Investigation of a Congenital Abnormal Plasminogen, Frankfurt I, and Its Relationship to Thrombosis

A new abnormal plasminogen, Frankfurt I, has been identified in the plasma of a 42 year-old male patient who has recurrent deep vein thrombosis. Clinical laboratory data showed normal hemostasis test results. Since plasma plasmin generation rates gave low values, the fibrinolytic system was analyzed for a possible fibrinolytic system defect. Functional and antigen plasminogen concentrations both in the plasma and with the isolated, purified plasminogen showed that only 49% of the antigen concentration had potential functional active sites. Also, a reduced antigen concentration was found in both the propositus, and his mother (46% active sites).

Sodium dodecyl sulfate polyacrylamide gel electrophoresis of the purified Frankfurt I plasminogen showed a normal native Glu-plasminogen band. Crossed-immunoelectrophoresis revealed a peak with normal size and shape, but displaced with respect to normal Glu-plasminogen toward the anode, i. e., was, as a whole, more negatively charged. Isoelectric focusing followed by zymog-raphy on a agarose-fibrin plate proved this observation, but did not indicate a separation of the normal from the abnormal plasminogen molecular species, also, fewer bands were found in the abnormal plasminogen isozyme pattern.

Kinetic studies of Frankfurt I Glu-plasminogen and plasmin led to the conclusion that most of the functional abnormality is related to absence of active sites in half of the molecules. The plasmin generated was very unstable in the absence of stabilizing ligands and/or substrates. After reduction, the plasmin was completely converted to the typical two plasmin chains, A and B.

The Frequency of Type I Heterozygous Protein S and Protein C Deficiency in 141 Unrelated Young Patients with Venous Thrombosis

The frequency of heterozygous protein C and protein S deficiency, detected by measuring total plasma antigen, in a group (n = 141) of young unrelated patients (<45 years old) with venous thrombotic disease was studied and compared to that of antithrombin III, fibrinogen, and plasminogen deficiencies. Among 91 patients not receiving oral anticoagulants, six had low protein S antigen levels and one had a low protein C antigen level. Among 50 patients receiving oral anticoagulant therapy, abnormally low ratios of protein S or C to other vitamin K-dependent factors were presented by one patient for protein S and five for protein C. Thus, heterozygous Type I protein S deficiency appeared in seven of 141 patients (5%) and heterozygous Type I protein C deficiency in six of 141 patients (4%). Eleven of thirteen deficient patients had recurrent venous thrombosis. In this group of 141 patients, 1% had an identifiable fibrinogen abnormality, 2% a plasminogen abnormality, and 3% an antithrombin III deficiency. Thus, among the known plasma protein deficiencies associated with venous thrombosis, protein S and protein C. deficiencies (9%) emerge as the leading identifiable associated abnormalities.

[First clinical experiences with a new cementless knee endoprosthesis for the dog]

OBJECTIVE

This paper reports on the clinical application and first experiences of a newly developed cementless knee endoprosthesis for dogs.

MATERIAL AND METHODS

The GenuSys knee-endoprosthesis was implanted in 23 knees of 22 dogs with severe gonarthritis and a history of pain. Their body weight ranged from 28 to 55 kg, their age between 5 and 12 years. This knee implant for dogs is a cementless "mobile bearing prosthesis". An additional fixation with one screw is necessary in the femoral component. Currently, there are four standard sizes of the prosthesis available.

RESULTS

At the end of the study, 16 of 22 controlled patients (72.7%) were fully weightbearing on the operated limb or only showed a discreet lameness. We observed no complications in 12 cases (54.5%). In 10 cases problems in the course of healing were detected and made or would have made reoperation necessary. The complications noted were subluxation (n = 6, 27.3%), wound infection (n = 3, 13.6%) and a serious decrease in the range of motion (n = 1, 4.5%). Four of these 10 patients (40%) were subsequently healed through surgery. The remaining six dogs (27.3%) were euthanized or underwent arthrodesis of the leg.

CONCLUSION AND CLINICAL RELEVANCE

Sixteen of 22 dogs (72.2%) showed much better weightbearing and an increased quality of life after endoprosthesis of the knee. Although the complication rate was high, we expect better results in the future due to improvements in the equipment and surgical procedure. A definitive conclusion can only be made based on the results of a long-term study.

