Standard vs. point-of-care measurement of fibrinogen: potential impact on clinical decisions.

BACKGROUND: Intraoperative major bleeding is a common complication during surgery and can lead to the transfusion of blood products and/or procoagulant drugs. This is a therapeutic challenge, and adherence to guidelines is desirable to preserve blood product resources. The intraoperative administration of fibrinogen concentrate, a pro-coagulant drug, in bleeding patients might reduce the use and therefore the risks associated with blood products. METHODS: In this observational pilot study we determined whether fibrinogen measured by point-of-care thromboelastometry (Rotem®, fibtem-test) would lead to a similar therapeutical decision concerning the administration of fibrinogen concentrate when compared to the standard method (Clauss). RESULTS: Blood samples of 36 patients undergoing major surgery were simultaneously analyzed using both methods. According to the cutoff values of current guidelines based on the standard method, no patient would receive fibrinogen concentrate. In comparison, if point-of-care thromboelastometry were used and its cutoff for fibrinogen applied, 16 patients (44%, P<0.001) would receive fibrinogen concentrate. CONCLUSION: The method used for intraoperative coagulation monitoring has a major impact on therapeutic decisions concerning the use of blood products and/or pro-coagulant drugs. If fibrinogen was measured by point-of-care thromboelastometry instead of the standard method according to Clauss, the use of fibrinogen concentrate would increase significantly and less fresh frozen plasma would be administered.

[Psychosocial aspects of bilateral subcutaneous reduction mastectomy in breast cancer]. / Psychosoziale Aspekte der beidseitigen subkutanen Reduktionsmastektomie bei Mammakarzinom.

The authors administered a questionnaire to 56 women with breast cancer who had bilateral subcutaneous mastectomies after Stroembeck/Beller since 1985. In this study, psychological aspects were investigated. There was no change in social behavior; isolation was not noticed. The negative effects on the body image were well accepted and discussed with relatives and friends. Psychological or emotional suffering was rare compared to patients with simple mastectomy. No change in sexual behavior was reported. The sexual function of the mamillae was significantly reduced. Although some cosmetic deformities were obvious, most patients would again choose the subcutaneous reduction mastectomy as operation of choice.

New model of cerebral thrombosis in dogs.

Experimental in situ thrombosis of the middle cerebral artery was produced in dogs by use of intravasally placed copper coils, which subsequently gave rise to an obstructing autologous thromboembolus. The resulting thrombosis was produced in the middle or rostral cerebral artery within 5-15 minutes after delivery of the thrombogenic device. The correlation of location of the coil in the intracranial vasculature of the internal carotid artery with the anatomic distribution of resulting cerebral infarcts suggests that this experimental model can produce a selective acute local occlusion of cerebral vessels in a high proportion of dogs without violating the cranium. The composition of the autologous thromboembolus, the low mortality rate, and the excellent reproducibility will make the correlative study of thrombolytic agents and their therapeutic efficacy possible.

[Experimental thrombolysis of thromboembolisms in the middle cerebral artery circulatory area]. / Experimentelle Thrombolyse von Thrombembolien im Arteria-cerebri-media-Stromgebiet.

Since the majority of ischaemic cerebral infarcts is caused by thromboemboli, we determined the benefit of fibrinolytic therapy in acute stroke. Thromboemboli were induced in the middle cerebral artery of 21 dogs. Urokinase was started at different time intervals after infarction (1, 3 and 5 hours) at a rate of 1000 IU/kg/min. Angiographically controlled thrombolysis was achieved in all 15 treated cases, whereas in the control group (n = 6) no case of recanalisation was observed. Systemic fibrinolysis occurred in all cases. Postmortem examinations of the brains showed no intracerebral haemorrhages. Our findings indicate that urokinase treatment may be of value in acute ischaemic stroke.

Treatment of vertebrobasilar insufficiency. Use of calcium antagonists.

The influence of various calcium-entry blockers on the vestibular system was investigated. This paper reports results from animal experiments and also from clinical studies with Flunarizine and Nimodipine. An animal experimental model of vertebrobasilar insufficiency was developed. The effect of these drugs on vestibular nystagmus was studied in Alsatian dogs before and after occluding one vertebral artery. In order to analyse the influence of these drugs on the vestibular nystagmus and on the clinical symptoms in patients with vertebrobasilar insufficiency, different open and double-blind studies were performed.

