bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential Stability Of Prostacyclin (PGI2) In Whole Blood And Plasma
Authors: Krishnamurthi S , Westwick J , Kakkar V V
Published: July 2018

The stability of PGI2 in human whole blood (WB) , platelet- rich plasma (PRP) and platelet-poor plasma (PPP) was studied. Following incubation of PGI2(60nM) in the three media, it was found that the half life (t 1/2) of PGI2 (as measured) by the rate of loss of PGI2 equivalents causing platelet inhibition in the supernatant of the incubates) was longer in PPP ᶓ PRP (t 1/2 49±4 ᶓ 42.5±5 min respectively, n=10). On investigation this was found to be largely due to the pH difference observed between PPPᶓPRP (both pH 7.8±1) and WB (pH 7.4±1). Addition of NaHCO3 to raise the pH of WB to 7.8 prolonged the stability of PGI2 with a th of 35±4 min and addition of HC1 to lower the pH of PPP to 7.4 shortened the th to 18.5±4 min. However, incubation of PGI2 in either Hanks buffer or washed red blood cells (WRBC) at pH 7.8 did not increase PG2 stability. Since addition of a mixed population of white blood cells (7xl06cells/ml in PBS pH 7.8) to PPP (pH7.8) did not alter the rate of loss of PGI2 activity and there was found to be no significant uptake (<15%) of 3H PGI2 in WRBC, the possibility of PGI2 conversion to a more stable and platelet-active metabolite such as 6-oxo-PGE2 in plasma was studied by extraction and TLC of the PPP and WB incubates. 3H PGI 2 was found to be converted to % 6-oxo-PGF2 in both WB (pH7.4) and PPP (pH 7.8) with no other detectable metabolites in three different solvent systems. Treatment of the incubates prior to extraction and TLC with NaBH4 (which by reducing free keto groups can distinguish between PGI2 and 6-oxo-PGF1α) showed that 10-20% of the added 3H PGI2 in PPP (pH 7.8) was unchanged even after 120 mins incubation while virtually all the added 3H PGI2 in WB (pH7.4) was converted to 3H 6-oxo-PGFlaby 50 min with a time course (% PGI2 60nM; 1/2 WB-14 min, PPP-35min) similar to the loss of PGI2 activity in WB and PPP on bioassay. We conclude that the prolonged platelet inhibitory activity following incubation of PGI2 in plasma compared to that in whole blood is due to unchanged PGI2 and not the formation of a 6-oxo-PGE1, like substance as suggested by Borda and Gimeno in Prostaglandins 19 pp 899 (1979).
Computed Tomography Detection Of Hemorrhagic And Thrombotic Disorders
Authors: Moncad Roqelio , Messmore Harry L , Love Leon , Parvez Zaheer , Fareed Jawed , Baker Mark
Published: July 2018

The a bility of computed tomography to detect minimal differential changes in the x-ray, tissue absorption coefficient has been u t iliz e d to diagnose c lo t associated radiodensity a ltera tions in a variety of clin ic alsettings. Freshly extravasated blood generally exhibits greater radiodensity than circulating blood and a progressive diminution in the clot radiodensity is observed over a period of approximately 4 weeks. This phenomenon has been successfully employed in the diagnosis of intracranial hemorrhage and th e ir sequale. As im ilar approach has been used to detect hemorrhagic and/or thrombotic incidents in the torso. The following categories have been examined.
Partial Purification and Characterization of an ADP Phosphohydrolase from Human Plasma
Authors: Holmsen I , Holmsen H
Published: July 2018

Plasma contains enzymes capable of dephosphorylating ADP, ATP and AMP (adenosine di-, tri- and monophosphate). In platelet-rich plasma these enzymes are important for the regulation of the levels of (platelet-aggregating) ADP and (aggregation-inhibitory) adenosine.

Plasma ADPase and ATPase were studied at 1 (µM substrate concentration using an isotope technique. Both enzymes were precipitated from plasma at 45-65% saturation with (NH4)2S04 and emerged together by gel filtration on Sephadex G-200 and from DEAE-Sephadex (0.12-0.20 M Cl-, pH 8.2). In combination these procedures gave 1,500-1,800 times purification of ADPase relative to plasma. The purest fraction contained ATPase, ADPase and AMPase in a 0.17:1.00:2.92 proportion, quite different from their 5.34:1.00:5.34 proportion in plasma. Adenosine deaminase and adenylate kinase were not present in the purest fraction, whereas nucleoside diphosphokinase appeared to be present.

The purified ADPase was stimulated by low concentrations of Mg2+ and Mn2+, whereas high concentrations were inhibitory. This inhibition could not be explained by an increase in the ionic strength. Ca2+ and Zn2+ were inhibitory at all concentrations used (0-3 mM). Lineweaver-Burke plots were linear for both ADPase and ATPase in the 0−4 x 10-5 M substrate range, and both enzymes had Km = 1.1 x 10−5 M. Increase of the substrate concentration above 4 x 10−5M gave deviation from MichaelisMenten kinetics, and Eadie-Hofstee plots indicated the presence of “high-Km” ADPase and ATPase. The latter enzymes were not studied.

Déphosphorylation of 3H-ADP by purified “low-Km” ADPase was reduced by nonradioactive diphosphates of guanosine, inosine, cytidine and uridine in the same way as when nonradioactive ADP was used. Nonradioactive AMP also reduced dephosphorylation of 3H-ADP, whereas nonradioactive ATP did not.

