Antithrombotic effects of synthetic peptides targeting various functional domains of thrombin

To determine in vivo functional roles for thrombin's structural domains, we have compared the relative antithrombotic and antihemostatic effects of (i) catalytic-site antithrombin peptide, D-Phe-Pro-Arg; (ii) exosite antithrombin peptide, the C-terminal tyrosine-sulfated dodecapeptide of hirudin; and (iii) bifunctional antithrombin peptide, a 20-mer peptide combining catalytic-site antithrombin peptide and exosite antithrombin peptide with a polyglycyl linker. All three peptides inhibited thrombin-mediated platelet aggregation and fibrin formation in vitro. In vivo thrombus formation was measured in real time as 111In-labeled platelet deposition and 125I-labeled fibrin accumulation on thrombogenic segments incorporated into chronic exteriorized arteriovenous access shunts in baboons. Under low flow conditions, the continuous infusion of peptides reduced thrombus formation onto collagen-coated tubing by half at doses (ID50) and corresponding concentrations (IC50) of 800 nmol per kg per min and 400 nmol/ml for catalytic-site antithrombin peptide, greater than 1250 nmol per kg per min and greater than 1500 mumol/ml for exosite antithrombin peptide, and 50 nmol per kg per min and 25 nmol/ml for bifunctional antithrombin peptide. Under arterial flow conditions, systemically administered bifunctional antithrombin peptide decreased thrombus formation in a dose-dependent manner for segments of collagen-coated tubing or prosthetic vascular graft ID50 and IC50 values of 120 nmol per kg per min and 15 nmol/ml; this dose also produced intermediate inhibition of hemostatic function [bleeding time, 21 +/- 3 min vs. 4.5 +/- 0.5 min (baseline values); P less than 0.001; activated partial thromboplastin time, 285 +/- 13 sec vs. 31 +/- 3 sec (baseline), P less than 0.001]. In contrast, thrombus formation onto segments of endarterectomized aorta was potently decreased by bifunctional antithrombin peptide with an ID50 value of 2.4 nmol per kg per min and an IC50 value of 0.75 nmol/ml, a systemic dose that failed to affect hemostasis. Thus, inhibiting both thrombin's catalytic and exosite domains increases antithrombotic potency by several orders of magnitude over the inhibition of either domain alone, particularly at sites of deep arterial injury.

Clinical correlates of cerebral ventricular enlargement in schizophrenia. Further evidence for frontal lobe disease

Numerous studies have shown evidence of cerebral ventricular enlargement in schizophrenia and its relationship to severity of clinical symptoms and psychosocial dysfunction. In this large prospective study, 88 noninstitutionalized DSM-III-R schizophrenic patients were administered a CT scan and rated for positive and negative symptomatology and premorbid adjustment. The CT scans from 14 healthy controls were used for comparison of cerebral ventricular measures. Patients had an enlarged ventricle to brain ratio of the anterior portion of the lateral ventricles, the frontal horns, compared with controls. Patients with larger frontal horns had more severe negative symptoms and poorer premorbid childhood adjustment. The area of the main body of the cerebral lateral ventricles, though not elevated in patients, was correlated with the total number of prior hospitalizations. These results support the hypothesis of a structural and functional "frontal" deficit in schizophrenia.

Induction of transient neurological dysfunction in baboons by platelet microemboli

BACKGROUND AND PURPOSE

To investigate experimental mechanisms of reversible cerebral dysfunction, we produced transient focal cerebral ischemia in five baboons by unilateral perfusion of internal carotid territories with platelet microemboli generated endogenously.

METHODS

Platelet microemboli were formed by incorporating segments of Dacron vascular graft for 1 hour as unilateral carotid arterio-arterial shunts. Platelet embolization was assessed by ultrasonography and isotopic imaging; cerebral function was evaluated by measurements of somatosensory evoked potentials and clinical motor performance.

