Clinical Hemorheology and Microcirculation - Volume 55, issue 4

Authors: Csorba, Roland | Yilmaz, Asli | Tsikouras, Panagiotis | Wieg, Christian | Teichmann, Alexander | von Tempelhoff, Georg-Friedrich

Article Type: Research Article

Abstract: INTRODUCTION: Previous studies have dealt with maternal blood rheology in preeclampsia (PE), but only a few focused on the fetal rheological parameters in this maternal state. PE is one of the most common severe complications of pregnancy world-wide associated with high maternal morbidity and mortality and intrauterine fetal growth restriction. Our objective was to explore the rheological parameters in the umbilical cord blood at term in the presence of moderate and severe forms of PE. METHODS: A subgroup analysis was performed in a community based retrospective study of 4,951 consecutively recorded singleton pregnant women of whom 423 had PE. In …the latter, umbilical cord blood was collected during delivery for testing of hematological and blood rheological parameters of their fetus. Fetal results from uneventful pregnancy were compared with those associated with preeclampsia. Furthermore, results were also evaluated in the presence of moderate and severe forms of PE. Plasma viscosity (pv) was examined using KSPV 1 Fresenius and Red Blood Cell (RBC) aggregation (stasis: E0 and low shear: E1) using MA1-Aggregometer; Myrenne. RESULTS: According to the definition of the German Society of Gynecology and Obstetrics (DGGG) 314 women had moderate (74.2%), while 109 had severe forms of PE due to the presence of a blood pressure > 170/110 mmHg (n = 41; 9.7%), and/or IUGR < 5th percentile (n = 28; 6.6%), and/or HELLP-Syndrome (n = 10; 2.4%), and/or proteinuria ≥ 5 g/24 h (n = 30; 7.1%). When comparing the fetal results from pregnancies with and without preeclampsia mean hemoglobin values (p < 0.001) and hematocrit (p < 0.001) were markedly higher, while plasma viscosity (p = 0.006) and erythrocyte aggreagtion (stase: p = 0.35; low shear: p = 0.08) were lower in association with preeclampsia. Gestational age, fetal birth-weight and umbilical arterial cord blood pH in women with severe PE was statistically significant lower as compared to those with moderate disease (p < 0.001). Mean hemoglobin level and hematocrit were higher in fetus from women with severe compared to moderate PE, while plasma viscosity (1.03 ± 0.07 mPas vs. 1.05 ± 0.07; p = 0.05) and erythrocyte aggregation in stase (2.3 ± 2.47 vs. 2.41 ± 2.46; p = 0.11) as well as under low shear (7.86 ± 4.63 vs. 8.06 ± 4.60; p = 0.15) were lower. HELLP-Syndrome was associated with the lowest plasma viscosity (1.00 ± 0.07 mPas; p = 0.019) and erythrocyte aggregation (low shear: 5.1 ± 5.0; p = 0.04) in fetus. CONCLUSION: The results of this study including a notable number of patients with PE and their newborns revealed an in part statistically significant association between variables of blood rheology and the presence, severity and type of preeclampsia with a trend towards hyperviscosity in severe forms of preeclampsia. The behaviour of blood rheological components in the neonate is remarkable since the number of red blood cells is raised while RBC aggregability and plasma viscosity is low. Show more

Keywords: Pregnancy, preeclampsia, fetal hemorheology, plasma viscosity, red blood cell aggregation

DOI: 10.3233/CH-131776

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 391-401, 2013

Authors: Agha, A. | Jung, E.M. | Janke, M. | Hornung, M. | Georgieva, M. | Schlitt, H.J. | Schreyer, A.G. | Strosczcynski, C. | Schleder, S.

