bluuebunny/crossref_metadata_2025 huggingface dataset:
Is It Possible To Increase The Effectiveness Of Heparin In Acute Thromboembolism?
Authors: Fontáyi S
Published: July 2018

The purpose of this study is to call attention to the possibility to increase the effectiveness of Heparin basing on our 25 years experience in the treatment of acute thromboembolism.

Our method developed gradually. First the only aim was to achieve limb salvage by preventing apposition of the thrombi and keeping the patency of segment below the occlusion. After unexpected and surprising recanalizations (tested by pedal pulses) in some cases, the aim to achieve recanalization has been endeavoured consciously. Technique: prolonged local massive intermittent Heparin dosage supported by simultaneous local Acetylcholine. Dosage: directed individually by daily clotting time control (Lee-White).

Material: 1955-79. 232 arterial embolism, 114 thrombosis (112 underwent embolectomy or thrombectomy) and 44 deep phlebothrombosis.

Results: according to some comparative studies on Heparin versus fibrinolytic treatment 2,5-23% of clearance (recanalization) of thrombosed veins has been achieved by Heparin with conventional intravenous doses. In our arterial material 33% recanalization and 46%b limb salvage represents the success. In deep phlebothrombosis only 4 cases showed mild postphlebitic symptoms at follow up.

Conclusions: To explain the increased effectiveness of Heparin the following factors have been taken into consideration: 1. synergistic pharmacological and 2. hemodynamic effects of Heparin and Acetylcholine, 3. pathological factor (solubility of fresh thrombi), clinical factors: advantages of 4. local and 5. intermittent (stoss) dosage, 6. keeping the principles of urgency, 7. economical factors (cheap, simple labor-control).
Extent Of Metabolic Changes During Ischemia
Authors: Schröer R , Nüdemberg F , Rudolphi K
Published: July 2018

Ischemic conditions in limbs can be provoked by occlusion with inflatable cuffs. The period of development of ischemia to an extent where muscle exercise is no longer possible is drastically shortened by muscle exercise itself. Blood obtained by venepuncture of the forearm under these conditions showed no differences in pH, PO2. pCO2 , and lactate and glucose levels in comparison with the blood taken before occlusion A special technique of blood sampling under low flow flushing conditions was developed, by which blood reflecting the ischemic state is obtained nearly without dilution from the cubital vein. This is demonstrated by measurements of pH, pO2 , pCO2, lactate concentration and osmolarity, which, under the latter conditions, revealed changes of about 0.3 pH units, 20 mm Hg, 80 mm Hg, 90 mg/dl, and 30 mosm/1 respectively. The extent of local changes of these parameters in the microcirculation of muscle tissue in the state of ischemic pain is suggested to be of the same order of magnitude.
Hypercoagulability In Diabetes And Its Correction By An Antiplatlet Drug: Piracetam
Authors: Bick R L , Skondia V , Fritch D
Published: July 2018

Vascular changes lead to significant complications in diabetes and are associated with neurological, renal, and visual impairment. It has been suggested that antiplatelet agents may reverse progression of retinopathy in diabetes. Piracetam, a new antiplatelet agent, was evaluated in 10 diabetics with severe retinopathy; the agent was taken orally as 2.4 gm QID. Response was assessed by clinical evaluation, platelet survival studies, platelet factor-4 (PF-4) levels, visual acuity, and fluorescein angiography. These studies were obtained before Piracetam, at six weeks, and three months. Pre-Piracetam, 9 of 10 patients had abnormal platelet survival and all showed correction within 6 weeks; all 10 patients had elevated PF-4 levels pre-Piracetam and in all 10 these levels dropped while taking Piracetam. Angiographic evaluation revealed deterioration in 1 patient and no deterioration in 9 patients over a 3 month period. Five patients related definite and significant improvement in vision and 5 patients noted no change. Visual acuity remained stable in 5 patients and deteriorated in 5 patients; however, there was marked disparity between objective findings of acuity and angiography and subjective visual reports by the individual patients. From these results, it is concluded that Piracetam corrects hypercoagulable laboratory findings in patients with diabetes; since the vascular complications of this disease are thought to be secondary to hypercoagulability and increased fibrin deposition in the microcirculation, this non-toxic oral drug may prove useful for the prophylaxis of progressive vascular changes in diabetic patients. In support of this conclusion is the noting of significant subjective visual improvement in 50% and absence of angiographic deterioration in 90% of diabetic patients taking this drug for a three month period.
Effects Of Aspirin (ASA) And Sulfinpyrazone (SPZ) On The Coagulopathy Of Diabetic Nephropathy (DN)
Authors: Mariscal I , Fernandez de Castro J
Published: July 2018

In diabetics, changes in the vessel wall and platelet hyperaggre- gability are well documented. Fg/Fn deposits in the glomeruli among other changes as well as cDIC have been described in DN. Based on these data this study was planned to explore the role of platelets in the coagolopathy of DN.

Eighteen patients with DN characterized by mild to severe urea retention, significant proteinuria and creatinine clearance of 67 ml/min or less participated in a study which was prospective,dou ble blind, random in distribution and subject to the patient's own control. ASA 1.0 gm or SPZ 600 mgs or placebo 3 pills/day was used. Coagulation and fibrinolysis tests were done regularly. ASA shortened thrombin time (Biggs) from 22.0 to 19.3 sec *, - raised plasminogen (Mancinni-M Partigen Plasminogen) from 12 to 13 mgs P=NS and decreased FDP (Merskey) in serum from 56 to 32 Ug ** and in urine from 2.8 to 1.0 Ug **. SPZ raised plasminogen from 12 to 13 mgs **.Both ASA and SPZ decreased fibrinogen (Ingram) P=NS and produce no change on PT (Quick), PTT (Proctor) and platelet count (Bratcher & Cronkite). SPZ changes were interesting but barely significant up to now. The changes induced by ASA are suggestive that cDIC was inhibited. Since ASA has no direct effect on the modified parameters, it can be considered that the action was due to ASA antiplatelet activity.

