Clinical Hemorheology and Microcirculation - Volume 16, issue 3
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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: Erythrocyte aggregation (EA) rates were measured at stasis (M) and at 3 sec−1 (M1) in four groups: healthy controls (HC) and three groups of coronary heart disease (CHD); stable angina pectoris (SAP), unstable angina pectoris (USAP) and post myocardial infarction (PostMI) patients. All CHD patients had similar risk factors. EA values were significantly higher. at M and M1 in USAP and PostMI groups than HC and SAP (p<0.0001). These values were also higher in men than women in premenopause (p<0.001) in HC group, but after menopause the differences were not significant (p>0.05). Since EA is higher in more severe…forms of CHD (USAP and PostMI) and atherosclerosis is more common in men than women before menopause, it is possible that EA might play a role in the development of especially severe forms of CHD.
Abstract: Isovolumetric hemodilution (IHD) is an established therapeutic procedure to improve chronic ischemia in patients suffering from intermittend claudication of the lower limbs. It is, however, still subject of discussion at which hematocrit the relation between blood flow properties and oxygen carrying capacity of blood is at its optimum in this defmed ischemic disease. The aim of the present study was to characterize the influence of hematocrit variations on the muscle tissue oxygen supply as the defmed muscle tissue pO2 in these patients at rest and afte exercise. Design, Material, and Methods: IHD was performed twice within 14 days in 23…patients (age: 41–72yrs) with a painfree walking distance less than 100 by withdrawl of whole blood and subsequent infusion of the same amount of a 10% hydroxyethyl starch solution 200/0.5 (HAES steril 10%, Fesenius, Oberusrsel Germany). Measurements of muscle tissue pO2 in the anterior tibial muscle (micro-needle-electrode method according to Ehrly and Schroeder) were performed regularly three days before and after pedalergometric exercise in parallel to several other hemodynamic and hemorheological tests. Results: At rest muscle tissue pO2 reading revealed an impaired oxygen supply at high (51 and low (34%) hematocrit values whereas an increase was found with hematocirt levels in ther normal range (approx. 40%). Mter excercise, significant increase of the muscle tissue pO2 was found exclusively at hematocrit levels of 40%–42%. This increase was accompanied by a “normalisation” of the execise induced pattern of “reactive hypoxia” as defmed by micro-needle-electrodes. Conclusion: In patients suffering from intermittent claudication IHD towards a hematocrit of 40%–42% resulted in improvement of muscle tissue oxygen supply and execise conditions. Further reduction of hematocritto hematocrit levels below 38% impairs muscle tissue oxygenation. Thus, for conservative treatment strategies, isovolemic hemodilution should be applied regularly and “optimal hematocrit” is the lower boderline of the normal range (40%–42%).
Abstract: In a Cross-Over study the influence of a hyper- and isovolaemic haemodilution on blood fluidity, blood flow in the macro- and microcirculation as well as on tissue oxygen tension (M. tibialis anterior) was investigated in n=8 patients with arterial occlusive disease stage II according to Fontaine. In both cases 500 ml hydroxyethyl starch (HES 20010.5 10%) were infused within a period of 60 minutes. In case of isovolaemic haemodilution 250 ml hydroxyethyl starch were given over 20 minutes, then 250 ml blood withdrawn (over 10 min), 250 ml hydroxyethyl starch given and at least again 250 ml blood withdrawn.…Prior to and 1, 3, 6 and 24 hours after haemodilution the rheological parameters (haematocrit, plasma viscosity, erythrocyte aggregation, erythrocyte rigidity and spontaneous thrombocyte aggregation) as well as the oxygen partial pressure histogram in the tibialis anterior muscle were measured. Blood pressure and heart rate did not change during and after haemodilution. Painfree walking distance increased after isovolaemic (105% after 1 h) more than after hypervolaemic (31% after 1 h) haemodilution. The fluidity of blood shows a significant improvement only after isovolaemic haemodilution; plasma viscosity decreased about 5%, erythrocyte aggregation about 22% and haematocrit about 16%. 24 h after haemodilution the rheological parameters reached initial values. The intramuscular oxygen partial pressure increased after hypervolaemic haemodilution about 35%, after isovolaemic haemodilution about 45%.
Abstract: The clinical benefit of hypervolumtric hemodilution combined with venesection applying 8 infusion of HES 200/0.5 10% (C2/C6 substitution ratio: 4.6) versus 8 Infusions of 250 ml Ringers' solution (p<0.05) was observed in this double blind placebo controlled crossover study on 20 patients (12 men, 8 women) of an average age of 58 with complaints of pectangina but free coronary system and/or symptoms of dyspnea and ischemia during stress ECGs or stress induced hypertension even at low stress levels. Only 2 patients presented mild side effects (hypertension, pectangina) without residual complaints. HES improved the microcirculation of the skin. HES increased blood…fluidity relevantly with particular influence on the plasma viscosity, the erythrocyte aggregation and hematocrit. Both infusion solutions decreased the systolic and diastolic blood pressure. The patients with pectangina profited clinically the most so that this form of treatment should be limited to this patient group.
Keywords: Hypervolumetric hemodilution, myocardial microangiopathy, normal left-ventricular function and angiographicaUy free coronary system, clinical benefit only for patients with pectangina
Abstract: Systemic hemorheologic abnormalities may playa role in the pathogenesis of central retinal vein occlusions. A statistically significant elevation of plasma viscosity was found in patients with acute central retinal vein occlusion compared with control patients. Local retinal blood flow parameters including arteriovenous passage time and mean arterial dye bolus velocity were significantly altered in the central retinal vein occlusion patients versus age matched controls at baseline examination.We performed a randomized, prospective, single-blind clinical investigation to determine the effect of hemorheological manipulation on the clinical course and retinal blood flow of eyes with central vein occlusion. Hemodilution included plasma expansion with…hydroxyethyl-starch, withdrawal of whole blood if the hematocrit was above 42%, and rheologic manipulation with parenteral pentoxifylline. We found a statistically significant improvement in visual acuity at the last follow-up visit 36 months post-treatment for the treated group compared with the control group. The retinal blood flow parameters were markedly improved soon after the institution of therapy and may have contributed to the improved visual prognosis in the treated patient group.
Keywords: hemodilution therapy, central retinalvein occlusion, retinal microcirculation
Abstract: Patients suffering from acute ischemic stroke have impaired cerebral autoregulation. For this reason, the perfusion of the penumbra depends directly on BP and CO. The CO can be increased by hypervolemic hemodilution and administration of positive inotropic drugs. In the present study, we examined the effect of different therapy protocols on hemodynamics in three patient groups. In patients with no manifest cardiac insufficiency, suffering from non-acute cerebrovascular diseases (group 1, n=6) we carried out a hypervolemic hemodilution with an initial loading dose. In a second group of patients (group 2, n=6), suffering from an acute stroke and limited cardiac…capacity, we combined hypervolemic hemodilution with administration of digitalis. In a third group of patients, suffering from an acute stroke, without manifest cardiac insufficiency, we combined hypervolemic hemodilution with the administration of sympathomimetics (group 3, n=6). Group 1 showed a rapid, 15% increase in CO that lasted approximately 3 hours. Group 2 showed a slow improvement in CO, which became apparent during the course of the therapy. Group 3 showed a rapid and lasting increase in CO of more than 30% which correlated closely with the administered dopamine/dobutamine dose. Hypervolemic hemodilution alone does not result in a rapid and long-lasting increase of CO, particularly not in patients with myocardial insufficiency. To improve the hemodynamic status of acute stroke patients, the administration of positive inotropic substances is a viable alternative.