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PubMed2006

[The value of TissueLink hemostatic sealer in hepatectomy for hepatocellular carcinoma].

BACKGROUND & OBJECTIVE: Managing the liver stumps reliably is an important guarantee for the accomplishment of hepatectomy. This study was to explore the value of TissueLink hemostatic sealer in hepatectomy for hepatocellular carcinoma (HCC), and evaluate its effects in extending incisal edge and reducing recurrence rate. METHODS: TissueLink hemostatic sealer was used on the liver stumps during hepatectomy for 20 patients (study group); whereas, conventional suturing of the vessels and bile ducts was performed in 28 patients (control group). Peri-operative serum alanine aminotransferase (ALT), total bilirubin, hospitalization period and complication occurrence were observed and compared. RESULTS: The amount of operative bleeding and the amount of post-operative abdominal cavity drainage were significantly lower in study group than in control group [(412.50+/-122.34) ml vs. (530.36+/-151.13) ml, P=0.006; (285.50+/-43.59) ml vs. (347.86+/-67.62) ml, P=0.001]. Three and 7 days after operation, serum ALT levels were significantly lower in study group than in control group [(152.36+/-93.32) U/ml vs. (246.19+/-159.85) U/ml, P=0.015; (56.63+/-21.59) U/ml vs. (96.46+/-47.97) U/ml, P=0.009]; serum total bilirubin levels were significantly lower in study group than in control group [(25.93+/-9.63) micromol/L vs. (40.12+/-16.54) micromol/L, P=0.004; (17.25+/-7.22) micromol/L vs. (39.63+/-19.06) micromol/L, P=0.001]. Hospitalization period was significantly shorter in study group than in control group [(10.5+/-1.5) days vs. (12.9+/-2.8) days, P=0.002]. The occurrence rate of complications was lower in study group than in control group. On CT image after operation, an annular zone of necrosis in the liver was found in most patients of study group. CONCLUSIONS: TissueLink hemostatic sealer is a safe device to manage the liver stumps in hepatectomy. It has less damage on liver function after operation, and can shorten hospitalization period and reduce the occurrence of post-operative complications.

Adult↗
PubMed1991

[Effect of plasmapheresis with substitution by dextran solutions on hemostatic parameters in patients with ischemic heart disease].

Plasmapheresis on a continuous blood flow fractionator to remove 1,200-2,000 ml plasma and substitute for the same values of dextran solutions was employed in the multi-modality treatment of 25 patients with Functional Classes II-IV exertional angina and myocardial infarction. Plasma and thrombocyte hemostatic parameters were examined just before and 24 and 48 hours after plasmapheresis. The analysis of the baseline data revealed that hemostatic changes were directly related to the severity of a disease in the patients and there was a correlation between the increased platelet aggregability and the elevated levels of fibrin-monomeric complexes. Plasmapheresis along with substitution of removed plasma for dextran solutions was accompanied by a profound hypocoagulative effect, as evidenced by plasma and thrombocyte hemostatic parameters. In addition, in patients with baseline high values of platelet aggregability plasmapheresis resulted in its decrease, whereas in those with baseline low values, it led to its increase.

Adult↗
PubMed1991

[Analysis of hemostatic abnormality in various disease using molecular-I. Liver disease].

We examined the hemostatic abnormality of liver disease using hemostatic molecular markers, i.e. TAT, FPA and SFMC for coagulation, B beta 15-42, FDP, D dimer and PIC for fibrinolysis, t-PA and TM for vessel wall. The molecular markers for coagulation were generally increased in cases of liver disease, which was most sensitively reflected by FPA. On the other hand, it was postulated that SFMC was a marker reflecting the complication of DIC in these cases. Hyperfibrinolysis of liver disease was sensitively reflected by the increase of B beta 15-42, and an occasional increase of SFMC or FDP was thought to indicate the complication of DIC in these cases. A high correlation was found between t-PA and TM. It was postulated that the increase of the both markers in liver disease was due to deteriorated clearance by liver dysfunction, although TM is regarded as a marker reflecting endothelial injury. It was expected that visualization of hemostatic disorder of liver disease was made practical with the use of radar chart of these molecular markers.

Antifibrinolytic Agents↗
PubMedDate not supplied

Hemostatic variables in nephrotic patients.

