Search PubMed⌕ Search

Biomedical subjects

L Heilmann

Publications and source records attributed to L Heilmann.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Hemoglobin--an obstetric risk factor].

The relationship between haemoglobin values (14th to 30th week of gestation), pregnancy outcome and perinatal morbidity was investigated in a prospective study. Subsequently, haemoglobin values, blood pressure, proteinuria and perinatal risk factors, together with the foetal cardiotocogram were abstracted from the obstetrician's records. Preterm birth (25%), intrauterine growth retardation (7.6%) gestational hypertension (31.5%) and low birth weight babies (10.3%) were seen significantly more often in women with haemoglobin > or = 13 g/dl in the 2nd trimester (14-30 wk). We observed a high perinatal morbidity from RDS (9.3%) and newborn hyperviscosity (23.9%) in women with a high haemoglobin level. These results were in agreement with the hypothesis, that a higher blood viscosity or a lack of haemodilution are risk factors for poor placental perfusion.

Adolescent↗
PubMed1991

[Rheology and gravidic hypertension].

Gestational hypertension is the development of hypertension and proteinuria after the 20th week of gestation. The most common causes of increased peripheral resistance are the vasoconstriction and hemoconcentration with plasma volume contraction. Additional rheological parameters are an elevated red blood cell aggregation and impaired erythrocyte deformability. Preeclamptic patients showed a significantly low cardiac output and central venous pressure than normal pregnant women. It has already been shown by the studies by Hytten and Paintin (1963) and also by the subsequent studies by Garn et al. (1981), Murphy et al. (1986) that a strong correlation exists between newborn weight and plasma volume. Other authors (Gallery et al. (1979/1981)) show the possibility that plasma volume contraction plays an even larger role than vasoconstriction in the fetal growth retardation that often accompanies maternal hypertension. This possibility is supported by the finding that hypertension and perinatal complications can be reduced in some pregnant women by the admission of oncotic solutions (i.e. hydroxyethyl-starch) that expand plasma volume. Volume expansion with hydroxyethyl-starch appears to be of therapeutic benefit for hypertensive patients and patients with fetal growth retardation with low cardiac output.

Birth Weight↗
PubMed1991

[Hemostasis and pre-eclampsia].

A longitudinal study has been undertaken in 125 pregnant women between 25 and 40 weeks of gestation, to provide systematic information on the changes that occur in a wide range of haemostasiological and haemorheological variables. Fibrinogen, D-Dimer, Factor VIIIR: Ag, erythrocyte aggregation and plasma viscosity rose markedly throughout pregnancy. Antithrombin III and alpha 2-antiplasmin were unchanged during pregnancy. There were no significant differences between women in the pre-eclamptic group (N = 16) and the control group. HELLP syndrome (N = 7) was associated with high D-Dimer (p less than 0.05), and TAT (p less than 0.05), low antithrombin III (p less than 0.03), protein C (p less than 0.01) and platelets (p less than 0.001). Our results demonstrate that during pregnancy (also, however, in pre-eclamptic women) alterations of the coagulation system occur, but these changes do not affect the overall haemostatic balance. Findings in patients with "true" HELLP syndrome are consistent with an increased tendency for intravascular coagulation.

Blood Coagulation Factors↗
PubMed1991

[Value of hemodilution therapy in pregnancy].

The ability to produce a large increase in plasma volume is one of the hallmarks of a successful pregnancy. Data from Garn et al. (5), Knottnerus et al. (14) and Murphy et al. (15) have shown, that hemoglobin levels above 13 g/dl or hematocrit 38% before admittance to hospital are associated with a high incidence of IUGR (intrauterine growth retardation), gestational hypertension and with a greater perinatal mortality. Patients with an elevated viscosity and hematocrit have increased perinatal risks. In these cases the hemodilution with hydroxy- ethylstarch (HES) improves the blood flow and decreases the incidence of dysmature babies and pregnancy complications. The effect of HES on certain coagulation assays seems qualitatively similar to those of Dextran. In a prospective trial we evaluated the effect of HES in the incidence of thrombosis after cesarean section and we found a 5.9% incidence of thrombosis in patients treated with 6% HES 0.62 compared with a 7.8% incidence in heparin treated patients. Treatment with 1500 ml 6% HES 0.62 before and after cesarean section is similarly effective in preventing deep vein thrombosis as heparin prophylaxis.

Blood Volume↗
PubMed1991

[Accumulation of two different hydroxyethyl starch preparations in the placenta after hemodilution in patients with fetal intrauterine growth retardation or pregnancy hypertension].