RESULTS

Platelet microemboli, detected by transcranial Doppler ultrasonography, accumulated rapidly in the shunted carotid hemispheric territory. Indium-111-labeled platelets reached a maximum value of 3.2 +/- 0.8 x 10(9) platelets in the dependent hemisphere of five animals after 20 minutes of carotid blood flow through the grafts when measured in real time by continuous scintillation camera imaging. The retained 111In-platelet microemboli cleared from the cerebral vasculature within 1 hour after removing the grafts. Corresponding blood markers of in vivo thrombus formation, beta-thromboglobulin, platelet factor 4, and fibrinopeptide A, increased eightfold to 20-fold after incorporating graft segments and normalized within 1 hour after removing the grafts. Coincidently, focal neurological function was temporarily impaired, as shown by the ipsilateral loss of somatosensory evoked potentials 5 minutes after initiating platelet microembolization, with restoration 1 hour after removing the grafts in five baboons, and contralateral hemiparesis in two recovered baboons, with complete resolution by 24 hours.

CONCLUSIONS

Endogenously generated platelet microemboli accumulate transiently in the dependent cerebral circulation and produce corresponding focal neurological dysfunction that resolves within hours after microembolization.

Slow changes of tyrosine hydroxylase gene expression in dopaminergic brain neurons after neurotoxin lesioning: a model for neuron aging

Slow neuron regression develops during the adult phase of life in select brain systems of mammals. We describe a model in adult rats that resolves several phases in a slow atrophic process that differentially influences levels of mRNA and protein for tyrosine hydroxylase (TH). Responses of striatal dopaminergic markers to 6-hydroxydopamine (6-OHDA) lesions in rats indicated that the striatal terminals maintained TH protein, despite greater than 3-fold loss of TH mRNA in the substantia nigra pars compacta (SNC) cell bodies whose axons project to the striatum. The loss of TH mRNA/cell was progressive up to 9 months, whereas SNC cell body shrinkage stabilized by 3 months post-lesioning. Consideration of possible mechanisms in protein turnover motivated a search for PEST motifs in the TH of rats and other vertebrates that could be a point of regulation by altering the rate of TH protein turnover.

Antithrombotic effects of combining activated protein C and urokinase in nonhuman primates

BACKGROUND

We have determined in vivo the relative antithrombotic efficacy and hemostatic safety of combining low-dose activated protein C (APC) and urokinase (urinary plasminogen activator, u-PA), two natural proteins that regulate thrombogenesis.

METHODS AND RESULTS

To model acute thrombotic responses of native blood under conditions of arterial flow, thrombogenic segments of Dacron vascular graft (VG) were incorporated into chronic exteriorized femoral arteriovenous (AV) access shunts in baboons. Thrombus formation on VG was determined by measuring 1) the deposition of autologous 111In platelets using real-time scintillation camera imaging, 2) the accumulation of 125I fibrin, 3) segment patency by Doppler flow analysis, and 4) blood tests for thrombosis, including plasma concentrations of platelet factor 4, beta-thromboglobulin, fibrinopeptide A (FPA), and D-dimer. Treatments consisting of low-dose and intermediate-dose APC (0.07 or 0.25 mg/kg.hr), u-PA (25,000 or 50,000 IU/kg.hr), or the combination were administered for 1 hour by continuous intravenous infusion. In untreated controls, platelets and fibrin accumulated rapidly, reaching plateau values at 1 hour of 15.1 +/- 3.8 x 10(9) platelets and 7.8 +/- 2.2 mg fibrin. Although the low-dose APC or u-PA alone did not decrease either platelet or fibrin deposition significantly, this combination moderately reduced both platelet and fibrin accumulation (7.3 +/- 2.6 x 10(9) platelets, p less than 0.05; 3.9 +/- 0.6 mg fibrin, p less than 0.05). Furthermore, intermediate-dose APC or u-PA reduced thrombus formation by half when administered alone (p less than 0.001 for both platelet and fibrin deposition), and the combination markedly interrupted the accumulation of platelets (3.0 +/- 1.0 x 10(9) platelets, p less than 0.001) and fibrin (1.3 +/- 0.6 mg fibrin, p less than 0.001). During active treatments, all VG segments remained patent. Hemostatic plug forming capability, as measured by template bleeding times, remained normal during all experiments (p greater than 0.05). The T50 clearance time for APC activity was not affected by the concurrent administration of u-PA. u-PA alone increased the plasma levels of D-dimer, FPA, and, interestingly, APC, implying that during pharmacological activation of the fibrinolytic system, thrombin activity was released, and the protein C pathway was activated.