We can propose that platelets play an important role in maintaining the coagulopathy of DN and possibly in initiating it.
The Effects Of Chemical Alterations Of The Benzoic Acid Nucleus On Platelet Function And Prostacyclin Activity In The Arterial Wall
Authors: Killackey B A , Killackey J J , Philp R B
Published: July 2018

The effects of a series of benzoic acid derivatives (ASA analogs) on prostacyclin (PGI2) synthesis by rabbit aorta rings and on human platelet function were examined to determine if antiplatelet activity could be separated from anti-PGI2 activity.

Rings of rabbit aorta were incubated with or without drugs in Tris 0.05 M, pH 7.5 for 6 m at room temperature (R.T.). Supernatant was then transferred to platelet-rich plasma incubated at 37°C for 3 m. ADP was added 60 s later and aggregation was measured and compared to controls. Rings were also incubated with 14C-arachidonic acid (14C-AA) for 60 m at R.T. in Tris with or without drugs. Products were extracted and measured by radio-T.L.C. along with known standards. Platelet aggregation and release of ATP were measured using a ChronoLog Lumi aggregometer. The effects of these agents on PGI2 activity were similar to their effects on platelet aggregation. ASA however did not exhibit the marked inhibitory potency that it had on the second phase of platelet aggregation and ATP release. Changing the 2-acetoxy group of A.S.A. to a 2-acetyl or 3-propionyloxy resulted in a loss of inhibitory activity in both systems. 2-Propionyloxy substitution resulted in a similar spectrum of activity to ASA. The effects of these agents on the metabolism of 14C-AA by rabbit aorta rings generally confirmed the bioassay results although some of the agents had novel effects on blood vessel arachidonic acid metabolism.

Despite potential species differences, this study demonstrates an inability to separate antiplatelet and anti-PGI2 effects with this series of benzoic acid derivatives. Further study of the effects of these agents on the metabolism of 14C-AA by rings of rabbit aorta may lead to a better understanding of PGI2 formation.
Effect Of Ibuprofen Combined With Prostacyclin On Platelet And Leukocyte Counts Following Acid Aspiration Injury
Authors: Shepro D , Utsunomiya T , Krausz M M , Hechtman H B
Published: July 2018

Thrombogenesis and certain aspects of inflammation are mediated by products of the arachidonic acid enzymatic cascade, such as prostacyclin (PGI2) and thromboxane A2 (TxA2). A ratio of these mediators has been theorized to be significant for modulating platelet and leukocyte activity. It has also been suggested that endothelial cell disruption or dysfunction will alter the titers of PGI2 and TxA2- Acid aspiration in dogs results in respiratory failure with a concomitant entrapment of platelets and leukocytosis. In this study the cyclo-oxygenase inhibitor ibuprofen andPd2, separately or together, were given IV to dogs after endotracheal instillation of 3.0 ml, 0.1 N HCl, and the effects on platelet and leukocyte (WBC) counts over a period of 4 h were quantitated. At 0.5 h platelet counts fell ∼25% to 160,800/mm3 (p < 0.05) and continued to fall (∼30% loss) over the course of 4 h. WBC counts increased gradually from ∼5,700/mm3 to ∼14,000/mm3 during the 4 h of observation Cp < 0.025). An infusion of PGI2 (100 ng/kg-mirrl; n=6) or an IV bolus of ibuprofen (12 mg/kg; n=6) given 1 h post-aspiration had no effect on either platelet or WBC counts in aspirated animals when compared with untreated controls. Six dogs received, 1 h post-aspiration, ibuprofen (12 mg/kg) in an IV bolus combined with a low dose of PGI2 (10 ng/kg-mirrl) infused IV for 1 h. In this experimental group platelet counts returned to baseline values and WBC counts remained above control values. Ibuprofen combined with PGI2 also was an effective therapy for the aspiration pneumonia, which also suggests that thromboxanes and prostaglandin secretions in some yet to be explained manner mediate platelet and/or leukocyte secretions which enhance lung injury.
Platelet Function During One Week Continuous Intra-Arterial PGI2-Infusion In Peripheral Vascular Disease
Authors: Silberbauer K , Sinzinger H , Gall Andrea
Published: July 2018

In 12 patients with peripheral vascular disease (Fontaine, stage II-IV), PGI2 (3-5ng/kg/min) was given intra-arterially continuously during 7 days. Besides angiological and hormonal control, the platelet behaviour was monitored by ADP- induced platelet aggregation (1μM), platelet sensitivity to PGI2, the platelet proteins β-TG and PF4, thromboxane B2 (RIA) and platelet count before, during and up to one week after termination of PGl2-infusion. In some patients platelet life span was performed by autologous 111 In-oxine labelled platelets prior and during PGl2-infusion. Immediately after beginning of PGI2-infusion, in general, a significant decrease in platelet activity can be detected. The response to ADP is diminished, as well as BTG and PF4. Between 24 and 48 hours after starting the PGI2-infusion, the levels reach again the starting level, followed thereafter by a significant increase in most of the patients. An increase in platelet count (in one patient to the fourfold) , a decrease in platelet sensitivity to PGI2 (≤50%) and a hyper-reactivity of the platelets to the in vitro ADP- stimulus is found. After termination of PGI2-treatment, the levels are returning back to normal within 48 hours, A trend to a prolonged platelet life span after PGI2-infusion is noted. Beside the clinical data, the prolonged platelet survival suggests a beneficial effect of the intra-arterial PGI2-application. The possible causes and risks of the temporary platelet activation during thePGI2-infusion are discussed.
Enhanced Platelet Thromboxane Synthesis In Normotensive And Hypertensive Pregnancies With Insufficient Fetal Growth
Authors: Wallenburg H C S , Rotmans P
Published: July 2018

In normal pregnancy platelet aggregation and blood flow in the uterine arteries could be modulated by the balance between the prostacyclin-generating system in the uterine arterial walls and the thromboxane-generating system in platelets. Since hypertensive pregnancies and pregnancies complicated by insufficient fetal growth are characterized
by a diminished uteroplacental blood flow,the present study was performed to investigate platelet thromboxane synthesis in these conditions.

