To study the possible risk factors for cardiovascular disease, we collected data on plasma levels of coagulation factors, blood pressure, serum cholesterol, and smoking in a random sample of 792 men 54 years of age. During 13.5 years of follow-up, myocardial infarction occurred in 92 men, stroke in 37, and death from causes other than myocardial infarction or stroke in 60. The blood pressure, degree of smoking, serum cholesterol, and fibrinogen level measured at the base-line examination proved to be significant risk factors for infarction by univariate analyses during follow-up, and blood pressure and fibrinogen were risk factors for stroke. Fibrinogen and smoking were strongly related to each other. The relation between fibrinogen and infarction, and between fibrinogen and stroke, became weaker when blood pressure, serum cholesterol, and smoking habits were taken into account, but was still significant for stroke. Although causality cannot be inferred from these data, it is possible that the fibrinogen level plays an important part in the development of stroke and myocardial infarction.

Fibrinogen as a Risk Factor for Stroke and Myocardial Infarction

The primary function of the corpus luteum is secretion of the hormone progesterone, which is required for maintenance of normal pregnancy in mammals. The corpus luteum develops from residual follic...

https://www.physiology.org/doi/pdf/10.1152/physrev.2000.80.1.1

Mechanisms Controlling the Function and Life Span of the Corpus Luteum

• To determine the predictive value of the IgG anticardiolipin antibody (ACA) test for thrombosis, recurrent fetal loss, and thrombocytopenia, the clinical features of 121 patients with varying antibody levels were studied. When patients were grouped into high-positive, low-positive, and normal groups according to their ACA levels, there were strong statistical correlations with arterial thrombosis, venous thrombosis, fetal loss, thrombocytopenia, and a positive Coombs' test. At levels of 7 SD and above, the test was highly specific (>80%) and predictive (>70%) for thrombosis, thrombocytopenia, and recurrent fetal loss. This study suggests that the IgG ACA test may be a useful predictor for thrombosis, recurrent fetal loss, and thrombocytopenia in patients with autoimmune disorders. ( Arch Intern Med 1986;146:2153-2156)

Thrombosis, Recurrent Fetal Loss, and Thrombocytopenia: Predictive Value of the Anticardiolipin Antibody Test

We identified eight patients with the lupus anticoagulant (an autoantibody acquired by some patients with systemic lupus erythematosus), by observation of an increased activated partial thromboplastin time and abnormal results on a tissue thromboplastin-inhibition test. The patients had experienced a total of 30 spontaneous abortions and fetal deaths in 31 previous pregnancies (96.8 per cent). During their next pregnancy, the patients were treated with 40 to 50 mg of prednisone per day and 81 mg of aspirin per day. The therapy shortened their activated partial thromboplastin times, produced normal values for tissue thromboplastin inhibition, and reduced the rate of pregnancy loss to 37.5 per cent. However, preeclampsia developed in the five patients who gave birth to live infants, and fetal growth retardation occurred in three cases. The corticosteroid and low-dose aspirin regimen appears to improve perinatal outcome in cases in which the mother has the lupus anticoagulant, but such practices as careful fetal surveillance and preterm delivery when appropriate are also important to successful obstetric management of such cases.

Obstetric complications associated with the lupus anticoagulant.

Summary
The clinical value of assessing degree of alcohol dependence is discussed in relation to goals of treatment. Further information is then provided on the use, reliability and validity of an instrument designed for this purpose -the SADQ. ‘Norms’ for SADQ scores from three samples of problem drinkers are given. Data indicating that individual items, sections and also the total scores of the SADQ have consistently high test-retest reliability coefficients are presented. A study is described in which a degree of construct validity is established by relating SADQ scores to one important component of the alcohol dependence syndrome [2]-narrowing of drinking repertoire. In addition, it is shown that SADQ scores have low, but significant, correlations with indicators of withdrawal severity for individuals treated at a Detoxification Unit. SADQ scores failed to correlate with indices of liver functioning. These results are discussed and it is concluded the SADQ is a quick, reliable and valid instrument.

The severity of alcohol dependence questionnaire: its use, reliability and validity.

Investigation and treatment of amenorrhœa developing after treatment with oral contraceptives

Efficacy of mefenamic acid in patients with a complaint of menorrhagia.

PIP: Marked rises in both unconjugated and sulphoconjugated estrone, estradiol-17-beta and estriol were observed in human fetal plasma between midgestation and term. Significant arterio-venous differences were found in the umbilical cord plasma. No consistent arterio-venous differences were found in the umbilical cord plasma. This indicates that all 3 estrogens are secreted from the placenta into the fetal circulation in the unconjugated form. Mean unconjugated estrogen (estrone + estradiol-17-beta + estriol) levels rose from 22.7 ng/ml at 17-20 weeks of gestation to 108.9 ng/ml at term in umbilical venous plasma and from 4.3 ng/ml to 23.3 ng/ml in umbilical arterial plasma. This represents a secretion rate of approximately 30 mg estrogen/day into the umbilical vein at term. Mean estrogen sulphate levels rose from 128 ng/ml to 313 ng/ml in the cord plasma during the same period. Of the 3 estrogens measured, estriol was quantitatively the major estrogen in fetal plasma. It consistently represented about 78% of the unconjugated fraction and 95% of the sulphate fraction at all stages of gestation. The method of delivery did not have a significant effect on the estrogen levels in uncomplicated pregnancies. Similar estrogen levels were found in fetal heart blood after either hysterotomy at spontaneous abortion at 16-20 weeks of gestation, and no significant differences were found for estrogen levels in cord plasma after elective Caesarean section at 38-39 weeks when compared with estrogen levels after normal delivery at term. A significant rise in fetal unconjugated estrogens at a time when fetal corticosteroids are increasing may be of physiological importance for fetal maturation in women.

R.P. Shearman

Papers

Investigation and treatment of amenorrhœa developing after treatment with oral contraceptives

Efficacy of mefenamic acid in patients with a complaint of menorrhagia.

Oestrone, oestradiol-17beta and oestriol levels in human foetal plasma during gestation and at term.

Prolonged secondary amenorrhoea after oral contraceptive therapy. Natural and unnatural history.

Amenorrhœa after treatment with oral contraceptives