Thromboembolic complications associated with L-asparaginase therapy. Etiologic role of low antithrombin III and plasminogen levels and therapeutic correction by fresh frozen plasma

A case of an 18-year-old woman with acute lymphoblastic leukemia who developed L-asparaginase-associated stroke and subclavian vein thrombosis is presented. The latter was also associated with a Hickman central venous catheter. Thrombotic complications occurred when plasma levels of plasminogen and antithrombin III were still markedly reduced as a result of L-asparaginase therapy, although the fibrinogen had recovered from its lower levels. The stroke was treated with fresh frozen plasma and the subclavian vein thrombosis was treated with streptokinase and fresh frozen plasma. L-asparaginase and Hickman-associated coagulopathy is reviewed and the treatment is discussed.

Rabbit monoarticular arthritis as a model for intra-articular drug injections. The local action of administered cortisol and alpha-1 proteinase inhibitor

Monoarticular arthritis in the rabbit has been used to study the effect of intra-articular administration of cortisol-21-phosphate and alpha-1-proteinase inhibitor. The preparations were administered both separately and in combination. All treatments improved parameters associated with joint biochemistry and histopathology, but the greatest effect was found when steroid was combined with anti-proteinase. Cortisol-21-phosphate had both an anti-inflammatory and anti-arthritic action, whereas alpha-1-proteinase inhibitor showed little anti-inflammatory action but had some anti-arthritic effect. Alpha-1-proteinase inhibitor had no anti-inflammatory action against carrageenan induced oedema in the rat, but was anti-arthritic against adjuvant induced arthritis in the rat where it reduced both primary and secondary arthritis.

The influence of urea diet supplemented with protected protein on metabolism and wool growth in sheep

The utility of blood meal and formaldehyde treated casein as protein supplements in the nutrition of sheep receiving approximately 50% of their total nitrogen from urea was studied. It was observed that protected protein supplements positively influenced wool growth and quality. On the basis of biochemical analysis of blood the mechanism of this effect is discussed. It seems that small protein supplements (about 6% of the total protein) are not only a source of amino acids in the duodenum but also influence the hormonal control in animals.

[Effect of hemodilution with plasma protein solution and hydroxyethyl starch on plasma fibronectin]

In nine adult patients at least 24 hours prior to vascular surgical operations about 25 p.c. of circulating blood volume was replaced by either 6 p.c. hydroxyethyl starch (HES) or 5 p.c. plasmaprotein solution (PPS). Following haemodilution, a proportional significant decrease of plasmafibronectin (PFN) was observed; when PPS was administered, levels were significantly higher than expected due to withdrawal of blood. Serumalbumin was decreased in the same way, however, in patients receiving HES it rose significantly within 24 hours. It is concluded that changes are essentially only dilutional and when haemodilution technique is used, also postoperatively no dramatic reduction of PFN following uncomplicated surgery has to be anticipated.

[Comparative biological value of protein hydrolysates and their fortified forms]

Experiments on Wistar male rats were made to study the biological value (with the use of the "growth" method) of basic and protein- and crystalline amino acids-enriched protein hydrolysates. Autolysine and protein hydrolysates obtained from formed elements of the blood of slaughtered animals (the degree of degradation 30 and 70%) and a mixture of crystalline amino acids composed according to the FAO/WHO scale were studied. Casein was used as control. The differences in the biological value of basic and protein hydrolysates-enriched preparations point to the necessity of correcting basic hydrolysates.

Efficacy of hetastarch in the resuscitation of patients with multisystem trauma and shock

A prospective trial of 6% hetastarch (HES) v 5% plasma protein fraction (PPF) as the colloid component of intravenous (IV) fluid resuscitation was conducted in 32 patients with multisystem trauma and/or hemorrhagic shock. Patient age, mechanism and pattern of injury, and IV fluid requirements were similar in both groups. No intergroup differences were noted in indexes of hepatic, pulmonary, or renal function or in the incidence of infection. The frequency of other complications, including bleeding diatheses, and mortality were identical in the two groups. Although this investigation should be viewed as a pilot study, our results suggest that, compared with PPF, HES in large volumes is a safe, effective colloid solution in the resuscitation of patients with multisystem trauma and/or hemorrhagic shock. Further study of HES in a larger number of patients is warranted by these findings.

