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Biomedical subjects

K Messmer

Publications and source records attributed to K Messmer.

At least 451 records · Page 25Linked to original sources
PubMed1977

Incidence and severity of anaphylactoid reactions to colloid volume substitutes.

All available colloid volume substitutes carry the risk of anaphylactoid reactions. In a multicentre prospective trial, 69 cases of anaphylactoid reactions have been observed among 200 906 infusions of colloid volume substitutes. The frequency of severe reactions (shock, cardiac and/or respiratory arrest) was 0-003% for plasma-protein solutions, 0-006% for hydroxyethyl starch, 0-008% for dextran, and 0-038% for gelatin solutions.

Aged↗
PubMed1977

Immunological properties of a high molecular weight component from yeast cell autolysate in dogs and evaluation of its potential role in human dextran reactions.

A high molecular weight component (HMC) of autolysate from Saccharomyces cerevisiae yeast cells was prepared. HMC was found to be immunogenic in dogs, inducing hemagglutinating antibody formation. Upon HMC challenge of immunized dogs, systemic anaphylactoid reactions were observed in 4/5 animals. The most prominent symptom was decreased cardiac output. Decrease in mean arterial pressure and increase in pulmonary arterial pressure were also observed. Consumption of total serum complement activity amounted to 22% of initial values. HMC also exhibited mitogenic activity in lymphocyte cultures from nonimmunized and immunized dogs. Since yeast autolysate is used as nitrogen source for Leuconostoc mesenteroides in the production of clinical B 512 dextran it is a theoretically possible trace contaminant of such solutions. Therefore, dogs hyperimmunized with HMC were also challenged with clinical dextran. No anaphylactoid signs were observed. These data suggest a negligible causal role of macromolecular contaminants derived from yeast cell autolysate in rare human anaphylactoid reactions following infusion of clinical dextran.

Anaphylaxis↗
PubMed1977

[Infusiontherapy with colloidal volumesubstitutes (author's transl)].

All colloidal plasma substitutes carry the risk of anaphylactoid complications with a general incidence of 0.03%. This incidence seems low; however severe complications may occur after infusion of colloids, including also human albumin solutions. In spite of the risk of anaphylactoid reactions, however, colloids should not be ommited from volume replacement therapy. When choosing a colloid for volume replacement the solution-specific risk of anaphylactoid complications has to be taken into consideration. From an increasing number of recent case reports the impression of a rising rate of complications has emerged; this impression was not substantiated by a prospective controlled trial performed in 1975. Since dextran in addition to its safe volume effect possesses well documented antithrombotic properties, it cannot be replaced by any other colloid without the addition of another thromboprophylactic agent.

Anaphylaxis↗
PubMed1976

Oxygen transport and hemodynamics of stroma-free hemoglobin solutions.

The intravascular persistence of hb-W is significantly longer than of pyridoxylated hb (hb-PLP), however, no significant differences in BV were observed after isovolemic exchange of 20 ml/kg b.w. Even though the oxygen affinity of hb-PLP in vitro was reduced when compared to the affinity of hb-W significant differences in vivo were lacking. The development of hypovolemia and thus the lack of an adequate increase in cardiac output have been recognized as the most relevant causes to explain the changes observed. Neither of the solutions is yet to be recommended for clinical blood replacement therapy.

Animals↗
PubMed1976

Histamine release in human subjects by modified gelatin (Haemaccel) and dextran: an explanation for anaphylactoid reactions observed under clinical conditions?

Histamine release by modified gelatin (Haemaccel) and dextran (Macrodex) has been demonstrated in volunteers by direct and indirect methods. In a pilot study of Haemaccel, histamine release was observed in six of seven volunteers. The highest plasma histamine concentration was 4.8 ng/ml, the lowest 1.7 ng/ml: two of the subjects showed slight allergic reactions. Using Haemaccel batch 2551, 10 out of 12 subjects reacted to the rapid infusion of Haemaccel with increased plasma histamine concentrations, whereas none reacted to Ringer's solution. None of the 10 subjects had an allergic reaction, but an increase in gastric secretion was observed in eight. Changes in the venous basophil granulocyte count were found in both those who reacted and those who did not react to Haemaccel. After the rapid infusion of dextran the highest plasma histamine concentration was 5.0 ng/ml, the lowest 1.3 ng/ml. The withdrawal of blood had no influence on plasma histamine concentration. The incidences of histamine release produced by Haemaccel varied with different batches. Thus, it seems unlikely that immunological mechanisms are principally responsible. Nine instances of allergic and anaphylactoid reactions to plasma substitutes have been reported, seven after Haemaccel infusion, and two after dextran administration. One of the patients who received dextran died. Histamine release was always associated with Haemaccel infusion and corresponded in extent to the clinical symptoms observed, but there was no significant histamine release associated with the reactions to dextran.

Adult↗
PubMed1976

Anaphylactoid reactions due to hydroxyethyl starch infusion.

Incompatibility reactions due to hydroxyethyl starch (HES) were observed during 8 out of 10,273 infusions of 500 ml 6% HES (Plasmasteril). The clinical symptoms ranged from skin reactions to tachycardia, hypotension and shock. In 3 of the 8 patients with incompatibility serum immunoglobulin concentrations were reduced after the anaphylactoid reaction. Specific antibodies against HES were, however, not detected. Serum IgE levels stayed within their normal limits. Positive reactions of the immediate type to intradermal skin tests with different dilutions of Plasmasteril were obtained in five patients.

Adult↗
PubMed1976

Intravascular persistence of hydroxyethyl starch in man.

