Morphometry of the Proximal End of Dry Adult Human Femora from the East African Population: A Cross-Section Study

Introduction: Proximal femur morphometry is important in the stability of the hip joint, the design of implants for hip replacement and forensic identification of unknown human remains. This study aimed at determining the proximal femur morphometry and factors associated with their variation. Materials and Methods: This was a cross-sectional study of the proximal end of 333 dry human femora from persons aged 20 to 75 years from the East African population. All the femora were observed macroscopically for the presence of the third trochanter, and the age, sex and nationality documented. The femoral head and neck circumferences were measured using a tape measure and the neck-shaft angle and the angle of anteversion measured using a goniometer. Data were entered in an Excel sheet and exported to STATA 14 for analysis. Univariate, bivariate and multivariable analyses were performed. A p-value of less than 0.05 was considered statistically significant. Results: Of the 333 dry femora, 7.21% (24/333) had a third trochanter. The mean femoral head circumference was 134.91 ± 8.91 mm, the mean neckshaft angle was 118 ± 6 degrees, the mean angle of anteversion was 17 ± 4 degrees, the mean femoral neck circumference was 91.71 ± 7.40 mm. Statistical significance was achieved between each of the proximal femur measurements and: sex, nationality and third trochanter status. Conclusion: The morphometry of the proximal femur varies with age, sex and nationality. These variations are pertinent in the design of tailored proximal femur implants, assessing the risk of fractures, forensic practice and regional comparisons.

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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The Number and Determinants of Nutrient foramina among dry human femur bones from the East African population: A Cross-section study

International Journal of Anatomy and Research ◽

10.16965/ijar.2021.152 ◽

2021 ◽

Vol 9 (3.3) ◽

pp. 8091-8096

Author(s):

Gerald Tumusiime ◽

◽

Gonzaga Gonza Kirum ◽

John Kukiriza ◽

◽

...

Keyword(s):

Cross Section ◽

African Population ◽

P Value ◽

Morphometric Characteristics ◽

East African ◽

Makerere University ◽

Human Femur ◽

Section Study ◽

Nutrient Foramina ◽

Portal Of Entry

Background: Nutrient foramina form important landmarks on the femur and other bones as the portal of entry for nutrient arteries. Nutrient arteries are important sources of blood supply for growing bones; and their variations may be due to congenital or acquired causes. These variations are important in anatomical comparisons, orthopaedic surgical practice and forensic medicine. Aims: This study aimed at establishing the number and determinants of the nutrient foramina among dry human femur bones from the East African population. Materials and methods: This was a cross-section study of 333 dry femur bones from the East African population, at the Galloway osteological collection of Makerere University college of health sciences. The number of nutrient foramina on the shaft of each femur, the corresponding demographic, clinical and morphometric characteristics were documented. Data were entered in an Excel sheet and exported to STATA 14 for analysis. Univariate, bivariate and multivariable analyses were performed to obtain the summary statistics and the measures of association. At all levels of analysis, a p-value of less than 0.05 was considered statistically significant. Results: Of the 333 femurs, 291 (87.4%) were from males; and 137(50.15%) were right femurs. The age ranged from 20 to 75 years with a mean age of 35 (SD± 12) years. Nutrient foramina ranged from one to four; mean of 1.4 (SD±0.5) and median of 1 (IQR: 1 to 2). Of the 333 femurs, 199 (59.8%) had one foramen, 129 (38.7%) had two foramina, four femurs had three foramina and one femur had four foramina. There was a statistically significant association between the number of nutrient foramina and the femur’s: mid-shaft circumference (p=0.014; 95%CI: 0.003 to 0.028), nationality (p=0.016; 95%CI: -0.284 to -0.030) and sex (p=0.012; 96%CI: -0.405 to -0.050). Conclusion: Nutrient foramina among femurs from the East African population range from one to four per femur, with predominantly one foramen. The key determinants of the number of foramina are: mean mid-shaft circumference, nationality and sex. These findings are significant in anatomical comparisons; forensic and orthopaedic practices. KEY WORDS: Nutrient foramina, dry human femur, East African population, morphometric characteristics.