Oral Masses in Two Cats

Incisional biopsies from the oral cavity of 2 adult cats were submitted for histological investigation. Cat No. 1 showed a solitary well-circumscribed neoplasm in the left mandible. Cat No. 2 demonstrated a diffusely infiltrating neoplasm in the left maxilla. Both tumors consisted of medium-size epithelial cells embedded in a fibrovascular stroma. The mitotic index was 0 to 1 mitosis per high-power field. The epithelial cells showed an irregular arrangement forming nests or streams in cat No. 1, whereas a palisading growth was noted in cat No. 2. Both tumors, especially that of cat No. 1, showed multifocal accumulations of amyloid as confirmed by Congo red staining and a distinct green birefringence under polarized light, which lacked cytokeratin immunoreactivity as well as and AL and AA amyloid immunoreactivity. In addition, the amyloid in cat No. 2 was positive for the odontogenic ameloblast-associated protein, formerly termed APin. In sum, both cats suffered from an amyloid-producing odontogenic tumor, but their tumors varied with respect to morphology and type of amyloid produced.

[Richard von Volkmann and the Surgical School of Halle in 1867 to 1889]

Richard von Volkmann (1830-1889) was appointed senior consultant of the University Surgical Hospital in Halle at the young age of 36. On returning home from the war of 1870/1871, he saw traumatic fever rampant in his hospital. He became a rigorous advocate of Lister's method of antisepsis. There were a large number of very serious accidents in the up-coming industrial town of Halle. Acute and chronic inflammation of the joint led to severe disfigurements. By invention of large reconstructive operations von Volkmann was able to obtain impressive results. He was the founder of traumatology and orthopaedic surgery. Tuberculosis was regarded at that time as the most common cause of death. By means of surgery certain forms of the illness could be cured. Tuberculous coxitis and gonarthritis were the most common indications for orthopaedic surgery. Von Volkmann used his distraction method for tuberculous spondylitis.Many terms used in medical practice derive from Richard von Volkmann. He described Volkmann's triangle, ischaemic muscle contractures and resorption fever. He developed a whole range of new methods of surgical procedures and the concept of wound drainage. His name is associated with Volkmann's splint, Volkmann's "sharp spoon" and several other inventions. Richard von Volkmann was one of the founders of the Deutsche Gesellschaft für Chirurgie (German Surgical Society). His famous Träumereien an französischen Kaminen ("Reveries at French Firesides"), an anthology of fairy-tales for his children, played an important role in his life's work.

Sonography of the musculoskeletal system in dogs and cats

Sonography of the musculoskeletal system in dogs and cats was undertaken to evaluate the application of this imaging procedure in orthopedics. In most of the patients a 7.5 MHz linear transducer was used because of its flat application surface and its resolving power. The evaluation of bone by sonography is limited, but sonography can provide addition information regarding the bone surface and surrounding soft tissue. Ultrasound is valuable for assessing joint disease. Joint effusion, thickening of the joint capsule and cartilage defects can be identified sonographically. It is also possible to detect bone destruction. Instabilities are often identified with the help of a dynamic examination. Soft tissue abnormalities of the musculoskeletal system lend themselves to sonographic evaluation. Partial or complete muscles or tendon tears are able to be differentiated and the healing process can be monitored. Most of the diseases that are in the area of the biceps or the achilles tendon, such as dislocation of the tendon, old injuries with scarification, free dissecates in the tendonsheath, tendinitis and/or tendosynovitis can be differentiated by sonography. In addition, with clinical and laboratory findings, it is often possible to make a correct diagnosis with ultrasound in patients with abscesses, foreign bodies, hematomas, soft tissue tumors and lipomas.

The frequency of type I heterozygous protein S and protein C deficiency in 141 unrelated young patients with venous thrombosis

The frequency of heterozygous protein C and protein S deficiency, detected by measuring total plasma antigen, in a group (n = 141) of young unrelated patients (less than 45 years old) with venous thrombotic disease was studied and compared to that of antithrombin III, fibrinogen, and plasminogen deficiencies. Among 91 patients not receiving oral anticoagulants, six had low protein S antigen levels and one had a low protein C antigen level. Among 50 patients receiving oral anticoagulant therapy, abnormally low ratios of protein S or C to other vitamin K-dependent factors were presented by one patient for protein S and five for protein C. Thus, heterozygous Type I protein S deficiency appeared in seven of 141 patients (5%) and heterozygous Type I protein C deficiency in six of 141 patients (4%). Eleven of thirteen deficient patients had recurrent venous thrombosis. In this group of 141 patients, 1% had an identifiable fibrinogen abnormality, 2% a plasminogen abnormality, and 3% an antithrombin III deficiency. Thus, among the known plasma protein deficiencies associated with venous thrombosis, protein S and protein C deficiencies (9%) emerge as the leading identifiable associated abnormalities.

