Clinical Hemorheology and Microcirculation - Volume 2, issue 5-6

Authors: Bartelheimer, H. | Schwartzkopff, W.

Article Type: Research Article

Abstract: One factor in the pathogenesis of atherosclerosis is an alteration in permeability to lipids and lipoproteins in the wall of the greater vessels, of the arterioles and of capillaries. A model to study the permeability of capillaries is the cantharidine blister fluid (CBF) and the filtrate which is passing through the membrane of the cantharidine-blister-base after applying negative pressure from 40 to 100 torr. The concentration of lipids etc. is lower in the blister fluid than in the serum. There is no relation between the sieving quotient C2/C1 of proteins (0,65) and of lipids in type IIa (0,49), in …type lIb (0,41), and in type IV (0,38). The concentration of lipids and lipoproteins in the CBF was not strictly correlated to those of the serum. In type IV the diffusion of the TG was more restricted (0,39) than in type IIb/a (0,40). The three fractions of lipoproteins (LDL, VLDL, HDL) had nearly the same relative distribution in the CBF as in the serum. The percentage of LDL and VLDL was in the CBF lower than in the serum. There is no difference of concentration for the HDL between both fluids. The sieving quotient C2/C1 for the lipoproteins etc. was different in the three HLP-types. TG, VLDL, CH and LDL were mostly restricted in type IV (C2/C1: TG = 0,39, VLDL = 0,38, CH = 0,36, LDL = 0,35). But the concentration of CH and LDL in the CBF was greater in type IIa/b than in type IV. The volume of capillary filtrate (ml/cm2 /min/mm Hg) was proportional to the negative pressure. With increasing filtrate volume the concentrations of lipids etc. decreased especially those of cholesterol and LDL. High blood pressure restricts the diffusion of cholesterol and LDL and promotes the deposition of these lipids in the vascular wall. Show more

Keywords: Permeability, cantharidine blister, hyperlipoproteinemia, cholesterol, filtration pressure

DOI: 10.3233/CH-1982-25-621

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 653-668, 1982

Authors: Bollinger, A.

Article Type: Other

DOI: 10.3233/CH-1982-25-622

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 669-669, 1982

Authors: Szabó, G.

Article Type: Research Article

Abstract: In normal dogs and rabbits plasma protein concentration is higher in tissue fluid than in lymph but after prolonged anaesthesis and immobilization tissue fluid protein concentration decreases, and the relationship is reverted. Chronic inferior v. cava constriction produces in dogs ascites and oedema. Protein content of tissue fluid and lymph decrease markedly, but tissue fluid concentration remains higher than lymphatic concentration. In acute thrombophlebitis with massive leg oedema protein content in tissue fluid and regional lymph do not change significantly. Both under normal and pathological conditions there is a linear correlation between tissue fluid and lymph protein concentrations. In …rabbits tissue injury was produced by burning the limb or by tourniquet application for 2 or 4 hr. After burning the increase in protein content was greater in tissue fluid than in lymph and there were big changes in lymphatic and tissue fluid activities of the cellular enzymes LDH and GOT. In normal animals LDH activity was about twice as high in tissue fluid as in lymph, but after burning its activity in tissue fluid became about 10 times higher than lymphatic activity. Total protein concentration in tissue fluid and lymph still showed in the burned leg a linear relationship, but the relationship between LDH activities was logarithmic. After ischaemic tissue injury in the body fluids there was again a big increase in the level of cellular enzymes especially in that of LDH and the increase was greater in tissue fluid than in lymph. Regional lymph flow was increased by intraarterial infusion of bradykinin but not by histamine. Lymphatic protein concentration increased by 45 % during bradykinin infusion, by 22 % during histamine infusion and by about 8 % in the controls. Tissue fluid protein concentration decreased in all experimental groups. A strong linear correlation was observed between tissue fluid and lymph concentration changes. The vasoactive agents increased the lymphatic transport of LDH. In the animals where lymph flow rate did not increase significantly the enzyme level in lymph rose markedly without a similar change in tissue fluid. At high lymph flow rates LDH in lymph was diluted, but the total enzyme flux was about 2 to 3 times higher than in the controls. In the tissue fluid no similar concentration changes were observed. It is concluded, that subcutaneous tissue fluid consists at least of two compartments, and only one of these, the perivascular interstitial space is drained directly by the lymph vessels. Consequently lymph represents essentially recent microvascular filtrate. The second compartment rinsing the cells and intracellular fibres is paralelly coupled with the first and is in exchange with it. In the normal state and under different pathological conditions there is a dynamic balance of macromolecular concentration in tissue fluid and lymph. The interstitial matrix seems to offer a substantial resistance to bulk flow and to macromolecular diffusion. This is reflected by the lack of equilibrium of extravascular plasma proteins between tissue fluid and lymph and by the considerable concentration gradient of cellular protein when their release is enhanced by injury. Show more

