Objective-To review the obstetric and gynaecological problems in women with congenital coagulopathics. Design-Retrospective rcview.

Summary and conclusions Blood viscosity (shear rate 100/s) and its major determinants (packed cell volume, plasma fibrinogen concentration, and plasma viscosity) were measured before coronary angiography in 50 men aged 30-55 and related to the extent of coronary artery disease. Twenty-six men had extensive disease (stenosis of two or three major coronary vessels), and 24 had either stenosis of one vessel or no stenosis. The 26 men with extensive disease had significantly higher mean blood viscosity than those with mild or no disease and 25 healthy controls (p <0 001). The increased viscosity was due partly to a higher packed cell volume and partly to a higher fibrinogen concentration; plasma viscosity was not significantly increased. These differences could not be explained by smoking history.These results suggest an association between increased blood viscosity and extensive coronary artery disease in men, which merits further investigation.

No abstract

SummaryIncreased plasma levels of β-thromboglobulin (βTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in normal women, women taking oral contraceptives, normal pregnancy and pregnant women with hypertension or pre-eclampsia. No significant increases in βTG or FPA were found in women taking oral contraceptives. Significantly increased concentrations of βTG, but not FPA, were found in normal pregnant women in the second and third trimester of pregnancy when compared with nonpregnant age-matched controls. In eleven women with pregnancy hypertension and thirteen women with pre-eclampsia significantly elevated levels of both βTG and FPA were found when compared with age, parity and gestation-matched pregnant controls. Although the mean value for both βTG and FPA in the group with pre-eclampsia was higher than the group with pregnancy hypertension, the difference was not statistically significant. These findings provide additional evidence that pre-eclampsia and pregnancy hypertension are associated with activation of the coagulation system and the platelet release reaction.

We failed to find a record ofintra-abdominal granuloma annulare lesions, and this case apyars to be the first of visceral granuloma annulare. The relation -tveen diabetes mellitus and generalised granuloma annulare has been a subject of speculation for years but remains unclear. Haim et al reported 13 patients with generalised granuloma annulare, three of whom had overt mild non-insulin dependent diabetes and seven others carbohydrate intolerance after provocative oral prednisolone.3 Other studies, however, have not confirmed this observation. A more recent report has suggested an association between granuloma annulare and insulin dependent diabetes.4 The relation between diabetes and granuloma annulare is made more complex by the histological appearance of necrobiosis lipoidica diabeticorum, granuloma annulare, and rheumatoid nodules. Each ofthese conditions includes collagen necrobiosis, and all three variants have been seen in a patient who had insulin dependent diabetes and a sister with rheumatoid arthritis.5 The histological similarities among these conditions are so great that they may share the same or a very similar pathogenesis. Immune complex deposition seems the most probable common pathway.Finally, in our patient there appeared to be a relation between diabetic control and the granuloma annulare. Poor diabetic control was associated with an exacerbation of the lesion, which in turn resulted in excessive working of the ileostomy, which was evident whatever the cause of his poor diabetic control. Biopsy sections of the skin and mesenteric nodes showed several discrete foci of connective tissue necrosis in the dermis and subcutaneous fat. The zones of necrosis were surrounded by histiocytes showing well marked palisading (figure). The histiocyte reaction was not strikingly tuberculoid. There were no giant cells, and no evidence of arteritis was detected. The cell mediated immune response was evaluated in vivo in 29 patients.twith clinically severe haemophilia by means of the dinitrochlorobenzene skin test. All patients had a response below the median normal value, and in 19.the response was on or below the lower limit of the normal range. There was no difference in skin response between patients positive and negative for the human immunodeficiency virus (HIV; formerly known as human T cell lymphotropic virus Im or lymphadenopathy associated virus). In tbe whole group, and in seronegative patients (n= 17), there was aan inverse relation between exposure to clotting factor and skin response. In seropositive patients (n= 12) no such association was apparent.This study shows that clotting factor concentrate impairs the cell mediated immune response to a new antigen in the absence of infection with HIV.