Control studies of women with preeclampsia and urinary tract infection in pregnancy.
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Biomedical subjects
Publications and source records attributed to G Vogel.
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The term thrombophilia has not yet been clearly defined. Starting from clinical observations, attempts were made to give a definition which may indicate the direction of further clinico-experimental studies. The known causes for thrombophilic states were discussed from the clinical point of view. Possibilities for diagnosis and treatment of thrombophilic states were reported.
In 20 patients the fibrinolytic capacity was assessed by the venous occlusion test and by stimulation with DDAVP injection (0.4 microgram/kg). Irrespective of the test used, all cases were classified into the same group of responsiveness (responder, low responder, non-responder) with the exception of one patient. DDAVP injection caused subjective discomfort only in some cases, while the venous occlusion test was invariably accompanied by pain.
The behaviour of the intrinsic fibrinolytic system was studied in healthy donors using the blood activator inventory test of Kluft. Moreover, the influence of several pre-analytical factors was examined. The activity of the intrinsic system was higher in the afternoon than in the morning. Medium physical stress caused an increase in activity which was not due to the influence of extrinsic activators. By inhalation of cigarette smoke the activity was decreased. In healthy volunteers the values of the test showed rightward shifted frequency distribution. Females between the age of 20 and 39 yr had significantly higher intrinsic fibrinolytic activity than males of the same age group. In both sexes the activity tended to decreasing values with increasing age.
In patients with thrombophilic states the plasma level of factor XII was lower by about 15 per cent, while the factor V content was higher by about 20 per cent than in healthy subjects. Plasma prekallikrein was unchanged. It is not clear whether these changes are the cause or the consequence of thrombotic events.
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Twenty patients with established diagnosis of insufficient fibrinolysis were treated with dehydrochlormethyl-testosterone (Turinabol). Doses of 5 or 10 mg per day, resp. were administered orally. Four weeks after the beginning of treatment the fibrinolytic capacity began to increase and reached a maximum in the 3rd and 4th months of treatment. In one patient with thrombotic tendency it disappeared under medication, however, after withdrawal of the drug it appeared anew. Side effects were roughness of the voice in two patients and slight weight gain in one patient.
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The kallikrein specific chromogenic peptide substrates S-2302 (KABI) and Chromozym PK (Boehringer) were used in the first analysis of a familial defect in the early stage of clotting. Slight to extensive prolongation of the activated partial thromboplastin time was seen in the affected persons. Using dextransulfate for activation of plasma marked deficiency in kallikrein activity was found in 3 persons. Using factor XIIa (activated Hageman factor) for activation normal prekallikrein levels were found in 2 of them whereas factor XII levels, however, were below normal. The third had a prekallikrein deficiency presumably caused by oral contraceptives. In a fourth member of the family factor XII deficiency was found with normal kallikrein activity. The application of chromogenic peptide substrates for analysing the early stage of clotting has to take into account the special mechanisms of activation.
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The filtration coefficients of polyvinylpyrrolidone (PVP) of molecular weight 10,000-110,000 were measured at the plasma-lymph barrier of the upper small intestine of rabbits, rats and cats. For this purpose the animals were given intravenous injections or infusions of PVP in such a way as to produce a constant blood level; PVP concentrations were measured in lymph obtained by cannulating the mesenteric duct and also in the plasma. In these species low molecular weight PVP had a filtration coefficient of 0.85-0.64, while high molecular weight PVP (MW 110,000) either had a very low filtration coefficient - 0.22 - or was not detectable in the intestinal lymph. The three species, representing herbivores, omnivores and carnivores, showed no differences in the penetration behavior of PVP, i.e., in the permeability of the plasma-lymph barrier to macromolecules.
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