Mathematical model describing erythrocyte sedimentation rate. Implications for blood viscosity changes in traumatic shock and crush syndrome.

BACKGROUND: The erythrocyte sedimentation rate (ESR) is a simple and inexpensive laboratory test, which is widespread in clinical practice, for assessing the inflammatory or acute response. This work addresses the theoretical and experimental investigation of sedimentation a single and multiple particles in homogeneous and heterogeneous (multiphase) medium, as it relates to their internal structure (aggregation of solid or deformed particles). METHODS: The equation system has been solved numerically. To choose finite analogs of derivatives we used the schemes of directional differences. RESULTS: (1) Our model takes into account the influence of the vessel wall on group aggregation of particles in tubes as well as the effects of rotation of particles, the constraint coefficient, and viscosity of a mixture as a function of the volume fraction. (2) This model can describe ESR as a function of the velocity of adhesion of erythrocytes; (3) Determination of the ESR is best conducted at certain time intervals, i.e. in a series of periods not exceeding 5 minutes each; (4) Differential diagnosis of various diseases by means of ESR should be performed using the aforementioned timed measurement of ESR; (5) An increase in blood viscosity during trauma results from an increase in rouleaux formation and the time-course method of ESR will be useful in patients with trauma, in particular, with traumatic shock and crush syndrome. CONCLUSION: The mathematical model created in this study used the most fundamental differential equations that have ever been derived to estimate ESR. It may further our understanding of its complex mechanism.

Autonomic function in hypertensive patients with neurovascular compression of the ventrolateral medulla oblongata.

OBJECTIVE: To study whether abnormalities of autonomic function exist in patients with essential hypertension and neurovascular compression (NVC) of the medulla oblongata. SUBJECTS AND METHODS: We studied 25 untreated patients with essential hypertension (13 men and 12 women, 27-74 years old). High-resolution magnetic resonance imaging and magnetic resonance angiography were used to detect NVC. Twenty-four-hour ambulatory monitoring of blood pressure and electrocardiogram were performed, and the power spectrum of heart rate variability was analyzed. On a separate day, various autonomic activity tests, including mental stress, hand grip, cold pressor, and Valsalva maneuver were performed. Baroreflex sensitivity was calculated from changes of blood pressure and R-R interval during phenylephrine infusion. A clonidine suppression test was also performed, with measurement of plasma catecholamine levels. RESULTS: Fourteen of 25 patients (56%) had NVC (C group), and 11 patients did not have NVC (NC group). There were no significant differences in age, sex, family history, or duration of hypertension between the C and NC groups. Average 24-h systolic blood pressure was similar between the two groups, although 24-h diastolic blood pressure was higher in the C group than the NC group. Daytime, night-time, and 24-h heart rate was significantly higher in the C group than in the NC group. Night-time low frequency/high frequency ratio was slightly higher in the C group. Plasma norepinephrine levels were significantly higher (467 +/- 217 versus 299 +/- 122 pg/ml), and baroflex sensitivity was slightly lower in the C group than in the NC group. Responses of blood pressure and heart rate to mental stress, cold pressor, hand grip, Valsalva maneuver, phenylephrine infusion, and clonidine tests were not significantly different between the two groups. CONCLUSIONS: NVC of the medulla oblongata was frequently found in patients with essential hypertension. Patients with NVC appeared to have enhanced sympathetic nervous activity compared with those without the compression.

Cervical radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: historical and histological evaluation of attendant inflammation.

Deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the yellow ligament occasionally leads to neurological deficits through compression of the spinal cord. Although it is widely accepted that CPPD crystal induces severe inflammation in arthropathy, little attention has been paid to the acute inflammation that may accompany the CPPD crystals in the ligamentum flavum. The present study reviews eight patients with radiculomyelopathy due to calcification of the cervical yellow ligament. Acute inflammation of the yellow ligament accompanying the crystalline deposits, both with and without attendant granulation tissue-proliferation, was evaluated as contributing to cervical radiculomyelopathy. Three cases with attendant granulation tissue suffered from recurrent attacks of neck pain and fever with coincidental radicular pain in the upper arm. The local inflammation of the ligamentum flavum might have participated in the exacerbation of the cervical radiculopathy.

Exertional compartment syndrome in covert mild hemophilia. A case report.

A 37-year-old white male experienced unexpected postoperative bleeding after fasciotomy and decompression for left pronator and compartment syndromes of the forearm. He was subsequently diagnosed with a mild form of hemophilia A. One year later, surgery was required for right pronator and compartment syndromes. Pre- and postoperative cryoprecipitate infusions controlled bleeding following the second operation until the patient discontinued his infusions, resulting in a wound hematoma. Covert mild hemophilia is implicated in the pathogenesis of his compartment syndromes.