In a prospective clinical study the safety of two hydroxyethylstarch preparations (HES steril 10%, Fresenius AG, Oberursel = HES-A; Haemufusin, Kabi-Pfrimmer, Erlangen = HES-B) were assessed. In 60 patients with fetal growth retardation and/or gestational hypertension, hematocrit, aPTT, factor VIIIR: Ag, fibrinogen, uric acid, cord blood hemoglobin, hematocrit, pH-value and the fetal/maternal hydroxyethylstarch concentration before and after eight (HES-B) or nine (HES-A) days of treatment were monitored. 500 ml HES-A (n = 36) or HES-B (n = 24) together with the same volume electrolyte solution, were infused daily. Both substances lowered significantly the maternal and fetal hematocrit. Histopathological changes of placenta (trophoblast cells and stroma) taking place after the infusion of HES-A or HES-B were depicted by light microscopy. Administration of HES-A or HES-B was associated with lower values of factor VIIIR: Ag and a prolongation of aPTT, but only HES-B demonstrated a significant effect (31% vs. 12%, p less than 0.01). We observed in 4 (16.7%) cases severe uterine bleeding complications and one woman (4.2%) with abruptio placentae in the group HES-B. Light microscopy shows vacuoled trophoblast and stroma cells after HES infusions. The marked vacuolisation of the placenta after HES-B is due to differences in the physicochemical characteristics of HES-A and HES-B. For this reason, we prefer to administer HES-A in the dilution treatment of patients with placental insufficiency.

Adolescent↗
PubMed1990

[Hemodynamic and hemorheologic findings in patients with pregnancy-induced hypertension: comparison of pre-eclampsia and chronic hypertension].

Forty-five women with preeclampsia and 39 woman with chronic hypertension in pregnancy were studied by catheterization of the superior vena cava and by impedance cardiography before therapy was started. An initial hemorrheology and hemostaseologic protocol was prepared which included hematocrit, erythrocyte aggregation, erythrocyte deformability, plasma viscosity, colloid osmotic pressure, serum osmolality, uric acid, fibronectin, antithrombin III and fibrinogen. The hematocrit and the peripheral resistance were greater in preeclampsia than in essential hypertension. Moreover, preeclamptic patients showed a significantly lower cardiac output and central venous pressure than women with chronic hypertension. On the other hand, the plasma viscosity of women with essential hypertension increased, whereas patients with preeclampsia showed a lower erythrocyte deformability and a higher concentration of leukocytes. Finally, volume expansion with Hydroxyethyl-starch appears to be of therapeutic benefit for hypertensive patients with low cardiac output.

Adolescent↗
PubMed1989

Hemodynamic and hemorheological profiles in women with proteinuric hypertension of pregnancy and in pregnant controls.

We obtained blood samples from 52 patients with pre-eclampsia and from 40 pregnant controls for measurement of plasma urate levels, hematocrit, white cell count and various hemorheological parameters. We also used impedance cardiography to measure cardiac output in both groups and from the results derived values for total peripheral resistance and oxygen transport. Central venous pressure was measured with a superior vena cava catheter in patients with pre-eclampsia but not in controls. Women with pre-eclampsia had significantly lower cardiac output and central venous pressure when compared with a control group. A modest correlation was observed between central venous pressure and cardiac output. The majority of pre-eclamptic patients had significantly raised hematocrit, leucocyte count, uric acid and red cell aggregation. Red cell deformability was significantly decreased in patients with pre-eclampsia. Most patients with severe pre-eclampsia (BP diast. greater than 100 mmHg) had a low Antithrombin III and colloid osmotic pressure level. The leucocyte count was raised when compared with the women with moderate pre-eclampsia. Oxygen delivery was reduced in patients with pre-eclampsia because of impaired rheological properties of their blood.

Cardiac Output↗
PubMed1989

[Microcirculation and hypertension in pregnancy].

The hypervolaemic and vasodilated circulation in normal pregnancy results in a high flow- low blood viscosity situation. In contrast, patients with gestational hypertension may have a contracted plasma volume. Hypovolaemia is reflected in a higher haematocrit than normal. In the cases of a hypovolaemic state, hemoconcentration is associated with a low cardiac output. In fetal distress and proteinuric hypertension the rheological data has a high predictive value for perinatal complications.

Blood Flow Velocity↗
PubMed1989

[Microcirculation and hemorheology in shock].

All types of circulatory shock result in a severe hypotensive state at some stage in their development and virtually all involve an early splanchnic vascular hypoperfusion and a later impairment of cardiac function. One important and consistent feature of circulatory shock is a fundamental insufficiency of microcirculatory flow leading to inadequate perfusion of the somatic cells of many of the important organs of the body. If the cellular hypoxic insult can be limited by fluid therapy with colloids and crystalloids, then the incidence of systemic complications in the post-shock period will also be reduced.

Cell Hypoxia↗
PubMed1989

Hemorheological parameters in patients with gynecologic malignancies.

