A probable fatal argon gas embolism during resection of a cutaneous biliary fistula - a case report / Provável embolia letal por gás argônio durante ressecção de fístula cutânea biliar - relato de caso

Abstract Background: The Argon Beam Coagulator (ABC) achieves hemostasis but has potential complications in the form of argon gas embolisms. Risk factors for embolisms have been identified and ABC manufacturers have developed guidelines for usage of the device to prevent embolism development. Case report: A 49 year-old male with history of recurrent cholangiocarcinoma status post resection presented for resection of a cutaneous biliary fistula. Shortly after initial use of the ABC, the patient underwent cardiac arrest. After resuscitation, air bubbles were observed in the left ventricle via Transesophageal Echo (TEE). Conclusion: Although argon embolisms have been described more commonly during laparoscopies, this patient most likely experienced an argon gas embolism during an open resection of a cutaneous biliary fistula via the biliary tract or vein with possible transpulmonary passage of the embolism. Consequently, a high degree of suspicion should be maintained for an argon gas embolism during ABC use in laparoscopic, open, and cutaneous surgeries.

Resumo Introdução: A Coagulação por Feixe de Argônio (CFA) promove hemostasia, mas pode levar a complicações na forma de embolia por gás argônio. Os fatores de risco para embolias foram identificados e os fabricantes de aparelhos de CFA desenvolveram diretrizes para o uso do dispositivo para impedir a ocorrência de embolia. Relato de caso: Paciente masculino de 49 anos com história de colangiocarcinoma recorrente pós-ressecção foi submetido à ressecção de fístula cutâneo-biliar. Logo após o início do uso do aparelho de CFA, o paciente apresentou parada cardíaca. Após o retorno da atividade cardíaca, a Eecocardiografia Transesofágica (ETE) detectou bolhas de ar no ventrículo esquerdo. Conclusões: Embora a embolia associada ao argônio seja mais frequentemente descrita durante laparoscopia, este paciente mais provavelmente apresentou embolia provocada pelo argônio durante cirurgia aberta para ressecção de fístula cutâneo-biliar, após o argônio ganhar acesso à circulação sanguínea através das vias biliares ou da veia biliar e possível passagem do êmbolo pela circulação pulmonar. Desta maneira, deve-se suspeitar de embolia por argônio, de forma judiciosa, durante o uso de CFA em procedimento cirúrgico laparoscópico, aberto ou cutâneo.

Effects of Salvia miltiorrhiza-Volatile Oil of Dalbergia odorifera on Blood Lipid and Blood Coagulation System in Coronary Heart Disease Myocardial Ischemia Miniature Swine with Blood Stasis Syndrome / 中国药房

OBJECTIVE:To observe the effects of Salvia miltiorrhiza-volatile oil of Dalbergia odorifera on blood lipid and blood coagulation system in coronary heart disease myocardial ischemia miniature swine with blood stasis syndrome. METHODS:A total of 18 swine were randomly divided into sham operation group (routine feed),model group (routine feed) and S.miltiorrhiza-volatile oil of D. odorifera group(1 g/kg S. miltiorrhiza+0.1 mL/kg oil of D. odorifera,mixing administration),for consecutive 8 weeks. At 4th week,coronary heart disease myocardial ischemia model of blood stasis syndrome was established by Ameriod coarctation ring implantation in other 2 groups except for sham operation group. At 8th week,the syndrome of the model was observed according to coronary angiography and the macroscopic indications. At 2th,6th,8th week,intravenous blood was collected to test the serum levels of TC,TG,LDL-C,HDL-C,apolipoprotein A1(apoA1),apoB,PT,APTT,TT and FIB in miniature swine. RESULTS:At 6th,8th week,compared with sham operation group,serum levels of TC,TG,LDL-C,apoB and FIB were increased in model group,while PT,APTT and TT were shortened and the levels of HDL-C and apoA1 were decreased,with statistical significance(P<0.05 or P<0.01). Compared with model group,the serum levels of TC,TG,LDL-C and apoB were decreased in S. miltiorrhiza-volatile oil of D. odorifera group,while PT,APTT and TT were prolonged and the levels of HDL-C and apoA1 were increased, with statistical significance (P<0.05 or P<0.01). CONCLUSIONS: The S.miltiorrhiza-volatile oil of D. odorifera could reduce blood lipid and improve blood coagulation system index disorder in coronary heart disease myocardial ischemia miniature swine with blood stasis syndrome.

