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Sample records for acute intravascular hemolysis

  1. The role of medical management for acute intravascular hemolysis in patients supported on axial flow LVAD.

    PubMed

    Hasin, Tal; Deo, Salil; Maleszewski, Joseph J; Topilsky, Yan; Edwards, Brooks S; Pereira, Naveen L; Stulak, John M; Joyce, Lyle; Daly, Richard; Kushwaha, Sudhir S; Park, Soon J

    2014-01-01

    Continuous flow left ventricular assist devices (LVADs) are used with good outcome. However, acute intravascular hemolysis due to thrombus in the pump remains a clinical challenge. We screened for LVAD-related intravascular hemolysis among 115 consecutive patients surviving HeartMateII implantation and investigated the role of medical therapy in resolving the hemolysis. Hemolytic events were identified in 7% of patients, 2-26 months after implant, manifested by peak lactate dehydrogenase (LDH) levels >6 times normal. With the institution of heparin and enhanced antiplatelet therapy, LDH levels receded rapidly reaching a stable trough level near baseline within 2 weeks with the resolution of clinical symptoms except in one patient who required additional therapy with tissue plasminogen activator (tPA). Complications included transient renal failure, one splenic infarct, and a cerebrovascular attack after tPA. The acute event of hemolysis resolved with medical therapy, and all were successfully discharged. However, recurrent hemolysis was common (6/8 patients over the next 1-7 months). At the end of follow-up, three patients were transplanted, one patient died refusing LVAD exchange for recurrent hemolysis, and 4 remained alive on LVAD support. Medical treatment with intensification of anticoagulation can be effective in resolving the acute hemolytic event. However, a definitive long-term strategy should be planned because the recurrence rate is high.

  2. Bothrops jararaca envenomation: Pathogenesis of hemostatic disturbances and intravascular hemolysis

    PubMed Central

    Senise, Luana V; Yamashita, Karine M

    2015-01-01

    To attain fully functional biological activity, vitamin-K dependent coagulation factors (VKDCF) are γ-carboxylated prior to secretion from liver. Warfarin impairs the γ-carboxylation, and consequently their physiological function. Bothrops jararaca snake venom (BjV) contains several activators of blood coagulation, especially procoagulant enzymes (prothrombin and factor X activators) and thrombin-like enzymes. In order to clarify the relative contribution of prothrombin and factor X activators to the hemostatic disturbances occurring during experimental B. jararaca envenomation, warfarin was used to deplete VKDCF, prior to BjV administration. Male Wistar rats were pretreated with saline (Sal) or warfarin (War) and inoculated subsequently with BjV or saline, thus forming four groups: Sal + Sal (negative control), Sal + BjV (positive control), War + Sal (warfarinization control), and War + BjV. Three hours after inoculation, prothrombin and factor X levels fell 40% and 50%, respectively; levels of both factors decreased more than 97% in the War + Sal and War + BjV groups. Platelet counts dropped 93% and 76% in Sal + BjV and War + BjV, respectively, and plasma fibrinogen levels decreased 86% exclusively in Sal + BjV. After 6 and 24 h, platelet counts and fibrinogen levels increased progressively. A dramatic augmentation in plasma hemoglobin levels and the presence of schizocytes and microcytes in the Sal + BjV group indicated the development of intravascular hemolysis, which was prevented by warfarin pretreatment. Our findings show that intravascular thrombin generation has the foremost role in the pathogenesis of coagulopathy and intravascular hemolysis, but not in the development of thrombocytopenia, in B. jararaca envenomation in rats; in addition, fibrinogenases (metalloproteinases) may contribute to coagulopathy more than thrombin-like enzymes. PMID:26080462

  3. Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection

    PubMed Central

    Karki, Pragya; Malik, Sarthak; Mallick, Bipadabhanjan; Sharma, Vishal; Rana, Surinder S

    2016-01-01

    Abstract Acute viral hepatitis is usually a self-limiting illness. However, it can lead to complications that can be life-threatening, such as acute liver failure. Glucose 6 phosphate dehydrogenase (G6PD) deficiency in the setting of acute viral hepatitis can lead to a massive hemolysis, manifesting as acute kidney injury and markedly raised bilirubin levels; although cases are rare. Here, we report such a case. The patient had a viral hepatitis E infection and presented with kidney injury requiring dialysis. Examination showed very high mixed hyperbilirubinemia due to massive intravascular hemolysis. The patient experienced a long, protracted course of illness, requiring renal replacement therapy with other supportive management, which led to improvement over a period of four weeks. This case highlights the importance of recognizing associated hemolysis in a patient with viral hepatitis who presents with very high bilirubin levels or associated kidney injury. Such patients will require aggressive supportive care with prompt fluid and electrolyte management. PMID:28097104

  4. Massive intravascular hemolysis with mechanical rheolytic thrombectomy of a hemodialysis arteriovenous fistula.

    PubMed

    Carrera, Louis A; Reddy, Rachita; Pamoukian, Vicken N; Michelis, Michael F; DeVita, Maria V; Rosenstock, Jordan

    2013-01-01

    A 57-year-old man with chronic kidney disease stage 5 presented for ambulatory evaluation of his arteriovenous fistula. He underwent rheolytic thrombectomy with tissue plasminogen activator infusion, angioplasty, and brachial artery stenting under local sedation. His immediate postoperative course was complicated by hypotension, cardiac dysrhythmias and hyperkalemia requiring emergent hemodialysis, due to severe intravascular hemolysis. This case illustrates that mechanical thrombectomy can cause clinically significant intravascular hemolysis, thus careful postoperative monitoring is recommended.

  5. [Thrombotic microangiopathy and intravascular hemolysis in pregnancy-induced hypertension. The lie of HELLP syndrome].

    PubMed

    Díaz de León-Ponce, Manuel Antonio; Briones-Garduño, Jesús Carlos; Meneses-Calderón, José; Moreno-Santillán, Armando Alberto

    2006-01-01

    We reviewed the literature regarding pregnancy-induced hypertension and its relation with thrombotic microangiopathy and intravascular hemolysis (TMIH). In the present work we described the background, frequency, mortality, clinical picture, classification, diagnosis, complications and treatment. In addition, we analyzed Weinstein's report of 1982, and we concluded that the reported data of the HELLP syndrome is not conclusive because the presence of TMIH is not demonstrable in his group of patients. Also, we retrospectively reviewed the medical charts from three Intensive Care Units from two specialized gyneco-obstetrics hospitals and from one General Hospital. From all the patients with pregnancy-induced hypertension and who developed TMIH confirmed clinically and by laboratory findings, we described the incidence of acute renal failure and the mortality in this group of patients.

  6. Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis.

    PubMed

    Sugiura, Tetsuro; Okumiya, Toshika; Kubo, Toru; Takeuchi, Hiroaki; Matsumura, Yoshihisa

    2016-07-27

    Chronic intravascular hemolysis has been identified in patients with cardiac valve prostheses, but only a few case reports have evaluated intravascular hemolysis in patients with native valvular heart disease. To detect intravascular hemolysis in patients with aortic stenosis, erythrocyte creatine was evaluated with hemodynamic indices obtained by echocardiography.Erythrocyte creatine, a marker of erythrocyte age, was assayed in 30 patients with aortic stenosis and 10 aged matched healthy volunteers. Peak flow velocity of the aortic valve was determined by continuous-wave Doppler echocardiography. Twenty of 30 patients with aortic stenosis had high erythrocyte creatine levels (> 1.8 µmol/g Hb) and erythrocyte creatine was significantly higher as compared with control subjects (1.98 ± 0.49 versus 1.52 ± 0.19 µmol/g Hb, P = 0.007). Peak transvalvular pressure gradient ranged from 46 to 142 mmHg and peak flow velocity ranged from 3.40 to 5.95 m/second. Patients with aortic stenosis had a significantly lower erythrocyte count (387 ± 40 versus 436 ± 42 × 10(4) µL, P = 0.002) and hemoglobin (119 ± 11 versus 135 ± 11 g/L, P < 0.001) as compared with control subjects. Erythrocyte creatine had a fair correlation with peak flow velocity (r = 0.55, P = 0.002).In conclusion, intravascular hemolysis due to destruction of erythrocytes was detected in patients with moderate to severe aortic stenosis and the severity of intravascular hemolysis was related to valvular flow velocity of the aortic valve.

  7. [Intravascular lymphoma causing acute abdomen].

    PubMed

    Kröber, S M

    2007-02-01

    A 65-year old man presented with acute abdominal pain and fever. The initial diagnosis was small bowel gangrene. Pathology revealed small to large abdominal vessels obliterated by cells of intravascular B-cell-lymphoma (IVL). Visceral IVL involvement is common at autopsy but rarely reported in patients with acute abdomen. The subtype of diffuse large B-cell lymphoma is a rare and aggressive malignancy, which in typical cases is characterized by cephalic or cutaneous manifestation. Few cases showed involvement of large vessels which in combination to fibrin thrombi may lead to infarction of the organ involved. Thus IVL should be considered in cases of ischemic diseases with fever of unknown origin.

  8. Thermal injury, intravascular hemolysis, and toxic oxygen products.

    PubMed Central

    Hatherill, J R; Till, G O; Bruner, L H; Ward, P A

    1986-01-01

    Acute thermal injury of rat skin produces an early, acute hemoglobinemia that is associated with the presence in blood of osmotically fragile red cells (RBC) that do not contain on their surfaces measurable amounts of complement components. The hemoglobinemia and the appearance in blood of osmotically fragile RBC appear to be the result of complement activation, which leads to oxygen radical production by neutrophils and damage of RBC. This has been demonstrated in vitro as well as in vivo by the ability of antioxidant interventions or neutrophil or complement depletion procedures to prevent the appearance of osmotically fragile RBC and the release of hemoglobin. These data may be relevant to the complications of hemoglobinemia and hemoglobinuria accompanying thermal injury in humans. PMID:3745430

  9. Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage

    PubMed Central

    Vermeulen Windsant, Iris C.; de Wit, Norbert C. J.; Sertorio, Jonas T. C.; van Bijnen, Annemarie A.; Ganushchak, Yuri M.; Heijmans, John H.; Tanus-Santos, Jose E.; Jacobs, Michael J.; Maessen, Jos G.; Buurman, Wim A.

    2014-01-01

    Introduction: Acute kidney injury (AKI) and intestinal injury negatively impact patient outcome after cardiac surgery. Enhanced nitric oxide (NO) consumption due to intraoperative intravascular hemolysis, may play an important role in this setting. This study investigated the impact of hemolysis on plasma NO consumption, AKI, and intestinal tissue damage, after cardiac surgery. Methods: Hemolysis (by plasma extracellular (free) hemoglobin; fHb), plasma NO-consumption, plasma fHb-binding capacity by haptoglobin (Hp), renal tubular injury (using urinary N-Acetyl-β-D-glucosaminidase; NAG), intestinal mucosal injury (through plasma intestinal fatty acid binding protein; IFABP), and AKI were studied in patients undergoing off-pump cardiac surgery (OPCAB, N = 7), on-pump coronary artery bypass grafting (CABG, N = 30), or combined CABG and valve surgery (CABG+Valve, N = 30). Results: FHb plasma levels and NO-consumption significantly increased, while plasma Hp concentrations significantly decreased in CABG and CABG+Valve patients (p < 0.0001) during surgery. The extent of hemolysis and NO-consumption correlated significantly (r2 = 0.75, p < 0.0001). Also, NAG and IFABP increased in both groups (p < 0.0001, and p < 0.001, respectively), and both were significantly associated with hemolysis (Rs = 0.70, p < 0.0001, and Rs = 0.26, p = 0.04, respectively) and NO-consumption (Rs = 0.55, p = 0.002, and Rs = 0.41, p = 0.03, respectively), also after multivariable logistic regression analysis. OPCAB patients did not show increased fHb, NO-consumption, NAG, or IFABP levels. Patients suffering from AKI (N = 9, 13.4%) displayed significantly higher fHb and NAG levels already during surgery compared to non-AKI patients. Conclusions: Hemolysis appears to be an important contributor to postoperative kidney injury and intestinal mucosal damage, potentially by limiting NO-bioavailability. This observation offers a novel diagnostic and therapeutic target to improve patient outcome after

  10. Acute Disseminated Intravascular Coagulation in Neuroendocrine Carcinoma

    PubMed Central

    Teh, Ru-Wen; Tsoi, Daphne T.

    2012-01-01

    Malignancy is a common cause of disseminated intravascular coagulation and usually presents as a chronic disorder in solid organ tumours. We present a rare case of recurrent acute disseminated intravascular coagulation in neuroendocrine carcinoma after manipulation, firstly, by core biopsy and, later, by cytotoxic therapy causing a release of procoagulants and cytokines from lysed tumour cells. This is reminiscent of tumour lysis syndrome where massive quantities of intracellular electrolytes and nucleic acid are released, causing acute metabolic imbalance and renal failure. This case highlights the potential complication of acute disseminated intravascular coagulation after trauma to malignant cells. PMID:23139666

  11. Hemolysis

    MedlinePlus

    ... eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 161. Gallagher PG. Red blood ... Basic Principles and Practice . 6th ed. Philadelphia, PA: Elsevier; 2013:chap 43. Michel M. Autoimmune and intravascular ...

  12. Warm autoimmune hemolytic anemia with mimicking anti-e specificity causing intravascular hemolysis in a chronic ITP patient.

    PubMed

    Datta, Suvro Sankha; Reddy, Mahua; Basu, Sabita

    2015-10-01

    A 12-year-old male child presented to the emergency room with three days history of cola-colored urine, mild icterus, dyspnea, palpitation and fatigue. He had a history of chronic ITP two years ago and had since been on steroid for maintenance of platelet count. He was subsequently diagnosed as a case of warm autoimmune hemolytic anemia. Laboratory investigations were suggestive of intravascular hemolysis, and on immuno-hematological evaluation it was diagnosed that the patient had autoantibody with mimicking anti-e specificity. The specificity of autoantibody was further confirmed by adsorption study. The patient was successfully managed by transfusion of Rh(e)-negative red cells,steroid and rituximab therapy. So an autoantibody with mimicking anti-e specificity was identified in this case, which was significant in clinical point of view.

  13. A hemolysis study of an intravascular blood cooling system for localized organ tissue cooling.

    PubMed

    Merrill, T L; Mingin, T; Merrill, D R; Botbyl, J; Akers, J E

    2013-01-01

    Therapeutic hypothermia can reduce both ischemic and reperfusion injury arising after strokes and heart attacks. New localized organ cooling systems offer a way to reduce tissue damage more effectively with fewer side effects. To assess initial blood safety of our new organ cooling system, the CoolGuide Cooling System (CCS), we investigated safe operating conditions and configurations from a hemolysis perspective. The CCS consists of a peristaltic pump, a custom-built external heat exchanger, a chiller, biocompatible polyvinyl cellulose (PVC) tubing, and a control console. The CCS cools and circulates autologous blood externally and re-delivers cooled blood to the patient through a conventional catheter inserted directly into the organ at risk. Catheter configurations used included: a 7F guide catheter only, a 7F guide with a 0.038" wire inserted through the center and advanced 2 cm distal to the catheter distal tip, a 6F guide catheter only and a 6F guide with a 0.014" guidewire similarly inserted through the center. Using porcine blood, an in vitro test rig was used to measure the degree of hemolysis generation, defined as the percentage change in free hemoglobin, adjusted for total hemoglobin and hematocrit, between exiting and entering blood. The highest degree of hemolysis generation was 0.11±0.04%, based on the average behavior with a 6F catheter and a 0.014" guidewire configuration at a blood flow rate of approximately 130 mL/min. In terms of average percentage free hemoglobin exiting the system, based on total hemoglobin, the highest value measured was 0.17%±0.03%, using this 6F and 0.014" guidewire configuration. This result is significantly below the most stringent European guideline of 0.8% used for blood storage and transfusion. This study provides initial evidence showing hemolysis generation arising from the CoolGuide Cooling System is likely to be clinically insignificant.

  14. [Favism. Acute hemolysis after intake of fava beans].

    PubMed

    Holm, B; Jensenius, M

    1998-01-30

    Acute haemolysis due to Glucose-6-Phosphate-Dehydrogenase deficiency is a common disorder in American and African Blacks, in Mediterranean people and among Orientals. The erythrocytes in affected individuals have insufficient reducing power against toxic peroxydes and free radicals generated during metabolism. Normally, affected individuals are without signs of disease, but under the influence of oxydants severe intravascular haemolysis may occur. One of the most important oxydants is the fava bean which, when ingested, may cause acute favism, a condition which has a 10% mortality if not treated properly. We describe a 35 year-old man from Iraq who developed serious haemolytic anemia with a fall in haemoglobin to 6.5 g/100 ml three days after ingestion of fava beans. He was treated with intravenous fluids and blood transfusions. He recovered and was discharged from hospital after nine days. This is the first described case of favism in Norway.

  15. Investigation of whether the acute hemolysis associated with Rho(D) immune globulin intravenous (human) administration for treatment of immune thrombocytopenic purpura is consistent with the acute hemolytic transfusion reaction model

    PubMed Central

    Gaines, Ann Reed; Lee-Stroka, Hallie; Byrne, Karen; Scott, Dorothy E.; Uhl, Lynne; Lazarus, Ellen; Stroncek, David F.

    2012-01-01

    BACKGROUND Immune thrombocytopenic purpura and secondary thrombocytopenia patients treated with Rho(D) immune globulin intravenous (human; anti-D IGIV) have experienced acute hemolysis, which is inconsistent with the typical presentation of extravascular hemolysis—the presumed mechanism of action of anti-D IGIV. Although the mechanism of anti-D-IGIV–associated acute hemolysis has not been established, the onset, signs/symptoms, and complications appear consistent with the intravascular hemolysis of acute hemolytic transfusion reactions (AHTRs). In transfusion medicine, the red blood cell (RBC) antigen-antibody incompatibility(-ies) that precipitate AHTRs can be detected in vitro with compatibility testing. Under the premise that anti-D-IGIV–associated acute hemolysis results from RBC antigen-antibody–mediated complement activation, this study evaluated whether the incompatibility(-ies) could be detected in vitro with a hemolysin assay, which would support the AHTR model as the hemolytic mechanism. STUDY DESIGN AND METHODS Seven anti-D IGIV lots were tested to determine the RBC antibody identities in those lots, including four lots that had been implicated in acute hemolytic episodes. Hemolysin assays were performed that tested each of 73 RBC specimens against each lot, including the RBCs of one patient who had experienced acute hemolysis after anti-D IGIV administration. RESULTS Only two anti-D IGIV lots contained RBC antibodies beyond those expected. No hemolysis endpoint was observed in any of the hemolysin assays. CONCLUSION Although the findings did not support the AHTR model, the results are reported to contribute knowledge about the mechanism of anti-D-IGIV–associated acute hemolysis and to prompt continued investigation into cause(s), prediction, and prevention of this potentially serious adverse event. PMID:19220820

  16. Cardiopulmonary Bypass is Associated with Hemolysis and Acute Kidney Injury in Neonates, Infants and Children

    PubMed Central

    Mamikonian, Lara S.; Mamo, Lisa B.; Smith, P. Brian; Koo, Jeannie; Lodge, Andrew J.; Turi, Jennifer L.

    2014-01-01

    Objective This pilot study assesses the degree of hemolysis induced by cardiopulmonary bypass (CPB) and determines its association with acute kidney injury (AKI) in pediatric patients. Further, it evaluates the degree to which the use of urinary biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C correlate with the presence of AKI and hemolysis following CPB. Design Prospective observational study Setting A 13-bed pediatric cardiac intensive care unit in a university hospital Patients Children undergoing cardiac surgery with the use of CPB Interventions None Measurements and Main Results Blood and urine samples were obtained at multiple time points before and after CPB. Hemolysis was assessed by measuring levels of plasma hemoglobin and haptoglobin. AKI was defined as a doubling in serum creatinine from preoperative baseline and by using the pediatric-modified RIFLE criteria. Urinary NGAL and Cystatin C levels were measured. A total of 40 patients (range: 3 days to 4.8 years) were enrolled. Plasma hemoglobin levels increased markedly on separation from CPB with a concurrent decrease in haptoglobin. This was associated with an increase in protein oxidation in the plasma. Hemolysis was more evident in younger patients with a longer duration of bypass and in those requiring a blood-primed circuit. 40% of patients had a doubling in serum creatinine and 88% of patients developed acute kidney injury when defined by the pediatric-modified RIFLE criteria. Controlling for CPB time, persistently elevated levels of plasma hemoglobin were associated with a 5 fold increase in AKI. Further, urinary NGAL measured 2 hours after separation from CPB was associated with AKI and with elevations in plasma hemoglobin. Conclusions CPB in pediatric patients results in significant hemolysis, which is associated with the development of AKI. The biomarker NGAL correlates with both AKI and hemolysis in this population. PMID:24394997

  17. Disseminated intravascular coagulation and acute myocardial necrosis caused by lightning.

    PubMed

    Ekoé, J M; Cunningham, M; Jaques, O; Balague, F; Baumann, R P; Humair, L; de Torrenté, A

    1985-01-01

    A 24-year-old woman was struck by lightning and suffered 20% second degree burns. She was admitted after cardiac and respiratory arrest. Despite intensive supportive care she died 24 h later of cardiogenic shock complicated by disseminated intravascular coagulation. At autopsy there was myocardial necrosis. Disseminated intravascular coagulation and myocardial necrosis are only rarely described as complications of lightning.

  18. Intravascular hemolysis increases atherogenicity of diet-induced hypercholesterolemia in rabbits in spite of heme oxygenase-1 gene and protein induction.

    PubMed

    Fernandez, A Z; López, F; Tablante, A; Romano, E; Hurt-Camejo, E; Camejo, G; Apitz-Castro, R

    2001-09-01

    Free radical mediated oxidation of apoB lipoproteins in the arterial intima appears to contribute to atherogenicity of the entrapped particles. A plausible pathogenic mechanism for oxidation is the one induced by heme leaking from erythrocytes that is then carried into the arterial wall by its high affinity for lipoproteins. In the intima, in the presence of H(2)O(2) secreted by macrophages, heme can be a potent oxidant. To study the role of heme as a promoter of oxidative stress damage in vivo we used a model of intravascular hemolysis (IVH) caused by phenylhydrazine in rabbits with and without diet-induced moderate hypercholesterolemia (MHC). Evaluation of the antioxidant status of plasma indicated that at the end of the treatment period this was compromised by the MHC-IVH. After 10 weeks the animals with combined MHC-IVH showed more of the aorta surface covered by lesions (27%+/-8, mean (SD) than the animals with only MHC (11%+/-7), in spite of having similar plasma levels of VLDL+LDL lipoproteins. The animals with only IVH, as well as the controls, showed minimal lesions (<1%). Heme oxygenase (HO-1) expression in aorta and other tissues was markedly increased in the group with MHC-IVH and it was correlated with the extent of IVH. The data suggest that the oxidative stress associated with IVH potentiates the atherogenicity of moderate hypercholesterolemia and that in spite of a strong induction of HO-1 this is not sufficient to counteract the atherogenicity of the combined condition.

  19. The critical roles of platelet activation and reduced NO bioavailability in fatal pulmonary arterial hypertension in a murine hemolysis model

    PubMed Central

    Hu, Weiguo; Jin, Richard; Zhang, Jinyan; You, Tao; Peng, Zhihai; Ge, Xiaowen; Bronson, Roderick T.; Halperin, Jose A.; Loscalzo, Joseph

    2010-01-01

    Pulmonary arterial hypertension (PAH) is suspected to be a strong mortality determinant of hemolytic disorders. However, direct contribution of acute intravascular hemolysis to fatal PAH has not been investigated. The roles of nitric oxide (NO) insufficiency and platelet activation in hemolysis-associated fatal PAH have been suspected but not been experimentally studied. We recently generated a unique intravascular hemolysis mouse model in which the membrane toxin, intermedilysin (ILY), exclusively lyses the erythrocytes of transgenically expressing human CD59 mice (ThCD59RBC), thereby inducing ILY-dose–dependent massive hemolysis. Using this murine hemolysis model, we found that the acute increase in pulmonary arterial pressure leading to right ventricle failure caused sudden death. Reduced NO bioavailability and massive platelet activation/aggregation leading to the formation of massive thrombosis specifically in the pulmonary microvasculature played the critical roles in pathogenesis of acute hemolysis-associated fatal PAH. Therapeutic interventions enhancing NO bioactivity or inhibiting platelet activation prevented sudden death or prolonged survival time via the suppression of the acute increase in pulmonary arterial pressure and improvement of right ventricle function. These findings further highlight the importance of the inhibition of platelet activation and the enhancement of NO bioavailability for the treatment and prevention of hemolysis-associated (fatal) PAH. PMID:20511540

  20. Unsuspected glucose-6-phosphate dehydrogenase deficiency presenting as symptomatic methemoglobinemia with severe hemolysis after fava bean ingestion in a 6-year-old boy.

    PubMed

    Odièvre, Marie-Hélène; Danékova, Névéna; Mesples, Bettina; Chemouny, Myriam; Couque, Nathalie; Parez, Nathalie; Ducrocq, Rolande; Elion, Jacques

    2011-05-01

    We report the occurrence of symptomatic methemoglobinemia in a previously healthy boy, who presented with severe acute hemolysis after fava bean ingestion. The methemoglobinemia revealed a previously unrecognized glucose-6-phosphate dehydrogenase (G6PD) deficiency. We discuss the pathophysiology of severe methemoglobinemia when associated with acute hemolysis, favism, and the common African G6PD A-variant [G6PD, VAL68MET, ASN126ASP]. In conclusion, screening for G6PD deficiency must be considered in symptomatic methemoglobinemia, especially in young boys, when associated with intravascular hemolysis.

  1. Prophylactic strategies for acute hemolysis secondary to plasma-incompatible platelet transfusions: correlation between qualitative hemolysin test and isohemagglutinin titration

    PubMed Central

    Landim, Cinthia Silvestre; Gomes, Francisco Carlos Almeida; Zeza, Bernardete Martin; Mendrone-Júnior, Alfredo; Dinardo, Carla Luana

    2015-01-01

    Objective Brazilian legislation has recently suggested the use of the qualitative hemolysin test instead of isohemagglutinin titers as prophylaxis for acute hemolysis related to plasma-incompatible platelet transfusions. The efficacy of this test in preventing hemolytic reactions has never been evaluated while isohemagglutinin titers have been extensively studied. The main objective of this study was to evaluate the correlation between the results of these two tests. The impact of each type of prophylaxis on the platelet inventory management and the ability of the qualitative hemolysin test to prevent red cell sensitization after the transfusion of incompatible units were also studied. Methods A total of 246 donor blood samples were evaluated using both isohemagglutinin titers and the qualitative hemolysin test, and the results were statistically compared. Subsequently, 600 platelet units were tested using the hemolysin assay and the percentage of units unsuitable for transfusion was compared to historical data using isohemagglutinin titers (cut-off: 100). Moreover, ten patients who received units with minor ABO incompatibilities that were negative for hemolysis according to the qualitative hemolysin test were evaluated regarding the development of hemolysis and red cell sensitization (anti-A or anti-B). Results Isohemagglutinin titration and the results of qualitative hemolysin test did not correlate. The routine implementation of the qualitative hemolysin test significantly increased the percentage of platelet units found unsuitable for transfusions (15–65%; p-value <0.001). Furthermore the qualitative hemolysin test did not prevent red blood cell sensitization in a small exploratory analysis. Conclusion Qualitative hemolysin test results do not correlate to those of isohemagglutinin titers and its implementation as the prophylaxis of choice for hemolysis associated with plasma-incompatible platelet transfusions lacks clinical support of safety and

  2. Acute kidney injury and disseminated intravascular coagulation due to mercuric chloride poisoning

    PubMed Central

    Dhanapriya, J.; Gopalakrishnan, N.; Arun, V.; Dineshkumar, T.; Sakthirajan, R.; Balasubramaniyan, T.; Haris, M.

    2016-01-01

    Mercury is a toxic heavy metal and occurs in organic and inorganic forms. Inorganic mercury includes elemental mercury and mercury salts. Mercury salts are usually white powder or crystals, and widely used in indigenous medicines and folk remedies in Asia. Inorganic mercury poisoning causes acute kidney injury (AKI) and gastrointestinal manifestations and can be life-threatening. We describe a case with unknown substance poisoning who developed AKI and disseminated intravascular coagulation (DIC). Renal biopsy showed acute tubular necrosis. Later, the consumed substance was proven to be mercuric chloride. His renal failure improved over time, and his creatinine normalized after 2 months. PMID:27194836

  3. Sub-acute hemolysis in sickle cell mice causes priapism secondary to NO imbalance and PDE5 dysregulation

    PubMed Central

    Sopko, Nikolai A.; Matsui, Hotaka; Hannan, Johanna L.; Berkowitz, Dan; Champion, Hunter C.; Hsu, Lewis L.; Musicki, Biljana; Burnett, Arthur L.; Bivalacqua, Trinity J.

    2015-01-01

    Introduction Recent research suggests that priapism in Sickle Cell Disease (SCD) is due to dysregulation of penile erection homeostasis including alteration of nitric oxide synthase (NOS) and phosphodiesterase 5 (PDE5) activities by excessive levels of reactive oxygen species (ROS) released during hemolysis. It is unknown if sub-acute exposure to hemolysis is sufficient or if chronic reconditioning of erectile tissues is required for perturbation of homeostatic pathways and whether PDE5 inhibitor (PDE5I) treatment can restore erectile homeostasis in the sub-acute setting. Aims To investigate the effects of sub-acute hemolysis (3 month exposure) on priapism and NO pathway regulation. Methods Mice underwent bone marrow transplantation with either SCD (BM-SS) or wild type (WT) bone marrow. BM-SS mice were treated with sildenafil 100mg/kg/day. We measured intracavernous pressure (ICP) measurements with or without cavernosal nerve stimulation (CNS) following bone marrow transplantation to assess for priapism. Main Outcome Measures ICP and frequency of erections were assessed. Penile tissues were analyzed for NOS, PKG, PDE5, and ROS activities. Results BM-SS mice demonstrated a priapism phenotype. PDE5I treatment reduced the frequency of erections in BM-SS mice (1.7 ± 1.1 vs. 5.5 ± 2.8 erections/hour, p<0.05). Penile tissues from BM-SS mice demonstrated decreased NOS, PKG, PDE5 and elevated ROS activities compared to that of control mice. PDE5I treatment increased NOS (11.6 ± 1.3% vs. 7.8 ± 2.3%, p<0.05) and PDE5 (76.3 ± 9.8% vs. 52.3 ± 11.1%, p<0.05) activities and decreased ROS activity (137.8 ± 12.1% vs. 199.1 ± 11.3%, p<0.05) compared to non-PDE5I treated BM-SS mice. PKG activity was increased beyond control levels with PDE5I treatment (158.4 ± 10.3%, p<0.05). Conclusion Short-term hemolysis is sufficient to establish a priapism phenotype and results in loss of erectile function. PDE5I treatment ameliorates priapism, in part, due to restored NO balance with

  4. Aphrodisiac drug-induced hemolysis.

    PubMed

    Stalnikowicz, Ruth; Amitai, Yona; Bentur, Yedidia

    2004-01-01

    Volatile alkyl nitrites have been used during the past decades for "recreational purposes," and for intensifying sexual experience. Their use has been associated with methemoglobinemia and hemolysis. We report three patients who presented over the past year with acute hemolysis after inhalation of butyl nitrite, two of them had glucose-6-phosphate dehydrogenase (G6PD) deficiency.

  5. [Disseminated intravascular coagulation and acute kidney injury requiring renal replacement therapy after diagnostic amniocentesis].

    PubMed

    Ratković, Marina; Bašić-Jukić, Nikolina; Gledović, Branka; Radunović, Danilo

    2014-04-01

    Disseminated intravascular coagulation (DIC) is a very rare complication of amniocentesis. We present a case of a 33-year-old patient who developed DIC with acute respiratory distress syndrome and acute kidney injury after diagnostic amniocentesis. The patient required replacement of renal function for 59 days with continuous venovenous hemodiafiltration and later with hemodialysis. She was treated with heparin, fresh frozen plasma, platelets and cryoprecipitate. Her condition was further complicated with the development of intracranial hematoma. After 67 days of hospitalization, she was discharged from the hospital with serum creatinine 337 μmol/L. Three years later, her serum creatinine was 102 μmol/L, and she is currently in the 7th month of pregnancy.

  6. Target deletion of complement component 9 attenuates antibody-mediated hemolysis and lipopolysaccharide (LPS)-induced acute shock in mice

    PubMed Central

    Fu, Xiaoyan; Ju, Jiyu; Lin, Zhijuan; Xiao, Weiling; Li, Xiaofang; Zhuang, Baoxiang; Zhang, Tingting; Ma, Xiaojun; Li, Xiangyu; Ma, Chao; Su, Weiliang; Wang, Yuqi; Qin, Xuebin; Liang, Shujuan

    2016-01-01

    Terminal complement membrane attack complex (MAC) formation is induced initially by C5b, followed by the sequential condensation of the C6, C7, C8. Polymerization of C9 to the C5b-8 complex forms the C5b-9 (or MAC). The C5b-9 forms lytic or non lytic pores in the cell membrane destroys membrane integrity. The biological functionalities of MAC has been previously investigated by using either the mice deficient in C5 and C6, or MAC’s regulator CD59. However, there is no available C9 deficient mice (mC9−/−) for directly dissecting the role of C5b-9 in the pathogenesis of human diseases. Further, since C5b-7 and C5b-8 complexes form non lytic pore, it may also plays biological functionality. To better understand the role of terminal complement cascades, here we report a successful generation of mC9−/−. We demonstrated that lack of C9 attenuates anti-erythrocyte antibody-mediated hemolysis or LPS-induced acute shock. Further, the rescuing effect on the acute shock correlates with the less release of IL-1β in mC9−/−, which is associated with suppression of MAC-mediated inflammasome activation in mC9−/−. Taken together, these results not only confirm the critical role of C5b-9 in complement-mediated hemolysis and but also highlight the critical role of C5b-9 in inflammasome activation. PMID:27444648

  7. Thromboemboli, acute right heart failure and disseminated intravascular coagulation after intraoperative application of a topical hemostatic matrix.

    PubMed

    Ferschl, Marla B; Rollins, Mark D

    2009-02-01

    Topical hemostatic agents are frequently used in spine surgeries to control or reduce bleeding. Although there are a number of commercially available products, at our institution, an absorbable gelatin powder (Surgifoam) is mixed with bovine thrombin and used for this purpose. We report the case of a patient undergoing a posterior spinal fusion for scoliosis who developed acute right heart failure, cardiac arrest, and disseminated intravascular coagulation after probable intravascular hemostatic agent-induced emboli. Clinicians need to be aware of this potentially deadly complication associated with topical hemostatic agents.

  8. Acute Hemolysis with Renal Failure due to Clostridium Bacteremia in a Patient with AML

    PubMed Central

    Medrano-Juarez, R. M.; Sotello, D.; D'Cuhna, L.; Payne, J. D.

    2016-01-01

    We present a case of acute hemolytic anemia, renal failure, and Clostridium perfringens bacteremia in a patient with acute myelogenous leukemia. The high fatality of C. perfringens bacteremia requires that clinicians recognize and rapidly treat patients at risk for this infection. Although other hemolytic processes are in the differential diagnosis of these events, the presence of high fever, chills, and rapidly positive blood cultures may help narrow the diagnosis. Most cases of C. perfringens bacteremia have a concomitant coinfection, which makes broad spectrum empiric therapy essential. There is a high mortality rate of C. perfringens infections associated with leukemia. PMID:27774325

  9. Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome

    PubMed Central

    Kwon, Jee Eun; Mintz, Gary S.; Hong, Young Joon; Lee, Sung Yun; Kim, Ki Seok; Hahn, Joo-Yong; Kumar, Kaup Sharath; Won, Hoyoun; Hyeon, Seong Hyeop; Shin, Seung Yong; Lee, Kwang Je; Kim, Tae Ho; Kim, Chee Jeong; Kim, Sang Wook

    2016-01-01

    Background and Objectives We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice. Subjects and Methods Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05. Results A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29). Conclusion Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion. PMID:27482258

  10. Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts.

    PubMed

    Minakami, Hisanori; Morikawa, Mamoru; Yamada, Takahiro; Yamada, Takashi; Akaishi, Rina; Nishida, Ryutaro

    2014-03-01

    As proposed criteria (Swansea criteria) for the diagnosis of acute fatty liver of pregnancy (AFLP) do not include antithrombin (AT) activity, diagnosis of AFLP may be delayed. The aim of this review is to underscore problems in the differential diagnosis of AFLP and the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) and to facilitate prompt diagnosis of AFLP. Published works dealing with liver dysfunction in pregnancy, HELLP syndrome and AFLP were reviewed. AFLP and HELLP syndrome shared common clinical, laboratory, histological and genetic features, and differential diagnosis between them was often difficult. However, HELLP syndrome was likely to occur in patients with hypertension, but AFLP occurred often in the absence of hypertension. In addition, AFLP was exclusively associated with pregnancy-induced antithrombin deficiency (PIATD). Approximately 50% of patients with AFLP did not have thrombocytopenia at presentation. As the Swansea criteria for AFLP did not include PIATD, diagnosis of AFLP was delayed until manifestation of life-threatening complications; 60% of women were admitted to intensive care and 15% to a specialist liver unit. In conclusion, incorporation of AT activity of less than 65% into the diagnostic criteria for AFLP may facilitate suspicion and prompt diagnosis of AFLP, decrease uncertainty regarding the diagnosis of AFLP, and contribute to better investigation and understanding of the process leading to the development of liver dysfunction.

  11. [Role of genetic polymorphisms of the hemostatic system in the development of multiple organ dysfunctions in acute disseminated intravascular coagulation].

    PubMed

    Vorob'eva, N A; Kapustin, S I

    2007-01-01

    The paper deals with the hereditary predisposition of the hemostatic system to the severe course of acute disseminated intravascular coagulation (DIC). The results of evaluation of some types of genetic polymorphisms of the factors of coagulation and of the fibrinolytic system are recent and important for clinical application. Analysis of mortality in the fulminant course of acute DIC showed significant differences in the detection rates of the variants of genetic polymorphism in the type I plasminogen activator inhibitor gene, which is indicative of the possible genetic determination of acute DIC.

  12. Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is 'shock liver' the unrecognized provocateur of ischemic limb necrosis?

    PubMed

    Warkentin, T E; Pai, M

    2016-02-01

    For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multiorgan failure, and disseminated intravascular coagulation develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis ('limb gangrene with pulses'). Case reports have described preceding 'shock liver' in some critically ill patients who developed such a picture of ischemic limb necrosis. This suggests that profoundly disturbed procoagulant-anticoagulant balance featuring uncontrolled generation of thrombin-resulting from failure of the protein C and antithrombin natural anticoagulant systems due to insufficient hepatic synthesis of these crucial proteins-could explain the microvascular thrombosis and associated limb loss. We hypothesize that shock liver is the key predisposing risk factor underlying ischemic limb necrosis in the majority of patients who develop this complication in the setting of acute disseminated intravascular coagulation complicating septic or cardiogenic shock. As shock liver precedes onset of limb ischemia by several days, therapeutic intervention may be possible.

  13. [A case of cat-scratch-induced Pasteurella multocida infection presenting with disseminated intravascular coagulation and acute renal failure].

    PubMed

    Fukuchi, Takahiko; Morisawa, Yuji

    2009-09-01

    Domestic animals are the main reservoirs of Pasteurella species for human zoonosis due to bites and scratches. Pasterurella multocida may cause serious soft-tissue infection and, less commonly, sepsis or septic shock, particularly in insufficient initial therapy and an immunocompromised host. We report a case of cat-scratch-induced P. multocida infection, presenting with disseminated intravascular coagulation and acute renal failure. A febrile 83-year-old woman with consciousness disturbance and a subcutaneous left-foot abscess due to a scratch from a pet cat. She was successfully treated with antibiotic piperacillin and clindamycin therapy and aggressive wound drainage.

  14. Acute viral hepatitis, intravascular haemolysis, severe hyperbilirubinaemia and renal failure in glucose-6-phosphate dehydrogenase deficient patients.

    PubMed Central

    Agarwal, R. K.; Moudgil, A.; Kishore, K.; Srivastava, R. N.; Tandon, R. K.

    1985-01-01

    Five patients with acute viral hepatitis developed severe intrasvascular haemolysis and unusually high levels of serum bilirubin (427 to 1368 mumol/l). All 5 had high fever, marked anaemia, reticulocytosis and neutrophilic leucocytosis. Three of them developed acute renal failure, which was of non-oliguric type in 2. The clinical course was protracted, but complete recovery occurred in 4 patients between 4 to 10 weeks. One patient with hepatic coma and oliguric renal failure died. Deficiency of the enzyme G-6-PD was confirmed in 4 cases. Massive haemolysis in the patients was probably induced by the administration of chloroquine and other drugs. Intravascular haemolysis should be suspected in patients with acute viral hepatitis, if they show unexplained anaemia and very high serum bilirubin levels, and measures to prevent renal failure should be instituted in such cases. PMID:4070114

  15. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study

    PubMed Central

    2011-01-01

    Introduction It is debated whether early trauma-induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. Methods An observational study was carried out at a single Level I Trauma Center. Eighty adult trauma patients (≥18 years) who met criteria for full trauma team activation and had an arterial cannula inserted were included. Blood was sampled a median of 68 minutes (IQR 48 to 88) post-injury. Data on demography, biochemistry, injury severity score (ISS) and mortality were recorded. Plasma/serum was analyzed for biomarkers reflecting tissue/endothelial cell/glycocalyx damage (histone-complexed DNA fragments, Annexin V, thrombomodulin, syndecan-1), coagulation activation/inhibition (prothrombinfragment 1+2, thrombin/antithrombin-complexes, antithrombin, protein C, activated protein C, endothelial protein C receptor, protein S, tissue factor pathway inhibitor, vWF), factor consumption (fibrinogen, FXIII), fibrinolysis (D-dimer, tissue-type plasminogen activator, plasminogen activator inhibitor-1) and inflammation (interleukin (IL)-6, terminal complement complex (sC5b-9)). Comparison of patients stratified according to the presence or absence of overt DIC (International Society of Thrombosis and Hemostasis (ISTH) criteria) or ACoTS (activated partial thromboplastin time (APTT) and/or international normalized ratio (INR) above normal reference). Results No patients had overt DIC whereas 15% had ACoTS. ACoTS patients had higher ISS, transfusion requirements and mortality (all P < 0.01) and a biomarker profile suggestive of enhanced tissue, endothelial cell and glycocalyx damage and consumption coagulopathy with low protein C, antithrombin, fibrinogen and FXIII levels

  16. Intravascular Ultrasound Observation of the Mechanism of No-Reflow Phenomenon in Acute Myocardial Infarction

    PubMed Central

    Li, Junxia; Wu, Longmei; Tian, Xinli; Zhang, Jian; Shi, Yujie

    2015-01-01

    Objective To study the mechanism of the no-reflow phenomenon using coronary angiography (CAG) and intravascular ultrasound (IVUS). Methods A total of 120 patients with acute myocardial infarction (AMI) who successfully underwent indwelling intracoronary stent placement by percutaneous coronary intervention (PCI). All patients underwent pre- and post-PCI CAG and pre-IVUS. No-reflow was defined as post-PCI thrombolysis in myocardial infarction (TIMI) grade 0, 1, or 2 flow in the absence of mechanical obstruction. Normal reflow was defined as TIMI grade 3 flow. The pre-operation reference vascular area, minimal luminal cross-sectional area, plaque cross-sectional area, lesion length, plaque volume and plaque traits were measured by IVUS. Results The no-reflow group was observed in 14 cases (11.6%) and normal blood-flow group in 106 cases (89.4%) based on CAG results. There was no statistically significant difference in the patients’ medical history, reference vascular area (no-flow vs. normal-flow; 15.5 ± 3.2 vs. 16.2 ± 3.3, p> 0.05) and lesion length (21.9 ± 5.1 vs. 19.5 ± 4.8, p> 0.05) between the two groups. No-reflow patients had a longer symptom onset to reperfusion time compared to normal blood-flow group [(6.6 ± 3.1) h vs (4.3 ± 2.7) h; p< 0.05] and higher incidence of TIMI flow grade< 3 (71.4% vs 49.0%, p< 0.05). By IVUS examination, the no-reflow group had a significantly increased coronary plaque area and plaque volume compared to normal blood-flow group [(13.7 ± 3.0) mm2 vs (10.2 ± 2.9) mm2; (285.4 ± 99.8) mm3 vs (189.7 ± 86.4) mm3; p< 0.01]. The presence of IVUS-detected soft plaque (57.1% vs. 24.0%, p< 0.01), eccentric plaque (64.2% vs. 33.7%, p< 0.05), plaque rupture (50.0% vs. 21.2%, p< 0.01), and thrombosis (42.8% vs. 15.3%) were significantly more common in no-reflow group. Conclusion There was no obvious relationship between the coronary risk factors and no-reflow phenomenon. The symptom onset to reperfusion time, TIMI flow grade before

  17. A Case of Acute Myocardial Infarction due to Left Main Trunk Occlusion Complicated With Aortic Dissection as Diagnosed by Intravascular Ultrasound

    PubMed Central

    Okamoto, Masashi; Amano, Tomonori; Matsuoka, Shunzo; Hirai, Hideki; Masuda, Kazunori; Nakajima, Kanta; Sueyoshi, Atsushi

    2012-01-01

    A 52-year-old man was transferred to our hospital with a sudden onset of severe chest pains. His electrocardiogram revealed ST-segment elevation suggestive of acute myocardial infarction. Emergency coronary angiography showed subtotal occlusion of left main trunk (LMT) with delayed coronary flow. Because intravascular ultrasound revealed a large intimal flap, we diagnosed aortic dissection involving the LMT. After stenting of the LMT, the patient underwent surgical repair of the aortic dissection. Although it is difficult to obtain a correct diagnosis of aortic dissection complicated with myocardial ischemia, we succeeded in diagnosing this rare condition by use of a intravascular ultrasound.

  18. Sepsis and disseminated intravascular coagulation in an eastern spiny softshell turtle (Apalone spinifera spinifera) with acute mycobacteriosis.

    PubMed

    Murray, Maureen; Waliszewski, Nicole T; Garner, Michael M; Tseng, Florina S

    2009-09-01

    An adult, captive eastern spiny softshell turtle (Apalone spinifera spinifera) was examined for a 4-day history of lethargy and plastron discoloration. The turtle was obtunded and had pale mucous membranes, hemorrhagic nasal discharge, and petechiae on all limbs. The turtle was euthanized due to its grave condition. Necropsy revealed hemorrhagic coelomic effusion, petechiae on the serosal surfaces of the intestinal tract, and bilaterally hemorrhagic lungs. Histologic examination revealed numerous emboli of bacteria associated with fibrinocellular thrombi throughout the blood vessels of multiple tissues. The bacteria in the thrombi were slender bacilli that stained intensely acid fast. Culture of the coelomic fluid yielded Mycobacterium chelonae. Although mycobacteriosis in reptiles is typically a chronic, granulomatous disease, this case demonstrates that mycobacteriosis should be considered in reptiles presenting with acute, nongranulomatous disease. This case also describes clinically apparent hemorrhage due to disseminated intravascular coagulation, which is rarely described in chelonians.

  19. Acute kidney injury due to menstruation-related disseminated intravascular coagulation in an adenomyosis patient: a case report.

    PubMed

    Son, Jungmin; Lee, Dong Won; Seong, Eun Young; Song, Sang Heon; Lee, Soo Bong; Kang, Jin; Yang, Byeong Yun; Lee, Su Jin; Choi, Jong-Ryeol; Lee, Kyu-Sup; Kwak, Ihm Soo

    2010-09-01

    The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.

  20. Acute Increase in Hepatic Arterial Flow During TIPS Identified by Intravascular Flow Measurements

    SciTech Connect

    Radeleff, Boris Sommer, Christof-Matthias; Heye, Tobias; Lopez-Benitez, Ruben; Sauer, Peter; Schmidt, Jan; Kauczor, Haus-Ulrich; Richter, Goetz Martin

    2009-01-15

    The purpose of this study was to investigate alterations of hepatic arterial flow during transjugular intrahepatic portosystemic stent shunt (TIPS) applying intravascular Doppler sonography. This prospective monocenter study included 25 patients with liver cirrhosis (alcohol induced [n = 19], chronic hepatitis associated [n = 3], primary biliary cirrhosis associated [n = 1], and cryptogenic [n = 2]) successfully treated with TIPS. All patients underwent intravascular hepatic arterial flow measurements during TIPS using an endoluminal flow sensor. The average arterial peak velocity (APV) and the maximum arterial peak velocity (MPV) were registered. Twenty-two patients (88%) showed increased APV, one patient (4%) showed unaffected APV, and two patients (8%) showed decreased APV after TIPS. The average portosystemic pressure gradient decreased significantly, from 22.0 {+-} 5.1 mmHg before TIPS to 11.0 {+-} 4.1 mmHg after TIPS (-50.0%; p < 0.0001). The average APV increased significantly, from 41.9 {+-} 17.8 cm/s before TIPS to 60.7 {+-} 19.0 cm/s after TIPS (+44.9%; p < 0.0001). The average MPV increased significantly, from 90.8 {+-} 31.7 cm/s before TIPS to 112.6 {+-} 34.9 cm/s after TIPS (+24.0%; p = 0.0002). These changes in perfusion set in within seconds after TIPS tract formation in all the patients with increased APV. We conclude that TIPS-induced portosystemic decompression leads to a significant increase in hepatic arterial flow. The changes occurred within seconds, suggesting a reflex-like mechanism.

  1. Intravascular OCT

    NASA Astrophysics Data System (ADS)

    Schmitt, Joseph M.; Adler, Desmond; Xu, Chenyang

    Since the first coronary angioplasty was performed in the late 1970s, imaging has played a central role in percutaneous coronary intervention (PCI). Today more than three million PCI procedures are performed worldwide to expand narrowed arteries and to clear blood clots that can cause debilitating symptoms of myocardial ischemia or fatal heart attacks. Although X-ray angiography is still the workhorse imaging modality in the field of interventional cardiology, intravascular imaging has become an indispensable tool for guiding complex PCI procedures. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the two most commonly used catheter-based imaging technologies in coronary procedures. Since the first commercial intravascular OCT systems were introduced in Japan and the European Union in 2004 and in the United States in 2009, the application of intravascular OCT has grown rapidly [3, 15, 16].

  2. Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

    PubMed Central

    Konishi, Hirotaka; Okamoto, Kazuma; Shoda, Katsutoshi; Arita, Tomohiro; Kosuga, Toshiyuki; Morimura, Ryo; Komatsu, Shuhei; Murayama, Yasutoshi; Shiozaki, Atsushi; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Otsuji, Eigo

    2017-01-01

    AIM To investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery. METHODS Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated. RESULTS Abscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all). CONCLUSION Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study. PMID:28223734

  3. Patrolling monocytes promote intravascular neutrophil activation and glomerular injury in the acutely inflamed glomerulus

    PubMed Central

    Finsterbusch, Michaela; Hall, Pam; Li, Anqi; Devi, Sapna; Westhorpe, Clare L. V.; Kitching, A. Richard

    2016-01-01

    Nonclassical monocytes undergo intravascular patrolling in blood vessels, positioning them ideally to coordinate responses to inflammatory stimuli. Under some circumstances, the actions of monocytes have been shown to involve promotion of neutrophil recruitment. However, the mechanisms whereby patrolling monocytes control the actions of neutrophils in the circulation are unclear. Here, we examined the contributions of monocytes to antibody- and neutrophil-dependent inflammation in a model of in situ immune complex-mediated glomerulonephritis. Multiphoton and spinning disk confocal intravital microscopy revealed that monocytes patrol both uninflamed and inflamed glomeruli using β2 and α4 integrins and CX3CR1. Monocyte depletion reduced glomerular injury, demonstrating that these cells promote inappropriate inflammation in this setting. Monocyte depletion also resulted in reductions in neutrophil recruitment and dwell time in glomerular capillaries and in reactive oxygen species (ROS) generation by neutrophils, suggesting a role for cross-talk between monocytes and neutrophils in induction of glomerulonephritis. Consistent with this hypothesis, patrolling monocytes and neutrophils underwent prolonged interactions in glomerular capillaries, with the duration of these interactions increasing during inflammation. Moreover, neutrophils that interacted with monocytes showed increased retention and a greater propensity for ROS generation in the glomerulus. Also, renal patrolling monocytes, but not neutrophils, produced TNF during inflammation, and TNF inhibition reduced neutrophil dwell time and ROS production, as well as renal injury. These findings show that monocytes and neutrophils undergo interactions within the glomerular microvasculature. Moreover, evidence indicates that, in response to an inflammatory stimulus, these interactions allow monocytes to promote neutrophil recruitment and activation within the glomerular microvasculature, leading to neutrophil

  4. Hemolysis after ABO-incompatible platelet transfusions.

    PubMed

    Chow, M P; Yung, C H; Hu, H Y; Tzeng, C H

    1991-08-01

    An 18 year old girl, with acute myeloid leukemia, developed progressive hemolysis after receiving multiple transfusions with ABO-incompatible platelets. It was caused by passive transfusion of anti-A and -B isoagglutinin from the donor plasma. Her hemoglobin level returned to normal after giving group compatible or pooled and reduced volume platelet concentrates. Transfusing group-incompatible platelets is not contraindicated, but donor plasma reduction should be considered for those patients who need prolonged platelet support. Testing for isoagglutinin titer in group O donors is an alternate method to reduce the incidence of plasma-induced hemolysis in group-incompatible platelet transfusions.

  5. Complement inhibitors to treat IgM-mediated autoimmune hemolysis

    PubMed Central

    Wouters, Diana; Zeerleder, Sacha

    2015-01-01

    Complement activation in autoimmune hemolytic anemia may exacerbate extravascular hemolysis and may occasionally result in intravascular hemolysis. IgM autoantibodies as characteristically found in cold autoantibody autoimmune hemolytic anemia, in cold agglutinin disease but also in a considerable percentage of patients with warm autoantibodies are very likely to activate complement in vivo. Therapy of IgM-mediated autoimmune hemolytic anemia mainly aims to decrease autoantibody production. However, most of these treatments require time to become effective and will not stop immediate ongoing complement-mediated hemolysis nor prevent hemolysis of transfused red blood cells. Therefore pharmacological inhibition of the complement system might be a suitable approach to halt or at least attenuate ongoing hemolysis and improve the recovery of red blood cell transfusion in autoimmune hemolytic anemia. In recent years, several complement inhibitors have become available in the clinic, some of them with proven efficacy in autoimmune hemolytic anemia. In the present review, we give a short introduction on the pathogenesis of autoimmune hemolytic anemia, followed by an overview on the complement system with a special focus on its regulation. Finally, we will discuss complement inhibitors with regard to their potential efficacy to halt or attenuate hemolysis in complement-mediated autoimmune hemolytic anemia. PMID:26521297

  6. Disseminated intravascular coagulation due to IgM-mediated autoimmune hemolytic anemia.

    PubMed

    Bleakly, N Teresa; Fontaine, Magali J; Pate, Lisa L; Sutherland, Scott M; Jeng, Michael

    2011-08-01

    Disseminated intravascular coagulation (DIC) due to red cell hemolysis has been previously attributed to transfusion-related hemolytic reactions, but not to autoimmune hemolytic anemia. We report a case of DIC in a child with complement-fixing IgM-mediated cold-agglutinin autoimmune hemolysis, which resulted in arterial thrombosis and gangrene of the upper and lower extremities.

  7. Intravascular ultrasound-guided percutaneous coronary intervention in a human immunodeficiency virus-positive patient with cocaine-associated acute myocardial infarction: case report and review.

    PubMed

    Sonne, Carolin; Stempfle, Hans-Ulrich; Klauss, Volker; Schiele, Thomas M

    2005-09-01

    Cocaine use is a major problem worldwide and there are numerous reports about cocaine-associated myocardial infarction. Nevertheless minimal data are available from randomised clinical trials to suggest evidence-based approaches to the management of cocaine-associated myocardial ischemia. Moreover, most reports have been limited to conservative management of cocaine-associated myocardial infarction. We report a case of a young male cocaine user with acute myocardial infarction, undergoing diagnostic coronary angiography and intravascular ultrasound revealing severe atherosclerosis, followed by successful stent implantation.

  8. Oxidative Hemolysis of Erythrocytes

    ERIC Educational Resources Information Center

    Wlodek, Lidia; Kusior, Dorota

    2006-01-01

    This exercise for students will allow them to simultaneously observe lipid peroxidation and consequent hemolysis of rat erythrocytes and the effect of sodium azide, a catalase inhibitor, on these processes. It will also demonstrate a protective action of antioxidants, the therapeutically used N-acetylcysteine and albumins present in plasma.

  9. Evaluation of the safety and efficacy of recombinant soluble thrombomodulin for patients with disseminated intravascular coagulation associated with acute leukemia: multicenter prospective study by the Tohoku Hematology Forum.

    PubMed

    Yokoyama, Hisayuki; Takahashi, Naoto; Katsuoka, Yuna; Inomata, Mitsue; Ito, Toshihiro; Meguro, Kuniaki; Kameoka, Yoshihiro; Tsumanuma, Riko; Murai, Kazunori; Noji, Hideyoshi; Ishizawa, Kenichi; Ito, Shigeki; Onishi, Yasushi; Harigae, Hideo

    2017-02-07

    It has been suggested that use of recombinant soluble thrombomodulin (rTM) is superior to conventional drugs in treatment of disseminated intravascular coagulation (DIC) complicating acute leukemia. However, its safety and efficacy have not been fully examined in prospective studies. Here, we performed a multicenter prospective study to examine outcomes of rTM treatment for DIC in patients with acute leukemia. Of 33 patients registered in this study, 13 had acute myeloid leukemia (AML), three had acute lymphoblastic leukemia (ALL), and 17 had acute promyelocytic leukemia (APL). The cumulative rates of DIC resolution at day 7 and day 35 were 56 and 81% in AML/ALL and 53 and 77% in APL, respectively. The median time from the initiation of rTM to DIC resolution was 4 days in AML/ALL and 6 days in APL patients. Adverse events related to hemorrhage occurred in two AML/ALL patients (13%) and three APL patients (18%). Of these, one AML/ALL patient died with intracranial hemorrhage, and two APL patients died with intracranial hemorrhage and pulmonary hemorrhage. These results suggest that rTM may improve the survival of acute leukemia patients with DIC by inhibiting early death related to hemorrhagic events, as reported previously.

  10. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management.

    PubMed

    Erez, Offer; Mastrolia, Salvatore Andrea; Thachil, Jecko

    2015-10-01

    Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanisms of disease leading to this complication in essential for a favorable outcome. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC.

  11. Hemolysis from ABO Incompatibility.

    PubMed

    Simmons, Daimon P; Savage, William J

    2015-06-01

    ABO incompatibility of red blood cells leads to brisk complement-mediated lysis, particularly in the setting of red cell transfusion. The ABO blood group is the most clinically significant blood group because of preformed immunoglobulin M (IgM) and IgG antibodies to ABO blood group antigens (isohemagglutinins) in everyone except group AB individuals. In addition to transfusion, ABO incompatibility can cause hemolysis in hematopoietic and solid organ transplantation, hemolytic disease of the newborn, and intravenous immunoglobulin infusion. It is important to prevent ABO incompatibility when possible and to anticipate complications when ABO incompatibility is unavoidable.

  12. Pathogenesis and mechanisms of antibody-mediated hemolysis

    PubMed Central

    Flegel, Willy A

    2015-01-01

    Background The clinical consequences of antibodies to red blood cells (RBC) have been studied for a century. Most clinically relevant antibodies can be detected by sensitive in vitro assays. Several mechanisms of antibody-mediated hemolysis are well understood. Such hemolysis following transfusion is reliably avoided in a donor/recipient pair, if one individual is negative for the cognate antigen to which the other has the antibody. Study design and results Mechanisms of antibody-mediated hemolysis were reviewed based on a presentation at the Strategies to Address Hemolytic Complications of Immune Globulin Infusions Workshop addressing intravenous immunoglobulin (IVIG) and ABO antibodies. The presented topics included the rates of intravascular and extravascular hemolysis; IgM and IgG isoagglutinins; auto- and alloantibodies; antibody specificity; A, B, A,B and A1 antigens; A1 versus A2 phenotypes; monocytes/macrophages, other immune cells and complement; monocyte monolayer assay (MMA); antibody-dependent cell-mediated cytotoxicity (ADCC); and transfusion reactions due to ABO and other antibodies. Conclusion Several clinically relevant questions remained unresolved, and diagnostic tools were lacking to routinely and reliably predict the clinical consequences of RBC antibodies. Most hemolytic transfusion reactions associated with IVIG were due to ABO antibodies. Reducing the titers of such antibodies in IVIG may lower the frequency of this kind of adverse event. The only way to stop these events is to have no anti-A or anti-B antibodies in the IVIG products. PMID:26174897

  13. Extravascular hemolysis and complement consumption in Paroxysmal Nocturnal Hemoglobinuria patients undergoing eculizumab treatment.

    PubMed

    Subías Hidalgo, Marta; Martin Merinero, Hector; López, Alicia; Anter, Jaouad; García, Sheila Pinto; Ataúlfo Gonzalez-Fernández, Fernando; Forés, Rafael; Lopez-Trascasa, Margarita; Villegas, Ana; Ojeda, Emilio; Rodríguez de Córdoba, Santiago

    2017-02-01

    Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemolytic anemia characterized by complement-mediated intravascular hemolysis that is effectively treated with eculizumab. However, treatment responses are reported heterogeneous with some patients presenting residual hemolysis and requiring RBC transfusions. Recent reports have shown that both extravascular hemolysis and incomplete C5 blockade can explain these suboptimal hematological responses. Here we have tested our eculizumab-treated PNH patients (n=12) for signs of hemolysis and assessed complement biomarkers. Patients were also genotyped for complement receptor 1 (CR1, CD35) and C5 polymorphisms and evaluated for free eculizumab in plasma. We report that 10 patients (83%) present parameters suggesting persistent hemolysis, although they did not require additional transfusions. Seven of them (58%) become direct Coombs-test positive as a consequence of treatment, including all patients carrying the low-expression CR1-L allele. CH50 and sC5b-9 assays demonstrate that the persistent low-level hemolysis identified in our treated patients is not a consequence of incomplete C5 blockade, supporting that this hemolysis, as has been suggested previously, results from the extravascular removal of C3 opsonized PNH erythrocytes. We also show that continuous alternative pathway activation in eculizumab-treated individuals carrying the CR1-L allele results in abnormally decreased levels of C3 in plasma that could, potentially, increase their susceptibility to bacterial infections. Finally, we encourage a routine evaluation of free eculizumab levels and terminal pathway activity to personalize eculizumab administration.

  14. Hemolysis induced by PMIVSD occluder.

    PubMed

    Rao, D Sheshagiri; Barik, Ramachandra; Siva Prasad, Akula

    2016-09-01

    Hemolysis related to occluder, prosthetic valve, and prosthetic ring used for mitral valve annuloplasty are not very unusual. However, hemolysis related to transcathetor closure of post-myocardial infarction ventricular septal defect (PMIVSD) is infrequent. A close follow-up for spontaneous resolution with or without blood transfusion has been reported in a few cases. Occasionally, surgical retrieval is unavoidable or lifelong blood transfusion is required if surgery cannot be done because of higher risk. In this illustration, we have showed a close follow-up of a case of hemolysis induced by atrial septal occluder used for VSD closure after myocardial infarction. Despite successful device closure of PMIVSD which is difficult, a close watch is needed for complications like residual leak, device embolization, and hemolysis.

  15. Hemolysis in different centrifugal pumps.

    PubMed

    Kawahito, K; Nosé, Y

    1997-04-01

    Different types of centrifugal pumps cause different amounts of hemolysis based on shear stress and blood exposure time. However, the hemolytic characteristics of centrifugal pumps in each clinical condition are not always clear. We compared the hemolytic characteristics of one cone-type centrifugal pump (Medtronic BioMedicus BP-80) and 2 impeller-type centrifugal pumps (Nikkiso HMS-12 and Terumo Capiox) under experimental conditions simulating their use in cardiopulmonary bypass (CPB), extracorporeal membrane oxygenation (ECMO), and percutaneous cardiopulmonary support (PCPS) as well as their use as left ventricular assist devices (LVADs). The normalized indexes of hemolysis (NIHs; grams free plasma hemoglobin per 100 L blood pumped) during use as LVADs were not significantly different among the 3 pumps. The BP-80 pump produced almost 3-fold more hemolysis than the HMS-12 and Capiox pumps during CPB, 3- to 4-fold more hemolysis during ECMO, and 5.5-fold more hemolysis during PCPS. The 2 impeller-type centrifugal pumps will therefore cause less hemolysis under high flow, high pressure difference (as in CPB) and low flow, high pressure difference (as in ECMO and PCPS) conditions than the cone-type pump.

  16. Acute In Vivo Performance Evaluation of the Fluorescence Affinity Sensor in the Intravascular and Interstitial Space in Swine

    PubMed Central

    Dutt-Ballerstadt, Ralph; Evans, Colton; Pillai, Arun P.; Gowda, Ashok; McNichols, Roger; Rios, Jesse; Cohn, William

    2013-01-01

    Objective We assessed and compared the performance levels of a fiber-coupled fluorescence affinity sensor (FAS) for glucose detection in the intradermal tissue and intravascular bed during glucose clamping and insulin administration in a large animal model. Research Design and Methods The FAS (BioTex Inc., Houston, TX) was implanted in interstitial tissue and in the intravenous space in nondiabetic, anesthetized pigs over 6–7 h. For intradermal assessment, a needle-type FAS was implanted in the upper back using a hypodermic needle. For intravenous assessment, the FAS was inserted through a catheter into the femoral artery and vein. Blood glucose changes were induced by infusion of dextrose and insulin through a catheterized ear or jugular vein. Results Based on retrospective analysis, the mean absolute relative error (MARE) of the sensor in blood and interstitial tissue was 11.9% [standard deviation (SD) = ±9.6%] and 23.8% (SD = ±19.4%), respectively. When excluding data sets from sensors that were affected by exogenous insulin, the MARE for those sensors tested in interstitial tissue was reduced to 16.3% (SD = ±12.5%). Conclusions The study demonstrated that the performance level of the FAS device implanted in interstitial tissue and blood can be very high. However, under certain circumstances, exogenous insulin caused the glucose concentration in interstitial tissue to be lower than in blood, which resulted in an overall lower level of accuracy of the FAS device. How significant this physiological effect is in insulin-treated persons with diabetes remains to be seen. In contrast, the level of accuracy of the FAS device in blood was very high because of high mass transfer conditions in blood. While the use of the FAS in both body sites will need further validation, its application in critically ill patients looks particularly promising. PMID:23439158

  17. The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion

    PubMed Central

    Xianxian, Zhao; Chengsong, Yue; Qiang, Mei; Fei, Wei; Lin, Shen; Huiyan, Ding; Zili, Gong

    2017-01-01

    In order to further optimize the treatment strategy for the patients with acute basilar artery occlusion, we were dedicated to study the therapeutic effects and influential factors in the process of treated basilar artery occlusion with thrombolytic combined vascular interventional therapy. 75 patients with acute basilar artery occlusion treated with arterial thrombolytic therapy were analyzed retrospectively. In accordance with the discharge records of patients, their short-term curative effect with 24-hour treatment and 14-days treatment were evaluated. Our data showed that the survival condition of the patients with acute acute basilar artery occlusion were visibly improved by combination thrombolytic and interventional therapy. Moreover, their BI scores were remarkably improved, while NIHSS and mRS scores were evidently reduced. These data proved that our treatment strategy was able to improve the survival condition of patients with acute basilar artery occlusion. Furthermore, our data showed that coagulation related factors remarkably improved in the patients, when they treated by combination thrombolytic therapy with interventional therapy. In addition, our results suggested that the patients' bilateral Babinski(+), revascularization and coma symptom were closely related to their prognosis after treated the patients with combination thrombolytic and vascular interventional therapy, and the difference was statistically significant (p<0.05, p<0.05, p<0.05). Besides, our data also displayed that the with stent assisted angioplasty was significantly superior to the patients with balloon angioplasty, and the difference was statistically significant (p<0.05). Anyhow, combination thrombolytic with interventional therapy can effectively promote the prognosis of the patients with acute basilar artery occlusion. The coma symptom, bilateral Babinski(+), and revascularization in the patients with acute basilar artery occlusion have an appreciable impact on the patients

  18. The thromboelastometric discrepancy between septic and trauma induced disseminated intravascular coagulation diagnosed by the scoring system from the Japanese association for acute medicine

    PubMed Central

    Koami, Hiroyuki; Sakamoto, Yuichiro; Sakurai, Ryota; Ohta, Miho; Imahase, Hisashi; Yahata, Mayuko; Umeka, Mitsuru; Miike, Toru; Nagashima, Futoshi; Iwamura, Takashi; Yamada, Kosuke Chris; Inoue, Satoshi

    2016-01-01

    Abstract The aim of this study is to evaluate the hematological differences between septic and traumatic disseminated intravascular coagulation (DIC) using the rotational thromboelastometry (ROTEM). This retrospective study includes all sepsis or severe trauma patients transported to our emergency department who underwent ROTEM from 2013 to 2014. All patients were divided into 2 groups based on the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We statistically analyzed the demographics, clinical characteristics, laboratory data, ROTEM findings (EXTEM and FIBTEM), and outcome. Fifty-seven patients (30 sepsis and 27 severe trauma) were included in primary analysis. Sepsis cases were significantly older and had higher systemic inflammatory response syndrome (SIRS) scores, whereas there were no significant differences in other parameters including Acute Physiology and Chronic Health Evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score. Twenty-six patients (14 sepsis and 12 severe trauma) were diagnosed with DIC. The Septic DIC (S-DIC) group was significantly older and had higher DIC scores than the traumatic DIC (T-DIC) group. Hematologic examination revealed significantly higher CRP, fibrinogen, lower FDP, DD, and higher FDP/DD ratio were found in the S-DIC group in comparison with the T-DIC group. ROTEM findings showed that the A10, A20, and MCF in the FIBTEM test were significantly higher in the S-DIC group. However, no statistical differences were confirmed in the LI30, LI45, and ML in EXTEM test. The plasma fibrinogen level and fibrinogen based clot firmness in whole-blood test revealed statistical significance between septic and traumatic DIC patients. PMID:27495106

  19. Real-Time Assessment of Cardiac Perfusion, Coronary Angiography, and Acute Intravascular Thrombi Using Dual-Channel Near-Infrared Fluorescence Imaging

    PubMed Central

    Tanaka, Eiichi; Chen, Frederick Y.; Flaumenhaft, Robert; Graham, Gwenda J.; Laurence, Rita G.; Frangioni, John V.