[Effect of meat pâtés of different composition on gastric secretory function]

Experiments on 4 dogs with isolated Pavlovian pouches were made to study the action on gastric secretion of a new type of a beef paté in which 20% of basic raw material was replaced by precipitated blood plasma proteins (a sample under study) and of a beef paté of a conventional composition (a control sample). Both paté samples were found to provoke a characteristic gastric juice secretion which strongly differed from the secretion pattern during beef feeding. This was determined by the presence in the patés of a significant amount of fat and by the homogenized nature of the paté mass. Gastric juice thus obtained was marked by a slightly decreased acidity, low content of hydrochloric acid pH 1.7-2.6, and moderate pepsin concentration. Replacement in beef paté of 20% of basic raw material by precipitated blood plasma proteins did not provoke any changes in gastric secretion as compared to that seen during intake of patés of a conventional composition.

The Gordon phenomenon induced by the eosinophil cationic protein and eosinophil protein X

Cerebellar Purkinje cell degeneration after intracerebral injection of eosinophil granulocytes or extracts thereof is known as the Gordon phenomenon. The reaction is said to be highly selective. An eosinophil-derived neurotoxin (EDN) has recently been reported to induce the Gordon phenomenon. However, we report here that two eosinophil-derived proteins, eosinophil cationic protein (ECP) and eosinophil protein X (EPX), may induce the Gordon phenomenon after intraventricular injection. The potency of ECP is far greater than that of EPX and the latter is possibly identical to EDN. The Fink-Heimer staining for degenerating nerve fibers and boutons, however, indicated that the selectivity of the Gordon phenomenon is not as specific as was previously thought, since this method revealed degeneration of all brain areas in proximity to the ventricular system.

Plasma derivatives and viral hepatitis

Plasma derivatives can be separated into those with either a low or a high risk of transmitting viral hepatitis. Low-risk products, with few exceptions, will remain low-risk irrespective of the plasma from which they are manufactured because they are heated at 60 degrees C for 10 hours (Albumin, Plasma Protein Fraction) or because they contain protective antibodies (Immune Globulin). This would appear to be the case not only for hepatitis B but also for non-A, non-B hepatitis. The risk of hepatitis B associated with plasma derivatives is reduced but not eliminated by HBsAg screening of donors. Further decreasing the risk of hepatitis B associated with AHF or Factor IX lots, as well as newer products like AT-III, alpha-1 antitrypsin, Fibronectin, C-1 Inactivator, and Factor XIII, may be accomplished either by the combination of stabilization and heating or by assuring that these products contain an excess of anti-HBS. For highly-purified products with little residual immunoglobulin it may be necessary to add anti-HBs. The addition of antibodies against non-A, non-B hepatitis agents when they are identified, could prevent transmission of both forms of viral hepatitis by plasma derivatives. Methods to stabilize and heat high-risk plasma derivatives to inactivate hepatitis viruses have the potential to remove both hepatitis B and non-A, non-B hepatitis infectivity.

Regeneration and repair after biologic treatment of root surfaces in monkeys. II. Proximal surfaces posterior teeth

THE HEALING of a new attachment procedures was evaluated in monkeys. Standard flap curettage procedures were made in posterior segments having previously created periodontal pockets. The diseased root surfaces were treated with sodium deoxycholate (2%) and human plasma fraction Cohn IV1 (5%), applied to experimental sites for 1 minute each. Control surfaces were similarly treated with phosphate buffered saline. The healing at 10 weeks postoperatively was described clinically, histologically, and by histometrics. There was a significant increase in connective tissue new attachment in experimental sites, compared to controls.

