[The rheologic properties of the blood during pregnancy].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
L Heilmann
Publications and source records attributed to L Heilmann.
[Hexoprenaline--a new tocolytic for treatment of premature labor].
Hexoprenaline is a selective beta 2-mimetic drug used in tocology for the prevention of premature labor and immature birth. From clinical application of the drug in bronchospasm therapy its selectivity, which is due to the elongated nitrogen substituent, is well-known. Because of the relatively small stimulation of cardiac beta 1-receptors the side-effects related therewith are less pronounced than with other beta-mimetics. The extent of tachycardia depends on the initial sympathomimetic condition of the patients. The success rate for hexoprenaline tocolyses is 34-78%, dependent on the initial tocological condition. The advantage of hexoprenaline compared with other tocolytics on the basis of experience made so far seems to relate to the smaller increase in chronotropy and the better tolerability.
Female↗
[Short-term prevention with cefoxitin in cesarean section].
In a preliminary prospective study, the febrile morbidity of 60 patients after Caesarean section was determined to investigate the prophylactic effect of a single-dose cefoxitin-application (2 g) intravenously at the time of induction of anaesthesia. Patients were randomly assigned to either the cefoxitin group or a control group without the antibiotic. Each group consisted of 30 patients. Although the numbers of patients were small, a statistically significant reduction (p less than 0.05) of febrile days was found for the cefoxitin group. As compared to previous studies with a three-dose regimen of cefoxitin, the per cent reduction rate of febrile morbidity was similar. In cases with certain risk profiles, such as premature rupture of the membranes or prolonged delivery, a single-dose appears to suffice and is therefore indicated.
Adult↗
[Maternal and fetal hemodynamics under simultaneous beta stimulation and beta1 blockade in a tocolysis model. Considerations on status of the neonatal beta receptor and transplacental passage of metoprolol].
This report summarizes the clinical experiences in the treatment of preterm labor using the combination of hexoprenaline and the beta 1-antagonist metoprolol. We found a dose dependency in the antagonism of positive inotropic effects primarily induced by the beta-stimulator hexoprenaline. To verify the pharmacological properties of metoprolol in transplacental passage we evaluated the plasma concentration of metoprolol in umbilical cord blood. There is quite a low concentration of the beta-blocker nearly 24 h after the last course of administration. The beta 2-receptor density--determined by (+/-)-125-iodocyanopindolol (ICYP) binding--and beta 2-receptor responsiveness--assessed by cyclic AMP response to isoprenaline stimulation--in lymphocytes derived from neonatal blood were also investigated. These results were compared with identical investigations in adult lymphocytes. The results indicate that in neonates beta 2-receptor density and responsiveness is significantly diminished in comparison to the adult controls. The present investigations induce a new concept for the estimation of concomitant fetal cardiovascular reactions under maternal beta-blockade.
Adrenergic beta-Agonists↗
[Effect of metoprolol on the flow properties of blood].
In the present article the interaction of 1- isopropylamino-3-[4-(2-methoxyethyl)-phenoxy]-2-propanol (metoprolol, Beloc) with human erythrocytes is reported. Metoprolol is well known and acts mainly as a selective beta-1-antagonist. While erythrocyte aggregation, suspension osmolality and pH-values were unchanged, red cell deformability was markedly improved. Investigation into the furosemide-sensitive fluxes resulted in an inhibition of sodium efflux and in a constant water content of human erythrocytes. These in vitro results suggest that metoprolol induced improvement of red cell deformability cannot be explained by shape changes of erythrocytes.
Blood Viscosity↗
Indices of cardiac function during treatment with betamimetic drugs (fenoterol and hexoprenaline).
The limiting factor in the treatment of preterm labor by betamimetics is the effect of these drugs on heart rate and cardiac action. In this paper we compare these effects produced by hexoprenaline and fenoterol, which are both beta-sympathomimetic drugs now in clinical use. As indices of cardiac action we measured the pre-ejection period (PEP), the left ventricular ejection time (LVET) and their sum, namely total electromechanical systole (QS2) by thoracic impedance cardiography. In 20 individual tests, seven subjects were given both hexoprenaline and fenoterol on separate occasions in a dose relationship of 1 : 12.5. We found a relation between PEP/LVET on the one hand and the Heather-index (an impedance specific parameter of response to stress) on the other. Both parameters represent inotropic effects in cardiac action. With increasing betamimetic stimulation there was a decrease of PEP/LVET (-23% for hexoprenaline and -29% for fenoterol) and an increase in the Heather-index (+98% for hexoprenaline and +117% for fenoterol). These results are not statistically significantly different and so we cannot agree with Lipshitz [19 ]who reported less beta 1-stimulation with hexoprenaline.
