Serum Platelet Levels Research Articles

SCIATIC DENERVATION-INDUCED SKELETAL MUSCLE ATROPHY IS ASSOCIATED WITH PERSISTENT INFLAMMATION AND INCREASED MORTALITY DURING SEPSIS.

Background: Patients with underlying skeletal muscle atrophy are likely to develop aggravated sepsis. However, no study has experimentally verified the association between the prognosis of sepsis and muscle atrophy, and the mechanism of aggravation of sepsis under muscle atrophy remains unclear. In this study, we investigated the effect of skeletal muscle atrophy induced by sciatic denervation (DN), an experimental muscle atrophy model, on sepsis prognosis. Methods: Skeletal muscle atrophy was induced by DN of the sciatic nerve in C57BL/6J male mice. Cecal ligation and puncture (CLP) was performed to induce sepsis. Results: The survival rates of the sham and DN groups 7 days after CLP were 63% and 35%, respectively, wherein an approximately 30% reduction was observed in the DN group ( P < 0.05, vs. sham-CLP). The DN group had a higher bacterial count in the blood 48 h after CLP ( P < 0.05, vs. sham-CLP). Notably, NOx (a metabolite of nitric oxide) concentrations in DN mice were higher than those in sham mice after CLP ( P < 0.05, vs. sham-CLP), whereas serum platelet levels were lower 48 h after CLP ( P < 0.05, vs. sham-CLP). In organ damage analysis, DN mice presented increased protein expression of the kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), a kidney injury marker, after CLP (NGAL 48 h after CLP, P < 0.05, vs. sham-CLP; KIM-1 24 h after CLP, P < 0.01, vs. sham-CLP). Furthermore, nitro tyrosine levels in the kidneys of DN mice were higher 48 h after CLP compared with those in sham-CLP mice, indicating the accumulation of nitrative stress ( P < 0.05, vs. sham-CLP). Serum cytokine levels were increased in both groups after CLP, but decreased in the sham group 48 h after CLP and remained consistently higher in the DN group (tumor necrosis factor [TNF]-α: P < 0.05, sham-CLP vs. DN-CLP; interleukin (IL)-1β: P < 0.01, sham-CLP vs. DN-CLP; IL-6: P < 0.05, DN vs. DN-CLP; IL-10: P < 0.05, sham-CLP vs. DN-CLP). Conclusions: We verified that skeletal muscle atrophy induced by DN is associated with poor prognosis after CLP-induced sepsis. Importantly, mice with skeletal muscle atrophy presented worsening sepsis prognosis at late onset, including prolonged infection, persistent inflammation, and kidney damage accumulation, resulting in delayed recovery.

The correlation between the number of platelets and endometrial pathology

Introduction. Circulating platelets play an essential role in the immune system and furthermore in tumor development and proliferation. Therefore, the correlation between different neoplasia and the number of platelets has been widely studied. The aim of the current paper is to investigate the correlation ship between platelet number and tumoral endometrial transformation. Material and methods. Between January 2022 and June 2022 22 patients with endometrial hyperplasia or endometrial cancer were submitted to surgery. The serum levels of platelets were determined and compared to those reported in a similar group of patients in whom the endometrial lining was normal. Results. Patients diagnosed with endometrial cancer presented a significantly higher number of platelets as well as a significantly higher platelet volume when compared to patients diagnosed with endometrial hyperplasia and respectively to those in whom a normal endometrial lining was found. Conclusions. The serum number of platelets and their volume seem to be positively correlated with the aggressivity of the tumoral transformation of the endometrial lining and should be therefore considered as part of the elements which should be analyzed when discussing the best therapeutic option in such patients.