Interaction between Paracoccidioides brasiliensis conidia and the coagulation system: involvement of fibrinogen

The infectious process starts with an initial contact between pathogen and host. We have previously demonstrated that Paracoccidioides brasiliensis conidia interact with plasma proteins including fibrinogen, which is considered the major component of the coagulation system. In this study, we evaluated the in vitro capacity of P. brasiliensis conidia to aggregate with plasma proteins and compounds involved in the coagulation system. We assessed the aggregation of P. brasiliensis conidia after incubation with human serum or plasma in the presence or absence of anticoagulants, extracellular matrix (ECM) proteins, metabolic and protein inhibitors, monosaccharides and other compounds. Additionally, prothrombin and partial thromboplastin times were determined after the interaction of P. brasiliensis conidia with human plasma. ECM proteins, monosaccharides and human plasma significantly induced P. brasiliensis conidial aggregation; however, anticoagulants and metabolic and protein inhibitors diminished the aggregation process. The extrinsic coagulation pathway was not affected by the interaction between P. brasiliensis conidia and plasma proteins, while the intrinsic pathway was markedly altered. These results indicate that P. brasiliensis conidia interact with proteins involved in the coagulation system. This interaction may play an important role in the initial inflammatory response, as well as fungal disease progression caused by P. brasiliensis dissemination.

Study on the cytotoxicity against brain microvessel endothelial cells and blood compatibility in rat of OX26 conjugated endomorphin loaded HBPG-PLGA nanoparticles / 国际生物医学工程杂志

Objective To study the cytotoxicity against brain microvessel endothelial cells and blood compatibility in rats of OX26 conjugated endomorphin (EM) loaded hyperbranched polyglycerols-poly(lactic-co-glycolic acid)(HBPG-PLGA) nanoparticles.Methods Prepared nanoparticles were divided into group B (HBPG-PLGA nanoparticles),group EP (EM-HBPG-PLGA nanoparticles) and group OEP (OX26-EM-HBPG-PLGA nanoparticles).The cytotoxicity against brain microvessel endothelial cells (BMECs) of nanoparticles of different groups were measured by MTT test,haemolysis test,normal haemotological parameter and several primary items of coagulation system were tested after nanoparticles of different groups and different dosages injection on rats.Results ①All the three groups of nanoparticles induced decreased cell viability in a dose dependent manner in MTT test,whereas all groups of nanoparticles showed low cytotoxicity against the BMECs during 30 to 600 μg/ml.②There was no significant difference in haemolysis ratio (P＞0.05) and normal haemotological parameter (P＞0.05).③There was no significant difference between the low dosage of all the three groups of nanoparticles and the control group on the function of coagulation system in rats (P＞0.05).④Compared with C group,high dose groups demonstrated longer prothrombin time (PT),activeated partial thromboplasting time (APTT) and lower fibrinogen (Fbg) (P＜0.05).At the same time,compared with the low dose subgroups,PT and APTT were prolonged,Fbg significantly decreased in the high dose subgroups (P＜0.05 or P＜0.01).Conclusion OX26 coupled with EM-HBPG-PLGA nanoparticles showed low cytotoxicity against BMECs and had no significant effect on the coagulation system in rats with low concentration and low dosage.