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Pie Crust Technique of the Deep Medial Collateral Ligament in Knee Arthroscopy: Ultrasound and Anatomic Study

The Journal of Knee Surgery ◽

10.1055/s-0038-1668125 ◽

2018 ◽

Vol 32 (08) ◽

pp. 764-769

Author(s):

Guillem Claret-Garcia ◽

Jordi Montañana-Burillo ◽

Eduard Tornero-Dacasa ◽

Manel Llusá-Pérez ◽

Dragos Popescu ◽

...

Keyword(s):

Medial Collateral Ligament ◽

Statistical Significance ◽

Mean Value ◽

Saphenous Nerve ◽

Medial Compartment ◽

P Value ◽

Collateral Ligament ◽

Anatomical Dissection ◽

Ultrasound Measurements ◽

The Mean

AbstractThis article determines compartment opening of the medial articular space of the knee after pie crust (PC) technique of the medial collateral ligament (MCL) by ultrasound measurements and anatomic dissection. This is a cadaveric study of 12 specimens. Four anatomic references were marked on the skin. Distances between the femur and tibia in the internal compartment at 30 degrees of flexion were obtained with ultrasound measurements in four situations: with and without applying valgus force both prior and after the PC technique. Ultrasound measurements of the medial articular compartment were made twice and mean value was calculated. An anatomical dissection was performed and distances between the puncture marks and the infrapatellar branch of the saphenous nerve was measured. Lilliefors test of normality was applied and variables were expressed as mean and standard deviation (SD). Qualitative variables were expressed by absolute frequencies and percentages. Statistical significance was a two-tailed p-value of < 0.05. Prior to the PC technique, mean (SD) distance between the femur and tibia in the medial compartment were 14.2 (4.0) mm in basal conditions and 17.1 (3.7) mm when applying valgus force (p = 0.003). PC technique increased the mean (SD) distance by 1.9 (1.9) mm under basal conditions (p < 0.01) and 2.9 (1.6) mm when applying valgus force (p < 0.01). The infrapatellar branches of the saphenous nerve were not damaged and the mean (SD) distance between the punctures and the nerve was 9.0 (3.3) mm. The PC is a reproducible, safe, and measurable surgical technique that opens controllably the medial compartment. PC as described avoided damage to the nerve branches.

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Unravelling the mystery of the ‘minimum important difference’ using practical outcome measures in chronic respiratory disease

Chronic Respiratory Disease ◽

10.1177/1479973118816491 ◽

2019 ◽

Vol 16 ◽

pp. 147997311881649 ◽

Cited By ~ 3

Author(s):

Linzy Houchen-Wolloff ◽

Rachael A Evans

Keyword(s):

Outcome Measures ◽

Outcome Measure ◽

Statistical Significance ◽

Minimum Clinically Important Difference ◽

Chronic Respiratory Disease ◽

Important Change ◽

P Value ◽

Minimum Important Difference ◽

The Mean ◽

Functional Outcome Measures

It is important for clinicians and researchers to understand the effects of treatments on their patients, both at an individual and group level. In clinical studies, treatment effects are often reported as a change in the outcome measure supported by a measure of variability; for example, the mean change with 95% confidence intervals and a probability ( p) value to indicate the level of statistical significance. However, a statistically significant change may not indicate a clinically meaningful or important change for clinicians or patients to interpret. The minimum clinically important difference (MCID) or minimally important difference (MID) has therefore been developed to add clinical relevance or patient experience to the reporting of an outcome measure. In this article, we consider the concept of the MID using the example of practical outcome measures in patients with CRD. We describe the various ways in which an MID can be calculated via anchor- and distribution-based methods, looking at practical examples and considering the importance of understanding how an MID was derived when seeking to apply it to a particular situation. The terms MID and MCID are challenging and often used interchangeably. However, we propose all MIDs are described as such, but they could be qualified by a suffix: MIDS (MID – Statistical), MID-C (MID – Clinical outcome), MID-P (MID – Patient determined). However, this type of classification would only work if accepted and adopted. In the meantime, we advise clinicians and researchers to use an MID where possible to aid their interpretation of functional outcome measures and effects of interventions, to add meaning above statistical significance alone.