Histological regression and clinical benefits in patients with liver cirrhosis after long-term anti-HBV treatment

Objective: Our study aims to determine histological regression and clinical improvement after long-term antiviral therapy in hepatitis B virus-related cirrhosis patients. Methods: Treatment-naïve chronic hepatitis B patients with histologically or clinically diagnosed liver cirrhosis were enrolled. Liver biopsies were performed after 5 years entecavir-based antiviral treatment. Patients were followed up every 6 months. Cirrhosis regression was evaluated based on Metavir system and P-I-R score. Clinical improvement was evaluated before and after the long-term treatment. Kruskal Wallis test and Wilcoxon signed-rank test were used for continuous variables, Fisher's exact test was used for categorical variables and multivariate analysis was performed using logistic regression analysis. Results: Totals of 73 patients with HBV-related liver cirrhosis were enrolled. Among them, 30 (41.1%) patients were biopsy proved liver cirrhosis and the remaining 43 (58.9%) cirrhotic patients were diagnosed by clinical features. Based on Metavir system and P-I-R score, 72.6% (53/73) patients attained histological regression. Furthermore, 30.1% (22/73) were defined as significant regression (Metavir decrease ≥2 stage), 42.5% (31/73) were mild regression (Metavir decrease 1 stage or predominantly regressive by P-I-R system if still cirrhosis after treatment) and 27.4% (20/73) were the non-regression. Compared to levels of clinical characteristics at baseline, HBV DNA, ALT, AST, liver stiffness(decreased from 12.7 to 6.4 kPa in significant regression, from 18.1 to 7.3 kPa in mild regression and from 21.4 to 11.2 kPa in non-regression)and Ishak-HAI score significantly decreased after 5 years of anti-HBV treatment, while serum levels of platelets and albumin improved remarkably (P<0.05). In multivariate analysis, only the pre-treatment liver stiffness level was associated with significant regression (OR=0.887, 95%CI: 0.802-0.981, P=0.020). Conclusions: After long-term antiviral therapy, patients with HBV-related cirrhosis are easily to attain improvements in clinical parameters, while a certain percentage of these patients still cannot achieve histological reversal.

Correlation between 1-FABP, Blood Routine and Grading of Necrotising Enterocolitis.

Correlation was sought between serum intestinal fatty acid binding protein (I-FABP), blood routine examination indexes, and necrotizing enterocolitis (NEC) disease classification. According to Bell-NEC grade, 86 children with NEC were divided into mild group (46 cases) and severe group (40 cases). Serum I-FBAP and blood routine indices including white blood cells (WBC), platelets (PLT), neutrophils and lymphocytes were determined. Serum levels of I-FABP and WBC in severe group were higher than those in mild group (both p <0.001), and serum level of PLT was lower than that in mild group (p <0.001). NEC grade was positively correlated with I-FABP and WBC (r=0. 930, p <0.001; r=0. 946, p <0.001), negatively correlated with PLT (r=-0. 602, p <0.001), and had weak correlation with neutrophils and lymphocytes (r=0. 186, p=0. 087; r=0. 072, p=0. 509). In conclusion, serum levels of I-FABP, WBC and PLT were correlated with the severity of NEC in children, which could be used as a reference index to judge prognosis of NEC children. Key Words: Necrotizing enterocolitis of newborn (NEC), Serum, Intestinal fatty acid binding protein (I-FABP), Routine blood indices.

Prognostic and predictive factors in cancer patients with obstructive jaundice treated by percutaneous transhepatic biliary drainage: A single-center experience.

Short-term survival rates are reported in the patients undergoing percutaneous transhepatic biliary drainage (PTBD). The purpose of this study was to determine the factors predicting survival following percutaneous biliary drainage. The data of 90 patients undergoing PTBD due to malignant biliary obstruction were analyzed retrospectively between January 2009 and November 2014. The median age of the patients were 64 years. Fifty-one (57%) of the patients were male. Median survival following PTBD was 44 days. Survival rates at 1 month, 3 months, and 6 months following PTBD were 58%, 33%, and 8.9%, respectively. Multivariate Cox's regression analysis showed that platelet (PLT) count is significantly associated with predictors of survival; the other factors affecting survival were receiving chemotherapy following PTBD, liver metastasis, and serum albumin levels. Lower serum PLT level following PTBD is associated with the short-term survival. Survival of patients who are not able to receive chemotherapy after PTBD, having a low level of serum albumin, and patients with liver metastasis were shorter.

Clinical features and prognostic factors of primary bone marrow lymphoma.