Thromboembolic events account for a significant number of complications during surgical and chemotherapeutic treatment for gynecologic malignancies. Besides changes in the hemostatic system, changes in hemorheological parameters facilitate initiation and promotion of thrombotic disease. We used a rheoaggregometer to determine erythrocyte aggregation and a capillary viscosimeter to evaluate plasma viscosity in patients with gynecologic malignancies at the time of primary diagnosis and during follow-up and compared the results to those for a normal control group. We found a significant elevation in plasma viscosity and erythrocyte aggregation as well as in fibrinogen and globulin concentrations in cancer patients. The extent of this rise was related to the tumor volume. Treatment with cisplatin, doxorubicin, and cyclophosphamide resulted in a further rise in erythrocyte aggregation which is attributed to a direct effect on the erythrocyte membrane. Thus, additional factors contributing to the risk of thrombosis in these patients were defined. Additional administration of rheologically active agents might improve the results of thrombosis prophylaxis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Prevention of thrombosis in gynecology: double-blind comparison of low molecular weight heparin and unfractionated heparin].

The safety and efficacy of low molecular heparin (Sandoz AG, Nürnberg), given 1500 aPTT once daily (and two placebo injections), in preventing postoperative venous thromboembolism, was assessed against sodium heparin at a dose of 5000 IU three times daily, in a unicenter double-blind randomized study. 300 patients, scheduled for major gynecological surgery, were included in this study. Two patients (1.3%) of 150 patients developed deep vein thrombosis in the LMWH-group, the corresponding figure for sodium heparin was 6 patients (4.0%). There was no statistically significant difference between the two groups in respect to the bleeding variables such as postoperative drainage, blood transfusions and haematoma. The antithrombotic effects were assessed with the anti-Xa assay and LMWH-fractions have shown a high antifactor Xa/activated partial thromboplastin time (aPTT) specific activity (2:1) compared to unfractionated heparin (1:1). It is concluded that one single daily injection of LMWH (without dihydergot) provides a convenient safe and effective prophylaxis against thromboembolism in gynecological surgery.

Adult↗
PubMed1988

Hemorheologic variables in breast cancer patients at the time of diagnosis and during treatment.

The increased risk of thrombosis seen in patients with malignancy also was recently confirmed in breast cancer patients undergoing hormonal or chemotherapeutic treatment. Besides changes within the coagulation system, alterations of hemorheologic variables have been implicated in the genesis of thrombosis. We evaluated plasma viscosity, erythrocyte aggregation, fibrinogen level, sedimentation rate, hematocrit concentration, and protein concentration in patients with breast cancer at the time of primary diagnosis and during follow-up with or without treatment. We then compared the results to a control group without malignant or infectious disease. Plasma viscosity and erythrocyte aggregation were significantly higher in patients with malignant disease, with a further increase at the time of dissemination. Plasma fibrinogen level was significantly higher only at the time of dissemination. The influence of therapy on hemorheologic variables was minor. Tumor volume was the most important factor. As individual values vary considerably and form a continuous spectrum, no cutoff line between normal and pathologic values can be defined. However, high values should induce further measures to diagnose metastatic disease. Second, these factors could explain the relative inefficiency of thrombosis prophylaxis in this patient group and suggest the addition of rheologically active drugs to the treatment regimen.

Blood Sedimentation↗
PubMed1987

Blood rheology and pregnancy.

Pregnancy is a hypervolaemic situation with early expanded plasma volume, a high cardiac output and a decrease in the vascular and rheological resistance. The increase in plasma volume correlates better with fetal size than maternal size. The hypervolaemic and vasodilated state that accompanies normal pregnancy results in a high flow in the uterine arteries. In contrast, patients with PIH (pregnancy-induced hypertension) or placental insufficiency may have a contracted plasma volume secondary to diffuse vasoconstriction. In spite of the intense vasospasm and hypovolaemia, pre-eclampsia has generally a cardiac output which may be equal, higher or lower compared with non-eclamptic pregnancy. Hypovolaemia is reflected in a higher haematocrit than normal. In the case of a hypovolaemic state, haemoconcentration is associated with high red cell aggregation. In fetal distress and severe PIH, the rheological status (haemoconcentration and elevated red cell aggregation) has a high predictive value for perinatal complications. In patients with severe PIH, erythrocyte filtration is impaired. The increased leukocyte count in patients with PIH may occlude small vessels and could be a factor impairing intervillous blood flow. The increased erythrocyte rigidity may result from a re-distribution of cellular calcium metabolism (Blaustein concept). We conclude that there is an optimal haematocrit during pregnancy between 30% and 38%. The presence of a high haematocrit and in addition elevated red cell aggregation should alert the physician to an increased risk of fetal compromise.