The effection of Shenfu Injection (Ginseng-radix aconitum Injection) to the coagulation in the patient of multiple trauma complicated with shock / 中华急诊医学杂志

Objective To investigate the effection of Shenfu Injection (Ginseng-radix aconitum Injection)to the blood coagulation system and its prognosis in the patient of multiple trauma complicated with shock.Methods We prospectively studied 90 patients of multiple trauma complicated with shock,who came from the emergency center of the Second Affiliated Hospital of Medicine' s college of Zhe-Jiang University and emergency department of Lishui People' s Hospital from February 2007 to December 2011,and excluded those suffered with the dysfunction of coagulation system and uncontrolled ongoing bleeding before trauma.And then these eligible patients were randomly divided into two groups:treatment group ( 45 cases ) and control group (45 cases),the control group were received the routine treatment,the treatment group were received Shenfu Injection in early stage based on the routine treatment.The two groups were measured the platelet count (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB) before treatment and 3,7 days after treatment.Results The differences of the PLT,PT,APTT,TT,FIB between the treatment group and control group at 3,7 d after the treatment was statistically significant (P ＜ 0.05 ). Conclusions Shenfu Injection has positive regulation to the coagulation system in the patient of multiple trauma complicated with shock.

An antithrombin-dependent sulfated polysaccharide isolated from the green alga Caulerpa cupressoides has in vivo anti- and prothrombotic effects / Um polissacarídeo sulfatado dependente de antitrombina isolado da alga verde Caulerpa cupressoides possui efeitos anti- e pró-trombótico in vivo

Red algae sulfated polysaccharides (SPs) have been widely described as anticoagulant and antithrombotic agents; however no description of antithrombotic activity regarding green algae SPs has been reported. Caulerpa cupressoides (Chlorophyta) has three different SPs fractions (SP1, SP2 and SP3). We investigated the effects of SP2 on thrombin activity by antithrombin and in an experimental model of venous thrombosis in rats. The inhibition of thrombin assay was evaluated using antithrombin (AT) in the presence of SP2 and the antithrombotic activity was investigated in rats with thromboplastin as the thrombogenic stimulus. The anticoagulant effects of SP2 are suggested be due to the potentiation of thrombin inhibition by antithrombin (IC50 ~ 10.0µg mL-1) and this mechanism of interaction is different when compared to other studied Caulerpa polysaccharides. SP2 exhibited antithrombotic effects at doses of 1.0 and 2.0mg kg-1 body weight, but at higher doses (>2.0mg kg-1 body weight) this polysaccharide revert the antithrombotic property. No hemorrhagic effect (2.0mg kg-1) was observed. As occurs with red algae SPs, these results indicate that green algae SPs are also capable of exhibiting different in vivo properties.

Os polissacarídeos sulfatados (PSs) de algas vermelhas têm sido relatados mundialmente como agentes anticoagulantes e antitrombóticos. Entretanto, nenhuma descrição de atividade antitrombótica tem sido relacionada com os PSs de algas verdes. A clorofícea Caulerpa cupressoides possui três frações de PSs (PS1; PS2 e PS3). Dessa forma, objetivou-se investigar os efeitos da fração PS2 sobre a atividade da trombina por antitrombina e usando um modelo experimental de trombose venosa em ratos. O ensaio de inibição da trombina foi avaliado usando a antitrombina (AT) na presença de PS2 e a atividade antitrombótica foi investigada em ratos, usando a tromboplastina como o estímulo trombogênico. Os efeitos anticoagulantes de PS2 devem-se provavelmente à sua potência de inibir a trombina mediada pela AT (IC50 ~ 10,0µg mL-1) e esse mecanismo de interação é diferente, comparado ao de outros polissacarídeos de Caulerpa estudados. PS2 exibiu efeitos antitrombóticos nas doses de 1,0 e 2,0mg kg-1 peso corpóreo, mas em doses mais elevadas (>2,0mg kg-1 peso corpóreo) esse polissacarídeo exibe efeitos pró-trombóticos. Também não foi observado nenhum efeito hemorrágico (2,0mg kg-1). Assim como ocorre com os PSs de algas vermelhas, os resultados indicam que os PSs de algas verdes também possuem atividades biológicas distintas in vivo.