Keywords: Tissue fluid, lymph, macromolecular permeability, extravascular plasmaprotein, edema

DOI: 10.3233/CH-1982-25-623

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 671-682, 1982

Authors: Földi, M.

Article Type: Research Article

Abstract: In a paper entitled “Lymphoedema: The case for doubt” (Brit.J. Plast. Surg. 21 (1968), 32–44) Calnan rejected the generally accepted pathophysiological basis of Lymphoedema. His arguments are:1. The age of onset in primary lymphoedema. Calnan finds it difficult to understand why a single hypoplastic lymphatic trunk which has served for the efficient return of lymph for 15 to 20 years begins to fail in its job without any obvious cause. Still more difficult to understand for Calnan is the case of the much older woman who has successfully passed adolescence, pregnancies and a very active life of sport before lymphoedema …appears. 2. Calnans next problem is female dominance in primary lymphoedema. According to him, the classical concept of lymphoedema does not account for this difference. 3. In 80 per cent of patients with primary lymphoedema the left leg is oedematous. The left common iliac vein is crossed by the right common iliac artery opposite the body of the 5th lumbar vertebra. According to Calnan the vein, which drains virtually all the blood from a leg, becomes compressed between artery and bone. Is “lymphoedema” in these cases an oedema of venous origin? 4. Sometimes lymphography shows normal lymphatics in patients with a clinically typical lymphoedema. How these cases can be explained? 5. Sometimes lymphography shows abnormal lymphatics in limbs free of oedema. How these cases can be explained? 6. At the time of radical mastectomy the surgeon may destruct the lymphatic pathways in the axilla completely and one would expect lymphoedema to follow. Yet in more than 80 per cent of patients there is minimal or no swelling. Why? The age of onset in primary lymphoedema. Calnan finds it difficult to understand why a single hypoplastic lymphatic trunk which has served for the efficient return of lymph for 15 to 20 years begins to fail in its job without any obvious cause. Still more difficult to understand for Calnan is the case of the much older woman who has successfully passed adolescence, pregnancies and a very active life of sport before lymphoedema appears. Calnans next problem is female dominance in primary lymphoedema. According to him, the classical concept of lymphoedema does not account for this difference. In 80 per cent of patients with primary lymphoedema the left leg is oedematous. The left common iliac vein is crossed by the right common iliac artery opposite the body of the 5th lumbar vertebra. According to Calnan the vein, which drains virtually all the blood from a leg, becomes compressed between artery and bone. Is “lymphoedema” in these cases an oedema of venous origin? Sometimes lymphography shows normal lymphatics in patients with a clinically typical lymphoedema. How these cases can be explained? Sometimes lymphography shows abnormal lymphatics in limbs free of oedema. How these cases can be explained? At the time of radical mastectomy the surgeon may destruct the lymphatic pathways in the axilla completely and one would expect lymphoedema to follow. Yet in more than 80 per cent of patients there is minimal or no swelling. Why? Calnans problems are analyzed and his questions are answered. The evidence shows that lymphoedema can be defined as the result of a low output failure of lymph flow in combination with a deficient extralymphatic mastering of stagnating plasma proteins. Show more

Keywords: Lymph edema, extravascular plasma proteins, lymph valve, lymph node

DOI: 10.3233/CH-1982-25-624

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 683-690, 1982

Authors: Neuhof, H.

