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The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery.

OBJECTIVE: The objective of this study was to determine the relationship of the kaolin-activated Thrombelastograph (TEG) with postoperative bleeding and laboratory tests of coagulation in the setting of cardiac surgery with the routine use of -aminocaproic acid. DESIGN: Prospective observational study. SETTING: An adult heart center at a tertiary referral, university hospital. PARTICIPANTS: Thirty adult cardiac surgical patients. INTERVENTIONS: The kaolin-activated TEG, platelet counts, prothrombin times, activated partial thromboplastin times, and fibrinogen levels were measured before induction of anesthesia, during cardiopulmonary bypass, and on arrival in the intensive care unit. Mediastinal and thoracostomy drainage were measured every hour for 4 hours after arrival in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: Correlation and multivariate linear regression modeling were used to describe relationships among coagulation tests, TEG parameters, and early postoperative bleeding. The TEG maximum amplitude (MA) parameter correlated well with postoperative bleeding (r = -0.6, p = 0.0018), more so than platelet count (r = -0.45, p = 0.02), fibrinogen level (r = -0.40, p = 0.06), or prothrombin time (r = 0.43, p = 0.02). The receiver operating characteristic curve c-index describing MA as a predictor for postoperative bleeding is 0.78. Abnormalities in all the laboratory test results were associated with an abnormal MA. CONCLUSIONS: In conclusion, the kaolin-activated TEG is associated with early coagulopathic bleeding. It may reflect the severity of a global coagulopathy affecting both platelets and coagulation factors and be a guide to incremental prohemostatic therapy in this setting.

Aged↗

Decreased bioavailability of digoxin due to antacids and kaolin-pectin.

Employing a Latin-square design and single-dose studies of bioavailability in 10 normal human volunteers, we tested the hypothesis that antacids and kaolin-pectin might interfere with the bioavailability of orally administered digoxin. Cumulative six-day urinary digoxin excretion (expressed as the percentage of a 0.75-mg dose recovered) was: control, 40.1+/-3.0 (S.E.); aluminum hydroxide, 30.7+/-2.9; magnesium hydroxide, 27.1+/-2.4; magnesium trisilicate, 29.1+/-1.7; and kaolin-pectin 23.4+/-2.0. The differences in means were highly significant (F = 10.47, P less than 0.005). Further analysis (multiple comparison test) revealed that control differed significantly from each of the other treatments (alpha = 0.05), but there was no such difference between any of the other treatment groups. The decreased cumulative excretion produced by antacids and kaolin-pectin reflected a striking reduction in digoxin absorption associated with these compounds that was not related to alteration of gut transit time or to adsorption of digoxin to these gastrointestinal medications.

Administration, Oral↗

Mechanisms and kinetics of high-temperature cadmium sorption by packed bed of calcined kaolin.

Sorption experiments by passing CdCl2-carrying flue gas through the packed bed of calcined macro-porous kaolin particles were performed over a temperature range of 973-1173K and a CdCl2 partial pressure range of 8-16.1 Pa. The observed structural change of the sorbent mineral at the stage of sorption and the results of desorption tests revealed the characteristics of an irreversible chemical reaction as a major cadmium capturing mechanism. In the fully saturated kaolin sorbent, CdO x Al2O x 2SiO2 is present as a sorption reaction product together with a smaller amount of 2CdO x Al2O x 2SiO2. The increase in sorbent bed temperature resulted in an increase in the rate of sorption, but it had no effect on maximum cadmium uptake. The gas-phase CdCl2 diffusion into the macro pores of calcined kaolin had a negligible effect on the overall sorption rate. The reaction between gaseous CdCl2 and solid Al2O3 x 2SiO2 is very sensitive to the concentration of CdCl2 but relatively insensitive to the temperature of the sorbent bed. The order of reaction with respect to the CdCl2 vapor concentration was determined to be 3.26. The activation energy, Ea, was estimated as 5.56 kcal/mol according to the Arrhenius relationship.

Adsorption↗

Silicosis in kaolin workers and firebrick makers.

