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PubMed1991

[Radioimmunodiagnosis in the correction of plasmapheresis methodology in thyrotoxicosis].

Differences in the rated and actual results were revealed during postoperative plasmapheresis in patients with thyrotoxicosis who did not tolerate or were resistant to thyrostatics. It was assumed that it was caused by a rise of the level of thyroid hormones resulting from heparin premedication. Gravitation plasmapheresis following heparin administration (150-200 U per 1 kg of body mass) was used in a study group of 25 patients. A dynamic study of T4, T3 and TSH was conducted with the help of radioimmunodiagnosis, based on the antigen-antibody reaction using radioimmunoassay kits. The "euthyroid" effect of plasmapheresis was shown to change as a result of heparin premedication. A significant rise of the levels of T4 and T3 by 63 and 36% was proved. The mechanism of this change was considered. The results were used for a choice of an optimum combination plasma substitutes (a mixture of albumin--30% of the total volume of substitution, and rheopolyglycine) to enhance the efficacy of preoperative preparation.

Heparin↗
PubMed1991

[Hemodilution, hemorheology and oxygen supply].

There is no doubt that hemorheological hemodilution in patients with ischaemic diseases improves the tissue oxygen supply, provided certain preconditions for therapy modalities are granted. As can be concluded from the title of this summary it is basically possible, not only to improve the blood flow properties but also - what is even more important - to optimize the oxygen supply of ischaemic tissue through hemodilution therapy. In the case of chronical arterial occlusive disease of the legs it was for the first time possible to establish a haematocrit value of about 40% as a guideline for the decrease of haematocrit in the course of hemodilution. This value, however, cannot be applied to other hemodilution schemes, other plasma substitutes, other states of chronical arterial occlusive disease or even other organs without specific examination. Before further comprehensive studies are initiated for instance of hemorheological hemodilution therapy in patients with cerebral ischaemia, optimal conditions should be experimentally determined in order to improve the prospects of the studies - as was proved in the case of intermittent claudication. Drawing from 25 years of clinical and scientific experience with hemodilution I would like to emphasize that today its therapeutic mechanism has been investigated to a high degree and its effectiveness in patients with peripheral ischaemic diseases as well as retinal ischaemic diseases can be considered as largely guaranteed. Contradictory results of clinical studies of cerebral ischaemia demand new clinical studies which not only should be improved as regards their design but also should contain concrete guidelines on the modalities of hemodilution therapy including the "optimal" haematocrit values which are to be reached.

Blood Flow Velocity↗
PubMed1991

[Optimal hypervolemic therapy for symptomatic vasospasm].

Thirty-five patients with symptomatic vasospasm (SV) following aneurysmal subarachnoid hemorrhage (SAH) were managed according to a method based on hemodynamic manipulation, monitored by Swan-Ganz catheter. Nine out of these had delayed surgery. For those who developed SV, the pulmonary wedge pressure (Pcwp) and/or central venous pressure (CVP) were immediately increased up to the point at which neurological deficit was reversed by rapid injection of fresh frozen plasma, albuminates, low molecular dextrose, and glycerol. On this regimen, patients were closely observed for any neurological change. Then the hemodynamic parameters were maintained as optimal values until they could be reduced below optimal values without reappearance of neurological deficit. In inoperable patients, special attention was given in making a decision about discontinuing the regimen. The results were compared with thirty-seven patients with SV who were treated with conventional hypervolemic therapy (CHT) by continuous administration of albuminates. In the treatment of CHT, optimal values could hardly be established, so the same hemodynamic parameters were applied in all the cases. From this study, in the majority of the cases optimal values were found as follows: Pcwp up to 10-15 mmHg, and CVP below 11 cmH2O. On the contrary, in 20% of patients, neurological deficit was reversed by increasing CVP to a point not above 7 cmH2O. Correlation between neurological reversal and systemic blood pressure was not statistically significant. After this regimen (OHT), 74% of patients showed immediate improvement after volume expansion, and, in 80%, outcome was good, while 20% died. The motor function at the time of discharge was more than 3 on the manual test in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Venous Pressure↗
PubMed1991

[Plasmapheresis in preoperative care of patients with thyrotoxicosis].