BackgroundPrimary bone marrow lymphoma (PBML) is a very uncommon neoplasm originally arising in the bone marrow system, and the most common pathological type is diffuse large B-cell lymphoma.Patients and methodsTo describe the clinical characteristics of PBML and evaluate the risk factors related to prognosis, we recruited and studied 66 patients from our center and the current published literature. Various symptoms are present at the onset of PBML, the most important of which is cytopenia, followed by fever. Forty-seven of these patients were included in our analysis.ResultsUnivariate analysis suggested that B symptoms (P=0.024), a low serum platelet level (<75×109/L; P=0.032), an elevated serum LDH level (P=0.039), and not achieving a complete response (CR) following initial therapy (P=0.007) are associated with worse outcomes. Multivariate analysis showed that only a low serum platelet level (<75×109/L), B symptoms, and not achieving a CR following initial therapy are independent factors for prognosis. In addition, intensive regimens appear to be beneficial for prognosis.ConclusionPBML is a lymphoma with special clinical features, and its recognition is important for establishing a definitive prognosis model and searching for appropriate therapy.

Early diagnosis of necrotizing enterocolitis by plasma RELMβ and thrombocytopenia in preterm infants: A pilot study

As the inflammatory regulators, Resistin-like molecule β (RELMβ) and Resistin might be potential biomarkers of necrotizing enterocolitis (NEC), while thrombocytopenia is often related to the severity of NEC, clinical observation suggests that thrombocytopenia might be an early biomarker of NEC. The aim of this study was to evaluate whether RELMβ, Resistin and thrombocytopenia could be biomarkers for early diagnosis of NEC in preterm infants. From January 2016 to March 2018, twenty-nine NEC preterm infants who were diagnosed with NEC (Bell's stage ≥Ⅱ) by two independent neonatologists and twenty-nine non NEC preterm infants at neonatal intensive care unit in our hospital were enrolled in this case-control study. Preterm infants with a history of serious infections (sepsis, pneumonia), asphyxia, and congenital malformations were excluded from the study. The plasma RELMβ and Resistin were evaluated by enzyme linked immunosorbent assay (ELISA) and serum platelet levels were measured directly by ordinary light microscope at the diagnosis of NEC (Bell's stage ≥Ⅱ). Plasma RELMβ levels in NEC group were significantly higher than control group (P<0.05). The optimal cut-off value of RELMβ determined by receiver operating characteristic curve (ROC) was 378.3ng/L. The overall estimates for sensitivity and specificity of high RELMβ concentrations in the detection of neonatal NEC were 71.4% and 91.7%, respectively. No significant difference was found in plasma Resistin levels between two groups (P>0.05). If platelet level was less than 157×109/L, the sensitivity and specificity were 69.34% and 82.87%, respectively. Interestingly, the combination of RELMβ and thrombocytopenia increased sensitivity and specificity to 82.89% and 93.21%, respectively. The combination of RELMβ and thrombocytopenia was a reliable biomarker for the early diagnosis of NEC in this study with 82.89% sensitivity and 93.21% specificity, respectively.

Neutrophil-to-lymphocyte ratio and platelet count as prognostic factors in ovarian malignancies.

The objectives of the present study were to demonstrate the influence of neutrophils, platelets, and neutrophil-lymphocyte ratio (NLR) in the ovarian cancer prognosis and to compare these parameters with benign ovarian neoplasms. Records of patients underwent surgery for ovarian cysts were evaluated. There were 72 malignant neoplasms and 213 benign neoplasms. Age, parity, histologic type, tumor stage, type of surgery performed, chemotherapy, disease-free survival, serum levels of tumor markers, neutrophils, lymphocytes, platelets, and NRL were recorded. The Mann-Whitney, the Chi-square test and multiple linear regression were used. A P-value < 0.05 was established as the significance level. Higher values of platelets, neutrophils, and NLR were found in malignant tumors (P = 0.0132, P = 0.0208, and P < 0.0001, respectively), while lymphocytes values were higher in benign group (P < 0.0001). Preoperative platelet count 300,000/mm3 was related to less aggressive histological types (P = 0.0148). NLR <3 was related to the initial stages (P = 0.0053), and patients with disease-free survival >24 months had most often neutropenia during chemotherapy (P = 0.0482). After multivariate analysis, platelets, NLR, and serum levels of CA15.3 were considered independent variables related to tumor staging (P = 0.028, P = 0.028, and P = 0.035, respectively). NLR and serum levels of platelets may represent potential prognostic factors in ovarian cancer, and they may also serve as therapeutic targets in the future treatment strategies.