Material and methods. The study was performed in a control group of 27 women with uncomplicated pregnancies and adequate-for-gestational age (AGA)infants(group I),23 women with uncomplicated pregnancies but small-for-gestational age(SGA) infants(group II); 18 women with pregnancy-induced hypertension (PIH) and AGA-infants(group III); 16 women
with PIH and SGA infants(group V).All women were investigated in the last trimester of pregnancy. Venous blood was obtained in EDTA. Platelet aggregation was induced with thrombin( l I.U./ml final concentration)in platelet-rich plasma, and the amount of malondehyde(MDA)generated was measured spectrophotometrically after reaction with thiobarbituric acid. The amount of MDA is equivalent to that of HHT and a measure of the formation of thromboxane.

Results. The amount of MDA (mmol/109 platelets ± S.D.)formed in group I was 5.35±0.8, in group II 6.32± 1.4,in group III 6.3 ± 1.5, and in group IV 6.4 ± 1.8. Groups II, III and IV were not different from each other, but were all significantly higher than group I(p < 0.01).

Conclusion. The results indicate that pregnant women with a high incidence of a compromised uterine circulation-normotensive with SGA, hypertensive with AGA or SGA- as a group exhibit a more active platelet thromboxane-synthesis. This might be due to defective production of PGI2 by the uterine arterial wall.
Thrombocytopaenia, Thromboxane And Prostacyclin Production During The Forssman Reaction In The Guinea-Pig: Effect Of A Thromboxane Synthetase Inhibitor
Authors: Westwick J , Butler K , Honey A , Krishnamurthi S , Kakkar V V
Published: July 2018

Intra venous (iv) injection of Forssman antibody into the guinea-pig (GP) is known to result in a rapid antigen antibody reaction in the lungs leading to bronchospasm and thrombocytopaenia. Death as a result of Forssman shock has been shown to be complement and platelet dependent

Groups of 5 Duncan-Hartley GP (350-400g) received either 0.2ml (sub lethal groups) or 0.6ml (lethal groups) of rabbit anti Forssman antiserum (RAFA) iv, then 5ml blood samples were collected via carotid artery cannula, into 0.5ml ice cold EDTA (lOOmM) and indomethacin (180μM) mixture at 0, 1, 3 and 5 min. post injection. The blood samples were rapidly centrifuged at 15,000g for 3 min, plasma removed and frozen at -20°C until assayed. The plasma was then assayed for TxB2 and 6-oxo-PGF1α using specific RIA’s. There was a marked TxB2 production during the thrombocytopaenia with a concomitant small increase in 6-oxo-PGF1α production.

However, when groups of 5 GPs were dosed iv with 0, 1, 3 or 10 mg/kg of UK-37, 248, a potent and selective thromboxane synthetase inhibitor, 3 mins prior to 0.2ml of RAFA the resulting thrombocytopaenia was not inhibited at 0, 0.5, 1, 2, 5, 10 and 15 min post RAFA. Thus thromboxane production does not appear to be contributory to the Forssman induced thrombocytopaenia in the GP.
Ethnic Differences In Blood Coagulation During Pregnancy
Authors: Goncalves M T Reboucas , Coutinho E , Thomson Jean M , Coutinho E , Poller L
Published: July 2018

A comparison has been performed of blood coagulation and fibrinolytic changes during the third trimester of pregnancy in a group of white Caucasian women in Manchester, UK, with a matched group of non-white women in Salvador, Brazil. The same standardised reagents and methods were used for all tests at both centres. Results show some highly significant differences between the two populations. Fibrinogen and factor VII levels were significantly higher and fibrinolytic activity was significantly lower in the Manchester women. These findings may provide a basis for the clinical impression that haemorrhage at delivery is relatively common in Salvador whereas post partum thrombosis is extremely rare.
Influence Of Noise On Blood Coagulation
Authors: Chohan I S , Singh I , Rai R M
Published: July 2018

Subtle evidence exists that exposure to higher level of noise.beyond a critical normal limit of 85 decibels(db),leads to development of systemic hypertension,abnormal ECG changes, and impaired function of cardiac muscle in man. Its effects on blood coagulation are not known.

A study Y’as conducted in albino female rats, 56 months old,which were exposed to a continuous noise of 110 db,for 2 hr daily,5 days a week,over a period of 3 weeks. Pour grouus,each of 8 rats, were studied. The unexposed animals acted as controls. The desired level of noise vas generated by masking system of an audiometer. Bleeding time (ET),plasma fibrinogen levels, and the activated Dartial thromboplastin time(APTT) were estimated before and after the noise exposure. Compared with controls,the noise exposure resulted in significantly orolonged BT(from 56.9 ± 5.2 to 79.9 ± 11.8 sec), higher plasma fibrinogen levels(from 116.7 ± 6.5 to 177.5 ± 6.9 mg/dl),and progressively shorter APTT(from 15.6 ± 1.01 to 13.9 .± 1.08 sec) in the test animals at the end of three weeks.

