Clinical Hemorheology and Microcirculation - Volume 12, issue 6

Authors: Schmid-Schonbein, H. | Goslinga, H.

Article Type: Review Article

Abstract: Strictly normovolemic. individualized exchange hemodilution is rapidly developing into the most potent therapeutic remedy of clinical hemorheology. Firm evidence from critically ill patients show that resolute reduction of the hematocrit level down to around 0.33 l/l is both safe and efficient in the treatment of various localized and global low flow states (or “hypokinetic” circulatory situations), provided that anaemia is accompanied by careful (and if possible monitored) maintenance of the cardiovascular filling pressure. Under these conditions the oxygenation and the performance of the myocardium (14) is maintained, as is the peripheral vascular bed in patients with decompensated POAD (30). The …significance of the latency between critical vascular incidents (shown in central retinal artery occlusion (27)) has come to the forefront. Urgency of treatment and the recruitment of expert intensive care competence has now led to the administration of “custom taylored hemodilution” in the treatment of cerebrovascular stroke. As shown by the success of the AMSTERDAM STROKE STUDY (Goslinga et al. 1992), when carefully separating exsiccated from non-exsiccated patients, mortality in both groups can be dramatically reduced by either aggressive rehydration or custom-taylored exchange hemodilution (Hct 0.32 l/l, pulmonary capillary wedge pressure 12 mmHg). Reduction of mortality from the conventional value of 30% down to 16 or 9%, accompanied by an elevation of full rehabilitation from 34 to 59 (and 48%) by far exceeds the success of any competing form of therapy. As an explanation for the obvious success of induced anaemia, the new paradigm of “optimum circulatory stability” for hypokinetic states by means of normovolaemic dilution has been formulated from theoretical, experimental and clinical studies. It focusses on the preponderance of benefits from iatrogenic dilution over normal hematocrit in bed ridden patients, and is set in opposition to the paradigm of “maximum oxygen transport efficacy”, which is largely irrelevant in low flow states. Show more

Keywords: Anemia, blood volume, central artery occlusion hemodilution, circulatory filling pressure, cerebrovascular stroke, hematocrit, intensive care medicine, myocardial oxygenation, normovolemia, peripheral arterial occlusive disease, pulmonary capillary wedge pressure, reperfusion injury

DOI: 10.3233/CH-1992-12611

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 883-901, 1992

Authors: Witte, Siegfried

Article Type: Research Article

Abstract: A survey is given which describes the actual situation of the rather new science of Perihemorheology, a term introduced by ALFRED L. COPLEY. Perihemorheology includes the exchange of rheological processes between the vessel - blood organ and its surrounding tissues as well as in reverse. The article summarizes the anatomical and physiological basis and includes own methodical approaches to the experimental and clinical pathophysiology of the Perihemorheology: the permeation through the blood vessel wall, the transport in the interstitium, the lymph production.

Keywords: Perihemorheology, permeability, microcirculation, interstitial fluid, lymph

DOI: 10.3233/CH-1992-12612

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 903-933, 1992

Authors: Isogai, Y. | Yokose, T. | Ikemoto, S. | Maeda, T. | Akiyama, M. | Kuchiba, K.

Article Type: Research Article

Abstract: In this study we attempt to clarify the pathophysiological significance of PFL determined by means of negative pressure filtration system using Nuclepore membrane. The platelet suspension was filtered through the Nuclepore membrane. In the course of filtration pressure difference was generated between the upper and lower sides of membrane due to the PFL. The difference pressure thus generated was detected by a sensitive transducer, variable inductive type, amplified and recorded as a differential pressure curve. The experiment was carried at 37°C in the constant temperature bath. PFL was found to be affected by some factors: 1) A decrease in PFL …was observed more significant in suspension of EDTA-platelet compared to that of citrate-platelet. 2) EtTect of ADP on PFL showed to decrease in both suspensions of EDTA and citrate-platelet after addition of ADP in final concentration of 7.5 μmol. However, in the case of citrate-platelet a more significant decrease than that of EDTA-platelet was observed after addition of ADP. 3) Mean platelet volume (MPV). Volume of platelet changed to increase approximately 10% was observed after addition of stimulants such as ADP. 4) PFL in diabetes showed decreasing along with HbA1 concentration. These changes of PFL caused by various factors would contribute to disturbances of microcirculation following microangiopathy. Show more

Keywords: platelet filterability, anticoagulant, shape change, platelet volume, diabetes mellitus

DOI: 10.3233/CH-1992-12613

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 935-945, 1992

Authors: Seaman, Geoffrey V.F. | Knox, R.I. | Jackson, Lavelle J. | Swafnk, Roy L.

Article Type: Research Article

Abstract: Physicochemical and hematological studies were performed on the blood and blood components from 227 clinically definite multiple sclerosis patients and 64 matched control subjects. Measurements included plasma and serum viscosity, screen filtration pressure, red blood cell osmotic and mechanical fragilities, erythrocyte sedimentation rate, hematocrit, total serum protein, platelet count, thrombo-Φ-time, platelet retention, platelet aggregation induced by ADP, collagen or ristocetin; plasma protein levels of fibrinogen, albumin, α-1, α-2, β- and γ-globulins, albumin/globulin ratio and standard chemistry screens for levels of sodium, potassium, calcium, glucose, cholesterol, triglycerides, LDH, SGOT, total bilirubin and uric acid. Highly significant differences were found between normal …and MS patients: red blood cell osmotic and mechanical fragilities were greatly elevated for MS patients; platelet aggregation induced by ADP, collagen or ristocetin, decreased for MS patients; platelet retention markedly increased in MS patients; and the level of β-globulin decreased while the level of γ-globulins increased in MS. Show more

Keywords: Antithrombin III, fibrinogen, mechanical fragility, multiple sclerosis, osmotic fragility, platelet aggregation, platelet retention, viscosity

DOI: 10.3233/CH-1992-12614

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 947-957, 1992

Authors: Ajmani, R. | Puniyani, R.R. | Jaiswal, V.S.

Article Type: Correction

DOI: 10.3233/CH-1992-12615

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 959-959, 1992

Article Type: Other

DOI: 10.3233/CH-1992-12616

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 961-971, 1992

Article Type: Other

DOI: 10.3233/CH-1992-12617

Citation: Clinical Hemorheology and Microcirculation, vol. 12, no. 6, pp. 972-972, 1992