Clinical experience with a new antithrombotic (dermatan sulfate) in chronic hemodialysis patients.

Dose finding studies with a new antithrombotic (dermatan sulfate) for the prevention of clot formation in the extracorporeal circuit were performed in chronic hemodialysis patients in comparison with standard heparin treatment. Dermatan sulfate (DS), which inhibits the coagulation via the heparin cofactor II pathway, was given in single predialysis injections, immediately before commencement of the dialysis procedures, in dosages ranging from 2 mg/kg to 6 mg/kg body weight. In our pilot study, an open non comparative study in patients using plate type dialyzers, we observed moderate clot formation in the extracorporeal circuit.

[Immunotherapy using the anti-endotoxin antibody HA-1A in patients with sepsis syndrome; good results in relation to treatment with placebo].

Passive immunization with a human anti-endotoxin monoclonal IgM antibody (Centoxin, HA-1A) was recently studied in patients with suspected Gram-negative sepsis. Comparison of the results obtained in the Amsterdam subpopulation with those in a larger international study population of which the Amsterdam patient group was a part, showed that it had been possible to select a patient population in which HA-1A has an 'intention-to-treat' effect based upon clinical criteria (a decrease in mortality compared with placebo by 42% (p = 0.04) and in the larger study by 9% (p = 0.

The value of lung scintigraphy in the diagnosis of pulmonary embolism.

The role of lung scintigraphy in the diagnostic management of patients with clinically suspected pulmonary embolism is reviewed. Evidence is provided that a normal perfusion scan excludes clinically relevant pulmonary embolism, and that a high probability lung scan, defined as a segmental perfusion defect with locally normal ventilation, sufficiently confirms the presence of pulmonary embolism in the majority of these patients. Furthermore, this review assesses the possibility of non-invasive tests for the diagnosis or exclusion of venous thromboembolic disease as a means of avoiding pulmonary angiography in patients with lung scan outcomes that are neither normal nor high probability.

Assessment of the relative contribution of different protease inhibitors to the inhibition of plasmin in vivo.

It has been shown that the most important inhibitor of plasmin is alpha 2-antiplasmin, however, other protease inhibitors are able to inhibit this proteolytic enzyme as well. The contribution of the various protease inhibitors to the inhibition of plasmin in vivo has never been quantitatively assessed. To assess the relative contribution of the different protease inhibitors on the inhibition of plasmin we developed a series of sensitive immunoassays for the detection of complexes between plasmin and the protease inhibitors alpha 2-antiplasmin, alpha 2-macroglobulin, antithrombin III, alpha 1-antitrypsin and C1-inhibitor, utilizing monoclonal antibodies that are specifically directed against complexed protease inhibitors and a monoclonal antibody against plasmin.

Validity of bite-wings for diagnosis of secondary caries in teeth with occlusal amalgam restorations in vitro.

This investigation was carried out to establish the validity of bite-wing radiographs for the diagnosis of secondary caries in teeth with occlusal amalgam restorations. One hundred and fifty-nine extracted molars with occlusal amalgam fillings and characteristics that might be indicative of the presence of secondary caries were selected. The characteristics were a blueish-gray discolouration of enamel, a brownish discolouration of the amalgam-enamel margin, marginal breakdown of the restoration, and/or deep fissures at the margin of the restoration.

Impaired fibrinolysis in cyclosporine-treated renal transplant patients. Analysis of the defect and beneficial effect of fish-oil.

Cyclosporine treatment has been associated with thrombotic vascular complications. We investigated the activity of the fibrinolytic system and its capacity to respond upon DDAVP stimulation in a group of 20 cyclosporine-treated patients as compared with a group of 9 azathioprine-treated patients. Furthermore, the effect of the administration of fish-oil to these patients on the endogenous fibrinolytic activity was studied in a double-blind randomized, placebo-controlled cross-over study.

Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels.

Gram-negative sepsis is caused by endotoxin-induced release of tumor necrosis factor (TNF) and other cytokines. HA-1A is a human monoclonal antibody that binds specifically to endotoxin. HA-1A should prevent death in endotoxemic patients and reduce serum levels of TNF and interleukin-6 (IL-6).

Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis.

Background: In most countries, heparin is used in the initial treatment of patients with deep-vein thrombosis. Well-designed studies establishing the efficacy of heparin therapy are lacking, however. Treatment with acenocoumarol alone, according to the hypothesis that high dosages of oral anticoagulants obviate the need for heparin, is considered an effective alternative in some countries.

Deep-vein thrombosis and the incidence of subsequent symptomatic cancer.

Background: In contrast to the established relation between overt cancer and subsequent venous thromboembolism, it is unclear whether symptomatic deep-vein thrombosis is associated with a risk of subsequent overt malignant disease.

Methods: Two hundred sixty consecutive patients with symptomatic, venographically proved deep-vein thrombosis were enrolled in a study, of whom 250 were followed during a two-year period. Among those assessed during follow-up, the incidence of subsequently detected cancer in the 105 patients with secondary venous thrombosis (i.