    2009-01-01

    Objectives We have developed an image-guided surgery system based on invisible near-infrared (NIR) fluorescent light. Presently, the only clinically-available NIR fluorophore is indocyanine green (ICG), which fluoresces at ≈ 800 nm and is used for coronary angiography. Our objective was to determine if methylene blue (MB), already FDA-approved for other indications, has useful NIR fluorescence properties for image-guided cardiac surgery. Methods The optical properties of MB were measured after dissolution in 100% serum. Biodistribution and clearance were quantified in organs and tissues after intravenous bolus injection of 2 mg/kg MB in N = 3 rats. Coronary arteriography and cardiac perfusion were imaged in real-time after intravenous bolus injection of 1 mg/kg MB in N = 5 pigs with coronary obstructions. Coronary angiography and acute thrombi were assessed using 800 nm fluorophores, ICG and IR-786-labeled platelets, respectively. Results The peak absorbance and emission of MB as a NIR fluorophore occur at 667 nm and 686 nm, respectively. After intravenous injection, MB provides highly sensitive coronary angiography. A lipophilic cation, MB is extracted rapidly into tissue, with myocardium displaying unusually high uptake. MB permits real-time visualization and quantitative assessment of myocardial perfusion. Because of absent spectral overlap, use of two independent fluorophores on our imaging system permits simultaneous quantification of perfusion, venous drainage and/or intravascular thrombi. Conclusions MB is an effective NIR fluorophore that provides direct visualization of coronary arteriography and cardiac perfusion. In conjunction with ≈ 800 nm NIR fluorophores, important functional assessments during cardiac surgery are also possible. PMID:19577070

  20. Iatrogenic subtle acute aortic dissection during coronary angioplasty for in-stent restenosis. Value of intravascular ultrasound for diagnosis and management.

    PubMed

    Alfonso, Fernando; Alvarez, Lucia; Almeria, Carlos

    2004-09-01

    A patient with a subtle, iatrogenic, type A aortic dissection following a coronary angioplasty is described. Intravascular ultrasound was useful to confirm the diagnosis of the confined aortic dissection and also to guide adequate stent coverage of its coronary entry door. Both transesophageal echocardiography and magnetic resonance imaging failed to detect any significant aortic wall abnormality.

  1. Effect of wall hardness on hemolysis.

    PubMed

    Yasuda, T; Shimokasa, K; Funakubo, A; Fukui, Y

    2000-08-01

    One of the major problems for artificial organs to develop and to improve is the reduction of hemolysis. The optimum designing of less hemolysis artificial organs is achieved through computational analysis and flow visualization techniques. However, it is impossible to know the quantitative relation between hemolysis and these analytic data. Thus, in vitro studies were performed to estimate these devices on hemolysis because there is no standard for designing these devices with less hemolysis. Therefore, it is essential to reveal the relation between blood flow behaviors and hemolysis. Previous studies reported that hemolysis was caused by a combination of physical factors. In particular, shear stress, pressure, and other fluid dynamical effects were shown to induce hemolysis. In another fluid dynamical experiment reported, the collision flow against the sanded wall was considered the most important factor that directly effected blood damage, which led to hemolysis. The blood flow impact of the collision against the wall effected serious damage to red blood cells. The objective of this study was to point out the relationship between physical force (pressure) in collision flow and hemolysis. In vitro tests using bovine blood and a circulation model that included a jet flow that collides against a wall were conducted. In these tests, we changed the material of the wall by replacing silicone rubber of various thicknesses. The thickness of the silicone rubber is inversely proportional to its hardness. The results show that the increasing rate of hemolysis was lower when the surface was coated by silicone rubber. In conclusion, we considered that it is possible to reduce hemolysis by adjusting the hardness of the material and contacted blood flow.

  2. Intravascular ultrasound imaging

    SciTech Connect

    Cavaye, D.M.; White, R.A. )

    1992-01-01

    This book will give vascular surgeons, cardiologists, radiologists, and technologists a complete working knowledge of intravascular ultrasound imaging and the crucial role of this new technology in endovascular diagnosis and therapy. The book reviews the essential principles of vascular pathology and ultrasound imaging and then provides state-of-the-art information on intraluminal ultrasound imaging devices and techniques, including practical guidelines for using catheters, optimizing image quality, and avoiding artifacts. Image interpretation and computerized image reconstruction are also discussed in detail. The first section explains the diagnostic, therapeutic, and experimental applications of intravascular ultrasound, particularly as a adjunct to angioplasty and other current interventional procedures.

  3. Butoxyacetic acid-induced hemolysis of rat red blood cells: effect of external osmolarity and cations.

    PubMed

    Udden, M M; Patton, C S

    2005-03-28

    Hemolysis is the principal toxicity of acute exposure to ethylene glycol monobutyl ether (EGBE) in rats. EGBE itself is not an active hemolytic agent, but its metabolite, butoxyacetic acid (BAA) formed as a result of dehydrogenase activity is a potent hemolysin. Here we address the role of osmolarity and cation composition of the suspending buffers in the mechanism of BAA-induced hemolysis of rat red blood cells in vitro. Rat erythrocytes were protected from BAA-induced cell swelling and hemolysis by the addition of sucrose to the suspending media. Hemolysis and cell swelling were also reduced by replacing external sodium with potassium. When calcium was not present in the suspending medium or when chelated by EGTA, hemolysis was increased after 2 h incubation with 1 mM or 2 mM BAA. Addition of as little as 0.05 mM CaCl(2) reduced hemolysis significantly while the addition of MgCl(2) had no effect. The dose-response relationship between BAA concentration and hemolysis determined in the presence or absence of calcium showed an increased effect of BAA in the absence of calcium. BAA-induced spherocytosis and cell fragmentation were more pronounced in the absence of calcium. The time course of BAA-induced hemolysis in the presence and absence of calcium demonstrated that the effect of calcium is to delay the onset of hemolysis. Increased intracellular calcium as a result of exposure to BAA was verified by atomic absorption spectroscopy. Charybdotoxin, an inhibitor of the calcium activated potassium channel, blocked the protective effect of calcium suggesting that the delay of onset of hemolysis in the presence of calcium is due to potassium loss caused by this channel. We conclude that the mode of action of BAA is to cause a colloid osmotic lysis of the rat red blood cell. Hemolysis requires external sodium and is associated with calcium uptake. Calcium appears to delay the onset of hemolysis. We speculate that: (1) BAA causes sodium and calcium to enter the cell; (2

  4. Relief of vasospasm by intravascular ultraviolet irradiation

    NASA Astrophysics Data System (ADS)

    Nakai, Kanji; Morimoto, Yuji; Ito, Hirotaka; Kominami, Kimito; Matsuo, Hirotaka; Arai, Tsunenori; Kikuchi, Makoto

    1998-05-01

    We investigated the photovasorelaxation with intravascular transluminal irradiation using in vivo model. A 2.5 Fr. catheter was inserted in the femoral artery of a rabbit under anesthesia. A 400 micrometers diameter quartz fiber was inserted through the catheter. The catheter was withdrawn from the distal end to the proximal end of the exposed femoral artery without laser irradiation in order to observe the mechanical dilation by the procedure. The femoral artery lumen was irradiated by a Helium-Cadmium(He-Cd) laser (wavelength; 325 nm) with 8 mW through the fiber during 30 s. We carried out that the laser irradiation produced vasorelaxation (185% on the average) compared with mechanical vasodilation (150% on the average) with angiography. The results suggest that intravascular transluminal irradiation with low-power UV laser might be applicable to the relief of acute arterial vasospasm.

  5. Intravascular ultrasound elastography.

    PubMed

    van der Steen, A F; de Korte, C L; Céspedes, E I

    1998-10-01

    Intravascular Ultrasound Blastography. The response of a tissue to mechanical excitation is a function of its mechanical properties. Excitation can be dynamic or quasistatic in nature. The response (e.g. displacement, velocity, compression) can be measured via ultrasound. This is the main principle underlying ultrasound elasticity imaging, sonoelasticity imaging, or ultrasound elastography. It is of great interest to know the local hardness of vessel wall and plaques. Intravascular elastography yields information unavailable or inconclusive if obtained from IVUS alone and thus contributes to more correct diagnosis. Potentially it can be used for therapy guidance. During the last decade several working groups used elastography in intravascular applications with varying success. In this paper we discuss the various approaches by different working groups. Focus will be on the approach of the Rotterdam group. Using a 30 MHz IVUS catheter, RF data are acquired from vessels in vitro at different intraluminal pressures. Local tissue displacement estimation by cross-correlation is followed by computation of the local strain. The resulting image supplies local information on the elastic properties of the vessel and plaque with high spatial resolution. Feasibility and usefulness are shown by means of phantom measurements. Furthermore, initial in vitro results of femoral arteries and correlation with histology are discussed. Phantom data show that the elastograms reveal information not presented by the echogram. In vitro artery data prove that in principle elastography is capable of identifying plaque composition where echography fails.

  6. Exercise-induced hemolysis in xerocytosis. Erythrocyte dehydration and shear sensitivity.

    PubMed Central

    Platt, O S; Lux, S E; Nathan, D G

    1981-01-01

    A patient with xerocytosis was found to have swimming-induced intravascular hemolysis and shortening of erythrocyte life-span. In a microviscometer, xerocytes were more susceptible than normal erythrocytes to hemolysis by shear stress. Fractionation of normal and abnormal cells on discontinuous Stractan density gradients revealed that increasingly dehydrated cells were increasingly more shear sensitive. This sensitivity was partially corrected by rehydrating xerocytic erythrocytes by means of the cation-ionophore nystatin in a high potassium buffer. Conversely, normal erythrocytes were rendered shear sensitive by dehydrating them with nystatin in a low potassium buffer. This effect of dehydration was entirely reversible if normal cells were dehydrated for less than 4 h but was only partially reversed after more prolonged dehydration. It is likely that dehydration of erythrocytes results in shear sensitivity primarily because of concentration of cell contents and reduced cellular deformability. With prolonged dehydration, secondary membrane changes may potentiate the primary effect. This increased shear sensitivity of dehydrated cells may explain atraumatic exercise-induced hemolysis in xerocytosis as cardiac output is shifted to vessels of exercising muscles with small diameters and high shear rates. PMID:7276163

  7. Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient

    PubMed Central

    Kurasawa, Miwa; Nishikido, Takashi; Koike, Junko; Tominaga, Shin-ichi; Tamemoto, Hiroyuki

    2014-01-01

    We experienced a case of liver abscess due to Clostridium perfringens (CP) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important. PMID:24748935

  8. An intravascular protein osmometer.

    PubMed

    Henson, J W; Brace, R A

    1983-05-01

    Our purpose was to develop an intravascular osmometer for measuring the colloid (i.e., protein) osmotic pressure (COP) of circulating blood. A semipermeable hollow fiber from a Cordis Dow artificial kidney (C-DAK 4000) was attached to polyethylene tubing on one end, filled with saline, and sealed at the other end. This was small enough to be inserted into the vasculature of research animals. Protein osmotic pressure plus hydrostatic pressure was measured by a Statham pressure transducer attached to the hollow fiber. Simultaneously, a second catheter and transducer was used to measure hydrostatic pressure, which was subtracted from the pressure measured from the fiber with an on-line computer. The system was documented by a variety of tests. The colloid osmotic pressure vs. albumin concentration curve determined with the fiber is identical to the curve determined by standard membrane osmometry. The time constant for 2- and 8-cm fibers was 2.6 +/- 0.6 and 1.5 +/- 0.5 (+/- SD) min, respectively. The reflection coefficient (+/- SD) of the fiber for NaCl is 0.042 +/- 0.019 (n = 38); COP measured at varying temperatures (absolute scale) changed linearly as expected from COP = nCRT (i.e., van't Hoff's law). Finally, hollow-fiber osmometers were inserted into femoral veins of dogs and sheep, and blood COP was continuously recorded during osmotic manipulations. In conclusion, we attempted to develop and document a simple method for continuous measurement of intravascular colloid osmotic pressure.

  9. Hemolysis-free blood plasma separation.

    PubMed

    Son, Jun Ho; Lee, Sang Hun; Hong, Soongweon; Park, Seung-min; Lee, Joseph; Dickey, Andrea M; Lee, Luke P

    2014-07-07

    Hemolysis, involving the rupture of red blood cells (RBCs) and release of their contents into blood plasma, is a major issue of concern in clinical fields. Hemolysis in vitro can occur as a result of errors in clinical trials; in vivo, hemolysis can be caused by a variety of medical conditions. Blood plasma separation is often the first step in blood-based clinical diagnostic procedures. However, inhibitors released from RBCs due to hemolysis during plasma separation can lead to problems in diagnostic tests such as low sensitivity, selectivity and inaccurate results. In particular, a general lack of simple and reliable blood plasma separation methods has been a major obstacle for microfluidic-based point-of-care (POC) diagnostic devices. Here we present a hemolysis-free microfluidic blood plasma separation platform. A membrane filter was positioned on top of a vertical up-flow channel (filter-in-top configuration) to reduce clogging of RBCs by gravity-assisted cells sedimentation. With this device, separated plasma volume was increased approximately 4-fold (2.4 μL plasma after 20 min with 38% hematocrit human whole blood), and hemoglobin concentration in separated plasma was decreased approximately 90% due to the prevention of RBCs hemolysis, when compared to conventional filter-in-bottom configuration blood plasma separation platforms. On-chip plasma contained ~90% of protein and ~100% of nucleic acids found in off-chip centrifuged plasma, confirming comparable target molecule recovery efficiency. This simple and robust on-chip blood plasma separation device integrates with downstream detection modules to ultimately create sample-to-answer microfluidic POC diagnostics devices.

  10. Choline or CDP-choline attenuates coagulation abnormalities and prevents the development of acute disseminated intravascular coagulation in dogs during endotoxemia.

    PubMed

    Yilmaz, Zeki; Ozarda, Yesim; Cansev, Mehmet; Eralp, Oya; Kocaturk, Meric; Ulus, Ismail H

    2010-06-01

    Sepsis/endotoxemia causes platelet dysfunctions, abnormalities in coagulation and hemostatic mechanisms leading to organ dysfunctions and mortality. Choline prevents organ injury and improves survival during endotoxemia. The main objective of the present study was to determine the effects of choline or cytidine-5'-diphosphocholine (CDP-choline) on endotoxin-induced activation of coagulation and development of disseminated intravascular coagulation (DIC). Dogs were treated intravenously (i.v.) with saline, choline (20 mg/kg), or CDP-choline (70 mg/kg) three times with 4-h intervals starting 5 min before i.v. injection of endotoxin (1 mg/kg). Platelet counts and functions, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, coagulation factors, D-dimer and antithrombin (AT) were measured before and at 0.5-96 h after endotoxin. Circulating platelet, fibrinogen, coagulation factors and AT were decreased, whereas PT and aPTT were prolonged and serum D-dimer levels were elevated after endotoxin. Endotoxin-induced reductions in platelet counts and functions, fibrinogen, coagulation factors and AT were attenuated or blocked by choline or CDP-choline. Choline or CDP-choline blocked endotoxin-induced prolongation in PT and aPTT and enhancement in D-dimer. Elevated DIC scores were attenuated by choline and blocked by CDP-choline. Choline administration increased serum choline concentrations and caused bradycardia. Choline also increased choline and acetylcholine contents of circulating mononuclear cells and inhibited radioligand binding to their cholinergic receptors. These data show that choline administration, as choline chloride or CDP-choline, restores the abnormalities in the primary, secondary, and tertiary hemostasis and prevents the development of DIC during experimental endotoxemia in dogs probably by increasing both neuronal and non-neuronal cholinergic activity.

  11. Microwave and thermal interactions with oxidative hemolysis

    SciTech Connect

    Kiel, J.L.; Erwin, D.N.

    1984-01-01

    The influence of microwave radiation (2450 MHz, 3,333 pulses per second, duty factor of 0.02, and average specific absorption rate of 0.4 W/kg) on spontaneous hemolysis of human erythrocytes was examined. Cells were exposed to microwave radiation for 20 minutes at 37 degrees, 42 degrees, or 48 degrees C. Some of these cells were sensitized to oxidative damage by treatment with 1-chloro-2,4-dinitrobenzene (CDNB) and/or by coating with wheat germ agglutinin-horseradish peroxidase (WGA-HRP) conjugate. Microwave radiation significantly decreased spontaneous hemolysis of untreated cells at 42 degrees C but had no effect at 37 degrees or 48 degrees C. Microwave exposure significantly enhanced a CDNB membrane stabilizing effect at 42 degrees C but had no effect at 37 or 48 degrees C. At 42 degrees C, microwave exposure increased hemolysis of WGA-HRP coated cells. Cells treated with both WGA-HRP and CDNB showed no change in fragility at 42 degrees C and increased fragility at 48 degrees C without a microwave effect. The microwave effects observed appear to involve perturbation of the thermal threshold for oxidative hyperthermic hemolysis.

  12. Microcystis aeruginosa toxin: cell culture toxicity, hemolysis, and mutagenicity assays.

    PubMed Central

    Grabow, W O; Du Randt, W C; Prozesky, O W; Scott, W E

    1982-01-01

    Crude toxin was prepared by lyophilization and extraction of toxic Microcystis aeruginosa from four natural sources and a unicellular laboratory culture. The responses of cultures of liver (Mahlavu and PCL/PRF/5), lung (MRC-5), cervix (HeLa), ovary (CHO-K1), and kidney (BGM, MA-104, and Vero) cell lines to these preparations did not differ significantly from one another, indicating that toxicity was not specific for liver cells. The results of a trypan blue staining test showed that the toxin disrupted cell membrane permeability within a few minutes. Human, mouse, rat, sheep, and Muscovy duck erythrocytes were also lysed within a few minutes. Hemolysis was temperature dependent, and the reaction seemed to follow first-order kinetics. Escherichia coli, Streptococcus faecalis, and Tetrahymena pyriformis were not significantly affected by the toxin. The toxin yielded negative results in Ames/Salmonella mutagenicity assays. Microtiter cell culture, trypan blue, and hemolysis assays for Microcystis toxin are described. The effect of the toxin on mammalian cell cultures was characterized by extensive disintegration of cells and was distinguishable from the effects of E. coli enterotoxin, toxic chemicals, and pesticides. A possible reason for the acute lethal effect of Microcystis toxin, based on cytolytic activity, is discussed. Images PMID:6808921

  13. Hemolysis induced by Bacillus cereus sphingomyelinase.

    PubMed

    Oda, Masataka; Takahashi, Masaya; Matsuno, Takayuki; Uoo, Kana; Nagahama, Masahiro; Sakurai, Jun

    2010-06-01

    Bacillus cereus sphingomyelinase (Bc-SMase) induces hemolysis of sheep erythrocytes which contain large amounts of sphingomyelin. We investigated the mechanism of this hemolysis in comparison to that induced by Clostridium perfringens alpha-toxin. Pertussis toxin, a Gi-specific inhibitor, N-oleoylethernolamine, a ceramidase inhibitor, and dihydrosphingosine, a sphingosine kinase inhibitor, did not inhibit the hemolysis by Bc-SMase, but did inhibit that by alpha-toxin. Bc-SMase broadly bound to whole membranes, and alpha-toxin specifically bound to the detergent-resistant membrane fractions, lipid rafts. The level of ceramide production induced by Bc-SMase in sheep erythrocytes was 6- to 15-fold that induced by alpha-toxin, when the extent of the hemolysis by Bc-SMase was the same as that by the toxin. However, the level of ceramide production induced by Bc-SMase in SM-liposomes was equal to that triggered by the toxin, when the carboxyl fluorescein-release from liposomes induced by Bc-SMase was the same as that induced by alpha-toxin. Confocal laser microscopy showed that treatment of the cells with Bc-SMase resulted in the formation of ceramide-rich domains. A photobleaching analysis suggested that treatment of the cells with Bc-SMase leads to a reduction in membrane fluidity. These results show that Bc-SMase-induced hemolysis of sheep erythrocytes is related to the formation of interface between ceramide-rich domains and ceramide-poor domains through production of ceramide from SM.

  14. Detection of Occult Acute Kidney Injury in Glucose-6-Phosphate Dehydrogenase Deficiency Anemia

    PubMed Central

    Abdel Hakeem, Gehan Lotfy; Abdel Naeem, Emad Allam; Swelam, Salwa Hussein; El Morsi Aboul Fotoh, Laila; El Mazary, Abdel Azeem Mohamed; Abdel Fadil, Ashraf Mohamed; Abdel Hafez, Asmaa Hosny

    2016-01-01

    Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia is associated with intravascular hemolysis. The freely filtered hemoglobin can damage the kidney. We aimed to assess any subclinical renal injury in G6PD children. Methods Sixty children were included. Thirty G6PD deficiency anemia children were enrolled during the acute hemolytic crisis and after the hemolytic episode had elapsed. Another thirty healthy children were included as controls. Serum cystatin C, creatinine levels, and urinary albumin/creatinine (A/C) ratio were measured, and the glomerular filtration rate (GFR) was calculated. Results Significantly higher urinary A/C ratio (p=0.001,0.002 respectively) and lower GFR (p=0.001 for both) were found during hemolysis and after the hemolytic episode compared to the controls. Also, significant higher serum cystatin C (p=0.001), creatinine (p=0.05) and A/C (p= 0.001) ratio and insignificant lower GFR (p=0.3) during acute hemolytic crisis compared to the same children after the hemolytic episode subsided. Conclusions G6PD deficiency anemia is associated with a variable degree of acute renal injury during acute hemolytic episodes which may persist after elapsing of the hemolytic crises. PMID:27648201

  15. Positron autoradiography for intravascular imaging: feasibility evaluation.

    PubMed

    Shikhaliev, Polad M; Xu, Tong; Ducote, Justin L; Easwaramoorthy, Balasubramaniam; Mukherjee, Jogeshwar; Molloi, Sabee

    2006-02-21

    Approximately 70% of acute coronary artery disease is caused by unstable (vulnerable) plaques with an inflammation of the overlying cap and high lipid content. A rupturing of the inflamed cap of the plaque results in propagation of the thrombus into the lumen, blockage of the artery and acute ischaemic syndrome or sudden death. Morphological imaging such as angiography or intravascular ultrasound cannot determine inflammation status of the plaque. A radiotracer such as 18F-FDG is accumulated in vulnerable plaques due to higher metabolic activity of the inflamed cap and could be used to detect a vulnerable plaque. However, positron emission tomography (PET) cannot detect the FDG-labelled plaques because of respiratory and heart motions, small size and low activity of the plaques. Plaques can be detected using a miniature particle (positron) detector inserted into the artery. In this work, a new detector concept is investigated for intravascular imaging of the plaques. The detector consists of a storage phosphor tip bound to the end of an intravascular catheter. It can be inserted into an artery, absorb the 18F-FDG positrons from the plaques, withdrawn from the artery and read out. Length and diameter of the storage phosphor tip can be matched to the length and the diameter of the artery. Monte Carlo simulations and experimental evaluations of coronary plaque imaging with the proposed detector were performed. It was shown that the sensitivity of the storage phosphor detector to the positrons of 18F-FDG is sufficient to detect coronary plaques with 1 mm and 2 mm sizes and 590 Bq and 1180 Bq activities in the arteries with 2 mm and 3 mm diameters, respectively. An experimental study was performed using plastic tubes with 2 mm diameter filled with an FDG solution, which simulates blood. FDG spots simulating plaques were placed over the surface of the tube. A phosphor tip was inserted into the tube and imaged the plaques. Exposure time was 1 min in all simulations and

  16. Positron autoradiography for intravascular imaging: feasibility evaluation

    NASA Astrophysics Data System (ADS)

    Shikhaliev, Polad M.; Xu, Tong; Ducote, Justin L.; Easwaramoorthy, Balasubramaniam; Mukherjee, Jogeshwar; Molloi, Sabee

    2006-02-01

    Approximately 70% of acute coronary artery disease is caused by unstable (vulnerable) plaques with an inflammation of the overlying cap and high lipid content. A rupturing of the inflamed cap of the plaque results in propagation of the thrombus into the lumen, blockage of the artery and acute ischaemic syndrome or sudden death. Morphological imaging such as angiography or intravascular ultrasound cannot determine inflammation status of the plaque. A radiotracer such as 18F-FDG is accumulated in vulnerable plaques due to higher metabolic activity of the inflamed cap and could be used to detect a vulnerable plaque. However, positron emission tomography (PET) cannot detect the FDG-labelled plaques because of respiratory and heart motions, small size and low activity of the plaques. Plaques can be detected using a miniature particle (positron) detector inserted into the artery. In this work, a new detector concept is investigated for intravascular imaging of the plaques. The detector consists of a storage phosphor tip bound to the end of an intravascular catheter. It can be inserted into an artery, absorb the 18F-FDG positrons from the plaques, withdrawn from the artery and read out. Length and diameter of the storage phosphor tip can be matched to the length and the diameter of the artery. Monte Carlo simulations and experimental evaluations of coronary plaque imaging with the proposed detector were performed. It was shown that the sensitivity of the storage phosphor detector to the positrons of 18F-FDG is sufficient to detect coronary plaques with 1 mm and 2 mm sizes and 590 Bq and 1180 Bq activities in the arteries with 2 mm and 3 mm diameters, respectively. An experimental study was performed using plastic tubes with 2 mm diameter filled with an FDG solution, which simulates blood. FDG spots simulating plaques were placed over the surface of the tube. A phosphor tip was inserted into the tube and imaged the plaques. Exposure time was 1 min in all simulations and

  17. Unexplained hemolysis in patients undergoing ECMO: beware of hypertriglyceridemia.

    PubMed

    Venado, A; Wille, K; Belott, S C; Diaz-Guzman, E

    2015-09-01

    Hemolysis is a common complication of extracorporeal membrane oxygenation (ECMO) support and is associated with increased mortality. Frequent monitoring of markers of hemolysis is performed at ECMO centers. We report two cases of spurious hemolysis caused by hypertriglyceridemia in patients undergoing ECMO support. Critically ill patients, including those receiving ECMO, may be at risk of developing medication-induced hypertriglyceridemia. The interference of lipids with the measurement of plasma free hemoglobin, a marker of hemolysis, should be recognized. Our cases highlight the importance of investigating hypertriglyceridemia as part of the assessment of unexplained hemolysis in patients supported with ECMO.

  18. Multi-Frequency Intravascular Ultrasound (IVUS) Imaging

    PubMed Central

    Ma, Teng; Yu, Mingyue; Chen, Zeyu; Fei, Chunlong; Shung, K. Kirk; Zhou, Qifa

    2015-01-01

    Acute coronary syndrome (ACS) is frequently associated with the sudden rupture of a vulnerable atherosclerotic plaque within the coronary artery. Several unique physiological features, including a thin fibrous cap accompanied by a necrotic lipid core, are the targeted indicators for identifying the vulnerable plaques. Intravascular ultrasound (IVUS), a catheter-based imaging technology, has been routinely performed in clinics for more than 20 years to describe the morphology of the coronary artery and guide percutaneous coronary interventions. However, conventional IVUS cannot facilitate the risk assessment of ACS because of its intrinsic limitations, such as insufficient resolution. Renovation of the IVUS technology is essentially needed to overcome the limitations and enhance the coronary artery characterization. In this paper, a multi-frequency intravascular ultrasound (IVUS) imaging system was developed by incorporating a higher frequency IVUS transducer (80 to 150 MHz) with the conventional IVUS (30–50 MHz) system. The newly developed system maintains the advantage of deeply penetrating imaging with the conventional IVUS, while offering an improved higher resolution image with IVUS at a higher frequency. The prototyped multi-frequency catheter has a clinically compatible size of 0.95 mm and a favorable capability of automated image co-registration. In vitro human coronary artery imaging has demonstrated the feasibility and superiority of the multi-frequency IVUS imaging system to deliver a more comprehensive visualization of the coronary artery. This ultrasonic-only intravascular imaging technique, based on a moderate refinement of the conventional IVUS system, is not only cost-effective from the perspective of manufacturing and clinical practice, but also holds the promise of future translation into clinical benefits. PMID:25585394

  19. [Pulsatile rotary pumps with low hemolysis].

    PubMed

    Qian, K; Zeng, P; Ru, W; Yuan, H; Feng, Z; Li, L

    2001-09-01

    As is well known, a pulsatile flow is important in assisted-circulation but it is difficult to produce a pulsatile flow with rotary pump, because excessive hemolysis will be generated. The authors have found that the turbulent shear is the main factor for red cell damage and therefore the key point of pulsatile rotary pumps is to reduce the turbulence by producing a pulsatile flow. In the authors' pulsatile axial pump, the pulsatile flow is obtained by axial reciprocation of constant rotating impeller; the rotation and reciprocation of the impeller are driven separately by a DC motor and a pneumatic device. Though a physiological pulsatile flow could be achieved and turbulence would not increase remarkably because the impeller rotates constantly, a second driver except a DC motor is nevertheless necessary, thus the system will become complicated. In the authors' pulsatile radial pump, a pulsatile flow is achieved by changing the rotating speed of the impeller periodically. Turbulence is minimized by a special design of twisted vanes which enable the blood flow to change its direction rather than its dimension during periodic change of rotating speed. Hemolysis tests demonstrated that the index of hemolysis(IH) of the author's pulsatile radial pump is 0.020, with is slightly more than that of the author's nonpulsatile radial pump(IH = 0.015). Animal experiments indicated that the pulsatile radial pump can assist the circulation of calves for several months without harm to blood elements and organ functions of the recipients.

  20. Fast integrated intravascular photoacoustic/ultrasound catheter

    NASA Astrophysics Data System (ADS)

    Choi, Changhoon; Cho, Seunghee; Kim, Taehoon; Park, Sungjo; Park, Hyoeun; Kim, Jinmoo; Lee, Seunghoon; Kang, Yeonsu; Jang, Kiyuk; Kim, Chulhong

    2016-03-01

    In cardiology, a vulnerable plaque is considered to be a key subject because it is strongly related to atherosclerosis and acute myocardial infarction. Because conventional intravascular imaging devices exhibit several limitations with regard to vulnerable plaque detection, the need for an effective lipid imaging modality has been continuously suggested. Photoacoustic (PA) imaging is a medical imaging technique with a high level of ultrasound (US) resolution and strong optical contrast. In this study, we successfully developed an integrated intravascular photoacoustic/ultrasound (IV-PAUS) imaging system with a catheter diameter of 1.2 mm for lipid-rich atherosclerosis imaging. An Nd:YAG pulsed laser with an excitation wavelength of 1064 nm was utilized. IV-PAUS offers 5-mm depth penetration and axial and lateral PA imaging resolutions of 94 μm and 203 μm, respectively, as determined by imaging a 6-μm carbon fiber. We initially obtained 3-dimensional (3D) co-registered PA/US images of metal stents. Subsequently, we successfully obtained 3D coregistered PA/US ex vivo images using an iliac artery from a rabbit atherosclerosis model. Accordingly, lipid-rich plaques were sufficiently differentiated from normal tissue in the ex vivo experiment. We validated these findings histologically to confirm the lipid content.

  1. Experience in reducing the hemolysis of an impeller assist heart.

    PubMed

    Qian, K X

    1989-01-01

    Blood trauma has been one of the main problems of centrifugal pumps. The difficulties in reducing hemolysis are many, and all the factors causing excessive hemolysis always act together, making them difficult to discover and distinguish. Furthermore, error could occur at many points during hemolysis testing, making it difficult to repeat results. In developing the low hemolysis pulsatile and nonpulsatile impeller pumps the authors established an experimental method for investigating and searching for the hemolysis factors. In this study two pumps with only one differing factor were compared or only one factor on one pump was changed in the middle of the test period. In this way the effect of the individual factor on pump hemolysis could be seen and some factors have been thus confirmed as important reasons for hemolysis: 1) the drift of the pump output (including the volume and efficiency) from the design point; 2) impeller vane angles, i.e., the radial logarithmic spiral angle and the axial helical spiral angle; 3) roughness of vane surface and other blood contacting surfaces of the sealing box and pump housing; 4) vibration of the rotor resulting from dynamic disequilibrium; and 5) prerotation swirl at the inlet of the pump. The blood pressure to be pumped has been shown to have no influence on pump hemolysis. After eliminating the hemolysis factors, the blood trauma of the impeller heart has been reduced remarkably. The index of hemolysis of the nonpulsatile pump is 0.015, about one fifth of a clinically used roller made in Shanghai and two sevenths of one Sarns 7,000 Roller; the index of hemolysis of the pulstile pump is 0.020, about one sixth of a self-made diaphragm pump and one thirteenth of the Polystan pulsa tile pump.

  2. Intravascular photoacoustic tomography for characterization of atherosclerotic lipid and inflammation

    NASA Astrophysics Data System (ADS)

    Zhang, Jian; Qin, Huan; Shi, Yujiao; Yang, Sihua; Xing, Da

    2014-09-01

    Photoacoustic imaging is a fast growing imaging technology depending on its high optical resolution of optics while taking the advantage of the high penetration depth of ultrasound. In this paper, we demonstrate the new progress in the photoacoustic imaging. Atherosclerosis is characterized by a progressive build-up of lipid in the arterial wall, which is known as plaque. Histological studies demonstrate that the primary cause of acute cardiovascular events is the rupture of atherosclerotic plaques. Lipid and inflammation within the plaque are related to influence the propensity of plaques to disrupt. Photoacoustic intravascular tomography (IVPAT) holds a great advantage in providing comprehensive morphological and functional information of plaques. Lipid relative concentration maps of atherosclerotic aorta were obtained and compared with histology. Furthermore, by selectively targeting the intravascular inflammatory cytokines, IVPAT is also capable of mapping the inflamed area and determining the degree of inflammation.

  3. Image Processing in Intravascular OCT

    NASA Astrophysics Data System (ADS)

    Wang, Zhao; Wilson, David L.; Bezerra, Hiram G.; Rollins, Andrew M.

    Coronary artery disease is the leading cause of death in the world. Intravascular optical coherence tomography (IVOCT) is rapidly becoming a promising imaging modality for characterization of atherosclerotic plaques and evaluation of coronary stenting. OCT has several unique advantages over alternative technologies, such as intravascular ultrasound (IVUS), due to its better resolution and contrast. For example, OCT is currently the only imaging modality that can measure the thickness of the fibrous cap of an atherosclerotic plaque in vivo. OCT also has the ability to accurately assess the coverage of individual stent struts by neointimal tissue over time. However, it is extremely time-consuming to analyze IVOCT images manually to derive quantitative diagnostic metrics. In this chapter, we introduce some computer-aided methods to automate the common IVOCT image analysis tasks.

  4. [Effect of impeller vane number and angles on pump hemolysis].

    PubMed

    Qian, Kunxi; Feng, Zhigang; Zeng, Pei; Ru, Weimin; Yuan, Haiyu

    2003-12-01

    To evaluate the effect of impeller design on pump hemolysis, five impellers with different number of vanes or different vane angles were manufactured and tested in one pump for hemolysis comparison. The impellers are made to have the same dimension and same logarithmic spiral vane from which coincide with the stream surfaces in the pump, according to the analytical and three-dimensional design method developed by the authors. Consequently, an impeller with 6 vanes and 30 degrees vane angle has the lowest hemolysis index. This result agrees with the theoretical analyses of other investigators searching optimal number of vanes and vane angle to achieve the highest efficiency of the pump.

  5. Intravascular probe for detection of vulnerable plaque

    NASA Astrophysics Data System (ADS)

    Patt, Bradley E.; Iwanczyk, Jan S.; MacDonald, Lawrence R.; Yamaguchi, Yuko; Tull, Carolyn R.; Janecek, Martin; Hoffman, Edward J.; Strauss, H. William; Tsugita, Ross; Ghazarossian, Vartan

    2001-12-01

    Coronary angiography is unable to define the status of the atheroma, and only measures the luminal dimensions of the blood vessel, without providing information about plaque content. Up to 70% of heart attacks are caused by minimally obstructive vulnerable plaques, which are too small to be detected adequately by angiography. We have developed an intravascular imaging detector to identify vulnerable coronary artery plaques. The detector works by sensing beta or conversion electron radiotracer emissions from plaque-binding radiotracers. The device overcomes the technical constraints of size, sensitivity and conformance to the intravascular environment. The detector at the distal end of the catheter uses six 7mm long by 0.5mm diameter scintillation fibers coupled to 1.5m long plastic fibers. The fibers are offset from each other longitudinally by 6mm and arranged spirally around a guide wire in the catheter. At the proximal end of the catheter the optical fibers are coupled to an interface box with a snap on connector. The interface box contains a position sensitive photomultiplier tube (PSPMT) to decode the individual fibers. The whole detector assembly fits into an 8-French (2.7 mm in diameter) catheter. The PSPMT image is further decoded with software to give a linear image, the total instantaneous count rate and an audio output whose tone corresponds to the count rate. The device was tested with F-18 and Tl-204 sources. Spectrometric response, spatial resolution, sensitivity and beta to background ratio were measured. System resolution is 6 mm and the sensitivity is >500 cps / micrometers Ci when the source is 1 mm from the detector. The beta to background ratio was 11.2 for F-18 measured on a single fiber. The current device will lead to a system allowing imaging of labeled vulnerable plaque in coronary arteries. This type of signature is expected to enable targeted and cost effective therapies to prevent acute coronary artery diseases such as: unstable angina

  6. Bioresorbable vascular scaffold restenosis: intravascular imaging evaluation.

    PubMed

    Fabris, Enrico; Kilic, Ismail Dogu; Caiazzo, Gianluca; Serdoz, Roberta; Foin, Nicolas; Sinagra, Gianfranco; Di Mario, Carlo

    2015-11-21

    The mechanism of restenosis in bioresorbable vascular scaffold (BVS) may be different from that of metallic stents and it is still poorly investigated. Intravascular imaging techniques are useful tools for corroborating or excluding possible mechanisms of intra-scaffold restenosis. In these novel devices intravascular imaging should be systematically used for a better comprehension of the in-scaffold restenosis mechanism.

  7. The relationship between the severity of hemolysis, clinical manifestations and risk of death in 415 patients with sickle cell anemia in the US and Europe.

    PubMed

    Nouraie, Mehdi; Lee, Janet S; Zhang, Yingze; Kanias, Tamir; Zhao, Xuejun; Xiong, Zeyu; Oriss, Timothy B; Zeng, Qilu; Kato, Gregory J; Gibbs, J Simon R; Hildesheim, Mariana E; Sachdev, Vandana; Barst, Robyn J; Machado, Roberto F; Hassell, Kathryn L; Little, Jane A; Schraufnagel, Dean E; Krishnamurti, Lakshmanan; Novelli, Enrico; Girgis, Reda E; Morris, Claudia R; Rosenzweig, Erika Berman; Badesch, David B; Lanzkron, Sophie; Castro, Oswaldo L; Goldsmith, Jonathan C; Gordeuk, Victor R; Gladwin, Mark T

    2013-03-01

    The intensity of hemolytic anemia has been proposed as an independent risk factor for the development of certain clinical complications of sickle cell disease, such as pulmonary hypertension, hypoxemia and cutaneous leg ulceration. A composite variable derived from several individual markers of hemolysis could facilitate studies of the underlying mechanisms of hemolysis. In this study, we assessed the association of hemolysis with outcomes in sickle cell anemia. A hemolytic component was calculated by principal component analysis from reticulocyte count, serum lactate dehydrogenase, aspartate aminotransferase and total bilirubin concentrations in 415 hemoglobin SS patients. Association of this component with direct markers of hemolysis and clinical outcomes was assessed. As primary validation, both plasma red blood cell microparticles and cell-free hemoglobin concentration were higher in the highest hemolytic component quartile compared to the lowest quartile (P≤0.0001 for both analyses). The hemolytic component was lower with hydroxyurea therapy, higher hemoglobin F, and alpha-thalassemia (P≤0.0005); it was higher with higher systemic pulse pressure, lower oxygen saturation, and greater values for tricuspid regurgitation velocity, left ventricular diastolic dimension and left ventricular mass (all P<0.0001). Two-year follow-up analysis showed that a high hemolytic component was associated with an increased risk of death (hazard ratio, HR 3.44; 95% confidence interval, CI: 1.2-9.5; P=0.02). The hemolytic component reflects direct markers of intravascular hemolysis in patients with sickle cell disease and allows for adjusted analysis of associations between hemolytic severity and clinical outcomes. These results confirm associations between hemolytic rate and pulse pressure, oxygen saturation, increases in Doppler-estimated pulmonary systolic pressures and mortality (Clinicaltrials.gov identifier: NCT00492531).

  8. The relationship between the severity of hemolysis, clinical manifestations and risk of death in 415 patients with sickle cell anemia in the US and Europe

    PubMed Central

    Nouraie, Mehdi; Lee, Janet S.; Zhang, Yingze; Kanias, Tamir; Zhao, Xuejun; Xiong, Zeyu; Oriss, Timothy B.; Zeng, Qilu; Kato, Gregory J.; Gibbs, J. Simon R.; Hildesheim, Mariana E.; Sachdev, Vandana; Barst, Robyn J.; Machado, Roberto F.; Hassell, Kathryn L.; Little, Jane A.; Schraufnagel, Dean E.; Krishnamurti, Lakshmanan; Novelli, Enrico; Girgis, Reda E.; Morris, Claudia R.; Rosenzweig, Erika Berman; Badesch, David B.; Lanzkron, Sophie; Castro, Oswaldo L.; Goldsmith, Jonathan C.; Gordeuk, Victor R.; Gladwin, Mark T.

    2013-01-01

    The intensity of hemolytic anemia has been proposed as an independent risk factor for the development of certain clinical complications of sickle cell disease, such as pulmonary hypertension, hypoxemia and cutaneous leg ulceration. A composite variable derived from several individual markers of hemolysis could facilitate studies of the underlying mechanisms of hemolysis. In this study, we assessed the association of hemolysis with outcomes in sickle cell anemia. A hemolytic component was calculated by principal component analysis from reticulocyte count, serum lactate dehydrogenase, aspartate aminotransferase and total bilirubin concentrations in 415 hemoglobin SS patients. Association of this component with direct markers of hemolysis and clinical outcomes was assessed. As primary validation, both plasma red blood cell microparticles and cell-free hemoglobin concentration were higher in the highest hemolytic component quartile compared to the lowest quartile (P≤0.0001 for both analyses). The hemolytic component was lower with hydroxyurea therapy, higher hemoglobin F, and alpha-thalassemia (P≤0.0005); it was higher with higher systemic pulse pressure, lower oxygen saturation, and greater values for tricuspid regurgitation velocity, left ventricular diastolic dimension and left ventricular mass (all P<0.0001). Two-year follow-up analysis showed that a high hemolytic component was associated with an increased risk of death (hazard ratio, HR 3.44; 95% confidence interval, CI: 1.2–9.5; P=0.02). The hemolytic component reflects direct markers of intravascular hemolysis in patients with sickle cell disease and allows for adjusted analysis of associations between hemolytic severity and clinical outcomes. These results confirm associations between hemolytic rate and pulse pressure, oxygen saturation, increases in Doppler-estimated pulmonary systolic pressures and mortality (Clinicaltrials.gov identifier: NCT00492531). PMID:22983573

  9. Hemolysis Is Associated with Low Reticulocyte Production Index and Predicts Blood Transfusion in Severe Malarial Anemia

    PubMed Central

    Rudat, Annika; Kreidenweiss, Andrea; Steur, Claudia; Appelmann, Iris; Ruehe, Bettina; Schröder, Paul; Berdel, Wolfgang E.; Kremsner, Peter G.; Mordmüller, Benjamin

    2010-01-01

    Background Falciparum Malaria, an infectious disease caused by the apicomplexan parasite Plasmodium falciparum, is among the leading causes of death and morbidity attributable to infectious diseases worldwide. In Gabon, Central Africa, one out of four inpatients have severe malarial anemia (SMA), a life-threatening complication if left untreated. Emerging drug resistant parasites might aggravate the situation. This case control study investigates biomarkers of enhanced hemolysis in hospitalized children with either SMA or mild malaria (MM). Methods and Findings Ninety-one children were included, thereof 39 SMA patients. Strict inclusion criteria were chosen to exclude other causes of anemia. At diagnosis, erythrophagocytosis (a direct marker for extravascular hemolysis, EVH) was enhanced in SMA compared to MM patients (5.0 arbitrary units (AU) (interquartile range (IR): 2.2–9.6) vs. 2.1 AU (IR: 1.3–3.9), p<0.01). Furthermore, indirect markers for EVH, (i.e. serum neopterin levels, spleen size enlargement and monocyte pigment) were significantly increased in SMA patients. Markers for erythrocyte ageing, such as CD35 (complement receptor 1), CD55 (decay acceleration factor) and phosphatidylserine exposure (annexin-V-binding) were investigated by flow cytometry. In SMA patients, levels of CD35 and CD55 on the red blood cell surface were decreased and erythrocyte removal markers were increased when compared to MM or reconvalescent patients. Additionally, intravascular hemolysis (IVH) was quantified using several indirect markers (LDH, α-HBDH, haptoglobin and hemopexin), which all showed elevated IVH in SMA. The presence of both IVH and EVH predicted the need for blood transfusion during antimalarial treatment (odds ratio 61.5, 95% confidence interval (CI): 8.9–427). Interestingly, this subpopulation is characterized by a significantly lowered reticulocyte production index (RPI, p<0.05). Conclusions Our results show the multifactorial pathophysiology of SMA

  10. Acute alterations in the regulation of lipid metabolism after intravascular reexposure to a single bolus of homologous virus during influenza B infection in ferrets: possible model of epiphenomena associated with influenza.

    PubMed Central

    Kang, E. S.; Galloway, M. S.; Bean, W.; Cook, G. A.; Olson, G.

    1991-01-01

    Metabolic responses occurring 24 h following the secondary haematogenous dissemination of influenza B virus during convalescence from infection were examined in the ferret as a possible model for epiphenomena which can occur following infection with influenza. Among the major changes found were a further rise in the mean fasting serum free fatty acid (FFA) level to three times the control mean value and a 50% drop in the mean serum triglyceride (TG) concentration after the intravascular administration of a single bolus of virus compared to levels found in uninfected or convalescent animals. In adipose tissue, hormone-sensitive and lipoprotein lipase activities were increased six and three-fold, respectively, over mean control values, probably accounting for the changes that were observed in serum lipid concentrations. In the liver, total carnitine palmitoyltransferase (CPT) activity was affected only slightly and the total lipid content of the liver remained unchanged. These findings indicate that 24 h after the intravascular dissemination of homologous virus in a single bolus during convalescence from influenza B infection, major distortions in the regulation of lipid metabolism occur in the ferret. Loss of the synchronous regulation of the two adipose tissue lipases is a significant consequence leading to the mobilization of a large amount of FFA during fasting from both adipose tissue and the circulating plasma TG stores. PMID:1843259

  11. Intravascular lymphoma and thyroid gland.

    PubMed

    Katalinić, Darko; Valković, Toni; Lucin, Ksenija; Rudez, Josip

    2006-03-01

    Intravascular lymphoma (IVL) is a rare disease characterized by the proliferation of neoplastic cells in the small blood vessels that frequently goes undiagnosed until the time of autopsy. The neoplastic cells are usually of B-cell origin. The clinical course was examined to determine factors that would facilitate antemortem diagnosis. IVL is observed with clinical, histopathological and immunohystochemical methods. This is a unique case because the thyroid gland is a rare place for IVL. Accent is given on immunohystochemical methods and tissue biopsy in the differential diagnosis of IVL when nervous system and thyroid gland dysfunction occur This report indicates that micro-ecosystem of multinodular goitrous might influence the expression of chemokines and/or adhesion moleculs on endothelial and lymphoma cells, leading to heavy infiltration of thyroid gland. Concurrently, that may guide the physician to tissue biopsy facilitating antemortem diagnosis and institution of appropriate therapy.

  12. Lipopolysaccharide-induced hemolysis: Evidence for direct membrane interactions

    PubMed Central

    Brauckmann, Stephan; Effenberger-Neidnicht, Katharina; de Groot, Herbert; Nagel, Michael; Mayer, Christian; Peters, Jürgen; Hartmann, Matthias

    2016-01-01

    While hemolysis in patients with sepsis is associated with increased mortality its mechanisms are unknown and Toll-like receptor (TLR)-4 mediated effects, complement-mediated hemolysis, or direct cell membrane effects are all conceivable mechanisms. In this study, we tested the hypotheses that toxic lipopolysaccharide (LPS) as well as non-toxic RS-LPS evokes hemolysis (1) by direct membrane effects, and (2) independent of the complement system and TLR-4 activation. We found, that incubation with LPS resulted in a marked time and concentration dependent increase of free hemoglobin concentration and LDH activity in whole blood and washed red cells. Red cell integrity was diminished as shown by decreased osmotic resistance, formation of schistocytes and rolls, and a decrease in red cell membrane stiffness. Non-toxic RS-LPS inhibited the LPS-evoked increase in TNF-α concentration demonstrating its TLR-4 antagonism, but augmented LPS-induced increase in supernatant hemoglobin concentration and membrane disturbances. Removal of plasma components in washed red cell assays failed to attenuate hemolysis. In summary, this study demonstrates direct physicochemical interactions of LPS with red cell membranes resulting in hemolysis under in vitro conditions. It might thus be hypothesized, that not all effects of LPS are mediated by TLR and may explain LPS toxicity in cells missing TLR. PMID:27759044

  13. Lipid peroxidation, hemolysis and antioxidant enzymes of erythrocytes in stroke.

    PubMed

    Sudha, K; Rao, Ashalatha V; Rao, Suryanarayana; Rao, Anjali

    2004-04-01

    Erythrocyte membrane lipid peroxidation and consequent percentage hemolysis and related antioxidant enzymes viz., superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase were determined in 16 cases of hemorrhagic stroke and 30 cases of thrombotic stroke. The results obtained were compared with 50 age and sex matched controls. 12 thrombotic stroke patients who showed symptomatic recovery after medication were considered for follow up. Lipid peroxidation and percentage hemolysis in patients with thrombotic stroke and hemorrhagic stroke was significantly elevated when compared to controls. Glutathione reductase and superoxide dismutase levels were found to be significantly reduced in thrombotic stroke and hemorrhagic stroke respectively, when compared to healthy subjects. There was no significant difference in the other parameters when compared to controls. In post treatment thrombotic stoke, catalase and glutathione reductase levels increased significantly and oxidative hemolysis decreased compared to their pretreatment values. Thus, our results indicate considerable oxidative stress in stroke.

  14. The Cluster [Re6Se8I6]3− Induces Low Hemolysis of Human Erythrocytes in Vitro: Protective Effect of Albumin

    PubMed Central

    Rojas-Mancilla, Edgardo; Oyarce, Alexis; Verdugo, Viviana; Zheng, Zhiping; Ramírez-Tagle, Rodrigo

    2015-01-01

    The cluster Re6Se8I63− has been shown to induce preferential cell death of a hepatic carcinoma cell line, thus becoming a promising anti-cancer drug. Whether this cluster induces acute hemolysis or if it interacts with albumin remains unclear. The effect of acute exposure of human red blood cells to different concentrations of the cluster with and without albumin is described. Red blood cells from healthy donors were isolated, diluted at 1% hematocrit and exposed to the cluster (25–150 µM) at 37 °C, under agitation. Hemolysis and morphology were analyzed at 1 and 24 h. The potential protection of 0.1% albumin was also evaluated. Exposition to therapeutic doses of the cluster did not induce acute hemolysis. Similar results were observed following 24 h of exposition, and albumin slightly reduced hemolysis levels. Furthermore, the cluster induced alteration in the morphology of red blood cells, and this was prevented by albumin. Together, these results indicate that the cluster Re6Se8I63− is not a hemolytic component and induces moderate morphological alterations of red blood cells at high doses, which are prevented by co-incubation with albumin. In conclusion, the cluster Re6Se8I63− could be intravenously administered in animals at therapeutic doses for in vivo studies. PMID:25590300

  15. Hemolysis induced by an extreme mountain ultra-marathon is not associated with a decrease in total red blood cell volume.

    PubMed

    Robach, P; Boisson, R-C; Vincent, L; Lundby, C; Moutereau, S; Gergelé, L; Michel, N; Duthil, E; Féasson, L; Millet, G Y

    2014-02-01

    Prolonged running is known to induce hemolysis. It has been suggested that hemolysis may lead to a significant loss of red blood cells; however, its actual impact on the erythrocyte pool is unknown. Here, we test the hypothesis that prolonged running with high hemolytic potential decreases total red blood cell volume (RCV). Hemolysis (n = 22) and RCV (n = 19) were quantified in ultra-marathon runners before and after a 166-km long mountain ultra-endurance marathon (RUN) with 9500 m of altitude gain/loss. Assessment of total hemoglobin mass (Hbmass) and RCV was performed using a carbon monoxide rebreathing technique. RUN induced a marked acute-phase response and promoted hemolysis, as shown by a decrease in serum haptoglobin (P < 0.05). Elevated serum erythropoietin concentration and reticulocyte count after RUN were indicative of erythropoietic stimulation. Following RUN, runners experienced hemodilution, mediated by a large plasma volume expansion and associated with a large increase in plasma aldosterone. However, neither Hbmass nor RCV were found to be altered after RUN. Our findings indicate that mechanical/physiological stress associated with RUN promotes hemolysis but this has no impact on total erythrocyte volume. We therefore suggest that exercise 'anemia' is entirely due to plasma volume expansion and not to a concomitant decrease in RCV.

  16. Anemia and mechanism of erythrocyte destruction in ducks with acute Leucocytozoon infections

    USGS Publications Warehouse

    Kocan, R.M.

    1968-01-01

    In the anemia which accompanies infection by Leucocytozoon simondi in Pekin ducks there was a far greater loss of erythrocytes than could be accounted for as a result of direct physical rupture by the parasite. Erythrocyte loss began at the same time the 1st parasites appeared in the blood and was severest just prior to maximum parasitemia. Blood replacement and parasite loss occurred simultaneously. Examination of the spleen and bone marrow revealed that erythrophagocytosis was not the cause of anemia as reported for infections of Plasmodium, Babesia and Anaplasma. An anti-erythrocyte (A-E) factor was found in the serum of acutely infected ducks which agglutinated and hemolyzed normal untreated duck erythrocytes as well as infected cells. This A-E factor appeared when the 1st red cell loss was detected and reached its maximum titer just prior to the greatest red cell loss. Titers of the A-E factor were determined using normal uninfected erythrocytes at temperatures between 4 and 42 C. Cells agglutinated below 25 C and hemolyzed at 37 and 42 C. These results indicated that the A-E factor could be responsible for loss of cells other than those which were infected and could thus produce an excess loss of red cells. Attempts to implicate the A-E factor as an autoantibody were all negative. The A-E factor was present in the gamma fraction of acute serum but no anamnestic response could be detected when recovered ducks were reinfected. Anemia was never as severe in reinfections as in primary infections. The A-E factor also never reached as high a titer and was removed from the circulation very rapidly in reinfected ducks. It is concluded that red cell loss in ducks with acute Leucocytozoon disease results from intravascular hemolysis rather than erythrophagocytosis. The A-E factor responsible for hemolysis is more likely a parasite product rather than autoantibody.

  17. Turbulence effects on hemolysis by revisiting experiments with LES computations

    NASA Astrophysics Data System (ADS)

    Ozturk, Mesude; O'Rear, Edgar; Papavassiliou, Dimitrios

    2015-11-01

    Determining mechanically stimulated red blood cell trauma as a function of turbulence properties is required to design prosthetic heart devices. Because blood is typically exposed to turbulence in such devices, the design of prosthetic heart devices depends on determining the effect of turbulent stresses on hemolysis. While turbulent stresses increase hemolysis when cells are exposed to them, turbulent flow characteristics in the vicinity of lysed blood cells, and the mechanism of cell damage remains uncertain. In this work, LES computations are used to investigate the effect of turbulent eddy structure on cell damage. The flow was simulated for classic Couette and capillary tube experiments, in order to examine the relation between hemolysis turbulence properties related to the dissipation of turbulent kinetic energy. The hypothesis tested is that eddies that are close in size with the erythrocytes are the ones that are responsible for hemolysis, rather than Reynolds stresses or viscous stresses. We define extensive measures, like the eddy areas for small eddies comparable to the size of the red blood cells, to provide a more general understanding of the mechanical cause of blood trauma.

  18. Relationship between polarization characteristics and hemolysis rate and its potential application

    NASA Astrophysics Data System (ADS)

    Wang, Xuezhen; Lai, Jiancheng; Li, Zhenhua

    2017-01-01

    Mueller polarimetry has been widely investigated in biomedical field. However the application in hemolysis monitoring is unavailable. This study deals with the backscattering polarimetric characterization of erythrocyte suspensions in low-osmolarity-induced hemolysis condition. Scattering and absorption are observed to decrease with increasing hemolysis. Increasing degree of polarization (DOP) corresponds to a decrease of scattering; increasing diattenuation corresponds to a decrease of scattering. However the decreasing absorption increases first and then decreases DOP in erythrocyte suspensions which are typical of Mie scatterers; reducing diattenuation corresponds to a decrease of absorption. Hence it is demonstrated that higher DOP is preserved in more serious hemolysis condition. In addition, DOP increasing trends are different in the conditions of below/above 6% hemolysis rate. Diatteunation shows an increasing trend at increase of blood hemolysis percentage with an exception when the hemolysis rate ranges from 5% to 6%. These results may be helpful for monitoring of hemolysis by polarimetric optical method.

  19. Comparative hemolysis study of clinically available centrifugal pumps.

    PubMed

    Naito, K; Suenaga, E; Cao, Z L; Suda, H; Ueno, T; Natsuaki, M; Itoh, T

    1996-06-01

    Centrifugal pumps have become important devices for cardiopulmonary bypass and circulatory assistance. Five types of centrifugal pumps are clinically available in Japan. To evaluate the blood trauma caused by centrifugal pumps, a comparative hemolysis study was performed under identical conditions. In vitro hemolysis test circuits were constructed to operate the BioMedicus BP-80 (Medtronic, BioMedicus), Sarns Delphin (Sarns/3M Healthcare), Isoflow (St. Jude Medical [SJM]), HPM-15 (Nikkiso), and Capiox CX-SP45 (Terumo). The hemolysis test loop consisted of two 1.5 m lengths of polyvinyl chloride tubing with a 3/8-inch internal diameter, a reservoir with a sampling port, and a pump head. All pumps were set to flow at 6 L/min against the total pressure head of 120 mm Hg. Experiments were conducted simultaneously for 6 h at room temperature (21 degrees C) with fresh bovine blood. Blood samples for plasma-free hemoglobin testing were taken, and the change in temperature at the pump outlet port was measured during the experiment. The mean pump rotational speeds were 1,570, 1,374, 1,438, 1,944, and 1,296 rpm, and the normalized indexes of hemolysis were 0.00070, 0.00745, 0.00096, 0.00066, 0.00090 g/100 L for the BP-80, Sarns, SJM, Nikkiso, and Terumo pumps, respectively. The change in temperature at the pump outlet port was the least for the Nikkiso pump (1.8 degrees C) and the most with the SJM pump (3.8 degrees C). This study showed that there is no relationship between the pump rotational speed (rpm) and the normalized index of hemolysis in 5 types of centrifugal pumps. The pump design and number of impellers could be more notable factors in blood damage.

  20. Hemolysis and cytotoxicity mechanisms of biodegradable magnesium and its alloys.

    PubMed

    Zhen, Zhen; Liu, Xiaoli; Huang, Tao; Xi, TingFei; Zheng, Yufeng

    2015-01-01

    Good hemocompatibility and cell compatibility are essential requirements for coronary stents, especially for biodegradable magnesium alloy stents, which could change the in situ environment after implanted. In this work, the effects of magnesium ion concentration and pH value on the hemolysis and cytotoxicity have been evaluated. Solution with different Mg(2+) concentration gradients and pH values of normal saline and cell culture media DMEM adjusted by MgCl2 and NaOH respectively were tested for the hemolysis and cell viability. Results show that even when the concentration of Mg(2+) reaches 1000 μg/mL, it has little destructive effect on erythrocyte, and the high pH value over 11 caused by the degradation is the real reason for the high hemolysis ratio. Low concentrations of Mg(2+) (<100 μg/mL) cause no cytotoxicity to L929 cells, of which the cell viability is above 80%, while high concentrations of Mg(2+) (>300 μg/mL) could induce obvious death of the L929 cells. The pH of the extract plays a synergetic effect on cytotoxicity, due to the buffer action of the cell culture medium. To validate this conclusion, commercial pure Mg using normal saline and PBS as extract was tested with the measurement of pH and Mg(2+) concentration. Pure Mg leads to a higher hemolysis ratio in normal saline (47.76%) than in buffered solution (4.38%) with different pH values and low concentration of Mg(2+). The Mg extract culture media caused no cytotoxicity, with pH=8.44 and 47.80 μg/mL Mg(2+). It is suggested that buffered solution and dynamic condition should be adopted in the hemolysis evaluation.

  1. Hemolysis in runners as evidenced by low serum haptoglobin: Implications for preflight monitoring of astronauts

    NASA Technical Reports Server (NTRS)

    Owens, Joyce; Spitler, Diane L.; Frey, Mary Anne Bassett

    1987-01-01

    Hematological parameters and serum haptoglobin were examined in 21 male employees of the Kennedy Space Center who were at 3 levels of physical activity: 7 subjects regularly ran more than 40 km (25 miles) per week (Group I); 7 ran 13 to 24 km (8 to 15 miles) per week (II), and 7 were sedentary (III). Blood was drawn on a different day of the week for five weeks. Differences between day of the week, visit number, and activity level were examined. No differences were observed for day of week or visit number; thus mean values for each variable were calculated for each subject. Variables did not differ among groups. However, trends with level of training were observed in some critical variables. Hemoglobin (Hb) and hematocrit (Hct) conformed to a staircase effect with Group I (14.5 gm/dl and 41.3 percent) lower than Group III (15.1 gm/dl and 42.9 percent). Reticulocyte count was higher and haptoglobin levels lower in Group I (1.35% and 75.7 gm/dl) than Group III (.99 percent and 132.9 gm/dl), with haptoglobin for the high mileage Group I in the clinically abnormal range. Since haptoglobin binds free Hb following RBC destruction, these results suggest that intravascular hemolysis occurs in trained male runners. These results may have special meaning for astronauts training before long-duration spaceflights, since the further reduction in red blood cells which is reported to occur during spaceflight could become detrimental to their health and performance.

  2. [Kidney donor with severe disseminated intravascular coagulation: transplantation however successful].

    PubMed

    Keeris, Lodewijk M; Bergmans, Dennis C J J; van der Sande, Frank M; Wind, Tineke J; van Suylen, Robert Jan; van Mook, Walther N K A

    2009-01-01

    A 41-year-old male, with no previous medical history, was admitted to our intensive care unit with severe isolated neurotrauma and a Glasgow Coma Scale of E1-M1-V1, mid-dilated unreactive pupils and severe abnormalities on the brain CT-scan. A severe syndrome of disseminated intravascular coagulation (DIC) and non-oliguric renal insufficiency developed. Following clinical and neurophysiological examination the patient was declared brain-dead, and the family gave permission for organ donation. The left kidney was transplanted and functioned well immediately. However, in view of the DIC and renal function disorders the right kidney was not considered usable for transplantation elsewhere. Pathological examination revealed many fibrin thrombi in the glomerular capillaries and acute tubular necrosis. This case supports the view that thrombotic microangiopathy in kidneys of patients with DIS, even with renal function impairment, is not an a priori reason for excluding donation.

  3. Testing of models of flow-induced hemolysis in blood flow through hypodermic needles.

    PubMed

    Chen, Yangsheng; Kent, Timothy L; Sharp, M Keith

    2013-03-01

    Hemolysis caused by flow in hypodermic needles interferes with a number of tests on blood samples drawn by venipuncture, including assays for metabolites, electrolytes, and enzymes, causes discomfort during dialysis sessions, and limits transfusion flow rates. To evaluate design modifications to address this problem, as well as hemolysis issues in other cardiovascular devices, computational fluid dynamics (CFD)-based prediction of hemolysis has potential for reducing the time and expense for testing of prototypes. In this project, three CFD-integrated blood damage models were applied to flow-induced hemolysis in 16-G needles and compared with experimental results, which demonstrated that a modified needle with chamfered entrance increased hemolysis, while a rounded entrance decreased hemolysis, compared with a standard needle with sharp entrance. After CFD simulation of the steady-state velocity field, the time histories of scalar stress along a grid of streamlines were calculated. A strain-based cell membrane failure model and two empirical power-law blood damage models were used to predict hemolysis on each streamline. Total hemolysis was calculated by weighting the predicted hemolysis along each streamline by the flow rate along each streamline. The results showed that only the strain-based blood damage model correctly predicted increased hemolysis in the beveled needle and decreased hemolysis in the rounded needle, while the power-law models predicted the opposite trends.

  4. Virucidal levels of ozone induce hemolysis and hemoglobin degradation

    SciTech Connect

    Wagner, S.J.; Wagner, K.F.; Friedman, L.I.; Benade, L.F. )

    1991-10-01

    The animal virus, vesicular stomatitis virus (VSV), and the bacterial virus, phi 6, were inactivated by greater than 4 log10 in response to incubation with 13 to 14 mL of 1.4 mmol per L (65 micrograms/mL) to 1.6 mmol per L (75 micrograms/mL) of overlaid ozone in virus-spiked, dilute, red cell suspensions. Virus inactivation was greatly inhibited when ozone was overlaid in the presence of high-hematocrit red cells or, to a lesser degree, high levels of plasma. At hematocrits at which 5 to 6 log10 of VSV were inactivated, ozone caused 30-percent hemolysis, as measured by the loss of total cellular hemoglobin. Unexpectedly, this level of hemolysis could not be observed in supernatants because of the ozone-induced destruction (bleaching) of extracellular hemoglobin. These results suggest that ozone may have little biological specificity for damaging viruses over red cells.

  5. Intravascular papillary endothelial hyperplasia of the foot.

    PubMed

    Cisco, R W; McCormac, R M

    1994-01-01

    Intravascular papillary endothelial hyperplasia is a rare benign reactive lesion usually found in thrombosed subcutaneous blood vessels. The lesion resembles malignant angiosarcoma clinically and histopathologically, and must be diagnosed correctly to avoid inappropriate treatment. The following is a case presentation involving the foot.

  6. Humoral immune response to the heat-labile enterotoxin of Escherichia coli in naturally acquired diarrhea and antitoxin determination by passive immune hemolysis.

    PubMed Central

    Evans, D J; Ruiz-Palacios, G; Evans, D E; DuPont, H L; Pickering, L K; Olarte, J

    1977-01-01

    Acute- and convalescent-phase sera from 132 students attending a university in rural Mexico were assayed for antibody against the heat-labile enterotoxin (LT) of Escherichia coli by neutralization of LT activity in the Y-1 adrenal cell assay and by passive immune hemolysis of LT-sensitized sheep erythrocytes. The two titration methods produced comparable results with respect to antitoxin responses detected. An inverse relationship was found between acute geometric mean antitoxin titer and the occurrence of diarrhea associated with LT-producing E. coli, especially in newly arrived students from the U.S.A. A significant correlation (P less than 0.00 5) was found between a rise in antitoxin titer detectable by the passive immune hemolysis technique and diarrhea with LT-producing E. coli isolated. Thus, humoral antitoxin titers appear to be a useful indicator of immune status with respect to enterotoxigenic (LT) E. coli diarrhea. PMID:330395

  7. Eptifibatide-induced thrombocytopenia: with thrombosis and disseminated intravascular coagulation immediately after left main coronary artery percutaneous coronary angioplasty.