Nine patients with disabling pneumoconiosis were selected over a three-year period for study because of a work history of kaolin exposure. All had worked in the Missouri firebrick industry. Chest roentgenograms from all nine and lung tissue from two were consistent with silicosis. Worksite analysis of airborne dust at several Missouri firebrick factories revealed that some current workers are exposed to both free silica (up to 4.5%) and cristobalite (up to 8.9%) at levels exceeding the threshold limit value (TLV). Analysis of airborne dust from several kaolin processing plants in South Carolina and Georgia revealed that a few workers are exposed to about 1% free silica at levels occasionally exceeding the TVL. We conclude that silicosis is a serious risk for Missouri kaolin workers and a potential risk for workers in South Carolina and Georgia. A prevalence survey is needed in Missouri to assess the problem.

Aged↗

Cerebral hypoperfusion and delayed hippocampal response after induction of adult kaolin hydrocephalus.

BACKGROUND AND PURPOSE: In chronic hydrocephalus, a role for tissue hypoxia resulting from cerebrovascular compression is suggested. The purpose of this study was to evaluate whether changes in cerebral blood flow (CBF) in the time course of adult kaolin-induced hydrocephalus correlated with immunohistochemical neuronal responses. METHODS: In 46 adult Sprague-Dawley rats, kaolin hydrocephalus was induced and immunostaining of neurofilament protein (NF68), synaptophysin (SYN38), and neuronal nitric oxide synthase (NOS) was performed at 2 (short term), 4 (intermediate term), and 6 and 8 (long term) weeks. Local CBF was measured quantitatively by [14C]iodoantipyrine ([14C]IAP) autoradiography in the short-term stage and in both long-term stages. RESULTS: At 2 weeks, neuronal NOS immunoreactivity was globally increased in cortical areas and within the hippocampus. Four weeks after hydrocephalus induction, a reactive increase of SYN38 and NF68 immunoreactivity in the periventricular cortex was seen. At 6 and 8 weeks, when the ventricular size was decreasing, immunohistochemical changes in the hippocampus became most evident. A maintained toxic NOS reactivity in the CA1 subfield was accompanied by a loss of NF68 staining. In the CA3 subfield, however, focal increases in NF68 and SYN38 immunoreactivity were found. Cortical and hippocampal blood flow showed prolonged decreases of 25% to 55% compared with control animals. At 8 weeks, control levels were reached. CONCLUSIONS: The observed temporary CBF decrease appears to correlate with an early global neuronal ischemic response. In addition, it may also account for the delayed selective response of ischemia-vulnerable structures, eg, hippocampus, in chronic adult kaolin-induced hydrocephalus.

Animals↗

Pneumoconiosis and lung function in a group of kaolin workers.

In June 1981, 65 current and former workers at a kaolin mine and mill were examined by chest radiography, spirometry, and a questionnaire. Five (13%) of 39 current workers and 3 (19%) of 16 former workers with 5 yr or more of exposure had radiographic evidence of pneumoconiosis. Among the 8 workers with pneumoconiosis, conglomerate upper lobe lesions were present in one half. No pneumoconiosis was observed among 8 current workers with less than 5 yr of exposure. Lung function testing showed significant reductions (p less than 0.05) in FVC, FEV1, and peak flow rate in kaolin workers compared with that in a control group. Environmental sampling during the testing period showed airborne dust to be composed of kaolinite (96%) and titanium dioxide (4%). Additional controlled epidemiologic studies among kaolin workers are needed to generate reliable prevalence data for pneumoconiosis and to assess the impact of dust exposure on pulmonary function.

Adult↗

Kaolin pneumoconiosis. Radiologic, pathologic, and mineralogic findings.

Pulmonary tissue obtained at thoracotomy or autopsy from 5 kaolin workers with complicated pneumoconiosis was studied by optical light and scanning electron microscopy. Premortem or preoperative chest roentgenograms demonstrated small irregular shadows and large opacities typical of kaolin pneumoconiosis. On gross examination, there were firm, grey-brown nodules and masses in the parenchyma and in the hilar lymph nodes. Histologically, there was extensive pulmonary kaolinite deposition associated with formation of peribronchiolar macules and nodules. The latter were comprised of kaolinite aggregates traversed by bands of fibrous tissue rather than dense whorled collagen, as seen in silicosis. Crystallographic studies confirmed the presence of kaolinite in the lungs, but silica was not demonstrable by either analytical scanning electron microscopy or X-ray diffractometry. These findings illustrate the pathology of human kaolin pneumoconiosis, confirm the fibrogenic potential of kaolinite, and emphasize differences in pulmonary responses to kaolinite and to silica.