Article Type: Research Article

Abstract: To evaluate the impact of high-resolution contrast-enhanced ultrasound (CEUS), Color Coded and Power Doppler Sonography (CCDS/PD), in the preoperative recognition of thyroid adenomas. A total of 64 patients (36 female, median age 54 years) underwent surgery for thyroid adenoma. CEUS with linear multifrequency probes (6–9 or 6–15 MHz) and CCDS/PD was performed in all patients preoperatively by an experienced examiner and images were stored in PACS. Reading of the ultrasound images was performed in consensus by two experienced radiologists. Histopathology was achieved as standard of reference in all patients. Median diameter of the tumor lesions was 27 mm. 31 nodules …were found on the left side. In B-Scan mode 13 (20%) adenomas showed complex cystic echo pattern and 44 (69%) had a complete and sharp hypoechoic edge. 43 (67%) thyroid adenomas had strong hypervascularization in CCDS/PD. In 61 (95%) adenomas early contrast enhancement was present in CEUS and 50 (78%) adenomas proved no wash-out or central wash-out with persisting edge enhancement. In 47 (73%) cases early contrast enhancement was combined with no washout or with central wash-out with persisting edge enhancement. 45 (70%) thyroid lesions had preoperatively been classified as benign lesions correctly. Dynamic evaluation of microcirculation by CEUS and CCDS/PD enables a more reliable preoperative characterization of thyroid adenomas. Show more

Keywords: CEUS, power doppler, ultrasound, thyroid adenoma

DOI: 10.3233/CH-131777

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 403-409, 2013

Authors: Jung, F. | Leithäuser, B. | Landgraf, H. | Jünger, M. | Franzeck, U. | Pries, A. | Sternitzky, R. | Franke, R.P. | Forconi, S. | Ehrly, A.M.

Article Type: Research Article

Abstract: Back scattered Laser Doppler (LD) signals are composed of two different individual signals. The number of the moving particles and the speed of the particles in the measured tissue volume determine the frequency shift and the band width of the Doppler signal. The dependence of the Laser Doppler flux on the number of scattering particles is highly nonlinear: at very low hematocrit and high speed the axial migration of the cells to the centre of the blood vessels is very strong, so that in these cases – because of the parabolic flow profile - the Doppler flux measurement overestimates the …mean real blood flow (up to two- or three-fold). The opposite is the case when the hematocrit is very high, then the blood flow might be underestimated (due to the increased amounts of blood cells near the vessel wall). In addition, a very change in number of moving particles - as can occur during the postprandial phase or during therapy - can change the signal also at a constant cell number. Also, it must be mentioned that the LD signal possibly is not only reflected by moving blood cells in the different skin layers but also by blood cells flowing in tissues below the skin (particularly below atrophied skin areas of older patients) so that in such cases the LD Flux signal reflects not exclusively the skin blood flow. Therefore, LD flux at rest may still be within the normal range even in advanced states of disease, since the scattered light is sampled from a tissue volume which may contain also non-nutritive shunt vessels. This critical analysis of the LD signals of course shall not lead to an overall rejection of the application of laser Doppler systems. Actual progress only can, however, be obtained under the exact consideration of anatomical conditions, technical restrictions and when generalizations are avoided. Show more

Keywords: Microcirculation, laser doppler measurements, cutaneous

DOI: 10.3233/CH-131778

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 411-416, 2013

Authors: Heibl, M. | Jung, E.M. | Beyer, L. | Wohlgemuth, W.A. | Stroszczynski, C. | Wiggermann, P.

