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R Zander

Publications and source records attributed to R Zander.

At least 19 recordsLinked to original sources
PubMed2001

[Definition of shock types].

Definitions of shock types. Hypovolaemic shock is a state of insufficient perfusion of vital organs with consecutive imbalance of oxygen supply and demand due to an intravascular volume deficiency with critically impaired cardiac preload. Subtypes are haemorrhagic shock, hypovolaemic shock in the narrow sense, traumatic-haemorrhagic shock and traumatic-hypovolaemic shock. Cardiac shock is caused by a primary critical cardiac pump failure with consecutive inadequate oxygen supply of the organism. Anaphylactic shock is an acute failure of blood volume distribution (distributive shock) and caused by IgE-dependent, type-I-allergic, classical hypersensibility, or a physically, chemically, or osmotically induced IgE-independent anaphylactoid hypersensibility. The septic shock is a sepsis-induced distribution failure of the circulating blood volume in the sense of a distributive shock. The neurogenic shock is a distributive shock induced by generalized and extensive vasodilatation with consecutive hypovolaemia due to an imbalance of sympathetic and parasympathetic regulation of vascular smooth muscles.

Anaphylaxis↗
PubMed2000

Haemoconcentration by gelatin-induced acceleration of erythrocyte sedimentation rate.

Erythrocyte sedimentation rates from 40 suspensions of packed red blood cells in modified fluid gelatin, 4% albumin solution, 6% hydroxyethyl starch and normal saline were measured at room temperature using Westergren's method. The erythrocyte sedimentation rate was extremely high in gelatin and this increase was significant after 10-60 min when compared with the other fluids. Erythrocyte sedimentation rates in albumin, hydroxyethyl starch and normal saline were low and there were no differences between these fluids [erythrocyte sedimentation after 60 min, median (interquartile range): gelatin 128 (111.2-130.0) mm, albumin 2 (1.5-2.0) mm, hydroxyethyl starch 1.5 (1.0-1.6) mm, normal saline 2 (1.9-2.5) mm, p < 0.0001]. The addition of twice the volume of modified fluid gelatin to a volume of red blood cells leads to rapid acceleration of the erythrocyte sedimentation rate. This is caused by increased erythrocyte aggregation, and in clinical practice this effect may be useful for the haemoconcentration of diluted blood from cardiopulmonary bypass circuits or cell-saver autotransfusion in paediatric surgery.

Albumins↗
PubMed2000

Protective effects of plasma replacement fluids on erythrocytes exposed to mechanical stress.

Haemoglobin release from 40 suspensions of packed red blood cells in modified fluid gelatin, 4% albumin solution, 6% hydroxyethyl starch and normal saline was investigated in vitro during circulation with a roller pump from a heart-lung machine for 120 min at a flow rate of 2.5 l.min-1 at room temperature. The lowest haemoglobin release was obtained with erythrocytes in modified fluid gelatin, whereas free haemoglobin concentrations became progressively higher with albumin, hydroxyethyl starch and normal saline [median free haemoglobin (interquartile range) after 120 min circulation: gelatin 493 (360-601) mg.l-1, albumin 692 (590-1111) mg.l-1, hydroxyethyl starch 1121 (692-1518) mg.l-1, normal saline 1178 (881-1757) mg.l-1, p < 0.001]. Modified fluid gelatin appears to have potent erythrocyte protective properties similar to those of albumin. This effect could decrease mechanical haemolysis during extracorporeal circulation or cell saver autotransfusion if modified fluid gelatin is used as part of a priming solution or as an additive in wash solutions.

Erythrocytes↗
PubMed1999

Alteration of anion gap during almost total plasma replacement with synthetic colloids in piglets.