CONCLUSIONS

A combination of intermediate-dose APC and u-PA produce substantial and efficient antithrombotic effects without impairing hemostatic function.

Effects of angiotensin converting enzyme inhibition with cilazapril on intimal hyperplasia in injured arteries and vascular grafts in the baboon

To determine the importance of angiotensin converting enzyme (ACE) activity in the development of arterial proliferative lesions in a primate model, the response to vascular injury was studied in five baboons treated with oral cilazapril (20 mg/kg/day) and in five untreated control animals. Each animal underwent three procedures: 1) carotid artery endarterectomy, 2) balloon catheter deendothelialization of the superficial femoral artery, and 3) surgical placement of bilateral aorto-iliac expanded polytetrafluoroethylene (Gore-Tex) vascular grafts. Cilazapril therapy was initiated 1 week preoperatively and continued throughout the study interval. At 1 and 3 weeks postoperatively, plasma ACE activity was inhibited by more than 96% versus control values. After animals were killed at 3 months, injured vessel and graft segments were evaluated morphometrically. Although the response between animals was variable, average cross-sectional areas of neointima did not differ between the cilazapril-treated and control groups at sites of carotid endarterectomy (0.26 +/- 0.12 versus 0.34 +/- 0.17 mm2, respectively; p greater than 0.5), femoral artery ballooning (0.15 +/- 0.08 versus 0.11 +/- 0.01 mm2; p greater than 0.5), or at graft anastomoses (1.86 +/- 0.50 versus 1.72 +/- 0.50 mm2; p greater than 0.5). Thus, cilazapril did not reduce intimal thickening over 3 months in these primate arterial injury models. However, a possible beneficial effect of cilazapril, which might be apparent at earlier time points or with larger animal groups, cannot be excluded.

Reduction in thrombus formation by placement of endovascular stents at endarterectomy sites in baboon carotid arteries

BACKGROUND

Although antithrombotic therapies with aspirin, dipyridamole, and heparin have decreased thrombo-occlusive events, they have not abolished these complications. Endovascular mechanical support, first reported by Dotter in 1969, has been proposed as a means to reduce both acute and chronic vessel closure by providing a supporting framework for the disrupted and sometimes dissected arterial wall.

METHODS AND RESULTS

To determine the effects of placing self-expanding stainless steel wire endoprostheses on the accumulation of thrombus at sites of carotid artery endarterectomy we measured platelet deposition continuously for 90 minutes and at 24 and 48 hours by gamma camera imaging of autologous 111In-labeled platelets in six stented and nonstented endarterectomized baboons that received heparin but no antiplatelet agents. At nonstented endarterectomy sites 5.36 +/- 1.25 x 10(8), 4.78 +/- 0.98 x 10(8), and 4.55 +/- 0.81 x 10(8) platelets per cm were deposited at 30, 60, and 90 minutes, respectively. In contrast, stented endarterectomy sites accumulated 0.99 +/- 0.31 x 10(8), 0.66 +/- 0.33 x 10(8), and 0.80 +/- 0.36 x 10(8) platelets per cm at 30 minutes (p = 0.02), 60 minutes (p = 0.004), and 90 minutes (p = 0.002), respectively. Platelet deposition remained reduced at 24 and 48 hours in stented endarterectomized carotid arteries (ECAs) when assessed as a ratio between net radioactivity in the endarterectomized region versus whole blood radioactivity (p = 0.006 and p = 0.009, respectively). Both stented and nonstented ECAs remained patent acutely, although two of six nonstented ECAs occluded by 30 days. By comparison 11 of 14 nonstented ECAs remained patent in another group of control animals. Scanning electron microscopy of control and stented arteries at 30 days demonstrated equivalently confluent endothelium.

CONCLUSIONS

We postulate that endovascular stents reduce the thrombogenic effects of flap formation, tearing, dissection, and vasospasm in ECAs.