Tissue fibrinolytic activity in different types of varicose veins

The fibrinolytic activity of the venous wall was investigated by using Todd's technique in 92 patients with different types of varicosis. A control group consisted of 19 patients with apparently normal superficial veins who had had a saphenectomy prior to an aortocoronary bypass operation. Fibrinolytic activity was mainly localized in the adventitia of varicose and normal veins. It significantly decreased in the distal regions of all types of varicosis. The highest fibrinolytic activity was detected in the proximal part of the varicose vena saphena magna and the lowest values were observed in the perforating and side branch veins of the calf. Fibrinolytic activity is higher (p less than 0.077) in the normal vena saphena magna than in the varicose vena saphena of the calf. Older patients show a loss of fibrinolytic activity in their vena saphena magna. Obese patients have less fibrinolytic activity in varicose calf veins than patients with normal weight do.

Investigation of a congenital abnormal plasminogen, Frankfurt I, and its relationship to thrombosis

A new abnormal plasminogen, Frankfurt I, has been identified in the plasma of a 42 year-old male patient who has recurrent deep vein thrombosis. Clinical laboratory data showed normal hemostasis test results. Since plasma plasmin generation rates gave low values, the fibrinolytic system was analyzed for a possible fibrinolytic system defect. Functional and antigen plasminogen concentrations both in the plasma and with the isolated, purified plasminogen showed that only 49% of the antigen concentration had potential functional active sites. Also, a reduced antigen concentration was found in both the propositus, and his mother (46% active sites). Sodium dodecyl sulfate polyacrylamide gel electrophoresis of the purified Frankfurt I plasminogen showed a normal native Glu-plasminogen band. Crossed-immunoelectrophoresis revealed a peak with normal size and shape, but displaced with respect to normal Glu-plasminogen toward the anode, i.e., was, as a whole, more negatively charged. Isoelectric focusing followed by zymography on a agarose-fibrin plate proved this observation, but did not indicate a separation of the normal from the abnormal plasminogen molecular species, also, fewer bands were found in the abnormal plasminogen isozyme pattern. Kinetic studies of Frankfurt I Glu-plasminogen and plasmin led to the conclusion that most of the functional abnormality is related to absence of active sites in half of the molecules. The plasmin generated was very unstable in the absence of stabilizing ligands and/or substrates. After reduction, the plasmin was completely converted to the typical two plasmin chains, A and B.

Immune thrombocytopenia in severe hemophilia A treated with high-dose intravenous immunoglobulin

Five patients with severe hemophilia A receiving long-term treatment with commercial factor VIII concentrates developed severe immune thrombocytopenia (ITP, platelet counts less than 20 X 10(9)/l). Concomitantly, they presented with a marked elevation of serum IgG concentrations (mean, 2364 mg/dl;range, 1712-2954 mg/dl). In four patients, the T helper to suppressor cell ratio was below 1. Treatment with high-dose intravenous immunoglobulin (IgG, 7s) at doses of 0.2g (n = 2) or 0.4g (n = 3) per kg of body weight on 5 consecutive days was effective immediately. The bleeding tendency ceased and platelet counts rose transiently. In three cases, treatment was repeatedly effective and patients underwent uneventful splenectomies. Thus, high-dose IgG therapy may serve as a life-saving agent in patients with severe hemophilia complicated by ITP.

Chronic thrombocytopenia in an immunodeficient patient with hemophilia A

Coincident hemophilia and idiopathic thrombocytopenia has been rarely observed. We report here on a young man with severe hemophilia A who was treated with concentrates of lyophilized antihemophilic factor for several years before he developed thrombocytopenia. An isolated thrombocytopenia coincident with reduced platelet survival, ample megakaryocytes in the bone marrow, elevated platelet-associated IgG, as well as remission after treatment with prednisone and splenectomy, suggest the idiopathic form of thrombocytopenia. In addition, defects in cellular immunity became obvious. A causal relationship between the application of blood-derived products and the development of the platelet disorder as well as the impairment of the T-cell system remain to be demonstrated.

Terpenes and Terpenoids. IV. Some Esters and Amides of Thujic Acid

Representatively substituted esters (3c–h) and amides (4a–l) of thujic acid (3a) were prepared using the acid chloride as intermediate and were screened for their insect repellent and attractant potential. N,N-Diethyl thujamide (4d) was found to be a highly active repellent of the yellow fever mosquito (Aedes aegypti) as well as of other insect species.

Diethylamide of thujic acid: a potent repellent of Aedes aegypti

A series of novel, representatively substituted amides of thujic acid were prepared and screened for insect repellent and attractant potential. In repel-lency tests the N,N-diethylamide was the most potent compound, surpassing the activity of the standard repellents dimethyl phthalate and fencholic acid. In contrast, the N-monoethylamide displayed attractant activity.

On the Isolation of (+)3-Thujone

Conditions necessary for the formation of the (+)3-thujone bisulfite adduct 1a and its utilization for the isolation of pure (+)-thujone have been established.