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Biomedical subjects

J Boldt

Publications and source records attributed to J Boldt.

At least 199 records · Page 11Linked to original sources
PubMed1994

RETRACTED: Platelet function in critically ill patients.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the editor In 2018, CHEST published a notice1 that all articles authored by Joachim Boldt be read with caution due to expressions of concern about falsified data. In 2020, CHEST received additional evidence of research misconduct and breaches of scientific integrity that were discovered following an investigation by the author's former institution, the University of Giessen2. In light of this new evidence, this article has been retracted by CHEST. 1. Irwin, R.S., MD, Master FCCP. Notice From the Editor in Chief. CHEST 153(3), p. 767. 2. Mukherjee, J. Statement on the scientific credibility of articles published by Joachim Boldt, formerly professor at Justus Liebig University (JLU), Giessen, Germany. https://ars.els-cdn.com/content/image/1-s2.0-S000709122030163X-mmc3.pdf.

Adult↗
PubMed1994

Influence of aprotinin on the thrombomodulin/protein C system in pediatric cardiac operations.

Thirty consecutive children scheduled for pediatric cardiac operation with cardiopulmonary bypass were included in the study. Before the operation, the patients were randomly divided into two groups: with aprotinin (n = 15, 30,000 U/kg after induction of anesthesia, 30,000 U/kg added to the prime of the cardiopulmonary bypass or without aprotinin (n = 15). Thrombomodulin, (free) protein S, protein C, and thrombin/antithrombin III complex were measured from arterial blood samples taken after induction of anesthesia (at baseline, before aprotinin) and before, during, and after cardiopulmonary bypass until the first postoperative day. Standard coagulation parameters (antithrombin III, fibrinogen, platelet count, and partial thromboplastin time) were without differences between the groups. Thrombomodulin plasma concentrations were within normal range ( < 40 micrograms/L) and were similar in both groups at baseline. During cardiopulmonary bypass and until 5 hours after cardiopulmonary bypass, however, thrombomodulin plasma levels were significantly lower in the children treated with aprotinin. No further differences were observed on the first postoperative day. Protein C and protein S plasma levels did not differ between the two groups. Thrombin/antithrombin III-complex plasma concentrations increased significantly during cardiopulmonary bypass, however, without showing differences between children with (225 +/- 49 micrograms/L) and without (149 +/- 31 micrograms/L) aprotinin treatment. Blood loss and the need for homologous blood and blood products did not differ significantly between the two groups. We concluded that administration of aprotinin resulted in reduced thrombomodulin plasma levels in pediatric patients undergoing cardiac operation without altering protein C/protein S plasma concentration. The exact role of aprotinin in endothelium-derived coagulation should be further studied.

Antithrombin III↗
PubMed1994

[Topographic electroencephalometry following anesthesia induction with ketamine-midazolam].

The neurophysiological action of ketamine has attracted increasing interest in recent years, with special interest in receptor action and in neurophysiological differences between and psychomimetic side effects of the two enantiomorphs. Most of the neurophysiological examinations published deal with ketamine as a single anaesthetic agent, although it has been suggested to that psychomimetic side-effects and haemodynamic deterioration could be avoided by combining ketamine with a sedative drug. The primary aim of our study was to examine the combined ketamine-midazolam action on cerebral activity; secondly, we planned to look at these interactions topographically at different points of the cortex to evaluate topographical differences in the combination's action; thirdly, the cerebral and haemodynamic reactions to anaesthesiological stimuli (intubation, gastric tube) were evaluated and compared. METHODS. Sixteen patients scheduled for elective aortocoronary bypass surgery were examined. Topographical electroencephalometric data were obtained by processed EEG with a CATEEM system at 17 recording points over the cortex and compared with heart rate and arterial blood pressure during the induction period. After documentation of the baseline data ketamine (3 mg/kg) and midazolam (0.15 mg/kg) were applied within 10 min by means of an automatic device. At the end of the infusion period patients were intubated, and after a further 10 min a gastric tube was placed. RESULTS. Induction resulted in increases in delta and beta 2 output (P < 0.05) in the early induction period and in significant decreases (P < 0.05) in alpha 1, alpha 2 and beta 1 activity. No significant change in theta activity was observed throughout the observation period. Intubation led to significant increases of power particularly in the temporal and parietal leads of all frequency bands, but not in the frontal area. Insertion of the gastric tube did not alter cerebral function. CONCLUSION. The interaction of ketamine and midazolam leads to increases in beta 2 and delta power and to significant decreases in the alpha bands and beta 1. Increases of theta activity, a typical effect of single-agent anaesthesia with ketamine, were not observed. Thus, the action of combined ketamine and midazolam on cerebral function is not an additive, but an interactive process. Despite a relatively high induction dosage, haemodynamic changes during intubation occurred and were accompanied by changes in cerebral activity. This can be regarded as incomplete cerebral suppression even by these induction dosages.

