[Use of partial thromboplastin time and thrombin time in the diagnosis of disseminated intravascular coagulation].
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Biomedical subjects
Publications and source records attributed to U Frick.
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Due to a slight haemooysis after the application of bromsulphalein an intravasal coagulation with reduction of the number of heparinocytes and an increase of fibrinolytic split products develops. These changes are to be observed in the vast majority of tests, also in such cases where no clinical signs of an incompatibility appear. Indocyanine-green does not cause these severe disturbances of coagulation. Slight changes are traced back to the examination technique. Patients with chronic liver disease already show increased values of fibrinolytic split products. In increased initial values of fibrinolytic split products bromsulphalein does not cause a further increase.
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Experimental and clinical investigations of an unviable split pigskin preserve, produced by a fairly simple industrial process, outline the following results: The skin preserve protects a wound surface against infection and prevents loss of fluid. The reaction of the wound surface is very restricted even after repeated application, whilst the viable pigskin releases a more intense host reaction.
In the emergency reaction there is a short-time increase of the values of basophilic leukocytes in connection with normal values of fibrinogen degradation products (FDP). After diminuation of basophils FDP are to be detected. In the chronical ill and under different hormonal contraceptives these two processes are overlapped disturbing a unique negative or positive correlation of heparinocytes and FDP. Concerning the situation under standardized conditions or in single cases worthful conclusions are possible about compensation or decompensation of a latent disseminated intravascular coagulation.
A reduction of the total leukocytes as well as a significant decrease of heparinocytes and BAI (basophilic age index) can be observed in rheumatoid arthritis in the course of a gold therapy. As some coagulation parameters simultaneously speak in favour of an enhancement of the intravasal coagulation, a partial blocking of the endogenous heparin caused by gold may be supposed. A combined heparin or heparinoid therapy in a low dosage is being recommended for risk patients of the vascular and coagulation system.
In 12 patients with chronic rheumatoid arthritis the immunoglobulins IgG, IgA and IgM were determined according to Mancini and the fibrinolytic split products according to Nilehn before and after a gold treatment of 3 to 6 months. The IgG values were always increased and even after the treatment there was only little regression. The fibrinolytic split products found in 5 cases speak in favour of an enhanced intravasal coagulation, which increased still further after the gold therapy. In spite of clinical improvement the immunological processes and latent actions of coagulation seem to pass almost undiminished.
Epidemiological, coagulational, haemodynamical, and morphological studies are critically analysed in this review. Our attitude about the surgical operation risk under hormonal contraceptives is explained. In smaller operative measures there musn't be a break in hormonal contraception. Planned greater operations are to performe only 4 to 6 weeks after cessation of hormonal contraceptives, i.e., after the first spontaneous menstrual bleeding. Hints for the necessity greater operations without a removal after pill or an additional risk factors are given.
After cessation of hormonal contraception a quick adaptation of the heparinocyte values to the normal menstrual phase course appears, but the values occur at a higher level. Fibrinolytic split products in the blood are really elevated nearly without exception in the first 4 to 6 weeks after ceasing of hormonal contraception. Foremost after the first spontaneous menstrual bleeding they are at a normal level.
Epidemiological, coagulational, hemodynamical, and morphological studies are critically analysed in this review. Our attitude towards the surgical operation risk under hormonal contraceptives is explained. For smaller operative procedures a break in hormonal contraception is not necessary. If greater operations are envisaged they have to be performed only 4 to 6 weeks after cessation of hormonal contraceptives, i.e., after the first spontaneous menstrual bleeding. Hints are given for the necessity of thromboembolic prophylaxis with heparin in unforseen greater operations without an interval free from pills or in additional risk factors.
Proceeding from experimental and natural conditions the modern opinion concerning the importance of Virchow's triad for the development and prophylaxis of thrombosis is explained. As to the point change of the quality of blood the author enters the newer findings of the behaviour of heparinocytes, fibrinolytic proactivators and split products as well as other endogenous protective mechanisms. The dependence on age of the heparinocytes and thymocytes is compared and the possible common root of the thrombogenesis and the genesis of tumours is taken into consideration. The influence of sexual steroids, nutrition, the consumption of coffee, tea, cigarettes, alcohol, etc., influence of weather and light on the endogenous and medical prophylaxis of thrombosis is discussed.
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During intake of four different hormonal contraceptives: Ovosiston (Mestranol 0,08 mg, Chlormadinone acetate 2 mg), Non Ovlon (Ethinylestradiol 0,05 mg, Norethindrone acetate 1 mg), Sequenz-Ovosiston and Deposiston (4th, 11th and 18th cycle day 1 mg Ethinylestradiolsulfonate, 25th cycle day 10 mg Norethindrone acetate) an increase of fibrinolytic split products in contrast to low values of the normal menstrual cycle is to be seen. While the values in the first two thirds of application of drugs undulate in the last third they are high in all four pills tested. It seems to be an interference of fibrinogenolysis by estrogens and secondary fibrinolysis after slight disseminated intravascular clotting by gestagens.
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The problem of intraoperative thrombocyte transfusion in splenectomy of patients with ITP is discussed. The indication for splenectomy cannot be equalized with that for intra-operative platelet substitution. Thrombocyte kinetic examinations with a concurrent determination of the thrombocyte turnover enable those patients to be recognized by their bleeding tendency who are particularly endangered by operations. The intraoperative platelet substitution should be limited to those patients with ITP whose turnover is markedly lowered as a manifestation of reduced thrombocytopoiesis. In these cases it is advisable to shift splenectomy to a later date.
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