Experimental arterial thrombosis in nonhuman primates

The baboon offers many advantages as an experimental animal to study vascular disease, thrombus formation and dissolution, effects of mediating variables, and the relative efficacy of therapeutic interventions. Each specific application for testing therapeutic agents may require testing in somewhat different model systems. For example, although the arteriovenous vascular graft model is efficient, cost effective, and well adapted to study of interventions for acute arterial thrombosis, surgical endarterectomy extends the evaluation to include interactions with the injured vascular wall. As the antithrombotic products of genetic engineering and molecular biology emerge, it will be increasingly important to have relevant, reproducible, and quantitative approaches to evaluate their effects in vivo.

Hirudin interruption of heparin-resistant arterial thrombus formation in baboons

To determine the role of thrombin in high blood flow, platelet-dependent thrombotic and hemostatic processes we measured the relative antithrombotic and antihemostatic effects in baboons of hirudin, a highly potent and specific antithrombin, and compared the effects of heparin, an antithrombin III-dependent inhibitor of thrombin. Thrombus formation was determined in vivo using three relevant models (homologous endarterectomized aorta, collagen-coated tubing, and Dacron vascular graft) by measuring: (1) platelet deposition, using gamma camera imaging of 111In-platelets; (2) fibrin deposition, as assessed by the incorporation of circulating 125I-fibrinogen; and (3) occlusion. The continuous intravenous infusion of 1, 5, and 20 nmol/kg per minute of recombinant hirudin (desulfatohirudin) maintained constant plasma levels of 0.16 +/- 0.03, 0.79 +/- 0.44, and 3.3 +/- 0.77 mumol/mL, respectively. Hirudin interrupted platelet and fibrin deposition in a dose-dependent manner that was profound at the highest dose for all three thrombogenic surfaces and significant at the lowest dose for thrombus formation on endarterectomized aorta. Thrombotic occlusion was prevented by all doses studied. In contrast, heparin did not inhibit either platelet or fibrin deposition when administered at a dose that maximally prolonged clotting times (100 U/kg) (P greater than .1), and only intermediate effects were produced at 10-fold that dose (1,000 U/kg). Moreover, heparin did not prevent occlusion of the test segments. Hirudin inhibited platelet hemostatic function in concert with its antithrombotic effects (bleeding times were prolonged by the intermediate and higher doses). By comparison, intravenous heparin failed to affect the bleeding time at the 100 U/kg dose (P greater than .5), and only minimally prolonged the bleeding time at the 1,000 U/kg dose (P less than .05). We conclude that platelet-dependent thrombotic and hemostatic processes are thrombin-mediated and that the biologic antithrombin hirudin produces a potent, dose-dependent inhibition of arterial thrombus formation that greatly exceeds the minimal antithrombotic effects produced by heparin.

Haloperidol treatment increases D2 dopamine receptor protein independently of RNA levels in mice

Haloperidol, administered to mice in their drinking water, produced a 21% increase in striatal D2 dopamine receptor density after seven days of continuous exposure. The steady-state D2 receptor RNA prevalence was unaffected by this treatment, yet the RNA coding for preproenkephalin was elevated, as expected. These data indicate that the homologous up-regulation of dopamine receptor density by antipsychotic drugs proceeds by mechanisms other than changes in RNA abundance.

Inhibition of thrombus formation by activated recombinant protein C in a primate model of arterial thrombosis

Activated protein C (APC) is an antithrombotic enzyme. The therapeutic potential of infused human recombinant APC (rAPC) was studied in a primate model of platelet-dependent thrombosis. Eight baboons with chronic femoral arteriovenous shunts received rAPC infusions for 1 hour. The shunts were extended with 5-cm long, 4-mm-i.d. thrombogenic Dacron graft segments for the time of infusion. The plasma level of the enzyme, the blood flow in the shunt, and the deposition of indium-111-labeled platelets and iodine-125 fibrinogen on the graft were measured. The influence of rAPC infused at doses of 0.25 and 1.0 mg/kg-hr was compared with the effects of control infusions of saline. Five of eight control grafts occluded within 60 minutes, whereas there was no change in the blood flow during rAPC infusion. Deposition of platelets was inhibited by 13 +/- 10% and by 42 +/- 13% (mean +/- SEM) after 30 minutes of infusion at the two doses, which gave rise to circulating rAPC plasma concentrations of 0.4 and 1.9 mg/l, respectively. Both doses significantly inhibited fibrin deposition in the graft. Circulating plasma markers of thrombus formation and of fibrinolysis did not increase significantly during rAPC infusion; measurements of bleeding time were also within normal limits. Thus, rAPC, like human plasma-derived APC, inhibited thrombus formation without impairing primary hemostasis.