    PubMed

    Tempelhof, Michael W; Benzuly, Keith H; Fintel, Dan; Krichavsky, Marc Z

    2012-01-01

    Early clinical trials of eptifibatide did not show a significant association between eptifibatide and the development of thrombocytopenia, thrombosis, or disseminated intravascular coagulation. However, more recent literature has suggested a significant association between eptifibatide and the development of thrombocytopenia and thrombosis. Although the true incidence and the pathophysiology of these associations are unknown, the development of these events can be life-threatening. Herein, we describe the case of a patient who experienced acute onset of profound thrombocytopenia, developing thrombosis, pulmonary emboli, and disseminated intravascular coagulation. This paper adds to the few previous reports of cases that suggested an association between thrombocytopenia, thrombosis, and the administration of eptifibatide. To the best of our knowledge, this is the first case report in the medical literature that associates the new onset of thrombocytopenia, thrombosis, and disseminated intravascular coagulation with the administration of eptifibatide. We also provide a subject review.

  8. Mechanisms of Acute Kidney Injury Induced by Experimental Lonomia obliqua Envenomation

    PubMed Central

    Berger, Markus; Santi, Lucélia; Beys-da-Silva, Walter O.; Oliveira, Fabrício Marcus Silva; Caliari, Marcelo Vidigal; Yates, John R.; Ribeiro, Maria Aparecida; Guimarães, Jorge Almeida

    2015-01-01

    Background Lonomia obliqua caterpillar envenomation causes acute kidney injury (AKI), which can be responsible for its deadly actions. This study evaluates the possible mechanisms involved in the pathogenesis of renal dysfunction. Methods To characterize L. obliqua venom effects we subcutaneously injected rats and examined renal functional, morphological and biochemical parameters at several time points. We also performed discovery based proteomic analysis to measure protein expression to identify molecular pathways of renal disease. Results L. obliqua envenomation causes acute tubular necrosis, which is associated with renal inflammation; formation of hematic casts, resulting from intravascular hemolysis; increase in vascular permeability and fibrosis. The dilation of Bowman’s space and glomerular tuft is related to fluid leakage and intra-glomerular fibrin deposition, respectively, since tissue factor procoagulant activity increases in the kidney. Systemic hypotension also contributes to these alterations and to the sudden loss of basic renal functions, including filtration and excretion capacities, urinary concentration and maintenance of fluid homeostasis. In addition, envenomed kidneys increases expression of proteins involved in cell stress, inflammation, tissue injury, heme-induced oxidative stress, coagulation and complement system activation. Finally, the localization of the venom in renal tissue agrees with morphological and functional alterations, suggesting also a direct nephrotoxic activity. Conclusions Mechanisms of L. obliqua-induced AKI are complex involving mainly glomerular and tubular functional impairment and vascular alterations. These results are important to understand the mechanisms of renal injury and may suggest more efficient ways to prevent or attenuate the pathology of Lonomia’s envenomation. PMID:24798088

  9. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    PubMed Central

    Giglio, Anna Maria; Scozzafava, Annamaria; Filippelli, Orazio; Serafino, Giuseppe; Verre, Mario

    2016-01-01

    The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe. PMID:27651958

  10. Mapping Intravascular Ultrasound Controversies in Interventional Cardiology Practice

    PubMed Central

    Maresca, David; Adams, Samantha; Maresca, Bruno; van der Steen, Antonius F. W.

    2014-01-01

    Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular. Since its introduction in the clinic 20 years ago, use of intravascular ultrasound innovation has been relatively limited. Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions. In this qualitative research study, we follow scholarship on the sociology of innovation in exploring both the current adoption practices and perspectives on the future of intravascular ultrasound. We conducted a survey of biomedical experts with experience in the technology, the practice, and the commercialization of intravascular ultrasound. The collected information enabled us to map intravascular ultrasound controversies as well as to outline the dynamics of the international network of experts that generates intravascular ultrasound innovations and uses intravascular ultrasound technologies. While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion. Furthermore, most of the controversies identified were external to intravascular ultrasound technology itself, meaning that decision making at the industrial, financial and regulatory levels are likely to determine the future of intravascular ultrasound. In light of opinions from the responding experts', a wider adoption of intravascular ultrasound as a stand-alone imaging modality seems rather uncertain, but the appeal for this technology may be renewed by improving image quality and through combination with complementary imaging

  11. Robust intravascular optical coherence elastography driven by acoustic radiation pressure

    NASA Astrophysics Data System (ADS)

    van Soest, Gijs; Bouchard, Richard R.; Mastik, Frits; de Jong, Nico; van der Steen, Anton F. W.

    2007-07-01

    High strain spots in the vessel wall indicate the presence of vulnerable plaques. The majority of acute cardiovascular events are preceded by rupture of such a plaque in a coronary artery. Intracoronary optical coherence tomography (OCT) can be extended, in principle, to an elastography technique, mapping the strain in the vascular wall. However, the susceptibility of OCT to frame-to-frame decorrelation, caused by tissue and catheter motion, inhibits reliable tissue displacement tracking and has to date obstructed the development of OCT-based intravascular elastography. We introduce a new technique for intravascular optical coherence elastography, which is robust against motion artifacts. Using acoustic radiation force, we apply a pressure to deform the tissue synchronously with the line scan rate of the OCT instrument. Radial tissue displacement can be tracked based on the correlation between adjacent lines, instead of subsequent frames in conventional elastography. The viability of the method is demonstrated with a simulation study. The root mean square (rms) error of the displacement estimate is 0.55 μm, and the rms error of the strain is 0.6%. It is shown that high-strain spots in the vessel wall, such as observed at the sites of vulnerable atherosclerotic lesions, can be detected with the technique. Experiments to realize this new elastographic method are presented. Simultaneous optical and ultrasonic pulse-echo tracking demonstrate that the material can be put in a high-frequency oscillatory motion with an amplitude of several micrometers, more than sufficient for accurate tracking with OCT. The resulting data are used to optimize the acoustic pushing sequence and geometry.

  12. A mobile phone-based approach to detection of hemolysis.

    PubMed

    Archibong, Edikan; Konnaiyan, Karthik Raj; Kaplan, Howard; Pyayt, Anna

    2017-02-15

    Preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome are pregnancy-related complications with high rates of morbidity and mortality. HELLP syndrome, in particular, can be difficult to diagnose. Recent work suggests that elevated levels of free cell hemoglobin in blood plasma can, as early as the first trimester, potentially serve as a diagnostic biomarker for impending complications. We therefore developed a point-of-care mobile phone-based platform that can quickly characterize a patient's level of hemolysis by measuring the color of blood plasma. The custom hardware and software are designed to be easy to use. A sample of the whole blood (~10µL or less) is first collected into a clear capillary tube or microtube, which is then inserted into a low-cost 3D-printed sample holder attached to the phone. A 5-10min period of quiescence allows for gravitational sedimentation of the red blood cells, leaving a layer of yellowish plasma at the top of the tube. The phone camera then photographs the capillary tube and analyzes the color components of the cell-free plasma layer. The software converts these color values to a concentration of free hemoglobin, based on a built-in calibration curve, and reports the patient's hemolysis level: non-hemolyzed, slightly hemolyzed, mildly hemolyzed, frankly hemolyzed, or grossly hemolyzed.. The accuracy of the method is ~1mgdL(-1). This phone-based point-of-care system provides the potentially life-saving advantage of a turnaround time of about 10min (versus 4+hours for conventional laboratory analytical methods) and a cost of approximately one dollar USD (assuming you have the phone and the software are already available).

  13. Techniques for Intravascular Foreign Body Retrieval

    SciTech Connect

    Woodhouse, Joe B.; Uberoi, Raman

    2013-08-01

    As endovascular therapies increase in frequency, the incidence of lost or embolized foreign bodies is increasing. The presence of an intravascular foreign body (IFB) is well recognized to have the potential to cause serious complications. IFB can embolize and impact critical sites such as the heart, with subsequent significant morbidity or mortality. Intravascular foreign bodies most commonly result from embolized central line fragments, but they can originate from many sources, both iatrogenic and noniatrogenic. The percutaneous approach in removing an IFB is widely perceived as the best way to retrieve endovascular foreign bodies. This minimally invasive approach has a high success rate with a low associated morbidity, and it avoids the complications related to open surgical approaches. We examined the characteristics, causes, and incidence of endovascular embolizations and reviewed the various described techniques that have been used to facilitate subsequent explantation of such materials.

  14. Time course and inhibition of saponin-induced hemolysis.

    PubMed

    Takechi, M; Shimada, S; Tanaka, Y

    1992-04-01

    Hemolytic activities of 3 steroid saponins reached plateaus within 5 min, whereas those of 4 triterpenoid saponins did not within 60 min. Erythrocytes pretreated with a low concentration of tigogenin were resistant to hemolysis of some of these saponins, but those pretreated with hecogenin or tomatidine were as sensitive as non-treated erythrocytes. Therefore, the ketone group of hecogenin or the amino group of tomatidine would weaken the interactions between the erythrocytes and these sapogenins. Furthermore, incubations of these saponins with a small amount of cholesterol diminished the hemolytic activities.

  15. Impella induced massive hemolysis: reemphasizing echocardiographic guidance for correct placement.

    PubMed

    Cardozo, Shaun; Ahmed, Tasneem; Belgrave, Kevin

    2015-01-01

    The Impella LP 2.5 (Abiomed, Danvers, MA) has been a tool of use for high risk coronary procedures and for cardiogenic shock. As with any invasive or intracardiac device, improper placement can result in disastrous complications. Hemolytic anemia secondary to Impella implantation is one of the documented complications. However, cases of severe hemolytic anemia are rare in the literature. Proven imaging modalities like ultrasound need to be used to guide proper placement. We present a case of device induced severe hemolysis due to Impella insertion and the need to use ultrasound guidance to avoid such an unnecessary complication.

  16. CREATION OF A SECONDARY VENTRICULAR OUTLET TO REVERSE HEMOLYSIS AFTER AORTIC VALVE REPLACEMENT

    PubMed Central

    Ott, David A.; Cooley, Denton A.; Norman, John C.

    1979-01-01

    A 66-year-old woman developed severe hemolysis after undergoing aortic valve replacement. A diminutive annulus and extensive calcification of the aorta precluded further surgery of the aortic root. Hemolysis was completely reversed by the implantation of a woven Dacron apicoabdominal aortic conduit incorporating a Cooley-Cutter prosthetic valve. Fractionation of stroke volume by means of a second ventricular outlet can reduce shear stresses and turbulence associated with unfavorable hemodynamic conditions, thereby successfully correcting hemolysis. Images PMID:15216312

  17. Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment

    PubMed Central

    Soltaninejad, Kambiz; Nelson, Leiws S.; Khodakarim, Nastaran; Dadvar, Zohreh; Shadnia, Shahin

    2011-01-01

    Methemoglobinemia and hemolysis are rare findings following phosphine poisoning. In this paper, a case of aluminum phosphide (AlP) poisoning complicated by methemoglobinemia and hemolysis with a successful treatment is reported. A 28-year-old male patient presented following intentional ingestion of an AlP tablet. In this case, hematuria, hemolysis and methemoglobinemia were significant events. A methemoglobin level of 46% was detected by CO-oximetry. The patient was treated with ascorbic acid and methylene blue and he also received supportive care. Two weeks after admission, the patient was discharged from the hospital. Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning. PMID:21814377

  18. Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment.

    PubMed

    Soltaninejad, Kambiz; Nelson, Leiws S; Khodakarim, Nastaran; Dadvar, Zohreh; Shadnia, Shahin

    2011-04-01

    Methemoglobinemia and hemolysis are rare findings following phosphine poisoning. In this paper, a case of aluminum phosphide (AlP) poisoning complicated by methemoglobinemia and hemolysis with a successful treatment is reported. A 28-year-old male patient presented following intentional ingestion of an AlP tablet. In this case, hematuria, hemolysis and methemoglobinemia were significant events. A methemoglobin level of 46% was detected by CO-oximetry. The patient was treated with ascorbic acid and methylene blue and he also received supportive care. Two weeks after admission, the patient was discharged from the hospital. Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning.

  19. Platelet function and hemolysis in centrifugal pumps: in vitro investigations.

    PubMed

    Steines, D; Westphal, D; Göbel, C; Reul, H; Rau, G

    1999-08-01

    The effects of centrifugal pumps on blood components other than erythrocytes, namely platelets and their interaction with the coagulation system, are not very well known. In a comparative study with three centrifugal pumps (BioMedicus BP-80, St. Jude Isoflow, and Sarns Delphin) and the Stockert roller pump hemolysis, platelet counts, thromboplastin and partial thromboplastin times, as well as resonance thrombography (RTG) parameters for the assessment of platelet and coagulation function were evaluated in vitro. Normalized indices of hemolysis (NIH) with ACD anticoagulation after 360 minutes were 0.008+/-0.004 (Isoflow), 0.018+/-0.017 (BP-80), 0.085+/-0.051 (Delphin), and 0.049+/-0.010 g/1001 (roller pump). Plasmatic coagulation was activated in all circuits. Platelet function was severely inhibited by the BP-80, indicated by increase in RTG platelet time to 358%+/-150% of initial values compared to 42%+/-29% (Isoflow), 40%+/-20% (Delphin), and 12%+/-10% (roller pump). Fibrin polymerization was affected similarly. The large surface area of the BP-80 leads to an extensive activation of platelets and plasminogen.

  20. Hemolysis-induced lethality involves inflammasome activation by heme

    PubMed Central

    Dutra, Fabianno F.; Alves, Letícia S.; Rodrigues, Danielle; Fernandez, Patricia L.; de Oliveira, Rosane B.; Golenbock, Douglas T.; Zamboni, Dario S.; Bozza, Marcelo T.

    2014-01-01

    The increase of extracellular heme is a hallmark of hemolysis or extensive cell damage. Heme has prooxidant, cytotoxic, and inflammatory effects, playing a central role in the pathogenesis of malaria, sepsis, and sickle cell disease. However, the mechanisms by which heme is sensed by innate immune cells contributing to these diseases are not fully characterized. We found that heme, but not porphyrins without iron, activated LPS-primed macrophages promoting the processing of IL-1β dependent on nucleotide-binding domain and leucine rich repeat containing family, pyrin domain containing 3 (NLRP3). The activation of NLRP3 by heme required spleen tyrosine kinase, NADPH oxidase-2, mitochondrial reactive oxygen species, and K+ efflux, whereas it was independent of heme internalization, lysosomal damage, ATP release, the purinergic receptor P2X7, and cell death. Importantly, our results indicated the participation of macrophages, NLRP3 inflammasome components, and IL-1R in the lethality caused by sterile hemolysis. Thus, understanding the molecular pathways affected by heme in innate immune cells might prove useful to identify new therapeutic targets for diseases that have heme release. PMID:25225402

  1. Numerical, hydraulic, and hemolytic evaluation of an intravascular axial flow blood pump to mechanically support Fontan patients.

    PubMed

    Throckmorton, Amy L; Kapadia, Jugal Y; Chopski, Steven G; Bhavsar, Sonya S; Moskowitz, William B; Gullquist, Scott D; Gangemi, James J; Haggerty, Christopher M; Yoganathan, Ajit P

    2011-01-01

    Currently available mechanical circulatory support systems are limited for adolescent and adult patients with a Fontan physiology. To address this growing need, we are developing a collapsible, percutaneously-inserted, axial flow blood pump to support the cavopulmonary circulation in Fontan patients. During the first phase of development, the design and experimental evaluation of an axial flow blood pump was performed. We completed numerical modeling of the pump using computational fluid dynamics analysis, hydraulic testing of a plastic pump prototype, and blood bag experiments (n=7) to measure the levels of hemolysis produced by the pump. Statistical analyses using regression were performed. The prototype with a 4-bladed impeller generated a pressure rise of 2-30 mmHg with a flow rate of 0.5-4 L/min for 3000-6000 RPM. A comparison of the experimental performance data to the numerical predictions demonstrated an excellent agreement with a maximum deviation being less than 6%. A linear increase in the plasma-free hemoglobin (pfHb) levels during the 6-h experiments was found, as desired. The maximum pfHb level was measured to be 21 mg/dL, and the average normalized index of hemolysis was determined to be 0.0097 g/100 L for all experiments. The hydraulic performance of the prototype and level of hemolysis are indicative of significant progress in the design of this blood pump. These results support the continued development of this intravascular pump as a bridge-to-transplant, bridge-to-recovery, bridge-to-hemodynamic stability, or bridge-to-surgical reconstruction for Fontan patients.

  2. Hypothesis: Disseminated Intravascular Inflammation as the Inflammatory Counterpart to Disseminated Intravascular Coagulation

    NASA Astrophysics Data System (ADS)

    Bull, Brian S.; Bull, Maureen H.

    1994-08-01

    We have identified a leukocyte activation syndrome that is occasionally associated with the transfusion of intraoperatively recovered erythrocytes. This syndrome appears to result from intravascular damage caused by leukocytes activated during the erythrocyte salvage process. We hypothesize that this syndrome is part of a larger disease grouping: disseminated intravascular inflammation (DII). DII is the analog of the coagulation disorder disseminated intravascular coagulation. In disseminated intravascular coagulation, the organ damage results from uncontrolled activation of the clotting pathway; in DII the damage is caused by leukocytes that have become activated by direct contact with bacteria or in rare instances-such as erythrocyte salvage-in the absence of bacteria and bacterial products. Recent studies of the hazards associated with intraoperative blood salvage indicate that activation of leukocytes can be achieved by exposure to activated platelets alone. If such activated leukocytes are reinfused along with the washed erythrocytes, widespread organ damage may result. The lung is the organ most severely affected by activated leukocytes. Adult respiratory distress syndrome is one outcome. It is likely that DII is a presently unrecognized pathophysiological process that complicates a variety of primary disease states and increases their lethality.

  3. What is the acceptable hemolysis index for the measurements of plasma potassium, LDH and AST?

    PubMed

    Rousseau, Nathalie; Pige, Raphaëlle; Cohen, Richard; Pecquet, Matthieu

    2016-06-01

    Hemolysis is a cause of variability in test results for plasma potassium, LDH and AST and is a non-negligible part of measurement uncertainty. However, allowable levels of hemolysis provided by reagent suppliers take neither analytical variability (trueness and precision) nor the measurand into account. Using a calibration range of hemolysis, we measured the plasma concentrations of potassium, LDH and AST, and hemolysis indices with a Cobas C501 analyzer (Roche Diagnostics(®), Meylan, France). Based on the allowable total error (according to Ricós et al.) and the expanded measurement uncertainty equation we calculated the maximum allowable bias for two concentrations of each measurand. Finally, we determined the allowable hemolysis indices for all three measurands. We observed a linear relationship between the observed increases of concentration and hemolysis indices. The LDH measurement was the most sensitive to hemolysis, followed by AST and potassium measurements. The determination of the allowable hemolysis index depends on the targeted measurand, its concentration and the chosen level of requirement of allowable total error.

  4. Intravascular haemolysis in the recreational runner.

    PubMed Central

    Deitrick, R W

    1991-01-01

    Intravascular haemolysis has been found to result from prolonged endurance competition, rigorous military training and participation in impact sports. Haematological research involving the recreational runner is sparse. Recreational runners frequently vary their training to avoid monotony and improve endurance capacity. This study investigated the haematological effects of a typical day of increased distance training in 15 male recreational runners (62.4(3.1) ml kg-1 min-1 treadmill VO2max; 44.6(8.4) km per week training (means(s.d.)). Venous blood samples were collected before, immediately after, 1 day, 4 days, and 10 days after a 13-km training run (about twice the subjects' typical running distance) and analysed for changes in bilirubin, serum potassium, haematocrit, haemoglobin, red blood cell count, haptoglobin, poikilocytosis and reticulocytosis. Urine samples were collected at the same times as the blood samples and analysed for urobilinogen. Significant (P less than 0.05) 1-day and 4-day decreases in mean haemoglobin, red blood cell count, and haptoglobin values, compared to before training venous blood values and significant (P less than 0.05) post-training increases in bilirubin, serum potassium, urobilinogen and poikilocytosis provided evidence for increased intravascular haemolysis. After 10 days the values for haematocrit, bilirubin, serum potassium, red blood cell count, urobilinogen and poikilocytosis were not significantly (P less than 0.05) different from pre-training values while haemoglobin remained significantly (P less than 0.05) lower, exhibiting a constant but not significant increase over the period from 1 to 10 days. The results indicate that mild intravascular 'footstrike' haemolysis can occur in the recreational runner when typical training distance is increased. This condition appears to be transient and benign. PMID:1810610

  5. Systematic Assessment of the Hemolysis Index: Pros and Cons.

    PubMed

    Lippi, Giuseppe

    2015-01-01

    Preanalytical quality is as important as the analytical and postanalytical quality in laboratory diagnostics. After decades of visual inspection to establish whether or not a diagnostic sample may be suitable for testing, automated assessment of hemolysis index (HI) has now become available in a large number of laboratory analyzers. Although most national and international guidelines support systematic assessment of sample quality via HI, there is widespread perception that this indication has not been thoughtfully acknowledged. Potential explanations include concern of increased specimen rejection rate, poor harmonization of analytical techniques, lack of standardized units of measure, differences in instrument-specific cutoff, negative impact on throughput, organization and laboratory economics, and lack of a reliable quality control system. Many of these concerns have been addressed. Evidence now supports automated HI in improving quality and patient safety. These will be discussed.

  6. Hemolysis and heat generation in six different types of centrifugal blood pumps.

    PubMed

    Araki, K; Taenaka, Y; Masuzawa, T; Tatsumi, E; Wakisaka, Y; Watari, M; Nakatani, T; Akagi, H; Baba, Y; Anai, H

    1995-09-01

    What the most causative factor affecting hemolysis is still controversial. To resolve this problem, we investigated the relationship between hemolysis and heat generation in six types of centrifugal blood pumps (Bio-Pump, Delphin, Capiox, Nikkiso, Isoflow, and Toyobo). The analyzed parameters were index of hemolysis in fresh goat blood, pumping performance, and heat generation in a thermally isolated mock circuit. These parameters were analyzed at a flow rate of 5 L/min by changing the pressure head (100 mm Hg and 500 mm Hg). At 500 mm Hg of pressure head, the Bio-Pump needed the highest rotation number and showed the highest hemolytic rate and heat generation. The index of hemolysis is well correlated to heat generation (r2 = 0.721). Heat may originate from the motor by conduction, hydraulic energy loss, and mechanical friction between the shaft and seal. We strongly suspect that hemolysis was caused by a factor such as mechanical friction which generates heat locally.

  7. Prolonged red cell storage before transfusion increases extravascular hemolysis

    PubMed Central

    Rapido, Francesca; Brittenham, Gary M.; Bandyopadhyay, Sheila; La Carpia, Francesca; L’Acqua, Camilla; McMahon, Donald J.; Rebbaa, Abdelhadi; Wojczyk, Boguslaw S.; Netterwald, Jane; Wang, Hangli; Schwartz, Joseph; Eisenberger, Andrew; Soffing, Mark; Yeh, Randy; Divgi, Chaitanya; Ginzburg, Yelena Z.; Shaz, Beth H.; Sheth, Sujit; Francis, Richard O.; Spitalnik, Steven L.; Hod, Eldad A.

    2016-01-01

    BACKGROUND. Some countries have limited the maximum allowable storage duration for red cells to 5 weeks before transfusion. In the US, red blood cells can be stored for up to 6 weeks, but randomized trials have not assessed the effects of this final week of storage on clinical outcomes. METHODS. Sixty healthy adult volunteers were randomized to a single standard, autologous, leukoreduced, packed red cell transfusion after 1, 2, 3, 4, 5, or 6 weeks of storage (n = 10 per group). 51-Chromium posttransfusion red cell recovery studies were performed and laboratory parameters measured before and at defined times after transfusion. RESULTS. Extravascular hemolysis after transfusion progressively increased with increasing storage time (P < 0.001 for linear trend in the AUC of serum indirect bilirubin and iron levels). Longer storage duration was associated with decreasing posttransfusion red cell recovery (P = 0.002), decreasing elevations in hematocrit (P = 0.02), and increasing serum ferritin (P < 0.0001). After 6 weeks of refrigerated storage, transfusion was followed by increases in AUC for serum iron (P < 0.01), transferrin saturation (P < 0.001), and nontransferrin-bound iron (P < 0.001) as compared with transfusion after 1 to 5 weeks of storage. CONCLUSIONS. After 6 weeks of refrigerated storage, transfusion of autologous red cells to healthy human volunteers increased extravascular hemolysis, saturated serum transferrin, and produced circulating nontransferrin-bound iron. These outcomes, associated with increased risks of harm, provide evidence that the maximal allowable red cell storage duration should be reduced to the minimum sustainable by the blood supply, with 35 days as an attainable goal. REGISTRATION. ClinicalTrials.gov NCT02087514. FUNDING. NIH grant HL115557 and UL1 TR000040. PMID:27941245

  8. Pulsed liquid microjet for intravascular injection

    NASA Astrophysics Data System (ADS)

    Palanker, Daniel V.; Fletcher, Daniel A.; Miller, Jason; Huie, Philip; Marmor, Michael; Blumenkranz, Mark S.

    2002-06-01

    Occlusions of the retinal veins and arteries are associated with common diseases such as hypertension and arteriosclerosis and usually cause severe and irreversible loss of vision. Treatments for these vascular diseases have been unsatisfactory to date in part because of the difficulty of delivering thrombolytic drugs locally within the eye. In this article we describe a pulsed liquid microjet for minimally invasive intra-vascular drug delivery. The microjet is driven by a vapor bubble following an explosive evaporation of saline, produced by a microsecond-long electric discharge in front of the 25 micrometers electrode inside the micronozzle. Expansion of the transient vapor bubble produces a water jet with a diameter equal to the diameter of the nozzle, and with a velocity and duration that are controlled by the pulse energy. We found that fluid could be injected through the wall of a 60-micrometers -diameter artery in choriallantoic membrane using a 15-micrometers diameter liquid jet traveling at more than 60 m/s. Histological analysis of these arteries showed that the width of the perforation is limited to the diameter of the micronozzle, and the penetration depth of the jet is controlled by the discharge energy. The pulsed liquid microjet offers a promising technique for precise and needle-free intravascular delivery of thrombolytic drugs for localized treatment of retinal vascular occlusions.

  9. Display Considerations For Intravascular Ultrasonic Imaging

    NASA Astrophysics Data System (ADS)

    Gessert, James M.; Krinke, Charlie; Mallery, John A.; Zalesky, Paul J.

    1989-08-01

    A display has been developed for intravascular ultrasonic imaging. Design of this display has a primary goal of providing guidance information for therapeutic interventions such as balloons, lasers, and atherectomy devices. Design considerations include catheter configuration, anatomy, acoustic properties of normal and diseased tissue, catheterization laboratory and operating room environment, acoustic and electrical safety, acoustic data sampling issues, and logistical support such as image measurement, storage and retrieval. Intravascular imaging is in an early stage of development so design flexibility and expandability are very important. The display which has been developed is capable of acquisition and display of grey scale images at rates varying from static B-scans to 30 frames per second. It stores images in a 640 X 480 X 8 bit format and is capable of black and white as well as color display in multiplevideo formats. The design is based on the industry standard PC-AT architecture and consists of two AT style circuit cards, one for high speed sampling and the other for scan conversion, graphics and video generation.

  10. Acute viral hepatitis E presenting with haemolytic anaemia and acute renal failure in a patient with glucose-6-phosphate dehydrogenase deficiency.

    PubMed

    Tomar, Laxmikant Ramkumarsingh; Aggarwal, Amitesh; Jain, Piyush; Rajpal, Surender; Agarwal, Mukul P

    2015-10-01

    The association of acute hepatitis E viral (HEV) infection with glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to extensive intravascular haemolysis is a very rare clinical entity. Here we discuss such a patient, who presented with acute HEV illness, developed severe intravascular haemolysis and unusually high levels of bilirubin, complicated by acute renal failure (ARF), and was later on found to have a deficiency of G6PD. The patient recovered completely with haemodialysis and supportive management.

  11. Harmonization of automated hemolysis index assessment and use: Is it possible?

    PubMed

    Dolci, Alberto; Panteghini, Mauro

    2014-05-15

    The major source of errors producing unreliable laboratory test results is the pre-analytical phase with hemolysis accounting for approximately half of them and being the leading cause of unsuitable blood specimens. Hemolysis may produce interference in many laboratory tests by a variety of biological and analytical mechanisms. Consequently, laboratories need to systematically detect and reliably quantify hemolysis in every collected sample by means of objective and consistent technical tools that assess sample integrity. This is currently done by automated estimation of hemolysis index (HI), available on almost all clinical chemistry platforms, making the hemolysis detection reliable and reportable patient test results more accurate. Despite these advantages, a degree of variability still affects the HI estimate and more efforts should be placed on harmonization of this index. The harmonization of HI results from different analytical systems should be the immediate goal, but the scope of harmonization should go beyond analytical steps to include other aspects, such as HI decision thresholds, criteria for result interpretation and application in clinical practice as well as report formats. With regard to this, relevant issues to overcome remain the objective definition of a maximum allowable bias for hemolysis interference based on the clinical application of the measurements and the management of unsuitable samples. Particularly, for the latter a recommended harmonized approach is required when not reporting numerical results of unsuitable samples with significantly increased HI and replacing the test result with a specific comment highlighting hemolysis of the sample.

  12. New Presentation of Hemolysis After Papillary Muscles Approximation for Mitral Valve Repair.

    PubMed

    Sarraj, Anas; Calle Valda, Corazón-Mabel; Muñoz, Daniel-Edgardo; Reyes, Guillermo

    2017-04-01

    Hemolysis is a well-recognized complication after prosthetic valve replacement, especially with perivalvular leaks. Hemolytic anemia associated with mitral valve (MV) repair is less common. We report the case of a young man with severe hemolytic anemia caused by turbulence of blood flow through a very small quadrangle orifice due to early failure of MV repair. The patient underwent redo MV biologic prosthesis replacement and tricuspid valve annuloplasty. The hemolysis completely disappeared few months later. In this case, we describe a new presentation of mechanical hemolysis due to early failure of MV repair that has not been described in the literature.

  13. Intravascular ultrasound for angiographically indeterminant left main coronary artery disease.

    PubMed

    Parashara, D K; Jacobs, L E; Ledley, G S; Yazdanfar, S; Oline, J; Kotler, M N

    1994-01-01

    The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

  14. Quinine-Induced Disseminated Intravascular Coagulation

    PubMed Central

    2016-01-01

    Every drug comes with some side effect. It is the benefit/risk ratio that determines the medical use of the drug. Quinine, a known antimalarial drug, has been used for nocturnal leg cramps since the 1930s; it is associated with severe life-threatening hematological and cardiovascular side effects. Disseminated intravascular coagulation (DIC), albeit rare, is a known coagulopathy associated with Quinine. It is imperative to inquire about the Quinine intake in medication history in patients with coagulopathy, as most patients still consider it a harmless home remedy for nocturnal leg cramps. In this report, we present a case of coagulopathy in a middle-aged woman, who gave a history of taking Quinine for nocturnal leg cramps, as her home remedy. Early identification of the offending agent led to the diagnosis, prompt discontinuation of the medication, and complete recovery and prevented the future possibility of recurrence. PMID:27293443

  15. Prostate cancer: beware of disseminated intravascular coagulation

    PubMed Central

    Desai, Mihir; John, Babbin; Evans, Gillian; Eddy, Ben

    2015-01-01

    Disseminated intravascular coagulation (DIC) is a pathological systemic condition resulting from aberrant activation of the coagulation system. It is characterised by the release and activation of procoagulants into the blood, with an associated consumption coagulopathy. Its association with solid and haematological malignancies is well described in literature. This case describes an elderly man, known to have prostate cancer, who following transurethral resection of the prostate developed DIC with haematuria, spontaneous ecchymoses and mucosal bleeding. Subsequent investigations revealed a prostate-specific antigen (PSA) >1000 µg/L, and staging CT showed multiple sclerotic metastatic lesions affecting the thoracic and lumbar vertebra, as well as infiltration into his left femur. Coagulation normalised with blood products and vitamin K within 1 week, and the patient responded to antiandrogen therapy with a reduction in pain and PSA on discharge. PMID:25819815

  16. Deformable cells in confined geometries: From hemolysis to hydrodynamic interactions

    NASA Astrophysics Data System (ADS)

    Abkarian, Manouk; Faivre, Magalie; Stone, Howard A.

    2004-11-01

    Recent developments in microfluidics allow a wide range of possibilities for studying cellular-scale hydrodynamics. Here we use microfluidic technology to address several open questions in the blood flow literature where cell deformation and hydrodynamic interactions are significant. In particular, we investigate the pressure-driven flow of a dilute suspension in a channel and characterize the transition from steady axisymmetric cell shapes (for which numerical calculations exist) to asymmetric, highly extended shapes, which are precursors to hemolysis (i.e. destruction of the cell). In addition, we examine the influence of geometry on hydrodynamic interactions of deformable cells by contrasting one-dimensional motion of a train of particles in a channel with two-dimensional motions in a Hele-Shaw cell. This study can help to understand flow of cells in microcirculation from the unidirectional flow in capillaries to the two-dimensional flow in the lung alveoli and provides the basic steps to understand certain aspects of microcirculatory deseases like sickle cell anemia for example.

  17. Continuous-flow automation and hemolysis index: a crucial combination.

    PubMed

    Lippi, Giuseppe; Plebani, Mario

    2013-04-01

    A paradigm shift has occurred in the role and organization of laboratory diagnostics over the past decades, wherein consolidation or networking of small laboratories into larger factories and point-of-care testing have simultaneously evolved and now seem to favorably coexist. There is now evidence, however, that the growing implementation of continuous-flow automation, especially in closed systems, has not eased the identification of hemolyzed specimens since the integration of preanalytical and analytical workstations would hide them from visual scrutiny, with an inherent risk that unreliable test results may be released to the stakeholders. Along with other technical breakthroughs, the new generation of laboratory instrumentation is increasingly equipped with systems that can systematically and automatically be tested for a broad series of interferences, the so-called serum indices, which also include the hemolysis index. The routine implementation of these technical tools in clinical laboratories equipped with continuous-flow automation carries several advantages and some drawbacks that are discussed in this article.

  18. Comparison of acute and long-term results and underlying mechanisms from sirolimus-eluting stent implantation for the treatment of in-stent restenosis and recurrent in-stent restenosis in patients in whom intracoronary radiation failed as assessed by intravascular ultrasound.

    PubMed

    Schiele, Thomas M; Rieber, Johannes; König, Andreas; Leibig, Marcus; Erhard, Isabelle; Theisen, Karl; Siebert, Uwe; Klauss, Volker

    2004-10-01

    In-stent restenosis (ISR), especially after vascular brachytherapy, is a therapeutic challenge. Sirolimus-eluting stent implantation is a promising new option for the treatment of patients with ISR. The efficacy of sirolimus-eluting stent implantation for the treatment of patients with their first episodes of ISR and with recurrent ISR due to the failure of vascular brachytherapy was compared using intravascular ultrasound imaging.

  19. Inhibitory and Restorative Effects of Adenine Nucleotides on Rickettsial Adsorption and Hemolysis

    PubMed Central

    Winkler, Herbert H.

    1974-01-01

    The adenine nucleotides, adenosine diphosphate, adenosine triphosphate, (ATP), and the methylene-bridge analogues are inhibitors of rickettsial adsorption to and the hemolysis of sheep erythrocytes. Other nucleotides, adenosine monophosphate, cyclic adenosine monophosphate, cytosine triphosphate, and guanosine triphosphate, are without effect. Adsorption and hemolysis require the generation of energy by the rickettsiae which is usually derived from glutamate. When the generation of energy from the metabolism of glutamate is inhibited by arsenite or cyanide, the addition of ATP can supply the energy to restore hemolysis. However, in the presence of the uncouplers, ATP can not restore hemolysis. Even when functioning in a restorative role, ATP still has its inhibitory properties. These results suggest that a high-energy intermediate (X ∼ I), rather than ATP itself, is the energy source. The interactions of inhibitory nucleotides suggest that these compounds share a common transport system. PMID:4357933

  20. Screening for Saponins Using the Blood Hemolysis Test. An Undergraduate Laboratory Experiment.

    ERIC Educational Resources Information Center

    Sotheeswaran, Subramaniam

    1988-01-01

    Describes an experiment for undergraduate chemistry laboratories involving a chemical found in plants and some sea animals. Discusses collection and identification of material, a hemolysis test, preparation of blood-coated agar plates, and application of samples. (CW)

  1. Correlation between microbubble-induced acoustic cavitation and hemolysis in vitro

    NASA Astrophysics Data System (ADS)

    Zhang, Chun-Bing; Liu, Zheng; Guo, Xia-Sheng; Zhang, Dong

    2011-02-01

    Microbubbles promise to enhance the efficiency of ultrasound-mediated drug delivery and gene therapy by taking advantage of artificial cavitation nuclei. The purpose of this study is to examine the ultrasound-induced hemolysis in the application of drug delivery in the presence of microbubbles. To achieve this goal, human red blood cells mixed with microbubbles were exposed to 1-MHz pulsed ultrasound. The hemolysis level was measured by a flow cytometry, and the cavitation dose was detected by a passive cavitation detecting system. The results demonstrate that larger cavitation dose would be generated with the increase of acoustic pressure, which might give rise to the enhancement of hemolysis. Besides the experimental observations, the acoustic pressure dependence of the radial oscillation of microbubble was theoretically estimated. The comparison between the experimental and calculation results indicates that the hemolysis should be highly correlated to the acoustic cavitation.

  2. Effect of hemolysis on nonesterified fatty acid and beta-hydroxybutyrate concentrations in bovine blood.

    PubMed

    Stokol, Tracy; Nydam, Daryl V

    2006-09-01

    Nonesterified fatty acid (NEFA) and beta-hydroxybutyrate (BHB) assays are used for evaluating dairy herds for negative energy balance and subclinical ketosis, respectively. Hemolysis is a common artifact in samples submitted to diagnostic laboratories. The effect of hemolysis on NEFA and BHB in bovine serum was determined. Hemolysis was introduced into 26 serum samples by adding serial dilutions of a red cell hemolysate, prepared by repeated freeze-thawing of EDTA-anticoagulated bovine blood. NEFA, BHB, and degree of hemolysis (hemolytic index) were measured by an automated chemistry analyzer. Two endpoint assays that differed by inclusion of a sample blank were used for NEFA measurement. A kinetic enzymatic assay with 2 reagent sources was used for BHB measurement. The assessed methods yielded similar NEFA or BHB results in baseline, nonhemolyzed samples (median NEFA: 0.25 mEq/L, median BHB: 3 mg/dL, median hemolytic index: 8 units). NEFA results were adversely affected by hemolysis, with values increasing significantly with higher degrees of hemolysis. Median values increased above a critical medical decision limit (0.40 mEq/L) at a hemolytic index of 506 units (marked hemolysis). This increase was prevented by inclusion of a sample blank. Result interpretation was affected in individual animals when samples were moderately hemolyzed (median hemolytic index: 258 units). In contrast, BHB results were unaffected by hemolysis with either reagent source. Thus, assays for measuring NEFAs should include a sample blank and NEFA results should not be interpreted in moderately to markedly hemolyzed bovine samples, because result accuracy cannot be assured.

  3. [THE PERCENTAGE OF BLOOD SERUM TESTS WITH HEMOLYSIS IN DIFFERENT GROUPS OF PATIENTS].

    PubMed

    Moshkin, A V

    2015-06-01

    In the process of laboratory analysis most of the errors occur at the pre-analytical stage. The percentage of blood serum tests with hemolysis is largely applied as an indicator of quality of sampling and transport of blood tests in laboratory. The study was carried out to analyze percentage of tests with hemolysis in different groups of in- and out-patients. The percentage of tests with hemolysis was estimated according actual recommendation of IFCC working group "Laboratory Errors and Patient Safety" as percentage oftests with free hemoglobin more than 0.5 g/l of total amount of serum tests analyzed on biochemical analyzer capable to measure hemolysis index. The hemolysis was identified in 199 (1.4%) out of 14 170 samples. The large dispersion of results in different groups of patient was established. In children younger than 7 years treated in hospital percentage of hemolysis amounted to 2.44%, in patients of reanimation department - 2.38%. In adult patients of hospital this indicator of quality ranged from 0.31% to 1.59%. In two groups of out-patients this indicator amounted to 0.36% (clinic personnel, dispensarization) and 1.81% (out-patients). Such a dispersion complicates inter-laboratory comparison of quality according this particular indicator. The necessity is substantiated to apply more efforts concerning harmonization of indicators of quality in laboratory medicine.

  4. The role of inflammation in intravenous immune globulin-mediated hemolysis.

    PubMed

    Pendergrast, Jacob; Willie-Ramharack, Kezia; Sampson, Lorna; Laroche, Vincent; Branch, Donald R

    2015-07-01

    Intravenous immune globulin (IVIG) therapy has shown great success in a number of autoimmune and inflammatory conditions and its use continues to increase worldwide. There is growing awareness of significant side effects of high-dose IVIG: however, particularly severe hemolysis in patients that are non-group O. It has been proposed that IVIG-associated hemolysis may be heralded by an existing inflammatory condition. In the work presented herein, we have provided a review of the pathophysiology of inflammation, particularly as it applies in immune-mediated red blood cell hemolysis, and a summary of previous publications that suggest an association between IVIG-mediated hemolysis and a state of existing inflammation. In addition, preliminary results from a prospective study to address the mechanism of IVIG-associated hemolysis are provided. These preliminary data support the idea of an existing inflammatory condition preceding overt hemolysis after high-dose IVIG therapy that: 1) is restricted to non-group O patients, 2) is seen when using IVIG doses of more than 2 g/kg, 3) involves an activated mononuclear phagocyte system, 4) may be presaged by a significant increase in the anti-inflammatory cytokine interleukin-1 receptor agonist, and 5) is independent of secretor status.

  5. Sodium nitrite induces acute central nervous system toxicity in guinea pigs exposed to systemic cell-free hemoglobin.

    PubMed

    Buehler, Paul W; Butt, Omer I; D'Agnillo, Felice

    2011-06-10

    Systemic cell-free hemoglobin (Hb) released via hemolysis disrupts vascular homeostasis, in part, through the scavenging of nitric oxide (NO). Sodium nitrite (NaNO(2)) therapy can attenuate the hypertensive effects of Hb. However, the chemical reactivity of NaNO(2) with Hb may enhance heme- or iron-mediated toxicities. Here, we investigate the effect of NaNO(2) on the central nervous system (CNS) in guinea pigs exposed to systemic cell-free Hb. Intravascular infusion of NaNO(2), at doses sufficient to alleviate Hb-mediated blood pressure changes, reduced the expression of occludin, but not zona occludens-1 (ZO-1) or claudin-5, in cerebral tight junctions 4h after Hb infusion. This was accompanied by increased perivascular heme oxygenase-1 expression, neuronal iron deposition, increased astrocyte and microglial activation, and reduced expression of neuron-specific nuclear protein (NeuN). These CNS changes were not observed in animals treated with Hb or NaNO(2) alone. Taken together, these findings suggest that the use of nitrite salts to treat systemic Hb exposure may promote acute CNS toxicity.

  6. Improved dosimetry techniques for intravascular brachytherapy

    NASA Astrophysics Data System (ADS)

    Sehgal, Varun

    Coronary artery disease leads to the accumulation of atheromatous plaque leading to coronary stenosis. Coronary intervention techniques such as balloon angioplasty and atherectomy are used to address coronary stenosis and establish a stable lumen thus enhancing blood flow to the myocardium. Restenosis or re-blockage of the arteries is a major limitation of the above mentioned interventional techniques. Neointimal hyperplasia or proliferation of cells in response to the vascular injury as a result of coronary intervention is considered to be one of the major causes of restenosis. Recent studies indicated that irradiation of the coronary lesion site, with radiation doses ranging from 15 to 30 Gy, leads to diminishing neointimal hyperplasia with subsequent reduction in restenosis. The radiation dose is given by catheter-based radiation delivery systems using beta-emitters 90Sr/90Y, 32P and gamma-emitting 192Ir among others. However the dose schema used for dose prescription for these sources are relatively simplistic, and are based on calculations using uniform homogenous water or tissue media and simple cylinder geometry. Stenotic coronary vessels are invariably lined with atheromatous plaque of heterogeneous composition, the radiation dose distribution obtained from such dosimetry data can cause significant variations in the actual dose received by a given patient. Such discrepancies in dose calculation can introduce relatively large uncertainties in the limits of dose window for effective and safe application of intravascular brachytherapy, and consequently in the clinical evaluation of the efficacy of this modality. In this research study we investigated the effect of different geometrical and material heterogeneities, including residual plaque, catheter non-centering, lesion eccentricity and cardiac motion on the radiation dose delivered at the lesion site. Correction factors including dose perturbation factors and dose variation factors have been calculated

  7. Toward a Continuous Intravascular Glucose Monitoring System

    PubMed Central

    Beier, Brooke; Musick, Katherine; Matsumoto, Akira; Panitch, Alyssa; Nauman, Eric; Irazoqui, Pedro

    2011-01-01

    Proof-of-concept studies that display the potential of using a glucose-sensitive hydrogel as a continuous glucose sensor are presented. The swelling ratio, porosity, and diffusivity of the hydrogel increased with glucose concentration. In glucose solutions of 50, 100, 200, and 300 mg/dL, the hydrogel swelling ratios were 4.9, 12.3, 15.9, and 21.7, respectively, and the swelling was reversible. The impedance across the hydrogel depended solely on the thickness and had an average increase of 47 Ω/mm. The hydrogels exposed to a hyperglycemic solution were more porous than the hydrogels exposed to a normal glycemic solution. The diffusivity of 390 Da MW fluorescein isothiocyanate in hydrogels exposed to normal and hyperglycemic solutions was examined using fluorescence recovery after photobleaching and was found to be 9.3 × 10−14 and 41.4 × 10−14 m2/s, respectively, compared to 6.2 × 10−10 m2/s in glucose solution. There was no significant difference between the permeability of hydrogels in normal and hyperglycemic glucose solutions with averages being 5.26 × 10−17 m2 and 5.80 × 10−17 m2, respectively, which resembles 2–4% agarose gels. A prototype design is presented for continuous intravascular glucose monitoring by attaching a glucose sensor to an FDA-approved stent. PMID:22344366

  8. Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis

    PubMed Central

    Morofuji, Toru; Inaba, Shinji; Aisu, Hiroe; Takahashi, Kayo; Saito, Makoto; Higashi, Haruhiko; Yoshii, Toyofumi; Sumimoto, Takumi

    2017-01-01

    Objective The underlying mechanisms of stent thrombosis are not completely understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS). Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases. Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis. PMID:28154268

  9. Immunological characterization of pulmonary intravascular macrophages

    NASA Technical Reports Server (NTRS)

    Chitko-McKown, C. G.; Reddy, D. N.; Chapes, S. K.; McKown, R. D.; Blecha, F.; Spooner, B. S. (Principal Investigator)

    1992-01-01

    Pulmonary intravascular macrophages (PIMs) are lung macrophages found apposed to the endothelium of pulmonary capillaries. In many species, they are responsible for the clearance of blood-borne particulates and pathogens; however, little else is known about their roles as immunologic effector cells. We compared PIMs with pulmonary alveolar macrophages (PAMs) to determine the relative immunological activities of these two cell populations. Our results suggested that both populations possess similar phagocytic and bactericidal activities. In assays measuring cytotoxicity, PIMs were more cytotoxic than PAMs against virally infected target cells; however, differences between these macrophage populations were not as marked when noninfected targets were used. LPS-stimulated PIMs produced more T-cell proliferative cytokines than PAMs, and both populations of nonstimulated macrophages produced similar amounts of the cytokines. In contrast, PAMs produced more TNF alpha and NO2- than PIMs when both populations were stimulated with LPS; however, nonstimulated PAMs and PIMs produced similar amounts of TNF alpha and NO2. These data suggest that bovine PIMs are immunologically active. Differences between the degrees of activity of PIMs and PAMs indicate that these macrophage populations may have different roles in lung surveillance.

  10. MULTI-LABORATORY STUDY OF FLOW-INDUCED HEMOLYSIS USING THE FDA BENCHMARK NOZZLE MODEL

    PubMed Central

    Herbertson, Luke H.; Olia, Salim E.; Daly, Amanda; Noatch, Christopher P.; Smith, William A.; Kameneva, Marina V.; Malinauskas, Richard A.

    2015-01-01

    Multilaboratory in vitro blood damage testing was performed on a simple nozzle model to determine how different flow parameters and blood properties affect device-induced hemolysis and to generate data for comparison with computational fluid dynamics-based predictions of blood damage as part of an FDA initiative for assessing medical device safety. Three independent laboratories evaluated hemolysis as a function of nozzle entrance geometry, flow rate, and blood properties. Bovine blood anticoagulated with acid citrate dextrose solution (2–80 h post-draw) was recirculated through nozzle-containing and paired nozzle-free control loops for 2 h. Controlled parameters included hematocrit (36 ± 1.5%), temperature (25°C), blood volume, flow rate, and pressure. Three nozzle test conditions were evaluated (n = 26–36 trials each): (i) sudden contraction at the entrance with a blood flow rate of 5 L/min, (ii) gradual cone at the entrance with a 6-L/min blood flow rate, and (iii) sudden-contraction inlet at 6 L/min. The blood damage caused only by the nozzle model was calculated by subtracting the hemolysis generated by the paired control loop test. Despite high intralaboratory variability, significant differences among the three test conditions were observed, with the sharp nozzle entrance causing the most hemolysis. Modified index of hemolysis (MIHnozzle) values were 0.292 ± 0.249, 0.021 ± 0.128, and 1.239 ± 0.667 for conditions i–iii, respectively. Porcine blood generated hemolysis results similar to those obtained with bovine blood. Although the interlaboratory hemolysis results are only applicable for the specific blood parameters and nozzle model used here, these empirical data may help to advance computational fluid dynamics models for predicting blood damage. PMID:25180887

  11. Case report: Rapid improvement of crossed cerebellar diaschisis after intravascular laser irradiation of blood in a case of stroke

    PubMed Central

    Yang, Wan-Hua; Lin, Shiou-Ping; Chang, Shin-Tsu

    2017-01-01

    Abstract Rationale: Crossed cerebellar diaschisis (CCD) is a poor prognostic factor after stroke because without immediate cerebral reperfusion no further improvements in the patient's condition can be achieved. We investigated the clinical effects of intravascular laser irradiation therapy (ILIB) on CCD and evaluated the therapeutic effect in the sub-acute post-stroke stage. Patient concerns: The 77-year-old male with cerebral infarction in the territory of the right anterior cerebral artery only underwent conservative treatment including hydration and aspirin in the acute post-stroke stage. Diagnosis: He was diagnosed as stroke based on the clinical presentations and imaging findings. Intervention: Once the patient was in stable condition, he underwent a daily hour-long ILIB (He-Ne laser) for ten consecutive days during the sub-acute post-stroke stage. Outcomes: We used single-photon emission computed tomography (SPECT) before and after intravascular laser irradiation to detect changes in cerebral and cerebellar perfusion. Then, we compared the two images. CCD was detected using the first SPECT. After intervention by ILIB, the second SPECT showed greater perfusion in the affected cerebellar hemisphere. Lessons: We found that ILIB helped eliminate CCD, which was previously shown to be an untreatable condition using any intervention during the sub-acute post-stroke stage. Stroke patients could therefore greatly benefit from ILIB. PMID:28079797

  12. Verification Benchmarks to Assess the Implementation of Computational Fluid Dynamics Based Hemolysis Prediction Models.

    PubMed

    Hariharan, Prasanna; D'Souza, Gavin; Horner, Marc; Malinauskas, Richard A; Myers, Matthew R

    2015-09-01

    As part of an ongoing effort to develop verification and validation (V&V) standards for using computational fluid dynamics (CFD) in the evaluation of medical devices, we have developed idealized flow-based verification benchmarks to assess the implementation of commonly cited power-law based hemolysis models in CFD. Verification process ensures that all governing equations are solved correctly and the model is free of user and numerical errors. To perform verification for power-law based hemolysis modeling, analytical solutions for the Eulerian power-law blood damage model (which estimates hemolysis index (HI) as a function of shear stress and exposure time) were obtained for Couette and inclined Couette flow models, and for Newtonian and non-Newtonian pipe flow models. Subsequently, CFD simulations of fluid flow and HI were performed using Eulerian and three different Lagrangian-based hemolysis models and compared with the analytical solutions. For all the geometries, the blood damage results from the Eulerian-based CFD simulations matched the Eulerian analytical solutions within ∼1%, which indicates successful implementation of the Eulerian hemolysis model. Agreement between the Lagrangian and Eulerian models depended upon the choice of the hemolysis power-law constants. For the commonly used values of power-law constants (α  = 1.9-2.42 and β  = 0.65-0.80), in the absence of flow acceleration, most of the Lagrangian models matched the Eulerian results within 5%. In the presence of flow acceleration (inclined Couette flow), moderate differences (∼10%) were observed between the Lagrangian and Eulerian models. This difference increased to greater than 100% as the beta exponent decreased. These simplified flow problems can be used as standard benchmarks for verifying the implementation of blood damage predictive models in commercial and open-source CFD codes. The current study only used power-law model as an illustrative example to emphasize the need

  13. Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins.

    PubMed

    Jauréguiberry, Stéphane; Ndour, Papa A; Roussel, Camille; Ader, Flavie; Safeukui, Innocent; Nguyen, Marie; Biligui, Sylvestre; Ciceron, Liliane; Mouri, Oussama; Kendjo, Eric; Bricaire, François; Vray, Muriel; Angoulvant, Adéla; Mayaux, Julien; Haldar, Kasturi; Mazier, Dominique; Danis, Martin; Caumes, Eric; Thellier, Marc; Buffet, Pierre

    2014-07-10

    Patients with severe malaria treated with artesunate sometimes experience a delayed hemolytic episode. Artesunate (AS) induces pitting, a splenic process whereby dead parasites are expelled from their host erythrocytes. These once-infected erythrocytes then return to the circulation. We analyzed hematologic parameters in 123 travelers treated with AS for severe malaria. Among 60 nontransfused patients observed for more than 8 days, 13 (22%) had delayed hemolysis. The peak concentration of circulating once-infected erythrocytes was measured during the first week in 21 patients and was significantly higher in 9 patients with delayed hemolysis than in 12 with other patterns of anemia (0.30 vs 0.07; P = .0001). The threshold of 180 million once-infected erythrocytes per liter discriminated patients with delayed hemolysis with 89% sensitivity and 83% specificity. Once-infected erythrocyte morphology analyzed by using ImageStream in 4 patients showed an 8.9% reduction in their projected area, an alteration likely contributing to their shorter lifespan. Delayed clearance of infected erythrocytes spared by pitting during AS treatment is an original mechanism of hemolytic anemia. Our findings consolidate a disease framework for posttreatment anemia in malaria in which delayed hemolysis is a new entity. The early concentration of once-infected erythrocytes is a solid candidate marker to predict post-AS delayed hemolysis.

  14. Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins

    PubMed Central

    Jauréguiberry, Stéphane; Ndour, Papa A.; Roussel, Camille; Ader, Flavie; Safeukui, Innocent; Nguyen, Marie; Biligui, Sylvestre; Ciceron, Liliane; Mouri, Oussama; Kendjo, Eric; Bricaire, François; Vray, Muriel; Angoulvant, Adéla; Mayaux, Julien; Haldar, Kasturi; Mazier, Dominique; Danis, Martin; Caumes, Eric; Thellier, Marc

    2014-01-01

    Patients with severe malaria treated with artesunate sometimes experience a delayed hemolytic episode. Artesunate (AS) induces pitting, a splenic process whereby dead parasites are expelled from their host erythrocytes. These once-infected erythrocytes then return to the circulation. We analyzed hematologic parameters in 123 travelers treated with AS for severe malaria. Among 60 nontransfused patients observed for more than 8 days, 13 (22%) had delayed hemolysis. The peak concentration of circulating once-infected erythrocytes was measured during the first week in 21 patients and was significantly higher in 9 patients with delayed hemolysis than in 12 with other patterns of anemia (0.30 vs 0.07; P = .0001). The threshold of 180 million once-infected erythrocytes per liter discriminated patients with delayed hemolysis with 89% sensitivity and 83% specificity. Once-infected erythrocyte morphology analyzed by using ImageStream in 4 patients showed an 8.9% reduction in their projected area, an alteration likely contributing to their shorter lifespan. Delayed clearance of infected erythrocytes spared by pitting during AS treatment is an original mechanism of hemolytic anemia. Our findings consolidate a disease framework for posttreatment anemia in malaria in which delayed hemolysis is a new entity. The early concentration of once-infected erythrocytes is a solid candidate marker to predict post-AS delayed hemolysis PMID:24859359

  15. Hemolysis assessment and antioxidant activity evaluation modified in an oxidized erythrocyte model.

    PubMed

    Xu, Xin; He, Jiayi; Liu, Guoyan; Diao, Xinyu; Cao, Yingying; Ye, Qun; Xu, Guangxin; Mao, Wendong

    2014-03-05

    Hydrogen peroxide (H₂O₂)-induced hemolysis is a commonly used model for antioxidant activity evaluation, and the hemolysis index is often presented as the absorbance of supernatant hemoglobin (Hb), which releases from injured cells. However, in previous studies, as an oxidation-sensitive protein, it has been recognized that Hb easily forms other types or substances, such as metHb, Heinz, and some fluorescent products. This study concerns whether Hb oxidation participated in H₂O₂-induced hemolysis and confirmed that the destruction of Hb under oxidizing condition had been a novel interfering factor that could reduce the absorbance in Hb quantitative detection. To correct the lower absorbance, the stable fluorescent products found in Hb degradation were selected, and the absorbance correction factor of 6.436 was drawn on the basis of the absorbance and fluorescent intensity. This correction factor obviously altered the results of both dose-dependent hemolysis of H₂O₂ and antioxidant activity. In addition, the assessment difference was innovatively discussed by altering the sequences of adding antioxidant and oxidant. These different sequences caused variations in hemolysis, indicating that multiple evaluations may be related to the antioxidant pathways which are necessary for more accurate bioactivity data.

  16. Lidocaine: an inhibitor in the free-radical-induced hemolysis of erythrocytes.

    PubMed

    Tang, You-Zhi; Liu, Zai-Qun; Wu, Di

    2009-01-01

    Lidocaine was reported to protect erythrocytes from hemolysis induced by 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH). Since AAPH-induced hemolysis was a convenient in vitro experimental system to mimic erythrocytes undergoing peroxyl radicals attack, the aim of this work was to investigate the antioxidant effect of lidocaine on AAPH-induced hemolysis by chemical kinetics. As a result, one molecule of lidocaine can only trap 0.37 radical, much lower than melatonin. Meanwhile, lidocaine cannot protect erythrocytes from hemolysis induced by hemin, which the mechanism of hemolysis was due to the erythrocyte membrane destroyed by hemin. Accordingly, lidocaine protected erythrocytes by scavenging radicals preferentially rather than by stabilizing membrane. Moreover, the interactions of lidocaine with two radical species, including 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonate) radical cation (ABTS(+*)) and 2,2'-diphenyl-1-picrylhydrazyl (DPPH), indicated that lidocaine can reduce ABTS(+*) with 260 microM as the 50% inhibition concentration (IC(50)) and cannot react with DPPH. Thus, lidocaine served as a reductant rather than a hydrogen donor to interact with radicals. Finally, the quantum calculation proved that, compared with the melatonin radical, the stabilization of N-centered radical of lidocaine was higher than the amide-type N-centered radical but lower than the indole-type N-centered radical in melatonin. These results provided basic information for lidocaine to be an antiradical drug.

  17. Influence of radial clearance and rotor motion to hemolysis in a journal bearing of a centrifugal blood pump.

    PubMed

    Kataoka, Hiroyuki; Kimura, Yuichi; Fujita, Hajime; Takatani, Setsuo

    2006-11-01

    Hemolysis due to narrow clearance of noncontact bearings is a critical problem for rotary blood pumps. We developed a centrifugal blood pump with a magnetic and hydrodynamic hybrid bearing, and found that the hemolysis in the narrow clearance depends not only on the clearance size, but also on the rotor stability. In this study, we quantified the relation between the hemolysis, radial clearance (c), and rotor stability through the measurement of the rotor motion and hemolysis. As a result, it was confirmed that the rotor of the current pump is stabilized within the oscillation of 20 microm in blood, and the hemolysis decreases with increase in the c, which is the opposite in the unstable rotor motion with the previous pump. In order to theoretically discuss this hemolysis tendency, we implemented hemolysis estimation in the c according to hydrodynamics and hemodynamics. This estimation can represent the measured hemolysis tendency, and revealed that the flow rate has large influence on the hemolysis in the c.

  18. Imminent Cardiac Risk Assessment via Optical Intravascular Biochemical Analysis

    SciTech Connect

    Wetzel, D.; Wetzel, L; Wetzel, M; Lodder, R

    2009-01-01

    Heart disease is by far the biggest killer in the United States, and type II diabetes, which affects 8% of the U.S. population, is on the rise. In many cases, the acute coronary syndrome and/or sudden cardiac death occurs without warning. Atherosclerosis has known behavioral, genetic and dietary risk factors. However, our laboratory studies with animal models and human post-mortem tissue using FT-IR microspectroscopy reveal the chemical microstructure within arteries and in the arterial walls themselves. These include spectra obtained from the aortas of ApoE-/- knockout mice on sucrose and normal diets showing lipid deposition in the former case. Also pre-aneurysm chemical images of knockout mouse aorta walls, and spectra of plaque excised from a living human patient are shown for comparison. In keeping with the theme of the SPEC 2008 conference Spectroscopic Diagnosis of Disease this paper describes the background and potential value of a new catheter-based system to provide in vivo biochemical analysis of plaque in human coronary arteries. We report the following: (1) results of FT-IR microspectroscopy on animal models of vascular disease to illustrate the localized chemical distinctions between pathological and normal tissue, (2) current diagnostic techniques used for risk assessment of patients with potential unstable coronary syndromes, and (3) the advantages and limitations of each of these techniques illustrated with patent care histories, related in the first person, by the physician coauthors. Note that the physician comments clarify the contribution of each diagnostic technique to imminent cardiac risk assessment in a clinical setting, leading to the appreciation of what localized intravascular chemical analysis can contribute as an add-on diagnostic tool. The quality of medical imaging has improved dramatically since the turn of the century. Among clinical non-invasive diagnostic tools, laboratory tests of body fluids, EKG, and physical examination are

  19. A Review of Intravascular Ultrasound–Based Multimodal Intravascular Imaging: The Synergistic Approach to Characterizing Vulnerable Plaques

    PubMed Central

    Ma, Teng; Zhou, Bill; Hsiai, Tzung K.; Shung, K. Kirk

    2015-01-01

    Catheter-based intravascular imaging modalities are being developed to visualize pathologies in coronary arteries, such as high-risk vulnerable atherosclerotic plaques known as thin-cap fibroatheroma, to guide therapeutic strategy at preventing heart attacks. Mounting evidences have shown three distinctive histopathological features—the presence of a thin fibrous cap, a lipid-rich necrotic core, and numerous infiltrating macrophages—are key markers of increased vulnerability in atherosclerotic plaques. To visualize these changes, the majority of catheter-based imaging modalities used intravascular ultrasound (IVUS) as the technical foundation and integrated emerging intravascular imaging techniques to enhance the characterization of vulnerable plaques. However, no current imaging technology is the unequivocal “gold standard” for the diagnosis of vulnerable atherosclerotic plaques. Each intravascular imaging technology possesses its own unique features that yield valuable information although encumbered by inherent limitations not seen in other modalities. In this context, the aim of this review is to discuss current scientific innovations, technical challenges, and prospective strategies in the development of IVUS-based multi-modality intravascular imaging systems aimed at assessing atherosclerotic plaque vulnerability. PMID:26400676

  20. Transient Stress- and Strain-Based Hemolysis Estimation in a Simplified Blood Pump

    PubMed Central

    Pauli, L.; Nam, J.; Pasquali, M.; Behr, M.

    2014-01-01

    SUMMARY We compare two approaches to numerical estimation of mechanical hemolysis in a simplified blood pump model. The stress-based model relies on the instantaneous shear stress in the blood flow, whereas the strain-based model uses an additional tensor equation to relate distortion of red blood cells to a shear stress measure. We use the newly proposed least-squares finite element method (LSFEM) to prevent negative concentration fields and show a stable and volume preserving LSFEM for the tensor equation. Application of both models to a simplified centrifugal blood pump at three different operating conditions show that the stress-based model overestimates the rate of hemolysis. The strain-based model is found to deliver lower hemolysis rates since it incorporates a more detailed description of biophysical phenomena into the simulation process. PMID:23922311

  1. Hemolysis as a possible indicator of neurotoxicity induced by organic solvents.

    PubMed Central

    Anderson, R J; Glasgow, C E; Dunham, C B

    1984-01-01

    The expense, length of time and number of animals required for routine toxicity testing have provided the incentive for finding alternative techniques which are faster, less expensive and equally valid. The purpose of this work was to examine the value of a simple in vitro test (hemolysis) as a correlate of the neurotoxicity produced by commonly used industrial organic solvents. Incubation of rat erythrocytes with organic alcohols produced hemolysis which correlates with the potency of the same alcohols to suppress membrane excitability, measured as reduction in the evoked action potential of the rat sciatic nerve. The hemolytic activity also reflects changes in water solubility among the compounds and thus can be used as an index of in vivo neurotoxicity, the extent of which partly depends on absorption of the agent and delivery to nerve tissue. Hemolysis therefore may be of value as a preliminary test for assessing the neurotoxicity of organic solvents. PMID:6525994

  2. Safety of blood transfusions using 27 gauge neonatal PICC lines: an in vitro study on hemolysis.

    PubMed

    Repa, A; Mayerhofer, M; Cardona, F; Worel, N; Deindl, P; Pollak, A; Berger, A; Haiden, N

    2013-12-01

    Blood transfusions are required by the majority of extremely premature infants. Packed red blood cells (PRBCs) are usually applied via simple peripheral cannulas. In situations where no peripheral venous access is achievable, 27 Gauge (G) neonatal PICC lines - that are ideally exclusively dedicated to application of parenteral nutrition - may represent a useful alternative access for PRBC transfusions. However, transfusion via small scaled catheters may damage PRBCs and lead to hemolysis. We here evaluate whether transfusion of irradiated PRBCs via 27 G PICC lines leads to hemolysis in vitro.Experimental transfusions of gamma-irradiated PRBCs were performed at increasing velocities (2.5, 3.7, 5 ml/h; full force manual push approximating 30 ml/h) via 27 G PICC lines of 20 and 30 cm length. Parameters of hemolysis (lactate dehydrogenase, potassium and free hemoglobin) were measured from the supernatants of transfused PRBCs and the percentage of hemolysis was calculated.Potassium and lactate dehydrogenase after transfusion at increasing velocities did not differ significantly from negative controls. Free hemoglobin levels showed a small but significant increase at the slowest transfusion speed (2.5 ml/h) using the 30 cm 27 G PICC line, with a relative hemolysis of only 0.13%. A manual push (approximating 30 ml/h) showed no significant changes of parameters from baseline.We conclude that transfusion of gamma-irradiated PRBCs using a 27 G neonatal PICC line does not cause clinically relevant hemolysis in vitro. Clinical studies are needed to confirm the feasibility and safety of the approach in vivo.

  3. A preliminary study of microcapsule suspension for hemolysis evaluation of artificial organs.

    PubMed

    Maruyama, O; Yamane, T; Tsunemoto, N; Nishida, M; Tsutsui, T; Jikuya, T

    1999-03-01

    A microcapsule suspension, a substitute for animal blood in hemolysis tests, has been developed for evaluation of the absolute hemolytic properties of circulatory artificial organs. The microcapsule suspension was made by dispersing microcapsule slurry into an ethylene glycol sodium chloride solution. The microcapsule slurry was composed of a leuco dye solution and polyurethane membrane made by the reaction between aliphatic poly-isocyanate and polyamine by interfacial polycondensation. The microcapsule was a small particle containing dye inside. The microcapsule suspension was white; the diameter of the microcapsules was from 5 to 100 microns. The specific gravity of the suspension was 1.024, and the membrane was elastic. The fluid showed Newtonian characteristics, different from animal blood, and its viscosity was approximately 5.8 mPa.s. After the microcapsules were destroyed, the leuco dye was extracted with n-hexane from the suspension and was measured by spectroscopy after being colored with acid ethanol. Hemolysis can be regarded as a fatigue fracture of cell membranes rather than a static fracture. The destruction of microcapsules by a Potter type tissue grinder was observed at a low stroke number region and was compared to rat blood. Moreover, hemolysis tests of a commercially available centrifugal blood pump and the prototype of our centrifugal pump for mechanism checks were carried out with bovine blood. The hemolysis level of the prototype pump increased with time while the hemolysis level of the commercial blood pump did not change as much as that of the control when both pumps were tested with the microcapsule suspension. These results are similar to tests utilizing bovine blood. Therefore, hemolysis tests of circulatory artificial organs completed with microcapsule suspension are expected to provide results similar to tests with animal blood.

