Clinical Hemorheology and Microcirculation - Volume 17, issue 1
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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: Damage to the endothelium is believed to be important in the development and progression of atherosclerosis. Consequently, vascular biologists are seeking good markers of endothelial cell function which hope to provide tools to dissect the role of these cells in disease. This review will examine a number of endothelial cell products (thrombomodulin, von Willebrand factor and soluble E‐selectin) and discuss their value as markers of vascular integrity.
Keywords: Atherosclerosis, endothelium, thrombomodulin, von Willebrand factor, soluble E‐selectin
Abstract: Congenital dysfibrinogenemia is based on different alterations in the structure of the fibrinogen molecule leading to a variety of disturbances in the clotting process. Clinical manifestations of the disorder are showing a wide range from asymptomatic states to mild bleeding diathesis as well as thrombotic complications. In this study two of the 14 patients with dysfibrinogenemia showed a history of mild bleeding while the others showed no clinical symptoms. As fibrinogen is also an important factor of the blood fluidity not only haemostatic but also rheological parameters were measured. Included in the study were 14 patients with ascertained dysfibrinogenemia…in comparison to 11 non‐affected relatives and a control group of 297 apparently healthy subjects. Plasma viscosity (p<0.0001) and erythrocyte aggregation index (p<0.00001) were significantly higher in the patients than in their healthy relatives and the control group. A pathologically increased erythrocyte aggregation was found in 10 of the 14 patients but only in 1 of the 10 relatives. The dysfunction of the fibrinogen molecule thus influences the aggregation process of the red blood cells to a greater extent than normal fibrinogen. Moreover, there seems to be a stronger influence of the dysfunctional fibrinogen molecule on the aggregation process than on plasma viscosity. To date the question if the enhanced erythrocyte aggregation in dysfibrinogenemic patients may be of any diagnostic interest and if there are significant differences between patients with bleeding diathesis and thrombophilia cannot be answered and remains to be cleared in further investigations.
Abstract: The severity of alterations in the microcirculatory bed and the incidence rate of myocardial dysfunction in 299 female patients with differently severe iron‐deficiency anaemia (IDA) as a mechanism of compensation and adaptation towards chronic anaemic hypoxia was investigated. Significant changes, mainly in the venular and capillary part of the microcirculatory bed in conjunctival biomicroscopy were observed. An increased diameter and a decreased linear density of the venules along with microcongestion foci, microhaemorrhages, an enhanced undulation and irregularity of both venules and capillaries and a ‘sludge‐phenomenon’ were demonstrated. Echocardiographically, a significant enlargement of telediastolic and telesystolic dimensions and volumes of the…left ventricle, a hyperdynamic working regimen of the heart with increased cardiac output and stroke volume were observed with advancing severity of IDA and microcirculatory alterations. A slight reduction of myocardial contractility was found only in the cases with a severe degree of anaemia. The treatment performed with parenteral iron induced a complete reversibility of both myocardial and microcirculatory changes with the moderate and slight degree of IDA while there was a delayed reversibility concerning normalization of the values of haemoglobin and serum iron that required a more prolonged follow‐up of these patients.
Abstract: To ascertain the contribution of blood rheological disorders in elevation of arterial pressure during hypertension, erythrocyte aggregability was investigated in rats and evaluated in patients with the Georgian technique. The evidence obtained for the significant role that blood rheological disorders play in development of this pathological phenomenon was found to be as follows: (a) the enhanced erythrocyte aggregation in rat’s blood (caused by high molecular weight dextran administration) results in a rise of the systemic arterial pressure while the arteriolar diameters remain unchanged; (b) a direct relationship has been found between the index of erythrocyte aggregability (Georgian technique) and total…peripheral resistance in patients with mild and severe forms of the essential hypertension; and (c) a linear relationship between lowering of erythrocyte aggregability and the diastolic arterial pressure, as well as total peripheral resistance, was revealed also following treatment of hypertensive patients with Ca‐antagonists. These findings support the conclusion that blood rheological disorders, related to increased erythrocyte aggregability, play a significant role in the concerted action of factors enhancing peripheral resistance and in elevation of the arterial pressure in patients with essential hypertension.
Abstract: This study was designed to characterize blood viscosity changes in 13 patients with mild to moderate diastolic hypertension treated with ramipril monotherapy for three months. The ramipril dose was titrated from 2.5 to 20 mg daily to achieve a diastolic blood pressure of less than 90 mm Hg. All patients received a stable dose of ramipril for three months. Viscosity measurements were made at 37°C with the Mettler Contraves LS‐40 microviscometer. Fibrinogen was determined by the Clauss method by averaging three separately acquired plasma samples. The systolic blood pressure (mean±standard deviation) was lowered from 141.2±9.1 to 129.2±11.2 mm Hg…(p=0.005) and the diastolic blood pressure was lowered from 95.2±4.9 to 84.2±7.3 mm Hg (p=0.0001). In 13 patients with mild to moderate diastolic hypertension, blood pressure reduction with ramipril was accompanied by no significant changes in blood viscosity, plasma viscosity, serum viscosity or fibrinogen.