Aspirin-independent antithrombotic effects of acutely attached cultured endothelial cells on endarterectomized arteries

We have compared the acute antithrombotic effects of aspirin-treated versus normal endothelial cell (EC) coverage of endarterectomized baboon aortic segments (EAS) incorporated into chronic exteriorized arteriovenous shunts in baboons. Human ECs grown in culture were incubated in control medium or medium containing aspirin (100 mumols/ml) and then attached at saturation density by incubating EC suspensions (6 x 10(5) cells/100 microliters) within EAS for 20 minutes. Nonendarterectomized aortic segments and untreated EAS served as negative and positive controls, respectively. The inhibitory effect of aspirin treatment on EC production of prostacyclin was confirmed by radioimmunoassay of its stable metabolic breakdown product, 6-keto-prostaglandin F1 alpha in supernatant medium. Thrombus formation in vivo was measured as the accumulation of indium 111-labeled platelets on endarterectomy sites in real time by scintillation camera imaging. 111In-labeled platelets were deposited rapidly, reaching a plateau by 60 minutes of 4.40 +/- 0.89 x 10(9) platelets/cm, compared with 111In-labled platelet deposition on nonendarterectomized segments of 0.89 +/- 0.26 x 10(9) platelets/cm (p = 0.008). Coverage of EAS with normal cultured ECs significantly reduced platelet deposition on EAS (1.05 +/- 0.45 x 10(9) platelets/cm; p = 0.009 at 1 hour compared with EAS not incubated with ECs). Aspirin-treated ECs also produced a marked reduction in platelet disposition (0.71 +/- 0.24 x 10 platelets/cm; p = 0.007 compared with EAS without ECs) that was equivalent to the effect of non-aspirin-treated ECs (p greater than 0.5). Scanning and transmission electron microscopy confirmed the antithrombotic effects of attached ECs. We conclude that endarterectomy of normal arteries produces a highly thrombogenic surface and the thrombogenicity is abolished by acutely attaching cultured human ECs.

Heparin-resistant thrombus formation by endovascular stents in baboons. Interruption by a synthetic antithrombin

Intravascular mechanical support has been proposed as a solution to the frequent occurrence of vascular narrowing and occlusion after transluminal balloon angioplasty or surgical endarterectomy. Although several endovascular stents are currently in clinical use for angioplasty of larger vessels, acute thrombosis is a troublesome complication of their use with coronary angioplasty. To study thrombus formation associated with metallic mesh endoprostheses, we have evaluated stents placed inside 3-mm expanded polytetrafluoroethylene (ePTFE) grafts incorporated into chronic exteriorized arteriovenous silicone rubber shunts in baboons. We have also compared the antithrombotic capacities of heparin and the synthetic antithrombin D-phenylalanyl-L-prolyl-L-arginyl-chloromethylkene (D-FPRCH2Cl) to interrupt this platelet-dependent process for two different endovascular stents. Acute platelet deposition was continuously measured during 1 hour using gamma camera imaging of platelets labeled with indium-111 oxine. On untreated control ePTFE grafts (n = 11), 0.87 +/- 0.15 x 10(9) platelets/cm were deposited during 60 minutes. In contrast, balloon-expandable endovascular stents within ePTFE (n = 6) accumulated 4.37 +/- 0.68 x 10(9) platelets/cm (p = 0.003 compared with controls), and self-expandable stents (n = 6) accumulated 3.91 +/- 0.42 x 10(9) platelets/cm (p = 0.006 compared with controls); no difference between stents was detected in this test system (p greater than 0.5). Systemic heparin treatment did not reduce platelet deposition (4.20 +/- 0.41 x 10(9) platelets/cm at 60 minutes; p greater than 0.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of thrombus formation in vivo by novel antiplatelet agent

