Biomedical subjects
Publications and source records attributed to S H Goodnight.
When thrombotic thrombocytopenic purpura (TTP) occurs in pregnancy, survival of either the mother or fetus is exceedingly rare. A patient is reported who developed this disease in the 17th week of pregnancy and recovered after treatment with antiplatelet drugs (aspirin, dipyridamole) and corticosteroids. The rationale and potential hazards of antiplatelet therapy in TTP are discussed.
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The hypothesis that pituitary hormones are required for increased fibrinogen synthesis after inflammation or endotoxin was tested by measuring plasma fibrinogen concentrations after inflammation or endotoxin in normal and hypophysectomized rats. Animals were divide into groups receiving no exogenous adrenal steroids, low-dose adrenal steroids, or high-dose adrenal steroids. Hypophysectomy failed to prevent fibrinogen levels from rising after intramuscular turpentine (mean 240 mg/100 ml prior to and 556 mg/100 ml 24 h after turpentine). Steroids did not suppress this rise. Endotoxin, 5 mug/100 g, caused a marked rise in fibrinogen in normal rats at 24 h (mean 296 mg/100 ml before endotoxin and 554 mg/100 ml after endotoxin). This dose of endotoxin killed hypophysectomized rats within 12 h. Hoevr, if hypophysectomized rats were protected with high-dose adrenal steroids, then 5 mug of endotoxin per 100 g caused the same fibrinogen rise as in normal rats (mean 299 mg/100 ml before endotoxin and 587 mg/100 ml after endotoxin). Aparently, pituitary hormones are not necessay for increased fibrinogen synthesis after either inflammation or endotoxin in the rat.
Hemophilia B (Factor IX deficiency, Christmas disease) may cause excessive bleeding in women. The obstetric and hematologic management of the pregnancy and delivery of a woman with a Factor IX level of 4% is presented and discussed.
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In a study of 1,551 hemophiliacs over a 4-year period of time, factor VIII utilization was assessed. It is clear that factor VIII usage is a function of severity of disease and therapeutic program. The average amount of factor VIII used per patient was 39,880 U/year. Patients selected for home care, use significantly more than those patients not on home care. As much as 101,000 U/year are used by a small number of patients on prophylaxis. These data can be used in predicting source plasma requirements for annual national use as well as costs.
A high intake of saturated fatty acids and cholesterol is associated with a high incidence of occlusive arterial lesions involving both atherosclerosis and thrombosis. The evidence is based on epidemiological, experimental, and clinical studies. Such dietary habits increase serum low density lipoprotein cholesterol, a main risk factor for atherosclerosis. The mechanisms by which dietary saturated fatty acids are connected to arterial thrombogenesis are only partly known. Experimental and epidemiological studies also indicate an association between dietary saturated fatty acids and venous thrombosis; however, the chain of evidence lacks documentation from prospective clinical studies. When unsaturated fatty acids of the (n-9), (n-6), or (n-3) families replace saturated fatty acids in the diet, risk factors related to atherosclerosis may be reduced and the development of atherosclerosis, inhibited. This potential is related both to the reduction of saturated fatty acids and, in varying degrees, to the individual unsaturated fatty acids. The very long-chain fatty acids of the (n-3) family and probably also linoleic acid of the (n-6) family have the potential to inhibit thrombogenesis. In this respect, the effect of the individual fatty acids seems even more important. To obtain an optimal dietary lipid composition for the prevention of atherosclerosis and thrombosis, it is important to appreciate the metabolic and structural effects of the individual fatty acids. The interaction between the various dietary fatty acids and their effects on lipid biosynthesis is still only partly known. The present nutritional recommendations include a low intake of saturated fatty acids and cholesterol and a balanced content of the unsaturated fatty acids and represent a well-documented approach to the prevention of both processes.
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Antibodies to negatively charged phospholipids including cardiolipin have been recognized in the sera of patients with systemic lupus erythematosus and other disorders. We report 4 patients who experienced cerebral infarctions and dementia in association with anticardiolipin antibodies. These patients did not have the characteristic lupus anticoagulant or systemic lupus erythematosus. The occurrence of anticardiolipin antibodies in patients with multiple cerebral infarctions who do not have evidence of a systemic vasculitis or inflammatory condition suggests that this association may be more common than previously recognized. It may be useful to test for the presence of anticardiolipin antibodies in patients who have unexplained cerebral infarctions.