Abstract: We aimed at investigating relationships between zinc status, blood rheology and blood glucose during exercise. Twenty‐one professional football players underwent a triangular maximal exercise test on cycloergometer, with progressively increasing work loads until VO2max . On the whole these subjects had a low serum zinc because nine of them had a hypozincemia (0.54 ± 0.01 mg/l) which suggested a zinc deficiency. Subjects with low serum zinc were able to perform a lower power output (123 ± 8.71 vs. 166.27 ± 14.84 watts, p=0.029) and exhibited a higher increase in blood lactate during exercise (7.51 ± 0.81 vs. 5.57 ± 0.33…mmol/l, p=0.024) resulting in a lower 2 mmol lactate threshold (44.7 ± 3.9% vs. 58.9 ± 4.8% of maximal power output, p=0.04). They were less able to maintain their plasma glucose and exhibited a tendency towards hypoglycemia (p=0.0153). Hypozincemia was associated with a higher viscometric RBC rigidity index (p=0.0009), and this index was negatively correlated to serum zinc (r=-0.68, p=0.7×10-3 ). Blood viscosity at high shear rate (MT90 viscosimeter) corrected for hematocrit (45%) remained higher during exercise in these hypozincemic subjects (p=0.003). This study suggests that zinc status may influence blood rheology during exercise, either by its direct action on RBC flexibility (demonstrated in vitro) or by its effect on lactate accumulation which may in turn modify erythrocyte fexibility.
Abstract: Symptomatic end‐stage arterial disease in coronary artery or peripheral arterial occlusive disease represents an increasing clinical problem as cardiovascular mortality in these patient groups has declined due to improved secondary prevention. While in peripheral arterial occlusive disease amputation with subsequent life‐long physical disability is the major problem, patients with end‐stage coronary artery disease and refractory angina pectoris repeatedly report to the emergency ward with the clinical symptoms of unstable coronary syndromes, but myocardial infarction is generally ruled out. For these patients long‐term intermittent urokinase therapy has been developed as an alternative treatment modality. Potential mechanisms for clinical effectiveness include improvement…of rheological blood properties, thrombolysis of non‐occluding arterial thrombi and possibly plaque regression. In coronary artery disease urokinase is applied as an intravenous bolus injection of 500,000 IU urokinase three times a week over a period of 12 weeks. This leads to a marked reduction of fibrinogen by about 35% and of clinical symptoms by around 70% accompanied by a reduction of exercise‐induced myocardial ischemia. In observational studies in patients with peripheral arterial occlusive disease injections of 500,000 IU of urokinase were usually given daily for a shorter time period of three to four weeks with a clinical success rate, defined as a cessation or marked reduction of rest pain and/or salvage of a limb, of around 50%. Given the state of critical ischemia in both entities of atherosclerotic disease, long‐term intermittent urokinase therapy represents a promising antiischemic approach. In particular in patients with peripheral arterial occlusive disease randomized controlled trials with prolonged treatment periods, which are likely to improve clinical results, are warranted.
Abstract: The neurologic outcome of 23 seven‐year old children who had cord blood hyperviscosity was compared with that of children with normal cord blood viscosity in a randomised, controlled and blinded study. Viscosity was measured using a coaxial narrow‐gap couette viscometer. Sixteen (69.6%) of the children with hyperviscous cord blood had a disability; this incidence being three times greater (22.7%) than in children whose cord blood was not hyperviscous (P<0.01). In three children with cord‐blood hyperviscosity, the disability was severe. No child had a severe disability with normal cord blood viscosity. Of the eight children whose cord blood was hyperviscous, but…not polycythemic, six (75.0%) had a disability and in one child the disability was severe. These results demonstrate an association between cord blood hyperviscosity and later neurologic development. Cord studies are non‐invasive and result in the rapid diagnosis of the neonatal hyperviscosity syndrome, so allowing earlier treatment. This may be crucial in altering the effects of hyperviscosity on the developing brain in the early neonatal period. Because the neurologic outcome of children was similar whether polycythemia was present or not, the prime factor was the viscosity and not the hematocrit level. We suggest it may be necessary to perform cord blood viscosity studies routinely.
Abstract: Five repeated submaximal treadmill exercises at 2 h intervals following a maximal test prolong walking distance and reduce haemorheological derangement in a second maximal test in patients affected with peripheral obliterative arterial disease (POAD). An increase in adenosine plasma levels is observed during maximal tests, thus suggesting the possibility of an ischaemic preconditioning of lower limbs. The intravenous infusion of 50–100–200 mg buflomedil, and the oral administration of 300–600–900 mg of the drug in POAD patients, also produce an increase in plasma levels of adenosine. Finally, 600 mg buflomedil orally at 12 h intervals produced pulse increase in adenosine plasma…levels without any accumulation of the drug or adenosine for at least one week. The possibility of a pharmacological preconditioning of ischaemia is suggested.