  4. 21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Subcutaneous, implanted, intravascular infusion... Hospital and Personal Use Therapeutic Devices § 880.5965 Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification. A subcutaneous, implanted, intravascular infusion port...

  5. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term intravascular catheter. (a) Identification. A percutaneous, implanted, long-term intravascular catheter is a device...

  6. 21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Subcutaneous, implanted, intravascular infusion... Hospital and Personal Use Therapeutic Devices § 880.5965 Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification. A subcutaneous, implanted, intravascular infusion port...

  7. 21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Subcutaneous, implanted, intravascular infusion... Hospital and Personal Use Therapeutic Devices § 880.5965 Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification. A subcutaneous, implanted, intravascular infusion port...

  8. Incidental Intravascular Lipoleiomyomatosis in A Hysterectomy Specimen: How To Manage?

    PubMed Central

    Aslanova, Rakhshanda; Can, Nuray; Okten, Sabri Berkem; Aslan, Mehmet Musa

    2015-01-01

    Leiomyomas are common benign tumors in female gynaecologic surgery. They are originated from smooth muscle cells of the uterus and/or sometimes of the uterine vessels. Intravascular lipoleiomyomatosis is a very rare form of leiomyomas which grow within veins and can extend up to vena cava inferior and right heart chamber with cardiac symptoms and is diagnosed by cardiovascular surgeons. We report a case of incidental intravascular lipoleiomyomatosis which was confined to the uterus being diagnosed after a total abdominal hysterectomy by pathology and its management strategy. PMID:25738043

  9. Extremely refractory Kawasaki disease with disseminated intravascular coagulation.

    PubMed

    Koh, Young Kwon; Lee, Jae Hee; Park, Yeong Bong

    2017-03-07

    Disseminated intravascular coagulation is a rare complication of Kawasaki disease and appears in <0.1% of Kawasaki disease patients. We report a case of refractory Kawasaki disease complicated with disseminated intravascular coagulation and giant coronary aneurysm. A 5-month-old boy presented with Kawasaki disease with coagulopathy. Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration. Despite all efforts to treatment, the patient had giant coronary aneurysms and died suddenly.

  10. Diagnostic exercise: hemolysis and sudden death in lambs.

    PubMed

    Giannitti, F; Rioseco, M Macias; García, J P; Beingesser, J; Woods, L W; Puschner, B; Uzal, F A

    2014-05-01

    Within a 24-hour period, 7 out of 200 three- to four-week-old pastured Katahdin lambs died after showing clinical signs of hemoglobinuria, red-tinged feces, weakness, and recumbency. One of the lambs that was examined clinically before natural death also had abdominal pain, trembling, tachycardia, and severe anemia with a packed cell volume of 4%. Pathologic findings included icterus, hemoglobinuric nephrosis, dark red urine, pulmonary edema, hydrothorax, splenomegaly, and acute centrilobular to midzonal hepatocellular degeneration and necrosis with cholestasis. The differential diagnoses and diagnostic workup to achieve the diagnosis are briefly discussed.

  11. Mechanical hemolysis in blood flow: user-independent predictions with the solution of a partial differential equation.

    PubMed

    Lacasse, David; Garon, Andre; Pelletier, Dominique

    2007-02-01

    This paper presents for the first time numerical predictions of mechanical blood hemolysis obtained by solving a hyperbolic partial differential equation (PDE) modelling the hemolysis in a Eulerian frame of reference. This provides hemolysis predictions over the entire computational domain as an alternative to the Lagrangian approach consisting in evaluating cell hemolysis along their trajectories. The solution of a PDE over a computational domain, such as in the approach presented herein, yields a unique solution. This is a clear advantage over the Lagrangian approach, which requires the human-made choice of a limited number of trajectories for integration and inevitably results in the incomplete coverage of the computational domain. The hyperbolic hemolysis model is solved with a Discontinuous Galerkin finite element method. The solution algorithm also includes adaptive remeshing to provide high accuracy simulations. Predictions of the modified index of hemolysis (MIH) are presented for flows in dialysis cannulae and sudden contractions. MIH predictions for cannulae differ significantly from those obtained by other authors using the Lagrangian approach. The predictions for flows in sudden contractions are used, along with our own experimental measurements, to assess the value of the threshold shear stress required for hemolysis that is included in the hemolysis model.

  12. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices §...

  13. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices §...

  14. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  15. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  16. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  17. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  18. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  19. 21 CFR 880.5210 - Intravascular catheter securement device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intravascular catheter securement device. 880.5210 Section 880.5210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  20. 21 CFR 880.5210 - Intravascular catheter securement device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intravascular catheter securement device. 880.5210 Section 880.5210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  1. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... side of the heart and the pulmonary circulation. (b) Classification. Class II. The special controls...

  2. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... side of the heart and the pulmonary circulation. (b) Classification. Class II. The special controls...

  3. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... side of the heart and the pulmonary circulation. (b) Classification. Class II. The special controls...

  4. A Prognostic Dilemma of Basal Cell Carcinoma with Intravascular Invasion

    PubMed Central

    Niumsawatt, Vachara; Castley, Andrew

    2016-01-01

    Summary: Basal cell carcinoma is the most common malignancy; however, it very rarely metastasizes. Despite the low mortality caused by this cancer, once it spreads, it has dim prognosis. We report a case of basal cell carcinoma with rare intravascular invasion and review the literature for risk factors and management of metastasis. PMID:27757356

  5. Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with pituitary apoplexy.

    PubMed

    Murao, Koji; Imachi, Hitomi; Muraoka, Tomie; Ishida, Toshihiko

    2011-07-01

    After hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome was diagnosed in a 35-year-old woman at 39 weeks' gestation, magnetic resonance imaging and hormone examination revealed pituitary apoplexy with panhypopituitarism and diabetes insipidus. Evaluation of pituitary function should be considered in patients with HELLP syndrome.

  6. Pressure Infusion Cuff and Blood Warmer during Massive Transfusion: An Experimental Study About Hemolysis and Hypothermia

    PubMed Central

    Pruneau, Denise; Dorval, Josée; Thibault, Louis; Fisette, Jean-François; Bédard, Suzanne K.; Jacques, Annie; Beauregard, Patrice

    2016-01-01

    Background Blood warmers were developed to reduce the risk of hypothermia associated with the infusion of cold blood products. During massive transfusion, these devices are used with compression sleeve, which induce a major stress to red blood cells. In this setting, the combination of blood warmer and compression sleeve could generate hemolysis and harm the patient. We conducted this study to compare the impact of different pressure rates on the hemolysis of packed red blood cells and on the outlet temperature when a blood warmer set at 41.5°C is used. Methods Pressure rates tested were 150 and 300 mmHg. Ten packed red blood cells units were provided by Héma-Québec and each unit was sequentially tested. Results We found no increase in hemolysis either at 150 or 300 mmHg. By cons, we found that the blood warmer was not effective at warming the red blood cells at the specified temperature. At 150 mmHg, the outlet temperature reached 37.1°C and at 300 mmHg, the temperature was 33.7°C. Conclusion To use a blood warmer set at 41.5°C in conjunction with a compression sleeve at 150 or 300 mmHg does not generate hemolysis. At 300 mmHg a blood warmer set at 41.5°C does not totally avoid a risk of hypothermia. PMID:27711116

  7. Analysis of beta-hemolysis in human blood agars by Streptococcus pyogenes.

    PubMed

    Zomorodian, Kamiar; Rahimi, Mohammad Javad; Safaei, Akbar; Bazargani, Abdollah; Motamadi, Marjan; Kharazi, Mahboobeh; Mostaghni, Setareh; Pakshir, Keyvan; Ghaedi, Hamid; Afsarian, Mohammad Hossein

    2011-06-01

    The aim of the study was to assess the reliability of human blood agar media (HuBA) in identifying Streptococcus pyogenes by hemolysis analysis. We analyze several factors that might affect the accuracy of HuBA media for microbial analysis, including incubation time, blood group, Rh factor and presence of antistreptolysin-o.

  8. [Numerical assessment of impeller features of centrifugal blood pump based on fast hemolysis approximation model].

    PubMed

    Shou, Chen; Guo, Yongjun; Su, Lei; Li, Yongqian

    2014-12-01

    The impeller profile, which is one of the most important factors, determines the creation of shear stress which leads to blood hemolysis in the internal flow of centrifugal blood pump. The investigation of the internal flow field in centrifugal blood pump and the estimation of the hemolysis within different impeller profiles will provide information to improve the performance of centrifugal blood pump. The SST kappa-omega with low Reynolds correction was used in our laboratory to study the internal flow fields for four kinds of impellers of centrifugal blood pump. The flow fields included distributions of pressure field, velocity field and shear stress field. In addition, a fast numerical hemolysis approximation was adopted to calculate the normalized index of hemolysis (NIH). The results indicated that the pressure field distribution in all kinds of blood pump were reasonable, but for the log spiral impeller pump, the vortex and backflow were much lower than those of the other pumps, and the high shear stress zone was just about 0.004%, and the NIH was 0.0089.

  9. Influence of artistic gymnastics on iron nutritional status and exercise-induced hemolysis in female athletes.

    PubMed

    Sureira, Thaiz Mattos; Amancio, Olga Silverio; Pellegrini Braga, Josefina Aparecida

    2012-08-01

    This study evaluates the relationship between body iron losses and gains in artistic gymnastics female athletes. It shows that despite the low iron intake and exercise-induced hemolysis, iron deficiency or iron-deficiency anemia does not occur, but partial changes in the hematological profile do. The hypothesis that gymnasts' nutritional behavior contributes to anemia, which may be aggravated by exercise-induced hemolysis, led to this cross-sectional study, conducted with 43 female artistic gymnasts 6-16 yr old. The control group was formed by 40 nontraining girls, paired by age. Hemogram, serum iron, ferritin, soluble transferrin receptor, haptoglobin, total and fractional bilirubin, Type I urine, and parasitologic and occult fecal blood tests were evaluated. The athletes presented mean hematimetric and serum iron values (p = .020) higher than those of the control group. The bilirubin result discarded any hemolytic alteration in both groups. The haptoglobin results were lower in the athlete group (p = .002), confirming the incidence of exercise-induced hemolysis. Both groups presented low iron intake. The results suggest that artistic gymnastics practice leads to exercise-induced hemolysis and partially changes the hematological profile, although not causing iron deficiency or iron-deficiency anemia, even in the presence of low iron intake.

  10. Sodium nitrite induces acute central nervous system toxicity in guinea pigs exposed to systemic cell-free hemoglobin

    SciTech Connect

    Buehler, Paul W.; Butt, Omer I.; D'Agnillo, Felice

    2011-06-10

    Highlights: {yields} Toxicological implications associated with the use of NaNO{sub 2} therapy to treat systemic cell-free Hb exposure are not well-defined. {yields} Systemic Hb exposure followed by NaNO{sub 2} infusion induces acute CNS toxicities in guinea pigs. {yields} These CNS effects were not reproduced by the infusion of cell-free Hb or NaNO{sub 2} alone. {yields} NaNO{sub 2}-mediated oxidation of cell-free Hb may play a causative role in the observed CNS changes. -- Abstract: Systemic cell-free hemoglobin (Hb) released via hemolysis disrupts vascular homeostasis, in part, through the scavenging of nitric oxide (NO). Sodium nitrite (NaNO{sub 2}) therapy can attenuate the hypertensive effects of Hb. However, the chemical reactivity of NaNO{sub 2} with Hb may enhance heme- or iron-mediated toxicities. Here, we investigate the effect of NaNO{sub 2} on the central nervous system (CNS) in guinea pigs exposed to systemic cell-free Hb. Intravascular infusion of NaNO{sub 2}, at doses sufficient to alleviate Hb-mediated blood pressure changes, reduced the expression of occludin, but not zona occludens-1 (ZO-1) or claudin-5, in cerebral tight junctions 4 h after Hb infusion. This was accompanied by increased perivascular heme oxygenase-1 expression, neuronal iron deposition, increased astrocyte and microglial activation, and reduced expression of neuron-specific nuclear protein (NeuN). These CNS changes were not observed in animals treated with Hb or NaNO{sub 2} alone. Taken together, these findings suggest that the use of nitrite salts to treat systemic Hb exposure may promote acute CNS toxicity.

  11. Blood Warming and Hemolysis: A Systematic Review With Meta-Analysis.

    PubMed

    Poder, Thomas G; Nonkani, Wendyam G; Tsakeu Leponkouo, Élyonore

    2015-07-01

    The use of fluid warmers during blood transfusion is recommended to avoid inducing hypothermia and its harmful effects. Fluid warmers offered by manufacturers can reach temperatures of 43°C. However, the recommendations of national regulatory organizations do not clearly indicate the maximum heating temperature in relation to the risk of hemolysis. To fill this gap, we conducted a systematic review of the literature with meta-analysis. To match clinical practice, this review was limited to fluid warmers that used contact heating; thus, studies that used radiofrequency or microwave heating were excluded. Twenty-four observational studies were included, 17 of which were the subject of a meta-analysis. A preliminary descriptive analysis indicated that multiple factors can influence the level of hemolysis during blood heating with a liquid warmer, including blood age, anticoagulant type, duration of exposure to heat, stirring the blood during heating, and various elements of the circuit through which blood flows (eg, type of infusion pump with pressure and flow, type of microfilter, and type of tubing). Moreover, the duration between sampling and hemolysis assay was a source of heterogeneity among studies, as were the initial free hemoglobin levels in the various experiments. In general, the increase generated by each of these factors other than temperature appears to have been limited except for blood age, which is an important parameter of hemolysis, the length of exposure to heat, and, in some studies, the type of infusion pump used. Regarding the meta-analysis, at temperatures at or less than 43°C and even up to 45-46°C, it appears that blood heating is safe and causes hemolysis only in clinically negligible proportions.

  12. A new model of centrifugal blood pump for cardiopulmonary bypass: design improvement, performance, and hemolysis tests.

    PubMed

    Leme, Juliana; Fonseca, Jeison; Bock, Eduardo; da Silva, Cibele; da Silva, Bruno Utiyama; Dos Santos, Alex Eugênio; Dinkhuysen, Jarbas; Andrade, Aron; Biscegli, José F

    2011-05-01

    A new model of blood pump for cardiopulmonary bypass (CPB) application has been developed and evaluated in our laboratories. Inside the pump housing is a spiral impeller that is conically shaped and has threads on its surface. Worm gears provide an axial motion of the blood column. Rotational motion of the conical shape generates a centrifugal pumping effect and improves pumping performance. One annular magnet with six poles is inside the impeller, providing magnetic coupling to a brushless direct current motor. In order to study the pumping performance, a mock loop system was assembled. Mock loop was composed of Tygon tubes (Saint-Gobain Corporation, Courbevoie, France), oxygenator, digital flowmeter, pressure monitor, electronic driver, and adjustable clamp for flow control. Experiments were performed on six prototypes with small differences in their design. Each prototype was tested and flow and pressure data were obtained for rotational speed of 1000, 1500, 2000, 2500, and 3000 rpm. Hemolysis was studied using pumps with different internal gap sizes (1.35, 1.45, 1.55, and 1.7 mm). Hemolysis tests simulated CPB application with flow rate of 5 L/min against total pressure head of 350 mm Hg. The results from six prototypes were satisfactory, compared to the results from the literature. However, prototype #6 showed the best results. Best hemolysis results were observed with a gap of 1.45 mm, and showed a normalized index of hemolysis of 0.013 g/100 L. When combined, axial and centrifugal pumping principles produce better hydrodynamic performance without increasing hemolysis.

  13. Massive Bleeding as the First Clinical Manifestation of Metastatic Prostate Cancer due to Disseminated Intravascular Coagulation with Enhanced Fibrinolysis

    PubMed Central

    Lopes, João Madeira; Victorino, Rui M. M.; Meneses Santos, João

    2016-01-01

    Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with metastatic prostate adenocarcinoma. However, DIC with enhanced fibrinolysis as an initial presentation of prostate cancer is extremely rare. The appropriate treatment to control bleeding in these situations is challenging, controversial, and based on isolated case reports in the literature. A 66-year-old male presented at the emergency department with acute severe spontaneous ecchymoses localized to the limbs, laterocervical hematoma, and hemothorax. Prostate specific antigen level was 385 μg/L, bone scintigraphy revealed multiple bone metastases, and prostate biopsy confirmed adenocarcinoma (Gleason 9; 4 + 5). Laboratory investigation showed a pattern of enhanced fibrinolysis rather than the more common intravascular coagulation mechanism. Epsilon aminocaproic acid in monotherapy was initiated with a clear and rapid control of bleeding manifestations. This rare case of massive bleeding due to DIC with enhanced fibrinolysis as the first manifestation of prostate cancer suggests that in selected cases where the acute bleeding dyscrasia is clearly associated with a dominant fibrinolysis mechanism it is possible to use an approach of monotherapy with antifibrinolytics. PMID:27803823

  14. Haematological abnormalities in acute pancreatitis. A prospective study.

    PubMed Central

    Murphy, D.; Imrie, C. W.; Davidson, J. F.

    1977-01-01

    Twenty-five patients with acute pancreatitis were studied prospectively in the first week of their admission using haematological and coagulation tests. Platelet counts initially fell and later returned to admission levels. Rising levels of plasma fibrinogen were recorded. The kaolin cephalin clotting time was shorter than its control in twenty-one patients. Eighteen patients had elevated fibrinogen degradation products and fourteen had a positive ethanol gelation test. It is suggested that by taking into account the results in series of individual patients a degree of intravascular coagulation may be a common feature of acute pancreatitis. In one patient (presented in detail) strong evidence for disseminated intravascular coagulation was found PMID:887529

  15. Intravascular near-infrared fluorescence molecular imaging of atherosclerosis

    PubMed Central

    Thukkani, Arun K; Jaffer, Farouc A

    2013-01-01

    Novel imaging modalities are required to better identify vulnerable atherosclerotic plaques before their dire consequences of myocardial infarction, sudden death, and stroke. Moving beyond traditional diagnostic methods, the field of molecular imaging offers an innovative approach to report upon critical in vivo biological features of high-risk plaques. Molecular imaging employs engineered, targeted imaging agents in conjunction with sophisticated, high-resolution detection systems. While various modalities have been investigated for this purpose, intravascular near infrared fluorescence imaging (NIRF) strategies are uniquely poised to provide high-resolution readouts of human coronary artery plaques. To date, preclinical animal studies have demonstrated feasibility of both standalone NIRF intravascular imaging as well as dual-modality approaches detecting inflammation and fibrin deposition in coronary-sized arteries. This translatable catheter-based approach is positioned to advance the identification of biologically vulnerable coronary plaques and coronary stents at risk of thrombosis. PMID:23638334

  16. Integrated intravascular optical coherence tomography ultrasound imaging system.

    PubMed

    Yin, Jiechen; Yang, Hao-Chung; Li, Xiang; Zhang, Jun; Zhou, Qifa; Hu, Changhong; Shung, K Kirk; Chen, Zhongping

    2010-01-01

    We report on a dual-modality optical coherence tomography (OCT) ultrasound (US) system for intravascular imaging. To the best of our knowledge, we have developed the first integrated OCT-US probe that combines OCT optical components with an US transducer. The OCT optical components mainly consist of a single-mode fiber, a gradient index lens for light-beam focusing, and a right-angled prism for reflecting light into biological tissue. A 40-MHz piezoelectric transducer (PZT-5H) side-viewing US transducer was fabricated to obtain the US image. These components were integrated into a single probe, enabling both OCT and US imaging at the same time. In vitro OCT and ultrasound images of a rabbit aorta were obtained using this dual-modality imaging system. This study demonstrates the feasibility of an OCT-US system for intravascular imaging, which is expected to have a prominent impact on early detection and characterization of atherosclerosis.

  17. Characterization of coronary atherosclerosis by intravascular imaging modalities

    PubMed Central

    Honda, Satoshi; Kanaya, Tomoaki; Noguchi, Teruo; Ogawa, Hisao; Yasuda, Satoshi

    2016-01-01

    Coronary artery disease (CAD) is highly prevalent in Western countries and is associated with morbidity, mortality, and a significant economic burden. Despite the development of anti-atherosclerotic medical therapies, many patients still continue to suffer from coronary events. This residual risk indicates the need for better risk stratification and additional therapies to achieve more reductions in cardiovascular risk. Recent advances in imaging modalities have contributed to visualizing atherosclerotic plaques and defining lesion characteristics in vivo. This innovation has been applied to refining revascularization procedure, assessment of anti-atherosclerotic drug efficacy and the detection of high-risk plaques. As such, intravascular imaging plays an important role in further improvement of cardiovascular outcomes in patients with CAD. The current article reviews available intravascular imaging modalities with regard to its method, advantage and disadvantage. PMID:27500094

  18. Intravascular magnetic resonance imaging using a loopless catheter antenna.

    PubMed

    Ocali, O; Atalar, E

    1997-01-01

    Recently, intravascular catheter probes have been developed to increase signal-to-noise ratio (SNR) for MR imaging of blood vessels. Miniaturization of these catheter probes without degrading their performances is very critical in imaging small vessels such as coronary arteries. Catheter coils have a loop incorporated in their structure and have limitations in physical dimensions and electromagnetic properties. The use of a loopless intravascular catheter antenna is proposed to overcome these problems. The catheter antenna is essentially a dipole, which makes a very thin diameter possible, and its electronic circuitry can be placed outside the blood vessels without performance degradation. The theoretical foundation for the design and operation of the catheter antenna is presented. Several catheter antennae, as small as 1.5 French, were constructed and tested on phantoms and rabbits with great success. The catheter antenna has a simple structure and is easy to design, implement, and operate.

  19. Integrated intravascular optical coherence tomography ultrasound imaging system

    PubMed Central

    Yin, Jiechen; Yang, Hao-Chung; Li, Xiang; Zhang, Jun; Zhou, Qifa; Hu, Changhong; Shung, K. Kirk; Chen, Zhongping

    2010-01-01

    We report on a dual-modality optical coherence tomography (OCT) ultrasound (US) system for intravascular imaging. To the best of our knowledge, we have developed the first integrated OCT-US probe that combines OCT optical components with an US transducer. The OCT optical components mainly consist of a single-mode fiber, a gradient index lens for light-beam focusing, and a right-angled prism for reflecting light into biological tissue. A 40-MHz piezoelectric transducer (PZT-5H) side-viewing US transducer was fabricated to obtain the US image. These components were integrated into a single probe, enabling both OCT and US imaging at the same time. In vitro OCT and ultrasound images of a rabbit aorta were obtained using this dual-modality imaging system. This study demonstrates the feasibility of an OCT-US system for intravascular imaging, which is expected to have a prominent impact on early detection and characterization of atherosclerosis. PMID:20210424

  20. Look away: arterial and venous intravascular embolisation following shotgun injury.

    PubMed

    Vedelago, John; Dick, Elizabeth; Thomas, Robert; Jones, Brynmor; Kirmi, Olga; Becker, Jennifer; Alavi, Afshin; Gedroyc, Wladyslaw

    2014-01-01

    We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

  1. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    PubMed

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  2. Treatment of Vertebro-Basilar Dissecting Aneurysms Using Intravascular Stents

    PubMed Central

    Yamasaki, S.; Hashimoto, K.; Kawano, Y.; Yoshimura, M.; Yamamoto, T.; Hara, M.

    2006-01-01

    Summary Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections. In this report, three patterns of stent application are described and their method of selection is discussed. PMID:20569619

  3. Spray drying for preservation of erythrocytes: effect of atomization on hemolysis.

    PubMed

    McLean, Mary; Han, Xiao-Yue; Higgins, Adam Z

    2013-04-01

    Spray drying has the potential to enable storage of erythrocytes at room temperature in the dry state. The spray drying process involves atomization of a liquid into small droplets and drying of the droplets in a gas stream. In this short report, we focus on the atomization process. To decouple atomization from drying, erythrocyte suspensions were sprayed with a two-fluid atomizer nozzle using humid nitrogen as the atomizing gas. The median droplet size was less than 100 μm for all of the spray conditions investigated, indicating that the suspensions were successfully atomized. Hemolysis was significantly affected by the hematocrit of the erythrocyte suspension, the suspension flow rate, and the atomizing gas flow rate (p<0.01 in all cases). Under appropriate conditions, it was possible to achieve less than 2% hemolysis, suggesting that spray drying may be a feasible option for erythrocyte biopreservation.

  4. Involvement of SpoVG in hemolysis caused by Bacillus subtilis.

    PubMed

    Pan, Xingliang; Chen, Xiuzhen; Su, Xiaoyun; Feng, Yuan; Tao, Yong; Dong, Zhiyang

    2014-01-17

    Bacillus subtilis is a facultative anaerobic Gram-positive non-pathogenic bacterium that includes members displaying hemolytic activity. To identify the genes responsible for hemolysis, a random mariner-based transposon insertion mutant library of B. subtilis 168 was constructed. More than 20,000 colonies were screened for the hypohemolytic phenotype on blood agar plates. One mutant showed significantly less pronounced hemolytic phenotype than the wild type. DNA sequencing and Southern blot analysis showed this mutant has a single transposable element inserted into the open reading frame (ORF) of the spoVG gene; complementation of the spoVG-disrupted mutant with a wild-type copy restored its hemolytic phenotype. It was therefore concluded that the spoVG gene, which plays a role in regulating asymmetric septation during sporulation in B. subtilis, is involved in hemolysis by B. subtilis.

  5. Hemolysis Related to Turbulent Eddy Size Distributions Using Comparisons of Experiments to Computations.

    PubMed

    Ozturk, Mesude; O'Rear, Edgar A; Papavassiliou, Dimitrios V

    2015-12-01

    Turbulent blood flow in medical devices contributes to blood trauma, yet the exact mechanism(s) have not been fully elucidated. Local turbulent stresses, viscous stresses, and the rate of dissipation of the turbulent kinetic energy have been proffered as hypotheses to describe and predict blood damage. In this work, simulations of experiments in a Couette flow viscometer and a capillary tube were used to examine extensive properties of the turbulent flow field and to investigate contributing factors for red blood cell hemoglobin release in turbulence by eddy analysis. It was found that hemolysis occurred when dissipative eddies were comparable in size to the red blood cells. The Kolmogorov length scale was used to quantify the size of smaller turbulent eddies, indicating correspondence of hemolysis with number and surface area of eddies smaller than about 10 μm when a k-ε turbulence model is adopted.

  6. Vascular wall stress during intravascular optical coherence tomography imaging

    NASA Astrophysics Data System (ADS)

    Sun, Cuiru; Yang, Victor

    2015-03-01

    Biomechanical properties of arterial wall is crucial for understanding the changes in the cardiovascular system. Catheters are used during intravascular optical coherence tomography (IVOCT) imaging. The presence of a catheter alters the flow field, pressure distribution and frictional resistance to flow in an artery. In this paper, we first study the transmural stress distribution of the catheterized vessel. COMSOL (COMSOL 4.4) was used to simulate the blood flow induced deformation in a catheterized vessel. Blood is modeled as an incompressible Newtonian fluid. Stress distribution from an three-layer vascular model with an eccentric catheter are simulated, which provides a general idea about the distribution of the displacement and the stress. Optical coherence elastography techniques were then applied to porcine carotid artery samples to look at the deformation status of the vascular wall during saline or water injection. Preliminary simulation results show nonuniform stress distribution in the circumferential direction of the eccentrically catheterized vascular model. Three strain rate methods were tested for intravascular OCE application. The tissue Doppler method has the potential to be further developed to image the vascular wall biomechnical properties in vivo. Although results in this study are not validated quantitatively, the experiments and methods may be valuable for intravascular OCE studies, which may provide important information for cardiovascular disease prevention, diagnosis and treatment.

  7. Intravascular foreign bodies: danger of unretrieved fragmented medical devices.

    PubMed

    Tateishi, Minori; Tomizawa, Yasuko

    2009-01-01

    A warning on the danger of unretrieved device fragments and recommendations to mitigate the danger were issued by the Food and Drug Administration in January 2008. The causes of intravascular foreign bodies are classified into three main categories: improper manipulation and usage, device defects, and others, such as patient and anatomical factors. Device failure after long-term use is rarely predicted at the time of approval, since device abnormality is rarely experienced in animal studies and clinical trials conducted during development of the device. Stent fracture due to metal fatigue is one example. Complex complications could occur from simultaneous use of two or more devices with diverse characteristics. The success rate of percutaneous retrieval of intravascular foreign bodies has improved with the advances in commercially available devices. However, the procedure is not always successful and sometimes surgical removal becomes necessary. Appropriate device selection and acquisition of experience in using the device are important. When an intravascular foreign body cannot be retrieved, the risk of complication could be high. Magnetic resonance imaging examination sometimes causes adverse events, including burns due to the heat generated by metal movement. Such information should be correctly recorded. Furthermore, it is necessary to provide patients with adequate information about the characteristics of implanted devices and unretrieved fragments. We reviewed the literature on unretrieved medical device fragments and include articles that describe the Japanese experience.

  8. Combined frequency domain photoacoustic and ultrasound imaging for intravascular applications

    PubMed Central

    Castelino, Robin F.; Hynes, Michael; Munding, Chelsea E.; Telenkov, Sergey; Foster, F. Stuart

    2016-01-01

    Intravascular photoacoustic (IVPA) imaging has the potential to characterize lipid-rich structures based on the optical absorption contrast of tissues. In this study, we explore frequency domain photoacoustics (FDPA) for intravascular applications. The system employed an intensity-modulated continuous wave (CW) laser diode, delivering 1W over an intensity modulated chirp frequency of 4-12MHz. We demonstrated the feasibility of this approach on an agar vessel phantom with graphite and lipid targets, imaged using a planar acoustic transducer co-aligned with an optical fibre, allowing for the co-registration of IVUS and FDPA images. A frequency domain correlation method was used for signal processing and image reconstruction. The graphite and lipid targets show an increase in FDPA signal as compared to the background of 21dB and 16dB, respectively. Use of compact CW laser diodes may provide a valuable alternative for the development of photoacoustic intravascular devices instead of pulsed laser systems. PMID:27895986

  9. Renal denervation by intravascular ultrasound: Preliminary in vivo study

    NASA Astrophysics Data System (ADS)

    Sinelnikov, Yegor; McClain, Steve; Zou, Yong; Smith, David; Warnking, Reinhard

    2012-10-01

    Ultrasound denervation has recently become a subject of intense research in connection with the treatment of complex medical conditions including neurological conditions, development of pain management, reproduction of skin sensation, neuropathic pain and spasticity. The objective of this study is to investigate the use of intravascular ultrasound to produce nerve damage in renal sympathetic nerves without significant injury to the renal artery. This technique may potentially be used to treat various medical conditions, such as hypertension. The study was approved by the Institutional Animal Care and Use Committee. Ultrasound was applied to renal nerves of the swine model for histopathological evaluation. Therapeutic ultrasound energy was delivered circumferentially by an intravascular catheter maneuvered into the renal arteries. Fluoroscopic imaging was conducted pre-and post-ultrasound treatment. Animals were recovered and euthanized up to 30 hours post procedure, followed by necropsy and tissue sample collection. Histopathological examination showed evidence of extensive damage to renal nerves, characterized by nuclear pyknosis, hyalinization of stroma and multifocal hemorrhages, with little or no damage to renal arteries. This study demonstrates the feasibility of intravascular ultrasound as a minimally invasive renal denervation technique. Further studies are necessary to evaluate the long-term safety and efficacy of this technique and its related clinical significance.

  10. Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension

    PubMed Central

    Griffith, Christopher C.; Raval, Jay S.; Nichols, Larry

    2012-01-01

    Intravenous injection of illegal drugs or medications meant for oral administration can cause granulomatous disease of the lung. This intravascular talcosis results in pulmonary fibrosis and pulmonary hypertension. Nine cases of histologically confirmed intravascular talcosis were reviewed with specific attention given to the clinical histories in these patients. Five autopsy cases were included in this series with detailed investigation in the anatomic features associated with intravascular talcosis and pulmonary hypertension. All nine patients showed perivascular and/or intravascular deposition of polarizable foreign material in their lungs. Intravascular talcosis as a result of previous intravenous drug use was not clinically suspected in any patient despite clinically diagnosed pulmonary hypertension in five. All patients showed dilatation of the right and left heart, but none had dilatation of the aortic valve. Congestive heart failure with hepatosplenomegaly was also common. We conclude that intravascular talcosis is an underdiagnosed cause of pulmonary hypertension in patients with known history of intravenous drug use. PMID:22645680

  11. Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension.

    PubMed

    Griffith, Christopher C; Raval, Jay S; Nichols, Larry

    2012-01-01

    Intravenous injection of illegal drugs or medications meant for oral administration can cause granulomatous disease of the lung. This intravascular talcosis results in pulmonary fibrosis and pulmonary hypertension. Nine cases of histologically confirmed intravascular talcosis were reviewed with specific attention given to the clinical histories in these patients. Five autopsy cases were included in this series with detailed investigation in the anatomic features associated with intravascular talcosis and pulmonary hypertension. All nine patients showed perivascular and/or intravascular deposition of polarizable foreign material in their lungs. Intravascular talcosis as a result of previous intravenous drug use was not clinically suspected in any patient despite clinically diagnosed pulmonary hypertension in five. All patients showed dilatation of the right and left heart, but none had dilatation of the aortic valve. Congestive heart failure with hepatosplenomegaly was also common. We conclude that intravascular talcosis is an underdiagnosed cause of pulmonary hypertension in patients with known history of intravenous drug use.

  12. Retrospective hemolysis comparison between patients with centrifugal biventricular assist and left ventricular assist devices.

    PubMed

    Stepanenko, Alexander; Krabatsch, Thomas; Hennig, Ewald; Kaufmann, Friedrich; Jurmann, Beate; Dranishnikov, Nikolay; Lehmkuhl, Hans B; Pasic, Miralem; Weng, Yuguo; Hetzer, Roland; Potapov, Evgenij V

    2011-01-01

    Little is known about the hemolysis rate in the case of concomitant implantation of two continuous flow pumps for the treatment of biventricular heart failure. We present a retrospective study comparing the hemolysis parameters in patients supported with one implantable centrifugal pump of the type HeartWare HVAD used as a left ventricular assist device (LVAD) and with two pumps as a biventricular assist device (BiVAD). A total of 20 consecutive patients who received HeartWare BiVAD (n = 10) and LVAD (n = 10) support at our institution between September 2009 and September 2010 were examined. Hemolysis- and anemia-related parameters were analyzed after 2 weeks, 5 weeks, 3 months, and 6 months of support. Preoperative levels of hemoglobin, lactate dehydrogenase (LDH), and total bilirubin were similar in both groups. There were no differences in LDH, plasma-free hemoglobin (fHB), or total bilirubin levels postoperatively for up to 6 months. Only the haptoglobin level was lower in BiVAD recipients up to 3 months after surgery: 2nd week (63.5 [range: 8-237] mg/dl vs. 151 [range: 11-263] mg/dl, p = 0.05), 5th week (67 [range: 8-196] mg/dl vs. 215 [range: 56-292] mg/dl, p = 0.046), and after 3rd month (42 [range: 8-205] mg/dl vs. 220 [range: 157-256] mg/dl, p = 0.048). Our retrospective analysis of BiVAD HeartWare and LVAD HeartWare recipients showed a lack of a clinically important degree of hemolysis when two centrifugal HeartWare pumps are used for biventricular support.

  13. Association between alcohol-induced erythrocyte membrane alterations and hemolysis in chronic alcoholics

    PubMed Central

    Bulle, Saradamma; Reddy, Vaddi Damodara; Padmavathi, Pannuru; Maturu, Paramahamsa; Puvvada, Pavan Kumar; Nallanchakravarthula, Varadacharyulu

    2017-01-01

    The present study aimed to understand the association between erythrocyte membrane alterations and hemolysis in chronic alcoholics. Study was conducted on human male volunteers aged between 35–45 years with a drinking history of 8–10 years. Results showed that plasma marker enzymes AST, ALT, ALP and γGT were increased in alcoholic subjects. Plasma and erythrocyte membrane lipid peroxidation, erythrocyte lysate nitric oxide (NOx) levels were also increased significantly in alcoholics. Furthermore, erythrocyte membrane protein carbonyls, total cholesterol, phospholipid and cholesterol/phospholipid (C/P) ratio were increased in alcoholics. SDS-PAGE analysis of erythrocyte membrane proteins revealed that increased density of band 3, protein 4.2, 4.9, actin and glycophorins, whereas glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and glycophorin A showed slight increase, however, decreased ankyrin with no change in spectrins (α and β) and protein 4.1 densities were observed in alcoholics. Moreover, alcoholics red blood cells showed altered morphology with decreased resistance to osmotic hemolysis. Increased hemolysis showed strong positive association with lipid peroxidation (r = 0.703, p<0.05), protein carbonyls (r = 0.754, p<0.05), lysate NOx (r = 0.654, p<0.05) and weak association with C/P ratio (r = 0.240, p<0.05). Bottom line, increased lipid and protein oxidation, altered membrane C/P ratio and membrane cytoskeletal protein profile might be responsible for the increased hemolysis in alcoholics. PMID:28163384

  14. Association between alcohol-induced erythrocyte membrane alterations and hemolysis in chronic alcoholics.

    PubMed

    Bulle, Saradamma; Reddy, Vaddi Damodara; Padmavathi, Pannuru; Maturu, Paramahamsa; Puvvada, Pavan Kumar; Nallanchakravarthula, Varadacharyulu

    2017-01-01

    The present study aimed to understand the association between erythrocyte membrane alterations and hemolysis in chronic alcoholics. Study was conducted on human male volunteers aged between 35-45 years with a drinking history of 8-10 years. Results showed that plasma marker enzymes AST, ALT, ALP and γGT were increased in alcoholic subjects. Plasma and erythrocyte membrane lipid peroxidation, erythrocyte lysate nitric oxide (NOx) levels were also increased significantly in alcoholics. Furthermore, erythrocyte membrane protein carbonyls, total cholesterol, phospholipid and cholesterol/phospholipid (C/P) ratio were increased in alcoholics. SDS-PAGE analysis of erythrocyte membrane proteins revealed that increased density of band 3, protein 4.2, 4.9, actin and glycophorins, whereas glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and glycophorin A showed slight increase, however, decreased ankyrin with no change in spectrins (α and β) and protein 4.1 densities were observed in alcoholics. Moreover, alcoholics red blood cells showed altered morphology with decreased resistance to osmotic hemolysis. Increased hemolysis showed strong positive association with lipid peroxidation (r = 0.703, p<0.05), protein carbonyls (r = 0.754, p<0.05), lysate NOx (r = 0.654, p<0.05) and weak association with C/P ratio (r = 0.240, p<0.05). Bottom line, increased lipid and protein oxidation, altered membrane C/P ratio and membrane cytoskeletal protein profile might be responsible for the increased hemolysis in alcoholics.

  15. Guidelines for the management of intravascular catheter-related infections.

    PubMed

    Mermel, L A; Farr, B M; Sherertz, R J; Raad, I I; O'Grady, N; Harris, J S; Craven, D E

    2001-01-01

    These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial

  16. Development of a Novel Quality Improvement Indicator Based on the Hemolysis Index

    PubMed Central

    Lee, Eun Jin; Kim, Miyoung; Kim, Han-Sung; Park, Min-Jeong; Lee, Young Kyung

    2016-01-01

    Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25. The monthly mean H index and monthly frequency of samples with an H index >25 were significantly different among the types of ward (P=0.001, respectively), and significantly decreased after replacement of a laboratory centrifuge lacking temperature control (20.6±0.58 vs 23.30±1.08, P=0.01; 23.4±1.69% vs 32.6±1.78%, P=0.01). The monthly mean H index and the monthly frequency of samples with an H index above a threshold value may be useful quality improvement indicators for detection of inappropriate procedures in the acquisition and handling of blood samples in medical care units. PMID:27578515

  17. Improvement of hemolysis in a centrifugal blood pump with hydrodynamic bearings and semi-open impeller.

    PubMed

    Kosaka, Ryo; Yamane, Takashi; Maruyama, Osamu; Nishida, Masahiro; Yada, Toru; Saito, Sakae; Hirai, Shusaku

    2007-01-01

    We have developed a centrifugal blood pump with hydrodynamic bearings and semi-open impeller, and evaluated the levitation performance test and the hemolysis test. This pump is operated without any complicated control circuit and displacement-sensing module. The casing diameter is 74 mm and the height is 38 mm including flanges for volts. The weight is 251 g and the volume is 159 cm3. By changing the stator relative position against the rotor, the levitation characteristics of the impeller can be adjusted. The diameter of impeller is 36 mm and the height is 25 mm. The impeller is levitated by the thrust bearing of spiral groove type and a radial bearing of herringbone type. The pump performance was evaluated through the levitation performance test and the hemolysis test. As a result, the normalized index of hemolysis (NIH) was reduced from 0.72 g/100 L to 0.024 g/100 L corresponding to the changes of the groove direction of the hydrodynamic bearing and the expansion of the bearing gap. During these studies, we confirmed that the hemolytic property was improved by balancing the fluid dynamic force and the magnetic force.

  18. Infection-related hemolysis and susceptibility to Gram-negative bacterial co-infection

    PubMed Central

    Orf, Katharine; Cunnington, Aubrey J.

    2015-01-01

    Increased susceptibility to co-infection with enteric Gram-negative bacteria, particularly non-typhoidal Salmonella, is reported in malaria and Oroya fever (Bartonella bacilliformis infection), and can lead to increased mortality. Accumulating epidemiological evidence indicates a causal association with risk of bacterial co-infection, rather than just co-incidence of common risk factors. Both malaria and Oroya fever are characterized by hemolysis, and observations in humans and animal models suggest that hemolysis causes the susceptibility to bacterial co-infection. Evidence from animal models implicates hemolysis in the impairment of a variety of host defense mechanisms, including macrophage dysfunction, neutrophil dysfunction, and impairment of adaptive immune responses. One mechanism supported by evidence from animal models and human data, is the induction of heme oxygenase-1 in bone marrow, which impairs the ability of developing neutrophils to mount a competent oxidative burst. As a result, dysfunctional neutrophils become a new niche for replication of intracellular bacteria. Here we critically appraise and summarize the key evidence for mechanisms which may contribute to these very specific combinations of co-infections, and propose interventions to ameliorate this risk. PMID:26175727

  19. Severe Hemolysis and Pulmonary Hypertension in a Neonate With Upshaw-Schulman Syndrome.

    PubMed

    Tsujii, Nobuyuki; Shiraishi, Isao; Kokame, Koichi; Shima, Midori; Fujimura, Yoshihiro; Takahashi, Yukihiro; Matsumoto, Masanori

    2016-12-01

    Pulmonary involvement is extremely rare in thrombotic thrombocytopenic purpura. In this report, we present a girl patient with congenital thrombotic thrombocytopenic purpura, known as Upshaw-Schulman syndrome (USS), complicated with severe hemolysis and pulmonary hypertension (PH). The assay results of a disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13) activity measured by FRETS-VWF73 and ADAMTS13-act-ELISA were different. Hyperbilirubinemia (total bilirubin, 25.3 mg/dL) interfered strongly with the FRETS-VWF73 assay. Plasma levels of ADAMTS13 activity by act-ELISA were <0.5% of normal. The diagnosis of USS was confirmed by ADAMTS13 gene analysis, which showed compound heterozygous mutations of p.G139Vfs*17 and p.I673F. The p.G139Vfs*17 mutation was previously unreported, and its effect in splicing was confirmed by reverse transcription polymerase chain reaction. The patient received oxygen therapy for PH and exchange blood transfusion for severe hemolysis. The PH resolved without specific treatment. Based on these findings, the PH may have been caused by free hemoglobin that scavenged nitrogen oxide or platelet thrombi in the lungs caused by ADAMTS13 deficiency. Thus, severe PH can occur in neonatal patients with USS, and severe hemolysis might result in overestimation of ADAMTS 13 activity. Both possibilities are important for the diagnosis and management of USS.

  20. Acute Liver Failure in a Pediatric Patient with Congenital Dysery-Thropoietic Anemia Type I Treated with Deferasirox

    PubMed Central

    Ling, Galina; Pinsk, Vered; Golan-Tripto, Inbal; Ling, Eduard

    2015-01-01

    Congenital dyserythropoietic anemias (CDA) represent a heterogeneous group of disorders characterized by morphological abnormalities of erythroid precursor cells and various degrees of hemolysis. Iron overload is a result of continuous hemolysis and recurrent transfusions. It is treated with iron chelators, including deferasirox. We present here a case of acute liver failure in a 12 years old girl with CDA type I treated with deferasirox and discuss the approach to treatment. PMID:26487935

  1. Acute Liver Failure in a Pediatric Patient with Congenital Dysery-Thropoietic Anemia Type I Treated with Deferasirox.

    PubMed

    Ling, Galina; Pinsk, Vered; Golan-Tripto, Inbal; Ling, Eduard

    2015-09-23

    Congenital dyserythropoietic anemias (CDA) represent a heterogeneous group of disorders characterized by morphological abnormalities of erythroid precursor cells and various degrees of hemolysis. Iron overload is a result of continuous hemolysis and recurrent transfusions. It is treated with iron chelators, including deferasirox. We present here a case of acute liver failure in a 12 years old girl with CDA type I treated with deferasirox and discuss the approach to treatment.

  2. Inhibition of lysenin-induced hemolysis by all-E-lutein derived from the plant Dalbergia latifolia.

    PubMed

    Niwa, Yuki; Matsui, Chino; Sukumwang, Neelanun; Iinuma, Hironobu; Ikeda, Yoko; Koyano, Takashi; Kovitayakorn, Taworn; Simizu, Siro; Umezawa, Kazuo

    2012-06-01

    Lysenin is a pore-forming toxin derived from coelomic fluid of the earthworm Eisenia foetida. The model of lysenin-induced hemolysis includes the specific binding of lysenin to sphingomyelin, oligomerization of the pore proteins, and pore formation. Although the mechanism of lysenin-induced hemolysis is unique, its precise mechanism of action and its inhibitors are poorly understood. In the present study, we screened for inhibitors of lysenin-induced hemolysis by using an optimized screening system and found a methanolic extract of Dalbergia latifolia leaves to be a potential candidate. After isolation and identification, all-E-lutein was identified as the hemolysis inhibitor with an effective dose of 0.025-2.5 ng/mL without any toxicity. The inhibition by all-E-lutein is likely to occur during the receptor binding and/or pore-forming protein oligomerization.

  3. The effects of carbogen and nicotinamide on intravascular oxyhaemoglobin saturations in SCCVII and KHT murine tumours.

    PubMed

    Fenton, B M

    1995-05-01

    Considerable effort has been focused on devising methods for manipulating tumour oxygenation and thereby improving tumour radiosensitivity. The combination of nicotinamide and carbogen has been proposed to oxygenate both chronically and acutely hypoxic cells in tumours. However, results have varied markedly with both tumour model and measurement technique. The current objectives were (1) to determine whether changes in radiosensitivity following oxygen manipulation correlated with changes in tumour oxygenation and (2) to assess whether oxygenation was preferentially improved in specific tumour micro-regions. Using two murine tumour lines, the SCCVII carcinoma and the KHT sarcoma, tumour intravascular HbO2 saturations were measured cryospectrophotometrically following nicotinamide, carbogen or the combination. Generally, nicotinamide had minor effects on oxygenation, arguing against a substantial effect on acute hypoxia, while carbogen and the combination produced marked and equivalent improvements in oxygen availability. These results demonstrate that changes in tumour radiosensitivity may not agree with corresponding changes in oxygenation, even within a given tumour model, and that the efficacy of a given manipulative agent may vary substantially with tumour line. One possible explanation for these findings is that different subpopulations of clonogenic vs non-clonogenic cells may be oxygenated by alternative treatments.

  4. Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound

    PubMed Central

    Bec, Julien; Xie, Hongtao; Yankelevich, Diego R.; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph

    2012-01-01

    Abstract. We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques. PMID:23224011

  5. Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound

    NASA Astrophysics Data System (ADS)

    Bec, Julien; Xie, Hongtao; Yankelevich, Diego R.; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph; Marcu, Laura

    2012-10-01

    We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques.

  6. Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound.

    PubMed

    Bec, Julien; Xie, Hongtao; Yankelevich, Diego R; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph; Marcu, Laura

    2012-10-01

    We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques.

  7. Ribavirin induced hemolysis: a novel mechanism of action against chronic hepatitis C virus infection.

    PubMed

    Soota, Kaartik; Maliakkal, Benedict

    2014-11-21

    Hepatitis C virus (HCV) is not usually cleared by our immune system, leading to the development of chronic hepatitis C infection. Chronic HCV induces the production of various cytokines, predominantly by Kupffer cells (KCs), and creates a pro-inflammatory state in the liver. The chronic dysregulated production of interferon (IFN) and other cytokines by KCs also promotes innate immune tolerance. Ribavirin (RBV) monotherapy has been shown to decrease inflammation in liver of patients with chronic hepatitis C. Sustained virological response (SVR) is significantly higher when IFN is combined with RBV in chronic HCV (cHCV) infection. However, the mechanism of their synergy remains unclear. Previous theories have attempted to explain the anti-HCV effect based on direct action of RBV alone on the virus or on the immune system; however, these theories have serious shortcomings. We propose that hemolysis, which universally occurs with RBV therapy and which is considered a limiting side effect, is precisely the mechanism by which the anti-HCV effect is exerted. Passive hemolysis results in anti-inflammatory/antiviral actions within the liver that disrupt the innate immune tolerance, leading to the synergy of RBV with IFN-α. Ribavirin-induced hemolysis floods the hepatocytes and KCs with heme, which is metabolized and detoxified by heme oxygenase-1 (HMOX1) to carbon monoxide (CO), biliverdin and free iron (which induces ferritin). These metabolites of heme possess anti-inflammatory and antioxidant properties. Thus, HMOX1 plays an extremely important anti-oxidant, anti-inflammatory and cytoprotective role, particularly in KCs and hepatocytes. HMOX1 has been noted to have anti-viral effects in hepatitis C infected cell lines. Additionally, it has been shown to enhance the response to IFN-α by restoring interferon-stimulated genes (ISGs). This mechanism can be clinically corroborated by the following observations that have been found in patients undergoing RBV/IFN combination

  8. Oral Administration of Ganoderma lucidum to Lead-Exposed Rats Protects Erythrocytes against Hemolysis: Implicates to Anti-Anemia

    PubMed Central

    Hossain, Shahdat; Bhowmick, Sujan; Islam, Saiful; Rozario, Liza; Jahan, Sabrin; Hassan, Mehedi; Sarkar, Marzan; Choudhury, Bazlul Karim; Ahmed, Sohel; Shahjalal, Hussain

    2015-01-01

    We studied the effect of chronic oral exposure to lead acetate (PbA) on the sensitivity of RBC to hemolysis and whether the sensitivity could be decreased by feeding the rats with extract of medicinal mushroom Ganoderma lucidum. Three groups of rats, control, PbA-exposed, and G. lucidum (Gl)+PbA, were used. PbA (3 mM) was administered via drinking water and G. lucidum extract by gavage at 300 mg/Kg BW/day for 12 weeks. Afterwards, the rats were killed and washed RBCs were subjected to hemolysis in the presence of Fenton's reagents. Hemolysis was determined by estimating the amount of released hemoglobin. The levels of lipid peroxide (LPO) and GSH were determined from RBC membranes and whole RBCs, respectively. The levels of TNFα and LPO also were determined from hepatic tissues. The RBCs of PbA-exposed rats displayed significantly higher sensitivity to hemolysis than those of the Gl+PbA rats. The levels of LPO increased and GSH decreased in the RBCs, with concomitant increases in the levels of hepatic TNFα and LPO in the PbA-exposed rats. The degree of hemolysis was significantly low in the RBCs of Gl+PbA rats, concurrently with amelioration of hepatic parameters. Finally, the study suggests that PbA-induced-hemolysis and related oxidative-toxicity might be minimized by consumption of G. lucidum. PMID:26300947

  9. Geometric optimization of a step bearing for a hydrodynamically levitated centrifugal blood pump for the reduction of hemolysis.

    PubMed

    Kosaka, Ryo; Yada, Toru; Nishida, Masahiro; Maruyama, Osamu; Yamane, Takashi

    2013-09-01

    A hydrodynamically levitated centrifugal blood pump with a semi-open impeller has been developed for mechanical circulatory assistance. However, a narrow bearing gap has the potential to cause hemolysis. The purpose of the present study is to optimize the geometric configuration of the hydrodynamic step bearing in order to reduce hemolysis by expansion of the bearing gap. First, a numerical analysis of the step bearing, based on lubrication theory, was performed to determine the optimal design. Second, in order to assess the accuracy of the numerical analysis, the hydrodynamic forces calculated in the numerical analysis were compared with those obtained in an actual measurement test using impellers having step lengths of 0%, 33%, and 67% of the vane length. Finally, a bearing gap measurement test and a hemolysis test were performed. As a result, the numerical analysis revealed that the hydrodynamic force was the largest when the step length was approximately 70%. The hydrodynamic force calculated in the numerical analysis was approximately equivalent to that obtained in the measurement test. In the measurement test and the hemolysis test, the blood pump having a step length of 67% achieved the maximum bearing gap and reduced hemolysis, as compared with the pumps having step lengths of 0% and 33%. It was confirmed that the numerical analysis of the step bearing was effective, and the developed blood pump having a step length of approximately 70% was found to be a suitable configuration for the reduction of hemolysis.

  10. Complement-mediated thrombotic microangiopathy secondary to sepsis-induced disseminated intravascular coagulation successfully treated with eculizumab

    PubMed Central

    Abe, Tomohiro; Sasaki, Akira; Ueda, Taichiro; Miyakawa, Yoshitaka; Ochiai, Hidenobu

    2017-01-01

    Abstract Secondary thrombotic microangiopathies (TMAs) are induced by several underlying conditions; most are resolved by treating background disease. Eculizumab is a human monoclonal antibody that blocks the final stage of the complement system and effectively treats atypical hemolytic uremic syndrome (aHUS). In this report, we present a patient with TMA secondary to sepsis- induced coagulopathy, who was successfully treated with eculizumab. A 44-year-old woman, who had no special medical history or familial history of TMAs, was admitted on suspicion of septic shock. Physical examination revealed gangrene on her soles. Blood tests revealed a decreased platelet count, disseminated intravascular coagulation (DIC), renal dysfunction, hemolysis, and infection. Although the coagulation disorder improved with intensive care, the low platelet count, elevated lactate dehydrogenase levels, and renal dysfunction persisted. Our investigations subsequently excluded thrombotic thrombocytopenic purpura and Shiga toxin-producing Escherichia coli-induced HUS. Plasma exchange only improved lactate dehydrogenase levels. We clinically diagnosed this case as atypical HUS and started eculizumab treatment. The patient's platelet count increased, her renal dysfunction improved, and the gangrene on her feet was ameliorated. The patient was discharged without maintenance dialysis therapy after approximately 3 months. Subsequent tests revealed elevated serum levels of soluble C5b-9, and genetic testing revealed compound heterozygous c.184G > A (Val62Ile) and c.1204T > C (Tyr402His) single-nucleotide polymorphisms in complement factor H. We encountered a case of complement-mediated TMA accompanied by DIC, which was successfully treated with eculizumab. Further studies are necessary to support the optimal use of eculizumab for TMA with background diseases. PMID:28178155

  11. Complement-mediated thrombotic microangiopathy secondary to sepsis-induced disseminated intravascular coagulation successfully treated with eculizumab: A case report.

    PubMed

    Abe, Tomohiro; Sasaki, Akira; Ueda, Taichiro; Miyakawa, Yoshitaka; Ochiai, Hidenobu

    2017-02-01

    Secondary thrombotic microangiopathies (TMAs) are induced by several underlying conditions; most are resolved by treating background disease. Eculizumab is a human monoclonal antibody that blocks the final stage of the complement system and effectively treats atypical hemolytic uremic syndrome (aHUS). In this report, we present a patient with TMA secondary to sepsis- induced coagulopathy, who was successfully treated with eculizumab.A 44-year-old woman, who had no special medical history or familial history of TMAs, was admitted on suspicion of septic shock. Physical examination revealed gangrene on her soles. Blood tests revealed a decreased platelet count, disseminated intravascular coagulation (DIC), renal dysfunction, hemolysis, and infection. Although the coagulation disorder improved with intensive care, the low platelet count, elevated lactate dehydrogenase levels, and renal dysfunction persisted. Our investigations subsequently excluded thrombotic thrombocytopenic purpura and Shiga toxin-producing Escherichia coli-induced HUS. Plasma exchange only improved lactate dehydrogenase levels. We clinically diagnosed this case as atypical HUS and started eculizumab treatment. The patient's platelet count increased, her renal dysfunction improved, and the gangrene on her feet was ameliorated. The patient was discharged without maintenance dialysis therapy after approximately 3 months. Subsequent tests revealed elevated serum levels of soluble C5b-9, and genetic testing revealed compound heterozygous c.184G > A (Val62Ile) and c.1204T > C (Tyr402His) single-nucleotide polymorphisms in complement factor H.We encountered a case of complement-mediated TMA accompanied by DIC, which was successfully treated with eculizumab. Further studies are necessary to support the optimal use of eculizumab for TMA with background diseases.

  12. Ceramide-enriched membrane domains in red blood cells and the mechanism of sphingomyelinase-induced hot-cold hemolysis.

    PubMed

    Montes, L-Ruth; López, David J; Sot, Jesús; Bagatolli, Luis A; Stonehouse, Martin J; Vasil, Michael L; Wu, Bill X; Hannun, Yusuf A; Goñi, Félix M; Alonso, Alicia

    2008-10-28

    Hot-cold hemolysis is the phenomenon whereby red blood cells, preincubated at 37 degrees C in the presence of certain agents, undergo rapid hemolysis when transferred to 4 degrees C. The mechanism of this phenomenon is not understood. PlcHR 2, a phospholipase C/sphingomyelinase from Pseudomonas aeruginosa, that is the prototype of a new phosphatase superfamily, induces hot-cold hemolysis. We found that the sphingomyelinase, but not the phospholipase C activity, is essential for hot-cold hemolysis because the phenomenon occurs not only in human erythrocytes that contain both phosphatidylcholine (PC) and sphingomyelin (SM) but also in goat erythrocytes, which lack PC. However, in horse erythrocytes, with a large proportion of PC and almost no SM, hot-cold hemolysis induced by PlcHR 2 is not observed. Fluorescence microscopy observations confirm the formation of ceramide-enriched domains as a result of PlcHR 2 activity. After cooling down to 4 degrees C, the erythrocyte ghost membranes arising from hemolysis contain large, ceramide-rich domains. We suggest that formation of these rigid domains in the originally flexible cell makes it fragile, thus highly susceptible to hemolysis. We also interpret the slow hemolysis observed at 37 degrees C as a phenomenon of gradual release of aqueous contents, induced by the sphingomyelinase activity, as described by Ruiz-Arguello et al. [(1996) J. Biol. Chem. 271, 26616]. These hypotheses are supported by the fact that ceramidase, which is known to facilitate slow hemolysis at 37 degrees C, actually hinders hot-cold hemolysis. Differential scanning calorimetry of erytrocyte membranes treated with PlcHR 2 demonstrates the presence of ceramide-rich domains that are rigid at 4 degrees C but fluid at 37 degrees C. Ceramidase treatment causes the disapperance of the calorimetric signal assigned to ceramide-rich domains. Finally, in liposomes composed of SM, PC, and cholesterol, which exhibit slow release of aqueous contents at 37

  13. Effects of hemolysis and lipemia interference on kaolin-activated thromboelastography, and comparison with conventional coagulation tests.

    PubMed

    Tang, Ning; Jin, Xi; Sun, Ziyong; Jian, Cui

    2017-04-01

    The effects of hemolysis and lipemia on thromboelastography (TEG) analysis have been scarcely evaluated in human samples, and neglected in clinical practice. We aimed to investigate the effects of in vitro mechanical hemolysis and lipemia on TEG analysis and conventional coagulation tests. Twenty-four healthy volunteers were enrolled in the study. Besides the controls, three groups with slight, moderate and severe mechanical hemolysis were constituted according to free hemoglobin (Hb) concentrations of 0.5-1.0, 2.0-6.0 and 7.0-13.0 g/L, respectively; and three groups with mild, moderate and high lipemia were established according to triglyceride concentrations of ∼6.0, ∼12.0, and ∼18.0 mmol/L, respectively. Four TEG parameters, reaction time (R), coagulation time (K), angle (α), and maximum amplitude (MA), were measured alongside conventional plasma tests including prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) by mechanical method, and platelet count by optical method. Results showed that the median R and MA values at moderate and severe hemolysis and K at severe hemolysis exceeded respective reference intervals, and were considered unacceptable. Median values of TEG parameters in lipemic samples were all within reference intervals. Bias values of conventional plasma tests PT, APTT and FIB in hemolyzed or lipemic samples were all lower than the Clinical Laboratory Improvement Amendments (CLIA) allowable limits. Bias values of platelet count at moderate to severe hemolysis and lipemia exceeded the CLIA allowable limits. In conclusion, the detection of TEG was in general more affected by mechanical hemolysis than plasma coagulation tests. Pre-analytical variables should be taken into account when unexpected TEG results are obtained.

  14. Why Have So Many Intravascular Glucose Monitoring Devices Failed?

    PubMed Central

    Smith, John L.; Rice, Mark J.

    2015-01-01

    Secondary to the inherent limitations of both point-of-care and central laboratory glucose technologies, continuous glucose measurement has recently enjoyed a high level of investment. Because of the perceived advantages by some of measuring in the intravascular space compared to the subcutaneous tissue, a number of technologies have been developed. In this review, we evaluate nine systems that have shown promise, although only one of these has been cleared for sale in the United States. The detection methodology, regulatory status, technical issues, and company circumstance surrounding each technology are examined. PMID:26129733

  15. Disseminated Intravascular Coagulation after Surgery for Facial Injury

    PubMed Central

    Tachibana, Hirohiko; Ishikawa, Shigeo; Yusa, Kazuyuki; Kitabatake, Kenichirou; Iino, Mitsuyoshi

    2016-01-01

    A case of disseminated intravascular coagulation (DIC) presenting after surgery for facial trauma associated with multiple facial bone fractures is described. With regard to the oral and maxillofacial region, DIC has been described in the literature following head trauma, infection, and metastatic disease. Until now, only 5 reports have described DIC after surgery for facial injury. DIC secondary to facial injury is thus rare. The patient in this case was young and had no medical history. Preoperative hemorrhage or postoperative septicemia may thus induce DIC. PMID:27313913

  16. Implantable ventricular assist device exchange with focused intravascular deairing techniques.

    PubMed

    Woo, Y Joseph; Acker, Michael A

    2011-01-01

    As ventricular assist devices are increasingly adopted and widely implemented as a highly effective therapy for end-stage heart disease, extended utilization periods for destination therapy or bridge-to-transplantation have created the possibility of device failure, infection, or thrombosis, requiring challenging implant exchanges. A major problem in these operations is the risk of air embolization, particularly in a nonsternotomy approach that precludes access to the outflow aortic graft and to the ascending aorta. We report a minimally invasive, nonsternotomy HeartMate II implantable left ventricular assist device (LVAD) exchange, using peripheral cardiopulmonary support and a novel approach to continuous intravascular ascending aortic air removal.

  17. Adhesive Tape and Intravascular-Catheter-Associated Infections

    PubMed Central

    Redelmeier, Donald A; Livesley, Nigel J

    1999-01-01

    Adhesive tape is placed in close contact with intravascular catheters for extended periods and could theoretically contribute to local infections. We found that 74% of specimens of tape collected in one hospital were colonized by pathogenic bacteria. However, only 5% of specimens had significant growth from an inner layer obtained by discarding the outside layer from each roll. We suggest that adhesive tape is a potential source of pathogenic bacteria and that discarding the outer layer from a partially used roll might be a simple method for reducing the risk of infection to patients. PMID:10354258

  18. Laser-activated shape memory polymer intravascular thrombectomy device

    NASA Astrophysics Data System (ADS)

    Small, Ward, IV; Wilson, Thomas S.; Benett, William J.; Loge, Jeffrey M.; Maitland, Duncan J.

    2005-10-01

    A blood clot (thrombus) that becomes lodged in the arterial network supplying the brain can cause an ischemic stroke, depriving the brain of oxygen and often resulting in permanent disability. As an alternative to conventional clot-dissolving drug treatment, we are developing an intravascular laser-activated therapeutic device using shape memory polymer (SMP) to mechanically retrieve the thrombus and restore blood flow to the brain. Thermal imaging and computer simulation were used to characterize the optical and photothermal behavior of the SMP microactuator. Deployment of the SMP device in an in vitro thrombotic vascular occlusion model demonstrated the clinical treatment concept.

  19. Removal of Chronic Intravascular Blood Clots using Liquid Plasma

    NASA Astrophysics Data System (ADS)

    Jung, Jae-Chul; Choi, Myeong; Koo, Il; Yu, Zengqi; Collins, George

    2011-10-01

    An electrical embolectomy device for removing chronic intravascular blood clots using liquid plasma under saline environment was demonstrated. We employed a proxy experimental blood clot model of deep vein thrombosis (DVT) and actual equine blood clot. Thermal damage to contiguous tissue and the collagen denaturing via the plasma irradiation were investigated by histological analysis using birefringence of the tissue and verified by FT-IR spectroscopic study, respectively, which showed the high removal rate up to 2 mm per minute at room temperature and small thermal damage less than 200 μm.

  20. [Intravascular large B-cell lymphoma with massive pulmonary lesions].

    PubMed

    Higashiyama, Asumi; Hashino, Satoshi; Onozawa, Masahiro; Takahata, Mutsumi; Okada, Kohei; Kahata, Kaoru; Taniguchi, Natsuko; Nasuhara, Yasuyuki; Kubota, Kanako; Fujimoto, Nozomu; Matsuno, Yoshihiro; Nishimura, Masahiro; Asaka, Masahiro

    2010-05-01

    A 61-year-old man was admitted to our hospital with dyspnea on effort. Neither computed tomography scan nor chest X-ray film detected any specific findings that could explain hypoxemia. Since (67)Ga scintigraphy showed abnormal uptake in the bilateral lungs, transbronchial lung biopsy (TBLB) was performed. The TBLB specimen was diagnosed as intravascular large B-cell lymphoma (IVLBCL). There was no involvement of any other organ considered typical of IVLBCL. In cases showing clinical findings such as hypoxia despite mild pulmonary radiographic changes, a definitive diagnosis should be made using methods such as TBLB with consideration given to the possibility of IVLBCL.

  1. Hemolysis in Cardiac Surgery Patients Undergoing Cardiopulmonary Bypass: A Review in Search of a Treatment Algorithm

    PubMed Central

    Vercaemst, Leen

    2008-01-01

    Abstract: Hemolysis is a fact in all extracorporeal circuits, as shown in various studies by the increasing levels of plasma-free hemoglobin (PfHb) and decreasing levels of haptoglobin during and after cardiopulmonary bypass (CPB). Beside complete red blood cell (RBC) destruction or hemolysis, RBCs can also be damaged on a sublethal level, resulting in altered rheological properties. Increased levels of free RBC constituents together with an exhaust of their scavengers result in a variety of serious clinical sequela, such as increased systemic and pulmonary vascular resistance, altered coagulation profile, platelet dysfunction, renal tubular damage, and increased mortality. Sublethal RBC damage is characterized by decreased microperfusion and hypoxic RBCs, leading to end organ dysfunction caused by cellular ischemia. Isolated extracorporeal circuit components can be considered non-hemolytic if used according to recommendations, but extracorporeal circuit composition and management during CPB can still be optimized, avoiding cell damaging mechanical forces. Although most RBC destruction in standard CPB remains within the capacity of the endogenous clearing mechanisms, in some cases, levels of PfHb do substantially rise, and precautionary measures need to be taken. Higher degree of hemolysis can be expected in young children, after extensive surgery, and in prolonged support as in patients supported by ventricular assist devices (VADs) or extracorporeal membrane oxygenation (ECMO). These patients are especially susceptible to the toxic influences of unscavenged RBC constituents and the loss of rheologic properties of the RBCs. Considering the high percentage of neurologic and renal sequela in post-cardiotomy patients, all imbalances possibly contributing to these morbidities should be focused on and prevented, if not treated. Considering the severity of the consequences of RBC damage, the high incidence of this complication, and especially the lack of interventional

  2. Effects of different general anesthetics on serum hemolysis and hepatic and muscular glycogenolysis in rats.

    PubMed

    Machado, E F A; Normand, A C R; Nunes, L A S; Brenzikofer, R; Macedo, D V

    2009-11-01

    Anesthetics can affect the structure and biological function of tissues and systems differentially. The aim of the present study was to compare three injectable anesthetics generally used in experiments with animals in terms of the degree of hemolysis and glycogenolysis occurring after profound anesthesia. Twenty-four male Wistar rats (330-440 g) were divided into three groups (N = 8): chloral hydrate (CH), ketamine + xylazine (KX), Zoletil 50(R) (zolazepam and tiletamine) + xylazine (ZTX). After deep anesthesia, total blood was collected. The liver and white (WG) and red gastrocnemius (RG) muscles were also immediately removed. The degree of serum hemolysis was quantified on the basis of hemoglobin concentration (g/L). Hepatic and muscular glycogen concentrations (mmol/kg wet tissue) were quantified by the phenol-sulfuric method. The CH and KX groups exhibited serum hemolysis (4.0 +/- 2.2 and 1.9 +/- 0.9 g/L, respectively; P < 0.05) compared to the ZTX group, which presented none. Only KX induced elevated glycogenolysis (mmol/kg wet tissue) in the liver (86.9 +/- 63.2) and in WG (18.7 +/- 9.0) and RG (15.2 +/- 7.2; P < 0.05). The CH and ZTX groups exhibited no glycogenolysis in the liver (164.4 +/- 41.1 and 176.8 +/- 54.4, respectively), WG (28.8 +/- 4.4, 32.0 +/- 6.5, respectively) or RG (29.0 +/- 4.9; 25.3 +/- 8.6, respectively). Our data indicate that ZTX seems to be an appropriate general anesthetic for studies that seek to simultaneously quantify the concentration of glycogen and serum biochemical markers without interferences. ZTX is reasonably priced, found easily at veterinary markets, quickly induces deep anesthesia, and presents a low mortality rate.