In two groups, each consisting of five healthy volunteers, 7 ml blood/kg body weight were exchanged with equal amount of hydroxyethyl starch (HES) and dextran 60 solutions, respectively. Dextran 60 plasma levels, determined by the anthrone method, were undetectable after 4 weeks. The elimination of HES from the blood, determined by an immunological technique and by the anthrone method, had a very protracted course. Two weeks after infusion the HES plasma concentrations were 9% of the initial value and after 17 weeks they were still above the 1% level. The prolonged intravascular persistence of HES in its commercially available preparation, and the possibility of tissue accumulation after repeated HES infusions were considered undesirable. The hypothesis that HES infusion causes and augmentation of serum alpha-amylase concentrations in man was confirmed. This effect should be borne in mind when HES solutions are given to patients in whom the diagnosis of acute pancreatitis might be considered.

Amylases↗
PubMed1976

[Resuscitation with stroma-free hemoglobin solution after acute blood loss].

Resuscitation and volume replacement after acute blood loss is possible for a short duration by means of 6% stroma-free hemoglobin solution (SFH). Despite transcapillary loss of SFH, pulmonary edema is not provoked after massive infusion of cristalloid solution. The oxygen supply to the tissues is maintained by a compensatory rise in cardiac output and O2-extraction, mainly from the remaining red cell hemoglobin.

Acute Disease↗
PubMed1976

[Myocardial contractility in dogs in hemorrhagic shock and after volumn replacement (author's transl)].

Myocardial contractility was evaluated in 8 out of 14 anaesthetized mongrel dogs during haemorrhagic shock and after volume replacement with Dextran 60 using the force-velocity relation of the contractile elements at zero load (Vmax). 7 animals received 50,000 or 20,000 KIE respectively of a proteinase inhibitor after bleeding and immediately before and one hour after the infusion of Dextran 60. The release of the lysosomal enzymes acid phosphatase and beta-glucuronidase was inhibited significantly (p less than 0.05) in the animals treated with Trasylol. However, the inhibition of the lysosomal enzymes seems not to have a decisive influence on the dynamic of the macro- and microcirculation and the myocardial contractility.

Acid Phosphatase↗
PubMed1976

[Preoperative haemodilution: basis adaption mechanism and limitation of clinical application (author's transl)].

Basically the adaptational mechanism in acute, normovolaemic dilutional anaemia with dextran-60 is an increased flow rate to organs and tissues due to decreased viscous flow resistance. There is no decrease in systemic oxygen transport and no increase in oxygen extraction ratio unless the hematocrit drops well below 20%. Thus adequate tissue oxygen supply is guaranteed in limited dilution as shown by direct measurements of tissue PO2. The feasibility of a new concept of acute preoperative haemodilution with subsequent autotransfusion of the shed blood is demonstrated in 34 patients. Within the safe limits of clinical dilution in the haematocrit range of 25-20% adequate tissue oxygenation is provided by a rise in cardiac output, whereas heart rate, blood gases and acid base status are essentially unchanged. Autotransfusion during surgery and postoperatively helps to save donor blood, is easy to perform, gives better tissue perfusion at the microcirculatory level and prevents postoperative thromboembolic complications.

Blood Transfusion, Autologous↗
PubMed1976

[Why are calculated "in-vitro" effects of preoperative haemodilution in variance with respective clinical findings? (author's transl)].

Whereas theoretical calculations on the effect of hemodilution show a low gain of erythrocytes, the blood saving effect under clinical conditions is considerably higher. Withdrawal of 1,975 ml blood for haemodilution and an intraoperative blood loss of 2,480 ml resulted in saving of 298 ml of red cells or 850 ml of whole blood (haematocrit 35%). This amount of blood saved seems not very much, but it made the transfusion of donor blood unnecessary in cases when otherwise 1--2 units of homologous blood would have been given. Withdrawal of autologous blood 8--10 days prior to an operation planned to be performed under haemodilution is possible, in our experience however, not practical in clinical routine, because of the considerable logistical problems involved.

Blood Transfusion, Autologous↗
PubMed1975

Hemodilution.

The dilution of whole blood leads to a significant improvement of its rheologic properties based on a decrease in hematocrit and, hence, blood viscosity. Under conditions of normovolemia and an adequate response of the cardiorespiratory system, the acute dilution of blood will enhance the venous return to the heart and thereby improve total and capillary blood flow significantly. In the hematocrit range of 25 to 30 per cent (limited hemodilution), this increase in flow rate is able to compensate fully for the diminished oxygen content of the blood. Changes in oxygen extraction or in oxygenhemoglobin affinity are only encountered at hematocrits below 20 per cent or if hemodilution is associated with hypovolemia. Since normovolemia is the condition sine qua non for the heart to increase its output compensatorily, intentional hemodilution should preferably be performed with colloid solutions which are capable of maintaining the colloid osmotic pressure of plasma and the circulating volume in normal limits. Limited normovolemic hemodilution with its beneficial effects on microcirculatory flow and tissue nutrition is emphasized for the treatment of impaired microcirculation as occurring in shock and low flow states, polycythemia, and high viscosity syndromes. Acute preoperative hemodilution is a means of reducing the use of bank blood and of avoiding the risks of blld transfusions in patients undergoing major elective surgery. Extreme hemodilution and total body washout in hypothermia appear to be effective clinical tools.

Animals↗
PubMed1975

Concentration and transport of different sugars in the lymph of the thoracic duct and in blood of the portal vein in dogs after enteral and parenteral administration.

The uptake and distribution of glucose, galactose, fructose and inulin in dogs was investigated in the lymph of the thoracic duct and in different blood vessels after enteral and parenteral administration. Whereas inulin could be detected neither in the lymph nor in portal venous blood after enteral administration, all other sugars were found in different concentrations in blood and lymph. Although the concentration of different sugars in the lymph after enteral and parenteral application can be compared to that in serum, the amount of sugars transported via the lymphatics is so small that it can be neglected.

Animals↗