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The behavior of Mean Platelet Volume in Sepsis in critical patients with and without sepsis

Bionatura ◽

10.21931/rb/2021.06.02.22 ◽

2021 ◽

Vol 6 (2) ◽

pp. 1812-1817

Author(s):

Pablo Andrés Vélez ◽

Lucy Baldeón R ◽

Jorge Luis Vélez-Paez

Keyword(s):

Mean Platelet Volume ◽

Statistical Significance ◽

Area Under The Curve ◽

Biological Behavior ◽

P Value ◽

Platelet Volume ◽

Significant Area ◽

The Mean ◽

Critical Patients ◽

Elevated Lactate

The mean platelet volume is an anatomical biomarker that has shown its usefulness in various cardiovascular and metabolic pathologies; in sepsis, it has been positioning itself as an indicator of mortality, easily accessible and immediately applicable when reported in the routine blood count. This study demonstrates the mean platelet volume's biological behavior in critical patients with sepsis compared with non-septic patients. An observational, longitudinal, prospective, monocentric cohort study was conducted in 250 patients treated at the intensive care unit of the Pablo Arturo Suárez Hospital, Quito- Ecuador, from January 2019 January 2020. A group of patients with sepsis (n = 125) and without infectious pathologies (n = 125) were studied. The inclusion criteria were patients over 18 years of age of both genders, diagnosed with sepsis or septic shock using SEPSIS 3 criteria, and patients without septic pathology. The mean platelet volume (MPV) of days 1, 2, and 3 were studied. Septic patients had a mean APACHE (18.74 SD 9.52) higher than the non-septic ones (11.93 SD 7.01) (p = < 0.000). The MPV was consistently higher in patients with sepsis than non-septic patients, but it reached statistical significance on day 3 (9.13 SD 1.55 vs. 8.66 SD 1.34, p=0.042). The MPV on day 3 presented a significant area under the curve (AUC =0.580) (CI. 0.500-0.661), where the cut-off point according to Youden's index was positive for sepsis if MPV≥ 9.85 femtoliter (fL) with OR=3.30 and p-value= 0.005. Likewise, lactate on admission showed an AUC of 0.625 (CI. 0.555-0.694), with a cut-off point ≥of 1.15 mmol / L, OR=2.51, and p=0.007. Age and hypertension did not show a multivariate relationship with the presence of sepsis. It was shown that MPV is higher in patients with sepsis compared to non-septic ones. This observation reaches significance on day 3. Additionally, elevated lactate at admission was also associated with a septic state. On the other hand, platelet count did not show the expected behavior.

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The role of valgus osteotomy with DHS fixation in the management of fracture nonunion of the neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175666 ◽

2017 ◽

Vol 4 (1) ◽

pp. 166

Author(s):

Yeshwanth Subash

Keyword(s):

Femoral Head ◽

Functional Results ◽

Valgus Osteotomy ◽

Neck Of Femur ◽

Non Union ◽

Neck Shaft Angle ◽

Fracture Nonunion ◽

The Mean ◽

The Right

Background: Management of fracture non-union of the neck of femur is age specific and is quite demanding. There is a need to salvage the femoral headin younger individuals which demands a procedure which suits the requirements. The aim of this study was to evaluate the role of valgus osteotomy with dynamic hip screw fixation(DHS) in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: This was a prospective study of 15 patients with fracture nonunion of the femoral neck conducted between January 2012 to January 2013 with a follow up period of 3 years.Results: There were 9 males and 6 female patients in our study with the right side being more commonly affected. The mean age of the patients was 45.2 years ranging from 36 to 58 years. All fractures united at the end of 6 months. Post operatively the mean Pauwels angle was 340 while the neck shaft angle was 135.20. There was a significant increase in the Oxford score from a mean of 20.4 preoperatively to 37.9 in the postoperative period. All patients were happy with the procedure and the functional outcome. Conclusions: Valgus osteotomy with DHS fixation is a good option for the management of fracture nonunion of the neck of femur in younger patients where there is a need to salvage the femoral head and it gives good functional results.