Article Type: Research Article

Abstract: PURPOSE: To evaluate tumor perfusion by means of dynamic contrast-enhanced ultrasonography (DCEUS) and aggregated time intensity curves (TICs) after transarterial chemoembolization with degradable starch microspheres (DSM-TACE). MATERIAL AND METHODS: 18 patients underwent 36 DCEUS examinations conducted via contrast agent application before and after DSM-TACE. Based on time intensity curves (TICs), we analyzed the microcirculation of the embolized HCC lesions with a dedicated perfusion software. RESULTS: Signal intensity was significantly reduced (p ≤ 0.001) after DSM-TACE at all time points measured. The mean signal intensity after 5, 10, 15, 20 and 25 s was 375.18 ± 16.41, 455.66 ± 17.92, 294.47 …± 19.91, 246.51 ± 20.99 and 173.45 ± 25.80 before TACE and 49.47 ± 2.43, 49.51 ± 2.40, 37.40 ± 2.45, 27.48 ± 2.65 and 27.96 ± 3.01 after TACE. CONCLUSION: In this study, tumor perfusion could be accurately evaluated by means of DCEUS and aggregated TICs after DSM-TACE. Show more

Keywords: HCC, DSM-TACE, DCE-US, TIC

DOI: 10.3233/CH-131779

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 417-421, 2013

Authors: Al-Banna, N.A. | Toguri, J.T. | Kelly, M.E.M. | Lehmann, Ch.

Article Type: Research Article

Abstract: Leukocyte-endothelial interactions within the microvasculature represent a hallmark of inflammation regardless of whether the inflammation results from non-infectious or infectious triggers. In this review, we highlight features of leukocyte recruitment in ocular disease and postulate mechanisms by which the infiltrating cells may lead to the progression of the ocular inflammatory response, including cytokine and chemokine production, T cell or non-T cell responses. Additionally, ex-vivo and in vivo methods used to study the general features of the immune response are discussed, with a specific focus on intravital imaging, which allows real-time non-invasive examination of leukocyte-endothelial interactions in the ocular microvasculature. At …the present time there are still significant gaps in our understanding of the process of leukocyte recruitment in vivo in different microvascular beds. Further studies using non-invasive imaging approaches, such as intravital microscopy, provide an opportunity to study dynamic tissue-specific leukocyte-endothelial interactions in vivo and identify novel targets for early intervention in the inflammatory process. This knowledge is essential to the rational use of therapeutics to resolve inflammation in ocular disease. Show more

Keywords: Ocular microcirculation, leukocyte-endothelium interaction, infection, inflammation, leukocyte infiltration, intravital microscopy

DOI: 10.3233/CH-131780

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 423-443, 2013

Authors: Wilbring, Manuel | Ebner, Annette | Schoenemann, Katrin | Knaut, Michael | Tugtekin, Sems Malte | Zatschler, Birgit | Waldow, Thomas | Alexiou, Konstantin | Matschke, Klaus | Deussen, Andreas

Article Type: Research Article

Abstract: OBJECTIVE: Several studies have addressed the optimal storage conditions for vascular grafts during surgery. The results remain contradictionary. This may be attributed to the fact, that the various vascular beds have a different sensitivity to storage. We analyzed the impact of storage in isotonic saline solution (NaCl) or heparinized blood the vascular functions of human saphenous vein grafts. Special care was taken to choose storage conditions which are relevant for intraoperative storage of a saphenous vein graft in a setting of coronary artery bypass grafting with vein and internal mammary artery as grafts. METHODS: Intraoperatively isolated V. saphena-segments (n = …36) were stored in NaCl or heparinized blood for approximately 30 minutes at room temperature. Subsequently, the segments were examined in a Mulvany-myograph. Following preconstriction with norepinephrine, concentration-relaxation curves were assessed for bradykinin and sodium-nitroprusside to assess developed vessel-wall tension as well as endothelium- and smooth-muscle-cell dependent vasorelaxation. The availability of adenosintriphosphate (energy charge) was determined based on liquid chromatography measurements of nucleotide tissue levels. RESULTS: Mean storage time was 27.4 ± 2.4 min in NaCl- and 26.3 ± 2.7 min in blood-group, respectively. After this period, receptor-dependent and-independent maximum of developed vessel wall tension was significantly reduced in NaCl-group (p = 0.05 and p = 0.045, respectively). Furthermore, the energy charge was significantly (p = 0.046) better preserved after blood storage (74 ± 1%) in comparison to NaCl-group (68 ± 2%). Endothelium-induced vasodilatation in response to bradykinin reached only 12.3 ± 2.5% in NaCl-group, but 19.3 ± 5.2% in blood-group (p = 0.033). Alike, EC50 -concentration of bradykinin for half-maximal relaxation was significantly lower in blood- than in NaCl-group (log EC50 −7.08 ± 0.3 and −5.91 ± 0.4; respectively; p = 0.046). Endothelium-independent smooth muscle relaxation in response to sodium-nitroprusside was not different between both groups. CONCLUSION: Heparinized blood better preserves vascular contractile and endothelial functions of the saphenous vein graft. Storage in NaCl rapidly compromises vascular functions and impaires cellular energy. NaCl should no longer be recommended for intraoperative storage of harvested V. saphena grafts. Show more