Cyanide, cysteine and tartrate inhibited “low-Km” ADPase whereas p-chloromercuribenzoate, p-chloromercuribenzoesulphonate and N-ethylmaleimide had no effect. EDTA inhibited the enzyme activity in a way that could not be abolished by excess Mg2+. Purified plasma “low-Km” ADPase thus appears to be an unspecific enzyme, as one and the same active site does not seem to distinguish between the base moiety of nucleoside diphosphates, and catalyzes hydrolysis of phosphate esters as well as pyrophosphate bonds. The relation between plasma ADPase and ATPase remains unclear.
Effects of Lead Acetate on Platelet Aggregation, Ultrastructure and Serotonin Release
Authors: Davis R. B , Holtz G. C
Published: July 2018

The effects of lead on blood platelet function and ultrastructure have been investigated. Lead acetate was injected intravenously in 27 rats and was added to rat and human platelet rich plasma in vitro. In vitro studies showed that concentrations of 2.5 × 10-3 M lead acetate reduced or blocked aggregation of rat and human platelets by adenosine diphosphate, collagen, and thrombin. Radioactive serotonin release from human platelets was inhibited by 10-4 M lead acetate. One hour after the injection of lead, platelet aggregation by thrombin was reduced, but platelet aggregation by adenosine diphosphate and collagen showed little change. Three days after lead, aggregation of platelets by collagen and thrombin was blocked and aggregation by adenosine diphosphate reduced. Thrombocytopenia was present 4 days after intravenous lead acetate. Electron micrographs of platelets showed that the mean number of mitochondria per platelet was increased, whereas alpha granules were reduced. Dense bodies were not significantly changed. Lead acetate affects platelet function in concentrations reported in human bone marrow in lead poisoning, and may relate to the binding of free sulfhydryl groups by lead.
Gel Filtration
Authors: Tangen O , Berman H. J , Marfey P
Published: July 2018

Hamster platelets have been separated from their plasmatic enviroment by means of gel filtration. This method of separation gave an excellent yield of platelets free of non-adsorbed plasma proteins.

Gel filtered platelets (GFP), and platelets washed by repeated centrifugations and resuspensions (CP) were compared to each other and to platelets left undisturbed in their native plasma (PRP). Only slight morphological differences between the three platelet preparations could be detected by phase microscopy. In the concentration range of .28–.71 μM ADP, GFP, resuspended in PPP, showed the same degree of aggregation as did PRP. At lower concentrations of ADP, GFP aggregated to a lesser degree than did PRP. CP exhibited aggregation comparable to PRP only at higher concentrations of ADP (.71–1.42 (μM ADP). GFP also supported clot retraction to the same extent as did PRP.

It would appear that gel filtration provides a new, gentle and rapid method for separation, from plasma, of platelets with activity very similar to that of platelets in PRP.
Activation of Fibrinolysis and of Plasma-Kinin System during Venostasis*
Authors: Buluk K , Malofiejew M , Czokalo Maria
Published: July 2018

In the plasma of stasis blood, fibrinolytic activity increases as a result of the enrichment of this blood by fibrinolysis activators of tissue origin. With the increase in fibrinolytic activity an increase in kallikrein and a temporary release of plasma kinin occurs. Plasma kallikrein, activated in the stasis blood through fibrinolysis activation on application of a manometric cuff retains its activity and may play some role in the lowering of blood pressure when the cuff is removed.
Primary Mural and Venous Thrombosis in the Heart*
Authors: Mann F. D , Buffmire D. K
Published: July 2018

Ten cases are presented of ventricular mural thrombosis and thebesian vein thrombosis with an adequate coronary system and without myocardial necrosis or myocarditis. In six cases there was reason to suspect a thrombosing tendency : namely, extensive neoplastic disease in four cases, thrombophlebitis in one, and small bowel infarction in one.
Aggregation of Rabbit Blood Platelets Produced in Vitro by Saline “Extract” of Tendons
Authors: Hovig Torstein
Published: July 2018

Rabbit blood platelet aggregates were produced in vitro by addition of rabbit tendon “extract” to citrated platelet-rich plasma. The aggregating activity was not due to presence of adenosine diphosphate in the “extracts” and was unrelated to blood coagulation. The aggregating principle was destroyed by heating of the “extract” to 60° C for 15 minutes or by incubation with collagenase for 1 hour at 37° C. The aggregating effect was associated with particles which were sedi- mented by centrifugation for 30 minutes at 10,000 G. By means of electron microscopy the particles were identified as cross-striated collagen fibrils.
Untersuchungen über Beziehungen zwischen Gefäß- und Gerinnungsfaktoren beim Sanarelli-Shwartzman-Phänomen
Authors: Müller-Berghaus G , Lasch H.-G
Published: July 2018

Beim Sanarelli-Shwartzman-Phänomen (SSP) kommt es zur ubiquitären intravasalen Gerinnung mit Fibrinthromben in der Gefäßperipherie und konsekutiver Verbrauchskoagulopathie. Der Auslösungsmechanismus der Vorgänge im Gerinnungssystem ist noch nicht in allen Einzelheiten bekannt. Um die Rolle des Gefäßendothels zu untersuchen, wird in vitro in Aortenpräparaten, die während der einzelnen Phasen des SSP gewonnen werden, gleiches Normalplasma rekalzifiziert. Dabei wird Faktor V als Indikator für die Funktion von Thrombin während des Gerinnungsvorganges bestimmt. Es zeigt sich, daß Aortenpräparate der Frühund Spätphase des SSP eine gegenüber Normalaorten steilere Aktivierung von Faktor V zu Faktor VI bewirken. Dieser Effekt wird auf eine größere Oberflächenwirkung bezogen und ist in allen Phasen des SSP gleich. Dagegen verläuft die Inaktivierung von Faktor V in der Frühphase des SSP steiler als in der Normalaorta, während sie in der Spätphase des SSP signifikant langsamer und flacher vor sich geht. Es wird diskutiert, ob hierfür die Verarmung der Aortenwand an gerinnungsaktiven Substanzen, wie “Vaskulokinase”, verantwortlich ist, die zunächst als Folge der Endotoxinwirkung aus dem Gefäß austritt und die intravasale Gerinnung akzeleriert (Frühphase). In einer späteren Phase des SSP ist die Gefäßwand erschöpft. Daneben bleibt zu überlegen, ob mit Zunahme der Zeit nach einem SSP thrombinhemmende Substanzen aus der Gefäßwand freiwerden und den Thrombineffekt abschwächen.
Activation of Serum Thrombotic Accelerator (STA) by Digitonin and Saponin
Authors: Howell R. M , Scott G. B. D
Published: July 2018

The steroid saponins digitonin and saponin white, compounds effective in disrupting membrane lipid-protein, have been shown to activate STA precursor.