Article Type: Research Article

Abstract: If the oxygenation of blood is not critically diminished, the oxygen transport to the tissues and thus the total oxygen consumption of the organism is limited by the function of microcirculation. The organism’s total oxygen consumption therefore decreases if shock develops. The total oxygen consumption can be easily measured continuously as the total oxygen uptake of the patient. In this way the impairment of tissue perfusion all over the organism may be quantified indirectly by the reactions in the aerobic metabolism. In shock patients an inadequate tissue perfusion is always followed by a decrease in total oxygen uptake even …if hemodynamics may pretent good conditions for the microcirculation. Comparable to shock states, the microcirculation may also be affected during extra corporeal circulation. Although a complete blood oxygenation can be performed easily and pump flow can be set to an optimal range, tissue perfusion may be insufficient. Even in this situation changes in total oxygen consumption reveal the status of microcirculation and the reactions in capillary gas exchange. Show more

Keywords: Shock, oxygen consumption, extracorporeal circulation, norepinephrine

DOI: 10.3233/CH-1982-25-625

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 691-703, 1982

Authors: Hauss, W.H.

Article Type: Research Article

Abstract: The microcirculation takes place in 2 histological areas, in an intravascular and in an intramural part. Both parts are produced by vessel wall cells which are mesenchymal cells. A larger number of heterogenous stimuli and injuries, especially the so-called risk factors, directly and regularly induce a reactive alteration of the mesenchymal metabolism (the “non-specific mesenchymal reaction”). Two types of the intramural part are serving for the microcirculation: a) the intramural part in the vessel wall and b) the intramural part in the capillary wall. The histological consequences of the reactive pathological metabolism in the intramural …part are described particularly with regard to the pathogenesis of arteriosclerosis of circulatory disturbances. Show more

Keywords: Arteriosclerosis, arterial wall, myocard, hypertension, diabetes

DOI: 10.3233/CH-1982-25-626

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 705-719, 1982

Authors: Meßmer, K. | Sunder-Plassmann, L. | v. Hesler, H. | Endrich, B.

Article Type: Research Article

Abstract: Hemorheological disorders include both impairment of the flow properties and the flow conditions of blood. Hyperviscosity of blood and the low flow are the most important prominent factors to cause hemorheological abnormalities. Since impaired fluidity of blood and uneven distribution of blood flow was found in peripheral vascular occlusive disease, improvement of blood fluidity by hemodilution has been suggested as a form of conservative treatment. To further substantiate the few clinical studies available, the effects of hemodilution were analysed in an experimental model of peripheral arterial occlusive disease. The study comprised analysis of collateral blood flow, segmental vascular resistance, …distribution of resting and hyperemia flow as well as local oxygen supply to the skeletal muscle. Hemodilution by Dextran 60 was found a most effective method to decrease collateral vessel blood flow and to improve tissue oxygen supply by cancelling of the pathologic inhomogeneity of microflow. Show more

Keywords: Hemodilution, peripheral vascular occlusion, hyperviscosity, Dextran 60, collateral vessel

DOI: 10.3233/CH-1982-25-627

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 721-731, 1982

Authors: Haanen, C. | Holdrinet, R.

Article Type: Research Article

Abstract: Disseminated thrombotic microangiopathy was until recently a fatal disease consisting of thrombocytopenic purpura, hemolytic anemia and progressive focal neurologic disturbances. Pathologically widespread hyaline occlusions are found in terminal arterioles and capillaries, which show enthothelial hyperplasia. The thrombi consist of platelets. This syndrome was first described by Moschcowitz in 1925 and is known in literature as thrombotic thrombocytopenic purpura (T.T.P.). In 1977 Byrnes and Khurana reported dramatic therapeutic responses in this hitherto fatal disorder, obtained by plasma infusions. Nine patients are described of which six were treated by massive plasma infusions, four which recovered completely. The experiences suggest the existence …of a plasma factor that is lacking or consumed in these patients and the producticn of which is modulated by the levels of estrogen/progestagen in the plasma. Identification of this anti-T.T.P. factor will be of great interest for understanding and treatment of T.T.P. and of increased platelet aggregation tendencies in general. Show more

Keywords: Disseminated thrombotic microangiopathie, Moschcowitz syndrome, thrombotic thrombocytopenic purpura

DOI: 10.3233/CH-1982-25-628

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 733-743, 1982

Authors: Merlen, Jean F.