Adult↗
PubMed1994

[Effectiveness of oral versus parenteral iron substitution in autologous blood donors].

OBJECTIVE: Is intravenous iron therapy as efficient as oral iron supplementation in patients undergoing autologous blood donation? DESIGN: Prospective, randomized study. PATIENTS AND SETTING: 30 male and 30 female patients, separated into two groups were examined prior to total hip replacement. INTERVENTIONS: Patients of group O were given 6 x 50 mg Fe2+ aspartate/day orally, and patients of group P were given 0.75 mg/kg BW complex-bound Fe3+ once a week by infusion. In both groups therapy was started two weeks prior to the first donation. The substitution was continued the following six weeks until surgery. Hemoglobin, ferritin plasma concentrations and reticulocytes were monitored. The appearance of unwanted side effects was studied by questionnaire. RESULTS: Hb decreased significantly in both groups. A difference was seen in the reticulocyte count and in the ferritin levels. Here we found a significant increase in group P compared with group O. 40% of the patients who took the iron orally complained about unwanted side effects such as obstipation and diarrhoea, whereas none of the patients of the parenteral group had any complaints. CONCLUSIONS: Stimulation of the erythropoiesis appeared to be more efficient with intravenous iron therapy than with oral iron supplementation. The oral dose has in about 40% unwanted side effects. For this reason a parenteral iron therapy can be considered, but one must be aware that in some cases dangerous anaphylactic reactions could appear.

Administration, Oral↗
PubMed1994

[Intracranial hemorrhage and hemostasis. Monitoring patients after intracranial hemorrhage by determination and follow-up of activation products of blood coagulation].

OBJECTIVE: The aim of the study was to improve the detection of small hemorrhages with minimal symptoms and of unruptured aneurysms after a subdural and subarachnoid bleeding by the control of the intravascular hemostatic system. DESIGN: Prospective, open study. SETTING: Neurosurgical intensive care unit of a university hospital. PATIENTS: 44 patients undergoing a cranial trepanation. Patients of group 1 (control n = 11) had an intrasellar hypophysoma, patients of group 2 (n = 12) a chronic subdural hematoma without a previous traumatic incident and patients of group 3 (n = 15) a subarachnoid hemorrhage caused by an intracranial aneurysm. INTERVENTIONS: After cranial trepanation changes of plasmatic hemostasis have been assessed by means of immunologically determined parameters of coagulation. The investigation included blood parameters (hemoglobin, hematocrit, thrombocytes), clotting status (prothrombin time, partial thromboplastin time, thrombin time, fibrinogen, plasminogen, antithrombin III [AT III] activity and proteinase inhibitors), as well as immunological methods such as fibrinopeptide A (FPA), thrombin-antithrombin III (TAT), protein C and factor XIII activity (F XIII activity). RESULTS: In comparison to group 1 (control) a significant difference (p < 0.001) was seen in groups 2 and 3 for thrombin-antithrombin III (TAT), fibrinopeptide A (FPA), protein C, and the antithrombin III activity. Intra- and postoperatively increased TAT levels in groups 2 (16.9 ng/ml) and 3 (21.1 ng/ml) and decreased protein C levels (group 2: 61% and group 3: 58%) demonstrated an intravascular thrombin generation. On account of the elevated FPA levels in groups 2 (6.5 ng/ml) and 3 (5.7 ng/ml) and decreased AT III activity in groups 2 (58%) and 3 (62%), this thrombin generation was only incompletely compensated. Caused by proteolytic thrombin effects, another sign for a thrombin-induced turnover of clotting factors is the significant reduction (p < 0.001) of F XIII activity in groups 2 (40%) and 3 (44%). In comparison to group 1 this significantly reduced F XIII activity in groups 2 and 3 was correlated (r = 0.99) to changes in FPA and TAT plasma levels, an indication of latent chronic clotting activity. No significant difference was found concerning total amount of infusion, intra- and postoperative blood loss and blood parameters. Eight patients (group 2: 5 patients, group 3: 3 patients) showed a rebleeding episode without operative interventions. In these patients increased clotting activity (TAT, FPA, protein C) caused by proteolytic thrombin effects was combined with a factor XIII activity smaller than 40%. CONCLUSION: The results of the recent study indicated that immunologically determined TAT, FPA, protein C, factor XIII and AT III activities might serve to improve management in patients with intracranial bleeding events. In view of these parameters the evaluation of risks for a rebleeding is improved. A decrease of the plasma factor XIII activity under 40% associated with a latent clotting activity induced by a thrombin generation caused a higher risk of rebleeding after an initial intracranial bleeding event. The necessity of substituting factor XIII in such cases should be elucidated to minimize risks of rebleeding.