Assesment of blood parameters relevant to aterosclerosis and coronary artery disease after paratiroidectomy

Objective: The preoperative and postoperative calcium, parathormone levels, platelet counts, mean platelet volume values of the patients were compared in order to investigate the changes in the risk of atherosclerosis and coronary artery disease in parathyroidectomy. Method: Twelve male and 43 female patients who underwent parathyroidectomy between 01.01.2008 and 01.01.2018 at the Cumhuriyet University Surgical Oncology Clinic were included in the study. On the tenth preoperative and postoperative day, blood was drawn for the platelet, mean platelet volume, calcium and parathyroid hormone levels after a fasting period of twelve hours. The preoperative and postoperative calcium, parathormone levels, platelet counts, mean platelet volume values of the patients were compared in order to investigate the changes in the risk of atherosclerosis and coronary artery disease in parathyroidectomy. Results: The mean pre-operative blood calcium levels of the patients included in the study were 10.75 ± 1.49 mg / dl, . Mean postoperative blood calcium level was 8.59 ± 1.14 mg / dl. The mean preoperative mean platelet volume of the patients was 26.1 ± 121.55 fL, Postoperative mean platelet volume was 9.36 ± 1.26 fL. The mean preoperative parathormone level was 535,08 ± 711,08, The mean postoperative parathyroid hormone level was 74.47 ± 128.02 pg / ml. The mean preoperative blood platelet count of the patients included in the study was 418000 ± 8000 / mm³, The mean postoperative blood platelet count was 252000 ± 7000 / mm³. Conclusions: In our study, we found that the decrease in serum parathormone level, serum platelet level, mean platelet volume, after parathyroidectomy was statistically significant. Mean platelet volume and platelet count were decreased after parathyroidectomy, which are indicators of atherosclerosis and coronary artery disease; Parathyroidectomy reduces the risk of atherosclerosis and coronary artery disease. Additional clinical and laboratory studies are needed to support the risk of atherosclerosis and coronary artery disease after parathyroidectomy.

The value of early changes in platelet counts in assessing the prognosis of aged patients with severe pneumonia

Objective To explore the predictive value of early changes in platelet counts in the prognosis of severe pneumonia in aged patients. Methods This retrospective study included elderly patients with severe pneumonia, who were ≥65 years old and whose length of ICU stay ≥72 hours, admitted to the intensive care unit(ICU)of NO.2 People's Hospital of Changzhou from January 2014 to January 2017.They were divided into a survival group and a death group according to the 28-day outcome.General information and serum platelet levels at 0, 24, 36, and 72 hours after admission were collected.Receiver operating characteristic curve(ROC)was plotted according to platelet counts, changes in platelet counts and rates of change in platelet counts to evaluate their predictive value for 28-day prognosis.Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between different groups of patients, who were further divided according to platelet counts at 0 and 72 hours after admission to ICU, changes in platelet counts and rates of change in platelet counts at 72 hours after admission. Results (1)One hundred elderly patients with severe pneumonia were enrolled, among whom 41 cases were in the death group, thus with a mortality of 41.0%.The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), sequential organ failure assessment(SOFA), C-reactive protein(CRP), and procalcitonin(PCT)in the death group were significantly higher than those in the survival group.2)Serum platelet levels showed a downward trend in both the death group and the survival group.The level of serum platelets at 72 hours after admission to ICU in the death group was significantly lower than that in the survival group(80.00×109/L vs.171.00×109/L, Z=5.786, P<0.05); changes in platelet counts and rates of change in platelet counts in the death group were significantly higher than those in the survival group, especially at 72 hours after admission to ICU(△PLT72: -79.00×109/L vs.-38.00×109/L, Z=4.938, P<0.05; △PLT 72%: -43.6% vs.-17.7%, Z=6.816, P<0.05). (3)ROC curve analysis showed that platelet levels, changes in platelet counts, and rates of change in platelet counts could predict 28-day mortality in aged patients with severe pneumonia.The largest area under ROC curve was 0.902 when plotted with the rate of platelet counts at 72 hours after admission to ICU.Using the cut-off value of -36.14% in the rate of change at 72 hours after admission to evaluate the predictive value in 28-day mortality, the sensitivity and specificity were 89.8% and 75.6%, respectively.(4)Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher and the length of survival was significantly greater when platelet counts at 0 and 72 hours after admission to ICU were higher than the cut-off value, and this also occurred in changes in platelet count and rates of change at 72 hours after admission to ICU. Conclusions Continuous decline in serum platelet levels indicates poor prognosis.When combined with platelet counts, changes in platelet counts and rates of change in platelet counts at 72 hours after admission to ICU, it may play an important role in assessing the prognosis of aged patients with severe pneumonia. Key words: Blood platelets; Pneumonia; Prognosis

