The Larsen syndrome and glial proliferation in the brain

A case of the Larsen syndrome is reported in which postmortem examination of the brain revealed glial proliferation resembling tuberous sclerosis. The differential diagnosis of the syndrome and the possible significance of the lesions are discussed.

Factor XIII (fibrin stabilising factor) in Henoch-Schönlein's purpura

In 13 out of 17 consecutive children with Henoch-Schönlein's purpura the factor XIII determined with the dansyl cadaverine method was found to be decreased during the acute phase. The decrease is assumed to be due to a specific degradation by proteolytic enzymes liberated from inflammatory cells, with defective local haemostasis as a result. This assumption is strengthened by the observation that treatment with factor XIII combined with an antifibrinolytic drug controlled life-threatening gastro-intestinal bleeding in one of the patients. It would therefore appear that such treatment might offer a new possibility of controlling severe haemorrhages in Henoch-Schönlein's purpura.

Sisomicin treatment of serious neonatal infections. A clinical and pharmacokinetic study

23 infants, 20 of which had verified or clinically highly suspected serious infections in the neonatal period, were treated with a new antibiotic aminoglycoside, sisomicin, i.m. in doses from 2.8 to 6.6 mg/kg/24 h. Clinical cure was obtained in 18 of 20 caes, and marked improvement in one case. Adverse effects were only observed in two infants with tenderness at the injection sites. Serum concentrations and half-life estimations showed that the concentrations were similar to those obtained for gentamicin, and that half-life was independent of postnatal age, but highly correlated to the gestational age and to body weight. Consideration should therefore be given to the prolonged half-life of the drug in immature and low birth weight infants.

Generalized proteolysis in a young woman with Weber-Christian disease (nodular nonsuppurative panniculitis)

A patient with Weber-Christian disease (syn. nodular nonsuppurative panniculitis) is reported. The generalized cellular destruction in this patient resulted in liberation of proteolytic enzymes into the circulation, which led to multiple haemostatic disturbances with haemorrhagic diathesis. The most prominent haemostatic defects were thrombocytopenia with a normal life span of isologous platelets, high levels of AHF-related antigen, hypofibronigenaemia with short fibrinogen survival, low levels of Factor XIII (fibrin stabilizing factor = FSF) and increased amounts of fibrin/fibrinogen degradation products (FDP). Proteolytic enzymes, other than thrombin and plasmin which especially degrade Factor XIII and fibrongen, derived from destroyed cells (probably leukocytes) seem to have been involved in the pathogenesis of the bleeding disorder in this patient.

Factor XIII in a clinical material

In 339 patients with various diseases factor XIII (FSF) was determined with the specific amine incorporation method of Lorand et al (1969). Normal values were found in patients with renal (216 patients) or liver diseases (33 patients), in 39 patients with recurrent deep venous thrombosis and in 17 children with congenital cyanotic heart disease. Low levels were found in patients with various conditions, such as sepsis, multiple fractures and combustio complicated by an abnormal proteolytic activity (fibrinolysis and/or activation of the coagulation system with signs of disseminated coagulation). No correlation was found between the FSF and the fibrinogen values or the levels of fibrin/fibrinogen degradation products (FDP). Low FSF values were found in 4 patients with erosive gastritis, with gastrointestinal bleedings and a local fibrinolytic activity in the gastric juice. Although the FSF must be very low (smaller than 1%) if it is to cause bleedings, the low levels in these patients with many other coexisting disturbances in the coagulation system and/or an increased fibrinolytic activity most probably contribute to the increased bleeding tendency in such patients.

Abnormal proteolysis in sick newborns

87 newborn infants were studied on their first day of life for defects in the coagulation and fibrinolytic systems. The infants were divided into two diagnostic groups, one with IRDS, the other with mixed neonatal disorders. Factor V, fibrinogen and fibrin/fibrinogen degradation products (FDP) were abnormal more often than any of the other factors examined. The presence or absence of "multiple defects" appeared to depend on the severity of the illness and its ultimate course. Thus 28% of the surviving infants or 85% of those who died had "multiple defects". The pattern of abnormalities did not differ between the infants with IRDS and those with mixed disorders. The "multiple defects" are ascribed to the following mechanisms: (1) impaired synthesis due to vitamin K deficiency and/or liver damage, (2) abnormal proteolytic activity stimulated by tissue damage and causing (a) an activation of the coagulation process (b) activation of the fibrinolytic system, or (c) of both the coagulation and the fibrinolytic systems. Differentiation between these pathways to defective haemostasis are important when deciding upon therapeutic measures in addition to the basic treatment.