Aneurysm, Ruptured↗
PubMed1994

Is continuous cardiac output measurement using thermodilution reliable in the critically ill patient?

OBJECTIVE: Evaluation of continuous cardiac output monitoring based on the thermodilution technique in the critically ill. DESIGN: Prospective clinical investigation. SETTING: A surgical intensive care unit of a university hospital. PATIENTS: Thirty-five critically ill patients (trauma and/or sepsis patients), who needed pulmonary artery catheterization. The patients were prospectively studied according to the following groups: a) patients with a heart rate of > 120 beats/min; b) those patients with a cardiac output of > 10 L/min; c) patients with a cardiac output of < 4.5 L/min; d) patients with a rectal temperature of > 39.0 degrees C; and e) patients with a pulmonary artery catheter inserted for > 4 days. INTERVENTIONS: Therapies were carried out according to modern intensive care medicine protocols by physicians who were not involved in the study. MEASUREMENTS: Cardiac output was monitored continuously using a new, modified pulmonary artery catheter. This catheter has a heating filament by which energy is transmitted to the circulating blood (modified thermodilution technique). A bedside microprocessor calculated cardiac output using a new algorithm. Standard bolus thermodilution technique (10 mL of ice-cold saline solution) was used to compare the continuous cardiac output measurement with the intermittent bolus cardiac output measurement. MAIN RESULTS: A total of 404 pairs of intermittent (bolus) cardiac output and continuous cardiac output measurements were obtained from the 35 patients. The bias (mean difference between bolus cardiac output measurement and continuous cardiac output measurement) of all measurements was 0.03 +/- 0.52 L/min and the 95% confidence limit (mean difference +/- 2 SD) was -1.01/1.06 L/min. Also, continuous cardiac output measurement agreed closely with bolus cardiac output measurement (bias was 0.16 +/- 0.57 L/min in the cardiac output of > 10 L/min group; bias was -0.17 +/- 0.50 L/min for the cardiac output of < 4.5 L/min group). Increased temperature and prolonged length of stay did not influence the agreement of continuous cardiac output measurement with bolus cardiac output measurement (bias was 0.09 +/- 0.51 L/min in the > 39 degrees C rectal temperature group). CONCLUSIONS: Continuous monitoring of cardiac output using a modified pulmonary artery catheter with a heated filament has proven to be accurate and precise in the critically ill patient when compared with the "standard" intermittent bolus thermodilution technique. The continuous monitoring technique enhances our armamentarium for more intensive monitoring of these patients under a variety of circumstances.

