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PubMed2004

Age effects on cortisol levels in depressed patients with and without comorbid post-traumatic stress disorder, and healthy volunteers.

BACKGROUND: Post-traumatic stress disorder (PTSD) and major depression are frequently comorbid. Age and major depression are associated with higher cortisol levels and dexamethasone resistance, whereas PTSD is associated with lower cortisol and dexamethasone supersensitivity. Therefore, we examined the effect of age on the hypothalamic-pituitary-adrenal (HPA) system in depressed patients with and without PTSD. METHODS: Thirty-one depressed patients without PTSD, 12 depressed patients with PTSD, and 23 healthy volunteers were studied on 2 days. Subjects received single-blind placebo on day 1 and fenfluramine on day 2. Cortisol levels were drawn before challenge and for 5 h thereafter. RESULTS: Cortisol levels increase with age in depressed patients without PTSD but not in depressed patients with PTSD or in healthy volunteers. Number of previous major depressive episodes was a predictor of the cortisol response to fenfluramine administration in depressed patients without PTSD. CONCLUSIONS: The results of our study highlight the importance of considering age in psychobiology. Further research is needed to fully delineate the role of age in abnormalities of the HPA axis found in major depression and PTSD.

Adult↗
PubMed1982

Foster mother rat entrains circadian adrenocortical rhythm in blinded pups.

Free-running patterns of blood corticosterone rhythm were examined between the fourth and eighth postnatal week in blinded pups optically enucleated on day 1. When blinded pups were raised by intact natural mothers, the peak time of corticosterone rhythm appeared near the time of light-dark (LD) transition, which was close to that of mothers, and then free-ran. This phase relation between mothers and pups showed that mothers entrained pups' corticosterone rhythm. When blinded pups born of LD (or DL) mothers were raised by DL (or LD) foster mothers, the corticosterone rhythm in blinded pups was close to that of foster mothers at 4 wk of age, indicating that a foster mother plays a predominant role in entraining the pups' rhythm. When blinded pups were raised by blinded mothers whose rhythm was out of phase of the lighting cycle, pups' rhythm was in phase with that of mothers, showing that lighting cycle did not affect the pups' rhythm. These facts indicate that the mother nursing pups acts as the most predominant entrainer of corticosterone rhythm of the blinded pups.

Adrenal Cortex↗
PubMed1984

Effect of blinding on the growth of reproductive organs in male rats treated neonatally with testosterone propionate.

Prepubertal blinding slightly retards the growth of seminal vesicles and prostate in male Wistar rats. Neonatal administration of testosterone propionate (TP) increases the susceptibility of rats to light deprivation. The growth of testes, seminal vesicles and prostate is markedly retarded in TP-treated rats blinded at 30 days of age. However, prepubertal blinding does not inhibit the tissue growth completely since even in TP-treated animals steady growth of reproductive organs occurs. Blinding of TP-treated adult rats induces involution of seminal vesicles and prostate although it has no effect on testis weight. The weight of testes can thus be influenced by light deprivation only during its growth in maturing animals, whereas the weights of seminal vesicles and prostate may be affected even in adult animals.

Age Factors↗
PubMed2000

The effects of epidermal debridement of partial-thickness burns on infection and reepithelialization in swine.

OBJECTIVE: Early postburn debridement of burn blisters is controversial. This study was conducted to compare rates of infection and reepithelialization in debrided vs nondebrided second-degree burns in swine. METHODS: This was a prospective, blinded, controlled, experimental trial using isoflurane-anesthetized swine. Standardized partial-thickness burns were inflicted by applying an aluminum bar preheated to 80 degrees C to the backs and flanks of two young pigs for 20 seconds. In half of the burns the necrotic epidermis was manually debrided. All burns were randomly treated with octylcyanoacrylate spray (OCA) or dry gauze (C). Full-thickness biopsies were taken at 7, 10, and 14 days for blinded histopathologic evaluation. The primary outcomes were the proportions of infected burns at days 7 and 10 and the proportion of completely reepithelialized burns at day 14. Burns were considered infected in the presence of intradermal neutrophils containing bacteria (intraobserver agreement, K = 1.00). A secondary outcome was the proportion of burns with the presence of scar tissue (abnormal collagen under polarized light; intraobserver correlation, K = 0.93). Chi-square tests were used for group comparisons. This study had 90% power to detect a 40-percentage-point difference in infection rates (alpha = 0.05). RESULTS: A total of 126 biopsies from 42 burns were available for review. Infection rates were higher in the debrided burns both at day 7 (55% vs 4.5%, p < 0.001) and at day 10 (65% vs 9%, p < 0.001) after injury. The proportion of nondebrided burns that were completely reepithelialized was higher at days 10 (68% vs 0%, p < 0.001) and 14 (100% vs 65%, p = 0.003). The presence of scar tissue was more common in debrided burns (75% vs 4.5%, p < 0.001). Burns treated with OCA had fewer infections than controls (4% vs 55%, p < 0.001). Fewer OCA-treated debrided burns were reepithelialized at 14 days than those that were not debrided (30% vs 100%, p = 0.001). CONCLUSIONS: Under the current study conditions, early postburn epidermal debridement of second-degree burns resulted in more infections and slower reepithelialization rates in swine. The effects of early postburn epidermal debridement in humans should be explored.