The antithrombotic and antihemostatic effects of the novel antiplatelet compound, alpha, alpha'-bis[3-(N,N-diethylcarbamoyl)piperidino]-p-xylene dihydrobromide (GT-12), were investigated in a baboon model of platelet-dependent thrombosis under high flow conditions. In this model, segments of collagen-coated tubing and Dacron vascular graft were placed as thrombus-inducing extension devices in exteriorized femoral arteriovenous shunts. The deposition of 111In-labeled platelets was measured for each thrombogenic segment throughout 1 hour by using gamma camera imaging. In addition, the 125I-fibrin retained in the forming thrombus was measured. Intravenous infusion of GT-12 (100 mumol/kg, 63.3 mg/kg) over a 15-minute period before the insertion of the test segments prolonged the bleeding time from a baseline value of 4.4 +/- 0.4 min to 7.6 +/- 1.0 min (p = 0.036) and inhibited platelet aggregation ex vivo induced by adenosine diphosphate (ED50 4.7 +/- 0.9 to 10.3 +/- 2.2 microM; p less than 0.02) and collagen (ED50 2.0 +/- 0.4 to 8.0 +/- 2.4 micrograms/ml; p less than 0.05). Deposition of platelets and fibrin was decreased in concert by 30% (p less than 0.05) for vascular grafts and possibly collagen segments at the end of the 60-minute observation period. We conclude that GT-12 is antithrombotic for Dacron graft-induced thrombus formation in vivo.

Effect of body posture on cardiopulmonary function in horses during five hours of constant-dose halothane anesthesia

Cardiovascular and respiratory functions were serially characterized in 7 healthy, spontaneously breathing, adult horses (from which food had been withheld) during 5 hours of constant 1.06% alveolar halothane (end-expired halothane concentration of 1.06%; equivalent to 1.2 times the minimal alveolar anesthetic concentration for horses). To enable comparison of temporal results in relation to 2 body postures, horses were studied in lateral recumbency (LR) and dorsal recumbency (DR) on separate occasions. Temporal changes in results of measures of circulation previously reported from this laboratory for horses in LR were confirmed (ie, a time-related increase in systemic arterial blood pressure, cardiac output, stroke volume, and PCV). During DR, systemic arterial blood pressure was initially significantly (P less than 0.05) greater and pulmonary artery pressure less than results at comparable periods during LR. Differences ceased to exist with duration of anesthesia. Except for a greater heart rate at hour 5 of DR, no other significant differences in circulation were found between LR and DR. In general, except for PaO2, measures of ventilation did not change with time in either LR or DR. The PaO2 was significantly greater during LR, compared with DR, but the average did not change significantly with time in either body posture.

Prevention of heparin-resistant thrombotic occlusion of hollow-fiber hemodialyzers by synthetic antithrombin

Because heparin anticoagulation during hemodialysis with hollow-fiber devices is associated with progressive loss of volume of fiber bundles subsequent to thrombotic occlusion, we examined the antithrombotic and antihemostatic effects of the irreversible synthetic thrombin inhibitor D-phenylalanyl-L-prolyl-L-arginyl-chloromethylketone (FPRCH2Cl) during repeated exposure of cupramonium cellulose hollow-fiber hemodialyzers in an extracorporeal blood circuit in baboons. By contrast with full anticoagulating doses of heparin, FPRCH2Cl (100 nmol/kg/min) decreased both the loss of fiber bundle volume (19.1% +/- 7.0% vs 6.4% +/- 3.6% p less than 0.01) and deposition of 111In-labeled platelets within the dialyzer (15.7 +/- 5.9 x 10(9) vs 3.2 +/- 1.2 x 10(9) platelets; p less than 0.01). Additionally, blood markers of thrombus formation in vivo (i.e., plasma beta-thromboglobulin, platelet factor 4, and fibrinopeptide A) remained at low levels throughout infusion of FPRCH2Cl, whereas levels were elevated during heparin therapy (p less than 0.01 in each case). FPRCH2Cl, but not heparin, prolonged bleeding times (p less than 0.001) without affecting the capacity of platelets to aggregate in response to the presence of either collagen or adenosine diphosphate ex vivo. Complement activation by the dialyzer was not affected by FPRCH2Cl. We conclude that the progressive loss of dialyzer hollow fibers is a platelet-dependent, thrombin-mediated process that, although resistant to heparin, is interrupted by the synthetic antithrombin FPRCH2Cl.