These changes are suggestive of coagulopathy induced by the noise stress. These adverse changes in blood coagulation,if confirmed in man, may predispose him to heart diseases. Those suffering from myocardial infarction and hypertension do overreact to adverse audiogenic stimuli by a rise in cortico-adrenal activity,plasma cholesterol, and 17-HOCS levels. This study indicates the need for an enquiry in the coagulation mechanism in humans exposed to varied degree of noise. Noise, therefore,poses a grave threat to environmental health.
Haemorrhagic Disorders Following Liver Cell Necrosis. Pathogenetic Investigations In Pigs
Authors: Fritsche H M , Sommoggy St V , Stemberger A , Fischer M , Blümel G
Published: July 2018

It is well known that acute hepatic failure due to liver cell necrosis is frequently complicated by severe haemorrhagic disorders.

In order to establish a therapeutic concept we have studied the pathogenetic mechanism of the clotting changes in a reproducible animal model. Pigs were exposed to complete liver ischemia for 180 min resulting in liver cell necrosis. Before, during and after temporary liver ischemia clotting changes were investigated by global and specific tests up to 48 hours after the ischemic lesion. The concentration of the coagulation factors I, II, X (measured with chromogenic substrates), V and VII (measured with deficient plasma) decreased significantly after the liver ischemia. The disappearing rate of factors with short and long half life time was nearly identical. Simultaneously fibrinogen-fibrin degradation-products and thrombocytopenia and pathy were observed. Besides this the plasmatic inhibitors antithrom III (AT III) and antiplasmin as well as plasminogen (measured with chromogenic substrates) decreased markedly showing minimum values 24 hours after the ischemic lesion. However, an increase in endogenous heparin liberation was not detecte.
Experimental Investigations On The Haemorrhagic Disorders In
Combined Injury Of Irradiation And Traumatic Lesion
Authors: Fritsche H M , Wustrow Th , Messerschmid O , Blümel G
Published: July 2018

The significance of combined injury of whole-body irradiation and traumatic lesion on hemostasis has become interesting since severe bleeding tendency has been reported in people involved in radiation accidents. The present investigations were made in an attempt to characterize the haemorrhagic disorders following combined injury in comparison with the coagulation defect induced by irradiation or traumatic lesion exclusively.

45 rabbits of both sexes were divided into five groups. Animals were sham irradiated,inflicted with an autologous hematoma as a trauma,whole-body irradiated with 500 R X-rays or inflicted with a combination of irradiation and autologous hematoma or skin- wound. Already 24 hours after irradiation a highly significant prolongation of the activated partial thromboplastin time has been observed. The concentration of factor X and fibrinogen increased in all irradiated animals 24 hours after irradiation. Following the combined injury of irradiation and skin-wound,such increases were significantly higher than those after irradiation exclusively .The activities of antithrombin III and antiplasmin, measured with chromogenic substrates,increased after irradiation as well as after combined injuries. In addition platelet adhesiveness and aggregability measured with the collagen-induced platelet aggregation test according to BORN and the platelet adhesion test according to MORRIS increased rapidly 24 hours after combined injuries followed by a significant decrease of platelet count. Inspite of the increased levels of fibrinogen and factor X we could register a hypocoagulability with a significant increase of plasmatic protease inhibitors and an insufficiency of platelet coagulation system after combined injuries. These findings are under consideration in radiotherapy of operated patients,in radiation burn or other radiation damages combined by traumatic lesions.
Anticoagulants Produced by Thrombin from Fibrin, the Effect on Blood Coagulation, Some Physical Characteristics
Authors: Muirhead Ch R. , Triantaphyllopoulos D. C
Published: July 2018

Chromatographed thrombin in the presence of both 50 Kallikrein inhibitor units of Trasylol per ml and 0.1 M E-ACA solubilized fibrin and the products of lysis possessed anticoagulant properties. The peak of the antithrombic activity coincided with the time of complete lysis of the fibrin clot, plasmin lysed fibrin exhibited the peak of its antithrombic activity much earlier. The effect of thrombin lysed fibrin on the prothrombin consumption of shed blood was found to be inhibitory.

The products of the digestion of fibrin by thrombin and by plasmin, isolated at an advanced stage of proteolysis were compared by gel filtration, disc electrophoresis and DEAE cellulose chromatography. Differences in physical characteristics of these fibrin breakdown products offer evidence that they were produced by two different enzymes.
Effects of a Variety of Endotoxins on Human and Rabbit Platelet Function
Authors: Nagayama M , Zucker M. B , Beller F. K
Published: July 2018

Endotoxin from Salmonella typhosa or enteritidis, Escherichia coli, or Serratia marcescens caused platelet aggregation, release of platelet-bound 14C-serotonin and development of platelet factor 3 activity when shaken at 37 °C with heparinized platelet-rich plasma (10 units/ml) from rabbits. The relative activity in each test differed for each agent. Endotoxoid only released 14C-serotonin. With human platelet-rich plasma, Salmonella typhosa, E. coli or Serratia marcescens endotoxin failed to induce aggregation or platelet factor 3 activity but caused slow release of platelet-bound 14C-serotonin. Earlier studies showed that endotoxemia in man or endotoxoid injection in rabbits was associated with thrombocytopenia without shock or disseminated intravascular coagulation. This effect appears to correlate with release of 14C-serotonin from platelets in vitro.
Inhibition of Fibrinolysis in Post-Traumatic Death
Authors: Rammer L , Saldeen T
Published: July 2018

The fibrinolytic system was studied in a number of autopsy cases. It was found that in contrast to most of the other autopsy cases those persons who had died later than 1 day after trauma, especially cases of fat embolism, often showed inhibition of fibrinolysis combined with the presence of intravascular fibrin in the pulmonary vessels. The importance of this observation for the pathogenesis and diagnosis of the fat embolism syndrome is discussed.
Further Studies on the Effect of Dextran of Various Molecular Weight on the Coagulation Mechanism
Authors: Nilsson Inga Marie , Eiken Oddvar
Published: July 2018

Dextran fractions of different molecular weights were given to dogs in order to ascertain at which molecular weight dextran interferes with the coagulation factors.