  3. Elevated Pulse Pressure is Associated with Hemolysis, Proteinuria and Chronic Kidney Disease in Sickle Cell Disease

    PubMed Central

    Novelli, Enrico M.; Hildesheim, Mariana; Rosano, Caterina; Vanderpool, Rebecca; Simon, Marc; Kato, Gregory J.; Gladwin, Mark T.

    2014-01-01

    A seeming paradox of sickle cell disease is that patients do not suffer from a high prevalence of systemic hypertension in spite of endothelial dysfunction, chronic inflammation and vasculopathy. However, some patients do develop systolic hypertension and increased pulse pressure, an increasingly recognized major cardiovascular risk factor in other populations. Hence, we hypothesized that pulse pressure, unlike other blood pressure parameters, is independently associated with markers of hemolytic anemia and cardiovascular risk in sickle cell disease. We analyzed the correlates of pulse pressure in patients (n  =  661) enrolled in a multicenter international sickle cell trial. Markers of hemolysis were analyzed as independent variables and as a previously validated hemolytic index that includes multiple variables. We found that pulse pressure, not systolic, diastolic or mean arterial pressure, independently correlated with high reticulocyte count (beta  =  2.37, p  =  0.02) and high hemolytic index (beta  =  1.53, p = 0.002) in patients with homozygous sickle cell disease in two multiple linear regression models which include the markers of hemolysis as independent variables or the hemolytic index, respectively. Pulse pressure was also independently associated with elevated serum creatinine (beta  =  3.21, p  =  0.02), and with proteinuria (beta  =  2.52, p  =  0.04). These results from the largest sickle cell disease cohort to date since the Cooperative Study of Sickle Cell Disease show that pulse pressure is independently associated with hemolysis, proteinuria and chronic kidney disease. We propose that high pulse pressure may be a risk factor for clinical complications of vascular dysfunction in sickle cell disease. Longitudinal and mechanistic studies should be conducted to confirm these hypotheses. PMID:25478953

  4. Shear-induced hemolysis: effects of blood chemistry (including aging in storage) and shearing surfaces.

    PubMed

    Offeman, R D; Williams, M C

    1976-01-01

    Rotating disks were used to hemolyze blood under low-stress laminar flow conditions. In the first sequence of tests, kinetic hemolysis curves (KHC) were obtained with polyethylene disks for three well-characterized bloods and repeated over a period of four weeks. Each blood had a KHC with different shape, which maintained its characteristics while aging. Correlations were sought between D6000 (percent of complete hemolysis, after 6000 sec of shear) and D0 (measured before shear) by two means of data analysis, in terms of blood chemistry. It was found that uric acid and very-low-density lipoprotein levels were most useful in predicting the characteristic D6000 vs. D0 relation for each blood, and that glucose levels correlated the rate of aging as measured by hemolysis. Other chemical factors are also displayed in terms of their influence on D0. The second series of tests consisted of comparing the KHC for four disk materials using a fourth blood, then repeating with a fifth blood. Hemolytic rankings of the materials were the same with these two blood, although the KHC shapes differed. The rankings were: polyvinyl chloride greater than Silastic approximately equal to polyethylene greater than polyether urethane, with PVC most hemolytic. In another sequence for examining materials effects, five different bloods were used to compare the hemolytic properties of Teflon, nylon, and polyethylene disks. Although the KHC for the three disks bore different relationships to each other with each different blood, extrapolation of data beyond 6000 sec suggests a ranking of Teflon greater than nylon greater than polyethylene.

  5. Human α-Defensins Inhibit Hemolysis Mediated by Cholesterol-Dependent Cytolysins▿

    PubMed Central

    Lehrer, Robert I.; Jung, Grace; Ruchala, Piotr; Wang, Wei; Micewicz, Ewa D.; Waring, Alan J.; Gillespie, Eugene J.; Bradley, Kenneth A.; Ratner, Adam J.; Rest, Richard F.; Lu, Wuyuan

    2009-01-01

    Many pathogenic gram-positive bacteria release exotoxins that belong to the family of cholesterol-dependent cytolysins. Here, we report that human α-defensins HNP-1 to HNP-3 acted in a concentration-dependent manner to protect human red blood cells from the lytic effects of three of these exotoxins: anthrolysin O (ALO), listeriolysin O, and pneumolysin. HD-5 was very effective against listeriolysin O but less effective against the other toxins. Human α-defensins HNP-4 and HD-6 and human β-defensin-1, -2, and -3 lacked protective ability. HNP-1 required intact disulfide bonds to prevent toxin-mediated hemolysis. A fully linearized analog, in which all six cysteines were replaced by aminobutyric acid (Abu) residues, showed greatly reduced binding and protection. A partially unfolded HNP-1 analog, in which only cysteines 9 and 29 were replaced by Abu residues, showed intact ALO binding but was 10-fold less potent in preventing hemolysis. Surface plasmon resonance assays revealed that HNP-1 to HNP-3 bound all three toxins at multiple sites and also that solution-phase HNP molecules could bind immobilized HNP molecules. Defensin concentrations that inhibited hemolysis by ALO and listeriolysin did not prevent these toxins from binding either to red blood cells or to cholesterol. Others have shown that HNP-1 to HNP-3 inhibit lethal toxin of Bacillus anthracis, toxin B of Clostridium difficile, diphtheria toxin, and exotoxin A of Pseudomonas aeruginosa; however, this is the first time these defensins have been shown to inhibit pore-forming toxins. An “ABCDE mechanism” that can account for the ability of HNP-1 to HNP-3 to inhibit so many different exotoxins is proposed. PMID:19581399

  6. Protective effect of quince (Cydonia oblonga Miller) fruit against oxidative hemolysis of human erythrocytes.

    PubMed

    Magalhães, Ana S; Silva, Branca M; Pereira, José A; Andrade, Paula B; Valentão, Patrícia; Carvalho, Márcia

    2009-06-01

    The aim of this study was to determine the phenolic content and evaluate the antioxidant activity of quince (Cydonia oblonga) fruit. For this purpose, fruits were separated into pulps, peels and seeds and methanolic extracts were prepared. The phenolic profiles were determined by HPLC/UV and antioxidant properties were studied for their ability to quench the stable free radical 2,2'-diphenyl-1-picrylhydrazyl (DPPH) and to inhibit the 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH)-induced oxidative hemolysis of human erythrocytes. The main phenolic compounds were 5-O-caffeoylquinic acid for pulp and peel (57% and 29%, respectively) and stellarin-2 for seed (18%). Total phenolics content was 2.5, 6.3 and 0.4g/kg of methanolic extract for pulp, peel and seed, respectively. Pulp and peel extracts showed similar DPPH free radical scavenging activities (EC(50) of 0.6 and 0.8 mg/ml, respectively), while seed extract presented much lower antioxidant potential (EC(50) of 12.2mg/ml). Under the oxidative action of AAPH, pulp and peel extracts showed significant protection of the erythrocyte membrane from hemolysis, in a time- and concentration-dependent manner. Seed extracts by themselves induced extensive hemolysis. These results indicate higher antioxidant activity for certain parts of quince fruit, namely pulp and peel, that may therefore represent accessible sources of natural antioxidants with potential application in nutritional/pharmaceutical fields, as preventive or therapeutic agents in diseases in which free radicals are implicated.

  7. Interference in coagulation testing: focus on spurious hemolysis, icterus, and lipemia.

    PubMed

    Lippi, Giuseppe; Plebani, Mario; Favaloro, Emmanuel J

    2013-04-01

    The chance that errors might jeopardize the quality of testing is inherently present throughout the total testing process, especially in the preanalytical phase. In the coagulation laboratory, as well as in other areas of diagnostic testing, spurious hemolysis, icteria, and lipemia in test samples represent by far the leading diagnostic challenges. Interference in hemostasis testing due to spurious hemolysis is attributed to both analytical and biologic elements, namely high absorbance of cell-free hemoglobin at wavelengths used by optical instrumentation and release of both cytoplasmatic and plasma membrane molecules (e.g., tissue factor, proteases, phospholipids, and ADP) that can spuriously activate blood coagulation and platelets. The interference attributable to hyperbilirubinemia is mostly due to spectral overlap, whereas that of hypertriglyceridemia mainly reflects elements of light scatter and volume displacement as well as direct interference of lipid particles with hemostasis. In practical terms, spurious hemolysis reflects a more generalized process of endothelial and blood cell damage, so that test results on spuriously hemolyzed specimens should be systematically suppressed. The bias attributable to hyperbilirubinemia is less significant using modern coagulometers equipped with dedicated wavelengths (i.e., with readings at 650 nm or above), so that test results in samples with a bilirubin concentration up to 20 mg/dL can still be analytically reliable. The interference observed in lipemic samples is most evident with readings using wavelengths lower than 500 nm and can hence be prevented with readings at 650 nm or above, and/or using higher dilutions of the test sample, or can be abated in high hypertriglyceridemic specimens (i.e., > 1,000 mg/dL) using high speed microcentrifugation or lipid extraction with organic solvents such as fluorine-chlorinated hydrocarbon, or lipid-clearing agents such as LipoClear (StatSpin Inc., Norwood, MA) and n-hexane.

  8. Intravascular eosinophilic deposits-when common knowledge is insufficient to render a diagnosis.

    PubMed

    Resnik, Kenneth S

    2009-05-01

    In the course of daily sign-out, the diagnoses within a histopathologist's armamentarium are limited by the scope of the histopathologist's knowledge, that is, one cannot diagnose what one does not know. The subject of homogeneous intravascular eosinophilic deposits is used to illustrate this point. A histopathologist unaware that a tick bite reaction can induce intravascular eosinophilic deposits may misdiagnose the specimen as representing a manifestation of cryoglobulinemia. Furthermore, conventional teaching imparts that monoclonal cryoglobulinemia shows intravascular eosinophilic deposits (cryoprecipitates) histopathologically, whereas mixed cryoglobulinemia is histopathologically manifested as leukocytoclastic vasculitis. Although it is not well known, this is not always the case because mixed cryoglobulinemia may histopathologically present itself as intravascular eosinophilic deposits without leukocytoclastic vasculitis. In addition, it is not common knowledge that intravascular cryoprecipitates, when present, may be associated with an increased number of blood vessels. Examples of these phenomena are presented in conjunction with a discussion of relevant issues/lessons learned from such cases.

  9. Radiation inactivation analysis of fusion and hemolysis by vesicular stomatitis virus

    SciTech Connect

    Bundo-Morita, K.; Gibson, S.; Lenard, J.

    1988-04-01

    Radiation inactivation analysis was used to determine the size of the functional unit responsible for fusion of vesicular stomatitis virus (VSV) with cardiolipin or phosphatidylcholine-phosphatidylethanolamine (1:1) liposomes, and for VSV-induced hemolysis. When radiation-insensitive background values were subtracted, the calculated functional units for all three activities were similar, ranging from 866 to 957 kDa, equivalent to about 15 G protein molecules. This is in striking contrast to results of similar studies with influenza and Sendai viruses, in which the functional unit corresponded in size to a single fusion protein monomer, and suggests that VSV fusion may occur by a different mechanism.

  10. Hemolytic evaluation using polyurethane microcapsule suspensions in circulatory support devices: normalized index of hemolysis comparisons of commercial centrifugal blood pumps.

    PubMed

    Maruyama, Osamu; Yamaguchi, Katsuhiro; Nishida, Masahiro; Onoguchi, Tomio; Tsutsui, Tatsuo; Jikuya, Tomoaki; Yamane, Takashi

    2008-02-01

    We have been developing some types of microcapsule suspensions with polyurethane membranes to evaluate the absolute hemolytic characteristics of the centrifugal blood pumps used in circulatory support devices such as artificial hearts. In order to facilitate/realize hemolysis testing on centrifugal blood pumps that have hemolysis levels as low as those of commercial centrifugal blood pumps, we eliminated capsules with diameters less than 72.2 microm, amounting to 15.4% of all capsules in the conventional suspension (crude suspension [CS]), and adjusted the capsule volume ratio to correspond to a hematocrit of 40%. In this way we succeeded in enhancing the sensitivity of the suspension to microcapsule destruction 61 fold. We used this new suspension (fine suspension [FS]) to perform hemolysis tests on four types of commercial pump with mock circulation systems. Under conditions of 500 mm Hg and 11.2 L/min, we successfully determined the hemolytic characteristics (normalized index of hemolysis [NIH]) of some of the centrifugal blood pumps; the results showed some correlation with those of hemolysis tests on bovine blood and suggest that microcapsule suspensions with polyurethane membranes are useful as standard test solutions for the absolute evaluation of centrifugal blood pumps.

  11. Development of catheters for combined intravascular ultrasound and photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Karpiouk, Andrei B.; Wang, Bo; Emelianov, Stanislav Y.

    2009-02-01

    Coronary atherosclerosis is a complex disease accompanied by the development of plaques in the arterial wall. Since the vulnerability of the plaques depends on their composition, the appropriate treatment of the arteriosclerosis requires a reliable characterization of the plaques' geometry and content. The intravascular ultrasound (IVUS) imaging is capable of providing structural details of the plaques as well as some functional information. In turn, more functional information about the same plaques can be obtained from intravascular photoacoustic (IVPA) images since the optical properties of the plaque's components differ from that of their environment. The combined IVUS/IVPA imaging is capable of simultaneously detecting and differentiating the plaques, thus determining their vulnerability. The potential of combined IVUS/IVPA imaging has already been demonstrated in phantoms and ex-vivo experiments. However, for in-vivo or clinical imaging, an integrated IVUS/IVPA catheter is required. In this paper, we introduce two prototypes of integrated IVUS/IVPA catheters for in-vivo imaging based on a commercially available single-element IVUS imaging catheter. The light delivery systems are developed using multimode optical fibers with custom-designed distal tips. Both prototypes were tested and compared using an arterial mimicking phantom. The advantages and limitations of both designs are discussed. Overall, the results of our studies suggest that both designs of integrated IVUS/IVPA catheter have a potential for in-vivo IVPA/IVUS imaging of atherosclerotic plaques.

  12. Focused intravascular ultrasonic probe using dimpled transducer elements.

    PubMed

    Chen, Y; Qiu, W B; Lam, K H; Liu, B Q; Jiang, X P; Zheng, H R; Luo, H S; Chan, H L W; Dai, J Y

    2015-02-01

    High-frequency focused intravascular ultrasonic probes were fabricated in this study using dimple technique based on PMN-PT single crystal and lead-free KNN-KBT-Mn ceramic. The center frequency, bandwidth, and insertion loss of the PMN-PT transducer were 34 MHz, 75%, and 22.9 dB, respectively. For the lead-free probe, the center frequency, bandwidth, and insertion loss were found to be 40 MHz, 72%, and 28.8 dB, respectively. The ultrasonic images of wire phantom and vessels with good resolution were obtained to evaluate the transducer performance. The -6 dB axial and lateral resolutions of the PMN-PT probe were determined to be 58 μm and 131 μm, respectively. For the lead-free probe, the axial and lateral resolutions were found to be 44 μm and 125 μm, respectively. These results suggest that the mechanical dimpling technique has good potential in preparing focused transducers for intravascular ultrasound applications.

  13. Dual-element needle transducer for intravascular ultrasound imaging

    PubMed Central

    Yoon, Sangpil; Kim, Min Gon; Williams, Jay A.; Yoon, Changhan; Kang, Bong Jin; Cabrera-Munoz, Nestor; Shung, K. Kirk; Kim, Hyung Ham

    2015-01-01

    Abstract. A dual-element needle transducer for intravascular ultrasound imaging has been developed. A low-frequency element and a high-frequency element were integrated into one device to obtain images which conveyed both low- and high-frequency information from a single scan. The low-frequency element with a center frequency of 48 MHz was fabricated from the single crystal form of lead magnesium niobate-lead titanate solid solution with two matching layers (MLs) and the high frequency element with a center frequency of 152 MHz was fabricated from lithium niobate with one ML. The measured axial and lateral resolutions were 27 and 122  μm, respectively, for the low-frequency element, and 14 and 40  μm, respectively, for the high-frequency element. The performance of the dual-element needle transducer was validated by imaging a tissue-mimicking phantom with lesion-mimicking area, and ex vivo rabbit aortas in water and rabbit whole blood. The results suggest that a low-frequency element effectively provides depth resolved images of the whole vessel and its adjacent tissue, and a high-frequency element visualizes detailed structure near the surface of the lumen wall in the presence of blood within the lumen. The advantages of a dual-element approach for intravascular imaging are also discussed. PMID:26158118

  14. TOPICAL REVIEW: Intravascular brachytherapy of the coronary arteries

    NASA Astrophysics Data System (ADS)

    Fox, R. A.

    2002-02-01

    This is a review of the relatively recently developed field of intravascular brachytherapy of coronary arteries. It presents a brief overview of the discipline of coronary angioplasty describing the problem of restenosis and discusses the potential for ionizing radiation to overcome this problem. It examines the various methods that have been used to irradiate the coronary arteries comparing their advantages and disadvantages. Special consideration is given to seeds and wires in the artery, radioactive liquids in the angioplasty balloon and radioactive stents. Passing reference is made to a number of other methods that have also been proposed, but which are not commonly used to irradiate the coronary arteries at present. The dosimetry of each of the major techniques is discussed and the data from different laboratories compared. Specific consideration is given to the need for centring of the radioactive source and the factors affecting the selection of a dose prescription. A brief review of recent clinical trials is followed by an examination of possible future directions in this field including the use of intravascular ultrasound to improve dosimetry, the use of gas-filled balloons to enhance the penetration of beta-emitting sources and the use of gamma-emitting stents to overcome the problems associated with edge restenosis.

  15. High speed intravascular photoacoustic imaging of atherosclerotic arteries (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Piao, Zhonglie; Ma, Teng; Qu, Yueqiao; Li, Jiawen; Yu, Mingyue; He, Youmin; Shung, K. Kirk; Zhou, Qifa; Kim, Chang-Seok; Chen, Zhongping

    2016-02-01

    Cardiovascular disease is the leading cause of death in the industrialized nations. Accurate quantification of both the morphology and composition of lipid-rich vulnerable atherosclerotic plaque are essential for early detection and optimal treatment in clinics. In previous works, intravascular photoacoustic (IVPA) imaging for detection of lipid-rich plaque within coronary artery walls has been demonstrated in ex vivo, but the imaging speed is still limited. In order to increase the imaging speed, a high repetition rate laser is needed. In this work, we present a high speed integrated IVPA/US imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A miniature catheter with 1.0 mm outer diameter was designed with a 200 μm multimode fiber and an ultrasound transducer with 45 MHz center frequency. The fiber was polished at 38 degree and enclosed in a glass capillary for total internal reflection. An optical/electrical rotary junction and pull-back mechanism was applied for rotating and linearly scanning the catheter to obtain three-dimensional imaging. Atherosclerotic rabbit abdominal aorta was imaged as two frame/second at 1725 nm. Furthermore, by wide tuning range of the laser wavelength from 1680 nm to 1770 nm, spectroscopic photoacoustic analysis of lipid-mimicking phantom and an human atherosclerotic artery was performed ex vivo. The results demonstrated that the developed IVPA/US imaging system is capable for high speed intravascular imaging for plaque detection.

  16. The syndrome of pneumococcemia, disseminated intravascular coagulation and asplenia.

    PubMed Central

    Kingston, M E; MacKenzie, C R

    1979-01-01

    A 58-year-old man who survived an episode of fulminant pneumococcal septicemia with disseminated intravascular coagulation had undergone splenectomy 23 years previously. In the literature there are 25 reported cases of fulminant septicemia and disseminated intravascular coagulation associated with asplenia in adults (excluding cases in which corticosteroid or immunosuppressive therapy was given). The pneumococcus was responsible for all of these cases as well. The mortality in this series was more than 90%, and death occurred within 24 hours of presentation at hospital in almost 70% of the fatal cases and was associated with high-density bacteremia and adrenal hemorrhage. Gram-staining of the buffy coat of the peripheral blood or the exudate from purpuric skin lesions was carried out in only 6 of the 26 cases but yielded positive results in all but 1. It is concluded that a diagnosis of septicemia in asplenic adults can be established within a short time of presentation on the basis of statistical probability and the results of Gram-staining of the peripheral blood and exudate from the skin lesions. Prevention appears to be the cornerstone of management because of the variable interval from splenectomy to the onset of the syndrome and the high mortality. Images FIG. 1 PMID:38002

  17. A short contemporary history of disseminated intravascular coagulation.

    PubMed

    Levi, Marcel; van der Poll, Tom

    2014-11-01

    Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to a widespread deposition of fibrin in the circulation. There is ample experimental and pathological evidence that the fibrin deposition contributes to multiple organ failure. The massive and ongoing activation of coagulation may result in depletion of platelets and coagulation factors, which may cause bleeding (consumption coagulopathy). The syndrome of DIC is well known in the medical literature for centuries, although a more precise description of the underlying mechanisms had to await the 20th century. Initial ideas on a role of the contact activation system as the primary trigger for the systemic activation of coagulation as well as a presumed hyperfibrinolytic response in DIC have been found to be misconceptions. Experimental and clinical evidence now indicate that the initiation of coagulation in DIC is caused by tissue factor expression, which in combination with downregulated physiological anticoagulant pathways and impaired fibrinolysis leads to widespread fibrin deposition. In addition, an extensive bidirectional interaction between coagulation and inflammation may further contribute to the pathogenesis of DIC.

  18. [Disseminated intravascular coagulation. Case series and literature review].

    PubMed

    Del Carpio-Orantes, Luis; García-Ortiz, Jorge José

    2014-01-01

    INTRODUCCIÓN: la coagulación intravascular diseminada es una entidad caracteriza por activación de la cascada de la coagulación y fibrinólisis endógena, que puede provocar la muerte. Nuestros objetivos fueron identificar la incidencia de coagulación intravascular diseminada, sus agentes etiológicos y la correlación entre la puntuación de la escala Apache II y la propuesta por la Sociedad Internacional de Trombosis y Hemostasia para el diagnóstico de esta entidad. MÉTODOS: estudio retrospectivo, observacional y descriptivo de pacientes atendidos en una unidad de cuidados intensivos en un periodo de 17 meses. Se analizó etiología, edad, sexo, conteo de plaquetas, coagulograma, niveles de fibrinógeno sérico y cuantificación del dímero D. Se calculó la puntuación de la escala propuesta por la Sociedad Internacional de Trombosis y Hemostasia y de la escala APACHE II.

  19. Current Pathological and Laboratory Considerations in the Diagnosis of Disseminated Intravascular Coagulation

    PubMed Central

    Alhamdi, Yasir; Abrams, Simon T.

    2016-01-01

    Systemically sustained thrombin generation in vivo is the hallmark of disseminated intravascular coagulation (DIC). Typically, this is in response to a progressing disease state that is associated with significant cellular injury. The etiology could be infectious or noninfectious, with the main pathophysiological mechanisms involving cross-activation among coagulation, innate immunity, and inflammatory responses. This leads to consumption of both pro- and anticoagulant factors as well as endothelial dysfunction and disrupted homeostasis at the blood vessel wall interface. In addition to the release of tissue plasminogen activator (tPA) and soluble thrombomodulin (sTM) following cellular activation and damage, respectively, there is the release of damage-associated molecular patterns (DAMPs) such as extracellular histones and cell-free DNA. Extracellular histones are increasingly recognized as significantly pathogenic in critical illnesses through direct cell toxicity, the promotion of thrombin generation, and the induction of neutrophil extracellular trap (NET) formation. Clinically, high circulating levels of histones and histone–DNA complexes are associated with multiorgan failure, DIC, and adverse patient outcomes. Their measurements as well as that of other DAMPs and molecular markers of thrombin generation are not yet applicable in the routine diagnostic laboratory. To provide a practical diagnostic tool for acute DIC, a composite scoring system using rapidly available coagulation tests is recommended by the International Society on Thrombosis and Haemostasis. Its usefulness and limitations are discussed alongside the advances and unanswered questions in DIC pathogenesis. PMID:27578502

  20. The potential value of intravascular ultrasound imaging in diagnosis of aortic intramural hematoma

    PubMed Central

    Hu, Wei; Schiele, Francois; Meneveau, Nicolas; Seronde, Marie-France; Legalery, Pierre; Bonneville, Jean-Francois; Chocron, Sidney; Bassand, Jean-Pierre

    2011-01-01

    Objective To evaluate the potential value of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic intramural hematoma (AIH). Methods From September 2002 to May 2005, a consecutive series of 15 patients with suspected aortic dissection (AD) underwent both IVUS imaging and spiral computed tomography (CT). Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group. Results The study group consisted of five males and one female with mean age of 66 years old. All of them had chest or back pain. In one patient, CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer (PAU), which were detected by IVUS. In another patient, CT mistaken a partly thrombosed false lumen as an AIH, whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen. In the four rest patients, both CT and IVUS made the diagnosis of AIH, however, IVUS detected three PAUs in three of them, only one of them was also detected by CT, and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging. Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH, particularly for diagnosing localized AIH, distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs. PMID:22783309

  1. The influence of variations in biophysical conditions on hemolysis near ultrasonically activated gas-filled micropores

    SciTech Connect

    Miller, D.L.; Thomas, R.M. )

    1990-05-01

    Hemolysis induced by 1.9-MHz ultrasound in 0.5% suspensions of canine erythrocytes with 3.7-{mu}m-diam micropore-trapped gas bodies was investigated for a variety of biophysical conditions. For isotonic media, hemolysis increased with exposure duration but did not greatly change with exposure temperature, or prior heat treatment. The temperature results were especially interesting because increased temperatures might have been expected to increase the sensitivity of the cells to the ultrasonically activated gas bodies. Variations in osmolarity had little influence on the results. Increasing the viscosity of the medium decreased the effect, and this did not seem to depend on the molecular weight of the dextran additive. A medium with elevated mass density seemed to increase the effectiveness of the exposures. This condition eliminated the density difference between the cells and the medium, and might have been expected to reduce the effectiveness of the exposures, because the radiation force, which theoretically gathers cells to the gas bodies, is minimized for such conditions. This information should aid in developing refinements to the theoretical understanding of low-intensity ultrasonic bioeffects.

  2. The Effect of Geometry on the Efficiency and Hemolysis of Centrifugal Implantable Blood Pumps.

    PubMed

    Mozafari, Sahand; Rezaienia, Mohammad A; Paul, Gordon M; Rothman, Martin T; Wen, Pihua; Korakianitis, Theodosios

    The application of centrifugal pumps as heart assist devices imposes design limitations on the impeller geometry. Geometry and operating parameters will affect the performance and the hemocompatibility of the device. Among all the parameters affecting the hemocompatibility, pressure, rotational speed, blade numbers, angle, and width have significant impact on the blood trauma. These parameters directly (pressure, speed) and indirectly (geometry) affect the efficiency of the pump as well. This study describes the experimental investigation on geometric parameters and their effect on the performance of small centrifugal pumps suitable for Mechanical Circulatory Support (MCS) devices. Experimental and numerical techniques were implemented to analyze the performance of 15 centrifugal impellers with different characteristics. The effect of each parameter on the pump performance and hemolysis was studied by calculating the normalized index of hemolysis (NIH) and the shear stress induced in each pump. The results show five and six blades, 15-35° outlet angle, and the lowest outlet width that meets the required pressure rise are optimum values for an efficient hemocompatible pump.

  3. The effect of turbulent viscous shear stress on red blood cell hemolysis.

    PubMed

    Yen, Jen-Hong; Chen, Sheng-Fu; Chern, Ming-Kai; Lu, Po-Chien

    2014-06-01

    Non-physiologic turbulent flow occurs in medical cardiovascular devices resulting in hemodynamic stresses that may damage red blood cells (RBC) and cause hemolysis. Hemolysis was previously thought to result from Reynolds shear stress (RSS) in turbulent flows. A more recent hypothesis suggests that turbulent viscous shear stresses (TVSS) at spatial scales similar in size to RBCs are related to their damage. We applied two-dimensional digital particle image velocimetry to measure the flow field of a free-submerged axisymmetric jet that was utilized to hemolyze porcine RBCs in selected locations. Assuming a dynamic equilibrium for the sub-grid scale (SGS) energy flux between the resolved and the sub-grid scales, the SGS energy flux was calculated from the strain rate tensor computed from the resolved velocity fields. The SGS stress was determined by the Smagorinsky model, from which the turbulence dissipation rate and then TVSS were estimated. Our results showed the hemolytic threshold of the Reynolds stresses was up to 517 Pa, and the TVSSs were at least an order of magnitude less than the RSS. The results provide further insight into the relationship between turbulence and RBC damage.

  4. Measurement of the rotor motion and corresponding hemolysis of a centrifugal blood pump with a magnetic and hydrodynamic hybrid bearing.

    PubMed

    Kataoka, Hiroyuki; Kimura, Yuichi; Fujita, Hajime; Takatani, Setsuo

    2005-07-01

    This study proposed a centrifugal blood pump with a novel magnetic and hydrodynamic hybrid passive bearing, which consisted of a plain journal bearing for radial stability and a permanent magnetic bearing for axial and tilting stability. We measured the radial motion of the bearing and performed hemolysis tests for the different radial clearance sizes. In the results, it appeared that the radial motion had two modes: the stable center mode, in which the radius of the radial motion rapidly converged to less than 20 microm; and the unstable circle mode, in which the rotor suspension linearly increased with the rotation speed. It also appeared that the pumps with the radial clearance of 80 microm caused more hemolysis than with the smaller clearance sizes in the circle mode. The circle mode was avoidable by the higher rotation or the asymmetric pump structure, but the mechanism of hemolysis in this mode was still unclear.

  5. Spurious hemolysis does not influence the reliability of digoxin testing on Siemens RXL MAX and Roche Cobas e601.

    PubMed

    Lippi, Giuseppe; Mercadanti, Mariella; Romero, Araelsis; Lipreri, Graziella; Salvagno, Gian Luca; Guidi, Gian Cesare

    2012-01-01

    Little information is available on the influence of spurious hemolysis on digoxin immunoassays. Seventeen consecutive, non-hemolyzed, sodium-heparin samples were divided in three aliquots. The first was immediately centrifuged and tested for hemolysis index (HI), as well as plasma digoxin on Siemens RXL MAX using the Siemens Dimension Flex and Roche Cobas e601 by electrochemiluminescent (ECLIA) technique. The second and third aliquots were subjected to mechanical hemolysis by aspirating the blood one and two times through a thin needle. The concentration of digoxin measured on Siemens RXL MAX was significantly decreased from aliquot #A, to aliquot #B (-4%), and aliquot #C (-6%), but in none of the hemolyzed specimens the 10% bias was exceeded. No significant variation was observed by measuring plasma digoxin on Roche Cobas.

  6. Evaluation of a Spiral Groove Geometry for Improvement of Hemolysis Level in a Hydrodynamically Levitated Centrifugal Blood Pump.

    PubMed

    Murashige, Tomotaka; Kosaka, Ryo; Sakota, Daisuke; Nishida, Masahiro; Kawaguchi, Yasuo; Yamane, Takashi; Maruyama, Osamu

    2015-08-01

    The purpose of this study is to evaluate a spiral groove geometry for a thrust bearing to improve the hemolysis level in a hydrodynamically levitated centrifugal blood pump. We compared three geometric models: (i) the groove width is the same as the ridge width at any given polar coordinate (conventional model); (ii) the groove width contracts inward from 9.7 to 0.5 mm (contraction model); and (iii) the groove width expands inward from 0.5 to 4.2 mm (expansion model). To evaluate the hemolysis level, an impeller levitation performance test and in vitro hemolysis test were conducted using a mock circulation loop. In these tests, the driving conditions were set at a pressure head of 200 mm Hg and a flow rate of 4.0 L/min. As a result of the impeller levitation performance test, the bottom bearing gaps of the contraction and conventional models were 88 and 25 μm, respectively. The impeller of the expansion model touched the bottom housing. In the hemolysis test, the relative normalized index of hemolysis (NIH) ratios of the contraction model in comparison with BPX-80 and HPM-15 were 0.6 and 0.9, respectively. In contrast, the relative NIH ratios of the conventional model in comparison with BPX-80 and HPM-15 were 9.6 and 13.7, respectively. We confirmed that the contraction model achieved a large bearing gap and improved the hemolysis level in a hydrodynamically levitated centrifugal blood pump.

  7. Comparison of Two Diagnostic Scores of Disseminated Intravascular Coagulation in Pregnant Women Admitted to the ICU

    PubMed Central

    Ducloy-Bouthors, Anne Sophie

    2016-01-01

    Objective To compare the validity of two previously published diagnostic scores of disseminated intravascular coagulation (DIC) in pregnant women admitted to ICU for an acute thrombotic or hemorrhagic complication of delivery and postpartum. Methods This was a population based retrospective study of 154 patients admitted to ICU for severe delivery and postpartum complications in a University Hospital. A recently published score (adapted to physiological changes of pregnancy and based on three components: platelet count, prothrombin time difference and fibrinogen) was compared to the International Society for Thrombosis and Hemostasis (ISTH) score (based on four components: platelet count, fibrinogen, prothrombin time, and fibrin related marker). Both scores were calculated at delivery, ICU admission (day 0), day 1 and day 2 during the postpartum ICU stay. The validity of both scores was assessed by comparison with the consensual and blinded analysis of two experts. The sensitivity, specificity, and area under the curve (AUC) of each score were calculated at each time and overall by generalized linear mixed model. The agreement between the two scores was evaluated by the Kappa coefficient. Results The new score had a sensitivity of 0.78, a specificity of 0.97 (p <0.01) and a global AUC of 96% while the ISTH score had a sensitivity of 0.31, a specificity of 0.99 and an AUC of 94% (p <0.01). The Kappa coefficient of correlation between both scores was 0.35. The lower sensitivity of the ISTH score was mainly explained by the lack of fibrinogen and fibrin-related peptides thresholds adapted to the physiological changes of coagulation induced by pregnancy. Conclusion The new DIC score seem highly discriminant in the subset of patients admitted to the ICU after delivery for an acute specific complication. The ISTH score is not recommended in pregnant women because of its poor sensitivity. PMID:27861597

  8. Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

    PubMed Central

    Nogami, Kenichiro; Muraki, Isao; Imano, Hironori; Iso, Hiroyasu

    2017-01-01

    Objectives To determine quantitatively the association between type 2 diabetes mellitus (T2DM) and disseminated intravascular coagulation (DIC). Design Retrospective cohort study using a claims database. Setting Medical care institutions representing 9% of all secondary hospitals (acute care hospitals) in Japan. Participants In total, 797 324 admissions, comprising 435 354 patients aged 18–79 years at the time of admission, were enrolled between January 2010 and September 2014. All patients were diagnosed with diabetes or admitted to hospitals that provided laboratory data. Main outcome measures Incidence of DIC reported by physicians in claims data. Results Logistic regression analysis found that the risk of DIC was significantly higher in T2DM patients than in non-DM patients (fully adjusted OR: 1.39 (95% CI 1.32 to 1.45)), independent of age, sex, admission year and potential underlying diseases. The higher risk of DIC in T2DM patients was apparent in those who were treated with insulin within the 30-day period prior to admission (1.53 (1.37 to 1.72)). When stratified by the potential underlying diseases, the risk of DIC was higher in T2DM patients with non-septic severe infection (1.67 (1.41 to 1.97)) and with solid tumour (1.59 (1.47 to 1.72)) than in non-DM patients with those underlying diseases. The risk was similar between T2DM and non-DM patients with sepsis (0.98 (0.90 to 1.08)) and lower in T2DM patients with acute leukaemia (0.70 (0.59 to 0.84)). Conclusions T2DM was associated with a higher risk of DIC, particularly when recently treated with insulin, as well as among admissions with solid tumour or non-septic severe infection. PMID:28122835

  9. Intravascular Ultrasound Imaging of Peripheral Arteries as an Adjunct to Balloon Angioplasty and Atherectomy

    SciTech Connect

    Korogi, Yukunori; Hirai, Toshinori; Takahashi, Mutsumasa

    1996-11-15

    This article reviews many of the applications of intravascular ultrasound (US) imaging for peripheral arterial diseases. In vitro studies demonstrate an excellent correlation between ultrasound measurements of lumen and plaque crossectional area compared with histologic sections. In vivo clinical studies reveal the enhanced diagnostic capabilities of this technology compared with angiography. Intravascular US imaging can provide valuable information on the degree, eccentricity, and histologic type of stenosis before intervention, and on the morphological changes in the arterial wall and the extent of excision after intervention. Intravascular US may also serve as a superior index for gauging the diameter of balloon, stent, laser probe, and/or atherectomy catheter appropriate for a proposed intervention. Significant new insights into the mechanisms of balloon angioplasty and atherectomy have been established by intravascular US findings. Intravascular US imaging has been shown to be a more accurate method than angiography for determining the cross-sectional area of the arterial lumen, and for assessing severity of stenosis. Quantitative assessment of the luminal cross-sectional area after the balloon dilatation should be more accurate than angiography as intimal tears or dissections produced by the dilatation may not be accurately evaluated with angiography. At the present time, intravascular US is still a controversial imaging technique. Outcome studies are currently being organized to assess the clinical value and cost effectiveness of intravascular ultrasound in the context of these interventional procedures.

  10. [Freshly frozen preserved plasma for the treatment of intravascular coagulation in polytraumatized patients].

    PubMed

    Hehne, H J; Nyman, D; Burri, H; Wolff, G

    1976-05-15

    Coagulation disorders in hemorrhagic shock need not represent an isolated intravascular coagulation. They may also occur as a complex of local disseminated intravascular consumption, extravascular consumption, dilution, and reduced synthesis of coagulation factors. In the severely bleeding patient with hemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability. Therefore, it fails to stop hemorrhage and shock remains untreatable. Fresh frozen plasma, however, has proved to be suitable as simultaneous substitution therapy of coagulopathy and of hypovolemic shock. 11 patients suffering from traumatic-hemorrhagic shock associated with intravascular coagulation and hemorrhagic diathesis were successfully treated with fresh frozen plasma, after conventional shock therapy had failed over a period of hours.

  11. [Management of intravascular catheters for prevention of perioperative cross infections].

    PubMed

    Okubo, Takashi; Ohara, Eiko; Nakamura, Akishige; Takeyama, Hiromitsu; Manabe, Tadao

    2004-11-01

    Bloodstream infection derived from an intravascular catheter occupies an important position among the various types of nosocomial infection. It is therefore necessary to establish a system for preventing catheter infection not only as measures for each separate infection, but also for the entire hospital. Catheter infections are mainly caused by contamination of the connecting part of a transfusion line during the infusion of drug solution as well as by contamination of the part of the catheter inserted. Consequently, the greatest possible care should be taken in the preparation of aseptic transfusion and the prevention of contamination when connecting a transfusion line. In particular, there are problems with three-way stopcocks, management of hubs, frequency of transfusion line exchange, fat emulsion injection method, and blood preparation. It is most important to consider effective nutritional management methods that do not require the insertion of a central venous catheter.

  12. Adaptive Estimation of Intravascular Shear Rate Based on Parameter Optimization

    NASA Astrophysics Data System (ADS)

    Nitta, Naotaka; Takeda, Naoto

    2008-05-01

    The relationships between the intravascular wall shear stress, controlled by flow dynamics, and the progress of arteriosclerosis plaque have been clarified by various studies. Since the shear stress is determined by the viscosity coefficient and shear rate, both factors must be estimated accurately. In this paper, an adaptive method for improving the accuracy of quantitative shear rate estimation was investigated. First, the parameter dependence of the estimated shear rate was investigated in terms of the differential window width and the number of averaged velocity profiles based on simulation and experimental data, and then the shear rate calculation was optimized. The optimized result revealed that the proposed adaptive method of shear rate estimation was effective for improving the accuracy of shear rate calculation.

  13. Mathematical Modeling of Intravascular Blood Coagulation under Wall Shear Stress

    PubMed Central

    Rukhlenko, Oleksii S.; Dudchenko, Olga A.; Zlobina, Ksenia E.; Guria, Georgy Th.

    2015-01-01

    Increased shear stress such as observed at local stenosis may cause drastic changes in the permeability of the vessel wall to procoagulants and thus initiate intravascular blood coagulation. In this paper we suggest a mathematical model to investigate how shear stress-induced permeability influences the thrombogenic potential of atherosclerotic plaques. Numerical analysis of the model reveals the existence of two hydrodynamic thresholds for activation of blood coagulation in the system and unveils typical scenarios of thrombus formation. The dependence of blood coagulation development on the intensity of blood flow, as well as on geometrical parameters of atherosclerotic plaque is described. Relevant parametric diagrams are drawn. The results suggest a previously unrecognized role of relatively small plaques (resulting in less than 50% of the lumen area reduction) in atherothrombosis and have important implications for the existing stenting guidelines. PMID:26222505

  14. Automatic classification of atherosclerotic plaques imaged with intravascular OCT

    PubMed Central

    Rico-Jimenez, Jose J.; Campos-Delgado, Daniel U.; Villiger, Martin; Otsuka, Kenichiro; Bouma, Brett E.; Jo, Javier A.

    2016-01-01

    Intravascular optical coherence tomography (IV-OCT) allows evaluation of atherosclerotic plaques; however, plaque characterization is performed by visual assessment and requires a trained expert for interpretation of the large data sets. Here, we present a novel computational method for automated IV-OCT plaque characterization. This method is based on the modeling of each A-line of an IV-OCT data set as a linear combination of a number of depth profiles. After estimating these depth profiles by means of an alternating least square optimization strategy, they are automatically classified to predefined tissue types based on their morphological characteristics. The performance of our proposed method was evaluated with IV-OCT scans of cadaveric human coronary arteries and corresponding tissue histopathology. Our results suggest that this methodology allows automated identification of fibrotic and lipid-containing plaques. Moreover, this novel computational method has the potential to enable high throughput atherosclerotic plaque characterization. PMID:27867716

  15. Intravascular Optical Imaging Technology for Investigating the Coronary Artery

    PubMed Central

    Suter, Melissa J.; Nadkarni, Seemantini K.; Weisz, Giora; Tanaka, Atsushi; Jaffer, Farouc A.; Bouma, Brett E.; Tearney, Guillermo J.

    2012-01-01

    There is an ever-increasing demand for new imaging methods that can provide additional information about the coronary wall to better characterize and stratify high-risk plaques, and to guide interventional and pharmacologic management of patients with coronary artery disease. While there are a number of imaging modalities that facilitate the assessment of coronary artery pathology, this review paper focuses on intravascular optical imaging modalities that provide information on the microstructural, compositional, biochemical, biomechanical, and molecular features of coronary lesions and stents. The optical imaging modalities discussed include angioscopy, optical coherence tomography, polarization sensitive-optical coherence tomography, laser speckle imaging, near-infrared spectroscopy, time-resolved laser induced fluorescence spectroscopy, Raman spectroscopy, and near-infrared fluorescence molecular imaging. Given the wealth of information that these techniques can provide, optical imaging modalities are poised to play an increasingly significant role in the evaluation of the coronary artery in the future. PMID:21920342

  16. Thrombotic thrombocytopenic purpura: a syndrome of intravascular platelet consumption.

    PubMed Central

    Neame, P. B.; Hirsh, J.; Browman, G.; Denburg, J.; D'Souza, T. J.; Gallus, A.; Brain, M. C.

    1976-01-01

    In four of five patients with thrombotic thrombocytopenic purpura (TTP) in whom serial tests of hemostatic function were performed, severe thrombocytopenia, normal plasma fibrinogen concentrations and mildly increased concentrations of fibrinogen/fibrin degradation products were observed. Widespread platelet thrombi were found in arterioles and capillaries. Fibrin could be seen around some of the platelet clumps and was the main component in a small number of the thrombi in two patients. The observations show that TTP is a disorder in which intravascular platelet consumption results in disseminated platelet thrombosis. The coagulation system is apparently activated secondarily to platelet aggregation and variable quantities of fibrin are incorporated into the thrombi. Clinical improvement resulted from combined therapy with corticosteroids, heparin and drugs that suppress platelet function. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 PMID:1084215

  17. Real-time simulator for intravascular ultrasound (IVUS)

    NASA Astrophysics Data System (ADS)

    Abkai, Ciamak; Becherer, Nico; Hesser, Jürgen; Männer, Reinhard

    2007-03-01

    Intravascular Ultrasound (IVUS) plays a significant role in diagnostics of atherosclerotic diseases. Simulation of imaging techniques promises a better understanding of the physical background and segmentation strategies. Most simulation approaches describe ultrasonic backscattering using wave-equation based simplifications. More complicated real-time simulation techniques are not available so far. In this paper, we present an empirical model derived from wave-equations given by the Rayleigh integration method. According to boundary conditions and weak scatterers, a hybrid approach including the Beer-Lambert law to model attenuation is introduced. Scatterers are described by a 4D vessel-system model based on elastic tubes. Sophisticated discretization and numerical simplifications in addition to a highly optimized implementation of the model yields a real-time and realistic IVUS simulation with 20 frames/s on a 3.2 GHz Pentium 4 PC.

  18. Basic studies on intravascular low-intensity laser therapy

    NASA Astrophysics Data System (ADS)

    Liu, Timon Cheng-Yi; Duan, Rui; Wang, Shuang-Xi; Liu, Jiang; Cui, Li-Ping; Jin, Hua; Liu, Song-Hao

    2006-09-01

    Intravascular low intensity laser therapy (ILILT) was originally put forward in USA in 1982, but popularized in Russia in 1980s and in China in 1990s, respectively. A randomized placebo-controlled study has shown ILILT clinical efficacy in patients suffering from rheumatoid arthritis. As Chinese therapeutic applications of ILILT were the most widely in the world, its basic research, such as intracellular signal transduction research, blood research in vitro, animal blood research in vivo, human blood research in vivo and traditional Chinese medicine research, was also very progressive in China. Its basic studies will be reviewed in terms of the biological information model of photobiomodulation in this paper. ILILT might work in view of its basic studies, but the further randomized placebo-controlled trial and the further safety research should be done.

  19. Asian-variant intravascular large B-cell lymphoma

    PubMed Central

    Pasch, Whitney; Costales, Cristina; Siddiqi, Imran; Mohrbacher, Ann

    2017-01-01

    Intravascular large B-cell lymphoma (IVLBCL) is a rare and deadly malignancy involving the growth of lymphoma cells within vessel lumina of all organ types. IVLBCL is further divided into the hemophagocytic Asian variant and a classical Western variant. Both variants are difficult to diagnose by imaging, and although diagnostic criteria have been developed to guide workup, histopathological examination remains imperative. Treatment of IVLBCL remains difficult given the high mortality of the disease, but rituximab has emerged as a promising therapeutic option when combined with various cytotoxic regimens. The two main variants of IVLBCL generally manifest in their respective Asian or Western populations, and crossover between ethnicities is rare. We present the second described case of Asian-variant IVLBCL in an African American individual.

  20. Advanced Congestive Heart Failure Associated With Disseminated Intravascular Coagulopathy.

    PubMed

    Sarcon, Annahita; Liu, Xiaoli; Ton, David; Haywood, James; Hitchcock, Todd

    2015-01-01

    Background. Disseminated intravascular coagulopathy (DIC) is a complication of an underlying disease and not a primary illness. It is most commonly associated with sepsis, trauma, obstetrical complications, and malignancies. There are very few cases in the literature illustrating the association between DIC and congestive heart failure. Findings. In this report, we present a case of severe congestive heart failure, leading to biventricular thrombi and subsequently DIC. Conclusion. We suggest that the association between congestive heart failure and DIC is an underrecognized one. Congestive heart failure continues to remain a major cause of morbidity and mortality despite advances in medical therapies. Thus far, the precise role of coagulation factors in congestive heart failure is unknown. Further investigations are needed to elucidate the pathophysiology of congestive heart failure and coagulation factors.

  1. [Acute kidney failure due to kidney cortex necrosis. 2 clinical cases of surviving patients].

    PubMed

    Fuenzalida, E

    1991-07-01

    A 22 year old female developed preeclampsia with fetal death in utero. After cesarean section she developed uterine inertia and acute hemorrhagic anemia complicated by sepsis, disseminated intravascular coagulation and total anuria for 4 weeks. She was treated with hemodialysis. The second patient, a 49 year old man developed sepsis and intravascular coagulation after a dog bite. Acute renal failure with a 3 week total anuria followed. He was initially treated with peritoneo dialysis. Renal biopsy showed evidence of renal cortical necrosis in both patients.

  2. The Development of a Continuous Intravascular Glucose Monitoring Sensor

    PubMed Central

    Crane, Barry C.; Barwell, Nicholas P.; Gopal, Palepu; Gopichand, Mannam; Higgs, Timothy; James, Tony D.; Jones, Christopher M.; Mackenzie, Alasdair; Mulavisala, Krishna Prasad; Paterson, William

    2015-01-01

    Background: Glycemic control in hospital intensive care units (ICU) has been the subject of numerous research publications and debate over the past 2 decades. There have been multiple studies showing the benefit of ICU glucose control in reducing both morbidity and mortality. GlySure Ltd has developed a glucose monitor based on a diboronic acid receptor that can continuously measure plasma glucose concentrations directly in a patient’s vascular system. The goal of this study was to validate the performance of the GlySure CIGM system in different patient populations. Methods: The GlySure Continuous Intravascular Glucose Monitoring (CIGM) System was evaluated in both the Cardiac ICU (33 patients) and MICU setting (14 patients). The sensor was placed through a custom CVC and measured the patients’ blood glucose concentration every 15 seconds. Comparison blood samples were taken at 2 hourly then 4 hourly intervals and measured on a YSI 2300 STAT Plus or an i-STAT. Results: Consensus error grid analysis of the data shows that the majority of the data (88.2% Cardiac, and 95.0% MICU) fell within zone A, which is considered to be clinically accurate and all data points fell within zones A and B. The MARD of the Cardiac trial was 9.90% and the MICU trial had a MARD of 7.95%. Data analysis showed no significant differences between data generated from Cardiac and MICU patients or by time or glucose concentration. Conclusions: The GlySure CIGM System has met the design challenges of measuring intravascular glucose concentrations in critically ill patients with acceptable safety and performance criteria and without disrupting current clinical practice. The accuracy of the data is not affected by the patients’ condition. PMID:26033921

  3. Mechanism of photobiological effects of psoralens: the involvement of photo-oxidized psoralens as reactive intermediate species in induction of photosensitized hemolysis and skin erythema

    NASA Astrophysics Data System (ADS)

    Lysenko, Eugene P.; Kyagova, Alla A.; Potapenko, Alexander Y.

    2002-07-01

    Psoralens combined with UVA irradiation are used for the treatment of skin and autoimmune diseases. In the present paper the involvement of psoralen photooxidation products (POP) into induction of PUVA-erythema was studied. Under low fluence rate (LFR) UVA-irradiation and/or at low psoralen concentrations POP-products were predominantly formed, which were detected by spin trp method and possessed immunosuppressive activity. Under high fluence rate (HFR) UVA-irradiation and/or at high psoralen concentrations POP2-products were predominantly formed, which could be detected by Fe(II)-induced chemiluminescence and possessed hemolytic activity. Both PUVA- and POP-induced hemolysis of erythrocytes as well as PUVA-erythema were strongly activated with the increase in UVA-fluence rate. Both LFR and HFR PUVA-hemolysis as well as POP-hemolysis were strongly activated by Fe(II)-ions, bivalent cation chelators produced different effects on these processes depending on UVA fluence rate. Ethylenediaminetetraacetate (EDTA), and o- fenanthroline were found to inhibit LFT PUVA-erythema and enhanced HFR PUVA-erythema. Similar regulatory effects of EDTA were found for PUVA- and POP-induced hemolysis. EDTA inhibited LFT PUVA-hemolysis and activated HFR PUVA- and POP-hemolysis that suggests a participation of POP1- products in induction of LFR PUVA-hemolysis and LFT PUVA- erythema and POP2-products in induction of HFR PUVA- hemolysis and HFR PUVA-erythema.

  4. Perihepatic adhesions: an unusual complication of hemolysis, elevated liver enzymes and low platelet syndrome.

    PubMed

    Koeneman, Margot M; Koek, Ger H; Bemelmans, Marc; Peeters, Louis L

    2014-07-14

    We present a case of symptomatic perihepatic adhesions, which developed after a pregnancy complicated by hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome, in which a subcapsular liver hematoma occurred. Our patient presented with complaints of persistent, severe right-sided upper abdominal pain. The complaints developed gradually, one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma. The hematoma had resolved spontaneously. An upper-abdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma, suspect of perihepatic adhesions. The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session. The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment. This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.

  5. Eugenol prevents amyloid formation of proteins and inhibits amyloid-induced hemolysis

    NASA Astrophysics Data System (ADS)

    Dubey, Kriti; Anand, Bibin G.; Shekhawat, Dolat Singh; Kar, Karunakar

    2017-02-01

    Eugenol has attracted considerable attention because of its potential for many pharmaceutical applications including anti-inflammatory, anti-tumorigenic and anti-oxidant properties. Here, we have investigated the effect of eugenol on amyloid formation of selected globular proteins. We find that both spontaneous and seed-induced aggregation processes of insulin and serum albumin (BSA) are significantly suppressed in the presence of eugenol. Isothermal titration calorimetric data predict a single binding site for eugenol-insulin complex confirming the affinity of eugenol for native soluble insulin species. We also find that eugenol suppresses amyloid-induced hemolysis. Our findings reveal the inherent ability of eugenol to stabilize native proteins and to delay the conversion of protein species of native conformation into β-sheet assembled mature fibrils, which seems to be crucial for its inhibitory effect.

  6. [Up-to-date on the HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets)].

    PubMed

    Medhioub Kaaniche, F; Chaari, A; Turki, O; Rgaieg, K; Baccouch, N; Zekri, M; Bahloul, M; Chelly, H; Ben Hamida, Ch; Bouaziz, M

    2016-06-01

    HELLP syndrome is an acronym for Hemolysis, Elevated Liver enzymes and Low Platelets. It is generally considered in the literature as a particular clinical form of pre-eclampsia, a severe complication of the second half of pregnancy. However, this syndrome can occur in isolation in the absence of pre-eclampsia symptoms. Its pathophysiology remains still unclear. The clinical picture is often incomplete and fruste at first. To date, its diagnosis and management is still the subject of much controversy. Associated or not with a vascular and renal manifestations, the HELLP syndrome is a high-risk maternal disorder. The objective of this article is to review the pathophysiological and clinical data and current treatment.

  7. Eugenol prevents amyloid formation of proteins and inhibits amyloid-induced hemolysis

    PubMed Central

    Dubey, Kriti; Anand, Bibin G.; Shekhawat, Dolat Singh; Kar, Karunakar

    2017-01-01

    Eugenol has attracted considerable attention because of its potential for many pharmaceutical applications including anti-inflammatory, anti-tumorigenic and anti-oxidant properties. Here, we have investigated the effect of eugenol on amyloid formation of selected globular proteins. We find that both spontaneous and seed-induced aggregation processes of insulin and serum albumin (BSA) are significantly suppressed in the presence of eugenol. Isothermal titration calorimetric data predict a single binding site for eugenol-insulin complex confirming the affinity of eugenol for native soluble insulin species. We also find that eugenol suppresses amyloid-induced hemolysis. Our findings reveal the inherent ability of eugenol to stabilize native proteins and to delay the conversion of protein species of native conformation into β-sheet assembled mature fibrils, which seems to be crucial for its inhibitory effect. PMID:28145454

  8. Fluid dynamic design for low hemolysis in a hydrodynamically levitated centrifugal blood pump.

    PubMed

    Murashige, Tomotaka; Kosaka, Ryo; Nishida, Masahiro; Maruyama, Osamu; Yamane, Takashi; Kuwana, Katsuyuki; Kawaguchi, Yasuo

    2013-01-01

    We have developed a hydrodynamically levitated centrifugal blood pump for extracorporeal circulatory support as a bridge to decision pump. The impeller is levitated using hydrodynamic bearings without any complicated control circuit or displacement sensor. However, the effect of the outer circumferential velocity and the bearing area on the hemolytic property has not been clarified, even if the bearing gap is same size. The purpose of this study is to experimentally evaluate the effect of the outer circumferential velocity and the bearing area in the bearing gaps on the hemolytic property in a hydrodynamically levitated centrifugal blood pump. We prepared three models for testing. These models have the same bearing gap size by adjusting the impeller levitation position. However, the outer circumferential velocity of the impeller and the bearing area in the minimum bearing gaps are different. The outer circumferential velocity of the impeller and the bearing area were assumed to be related to the maximum shear rate and the exposure time. For the evaluation, we conducted an impeller levitation performance test and an in vitro hemolysis test. As a result, the normalized index of hemolysis (NIH) was reduced from 0.084 g/100 L to 0.040 g/100 L corresponding to a reduction in the outer circumferential velocity and a reduction in the bearing area, even if the minimum bearing gaps were same size. We confirmed that, even if the bearing gap was same size under the stably levitated condition, the outer circumferential velocity and the bearing area should be decreased in order to improve the hemolytic property.

  9. Bovine serum albumin bioconjugated graphene oxide: Red blood cell adhesion and hemolysis studied by QCM-D

    NASA Astrophysics Data System (ADS)

    Cai, Bing; Hu, Kebang; Li, Chunming; Jin, Jing; Hu, Yuexin

    2015-11-01

    Graphene oxide (GO) had great potential in various applications especial biomedical materials. In this study, we improved the hemocompatibility especial hemolysis properties of GO nanosheets by grafting bovine serum albumin (BSA). The hemocompatibility of GO-g-BSA was improved. The hemolysis ratio of GO-g-BSA was lower than 0.2% and no visible hemoglobin release was observed. In a flowed condition, the interaction between GO and RBC was monitored real time by quartz crystal microbalance with dissipation (QCM-D) and the hemolysis rates of eluted RBC solution was determined. The balance between the adsorption and degradation of RBC on the surface of GO was a linear process. The GO-g-BSA surface decreased the adhesion of RBC in a flowed condition, maintained the morphology of RBC and reduced the hemolysis rate in the most effective manner. The inert of BSA resisted GO interacting with the lipid bilayers of RBC and the negative charge on the surface of BSA repelled the approach of negative charged RBC. The excellent hemocompatibility of the BSA modified GO might confer its great potentials for various biomedical applications.

  10. Microstructure, mechanical properties, corrosion behavior and hemolysis of as-extruded biodegradable Mg-Sn-Zn alloy

    NASA Astrophysics Data System (ADS)

    Hou, L.; Li, Z.; Pan, Y.; Du, L.; Li, X.; Zheng, Y.; Li, L.

    2016-04-01

    As biodegradable biomaterials, magnesium alloys have favorable physical, chemical and mechanical properties, as well as good biocompatibility, and are expected to totally biodegrade in the body environment. The microstructure, mechanical properties, corrosion behaviors and hemolysis of biodegradable Mg-Sn-Zn alloy were investigated under three extrusion ratios in the present work. It is revealed that the as-extruded microstructure is obviously refined with smaller grains compared with the as-cast structure while some twins form simultaneously. The tensile strengths of the as-extruded alloys fabricated with the higher extrusion ratio is 249MPa, and elongations is 16.3% respectively. Besides, the corrosion rate of as-extruded magnesium alloys increases with the increasing extrusion ratio. The hemolysis test result shows that the hemolysis rate of biodegradable magnesium alloys fabricated with the higher extrusion ratio is 4.8%, when hemolysis rate lower than 5% has been demonstrated safe according to ISO 10993-4. In conclusion, the as-extruded biodegradable Mg-Sn-Zn alloy shows great potential as a novel medical implant material.

  11. Early Effects of Intensive Lipid-Lowering Treatment on Plaque Characteristics Assessed by Virtual Histology Intravascular Ultrasound

    PubMed Central

    Lee, Jung-Hee; Shin, Dong-Ho; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo

    2016-01-01

    Purpose The effects of short-term intensive lipid-lowering treatment on coronary plaque composition have not yet been sufficiently evaluated. We investigated the influence of short-term intensive lipid-lowering treatment on quantitative and qualitative changes in plaque components of non-culprit lesions in patients with acute coronary syndrome. Materials and Methods This was a prospective, randomized, open-label, single-center trial. Seventy patients who underwent both baseline and three-month follow-up virtual histology intravascular ultrasound were randomly assigned to either an intensive lipid-lowering treatment group (ezetimibe/simvastatin 10/40 mg, n=34) or a control statin treatment group (pravastatin 20 mg, n=36). Using virtual histology intravascular ultrasound, plaque was characterized as fibrous, fibro-fatty, dense calcium, or necrotic core. Changes in plaque components during the three-month lipid-lowering treatment were compared between the two groups. Results Compared with the control statin treatment group, there was a significant reduction in low-density lipoprotein cholesterol in the intensive lipid-lowering treatment group (-20.4±17.1 mg/dL vs. -36.8±17.4 mg/dL, respectively; p<0.001). There were no statistically significant differences in baseline, three-month follow-up, or serial changes of gray-scale intravascular ultrasound parameters between the two groups. The absolute volume of fibro-fatty plaque was significantly reduced in the intensive lipid-lowering treatment group compared with the control group (-1.5±3.4 mm3 vs. 0.8±4.7 mm3, respectively; p=0.024). A linear correlation was found between changes in low-density lipoprotein cholesterol levels and changes in the absolute volumes of fibro-fatty plaque (p<0.001, R2=0.209). Conclusion Modification of coronary plaque may be attainable after only three months of intensive lipid-lowering treatment. PMID:27401638

  12. Optimal bearing gap of a multiarc radial bearing in a hydrodynamically levitated centrifugal blood pump for the reduction of hemolysis.

    PubMed

    Kosaka, Ryo; Yasui, Kazuya; Nishida, Masahiro; Kawaguchi, Yasuo; Maruyama, Osamu; Yamane, Takashi

    2014-09-01

    We have developed a hydrodynamically levitated centrifugal pump as a bridge-to-decision device. The purpose of the present study is to determine the optimal bearing gap of a multiarc radial bearing in the developed blood pump for the reduction of hemolysis. We prepared eight pump models having bearing gaps of 20, 30, 40, 80, 90, 100, 180, and 250 μm. The driving conditions were set to a pressure head of 200 mm Hg and a flow rate of 4 L/min. First, the orbital radius of the impeller was measured for the evaluation of the impeller stability. Second, the hemolytic property was evaluated in an in vitro hemolysis test. As a result, the orbital radius was not greater than 15 μm when the bearing gap was between 20 and 100 μm. The relative normalized index of hemolysis (NIH) ratios in comparison with BPX-80 were 37.67 (gap: 20 μm), 0.95 (gap: 30 μm), 0.96 (gap: 40 μm), 0.82 (gap: 80 μm), 0.77 (gap: 90 μm), 0.92 (gap: 100 μm), 2.76 (gap: 180 μm), and 2.78 (gap: 250 μm). The hemolysis tended to increase at bearing gaps of greater than 100 μm due to impeller instability. When the bearing gap decreased from 30 to 20 μm, the relative NIH ratios increased significantly from 0.95 to 37.67 times (P < 0.01) due to high shear stress. We confirmed that the optimal bearing gap was determined between 30 and 100 μm in the developed blood pump for the reduction of hemolysis.

  13. Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge.

    PubMed

    Khan, Maria S; McCubbin, Mark; Nand, Sucha

    2014-01-01

    Case Presentation. A 69-year-old Hispanic male, with a past history of diabetes and coronary disease, was admitted for fever, diarrhea, and confusion of 4 weeks duration. Physical examination showed a disoriented patient with multiple ecchymoses, possible ascites, and bilateral scrotal swelling. Hemoglobin was 6.7, prothrombin time (PT) 21.4 seconds with international normalized ratio 2.1, partial thromboplastin time (PTT) 55.6 seconds, fibrin split 10 µg/L, and lactate dehydrogenase (LDH) 1231 IU/L. Except for a positive DNA test for Epstein-Barr virus (EBV) infection, extensive diagnostic workup for infections, malignancy, or a neurological cause was negative. Mixing studies revealed a nonspecific inhibitor of PT and PTT but Factor VIII levels were normal. The patient was empirically treated with antibiotics but developed hypotension and died on day 27 of admission. At autopsy, patient was found to have intravascular diffuse large B-cell lymphoma involving skin, testes, lung, and muscles. The malignant cells were positive for CD20, CD791, Mum-1, and Pax-5 and negative for CD3, CD5, CD10, CD30, and Bcl-6. The malignant cells were 100% positive for Ki-67. Discussion. Intravascular large cell B-cell lymphoma (IVLBCL) is rare form of diffuse large B-cell lymphoma and tends to proliferate within small blood vessels, particularly capillaries and postcapillary venules. The cause of its affinity for vascular bed remains unknown. In many reports, IVLBCL was associated with HIV, HHV8, and EBV infections. The fact that our case showed evidence of EBV infection lends support to the association of this diagnosis to viral illness. The available literature on this subject is scant, and in many cases, the diagnosis was made only at autopsy. The typical presentation of this disorder is with B symptoms, progressive neurologic deficits, and skin findings. Bone marrow, spleen, and liver are involved in a minority of patients. Nearly all patients have elevated LDH, and about 65% are

  14. Intravascular laser speckle imaging for the mechanical analysis of coronary plaques (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Hosoda, Masaki; Wang, Jing; Tsikudi, Diane; Nadkarni, Seemantini

    2016-02-01

    Acute myocardial infarction is frequently caused by the rupture of coronary plaques with severely compromised viscoelastic properties. We have developed a new optical technology termed intravascular laser speckle imaging (ILSI) that evaluates plaque viscoelastic properties, by measuring the time scale (time constant, τ) of temporally evolving laser speckle fluctuations. To enable coronary evaluation in vivo, an optical ILSI catheter has been developed that accomplishes omni-directional illumination and viewing of the entire coronary circumference without the need for mechanical rotation. Here, we describe the capability of ILSI for evaluating human coronary atherosclerosis in cadaveric hearts. ILSI was conducted in conjunction with optical coherence tomography (OCT) imaging in five human cadaveric hearts. The left coronary artery (LCA), left anterior descending (LAD), left circumflex artery (LCx), and right coronary artery (RCA) segments were resected and secured on custom-developed coronary holders to enable accurate co-registration between ILSI, OCT, and histopathology. Speckle time constants, τ, calculated from each ILSI section were compared with lipid and collagen content measured from quantitative Histopathological analysis of the corresponding Oil Red O and Picrosirius Red stained sections. Because the presence of low viscosity lipid elicits rapid speckle fluctuations, we observed an inverse correlation between τ measured by ILSI and lipid content (R= -0.64, p< 0.05). In contrast, the higher viscoelastic modulus of fibrous regions resulted in a positive correlation between τ and collagen content (R= 0.54, p< 0.05). These results demonstrate the feasibility of conducting ILSI evaluation of arterial mechanical properties using a miniaturized omni-directional catheter.

  15. Intracerebroventricular and Intravascular Injection of Viral Particles and Fluorescent Microbeads into the Neonatal Brain.

