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The case report of a 46-year-old woman diagnosed with complete aortic coarctation and multiple intercostal artery aneurysms using 'ultrafast time-resolved' multiphase contrast-enhanced magnetic resonance angiography and conventional single-phase, high-resolution breath-hold contrast-enhanced magnetic resonance angiogram techniques is presented. A review of intercoastal artery aneurysms occurring in conjunction with aortic coarctation and the various contrast-enhanced magnetic resonance angiography techniques currently available is provided.

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A case of fatal spontaneous gas gangrene due to Clostridium septicum septicaemia associated with an occult rectal malignancy is presented. This condition has a rapid progression and a high mortality even with prompt treatment. It is important that the radiologist considers this diagnosis in an appropriate clinical setting to allow rapid instigation of appropriate therapy.

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This open controlled study compared the effects of subcutaneous administration of two types of heparin in two groups of 40 patients each with deep vein thrombosis. One group received calcium heparin and the other received low molecular weight heparin for 40 days in each case. Patients receiving low molecular weight heparin showed a greater increase in inhibition of activated factor X than those receiving calcium heparin. Both drugs slightly reduced activated partial thromboplastin time. No patient experienced pulmonary embolism during the study. At the end of the study, maximum venous outflow was significantly higher in patients given low molecular weight heparin than in those given calcium heparin. No major side-effects were observed. This study showed that: (a) the anti-thrombotic effect of low molecular weight heparin was greater than for calcium heparin; and (b) low molecular weight heparin improved maximum venous outflow in approximately half of the patients, possibly by promoting or accelerating recanalization of the vessel.

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A multicentric study was carried out involving six italian departments of general surgery to assess the efficacy of a low molecular weight (LMW) heparin called Fluxum compared to standard calcium heparin in low doses for prevention of postoperative thromboembolic complications (deep vein thrombosis and pulmonary embolism). 610 patients were treated; 308 (50.5%) of whom were treated with Fluxum at doses of 4,000 or 8,000 I.U. Axa once a day by subcutaneous injection and 302 (49.5%) with heparin calcium at doses of 5,000 I.U. two or three times a day by subcutaneous injection. We observed a total of 29 deep vein thrombosis (4.7%); 10 (3.2%) from the group treated with LMW heparin and 19 (6.3%) from the comparative group. During the study 4 (0.65%) pulmonary embolism were found, 1 (0.32%) in the group treated with LMW heparin and 3 (1%) in the group treated with calcium heparin. None serious hemorrhagic accident was reported during the study. The antithrombotic prophy laxis carried out with Fluxum was on the whole better tolerated than the treatment of the other group, registering a lower frequency of hematomas at the injection and surgical wound sites.

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The effectiveness of two different heparin types in preventing deep vein thrombosis after surgery was studied in 173 patients, randomly assigned to treatment by a new low molecular weight (LMWH) heparin or trade calcium heparin (CH). Both drugs were administered subcutaneously, 2 h before surgery and for 7 days after, at dose of 7,500 anti activated factor X Units once a day in low molecular weight heparin group, or 5,000 International Units t.i.d. in calcium heparin group. Both activated factor X inhibition and activated partial thromboplastin time evaluations were performed before the surgery, and 3 and 7 days after, to monitor drug effects. Results clearly demonstrated that low molecular weight heparin exerts a marked inhibition on plasma activated factor X. On the contrary, calcium heparin was less powerful in inhibiting this coagulation factor. Both drugs revealed a lower effectiveness in increasing activated partial thromboplastin time. Efficacy in preventing postoperative thrombo-embolism appeared about 3 times higher for the new low molecular weight heparin, despite the lower daily administration numbers. No major side effects related to drug were observed in both treatment groups; also hemorrhage frequency was the same. No differences related to the operation type were found in preventive actions of both drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

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Thirty healthy volunteers underwent a pharmacokinetic study to control the effect of calcium heparin and low-molecular-weight heparin on coagulation factors. Activated partial thromboplastin time (aPTT), thrombin time (TT) and inhibition of activated factor X (Xa) were checked after a single subcutaneous administration of calcium heparin, 5000 IU (CH group); low-molecular-weight heparin 7500 AXaU (LMWH-LD group); and LMW heparin, 15,000 AXaU (LMWH-MD group). The mean values of aPTT rose significantly only after administration of LMW heparin (15,000 AXaU), while no relevant variations were observed after CH and LMWH-LD administration. The effects on TT were also very small and not relevant to an anticoagulant response. The Xa inhibitory effect exerted by the two LMW heparin doses proved substantially higher and longer-lasting than the effect of unfractioned heparin. A statistically significant Xa inhibition was still present 24 h after LMWH-MD administration and 16-20 h after LMWH-LD administration, while 6 h after CH administration no effect was detectable. The laboratory results confirm the marked antithrombophylic action, without relevant anticoagulant effects, already attributed by other authors to the new LMW heparin under study.

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