Treatment of respiratory distress in a prematurely born foal

A foal born 3 weeks prematurely was treated for respiratory distress, using a combination of oxygen therapy and mechanical ventilatory assistance. Clinical response and arterial blood gas tensions were monitored regularly. Continuous positive-airway pressure and intermittent positive-pressure ventilation administered via a nasotracheal tube were effective in improving arterial oxygenation and ventilatory function.

Acute intracranial hemorrhage: intensity changes on sequential MR scans at 0.5 T

Thirty-seven patients underwent MR imaging at 0.5 T within 7 days of a CT-documented intracranial hemorrhage. A total of 57 hematomas were evaluated. Twelve patients underwent serial scanning and 12 patients had multiple hemorrhages into different intracranial compartments. The appearances of the hematomas on spin-echo (SE) images with a short repetition time (TR) of 500 msec and short echo time (TE) of 32 msec (SE 500/32), long TR/intermediate TE (SE 2000/60), and long TR/long TE (SE 2000/120) were carefully evaluated with specific attention to the precise time after ictus. Hematomas showed heterogeneous, complex, rapidly changing intensities. There was a significant amount of variation among patients, especially between the third and seventh days. Hematomas studied between 12 and 24 hr after hemorrhage were mildly hyperintense on short TR scans and markedly hyperintense on long TR (intermediate and long TE) scans (stage I). These findings in acute hemorrhage have received little prior attention. Over the next 1-2 days, hematomas became iso- to mildly hypointense on short TR scans and markedly hypointense on long TR scans (stage II). Hypointensity on long TR scans has previously been described at high field strengths; our communication demonstrates that this phenomenon is seen routinely at intermediate field strengths as well. Hematomas became markedly hyperintense on short TR scans beginning on approximately the fourth day postictus and redeveloped hyperintensity on long TR scans approximately 5-6 days after ictus (stage III). By the end of the first week they were hyperintense on all pulse sequences (stage IV). MR findings on the first day after intracranial hemorrhage (in particular, subtle hyperintensity on short TR scans) probably allow for a specific diagnosis, while the variable, hetergeneous, and rapidly changing intensities noted between days 2 and 7 are often less specific.

Head trauma: comparison of MR and CT--experience in 100 patients

The results of CT and MR imaging were reviewed retrospectively and compared in 100 patients who experienced clinically significant head trauma. The findings were analyzed on the basis of several parameters in an attempt to establish objective clinical guidelines for the use of each diagnostic technique. CT remains the screening method of choice in evaluating acute severe head trauma; however, MR revealed additional clinically relevant findings in all four cases in which the patient's clinical symptoms were disproportionate to the CT findings. MR was equal or superior to CT in the evaluation of all patients with acute minor head trauma and in 94 of 95 patients examined in the subacute, chronic, or remote phase of injury, irrespective of the severity or pathologic nature of their injuries. All subacute contusions (21 lesions) and white-matter shearing lesions (18 cases) were demonstrated to particular advantage on MR compared with CT, as were all subdural hematomas (of 52 small subdural collections, 58% were detected only by MR). Although surgical management was not altered by the additional information provided by MR, the implications regarding the medical management and disposition of the patients with head trauma were significant.

Time-related responses of spontaneously breathing, laterally recumbent horses to prolonged anesthesia with halothane

Cardiovascular and respiratory functions were serially evaluated in ten healthy, fasting, spontaneously breathing, laterally recumbent adult horses during five hours of constant 1.06% alveolar halothane (equivalent to 1.2 times the minimum alveolar concentration for horses). Mean carotid arterial pressure was about 25% higher after one hour of constant-dose halothane than after 30 minutes of constant-dose (P less than 0.05), and remained increased throughout the study. Mean carotid arterial pressure peaked after 90 minutes, and was about 30% higher than at 30 minutes. Total peripheral vascular resistance initially increased (20% at one hour), then gradually returned to the 0.5-hour value over the next four hours. Cardiac output progressively increased with time (P less than 0.05; 20% by two hours; nearly 40% by five hours) because of an increase in stroke volume. An increase (P less than 0.05) in mixed venous PO2 accompanied the increase in cardiac output. Heart rate did not change significantly (P greater than 0.05). Some measures of ventilation changed significantly with time (P less than 0.05). After four and five hours of constant alveolar halothane, the PaCO2, inspired gas flow, and ratio of inspired vs expired gas flow were significantly higher than the 0.5-hour values. Inspiratory time significantly decreased, beginning at three hours. All horses recovered from anesthesia and recumbency without complications.