The paper reviews data in the literature as well as the authors' own investigations, performed during the last seven years, concerning the hemostatic balance in nephrotic patients. The obviously increased plasma levels of fibrinogen, fibronectin, fibrin-stabilizing factor XIII, clotting factors V and VIII, von Willebrand factor as well as the enhanced platelet aggregability of such patients, associated with a decreased plasma antithrombin III, are compatible with a thrombotic tendency. On the other hand the increased plasma protein C may provide a compensative antithrombotic mechanism. A rather complex behaviour of the fibrinolytic system was noted in the nephrotic syndrome. Actually the enhanced release of tissue plasminogen activator (t-PA) from the endothelia of nephrotic patients is accompanied by an accelerated lysis of dilute blood clots, although the inhibitors of fibrinolysis such as alpha 2-macroglobulin and alpha 2-antiplasmin are increased. Failure or exhaustion of the compensative antithrombotic mechanisms would accentuate the hemostatic imbalance and favour the occurrence of thrombotic events. It is considered that increased urinary loss of antithrombin III and the enhanced hepatic synthesis of clotting factors would represent the main mechanisms involved in the production of this precarious hemostatic balance of nephrotic patients.

Antithrombin III↗
PubMed1991

Prothrombotic hemostatic abnormalities in patients with refractory malignant lymphoma presenting for autologous stem cell transplantation.

Forty-six patients with refractory malignant lymphoma (Hodgkin's and non-Hodgkin's) admitted for autologous marrow or peripheral blood stem cell transplantation (ASCT) were evaluated for the presence of hemostatic abnormalities known to be associated with a hypercoagulable state in other patient populations. All patients had received numerous chemotherapeutic agents in the past and often radiation therapy as well. Hemostatic abnormalities were found to be common in these patients. The most frequent finding was hyperfibrinogenemia, present in 35% of patients. Decreased protein C activity was present in 32% of patients. Protein C antigen was low in only one individual and protein S was normal or increased in all patients. Low levels of antithrombin III were present in 16%. Plasminogen activator inhibitor was elevated in 20%. Anticardiolipin antibodies were present in 29% of patients; other evidence of a lupus anticoagulant was present in only eight patients. The frequency of each hemostatic abnormality was similar for patients with Hodgkin's disease (HD) and those with non-Hodgkin's lymphoma (NHL) despite the fact that significantly more patients with HD had received irradiation and/or previous splenectomy than patients with NHL. We conclude that multiple prothrombotic abnormalities of hemostasis are present in patients with refractory lymphoma referred for ASCT. Whether these are the result of lymphoma or the result of therapy cannot be determined from this study.

Adult↗
PubMed1990

[The mechanisms of disorders in the hemostatic system of patients with chronic diffuse liver diseases].

A total of 70 patients with chronic hepatitis and 60 with liver cirrhosis (LC) were examined. The hemorrhagic syndrome (HS) was identified in 16% of patients with chronic active hepatitis, in 26% with compensated and in 76% with decompensated LC. Intravital study of intravascular blood coagulation and liver microcirculation with the aid of fibrin determination according to D. D. Zerbino made it possible to establish local intravascular coagulation (LIC-syndrome). Study into the hemostatic and fibrinolytic systems, analysis of liver function, hemocoagulation and the intensity of the LIC-syndrome permitted one to arrive at conclusions about complex impairments of the hemostatic system in patients with chronic diffuse liver diseases characterized by a tendency towards blood hypocoagulation in the systemic blood flow with the risk of the development of the HS and a tendency towards hypercoagulation (with the risk of thrombosis development) in the vascular bed of the liver. It has been shown that the main cause of the HS occurring in chronic diffuse liver diseases lies in derangements of the thrombocytic component of the hemostatic system: thrombocytopenia as a consequence of hypersplenism and consumption of the most active thrombocytes in the process of the LIC. Activated fibrinolysis starts to exert an inhibitory action on hemocoagulation in patients with chronic diffuse liver diseases in the stage of decompensated LC. In compensated hepatopathies, the influence of fibrinolysis on coagulation and the development of the HS was immaterial.

Blood Coagulation Disorders↗
PubMed1989

ARIC hemostasis study--I. Development of a blood collection and processing system suitable for multicenter hemostatic studies.