Keywords: CABG, saphenous vein graft, endothelial vascular function, preservation, storage solution, blood

DOI: 10.3233/CH-131781

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 445-455, 2013

Authors: Waldow, T. | Szlapka, M. | Haferkorn, M. | Bürger, L. | Plötze, K. | Matschke, K.

Article Type: Research Article

Abstract: After withdrawal of aprotinin in 2008 only tranexamic acid (TxA, Cyclocapron, Pfitzer, Germany) remains available as antihyperfibrinolytic agent in Europe. Dosage (from 1 g to 20 g) and application strategy (single shot i.v., infusion i.v., topical) reflect an indiscriminate use of TXA in cardiac surgery. We use data analysis of three registries to evaluate safety issues and sufficiency of different TxA dosages in our center. METHODS: Registry 1: Single shot ultra-low dose TxA (1 g in priming volume). Registry 2: Single shot medium dose TxA (5 g in priming volume). Registry 3: Single shot medium dose TxA (3 g in …priming volume) and continuous, weight-adapted administration during cross clamping. Independence of surgeon's preference was achieved by changing dosage every surgery day regardless of operation schedule. RESULTS: Data analysis was carried out on 1182 consecutive, elective patients (1 g TxA n = 415; 3 g + x g TA n = 367; mean TxA dose 4.4 g ± 1.0 g; 5 g TxA n = 400). Patient characteristics were well matched in all three registries (mean age: 69 ± 9.5y, BMI 28.2 ± 4.7, Creatinin 107.5 ± 52.8 μM), as were performed surgical procedures (excluding organ transplantation). Postoperative data showed no significant differences for blood loss and major adverse events (1 g vs. 3 + g vs. 5 g: blood loss: 894 ± 1479 vs. 903 ± 1282 vs. 1004 ± 1604 ml; stroke: 1.5 vs. 1.6 vs. 1.5%; myocardial infarction 2.7 vs. 3.3 vs. 1.3%; 30d mortality 3.9 vs. 4.2 vs. 4.8%, respectively). Secondary endpoints (de novo dialysis, transfusion requirement, ICU and total treatment time) showed no significant differences between registries. CONCLUSION: Use of 1 g TxA is safe and sufficient for elective patients with on pump cardiac surgery and thus has been established as strategy of choice in our center. Show more

DOI: 10.3233/CH-131782

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 457-468, 2013

Authors: Gerk, U. | Mrowietz, C.

Article Type: Research Article

Abstract: The data on the viscosities of radiographic contrast media (RCM) in the literature diverge, sometimes considerably. A direct comparative study of RCM appears reasonable and necessary, since different studies have been based on the assumption of the correctness of historical data from the literature. RCM viscosities in the literature differ for one and the same contrast medium by up to 19.1%. Therefore, the measurement of these substances was carried out in terms of their viscosity with the same device under identical experimental conditions at virtually the same time. Of the 15 investigated RCMs, the viscosities were in 9 cases higher …than the highest specification in the literature, the values were in the range of literature in three substances, and in three cases the values were a little below the lowest values in literature. Show more

Keywords: Radio contrast media, viscosity, cardiology

DOI: 10.3233/CH-131783

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 469-472, 2013

Authors: Hiebl, B. | Hopperdietzel, C. | Hünigen, H. | Dietze, K. | Klein, S. | Schreier, B. | Jung, F.