    PubMed

    Kawasaki, Hideya; Kosugi, Isao; Sakao-Suzuki, Makiko; Meguro, Shiori; Tsutsui, Yoshihiro; Iwashita, Toshihide

    2016-07-24

    In the study on the pathogenesis of viral encephalitis, the infection method is critical. The first of the two main infectious routes to the brain is the hematogenous route, which involves infection of the endothelial cells and pericytes of the brain. The second is the intracerebroventricular (ICV) route. Once within the central nervous system (CNS), viruses may spread to the subarachnoid space, meninges, and choroid plexus via the cerebrospinal fluid. In experimental models, the earliest stages of CNS viral distribution are not well characterized, and it is unclear whether only certain cells are initially infected. Here, we have analyzed the distribution of cytomegalovirus (CMV) particles during the acute phase of infection, termed primary viremia, following ICV or intravascular (IV) injection into the neonatal mouse brain. In the ICV injection model, 5 µl of murine CMV (MCMV) or fluorescent microbeads were injected into the lateral ventricle at the midpoint between the ear and eye using a 10-µl syringe with a 27 G needle. In the IV injection model, a 1-ml syringe with a 35 G needle was used. A transilluminator was used to visualize the superficial temporal (facial) vein of the neonatal mouse. We infused 50 µl of MCMV or fluorescent microbeads into the superficial temporal vein. Brains were harvested at different time points post-injection. MCMV genomes were detected using the in situ hybridization method. Fluorescent microbeads or green fluorescent protein expressing recombinant MCMV particles were observed by fluorescent microscopy. These techniques can be applied to many other pathogens to investigate the pathogenesis of encephalitis.

  16. Angioplasty Guided by Intravascular Ultrasound: Meta-Analysis of Randomized Clinical Trials

    PubMed Central

    de Figueiredo, José Albuquerque; Nogueira, Iara Antonia Lustosa; Figueiro, Mabel Fernandes; Buehler, Anna Maria; Berwanger, Otavio

    2013-01-01

    Background The impact of intravascular ultrasound (IVUS) use on stenting has shown inconclusive results. Objective Systematic review and meta-analysis of the impact of IVUS on stenting regarding the clinical and angiographic evolution. Methods A search was performed in Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus and Web of Science databases. It included randomized clinical trials (RCTs) that evaluated the implantation of stents guided by IVUS, compared with those using angiography alone (ANGIO). The minimum follow-up duration was six months and the following outcomes were assessed: thrombosis, mortality, myocardial infarction, percutaneous and surgical revascularization, major adverse cardiovascular events (MACE) and restenosis. The binary outcomes were presented considering the number of events in each group; the estimates were generated by a random effects model, considering Mantel-Haenszel statistics as weighting agent and magnitude of effect for the relative risk (RR) with its respective 95% confidence interval (95%CI). Higgins I2 test was used to quantify the consistency between the results of each study. Results A total of 2,689 articles were evaluated, including 8 RCTs. There was a 27% reduction in angiographic restenosis (RR: 0.73, 95% CI: 0.54-0.97, I2 = 51%) and statistically significant reduction in the rates of percutaneous revascularization and overall (RR: 0.88; 95% CI: 0.51 to 1.53, I2 = 61%, RR: 0.73, 95% CI: 0.54 to 0.99, I2 = 55%), with no statistical difference in surgical revascularization (RR: 0.95, 95% CI: 0.52-1.74, I2 = 0%) in favor of IVUS vs. ANGIO. There were no differences regarding the other outcomes in the comparison between the two strategies. Conclusion Angioplasty with stenting guided by IVUS decreases the rates of restenosis and revascularization, with no impact on MACE, acute myocardial infarction, mortality or thrombosis outcomes. PMID:23821407

  17. A new mock circulatory loop and its application to the study of chemical additive and aortic pressure effects on hemolysis in the Penn State electric ventricular assist device.

    PubMed

    Garrison, L A; Frangos, J A; Geselowitz, D B; Lamson, T C; Tarbell, J M

    1994-05-01

    A new mock circulatory loop was developed for hemolysis studies associated with the Penn State electric ventricular assist device (EVAD). This flow loop has several advantages over previously designed loops. It is small enough to accommodate experiments in which only single units of blood are available, it is made out of biocompatible materials, it incorporates good geometry, and it provides normal physiological pressures and flows to both the aortic outlet and the venous inlet of the pumping device. Experiments with reduced aortic pressure but normal cardiac output showed that hemolysis in a loop with normal aortic blood pressure was significantly higher than that in a loop with lowered aortic pressure, thereby illustrating the importance of maintaining loop pressures as close as possible to those found in vivo. This data also imply that blood traveling through the left ventricle in an artificial heart may be subject to higher hemolysis rates than that traversing the right ventricle. Another set of experiments to determine the effects of 4 hemolysis or drag-reducing agents (Pluronic F-68, Dextran-40, Polyox WSR-301, and Praestol 2273TR) on blood trauma due to the EVAD and associated valves was performed. Results indicated that none of the additives significantly reduced hemolysis under the conditions found in the mock loop. Finally, a compilation of data gathered in these experiments showed that the index of hemolysis (IH) is dependent on hematocrit (HCT), which suggests that another parameter, IH/HCT, may be more suited to the quantification of hemolysis.

  18. Acoustic determination of early stages of intravascular blood coagulation.

    PubMed

    Uzlova, Svetlana G; Guria, Konstantin G; Guria, Georgy Th

    2008-10-13

    The blood coagulation system (BCS) is a complex biological system playing a principal role in the maintenance of haemostasis. Insufficient activity of the BCS may lead to bleeding and blood loss (e.g. in the case of haemophilia). On the other hand, excessive activity may cause intravascular blood coagulation, thromboses and embolization. Most of the methods currently used for BCS monitoring suffer from the major disadvantage of being invasive. The purpose of the present work is to demonstrate the feasibility of using ultrasonic methods for non-invasive registration of the early stages of blood coagulation processes in intensive flows. With this purpose, a special experimental set-up was designed, facilitating the simultaneous detection of optical and acoustic signals during the clotting process. It was shown that (i) as microemboli appear in the flow during the early stage of blood coagulation, the intensity of the Doppler signal increases twofold, and (ii) microemboli formation in the early stages of blood clotting always reveals itself through an acoustic contrast. Both of these effects are well defined, so we hope that they may be used for non-invasive BCS monitoring in clinical practice.

  19. Monolithic CMUT on CMOS Integration for Intravascular Ultrasound Applications

    PubMed Central

    Zahorian, Jaime; Hochman, Michael; Xu, Toby; Satir, Sarp; Gurun, Gokce; Karaman, Mustafa; Degertekin, F. Levent

    2012-01-01

    One of the most important promises of capacitive micromachined ultrasonic transducer (CMUT) technology is integration with electronics. This approach is required to minimize the parasitic capacitances in the receive mode, especially in catheter based volumetric imaging arrays where the elements need to be small. Furthermore, optimization of the available silicon area and minimized number of connections occurs when the CMUTs are fabricated directly above the associated electronics. Here, we describe successful fabrication and performance evaluation of CMUT arrays for intravascular imaging on custom designed CMOS receiver electronics from a commercial IC foundry. The CMUT on CMOS process starts with surface isolation and mechanical planarization of the CMOS electronics to reduce topography. The rest of the CMUT fabrication is achieved by modifying a low temperature micromachining process through the addition of a single mask and developing a dry etching step to produce sloped sidewalls for simple and reliable CMUT to CMOS interconnection. This CMUT to CMOS interconnect method reduced the parasitic capacitance by a factor of 200 when compared with a standard wire bonding method. Characterization experiments indicate that the CMUT on CMOS elements are uniform in frequency response and are similar to CMUTs simultaneously fabricated on standard silicon wafers without electronics integration. Experiments on a 1.6 mm diameter dual-ring CMUT array with a 15 MHz center frequency show that both the CMUTs and the integrated CMOS electronics are fully functional. The SNR measurements indicate that the performance is adequate for imaging CTOs located 1 cm away from the CMUT array. PMID:23443701

  20. Heartbeat OCT: in vivo intravascular megahertz-optical coherence tomography.

    PubMed

    Wang, Tianshi; Pfeiffer, Tom; Regar, Evelyn; Wieser, Wolfgang; van Beusekom, Heleen; Lancee, Charles T; Springeling, Geert; Krabbendam, Ilona; van der Steen, Antonius F W; Huber, Robert; van Soest, Gijs

    2015-12-01

    Cardiac motion artifacts, non-uniform rotational distortion and undersampling affect the image quality and the diagnostic impact of intravascular optical coherence tomography (IV-OCT). In this study we demonstrate how these limitations of IV-OCT can be addressed by using an imaging system that we called "Heartbeat OCT", combining a fast Fourier Domain Mode Locked laser, fast pullback, and a micromotor actuated catheter, designed to examine a coronary vessel in less than one cardiac cycle. We acquired in vivo data sets of two coronary arteries in a porcine heart with both Heartbeat OCT, working at 2.88 MHz A-line rate, 4000 frames/s and 100 mm/s pullback speed, and with a commercial system. The in vivo results show that Heartbeat OCT provides faithfully rendered, motion-artifact free, fully sampled vessel wall architecture, unlike the conventional IV-OCT data. We present the Heartbeat OCT system in full technical detail and discuss the steps needed for clinical translation of the technology.

  1. Heartbeat OCT: in vivo intravascular megahertz-optical coherence tomography

    PubMed Central

    Wang, Tianshi; Pfeiffer, Tom; Regar, Evelyn; Wieser, Wolfgang; van Beusekom, Heleen; Lancee, Charles T.; Springeling, Geert; Krabbendam, Ilona; van der Steen, Antonius F.W.; Huber, Robert; van Soest, Gijs

    2015-01-01

    Cardiac motion artifacts, non-uniform rotational distortion and undersampling affect the image quality and the diagnostic impact of intravascular optical coherence tomography (IV-OCT). In this study we demonstrate how these limitations of IV-OCT can be addressed by using an imaging system that we called “Heartbeat OCT”, combining a fast Fourier Domain Mode Locked laser, fast pullback, and a micromotor actuated catheter, designed to examine a coronary vessel in less than one cardiac cycle. We acquired in vivo data sets of two coronary arteries in a porcine heart with both Heartbeat OCT, working at 2.88 MHz A-line rate, 4000 frames/s and 100 mm/s pullback speed, and with a commercial system. The in vivo results show that Heartbeat OCT provides faithfully rendered, motion-artifact free, fully sampled vessel wall architecture, unlike the conventional IV-OCT data. We present the Heartbeat OCT system in full technical detail and discuss the steps needed for clinical translation of the technology. PMID:26713214

  2. Intra-Vascular Neural Interface with Nano-Wire Electrode

    NASA Astrophysics Data System (ADS)

    Watanabe, Hirobumi; Takahashi, Hirokazu; Nakao, Masayuki; Walton, Kerry; Llinás, Rodolfo R.

    A less-invasive recording technique capable of simultaneously monitoring the activity of significant number (103 ∼ 104) of neurons is a vital step in developing an effective brain-machine interface. Although there are many excellent techniques for recording activities of a single neuron or a group of neurons, there is no methodology for accessing large number of cells in a behaving experimental animal or human individual. Brain vascular parenchyma offers the promising candidate to solve this problem. We have proposed the use of myriad of nano-wire-electrodes that are introduced into the Central Nervous System through the vascular system to address any brain area. In this study we design a microcatheter for ex vivo experiments. Using a Wollaston platinum wire we design a submicron-scale electrode, and develop the fabrication method. We then evaluate the mechanical property of the electrode to flow into the intricacies of the capillary bed in ex vivo Xenopus laevis. Furthermore, we demonstrate the feasibility of intravascular recording in the spinal cord of Xenopus laevis.

  3. Light intensity matching between different intravascular optical coherence tomography systems

    NASA Astrophysics Data System (ADS)

    Liu, Shengnan; Eggermont, Jeroen; Nakatani, Shimpei; Lelieveldt, Boudewijn P. F.; Dijkstra, Jouke

    2016-02-01

    Currently two commercial intravascular optical coherence tomography (IVOCT) systems are available: Illumien Optis from St. Jude Medical (SJM) and Lunawave from Terumo. Both systems store the light intensity data in a raw vendor specific polar format. However, whereas SJM uses 16-bits per pixel Terumo uses 8-bits meaning the intensity values are in different ranges. This complicates quantitative light intensity based analysis when comparing results based on data from both systems. Therefore, this work aims to find an intensity transformation function from Terumo's 8-bit OFDI data to SJM's 16-bit range. The data consists of 8 pullbacks, 4 acquired with each system in the same arteries of 2 different patents pre- and post-stenting implantation. A total of 133 matching sections without stent struts from the two sets of pullbacks were identified based on landmarks such as side-branches and calcified regions. Since the main region of interest in the image is the tissue region only the pixels within 2mm behind the lumen border are used. In order to match the SJM data range, the Terumo data was rescaled and cumulative distribution functions (CDF) were calculated based on the histogram distributions. Comparing these CDFs, the transformation function can be determined. Application of this transformation function not only improves the visual similarity of matching slices it can also be used for further quantitative analysis.

  4. Cerebral Blood Volume MRI with Intravascular Superparamagentic Iron Oxide Nanoparticles

    PubMed Central

    Kim, Seong-Gi; Harel, Noam; Jin, Tao; Kim, Tae; Lee, Phil; Zhao, Fuqiang

    2013-01-01

    Cerebral blood volume (CBV) is a crucial physiological indicator of tissue viability and vascular reactivity. Thus, non-invasive CBV mapping has been of great interest. For this, ultrasmall superparamagnetic iron oxide nanoparticles (USPIO) including monocrystalline iron oxide nanoparticles (MION) can be used as long half-life, intravascular susceptibility agents of CBV MRI measurements. Also, CBV-weighted fMRI with USPIO provides enhanced sensitivity, reduced large vessel contribution, and improved spatial specificity compared to conventional blood oxygenation-level dependent (BOLD) fMRI, and measures a single physiological parameter that is easily interpretable. We review physiochemical and magnetic properties as well as pharmacokinetics of USPIO in brief. We then extensively discuss quantifications of baseline CBV, vessel size index, and functional CBV change. We also provide reviews of dose-dependent sensitivity, vascular filter function, specificity, characteristics, and impulse response function of CBV fMRI. Examples of CBV fMRI specificity at the laminar and columnar resolution are provided. Finally, we briefly review application of CBV measurements to functional and pharmacological studies in animals. Overall, the use of USPIO can determine baseline CBV and its changes induced by functional activity and pharmacological interventions. PMID:23208650

  5. Trombocytopenia: one of the markers of disseminated intravascular coagulation.

    PubMed

    Ten Cate, Hugo

    Disseminated intravascular coagulation (DIC) is a complication of a variety of severe underlying diseases and a contributing factor in multi-organ failure and death. DIC is diagnosed on the basis of clinical findings (organ failure, bleeding) and laboratory abnormalities. The laboratory data include (repeated) measurements of platelet count and global clotting tests, to which more specific and sensitive tests for activated coagulation are added. The focus of this paper is on thrombocytopenia (platelet count < 100 x 103/microl) as a marker in DIC. First, in patients with suspected DIC it is imperative to consider alternative causes of thrombocytopenia,such as related to heparin use (heparin induced thrombocytopenia II) or thrombocytopenic purpura. Second, the observation of thrombocytopenia in relation to DIC should be interpreted as a marker of advanced or overt DIC and not as an early indicator. According to recommended guidelines measurements of platelet counts should always be coupled to a panel of coagulation markers and not be used as single marker of DIC (or other syndromes). In general, thrombocytopenia should not trigger platelet transfusions except in patients with severe bleeding complications.

  6. Biochemistry and pathophysiology of intravascular and intracellular lipolysis

    PubMed Central

    Young, Stephen G.; Zechner, Rudolf

    2013-01-01

    All organisms use fatty acids (FAs) for energy substrates and as precursors for membrane and signaling lipids. The most efficient way to transport and store FAs is in the form of triglycerides (TGs); however, TGs are not capable of traversing biological membranes and therefore need to be cleaved by TG hydrolases (“lipases”) before moving in or out of cells. This biochemical process is generally called “lipolysis.” Intravascular lipolysis degrades lipoprotein-associated TGs to FAs for their subsequent uptake by parenchymal cells, whereas intracellular lipolysis generates FAs and glycerol for their release (in the case of white adipose tissue) or use by cells (in the case of other tissues). Although the importance of lipolysis has been recognized for decades, many of the key proteins involved in lipolysis have been uncovered only recently. Important new developments include the discovery of glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1), the molecule that moves lipoprotein lipase from the interstitial spaces to the capillary lumen, and the discovery of adipose triglyceride lipase (ATGL) and comparative gene identification-58 (CGI-58) as crucial molecules in the hydrolysis of TGs within cells. This review summarizes current views of lipolysis and highlights the relevance of this process to human disease. PMID:23475957

  7. Acute hemolytic vascular inflammatory processes are prevented by nitric oxide replacement or a single dose of hydroxyurea.

    PubMed

    Almeida, Camila Bononi; Souza, Lucas Eduardo Botelho; Leonardo, Flavia Costa; Costa, Fabio Trindade Maranhão; Werneck, Claudio C; Covas, Dimas Tadeu; Costa, Fernando Ferreira; Conran, Nicola

    2015-08-06

    Hemolysis and consequent release of cell-free hemoglobin (CFHb) impair vascular nitric oxide (NO) bioavailability and cause oxidative and inflammatory processes. Hydroxyurea (HU), a common therapy for sickle cell disease (SCD), induces fetal Hb production and can act as an NO donor. We evaluated the acute inflammatory effects of intravenous water-induced hemolysis in C57BL/6 mice and determined the abilities of an NO donor, diethylamine NONOate (DEANO), and a single dose of HU to modulate this inflammation. Intravenous water induced acute hemolysis in C57BL/6 mice, attaining plasma Hb levels comparable to those observed in chimeric SCD mice. This hemolysis resulted in significant and rapid systemic inflammation and vascular leukocyte recruitment within 15 minutes, accompanied by NO metabolite generation. Administration of another potent NO scavenger (2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide) to C57BL/6 mice induced similar alterations in leukocyte recruitment, whereas hemin-induced inflammation occurred over a longer time frame. Importantly, the acute inflammatory effects of water-induced hemolysis were abolished by the simultaneous administration of DEANO or HU, without altering CFHb, in an NO pathway-mediated manner. In vitro, HU partially reversed the Hb-mediated induction of endothelial proinflammatory cytokine secretion and adhesion molecule expression. In summary, pathophysiological levels of hemolysis trigger an immediate inflammatory response, possibly mediated by vascular NO consumption. HU presents beneficial anti-inflammatory effects by inhibiting rapid-onset hemolytic inflammation via an NO-dependent mechanism, independently of fetal Hb elevation. Data provide novel insights into mechanisms of hemolytic inflammation and further support perspectives for the use of HU as an acute treatment for SCD and other hemolytic disorders.

  8. Acute Arterial Thrombosis of the Hand.

    PubMed

    Iannuzzi, Nicholas P; Higgins, James P

    2015-10-01

    Arterial thrombosis of the hand occurs infrequently but may result in considerable morbidity and compromise of hand function. The hand surgeon may be called upon to direct management in cases of acute arterial thrombosis of the hand and should have an understanding of the available diagnostic tools and treatment modalities. This article discusses the vascular anatomy of the hand and clinical manifestations of arterial thrombosis. Differences between isolated thrombosis and diffuse intravascular injury are detailed, and treatment options for these conditions are described. Appropriate care often requires coordination with interventional radiologists or vascular surgeons. Outcomes after treatment of arterial thrombosis of the hand are variable, and prognosis may be related to whether isolated thrombosis or diffuse intravascular injury is present.

  9. G6PD deficiency and fava bean consumption do not produce hemolysis in Thailand.

    PubMed

    Kitayaporn, D; Charoenlarp, P; Pattaraarechachai, J; Pholpoti, T

    1991-06-01

    Favism, a hemolytic condition associated with fava bean consumption among the glucose-6-phosphate dehydrogenase (G6PD) deficient persons, is well described in the Middle East and Mediterranean areas. However, it is not well documented among the Thais or other Southeast Asians. It is possible that it does exist but that hemolysis which develops is of very minor degree and thus escapes clinical detection. This cross-sectional study hypothesizes that if the fava bean and G6PD deficiency interact in the Thai population, they should cause a significant difference in hematocrit level. The study was carried out in a community hospital in a malaria endemic area. We found that there was a trivial difference of the hematocrit (approximately 1%) which was too small to warrant any clinical significance after controlling for the extraneous effects of age, sex, use of malaria chemoprophylaxis, falciparum infection, use of analgesics/antipyretics and admission status of the patients (p = 0.668). This may be due to the presence of different G6PD mutants to those found elsewhere or due to different consumption patterns of fava beans among the Thais compared to people in other areas with high prevalence of G6PD deficiency.

  10. A teaspoon pump for pumping blood with high hydraulic efficiency and low hemolysis potential.

    PubMed

    Dame, D

    1996-06-01

    Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.

  11. Prevention of complement-mediated immune hemolysis by a small molecule compound.

    PubMed

    Mqadmi, Amina; Zheng, Xiaoying; Song, Jinmei; Abramowitz, Steven; Giclas, Patricia; Yazdanbakhsh, Karina

    2004-12-24

    Complement sensitization of red blood cells (RBCs) can result in transfusion reactions and hemolytic anemias. We hypothesized that manipulating the complement system using small organic molecules might prevent RBC destruction, thereby prolonging RBC survival in patients. Using a simple, rapid, large-scale hemolytic assay, we screened a 10,000 compound library, enriched in anti-inflammatory compounds at a final concentration of 25 microM, and identified a 549Da compound (C(34)H(24)N(6)O(2)) with a symmetrical structure containing two benzimidazole rings that, as compared to a known anti-complement molecule FUT-175, was more effective in reducing hemolysis by the classical pathway and had comparable anti-hemolytic activity against the alternative pathway. Furthermore, in a xenotransfusion mouse model, treatment of mice with 1.2mg/kg of the compound significantly prolonged the survival of transfused RBCs, reducing C3 deposition, but not the deposition of control IgG or IgM, for the first hour post-transfusion. These data suggest that further studies are warranted to determine if this compound has usefulness in a transfusion setting.

  12. Aeromonas hydrophila isolated from food and drinking water: hemagglutination, hemolysis, and cytotoxicity for a human intestinal cell line (HT-29).

    PubMed Central

    Handfield, M; Simard, P; Couillard, M; Letarte, R

    1996-01-01

    Aeromonas hydrophila isolated from food and drinking water was tested for pathogenicity by studying its hemolysis, hemagglutination, and cytotoxicity. Hemolysis, tested on erythrocytes from six different species, was more frequently seen with water isolates (64%) than with food isolates (48%). Hemagglutination was more frequently encountered with food isolates (92%) than with water isolates (73%). Cytotoxicity, evaluated on seven cell lines, was frequently observed with food isolates (92%) and with water isolates (73%). Heat treatment (56 degrees C for 10 min) of culture supernatant fluids inhibited the toxicity of some but not all toxin-producing isolates. Our results suggest that the human intestinal cell line HT-29 could be a useful complement for testing A. hydrophila exotoxins and for studying the enteropathogenicity of this species for humans. PMID:8795237

  13. [Nanocerium restores the erythrocytes stability to acid hemolysis by inhibition of oxygen and nitrogen reactive species in old rats].

    PubMed

    Kotsuruba, A V; Kopjak, B S; Sagach, V F; Spivak, N Ja

    2015-01-01

    In experiments in vivo the effect of nanocerium (cerium oxide nanoparticles) on the stability of red blood cells to acid hemolysis, levels of both ROS and RNS generation and H2S pools in plasma and erythrocytes of old rats were investigated. In red blood cells of old rats the proton penetration into the matrix of erythrocytes showed a significant raising and the fate of labile "aging" erythrocytes in old animals compared with adult were up- regulated. These phenomena paralleled with significant up-regulation of ROS and RNS generation. Introduction for 14 days per os to old rats 0.1 mg/kg of nanocerium fully restored resistance of erythrocytes to acid hemolysis by ROS and RNS in both plasma and erythrocytes reduction. Nanocerium decreased the erythrocytes and, conversely, significantly increased the plasma's pools of H2S.

  14. Calculation of intravascular signal in dynamic contrast enhanced-MRI using adaptive complex independent component analysis.

    PubMed

    Mehrabian, Hatef; Chopra, Rajiv; Martel, Anne L

    2013-04-01

    Assessing tumor response to therapy is a crucial step in personalized treatments. Pharmacokinetic (PK) modeling provides quantitative information about tumor perfusion and vascular permeability that are associated with prognostic factors. A fundamental step in most PK analyses is calculating the signal that is generated in the tumor vasculature. This signal is usually inseparable from the extravascular extracellular signal. It was shown previously using in vivo and phantom experiments that independent component analysis (ICA) is capable of calculating the intravascular time-intensity curve in dynamic contrast enhanced (DCE)-MRI. A novel adaptive complex independent component analysis (AC-ICA) technique is developed in this study to calculate the intravascular time-intensity curve and separate this signal from the DCE-MR images of tumors. The use of the complex-valued DCE-MRI images rather than the commonly used magnitude images satisfied the fundamental assumption of ICA, i.e., linear mixing of the sources. Using an adaptive cost function in ICA through estimating the probability distribution of the tumor vasculature at each iteration resulted in a more robust and accurate separation algorithm. The AC-ICA algorithm provided a better estimate for the intravascular time-intensity curve than the previous ICA-based method. A simulation study was also developed in this study to realistically simulate DCE-MRI data of a leaky tissue mimicking phantom. The passage of the MR contrast agent through the leaky phantom was modeled with finite element analysis using a diffusion model. Once the distribution of the contrast agent in the imaging field of view was calculated, DCE-MRI data was generated by solving the Bloch equation for each voxel at each time point. The intravascular time-intensity curve calculation results were compared to the previously proposed ICA-based intravascular time-intensity curve calculation method that applied ICA to the magnitude of the DCE-MRI data

  15. Evidence for coupling of Clostridium perfringens alpha-toxin-induced hemolysis to stimulated phosphatidic acid formation in rabbit erythrocytes.

    PubMed Central

    Sakurai, J; Ochi, S; Tanaka, H

    1993-01-01

    When rabbit erythrocytes were exposed to low concentrations of Clostridium perfringens alpha-toxin, hot-cold hemolysis was observed. The toxin induced production of phosphatidic acid (PA) in a dose-dependent manner when incubated with erythrocytes at 37 degrees C. When erythrocyte membranes were incubated with the toxin and [gamma-32P]ATP in the presence or absence of ethanol, [32P]PA formation was maximal within 30 s, then sharply decreased, and began again after 5 min of incubation. Ethanol had no effect on the early appearance (at approximately 5 min) of PA formation induced by the toxin but significantly inhibited formation of PA over 10 min of incubation. Treatment of erythrocyte membranes with alpha-toxin resulted in the biphasic formation of 1,2-diacylglycerol and PA as well as an increase of inositol-1,4,5-trisphosphate (IP3) and decrease of phosphatidylinositol-4,5-bisphosphate (PIP2) within 30 s. Neomycin inhibited the toxin-induced increase in turbidity of egg yolk suspensions but did not inhibit the toxin-induced hemolysis of intact erythrocytes. On the other hand, neomycin inhibited the toxin-induced hemolysis of saponin-treated erythrocytes. In addition, neomycin inhibited PA formation induced by the toxin in erythrocyte membranes. IP3 was released by incubation of PIP2 with erythrocyte membranes but not by incubation of PIP2 with the toxin. The toxin stimulated the membrane-induced release of IP3 from PIP2. These data suggest that the toxin-induced hemolysis is dependent on the action of phospholipase C in erythrocyte membranes. PMID:8395469

  16. HHV-8 and EBV-positive intravascular lymphoma: an unusual presentation of extracavitary primary effusion lymphoma

    PubMed Central

    Crane, Genevieve M.; Ambinder, Richard F.; Shirley, Courtney M.; Fishman, Elliot K.; Kasamon, Yvette L.; Taube, Janis M.; Borowitz, Michael J.; Duffield, Amy S.

    2014-01-01

    Intravascular lymphomas are rare and aggressive hematolymphoid tumors. Here we describe a human herpesvirus type-8/Kaposi sarcoma-associated herpesvirus (HHV-8/KSHV) and Epstein-Barr virus (EBV) positive intravascular lymphoma. The patient was a 59 year-old HIV-positive man who presented with diarrhea, abdominal pain, fevers, night sweats, and weight loss. Radiographic studies of the abdomen and pelvis revealed numerous subcentimeter nodules within the subcutaneous fat that lacked connection to the skin. An excisional biopsy demonstrated large atypical cells within vessels in the deep subcutaneous fat, and many of the vessels contained extensive organizing thrombi. The atypical cells lacked strong expression of most B-cell markers but were positive for MUM-1 and showed partial expression of several T-cell markers. An immunohistochemical stain for HHV-8 and an in situ hybridization for EBV were both positive in the neoplastic cells. The disease had a rapidly progressive and fatal course. This lymphoma appears to represent an entirely intravascular form of primary effusion lymphoma, and highlights the propensity for HHV-8 and EBV-positive lymphoid neoplasms to show aberrant expression of T-cell markers, illustrates the utility of skin biopsies for the diagnosis of intravascular lymphoma, and suggests that biopsies to evaluate for intravascular lymphoma should be relatively deep and include subcutaneous fat. PMID:24525514

  17. Platelets and neutrophil extracellular traps collaborate to promote intravascular coagulation during sepsis in mice.

    PubMed

    McDonald, Braedon; Davis, Rachelle P; Kim, Seok-Joo; Tse, Mandy; Esmon, Charles T; Kolaczkowska, Elzbieta; Jenne, Craig N

    2017-03-09

    Neutrophil extracellular traps (NETs; webs of DNA coated in antimicrobial proteins) are released into the vasculature during sepsis where they contribute to host defense, but also cause tissue damage and organ dysfunction. Various components of NETs have also been implicated as activators of coagulation. Using multicolor confocal intravital microscopy in mouse models of sepsis, we observed profound platelet aggregation, thrombin activation, and fibrin clot formation within (and downstream of) NETs in vivo. NETs were critical for the development of sepsis-induced intravascular coagulation regardless of the inciting bacterial stimulus (gram-negative, gram-positive, or bacterial products). Removal of NETs via DNase infusion, or in peptidylarginine deiminase-4-deficient mice (which have impaired NET production), resulted in significantly lower quantities of intravascular thrombin activity, reduced platelet aggregation, and improved microvascular perfusion. NET-induced intravascular coagulation was dependent on a collaborative interaction between histone H4 in NETs, platelets, and the release of inorganic polyphosphate. Real-time perfusion imaging revealed markedly improved microvascular perfusion in response to the blockade of NET-induced coagulation, which correlated with reduced markers of systemic intravascular coagulation and end-organ damage in septic mice. Together, these data demonstrate, for the first time in an in vivo model of infection, a dynamic NET-platelet-thrombin axis that promotes intravascular coagulation and microvascular dysfunction in sepsis.

  18. Percutaneous Retrieval of Misplaced Intravascular Foreign Objects with the Dormia Basket: An Effective Solution

    SciTech Connect

    Sheth, Rahul Someshwar, Vimal; Warawdekar, Gireesh

    2007-02-15

    Purpose. We report our experience of the retrieval of intravascular foreign body objects by the percutaneous use of the Gemini Dormia basket. Methods. Over a period of 2 years we attempted the percutaneous removal of intravascular foreign bodies in 26 patients. Twenty-six foreign bodies were removed: 8 intravascular stents, 4 embolization coils, 9 guidewires, 1 pacemaker lead, and 4 catheter fragments. The percutaneous retrieval was achieved with a combination of guide catheters and the Gemini Dormia basket. Results. Percutaneous retrieval was successful in 25 of 26 patients (96.2%). It was possible to remove all the intravascular foreign bodies with a combination of guide catheters and the Dormia basket. No complication occurred during the procedure, and no long-term complications were registered during the follow-up period, which ranged from 6 months to 32 months (mean 22.4 months overall). Conclusion. Percutaneous retrieval is an effective and safe technique that should be the first choice for removal of an intravascular foreign body.

  19. Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

    PubMed Central

    Yu, Robinson K.; Ghodadra, Anish; Agarwal, Vikas

    2016-01-01

    Background Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. Methods Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate. Results Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P<0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both. Conclusions An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. PMID:28097241

  20. Acute myocardial infarction as a finding of acute promyelocytic leukemia-related coagulation disorder.

    PubMed

    Özkurt, Zübeyde N; Aypar, Eda; Sarifakiogullari, Serpil; Taçoy, Gülten; Özdag, Murat; Kahraman, Seda; Çengel, Atiye

    2015-12-01

    Acute promyelocytic leukemia (APL) has one of the most favorable prognoses among other leukemia subtypes. However, the major cause of mortality in APL is disseminated intravascular coagulation at the presentation. We present a case of acute myocardial infarction (MI) at the time of APL diagnosis before treatment. The patient suffered from chest pain, sweating and giddiness. He was hypoxic, hypotensive and bradycardic. ECG showed inferior MI. Unfractioned heparin infusion (850 U/h) was started and 5 min after the previous ECG showed total ST resolution. We suggest that in this case, MI was not related to atherosclerotic plaque rupture but related to DIC manifestation.

  1. Effect of air exposure and suction on blood cell activation and hemolysis in an in vitro cardiotomy suction model.

    PubMed

    El-Sabbagh, Ahmed M; Toomasian, Cory J; Toomasian, John M; Ulysse, Guerlain; Major, Terry; Bartlett, Robert H

    2013-01-01

    Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The cause may include surface-induced leukocyte activation and hemolysis. A study was designed to describe the effects of both suction and an air-blood interface independently and in combination on leukocyte and platelet activation, and hemolysis in an in vitro model. Fresh human blood was drawn and tested in four different conditions including control (A), 10 minutes of -600 mm Hg suction (B), 10 minutes of blood exposure to room air at 100 ml/min (C), and 10 minutes of simultaneous suction and air flow (D). Samples were analyzed by flow cytometry (platelets and leukocytes) and plasma-free hemoglobin (PFHb). Leukocyte CD11b expression and platelet P-selectin (CD62P) were analyzed by flow cytometry. In comparison with baseline, granulocytes were significantly activated by air (group C, p = 0.0029) and combination (group D, p = 0.0123) but not by suction alone (group B). Monocytes and platelets were not significantly activated in any group. The PFHb increased significantly in group C (p < 0.001) and group D (p < 0.001). This study suggests that the inflammatory response and associated hemolysis during CPB may be related to air exposure, which could be reduced by minimizing the air exposure of air to blood during cardiotomy suction.

  2. Protection of Clitoria ternatea flower petal extract against free radical-induced hemolysis and oxidative damage in canine erythrocytes.

    PubMed

    Phrueksanan, Wathuwan; Yibchok-anun, Sirinthorn; Adisakwattana, Sirichai

    2014-10-01

    The present study assessed the antioxidant activity and protective ability of Clitoria ternatea flower petal extract (CTE) against in vitro 2,2'-azobis-2-methyl-propanimidamide dihydrochloride (AAPH)-induced hemolysis and oxidative damage of canine erythrocytes. From the phytochemical analysis, CTE contained phenolic compounds, flavonoids, and anthocyanins. In addition, CTE showed antioxidant activity as measured by oxygen radical absorbance capacity (ORAC) method and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay. CTE (400 µg/ml) remarkably protected erythrocytes against AAPH-induced hemolysis at 4 h of incubation. Moreover, CTE (400 µg/ml) reduced membrane lipid peroxidation and protein carbonyl group formation and prevented the reduction of glutathione concentration in AAPH-induced oxidation of erythrocytes. The AAPH-induced morphological alteration of erythrocytes from a smooth discoid to an echinocytic form was effectively protected by CTE. The present results contribute important insights that CTE may have the potential to act as a natural antioxidant to prevent free radical-induced hemolysis, protein oxidation and lipid peroxidation in erythrocytes.

  3. Protective effects of kaempferol against reactive oxygen species-induced hemolysis and its antiproliferative activity on human cancer cells.

    PubMed

    Liao, Wenzhen; Chen, Luying; Ma, Xiang; Jiao, Rui; Li, Xiaofeng; Wang, Yong

    2016-05-23

    The protective effects of kaempferol against reactive oxygen species (ROS)-induced hemolysis and its antiproliferative activity on human cancer cells were evaluated in this study. Kaempferol exhibited strong cellular antioxidant ability (CAA) with a CAA value of 59.80 ± 0.379 μM of quercetin (QE)/100 μM (EC50 = 7.74 ± 0.049 μM). Pretreatment with kaempferol significantly attenuated the ROS-induced hemolysis of human erythrocyte (87.4% hemolysis suppressed at 100 μg/mL) and reduced the accumulation of toxic lipid peroxidation product malondialdehyde (MDA). The anti-hemolytic activity of kaempferol was mainly through scavenging excessive ROS and preserving the intrinsic antioxidant enzymes (superoxide dismutase, SOD; catalase, CAT; and glutathione peroxidase, GPx) activities in normal levels. Additionally, kaempferol showed significant antiproliferative activity on a panel of human cancer cell lines including human breast carcinoma (MCF-7) cells, human stomach carcinoma (SGC-7901) cells, human cervical carcinoma (Hela) cells and human lung carcinoma (A549) cells. Kaemperol induced apoptosis of MCF-7 cells accompanied with nuclear condensation and mitochondria dysfunction.

  4. Mechanotransductional Basis of Endothelial Cell Response to Intravascular Bubbles

    PubMed Central

    Klinger, Alexandra L.; Pichette, Benjamin; Sobolewski, Peter; Eckmann, David M.

    2011-01-01

    Vascular air embolism resulting from too rapid decompression is a well-known risk in deep-sea diving, aviation and space travel. It is also a common complication during surgery or other medical procedures when air or other endogenously administered gas is entrained in the circulation. Preventive and post-event treatment options are extremely limited for this dangerous condition, and none of them address the poorly understood pathophysiology of endothelial response to intravascular bubble presence. Using a novel apparatus allowing precise manipulation of microbubbles in real time fluorescence microscopy studies, we directly measure human umbilical vein endothelial cell responses to bubble contact. Strong intracellular calcium transients requiring extracellular calcium are observed upon cell-bubble interaction. The transient is eliminated both by the presence of the stretch activated channel inhibitor, gadolinium, and the transient receptor potential vanilliod family inhibitor, ruthenium red. No bubble induced calcium upsurge occurs if the cells are pretreated with an inhibitor of actin polymerization, cytochalasin-D. This study explores the biomechanical mechanisms at play in bubble interfacial interactions with endothelial surface layer (ESL) macromolecules, reassessing cell response after selective digestion of glycocalyx glycosoaminoglycans, hyaluran (HA) and heparin sulfate (HS). HA digestion causes reduction of cell-bubble adherence and a more rapid induction of calcium influx after contact. HS depletion significantly decreases calcium transient amplitudes, as does pharmacologically induced sydencan ectodomain shedding. The surfactant perfluorocarbon oxycyte abolishes any bubble induced calcium transient, presumably through direct competition with ESL macromolecules for interfacial occupancy, thus attenuating the interactions that trigger potentially deleterious biochemical pathways. PMID:21931900

  5. Central respiratory and circulatory depression caused by intravascular saxitoxin

    PubMed Central

    Borison, H.L.; Culp, W.J.; Gonsalves, S.F.; McCarthy, L.E.

    1980-01-01

    1 In cats anaesthetized with pentobarbitone and vagotomized, observations were made on the phrenic nerve action potential and the diaphragm electromyogram (EMG) at constant end-tidal Pco2. Arterial blood pressure was stabilized by intravenous infusions of noradrenaline. 2 Intravenous administration of saxitoxin (STX) initially abolished respiratory activity in the EMG and caused a slowing of oscillation in the central phrenic neurogram. Additional STX produced apneustic phrenic discharges followed by a progressive loss of nerve action potentials. 3 The inspiratory centre in the medulla oblongata was stimulated electrically to evoke a sustained phrenic nerve discharge. STX, given intravenously, resulted in the elimination of spontaneous nerve activity without interfering with the evoked response. 4 The cephalic intravascular infusion of STX into a carotid or vertebral artery depressed spontaneous respiratory activity while sparing EMG activity evoked by electrical stimulation of the intact phrenic nerve. 5 Spontaneous respiratory discharge in the phrenic nerve was eliminated by smaller doses of STX administered intra-arterially than were required intravenously. In addition, onset of and recovery from neural silence occurred faster following intra-arterial injection of STX. 6 Depressant effects on arterial blood pressure coincided with those on respiration when STX was given intra-arterially. 7 An electrophysiological assay on frog sartorius muscle was used to measure STX in the cerebrospinal fluid. Levels of STX detected were proportional to amounts of the toxin infused intra-arterially. 8 It is concluded that STX exchanges rapidly between blood and brain to bring about central depression and this adds to its peripheral paralytic actions. PMID:7357210

  6. Protection against high intravascular pressure in giraffe legs.

    PubMed

    Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian

    2013-11-01

    The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure.

  7. Fast treatment planning with IVUS imaging in intravascular brachytherapy

    NASA Astrophysics Data System (ADS)

    Novario, Raffaele; Bianchi, Carla; Lorusso, Rita; Sampietro, Chiara; Tanzi, Fabio; Conte, Leopoldo; Vescovi, Mario; Caccia, Massimo; Alemi, Mario; Cappellini, Chiara

    2004-05-01

    The planned target volume in intracoronary brachytherapy is the vessel wall. The success of the treatment is based on the need of delivering doses possibly not lower than 8 and not higher than 30 Gy. An automatic procedure in order to acquire intravascular ultrasound images of the whole volume to be irradiated is pointed out; a motor driven pullback device, with velocity of the catheter of 0.5 and 1 mm/s allows to acquire the entire target volume of the vessel with a number of slices normally ranging from 400 to 1600. A semiautomatic segmentation and classification of the different structures in each slice of the vessel is proposed. The segmentation and the classification of the structures allows the calculation of their volume; this is very useful in particular for plaque volume assessment in the follow-up of the patients. A 3D analyser tool was developed in order to visualize the walls and the lumen of the vessel. The knowledge, for each axial slice, of the position of the source (in the centre of the catheter) and the position of the target (vessel walls) allows the calculation of a set of source-target distances. Given a time of irradiation, and a type of source a dose volume histogram (DVH) describing the distribution of the doses in the whole target can be obtained. The whole procedure takes few minutes and then is compatible with a safe treatment of the patient, giving an important indication about the quality of the radiation treatment selected.

  8. Monolithic CMUT-on-CMOS integration for intravascular ultrasound applications.

    PubMed

    Zahorian, Jaime; Hochman, Michael; Xu, Toby; Satir, Sarp; Gurun, Gokce; Karaman, Mustafa; Degertekin, F Levent

    2011-12-01

    One of the most important promises of capacitive micromachined ultrasonic transducer (CMUT) technology is integration with electronics. This approach is required to minimize the parasitic capacitances in the receive mode, especially in catheter-based volumetric imaging arrays, for which the elements must be small. Furthermore, optimization of the available silicon area and minimized number of connections occurs when the CMUTs are fabricated directly above the associated electronics. Here, we describe successful fabrication and performance evaluation of CMUT arrays for intravascular imaging on custom-designed CMOS receiver electronics from a commercial IC foundry. The CMUT-on-CMOS process starts with surface isolation and mechanical planarization of the CMOS electronics to reduce topography. The rest of the CMUT fabrication is achieved by modifying a low-temperature micromachining process through the addition of a single mask and developing a dry etching step to produce sloped sidewalls for simple and reliable CMUT-to-CMOS interconnection. This CMUT-to-CMOS interconnect method reduced the parasitic capacitance by a factor of 200 when compared with a standard wire-bonding method. Characterization experiments indicate that the CMUT-on-CMOS elements are uniform in frequency response and are similar to CMUTs simultaneously fabricated on standard silicon wafers without electronics integration. Ex- periments on a 1.6-mm-diameter dual-ring CMUT array with a center frequency of 15 MHz show that both the CMUTs and the integrated CMOS electronics are fully functional. The SNR measurements indicate that the performance is adequate for imaging chronic total occlusions located 1 cm from the CMUT array.

  9. Hepatic abscess-associated Clostridial bacteraemia presenting with intravascular haemolysis and severe hypertension

    PubMed Central

    Lim, Andrew George; Rudd, Kristina Elizabeth; Halliday, Melissa; Hess, John Rider

    2016-01-01

    Summary Clostridium perfringens bacteraemia is a potentially fatal condition, and its early identification is paramount to maximise chances of survival. Prompt recognition of intravascular haemolysis, a known complication of C. perfringens bacteraemia, can help guide clinical decision-making before microbiology data becomes available. We present a novel finding of severe hypertension in a fatal case of Clostridial bacteraemia with massive haemolysis. A 58-year-old man with no known medical history presented to the emergency department with malaise, fever and hypertension. He developed abdominal pain and a hepatic abscess was identified on CT imaging. Within 4 h of presentation, he developed massive intravascular haemolysis, extreme hypertension, pulmonary oedema and respiratory failure. He died less than 8 h after presentation. His blood cultures subsequently grew C. perfringens. This case underscores the importance of early recognition of intravascular haemolysis complicating C. perfringens bacteraemia, and discusses the rare complication of hypertensive emergency in this setting. PMID:26823354

  10. Nonlinear dynamic characteristics of SMA intravascular stent under radial stochastic loads.

    PubMed

    Zhu, Zhiwen; Zhang, Qingxin; Xu, Jia

    2014-01-01

    Nonlinear dynamic characteristics of shape memory alloy (SMA) intravascular stent under radial stochastic loads were studied in this paper. Von de Pol item was improved to interpret the hysteretic phenomena of SMA, and the nonlinear dynamic model of SMA intravascular stent under radial stochastic loads was developed. The conditions of stochastic stability of the system were obtained in singular boundary theory. The steady-state probability density function of the dynamic response of the system was given, and the stochastic Hopf bifurcation characteristics of the system were analyzed. Theoretical analysis and numerical simulation show that the stability of the trivial solution varies with bifurcation parameters, and stochastic Hopf bifurcation appears in the process, which can cause stent fracture or loss. The results of this paper are helpful to application of SMA intravascular stent in biomedical engineering fields.

  11. Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview.

    PubMed

    Tenekecioglu, Erhan; Albuquerque, Felipe N; Sotomi, Yohei; Zeng, Yaping; Suwannasom, Pannipa; Tateishi, Hiroki; Cavalcante, Rafael; Ishibashi, Yuki; Nakatani, Shimpei; Abdelghani, Mohammad; Dijkstra, Jouke; Bourantas, Christos; Collet, Carlos; Karanasos, Antonios; Radu, Maria; Wang, Ancong; Muramatsu, Takashi; Landmesser, Ulf; Okamura, Takayuki; Regar, Evelyn; Räber, Lorenz; Guagliumi, Giulio; Pyo, Robert T; Onuma, Yoshinobu; Serruys, Patrick W

    2017-01-21

    By providing valuable information about the coronary artery wall and lumen, intravascular imaging may aid in optimizing interventional procedure results and thereby could improve clinical outcomes following percutaneous coronary intervention (PCI). Intravascular optical coherence tomography (OCT) is a light-based technology with a tissue penetration of approximately 1 to 3 mm and provides near histological resolution. It has emerged as a technological breakthrough in intravascular imaging with multiple clinical and research applications. OCT provides detailed visualization of the vessel following PCI and provides accurate assessment of post-procedural stent performance including detection of edge dissection, stent struts apposition, tissue prolapse, and healing parameters. Additionally, it can provide accurate characterization of plaque morphology and provides key information to optimize post-procedural outcomes. This manuscript aims to review the current clinical and research applications of intracoronary OCT and summarize the analytic OCT imaging software packages currently available. © 2017 Wiley Periodicals, Inc.

  12. High-sensitivity intravascular photoacoustic imaging of lipid–laden plaque with a collinear catheter design

    PubMed Central

    Cao, Yingchun; Hui, Jie; Kole, Ayeeshik; Wang, Pu; Yu, Qianhuan; Chen, Weibiao; Sturek, Michael; Cheng, Ji-Xin

    2016-01-01

    A highly sensitive catheter probe is critical to catheter-based intravascular photoacoustic imaging. Here, we present a photoacoustic catheter probe design on the basis of collinear alignment of the incident optical wave and the photoacoustically generated sound wave within a miniature catheter housing for the first time. Such collinear catheter design with an outer diameter of 1.6 mm provided highly efficient overlap between optical and acoustic waves over an imaging depth of >6 mm in D2O medium. Intravascular photoacoustic imaging of lipid-laden atherosclerotic plaque and perivascular fat was demonstrated, where a lab-built 500 Hz optical parametric oscillator outputting nanosecond optical pulses at a wavelength of 1.7 μm was used for overtone excitation of C-H bonds. In addition to intravascular imaging, the presented catheter design will benefit other photoacoustic applications such as needle-based intramuscular imaging. PMID:27121894

  13. A case of intravascular lymphoma complicated with Fournier's syndrome due to multidrug-resistant Pseudomonas aeruginosa.

    PubMed

    Kaya, Hiroyasu; Yoshida, Takashi

    2011-01-01

    Fournier's syndrome is the fulminant necrotizing fasciitis of the external genitalia. The occurrence of Fournier's syndrome in patients with hematologic malignancies has been reported. Here we report a case of an intravascular lymphoma complicated with Fournier's syndrome due to multidrug-resistant Pseudomonas aeruginosa (MDRP). A 71-year-old Japanese man received intensive chemotherapy for recurring intravascular lymphoma. Blood culture revealed MDRP, and physical examination led to the diagnosis of Fournier's syndrome. Aggressive treatment that comprised granulocyte transfusion, granulocyte stimulating factor, endotoxin filtration, appropriate antibiotic coverage, and aggressive surgical therapy was administered, and this lead to the successful recovery from sepsis and Fournier's syndrome.

  14. Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism

    SciTech Connect

    McDonald, Douglas K.; Kalva, Sanjeeva P. Fan, C.-M.; Vasilyev, Aleksandr

    2007-02-15

    We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism.

  15. Rifampicin-induced disseminated intravascular coagulation in pulmonary tuberculosis treatment

    PubMed Central

    Chen, Guo; He, Jian-Qing

    2017-01-01

    Abstract Rationale: Disseminated intravascular coagulation (DIC) induced by daily rifampicin therapy is rare, especially the patient is absent of malignancy, severe infection, and prior exposure to rifampicin. Patient concerns: We report a case of DIC induced by daily rifampicin treatment for pulmonary tuberculosis. A 22-year-old, previously healthy man received an anti-tuberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide on the daily dose recommended by the World Health Organization tuberculosis guidelines after a diagnosis of pulmonary tuberculosis. Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days. Diagnoses: Laboratory data and symptoms on admission indicated DIC. Interventions: The anti-tuberculosis drugs were discontinued after admission and he was initiated with targeted treatment for DIC, omeprazole and polyene hosphatidylcholine infusion, as well as nutrition supportive treatment. Five days after admission, ethambutol, moxifloxacin, and amikacin were added to the patient without further active hemorrhage. Eight days after admission, the platelet count had risen gradually. Isoniazid was administered on 24 days after admission, while his liver function tests and platelet counts returned to normal. No recurrence of DIC occurred. The diagnosis of rifampicin-induced DIC was confirmed. Outcomes: The patient recovered and left hospital with isoniazid, ethambutol, levofloxacin, and streptomycin after 4 weeks of hospitalization. There was no recurrence of DIC or hemorrhage during the 8 months of follow-up. The literature review revealed that there were 10 other cases of rifampicin-induced DIC. Only 4 cases received rifampicin on a daily basis for pulmonary tuberculosis treatment and the others were on intermittent dosing schedule for pulmonary tuberculosis or leprosy treatment. Lessons: As a rare adverse effect, DIC induced by

  16. Meta-analysis on intravascular low energy laser therapy

    NASA Astrophysics Data System (ADS)

    Zhao, Shu-Dong; Liu, Timon Cheng-Yi; Wang, Yan-Fang; Liu, Song-Hao

    2008-12-01

    Intravascular low energy laser therapy (ILELT) was put forward for cardiocirculatory diseases in USA in 1982, was popular in Russia in 1980s, and then in China in 1990s. The therapeutic effects of ILELT and drugs in comparison with drugs only on Chinese patients and their blood parameters were analyzed with meta-analyses and reported as (OR, 95%CI) for patient improvement and (WMD, 95% CI) for blood parameter improvement, where 95%CI, OR and WMD denoted 95% confidence intervals, odds ratio and weighted mean difference, respectively. It was found that the patients of cerebral infarction (2.39, 2.09~2.74) and cerebrovascular diseases (2.97, 1.69~2.53) were cured, respectively, (P < 0.01), and the symptom improvement of patients of cerebral infarction, cerebrovascular diseases and diabetes were significant (3.13, 2.79~3.51), (4.92, 3.39~7.14) , and (3.80, 2.79~5.18), and mild (3.66, 3.15~4.24), (4.95, 2.77~8.84), and (7.11, 4.54~11.13), respectively, (P < 0.01). It was also found that the blood parameters such as cholesterol (-0.78, -1.32~-0.24), total cholesterol (-1.08, -1.80~-0.36), low density lipoprotein cholesterol (-0.6, -1.01~-0.19), triacylglycerol (0.63, -0.83~-0.42), high density lipoprotein (0.34, 0.10~0.59), erythrocyte aggregation index (-0.24, -0.27~-0.21), erythrocyte Sedimentation Rate (-4.57, -7.26~-1.89), fibrinogen (-0.76, -1.31~-0.21), whole blood contrast viscosity (-0.40, -0.69~-0.12), low cut blood viscosity (-1.2, -1.93~-0.48), high cut blood viscosity (-0.62, -0.92~-0.32), whole blood viscosity(-1.2, -1.85~-0.54) and plasma blood contrast viscosity(-0.07, -0.12~-0.03) were found improved (P < 0.05). It is concluded that the patients of cerebral infarction, cerebrovascular diseases and diabetes might be improved with ILELT, which might be mediated by blood parameter improvement.

  17. Catheter-related infections: diagnosis and intravascular treatment.

    PubMed

    Bouza, E; Burillo, A; Muñoz, P

    2001-11-01

    catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called "antibiotic lock-in technique", which consists in locking the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

  18. Relation between baseline plaque features and subsequent coronary artery remodeling determined by optical coherence tomography and intravascular ultrasound.

    PubMed

    Xie, Zulong; Dong, Nana; Sun, Rong; Liu, Xinxin; Gu, Xia; Sun, Yong; Du, Hongwei; Dai, Jiannan; Liu, Youbin; Hou, Jingbo; Tian, Jinwei; Yu, Bo

    2017-01-17

    Atherosclerosis often leads to myocardial infarction and stroke. We examined the influence of baseline plaque characteristics on subsequent vascular remodeling in response to changes in plaque size. Using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), we examined 213 plaques from 138 patients with acute coronary syndrome at baseline and repeated IVUS at the 12-month follow-up. The change in external elastic membrane (EEM) area for each 1 mm2 change in plaque area (i.e., the slope of the regression line) was calculated as a measure of vascular remodeling capacity. In plaques with static positive remodeling, the slope was smaller than in plaques without static positive remodeling. In addition, the slope of the regression line for lesions with a large plaque burden was much smaller than that for lesions with a small plaque burden. Multivariate linear regression analysis showed that diabetes, calcification and static positive remodeling were inversely and independently associated with the level of change in EEM area/change in plaque area. Lesions with a large plaque burden, calcifications or static positive remodeling had less remodeling capacity, and calcification and static positive remodeling were independent predictors of reduced subsequent remodeling. Therefore, calcifications and static positive remodeling could be used as morphological biomarkers to predict decreased subsequent arterial remodeling.

  19. Integrin activation by P-Rex1 is required for selectin-mediated slow leukocyte rolling and intravascular crawling.

    PubMed

    Herter, Jan M; Rossaint, Jan; Block, Helena; Welch, Heidi; Zarbock, Alexander

    2013-03-21

    Integrin activation is essential for the function of leukocytes. Impaired integrin activation on leukocytes is the hallmark of the leukocyte adhesion deficiency syndrome in humans, characterized by impaired leukocyte recruitment and recurrent infections. In inflammation, leukocytes collect different signals during the contact with the microvasculature, which activate signaling pathways leading to integrin activation and leukocyte recruitment. We report the role of P-Rex1, a Rac-specific guanine nucleotide exchanging factor, in integrin activation and leukocyte recruitment. We find that P-Rex1 is required for inducing selectin-mediated lymphocyte function-associated antigen-1 (LFA-1) extension that corresponds to intermediate affinity and induces slow leukocyte rolling, whereas P-Rex1 is not involved in the induction of the high-affinity conformation of LFA-1 obligatory for leukocyte arrest. Furthermore, we demonstrate that P-Rex1 is involved in Mac-1-dependent intravascular crawling. In vivo, both LFA-1-dependent slow rolling and Mac-1-dependent crawling are defective in P-Rex1(-/-) leukocytes, whereas chemokine-induced arrest and postadhesion strengthening remain intact in P-Rex1-deficient leukocytes. Rac1 is involved in E-selectin-mediated slow rolling and crawling. In vivo, in an ischemia-reperfusion-induced model of acute kidney injury, abolished selectin-mediated integrin activation contributed to decreased neutrophil recruitment and reduced kidney damage in P-Rex1-deficient mice. We conclude that P-Rex1 serves distinct functions in LFA-1 and Mac-1 activation.

  20. Serotonin syndrome, disseminated intravascular coagulation, and hepatitis after a single ingestion of MDMA in an Asian woman.

    PubMed

    Nadkarni, Girish N; Hoskote, Sumedh S; Piotrkowski, Jared; Annapureddy, Narender

    2014-01-01

    N-Methyl-3,4-methylenedioxyamphetamine (MDMA), also called "Ecstasy," is a commonly abused psychoactive drug among the American youth. We present the case of a 23-year-old Korean-American woman who presented with seizure, delirium, and rigidity after MDMA ingestion. She was febrile (38.7°C), tachycardic (188 beats/min), tachypneic (26 breaths/min) with a borderline blood pressure (95/43 mm Hg). Examination revealed generalized muscle rigidity, tremors, hyperreflexia, and ocular clonus, leading to the diagnosis of serotonin syndrome. Urine toxicology screen was only positive for amphetamines, consistent with the history of MDMA ingestion. Initial laboratory testing showed thrombocytopenia, further testing showed deranged prothrombin time, partial thromboplastin time, decreased fibrinogen, and elevated D-dimer, suggesting disseminated intravascular coagulation. Hepatic transaminases trended up dramatically reflecting acute hepatitis. The patient received supportive care and improved by hospital day 3. MDMA toxicity manifested as serotonin syndrome, hepatitis, and coagulopathy is exceedingly rare. MDMA is metabolized by the hepatic CYP2D6 enzyme. Certain populations, such as Koreans, Chinese, and Japanese have a high prevalence of a polymorphism that confers reduced enzyme activity. We discuss this hypothesis as a possible cause for this severe presentation in our patient after a single ingestion.

  1. Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity?

    PubMed

    Marashi, Sayed Mahdi; Arefi, Mohammad; Behnoush, Behnam; Nasrabad, Mahdi Ghazanfari; Nasrabadi, Zeynab Nasri

    2011-04-01

    Acute aluminum phosphide poisoning is a serious toxicity and results in high mortality rate despite the progress of critical care. After ingestion, phosphine gas is released and absorbed quickly, causing systemic poisoning and cell hypoxia. Excessive thirst, severe hypotension, arrhythmias, tachypnea, and severe metabolic acidosis are the common clinical manifestations. We think acute metabolic response which characteristically occurs in severe injury also happens in aluminum phosphide poisoning. Necropsy examinations indicate congestion in almost all vital organs because of leakage of fluids from intravascular to extravascular space. The most favorable type of fluid for intravascular volume resuscitation persists and is disputed. Colloids remain in the intravascular space rather than crystalloids, and provide more rapid hemodynamic stabilization. Furthermore, hydroxyethyl starch solution may have other benefits e.g. it can reduce the extra vascular leak of albumin and fluids from an endothelial injury site. As refractory hypotension and cardiovascular collapse, because leakage of fluids from intravascular to extravascular space are common cause of death in this toxicity, we propose that hydroxyethyl starch can dominate this refractory hypotension and consequently acute metabolic response.

  2. Low-level He-Ne laser in intravascular irradiation treatment of schizophrenia

    NASA Astrophysics Data System (ADS)

    Zhou, Yu-Xue; Fu, Zheng-Hua

    1998-11-01

    Intravascular low level He-Ne laser irradiation is a new therapy developed in recent years. In our hospital it was applied in the treatment and observation of 220 cases of schizophrenia, among which certain effect was achieved and about which the detail was collated and elaborated.

  3. Recanalized chronic coronary thrombus: unraveling a hazy coronary lesion by intravascular ultrasound

    PubMed Central

    Chotai, Shayna; Khokhar, Azhar A.; Kelly, Paul A.

    2016-01-01

    Hazy lesions in coronary angiography can often be a puzzle for the interventional cardiologist. Recanalized chronic coronary thrombus, although rare, is one of the potential diagnoses. Intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are tools that can guide to the correct diagnosis. We present the images of a case where IVUS was used to unravel such a lesion. PMID:27054109

  4. Research of epidermal cellular vegetal cycle of intravascular low level laser irradiation in treatment of psoriasis

    NASA Astrophysics Data System (ADS)

    Zhu, Jing; Bao, Xiaoqing; Zhang, Mei-Jue

    2005-07-01

    Objective: To research epidermal cellular vegetal cycle and the difference of DNA content between pre and post Intravascular Low Level Laser Irradiation treatment of psoriasis. Method: 15 patients suffered from psoriasis were treated by intravascular low level laser irradiation (output power: 4-5mw, 1 hour per day, a course of treatment is 10 days). We checked the different DNA content of epidermal cell between pre and post treatment of psoriasis and 8 natural human. Then the percentage of each phase among the whole cellular cycle was calculated and the statistical analysis was made. Results: The mean value of G1/S phase is obviously down while G2+M phase increased obviously. T test P<0.05.The related statistical analysis showed significant difference between pre and post treatments. Conclusions: The Intravascular Low Level Laser Irradiation (ILLLI) in treatment of psoriasis is effective according to the research of epidermal cellular vegetal cycle and the difference DNA content of Intravascular Low Level Laser Irradiation between pre and post treatment of psoriasis

  5. Microfluidics in the Undergraduate Laboratory: Device Fabrication and an Experiment to Mimic Intravascular Gas Embolism

    ERIC Educational Resources Information Center

    Jablonski, Erin L.; Vogel, Brandon M.; Cavanagh, Daniel P.; Beers, Kathryn L.

    2010-01-01

    A method to fabricate microfluidic devices and an experimental protocol to model intravascular gas embolism for undergraduate laboratories are presented. The fabrication process details how to produce masters on glass slides; these masters serve as molds to pattern channels in an elastomeric polymer that can be adhered to a substrate, resulting in…

  6. Multi-mode Intravascular RF Coil for MRI-guided Interventions

    PubMed Central

    Kurpad, Krishna N.; Unal, Orhan

    2011-01-01

    Purpose To demonstrate the feasibility of using a single intravascular RF probe connected to the external MRI system via a single coaxial cable to perform active tip tracking and catheter visualization, and high SNR intravascular imaging. Materials and Methods A multi-mode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms. Results The multi-mode coil behaves as an inductively-coupled transmit coil. Forward looking capability of 6mm is measured. Greater than 3-fold increase in SNR compared to conventional imaging using optimized external coil is demonstrated. Simultaneous active tip tracking and catheter visualization is demonstrated. Conclusions It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multi-mode intravascular RF coil that is connected to the external system via a single coaxial cable. PMID:21448969

  7. Cremophor-free intravenous microemulsions for paclitaxel I: formulation, cytotoxicity and hemolysis.

    PubMed

    Nornoo, Adwoa O; Osborne, David W; Chow, Diana S-L

    2008-02-12

    Two cremophor-free microemulsions, lecithin:butanol:myvacet oil:water (LBMW) and capmul:myvacet oil:water (CMW) for paclitaxel (PAC) were developed for intravenous (i.v.) administration. Six surfactants and four oils were screened with various combinations for maximal water incorporation and PAC solubility. Microemulsion regions were subsequently determined in ternary phase diagrams. Cytotoxicity in an MDA-M231 human breast cancer cell line and hemolytic potential were assessed in these systems compared to Taxol (cremophor EL:ethanol, 1:1, 6 mgPAC/ml). The maximal water incorporation into the lecithin:butanol surfactant blend was greater than that incorporated into capmul when combined with the oils screened. PAC solubility in myvacet oil was increased 1389-fold over its aqueous solubility. LBMW had a larger microemulsion region (46.5% of total ternary phase diagram) than that seen with CMW (18.6%). The droplet size of the dispersed phase was 111.5 (4.18)nm for LBMW and 110.3 (8.09)nm for CMW. Cytotoxicity of PAC was in decreasing order of: Taxol>LBMW>CMW. The IC50 values for LBMW and CMW ranged from 4.5 to 5.7 and >10 microM, respectively, as compared to that of Taxol (1.3 to 1.8 microM). Eighty-three percent, 68%, and 63% of red blood cells remain unlysed at a formulation volume to blood ratio of 0.035 in LBMW, CMW and Taxol. Promising microemulsions, LBMW and CMW were developed that can incorporate approximately 12 mg/g of PAC, substantially higher than its aqueous solubility (10.8 microg/ml) and that in the Taxol vehicle (6 mg/ml). PAC retained its cytotoxicity in the LBMW and CMW and was less likely to cause hemolysis compared to Taxol. This higher drug loading results in a smaller vehicle volume in required doses of these formulations and potentially less vehicle-related side effects are anticipated.

  8. An experimental study of hemolysis induced by onion (Allium cepa) poisoning in dogs.

    PubMed

    Tang, X; Xia, Z; Yu, J

    2008-04-01

    The mechanism of hemolysis induced by onion poisoning in dogs was studied. Six adult, clinically normal Pekingese dogs were fed cooked onions at 30 g/kg body weight/day for 2 days. Blood samples were collected on days 1, 3, 5, 8, 12, 18 and 24 after onion administration, and urine was collected the day after bleeding. Red blood cell counts, hemoglobin and hematocrit were decreased from day 1, and significantly so on day 5 (P < 0.01), contrary to the results of white blood cell counts. So the plasma bilirubin levels and urobilinogen were increased on day 3 (P < 0.01) and day 4 (P < 0.01), respectively. The Heinz body counts were increased dramatically from day 1 (P < 0.01), peaking on day 3 (P < 0.01). Reticulocyte counts were increased from day 1 and the highest value was on day 8 (P < 0.01). Besides anemia, the following erythrocyte parameters were altered: erythrocyte glucose-6-phosphate dehydrogenase was reduced from day 1 and reached the lowest value on day 5 (P < 0.01); the reduced form of nicotinamide adenine dinucleotide phosphate was decreased on day 1 (P < 0.01); reduced glutathione was decreased from day 1 (P < 0.01) and the lowest value was on day 3 (P < 0.01); glutathione-peroxidase was increased on day 1, but decreased significantly on day 3 (P < 0.01); hydrogen peroxide was increased on day 1 (P < 0.01), then went down on days 3-12 (the undermost value on day 5, P < 0.01); catalase was risen dramatically on day 5 (the peak value, P < 0.01); malondialdehyde (MDA) was increased on days 1-8, (P < 0.01), and reached the peak value on day 5 (P < 0.01). Deformity of the erythrocyte membrane was decreased on days 1-12 and fluorescence polarization (rho) and microviscosity (eta) of the erythrocyte membrane were increased on days 1-12 (P < 0.01). There were positive correlations between MDA and rho as well as eta, with correlation coefficients of 0.908 and 0.922, respectively (P < 0.01), but there was a negative correlation between MDA and deformity index

  9. Nonlinear Flow Rate Response to Pumping Frequency and Reduced Hemolysis in the Drastically Under-Occluded Pulsatile Roller Pump.

    PubMed

    Yap, Choon Hwai; Lai, Chang Quan; Loh, Ivan Guang Hui; Ong, Thaddaeus Zhongren

    2017-02-01

    Roller pumps are widely used in many medical procedures including cardiopulmonary bypass, left/right ventricular assist, and hemodialysis. However, to date, the problem of the roller pumping mechanism causing significant hemolysis remains unresolved. It has been shown that with under-occlusion of the roller pump, hemolysis can be reduced, but significant reduction of the mean flow rate also takes place due to backflow through the under-occlusion. We performed an investigation of the flow dynamics of an under-occluded roller pump which featured significantly higher amount of under-occlusion than previously investigated. Our results showed that the mean flow rate produced by the pump has a strong, nonlinear dependence on pumping frequency. Mean flow rate generally increases with the pumping frequency and the degree of maximum occlusion except at certain frequencies where sharp reductions were observed. These frequencies coincide with the fundamental frequency of the system and its harmonics, bearing resemblance to the impedance pump, suggesting that the drastically under-occluded roller pump is a unique device that employs the pumping mechanisms of both roller pumping and impedance pumping. At the appropriate frequencies, this under-occluded roller pump could sustain sufficiently high flow rates for clinical uses. Blood damage potential of the under-occluded roller pump was compared to a fully occluded roller pump via the assay of free-plasma hemoglobin, and it was found that the under-occlusion reduced hemolysis by about half for any given flow rate. The drastically under-occluded roller pumping reported in this study, therefore, has the potential of being translated into an improved clinical blood pump.