In order to carry out a multicenter study aimed at understanding the association of hemostatic factors with atherosclerotic vascular disorders for the Atherosclerosis Risk In Communities (ARIC) Study, we compared a blood collection and processing system developed in our laboratory with the state-of-the-art-procedures. The salient features of our system included the use of a new phlebotomy set for venipuncture, the use of Millipore filters for removing platelet residues in the plasma and the use of a mixture of anticoagulants and antiplatelet agents for inhibiting the in vitro activation of platelets, coagulation and fibrinolytic system. The results derived from systematic evaluations indicate that this newly developed system yields the lowest values of plasma beta TG, PF 4 and FPA when compared with the reported values. The technique also gave reliable values of representative hemostatic measurements such as fibrinogen, factor VII, factor VIII, von Willebrand factor, antithrombin-III, protein C, tissue-type plasminogen activator, and serum thromboxane B2. Further experiments revealed that the samples withstood temporary storage at -70 degrees C and overnight "shipping" manipulations without significant changes in the hemostatic values. We conclude that the described blood collection and processing system may be a valuable asset for conducting multicenter cooperative clinical trials and epidemiologic studies involving blood collection by multiple field centers or clinics.

Adult↗
PubMed1989

[Hemostatic changes after local exposure to low temperatures (frostbite)].

Hemostatic blood potential was studied in experiments on 400 rats, 25 dogs and in 120 patients, during changes of CNS reactivity after intraventricular injection of reserpine, adrenaline, and irritation of the thalamus ventromedial nucleus (VMN) or its destruction. CNS reactivity in dogs changed after intraarterial injections of acetylcholine, reserpine, heparin and fibrinolysin solutions. It was shown that activation of adrenergic structures of the hypothalamus by intraventricular adrenaline injections, or the hypothalamus VMN irritation, stimulated coagulation and depressed anticoagulation mechanisms of the blood, and increased hemostatic blood potential, that led to rejection of frostbitten tissues. Activation of the hypothalamus cholinergic structures by intraventricular injections of reserpine, destruction of the hypothalamus VMN, and intraarterial injections of acetylcholine, reserpine, heparin, fibrilysin and contrycal mixtures stimulated the blood anticoagulation mechanisms, decreased the hemostatic potential, led to retention of cryodestructed tissues.

Animals↗
PubMed1989

[Significance of the hemostatic effect of lasers in oral surgery].

The authors summarize the operative experiences performed with CO2 laser in 352 cases of oral surgery with special regard to the hemostatic effect. One of the patients suffered from hemophilia, 5 from thrombocytopenia and 5 from hypoprothrombinemia. Of the alterations to be eliminated 128 were especially inclined to hemorrhage (hemangioma, epulis, granuloma fissuratum). The operations were carried out with out-patients in local anesthesia. Due to the hemostatic effect of the laser the surgery could be performed in dry operative areas, the laser knife coagulates in the course of cutting the small vessels. Both in the group of patients with hemorrhagic diathesis and in the group of operation of alterations inclined to bleeding the experiences were highly favourable. No significant differences were found between the group of patients with hemorrhagic diathesis and other patients in the respect of the duration of operation, degree of bleeding, healing of the wound and complication. CO2 laser of high energy was found to be well applicable in the field of oral surgery owing to its excellent hemostatic effect, especially in operations where the patient or the alteration to be removed (possibly both) are disposed to bleeding.

Blood Coagulation Disorders↗
PubMedDate not supplied

Hyperlipoproteinemia, hemostatic variables and thromboatherosclerosis.

A concept is gradually being established that certain forms of hyperlipoproteinemia are apt to be accompanied by disturbances of the hemostatic balance favouring fibrin deposition and the incorporation of microthrombi into the arterial wall. Author's clinical and laboratory observations emphasized that endogenous hypertriglyceridemia is often accompanied by raised plasma levels of fibrin stabilizing factor XIII, fibronectin and fibrinolytic inhibitors rendering the fibrin clots more resistant to fibrinolysis and more readily attached to the subendothelial layers of the vessel wall. Increased activity of vitamin K-dependent clotting factors partially counterbalanced by a rather high level of antithrombin III were also detected. Since endogenous hypertriglyceridemia is characterized by an accelerated synthesis and turnover of lipoproteins it may be suggested that this process somehow stimulates the hepatic production of the above-mentioned hemostatic variables. The subsequent alteration of the hemostatic balance is compatible with the localized character and the slow progression of thromboatherosclerosis.