1. Infusions of dextran with an average molecular weight of 130,000 (Intradex®) and in doses of 1.5 g dextran per kg body weight induced a moderate coagulation defect. There was a slight prolongation of the bleeding time and a slight drop in platelet count. Values for AHF, factor V, prothrombin and factor VII, and fibrinogen declined by 10 to 40% of the original values.

2. Infusions of dextran with an average molecular weight of 75,000 (Macrodex®) in doses of 1.5 g per kg body weight did not produce any significant changes in bleeding time and platelet count. The AHF level decreased by 40% and the levels of prothrombin and factor VII, factor V and fibrinogen by about 10% of the original values. In a dose of 2 g per kg body weight this fraction produced a significant coagulation defect with a fall of the various coagulation factors by about 40 to 50%.

3. A dextran fraction with an average molecular weight of 60,000 in doses of 1.5 g per kg body weight did not prolong the bleeding time and caused only a very slight decrease in platelet count. There were no changes in the values for AHF, factor V, prothrombin and factor VII but a slight drop occurred in the fibrinogen levels.

4. Dextran with an average molecualr weight of 40,000 (Rheomacrodex ® ) in doses of 1.5 g per kg body weight did not affect the bleeding time or the platelet count. Nor did any significant decline occur in the amounts of the other coagulation factors.

No changes in the Duke or in the Ivy bleeding times were observed in human beings given Macrodex® and Rheomacrodex® in doses of 1 g per kg body weight.

Intradex® and Macrodex® in doses of up to 1-1.5 g per kg bodyweight to persons with normal blood coagulation are considered not associated with any appreciable risk of haemorrhage, but they are contraindicated in patients with haemorrhagic diathesis. The experiments indicate that Rheomacrodex® in similar doses does not incur any risk of haemorrhage.
A Study in Viscosity and Clotting of Blood in Haemophiliacs*
Authors: Dintenfass L , Castaldi P
Published: July 2018

Viscosity and clotting of blood were studied an a series of eight haemophilic (Factor VIII deficiency) patients. A cone-in-cone rotational viscometer was employed. Viscosity was determined over a range of rates of shear (0.04- 100 sec-1). Blood was found to be thixotropic, but great variations were observed between the individual cases. The extreme difference in viscosity between the severe and the mild haemophiliacs was 20-fold.

A tendency was observed for the clotting time to decrease with an increase in the velocity gradient. Clotting time was found also to decrease with an increase in temperature if determined at high rates of shear.
Investigations on Adenosine Diphosphate (ADP) Induced Platelet Adhesiveness in Vitro* Part II. Studies on the Mechanism
Authors: Skålhegg B. A , Hellem A. J , Ödegaard A. E
Published: July 2018

An attempt to clarify the ADP platelet reaction has been done by investigating the effect of substances which inhibit the reaction in vitro. The inhibitors used may be divided into two groups. Monoiodo acetic acid, molecular iodine, para-chloro mercuribenzoic acid and potassium ferricyanid lead to noncompetitive inhibition. Substances containing free -SH groups and adenine conjugates show competitive inhibition.

The primary bleeding time is prolonged when wounds are flushed with solutions of these compounds.

It is shown that adenosine tetraphosphate aggregates platelets in the same manner as ADP.

Based upon these observations an attempt is made to explain some of the steps involved in the ADP platelet reaction.
Turnover and Distribution of 131Iodine-Labelled Human Fibrinogen
Authors: Amris Annemarie , Amris C. J
Published: July 2018

14 patients (5 diabetics with arteriosclerotic complications, 4 patients with thrombo-embolic disease, 4 with cirrhosis, coagulation defects and increased fibrinolytic activity, and 1 cancer patient) and 3 control patients were subjected to turnover studies with 13iodine labelled human fibrinogen.

Half-life times in the control patients were found to be 4 days, the fractional turnover rates 19–23 per cent, of intravascular fibrinogen per day, and the absolute turnover 0.02 to 0.06 gm per day per kg. body weight. The other patient’s half-life times and turnover rates varied considerably from 0.9–5.5 days, 13–160 per cent, per day of intravascular fibrinogen and 0.02–0.4 gm per day per kg. body weight respectively.

As fibrinogen unlike other proteins subjected to turnover studies, is converted to fibrin, it is not possible to measure the true intra-extravascular distribution ratio of fibrinogen. But intravascular fibrinogen could be approximated to constitute 68–99 per cent, of the total fibrinogen. There is justification in believing that fibrinogen is degradated through a continuous coagulation in equilibrium with fibrinolysis, and that the organism contains a greater mass of fibrin, the “fibrin pool”. Considerations of the turnover mechanism can however only be hypothetical.
A Study of the Cation-and pH-Dependent Stability of Factors V and VIII in Plasma*
Authors: Weiss HJ
Published: July 2018

The in vitro lability of factors V and VIII in plasma has been studied. In agreement with previous reports, an increase in anticoagulant concentration renders both factors more labile (cation-deficient decay), as does an increase in the pH above 7.3 (alkaline-decay). Calcium appears to be the plasma cation which protects factors V and VIII against in vitro loss of activity. The protection obtained by the addition of other divalent cations depended on the type of plasma used. When resin-EDTA plasma was made cation free by dialysis at 4° C and then incubated at 37° C, the rapid loss of factors V and VIII activity could be prevented by prior addition of strontium, manganese and magnesium. In oxalate plasma, nickel, manganese, cadmium and strontium were effective.