The authors studied the efficacy of plasmapheresis in preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents. Seventy-three patients were examined. Preoperative management was accomplished by gravitation plasmapheresis (PP) with a PP-0.5 apparatus according to the continuous flow principle. The course consisted of 1-5 sessions during which a total volume of 800-5,000 ml of plasma was removed. Heparin was administered in a dose of 150-200 U/kg before PP. It was proved that the most rational technique was replacement of the lost plasma by reopolyglucin with albumin--300% of the total volume of the plasma substitute. Dynamic study of the level of the T3, T4, and TSH hormones proved that the use of such substituting medium leads to stable euthyroidism and that PP is the optimal method of preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents.

Female↗
PubMedDate not supplied

The influence of hemodilution on left ventricular function.

In nine anesthetized mongrel dogs anemia was produced by exchanging blood with plasma substitute thus reducing hemoglobin gradually in three steps. Aortic, atrial and ventricular blood pressures, cardiac output, electrocardiogram, phonocardiogram and the first derivative of the left ventricular pressure were continuously monitored. Blood samples were taken to determine hemoglobin, blood gases and whole blood viscosity. Progressive hemodilution resulted in a significant increase in cardiac output and left ventricular stroke work, while total peripheral resistance, oxygen content and whole blood viscosity decreased significantly. There were no significant changes in cardiac pressures, myocardial contractility, diastolic pressure time index and blood gases. The oxygen supply/demand ratio had gradually declined, while electrocardiogram showed no significant changes. These results suggest that moderate isovolemic hemodilution in animals with normal coronary vessels does not impair left ventricular function as this was manifested by the unchanged hemodynamic and electrocardiographic findings.

Animals↗
PubMed1990

The effect of plasma volume expansion on uteroplacental blood flow in hypertensive pregnancies.

The effect of plasma volume expansion on uteroplacental blood flow was investigated in 20 hypertensive women in the 3rd trimester of pregnancy by measuring the radioactivity in the region of the placenta with a gamma camera after an intravenous injection of indium-113. Despite a significant increase in plasma volume there was no change in maternal blood pressure or in uteroplacental blood flow. This suggests an autoregulation of both blood pressure and uteroplacental blood flow.

Adult↗
PubMed1990

[Microcirculation, hemodynamics and blood rheology in peritonitis during plasmapheresis].

By means of biomicroscopy, electrophysiological and hemorheological techniques effect of plasmapheresis with use of various plasma -substituting solutions and their combination on microcirculation, hemodynamics and rheology of blood at peritonitis has been studied in the experiment on 329 white non-inbred rats and on 50 mature dogs. Three periods of disturbances in hemomicrocirculation of the small intestine mesentery at peritonitis have been revealed: I (3-6h)--a relative well-being and compensatory reactions in the system of hemomicrocirculation; II (9-15h)--development of disturbances in the aggregate state of blood; III (18-24h)--pronounced disturbances in hemomicrocirculation. Plasmapheresis at peritonitis facilitates: to better functioning of the microcirculatory system, namely, a sharp increasing of the blood flow rate, joining into the blood flow of capillaries that did not function previously and increasing functional capacity of the capillary bed; decreasing blood viscosity and aggregation of erythrocytes. Plasmapheresis applied at peritonitis produces a favourable effect to hemodynamics, evident as an increasing minute and stroke volume of the blood flow, cardiac index, the left ventricle activity and decrease in peripheral vascular resistance.

Animals↗
PubMed1985

Burns. Fluid and electrolyte management.

Fluid resuscitation of the burn victim has evolved into a sophisticated science based on sound physiologic principles. This article presents these new developments in the context of the physiology of burn injury.

Blood Transfusion↗
PubMed1988

The antithrombotic efficacy of dextran.