Ventilation-perfusion lung scanning and the diagnosis of pulmonary embolism: improvement of observer agreement by the use of a lung segment reference chart.

Objective: To test the hypothesis that the systematic use of a lung segment reference chart can improve the inter- and intra-observer agreement for the interpretation of ventilation-perfusion lung scans.

Design: A randomized trial.

Study Population: Ventilation-perfusion lung scans were obtained in a series of 220 consecutive patients with clinically suspected pulmonary embolism.

Detection of deep vein thrombosis with impedance plethysmography and real-time compression ultrasonography in hospitalized patients.

Background: Serial testing with impedance plethysmography or compression ultrasonography has been demonstrated to be feasible and accurate for the detection of deep vein thrombosis (DVT) in symptomatic outpatients, and these techniques are replacing contrast venography in this patient category. Limited data, however, are available on the clinical utility of these noninvasive tests in symptomatic hospitalized patients. The objectives of our study were to determine the feasibility of ascending contrast venography and to evaluate the accuracy of these two noninvasive methods for the detection of DVT in symptomatic hospitalized patients.

Solubilization of dentin matrix collagen in situ.

The effects of the oral environment on dentin matrix collagen were studied. In the partial prostheses of 12 participants, two completely demineralized dentin specimens were mounted covered by a Dacron gauze. After an experimental period of seven weeks, the specimens were transferred to a trypsin-containing buffer for determination of the amount of denatured collagen.

Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis.

In the diagnostic management of patients with clinically suspected recurrent deep-vein thrombosis (DVT), there are potential limitations to all available diagnostic techniques. Since venous abnormalities may persist for some time after an acute thrombosis, the usefulness of compression ultrasonography (US) for the detection of recurrent DVT may be jeopardized. We determined the rate of normalization of an abnormal compression US test of the popliteal and the common femoral veins in patients after a first episode of proximal DVT.

Replication of Autographa californica baculovirus (AcMNPV) in a coleopteran cell line.

A coleopteran cell line (AGE) derived from the cotton boll weevil Anthonomus grandis supported replication of Autographa californica multiple nuclear polyhedrosis virus (AcMNPV). The titer of extracellular virus (ECV) and the number of occlusion bodies (OB) produced in AGE cells were approximately equal to those produced by a Trichoplusia ni cell line (TN-CL1), and the OB produced by both cell lines were equally infectious for T. ni larvae.

Preventive measures and caries progression: an in vitro study on fissures and smooth surfaces of human molars.

The aim of this study was to compare pit-and fissure sealants with fluoride treatments in their effectiveness to inhibit or reduce the progression of enamel lesions, particularly in the fissure region. The effects of fissure probing as used in diagnosis were compared with in the same protocol. Using a combination of image analysis of X-ray pictures of full crowns and a light microscopic evaluation of cross-sections provided information on the three dimensional spread of enamel demineralization.

[Caries-- changing patterns].

This article briefly describes the pathogenesis of dental caries. It focuses on the relevant chemical processes and histological changes in dental enamel. Recent studies have shown that the mineral balance at the tooth-oral fluid interface are determinants for the occurrence of caries, and more important than the intrinsic tissue properties.

Tumor necrosis factor induces von Willebrand factor release in healthy humans.

Tumor necrosis factor (TNF) is an important mediator of the host responses to systemic infection. To investigate the effect of TNF on the release of von Willebrand factor (vWF) into the circulation, we performed a controlled study in six healthy men, sequentially measuring the plasma concentrations of vWF antigen after a bolus intravenous injection of recombinant human TNF (50 micrograms/m2). TNF induced a marked increase in vWF antigen plasma levels, becoming significant after 45 min and peaking after 4 h (percentage increase from base line: 351 +/- 46; p less than 0.

[Dentin remineralization induced by glass ionomers].

Using an intra-oral model the effects of restorations on adjacently placed demineralized dentine were studied. After 12 weeks in situ, glass ionomer induced hypermineralization of dentine, in particular at the surface in contact with the filling. Next to amalgam restorations the dentine was found to be further demineralized.

Patient selection and appliance design in intra-oral models.

The conclusions derived from in situ studies are influenced by the choices made with respect to parameters of the intra-oral model systems. In an attempt to reach a consensus, this paper considers the variables (a) selection of panelists and (b) appliance design. On both topics, a short review of available systems is given.

Importance of model parameters in the assessment of intra-oral remineralization.

Since the introduction of the Intra-oral Cariogenicity Test by Koulourides et al. (1974), many groups around the world have been developing and using intra-oral models to test new caries-preventive products, as well as to study physiological processes in the oral cavity. In spite of the large numbers of papers reporting these methods, very little research has been done to determine the importance of the many variable parameters which influence the performance of these models.

[Saliva, caries and diagnostics].

During the last decades the proportion of children without tooth decay and dental restorations has strongly increased. Yet, some patients show rampant caries or a sudden progression of decay into the dentin. In order to intervene adequately in such cases, it is of importance to determine first of all the underlying causes.