Ultracentrifuge studies showed a radical alteration in the floatation behaviour of the precursor complex on activation by digitonin, indicating an increase in its molecular size.

Gel-filtration studies, on the other hand, revealed that activation by digitonin was reversible, since passage down a Sephadex G-200 column not only removed digitonin but abolished all activity, the latter being fully restored by the further addition of digitonin. Furthermore, since the elution positions of inactive precursor and deactivated STA were identical, this de-activation was accompanied by the return of the complex to its original size. The failure of cardiac glycosides, other than digitonin, to activate the precursor may be due to their being more hydrophobic and suggests that hypercoagulability leading to possible thrombosis does not arise from their therapeutic use.
A Comparison of the Effect of Platelets and Erythrocytes on the Inhibitory Action of Blood Coagulation by Polybrene and Heparin
Authors: Shanberge J. N , Furuta S
Published: July 2018

Although the inhibitory action of Polybrene and heparin on blood coagulation in vitro is inversely proportional to the number of platelets present, the reason for this in each case is different. Whereas heparin is counteracted by a substance present in platelets, the platelet factor 4, Polybrene is partially neutralized by adsorption onto the surface of the platelets.

Under similar conditions Polybrene is adsorbed by erythrocytes while heparin is not.

Platelet factor 4 not only is not anti-Polybrene but, like Polybrene, is also inhibitory in the intermediate product I formation test so that the two together have a greater inhibitory action than either one alone.
Fluoreszenzmikroskopische Lebendbeobachtungen zur Frage einer Abhängigkeit der Gefäßwand-Schrankenfunktion vom hämostatischen Gleichgewicht
Authors: Hauck Günther , Schröer Heinz
Published: July 2018

Es wird über fluoreszenzmikroskopische Untersuchungen an der terminalen Strombahn des Kaninchenmesenteriums berichtet, wobei die Auswirkungen experimentell verursachter Störungen des hämostatischen Glei chge wi cht e s auf die Gefäßwand-Schrankenfunktion beobachtet und mit den Verhältnissen bei unbeeinflußten Tieren verglichen wurden. Im Vordergrund standen hierbei Permeabilitätsuntersuchungen im Stadium einer durch Thrombininfusion hervorgerufenen Afibrinogenämie. Als Indikatorsubstanz diente das saure Fluorochrom Brillantsulf oflavin.

Bei Kaninchen mit unbeeinflußtem fibrinoplastischem und fibrinolytische m Potential kam es schon kurze Zeit nach der Farbstoffapplikation in die li. vena jugularis zur transvaskulären Farbstoffpassage ; es wurde ein Austrittsmodus im Sinne eines sog. Permeabilitätsgradienten konstatiert. Demgegenüber zeigten Kaninchen im Stadium der Afibrinogenämie in vergleichbaren Zeitabständen entweder keinen oder einen wesentlich geringeren Farbstoff austritt. Diesem permeabilitätsmindernden Früheffekt folgte eine Phase erhöhter Farbstoff dur chlässigkeit , z.T. mit zellulärer Extravasatbildung, wofür das durch die Thrombininfusion geschwächte Gerinnungspotential verantwortlich gemacht wird. Über die Mitbeteiligung fibrinoly tis cher V orgänge an der Beeinflußung der Gefäßpermeabilität konnte keine Aussage gemacht werden. Da es im Verlaufe einer Thrombininfusion zu einem massiven Thrombozytenabfall kommt und somit ein temporär erhöhtes Angebot an Thrombosthenin im strömenden Blut angenommen werden kann, war auch nicht zu entscheiden, welchem Mechanismus - Einbau von Fibrin oder Einbau von Thr o mb osthenin in die Kapillarwand - für die Permeabilitätseinschränkung eine besondere oder ausschließliche Bedeutung beizumessen ist. Einige der Thrombininfusions-versuche erfolgten nach vorheriger Applikation von Fibrinogen, andere in Kombination mit Epsilon-Aminocapronsäure. Ferner wurde das Verhalten der terminalen Strombahn bei unterschiedlicher Heparin- bzw. Streptasedosierung beobachtet.
Calidad seminal e inseminación intrauterina: estudio retrospectivo
Authors: Calderón-Mendoza Luisa , Castrillón López Lucero , Vélez Giraldo Carlos , Cardona-Maya Walter , Álvarez Verónica
Published: July 2018

Objetivo El objetivo de este estudio fue evaluar los parámetros seminales en muestras seminales frescas y seleccionadas y determinar los factores que predicen el éxito de la inseminación intrauterina (IIU).

Materiales y Métodos Todas las parejas que se sometieron a IIU se registraron retrospectivamente y se incluyeron un total de 419 ciclos. Las muestras de semen fueron seleccionadas usando el método swim-up.

Resultados No se encontró un parámetro seminal que pueda ser considerado como predictor de embarazo. Después de la preparación de la muestra, hubo una mejoría en la movilidad espermática y una disminución en la concentración. Adicionalmente, una diferencia significativa en el volumen entre los individuos menores de 40 años y mayores de 40 años fue observada.

Conclusión No existen parámetros seminales que puedan predecir el éxito de la inseminación, básicamente debido a que lograr un embarazo depende de muchos factores. Sin embargo, el procesamiento en el laboratorio mejora considerablemente la movilidad espermática de las muestras y la IIU tiene tasas de embarazo aceptables; por lo tanto, debe ser considerada como primera elección de tratamiento.
Nefrectomía radical laparoscópica en tumores mayores de 7 cm: serie de casos
Authors: Otero Andrade Fabio , Quiroz Madarriaga Yesica , Franco Leon Diana , Rendon Ferguson Eduardo
Published: July 2018

Introducción y Objetivo Los tumores renales representan el 2%–3% de todos los cánceres a nivel mundial y tan solo el 40% se maneja de manera mínimamente invasiva. Se pretende describir aquí la experiencia de un cirujano en nefrectomías radicales por laparoscopia (NRL) en tumores mayores de 7 cm.

