Trimix instead of air, decreases the effect of short-term hyperbaric exposures on platelet and fibrinolysis activation.

PURPOSE: Short-term and saturated simulated dives followed by decompression with air, cause a decrease in platelet count and increased activation of fibrinolysis. The aim of this study was to determine whether short-term dives with trimix as a breathing mixture induce the activation of platelets, and/or fibrinolysis. MATERIAL AND METHODS: 30 male divers were subjected to short-term hyperbaric exposures to 0.7 MPa. Thirty divers used air and then the same divers used trimix as a breathing mixture. RESULTS: The mean platelet count dropped significantly after decompression only in the group breathing air. The number of CD62P positive platelets and the amount of platelet-derived micro particles were statistically significant higher after decompression in both exposures. The number of CD61 positive platelets increased significantly only in the group breathing air. We observed a significant decrease of factor XII and fibrinogen concentrations after decompression only in the group breathing air. A significant increase in the concentration of plasminantiplasmin complex in both groups was detected. CONCLUSIONS: Short-term hyperbaric exposure and decompression performed according to current safety standards activates platelets and the fibrinolytic system. Trimix protects divers from a reduction in the amount of platelets, fibrinogen and factor XII in the course of these exposures.

[The role of infusion fluids and blood derived preparations during the perioperative period]. / Miejsce plynów infuzyjnych i krwiopochodnych w okresie okolooperacyjnym.

The treatment with infusion fluids in perioperative period is a basic therapeutic method. Depending on clinical situation, the doctor has various fluids available, both blood-replacing, and blood-derived. The number of crystaloid and colloidal fluids used has been systematically growing in two last decades. Ever more importance, beside the 0.9% NaCl solution and Ringer's solution used, is gaining 7.5% NaCl solution and hydroxyethyl starch solutions. The production of hydroxyethyl starch solutions in Poland has created an alternative to the use of dextran and gelatin solutions. The change towards treatment with blood components has caused the change of the strategy of therapeutic management of patients used as yet. For compensation of oxygen demand during blood loss, erythrocyte concentrate is commonly used. Such management requires blood-clotting factor monitoring. Hypofibrinogenaemia develops earlier than deficiencies of the remaining blood-clotting factors and later than thrombocytopenia. The use of fresh frozen plasma (FFP) is the first step in the treatment of pathological bleeding in surgically treated patients. The occurrence of thrombocytopenia shows great individual variability. Thrombocyte concentrate transfusion should be performed after laboratory determination of thrombocyte count.

[Therapeutic plasma exchange with particular regard to the perioperative period]. / Lecznicza wymiana osocza ze szczególnym uwzglednieniem okresu okolooperacyjnego.

The end of the last decade of the XXth century caused that therapeutic plasma exchanges have found an important place in the therapeutic management of many pathological conditions. This was possible owing to the knowledge of the pathophysiology of many diseases and pathological factors present in circulation. Therapeutic plasma exchange is the procedure during which pathological substances are removed from patient's circulation without causing anaemia and oncotic pressure disturbances. The procedures are carried out in order to eliminate pathological components of the plasma. Therefore, the general indication to plasma exchange are disease entities, the pathogenesis of which depends on plasma composition abnormalities. The understanding of the mechanisms of action of therapeutic plasma exchange, pathogenesis of certain diseases, and results of controlled studies of procedure effectiveness made possible to establish the indications to the procedure. In view of varying indications to therapeutic plasma exchange, in the paper these indications are discussed which are of importance in perioperative period. In clinical practice, therapeutic plasma exchange in myasthenia gravis has been applied, among other, in acute states in order to stabilize patient's condition after thymectomy or during preparation for thymectomy. The resistance occurring to preparations of blood-clotting factors is the cause of their ineffectiveness in control of bleeding. Application of plasma exchange and removal of antibodies make possible to achieve sensitivity of patient's organisms to exogenous blood-clotting factors. Good effects were observed in the treatment of hepatic coma in which application of the procedures frequently enables survival until performing transplantation. Therapeutic plasma exchange is the method of symptomatic treatment. The procedures may enable or facilitate management of patients in preoperative or postoperative periods but they cannot cause permanent cure.

[Therapeutic plasma exchanges with cyclophosphamide in the treatment of rapidly progressing glomerulonephritis]. / Skojarzenie leczniczej wymiany osocza z cyklofosfamidem w leczeniu gwaltownie postepujacego klebuszkowego zapalenia nerek.

On the basis of two cases of rapidly progressive glomerulonephritis with over 50% crescents in percutaneous renal biopsy, anti-GBM antibodies in one case and progressive renal failure in both cases, successful treatment with plasma exchanges and aggressive immunosuppression according to our own protocol is presented and discussed with literature.

[Plasmapheresis in neurology -- personal experience]. / Plazmafereza w neurologii--doswiadczenia wlasne.

Since the time of its first therapeutic application in 1956 plasmapheresis has been accepted in neurology in the treatment of life-threatening conditions in autoimmune diseases. The own experience has based on 30 cases treated by this method: 15 cases of Guillain-Barré syndrome, 9 of myasthenia, 3 cases of polyneuropathies of unknown origin, 1 case of dermatomyositis, 1--Fischer syndrome, 1--multiple sclerosis. Twelve patients were in very serious condition with rapidly progressing deterioration. Plasmapheresis was carried out in the acute stage of the disease, possibly early. During one procedure 100-150% of plasma volume was exchanged. The therapeutic course comprised 4-5 procedures. The result was very good in 10 cases, and good in 16. In 3 cases no effect was obtained (Guillain-Barré syndrome and polyneuropathy) and one patient died (carcinomatous polyneuropathy). Plasmapheresis is the method of choice in serious neurological states in Guillain-Barré syndrome and myasthenia.

[Lupus nephritis with nephrotic syndrome successfully treated with plasmapheresis and cyclophosphamide]. / Toczniowe zapalenie klebków nerkowych z zespolem nerczycowym skutecznie leczone skojarzeniem plazmaferez leczniczych z cyklofosfamidem.

In a 45 years woman with advanced nephrotic syndrome in the course of SLE IgM nephropathy, transient renal failure made the continuation of the conventional steroid therapy impossible. Applied as a saving life therapy, plasmapheresis followed by i.v. pulses of cyclophosphamide, caused resolution of lupus nephritis. Since the withdrawal of cyclophosphamide, the patient has been observed for 18 month, showing no evidence of recurrence of lupus nephritis.