[Femoral nerve lesion in heparin therapy]. / Nervus femoralis-Läsion unter Heparintherapie.

Two case reports on femoral nerve lesion due to hematoma in the iliopsoas muscle or as the case may be in the iliacus muscles on both sides are presented with review of the literature. Synopsis of the reported cases--certainly a minority of anticoagulant therapy complications nevertheless increasingly mentioned in the literature--suggests that there might be a higher risk of bleeding for women within the first week of so-called high-dose heparin therapy. Coagulation studies do not contribute essentially in preventing retroperitoneal haematoma since they are within therapeutic limits in many cases. So clinical observation is crucial in the diagnosis of this complication of heparin therapy, which might occur more frequently under concomitant administration of acetacylic acid. Early surgical decompression of the femoral nerve seems to provide better results seen on follow-up than conservative treatment, especially in patients with rapid onset of severe limb weakness.

Rhabdomyolysis following total hip arthroplasty.

We report six cases of contralateral limb involvement during total hip arthroplasty including swelling of the gluteal muscle compartments, rhabdomyolysis, myoglobinuria, and sciatic nerve palsy. The risk factors for such complications include obesity, prolonged operative time, and positioning in the lateral decubitus position. The laboratory and clinical findings are consistent with a gluteal muscle crush-injury with consequent compartment syndrome. The patients should be treated conservatively as symptoms can be expected to resolve.

Plasma and cerebrospinal fluid concentrations of indomethacin in humans. Relationship to analgesic activity.

Plasma and cerebrospinal fluid (CSF) concentrations of indomethacin have been determined in 52 patients hospitalized for nerve-root compression pain. Samples of blood and CSF were collected at the same time in each subject, 0.5 to 12 h after a single intramuscular injection of 50 mg indomethacin. Analgesic effect was assessed by the absolute and percentage variation in Huskisson's visual analogue scale between dosing and sampling. According to its high lipid solubility, indomethacin rapidly crossed the blood-brain barrier, being detected in CSF 0.5 h after administration. After attainment of equilibrium within 2 h, the CSF level exceeded the free plasma level. Since the drug was extensively bound to serum albumin (99.7 +/- 0.1%), this phenomenon may represent a slight degree of binding of indomethacin in CSF. The analgesic activity was not related to either the plasma or CSF concentration of indomethacin.

[Lactate dehydrogenase and creatine kinase activity in nerve compression and myodystrophic syndromes of lumbar osteochondrosis]. / Aktivnost' laktatdegidrogenazy i kreatinkinazy pri kompressionno-nevral'nykh i miodistroficheskikh sindromakh poiasichnogo osteokhondroza.

The blood serum lactate dehydrogenase (LDH), creatine kinase (CK), and LDH isoforms activities have been measured in 103 patients with the compression neural and myodystrophic syndromes of lumbar osteochondrosis. The studies have revealed a relationship between the myodystrophic process severity and the intensity of LDH and CK ejection from the muscle into the blood, particularly in the trigger stage. The shift of LDH activity towards the predominance of slowly migrating isoforms augments and the total blood serum LDH and CK activities grow as the muscular syndrome progresses. These data permit a differentiation between the compression neural and the myodystrophic syndromes, as well as between the algic and the trigger stages of muscle involvement. Such a differentiation does not involve biopsy in many cases.

Spinal cord compression in multiple myeloma: who gets it?

Of 97 Chinese patients with multiple myeloma seen over a 12-year period, 23.7% were found to have cauda equina or spinal cord compression (SCC). Predictive features for SCC include paraprotein type, hemoglobin level, and the extent of bone lesion at initial hematological diagnosis. A discriminant function derived from this analysis can be used to predict the likelihood of SCC with 79% accuracy. It is postulated that when the cortex is more involved than the medulla in a vertebra, it will predispose to SCC while hemopoiesis is relatively preserved. Our patients presented late with advanced neurological deficit so that treatment was unsatisfactory. It is emphasised that early recognition of back pain and neurological symptoms is essential, as any delay would jeopardize the chance of neurological recovery.

[Hydroxocobalamin treatment of hypercyanemia and hypercyanuria following sciatic nerve compression in rabbits]. / Traitement par l'hydroxocobalamine del l'hypercyanémie et de l'hypercyanurie consécutives à la compression du nerf sciatique chez le Lapin.

Compression of sciatic nerve of rabbits with an inoxidizable clip increases free and combinated cyanides levels both in blood and urine in days following the operation. A treatment with hydroxocobalamin decreases them significantly.