Clinical Hemorheology and Microcirculation - Volume 6, issue 4
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Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research.
The endeavour of the Editors-in-Chief and publishers of
Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of
Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process.
Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.
The following professionals and institutions will benefit most from subscribing to
Clinical Hemorheology and Microcirculation: medical practitioners in all fields including hematology, cardiology, geriatrics, angiology, surgery, obstetrics and gynecology, ophthalmology, otology, and neurology. Pharmacologists, clinical laboratories, blood transfusion centres, manufacturing firms producing diagnostic instruments, and the pharmaceutical industry will also benefit.
Important new topics will increasingly claim more pages of
Clinical Hemorheology and Microcirculation: the role of hemorheological and microcirculatory disturbances for epidemiology and prognosis, in particular regarding cardiovascular disorders, as well as its significance in the field of geriatrics. Authors and readers are invited to contact the editors for specific information or to make suggestions.
Abstract: After a quick analysis of the haemorrheological components that intervene in arteriosclerosis obliterans of the lower limbs reducing peripheral flow, the effects of some drugs on haematic and plasmatic viscosity are described. The importance of the role played by the red blood cells both in causing an increase of viscosity and in the microcircle is stressed. In the latter the reduced red cell deformability together with the thrombophylic syndrom, present in these arterial diseases, creates a vicious circle which causes a further worsening of the tissue ischaemia. In the therapy of these vascular diseases buflomedyl chlorhydrate and pentoxyfilline are…of particular importance. The latter especially, through its different actions on several pathological components of the secondary hyperviscosity syndrom, represents an effective therapeutic remedy in the treatment of arteriosclerotic arterial diseases. For a long term prognosis of these patients, anyhow, further and wider long term studies are necessary.
Abstract: Presently the clinical efficacy of hemodilution in peripheral vascular disease is only supported by uncontrolled trials. This is a preliminary report about results obtained in a randomized placebo-controlled, double blind, cross-over study. Fourteen male patients with stable intermittant claudication, hematocrit higher than 45%, walking distance between 200 and 300 m and subtotal stenosis or obstruction of a femoral artery with good collateralization were admitted. Isovolemic hemodilution was performed three times per week with 500 ml of 10% hydroxyethyl starch (200) for three weeks. This was followed by a “wash-out” period of two weeks. Finally a three weeks’ period of regular…“sham” dilutions was introduced, which for the patient appeared identical to hemodilutions, but where no blood was exchanged. This regim was randomly executed for- or backwards. To keep double blind standards, clinical assessment of the patients (maximal walking distance on a treadmill and plethysmogram) was done by a third party and hemorheological measurements (blood viscosity and hematocrit) by a forth party. Results show that “sham” dilutions did not induce any positive changes, while hemodilution resulted in a significant fall of hematocrit and blood viscosity paralleled by a significant rise in walking distance and resting blood flow.
Abstract: Increased blood viscosity is present in diabetes mellitus: this may act as an accelerating factor in diabetic microangiopathy. The impaired rheological properties of diabetic blood are due to the increased plasma viscosity, enhanced red cell aggregation, reduced red cell deformability, circulating platelet aggregates, and seem strictly linked to the extent of blood glucose. Optimized metabolic control, particularly if obtained using insulin, has been shown to be successful in reversing many of the alterations present, but it must be achieved avoiding hypoglycemic events,which immediately worsen diabetic rheological alterations. Anyway, as any hypoglycemic treatment obtaining a good metabolic control does not reverse…completely the pre-thrombotic state present in diabetics and as metabolic control is often difficult to be achieved steadily, some specific intervention must be undertaken. A part from isovolemic haemodilution, many drugs are proposed in this sense: some of them specifically act on plasma macroglobulins (fibrinolytic agents), on red cell deformability (pentoxifylline, calcium antagonists), on platelet aggregation (antiplatelet agents) and vessel walls (vasoactive drugs). Some seem to exert more than a single action, such as pentoxifylline, ticlopidine, calcium antagonists, suloctidil; it is proposable to prefer these drugs, if the case allows the choice. Other drugs (solfonylureas, mucopolysaccarides, lecitins) seem to be experimentally important, but have to be proven effective in vivo.
Abstract: In this overview the relationship between an improvement of the flow properties of blood by several drugs in the one hand and the net tissue supply in patients on the other hand is described. There is clear evidence that it is not allowed to calculate an improvement in nutritive blood flow from hemorheologic extra vivum-data only. Direct measurements of tissue oxygen pressure allow to evaluate beneficial effects of hemorheologic treatment which do correlate to the patients benefit.
Abstract: In a total of 294 patients with CVD recently the implication of haemorheologic abnormalities has been investigated. Alterations of haematocrit, fibrinogen and red cell filterability were identified as most important factors leading to increased relative blood viscosity and were frequently associated with severe vessel wall changes. In 36 asymptomatic volunteers with evidence of atherosclerotic lesions a relative increase of the fibrinogen level together with changes of blood viscosity were noted and during follow up one patient developed an ischaemic stroke. The importance of the haemorheologic alterations for therapeutic measures is based on the inverse relationship of blood viscosity with cerebral…blood flow indicating that lowering of blood viscosity is followed by an increase of flow.
Abstract: A Percoll-Isopaque density gradient fractionation technique has been developed for rheological study of the more dense and older erythrocytes from patients with vascular disease. Thirty patients with insulin-dependent diabetes and 30 patients with atherosclerotic peripheral occlusive arterial disease were matched with healthy controls and erythrocyte rheology studied by filtration through 3 and 5 µm diameter pores and by ektacytometry. Density gradient fractionation confirmed that erythrocytes are not rheo1ogical1y homogeneous, cells from the dense fraction being poorly deformable. This applied equally to patients and controls, however, with no evidence of a selective sub-population of rheologically compromised erythrocytes in diabetes or atherosclerosis.
Abstract: The whole blood filtration rate (WBFR) according to Reid, the KT product using Taylor’s formula and the apparent internal viscosity (η i ) following Dintenfass’s method were determined in healthy subjects (n.26) and in patients (n.26) with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure (CRF) of various degree, the latter subdivided in two groups according to the value of the hematocrit (Ht): COPD1 with Ht ⩽ 49% and COPD2 with Ht > 49%. The mean value of WBFR was significantly reduced in both COPD1 (10.37 ± 3.90 µl/s) and COPD2 (10.72 ± 4.54 µl/s) patients as compared with…normals (17.84 ± 4.35 µl/s); respectively p < 0.001 and p < 0.002. In normals a slowing of WBFR was observed in relation to the increase of Ht (r= -0.52, p < 0.01), whereas in COPD1 patients the WBFR was directly correlated to Ht (r = + 0.64, p < 0.05). No difference in WBFR was observed between the two patient subgroups. An increased red cell deformability as detected by the KT value was found in COPD1 (2.69 ± 0.17) and COPD2 (2.52 ± 0.16) patients as compared with normals (2.87 ± 0.16) ; respectively p < 0.005 and p < 0.001. The impairment of WBFR in patients with CRF appeared to depend on extra-erythrocyte factors and/or increased red cell aggregation. The higher red cell deformability may be explained by the fact that the red cells altered as a consequence of the modifications of pH, Pa02 and PaC02 produced by CRF are rapidly removed from the circulation and replaced by more deformable young cells.