Radiolabeling of equine platelets in plasma with 111In-(2-mercaptopyridine-N-oxide) and their in vivo survival

A method is presented for the in vitro isolation and radiolabeling of equine platelets with the isotope indium 111 (111In: half-life = 2.8 days, gamma = 173 keV, 89%; 247 keV, 94%). The technique described involves complexing 111In with the lipid-soluble chelating agent, 2-mercaptopyridine-N-oxide (merc), in an aqueous medium. 111In-merc platelet-labeling efficiencies in autologous plasma pretreated with or without ferric citrate reagent were 82 +/- 7% and 24 +/- 12%, respectively. Mean intravascular survivals of 111In-merc-radiolabeled platelets in 8 healthy horses according to simple linear, exponential, mean, weighted-mean residual sum of squares analysis, and multiple-hit model were 5.5 +/- 0.49, 3.5 +/- 0.53, 4.5 +/- 0.18, 4.3 +/- 0.65, and 3.6 +/- 0.97 days, respectively.

Loss control and its place in the insurance industry

The historical development of the insurance industry's role in efforts to prevent industrial accidents and occupational disease will be discussed. The various approaches that have evolved include fire insurance, casuality insurance, and compensation for occupational diseases. The basic approach used in insurance programs involved with occupational disease is to identify the toxic material to which employees are exposed, recommend engineering controls to reduce the exposure, and suggest a medical surveillance program. The insurance industry's efforts in industrial hygiene are also described.

Antithrombin III activity in horses with large colon torsion

A chromogenic peptide substrate assay was used to determine serially plasma antithrombin III (AT III) activity in 4 groups of horses. Group I consisted of healthy, mature horses in which AT III activity was determined twice daily for 7 consecutive days. Groups 2 and 3 contained healthy horses in which AT III activity was monitored for 7 days after controlled, but varying, conditions of general anesthesia and surgery (median celiotomy). Group 4 was made up of patients with a presurgical diagnosis of colonic torsion. In healthy awake horses (group I), there was no difference in AT III values over time. Postoperative AT III activity in the halothane-anesthetized horses (group 2) and in the sham-operated horses (group 3) was not significantly (P = 0.05) different from base-line values at any time. A significant decrease (P = 0.05) in AT III activity was observed on postoperative days 1 through 3 in the group of horses with large colon torsion, but returned to preoperative values by day 4 after surgery in the horses that survived. In those horses that did not survive, AT III activity remained below base-line values for the duration of observation. Seemingly, plasma AT III activity in horses was not significantly affected by halothane anesthesia or surgery. Serial evaluation of AT III activity may be useful for predicting survival in horses with large colon torsion.

Rapid extraction, radioiodination, and in vivo catabolism of 125I-labeled fibrinogen in the horse

Two methods were analyzed for the rapid extraction of equine fibrinogen from fresh plasma, using ammonium sulfate-sodium phosphate buffer. Fibrinogen from each of these 2 methods was then radiolabeled with 125I (half-life = 60.2 days, gamma = 35 keV), using monochloroiodine reagent. Mean protein-bound activity was 98.5% and mean clottable radioactivity was 94.1%. Radiolabeled fibrinogen administered IV to 15 horses had an overall mean (+/- SD) plasma half-life of 4.95 +/- 0.44 days.

Extraction, radioiodination, and in vivo catabolism of equine fibrinogen

Equine fibrinogen was isolated and aliquots were stored frozen at -70 C before radiolabeling with 125I (half-life = 60.2 days; gamma = 35 keV, using monochloroiodine reagent. Radioiodination efficiencies were 49% to 53%, resulting in a labeled product with 98% protein-bound activity and 91% clottable radioactivity. In 6 equine in vivo investigations, plasma half-lives of 125I-labeled fibrinogen were from 4.1 to 5.2 days, corresponding to a mean daily plasma elimination rate of approximately 15%.