Adult↗
PubMed1994

[Value of phosphodiesterase inhibitors in anesthesia and intensive care].

During anesthesia and in intensive care, pharmacological support is often required in patients with preexisting myocardial dysfunction as well as in patients with normal preoperative ventricular function. Abnormalities in both systolic and diastolic function may occur in this situation. Standard therapy used in this situation act on alpha-, beta- or dopaminergic-receptors. However, the observation of beta-receptor down-regulation phenomenon has led to the development of substances which act independently of the beta-receptor. The imidazole derivative enoximone belongs to a new class of non-catecholaminergic positive inotropics, which acts by selectively inhibiting phosphodiesterase type-III thus using a mechanism distal of the beta-receptor. Enoximone has been proven to successfully improve hemodynamics by either its positive inotropic and lusitropic or its vasodilating properties. The expected increase in MVO2 secondary to the increase in myocardial contractility appears to be compensated by the decrease in ventricular pre- and afterload. The most obvious positive hemodynamic effects are reported for patients undergoing cardiac surgery. In both adults and pediatric patients hemodynamics were improved significantly in this situation. There is a particular indication for enoximone for patients with severely impaired hemodynamics awaiting heart transplantation ("pharmacological" bridging). The first promising results were documented when PDE-III-inhibitors were given in myocardial infarction and septic shock patients. The most important risk associated with the use of enoximone is the reduction in blood pressure due to its arterial and venous vasodilatory effects. Limitation to a bolus of 0.5 mg/kg or a perfusor controlled therapy help to avoid critical decrease in perfusion pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Mechanistic studies of the plasma membrane block to polyspermy in mouse eggs.

The mechanisms responsible for the plasma membrane associated block to polyspermy in mouse eggs were studied. Reinsemination experiments using zona-free eggs indicated that, after fertilization, the egg plasma membrane is altered such that sperm binding to the egg plasma membrane is blocked, except in the region of the second polar body. Activation of the egg with either ethanol or strontium chloride did not result in a block to polyspermic penetration, as artificially activated eggs displayed identical penetration levels as to nonactivated control eggs. The penetrability of activated eggs was not altered by the presence or absence of the zona pellucida during activation. Lectin staining for egg cortical granule material indicated that activation did cause cortical granule exocytosis; however, activated eggs remained penetrable. These data support the following conclusions: (1) an alteration in the ability of the egg plasma membrane to allow sperm adherence accounts for the block to polyspermy; (2) establishment of the plasma membrane block to polyspermy is sperm dependent, since artificial egg activation does not result in a block response; (3) the contents of the egg's cortical granules do not play a role in the establishment of the plasmalemma block response.

Animals↗
PubMed1993

Does platelet size correlate with function in patients undergoing cardiac surgery?

OBJECTIVE: Platelet dysfunction secondary to cardiopulmonary bypass (CPB) is one of the major reasons for nonsurgical post-operative bleeding in cardiac surgery. Whether platelet size is an indicator for platelet function was investigated in patients undergoing coronary artery bypass grafting. DESIGN: Prospective study. SETTING: Intra-operative, cardiac surgery operations. PATIENTS: 80 consecutive patients undergoing coronary artery bypass grafting. Excluding criteria were pre-operative coagulation disorders and medication with anticoagulants within the last 10 days before the operation day. MEASUREMENTS AND RESULTS: Platelet function was assessed by aggregometry using a turbidimetric method (inductors: ADP 2.0 mumol/l, collagen 4 micrograms/l, epinephrine 25 mumol/l). Mean platelet volume (MPV) was measured by an electrical conductivity method. Measurements were carried out before, during, and after CPB until the 1st post-operative day on intensive care unit (ICU). Platelet size decreased significantly during CPB (max. -25% after weaning from bypass) and returned to baseline values on the 1st post-operative day. Platelet count (ranging from 93 - 304 x 10(9)/l) did not correlate significantly with MPV or aggregation variables. Maximum aggregation and maximum gradient of aggregation induced by ADP and collagen were significantly decreased by CPB with the most pronounced reduction at the end of CPB (ranging from -25% to -45%). Analyses of co-variance revealed a significant correlation between changes in MPV and changes in aggregation variables (ADP, collagen). CONCLUSIONS: Platelet volume is easy to measure even in the operation room or in ICU and may indicate abnormalities in platelet function in the post-bypass period of cardiac surgery patients.