Materiales y Métodos se revisaron las historias clínicas de los pacientes sometidos a NRL de un cirujano desde enero del 2011 hasta abril del 2016, encontrando 20 casos de masas mayores de 7 cm y se describen: tiempo quirúrgico, sangrado, transfusiones, complicaciones perioperatorias, TNM, tamaño por patología y resultado al mes posoperatorio.

Resultados se encontraron 20 pacientes, 40% eran mujeres, con edad promedio de 55,7 años. Se realizó la misma técnica quirúrgica y el tiempo fue de 115 minutos, con sangrado de 333cc. Permanecieron hospitalizados en promedio 3,7 días. Cuatro pacientes requirieron transfusión, 1 paciente presentó complicaciones Clavien-Dindo grado II, uno grado IV y uno murió por sepsis previa a la cirugía. El 70% fue por carcinoma de células claras con Furhman 2 en el 57,1%, y 3 y 4 en el 21,4%. El 60% de los tumores eran T2, 30% T3 y 10% T4 y el tamaño promedio fue de 8 cm.

Conclusión La nefrectomía radical por laparoscopia es una opción viable y segura para tumores renales mayores de 7 cm, si se cuenta con la experiencia necesaria para llevar a cabo dicho procedimiento, sin embargo, hace falta seguimiento a largo plazo para evaluar su eficacia en cuanto al control oncológico.
Reokklusionsprophylaxe im Kindesalter
Authors: Becker Sabine , Heller Christine , Lenz Elisabeth , Kreuz W.
Published: July 2018

Zuammenfassung

Für eine erfolgreiche Lysetherapie bei venösen und arteriellen thrombotischen Verschlüssen ist eine Reokklusionsprophylaxe essentiell. Dabei ist ein möglichst frühzeitiger Beginn - parallel zur Lysetherapie - wichtig. Als Adjuvans zu den Fibrinolytika werden bei Erwachsenen neben unfraktioniertem Heparin auch niedermolekulare Heparine (LMWH) eingesetzt; letztere scheinen zumindest gleich wirksam bei etwas geringerem Blutungs- und Nebenwirkungsrisiko. Nach venösen Thrombosen im Kindesalter werden zur Langzeitprophylaxe Cumarinderivate eingesetzt. Bei Kontraindikationen für Cumarin könnten sich niedermolekulare Heparine (LMWH) in Zukunft als vielversprechende Alterna-tiven auch für pädiatrische Patienten erweisen. Allerdings gibt es noch keine Daten zum Osteoporoserisiko unter Langzeitgabe von LMWH; speziell im Kindesalter sollten Nutzen und Risiken für diese Substanzen sorgfältig abgewogen werden. Die Reokklusionsprophylaxe arterieller Gefäße stellt eine Indikation in erster Linie für Azetylsalizylsäure neben unfraktioniertem Heparin und LMWH dar. Im Gegensatz zum Erwachsenenalter werden bei Kindern alle Dosierungen an das Körpergewicht oder die Körperoberfläche angepaßt.
Lyse von Plasmagerinnseln nach Zugabe verschiedener Plasminogenaktivatoren in vitro
Authors: Rauch R. , Klinge J. , Trusen B. , Zenker M. , Harms D. , Ries M.
Published: July 2018

Während bei Erwachsenen zahlreiche Studien zur Durchführung einer thrombo-lytischen Therapie publiziert wurden, gibt es für das Neugeborenenalter ver-gleichsweise wenig Daten. Intrauterin und in der Neonatalperiode zeigen sich sowohl bei der Gerinnung als auch bei der Fibrinolyse Unterschiede in der Konzen-tration und Funktion mehrerer Faktoren. Neben den Methoden zur Bestimmung von Einzelfaktoren haben globale Tests, z.B. zur Erfassung des gesamten fibri-nolytischen Potentials, nach wie vor große Bedeutung.

Wir berichten über die Befunde von Gerinnsel-Lysetests bei Neugeborenen verglichen mit Erwachsenen und diskutieren mögliche Auswirkungen dieser Befun-de auf Dosierungsrichtlinien einer thrombolytischen Therapie im Neugeborenen-alter.
Thrombolytische Therapie mit rt-PA
Authors: Knöfler R. , Rupprecht E. , Kabus Maria , Lauterbach Ingrid , Weißbach G.
Published: July 2018

Zur Optimierung der thrombolytischen Therapie im Kindesalter werden mehr klinische Daten benötigt. Wir berichten deshalb über unsere Erfahrungen mit der rt-PA-Behandlung bei 1 2 Kindern (7 Tage bis 16 Jahre) mit venösen Thrombosen (n = 10) und Purpura fulminans bei Meningokokkensepsis (n = 2). Die venösen Verschlüsse bestanden im Bereich der Becken-Beinvenen (n = 5), der Halsvenen (n = 4) sowie der oberen Hohlvene (n = 1). Zentralvenöse Katheter waren bei 4 Patienten pathogenetisch bedeutsam. Die Patienten wurden 10,5 Stunden bis zu 13 Tagen mit rt-PA (Actilyse®) in einer Dosierung von 0,2 bis 0,5 mg/kg KG für den initialen Bolus und 1,0 bis 2,0 mg/kg KG/d für die anschließende kontinuierliche Gabe behandelt. 11 Kinder erhielten eine parallele Heparininfusion. Bei 7 Pa-tienten wurde ein kompletter, bei einem Kind ein teilweiser Therapieerfolg erzielt. Für die 4 Patienten mit erfolgloser Behandlung war eine Verschlußdauer von 3 oder mehr Wochen kennzeichnend. Bei 5 Patienten wurden kleinere Blutungen aus Stichkanälen beobachtet. Systemische Effekte, wie das Absinken des Fibrinogenspiegels und aPTT-Anstiege, waren selten. Die Therapie mit rt-PA stellte sich bei den von uns verwendeten Dosen als effektive und sichere Behandlungsform dar.
Thrombolyse bei Neugeborenen und Säuglingen
Authors: Schlößer R. , Auberger K. , von Kries R. , Nowak-Göttl Ulrike , Schwabe D.
Published: July 2018