Calcium antagonists in an animal model of vertebrobasilar insufficiency.

Vertigo as a symptom of vertebrobasilar insufficiency (VBI) is a serious clinical problem in elderly patients. Recent epidemiologic studies have shown that patients with VBI run the same risk of developing complete cerebral infarction as do patients with TIAs. In order to study the efficacy of calcium antagonists in vertebrobasilar insufficiency, an animal model of VBI was developed by occluding one vertebral artery with a balloon catheter. Judging by the reversal of the nystagmic pattern of petite ecriture, the calcium antagonists flunarizine and nimodipine are effective drugs in this animal model of VBI.

[Thrombolysis of cerebral thromboembolism by urokinase in an animal model]. / Untersuchungen zur Thrombolyse zerebraler Thrombembolien mittels Urokinase an einem Tiermodell.

The majority of ischemic cerebral insults are caused by thromboembolism. In animal experiments we have investigated the possibility of reperfusing ischemically damaged brain tissue by thrombolysis of cerebral emboli. 1, 3 and 5 hours after cerebral infarction due to thromboembolism, thrombolytic treatment with urokinase (1000 IU/kg/min) was started. Thrombolysis, monitored by angiography, was successful in all cases (n = 15). In all cases the fall in fibrinogen, alpha 2-antiplasmin and plasminogen reflected systemic fibrinolytic effects. Anatomo-pathologic investigation of the brains revealed no intracerebral bleeding complications. The results of the study suggest a favourable effect of urokinase on acute ischemic cerebral infarction.

Development of a subacute tetraparesis after disulfiram intoxication. Case report.

A chronic alcoholic was intoxicated with the excessive dose of 25 g of disulfiram and developed a subacute flaccid tetraparesis and an associated encephalopathy. The severity of the clinical picture is partly explained by malnourishment including folate and vitamin B12 deficiency. The clinical, electrophysiological and pathological examinations are in accordance with the concept of a central-peripheral distal axonopathy.

Alveolar macrophages after chronic tobacco smoke inhalation and after artificial respiratory therapy for acute pulmonary failure.

To determine possible characteristic changes of alveolar macrophages, we used light and electron microscopy to study 25 lung biopsy specimens from patients who had received respiratory therapy or from chronic inhalative smokers. In addition to investigating the density and size of the alveolar macrophages and the number and size of their inclusion bodies, we also performed a histochemical analysis of these cells. In lungs of chronic smokers and of patients who had received respiratory therapy for adult respiratory distress syndrome, the number of alveolar macrophages was 8-10 fold above normal. The macrophages differed in size and shape and were characterized by a variety of heterogeneous inclusions. However, a comparative analysis of the alveolar macrophages showed no significant differences in density, cell diameter, or number and size of the inclusion bodies. In some so-called smokers' macrophages, crystalline inclusion bodies could be demonstrated, probably kaolinite. Fifteen morphologically different inclusion bodies were observed in alveolar macrophages. With the exception of inclusions characteristic of lipid phagocytosis, e.g., myelin structures, erythrocytes, and kaolinite crystals, there was no correlation between the ultrastructure of the storage granules and the phagocytized material. These findings indicate that the activation of the alveolar macrophages of the lung is an unspecific reaction to exogeneous (cigarette smoke) and endogenous (accumulation of cell detritus or fibrin) stimulation. Organic substances are degraded to amorphous, sometimes lipophilic structures. The presence of anorganic foreign bodies like kaolinite crystals permits histochemical and histophysical conclusions about the phagocytized material which can not be decomposed in the lysosomes.(ABSTRACT TRUNCATED AT 250 WORDS)

MULTIVARIATE ANALYSIS OF CONCEPTS INDUCED FROM BOUNDED PREDICATIVE VALUE-STATEMENTS.

A conceptual domain was sampled by eliciting own-words statements from 267 college atudents with a domain-bunding question-What is a bad thing to do? Bath respondent produced 10 predicative examples (descriptions of behavior he thought belonged in the domain) but could explicitly disqualify no idea. From the elicited statements, E induced a set of internally consistent, mutually exclusive, emergent concepts by putting statements together that, in E's judgment, said or meant the same thing. 11 different indices of interconcept association (across persons) were tested and evaluated. A 73-concept matrix of association indices was factor-analyzed. Concepts were progressively excluded by objective rules until an interpretable, simple-struoture solution was obtained wit41 31 concepts, comprising 62% of the data.