Colloids decrease clot propagation and strength: role of factor XIII-fibrin polymer and thrombin-fibrinogen interactions

Colloid-mediated hypocoagulability is clinically important, but the mechanisms responsible for coagulopathy have been incompletely defined. Thus, my goal was to elucidate how colloids decrease plasma coagulation function. Plasma was diluted 0% or 40% with 0.9% NaCl, three different hydroxyethyl starches (HES, mean molecular weight 450, 220 or 130 kDa), or 5% human albumin. Samples (n=6 per condition) were activated with celite, and diluted samples had either no additions or addition of fibrinogen (FI), thrombin (FIIa) or activated Factor XIII (FXIIIa) to restore protein function to prediluted values. Thrombelastographic variables measured included clot propagation (angle, alpha), and clot strength (amplitude, A; or shear elastic modulus, G). Dilution with 0.9% NaCl significantly decreased alpha, A and G-values compared to undiluted samples. Supplementation with FI, but not FIIa or FXIIIa, resulted in 0.9% NaCl-diluted thrombelastographic variable values not different from those of undiluted samples. FI supplementation of HES 450, HES 220, HES 130 and albumin-diluted samples only partially restored alpha, A and G-values compared to undiluted samples. FIIa addition only improved clot propagation and strength in albumin-diluted samples. FXIIIa supplementation improved propagation in samples diluted with HES 450, HES 220 and albumin, and clot strength improved in HES 450 and albumin-diluted plasma. Considered as a whole, these data support compromise of FIIa-FI and FXIIIa--fibrin polymer interactions as the mechanisms by which colloids compromise plasma coagulation. Investigation to determine if clinical enhancement of FXIII activity and/or FI concentration (e.g. fresh-frozen plasma, cryoprecipitate) can attenuate colloid-mediated decreases in hemostasis is warranted.     

Effects of coagulation factor deficiency on plasma coagulation kinetics determined via thrombelastography: critical roles of fibrinogen and factors II, VII, X and XII

BACKGROUND: Thrombelastography (TEG) is used to assess coagulopathy. However, a comprehensive characterization of the effects of specific coagulation factor deficiencies and mode of activation on TEG data does not exist. METHODS: Thrombelastography was performed for 15 min with control plasma and plasmas deficient (<1% activity) in Factors II, V, VII, VIII, IX, X, XI, XII, or XIII activated with celite (0.28 mg ml(-1)) or tissue factor (TF, 0.1%) (n = 6 per condition). Additional fibrinogen concentration activity (75-345 mg dl(-1)) and Factor II, VII, X and XII activity-response relationships (1%, 6.25%, 12.5%, 25%, 50% and 100% activity) were obtained (n = 8 per condition). Thrombelastography parameters included reaction time (R), angle (alpha), and clot strength (A, amplitude; G, elastic modulus). RESULTS: Celite activation of FXII-deficient plasma, TF activation of FVII-deficient and FX-deficient plasma, and celite or TF activation of FII-deficient plasma resulted in an almost undetectable clot. Compared to control values, celite activation of plasmas deficient in FXI, FIX and FVIII resulted in prolonged R and decreased alpha values, whereas TF activation resulted in decreased alpha values. Celite and TF activation of FV-deficient plasma resulted in prolonged R and decreased alpha values, whereas FXIII-deficient plasma had decreased alpha, A and G-values compared to control values. CONCLUSIONS: The fundamental finding of this study is that coagulation factor deficiencies affect TEG parameters in both a factor-dependent and activation-dependent fashion. Utilizing both celite and TF activation improves the diagnostic power of TEG. Based on such TEG data, more targeted administration of blood products could potentially help improve perioperative hemostatic outcomes.     

Treatment of symptomatic epilepsy with lesionectomies combined with bipolar coagulation of the surrounding cortex

Objective To observe the clinical effects of lesionectomies combined with bipolar coagulation of the surrounding cortex (BCSC) on symptomatic epilepsy. Methods The effectiveness of lesionectomies combined with BCSC (71 patients) and of lesionectomies alone (78 patients) were compared in follow-up surveys conducted 2-5 years (average of 37 months) post-operation.Results Treatment in the BCSC group was significantly more effective than in the lesionectomy group （P&lt;0.01）. Meanwhile, patients in the BCSC group suffered no permanent post-operative complications.Conclusion Lesionectomy combined with BCSC is a new, effective and safe treatment for symptomatic epilepsy.     