Animals↗
PubMed2006

Efficacy and tolerability of paracetamol/tramadol (325 mg/37.5 mg) combination treatment compared with tramadol (50 mg) monotherapy in patients with subacute low back pain: a multicenter, randomized, double-blind, parallel-group, 10-day treatment study.

BACKGROUND: In various pain studies, the single-dose combination of paracetamol/tramadol (PIT) was found to be more effective than either agent alone. PIT could provide benefit in patients with subacute low back pain (LBP). OBJECTIVE: This study compared the efficacy and tolerability of PIT with tramadol alone (T) in patients with subacute LBP and assessed whether, under comparable analgesic conditions, PIT would be better tolerated. METHODS: This was a multicenter, randomized, double-blind, parallel-group study. Patients were enrolled if they suffered from nonspecific LBP lasting 10 to 42 days and experienced at least moderate pain (> or =40 mm on a 100-mm visual analog scale). Patients were randomized and treated for 10 days with PIT (325 mg/37.5 mg) or T (50 mg). The study outcomes were treatment efficacy (pain intensity, pain relief, patient satisfaction, physicians' assessment of pain control) and tolerability (adverse events [AEs], patients' tolerability judgment). RESULTS: A total of 119 patients were enrolled (PIT, n = 59; T, n = 60). Demographic characteristics of patients were comparable between the PIT and T groups in regard to age (mean, 56.5 vs 54.1 years, respectively), sex (women/men, 38121 vs 31129), race (white, 96.1% vs 94.2%), and body mass index (24.9 vs 26.1 kg/m2). Pain intensity (mean [SD] percentage of worst imaginable pain) improved from nearly identical levels at baseline (P/T, 67.5 [13.0] vs T, 65.3 [14.6]; P = NS) to similarly low levels at the final visit (P/T, 27.9 [22.7] vs T, 24.8 [21.6]; P = NS). The reduction in pain intensity was significant in both treatment groups (P < 0.001). Adequate pain relief (ie, "moderate," "important," or "complete") was observed in 81.6% (40149) of PIT patients versus 82.9% (39147) of T patients (P = NS). Comparably high rates of overall patient satisfaction (72.5% [37151] vs 72.9% [35148], respectively; P = NS) were achieved. Both treatment groups took a comparable number of daily units of study medication, which resulted in significantly (P < 0.001) lower daily doses of tramadol in the P/T group (mean [SD], 172.5 [46.6] mg) than in the T group (227.3 [59.7] mg). More P/T patients (84.3%) than T patients (68.8%) judged treatment tolerability as good or very good (P = NS). Significantly fewer AEs (P < 0.001) were observed in PIT patients, and the overall incidence of AEs (mostly opioid-typical AEs [eg, nausea, dizziness/vertigo, sleepiness/drowsiness, constipation, vomiting]) was much lower after P/T compared with T (P = 0.019). The most common AEs in the P/T and T groups were nausea (8159 vs 21160 patients, respectively; P = 0.012) and dizziness (3/59 vs 15/60 patients; P= 0.006). CONCLUSIONS: Tramadol, alone and in combination with paracetamol, provided highly effective analgesia for these patients with subacute LSP However, the combination of PIT, which resulted in 25% less tramadol than equianalgesic daily doses of T alone, considerably reduced the incidence of AEs and improved tolerability.