Adult↗
PubMed1993

Platelet function in cardiac surgery: influence of temperature and aprotinin.

Hypothermic cardiopulmonary bypass (CPB) has been associated with both coagulation defects and hemorrhage. The influence of temperature on platelet function and the benefits of aprotinin in this situation were studied in 60 patients undergoing elective aortocoronary bypass grafting. The patients were randomly divided into four groups (15 patients per group): group 1, normothermic CPB (nasopharyngeal temperature > 34 degrees C); group 2, normothermic bypass and administration of high-dose aprotinin (2 million IU before CPB, 500,000 IU/h until the end of the operation, and 2 million IU added to the prime); group 3, hypothermic CPB (nasopharyngeal temperature < 28 degrees C); and group 4, hypothermic CPB and aprotinin. Platelet function was evaluated by aggregometry (turbidimetric technique), and aggregation was induced by adenosine diphosphate (1 and 2 mumol/L), collagen (4 micrograms/L), and epinephrine (25 mumol/L) before, during, and after CPB into the first postoperative day. Starting from comparable baseline values, maximum platelet aggregation and maximum gradient of platelet aggregation were significantly most reduced after CPB in group 3 (hypothermic CPB without aprotinin) (ranging from -30% to -53% relative to baseline values). In comparison with the other groups, platelet function in this group also recovered less quickly in the later post-bypass period. Hypothermic CPB with aprotinin resulted in less-altered platelet function than hypothermic CPB without aprotinin. Platelet aggregation in aprotinin-treated patients was comparable overall with that in patients undergoing normothermic CPB. On the first postoperative day, aggregation variables had returned to or exceeded baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)

Aprotinin↗
PubMed1993

Aprotinin in pediatric cardiac operations: platelet function, blood loss, and use of homologous blood.

Excessive hemorrhage secondary to cardiopulmonary bypass may be encountered after pediatric cardiac operations. Platelet dysfunction appears to be especially responsible for this problem. The proteinase inhibitor aprotinin is suggested to possess platelet preservation properties and reduce blood loss in this situation. The effects of aprotinin (25,000 U/kg after induction of anesthesia, 25,000 U/kg added to the prime, 25,000 U/kg every hour of cardiopulmonary bypass) on platelet function were randomly studied in 12 children with a weight of less than 10 kg (group 2) and 12 children weighing more than 10 kg (group 4), who were compared with two groups of children without aprotinin (group 1, < 10 kg; group 3, > 10 kg). Twelve children undergoing major vessel operations without cardiopulmonary bypass and aprotinin served as a control. Platelet function was assessed using aggregometry (turbidometric technique with adenosine diphosphate, 2.0 mumol/L; collagen, 4 micrograms/mL; epinephrine, 25 mumol/L; NaCl [control]). Platelet function was not altered in the control patients within the entire investigation period. Maximum aggregation in the small children was already lower at baseline in comparison with that of the children > 10 kg. Cardiopulmonary bypass was followed by a significant reduction in platelet aggregation in all groups. Treatment with aprotinin did not improve platelet function (maximum aggregation and maximum gradient of aggregation) in any group. On the first postoperative day, maximum aggregation in the small children exceeded baseline values, whereas in both groups of children > 10 kg baseline values had almost been established. Postoperative blood loss was not reduced by treatment with aprotinin.(ABSTRACT TRUNCATED AT 250 WORDS)

Aprotinin↗
PubMed1993

Volume replacement with hydroxyethyl starch solution in children.