Adult↗

Association of learning and memory impairments with changes in the septohippocampal cholinergic system in rats with kaolin-induced hydrocephalus.

OBJECTIVE: The septohippocampal cholinergic (SHC) system plays an important role in the maintenance of normal memory and learning. However, the fact that memory and learning impairments under hydrocephalic conditions are directly related to the SHC system is less well known. We investigated the relationships between pathological changes in SHC neurons and impairments in memory and learning among hydrocephalic rats. METHODS: Rats with kaolin-induced hydrocephalus were prepared with injections of kaolin suspension into the cisterna magna. Learning and memory performance was assessed with the passive avoidance and Morris water maze tests. Ventricular sizes were measured for the lateral and third ventricles. Acetylcholinesterase and choline acetyltransferase immunostaining was performed to investigate degenerative changes in cholinergic neurons in the medial septum and hippocampus. RESULTS: Hydrocephalic rats demonstrated significant learning and memory impairments in the passive avoidance and Morris water maze tests. Decreased hesitation times in the passive avoidance test and markedly increased acquisition times and decreased retention times in the Morris water maze test indicated learning and memory dysfunction among the hydrocephalic rats. The numbers of cholinergic neurons in the medial septum and hippocampus were decreased in the hydrocephalic rats. The decreases in choline acetyltransferase and acetylcholinesterase immunoreactivity were significantly correlated with enlargement of the ventricles. CONCLUSION: Impairment of spatial memory and learning may be attributable to degeneration of SHC neurons. These results suggest that learning and memory impairments in rats with kaolin-induced hydrocephalus are associated with the dysfunction of the SHC system induced by ventricular dilation.

Animals↗

Room-temperature luminescence from kaolin induced by organic amines.

Several new, room-temperature luminescent phenomena, resulting from the interaction of kaolin and various amino compounds, have been observed. The emission of light from kaolin pastes (treated with quinoline, pyridine, hydrazine, monoethanolamine, n-butylamine, and piperidine) was shown to decay monotonically over a period of hours to days. More light was released by a given amino compound after it was dried and purified. Hydrazine, in addition to the monotonically decaying photon release, produces delayed pulses of light with peak emission wavelength of 365 nm which last between several hours and several days. These photon burst are acutely sensitive to the initial dryness of the hydrazine, both in the number of bursts and the integrated photon output. The amount of light and the capacity of the kaolin to produce the delayed burst appeared to be strongly dependent on preliminary heating and on gamma-irradiation, analogous to the dehydration-induced light pulse previously reported from the Ames Research Center. A small, delayed burst of photons occurred when piperidine and n-butylamine were removed by evaporation into an H2SO4 reservoir.

Aluminum Oxide↗

Effect of captopril on the time-dependent variation of kaolin-induced writhing reaction.

Effect of captopril, an angiotensin-converting enzyme (ACE) inhibitor, on the time-dependent variation of kaolin-induced writhing reactions was examined in mice kept under conditions of light from 07:00 to 19:00 and dark from 19:00 to 07:00. The number of writhes was counted for 60 minutes after a single intraperitoneal injection of kaolin at 01:00, 07:00, 13:00, and 19:00. The number of writhes showed a time-dependent variation, with a peak at 19:00 and a trough at 07:00 in the control group. Captopril significantly increased the number of writhes after dosing at 01:00 and 07:00 (during the active period). The ACE activity following captopril dosing was significantly lower in the 07:00 than the 19:00 trial. These results suggest that the pharmacological effect of captopril varies with the dosing time, and the enhancement of the kaolin-induced writhing reaction is greater following dosing of the agent at nighttime in mice.