Sechzehn Kinder (3 Tage bis 11 Monate, Median 6 Wochen) mit thrombotischen oder embolischen Verschlüssen großer Gefäße wurden mit rt-PA behandelt. Betroffen waren die Nierenvenen beider Seiten oder eine Nierenvene und die V. cava inferior (n = 8), die V. cava superior (n = 3), beide Nierenvenen, die V. cava inferior und die Aorta (n = 1), der linke Ventrikel (n = 1), isoliert die Aorta (n = 1), die A. femoralis (n = 1) und die V. portae (n = 1). Zehn der 16 Okklusionen waren Katheter-assoziiert. Die Thrombolyse wurde mit einem Bolus von 0,1-0,2 mg/kg rt-PA eingeleitet und mit einer Dauerinfusion fortgeführt (0,8-2,4 [-9] mg/kg/24 h). Heparin in niedriger Dosis (100 IE/kg/24 h) begleitete die Therapie. Unmittelbar nach Beendigung der Thrombolyse erfolgte eine Voll-heparinisierung (aPTT 1,5- bis 2fache der Norm). Fünf Patienten erhielten rt-PA lokoregionär durch den liegenden Katheter, die anderen systemisch. Bei 13 Patienten gelang eine vollständige Rekanalisierung, bei zweien eine partielle. Bei einem Patient mußte die Behandlung abgebrochen werden. Zwei Patienten erlitten eine spätere Reokklusion des betroffenen Gefäßes. Blutungen verzeichneten wir bei 3 Patienten, alle aus frischen Punktionsstellen. Die Resultate rechtfertigen die Durchführung einer systematischen multizentrischen Therapiestudie.
Lokale Thrombolyse im Kindesalter nach kardiochirurgischen Eingriffen mit niedrig dosiertem rt-PA
Authors: Ries M. , Rauch R. , Hofbeck M. , Scharf J. , Singer H. , Klinge J.
Published: July 2018

Unmittelbar postoperativ auftretende Thrombosen in aorto-pulmonalen Shunts stellen bei Kindern mit zyanotischen Herzfehlern eine schwierige therapeutische Situation dar, da zum einen die Abhängigkeit der Lungendurchblutung vom Blutfluß im Shunt rasche Therapiemaßnahmen erfordert, andererseits aber eine systemische thrombolytische Therapie wegen der Gefahr einer lebensbedrohlichen thorakalen Blutung kontraindiziert ist.

Wir haben bei 7 Patienten mit 8 Thrombosen eine lokale thrombolytische Therapie mit rt-PA durchgeführt. Trotz der sehr niedrigen Dosis von 0,1-0,25 mg/ kg/Bolus konnten wir 5 der 8 Thrombosen vollständig auflösen und eine operative Revision dadurch vermeiden. Therapieversagen war bei einem Patienten durch das Thrombusalter, bei den beiden anderen durch eine chirurgische Stenose im Shunt bedingt. Bei einer Patientin sahen wir eine therapiebedingte Blutung, zwei Patienten entwickelten schwitzende Shunts im Sinne einer Perigraft-reaktion.

Bei lokaler Applikation stellt die thrombolytische Therapie mit rt-PA aufgrund unserer bisherigen Erfahrungen eine gute Alternative zur sofortigen operativen Revision des Shunts dar.
Thrombolyse bei Nierenvenenthrombosen
Authors: von Kries R. , Nowak-Göttl Ulrike , Hoyer P. F. , Bökenkamp A.
Published: July 2018

Akute Nierenvenenthrombosen führen in der Mehrzahl der Fälle zu einer hämor-rhagischen Infarzierung mit konsekutiver Atrophie. Gegenwärtig konkurrieren drei Therapiekonzepte: die rein supportive Therapie, die Antikoagulation mit Heparin oder Coumarinderivaten und die Thrombolyse mit rt-PA, Streptokinase oder Urokinase. Aufgrund der geringen Inzidenz fehlen vergleichende Studien zur Effektivität dieser Therapieansätze. Insbesondere über thrombolytische Therapie wurde bisher nur kasuistisch berichtet.

In einer umfangreichen Literaturrecherche wurden Berichte über Thrombolysen bei Nierenvenenthrombosen hinsichtlich Therapiemodalität, Effektivität und Nebenwirkungen zusammengetragen. Dabei wurde zwischen der adulten Form mit Beginn im Nierenvenenhauptstamm und der neonatalen Form mit Beginn in kleinen intrarenalen Venolen unterschieden. Insgesamt konnten Daten über 37 Patienten ausgewertet werden. Bei der adulten Form atrophierten 5 von 18 betroffenen Organen (28%) im weiteren Verlauf, bei der neonatalen betrug die Schrumpfungsrate 40% (12 von 30 Organen). Diese Daten deuten im Vergleich zu den Ergebnissen der konkurrierenden Ansätze auf einen positiven Therapie-effekt der Thrombolyse hin. Dies sollte in prospektiv-randomisierten Vergleichsstudien überprüft werden.
Inhibition of Fibrinolysis and Fibrinogenolysis in Man: Comparison of ε-Aminocaproic Acid and Kallikrein Inhibitor
Authors: Beck E , Schmutzler R , Duckert F ,   Technical assistance: L. Müller and C. Vogel
Published: July 2018

Inhibitor of kallikrein and trypsin (KI) extracted from bovine parotis was compared with ε-aminocaproic acid (EACA): both substances inhibit fibrinolysis induced with streptokinase. EACA is a strong inhibitor of fibrinolysis in concentrations higher than 0, 1 mg per ml plasma. The same amount and higher concentrations are not able to inhibit completely the proteolytic-side reactions of fibrinolysis (fibrinogenolysis, diminution of factor V, rise of fibrin-polymerization-inhibitors). KI inhibits well proteolysis of plasma components in concentrations higher than 2,5 units per ml plasma. Much higher amounts of KI are needed to inhibit fibrinolysis as demonstrated by our in vivo and in vitro tests.