Adult↗
[Single-dose mezlocillin prophylaxis and postoperative morbidity after vaginal hysterectomy: pharmacokinetic and clinical results].
In this prospective, randomized study we evaluated the prophylactic administration of 5 g Meclocillin in a single dose. 100 patients undergoing vaginal hysterectomies were observed. Clinical parameters as well as Meclocillin concentrations in serum and myometrium were compared. We found a sufficient Meclocillin concentration in serum and myometrium 30 minutes after intravenous administration. In the control group (n = 50) 8 patients had a febrile postoperative course whereas there was 1 patient only in the treated group. A more detailed analysis regarding predisposing risk factors, urinary tract infections and pathogens of the vaginal wound secretions is presented. The single dose administration had no significant effect on the incidence of postoperative urinary tract infections. The preliminary result of our study reveals the single dose treatment to be a remarkable alternative to the three-dose-perioperative regimen. Regarding the general question of prophylactic antibiotic treatment at time of vaginal hysterectomy especially individual factors as well as preoperative risk factors have to be taken into account.
Drug Administration Schedule↗
[Hypervolemic hemodilution in pre-eclampsia].
Studying 30 pregnant women, 26 resulted in a pre-eclampsia and 4 in a fetal intrauterine growth retardation. The patients were treated with 500 ml low molecular dextran per hour. We found a hemodilution, an increase of plasma viscosity (5.4%), and a raised cardiac output (32.4%). Resulting from the increased cardiac output we saw a raised systemic oxygen transport capacity in contrast to the hemodilution. The hemodilution is characterized by the increase in stroke volume, whereas heart rate and mean arterial blood pressure are remaining unchanged. The erythrocyte aggregation fell (32.4%) and colloid osmotic pressure raised (27%). Watching the clinical course, we observed a prolongation of gestation above 14 days in ten patients with pre-eclampsia and intrauterine growth retardation. One intrauterine death had to be noticed. The data suggest that only an early infusion therapy with low molecular colloids can be successful in the treatment of hemorheological disorders in pre-eclampsia.
Adult↗
[Severe pregnancy hemostasis disorders: diagnosis and therapeutic procedures].
We evaluated 21 pregnant patients with severe disorders of haemostasis by retrospective chart analyses, 15 patients were treated with intravenous heparin (10.000 to 20.000 I.U.) during and after surgery. Eighteen of 21 patients developed renal failure and 8 died. Postoperative bleeding complications making laparotomies mandatory occurred in 10 patients. These bleeding complications are seen in relation to the heparin treatment instituted immediately after surgery. We do not favor the administration of heparin during the immediate obstetrical postoperative period, the more as Antithrombin III-concentrate is now available. Surgical intervention in order to achieve haemostasis is of paramount therapeutic importance. Drainage of infections remains furthermore the most important task in those obstetrical emergency cases where infections play a predominant role. To maintain or to re-establish the normovolemic perfusion ameliorates the rheological conditions which should monitored with care.
Adult↗
[Thrombophilic factors in the treatment of vulvar cancer (author's transl)].
Explore the source record for details and available documents.
Adult↗
[Hemorheologic examinations in pregnancy].
Explore the source record for details and available documents.
Blood Viscosity↗
[A rheological method for the measurement of red cell deformability (author's transl)].
In a comparison of the filtration methods of Reid et al. and Schmid-Schönbein et al., the significance of other formed blood elements for the assessment of red cell deformability is established. The hydrodynamic measurements and the morphological inspection of the sieves show the interference of red cell pore passage by thrombozyte aggregates and white blood cells (which were not further identified). In light of these findings, which have since been corroborated by other groups, it is mandatory to remove all cellular blood elements exept the red cells in filtration test of the latter. Lowering the hematocrit improves the reliability of the test. The whole blood filtration test, popular because of its simplicity, cannot be standardized and yields results of questionable relevance.