Acetaminophen↗
PubMed1986

Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. A 90-day multi-center study.

The short- and long-term efficacy and safety of an inhaled quaternary ammonium anticholinergic agent, ipratropium bromide, and a beta agonist aerosol, metaproterenol, were compared in 261 nonatopic patients with chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, 90-day, parallel-group trial. On three test days-one, 45, and 90-mean peak responses for forced expiratory volume in one second and forced vital capacity and mean area under the time-response curve were higher for ipratropium than for metaproterenol. Clinical improvement was noted in both treatment groups, especially during the first treatment month, with persistence of improvement throughout the remainder of the study. Side effects were relatively infrequent and generally mild; tremor, a complication of beta agonists, was not reported by any subject receiving ipratropium. These results support the effectiveness and safety of long-term treatment with inhaled ipratropium in COPD.

Adult↗
PubMed2000

Octylcyanoacrylate versus polyurethane for treatment of burns in swine: a randomized trial.

In order to determine whether the enhanced reepithelialization of second-degree burns treated with octylcyanoacrylate (OCA) was due to its occlusive nature we compared reepithelialization (REP) and infection rates of second degree burns treated with OCA and polyurethane film (Tegaderm) in swine. Forty-four standardized partial thickness burns were created by applying an aluminum bar preheated to 80 degrees C to the backs of pigs for 20 s and randomly treated with OCA or Tegaderm. Full thickness biopsies were taken at 7, 10 and 14 days for blinded histopathological evaluation of rates of infection and reepithelialization. T-tests and chi(2) tests were used for group comparisons. There were no between group difference in the rates of reepithelialization and infection. All wounds were reepithelialized by day 14 and there were no infections in either group. We conclude that treatment of partial thickness burns with OCA spray or Tegaderm results in similar rates of reepithelialization and infection, suggesting that the beneficial effects of OCA on reepithelialization are due to its occlusive nature.

Animals↗
PubMed1999

Octylcyanoacrylate for the treatment of partial-thickness burns in swine: a randomized, controlled experiment.

OBJECTIVE: To compare re-epithelialization rates of superficial partial-thickness burns treated with octylcyanoacrylate (OCA), silver sulfadiazine (SSD), and dry gauze (controls) in swine. METHODS: This was a prospective, longitudinal, blinded, controlled, experimental trial using anesthetized swine. Sixty-three standardized burns were created by applying an aluminum bar preheated to 80 degrees C for 20 seconds to the flanks of four young pigs. Three equal sets of 21 burns were randomly treated with OCA spray, SSD, or dry gauze (controls). Full-thickness biopsies were taken after 30 minutes and at seven and 14 days for blinded histopathologic evaluation by two dermatopathologists using hematoxylin and eosin staining. The percent of wound re-epithelialization was measured at days 7 and 14, calculated by dividing the length of the regenerated epidermis by the measured width of the biopsy. Analysis of variance (ANOVA) and repeated-measures ANOVA controlling for the individual pig were used for comparisons among groups. This study had 80% power to demonstrate a large between-group difference in percent re-epithelization (alpha = 0.05). RESULTS: There were 63 burns and 126 biopsies. Ten biopsies were excluded for technical reasons. At seven days, there was a significant between-group difference in percent re-epithelialization. Percent re-epithelialization was greatest in the OCA group (65.0%), followed by the SSD group (37.6%), and lowest in the control group (8.8%). At 14 days, all wounds demonstrated near complete re-epithelialization and there was no significant difference in the percent of re-epithelialization among the groups. There was only one wound infection in the OCA group. CONCLUSIONS: Under these study conditions, treatment of partial-thickness burns with OCA spray resulted in a higher percent of re-epithelialization at seven but not 14 days when compared with both SSD and control, with no significant increase in infection rates. Future studies should evaluate the use of OCA for the treatment of burns in humans.

Analysis of Variance↗
PubMed2006

Cerebral embolic ischemia in rats: correlation of stroke severity and functional deficit as important outcome parameter.