Combination of the two substances for clinical use is suggested. Therapeutic possibilities are discussed.
Development and Validation of a Brief Four-Component Questionnaire to Identify Patient's Motivation to Undergo Functional Rhinoplasty
Authors: Savvas Eleftherios , Rudack Claudia , Stenner Markus , Spiekermann Christoph
Published: July 2018

Outcome of functional rhinoplasty depends on different domains such as functional and aesthetic improvement. The aim of this study was to develop a brief and comprehensible questionnaire to identify patient motivation to undergo rhinoplasty and to measure the outcome of an intervention within a short time during outpatient consultation. Patients undergoing rhinoplasty were asked to complete the Rhinoplasty Outcome Evaluation (ROE) questionnaire, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (OAR) preoperatively, as well as one, three, and twelve months postoperatively. Patient satisfaction after surgery was assessed at postoperative consultations using a five-point Likert scale. Principle component analysis was performed to reveal the main domains, which were detected by the different questionnaires. Items with the strongest loading on a factor were identified by correlation matrix. Influence of the nasal appearance on the quality of life, troubles with nasal breathing, subjective perception of nasal appearance, and the wish for modification or alteration were found to be the four important domains of the questionnaires. The questions with the strongest loading on these domains were compiled and the four-component questionnaire (4CQ) was developed. The 4CQ is a very effective instrument to obtain a comprehensive impression of the varied determinants representing the major motifs to undergo functional rhinoplasty within a short time. The preoperative assessment of the 4CQ allows an estimation concerning the expected outcome.
Schistosomal Cervical Myelopathy
Authors: Farias Ronald , Oliveira Kléver , Mendes George , Meira Ussânio
Published: July 2018

Schistosomiasis is an infectious disease caused by trematode platyhelminths of the genus Schistosoma. The involvement of the cervical spinal cord is rare, with few cases reported in the literature. The management of such patients is particularly challenging, since clinical and radiological findings may be confounded with other inflammatory diseases and/ or spinal cord tumors. We describe a 20-year old male with a history of swimming outdoors. He first presented pain in the back of the neck extending to shoulders and upper limbs paresis associated with four limbs hyperreflexia. The magnetic resonance imaging (MRI) showed a hypointense T1-weighted lesion in the cervical spinal cord, which was hyperintense on T2 images. The serologic testing was negative for schistosomiasis. A cervical cord biopsy at the C5-C6 level showed Schistosoma eggs in the histopathological examination. The treatment was performed using a single dose of praziquantel 50 mg/kg, with prednisone 40 mg/day for 3 weeks. On the follow-up, 1 year later, the patient presented mild reduction of the vibratory sensitivity in the distal third of both legs. Our illustrative case strengthens that, in endemic regions, Schistosoma mansoni infestation should be included in the differential diagnosis of intramedullary expansive lesions.
Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies
Authors: Shi Shao-hua , Zhai Zheng-long , Zheng Shu-sen
Published: July 2018

Pyogenic liver abscess (PLA) of biliary origin in Southeast Asia mainly occurs in patients with intrahepatic bile duct stone (IBDS) and extrahepatic bile duct stone (EBDS), bilioenteric anastomosis, or biliary stent. IBDS, as an endemic to Southeast Asia, remains a frequent etiology of acute cholangitis and PLA. PLA related to IBDS is characterized by high incidences of PLA recurrence and death related to infection, and difficulties in diagnosis of concomitant cholangicarcinoma. PLA of biliary origin is more likely caused by Escherichia coli, more often presented as polymicrobial infections, and more associated with extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae isolates. In this review, the authors summarize the differences on the presumed causes, pathogens, multidrug resistance, treatment, and prognosis of PLA between biliary origin and cryptogenic origin, the latter serving as a first and foremost presumed etiology of PLA. The authors also discuss the existing problems on early diagnosis of concomitant cholangicarcinoma related to IBDS.
Tip-on-Tip Scapular (TOTS) Flap for Reconstruction of Combined Palatectomy and Rhinectomy Defects
Authors: Bartholomew Ryan , Zenga Joseph , Lin Derrick , Deschler Daniel , Richmon Jeremy
Published: July 2018

Combination anterior palatectomy and rhinectomy defects result in complete loss of midface and nasal support and present a significant reconstructive challenge. A novel use of the scapular tip free flap—the tip-on-tip scapula flap—was developed to provide both palatal repair and restoration of intrinsic nasal support. The scapular tip bone is split into a large proximal segment for the anterior palate and a smaller distal bone segment for nasal framework reconstruction. Two patients undergoing reconstruction of both total palatectomy and partial rhinectomy defects at a single academic tertiary care center were reviewed. In both cases, the larger proximal segment of the scapular tip flap, used for the palatal defect, was based on the angular artery. The distal bone segment, used for nasal framework repair, was vascularized in one of two ways. In the osteomyogenous serratus-scapular tip variant, the serratus arterial branch provided periosteal blood supply to the bone through a cuff of attached serratus muscle. In the split-scapular tip variant, the periosteum of the scapular tip was kept in continuity with the distal bone segment and fed through the periosteal vascular arcade from the angular branch. In both patients, the distal bone segment demonstrated robust intraoperative vascularity and both flaps healed without complication. Both patients were able to resume oral diets and had good nasal breathing.
Lateral Abdominal Wall Reconstruction
Authors: Kapur Sahil , Butler Charles
Published: July 2018