In 30 consecutive children undergoing cardiac surgery, two different types of fluid were given randomly for volume replacement in the pre-bypass period. In group 1 (n = 15), low molecular weight hydroxyethyl starch solution (LMW-HES) (6% HES; mean molecular weight 200,000 Da, molar substitution 0.5) and in group 2 (n = 15) 20% albumin (HA) was infused from the induction of anaesthesia until the start of cardiopulmonary bypass (CPB). In addition to haemodynamic values, various laboratory variables were measured before and after CPB until the morning of the 1st day after operation. The patients did not differ in diagnosis and conduct of CPB (lowest rectal temperatures: group 1 29.0 (SD 1.1) degrees C; group 2 29.4 (1.0) degrees C). Haemodynamic data (MAP, HR, CVP), anti-thrombin-III, fibrinogen, platelet count and coagulation variables were comparable between the groups until the 1st day after operation. Postoperative blood loss and the use of homologous blood or blood products were similar in all children. Albumin concentration increased after infusion of albumin (35-47 g litre-1) and was significantly greater until the end of the operation compared with the LMW-HES-treated children. Colloid osmotic pressure, however, was similar in the two groups and returned to baseline values on the 1st day after operation (LMW-HES group 19.31 (1.2) mm Hg; HA group 18.0 (1.3) mm Hg). Post-bypass urine output and creatinine values also did not differ between the groups. Anaphylactic reactions were not observed in any of the patients. It can be concluded that LMW-HES solution can be used effectively and safely for volume replacement in the pre-bypass period in small children undergoing cardiac surgery.

Antithrombin III↗
PubMed1993

Does correction of acidosis influence microcirculatory blood flow during cardiopulmonary bypass?

We studied 15 patients undergoing cardiopulmonary bypass (CPB) to examine the effect of response to correction of acidosis on microcirculatory blood flow. Acidosis was defined when base excess was less than -10.0 mmol litre-1 while carbon dioxide partial pressure was within the normal range. CPB was carried out at almost normothermic temperature (smallest rectal temperature 35.2 (SD) 0.4 degrees C). Sodium bicarbonate (NaHCO3) was given to correct acidosis during steady state CPB. Skin microcirculatory blood flow was assessed using a double-channel laser Doppler flow (LDF) monitor. LDF was measured on the patient's forehead and forearm before infusion of NaHCO3 (baseline) and 30 s, 1, 3, 5, 7, 10 and 15 min later. Skin, blood, rectal and nasopharyngeal temperatures did not change during the investigation. Plasma viscosity, haemoglobin and carbon dioxide partial pressure also remained unchanged. Mean arterial pressure (MAP) and systemic vascular resistance (SVR) decreased slightly after infusion of NaHCO3 (MAP -29%; SVR -32%). A total of NaHCO3 99.4 (4.4) mmol litre-1 was given for correction of acidosis. pH and HCO3- were within the normal range shortly after the infusion of NaHCO3. LDF measured on both the forehead (+49%) and the forearm (+29%) increased significantly after infusion of NaHCO3. Changes in pH correlated positively with changes in LDF (analyses of co-variance, P < 0.02), but haemodynamic and other laboratory values did not correlate with LDF. We conclude that the microcirculatory response to correction of acidosis with NaHCO3 during CPB can be monitored using skin laser Doppler flowmetry. Infusion of NaHCO3 resulted in a significant improvement in skin microcirculatory perfusion.

Acidosis↗
PubMed1993

Circulatory effects of the PDE-inhibitors piroximone and enoximone.