Clinical value of intraoperative interorganizational targeted injection chemotherapy for Dixon operation of advanced rectal cancer

Objective To explore the clinical value of intraoperative interorganizational targeted injection chemotherapy (IITIC) in Dixon operation of advanced rectal cancer (ARC). Methods From June 2013 to December 2013, 53 patients who suffered from ARC and were treated by operation in our hospital were divided into group A and group B randomly. 29 patients in group A were carried out Dixon operation and IITIC, while 24 patients in group B were carried out Dixon operation only. Serum levels of tumor necrosis factor α (TNF-α), carcinoembryonic antigen (CEA) and carbohydrate antigen 242 (CA242) were measured and compared for all the patients in perioperative period. Also, Serum levels of white blood cell (WBC), platelet (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine (Cr) were measured and compared for all the patients in perioperative period. Postoperative anastomotic fistula, intra-abdominal hemorrhage, intra-abdominal abscess and death were observed and compared between group A and group B. Postoperative follow-up and survival analysis were carried out for patients in both groups. Results The serum levels of TNF-α, CEA and CA242 at each time point were significantly different both in group A and group B (P 0.05). The serum levels of WBC, ALT, AST and Cr were not statistically significant difference between group A and group B (P>0.05), while the serum levels of PLT were statistically significant difference (P 0.05). Conclusions It is safe and feasible to carry out IITIC in Dixon operation for ARC. IITIC can increase the treatment effect to operation of ARC, which also can improve patients′ prognosis. Key words: Rectal neoplasms/SU; Rectal neoplasms/DT; Intraoperative period; Tumor markers, biological

Longitudinal study of the association between thrombocytopenia and retinopathy of prematurity

An association between thrombocytopenia and retinopathy of prematurity (ROP) has been suggested but not been studied longitudinally. We sought to identify the time period in postnatal development during which thrombocytopenia and the subsequent development of severe ROP are associated. This was a retrospective case-control study of 100 subjects who received laser photocoagulation for type 1 ROP between 2005 and 2009 and 100 controls with no ROP or only stage 1 ROP. The proportions of infants with thrombocytopenia, defined as a serum platelet level of <150,000/μL, among cases versus controls were compared on a weekly basis from birth through the time of laser during early (postmenstrual age [PMA] weeks 24-28), middle (PMA weeks 29-34), and late (PMA weeks 35-38) time periods. Main outcome measures were odds ratios for the association between thrombocytopenia and type 1 ROP from multivariate logistic regression models adjusted for gestational age, birth weight, culture-proven sepsis, and necrotizing enterocolitis. Thrombocytopenia was significantly associated with severe ROP during PMA weeks 24-28 (adjusted OR, 4.7; 95% CI, 2.0-1.1; P=0.001) and 29-34 (adjusted OR, 2.8; 95% CI, 1.4-5.6; P=0.006), but not during weeks 35-38 (adjusted OR, 2.0; 95% CI, 0.9-4.3; P=0.10). Thrombocytopenia from birth through 34weeks' PMA was associated with subsequent severe ROP. This time period corresponds to a period of poor retinal vascular growth, suggesting a possible proangiogenic effect of platelets in normal retinal vascular development in infants at risk for ROP.