Lateral abdominal wall defects, while rare, present a more challenging problem than commonly encountered ventral defects due to the complexity of the anatomy, physiologic forces, and impact of muscle denervation. The lateral abdominal wall encompasses a large surface area ranging from the costal margin superiorly to the iliac crest inferiorly and from the linea semilunaris anteriorly to the paraspinous musculature posteriorly. The ratio of muscle to fascia/aponeurosis is much higher, which makes repair through muscle tissue versus fascia less secure. Furthermore, these defects are subject to asymmetric forces caused by the independent contraction of anterior and posterior muscle units, which lead to unbalanced strain and hernia progression. These features necessitate the use of wide underlay mesh load bearing repairs supported by the static pillars of the abdominal wall. Management can be further complicated when defects extend beyond the defined boundaries, requiring surgical repair to be adapted based on the border structures involved. Primary fascial coaptation may not be as easily accomplished, and therefore careful planning is important to ensure stable coverage of exposed mesh.
Management of the Open Abdomen
Authors: Mericli Alexander
Published: July 2018

Management of the abdominal catastrophe requires a multidisciplinary approach. The plastic surgeon is a key member of the surgical team assisting in the creation of a durable, functional anatomic abdominal wall reconstruction. Plastic surgeons must be familiar with the concepts and pathophysiology related to the open abdomen, techniques for temporary abdominal closure, and when such techniques are appropriate to implement. In this article, the authors provide a review of the open abdomen concept, which practicing plastic surgeons and trainees may find helpful if faced with this clinical scenario.
Una sola tableta de Abiraterona con comida en vez de 4 tabletas en ayuno para pacientes con cáncer de próstata metastásico resistente a la castración: perspectivas fármaco-económicas en un país en desarrollo
Authors: Sierra Pablo S.
Published: July 2018

Recientemente se publicó en el Journal of Clinical Oncology un estudio prospectivo aleatorizado fase II, que comparó dosis bajas de Abiraterona (250mg) administrada con comida vs la dosis estándar de dicho medicamento (1000mg), en pacientes con cáncer de próstata metastásico resistente a la castración (mCRPC)1 y concluyó que la dosis baja no es inferior a la dosis estándar en cuanto a la respuesta de PSA y a la supervivencia libre de progresión (PFS).
The Boomerang Thigh Flap: Optimizing the Donor Site for an Extended Skin Island Flap
Authors: Fioravanti Alex , Borges Luiz , Snider Chelsea , Barreiro Guilherme
Published: July 2018

Background The anterolateral region of the thigh is one of the most used donor areas for flaps. However, there are cases in which large defects require more than the conventional skin island provided by the anterolateral thigh flap (ALT). For an extended skin island flap, we developed a new boomerang thigh flap (BTF), in which a boomerang design includes perforators from multiple branches of the lateral circumflex femoral artery (LCFA), providing a single-pedicle, large, reproducible, and reliable flap. We report the anatomical study and the use of the new BTF in a clinical series.

Methods We dissected 20 flaps in fresh cadavers to determine the anatomical landmarks, vascular pedicle pattern, perforator distribution, and BTF flap dissection technique. After achieving a reproducible and reliable technique, with primary closure of the donor site based on the pinch test, the BTF was applied for microsurgical reconstructions in the head and neck, lower limb, and upper limb regions.

Results The BTF corresponds to a 45° confluence of the ALT and the tensor fascia lata (TFL) elliptical skin islands. It includes the perforators from the transverse/ascending and the descending branches of the LCFA , which conjoined into a single arterial LCFA pedicle in 85% (17) of the cadaver dissections. All the venous branches drained into a single lateral circumflex femoral vein. ALT perforator distribution followed literature descriptions, while TFL perforators were mainly septocutaneous and projected into a virtual rectangle of 6 × 4 cm at the lateral margin of the TFL. Average BTF dimensions were 40 × 8.6 cm. For the clinical cases, flap dimensions and pedicle characteristics were equivalent to the anatomical findings. The BTF was separated into two skin islands in four cases and no major complications were reported.

Conclusion The BTF is a reliable, reproducible, and divisible flap that provides extended skin island for reconstruction of large defects.
Homemade Glove Port for Single-Incision Pediatric Endosurgery (SIPES) Appendectomy—How We Do It
Authors: Martynov Illya , Lacher Martin
Published: July 2018

Introduction Single-incision pediatric endosurgery (SIPES) for the treatment of acute appendicitis in children has recently gained popularity due to its advantages including minimization of postoperative scars or less incisional pain. The principal disadvantages of SIPES include the limited degrees of freedom of movement and high health care costs. To overcome these issues, some surgeons have reported to use noncommercial ports for SIPES appendectomy.

Case Report In this report, we present a case of a 10-year-old female patient with acute appendicitis undergoing SIPES appendectomy using own homemade glove port and straight rigid instruments.

Conclusion SIPES appendectomy using the glove port is a low-cost alternative to commercially available port systems. It is easy to set up and use.
Optimal scheduled unit commitment considering suitable power of electric vehicle and photovoltaic uncertainty
Authors: Maghsudlu Saniya , Mohammadi Sirus
Published: July 2018

In this paper, a method to review the role of renewable energy as an energy producer in scheduling a problem unit commitment is presented. Today, renewable energy sources, due to the lack of environmental pollution, and consequently a very low marginal cost, have been receiving considerable attention in power systems. The correct management of the unit commitment (UC) is a controversial and important issue in the power production unit, which requires suitable scheduled hours to obtain a minimum cost. This study was conducted to investigate the presence of electric vehicles and photovoltaic sources in UC and their impact to reduce production costs and improve load profiles. To achieve the optimum solution, a meta-heuristic Cuckoo search algorithm with high convergence speed is used to solve the UC problem. An IEEE 10-unit test system is employed to investigate the impacts of PEVs and PV on generation scheduling. Since the PV system is associated with uncertainty, in this study, the Uncertainty problem has been modeled using an iterative algorithm randomly with the allocation of density functions that fits the solar radiation. So, the used stochastic Monte Carlo optimization algorithm is capable of handling uncertain outputs of solar power. The simulation results show the effectiveness of the proposed method in reducing production costs and improving load profiles.
Relation between HVG-irreversibility and persistence in the modified Langevin equation
Authors: Telesca Luciano , Czechowski Zbigniew
Published: July 2018