Correlation of hypotensive effect of plasma protein fraction with prekallikrein activator activity: a clinical study in patients having open-heart surgery

We studied the hemodynamic responses to the administration of 20 ml of three protein solutions having different prekallikrein activator (PKA) activities in patients undergoing cardiac operation. PKA levels of the two plasma protein fraction (PPF) solutions studied were 193% and 60%, respectively, while that of the albumin solution was less than or equal to 3%. A significant correlation was found between the PKA activity of the test solutions and the decrease in systemic vascular resistance produced by the solutions during cardiopulmonary bypass and in the postoperative period. Vasodilatation was considerably more marked in the postoperative phase than during cardiopulmonary bypass. Since cardiac output increased simultaneously with the decrease in vascular resistance in the postoperative period, the hypotension observed did not fully reflect the degree of vasodilatation. In some patients, substantial vasodilatation was observed also after the administration of albumin solution with low PKA level. We conclude that although the PPF-induced vasodilatation correlates with the PKA activity of the solution, occasional hypotensive reactions are probably due to mechanisms other than those linked with increased PKA level.

Cholesteryl esters in pig liver during atherogenic diets and foreign serum protein infusions

Eight-month-old pigs were fed a diet supplemented with 15% lard (group II) or 15% lard plus 1.5% cholesterol (group III) for 4 months. Five of the animals fed the high fat and cholesterol diet received two i.v. infusions of foreign serum protein (group IV). One group of animals was treated with the same infusions without dietary fat or cholesterol supplement (group V). Liver lipids and serum cholesterol levels were determined. In group II the concentration and fatty acid composition of hepatic cholesteryl esters showed no marked differences from controls (group I). The same findings were present in 2 of 5 animals of group III; in the other 3 animals higher hepatic cholesteryl ester concentrations and predominantly an elevation of monoenoic acid fraction, in one case also a rise of trienoic acid fraction were obtained. These alterations were found in the liver of all animals of group IV. The reverse was observed in the animals which were given the same serum infusions but only the stock diet (group V): a reduction of hepatic cholesteryl ester concentration and no striking alteration in fatty acid pattern. In cryostat sections of all liver specimens no stainable lipid could be detected. There was no correlation between liver and serum fatty acid composition of cholesteryl esters. The total cholesterol levels in serum showed no increase in group V, a slight increase in group II, a moderate increase in group IV, and a marked, partly large increase in group III. These results are discussed in relation to the effect of cholesterol and fat feeding on cholesterol metabolism and essential fatty acid requirement.

[Metabolic processes in children with chronic kidney failure as affected by protein-limited diets]

The time course of a number of characteristics of protein and mineral metabolism was studied in 55 children suffering from renal diseases in the stage of chronic renal insufficiency. Use was made of the diets in which protein was restricted to a varying degree relatively to azotemia severity. It was shown that the diet with protein restriction up to 1.5-1.0 g/kg bw has a pronounced antiazotemic action. Therefore, it is desirable to administer it to patients with moderate and remarkable azotemia. In stable and pronounced azotemia, it is advisable to administer the diet with a sharp restriction to protein (up to 0.65 g/kg bw).

Ornithine decarboxylase activity in retinal explants of goldfish undergoing optic nerve regeneration

Retinal explants cultured in the presence of fetal calf serum (FCS) exhibit an increase in the activity of ornithine decarboxylase which is maximal several hours after explantation. The measured activity of this enzyme is higher in explants of retinas whose optic nerve had been crushed several days previously (post-crush, PC) than in control (normal, N) retinas. The addition of rabbit antibodies against nerve growth factor (NGF) to the incubation medium does not block this stimulatory effect of FCS, a result suggesting that factors other than NGF present in FCS are responsible for the observed stimulation. An inhibitor of ODC synthesis, diaminopropane (DAP), and an irreversible inhibitor of ODC activity, alpha-DL-difluoromethylornithine (alpha-DFMO), each suppressed the FCS-stimulated ODC activity when added to the culture medium. Since FCS addition also promotes neuritic outgrowth from PC goldfish retinal explants, we explored the possible relationship of the stimulated ODC activity and the ability of explants to extend neurites. Concentrations of DAP or alpha-DFMO that block ODC activity also suppress neuritic outgrowth. Possible non-specific actions of the drugs unrelated to the block of ODC are examined. While the increases in OCD activity seen in PC and N goldfish retinas explanted into FCS-containing medium may be a requisite, they cannot be sufficient to support neuritic outgrowth. Intrinsic changes in the retinal explant secondary to crush of its optic nerve as well as factor(s) present in FCS that may be unrelated to the stimulation of ODC activity also appear necessary for neuritic outgrowth.