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The Early Outcome Of the Bernese Periacetabular Osteotomy For Hip Dysplasia In Multiple Epiphyseal Dysplasia

10.21203/rs.3.rs-691751/v1 ◽

2021 ◽

Author(s):

Yao-Yuan Chang ◽

Chia-Che Lee ◽

Sheng-Chieh Lin ◽

Ken N Kuo ◽

Kuan-Wen Wu ◽

...

Keyword(s):

Femoral Head ◽

Statistical Significance ◽

Periacetabular Osteotomy ◽

Hip Osteoarthritis ◽

Multiple Epiphyseal Dysplasia ◽

Harris Hip Score ◽

Joint Preserving Surgery ◽

The Mean ◽

Epiphyseal Dysplasia

Abstract Background:Multiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as third to the fourth decade. Currently, there is no consensus on how to prevent or slow the process of secondary hip osteoarthritis.The Bernese periacetabular osteotomy is a joint preserving surgery to reshape acetabulum and extend coverage for the hip, however, there is no established evidence of the effectiveness for the MED hips.Patients and methods:A retrospective series of 6 hips in 3 patients with multiple epiphyseal dysplasia treated with the Bernese periacetabular osteotomy were reviewed. The average age at the time of surgery was 14.3 years (range: 11.4 to 17.2 y). Radiographic parameters were analyzed preoperatively and 1-year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery. Results:The mean follow-up time was 1.7 years. The mean LCEA increased from 3.8° to 47.1° (p = .02), ACEA increased from 7.3° to 35.1° (p = .02), and AI decreased from 27.8° to 14.6° (p=.04). The femoral head coverage ratio increased from 66.8% to 100% (p= .02). The procedure achieved femoral head medialization by decreasing central head distance from 86.7mm preoperatively to 82.7mm postoperatively, however, without statistical significance. (p = .699). The improvement of clinical outcomes by mean HHS was significant from 67.3 preoperatively to 86.7 postoperatively (p=0.05).Conclusion:Bernese PAO is a feasible option for treatment of the hip problems in MED patients. It reshapes acetabular and femoral morphology 3-dimensionally. In our study, the short-term follow-up results showed obvious functional and radiographic improvement. A long-term follow-up is necessary in the future.

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Job Satisfaction among Hemodialysis and Labour Ward Nurses: A Comparative Descriptive Study

TEXILA INTERNATIONAL JOURNAL OF NURSING ◽

10.21522/tijnr.2015.se.21.01.art004 ◽

2021 ◽

pp. 48-56

Author(s):

Monisayo Olayemi Komolafe

Keyword(s):

Job Satisfaction ◽

Work Environment ◽

Statistical Significance ◽

Descriptive Study ◽

P Value ◽

Satisfaction Scale ◽

Cross Sectional ◽

Dialysis Unit ◽

The Mean ◽

Labour Ward

Introduction: Increasing CKD cases means higher demands for haemodialysis nurses. Haemodialysis nurses are required to fulfil many demanding roles such as advocate, caregiver, educator, mentor and technician while patients attend a dialysis unit. The complexities of the role that are performed by these nurses along with organization factors within the work environment have led to haemodialysis nurses experiencing high levels of burnout thus impacting on satisfaction derived from job done. Objectives: To compare job satisfaction among haemodialysis nurses with that of labour ward nurses and determine if the type of patient managed affects job satisfaction of nurses. Methodology: The multidimensional Job satisfaction scale designed and validated by Murat Ozpehlivan and Zafer Acar was used to determine job satisfaction among sixty-six hemodialysis nurses and sixty-four labour ward nurses in a cross sectional comparative descriptive study. Statistical significance difference between the two group of nurses attributed to events with a p-value lower than 5% (p < 0.05). Results: The overall mean job satisfaction score was higher among the labour ward nurses 67.95 ± 13.39 compared to the mean score among renal nurses 65.07 ± 14.24 (T= 1.81, p = 0.240). The mean score of labour ward nurses regarding satisfaction based on patient managed 74.51 ± 14.96 is higher than the mean score among renal participants of 71.21 ± 14.70 (T= 1.27, p = 0.201). Conclusion: Hemodialysis nurses in Nigeria are satisfied with the job they do and this is comparable to that of nurses in labour ward.

