John R. Ross

Acute Profound Thrombocytopenia Associated with Eptifibatide Therapy

An 80‐year‐old woman and a 79‐year‐old man underwent urgent percutaneous coronary intervention and received adjunctive eptifibatide. Platelet counts in both patients fell to below 20 times 103/mm3 within 4 hours of eptifibatide administration. Reports in the medical literature reinforce the importance of recognizing that eptifibatide can cause acute profound thrombocytopenia. All three available glycoprotein IIb‐IIIa inhibitors—abciximab, eptifibatide, and tirofiban—have been associated with the development of this disorder. Thus, clinicians should routinely monitor platelet counts in patients receiving glycoprotein IIb‐IIIa inhibitors within 2–4 hours of the start of the infusion.

Impact of stress testing before percutaneous coronary intervention or medical management on outcomes of patients with persistent total occlusion after myocardial infarction: Analysis from the occluded artery trial

BACKGROUND In the Occluded Artery Trial (OAT), 2,201 stable patients with an occluded infarct-related artery (IRA) were randomized to percutaneous coronary intervention (PCI) or optimal medical treatment alone (MED). There was no difference in the primary end point of death, reinfarction, or congestive heart failure (CHF). We examined the prognostic impact of prerandomization stress testing. METHODS Stress testing was required by protocol except for patients with single-vessel disease and akinesis/dyskinesis of the infarct zone. The presence of severe inducible ischemia was an exclusion criterion for OAT. We compared outcomes based on performance and results of stress testing. RESULTS Five hundred ninety-eight (27%) patients (297 PCI, 301 MED) underwent stress testing. Radionuclide imaging or stress echocardiography was performed in 40%. Patients who had stress testing were younger (57 vs 59 years); had higher ejection fractions (49% vs 47%); and had lower rates of death (7.8% vs 13.2%), class IV CHF (2.4% vs 5.5%), and the primary end point (13.9% vs 18.9%) than patients without stress testing (all P < .01). Mild-moderate ischemia was observed in 40% of patients with stress testing and was not related to outcomes. Among patients with inducible ischemia, outcomes were similar for PCI and MED (all P > .10). CONCLUSIONS In OAT, patients who underwent stress testing had better outcomes than patients who did not, likely related to differences in baseline characteristics. In patients managed with optimal medical therapy or PCI, mild-moderate inducible ischemia was not related to outcomes. The lack of benefit for PCI compared to MED alone was consistent regardless of whether stress testing was performed or inducible ischemia was present.

Increased Resistance of Rachitic Rats fed Irradiated Food.

Summary Of 89 rats fed a rachitic diet including non-irradiated muffets, 5% survived a per Os enteriditis infection, as compared with 30% of 94 rats fed the same diet including irradiated muffets. Therefore we conclude that the use of irradiated whole wheat (muffets) in a rachitogenic diet fed to rats increases their resistance against infection.

Increased resistance of rachitic rats exposed to sunlight through Vita glass.

Summary Of 41 rats fed a rachitic diet and exposed to sunshine through Vita glass, 61% survived a per os enteriditis infection, as compared with 28% of 32 similar rats exposed to sunshine through plain or ordinary glass.

Delayed absorption of proteins in the guinea pig.

Abstract 1.1. From these experiments it is seen that when untreated solutions of purified egg albumin are injected subcutaneously into sensitized guinea pigs, fatal anaphylaxis is produced if the dosage is in excess of 12.5 mg. 2.2. If similar solutions are suspended in 10 per cent polyvinyl alcohol, fatal anaphylaxis is not produced until 27.5 mg. of egg albumin are injected. 3.3. If similar solutions are treated with protamine-zine and then suspended in 10 per cent polyvinyl alcohol, fatal anaphylaxis is not produced until 50.0 mg. are injected. 4.4. This delay in the production of fatal anaphylactic shock has probably been effected by a delay in the absorption of the antigen from the subcutaneous tissues, and in experiment 3 it is seen that four times the dose of antigen is tolerated by the pigs. The delayed reaction probably results from the slower absorption of the antigen through lymph channels rather than the more direct absorption through the capillaries. 5.5. Fatal anaphylaxis is only produced in the guinea pig when amounts of antigen in excess of 12.5 mg. are absorbed during a short period, probably only a few minutes. If the absorption is delayed sufficiently, so that amounts less than 12.5 mg. are absorbed at any one moment, but are absorbed continuously over a period of hours, the animal will not suffer fatal shock.

The effect of cooking on the digestibility of cereals.

Conclusions 1.Cooking for more than thirty minutes in a double boiler did not significantly increase the digestibility of cereal starches as shown by the amount of maltose and of total soluble carbohydrate formed in vitro under standard digestion conditions. 2.No significant differences were found in the relative starch digestibility of Cream of Wheat, corn meal, Meads Cereal, Quaker rolled oats and Quick Quaker oats. Whole wheat, however, was slightly less readily digested. 3.The starch digestibility of a special precooked cereal mixture was more rapid than the starch digestibility of any of the other cereals tested.