In ten piglets (body weight 8.2-11.6 kg), acid base, electrolyte and anion gap changes were investigated during almost total plasma replacement with hydroxyethyl starch (HES) and modified fluid gelatin (GEL) in saline solution using a cell saver autotransfusion technique. During the study, there were only moderate acid base changes, but marked disturbances in anion balance. At study end, the mean chloride concentration was significantly higher (mmol/l: normal values 97-108, HES 116 +/- 1.5, GEL 108 +/- 1.1, p < 0.01) and the mean anion gap was significantly lower in the HES group in comparison to the GEL group (mmol/l: normal values 5-14, HES 3 +/- 1.7, GEL 11.9 +/- 0.9, p < 0.01). It is concluded that plasma replacement with electroneutral HES, but not with negatively charged GEL, can lower the anion gap irrespective of the underlying disease. This can be misleading when the anion gap is used for differential diagnosis of metabolic acidosis in patients after large volume infusion of synthetic colloids.

Acid-Base Equilibrium↗
PubMed1999

Physiological HEPES buffer proposed as a calibrator for pH measurement in human blood.

N-(2-hydroxyethyl)-piperazine-N'-2-ethanesulfonic acid, known as HEPES buffer, with pK in the physiological range was studied for use as an alternative to conventional phosphate buffer for the calibration of pH in modern clinical analyzers. In different series of aqueous equimolar HEPES buffer, pH was measured at 37 degrees C with a capillary glass electrode standardized previously using phosphate, and variations due to changes in total HEPES buffer concentration (0.025 to 0.320 mol/l), and NaCl (0 to 0.250 mol/l) were monitored. For 0.05 equimolar HEPES buffer without NaCl, the pH of 7.362+/-0.003 (n = 15) obtained coincided well with the reference pH (7.364) from the National Institute of Standards and Technology (NIST). In particular, in the preferred 0.05 equimolar HEPES buffer/0.110 mol/l NaCl, which is isotonic to human plasma (0.160 mol/l), and termed physiological HEPES buffer (PHB), the pH of 7.346+/-0.003 (n = 84) can be related to the calculated corresponding reference pH from NIST without liquid junction (7.374), and is also compatible with the pH measured in normal arterial blood, pH = 7.403+/-0.003 (n = 20). Hence, in the two-point calibration of clinical analyzers, PHB, which is defined operationally with respect to the glass electrode and to phosphate buffer, may be useful as a calibrator in the range of buffer adjustment control to meet the correct values for pH when measuring in blood. Whereas Na-HEPES salt is hygroscopic and does not meet the declared purity grade (> 99%), pure HEPES acid is non-hygroscopic and conforms to the manufacturer's purity grade (> or = 99%). Therefore, for easy preparation of PHB, HEPES acid is the preferred starting material.

Blood Chemical Analysis↗
PubMed1998

Solubility of NH3 and apparent pK of NH4+ in human plasma, isotonic salt solutions and water at 37 degrees C.

The solubility of ammonia, alphaNH3 (mM/mmHg), was determined at 37 degrees C and low ammonia partial pressure (0.02-1 mmHg) in pure water (n =24) as 46.70+/-0.40; aqueous isotonic salt solutions (n = 7) as 46.8+/-0.81; and human plasma (n = 5) as 42.0+/-0.66. The last figure increases to 45.3+/-0.63 if expressed in molal units (mmol/kg plasma water x mmHg) instead of molarity with respect to the water content of the plasma (mean from four healthy and fasting donors: 0.908+0.005 kg H2O/kg plasma; mean density at 37 degrees C: 1.020+/-0.002 kg/l). In pure water, the solubility value is the mean of three different methods: (a) extrapolation of the salting-out effect of ammonia in aqueous NaOH to zero concentration; (b) slope of Henry-Dalton's law and (c) directly measured in pure water and 0.001 M aqueous NaOH. Based on the Henderson-Hasselbalch equation for the system NH4/NH3 in isotonic salt solutions and human plasma, both constants, apparent pK and solubility, can be derived from total ammonia concentration and pH at equilibrium with defined ammonia gas phase, if additionally the concentration of NH4 or NH3 is known. This was verified, in the first case, by determining the concentration of NH4+ by the experimental conditions, and in the second, by two measurements of total ammonia concentration at two different pH values. Total ammonia concentration was measured by a specific enzymatic standard test and pH with the glass electrode. The mean apparent pK was 8.968+/-0.013 in isotonic salt solutions (n = 7), and in human plasma (n = 10) it was 9.014+/-0.033.

Ammonia↗