The embolic MCA occlusion model in rats is used for recanalisation studies in acute stroke. In addition to the determination of lesion size, the assessment of functional outcome may improve the value of this model. Male Wistar rats were submitted to MCA clot embolism or sham surgery. In order to achieve a larger variety of lesion volume, 2 subgroups (each 7 animals) were subjected to differently sized emboli (30 and 40 mm). Follow-up period was 6 days. Outcome assessment consisted of a test battery including parallel bar crossing, observation of behaviour in an open field and an 8-arm maze and a neurological score with ten different sensorimotor and coordinative items. Animals were perfusion-fixed on day 7 (blinded examination). For both subgroups, there were significant impairments with regard to performance on the Neuro score, parallel bar crossing and maze exploration. Improvement was only partial during the follow-up period. On follow-up day 6, there was still a significant correlation between total infarct volume and functional outcome on the Neuro score (R=0.80, p=0.0006) and the exploration behaviour in the maze (R=0.66, p=0.01). Application of emboli with a length of 40 mm caused more functional impairment and a more extended lesion volume compared with 30 mm. We present outcome tests that provide quantitative and objective tools to test functional impairment in rats following embolic stroke.

Analysis of Variance↗
PubMed2000

Octylcyanoacrylate for the treatment of contaminated partial-thickness burns in swine: a randomized controlled experiment.

OBJECTIVE: To compare infection and reepithelialization rates of contaminated second-degree burns treated with octylcyanoacrylate (OCA), silver sulfadiazine (SSD), polyurethane (PU) film, and dry gauze (control; C) in swine. METHODS: Eighty standardized burns were created by applying an aluminum bar preheated to 80 degrees C to the backs and flanks of young pigs for 20 seconds. All burns were immediately contaminated with 0.1 mL of Staphylococcus aureus 10(5)/mL and randomly treated with OCA spray, SSD, PU, or dry gauze (C). Full-thickness biopsies were taken at 3, 7, and 14 days for blinded histopathologic evaluation using hematoxylin and eosin (H&E)-stained slides. Burns were considered infected in the presence of interstitial reticular dermal neutrophils containing bacteria (intraobserver agreement, kappa = 1.00). Quantitative wound cultures were performed on a second day-3 specimen. RESULTS: At day 3, wound infection rates were 30% (OCA), 50% (SSD), 55% (PU), and 50% (C); p = 0.40 (Kruskal-Wallis test). At day 7, infection rates were 35% (OCA), 85% (SSD), 70% (PU), and 65% (C); p = 0.01. Median bacterial counts at day 3 were 6,500 (OCA), 20,000 (SSD), 1,000,000 (PU), and 650,000 (C); p = 0.29. The proportion of completely reepithelialized wounds at day 14 were 75% (OCA), 90% (SSD), 85% (PU), and 90% (C); p = 0.50. CONCLUSIONS: Treatment of contaminated partial-thickness burns with OCA spray resulted in fewer infections at one week than with the other three treatments.

Animals↗
PubMed2005

Histologic effects of laser-assisted topical anesthesia in a porcine model.

OBJECTIVES: A handheld laser device that removes the stratum corneum, the major barrier to transdermal absorption, has recently been approved to assist with topical anesthesia before painful procedures such as intravenous cannulation. The authors assessed the cutaneous histomorphologic effects of the laser device and the ability of the laser-treated skin to resist infection in a porcine model. METHODS: This was a blinded, randomized animal experiment using isoflurane-anesthetized young domestic pigs. The ventral surface of the animals was irradiated multiple times with a lightweight, portable erbium yttrium-aluminum-garnet unit or a sham laser. One third of the wounds were inoculated with a Staphylococcus aureus suspension. The treated areas were then covered with a dry dressing, and full-thickness biopsy specimens of the treated areas were obtained immediately after treatment and at three, seven, ten, and 14 days for blinded histopathologic evaluation using hematoxylin and eosin staining and electron microscopy. Quantitative bacterial counts were obtained at three days in wounds exposed to bacteria. Main outcomes were quantitative bacterial counts, presence of cellular necrosis, epidermal integrity, and dermal scarring. Data analysis was conducted with descriptive statistics. RESULTS: Laser irradiation resulted in immediate disruption of the cornified layer of the skin and necrosis of the stratum spinosum in all treated areas. There were also focal areas of vacuolar alteration of the basal one third of the epidermis. There was no evidence of any damage to the basement membrane or the underlying dermis. At three days, the epidermis had healed and there was evidence of epidermal hyperplasia and hyperkeratosis that was completely resolved by 14 days. There were no infections and no scarring. Sham laser had no histomorphologic effects on the skin. There was no bacterial growth from all sham laser-treated wounds challenged with bacteria. Three of 20 (15%; 95% confidence interval = 0% to 31%) laser-irradiated wounds that were challenged with bacteria grew between 280,000 and 1,600,000 colony-forming units/g. CONCLUSIONS: Laser irradiation results in ablation of the stratum corneum and a superficial burn to the epidermis that heals by three to 14 days without any scarring or infection in pigs. Challenging laser-irradiated cutaneous wounds with a large bacterial inoculum resulted in bacterial growth in a minority of wounds.