1. The isolated circulatory response to intravenous application of the phosphodiesterase (PDE) inhibitors piroximone and enoximone was studied. 2. In a randomized sequence of 30 male patients undergoing elective aortocoronary bypass grafting either piroximone (0.5 mg kg(-1); n = 10) or enoximone (0.5 mg kg(-1); n = 10) were given during steady state of cardiopulmonary bypass (CPB). A group in which NaCl was given as a placebo served as a control (n = 10). 3. MAP was reduced by piroximone (maximum -23 mm Hg) and enoximone (maximum -18 mm Hg), whereas it increased in the control (+20 mm Hg). Volume of the extracorporeal circuit indicating venous pooling decreased more pronouncedly in the enoximone patients (-440 ml) than in the piroximone group (-300 ml). 4. Laser Doppler flows (LDFs) increased in both PDE-III inhibitor groups with the higher and longer increase in the enoximone-treated patients (LDF-forehead maximum +44%, LDF-forearm maximum +33%). Piroximone-induced increase in both LDFs was less pronounced with respect to both time and degree (LDF-forehead maximum +30%, LDF-forearm +12%). 5. Oxygen consumption (VO2) was significantly higher in the PDE-III inhibitor-treated than in the control patients. 6. Piroximone and enoximone showed significant vasodilatory properties at the arterial and venous side (= 'venous pooling'), from which patients with heart failure would profit. 7. Vasodilation could be observed for a longer period and was more pronounced in the enoximone-treated than in the piroximone patients. Alterations in capillary skin blood flow measured by laser Doppler technique gave evidence for an improvement in nutritive microcirculation, which was slightly more pronounced in the enoximone patients.

Aged↗
PubMed1993

Influence of different glucose-insulin-potassium regimes on glucose homeostasis and hormonal response in cardiac surgery patients .

Intravenous infusion of glucose/insulin in combination with potassium (GIK) is an often used technique to improve myocardial preservation in cardiac surgery. In a randomized study in 50 patients undergoing elective aortocoronary bypass grafting with good ventricular function, the influence on glucose homeostasis and hormonal response to four different glucose/insulin regimes were compared to an untreated control: 1) 50 g of glucose mixed with 100 U of human insulin (HI/100); 2) 50 g of glucose mixed with 100 U of bovine insulin (BI/100); 3) 50 g of glucose mixed with 50 U of human insulin (HI/50); and 4) 50 g of glucose mixed with 50 U of bovine insulin (BI/50) [corrected]. Glucose/insulin were given in combination with 70 mmol of potassium 40 min before beginning the operation. In addition to blood glucose concentrations various endocrine variables were studied before, during and after cardiopulmonary bypass (CPB). Hemodynamic data (arterial blood pressure, heart rate, cardiac index, systemic vascular resistance) were similar in all five groups. Inotropic support after CPB was necessary in none of the patients. Blood glucose levels showed no differences among all GIK groups (groups 1-4) but were significantly higher than in the control patients. The incidence of severely reduced (< 50 mg/dL) or elevated blood glucose level (> 300 mg/dL) did not differ between HI- and BI-treated patients but was significantly lower in the untreated control. Insulin plasma level increased significantly after infusion of GIK with higher levels in HI- than BI-treated patients (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass.

The influence of four different kinds of intravascular volume replacement on platelet function was investigated in 60 patients undergoing elective aortocoronary bypass grafting using cardiopulmonary bypass (CPB). In a randomized sequence, high-molecular weight hydroxyethyl starch solution (HMW-HES, mean molecular weight [Mw] 450,000 d), low-molecular weight HES (LMW-HES, Mw 200,000 d), 3.5% gelatin or 5% albumin were infused preoperatively to double reduced filling pressure (pulmonary capillary wedge pressure [PCWP] < 5 mm Hg). Fifteen untreated patients served as a control. Platelet function was assessed by aggregometry using turbidometric technique (inductors: ADP, epinephrine, collagen). Maximum aggregation, maximum gradient of aggregation, and platelet volume were measured before, during, and after CPB until the first postoperative day. HMW-HES 840 +/- 90 mL, LMW 850 +/- 100 mL, gelatin 950 +/- 110 mL, and albumin 810 +/- 100 mL were given preoperatively. Maximum platelet aggregation (ranging from -23% to -44% relative from baseline value) and maximum gradient of platelet aggregation (ranging from -26% to -45% relative from baseline values) were reduced only in the HMW-HES patients. After CPB, aggregometry also was impaired most markedly in these patients. The other volume groups showed less reduction in platelet aggregation and were similar to the untreated control. On the first postoperative day, aggregation variables had returned almost to baseline in all patients. Platelet volume was the same among the groups within the investigation period. Postbypass blood loss was highest in the HMW-HES group (890 +/- 180 mL). There was significant (P < 0.04) correlation in this group between blood loss and change in platelet aggregation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