We compared the efficacy and complications of anticoagulation with warfarin in 258 patients with prosthetic heart valves treated with regimens of "moderate intensity" (prothrombin-time ratio, 1.5; international normalized ratio, 2.65) or "high intensity" (prothrombin-time ratio, 2.5; international normalized ratio, 9) in a prospective, randomized study. The two patient groups were followed up for 421 patient-years and 436 patient-years, respectively. Eleven patients were lost to follow-up. Thromboembolism occurred with similar frequency in the two groups (4.0 and 3.7 episodes per 100 patient-years, respectively), but there was a total of 6.2 bleeding episodes per 100 patient-years in the moderate-intensity group, as compared with 12.1 episodes in the high-intensity group (P less than 0.002). There were 5.2 episodes of minor bleeding per 100 patient-years in the moderate-intensity group, as compared with 10.1 episodes in the high-intensity group (P less than 0.01). Major bleeding was also more common in the high-intensity group (2.1 episodes per 100 patient-years--including the only two fatal hemorrhages--as compared with 0.95 episode in the moderate-intensity group), but the difference was not statistically significant. We conclude that a moderate anticoagulant effect (prothrombin-time ratio, about 1.5) in patients with a mechanical prosthetic heart valve offers protection equivalent to that of more intensive therapy, but at a significantly lower risk.

No abstract

An 18-year-old man presented with a history of oral sores and presence of high fever, scrotal ulcerations and haemoptysis. Multiple mural cardiac masses were present in the right atrium, right ventricle and left ventricle. Furthermore, pulmonary vasculitis with aneurysm formation and venous thrombosis involving the superior sagittal sinus and right transverse sinus were found, and the diagnosis was made of (incomplete) Behçet's disease. While receiving anticoagulation and later, treatment with prednisone and cyclophosphamide, the cardiac thrombi gradually disappeared. We stress the importance of early echocardiography to evaluate cardiac abnormalities in Behçet's disease.

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Scand J Rheumatol Downloaded from informahealthcare.com by Thomas Jefferson University on 12/26/14 For personal use only. Scand J Rheumatol Downloaded from informahealthcare.com by Thomas Jefferson University on 12/26/14 For personal use only.

Between 1981 and 1985, a total of 289 patients were seen at our anticoagulation clinic. Two hundred and fortyseven received long-term oral anticoagulation therapy because of a cardiac condition, 42 for deep vein thrombosis with or without pulmonary embolism. While on treatment, 106 patients fasted 309 Ramadan months and 183 patients elected not to fast during 594 Ramadan months. The incidence of thromboembolic events and hemorrhagic complications in the two groups was compared and no statistically significant differences were found. We conclude that Ramadan fasting, or any other form of short-term fasting, has no adverse effects on the efficacy and safety of long-term oral anticoagulation. JN Saour, JO Sieck, M Khan, L Mammo, Does Ramadan Fasting Complicate Anticoagulation Therapy. 1989; 9(6): 538-540 It is currently estimated that more than 555 million people belong to the Muslim faith.

4 patients with prolactinomas and visual field defects are presented. 2 were treated with bromocriptine alone; 1 patient with an 8-month history of visual disturbance had complete recovery of visual fields after 2 weeks and an acute fall in serum prolactin levels. This coincided with disappearance of the suprasellar extension on computed tomography (CT) scanning. The second patient, with a 2-year history, had no visual improvement after 1 year of treatment, although CT scanning showed absence of the suprasellar extension when repeated after 3 months. 2 other patients initially had neurosurgery; 1 with a 2-year history had complete visual recovery, the other with a 1 -year history did not recover. Both needed subsequent bromocriptine treatment. In all 4 patients this drug produced a sustained fall in serum prolactin levels. We conclude that bromocriptine therapy can rapidly reduce prolactinoma tumor size and should obviate the necessity for acute neurosurgical intervention in carefully selected patients.

24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5–40 mg bromocriptine daily for 13–252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.