Angiotensin-Converting Enzyme Inhibitors↗

Pressure-absorption responses to the infusion of fluid into the spinal cord central canal of kaolin-hydrocephalic cats.

The resistance to cerebrospinal fluid (CSF) absorption through the alternative CSF absorption pathway in kaolin-induced hydrocephalic cats was measured by the constant infusion-manometric test. The cerebral ventricles were bypassed, and artificial CSF was infused directly into the central canal of the spinal cord. The infusion rates were increased stepwise from 0.022 to 0.168 ml/min when the capacity to absorb CSF was exceeded. There was an initial increase in resistance which was associated with the emergence of infusion fluid through a slit-like opening in the dorsal columns of the lower lumbar spinal cord. The resistance to flow decreased when the infusion rate was greater than 0.086 ml/min. Fluid accumulated in the spinal subarachnoid space when the ability to absorb was exceeded. The diversion of this fluid caused the pressure in the spinal cord central canal to fall rapidly. The results suggest that the CSF absorption deficit in chronic kaolin-induced hydrocephalic cats is probably caused by the restriction of CSF flow from the central canal through the spinal cord and into the spinal subarachnoid space. As a result of kaolin, the central canal is sufficiently dilated to permit, during infusion, the flow of at least five times as much CSF as the hydrocephalic cats produce. It is not clear whether the overloading of the CSF absorption mechanism is due to the restrictions imposed by the size of the subarachnoid space, or to the structures in this space involved with the return of CSF to the blood.

Absorption↗

Kaolin-induced congenital hydrocephalus in utero in fetal lambs and rhesus monkeys.

A model of congenital hydrocephalus in utero in fetal lambs and rhesus monkeys has been produced by the intracisternal injection of kaolin. Initial attempts to produce hydrocephalus using silicone oil were unrewarding. Hydrocephalus had developed by 2 weeks post-injection and could be followed by ultrasonography. The pathological findings were similar to those reported using kaolin in other species. Ventriculoamniotic shunting, when successful, was capable of partially reversing the deleterious effects of hydrocephalus. The major drawback of the present model is that hydrocephalus is produced during the second rather than the first trimester of pregnancy. However, kaolin produces mainly an obstructive hydrocephalus without other associated brain or systemic anomalies.

Animals↗

Morphological study of experimental syringomyelia with kaolin-induced hydrocephalus in a canine model.

In this morphological study the authors investigated whether spinal cord cavitation, produced in young mongrel dogs that had been rendered hydrocephalic by cisternal injection of kaolin, consists of a dilated central canal or intramedullary cavities. Hydrocephalus was noted in 50 of 56 dogs treated with kaolin. Of the 50 hydrocephalic young dogs, 29 were shown to have central canal dilation that was prominent at the thoracic level and 21 to have cervical intramedullary cavities in the posterior column and/or the posterior horn. In 11 dogs from the latter group these cavities were demonstrated to have no communication with the central canal. This finding could not be explained by the hydrodynamic theory. On histopathological examination, myelomalacia and hemorrhagic infarction following ventricular shunting were noted adjacent to the cervical cavities, which suggested vascular impairment. A perfusion study revealed insufficient blood flow within the cervical cord at the level of the intramedullary cavities. A close correlation between the vascular insufficiency of the cervical cord and the pressure cone resulting from significant hydrocephalus was observed. The latter may cause cervicomedullary compression at the foramen magnum, affecting the venous drainage of the cervical cord below that level, resulting in intramedullary cavitation. Accordingly, vascular impairment was thought to play a significant role in the development of cervical syrinx formation in our kaolin model. The current results may provide a reasonable explanation for the formation of noncommunicating cervical syringomyelia in Chiari I malformation.

Animals↗

Preadsorption of boar semen with kaolin: increased efficiency of foot-and-mouth disease virus detection.

The boar semen-associated cytotoxic factor(s), but not the antiviral activity, were removed by adsorption with kaolin. Although foot-and-mouth disease virus was efficiently removed from medium by kaolin or kieselguhr, the virus was not removed from semen-virus mixtures. Because the cytotoxicity induced by boar semen apparently altered the ability of tissue culture cells to support virus replication, preadsorption with kaolin increased the probability of detecting this virus in semen samples.