Arteriosclerosis↗
PubMed1988

Effect of equine ehrlichial colitis on the hemostatic system in ponies.

Hemostatic function was determined in 10 ponies at various times after inoculation with Ehrlichia risticii to determine whether equine ehrlichial colitis (EEC) caused changes in the hemostatic system and to determine the prognostic value of hemostatic function tests during EEC. Mean platelet count; plasma fibrinogen, fibronectin, factor VIII: coagulant, alpha 2-antiplasmin, and plasminogen values; and serum concentrations of fibrin/fibrinogen degradation products changed significantly (P less than 0.05) from base line (day 0, before inoculation) during 18 days after inoculation with E risticii. Four ponies that died or were euthanatized because of severe clinical signs of EEC had significantly (P less than 0.05) greater mean plasma fibrinogen concentrations plasma factor VIII:coagulant values, and activated partial thromboplastin times immediately before death than did the 6 surviving ponies. Factor V concentrations were significantly (P less than 0.05) lower on postinoculation days 10 and 20 in nonsurvivors. Seemingly, changes in hemostasis took place during EEC. Ponies that did not survive EEC had greater laboratory evidence of coagulopathy.

Animals↗
PubMed1986

Hemostatic plug formation in normal and von Willebrand pigs: the effect of the administration of cryoprecipitate and a monoclonal antibody to Willebrand factor.

Hemostatic plug (HP) formation was investigated in the ear bleeding time incision in normal and von Willebrand pigs. HP volume was calculated by integrating the areas of serial sections. In normal pigs (n = 11), platelets immediately formed a layer on the surface of the cut channel. Platelet aggregates formed at the ends of transected vessels and gradually enlarged. Finally, all transected vessels were occluded by HP and bleeding stopped. In contrast, large HPs were formed in the incision in von Willebrand's disease (vWD) pigs (n = 4); these HPs did not cover the ends of the transected vessels, which continued to bleed, allowing the formation of large hemostatically ineffective platelet aggregates in the incision. Canals traversed these HPs, and bleeding from the open vessels may have continued through them. After infusion of cryoprecipitate into a vWD pig, the bleeding time shortened, and the morphological findings of the HPs were similar to those of normal pigs. In normal pigs (n = 3) infused with an anti-Willebrand factor monoclonal antibody, which prolonged the bleeding time, a large HP formed in the incision, similar to that observed in the vWD pig. The volume of the normal and vWD HPs increased with time. These in vivo findings suggest that Willebrand factor is involved in the localization of the HP to the damaged vessel and may also play a role in platelet-platelet interaction. A computerized morphometric technique was used for measuring the volume of the hemostatic plugs and the distance of sequential points on the perimeter of the HP from the center of selected bleeding vessels.

Animals↗
PubMed1986

Hemostatic abnormalities in equine colic.

Hemostatic profiles were determined in 30 horses with clinical colic. Blood samples were obtained at the time of the animal's admission, and the following hemostatic tests were done: blood platelet count, plasma fibrinogen, plasma antithrombin, prothrombin time, partial thromboplastin time, thrombin time, protamine sulfate test for soluble fibrin monomer, and fibrin-fibrinogen degradation products. The patients were categorized in retrospect, according to the cause of the colic: group 1--colic associated with colitis and/or severe diarrhea, group 2--colic associated with torsion or obstruction of the intestine, and group 3--colic associated with impaction of the intestine or the presence of enteroliths. Of the 30 horses with colic, 28 had at least 1 abnormality in their coagulogram--the most frequent abnormalities being high plasma fibrinogen concentration, high circulating soluble fibrin monomer, or a long partial thromboplastin time or thrombin time. The horses in group 1 seemed to have the most severe coagulopathies, as indicated by the average number of demonstrable abnormalities. The horses in group 3 showed the fewest abnormalities--usually a high plasma concentrations of fibrinogen and/or soluble fibrin monomer. The results indicated that hemostatic abnormalities are not uncommon in horses with gastrointestinal disease and colic--the degree of severity depending to some extent on the cause of the colic.

Animals↗
PubMed1985

[Role of disorders of the hemostatic system in the pathogenesis of multiple sclerosis and ways of correcting them].

