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PubMed · 7510416

Human complement activation by polygeline and dextran 70.

Abstract

The complement cascade is activated during cardiopulmonary bypass (CPB) and in trauma victims. In order to study whether plasma expanders may contribute to complement activation in these settings, fresh human serum was incubated with dextran 70 and polygeline. C3-activation products and the terminal complement complex (TCC) were quantified in enzyme immunoassays. At 37 degrees C, dextran caused immediate, dose-dependent C3 activation and TCC formation with decline later in the rate of TCC formation relative to serum-saline controls. High doses of polygeline caused slight activation after 15-30 min. The authors tested also the activation under conditions comparable to those found during clinical CPB. Activation induced by dextran and polygeline was increased by dilution of the serum. Furthermore, the plasma expanders counteracted the well-known inhibitory effects of heparin (4 IU/ml) and moderate hypothermia (30 degrees C) on complement activation. The authors conclude that dextran, and to a lesser extent polygeline, may contribute to complement activation during CPB and other clinical settings such as shock treatment.

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BibTeXRIS

V Videm, T E Mollnes. 1994. Human complement activation by polygeline and dextran 70.. https://doi.org/10.1111/j.1365-3083.1994.tb03377.x

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Continuous SvO2 measurement in infants undergoing congenital heart surgery--first clinical experiences with a new fiberoptic probe.

BACKGROUND: SvO2-guided therapy, using fiberoptic oximetric catheters can help to improve the outcome after complex congenital heart surgery especially in infants undergoing the Stage 1-Norwood-Procedure. So far, fiberoptic catheters have to be placed transthoracically by the surgeon into the vena cava or the pulmonary artery putting the infant at an additional risk of bleeding at the time of catheter removal. METHODS: We used a new percutaneously applicable fiberoptic probe for continuous monitoring of central venous saturation in three infants undergoing modifications of the Stage 1-Norwood-Procedure (reconstruction of the aortic arch), two in combination with a bidirectional cavopulmonary connection (Glenn shunt), the third with reconstruction of the pulmonary arteries (biventricular repair). The approved clinical monitoring system consisted of a small (2 F) fiberoptic probe and a bed-side-monitor. The probe was inserted via the routine central venous access for such a case. RESULTS: Continuous SvO2 measurement is feasible in infants using the CeVOX system in combination with routine central venous access, and the advantages of continuous monitoring are discussed. CONCLUSIONS: We believe that compared with transthoracically inserted oximetric catheter, the presented percutaneous technique avoids additional risks at the time of catheter removal (i.e. bleeding) and has become part of our standard management.

Cardiopulmonary Bypass↗

An alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass surgery and major abdominal surgery.

INTRODUCTION: We conducted this prospective study in order to investigate the hypotheses that an alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass (CPB) surgery and major abdominal surgery and that the levels of fibrin degradation products digested by polymorphonuclear neutrophil elastase (elastase-XDP) and the D-dimer increase in the patients' plasma. MATERIALS AND METHODS: We studied a total of 77 patients who were scheduled to undergo either CPB surgery (36 patients) or major abdominal surgery (41 patients) and then measured the elastase-XDP and D-dimer levels at several time points both during and after the surgeries. The CPB surgery was divided into surgery for aortic dissection (AD) and cardiac surgery. The major abdominal surgery consists of hepatic resection and esophagectomy. RESULTS: The elastase-XDP and D-dimer levels significantly increased in the patients who underwent both CPB surgery and major abdominal surgery. The elastase-XDP levels in AD surgery showed highest values at the end of the CPB, while the levels in the other surgeries reached their peak on the day after the surgery. Statistical difference was seen in the levels of elastase-XDP among the three subgroups undergoing a hepatic resection. While we found significant correlations between the levels of elastase-XDP and D-dimer in patients undergoing CPB surgery and a subsegmentectomy of a cirrhotic liver, the correlation coefficients were markedly low in comparison to those of the other surgeries. CONCLUSIONS: Our findings demonstrated that the elastase-mediated pathway of fibrinolysis is activated to varying degrees depending on the surgery performed. Variations in the correlation coefficients between the levels of elastase-XDP and D-dimer may suggest that elastase-mediated fibrinolysis play a different role from the physiological fibrinolysis mediated by plasmin.

Cardiopulmonary Bypass↗