Dextran was introduced as early as 1944 as a plasma substitute. Since 1962 dextran has also proved to be effective as a prophylactic agent against postoperative thrombo-embolism. In general surgery low-dose heparin (LDH) is more effective in preventing isotopic deep-vein thrombosis diagnosed by the radioactive fibrinogen test, but in orthopaedic surgery dextran is superior to heparin. Dextran seems equally effective as LDH in preventing fatal pulmonary embolism both in general and orthopaedic surgery. In routine surgery, infusion of 500-1,000 ml of dextran will replace the first blood loss of 500-800 ml without risk of transmitting diseases. Simultaneously thrombo-embolic prophylaxis will be achieved with a decreased risk of haemorrhagic complications than is seen with heparin prophylaxis. The risk for severe anaphylaxis to dextran is minimal today (approx. 1 case in every 40,000 treated patients) thanks to hapten inhibition.

Anaphylaxis↗
PubMed1989

Ultrafiltration and absorption characteristics of hydroxyethylstarch and dextran during long dwell peritoneal dialysis exchanges in rats.

Glucose has several disadvantages such as low pH, high osmolality and hyperglycemia. Rapid glucose absorption contributes to hyperlipidemia, obesity and ultrafiltration failure in peritoneal dialysis patients. Two commercially available plasma substitutes 10% hydroxyethylstarch (HES) and 6% dextran were studied for ultrafiltration and absorption patterns. 18 ml of each solution were instilled into the peritoneal cavity of 6 non-uremic rats. HES yielded a significantly (p less than 0.02) greater ultrafiltration after 6 h of dwell, whereas 2.3% glucose solution showed the typical ultrafiltration pattern of an easily absorbable osmotic agent. With 6% dextran ultrafiltration was markedly lower. At the end of cycle time the mean absorption rates for HES were 62.7% and 41.5% for dextran. It is concluded that HES is a potent osmotic agent due to sustained colloidal ultrafiltration. However, despite their high molecular weights both solutions were markedly absorbed probably by lymphatics. However, accumulation in tissues and undefined metabolic pathways might prove disadvantageous in patients with ESRD.

Absorption↗
PubMed1989

[Morphology and pathogenesis of changes in the lungs during drug-induced anaphylactic shock in humans].

The paper presents the results from examinations of morphological changes in the lung of 51 persons who died from drug-induced anaphylactic shock at the age of 6 months to 67 years. The patients died several minutes to 7-10 days following drug administration. The causes of the shock were administrations of antibiotics, novocain (procaine hydrochloride), glucose, radiopaque agents, plasma-substituting solutions, protein hydrolysates, and other substances. Forty-nine persons died after parenteral drug administration. The most frequent concurrent conditions were gastrointestinal and respiratory diseases and pregnancy. A clinical and morphological analysis of the material enabled the authors to single out 6 types of drug-induced anaphylactic shock: asphyxial, bronchospasmic, hemodynamic, cerebral, abdominal and a variant with prevalent pulmonary edema. Typical characteristics of pulmonary alterations are described in each type of the shock.

Adolescent↗
PubMed1989

The effects of hypoproteinemia and volume expansion on lung and soft tissue transvascular fluid filtration.

Resuscitation from major trauma or replacement of major operative blood loss frequently results in varying levels of protein depletion and alterations in plasma volume. To assess the importance of these factors on pulmonary and soft tissue transvascular fluid filtration, we compared the effects of hypoproteinemia and plasma volume expansion on the rate of lung and soft tissue transvascular fluid filtration in unanesthetized adult sheep. Ten animals were surgically prepared with chronic lung and soft tissue lymph fistulas. Lung (QL) and soft tissue (Qs) lymph flow rates were used to determine changes in transvascular fluid filtration. Initially, lactated Ringer's solution (LR) was infused to elevate pulmonary arterial wedge pressure of normoproteinemic animals (Norm/LR) 5 mm Hg for 2 1/2 hours. After a plasmapheresis-induced protein depletion of 30% to 35%, similar volume expansions with LR (Hypo/LR) and fresh frozen plasma (Hypo/Plas) were performed. Plasma, lung lymph, and soft tissue lymph oncotic pressures were determined, and transvascular oncotic gradients were calculated. Plasma volume expansion during Hypo/Plas conditions limited (p less than or equal to 0.05, 3 hours after infusion) Qs elevations compared with Hypo/LR expansion. However, there appeared to be no significant advantage with fresh frozen plasma over LR infusion in limiting QL. During fresh frozen plasma infusion, a distinct 10- to 12-hour lag in protein transport into the interstitium was observed in the soft tissue but not the lung microcirculation. The resultant differences in fluid filtration properties were in part the result of significant widening of the oncotic gradient in soft tissue. Plasma protein infusion appeared not to be beneficial over LR in limiting lung transvascular fluid filtration during hypoproteinemic states but significantly decreased soft tissue transvascular fluid flux.