The alkaline decay of both factors V and VIII is irreversible. Partial reversibility of the cation-deficient decay was demonstrated for factor V, but not for factor VIII. The temperature coefficient for both the cation-deficient and alkaline decay is 2-3, suggesting an enzymatic rather than a physical reaction.

There was no evidence to implicate thrombin, plasmin or trypsin since inhibitors of these enzymes failed to modify either type of decay.
Edude d’un Cas avec Déficit Congénital en Facteur XIII (FSF)
Authors: Tsevrenis H , Mandalaki T , Chouliaras Ch , Tzimas S
Published: July 2018

Les auteurs rapportent un cas nouveau de syndrome hémorragique congénital lié à un déficit en facteur XIII (F S F) le premier observé en Grèce.
The Conversion of Prothrombin in the Intrinsic System*
Authors: Müller G. H
Published: July 2018

A method is described for formation and partial isolation of intrinsic activator (I.A.). The term intrinsic activator of prothrombin conversion is used instead of blood thromboplastin to avoid ambiguity.

The reaction of a purified prothrombin, I.A. and calcium in the thrombin formation is studied in different experiments. The following results are given as conclusion :

A determinated amount of calcium is necessary for the full activity of the intrinsic activator. Calcium is probably fixed to the I.A. A too high concentration of calcium produces inhibition.

The I.A. behaves as an enzyme in prothrombin conversion, prothrombin as a substrate.
Effects of Staphylococcal Enterotoxin B on the Coagulation Mechanism and Leukocytic Response in Beagle Dogs – A Preliminary Study
Authors: Gilbert Ch. F
Published: July 2018

Ten beagle dogs were given highly purified staphylococcal enterotoxin B intravenously and were observed and bled at intervals during a 55-day-period. Pre- and postchallenge determinations of the whole blood clotting time, clot retraction, clot lysis, total white and differential cell count, prothrombin time, and partial thromboplastin time were performed on each sample. An abnormality was indicated by each test at some point during the testing period with the exception of clot lysis. The most frequent and more severe abnormalities occurred within the first four days after challenge. The results indicate that alterations of the clotting mechanism do occur after administration of staphylococcal enterotoxin and suggests that the plasma factors are primarily involved. Changes in the leukocytic response appear to be similar to those sometimes observed in a severe bacterial infection.
Radioablación por laparoscopia de masas renales pequeñas en pacientes octogenarios: técnica paso a paso
Authors: Delgado Natalia , Forero Jorge , Varela Rodolfo , Cabrera F Marino
Published: July 2018

Introducción La cirugía preservadora de nefronas sigue siendo el gold standard de manejo en pacientes con tumores renales pequeños. La ablación por radiofrecuencia es una alternativa mínimamente invasiva con evidencia sustancial en efectividad en la erradicación tumoral completa.

Objetivo Reportar el caso y la técnica paso a paso de la radioablación laparoscópica de un tumor renal en un centro de oncología de III nivel de Bogotá - Colombia.

Materiales y Métodos Revisión de la historia clínica de un paciente con hallazgo incidental de una masa renal pequeña sometido a radioablación laparoscópica en un centro de oncología de III nivel de Bogotá.

Conclusión La ablación por radiofrecuencia es una alternativa válida para el tratamiento de tumores renales pequeños, especialmente en adultos mayores y con alto riesgo quirúrgico, ofreciendo tasas de supervivencia libre de enfermedad comparables con la nefrectomía parcial.
Factores de riesgo de estenosis de cuello vesical asociada a prostatectomía radical por carcinoma prostático – experiencia en un único centro
Authors: Sánchez-Rodríguez Carlos , González-Valverde Francisco Miguel
Published: July 2018

Objetivo La estenosis de la anastomosis uretrovesical (EAU-V) afecta al 8,4% de pacientes intervenidos de prostatectomía radical retropúbica por cáncer. Nuestro propósito fue estudiar los factores de riesgo de estenosis de cuello vesical asociada a prostatectomía radical por carcinoma prostático en nuestro centro.

Material y Métodos Estudio de casos-controles en una cohorte constituida por 120 pacientes intervenidos por adenocarcinoma prostático entre 2005 y 2012. Realizamos un análisis descriptivo de la muestra y el cálculo de la incidencia de EAU-V, un análisis univariante de los factores asociados mediante la t de Student y la chi cuadrado de Pearson, un análisis del tiempo transcurrido hasta la aparición de estenosis y una predicción del riesgo de EAU-V.

Resultados La incidencia de EAU-V tras prostatectomía radical en nuestro servicio fue del 22,5%. Encontramos mayor riesgo en aquellos pacientes con débito por drenaje Jackson-Pratt (J-P) mayor de 500cc, drenaje J-P retirado después del tercer día, estancia superior a 8 días, hemoglobina postoperatoria baja, PSA preoperatorio bajo, densidad de PSA elevada o que fueron intervenidos por el cirujano 1 o 5. Todas las estenosis se produjeron en los 3 primeros años tras la cirugía. Los pacientes con un débito del drenaje por encima de 500cc y en los que el drenaje se retiró después del tercer día tienen 7,7 y 3,2 veces, respectivamente, más riesgo de padecer una EAU-V.