  10. Asian variant of intravascular large B cell lymphoma causes patients to frequently develop the syndrome of inappropriate antidiuretic hormone secretion.

    PubMed

    Onishi, Chie; Ikejiri, Fumiyoshi; Kawakami, Koshi; Miyake, Takaaki; Kumanomido, Satoshi; Inoue, Masaya; Takahashi, Tsutomu; Tanaka, Junko; Yamamoto, Masahiro; Sugimoto, Toshitsugu; Suzumiya, Junji

    2011-11-01

    The Asian variant of intravascular large B cell lymphoma is a special type of intravascular lymphoma with hemophagocytic syndrome and hypercytokinemia including interleukin-6, which stimulates antidiuretic hormone synthesis in the hypothalamus. We present here that the syndrome of inappropriate antidiuretic hormone secretion frequently occurs in patients with the Asian variant of intravascular large B cell lymphoma. The syndrome of inappropriate antidiuretic hormone secretion was found in eight of 118 (6.8%) lymphoma patients at the first diagnosis. Although there were six (5.1%) among 118 lymphoma patients with the Asian variant of intravascular large B cell lymphoma, four of the six patients (66.7%) developed the syndrome of inappropriate antidiuretic hormone secretion. In four patients with the Asian variant of intravascular large B cell lymphoma with the syndrome of inappropriate antidiuretic hormone secretion, elevated serum interleukin-6 and low sodium levels were almost normalized after chemotherapy. The Asian variant of intravascular large B cell lymphoma patients frequently develop the syndrome of inappropriate antidiuretic hormone secretion, and interleukin-6 might play a role in the occurrence of this disease. We should pay attention to hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion in patients with the Asian variant of intravascular large B cell lymphoma.

  11. Effectiveness of practices to reduce blood sample hemolysis in EDs: A laboratory medicine best practices systematic review and meta-analysis

    PubMed Central

    Heyer, Nicholas J.; Derzon, James H.; Winges, Linda; Shaw, Colleen; Mass, Diana; Snyder, Susan R.; Epner, Paul; Nichols, James H.; Gayken, Julie A.; Ernst, Dennis; Liebow, Edward B.

    2015-01-01

    Objective To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. Results A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11–0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35–0.57]. Conclusions Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site. Disclaimer The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC. PMID:22968086

  12. A galactose-binding lectin isolated from Aplysia kurodai (sea hare) eggs inhibits streptolysin-induced hemolysis.

    PubMed

    Hasan, Imtiaj; Watanabe, Miharu; Ishizaki, Naoto; Sugita-Konishi, Yoshiko; Kawakami, Yasushi; Suzuki, Jun; Dogasaki, Chikaku; Rajia, Sultana; Kawsar, Sarkar M A; Koide, Yasuhiro; Kanaly, Robert A; Sugawara, Shigeki; Hosono, Masahiro; Ogawa, Yukiko; Fujii, Yuki; Iriko, Hideyuki; Hamako, Jiharu; Matsui, Taei; Ozeki, Yasuhiro

    2014-09-05

    A specific galactose-binding lectin was shown to inhibit the hemolytic effect of streptolysin O (SLO), an exotoxin produced by Streptococcus pyogenes. Commercially available lectins that recognize N-acetyllactosamine (ECA), T-antigen (PNA), and Tn-antigen (ABA) agglutinated rabbit erythrocytes, but had no effect on SLO-induced hemolysis. In contrast, SLO-induced hemolysis was inhibited by AKL, a lectin purified from sea hare (Aplysia kurodai) eggs that recognizes α-galactoside oligosaccharides. This inhibitory effect was blocked by the co-presence of d-galactose, which binds to AKL. A possible explanation for these findings is that cholesterol-enriched microdomains containing glycosphingolipids in the erythrocyte membrane become occupied by tightly stacked lectin molecules, blocking the interaction between cholesterol and SLO that would otherwise result in penetration of the membrane. Growth of S. pyogenes was inhibited by lectins from a marine invertebrate (AKL) and a mushroom (ABA), but was promoted by a plant lectin (ECA). Both these inhibitory and promoting effects were blocked by co-presence of galactose in the culture medium. Our findings demonstrate the importance of glycans and lectins in regulating mechanisms of toxicity, creation of pores in the target cell membrane, and bacterial growth.

  13. Interactions of PLGA nanoparticles with blood components: protein adsorption, coagulation, activation of the complement system and hemolysis studies.

    PubMed

    Fornaguera, Cristina; Calderó, Gabriela; Mitjans, Montserrat; Vinardell, Maria Pilar; Solans, Conxita; Vauthier, Christine

    2015-04-14

    The intravenous administration of poly(lactic-co-glycolic) acid (PLGA) nanoparticles has been widely reported as a promising alternative for delivery of drugs to specific cells. However, studies on their interaction with diverse blood components using different techniques are still lacking. Therefore, in the present work, the interaction of PLGA nanoparticles with blood components was described using different complementary techniques. The influence of different encapsulated compounds/functionalizing agents on these interactions was also reported. It is worth noting that all these techniques can be simply performed, without the need for highly sophisticated apparatus or skills. Moreover, their transference to industries and application of quality control could be easily performed. Serum albumin was adsorbed onto all types of tested nanoparticles. The saturation concentration was dependent on the nanoparticle size. In contrast, fibrinogen aggregation was dependent on nanoparticle surface charge. The complement activation was also influenced by the nanoparticle functionalization; the presence of a functionalizing agent increased complement activation, while the addition of an encapsulated compound only caused a slight increase. None of the nanoparticles influenced the coagulation cascade at low concentrations. However, at high concentrations, cationized nanoparticles did activate the coagulation cascade. Interactions of nanoparticles with erythrocytes did not reveal any hemolysis. Interactions of PLGA nanoparticles with blood proteins depended both on the nanoparticle properties and the protein studied. Independent of their loading/surface functionalization, PLGA nanoparticles did not influence the coagulation cascade and did not induce hemolysis of erythrocytes; they could be defined as safe concerning induction of embolization and cell lysis.

  14. Antibacterial and hemolysis activity of polypyrrole nanotubes decorated with silver nanoparticles by an in-situ reduction process.

    PubMed

    Upadhyay, J; Kumar, A; Gogoi, B; Buragohain, A K

    2015-09-01

    Polypyrrole nanotube-silver nanoparticle nanocomposites (PPy-NTs:Ag-NPs) have been synthesized by in-situ reduction of silver nitrate (AgNO3) to suppress the agglomeration of Ag-NPs. The morphology and chemical structure of the nanocomposites have been studied by HRTEM, SEM, XRD, FTIR and UV-vis spectroscopy. The average diameter of the polypyrrole nanotubes (PPy-NTs) is measured to be 130.59±5.5 nm with their length in the micrometer range, while the silver nanoparticles (Ag-NPs) exhibit spherical shape with an average diameter of 23.12±3.23 nm. In-vitro blood compatibility of the nanocomposites has been carried out via hemolysis assay. Antimicrobial activity of the nanocomposites has been investigated with Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria. The results depict that the hemolysis and antimicrobial activities of the nanocomposites increase with increasing Ag-NP concentration that can be controlled by the AgNO3 precursor concentration in the in-situ process.

  15. Intravascular contrast agents suitable for magnetic resonance imaging. [Dogs

    SciTech Connect

    Runge, V.M.; Clanton, J.A.; Herzer, W.A.; Gibbs, S.J.; Price, A.C.; Partain, C.L.; James, A.E. Jr.

    1984-10-01

    Two paramagnetic chelates, chromium EDTA and gadolinium DTPA, were evaluated as potential intravenous contrast agents for magnetic resonance imaging. After evaluating both agents in vitro, in vivo studies were conducted in dogs to document changes in renal appearance produced by contrast injection. Acute splenic and renal infarction were diagnosed with contrast-enhanced MR and confirmed by gamma camera imaging following administration of Tc-99m-labeled DMSA and sulfur colloid. The authors conclude that intravenous paramagnetic contrast agents presently offer the best mechanism for assessment of tissue function and changes in perfusion with MR.

  16. Bath Salts: A Newly Recognized Cause of Acute Kidney Injury

    PubMed Central

    McNeely, Jonathan; Parikh, Samir; Valentine, Christopher; Haddad, Nabil; Shidham, Ganesh; Rovin, Brad; Hebert, Lee; Agarwal, Anil

    2012-01-01

    Bath salts are substance of abuse that are becoming more common and are difficult to recognize due to negative toxicology screening. Acute kidney injury due to bath salt use has not previously been described. We present the case of a previously healthy male who developed acute kidney injury and dialysis dependence after bath salt ingestion and insufflation. This was self-reported with negative toxicology screening. Clinical course was marked by severe hyperthermia, hyperkalemia, rhabdomyolysis, disseminated intravascular coagulation, oliguria, and sepsis. We discuss signs and symptoms, differential diagnoses, potential mechanisms of injury, management, and review of the literature related to bath salt toxicity. PMID:24555135

  17. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy

    PubMed Central

    Woudstra, Douglas M; Chandra, Sue; Hofmeyr, G Justus; Dowswell, Therese

    2014-01-01

    Background Pre-eclampsia is a relatively common complication of pregnancy. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a severe manifestation of pre-eclampsia with significant morbidity and mortality for pregnant women and their children. Corticosteroids are commonly used in the treatment of HELLP syndrome in the belief that they improve outcomes. Objectives To determine the effects of corticosteroids on women with HELLP syndrome and their children. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 June 2010). Selection criteria Randomized controlled trials comparing any corticosteroid with placebo, no treatment, or other drug; or comparing one corticosteroid with another corticosteroid or dosage in women with HELLP syndrome. Data collection and analysis Two review authors assessed trial quality and extracted data independently. Main results Eleven trials (550 women) compared corticosteroids with placebo or no treatment. There was no difference in the risk of maternal death (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.28 to 3.21), maternal death or severe maternal morbidity (RR 0.27, 95% CI 0.03 to 2.12), or perinatal/infant death (RR 0.64, 95% CI 0.21 to 1.97). The only clear effect of treatment on individual outcomes was improved platelet count (standardized mean difference (SMD) 0.67, 95% CI 0.24 to 1.10). The effect on platelet count was strongest for women who commenced treatment antenatally (SMD 0.80, 95% CI 0.25 to 1.35). Two trials (76 women) compared dexamethasone with betamethasone. There was no clear evidence of a difference between groups in respect to perinatal/infant death (RR 0.95, 95% CI 0.15 to 6.17) or severe perinatal/infant morbidity or death (RR 0.64, 95% CI 0.27 to 1.48). Maternal death and severe maternal morbidity were not reported. In respect to platelet count, dexamethasone was superior to betamethasone (MD 6.02, 95% CI 1.71 to 10.33), both when treatment was

  18. European Society of Cardiology-Acute Cardiovascular Care Association Position paper on acute heart failure: A call for interdisciplinary care.

    PubMed

    Mueller, Christian; Christ, Michael; Cowie, Martin; Cullen, Louise; Maisel, Alan S; Masip, Josep; Miro, Oscar; McMurray, John; Peacock, Frank W; Price, Susanna; DiSomma, Salvatore; Bueno, Hector; Zeymer, Uwe; Mebazaa, Alexandre

    2017-02-01

    Acute heart failure (AHF) continues to have unacceptably high rates of mortality and morbidity. This position paper highlights the need for more intense interdisciplinary cooperation as one key element to overcome the challenges associated with fragmentation in the care of AHF patients. Additional aspects discussed include the importance of early diagnosis and treatment, options for initial treatment, referral bias as a potential cause for treatment preferences among experts, considerable uncertainty regarding patient disposition, the diagnosis of accompanying acute myocardial infarction, the need for antibiotic therapy, as well as assessment of intravascular volume status.

  19. Optimal design of the hydrodynamic multi-arc bearing in a centrifugal blood pump for the improvement of bearing stiffness and hemolysis level.

    PubMed

    Yasui, Kazuya; Kosaka, Ryo; Nishida, Masahiro; Maruyama, Osamu; Kawaguchi, Yasuo; Yamane, Takashi

    2013-09-01

    The purpose of the present study is to establish an optimal design of the multi-arc hydrodynamic bearing in a centrifugal blood pump for the improvement of bearing stiffness and hemolysis level. The multi-arc bearing was designed to fulfill the required specifications: (i) ensuring the uniform bearing stiffness for various bearing angles; (ii) ensuring a higher bearing stiffness than the centrifugal force to prevent impeller whirl; and (iii) adjusting the bearing clearance as much as possible to reduce hemolysis. First, a numerical analysis was performed to optimize three design parameters of the multi-arc bearing: number of arcs N, bearing clearance C, and groove depth H. To validate the accuracy of the numerical analysis, the impeller trajectories for six pump models were measured. Finally, an in vitro hemolysis test was conducted to evaluate the hemolytic property of the multi-arc bearing. As a result of the numerical analysis, the optimal parameter combination was determined as follows: N=4, C=100 μm, and H ≥ 100 μm. In the measurements of the impeller trajectory, the optimal parameter combination was found to be as follows: N=4, C=90 μm, and H=100 μm. This result demonstrated the high reliability of the numerical analysis. In the hemolysis test, the parameter combination that achieved the smallest hemolysis was obtained as follows: N=4, C=90 μm, and H=100 μm. In conclusion, the multi-arc bearing could be optimized for the improvement of bearing stiffness and hemolysis level.

  20. Multispectral fluorescence lifetime imaging system for intravascular diagnostics with ultrasound guidance: in vivo validation in swine arteries.

    PubMed

    Bec, Julien; Ma, Dinglong M; Yankelevich, Diego R; Liu, Jing; Ferrier, William T; Southard, Jeffrey; Marcu, Laura

    2014-05-01

    Fluorescence lifetime technique has demonstrated potential for analysis of atherosclerotic lesions and for complementing existing intravascular imaging modalities such as intravascular ultrasound (IVUS) in identifying lesions at high risk of rupture. This study presents a multimodal catheter system integrating a 40 MHz commercial IVUS and fluorescence lifetime imaging (FLIm) using fast helical motion scanning (400 rpm, 0.75 mm/s), able to acquire in vivo in pulsatile blood flow the autofluorescence emission of arterial vessels with high precision (5.08 ± 0.26 ns mean average lifetime over 13 scans). Co-registered FLIm and IVUS data allowed 3D visualization of both biochemical and morphological vessel properties. Current study supports the development of clinically compatible intravascular diagnostic system integrating FLIm and demonstrates, to our knowledge, the first in vivo intravascular application of a fluorescence lifetime imaging technique.

  1. An intravascular immune response to Borrelia burgdorferi involves Kupffer cells and iNKT cells

    PubMed Central

    Lee, Woo-Yong; Moriarty, Tara J; Wong, Connie H Y; Zhou, Hong; Strieter, Robert M; van Rooijen, Nico; Chaconas, George; Kubes, Paul

    2016-01-01

    Here we investigate the dynamics of the hepatic intravascular immune response to a pathogen relevant to invariant natural killer T cells (iNKT cells). Immobilized Kupffer cells with highly ramified extended processes into multiple sinusoids could effectively capture blood-borne, disseminating Borrelia burgdorferi, creating a highly efficient surveillance and filtering system. After ingesting B. burgdorferi, Kupffer cells induced chemokine receptor CXCR3–dependent clustering of iNKT cells. Kupffer cells and iNKT cells formed stable contacts via the antigen-presenting molecule CD1d, which led to iNKT cell activation. An absence of iNKT cells caused B. burgdorferi to leave the blood and enter the joints more effectively. B. burgdorferi that escaped Kupffer cells entered the liver parenchyma and survived despite Ito cell responses. Kupffer cell–iNKT cell interactions induced a key intravascular immune response that diminished the dissemination of B. burgdorferi. PMID:20228796

  2. Distal polyneuropathy after canine heartworm disease therapy complicated by disseminated intravascular coagulation.

    PubMed

    Dillon, A R; Braund, K G

    1982-08-01

    A 3-year-old male Setter-type dog had a progressive distal sensorimotor polyneuropathy characterized by weakness, bilateral atrophy of distal appendicular musculature, and reduced response to tactile stimuli. The diagnosis of a distal axonopathy was supported by electromyographic findings of fibrillation potentials, positive sharp waves in distal limb muscles, and absence of evoked action potentials, myopathic changes of atrophic angular fibers, and myelinated nerve fiber depletion in distal parts of peripheral nerves. The neuropathy appeared 5 weeks after 38 days of heparin therapy for disseminated intravascular coagulation. The disseminated intravascular coagulation, a complication of thiacetarsamide therapy for heartworm disease, had resolved 40 days after the end of heparin therapy. The cause of the neuropathy was not determined.

  3. A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections.

    PubMed

    Candido, Kenneth D; Ghaly, Ramsis F; Mackerley, Sara; Knezevic, Nebojsa Nick

    2010-07-01

    We present a case of intravascular injection in a 41-year-old female during cervical selective nerve root injection using a 22-gauge 3.5-inch Whitacre-type pencil-point subarachnoid needle with a curve placed at the distal tip positioned using continual live fluoroscopic guidance. After negative aspiration for blood and cerebrospinal fluid and no elicited paresthesias during the procedure, 1 mL of contrast was injected. Initial imaging at C6 captured the outline of the nerve root along with a significant amount of transient vascular runoff. This case report demonstrates that Whitacre-type spinal needles do not prevent vascular injection, and that aspiration of the needle is not a reliable sign of intravascular injection.

  4. [Decision-making while implantation of biodegradable vascular scaffolds ABSORB based on methods of intravascular visualization].

    PubMed

    Buzaev, I V; Plechev, V V; Nikolaeva, I E; Zagitov, I G; Oleĭnik, B A

    A series of studies demonstrated comparability of the incidence rate of major adverse cardiac events (MACE) in the middle-term postoperative period following implantation of last-generation drug-coated stents and biodegradable intravascular scaffolds. It was noted observed that these complications may be associated with malposition and inadequate inappropriate preparation of the lesion. We carried out a total of 16 percutaneous coronary interventions (PCI) with implantation of absorbable vascular scaffolds (Absorb, Abbott Vascular) under the guidance of optical coherent tomography. Besides, a further 16 PCIs were performed without intravascular visualization (control group). As experience was gathered, the algorithm of carrying out optical coherent tomography was subjected to changes, resulting in proposal of an optimal algorithm for choice of intraoperative policy based on the findings obtained in optical coherent tomography.

  5. Enhanced glucose tolerance by intravascularly administered piceatannol in freely moving healthy rats.

    PubMed

    Oritani, Yukihiro; Okitsu, Teru; Nishimura, Eisaku; Sai, Masahiko; Ito, Tatsuhiko; Takeuchi, Shoji

    2016-02-12

    Piceatannol is a phytochemical in the seeds of passion fruit that has a hypoglycemic effect when orally administered. To elucidate the contribution of intact and metabolites of piceatannol after gastro-intestinal absorption to hypoglycemic effect, we examined the influence of piceatannol and isorhapontigenin on blood glucose concentrations during fasting and glucose tolerance tests by administering them intravascularly to freely moving healthy rats. We found that intravascularly administered piceatannol reduced the blood glucose concentrations during both fasting and glucose tolerance tests, but isorhapontigenin did not during either of them. Furthermore, we found that piceatannol increased the insulinogenic index during glucose tolerance tests and that piceatannol had no influence on insulin sensitivity by performing hyperinsulinemic euglycemic clamping tests. These results suggest that piceatannol orally intaken may enhance glucose tolerance by the effect of intact piceatannol through enhanced early-phase secretion of insulin. Therefore, oral intake of piceatannol might contribute to proper control of postprandial glycemic excursions in healthy subjects.

  6. A Novel Stopped-Flow Assay for Quantitating Carbonic-Anhydrase Activity and Assessing Red-Blood-Cell Hemolysis

    PubMed Central

    Zhao, Pan; Geyer, R. Ryan; Boron, Walter F.

    2017-01-01

    We report a novel carbonic-anhydrase (CA) assay and its use for quantitating red-blood-cell (RBC) lysis during stopped-flow (SF) experiments. We combine two saline solutions, one containing HEPES/pH 7.03 and the other, ~1% CO2/44 mM HCO3-/pH 8.41, to generate an out-of-equilibrium CO2/HCO3- solution containing ~0.5% CO2/22 HCO3-/pH ~7.25 (10°C) in the SF reaction cell. CA catalyzes relaxation of extracellular pH to ~7.50: HCO3- + H+ → CO2 + H2O. Proof-of-concept studies (no intact RBCs) show that the pH-relaxation rate constant (kΔpH)—measured via pyranine fluorescence—rises linearly with increases in [bovine CAII] or [murine-RBC lysate]. The y-intercept (no CA) was kΔpH = 0.0183 s−1. Combining increasing amounts of murine-RBC lysate with ostensibly intact RBCs (pre-SF hemolysis ≅0.4%)—fixing total [hemoglobin] at 2.5 μM in the reaction cell to simulate hemolysis from ostensibly 0 to 100%—causes kΔpH to increase linearly. This y-intercept (0% lysate/100% ostensibly intact RBCs) was kΔpH = 0.0820 s−1, and the maximal kΔpH (100% lysate/0% intact RBCs) was 1.304 s−1. Thus, mean percent hemolysis in the reaction cell was ~4.9%. Phenol-red absorbance assays yield indistinguishable results. The increase from 0.4 to 4.9% presumably reflects mechanical RBC disruption during rapid mixing. In all fluorescence studies, the CA blocker acetazolamide reduces kΔpH to near-uncatalyzed values, implying that all CA activity is extracellular. Our lysis assay is simple, sensitive, and precise, and will be valuable for correcting for effects of lysis in physiological SF experiments. The underlying CA assay, applied to blood plasma, tissue-culture media, and organ perfusates could assess lysis in a variety of applications.

  7. Comparison of hemolysis between CentriMag and RotaFlow rotary blood pumps during extracorporeal membrane oxygenation.

    PubMed

    Palanzo, David A; El-Banayosy, Aly; Stephenson, Edward; Brehm, Christoph; Kunselman, Allen; Pae, Walter E

    2013-09-01

    The purpose of this investigation was to compare the hemolysis levels for patients on extracorporeal membrane oxygenation (ECMO) incorporating two different rotary blood pumps (CentriMag [CMAG] and RotaFlow [RF]) in identical circuits otherwise. The difference between the two pumps is the cost. One is 20-30 times less expensive than the other. A retrospective analysis of all patients placed on ECMO from June 2008 through May 2012 was done to evaluate hemolysis. Daily plasma hemoglobin (pHb), lactate dehydrogenase (LDH), and lactate levels were collected on all patients. Values were compared between those patients who received a CMAG and those who received an RF. Patients had to be on ECMO for more than 2 days to be included in the study. Linear mixed effects models were fit to the data to assess differences over time for each continuous outcome. Forty patients were placed on ECMO incorporating CMAG, whereas 40 patients received an RF. There were no significant statistical differences between CMAG and RF groups when comparing days on support (8.7 ± 5.0; 8.4 ± 5.7), age (44.8 ± 18.3; 46.1 ± 16.0), body surface area (2.03 ± 0.36; 1.96 ± 0.31), gender (male: 58%, female: 42%; male: 55%, female: 45%), etiology, type of support (veno-arterial [VA)]: 78%, veno-venous [VV)]: 22%; VA: 82%, VV: 18%) and pre-ECMO LDH levels (4004.0 ± 3583.2; 3603.7 ± 3354.1). There were also no significant differences between the CMAG and RF groups when comparing the mean values for daily pHb levels (5.7 ± 3.6; 5.7 ± 4.2), lactate levels (2.8 ± 1.9; 3.0 ± 2.1), and LDH levels (2656.3 ± 1606.8; 2688.6 ± 1726.1) or daily lactate, LDH, and pHb levels for the first 10 days of support. From our investigation, there is no difference between the CMAG and the RF blood pumps in regard to the creation of hemolysis during ECMO. The difference in cost of the devices does not correlate with the performance and outcomes.

  8. Automatic lumen contour detection in intravascular OCT images using Otsu binarization and intensity curve.

    PubMed

    Kim, Hye Min; Lee, Seung Hwan; Lee, Chungkeun; Ha, Jong-Won; Yoon, Young-Ro

    2014-01-01

    This paper proposes an automatic method for the detection of lumen contours in intravascular OCT images with guide wire shadow artifacts. This algorithm is divided into five main procedures: pre-processing, an Otsu binarization approach, an intensity curve approach, a lumen contour position correction, and image reconstruction and contour extraction. The 30 IVOCT images from six anonymous patients were used to verify this method and we obtained 99.2% sensitivity and 99.7% specificity with this algorithm.

  9. Evaluation of intravascular microdialysis for continuous blood glucose monitoring in hypoglycemia: an animal model.

    PubMed

    Schierenbeck, Fanny; Wallin, Mats; Franco-Cereceda, Anders; Liska, Jan

    2014-07-01

    We have previously shown that intravascular microdialysis in a central vein is an accurate method for continuous glucose monitoring in patients undergoing cardiac surgery. However, no hypoglycemia occurred in our earlier studies, prompting further evaluation of the accuracy of intravascular microdialysis in the hypoglycemic range. Thus, this animal study was performed. A porcine model was developed; hypoglycemia was induced using insulin injections. The pigs were monitored with intravascular microdialysis integrated in a triple-lumen central venous catheter. As reference, venous blood gas samples were taken every 5 minutes and analyzed in a blood gas analyzer. Ethical permission for the animal experiments was obtained from the Stockholm Regional Ethical Committee, reference no N397/09. A total of 213 paired samples were obtained for analysis, and 126 (59.2%) of these were in the hypoglycemic range (<74 mg/dl). Using Clarke error grid analysis, 100% of the paired samples were in region AB and 99% in region A. The ISO standard (ISO15197) was met. Bland-Altman analysis showed bias (mean difference) ± limits of agreement was -0.18 ± 16.2 mg/dl. No influence from glucose infusions was seen. The microdialysis monitoring system was found to be very responsive in rapid changes in blood glucose concentration. This study shows that intravascular microdialysis in a central vein is an accurate method for continuous glucose monitoring in hypoglycemia in a porcine experimental model. Furthermore, the system was not influenced by glucose administration and was found to be responsive in rapid blood glucose fluctuations.

  10. Effect of intravascular irradiation of He-Ne laser on cerebral infarction: Hemorrheology and apoptosis

    NASA Astrophysics Data System (ADS)

    Zhu, Jian; Liang, Min-yi; Cao, Hao-cai; Li, Xiao-Yuan; Li, Shao-ming; Li, Shun-hao; Li, Wen-qi; Zhang, Jin-hong; Liu, Lei; Lai, Jian-hong

    2005-07-01

    Objective: To explore the efficacy of He-Ne laser intravascular irradiation on infarction and hemorrheology. To observe the effects of intravascular low level He-Ne laser irradiation (ILLLI) of blood on cell proliferation, apoptosis and chromosome in lymphocyte from cerebral infarction Methods: Seventy cases with cerebral infarction were randomly divided into groups control group (35 cases) treated only with common drugs and therapeutic group (35 cases) treated besides common drugs also by He-Ne laser intravascular irradiation. Their hemorrheology index and treatment results were observed and compared. The blood lymphocytes of cerebral infarction were cultured before and after treatment. After that, the mitosis index (MI), cell kinetics index (CKI), sister-chromatid exchanges (SCE) frequencies and apoptosis were determined. Results The therapeutic group was better than the control one. The effective rate in the therapeutic group was 88.6%, in the control one was 65.7%. The viscosity and fibrinogen, etc were better than that in the control group with significant difference (P<0.01). The lymphocyte proliferation index was significantly two increased than the control one (P>0.05) in cerebral infarction patients after treatment; The CKI of lymphocytes had no obvious difference among groups (P>0.05) SCE frequencies of lymphocytes had no statistic significance between control group and ILLLI on (P>0.05). It showed the apoptosis rate of lymphocytes in cerebral infarction patients after ILLLI treatment increased significantly compared with the control group, (P<0.001). There was a significant difference of apoptosis rate of lymphocytes in cerebral infarction patients than the control (P<0.001). Conclusions: During the He-Ne laser intravascular irradiation of the cerebral infarction, the low level He-Ne by ILLLI can increase the proliferation of lymphocytes, and can induce lymphocytes to apoptosis, but has no mutagenicity of cells.

  11. Laparoscopic manipulation of a probe-based confocal laser endomicroscope using a steerable intravascular catheter.

    PubMed

    Schneider, Crispin; Desjardins, Adrien E; Gurusamy, Kurinchi; Hawkes, David J; Davidson, Brian R

    2015-04-01

    Probe-based confocal laser endomicroscopy is an emerging imaging modality that enables visualization of histologic details during endoscopy and surgery. A method of guiding the probe with millimeter accuracy is required to enable imaging in all regions of the abdomen accessed during laparoscopy. On the basis of a porcine model of laparoscopic liver resection, we report our experience of using a steerable intravascular catheter to guide a probe-based confocal laser endomicroscope.

  12. Laparoscopic Manipulation of a Probe-based Confocal Laser Endomicroscope Using a Steerable Intravascular Catheter

    PubMed Central

    Desjardins, Adrien E.; Gurusamy, Kurinchi; Hawkes, David J.; Davidson, Brian R.

    2015-01-01

    Probe-based confocal laser endomicroscopy is an emerging imaging modality that enables visualization of histologic details during endoscopy and surgery. A method of guiding the probe with millimeter accuracy is required to enable imaging in all regions of the abdomen accessed during laparoscopy. On the basis of a porcine model of laparoscopic liver resection, we report our experience of using a steerable intravascular catheter to guide a probe-based confocal laser endomicroscope. PMID:25807277

  13. Surgical management of Wilms tumor with intravascular extension: a single-institution experience.

    PubMed

    Aspiazu, Diego; Fernandez-Pineda, Israel; Cabello, Rosa; Ramirez, Gema; Alvarez-Madrid, Antonio; De Agustin, Juan Carlos

    2012-02-01

    The purpose of this study was to retrospectively analyze the clinical presentation, treatment, and outcomes of children with Wilms tumor (WT) and intravascular extension who were treated at a single institution. A retrospective review was conducted of medical records of all children with Wilms tumor and intravascular extension treated at Virgen del Rocio Children's Hospital between 1992 and 2010. Seven patients (median age 3.4 years, range 2-8.1 years) were identified. At diagnosis, 6 of the 7 patients (85.7%) presented with tumor thrombus that reached the right atrium (RA) and 1 patient with infrahepatic inferior vena cava (IVC) thrombus. All patients received neoadjuvant chemotherapy (SIOP 2001 protocol) with vincristine, doxorubicin, and actinomycin D. Regression of the intravascular extension of the tumor was documented in all patients. Postchemotherapy level of extension was suprahepatic IVC in 1 patient, infrahepatic IVC in 2 patients, renal vein (RV) in 1 patient, and RA in 3 patients. Nephrectomy and thrombectomy were performed in all cases, requiring cardiopulmonary bypass for the 4 patients who presented with suprahepatic IVC and RA thrombus. The other 3 patients with infrahepatic IVC and RV involvement underwent cavotomy and thrombus extraction. Computed tomography, ultrasonography, and echocardiography were used for diagnosis and follow-up. All patients remain disease-free with a median follow-up of 6.3 years (range, 2-19 years). Neoadjuvant chemotherapy for WT with intravascular extension may facilitate the resection by decreasing the extent of the tumor thrombus. Cardiopulmonary bypass is indicated for suprahepatic IVC and RA involvement. Accurate diagnostic imaging is necessary.

  14. [Interest of an intensive chemotherapy for intravascular large B cell lymphoma].

    PubMed

    Baldolli, Aurélie; Chuffart, Marie; Geffray, Loik; Verneuil, Laurence; Reman, Oumédaly

    2013-04-01

    We describe three cases of intravascular lymphoma B with different clinical presentation: one case of a cutaneous variant and two cases with surrenal and cutaneous localisation. All patients are in complete remission after chemotherapy alone or after chemotherapy and autologous stem cells transplantation. The review of the literature as well as our cases specify the interest of an aggressive chemotherapy with autologous of peripheral stem cells if it was possible.

  15. Thromboelastographic profile for a dog with hypocoagulable and hyperfibrinolytic phase of disseminated intravascular coagulopathy.

    PubMed

    Vilar-Saavedra, P; Hosoya, K

    2011-12-01

    The objective of this study is to report the use of thromboelastography as a diagnostic tool for the hyperfibrinolytic phase of disseminated intravascular coagulopathy in a dog with metastatic haemangiosarcoma. We established a cytological (i.e. fine needle aspirate) and histopathological (i.e. excisional surgical biopsy) diagnosis of haemangiosarcoma in a 10-year-old male castrated Bichon Frise with multiple dark purple dermoepidermal nodules on the ventral abdomen and medial stifle areas, multiple small pulmonary nodules and a solitary liver mass. The dog was treated with chemotherapy (AC protocol). Forty-nine days after completion of four treatment cycles, the dog was presented for recheck. Complete blood count revealed anaemia and mild thrombocytopenia. Chemistry profile showed no significant abnormalities. Analysis of haemostasis consisted of prolonged clotting times (prothrombin time, activated partial thromboplastin time), mild hypofibrinogenaemia and increased D-dimers. A presumptive diagnosis of disseminated intravascular coagulopathy was made. A re-calcified thromboelastography was simultaneously done to confirm the coagulopathy. Thromboelastographic tracings correlated with the plasma-based test results showing hypocoagulability (prolonged clotting times and prolonged thromboelastography clot kinetics; weaker clot with decreased fibrinogen levels, platelet count and lower thromboelastography tracing amplitude) and hyperfibrinolysis (increased D-dimers and increased D-dimers and increased thromboelastography lysis parameters). Based on these results, the dog was considered to be in the hyperfibrinolytic phase of disseminated intravascular coagulopathy. Results of the conventional haemostasis tests supported those obtained on thromboelastography. Humane euthanasia was performed because of poor prognosis and progressive disease, making further follow-up unavailable. As demonstrated in this case report, thromboelastography was found to be a helpful

  16. Intravascular haemolysis during prolonged running on asphalt and natural grass in long and middle distance runners.

    PubMed

    Janakiraman, Kamal; Shenoy, Shweta; Sandhu, Jaspal Singh

    2011-09-01

    Surface features such as uneven playing surfaces, low impact absorption capacity and inappropriate friction/traction characteristics are connected with injury prevalence whereas force impact during foot strike has been suggested to be an important mechanism of intravascular haemolysis during running. We aimed to evaluate intravascular haemolysis during running and compare the effect of running on two different types of surfaces on haemolysis. We selected two surfaces (asphalt and grass) on which these athletes usually run. Participants were randomly assigned to group A (asphalt) or group B (grass) with 10 athletes in each group. Each athlete completed one hour of running at the calculated target heart rate (60-70%). Venous blood samples were collected before and immediately after running. We measured unconjugated bilirubin (UBR) (mg · dl(-1)), lactate dehydrogenase (LDH) (μ · ml(-1)), haemoglobin (g · l(-1)) and serum ferritin (ng · ml(-1)) as indicators of haemolysis. Athletes who ran on grass demonstrated an increase in the haematological parameters (UBR: P < 0.01, LDH: P < 0.05) when compared to athletes who ran on asphalt (UBR: P < 0.05, LDH: P = 0.241). Our findings indicate that intravascular haemolysis occurs significantly after prolonged running. Furthermore, we conclude that uneven grass surface results in greater haemolysis compared to asphalt road.

  17. Intravascular near-infrared fluorescence catheter with ultrasound guidance and blood attenuation correction

    NASA Astrophysics Data System (ADS)

    Dixon, Adam J.; Hossack, John A.

    2013-05-01

    Intravascular near-infrared fluorescence (NIRF) imaging offers a new approach for characterizing atherosclerotic plaque, but random catheter positioning within the vessel lumen results in variable light attenuation and can yield inaccurate measurements. We hypothesized that NIRF measurements could be corrected for variable light attenuation through blood by tracking the location of the NIRF catheter with intravascular ultrasound (IVUS). In this study, a combined NIRF-IVUS catheter was designed to acquire coregistered NIRF and IVUS data, an automated image processing algorithm was developed to measure catheter-to-vessel wall distances, and depth-dependent attenuation of the fluorescent signal was corrected by an analytical light propagation model. Performance of the catheter sensing distance correction method was evaluated in coronary artery phantoms and ex vivo arteries. The correction method produced NIRF estimates of fluorophore concentrations, in coronary artery phantoms, with an average root mean square error of 17.5%. In addition, the correction method resulted in a statistically significant improvement in correlation between spatially resolved NIRF measurements and known fluorophore spatial distributions in ex vivo arteries (from r=0.24 to 0.69, p<0.01, n=6). This work demonstrates that catheter-to-vessel wall distances, measured from IVUS images, can be employed to compensate for inaccuracies caused by variable intravascular NIRF sensing distances.

  18. The lateral neostriatum is necessary for compensatory ingestive behaviour after intravascular dehydration in female rats.

    PubMed

    Lelos, M J; Harrison, D J; Rosser, A E; Dunnett, S B

    2013-12-01

    Aberrant striatal function results in an array of physiological symptoms, including impaired consummatory and regulatory behaviours, which can lead to weight loss and dehydration. It was hypothesised, therefore, that cell loss in the neostriatum may contribute to altered fluid intake by regulating physiological signals related to dehydration status. To test this theory, rats with lesions of the lateral neostriatum and sham controls underwent a series of physiological challenges, including the experimental induction of intracellular and intravascular dehydration. No baseline differences in prandial or non-prandial drinking were observed, nor were differences in locomotor activity evident between groups. Furthermore, intracellular dehydration increased water intake in lesion rats in a manner comparable to sham rats. Interestingly, a specific impairment was evident in lesion rats after subcutaneous injection of poly-ethylene glycol was used to induce intravascular dehydration, such that lesion rats failed to adapt their water intake to this physiological change. The results suggest that the striatal lesions resulted in regulatory dysfunction by impairing motivational control over compensatory ingestive behaviour after intravascular hydration, while the physiological signals related to dehydration remain intact. Loss of these cells in neurodegenerative disorders, such Huntington's disease, may contribute to regulatory changes evident in the course of the disease.

  19. High frame-rate intravascular optical frequency-domain imaging in vivo

    PubMed Central

    Cho, Han Saem; Jang, Sun-Joo; Kim, Kyunghun; Dan-Chin-Yu, Alexey V.; Shishkov, Milen; Bouma, Brett E.; Oh, Wang-Yuhl

    2013-01-01

    Intravascular optical frequency-domain imaging (OFDI), a second-generation optical coherence tomography (OCT) technology, enables imaging of the three-dimensional (3D) microstructure of the vessel wall following a short and nonocclusive clear liquid flush. Although 3D vascular visualization provides a greater appreciation of the vessel wall and intraluminal structures, a longitudinal imaging pitch that is several times bigger than the optical imaging resolution of the system has limited true high-resolution 3D imaging, mainly due to the slow scanning speed of previous imaging catheters. Here, we demonstrate high frame-rate intravascular OFDI in vivo, acquiring images at a rate of 350 frames per second. A custom-built, high-speed, and high-precision fiber-optic rotary junction provided uniform and high-speed beam scanning through a custom-made imaging catheter with an outer diameter of 0.87 mm. A 47-mm-long rabbit aorta was imaged in 3.7 seconds after a short contrast agent flush. The longitudinal imaging pitch was 34 μm, comparable to the transverse imaging resolution of the system. Three-dimensional volume-rendering showed greatly enhanced visualization of tissue microstructure and stent struts relative to what is provided by conventional intravascular imaging speeds. PMID:24466489

  20. Use of an oxygen-carrying blood substitute to improve intravascular optical coherence tomography imaging

    NASA Astrophysics Data System (ADS)

    Hoang, Khiet C.; Edris, Ahmad; Su, Jianping; Mukai, David S.; Mahon, Sari; Petrov, Artiom D.; Kern, Morton; Ashan, Chowdhury; Chen, Zhongping; Tromberg, Bruce J.; Narula, Jagat; Brenner, Matthew

    2009-05-01

    Optical coherence tomography (OCT) is a catheter-based imaging technology with powerful resolution capable of identifying vulnerable plaques and guiding coronary intervention. However, a significant limitation of intravascular OCT imaging is its attenuation by blood. We propose that the use of an oxygen-carrying blood substitute could potentially optimize OCT image quality. Surgical isolation of the descending thoracic aorta of six rabbits is performed, followed by intravascular OCT imaging of the abdominal aorta. Perfluorodecalin (PFD) is oxygenated using a bubble-through technique with 100% oxygen. OCT imaging is performed and compared using three different flushing modalities: PFD; saline; and blood. OCT imaging of the rabbit abdominal aorta is successful in all of the subjects. In each of the six studied subjects, flushing with PFD consistently provides dramatically better imaging of the vessel wall tissue structures. OCT image quality is highly dependent on the ability of the flushing modality to remove blood from the imaging field. From this proof-of-concept study, we demonstrate that endovascular flushing with an oxygen-carrying blood substitute (PFD) is optically superior to saline flushing for intravascular imaging.

  1. A novel dual-frequency imaging method for intravascular ultrasound applications.

    PubMed

    Qiu, Weibao; Chen, Yan; Wong, Chi-Man; Liu, Baoqiang; Dai, Jiyan; Zheng, Hairong

    2015-03-01

    Intravascular ultrasound (IVUS), which is able to delineate internal structures of vessel wall with fine spatial resolution, has greatly enriched the knowledge of coronary atherosclerosis. A novel dual-frequency imaging method is proposed in this paper for intravascular imaging applications. A probe combined two ultrasonic transducer elements with different center frequencies (36 MHz and 78 MHz) is designed and fabricated with PMN-PT single crystal material. It has the ability to balance both imaging depth and resolution, which are important imaging parameters for clinical test. A dual-channel imaging platform is also proposed for real-time imaging, and this platform has been proven to support programmable processing algorithms, flexible imaging control, and raw RF data acquisition for IVUS applications. Testing results show that the -6 dB axial and lateral imaging resolutions of low-frequency ultrasound are 78 and 132 μm, respectively. In terms of high-frequency ultrasound, axial and lateral resolutions are determined to be as high as 34 and 106 μm. In vitro intravascular imaging on healthy swine aorta is conducted to demonstrate the performance of the dual-frequency imaging method for IVUS applications.

  2. The intravascular low level laser irradiation (ILLLI) in treatment of psoriasis clinically

    NASA Astrophysics Data System (ADS)

    Zhu, Jing; Nie, Fan; Shi, Hong-Min

    2005-07-01

    Objective: The title is research curative effect of intravascular low level laser irradiation (ILLLI) in treatment of psoriasis. Method: 478 patients with psoriasis from five groups to observe their efficacy. Group1 were treated by He-Ne laser combined with drug. Group 2 were treated by semi-conductor laser combined with drug. Group 3 were treated only by He-He laser. Group 4 were treated by semi-conductor laser. Group 5 were treated only by drug. The Ridit statistical analysis was applied to all of these data. The treatment of intravascular low level laser irradiation is as follow: laser power:4-5mw, 1 hour per day and 10 days as a period combined with vit C 2.0 g iv and inhalation of O2. Results: The clinical results: the near efficient rate was 100%, in group1-4, if combined with drugs it would be better. Ridit statistical analysis showed no significant difference between group1-4, p>0.05. The efficient rate 72.97% in group5.There were showed very significant difference with group1-4, p<0.01. 2.There were no significant differences between He-Ne laser (632.8nm) and semiconductor laser(650nm); 3.The efficacy of ILLLI in psoriasis was positive correlation to the ILLLI times. Conclusions: It can improve curative effect of intravascular low levellaser irradiation (ILLLI) in treatment of psoriasis.

  3. Stochastic bifurcation characteristics of SMA intravascular stent subjected to radial and axial excitations.

    PubMed

    Zhu, Zhiwen; Zhang, Wendi; Xu, Jia

    2014-01-01

    A kind of shape memory alloy (SMA) hysteretic nonlinear model is developed, and the stochastic bifurcation characteristics of SMA intravascular stents subjected to radial and axial excitations are studied in this paper. A new nonlinear differential item is introduced to interpret the hysteretic phenomena of SMA strain-stress curves, and the dynamic model of SMA intravascular stent subjected to radial and axial stochastic excitations is established. The conditions of the system's stochastic stability are determined, and the probability density function of the system response is obtained. Finally, the stochastic Hopf bifurcation characteristics of the system are analyzed. Theoretical analysis and numerical simulation show that the system stability varies with bifurcation parameters, and stochastic Hopf bifurcation occurs in the process; there are two limit cycles in the stationary probability density of the system response in some cases, which means that there are two vibration amplitudes whose probability are both very high; jumping phenomena between the two vibration amplitudes appears with the change of conditions, which may cause stent fracture or loss. The results of this paper are helpful for application of SMA intravascular stent in biomedical engineering fields.

  4. Evidence of hemolysis in pigs infected with highly virulent African swine fever virus

    PubMed Central

    Karalyan, Zaven; Zakaryan, Hovakim; Arakelova, Elina; Aivazyan, Violeta; Tatoyan, Marina; Kotsinyan, Armen; Izmailyan, Roza; Karalova, Elena

    2016-01-01

    Aim: The research was conducted to understand more profoundly the pathogenetic aspects of the acute form of the African swine fever (ASF). Materials and Methods: A total of 10 pigs were inoculated with ASF virus (ASFV) (genotype II) in the study of the red blood cells (RBCs), blood and urine biochemistry in the dynamics of disease. Results: The major hematological differences observed in ASFV infected pigs were that the mean corpuscular volume, mean corpuscular hemoglobin, and hematocrits were significantly decreased compared to controls, and the levels of erythropoietin were significantly increased. Also were detected the trends of decrease in RBC count at terminal stages of ASF. Analysis of blood biochemistry revealed that during ASF development, besides bilirubinemia significantly elevated levels of lactate dehydrogenase, and aspartate aminotransferase were detected. Analysis of urine biochemistry revealed the presence of bilirubinuria, proteinuria during ASF development. Proteinuria, especially at late stages of the disease reflects a severe kidney damage possible glomerulonefritis. Conclusion: The results of this study indicate the characteristics of developing hemolytic anemia observed in acute ASF (genotype II). PMID:28096614

  5. Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound.

    PubMed

    Zacharias, Sibin K; Safian, Robert D; Madder, Ryan D; Hanson, Ivan D; Pica, Mark C; Smith, James L; Goldstein, James A; Abbas, Amr E

    2016-08-01

    The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies. NIRS has been validated to detect lipid-core plaque (LCP) in the coronary circulation. We imaged severe SFA stenoses with NIRS-IVUS prior to revascularization in 31 patients (46 stenoses) with Rutherford claudication ⩾ class 3. Angiographic parameters included lesion location and stenosis severity. IVUS parameters included plaque burden and presence of calcium. NIRS images were analyzed for LCP and maximum lipid-core burden index in a 4-mm length of artery (maxLCBI4mm). By angiography, 38 (82.6%) lesions were calcified and 9 (19.6%) were chronic total occlusions. Baseline stenosis severity and lesion length were 86.0 ± 11.0% and 36.5 ± 46.5 mm, respectively. NIRS-IVUS identified calcium in 45 (97.8%) lesions and LCP in 17 (37.0%) lesions. MaxLCBI4mm was 433 ± 244. All lesions with LCP also contained calcium; there were no non-calcified lesions with LCP. In conclusion, this is the first study of combined NIRS-IVUS in patients with PAD. NIRS-IVUS demonstrates that nearly all patients with symptomatic severe SFA disease have fibrocalcific plaque, and one-third of such lesions contain LCP. These findings contrast with those in patients with acute coronary syndromes, and may have implications regarding the pathophysiology of atherosclerosis in different vascular beds.

  6. Interactions of PLGA nanoparticles with blood components: protein adsorption, coagulation, activation of the complement system and hemolysis studies

    NASA Astrophysics Data System (ADS)

    Fornaguera, Cristina; Calderó, Gabriela; Mitjans, Montserrat; Vinardell, Maria Pilar; Solans, Conxita; Vauthier, Christine

    2015-03-01

    The intravenous administration of poly(lactic-co-glycolic) acid (PLGA) nanoparticles has been widely reported as a promising alternative for delivery of drugs to specific cells. However, studies on their interaction with diverse blood components using different techniques are still lacking. Therefore, in the present work, the interaction of PLGA nanoparticles with blood components was described using different complementary techniques. The influence of different encapsulated compounds/functionalizing agents on these interactions was also reported. It is worth noting that all these techniques can be simply performed, without the need for highly sophisticated apparatus or skills. Moreover, their transference to industries and application of quality control could be easily performed. Serum albumin was adsorbed onto all types of tested nanoparticles. The saturation concentration was dependent on the nanoparticle size. In contrast, fibrinogen aggregation was dependent on nanoparticle surface charge. The complement activation was also influenced by the nanoparticle functionalization; the presence of a functionalizing agent increased complement activation, while the addition of an encapsulated compound only caused a slight increase. None of the nanoparticles influenced the coagulation cascade at low concentrations. However, at high concentrations, cationized nanoparticles did activate the coagulation cascade. Interactions of nanoparticles with erythrocytes did not reveal any hemolysis. Interactions of PLGA nanoparticles with blood proteins depended both on the nanoparticle properties and the protein studied. Independent of their loading/surface functionalization, PLGA nanoparticles did not influence the coagulation cascade and did not induce hemolysis of erythrocytes; they could be defined as safe concerning induction of embolization and cell lysis.The intravenous administration of poly(lactic-co-glycolic) acid (PLGA) nanoparticles has been widely reported as a promising

  7. Rice Germosprout Extract Protects Erythrocytes from Hemolysis and the Aorta, Brain, Heart, and Liver Tissues from Oxidative Stress In Vitro

    PubMed Central

    Hussain, Jakir; Islam, Saiful

    2016-01-01

    Identifying dietary alternatives for artificial antioxidants capable of boosting antihemolytic and antioxidative defense has been an important endeavor in improving human health. In the present study, we studied antihemolytic and antioxidative effects of germosprout (i.e., the germ part along with sprouted stems plus roots) extract prepared from the pregerminated rice. The extract contained considerable amounts of antioxidant β-carotene (414 ± 12 ng/g of extract) and phytochemicals such as total polyphenols (12.0 ± 1.1 mg gallic acid equivalent/g of extract) and flavonoids (11.0 ± 1.4 mg catechin equivalent/g of extract). The antioxidant potential of the extract was assessed by its DPPH- (2,2-diphenyl-1-picrylhydrazyl-) free radical scavenging activity where we observed that germosprout extract had considerable antioxidative potentials. To evaluate antihemolytic effect of the extract, freshly prepared erythrocytes were incubated with either peroxynitrite or Fenton's reagent in the absence or presence of the extract. We observed that erythrocytes pretreated with the extract exhibited reduced degree of in vitro hemolysis. To support the proposition that germosprout extract could act as a good antioxidative agent, we also induced in vitro oxidative stress in erythrocyte membranes and in the aorta, brain, heart, and liver tissue homogenates in the presence of the extract. As expected, germosprout extract decreased oxidative stress almost to the same extent as that of vitamin E, as measured by lipid peroxide levels, in all the mentioned tissues. We conclude that rice germosprout extract could be a good natural source of antioxidants to reduce oxidative stress-induced hemolysis and damage of blood vessels and other tissues. PMID:27413391

  8. In vitro degradation, hemolysis, and cytocompatibility of PEO/PLLA composite coating on biodegradable AZ31 alloy.

    PubMed

    Wei, Zhongling; Tian, Peng; Liu, Xuanyong; Zhou, Bangxin

    2015-02-01

    Magnesium and its alloys have large potential as degradable and absorbable biomaterials because of their mechanical properties and biocompatibility. However, their corrosion resistance is usually inadequate especially in physiological environment, which limits their broad applications in biomedical areas. In this work, plasma electrolytic oxidized/poly(l-lactide) (PEO/PLLA) composite coating was successfully fabricated on biodegradable AZ31 alloy by combing PEO process and sealing with PLLA. The microstructure, elemental composition, and phase composition of the PEO/PLLA composite coating were investigated. The in vitro degradation of the PEO/PLLA composite coating in simulated body fluid (SBF) was also systematically evaluated. The results revealed that the PEO/PLLA composite coating improved the corrosion resistance of AZ31 alloy significantly. The corrosion potential shifted from -1.663V to more positive position -1.317 V and the corrosion current density was reduced with six-order of magnitude. The Mg(2+) ions, hydrogen release, and pH value change of solution caused by degradation were all decreased significantly. Moreover, the PEO process played a critical role in sustaining the integrity of the implant in long-term service. The result of hemolysis test showed that the PEO/PLLA composite coating vested AZ31 alloy a low hemolysis ratio (0.806 ± 0.771)%, which is much lower than the safe value of 5% according to ISO 10993-4. For the cytocompatibility test, compared with bare AZ31 alloy and PEO coating, MC3T3-E1 cells showed much better adhesion and proliferation on the PEO/PLLA composite coating with nearly 4-fold increase of cells after 7-day cultivation, indicating that the PEO/PLLA composite coating has good biocompatibility for biomedical applications.

  9. A Novel Mechanical Thrombectomy Device for Retrieval of Intravascular Thrombus

    SciTech Connect

    Monsky, Wayne L.; Finitsis, Stephanos; Cicco, Dino De; Brock, John M.; Kucharczyk, John; Latchaw, Richard E.

    2011-04-15

    Purpose: Thrombotic and embolic vascular occlusion represents a leading cause of morbidity and mortality. Currently available thrombectomy devices have limitations, including difficulty removing organized thrombus and clot fragmentation with distal embolization. A novel mechanical thrombectomy device (MTD), designed to remove both hard and soft thrombus without trauma to the blood vessel, was tested in preclinical porcine models evaluating efficacy, safety, and ease of use. Materials and Methods: A total of 26 vessels in 14 pigs underwent mechanical thrombectomy with MTD. Thrombectomy was performed in nine superficial femoral arteries, eight subclavian arteries, five primary branches of the subclavian artery, lateral thoracic artery or the thyrocervical trunk, and four external carotids. Subacute organized fibrin-laden thrombus was injected into the arteries producing vascular occlusion. The MTD was then used for thrombectomy to restore patency and blood flow. Results: Intact thrombus was retrieved from 24 of 26 of the vessels with a single pass of the MTD, resulting in complete restoration of patency in 21 vessels and partial patency in 4 vessels. In 8 cases that used an early design, the embolic material fragmented during withdrawal from the access sheath. In 4 procedures that used an early design, the MTD failed to deploy fully and the embolus was not completely captured. No intraprocedural complications or vascular damage occurred. Conclusions: The present pilot studies demonstrate basic safety and efficacy of a novel MTD with design attributes suitable for retrieval of intact acute and organized chronic thrombus. The device has potential intracranial and peripheral utility.

  10. A PTS EII mutant library in Group A Streptococcus identifies a promiscuous man-family PTS transporter influencing SLS-mediated hemolysis.

    PubMed

    Sundar, Ganesh S; Islam, Emrul; Gera, Kanika; Le Breton, Yoann; McIver, Kevin S

    2017-02-01

    The Group A Streptococcus (GAS, Streptococcus pyogenes) is a Gram-positive human pathogen that must adapt to unique host environments in order to survive. Links between sugar metabolism and virulence have been demonstrated in GAS, where mutants in the phosphoenolpyruvate-dependent phosphotransferase system (PTS) exhibited Streptolysin S (SLS)-mediated hemolysis during exponential growth. This early onset hemolysis correlated with an increased lesion size and severity in a murine soft tissue infection model when compared with parental M1T1 MGAS5005. To identify the PTS components responsible for this phenotype, we insertionally inactivated the 14 annotated PTS EIIC-encoding genes in the GAS MGAS5005 genome and subjected this library to metabolic and hemolysis assays to functionally characterize each EIIC. It was found that a few EIIs had a very limited influence on PTS sugar metabolism, whereas others were fairly promiscuous. The mannose-specific EII locus, encoded by manLMN, was expressed as a mannose-inducible operon that exhibited the most influence on PTS sugar metabolism, including mannose. Importantly, components of the mannose-specific EII also acted to prevent the early onset of SLS-mediated hemolysis. Interestingly, these roles were not identical in two different M1T1 GAS strains, highlighting the possible versatility of the PTS to adapt to strain-specific needs.

  11. Ex vivo red blood cell hemolysis assay for the evaluation of pH-responsive endosomolytic agents for cytosolic delivery of biomacromolecular drugs.

    PubMed

    Evans, Brian C; Nelson, Christopher E; Yu, Shann S; Beavers, Kelsey R; Kim, Arnold J; Li, Hongmei; Nelson, Heather M; Giorgio, Todd D; Duvall, Craig L

    2013-03-09

    Phospholipid bilayers that constitute endo-lysosomal vesicles can pose a barrier to delivery of biologic drugs to intracellular targets. To overcome this barrier, a number of synthetic drug carriers have been engineered to actively disrupt the endosomal membrane and deliver cargo into the cytoplasm. Here, we describe the hemolysis assay, which can be used as rapid, high-throughput screen for the cytocompatibility and endosomolytic activity of intracellular drug delivery systems. In the hemolysis assay, human red blood cells and test materials are co-incubated in buffers at defined pHs that mimic extracellular, early endosomal, and late endo-lysosomal environments. Following a centrifugation step to pellet intact red blood cells, the amount of hemoglobin released into the medium is spectrophotometrically measured (405 nm for best dynamic range). The percent red blood cell disruption is then quantified relative to positive control samples lysed with a detergent. In this model system the erythrocyte membrane serves as a surrogate for the lipid bilayer membrane that enclose endo-lysosomal vesicles. The desired result is negligible hemolysis at physiologic pH (7.4) and robust hemolysis in the endo-lysosomal pH range from approximately pH 5-6.8.

  12. Human erythrocyte hemolysis induced by selenium and tellurium compounds increased by GSH or glucose: a possible involvement of reactive oxygen species.

    PubMed

    Schiar, Viviane Patrícia P; Dos Santos, Danúbia B; Paixão, Márcio W; Nogueira, Cristina Wayne; Rocha, João Batista T; Zeni, Gilson

    2009-01-15

    Oxidative stress can induce complex alterations of membrane proteins in red blood cells (RBCs) eventually leading to hemolysis. RBCs represent a good model to investigate the damage induced by oxidizing agents. Literature data have reported that chalcogen compounds can present pro-oxidant properties with potent inhibitory effects on cell growth, causing tissue damage and inhibit a variety of enzymes. In this study, human erythrocytes were incubated in vitro with various chalcogen compounds at 37 degrees C: diphenyl ditelluride (1), dinaphthalen diteluride (2), diphenyl diselenide (3), (S)-tert-butyl 1-diselenide-3-methylbutan-2-ylcarbamate (4), (S)-tert-butyl 1-diselenide-3-phenylpropan-2-ylcarbamate (5), selenium dioxide (6) and sodium selenite (7) in order to investigate their potential in vitro toxicity. After 6h of incubation, all the tested compounds increased the hemolysis rate, when compared to control and compound (2) had the most potent hemolytic effect. The addition of reduced glutathione (GSH) or glucose to the incubation medium enhanced hemolysis caused by chalcogen compounds. The thiol oxidase activity of these compounds was evaluated by measuring the rate of cysteine (CYS) and dithiotreitol (DTT) oxidation. DTT and cysteine oxidation was increased by all the compounds tested. The results suggest a relationship between the oxidation of intracellular GSH and subsequent generation of free radicals with the hemolysis by chalcogen compounds.

  13. Effect of acute pericardial tamponade on the relative contributions of systolic and diastolic pulmonary venous return: a transesophageal pulsed Doppler study.

    PubMed

    Louie, E K; Hariman, R J; Wang, Y; Hwang, M H; Loeb, H S; Scanlon, P J

    1995-01-01

    The effect of acute pericardial tamponade on pulmonary venous return was assessed by transesophageal pulsed Doppler echocardiography. In 14 open-chest anesthetized dogs peak pulmonary venous flow velocities in systole (VJ) and in diastole (VK) were measured during apnea and atrial pacing while acute tamponade was induced by intrapericardial instillation of 0.9% sodium chloride solution. Before intravascular volume expansion, induction of acute tamponade resulted in a significant decline in VK (43 +/- 17 to 19 +/- 8 cm/sec; p < 0.05) but no change in VJ or the ratio VJ/VK. After intravascular volume expansion, induction of acute tamponade resulted in significant reductions in VJ (43 +/- 9 to 29 +/- 10 cm/sec; p < 0.001) and VK (37 +/- 19 to 15 +/- 11 cm/sec; p < 0.001). The effect was disproportionately greater on VK, however, resulting in a significant increase in VJ/VK (1.51 +/- 0.84 to 2.58 +/- 1.41; p < 0.001). The disproportionate effect of acute tamponade on VK suggests that increased pericardial pressure directly constrains diastolic filling of the left atrium as a conduit to the left ventricle and that it does not decrease the systolic and diastolic phases of pulmonary venous return uniformly. Intravascular volume expansion increases cardiac output before acute tamponade, but during acute tamponade it amplifies the disproportionate impact of increased pericardial pressure on left ventricular diastolic filling as the left ventricle is constrained within the fluid-filled pericardial sac.

  14. Acute toxicity from baking soda ingestion.

    PubMed

    Thomas, S H; Stone, C K

    1994-01-01

    Sodium bicarbonate is an extremely well-known agent that historically has been used for a variety of medical conditions. Despite the widespread use of oral bicarbonate, little documented toxicity has occurred, and the emergency medicine literature contains no reports of toxicity caused by the ingestion of baking soda. Risks of acute and chronic oral bicarbonate ingestion include metabolic alkalosis, hypernatremia, hypertension, gastric rupture, hyporeninemia, hypokalemia, hypochloremia, intravascular volume depletion, and urinary alkalinization. Abrupt cessation of chronic excessive bicarbonate ingestion may result in hyperkalemia, hypoaldosteronism, volume contraction, and disruption of calcium and phosphorus metabolism. The case of a patient with three hospital admissions in 4 months, all the result of excessive oral intake of bicarbonate for symptomatic relief of dyspepsia is reported. Evaluation and treatment of patients with acute bicarbonate ingestion is discussed.

  15. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    PubMed

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F

    1992-08-01

    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.

  16. Impact of gender and age on in vivo virtual histology-intravascular ultrasound imaging plaque characterization (from the global Virtual Histology Intravascular Ultrasound [VH-IVUS] registry).

    PubMed

    Qian, Jie; Maehara, Akiko; Mintz, Gary S; Margolis, M Pauliina; Lerman, Amir; Rogers, Jason; Banai, Shuel; Kazziha, Samer; Castellanos, Celia; Dani, Lokesh; Fahy, Martin; Stone, Gregg W; Leon, Martin B

    2009-05-01

    Virtual histology intravascular ultrasound (VH-IVUS) analyses were performed in the first 990 patients enrolled in the 3,000+ patient global VH-IVUS Registry to assess the impact of gender and age on in vivo VH-IVUS plaque characterization. The 990 patients were divided into 3 age group terciles (<58, 58 to 68, and >68 years) and again divided according to gender. In conclusion, (1) both women and men had an increase in plaque with increasing age; (2) at any age, men had more plaque than women; (3) percentages of dense calcium and necrotic core increased with increasing patient age in both men and women; and (4) gender differences were lowest in the oldest tercile (>68 years).

  17. Acute exercise does not induce an acute phase response (APR) in Standardbred trotters.

    PubMed

    Kristensen, Lena; Buhl, Rikke; Nostell, Katarina; Bak, Lars; Petersen, Ellen; Lindholm, Maria; Jacobsen, Stine

    2014-04-01

    The purpose of the study was to investigate whether acute strenuous exercise (1600- to 2500-m race) would elicit an acute phase response (APR) in Standardbred trotters. Blood levels of several inflammatory markers [serum amyloid A (SAA), haptoglobin, fibrinogen, white blood cell count (WBC), and iron], muscle enzymes [creatinine kinase (CK) and aspartate transaminase (AST)], and hemoglobin were assessed in 58 Standardbred trotters before and after racing. Hemoglobin levels increased and iron levels decreased 12 to 14 h after racing and haptoglobin concentrations, white blood cell counts, and iron levels were decreased 2 and/or 7 d after racing. Concentrations of CK, AST, SAA, and fibrinogen were unaltered in response to racing. Acute strenuous exercise did not elicit an acute phase reaction. The observed acute increase in hemoglobin levels and decreases in haptoglobin and iron levels may have been caused by exercise-induced hemolysis, which indicates that horses might experience a condition similar to athlete's anemia in humans. The pathogenesis and clinical implications of the hematological and blood-biochemical changes elicited by acute exercise in Standardbred trotters in the present study warrant further investigation.

  18. A hemolysis trigger in glucose-6-phosphate dehydrogenase enzyme deficiency. Vicia sativa (Vetch).

    PubMed

    Bicakci, Zafer

    2009-02-01

    Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme, playing an important role in the redox metabolism of all aerobic cells. It was reported that certain medications, fava beans, and infections can trigger acute hemolytic anemia in patients with G6PD deficiency. An 8-year-old male patient was admitted to the hospital with blood in the urine, headache, dizziness, fatigue, loss of appetite, and jaundice in the eyes, 24 hours after eating large amounts of fresh, vetch grains. Laboratory investigation revealed hemolytic anemia, hyperbilirubinemia, and G6PD deficiency. Approximately 0.5% of fava bean seeds have 2 pyrimidine beta-glycosides called, vicine and convicine. Vetch has 0.731% vicine, 0.081% convicine, and 0.530% beta cyanoalanine glycosides. The aim of this case report is to emphasize the importance of vetch seeds as a cause for hemolytic crisis in our country, where approximately one million tons of vetch is produced per year, especially in the agricultural regions.

  19. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  20. Slow continuous intracorporeal plasmapheresis for acute fluid overload.

    PubMed

    Handley, Harold H; Gorsuch, Rey; Levin, Nathan W; Ronco, Claudio

    2003-01-01

    Intermittent dialysis is still the predominant treatment for acute or chronic renal insufficiency in the USA despite increasing evidence that slower and longer fluid management therapies are more beneficial to the patient. We have investigated the use of slow continuous intracorporeal plasmapheresis (SCIP) as a more efficient and hemodynamically stable alternative means of treating acute fluid overload. In this paper we discuss preliminary observations on the safety of SCIP catheter insertion, fluid removal, extraction and pathology in Yorkshire pigs. SCIP catheters removed plasma for extracorporeal plasma water removal without significant gross or histopathological changes. Blood chemistry and cell counts remained stable during therapy. Toxicological studies indicated no pyrogenicity, hemolysis, cytotoxicity, acute systemic toxicity, delayed-type hypersensitivity, or blood recalcification coagulation inhibition. Intracutaneous extracts caused only mild irritation. SCIP therapy appears to be safe for use in the removal of plasma and plasma water from experimental animals.

  1. Acute fatty liver of pregnancy.

    PubMed

    Papafragkakis, Haris; Singhal, Shashideep; Anand, Sury

    2013-10-01

    Acute fatty liver of pregnancy is a rare but serious and potentially fatal complication of pregnancy. It typically presents in the third trimester with microvesicular fatty infiltration of the liver and can lead to multiorgan failure and death. Differentiation from hemolysis-elevated liver enzymes-low platelets syndrome can guide management. A high index of suspicion is necessary in the appropriate clinical setting to identify clinical manifestations and complications and manage them appropriately. In severe cases, prompt delivery can be lifesaving for the mother and fetus. Liver transplantation remains controversial and must be considered individually. Defects in fatty acid oxidation secondary to various enzymatic deficiencies have been associated with acute fatty liver of pregnancy. Women or couples with known defects in fatty acid oxidation and women with a history of previous liver disease during pregnancy or sudden death of a child within the first 2 years of life should be assessed for a defect in fatty acid oxidation and monitored carefully. Our review summarizes the current knowledge in pathophysiology, diagnostic approach and management of this disorder.

  2. Microparticle production, neutrophil activation, and intravascular bubbles following open-water SCUBA diving.

    PubMed

    Thom, Stephen R; Milovanova, Tatyana N; Bogush, Marina; Bhopale, Veena M; Yang, Ming; Bushmann, Kim; Pollock, Neal W; Ljubkovic, Marko; Denoble, Petar; Dujic, Zeljko

    2012-04-01

    The goal of this study was to evaluate annexin V-positive microparticles (MPs) and neutrophil activation in humans following decompression from open-water SCUBA diving with the hypothesis that changes are related to intravascular bubble formation. Sixteen male volunteer divers followed a uniform profile of four daily SCUBA dives to 18 m of sea water for 47 min. Blood was obtained prior to and at 80 min following the first and fourth dives to evaluate the impact of repetitive diving, and intravascular bubbles were quantified by trans-thoracic echocardiography carried out at 20-min intervals for 2 h after each dive. MPs increased by 3.4-fold after each dive, neutrophil activation occurred as assessed by surface expression of myeloperoxidase and the CD18 component of β(2)-integrins, and there was an increased presence of the platelet-derived CD41 protein on the neutrophil surface indicating interactions with platelet membranes. Intravascular bubbles were detected in all divers. Surprisingly, significant inverse correlations were found among postdiving bubble scores and MPs, most consistently at 80 min or more after the dive on the fourth day. There were significant positive correlations between MPs and platelet-neutrophil interactions after the first dive and between platelet-neutrophil interactions and neutrophil activation documented as an elevation in β(2)-integrin expression after the fourth dive. We conclude that MPs- and neutrophil-related events in humans are consistent with findings in an animal decompression model. Whether there are causal relationships among bubbles, MPs, platelet-neutrophil interactions, and neutrophil activation remains obscure and requires additional study.

