gly-(NMe)Phe-NH2) was examined to identify conformations that are active and inactive at the opiate analgesic receptor. By using an empirical energy program, conformational energies were obtained for the optimized geometries of each tetrapeptide. Two methods of selecting candidate active conformations from low-energy conformers were used. In the first method, inactive conformers were designated as low-energy conformations of the very weak tetrapeptide, Tyr-Gly-Gly-Phe-OH. These candidate inactive conformers had geometries resembling beta V, beta I, "random" peptide conformations. Candidate active conformers selected were low-energy conformations found for both Tyr-D-Ala-Gly-Phe-NH2 and Tyr-D-Ala-Gly-(NMe)Phe-NH2 but not low-energy conformers for Tyr-Gly-Gly-Phe-OH. In the second method of selection, conformers with relative energies in the active and inactive peptides that followed the potency order Tyr-Gly-Gly-Phe-OH much less than Tyr-D-Ala-Gly-Phe-NH2 less than or equal to Tyr-D-Ala-Gly-(NMe)Phe-NH2 were chosen as candidate active conformers. By using both methods of selection, a beta II' bend geometry was found as the active conformer. This beta II' conformer was not stabilized by a 1-4 hydrogen bond, but instead was stabilized by a hydrogen bond between the tyrosine amine hydrogen atom and the phenylalanine carbonyl oxygen atom. The effect of C-terminal amide derivitization on peptide conformation was also examined by comparing the conformational profiles of Tyr-Gly-Gly-Phe-OH and Tyr-D-Ala-Gly-Phe-OH with their amides Tyr-Gly-Gly-Phe-OH-NH2 and Tyr-D-Ala-Gly-Phe-NH2. No significant difference in conformational behavior was found for the Tyr-Gly-Gly-Phe pair; however, a difference in conformational behavior was found between the Tyr-D-Ala-Gly-Phe acid and amide. Thus, on the basis of conformational data, the Tyr-Gly-Gly-Phe-NH2 analogue is predicted to have very weak opiate activity.

Sister chromatid exchange and chromosome aberration rates in a group of psoriatics before and after a course of PUVA treatment

Blood was cultured and chromosome preparations were examined for sister chromatid exchanges and chromosome aberrations in eighteen patients receiving photochemotherapy with 8-MOP and UV-A for the treatment of psoriasis, both before starting treatment and again 6 months later. The UV-A was administered both by means of low output (irradiance: 1.1--2.25 mW/cm2) and high output (irradiance: 6.1--7.6 mW/cm2) UV-A radiation cubicles. Irrespective of the intensity of irradiation or the total dose of UV-A administered there was no evidence of chromosome damage in lymphocytes following treatment.