Administration, Topical↗
PubMed1991

Quadriplegia prolonged unconsciousness and transient blindness after eclampsia--case report.

In eclampsia neurological complications carry a high maternal mortality and morbidity. The case of an unbooked 15-year-old primiparous teenager who presented in shock, unconscious, quadriplegic and transiently blind one day after home delivery is reported. Co-operative inter-departmental management was undertaken and the patient was discharged, satisfactorily recovered.

Adolescent↗
PubMed1980

Acute ischemic optic neuropathy in severe preeclampsia.

A 32-year-old woman developed bilateral blindness along with severe preeclampsia of pregnancy. Ophthalmoscopic examination disclosed chalky-white optic disks with only minimal changes in the retinal vasculature. After caesarean section, the preeclampsia improved, and complete return of visual acuity occurred during a three-day period. Blindness has rarely been reported as a complication of preeclampsia. In almost all cases it has been associated with severe compromise of the retinal vasculature. conversely, the ophthalmoscopic findings in our case strongly support acute ischemic optic neuropathy as the cause of blindness.

Adult↗
PubMed1996

Persistence of circadian oscillation while locomotor activity and plasma melatonin levels became aperiodic under prolonged continuous light in the rat.

In order to examine the mechanism for a loss of circadian rhythms in several functions under prolonged continuous light (LL), rats were blinded following LL over 5 months, and the mode of reappearance of circadian rhythms were analyzed in locomotor activity and plasma melatonin levels. Locomotor activity and plasma melatonin levels in individual rats became aperiodic after the exposure to LL. On the day of blinding, plasma melatonin levels showed circadian rhythms having a peak coincided with the activity time of locomotor rhythm which was restored after blinding. The time of melatonin peak was not related to the time of blinding (onset of darkness) nor to the initial time of blood sampling. Circadian rhythm in plasma melatonin levels reappeared faster than those in locomotor activity. The findings suggest that aperiodism developed in these functions under prolonged LL is not due to disruption of the circadian oscillation but to uncoupling of overt functions from the circadian pacemaker.

Animals↗
PubMed1995

A placebo controlled clinical trial of buprenorphine as a treatment for opioid dependence.

Large-scale placebo controlled clinical trials assessing the efficacy of medications for the treatment of drug dependence have generally been limited to alcohol, cocaine and nicotine dependent populations. The purpose of the present study was to assess the early (1-2 week) clinical effectiveness of buprenorphine versus placebo in an opioid dependent population. The study used a parallel-group design with a behavioral choice component to compare buprenorphine (a mu-opioid partial agonist) to placebo for the treatment of opioid dependence. Opioid dependent volunteer patients participated in a 14-day study to assess the effectiveness and patient acceptance of this new pharmacotherapy for the treatment of opioid dependence. Patients were randomly assigned to placebo (n = 60) or 2 mg (n = 60) or 8 mg (n = 30) daily sublingual buprenorphine. All doses were administered double-blind. On days 6-13 all patients could request a dose change, knowing that their new dose would be randomly chosen from the remaining 2 alternatives. Compared to placebo, patients given buprenorphine (independent of dose) showed greater time on initial dose, requested fewer dose changes, used less illicit opioids (assessed by urinalysis), and rated dose adequacy higher. These results demonstrate that a placebo controlled study with a behavioral choice component is an effective means of assessing the potential efficacy and acceptability of new pharmacotherapies for opioid dependence.

Administration, Sublingual↗
PubMed2003

Randomized double-blind study comparing 3- and 6-day regimens of azithromycin with a 10-day amoxicillin-clavulanate regimen for treatment of acute bacterial sinusitis.