Conclusiones Nuestra incidencia de EAU-V y sus factores asociados coinciden con los publicados. El modelo predictivo desarrollado tiene utilidad meramente teórica ya que no abarca la totalidad de los factores que pueden influir en la aparición de la estenosis.
Thrombolytische Therapieformen im Kindesalter
Authors: Vielhaber H. , Nowak-Göttl Ulrike , Kehl H. G.
Published: July 2018

Thrombosen und Embolien sind im Kindesalter nicht zu unterschätzen. Typische Ursachen sind zentrale Katheter, Herzkatheteruntersuchungen mit Intervention, größere operative Eingriffe neben primären oder sekundären Mangelzuständen von Gerinnungsinhibitoren. Geschätzt wird eine Inzidenz von etwa 5 auf 10000 hospitalisierte Kinder mit einer Mortalität von 2%, einer Rezidivrate von 7-18% sowie der Entwicklung postthrombotischer Syndrome in 20% der Fälle. Die Erfahrungen mit thrombolytischen Therapieformen im Kindesalter sind begrenzt. In mehreren Studien gut dokumentiert sind Thrombolysen von akuten Verschlüssen der Femoralarterien nach Herzkatheruntersuchungen: In 10 Studien wurden 147 von 164 (90%) Patienten erfolgreich lysiert, lokale Blutungen traten bei 41 von 164 (25%) auf. Auf kleinere Studien begrenzt sind Therapien von Thrombosen in den Nierenvenen, den zentralvenösen Gefäßen sowie im rechten Atrium. Erfahrungen mit Lysen linksatrialer, linksventrikulärer oder aortaler Thrombosen sowie Lungenembolien im Kindesalter liegen bisher nur in Form von Kasuistiken vor.
Thrombolytische Therapie mit Urokinase bei hämolytisch-urämischem Syndrom
Authors: Löffler G. , Seyfert U. T. , Limbach H.-G.
Published: July 2018

Vier Kleinkinder im Alter zwischen 1 7 Monaten und 3½ Jahren wurden unmittel-bar nach Sicherung der Diagnose eines post-gastroenteritischen hämolytischurämischen Syndromes fibrinolytisch mit niedrig dosierter Urokinase (Dauerinfusion von 1000 E/kg/h) und antikoagulatorisch mit Heparin (15-25 E/kg/h) be-handelt. Bei Kreatininwerten von 3,0 bis 5,9 mg/dl und Harnstoffkonzentrationen von 179 bis 269 mg/dl war in allen 4 Fällen noch eine Restdiurese vorhanden, die unter kontinuierlicher Furosemid-Infusion in Verbindung mit der Lysetherapie innerhalb weniger Stunden in eine Polyurie überging. Die Dauer der Lysetherapie betrug im Mittel 88 Stunden (64-108 h). Die Parameter der Hämolyse und der Nierenfunktion konnten in allen Fällen ohne Dialyseverfahren und Plasmapheresen normalisiert werden. In zwei Fällen entwickelte sich bei normaler Nierenfunktion ein behandlungsbedürftiger Hypertonus.
Fibrinolytische Behandlung zweier Säuglinge mit fulminanter Meningokokkensepsis
Authors: Muntean W. , Gallistl S. , Zenz W.
Published: July 2018

Die fulminante Meningokokkensepsis ist eine hochletale Erkrankung mit einem schwersten septischen Schock und progredienten dermalen Thrombosen mit histologisch nachweisbaren disseminierten intravasalen Mikrothromben. Bereits vor 20 Jahren wurde unter der Vorstellung einer Verbesserung der Organdurchblutung durch eine fibrinolytische Behandlung Streptokinase verwendet. Im Gegensatz zu Streptokinase entspricht der rekombinante Gewebe-Plasmino-genaktivator (rt-PA) dem physiologischen Aktivator der menschlichen Fibrinolyse und interferiert spezifisch mit dem bei dieser Erkrankung massiv erhöhten Plasminogenaktivator-Inhibitor 1. Weiters induziert rt-PA eine fibrinselektive Fibrinolyse mit nur geringem Fibrinogenabfall und ist wegen seiner kürzeren Halbwertszeit besser zu steuern als Streptokinase. Wir beschreiben den Einsatz von rt-PA bei der erfolgreichen Therapie von zwei Säuglingen mit fulminanter Meningokokkensepsis. Bei beiden Kindern wurde rt-PA als Ultima ratio verwendet, nachdem die »konventionelle« Therapie wirkungslos geblieben war. Wir hatten den klinischen Eindruck, daß die Gabe von rt-PA eng mit dem Wiederauftreten der peripheren Mikrozirkulation und der Durchbrechung des Schocks assoziiert war. Obwohl beide Kinder eine komplexe Behandlung erhielten, glauben wir, daß eine fibrinolytische Therapie mit rt-PA bei lebensbedrohlichen Verläufen einer Meningokokkensepsis eine experimentelle therapeutische Option darstellt.
Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis
Authors: Schepis Filippo , Turco Laura , Bianchini Marcello , Villa Erica
Published: July 2018

Cirrhosis represents the end stage of chronic liver disease and its transition from a compensated to a decompensated status is mainly driven by portal hypertension and systemic inflammation. Although relevant modifications in the evaluation of the coagulative balance in cirrhosis across its natural history have occurred and alterations in routine indices of hemostasis have lost their role as indicators of the hemorrhagic risk of patients with liver cirrhosis, these are still perceived as prone to bleed when admitted to invasive procedures. This view, which is still present in guidelines addressing the management of bleeding risk, makes preprocedural transfusion of plasma and platelets still an ongoing clinical practice. In this review, we describe the limitations of both bleeding risk assessment in cirrhotic patients admitted to radiologic and endoscopic invasive procedures and evaluate whether preventive strategies indicated by current guidelines can affect the procedure-related hemorrhagic events.
Flap Reconstruction of the Abdominal Wall
Authors: Baumann Donald , Roubaud Margaret
Published: July 2018