Introduction to Coagulation System

Coagulation involves the regulated sequence of proteolytic activation of a series of proteins to achieve appropriate and timely hemostasis in an injured vessel. In the non-pathological state, the inciting event involves exposure of circulating factor VIIa to extravascularly expressed tissue factor, which brings into motion the series of steps which results in cell based model of coagulation. In the new concepts of coagulation system, initiation, amplification and propagation steps are involved to converse of fibrinogen to fibrin. The precisely synchronized cascade of events is counter-balanced by a system of anticoagulant mechanisms. Developmental hemostasis refers to the age-related changes in the coagulation system that are most marked during neonate and childhood. An understanding of these changes in crucial to the accurate diagnosis of hemostatic abnormalities in neonate and children. This review aims to elucidate the main events within the coagulation cascade as it is currently understood to operate in vivo, and also a short review of the anticoagulants as they relate to this model. Also this paper describes the common pitfalls observed in the clinical data related to the coagulation system in neonate to children.

Comparison of Yangxue Qingnao Granule and Xueshuantong Capsule in adjusting abnormal coagulation system caused by migraine / 国际中医中药杂志

Objective To compare the effects of Yangxue Qingnao Granule and Xueshuantong Capsule on abnormal coagulation system in migraine patients. Methods All patients were divided into group A and group B according to sex. Each group contained 60 patients. Yangxue Qingnao Granule and Xueshuantong Capsule was administrated in group A and group B respectively. The adjusting functions of abnormal coagulation system of migraine patients in the two groups were compared.Results Xueshuantong Capsule was better than Yangxue Qinguao Granule in adjusting blood coagulation system (P< 0.05). Conclusion The clinical usage of Xueshuantong capsule has better effect than Yangxue Qingnao Granule on regulating abnormal blood coagulation system.

Dynamic Changes of Coagulation System Following Radiofrequency Catheter Ablation and Effect of Molecular Weight Heparin / 中国循环杂志

Objective:To investigate the dynamic changes of coagulation system following radiofrequency catheter ablation(RFCA) and effect of molecular weight heparin. Methods:Blood samples were collected at 6 different times to measure the thrombin-antithrombinⅢcomplex (TAT) and hepatocyte growth factor (HGF) in 60 RFCA candidates and 22 controls undergoing electrophysiological study (EPS).Patients were randomly divided into 2 groups.Low molecular weight heparin was given to 31 pationts (subgroup B) after RFCA,but not to the others (subgroup A). Results:①Plasma TAT exhibited a double peaked pattern in the subgroup A.The first peak occurred instantly after RFCA (42.8?15.7 ng/ml),and the second 3 days later (20.1?19.4 ng/ml).The second peak was significantly higher than that of the control group (2.7?1.5 ng/ml) and the subgroup B(4.3?5.2 ng/ml)(P

Coagulation-Fibrinolysis system in acute progressive and non-progressive stroke: Preliminary study

BACKGROUND & PURPOSE: Fibrinoeptide-A (FpA) and D-dimer have been well known as hematologic parameters for activation of the coagulation and the endogeneous fibrinolysis system during acute phase of ischemic stroke. We measured the levels of FpA and D-dimer in acute progressive and non-progressive ischemic strokes to assess whether these markers are valuable as a predictor of stroke progression during acute phase. METHODS: FpA (RIA method) and D dimer (ELISA method) were determined in 54 patients, 9 with acute progressive and 45 with non-progressive within acute stage(< 48 hours of onset) of cerebral infarction. RESULTS: Levels of FpA in patients with acute progressive stroke were significantly higher than those in patients with non-progressive stroke, indicating activation of the coagulation system (P = 0.013). And, levels of D-dimer in patients with acute progressive stroke were also higher than those in patients with non-progressive stroke but statistically insignificant(P-0.071). CONCLUSIONS: These findings suggest that the coagulation system is more enhanced in progressive stroke than non-progressive one during acute stage of ischemic stroke. Higher levels of FpA are thought to be useful markers to predict stroke in progression.