Animals↗
PubMed1978

[Successful therapy of a severe dextran incident using histamin H1- and H2-receptor blockaders].

A case of a severe systemic anaphylactoid reaction is reported in a patient treated with dextran 60 to prevent venous thrombosis. Significant improvement of clinical symptoms occurred after the usual treatment of such incidents with corticosteroids, histamine H1 receptor antagonists, and plasma substitutes was supplemented with a histamine H2 receptor antagonist. We would therefore like to recommend that for such cases a histamine H2 receptor antagonist should be given in addition to the usual medication with corticosteroids and histamine H1 receptor antagonists. However, the value of complete histamine antagonism in these rather rare occurrences, can only be determined after furtherexperience has been gained.

Adult↗
PubMed1979

[Effect of gelatin and dextran infusion on the reticuloendothelial system].

The purpose of this study was evaluation of the phagocytic ability of peripheral blood leucocytes and reticuloendothelial system of the lungs, liver and spleen after one infusion of plasma-substituting preparations: Fluigel and dextran 70 in volumes of 20 ml/kg of body weight. The experiments were done in rabbits. The response of the reticuloendothelial system was assessed on the basis of its ability of eliminating foreign erythrocytes labelled with 51Cr from the circulating blood and radioactivity accumulation in the liver and spleen. It was found that infusion of Fluigel and dextran produced transient changes in the function of the reticuloendothelial system with increased number of granulocytes and a fall of their radioactivity 3 and 6 hours after infusion, reduced ability of pulmonary 51Cr accumulation and increased storage in the spleen observed 24 hours after infusion.

Animals↗
PubMed1988

Plasma volume expansion in pregnancy hypertension.

Stabilised human serum 500 ml was infused intravenously over 90 minutes in 14 hypertensive women in late pregnancy, and the haemodynamic changes were investigated and compared with those in 7 similar women who were not treated. There was a significant mean increase of 1,85 l in plasma volume, a decrease in diastolic and systolic blood pressure, and an increase in central venous pressure (CVP), pulse pressure and pulse rate in the treated group at 2 hours but not in the control group. After 24 hours most of the observations were not significantly different from the pretreatment levels except the CVP and pulse rate measurements which were still significantly raised. The CVP measurements in the hypertensive women before treatment were relatively low compared with those reported in normal women in late pregnancy. It is suggested that there may be an under-filling of the circulation in pregnancy hypertension and that plasma volume expansion may have an important therapeutic effect by increasing cardiac output and renal and uterine blood flow.

Blood Pressure↗
PubMed1986

Flow-induced control of arterial lumen.

Blood flow velocity is a factor that affects the diameter of arteries. In order to investigate the flow-induced arterial dilatation, the outer diameter of the femoral, common carotid or renal arteries of anaesthetized cats was measured during perfusion of these arteries with blood or plasma-substituting solutions under conditions of stabilized perfusion pressure. It has been shown that, whatever the perfusate, blood or a substituent, an increase in flow makes the artery to dilate. Consequently, the flow-induced dilatation is not due to any blood-borne humoral factor. As an increase in the solution's viscosity causes dilatation even at constant flow-rate and pressure in the artery, the effect is to be ascribed to the ability of the vascular wall to perceive shear stress. As far as removal of endothelium eliminates the dilatation evoked by increasing flow or fluid viscosity, it may be concluded that the flow-induced dilatation is due to the sensitivity to shear stress of the endothelium.

Animals↗