Low serum interleukin-6 levels as a predictive marker of recurrence in patients with hepatitis B virus related hepatocellular carcinoma who underwent curative treatment

BackgroundWe aimed to investigate the use of novel serum biomarkers for predicting the recurrence and survival of patients with hepatitis B virus (HBV)-related early hepatocellular carcinoma (HCC) after hepatic resection or radiofrequency ablation (RFA). MethodsOne hundred and five patients with HBV-related HCC, who fulfilled the Milan criteria without vascular invasion and underwent hepatic resection or RFA, were followed-up for a median duration of 52months. Pretreatment serum concentrations of 16 cytokines including interleukin-6 (IL-6) were measured by using a Luminex 200 system. The measured serum cytokines and several clinical factors were analyzed retrospectively. ResultsUnivariate analysis showed that patients with lower pretreatment serum levels of IL-10, IL-6, monocyte chemoattractant protein-1, and tumor necrosis factor-α had significantly shorter disease-free survival (DFS) than those with higher levels. Multivariate analysis revealed that a low serum IL-6 level (⩽33.00pg/mL; hazard ratio [HR]=5.39; 95% confidence interval [CI]=1.27–22.93; P=0.022), low platelet count (<100×109/L; HR=2.23; 95% CI=1.28–3.89; P=0.005), and low serum albumin level (⩽3.5g/L; HR=2.26; 95% CI=1.28–3.97; P=0.005) had a negative prognostic impact on DFS. In the analysis for overall survival, a low serum platelet level (<100×109/L; HR=2.80; 95% CI=1.31–5.99; P=0.008) and multiple tumor (⩾2; HR=4.05; 95% CI=1.56–10.48; P=0.004) showed a negative prognostic impact on the overall survival. ConclusionA low serum IL-6 level is, in addition to low platelet count and low serum albumin level, an independent prognostic factor for DFS in patients with HBV-related early HCC who underwent hepatic resection or RFA with curative intention.

Early Detection of Kawasaki Disease in Infants.

Background and ObjectivesThis study aimed to investigate the clinical characteristics of infantile Kawasaki disease (KD), and to evaluate early diagnostic features of KD in febrile infants.Subjects and MethodsWe retrospectively reviewed the medical records of 64 KD patients from January 2010 to October 2014. There was an analysis of the clinical, laboratory data of the infants versus children groups. Furthermore, the clinical and laboratory data of infantile KD patients were compared with 16 infants who were admitted for other acute febrile diseases.ResultsA total of 64 patients with KD were identified; 20 (31.3%) were infants; 44 (68.8%) were >1 year old children. Incomplete KD was much more common in infants (n=13, 65.0%) than in children group (n=14, 31.8%) (p=0.013). The infants were characterized by significantly higher rates of inflammatory changes at the Bacille Calmett-Guérin (BCG) inoculation site (p<0.001), but lower rates of changes in the extremities (p=0.029) and cervical lymphadenopathy (p=0.006). The serum levels of platelet after 1 week (p=0.005), C-reactive protein (p=0.038), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (p=0.026) were all significantly higher in the infants group. Comparing the infants with KD versus the other acute febrile diseases, there were significantly higher serum levels of erythrocyte sedimentation rate (p=0.002), C-reactive protein (p=0.046) and NT-proBNP (p=0.001) for the infants with KD group.ConclusionBCGitis and higher levels of NT-proBNP can be helpful for early diagnosis of the incomplete KD in infants, and may be a good predictor of KD in acute febrile infants, when combined with other acute phase reactants.

English

The effect of aqueous leaf and berry extracts of&nbsp;Phytolacca dioica&nbsp;administered at 50, 100 and 200 mg/kg body weight for 14 days was investigated on haematology and weight parameters of Wistar rats. The extracts at all doses had no significant effect on the red blood cells (RBC), haemoglobin (HB), parked cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) when compared with the animals in the control group. In contrast, the extracts at all doses caused a progressive significant reduction in the serum levels of platelets, white blood cells (WBC), neutrophils and monocytes. Also, there was dose-dependent significant increase in the serum levels of lymphocytes and a reduction in the level of eosinophils. Administration of the extracts at all doses investigated led to a significant reduction in the body weight, absolute organ weight and organ-body weight ratio. These observable alterations in some parameters were indications that the leaf and berry extracts of&nbsp;P. dioica&nbsp;possess slight toxicity. Therefore, the crude extracts from the leaf and berry may not be completely safe as oral remedies. &nbsp; Key words:&nbsp;Phytolacca dioica, haematology, weight parameters, slight toxicity, oral remedy.