A randomized, double-blind, multicenter study of adults with acute bacterial sinusitis (ABS) compared the efficacy and safety of two azithromycin (AZM) regimens, 500 mg/day once daily for 3 days (AZM-3) or 6 days (AZM-6) to the efficacy and safety of an amoxicillin-clavulanate (AMC) regimen of 500-125 mg three times daily for 10 days. A total of 936 subjects with clinically and radiologically documented ABS were treated (AZM-3, 312; AZM-6, 311; AMC, 313). Clinical success rates were equivalent among per-protocol subjects at the end of therapy (AZM-3, 88.8%; AZM-6, 89.3%; AMC, 84.9%) and at the end of the study (AZM-3, 71.7%; AZM-6, 73.4%; AMC, 71.3%). Subjects treated with AMC reported a higher incidence of treatment-related adverse events (AE) (51.1%) than AZM-3 (31.1%, P < 0.001) or AZM-6 (37.6%, P < 0.001). More AMC subjects discontinued the study (n = 28) than AZM-3 (n = 7) and AZM-6 (n = 11) subjects. Diarrhea was the most frequent treatment-related AE. AZM-3 and AZM-6 were each equivalent in efficacy and better tolerated than AMC for ABS.

Acute Disease↗
PubMed2005

Continuous passive motion improves shoulder joint integrity following stroke.

OBJECTIVE: In a pilot study of patients with a first stroke and hemiparesis, we sought to determine whether treatment of the upper limb with continuous passive motion (CPM) that was device delivered would alter impairment, disability or the associated adverse symptoms of shoulder joint instability, pain and tone. DESIGN: Patients were randomly assigned to receive daily CPM treatments or participate in self-range of motion groups under the supervision of an occupational therapist. All patients received standard daily poststroke therapy for 3.5 h per day. A blinded evaluator at admission and discharge assessed patients using standardized scales of impairment, disability and adverse symptoms. SETTING: Specialized stroke unit of an acute rehabilitation hospital. SUBJECTS: Two hundred and eighty consecutive patients were screened and 35 of these with a first unilateral stroke, 13 +/- 6 days following the acute event, provided informed consent and were randomly assigned to CPM treatment or supervised group self-range exercise. MAIN MEASURES: Thirty-two completed the study and were evaluated using standardized measures for motor impairment (Fugl-Meyer, Motor Status Scale and Medical Research Council Motor Power), adverse symptoms (gleno-humeral stability, pain and tone), and disability (Functional Independence Measure). RESULTS: CPM-treated patients demonstrated positive trends towards improved shoulder joint stability (p = 0.06, confidence interval -0.03, 2.3) when compared with patients performing therapist-supervised self-range of motion. There were no significant differences in motor impairment, disability, pain or tone. CONCLUSIONS: Device-delivered continuous passive range of motion may offer an enhanced benefit for some adverse symptom reduction in the hemiplegic arm after stroke over traditional self-range of motion exercise.

Aged↗
PubMed1992

Reactivation of unstable angina after the discontinuation of heparin.

BACKGROUND: Heparin is an effective, widely used treatment for unstable angina. Among patients enrolled in a double-blind, randomized, placebo-controlled trial comparing intravenous heparin, aspirin, both treatments, and neither during the acute phase of unstable angina, we encountered patients in whom unstable angina was reactivated after heparin was discontinued. METHODS: The study population included 403 of the original 479 patients in the trial who had completed six days of blinded therapy without refractory angina or myocardial infarction. After the discontinuation of therapy, clinical events, including reactivation of unstable angina and myocardial infarction occurring within 96 hours after hospitalization, were closely monitored. RESULTS: Early reactivation occurred in 14 of the 107 patients who received heparin alone, as compared with only 5 patients in each of the other three study groups (P less than 0.01). These reactivations required urgent intervention (thrombolysis, angioplasty, or coronary-bypass surgery) in 11 patients treated with heparin alone, but in only 2 patients in the other groups combined (P less than 0.01). Four of the six patients who had a myocardial infarction during a reactivation of their disease were in the heparin group. Reactivations in this group occurred in a cluster a mean (+/- SD) of 9.5 +/- 5 hours after the discontinuation of the study drug but were randomly distributed over the initial 96 hours in the other three groups. CONCLUSIONS: Although heparin is beneficial in treating unstable angina, the disease process may be reactivated within hours of the discontinuation of this drug. Concomitant therapy with aspirin may prevent this withdrawal phenomenon.

Acute Disease↗