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227 CALRETICULIN, A 60-kDa PROTEIN, PREVENTS POLYSPERMY IN ZONA PELLUCIDA-FREE PIG OCYTES

Reproduction Fertility and Development ◽

10.1071/rdv25n1ab227 ◽

2013 ◽

Vol 25 (1) ◽

pp. 261

Author(s):

R. Romar ◽

C. Soriano-Úbeda ◽

M. D. Saavedra ◽

J. Gadea ◽

M. Avilés ◽

...

Keyword(s):

Zona Pellucida ◽

Calcium Binding ◽

Statistical Significance ◽

P Value ◽

Oocyte Activation ◽

Cortical Granules ◽

Chaperone Protein ◽

The Mean

After gamete membrane fusion or artificial oocyte activation, cortical granules undergo exocytosis and the released content modifies the zona pellucida (ZP), preventing polyspermy. Calreticulin (CRT), a calcium-binding highly conserved protein of 60 kDa, is contained in cortical granules from hamster eggs (Muñoz-Gotera et al. 2001 Mol. Reprod. Dev. 60), and we recently showed it is exocytosed from chemically activated ZP-free pig oocytes (Romar et al. 2012 Reprod. Fertil. Dev. 24). When pig ZP-enclosed oocytes were incubated with CRT, monospermy was not improved (Romar et al. 2011, Maternal communication with gametes and embryo, p. 72), suggesting that the likely role of CRT in preventing polyspermy might be carried out at the oolemma level. Our objective was to evaluate whether CRT prevents polyspermy in pig ZP-free oocytes by treating the cells with this protein before being inseminated. In vitro-matured cumulus–oocyte complexes (44 h, NCSU-37 medium) were decumulated and ZP was digested with Tyrode’s acid. The ZP-free oocytes were incubated for 30 min in TALP medium supplemented with 0, 100, 1000, and 5000 pg of CRT (ab91577, Abcam, Cambridge, MA, USA) per oocyte. After washing, ZP-free oocytes were inseminated (25 000 sperm mL–1) and gametes were co-cultured for 18 h. Putative zygotes were fixed and stained with Hoechst 33342 to analyse the fertilization results. Four replicates with 30 to 35 oocytes per group were done, and results were analysed by one-way ANOVA. A P-value ≤0.05 was taken to denote statistical significance. Incubation with CRT did not affect penetration rates that were similar among groups (77.12 ± 3.88 and 72.73 ± 4.07, respectively, for the 0- and 5000-pg CRT groups). However, the mean number of sperm per penetrated oocyte decreased from 3.01 ± 0.28 (0-pg group) to 2.07 ± 0.16 (5000-pg group), and monospermy rate increased from 30.77 ± 4.87 (0-pg group) to 52.27 ± 5.36 (5000-pg group; P ≤ 0.05). Incubation with CRT did not affect the number of sperm attached to oolemma, which was similar among all groups (11.45 ± 1.16 v. 10.75 ± 1.17, respectively, for 0 and 5000 pg of CRT). These preliminary data suggest that CRT, a protein exocytosed after oocyte activation, participates in the membrane block to polyspermy in pigs. Future studies to describe the exact mechanism of action of this chaperone protein are necessary. Supported by MEC and FEDER (AGL2009-12512-C02-01).

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Activation of Clotting Factors in Thrombocytopenia Due to Platelets Destruction: A Possible Compensated Mechanism for Hemostasis.