Article Type: Research Article

Abstract: Capillary disturbances are pathological confines of dermatology and angiology. The word “histangiopathy” must be prefered to the one “microangiopathy” (CURRI and MERLEN). According to the nomenclature established in 1972 by the International Union of Angiology, we distinguish 1) permanent acrosyndromes as Acrocyanosis, a group of six facets, where hypotonia and stasis in the capillary-venular anastomoses, more numerous than normally and above all more enlarged (MERLEN and CURRI 1965), beside chillblains, livedo, red palms and soles ... pure subjective acrorhigosis is at the base. 2) Paroxystic acrosyndromes due to coldness, Raynaud type or to heat, erythermalgia type. Raynaud’s phenomenon …and diseases are exposed, nobody has the right to assimilate Raynaud and sclerodermia or loco regional arteriopathy. There is a peculiar pattern of pulpar biopsy. Erythralgia, erythermalgia, acroerythrosis, acromelalgia, causalgia and Sudeck’s dystrophy are very near one another. 3) Dystrophic disturbances are intermediary forms with organic histangiopathies . The former concern livedo racemosa, perniosis, acrodynia, ulcero-mutilating acropathies. The latter are relative to dermatological lesions in the superficial or deep layers of the skin and they are quite different in clinical, anatomical and pathogenical aspects although a relative unity is however secured. A special attention must be paid to the diabetic microangiopathy due to stasis in the capillary-venular segment and shunting of blood by permanent opening of A.V. Anastomoses and blocking devices. There are specific lesions of the myoepithelioid cells of the A.V.A. and of the pericytes. Show more

Keywords: Capillary disturbances, histangiopathy, acrosyndromes, Raynaud’s syndrome, erythralgia, diabetes

DOI: 10.3233/CH-1982-25-629

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 745-751, 1982

Authors: de Nicola, P. | Tassi, G.

Article Type: Research Article

Abstract: During aging there are significant modifications of the mechanism of hemostasis, including blood coagulation, fibrinolysis, platelets and vascular factors. A tendency toward thrombophilia is usually observed in the presenile age (45 to 60) with an increase of coagulability (reduction of antithrombin III and increase of fibrinogen turnover), a decrease of fibrinolytic activity and an increase of platelet aggregation. In the actual senile age, after 70, such a tendency may disappear and normal values or even signs of hypocoagulability may be found, in association with an increased capillary fragility and hemorrhagic diathesis. The thrombophilic tendency may be more marked in the …presence of predisposing diseases such as diabetes, hypertension, obesity and atherosclerosis. Today the role of gamma-carboxy-glutamic acid has been emphasized, insofar the abnormal proteins, which are formed due to the action of antivitamin K (indirect anticoagulants) or in the absence of vitamin K (as in malabsorption syndrome, frequently observed in the aged), do not contain gamma-carboxy-glutamic acid and act through an inhibition of factor Xa,thus increasing indirectly the antithrombin III activity. Therefore indirect and direct anticoagulants may be similar in this respect, namely enhancing antithrombin III activity. Thrombophilia in the arteriosclerotic aged subjects may be interpreted today as the consequence of a latent, intravascular coagulation syndrome. Besides the increased capillary fragility in the aged, which may be corrected by means of a number of drugs (e.g. aminaphtone, “vascular factor”, etc.), the small vessels in the aged nay exhibit some typical findings, e.g, in the conjunctiva, especially in cases of arteriosclerosis, hypertension, diabetes etc. The action of some drugs on microcirculation may be evaluated by studying the modifications of the conjunctival vessels, in addition to the other findings concerning blood viscosity and erythrocyte deformability. Show more

Keywords: Coagulation, thrombophilia, fibrinogen, prothrombin, bleeding time, microcirculation in the aged

DOI: 10.3233/CH-1982-25-630

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 753-763, 1982

Article Type: Other

DOI: 10.3233/CH-1982-25-631

Citation: Clinical Hemorheology and Microcirculation, vol. 2, no. 5-6, pp. 765-767, 1982