Adsorption↗

[Adsorption potency of 2 clays, smectite and kaolin on bacterial enterotoxins. In vitro study in cell culture and in the intestine of newborn mice].

The use of clays in the treatment of enterocolitis is justified by their ability to adsorb viruses, biliary acids and bacterial toxins secreted into the intestinal lumen. We have studied the in vitro inactivation of the LT toxins of Vibrio cholerae and E. coli, the ST toxin of ETEC and the verotoxin of EHEC. These various toxins were incubated with two types of clays, smectite and kaolin, to investigate the influence of dose, pH variations and the duration of contact of the clays with the toxins. Irrespective of their presence or absence in the supernatant, the biological activity of the toxins was assessed in cell culture and in the newborn mouse test. Both clays inactivated the LT toxin. Smectite was more efficient than kaolin as it was active immediately especially at the pH of intestinal chyme. The LT toxins were adsorbed on the clays by hydrogen bonding. This permitted the segregation of the toxins and prevented them from being fixed to the membrane receptors on the cells. The two clays were ineffective against the verotoxin of EHEC when the pH was alkaline although they were more efficient at acid pH. ST toxin of ETEC was slightly adsorbed by smectite and kaolin.

Adsorption↗

Effect of pectin and kaolin on bioavailability of co-trimoxazole suspension.

Bioavailability of co-trimoxazole suspension was determined with and without concurrent administration of pectin and kaolin in 8 volunteers. Twenty ml suspension of co-trimoxazole containing 160 mg trimethoprim (TMP) and 800 mg sulphamethoxazole (SMX) and co-trimoxazole suspension along with 20 ml of pectin-kaolin suspension were administered in a random order with 7 days interval. Plasma estimation of trimethoprim and sulphonamide was carried out at serial intervals. Area under curve (AUC) and Cmax of TMP were significantly higher when co-trimoxazole suspension alone was used. No statistically significant changes were observed in case of sulphamethoxazole. Clinical study is necessary to verify whether concurrent administration of co-trimoxazole and pectin-kaolin leads to loss of antibacterial efficacy.

Adult↗

Rat pleurisy induced by kaolin or croton oil: time course of fluid accumulation and white cell migration.

Rat pleurisy was induced by intrapleural injection of 0.1 ml of 1% kaolin or 1% croton oil, and the time courses of pleural fluid accumulation and white cell migration were examined. Peak pleural fluid accumulation was observed at respectively 5 and 16 h after the inciter injection. Migration of white cells into the pleural cavity showed a peak at respectively 7 or 24 h after each inciter. Polymorphonuclear leukocytes were predominant in pleural cells of kaolin pleurisy at 3 h, while in croton-oil pleurisy the major white cells were mononuclear cells and lymphocytes at 3 h, and polymorphonuclear leukocytes appeared later around 16 h. Pretreatment with several agents modified both types of induced pleurisy. Kaolin pleurisy at 3 h was suppressed by indomethacin, mefenamic acid, paramethasone, bromelain and soy-bean trypsin inhibitor, while croton oil pleurisy at 3 h was suppressed significantly by indomethacin and paramethasone.

Animals↗

Determination of coagulation factors (II-VII-X) and kaolin partial thromboplastin time by the LKB 8600 Reaction Rate Analyser.

Testing of a modified Reaction Rate Analyser 8600 in the automatic determination of coagulation time was accomplished with the assays Thrombotest Normotest and Kaolin Partial Thromboplastin Time. Variations in extinctions, from the adding of start reagent until coagulation, were recorded. The coagulation activities, found by the automatic method for the assays Thrombotest and Normotest, were compared with a manual method. Thrombotest showed a good correlation: 0.30 greater than P greater than 0.25 (paired t test). Normotest showed significantly different values by the methods: P less than 0.001 (paired t test). Kaolin Partial Thromboplastin Time (Activated Partial Thromboplastin Time with kaolin as activator) gave significantly lower vales--the difference was 3 sec--compared with a manual method, and the precision was considerably improved.

Blood Coagulation Tests↗