Heparin-induced thrombocytopenia--association with a platelet aggregating factor and cross-sensitivity to bovine and porcine heparin

Heparin-induced thrombocytopenia is an infrequently suspected adverse drug reaction since its sequelae often mimic the underlying condition for which the drug is being used. A concomitant decline in platelet count and increase in heparin requirements should alert the clinician to the possible presence of this disorder. A 36-year-old black male developed severe thrombocytopenia with thrombosis while being treated with porcine intestinal mucosal heparin. Platelet counts returned to near-normal levels upon discontinuation of heparin, but quickly dropped again upon resuming treatment with bovine lung heparin. The patient subsequently was treated with warfarin and dipyridamole, with no further complications. Treatment of delayed-onset severe heparin-induced thrombocytopenia consists of stopping the heparin and substituting antiplatelet agents and oral anticoagulants when continued inhibition of coagulation is required.

Simultaneous determination of neopynamine and piperonyl butoxide by capillary column gas-liquid chromatography

A method is developed for the simultaneous determination of neopynamine and piperonyl butoxide by chromatography on a quartz capillary column using flame ionization detection. Benzyl mandelate is used as an internal standard. Calibration graphs are linear down to at least 3.75 mg% and 3 mg% for neopynamine and piperonyl butoxide, respectively.

[Surgically curable hypertension (author's transl)]

A case of hypertension was cured by simultaneous surgical treatment of an obstructive urolithiasis associated with a pheochromocytoma. Primary devascularization of the adrenal tumor, reducing blood pressure and cardiac rhythm variations was allowed by preoperative arteriography.

[Current aspects of the treatment of deep venous thromboses by heparin (author's transl)]

The use of heparin by continuous infusion from a electric pump gives very good immediate results in the treatment of venous thromboses. In 58 patients, there was a constant improvement in clinical signs and recurrence of the venous thrombosis was exceptional (2%), pulmonary embolism rare (3.5%) and well tolerated. Constant flow and the surveillance of treatment led to the method ensuring stable blood heparin levels. Mid-term results (8 months) in 43 patients appeared to be less favourable, the prevalence of venous sequelae reaching 50% for iliac phlebitis, 28% for sural phlebitis. The respective advantages and disadvantages of heparin and fibrinolytic agents are discussed.

[Shock in abruptio placentae (author's transl)]

In sixty abruptions of the placenta observed during eighteen months, a severe condition of shock was observed in thirty per cent of patients. This shock state is seen during the abruption or after delivery. It's essentially a question of hemorrhagic shock, the importance of hemorrhagy being often underestimated, if the drop of blood pressure and blood losses are only estimated. The measurement of central venous pressure and the research of metabolic acidosis are better indexes of shock. This shock is associated with hypofibrinogenaemia and with other symptoms of disseminated intra-vascular coagulation. Fibrinolysis is rarely observed (3 times). Presence of fibrin degradation products is frequent. Renal complications are observed only in 1/6 of cases, but are frequently severe (one case of renal cortical necrosis). Heparinotherapy does not confirm the hope be suscited and seems to be a frequent source of ehmorrhagic complications in African women. Perfusion of fibrinogen, if useful, can be another source of complications. Rapid transfusion is the more effective treatment of abruption placenta and probably the less dangerous with strict control of the central venous pressure.

[Shock during necrotic amoebic colitis (author's transl)]

Two varieties of conditions of shock may be isolated during necrotic amoebic colitis (13 cases). Eight patients present a simple hypovolemic shock secondary to wastage by diarrhea and perilesional oedema with globular, protein, alcaline and potassic deficiency. Its prognosis is relatively good, after vascular infilling and corrections of metabolic disorders. Five other patients present real toxi-infectious shock resulting from widespread tissue necrosis with auto-intoxication associated with septicemic complications. Its prognosis is frankly bad. The treatment is far more difficult. The use of cardiovascular analeptics, such as dopamine, after an infilling failure, is not always sufficient to re-establish the situation. The exeresis of necrotic tissues is an indispensable condition to remove the cause of the shock before septicaemic generalisation.

[Is sexual differentiation in cephalopods embryos (Sepia officinalis L) under endocrine control (author's transl)]

The sex differenciation in the gonad of the cuttlefish is only evident after the hatching, -- the "A" cells become spermatogonia or ovogonia. In the embryonic gonads, bigger cells called "B" seem participate in this differenciation (ultrastructural active aspects in concordance with sexual differentiation).

[Bacteroides fragilis bacteremias: clinical and evolutive features about 33 cases (author's transl)]

The frequency of non soil dwelling anaerobic infections is increasing. The authors report 33 cases of Bacteroides fragilis bacteremias, and study the responsabilities of different factors of prognosis (especially age and underlying conditions). Nitroimidazoles are very active against all Bacteroides fragilis. This therapy is the drug of choice for such infections.

[Transverse laparotomy by supre-pubic detachment of the recti muscles in gynecologic surgery. Apropos of 266 cases]

The authors have studied 266 case histories where supra-pubic detachment of rectus muscles was used according to Cherny's method. This allowed aseptic gynaecological surgery to be carried out in all its forms by a true transverse incision. The advantages are great : it is aesthetic and the incision can be enlarged if necessary indefinitely. This means that surgery can be carried out easily and explains the great rarity of intra-abdominal complications. On the other hand two relatively rare complications do occur with this incision : peritoneal haematomata and lateral herniations. Details have been given of the methods necessary to avoid these complications.

[Clinical, ultrastructural and biochemical study of a case of GM1 type 2 gangliosidosis]

Clinical, histological, ultrastructural and biochemical studies have been performed in a living 20-month-old infant with GM1-gangliosidosis type 2. Rectum, brain and liver biopsies were done. The histological and ultrastructural examination revealed the presence of cytoplasmic membranous bodies in the nervous system and a vacuolisation of the visceral parenchymatous cells, particularly histiocytes. The diagnosis was established by the finding of a generalized beta-galactosidase deficiency and an accumulation of GM1-ganglioside in brain. In leukocytes, the activity of p-nitrophenyl-beta-galactosidase was below 5%, and that of GM1-ganglioside beta-galactosidase below 1% of values obtained in controls. In cerebral tissue, GM1 ganglioside constituted 80% of total gangliosides; its concentration was 15 times that in age-matched controls. No accumulation of GM1 could be evidence in liver. Enzymatic examination of leukocytes obtained from the consanguineous parents revealed heterozygote values.

[Use of a new long acting local anesthetic, etidocaine in anesthesia-resuscitation (Duranest)]

Our experiment covered 123 patients who were given this new preparation with long action for various types of local and regional anesthesia. In 9 cases of peridural administration for several days, the total doses were very high and tolerance excellent. Results were good for all local and regional anesthesia for which this product was used: - Good local and general tolerance - Short latency period - Duration constantly and regularly prolonged: an average of 3 hours for non-adrenalin forms and 5 hours for adrenalin forms.

Serological specificity of IgG and IgM antiglobulin antibodies in anti-Gm(a) antisera

Serological study of a chromatographed Ragg anti-Gm(a) serum has shown differences in specificity of the IgG serum agglutinators and the IgM rheumatoid factor monospecific for Gm(a). The specificity of the IgG serum agglutinators is determined by the enzymatic modification of the globulin molecules and is unrelated to the Gm type.

Both serum agglutinators and anti-Gm(a) antibodies were demonstrable in a (heterologous) baboon anti-Gm(a) serum; however, both types of antibodies in this animal were IgG.