The changes in the hemostatic system were studied in 77 patients with different patterns of disseminated sclerosis (DS). The studies demonstrated activation of both vasculothrombocytic and coagulation components of hemostasis as well as of fibrinolytic blood properties. The latent course of the disseminated intravascular coagulation was revealed in 20.7% of cases. The role of hemostatic disorders in the pathogenetic mechanisms of DS is discussed. The patients with DS received pathogenetic treatment including drugs eliminating hemostatic disorders, which was beneficial for most patients.

Adult↗
PubMed1985

[Biological testing of hemostatic properties of various collagen preparations].

In experiments on animals a method of studying electrostatic and hemostatic properties of collagens was worked out. Following hemostatic collagen sponges were used: Superstat (Interface Biomedical Laboratories Corporation, USA), Hemostatic Felt (B. Braun, BRD), collagen sponge and collagen foil (Central Tissue Bank of Transplantation Institute, Medical Academy, Warsaw). Biological experiments were performed on rabbits in 4 groups, depending of the implanted material. Basing on surgical macro- and microscopic evaluation it was found that collagen preparations used in the experiments shorten the duration of bleeding of damaged liver, and that biological reactivity of studied collagen preparations is proportional to the duration of their resorption time in tissues. The shortest resorption time gave the Superstat.

Animals↗
PubMed1985

[Changes in the hemostatic system in patients with ischemic heart disease after isovolemic hemodilution].

To specify indications for isovolumic hemodilution, hemostatic parameters (fibrinogen, soluble fibrin, fibrin decomposition products, platelet aggregation, thromboelastograms) were compared with clinical manifestations of coronary heart diseases (CHD) and coronarographic and bicycle-ergometric findings in 41 coronary patients. The increased blood viscosity syndrome was found in 63% of the patients. Isovolumic hemodilution was performed to control the detected disorders in 17 patients. Hemodilution was shown to be an effective means of controlling hemostatic disorders in coronary patients, hemostatic normalization being accompanied with clinical improvement in part of the cases.

Adult↗
PubMed1979

The hemostatic imbalance of plasma-exchange transfusion.

Plasma exchange has been proposed as a treatment for multiple disorders. Three patients with amyotropic lateral sclerosis, who were hemostatically normal, were studied through a total of 11 4-liter exchanges. Plasma was replaced by an equal volume of 5% albumin or 5% plasma protein fraction. Serial studies revealed that immediately after the exchange transfusion, there was significant prolongation of the prothrombin, partial thromboplastin, and thrombin times with reduction of the fibrinogen and antithrombin III levels. Factors V, VII-X, IX, and X were all significantly decreased, as were the factor VIII antigen, procoagulant, and the ristocetin cofactor activities. Platelet counts were obtained before and after exchanges and revealed significant decreases. Four hours after exchange, all parameters remained abnormal except the factor IX, ristocetin cofactor, and factor VIII procoagulant activities. By 24 hr, all hemostatic parameters had returned to normal. These studies indicate that plasma-exchange transfusion with material devoid of coagulation factors results in a coagulation defect that may be of clinical significance in a hemostatically compromised patient.

Amyotrophic Lateral Sclerosis↗
PubMedDate not supplied

Late changes in hemostatic parameters following open-heart surgery.

Changes in hemostatic parameters following open-heart surgery with cardiopulmonary bypass were studied in twelve patients for two postoperative weeks. No clinical manifestations of hemostatic abnormalities were found in these patients throughout the study period. The prothrombin time and activated partial thromboplastin time were within normal limits. The platelet counts and fibrinogen levels were depleted on the first postoperative day, followed by a rapid return to above normal levels within 7 days. The fibrinogen/fibrin degradation products (FDP) showed a peak elevation on the first day, followed by a gradual decline. In 92% of the patients, the FDP levels became elevated to more than 10 micrograms/ml. Rate of the increase in FDP level was closely reflected by the amount of postoperative blood loss when the loss exceeded 10 ml/kg of body weight during 48 hours postoperatively. The levels of plasmin inhibitors (alpha 1-antitrypsin and alpha 2-macroglobulin) were also measured. the alpha 1 antitrypsin was elevated during the postoperative period. The alpha 2-macroglobulin showed no significant changes. In summary, the hemostatic changes following open-heart surgery included activation of the fibrinolytic system and depletion of coagulation factors immediately after surgery, followed by hypercoagulability due to a rapid return to above normal levels of coagulation factors and plasmin inhibitors. We consider, however, these changes to be part of the homeostatic response following open-heart surgery.

Adult↗