Influência da inversão do diâmetro veia porta/veia esplênica nos resultados do tratamento cirúrgico da hipertensão portal esquistossomótica

To evaluate the morbidity and mortality in surgical treatment of schistosomal portal hypertension in patients with inversion of the Portal/Splenic Vein diameter ratio. We conducted a retrospective cross-sectional study of patients undergoing surgical treatment of portal hypertension in the period between September 1993 and January 2004. The study population was divided into two groups: a) Inversion--splenic vein diameter greater than or equal to portal vein's--and b) control group (portal vein diameter greater than the splenic vein's). Statistical comparisons used the Student t test for averages difference, chi-square test for proportions difference and Fisher's exact test for small samples. 169 patients were analyzed, with follow-up averaging 23.6 months. Twenty-one patients (12.4%) had splenic vein caliber greater of equal than the portal vein's (Inversion--study group). The mean preoperative diameter of the portal and splenic veins were respectively 1.49 and 1.14 cm in the control group, and 0.98 versus 1.07 cm in the inversion group. The portal vein diameter was significantly higher in the control group when compared to the inversion group (p <0.05). Varices in the gastric fundus were found in 33.3% of the inversion group and in 38.5% of patients in the control group. Postoperative rebleeding occurred in 23.1% of patients in the inversion group and in 13.4% of the control group ones (p > 0.05). In the postoperative evaluation with Doppler ultrasonography of portal vessels, no cases of portal vein thrombosis were observed in the inversion group, whilst in the control group portal thrombosis was identified in 16.9% of the patients (p <0.05). Death occurred in one (4.8%) individual from the inversion group; mortality was 4.1% in the control group (p>0.05). The mean serum level of platelets was significantly lower (65,950/mm²) in the inversion group than in the controls (106,647/mm²) (p<0.05). The results suggest that the reversal of portal/splenic vein caliber ratio does not represent a contraindication to surgical treatment of schistosomal portal hypertension.

Vitreous and Serum Levels of Platelet-Derived Growth Factor and Their Correlation in Patients with Proliferative Diabetic Retinopathy

Purpose: We investigated possible correlations between vitreous and/or serum levels of platelet derived growth factor isoforms (PDGF-AA, -AB, -BB) with parameters associated with proliferative diabetic retinopathy (PDR), and compared the results to vascular endothelial growth factor (VEGF), which is an established growth factor affecting PDR. Methods: Thirty-one patients with PDR and 15 non-diabetic patients were included in the study. Vitreous and serum samples were obtained during vitrectomy. PDGF-AA, -AB, and -BB, as well as VEGF, were measured by enzyme-linked immunosorbent assay. Results: PDGF-AA, -AB, -BB, and VEGF were all expressed in serum and vitreous of controls and patients with PDR. The levels of all PDGF isoforms and VEGF in vitreous were significantly increased in the PDR group, as compared to controls. No such differences were evident in serum. PDGF-AA and PDGF-BB correlated significantly to the severity but not the activity of PDR. PDGF-AB and -BB were significantly lower in vitreous of patients with pre-performed complete panretinal photocoagulation (PRP) as compared to incomplete or without PRP. PDGF did not correlate significantly to fibrovascular tissue, on the disc or elsewhere, to long-standing vitreous hemorrhage, to tractional retinal detachment, or to posterior vitreous detachment. PDGF or VEGF in vitreous or serum of PDR patients did not correlate with the serum levels of HbA1C. There was no correlation between the vitreous and serum levels of VEGF or PDGF in patients with PDR. Conclusions: It appears that, in addition to VEGF, PDGF-AA, -AB, and -BB in the vitreous are also correlated with PDR.