血管内栓塞术在肺部咯血性疾病大咯血治疗中的应用

目的探讨动脉血管内栓塞术在肺部咯血性疾病大咯血治疗中的应用方法和价值。方法采用30%的碘海醇非离子型碘剂对71例大咯血患者进行病变区血管造影,造影顺序按支气管动脉、肋间动脉、胸廓内动脉和病变部邻近部位动脉依次进行。根据出血部位血管管径等具体情况,选择明胶海绵颗粒或弹簧钢圈法进行血管内栓塞,栓塞后4周内无咯血者认定治疗成功。结果对71例患者共实施了193支异常血管栓塞处理,其中明胶海绵颗粒法栓塞血管185支(96%),弹簧钢圈法栓塞8支(4%)。一次介入栓塞成功止血63例(89%),再次栓塞成功止血8例(11%)。所有患者除感栓塞部位轻微疼痛外,未出现其他并发症。结论动脉血管内栓塞术具有操作简洁、显效快、成功率高、并发症轻且费用相对低廉等优势,值得在肺部咯血性疾病的治疗中推广应用。     

A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas

OBJECTIVE: To determine the difference between two laparoscopic methods for the management of endometriomas with regard to recurrence of signs and symptoms and pregnancy rate. DESIGN: Prospective, randomized clinical trial. SETTING: Infertility and gynecologic endoscopy units of two medical university hospitals. PATIENT(S): One hundred patients with endometriomas who had either infertility or pelvic pain. INTERVENTION(S): Patients were randomly divided into two groups; one group underwent cystectomy (group 1), and fenestration and coagulation were performed for the other (group 2). MAIN OUTCOME MEASURE(S): A comparison of recurrence of signs and symptoms of endometriomas and pregnancy rates in two groups. RESULT(S): Fifty-two patients were studied in group 1 and 48 in group 2. The recurrence of symptoms, such as pelvic pain and dysmenorrhea, was 15.8% in group 1 and 56.7% in group 2 after 2 years. The rate of reoperation was 5.8% in group 1 and 22.9% in group 2 and these differences were statistically significant. The cumulative pregnancy rate was significantly higher in group 1 (59.4%) than in group 2 (23.3%) at 1-year follow-up. CONCLUSION(S): Laparoscopic cystectomy of endometriomas is a better choice than fenestration and coagulation because the former technique leads to a lower recurrence of signs and symptoms and a lower rate of reoperation and a higher cumulative pregnancy rate than the latter.     

Updates in perioperative coagulation: physiology and management of thromboembolism and haemorrhage

Understanding of blood coagulation has evolved significantlyin recent years. Both new coagulation proteins and inhibitorshave been found and new interactions among previously knowncomponents of the coagulation system have been discovered. Thisincreased knowledge has led to the development of various newdiagnostic coagulation tests and promising antithrombotic andhaemostatic drugs. Several such agents are currently being introducedinto clinical medicine for both the treatment or prophylaxisof thromboembolic disease and for the treatment of bleeding.This review aims to elucidate these new concepts and to outlinesome consequences for clinical anaesthesia and perioperativemedicine.     

生栀子、焦栀子50%和95%乙醇洗脱部位药效学比较研究

目的:对炮制前后变化明显的组分50%和95%乙醇洗脱部位(简称部位)进行药效学比较研究,为阐明栀子的炮制原理和栀子饮片的合理应用提供科学依据。方法:采用抗炎、镇静、凝血及化学性肝损伤等指标,观察生栀子、焦栀子50%和95%部位作用的差别。结果:生栀子、焦栀子50%和95%部位对小鼠炎症反应有较好的抑制作用,对小鼠镇静作用不明显,对四氯化碳造成的肝损伤没有保护作用,焦栀子95%部位有明显的促进血液凝固的作用。结论:生栀子、焦栀子两个洗脱部位抗炎作用较好,对镇静和肝损伤作用不明显。焦栀子95%部位凝血作用明显,有较好的止血功效。     

乳腺癌播散肿瘤细胞检测的临床应用

乳腺癌作为一种全身性疾病,在其病程早期即可检测出播散肿瘤细胞(DTC)。近年随着检测技术的发展成熟,检测敏感性、特异性均有所提高。该检测对于评价患者个体化疗效、指导临床分期、判断患者预后等方面均有着重要价值。     

青光眼滤过术后视网膜脱离的激光治疗临床观察

目的探讨青光眼滤过术后发生视网膜脱离进行激光治疗的临床疗效。方法对8例(8眼)青光眼滤过术后发生上方裂孔的孔源性视网膜脱离的患者未采用手术治疗,而是先通过合适的体位及双眼包扎后,当视网膜下液全部或大部分吸收后采用了激光封闭视网膜裂孔的方法。结果随访6月～1年,8例视网膜均复位,且未破坏青光眼滤过手术的效果。结论对于青光眼滤过术后上方视网膜裂孔的孔源视网膜脱离,通过合适的体位及双眼包扎后,当视网膜下液全部或大部分吸收后可采用激光封闭视网膜裂孔,不用手术治疗,以避免因手术治疗而破坏抗青光眼手术的效果。