In this study, we investigate the relationship between persistence/antipersistence and time-irreversibility by using the Kullback-Leibler Divergence (KLD) in the directed Horizontal Visibility Graph applied to a new modified Langevin equation with persistence parameter d. A non-trivial relationship KLD(d) was found, characterized by a non-symmetric shape, which suggests that time-irreversibility increases with the degree of persistence or antipersistence. The analysis is applied to the population growth model, where the level of irreversibility may represent important features of the population dynamics, like its stability and ecosystem health.
Revealing mechanisms of PL properties at high and low temperature regimes in CdSe/ZnS core/shell quantum dots
Authors: Li Bo , Liu Weilong , Yan Lin , Zhu Xiaojun , Yang Yanqiang , Yang Qingxin
Published: July 2018

Here, we report on the strong temperature dependence of PL properties in CdSe/ZnS core/shell quantum dots, within a broad temperature range of 80–500 K. Our results demonstrate different PL quenching mechanisms in high and low temperature ranges. In the low temperature range of below 320 K, PL quenching is proved to be dominated by thermally activated carrier escape. While in the high temperature range of above 320 K, PL undergoes additional quenching because of surface trapping by the thermally created surface defects, which is calculated and proved by the rapidly decreasing PL lifetime. Our calculating result proves that the model of thermally activated carrier escape is also responsible for PL quenching in the high temperature range. However, the red-shifted PL peak energy and the broadened FWHM with increasing temperature follow the same mechanisms in the whole temperature range. The former is due to the temperature-dependent band-gap shrinkage and the latter is due to the exciton scattering with acoustic and longitudinal-optical phonons.
A parameter to probe microdroplet dynamics and crystal nucleation
Authors: Grossier R. , Tishkova V. , Morin R. , Veesler S.
Published: July 2018

We present a simple and efficient digital-image processing method to simultaneously monitor the contraction of a statistically relevant number of microdroplets of the same size and the nucleation of single salt crystals inside. Each individual microdroplet image is reduced to a scalar, standard deviation σ of the grey-level of pixels inside a region of interest containing the microdroplet image, and overall microdroplet dynamics is monitored using standard-deviation time-evolution plots. It is shown that this approach makes it possible to measure the nucleation time and also that microdroplets interact via water diffusion dynamics. This effect actually decreases the nucleation rate, contrary to previous findings. This “σ approach” can be compared to recording the order parameter in phase transition, which makes it ideal for studying dynamics of systems where images are the primary outputs.
Transverse structure of the wave function of field emission electron beam determined by intrinsic transverse energy
Authors: Tsujino Soichiro
Published: July 2018

The average transverse energy of field emission electrons at the cathode surface is one of the key factors that determines the virtual source size, hence the transverse spatial coherence of field emitters. In the past, the subject has been intensively studied by classical electron optics analysis but its wave optical studies are rare. In this work, we therefore aim to elucidate the influence of the transverse momentum in solid on the transverse structure of the wave function of field emission electrons. From the calculation extending the standard field emission theory within the WKB approximation for model planar free-electron metal, we obtained a Gaussian-beam-type wave function that exhibits a minimum transverse width at the cathode surface as determined by the average transverse energy and propagates the first few nanometers with a limited transverse spread. At far field, the wave function spreads as the electron propagates away from the cathode surface. Comparison with classical results indicated that, in the present planar field emitter model, the neglect of the three-dimensional potential around the tip apexes of actual field emitters underestimates the transverse spread up to a factor of 2. However, when the cathode size is finite and the electrons in the solid are phase-coherent within the source area, the transverse spread is much smaller than that of the point-source wave function. Our result indicates that the intrinsic transverse emittance of a finite size fully coherent field emitter is much smaller than the value predicted by classical analysis.
Multi-scale analysis of strain-dependent magnetocrystalline anisotropy and strain-induced Villari and Nagaoka-Honda effects in a two-dimensional ferromagnetic chromium tri-iodide monolayer
Authors: Liu Jie , Mo Pinghui , Shi Mengchao , Gao Dan , Lu Jiwu
Published: July 2018

This paper analyzes the magnetic properties of the emerging ferromagnetic chromium tri-iodide (CrI3) monolayer, under compressive and tensile biaxial strains. By combining first-principles density functional theory and Metropolis Monte Carlo methods, the multi-scale simulations are used to quantitatively analyze the strain-dependent magnetocrystalline anisotropy energy, Heisenberg isotropic symmetric exchange effects, anisotropic symmetric exchange effects, magnetic moment, and Curie temperature (Tc). The Villari effect (or the inverse magnetostrictive effect) and the Nagaoka-Honda effect (or the inverse Barret effect) are unraveled. It is shown that a small strain (e.g., smaller than 1%) could change Tc by only less than 1 K. By contrast, a small strain can noticeably influence the hysteresis curve shape and significantly alter the coercive magnetic field (Bc), which offers one of the possible explanations of the large variation of Bc as measured on the strain-prone exfoliated CrI3 monolayers. This also indicates the importance to vanish strain to ensure small device-to-device variation of magnetic properties in the monolayer-based spintronics memory and logic devices. It is revealed that strain can induce changes on a series of key magnetic properties (e.g., the strain-induced magnetization direction flip, the strain-induced ferromagnetic/antiferromagnetic transition, the strain-induced change of magnetic coercivity, etc.), which might be useful to enable monolayer-based sensor applications.
Investigating periodic nanoparticle arrays with k-space optical microscopy
Authors: Kim Meeri
Published: July 2018

A new study provides a detailed description of k-space optical microscopy using different illumination conditions and describes how the technique’s artifacts may be exploited.
An applied electrostatic field changed grain boundary structures in a ceramic
Authors: Leahy Rhys
Published: July 2018

By forming ceramic bicrystals, researchers eliminated other parameters to show how an applied electrostatic field changed grain boundary core structures in SrTiO3.