Serum Levels of Platelet Released CD40 Ligand Are Increased in Early Onset Occlusive Carotid Artery Disease

Objective: Soluble CD40 ligand (sCD40L) has been suggested as a key mediator between inflammation and atherosclerosis, and the CD40-CD40L interaction has a role in atherosclerotic lesion progression. We evaluated if platelet released serum sCD40L and sCD40 levels differ between patients with early onset occlusive carotid artery disease and age-matched controls. Methods: sCD40L and sCD40 levels were measured in serum samples of 60 patients with occlusive carotid artery disease and 30 age-matched controls using ELISA. Degree of stenosis of the internal carotid artery (ICA), and intima-media thickness (IMT) in the common carotid artery were measured by high resolution ultrasound. Values are given as mean ± SD. Results: Mean age was 50.9 ± 3.5 and 50.1 ± 3.5 years in the patient and control groups. IMT was significantly thicker in patients than in controls (0.89 ± 0.14 vs. 0.78 ±0.12 mm, p = 0.0003). Serum levels of sCD40L were significantly higher (6.9 ± 5 vs. 4.5 ± 3.0 ng/mL, p = 0.038) in patients, whereas sCD40 did not differ significantly between patients and controls (85 ± 56.9 vs. 79.3 ± 18.7 pg/mL, p = 0.34). IMT did not correlate with sCD40L or sCD40 levels (R = −0.03, p = 0.77; and R = 0.109, p = 0.308, respectively). Conclusions: sCD40L but not sCD40 levels are significantly higher in patients with occlusive carotid artery disease. Platelet derived sCD40L may be a key mediator among inflammation, thrombosis and atherosclerosis.

Kaposiform hemangioendothelioma without Kasabach-Merritt phenomenon

Kasabach-Merritt phenomenon is a serious coagulopathy associated with kaposiform hemangioendothelioma (KHE), tufted angioma, and possibly other vascular neoplasms. KHE presenting in the absence of Kasabach-Merritt phenomenon is rare, although tufted angioma frequently occurs without thrombocytopenia. We retrospectively reviewed 10 cases of KHE without Kasabach-Merritt phenomenon. The tumors appeared as soft tissue masses with the overlying skin being either normal, erythematous, or violaceous. There were no radiologic or microscopic differences in noncoagulopathic KHE as compared with coagulopathic KHE. Evidence of platelet trapping and hemosiderin deposition was seen histologically, despite normal serum platelet levels. All KHE were less than 8 cm in diameter, suggesting that tumors that grow no larger than this size are less likely to trap platelets in sufficient quantity to cause thrombocytopenia. Our series confirms that KHE appears with a wide spectrum of behavior and response to treatment. The decision as to whether or not to treat a noncoagulopathic KHE should be based on the size and location of the tumor and the possible side effects of therapy.

Correlação entre a contagem de plaquetas no sangue e o gradiente de pressão venosa hepática em pacientes cirróticos

Determination of hepatic venous pressure gradient is the main method used to assess portal pressure. Recently, platelet blood levels has been indicated as a non-invasive marker of the presence of portal hypertension. To correlate platelet blood levels with the hepatic venous pressure gradient among patients with cirrhosis. A total of 83 cirrhotic patients who had undergone hepatic venous pressure gradient over the last 6 years were included. Patients were divided in groups according to Child-Pugh classification. All had upper digestive endoscopy to assess the presence of esophageal varices and platelet serum levels were recorded. Platelet serum levels range varied between 45,000/mm(3) and 389,000/mm(3) (mean: 104,099; standard deviation: 58,776). Mean hepatic venous pressure gradient was 15.2 mm Hg with a standard deviation of 6.4 mm Hg (range: 1 to 29 mm Hg). Simple linear regression analysis was applied to verify an association of hepatic venous pressure gradient and platelet serum levels, revealing a weak correlation between both variables. We observed a progressive reduction of serum platelet levels as esophageal varices diameter increased and hepatocellular function (established by Child-Pugh classification) decreased. However, these findings did not reach statistical significance. Despite the lack of a statistical significant correlation among serum platelet levels and hepatic venous pressure gradient or hepatocellular function, there was a clear tendency indicating that those variables could be involved in the pathogenesis of low platelet levels.