Due to the abundant and lax tissue of the abdominal wall, most ventral trunk defects are amenable to local soft tissue closure. However, when abdominal defects are accompanied by a lack of soft tissue, the surgeon faces a more complex subset of reconstructions. Three important principles guide the reconstruction of these wounds: timing of closure, careful assessment of the true extent of the wound, and the components of the defect. This article focuses on these three guiding principles and suggests the authors' preferred technique for these difficult defects.
Retromuscular Sublay Technique for Ventral Hernia Repair
Authors: Rhemtulla Irfan , Fischer John
Published: July 2018

Rives and Stoppa described the sublay technique of hernia repair more than half a century ago, but it took almost three decades to become truly appreciated and even longer for its full clinical potential and benefits to be realized. Modifications to the original operation have significantly improved surgical approaches, postsurgical outcomes, and quality of life. The retromuscular approach requires technical expertise and a firm grasp of the anatomy. With constant substitution of the terms sublay, retrorectus, retromuscular, preperitoneal, and Rives-Stoppa throughout the literature, the nuances need to be distinguished to appreciate the surgical planes encountered during the operation. This article explains the origin of the nomenclature while clarifying these terms, describing the technique, highlighting outcomes, and discussing future considerations.
Endoscopic Endonasal Odontoidectomy: Nuances of Neurosurgical Technique
Authors: Romero Flavio , Vieira Rodolfo , Ancheschi Bruno
Published: July 2018

Odontoidectomy is the treatment of choice for some diseases that cause irreducible ventral compression of the brainstem. In this study, we present our series emphasizing the technical nuances of endoscopic endonasal odontoidectomy.
Effect of Br-doping and choice of precursor solvent on morphology of lead free (CH3NH3)3Bi2I9 perovskites
Authors: Shrivastava Priya , Balasubramaniam K. R. , Bhargava Parag
Published: July 2018

Thin films of methyl ammonium iodobismuthate (MA3Bi2I9, MBI) doped on the anion site with bromine (MA3Bi2I9-xBrx), with x in the range of 0.46–0.51, have been fabricated using a two-step solution processing method. The use of dimethyl sulfoxide (DMSO) leads to high coverage films in comparison to the films fabricated using N, N-dimethylformamide (DMF). Films fabricated with dimethyl sulfoxide (DMSO) as the precursor solvent have a similar microstructure, irrespective of Br doping. In addition, the Br doping of the phase pure MBI leads to a decrease in the lattice parameter, probably due to the smaller bromide ion. The power conversion efficiency increases using Br-doped films as an absorber layer as compared to pristine MBI films. The band alignment of the Br-doped film has been calculated by ultraviolet photoelectron spectroscopy. X-ray photoelectron spectroscopy results indicate that Br-doping could prove beneficial against surface reactions in a humid environment.
Invited Article: Mode-locked waveguide lasers modulated by rhenium diselenide as a new saturable absorber
Authors: Li Ziqi , Dong Ningning , Zhang Yuxia , Wang Jun , Yu Haohai , Chen Feng
Published: July 2018

The layered two-dimensional (2D) materials with extraordinary optical properties play important roles in the development of ultrafast photonics, in which mode-locking lasers with a high fundamental repetition rate (>1 GHz) are of particular interest. The nonlinear optical properties of one of the emerging 2D materials, rhenium diselenide (ReSe2), have been investigated for the first time. Broadband ultrafast saturable absorption of ReSe2 from the visible to the near infrared wavelength regimes has been observed, which enables potential applications in ultrafast lasing. With typical end-pump arrangement, continuous-wave mode-locking based on the ReSe2 saturable absorber has been realized, reaching a fundamental repetition-rate of 6.5 GHz and pulse duration as short as 29 ps at 1 μm in a monolithic waveguide platform. This work indicates intriguing applications of ReSe2 for the development of on-chip ultrafast photonic devices.
Femtosecond laser ablation properties of Er3+ ion doped zinc-sodium tellurite glass
Authors: Mann Thomas , Mathieson Robert , Murray Matthew , Richards Billy , Jose Gin
Published: July 2018

We report the femtosecond laser (100 fs, 800 nm) ablation properties of Er3+ ion doped zinc-sodium tellurite glass. Ablation thresholds in dependence of the beam radius (13.9 and 32.0 μm), pulse number, and Er3+ ion dopant concentration have been determined. The ablation rate and crater profile depended on the applied fluence.
Carbon velvet trumps graphite for plasma devices by trapping electrons
Authors: Agner Mary Alexandra
Published: July 2018

Texturing the carbon used in the walls of high-energy ion applications, such as plasma chambers, reduces ion-induced electron emission.
Open woodland tree and shrub dynamics and landscape function in central Queensland after killing the trees with herbicide
Authors: Jones P. , Hall T. J. , Silcock R. G. , Filet P. G.
Published: July 2018

Herbicides are used in savanna to control tree and shrub density, primarily to maintain the value of the country for pastoral enterprises. However, the concomitant effects on biodiversity and landscape functioning need to be recognised and better understood. This study monitored tree and shrub dynamics and eventual landscape functionality in response to tree-killing over 7–8 years at two open eucalypt woodland sites in central Queensland. Paddocks denuded of trees using herbicide or not so treated were subject to three differing grazing pressures by cattle. Similarly treated but ungrazed sets of plots were subjected to either regular spring burns or were rarely burnt.
Tree and shrub growth and seedling recruitment were slightly affected by grazing pressure but regular spring burns minimised recruitment of minor woodland species and reduced the population of original saplings and seedlings that survived the herbicide. Few eucalypt seedlings emerged from soil surface samples taken each spring in any treatment, despite the presence of flowering trees in half the treatments. Capture and retention of resources, particularly rainfall and nutrients, were slightly improved by killing the trees, and worsened by grazing. We conclude that killing trees with herbicide at these sites did not adversely affect landscape function and that woody species regeneration was almost inevitable on these open eucalypt woodland native pastures.