Blood Flow Velocity↗
PubMed1987

[Hemorrheologic findings in severe gestosis].

On the basis of the hemorrheologic and hemodynamic data of 30 severe gestoses the importance of rheology in the diagnosis and treatment of these conditions is discussed. It was found that the gestoses can occur with a variety of clinical phenomena (HELLP syndrome, hypervolemic gestosis). The classic picture comprises hemoconcentration, increased erythrocyte aggregation, low central venous pressure and low-normal cardiac output with increased blood viscosity. Depending on the condition of the microcirculation, laboratory values can fluctuate considerably. The mean antithrombin-III value was not subnormal, but the fibronectin value was high. The causes of the increased fibronectin values are still not clear. It seemed important that with a hematocrit of over 38% and an erythrocyte aggregation over 28(-) there was a high probability of the fetus being at risk. Erythrocyte deformability is reduced. The reasons for this still have to be identified. Changes in the ion transport system on the erythrocyte membrane, with accumulation of sodium and calcium inside the cell, are discussed. Additionally, leukocytosis causes an impairment of blood flow characteristics.

Adult↗
PubMed1986

Rheological studies on patients with pregnancy-induced hypertension (PIH).

Hypertension during pregnancy is a disorder which is associated with high maternal and foetal morbidity. Whilst the aetiology remains unknown, a generalized microcirculatory disorder must be presumed as a joint pathophysiological fundamental concept. Vascular, haemorheological and haemostasiological disorders are combined here. For the haemorheological changes, the reduction in plasma volume along with haemoconcentration and pathological erythrocyte aggregation stands out as a significant factor. The overall flow behavior of the blood is impaired, whereby leucocytosis is of particular significance in cases of PIH. A series of observations exist which closely connect rheological changes with the foetal state. No conclusive statement can as yet be made as to the extent to which erythrocyte deformability is impaired, due to the highly susceptible laboratory procedures.

Blood Viscosity↗
PubMed1986

Simultaneous investigations of maternal cardiac output and fetal blood flow during hypervolemic hemodilution in preeclampsia--preliminary observations.

In pre-eclampsia hemodynamic alterations are characterized by a lack of plasma volume expansion and a raised peripheral vascular resistance. For the compensation of plasma volume deficit and to restitute blood fluidity the therapeutic use of plasma volume expanders (f.e. low molecular dextran) is recommended. Several groups (Goodlin et al., Cloeren et al., Heilmann et al., Seghal et al., Schröck) have demonstrated benefitial effects on fetal status and development in the course of hypervolemic hemodilution in preeclampsia. This therapeutic procedure presumes the continuous surveillance of maternal hemodynamics to early recognize heart insufficiency or fluid overload in the lungs. We use the noninvasive thoracic impedance cardiography for continuous monitoring of maternal heart performance. The effect of hypervolemic hemodilution on fetal circulation has not been quantitatively investigated yet. Meanwhile pulsed doppler ultrasonography offers the possibility of estimating quantitative changes on fetal blood flow. We used both noninvasive techniques--thoracic impedance cardiography and pulsed doppler imaging system--for the simultaneous evaluation of maternal and fetal hemodynamic parameters during hypervolemic hemodilution. This preliminary report summarizes the investigations in 5 patients with pre-eclampsia (mean arterial blood pressure greater than or equal to 103.3 mm Hg, hemoconcentration with elevated hematocrit levels greater than or equal to 38%). The patients received an infusion of 500 ml dextran 40 over a period of exactly 60 minutes. The simultaneous measurements of maternal and fetal cardiovascular parameters were performed in 15-minutes intervals during dextran application and 15 minutes (p 15), 30 minutes (p 30) and 60 minutes (p 60) after the end of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Changes in flow properties of the blood in pregnancy].

Over the past decade it has been shown that abnormalities of blood rheology exist in certain obstetrical conditions and are associated with circulatory disturbances. Hemorheological parameters (erythrocyte aggregation, rigidity of red cells, plasma viscosity, hematocrit) and biochemical factors (fibrinogen, albumin, total protein, water and sodium content of erythrocytes) were studied during pregnancy. Erythrocyte aggregation, plasma viscosity and fibrinogen rose with gestational age. Hematokrit, serumosmolality and colloidosmotic pressure decreased progressively during advancing pregnancy. In gestosis erythrocyte aggregation was significantly elevated after correction for packed cell volume. Hemoconcentration and an impaired red cell deformability were contributed significantly to the decrease in blood fluidity. These findings are of considerable relevance for the treatment of gestosis. Plasmavolume expander, such as salt poor human albumin, low molecular dextran or hydroxyethylstarch 200 will reduce hematocrit and erythrocyte aggregation and improve fetal outcome.

Blood Flow Velocity↗