Article Type: Research Article

Abstract: It is well known that clinically relevant concentrations of iodine-containing radiographic contrast media (CM) induce morphological changes in human erythrocytes. However, there are only few reports about CM effects on erythrocytes of animals (e.g. mice, rats, rabbits, and pigs). Thus, two conventional iodine-containing CM (iodixanol, Visipaque™ 320; iomeprol, Iomeprol™ 350) were tested for their effects on the morphology of erythrocytes from these. After venous blood sampling and blood centrifugation, the autologous plasma was supplemented with 40 vol% CM. Then, a defined number of erythrocytes was incubated in this CM-supplemented plasma for 5 min at body temperature (37°C). Subsequently, 10 μL …of the cell suspension were transferred to a purified glass slide and the number of discocytes, echinocytes, and acanthocytes was counted within a total number of 100 erythrocytes (40 fold primary magnification, transmitted light mode). Shape changes of the erythrocytes from all animal species strongly depended on the type of CM and compared to the effects which have already been described for human erythrocytes. Incubation in both CM resulted in morphological changes of the erythrocytes. Incubation in a iodixanol/plasma mixture induced the lowest echinocyte or acanthocyte formation. Porcine erythrocytes showed a much more distinct shape change than those of other animal species and humans. These results suggest erythrocytes from mice, rats, and rabbits are a suitable model system for human erythrocytes when CM effects on the cellular shape of erythrocytes have to be tested. The distinct deformation of the pig erythrocytes could be due to differences in the pig erythrocyte membrane or the physical and chemical constitution of pig erythrocytes. Show more

Keywords: Erythrocytes, laboratory animals, radio contrast media

DOI: 10.3233/CH-131784

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 473-479, 2013

Authors: Franke, R.P. | Scharnweber, T. | Fuhrmann, R. | Krüger, A. | Wenzel, F. | Mrowietz, C. | Jung, F.

Article Type: Research Article

Abstract: A type-dependent chemotoxic effect of radiographic contrast media on erythrocytes and endothelial cells was reported several times. While mechanisms of toxicity are still unclear the cellular reactions e.g. echinocyte formation in erythrocytes and the buckling of endothelial cells coincided with deterioration of capillary perfusion (in patients with coronary artery disease) and tissue oxygen tension (in the myocardium of pigs). Whether the shape changes in erythrocytes coincide with changes in the arrangement of actin, the core of the actin-spectrin cytoskeletal network and possible actor in membrane stresses and deformation is not known until now. To get specific informations actin was stained …using two different staining methods (antibodies to β-actin staining oligomeric G-actin and polymeric F-actin and Phalloidin-Rhodamin staining polymeric F-actin only). In addition, an advanced version of confocal laser scanning microscopes was used enabling the display of the actin arrangement near substrate surfaces. Blood smears were produced after erythrocyte suspension in autologous plasma or in two different plasma/RCM mixtures. In this study an even homogenous distribution of fine grained globular actin in the normal human erythrocyte could be demonstrated. After suspension of erythrocytes in a plasma/Iodixanol mixture an increased number of membrane protrusions appeared densely filled with intensely stained actin similar to cells suspended in autologous plasma, however, there in less numbers. Suspension in Iopromide, in contrast, induced a complete reorganization of the cytoskeletal actin: the fine grained globular actin distribution disappeared and only few, long and thick actin filaments bundled and possibly polymerized appeared, instead, shown here for the first time. Show more

Keywords: Erythrocyte, actin, membrane cytoskeleton, human, Iodixanol, Iopromide

DOI: 10.3233/CH-131789

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 4, pp. 481-490, 2013