Blood ◽

10.1182/blood.v106.11.3999.3999 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3999-3999

Author(s):

Vincenzo Fontana ◽

Wenche Jy ◽

Eugene Ahn ◽

Pamela Dudkiewicz ◽

Lawrence L. Horstman ◽

...

Keyword(s):

Bone Marrow Failure ◽

Statistical Significance ◽

Mean Value ◽

P Value ◽

Clotting Factors ◽

Platelet Destruction ◽

Excessive Bleeding ◽

Giant Platelets ◽

Fatal Bleeding ◽

The Mean

Abstract INTRODUCTION. Thrombocytopenia (TP) due to bone marrow failure, as in aplastic anemia (AA), is often associated with frequent and fatal bleeding, whereas fatal bleeding in TP due to platelet destruction, as in ITP, is rare. It has been suggested that giant platelets or increased cell-derived microparticles (MP) act to limit bleeding in ITP. We investigated clotting factors and MP from 3 cell types, platelets (PMP), leukocytes (LMP), and endothelial (EMP), in patients with different causes of their TP. METHODS. Group 1 (platelet destruction) consisted of 2 subgroups, Grp 1a having n=35 pts with active ITP (ITP-A) and Grp 1b having n=15 pts with platelet destruction (PD) by other disorders (TTP, PNH, others). Group 2 (impaired production (IP)) consisted of n=19 pts with AA, MDS/MPD, and others. Group 3 comprised n=28 pts with ITP in remission (ITP-R). Laboratory measures included CBC, platelets, FVIII, FIX, FXI, and 3 kinds of MP: PMP, LMP, EMP. Signs and symptoms of bleeding were graded and recorded. RESULTS. Key data is summarized in Table 1. The percentage of patients with elevated activity of FVIII was significantly more prevalent in Grp 1a vs. Grp 3 (53% vs. 15%, p=0.002) or Grp 1b vs. Grp 2 (73% vs. 11%, p=0.0002). The mean value of FVIII titer was also significantly higher in Grp 1a vs. Grp 3 (1.92 vs. 1.33 U/mL, p=0.0036) or Grp 1b vs. Grp 2 (2.44 vs. 1.18 U/mL, p=0.00007). The mean percentage of patients with elevated FIX or FXI, or the mean value of FIX or FXI titer were also higher in Grp 1a vs. Grp 3 or Grp 1b vs. Grp 2, but the difference did not reach statistical significance. PMP counts were found to correlate with platelet counts in all groups, and were significantly higher in Grp 3 than Grp 1a (p=0.0004). Grp 3 also had higher EMP than Grp 1a (p=0.04). LMP showed no significant differences. REPRESENTATIVE CASE. A patient with chronic ITP who relapsed with severe acute ITP was monitored sequentially. In acute phase of TP, activities of FVIII, FIX, and FXI surged, in parallel with shortening of aPTT, and patient had minimal signs of bleeding. Serial assays revealed gradual fall of factor activities, reaching normal levels after 5 months. A similar pattern was observed in another patient, with acute TTP: clotting factors returned to normal after 2 months. CONCLUSION. TP due to platelet destruction appears to trigger activation of intrinsic clotting pathway which may protect from excessive bleeding. Surge in FVIII was most notable. This compensation effect appears to be absent in TP due to depressed platelet production, and likewise for ITP in remission. The mechanism underlying this phenomenon remains to be elucidated. Further study is in progress to delineate the mechanism. Table 1 Grp1a (ITP-A) Grp1b (PD) Grp2 (IP) Grp3 (ITP-R) p value p value Number 35 15 19 28 1a vs 3 1b vs 2 FVIII (%) 53 73 11 15 0.002 0.0002 FIX (%) 19 27 6 13 NS NS FXI (%) 16 14 0 8 NS NS PMP 8315 15531 9768 17085 0.0004 NS EMP 328 325 393 578 0.04 NS LMP 1388 1230 1255 1486 NS NS

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