Blood↗
Hemoconcentration and pre-eclampsia.
We measured erythrocyte aggregation and hematocrit in 155 uncomplicated pregnancies and in 55 pregnant women with pre-eclampsia. In the later group we found increased erythrocyte aggregation and a higher hematocrit than in normal patients of comparable gestational age. Erythrocyte aggregation correlated well with plasma fibrinogen levels (r = 0.74) but other high molecular weight proteins such as alpha-2-macroglobulin, IgM and lipoproteins were not measured. Hematocrit showed correlation with mean arterial blood pressure (r = 0.69) and peripheral vascular resistance (r = 0.73). The possible effects of changes in hematocrit and erythrocyte aggregation on blood flow through the intervillous circulation are discussed as are the clinical implications of our findings.
Adult↗
Unfolded 30 S ribosomal subunits.
The 30 S ribosomal subunit from Escherichia coli was unfolded into discrete particles upon which physical studies were carried out. These particles were found to be homogeneous and were characterized using sedimentation velocity, diffusion, density and viscosity measurements. The results of these studies clearly certify two distinct stages of unfolding, neither involving a significant loss of protein. However, the results also clearly show that the measurement of only one characteristic (e.g., the sedimentation coefficient) is not sufficient to suggest a structural change. The significance and importance of the apparent specific volume are stressed.
Diffusion↗
[Flow properties of blood in women on oral contraceptives (author's transl)].
Erythrocyte deformability, whole-blood viscosity, haematocrit as well as fibrinogen and plasminogen concentrations were checked in 39 clinically intact women of whom 22 had been on oral contraceptives for upto five years. Also determined were several serum proteins, such as transferrin, coeruloplasmin, alpha-2 macroglobulin, alpha-1-trypsin, beta-lipoprotein, and inactivated complement component C3. -Seventeen women with intra-uterine devices were chosen to form a control group. Proteins with sensitivity to oestrogen as well as whole-blood viscosity were found to be increased whereas erythrocyte deformability was decreased. Yet, no haemodynamic manifestation took place ot those rheological parameters, since haematocrit declined or remained constant, and no change occurred to fibrinogen and plasminogen concentrations.
Adolescent↗
[High molecular weight albumins in normal and pathological pregnancies and under tocolytic therapy. Serum concentrations of beta-1-SP-1, IgM and alpha-2-macroglobulin].
Pregnancy protein beta-1-glycoprotein levels were determined in serum obtained from 100 women with undisturbed pregnancy and 35 women with high risk pregnancy. Concentrations lower than normal, i.e. below the 1s range, were found only in preeclampsia and in pregnancies with intrauterine growth retardation. Antepartum CTG scoring showed reasonable correlation with the SP-1 values. Due to its long half life time and its relation to the trophoblast, the diagnostic value of SP-1 in cases of placental insufficiency is limited.
Adult↗
[Paroxysmal nocturnal haemoglobinuria (PNH) and pregnancy (author's transl)].
A case report concerning paroxysmal nocturnal hemoglobinuria is presented. The role of hemorheologic factors in perfusion of the placenta is clearly demonstrated. Fetal monitoring and the application of hypervolemic hemodilution enabled prolongation of the pregnancy until a healthy neonate could be delivered by Ceasarean section at the 34th week of gestation.
Cesarean Section↗
[Disturbed microcirculation in gestosis (author's transl)].
1. Impairment of the flow properties of the blood in gestosis is still compensated in the early phase of the disease by the vasodilation resulting gestation. 2. The structural viscosity of the blood becomes haemodynamically relevant in the late phase or in gestoses of a dramatic nature. 3. Due to the resulting low thrust force, even slight increases in the haematocrite level and shifts in the relation of plasma albumins will result in the formation of aggregates which, in their turn, can be responsible for the occurrence of stagnation anoxia. Additive damage is produced in this manner. 4. There is a direct relationship between changes in the flow properties and secondary morphological findings in the placenta or the foetal state index. 5. Improvement of the flow properties of the blood would result in advantages for foetal oxygenation as well, since this would enable to maintain--at least for some time--a more uniform and satisfactory perfusion within the placental flow unit.
Female↗