  3. In vivo intravascular electric impedance spectroscopy using a new catheter with integrated microelectrodes.

    PubMed

    Süselbeck, Tim; Thielecke, Hagen; Weinschenk, Ines; Reininger-Mack, Alexandra; Stieglitz, Thomas; Metz, Jürgen; Borggrefe, Martin; Robitzki, Andrea; Haase, Karl K

    2005-01-01

    Interventional techniques are necessary, which allow the characterization of intravascular pathological processes. Electric impedance spectroscopy (EIS) can provide cellular information of biological tissue. We tested the feasibility of intravascular EIS by using a new impedance catheter system with integrated microelectrodes in an experimental animal model. Eighteen stents were implanted into the iliac arteries of female New Zealand White rabbits (n = 11) to induce intimal proliferation. After 14, 28 and 56 days the electric impedance was measured inside and outside of the stented arterial segments by using a balloon catheter with four integrated microelectrodes. The impedance was recorded at a frequency ranging from 1 Hz to 1 MHz. After the measurements, the stents were explanted and histomorphometry was performed. The impedance inside and outside the stent was analysed and compared with the histomorphometric data. Fourteen (n = 6), 28 (n = 5) and 56 (n = 6) days after stent implantation the difference of the electrical impedance between the native and the stented iliac artery segment increased from -924 +/- 715 Ohm to 3689 +/- 1385 Ohm (14 days vs. 28 days; p < 0.05) and 8637 +/- 2881 Ohm (14 days vs. 56 days; p < 0.05), respectively. The increase of the electrical impedance corresponded to an increased neointimal proliferation in the stented arterial segment of 3.6% +/-0.7% after 14 days, 8.4% +/- 4.8% after 28 days (14 days vs. 28 days; p < 0.05) and 10.0% +/- 4.1% after 56 days (14 days vs. 56 days; p < 0.01). Intravascular EIS can be performed by a balloon catheter with integrated microelectrodes and allows the detection of neointimal proliferation after stent implantation.

  4. All-optical pulse-echo ultrasound probe for intravascular imaging (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Colchester, Richard J.; Noimark, Sacha; Mosse, Charles A.; Zhang, Edward Z.; Beard, Paul C.; Parkin, Ivan P.; Papakonstantinou, Ioannis; Desjardins, Adrien E.

    2016-02-01

    High frequency ultrasound probes such as intravascular ultrasound (IVUS) and intracardiac echocardiography (ICE) catheters can be invaluable for guiding minimally invasive medical procedures in cardiology such as coronary stent placement and ablation. With current-generation ultrasound probes, ultrasound is generated and received electrically. The complexities involved with fabricating these electrical probes can result in high costs that limit their clinical applicability. Additionally, it can be challenging to achieve wide transmission bandwidths and adequate wideband reception sensitivity with small piezoelectric elements. Optical methods for transmitting and receiving ultrasound are emerging as alternatives to their electrical counterparts. They offer several distinguishing advantages, including the potential to generate and detect the broadband ultrasound fields (tens of MHz) required for high resolution imaging. In this study, we developed a miniature, side-looking, pulse-echo ultrasound probe for intravascular imaging, with fibre-optic transmission and reception. The axial resolution was better than 70 microns, and the imaging depth in tissue was greater than 1 cm. Ultrasound transmission was performed by photoacoustic excitation of a carbon nanotube/polydimethylsiloxane composite material; ultrasound reception, with a fibre-optic Fabry-Perot cavity. Ex vivo tissue studies, which included healthy swine tissue and diseased human tissue, demonstrated the strong potential of this technique. To our knowledge, this is the first study to achieve an all-optical pulse-echo ultrasound probe for intravascular imaging. The potential for performing all-optical B-mode imaging (2D and 3D) with virtual arrays of transmit/receive elements, and hybrid imaging with pulse-echo ultrasound and photoacoustic sensing are discussed.

  5. Frequency-Domain Intravascular Optical Coherence Tomography of the Femoropopliteal Artery

    SciTech Connect

    Karnabatidis, Dimitris Katsanos, Konstantinos; Paraskevopoulos, Ioannis; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Siablis, Dimitris

    2011-12-15

    Purpose: Optical coherence tomography (OCT) is a catheter-based imaging method that employs near-infrared light to produce high-resolution intravascular images. The authors report the safety and feasibility and illustrate common imaging findings of frequency-domain OCT (FD-OCT) imaging of the femoropopliteal artery in a series of 20 patients who underwent infrainguinal angioplasty. Methods: After crossing the lesion of interest, OCT was performed with a dextrose saline flush technique with simultaneous obstructive manual groin compression. An automatic pullback FD-OCT device was employed (each scan acquiring 54 mm of vessel lumen in 271 consecutive frames). OCT images were acquired before and after balloon dilatation and following provisional stenting if necessary and were evaluated for baseline characteristics of plaque or in-stent restenosis (ISR), vessel wall trauma after angioplasty, presence of thrombus, stent apposition, and tissue prolapse. Imaging follow-up was not included in this study's protocol. Results: Twenty-seven obstructive lesions (18 cases of de novo atherosclerosis and 9 of ISR) of the femoropopliteal artery were imaged and 148 acquisitions were analyzed in total. High-resolution intravascular OCT imaging with effective blood clearance was achieved in 93.9%. Failure was mainly attributed to preocclusive proximal lesions and/or collateral flow. Mixed features of lipid pool areas, calcium deposits, necrotic core, and fibrosis were identified in all of the imaged atherosclerotic lesions, whereas ISR was purely fibrotic. After balloon angioplasty, OCT identified extensive intimal tears in all cases and one case of severe dissection that biplane subtraction angiography failed to identify. Conclusions: Infrainguinal frequency-domain optical coherence tomography is safe and feasible and may provide intravascular high-resolution imaging of the femoropopliteal artery during infrainguinal angioplasty procedures.

  6. Helicobacter pylori Eradication Therapy for Thrombocytopenia after Surgery for Abdominal Aortic Aneurysm with Disseminated Intravascular Coagulation

    PubMed Central

    Akiyama, Daichi; Okada, Hiroshi; Date, Kazuma; Furukawa, Hiroshi; Takeda, Makoto

    2016-01-01

    Abdominal aortic aneurysm (AAA) is known to be rarely accompanied by disseminated intravascular coagulation (DIC). We report a case of AAA with DIC. An 81-year-old man with abdominal pain referred to our hospital. Computed tomography demonstrated an AAA (maximum diameter: 90 mm). The patient underwent a laparotomy, and an abdominal aorta replacement was performed. At the 3-month follow-up, the patient underwent Helicobacter pylori eradication treatment for 1 week. After treatment, the platelet count dramatically increased. The mechanism by which H. pylori eradication therapy improves hematological parameters has not been elucidated; however, this noninvasive treatment effectively resolved DIC associated with AAA. PMID:28018509

  7. Inflammatory abdominal aortic aneurysm followed by disseminated intravascular coagulation and immune thrombocytopenia.

    PubMed

    Machida, Hisanori; Kobayashi, Makoto; Taguchi, Hirokuni

    2002-11-01

    A 71-year-old man was diagnosed as having an abdominal aortic aneurysm when he was treated for idiopathic interstitial pneumonia (IIP). Three years later, he developed severe thrombocytopenia and had disseminated intravascular coagulation (DIC) that was associated with the inflammatory abdominal aortic aneurysm (IAAA). The coagulation abnormalities were corrected by low-molecular weight heparin, however the platelet count remained low. Bone marrow showed normocellularity with an increase of immature and mature forms of megakaryocytes. Platelet-associated IgG level was high. These findings suggested that the patient had severe thrombocytopenia caused by unusual complications of immune thrombocytopenic purpura and IAAA-associated DIC.

  8. Specific imaging of atherosclerotic plaque lipids with two-wavelength intravascular photoacoustics

    PubMed Central

    Wu, Min; Jansen, Krista; van der Steen, Antonius F. W.; van Soest, Gijs

    2015-01-01

    The lipid content in plaques is an important marker for identifying atherosclerotic lesions and disease states. Intravascular photoacoustic (IVPA) imaging can be used to visualize lipids in the artery. In this study, we further investigated lipid detection in the 1.7-µm spectral range. By exploiting the relative difference between the IVPA signal strengths at 1718 and 1734 nm, we could successfully detect and differentiate between the plaque lipids and peri-adventitial fat in human coronary arteries ex vivo. Our study demonstrates that IVPA imaging can positively identify atherosclerotic plaques using only two wavelengths, which could enable rapid data acquisition in vivo. PMID:26417500

  9. Delivery of Adeno-Associated Virus Gene Therapy by Intravascular Limb Infusion Methods.

    PubMed

    Gruntman, Alisha M; Flotte, Terence R

    2015-09-01

    Recombinant adeno-associated virus (rAAV) can be delivered to the skeletal muscle of the limb (pelvic or thoracic) by means of regional intravascular delivery. This review summarizes the evolution of this technique to deliver rAAV either via the arterial blood supply or via the peripheral venous circulation. The focus of this review is on applications in large animal models, including preclinical studies. Based on this overview of past research, we aim to inform the design of preclinical and clinical studies.

  10. Disseminated Intravascular Coagulation and Excessive Fibrinolysis (DIC XFL) Syndrome in Prostate Cancer: A Rare Complicated Disorder

    PubMed Central

    Hamzah, Azhar Bin Amir; Choo, Yew Maw; Saleem, Fahad; Verma, Ashutosh Kumar

    2017-01-01

    Disseminated Intravascular Coagulation (DIC) develops in patient with prostate cancer, which is manifested by systemic, intracranial, intracavitary or intracutaneous bleeding indicating uncompensated or excessive fibrinolysis (XFL). This case report is a description of a 61-year-old male with metastatic prostate cancer that progressed to manifest DIC. The condition is rare in clinical practice, and even rarer when is coupled with XFL. Treatment was mainly replenishing coagulation factors, platelets and controlling the disease progression with aggressive hormonal therapy. The patient progressed to coagulopathy further with fibrinolysis, hence leading to mortality. This case study discusses the pathophysiology of this complication and various methods to monitor the disease progression are discussed. PMID:28274032

  11. A Case of Hypereosinophilic Syndrome Presenting With Multiorgan Infarctions Associated With Disseminated Intravascular Coagulation

    PubMed Central

    Park, Sun-Mi; Park, Ji-Won; Kim, Sung-Min; Koo, Eun-Hee; Lee, Jin-Young; Lee, Chul-Su; Choi, Dong-Chull

    2012-01-01

    Thromboembolism is one of the most critical complications of hypereosinophilic syndrome (HES). We report here a case of multi-organ infarctions related to HES. A 23-year-old woman was referred to our hospital with hemoptysis. Not only pulmonary, but also renal and splenic infarctions were detected on computed tomography images. Blood tests showed profound peripheral eosinophilia. She was diagnosed with HES with disseminated intravascular coagulation (DIC). We initiated infusion of corticosteroids, which effectively suppressed peripheral eosinophilia. However, consumptive coagulopathy did not improve and intracerebral hemorrhage related to thrombosis then developed. Addition of interferon-alpha resulted in the correction of the DIC associated with HES. PMID:22548210

  12. Intravascular large B-cell lymphoma presenting pulmonary arterial hypertension as an initial manifestation.

    PubMed

    Kotake, Takeshi; Kosugi, Satoru; Takimoto, Takayuki; Nakata, Soichi; Shiga, Junko; Nagate, Yasuhiro; Nakagawa, Tsutomu; Take, Hironori; Katagiri, Shuichi

    2010-01-01

    We report a 39-year-old man with intravascular large B-cell lymphoma (IVLBCL) who had been treated as a case with pulmonary arterial hypertension (PAH) for one year. After he became worse, diffuse pulmonary (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) suggested the existence of IVLBCL in the lung showing normal CT images. The diagnosis was confirmed with random transbronchial lung biopsy, and he was then successfully treated. Since IVLBCL presenting PAH has been rare and is difficult to diagnose, early application of FDG-PET may provide early recognition of the disorder, leading to a better outcome.

  13. Rash, disseminated intravascular coagulation and legionella: Episode 10 and a rewind into the past

    PubMed Central

    Thalanayar, Prashanth M.; Holguin, Fernando

    2015-01-01

    Legionella pneumophila is the most common cause of legionellosis and is one of the organisms causing atypical pneumonia. We report the presentation of disseminated intravascular coagulation (DIC) and skin rash in a single case of severe Legionella pneumonia. The unique clinical presentation of a diffuse rash diagnosed as purpura fulminans and the unpredictable variations encountered during the diagnostic work-up of the case make this write-up crucial. This article synthesizes all reported cases of L. pneumonia associated with cutaneous manifestations as well as cases presenting with DIC. Furthermore, this manuscript illustrates the correlation between cutaneous and coagulopathic manifestations, and morbidity and mortality from L. pneumonia. PMID:26236615

  14. Intravascular low-level laser irradiation in the treatment of psoriasis

    NASA Astrophysics Data System (ADS)

    Zhu, Jing; Shi, Hong-Min; Zhang, Hui-Guo; Zhang, Mei-Jue; Xu, Jian; Zhou, Min; Hu, Guo-Qiang

    1998-11-01

    Liu TCY et al have put forward the biological information model on low intensity laser irradiation (BIML): low intensity laser irradiation couples with intracellular messenger through the chromophore absorption in the cell membrane: hot-color laser irradiation activates cAMP phosphodiestererase through Gi protein, or activates phosphoinositide phospholipase C through G protein, or activates one of receptor-associated kinases: cAMP; cold- color laser irradiation activates adenylate cyclase through Gs protein: cAMP$ARUP. In this paper, under the guidance of BIML, we applied the intravascular low intensity He-He laser irradiation on blood to a patient of idiopathic edema, and succeeded.

  15. Blue or red: which intravascular laser light has more effects in diabetic patients?

    PubMed

    KazemiKhoo, N; Ansari, F

    2015-01-01

    The effects of intravascular laser irradiation of blood (ILIB), with 405 and 632.8 nm on serum blood sugar (BS) level, were comparatively studied. Twenty-four diabetic type 2 patients received 14 sessions of ILIB with blue and red lights. BS was measured before and after therapy. Serum BS decreased highly significant after ILIB with both red and blue lights (p < 0.0001), but we did not find significant difference between red and blue lights. The ILIB effect would be of benefit in the clinical treatment of diabetic type 2 patients, irrespective of lasers (blue or red lights) that are used.

  16. Knuckle technique guided by intravascular ultrasound for in-stent restenosis occlusion treatment

    PubMed Central

    Tasic, Mladen; Jagic, Nikola; Miloradovic, Vladimir; Nikolic, Dusan

    2015-01-01

    One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion. PMID:25848374

  17. Intravascular Papillary Endothelial Hyperplasia (Masson’s Tumor): Diagnosis the Plastic Surgeon Should Be Aware of

    PubMed Central

    Boukovalas, Stefanos; Dillard, Rachel; Qiu, Suimin

    2017-01-01

    Summary: Intravascular papillary endothelial hyperplasia (IPEH) or Masson’s tumor is a rare benign entity commonly found on the head, neck, and upper extremities. It usually arises within a blood vessel but is considered to be a nonneoplastic reactive process often associated with vascular injury. Typically, IPEHs cause no symptoms and present as slowly growing soft-tissue masses. Given their prevalent location and indolent clinical presentation, the plastic surgeon should be familiar with this rare entity. We are presenting a case of IPEH of the forehead with unusual clinical and pathologic characteristics. Differential diagnosis, special considerations regarding preoperative work-up, and treatment options are discussed. PMID:28203491

  18. Disseminated intravascular coagulation in a patient with metastatic prostate cancer: Fatal outcome following strontium-89 therapy

    SciTech Connect

    Leong, C.; McKenzie, R.; Coupland, D.B.

    1994-10-01

    A patient with metastatic prostate cancer was found to have low-grade disseminated intravascular coagulation (DIC). He had significant bone pain despite external-beam radiotherapy and was given {sup 89}Sr with subsequent thrombocytopenia and epistaxis. The patient died from generalized hemorrhage 36 days postinjection. Although it is not possible to establish a causal relationship between {sup 89}Sr and DIC, practitioners should be alert to complications associated with the primary disorder which might occur at a time to raise concern about the intervention. 8 refs., 1 tab.

  19. Nephrotic syndrome resulting in thromboembolic disease and disseminated intravascular coagulation in a dog.

    PubMed

    Ritt, M G; Rogers, K S; Thomas, J S

    1997-01-01

    Thromboembolic disease and progression to disseminated intravascular coagulation (DIC) are potential life-threatening complications for dogs with nephrotic syndrome. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), plasma concentration of fibrinogen degradation products (FDPs), antithrombin III (ATIII), protein C, and plasminogen were used to identify hemostatic abnormalities in a dog with nephrotic syndrome. Pulmonary thromboembolic disease was diagnosed by thoracic radiography, arterial blood gas analysis, and pulmonary scintigraphy. Prompt recognition and treatment of hemostatic complications is necessary in dogs with nephrotic syndrome.

  20. Mechanical effects of muscle contraction increase intravascular ATP draining quiescent and active skeletal muscle in humans.

    PubMed

    Crecelius, Anne R; Kirby, Brett S; Richards, Jennifer C; Dinenno, Frank A

    2013-04-01

    Intravascular adenosine triphosphate (ATP) evokes vasodilation and is implicated in the regulation of skeletal muscle blood flow during exercise. Mechanical stresses to erythrocytes and endothelial cells stimulate ATP release in vitro. How mechanical effects of muscle contractions contribute to increased plasma ATP during exercise is largely unexplored. We tested the hypothesis that simulated mechanical effects of muscle contractions increase [ATP](venous) and ATP effluent in vivo, independent of changes in tissue metabolic demand, and further increase plasma ATP when superimposed with mild-intensity exercise. In young healthy adults, we measured forearm blood flow (FBF) (Doppler ultrasound) and plasma [ATP](v) (luciferin-luciferase assay), then calculated forearm ATP effluent (FBF×[ATP](v)) during rhythmic forearm compressions (RFC) via a blood pressure cuff at three graded pressures (50, 100, and 200 mmHg; Protocol 1; n = 10) and during RFC at 100 mmHg, 5% maximal voluntary contraction rhythmic handgrip exercise (RHG), and combined RFC + RHG (Protocol 2; n = 10). [ATP](v) increased from rest with each cuff pressure (range 144-161 vs. 64 ± 13 nmol/l), and ATP effluent was graded with pressure. In Protocol 2, [ATP](v) increased in each condition compared with rest (RFC: 123 ± 33; RHG: 51 ± 9; RFC + RHG: 96 ± 23 vs. Mean Rest: 42 ± 4 nmol/l; P < 0.05), and ATP effluent was greatest with RFC + RHG (RFC: 5.3 ± 1.4; RHG: 5.3 ± 1.1; RFC + RHG: 11.6 ± 2.7 vs. Mean Rest: 1.2 ± 0.1 nmol/min; P < 0.05). We conclude that the mechanical effects of muscle contraction can 1) independently elevate intravascular ATP draining quiescent skeletal muscle without changes in local metabolism and 2) further augment intravascular ATP during mild exercise associated with increases in metabolism and local deoxygenation; therefore, it is likely one stimulus for increasing intravascular ATP during exercise in humans.

  1. High speed intravascular photoacoustic imaging with fast optical parametric oscillator laser at 1.7 μm.

    PubMed

    Piao, Zhonglie; Ma, Teng; Li, Jiawen; Wiedmann, Maximilian T; Huang, Shenghai; Yu, Mingyue; Kirk Shung, K; Zhou, Qifa; Kim, Chang-Seok; Chen, Zhongping

    2015-08-24

    Intravascular photoacoustic imaging at 1.7 μm spectral band has shown promising capabilities for lipid-rich vulnerable atherosclerotic plaque detection. In this work, we report a high speed catheter-based integrated intravascular photoacoustic/intravascular ultrasound (IVPA/IVUS) imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A lipid-mimicking phantom and atherosclerotic rabbit abdominal aorta were imaged at 1 frame per second, which is two orders of magnitude faster than previously reported in IVPA imaging with the same wavelength. Clear photoacoustic signals by the absorption of lipid rich deposition demonstrated the ability of the system for high speed vulnerable atherosclerotic plaques detection.

  2. High speed intravascular photoacoustic imaging with fast optical parametric oscillator laser at 1.7 μm

    PubMed Central

    Piao, Zhonglie; Ma, Teng; Li, Jiawen; Wiedmann, Maximilian T.; Huang, Shenghai; Yu, Mingyue; Kirk Shung, K.; Zhou, Qifa; Kim, Chang-Seok; Chen, Zhongping

    2015-01-01

    Intravascular photoacoustic imaging at 1.7 μm spectral band has shown promising capabilities for lipid-rich vulnerable atherosclerotic plaque detection. In this work, we report a high speed catheter-based integrated intravascular photoacoustic/intravascular ultrasound (IVPA/IVUS) imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A lipid-mimicking phantom and atherosclerotic rabbit abdominal aorta were imaged at 1 frame per second, which is two orders of magnitude faster than previously reported in IVPA imaging with the same wavelength. Clear photoacoustic signals by the absorption of lipid rich deposition demonstrated the ability of the system for high speed vulnerable atherosclerotic plaques detection. PMID:26339072

  3. Myocardial Bridge and Acute Plaque Rupture

    PubMed Central

    Perl, Leor; Daniels, David; Schwartz, Jonathan; Tanaka, Shige; Yeung, Alan; Tremmel, Jennifer A.; Schnittger, Ingela

    2016-01-01

    A myocardial bridge (MB) is a common anatomic variant, most frequently located in the left anterior descending coronary artery, where a portion of the coronary artery is covered by myocardium. Importantly, MBs are known to result in a proximal atherosclerotic lesion. It has recently been postulated that these lesions predispose patients to acute coronary events, even in cases of otherwise low-risk patients. One such mechanism may involve acute plaque rupture. In this article, we report 2 cases of patients with MBs who presented with acute coronary syndromes despite having low cardiovascular risk. Their presentation was life-risking and both were treated urgently and studied with coronary angiographies and intravascular ultrasound. This latter modality confirmed a rupture of an atherosclerotic plaque proximal to the MB as a likely cause of the acute events. These cases, of unexplained acute coronary syndrome in low-risk patients, raise the question of alternative processes leading to the event and the role MB play as an underlying cause of ruptured plaques. In some cases, an active investigation for this entity may be warranted, due to the prognostic implications of the different therapeutic modalities, should an MB be discovered. PMID:28251167

  4. Role of amphipathicity and hydrophobicity in the balance between hemolysis and peptide-membrane interactions of three related antimicrobial peptides.

    PubMed

    Hollmann, Axel; Martínez, Melina; Noguera, Martín E; Augusto, Marcelo T; Disalvo, Anibal; Santos, Nuno C; Semorile, Liliana; Maffía, Paulo C

    2016-05-01

    Cationic antimicrobial peptides (CAMPs) represent important self defense molecules in many organisms, including humans. These peptides have a broad spectrum of activities, killing or neutralizing many Gram-negative and Gram-positive bacteria. The emergence of multidrug resistant microbes has stimulated research on the development of alternative antibiotics. In the search for new antibiotics, cationic antimicrobial peptides (CAMPs) offer a viable alternative to conventional antibiotics, as they physically disrupt the bacterial membranes, leading to lysis of microbial membranes and eventually cell death. In particular, the group of linear α-helical cationic peptides has attracted increasing interest from clinical as well as basic research during the last decade. In this work, we studied the biophysical and microbiological characteristics of three new designed CAMPs. We modified a previously studied CAMP sequence, in order to increase or diminish the hydrophobic face, changing the position of two lysines or replacing three leucines, respectively. These mutations modified the hydrophobic moment of the resulting peptides and allowed us to study the importance of this parameter in the membrane interactions of the peptides. The structural properties of the peptides were also correlated with their membrane-disruptive abilities, antimicrobial activities and hemolysis of human red blood cells.

  5. Quantitative structure-activity relationship of hydroxyl-substituent Schiff bases in radical-induced hemolysis of human erythrocytes.

    PubMed

    Tang, You-Zhi; Liu, Zai-Qun

    2008-01-01

    The major objective of this work was to explore the quantitative structure-activity relationship (QSAR) of hydroxyl-substituent Schiff bases in protecting human erythrocytes against 2,2'-azobis(2-amidinopropane hydrochloride) (AAPH)- induced hemolysis, in which 10 Schiff bases including 4-phenyliminomethylphenol (PIH); 4-((4-hydroxybenzylidene) amino)phenol (PAH); 2-methoxy-4-((4-hydroxyphenylimino)methyl)phenol (PMH); 4-((furan-2-ylmethylene)amino) phenol (FAH); 4-((4-N,N-dimethylaminobenzylidene)amino)phenol (PDH); 2-((4-N,N-dimethylaminobenzylidene)amino) phenol (ODH); 2-(naphthalene-1-yliminomethyl)phenol (NAH); 2-(benzyliminomethyl)phenol (BPH); 1,4-di((2-hydroxyphenylimino) methyl)benzene (DOH); 1,4-di((4-hydroxyphenylimino)methyl)benzene DPH, were available for this in vitro experimental system. The results revealed that the radical-scavenging activity of the --OH attached to the para position of methylene in Schiff base was much lower than that attached to the ortho position of the N atom. The large conjugate system and low steric hindrance in the framework of Schiff base benefit the Schiff base to trap radicals. Meanwhile, since a Schiff base, even without any substituent, can also play an antioxidative role in this experimental system, the QSAR results suggest that hydroxyl-substituent Schiff bases are potential drugs in the treatment of radical-related diseases, and provide more information for designing novel drugs.

  6. Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non-transferrin-bound iron.

    PubMed

    Hod, Eldad A; Brittenham, Gary M; Billote, Genia B; Francis, Richard O; Ginzburg, Yelena Z; Hendrickson, Jeanne E; Jhang, Jeffrey; Schwartz, Joseph; Sharma, Shruti; Sheth, Sujit; Sireci, Anthony N; Stephens, Hannah L; Stotler, Brie A; Wojczyk, Boguslaw S; Zimring, James C; Spitalnik, Steven L

    2011-12-15

    Transfusions of RBCs stored for longer durations are associated with adverse effects in hospitalized patients. We prospectively studied 14 healthy human volunteers who donated standard leuko-reduced, double RBC units. One unit was autologously transfused "fresh" (3-7 days of storage), and the other "older" unit was transfused after 40 to 42 days of storage. Of the routine laboratory parameters measured at defined times surrounding transfusion, significant differences between fresh and older transfusions were only observed in iron parameters and markers of extravascular hemolysis. Compared with fresh RBCs, mean serum total bilirubin increased by 0.55 mg/dL at 4 hours after transfusion of older RBCs (P = .0003), without significant changes in haptoglobin or lactate dehydrogenase. In addition, only after the older transfusion, transferrin saturation increased progressively over 4 hours to a mean of 64%, and non-transferrin-bound iron appeared, reaching a mean of 3.2μM. The increased concentrations of non-transferrin-bound iron correlated with enhanced proliferation in vitro of a pathogenic strain of Escherichia coli (r = 0.94, P = .002). Therefore, circulating non-transferrin-bound iron derived from rapid clearance of transfused, older stored RBCs may enhance transfusion-related complications, such as infection.

  7. Acute hemolytic transfusion reaction in a pediatric patient following transfusion of apheresis platelets.

    PubMed

    Sapatnekar, Suneeti; Sharma, Girish; Downes, Katharine A; Wiersma, Susan; McGrath, Claire; Yomtovían, Roslyn

    2005-12-01

    The practice of transfusing ABO-incompatible platelets, driven primarily by concerns about inventory management, has been considered generally safe because the accompanying plasma is usually diluted in the recipient's total blood volume. However, if the platelet product contains a large volume of plasma or a high concentration of incompatible isoagglutinin, there may be hemolysis of the recipient's red cells. Patients with a small blood volume, such as babies and children, are considered to be at particular risk for such a complication. We describe the case of a baby who suffered massive hemolysis of her group A red cells after transfusion of group O Apheresis Platelets containing a high-titered anti-A isoagglutinin. We also offer a review of the literature on this subject and recommendations to avoid acute hemolytic reactions as a result of platelet transfusion.

  8. Hemoglobinuria and acute kidney injury requiring hemodialysis following intravenous immunoglobulin infusion.

    PubMed

    Welles, Christine C; Tambra, Shouieb; Lafayette, Richard A

    2010-01-01

    Intravenous immunoglobulin (IVIG), a product initially developed for patients with immunodeficiencies, now has multiple other indications and increasing off-label use. IVIG generally is well tolerated, with few adverse effects. Antibody-mediated (Coombs-positive) hemolysis is known to occur after IVIG infusion, but often is subclinical and previously has not been reported to lead to acute kidney injury (AKI). The predominantly known mechanism of AKI after IVIG infusion has been osmotic nephrosis, primarily associated with sucrose-containing formulations. We present a case of a bone marrow transplant recipient who was treated with a sucrose-free IVIG product and subsequently developed Coombs-positive hemolysis leading to AKI requiring hemodialysis, who ultimately died secondary to infectious complications. The severity of this case emphasizes the importance of identifying populations who may be at increased risk of pigment-mediated kidney injury before consideration of IVIG therapy.

  9. Hemolytic disease of the fetus and newborn due to anti-Ge3: combined antibody-dependent hemolysis and erythroid precursor cell growth inhibition.

    PubMed

    Blackall, Douglas P; Pesek, Gina D; Montgomery, Matthew M; Oza, Krishna K; Arndt, Patricia A; Garratty, George; Shahcheraghi, Ali; Denomme, Gregory A

    2008-10-01

    The Gerbich (Ge) antigens are a collection of high-incidence antigens carried on the red blood cell membrane glycoproteins, glycophorins C and D. Antibodies against these antigens are uncommon, and there have been only rare case reports of hemolytic disease of the fetus and newborn due to anti-Ge. In this case report, we present a neonate with severe anemia and hyperbilirubinemia due to anti-Ge3. Routine and special laboratory studies undertaken in this case suggested two mechanisms for the patient's hemolysis and persistent anemia. Antibody-dependent hemolysis was associated with early-onset hyperbilirubinemia, anemia, and a mild reticulocytosis, and inhibition of erythroid progenitor cell growth was associated with late anemia and normal bilirubin and reticulocyte values. Though rare, anti-Ge3 can be a dangerous antibody in pregnancy. Affected neonates may require intensive initial therapy and close follow-up for at least several weeks after delivery.

  10. A novel δ-hemolysis screening method for detecting heteroresistant vancomycin-intermediate Staphylococcus aureus and vancomycin-intermediate S. aureus.

    PubMed

    Cafiso, V; Bertuccio, T; Spina, D; Purrello, S; Blandino, G; Stefani, Stefania

    2012-05-01

    We assessed a new screening method, based on δ-hemolysin production in the presence of 6 mg/liter vancomycin, to distinguish heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) and vancomycin-intermediate S. aureus (VISA) from vancomycin-susceptible S. aureus (VSSA). On 37 clinical methicillin-resistant S. aureus (MRSA) isolates, hVISA and VISA displayed no δ-hemolysis whereas VSSA displayed strong δ-hemolysis, showing 91.6% sensitivity. These data, supported by real-time reverse transcription PCR (real-time RT-PCR) highlighting an hld downregulation, i.e., VSSA>hVISA>VISA, define this new assay as a valid screening method.

  11. Screening study on hemolysis suppression effect of an alternative plasticizer for the development of a novel blood container made of polyvinyl chloride.

    PubMed

    Haishima, Yuji; Kawakami, Tsuyoshi; Hasegawa, Chie; Tanoue, Akito; Yuba, Toshiyasu; Isama, Kazuo; Matsuoka, Atsuko; Niimi, Shingo

    2014-05-01

    The aim of this study is to identify a plasticizer that is effective in the suppression of the autohemolysis of the stored blood and can be used to replace di(2-ethylhexyl) phthalate (DEHP) in blood containers. The results of hemolysis test using mannitol-adenine-phosphate/red cell concentrates (MAP/RCC) spiked with plasticizers included phthalate, phthalate-like, trimeliate, citrate, and adipate derivatives revealed that di-isononyl-cyclohexane-1,2-dicarboxylate (Hexamoll(®) DINCH), di(2-ethylhexyl)-1,2,3,6-tetrahydro-phthalate (DOTP), and diisodecyl phthalate (DIDP) exhibited a hemolysis suppression effect almost equal to that of DEHP, but not other plasticizers. This finding suggested that the presence of 2 carboxy-ester groups at the ortho position on a 6-membered ring of carbon atoms may be required to exhibit such an effect. The hemolytic ratios of MAP/RCC-soaked polyvinyl chloride (PVC) sheets containing DEHP or different amounts of DINCH or DOTP were reduced to 10.9%, 9.2-12.4%, and 5.2-7.8%, respectively (MAP/RCC alone, 28.2%) after 10 weeks of incubation. The amount of plasticizer eluted from the PVC sheet was 53.1, 26.1-36.5, and 78.4-150 µg/mL for DEHP, DINCH, and DOTP, respectively. PVC sheets spiked with DIDP did not suppress the hemolysis induced by MAP/RCC because of low leachability (4.8-6.0 µg/mL). These results suggested that a specific structure of the plasticizer and the concentrations of least more than ∼10 µg/mL were required to suppress hemolysis due to MAP/RCC.

  12. MicroRNA hsa-miR-4674 in Hemolysis-Free Blood Plasma Is Associated with Distant Metastases of Prostatic Cancer.

    PubMed

    Knyazev, E N; Samatov, T R; Fomicheva, K A; Nyushko, K M; Alekseev, B Ya; Shkurnikov, M Yu

    2016-05-01

    We analyzed microRNA profile in hemolysis-free blood plasma of patients with prostatic cancer. The metastatic form of prostatic cancer was found to be associated with increased levels of hsa-miR-22-3p, hsa-miR-663a, and hsa-miR-4674 in comparison with non-metastatic form. Common candidate target genes of these microRNA include JUNB, KMT2A, and XPO6.

  13. A Broadband Polyvinylidene Difluoride-Based Hydrophone with Integrated Readout Circuit for Intravascular Photoacoustic Imaging.

    PubMed

    Daeichin, Verya; Chen, Chao; Ding, Qing; Wu, Min; Beurskens, Robert; Springeling, Geert; Noothout, Emile; Verweij, Martin D; van Dongen, Koen W A; Bosch, Johan G; van der Steen, Antonius F W; de Jong, Nico; Pertijs, Michiel; van Soest, Gijs

    2016-05-01

    Intravascular photoacoustic (IVPA) imaging can visualize the coronary atherosclerotic plaque composition on the basis of the optical absorption contrast. Most of the photoacoustic (PA) energy of human coronary plaque lipids was found to lie in the frequency band between 2 and 15 MHz requiring a very broadband transducer, especially if a combination with intravascular ultrasound is desired. We have developed a broadband polyvinylidene difluoride (PVDF) transducer (0.6 × 0.6 mm, 52 μm thick) with integrated electronics to match the low capacitance of such a small polyvinylidene difluoride element (<5 pF/mm(2)) with the high capacitive load of the long cable (∼100 pF/m). The new readout circuit provides an output voltage with a sensitivity of about 3.8 μV/Pa at 2.25 MHz. Its response is flat within 10 dB in the range 2 to 15 MHz. The root mean square (rms) output noise level is 259 μV over the entire bandwidth (1-20 MHz), resulting in a minimum detectable pressure of 30 Pa at 2.25 MHz.

  14. Influence of distance and incident angle on light intensities in intravascular optical coherence tomography pullback runs

    NASA Astrophysics Data System (ADS)

    Liu, Shengnan; Eggermont, Jeroen; Wolterbeek, Ron; Lelieveldy, Boudewijn P. F.; Dijkstra, Jouke

    2016-02-01

    Intravascular optical coherence tomography (IVOCT) is an intravascular imaging modality which enables the visualization arterial structures at the micro-structural level. The interpretations of these structures is mainly on the basis of relative image intensities. However, even for homogeneous tissue light intensities can differ. In this study the incident light intensity is modeled to be related to the catheter position. Two factors, the distance between catheter and inner lumen wall as well as the incident angle of the light upon the lumen wall, are considered. A three-level hierarchical model is constructed to statistically validate this model to include the potential effect of different pullbacks and/or frame numbers. The model is solved using 169 images out of 9 pull-backs recorded with a St.Jude Medical IVOCT system. F-tests results indicate that both the distance and the incident angle contribute to the model statistically significantly with p < 0.001. Based on the results from the statistical analysis, a potential compensation method is introduced to normalize the IVOCT intensities for the catheter position effects and small shadows.

  15. NIR fluorescence lifetime sensing through a multimode fiber for intravascular molecular probing

    NASA Astrophysics Data System (ADS)

    Ingelberts, H.; Hernot, S.; Debie, P.; Lahoutte, T.; Kuijk, M.

    2016-04-01

    Coronary artery disease (CAD) contributes to millions of deaths each year. The identification of vulnerable plaques is essential to the diagnosis of CAD but is challenging. Molecular probes can improve the detection of these plaques using intravascular imaging methods. Fluorescence lifetime sensing is a safe and robust method to image these molecular probes. We present two variations of an optical system for intravascular near-infrared (NIR) fluorescence lifetime sensing through a multimode fiber. Both systems are built around a recently developed fast and efficient CMOS detector, the current-assisted photonic sampler (CAPS) that is optimized for sub-nanosecond NIR fluorescence lifetime sensing. One system mimics the optical setup of an epifluorescence microscope while the other uses a practical fiber optic coupler to separate fluorescence excitation and emission. We test both systems by measuring the lifetime of several NIR dyes in DMSO solutions and we show that these systems are capable of detecting lifetimes of solutions with concentrations down to 370 nM and this with short acquisition times. These results are compared with time-correlated single photon counting (TCSPC) measurements for reference.

  16. Induction of microparticle- and cell-associated intravascular tissue factor in human endotoxemia.

    PubMed

    Aras, Omer; Shet, Arun; Bach, Ronald R; Hysjulien, Jessica L; Slungaard, Arne; Hebbel, Robert P; Escolar, Gines; Jilma, Bernd; Key, Nigel S

    2004-06-15

    The precise role of intravascular tissue factor (TF) remains poorly defined, due to the limited availability of assays capable of measuring circulating TF procoagulant activity (PCA). As a model of inflammation-associated intravascular thrombin generation, we studied 18 volunteers receiving an infusion of endotoxin. A novel assay that measures microparticle (MP)-associated TF PCA from a number of cellular sources (but not platelets) demonstrated an 8-fold increase in activity at 3 to 4 hours after endotoxin administration (P <.001), with a return to baseline by 8 hours. TF antigen-positive MPs isolated from plasma were visualized by electron microscopy. Interindividual MP-associated TF response to lipopolysaccharide (LPS) was highly variable. In contrast, a previously described assay that measures total (cell and MP-borne) whole-blood TF PCA demonstrated a more modest increase, with a peak in activity (1.3-fold over baseline; P <.000 01) at 3 to 4 hours, and persistence for more than 24 hours. This surprisingly modest increase in whole-blood TF activity is likely explained by a profound although transient LPS-induced monocytopenia. MP-associated TF PCA was highly correlated with whole-blood TF PCA and total number of circulating MPs, and whole-blood TF PCA was highly correlated with TF mRNA levels.

  17. Lipid detection by intravascular photoacoustic imaging with flexible catheter at 20 fps (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Wu, Min; Daeichin, Verya; Springeling, Geert; van der Steen, Antonius F. W.; van Soest, Gijs

    2016-02-01

    Intravascular Photoacoustic (IVPA) imaging is a promising new technology to assess lipid content of coronary atherosclerotic plaque, an important determinant of the risk associated with the plaque triggering a heart attack. Clinical translation of IVPA imaging requires real-time image acquisition, which has been a technological challenge. In this work, we demonstrate a high-speed, dual-wavelength IVPA imaging system at 1.7 µm wavelength, operating with a flexible catheter of 1.2 mm outer diameter (including outer sheath). The catheter was custom designed and fabricated, and used a 40 MHz transducer for intravascular ultrasound (IVUS) and IVPA imaging. The optical excitation is provided by a dual OPO system, pumped by CW diode-pumped Q-switched Nd:YAG lasers, with a repetition rate of 5 kHz. Each OPO can be tuned to a custom wavelength between 1690 and 1750 nm; two wavelengths only are needed to discriminate between plaque lipids and adipose tissue. The pulse energy is about 80 µJ. We tested the imaging performance of the presented system in a polyvinyl-alcohol (PVA) vessel mimicking phantom and human coronary arteries ex vivo. IVPA identified lipid deposits inside atherosclerotic plaque, while IVUS showed tissue structure. We demonstrated IVPA imaging at a speed of 20 frames per second, with 250 A-scans per frame. This is significantly faster than previous IVPA imaging systems, and will enable the translation of IVPA imaging into clinical practice.

  18. Fluorescence Lifetime Imaging and Intravascular Ultrasound: Co-Registration Study Using Ex Vivo Human Coronaries

    PubMed Central

    Gorpas, Dimitris; Fatakdawala, Hussain; Bec, Julien; Ma, Dinglong; Yankelevich, Diego R.; Qi, Jinyi

    2015-01-01

    Fluorescence lifetime imaging (FLIM) has demonstrated potential for robust assessment of atherosclerotic plaques biochemical composition and for complementing conventional intravascular ultrasound (IVUS), which provides information on plaque morphology. The success of such a bi-modal imaging modality depends on accurate segmentation of the IVUS images and proper angular registration between these two modalities. This paper reports a novel IVUS segmentation methodology addressing this issue. The image preprocessing consisted of denoising, using the Wiener filter, followed by image smoothing, implemented through the application of the alternating sequential filter on the edge separability metric images. Extraction of the lumen/intima and media/adventitia boundaries was achieved by tracing the gray-scale peaks over the A-lines of the IVUS preprocessed images. Cubic spline interpolation, in both cross-sectional and longitudinal directions, ensured boundary smoothness and continuity. The detection of the guide-wire artifact in both modalities is used for angular registration. Intraluminal studies were conducted in 13 ex vivo segments of human coronaries. The IVUS segmentation accuracy was assessed against independent manual tracings, providing 91.82% sensitivity and 97.55% specificity. The proposed methodology makes the bi-modal FLIM and IVUS approach feasible for comprehensive intravascular diagnosis by providing co-registered biochemical and morphological information of atherosclerotic plaques. PMID:25163056

  19. Intravascular Ultrasound Catheter to Enhance Microbubble-Based Drug Delivery via Acoustic Radiation Force

    PubMed Central

    Kilroy, Joseph P.; Klibanov, Alexander L.; Wamhoff, Brian R.; Hossack, John A.

    2015-01-01

    Previous research has demonstrated that acoustic radiation force enhances intravascular microbubble adhesion to blood vessels in the presence of flow for molecular-targeted ultrasound imaging and drug delivery. A prototype acoustic radiation force intravascular ultrasound (ARFIVUS) catheter was designed and fabricated to displace a microbubble contrast agent in flow representative of conditions encountered in the human carotid artery. The prototype ARFIVUS transducer was designed to match the resonance frequency of 1.4- to 2.6-μm-diameter microbubbles modeled by an experimentally verified 1-D microbubble acoustic radiation force translation model. The transducer element was an elongated Navy Type I (hard) lead zirconate titanate (PZT) ceramic designed to operate at 3 MHz. Fabricated devices operated with center frequencies of 3.3 and 3.6 MHz with −6-dB fractional bandwidths of 55% and 50%, respectively. Microbubble translation velocities as high as 0.86 m/s were measured using a high-speed streak camera when insonating with the ARFIVUS transducer. Finally, the prototype was used to displace microbubbles in a flow phantom while imaging with a commercial 45-MHz imaging IVUS transducer. A sustained increase of 31 dB in average video intensity was measured following insonation with the ARFIVUS, indicating microbubble accumulation resulting from the application of acoustic radiation force. PMID:23143566

  20. Intravascular papillary endothelial hyperplasia: report of 4 cases with immunohistochemical findings.

    PubMed

    Campos, Marcia-Sampaio; Garcia-Rejas, Roberto-A; Pinto, Décio-Santos; de Sousa, Suzana-C O M; Nunes, Fabio-Daumas

    2009-10-01

    Intravascular papillary endothelial hyperplasia (IPEH) is a benign endothelial proliferation, usually intravascular, that may mimic angiosarcoma. In this report, four new cases of IPEH involving the oral region are described. The affected sites were the lower lip, labial comissure and the submandibular region. After clinical evaluation, the complete removal of the lesions showed a circumscribed and soft mass. Histologically, the major feature was a reactive proliferation of endothelial cells composed of small papillary structures with hypocellular and hyalinized cores arising in an organized thrombus. Immunohistochemical staining for CD34 was strongly positive in endothelial cells. Vimentin and laminin immunolabelling were also consistent with a vascular origin. In order to verify the proliferative potential of the lesions, the Ki-67 antibody was used, revealing low percentage of labeled cells (<20%). No immunoreactivity for GLUT-1 was observed. Since the complete removal is curative, no additional treatment was necessary, and no signs of recurrence had been observed until now. Due to the particular features of IPEH, it is important for pathologists and clinicians to become familiar with this lesion. Additionally, the specific histological arrangement, including the absence of cellular pleomorphism, mitotic activity and necrosis, represents a guide to help in the differential diagnosis. Moreover, the vascular origin and the proliferative index should be assessed by immunohistochemistry in order to provide an accurate diagnosis.

  1. Automatic classification of atherosclerotic plaques imaged with intravascular OCT (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Rico-Jimenez, Jose D.; Campos-Delgado, Daniel U.; Villiger, Martin; Bouma, Brett; Jo, Javier A.

    2016-03-01

    A novel computational method for plaque tissue characterization based on Intravascular Optical Coherence Tomography (IV-OCT) is presented. IV-OCT is becoming a powerful tool for the clinical evaluation of atherosclerotic plaques; however, it requires a trained expert for visual assessment and interpretation of the imaged plaques. Moreover, due to the inherit effect of speckle and the scattering attenuation of the optical scheme the direct interpretation of OCT images is limited. To overcome these difficulties, we propose to automatically identify the A-line profiles of the most significant plaque types (normal, fibrotic, or lipid-rich) and their respective abundance by using a probabilistic framework and blind alternated least squares to achieve the optimal decomposition. In this context, we present preliminary results of this novel probabilistic classification tool for intravascular OCT that relies on two steps. First, the B-scan is pre-processed to remove catheter artifacts, segment the lumen, select the region of interest (ROI), flatten the tissue surface, and reduce the speckle effect by a spatial entropy filter. Next, the resulting image is decomposed and its A-lines are classified by an automated strategy based on alternating-least-squares optimization. Our early results are encouraging and suggest that the proposed methodology can identify normal tissue, fibrotic and lipid-rich plaques from IV-OCT images.

  2. Design factors of intravascular dual frequency transducers for super-harmonic contrast imaging and acoustic angiography.

    PubMed

    Ma, Jianguo; Martin, K Heath; Li, Yang; Dayton, Paul A; Shung, K Kirk; Zhou, Qifa; Jiang, Xiaoning

    2015-05-07

    Imaging of coronary vasa vasorum may lead to assessment of the vulnerable plaque development in diagnosis of atherosclerosis diseases. Dual frequency transducers capable of detection of microbubble super-harmonics have shown promise as a new contrast-enhanced intravascular ultrasound (CE-IVUS) platform with the capability of vasa vasorum imaging. Contrast-to-tissue ratio (CTR) in CE-IVUS imaging can be closely associated with low frequency transmitter performance. In this paper, transducer designs encompassing different transducer layouts, transmitting frequencies, and transducer materials are compared for optimization of imaging performance. In the layout selection, the stacked configuration showed superior super-harmonic imaging compared with the interleaved configuration. In the transmitter frequency selection, a decrease in frequency from 6.5 MHz to 5 MHz resulted in an increase of CTR from 15 dB to 22 dB when receiving frequency was kept constant at 30 MHz. In the material selection, the dual frequency transducer with the lead magnesium niobate-lead titanate (PMN-PT) 1-3 composite transmitter yielded higher axial resolution compared to single crystal transmitters (70 μm compared to 150 μm pulse length). These comparisons provide guidelines for the design of intravascular acoustic angiography transducers.

  3. CONTRAST-ENHANCED INTRAVASCULAR ULTRASOUND PULSE SEQUENCES FOR BANDWIDTH-LIMITED TRANSDUCERS

    PubMed Central

    Maresca, David; Renaud, Guillaume; van Soest, Gijs; Li, Xiang; Zhou, Qifa; Shung, K. Kirk; de Jong, Nico; van der Steen, Antonius F. W.

    2013-01-01

    We demonstrate two methods for vasa vasorum imaging using contrast-enhanced intravascular ultrasound, which can be performed using commercial catheters. Plaque neovascularization was recognized as an independent marker of coronary artery plaque vulnerability. IVUS-based methods to image the microvessels available to date require high bandwidth (−6 dB relative frequency bandwidth >70%), which are not routinely available commercially. We explored the potential of ultraharmonic imaging and chirp reversal imaging for vasa vasorum imaging. In vitro recordings were performed on a tissue-mimicking phantom using a commercial ultrasound contrast agent and a transducer with a center frequency of 34 MHz and a −6 dB relative bandwidth of 56%. Acoustic peak pressures <500 kPa were used. A tissue-mimicking phantom with channels down to 200 μm in diameter was successfully imaged by the two contrast detection sequences while the smallest channel stayed invisible in conventional intravascular ultrasound images. Ultraharmonic imaging provided the best contrast agent detection. PMID:23384459

  4. Design factors of intravascular dual frequency transducers for super-harmonic contrast imaging and acoustic angiography

    NASA Astrophysics Data System (ADS)

    Ma, Jianguo; Martin, K. Heath; Li, Yang; Dayton, Paul A.; Shung, K. Kirk; Zhou, Qifa; Jiang, Xiaoning

    2015-05-01

    Imaging of coronary vasa vasorum may lead to assessment of the vulnerable plaque development in diagnosis of atherosclerosis diseases. Dual frequency transducers capable of detection of microbubble super-harmonics have shown promise as a new contrast-enhanced intravascular ultrasound (CE-IVUS) platform with the capability of vasa vasorum imaging. Contrast-to-tissue ratio (CTR) in CE-IVUS imaging can be closely associated with low frequency transmitter performance. In this paper, transducer designs encompassing different transducer layouts, transmitting frequencies, and transducer materials are compared for optimization of imaging performance. In the layout selection, the stacked configuration showed superior super-harmonic imaging compared with the interleaved configuration. In the transmitter frequency selection, a decrease in frequency from 6.5 MHz to 5 MHz resulted in an increase of CTR from 15 dB to 22 dB when receiving frequency was kept constant at 30 MHz. In the material selection, the dual frequency transducer with the lead magnesium niobate-lead titanate (PMN-PT) 1-3 composite transmitter yielded higher axial resolution compared to single crystal transmitters (70 μm compared to 150 μm pulse length). These comparisons provide guidelines for the design of intravascular acoustic angiography transducers.

  5. Atomic layer deposition enhanced grafting of phosphorylcholine on stainless steel for intravascular stents.

    PubMed

    Zhong, Qi; Yan, Jin; Qian, Xu; Zhang, Tao; Zhang, Zhuo; Li, Aidong

    2014-09-01

    In-stent restenosis (ISR) and re-endothelialization delay are two major issues of intravascular stent in terms of clinical safety and effects. Construction of mimetic cell membrane surface on stents using phosphorylcholine have been regarded as one of the most powerful strategies to resolve these two issues and improve the performance of stents. In this study, atomic layer deposition (ALD) technology, which is widely used in semiconductor industry, was utilized to fabricate ultra-thin layer (10nm) of alumina (Al2O3) on 316L stainless steel (SS), then the alumina covered surface was modified with 3-aminopropyltriethoxysilane (APS) and 2-methacryloyloxyethyl phosphorylcholine (MPC) sequentially in order to produce phosphorylcholine mimetic cell membrane surface. The pristine and modified surfaces were characterized using X-ray photoelectron spectroscopy, atomic force microscope and water contact angle measurement. Furthermore, the abilities of protein adsorption, platelet adhesion and cell proliferation on the surfaces were investigated. It was found that alumina layer can significantly enhance the surface grafting of APS and MPC on SS; and in turn efficiently inhibit protein adsorption and platelet adhesion, and promote the attachment and proliferation of human umbilical vein endothelial cells (HUVEC) on the surfaces. In association with the fact that the deposition of alumina layer is also beneficial to the improvement of adhesion and integrity of drug-carrying polymer coating on drug eluting stents, we expect that ALD technology can largely assist in the modifications on inert metallic surfaces and benefit implantable medical devices, especially intravascular stents.

  6. Computational analysis of the effectiveness of blood flushing with saline injection from an intravascular diagnostic catheter.

    PubMed

    Ghata, Narugopal; Aldredge, Ralph C; Bec, Julien; Marcu, Laura

    2014-11-01

    Optical techniques including fluorescence lifetime spectroscopy have demonstrated potential as a tool for study and diagnosis of arterial vessel pathologies. However, their application in the intravascular diagnostic procedures has been hampered by the presence of blood hemoglobin that affects the light delivery to and the collection from the vessel wall. We report a computational fluid dynamics model that allows for the optimization of blood flushing parameters in a manner that minimizes the amount of saline needed to clear the optical field of view and reduces any adverse effects caused by the external saline jet. A 3D turbulence (k - ω) model was employed for Eulerian-Eulerian two-phase flow to simulate the flow inside and around a side-viewing fiber-optic catheter. Current analysis demonstrates the effects of various parameters including infusion and blood flow rates, vessel diameters, and pulsatile nature of blood flow on the flow structure around the catheter tip. The results from this study can be utilized in determining the optimal flushing rate for given vessel diameter, blood flow rate, and maximum wall shear stress that the vessel wall can sustain and subsequently in optimizing the design parameters of optical-based intravascular catheters.

  7. Pulmonary intravascular lymphoma detected by FDG PET-CT: a case report.

    PubMed

    Kohan, A A; Paganini, L; Biedak, P; Arma, J I; Dalurzo, M C L; Garcia-Monaco, R D

    2013-01-01

    Intravascular lymphoma is a rare subtype of extranodal Non-Hodgkin's lymphoma. Its prognosis is poor in a high percentage of cases due to its insidious appearance and low clinical suspicion. Its diagnosis is usually only reached after an autopsy. It may affect different organs as a whole or only one organ. It is extremely rare that the lung is the only damaged organ. Its diagnosis depends of the clinician's suspicion and proper evaluation with imaging studies as well as correct selection of the organ to be biopsied. When detected on time, the treatment of choice is a combination of a series of chemotherapy associated to a monoclonal antibody (anti-CD20). We present the case of a male patient who underwent a positron emission tomography-computed tomography with 2-[F-18]-fluoro-2 deoxy-D-glucose (FDG) due to symptoms suggestive of a lymphoproliferative disease with no clear structural abnormalities. The images led to a diagnosis of pulmonary intravascular large B cell lymphoma.

  8. Design factors of intravascular dual frequency transducers for super-harmonic contrast imaging and acoustic angiography

    PubMed Central

    Ma, Jianguo; Martin, K. Heath; Li, Yang; Dayton, Paul A.; Shung, K. Kirk; Zhou, Qifa; Jiang, Xiaoning

    2015-01-01

    Imaging of coronary vasa vasorum may lead to assessment of the vulnerable plaque development in diagnosis of atherosclerosis diseases. Dual frequency transducers capable of detection of microbubble super-harmonics have shown promise as a new contrast-enhanced intravascular ultrasound (CE-IVUS) platform with the capability of vasa vasorum imaging. Contrast-to-tissue ratio (CTR) in CE-IVUS imaging can be closely associated with the low frequency transmitter performance. In this paper, transducer designs encompassing different transducer layouts, transmitting frequencies, and transducer materials are compared for optimization of imaging performance. In the layout selection, the stacked configuration showed superior super-harmonic imaging compared with the interleaved configuration. In the transmitter frequency selection, a decrease in frequency from 6.5 MHz to 5 MHz resulted in an increase of CTR from 15 dB to 22 dB when receiving frequency was kept constant at 30 MHz. In the material selection, the dual frequency transducer with the lead magnesium niobate-lead titanate (PMN-PT) 1-3 composite transmitter yielded higher axial resolution compared to single crystal transmitters (70 μm compared to 150 μm pulse length). These comparisons provide guidelines for design of intravascular acoustic angiography transducers. PMID:25856384

  9. Effect of O(2)/O(3) atmosphere on the rate of osmotic hemolysis of bovine erythrocytes in the presence of some antioxidants.

    PubMed

    Bialas, W A; Dryjańska, A; Gomulkiewicz, J

    2001-04-01

    Purified red blood cells, exposed to an ozone atmosphere, show an increased rate of hemolysis on sudden osmotic stress. To determine this effect of ozone in the presence of natural antioxidants, bovine red blood cells, used as models, were suspended in blood plasma, or in physiological saline with one of the following antioxidants: albumin, glutathione, uric acid, glucose and a vitamin E analog (trolox). After exposure of the suspensions to oxygen and oxygen/ozone atmospheres the rates of osmotic hemolysis were measured, using a stop-flow technique, and compared with rates measured in air-exposed controls. Blood plasma, containing all natural antioxidants, caused a decreased rate of osmotic hemolysis of cells exposed to oxygen and also decreased the effect of ozone. Trolox cancelled the oxygen effects only. Albumin, glutathione and uric acid tended to protect the cells from the hemolytic effects of ozone. The antihemolytic effect of glucose, seen only in some samples, may depend on uncontrolled factors. The alteration of the rates correlates with an increased fluidity of red cell membranes exposed to ozone.

  10. Comparative effects of macro-sized aluminum oxide and aluminum oxide nanoparticles on erythrocyte hemolysis: influence of cell source, temperature, and size

    NASA Astrophysics Data System (ADS)

    Vinardell, M. P.; Sordé, A.; Díaz, J.; Baccarin, T.; Mitjans, M.

    2015-02-01

    Al2O3 is the most abundantly produced nanomaterial and has been used in diverse fields, including the medical, military, and industrial sectors. As there are concerns about the health effects of nanoparticles, it is important to understand how they interact with cells, and specifically with red blood cells. The hemolysis induced by three commercial nano-sized aluminum oxide particles (nanopowder 13 nm, nanopowder <50 nm, and nanowire 2-6 × 200-400 nm) was compared to aluminum oxide and has been studied on erythrocytes from humans, rats, and rabbits, in order to elucidate the mechanism of action and the influence of size and shape on hemolytic behavior. The concentrations inducing 50 % hemolysis (HC50) were calculated for each compound studied. The most hemolytic aluminum oxide particles were of nanopowder 13, followed by nanowire and nanopowder 50. The addition of albumin to PBS induced a protective effect on hemolysis in all the nano-forms of Al2O3, but not on Al2O3. The drop in HC50 correlated to a decrease in nanomaterial size, which was induced by a reduction of aggregation. Aluminum oxide nanoparticles are less hemolytic than other oxide nanoparticles and behave differently depending on the size and shape of the nanoparticles. The hemolytic behavior of aluminum oxide nanoparticles differs from that of aluminum oxide.

  11. Severe Hemolysis in a Patient With Erythrocytosis During Coupled Plasma Filtration Adsorption Therapy Was Prevented by Changing From Membrane-Based Technique to a Centrifuge-Based One.

    PubMed

    Fan, Rong; Wu, Buyun; Kong, Ling; Gong, Dehua

    2016-01-01

    Coupled plasma filtration adsorption (CPFA) usually adopts membrane to separate plasma from blood. Here, we reported a case with erythrocytosis experienced severe hemolysis and membrane rupture during CPFA, which was avoided by changing from membrane-based technique to a centrifuge-based one. A 66-year-old man was to receive CPFA for severe hyperbilirubinemia (total bilirubin 922 μmol/L, direct bilirubin 638 μmol/L) caused by obstruction of biliary tract. He had erythrocytosis (hemoglobin 230 g/L, hematocrit 0.634) for years because of untreated tetralogy of Fallot. Severe hemolysis and membrane rupture occurred immediately after blood entering into the plasma separator even at a low flow rate (50 mL/min) and persisted after changing a new separator. Finally, centrifugal plasma separation technique was used for CPFA in this patient, and no hemolysis occurred. After 3 sessions of CPFA, total bilirubin level decreased to 199 μmol/L with an average decline by 35% per session. Thereafter, the patient received endoscopic biliary stent implantation, and total bilirubin level returned to nearly normal. Therefore, centrifugal-based plasma separation can also be used in CPFA and may be superior to a membrane-based one in patients with hyperviscosity.

  12. Successful combined use of tranexamic acid and unfractionated heparin for life-threatening bleeding associated with intravascular coagulation in a patient with chronic myelogenous leukemia in blast crisis.

    PubMed

    Koseki, Mihoko; Asada, Noboru; Uryu, Hidetaka; Takeuchi, Masami; Asakura, Hidesaku; Matsue, Kosei

    2007-12-01

    The current therapeutic strategy for disseminated intravascular coagulation (DIC) is limited to control of the underlying disease, and methods for the effective management of DIC have not been established. We report the successful use of tranexamic acid (TA) combined with unfractionated heparin in a patient with life-threatening bleeding from the sigmoid colon caused by DIC. A 35-year-old man who had undergone allogeneic bone marrow transplantation for chronic myelogenous leukemia was referred for relapse of his leukemia. The patient was first treated with imatinib at 600 mg/day. Although the disappearance of leukemic cells and a decrease in the BCR/ABL fusion gene were observed, he developed massive bleeding from the sigmoid colon after defecation. A laboratory diagnosis of DIC with prominent fibrinolysis was based on elevated levels of both plasmin-alpha2-plasmin inhibitor complex and thrombin-antithrombin III complex. Despite vigorous supportive therapy, including multiple transfusions and aggressive fluid resuscitation, the patient developed hypovolemic shock due to the uncontrollable bleeding. TA combined with unfractionated heparin was instituted to inhibit excessive fibrinolysis. A prompt response was observed soon after the commencement of therapy. No organ dysfunction was observed throughout TA and heparin use. To our knowledge, this report is the first to describe successful treatment with TA combined with heparin for life-threatening intestinal bleeding due to acute DIC associated with hematologic malignancy.

  13. The Role of Intracoronary Plaque Imaging with Intravascular Ultrasound, Optical Coherence Tomography, and Near-Infrared Spectroscopy in Patients with Coronary Artery Disease.

    PubMed

    Hoang, Vu; Grounds, Jill; Pham, Don; Virani, Salim; Hamzeh, Ihab; Qureshi, Athar Mahmood; Lakkis, Nasser; Alam, Mahboob

    2016-09-01

    The development of multiple diagnostic intracoronary imaging modalities has increased our understanding of coronary atherosclerotic disease. These imaging modalities, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), have provided a method to study plaques and introduced the concept of plaque vulnerability. They are being increasingly used for percutaneous coronary intervention (PCI) optimization and are invaluable tools in research studying the pathophysiology of acute coronary syndrome (ACS), in-stent thrombosis and in-stent restenosis. IVUS has the ability to visualize the intracoronary lumen and the vessel wall and can be used to detect early atherosclerotic disease even in the setting of positive arterial remodeling. Studies supporting the use of IVUS to optimize stent deployment and apposition have shown a significant reduction in cardiovascular events. OCT provides even higher resolution imaging and near microscopic detail of plaques, restenoses, and thromboses; thus, it can identify the etiology of ACS. Ongoing trials are evaluating the role of OCT in PCI and using OCT to study stent endothelialization and neointimal proliferation. NIRS is a modality capable of localizing and quantifying lipid core burden. It is usually combined with IVUS and is used to characterize plaque composition. The benefits of NIRS in the setting of ACS have been limited to case reports and series. The utilization of all these intracoronary imaging modalities will continue to expand as their indications for clinical use and research grow. Studies to support their use for PCI optimization resulting in improved outcomes with potential to prevent downstream events are ongoing.

  14. Hemolysis of human erythrocytes by hypochlorous acid is modulated by amino acids, antioxidants, oxidants, membrane-perforating agents and by divalent metals.

    PubMed

    Ginsburg, Isaac; Sadovnic, Milu; Yedgar, Shaul; Kohen, Ron; Hrbac, Jan

    2002-06-01

    The optimal conditions under which hypochlorous acid (NaOCl) either hemolyzes human RBC or kills monkey kidney epithelial cells (BGM) in culture had been investigated. While in Hank's balanced salt solution (HBSS), micromolar amounts of NaOCl caused full hemolysis and also killed BGM cells, in D-MEM or RPMI media rich in amino acids, 25-40 mM of hypochlorite were needed to induce cell injury. Cells exposed to high amounts of NaOCl became highly refractory to strong detergents. Hemolysis by NaOCl was strongly inhibited by a large variety of antioxidants. RBC treated by subtoxic concentrations either of peroxide, peroxyl radical, NO, cholesterol, PLA2, PLC as well as by N2, argon or by mixture of CO2 (10%) and O2 (90%) became much more susceptible to lysis by NaOCl. On the other hand, while RBC treated by Fe2+, Co2+, and V2+ and to a lesser extent with Cu2+ became highly resistant to NaOCl hemolysis presumably due to NaOCl decomposition, no such effect was found either with Co2+ or by Mn2+. RBC treated by azide to destroy catalase and then incubated with peroxide and with NaOCl failed to undergo hemolysis due to the ability of peroxide to decompose NaOCl. The inhibitory effects of the divalent metals on NaOCl-induced hemolysis were also substantiated by measuring the decrease in pH and by cyclic voltammetry. The findings that like peroxide, NaOCl also synergizes with membrane-perforating agents and with a protease to kill epithelial cells further implicate such "cocktails" in cell injury in inflammatory conditions. Taken together, because of the capacity of many agents to scavenge NaOCl, tissue damage by NaOCl-generated neutrophils can take place primarily if activated neutrophils closely adhere to target cells to avoid the scavenging effects of amino acids and of antioxidants. Therefore, the significance of the data which had tested the cytotoxic effects of NaOCl using cells suspended only in salt solutions, should be reconsidered.

  15. Brain damage complicating septic shock: acute haemorrhagic leucoencephalitis as a complication of the generalised Shwartzman reaction.

    PubMed Central

    Graham, D I; Behan, P O; More, I A

    1979-01-01

    The neuropathological findings in six patients who developed neurological signs after the onset of "septic shock" caused by Gram-negative septicaemia are described. The changes in the brains were characteristic of acute haemorrhagic leucoencephalitis, and there was evidence, particularly in the kidneys, of disseminated intravascular coagulation with tubular necrosis and, in some, appearances indistinguishable from membrano-proliferative glomerulonephritis. It is agreed that acute haemorrhagic leucoencephalitis is another manifestation of a generalised Shwartzman reaction, and it is suggested that activation of complement is the final common pathway that produces tissue damage in the brain and kidney. Images PMID:762582

  16. Acute hyponatraemia secondary to cerebral salt wasting syndrome in a patient with tuberculous meningitis.

    PubMed

    Ti, L K; Kang, S C; Cheong, K F

    1998-08-01

    A 30-year-old HIV-positive man presented with acute hydrocephalus secondary to tuberculous meningitis, for which an external ventricular drain was inserted. He developed marked natriuresis in the postoperative period, which resulted in acute hyponatraemia (131 to 122 mmol/l) and a contraction of his intravascular volume. A diagnosis of cerebral salt wasting syndrome was made, and he responded to sodium and fluid loading. This case highlights the differentiation of cerebral salt wasting syndrome from the more commonly occurring syndrome of inappropriate anti-diuretic hormone secretion as the aetiology of the hyponatraemia.

  17. Intravascular Biphasic Synovial Sarcoma: The Beneficial Role of Adjuvant Treatment Approach in the Pre-metastatic Stage.

    PubMed

    Chicas-Sett, Rodolfo; Farga-Albiol, Dolores; Collado, Erica; Pacheco, Ariel; Zac, Carlos; Diaz, Roberto; Celada, Francisco; Burgos, Javier; Perez, Maria Jose; Tormo, Alejandro

    2016-04-16

    Synovial sarcoma (SS) is a high-grade, rare variant of soft tissue sarcoma (STS). The biphasic subtype is less common than the monophasic subtype. SS is very common around joint cavities in the extremities, but can be present elsewhere in the body. Tumor staging and therapeutic management are usually clear for a localized disease, but the proper management at the metastatic stage can be unclear. According to the literature, the histologic presence of an SS tumor thrombus affects tumor staging, making it unclear whether the tumor stage corresponds to localized or metastatic disease. An intravascular SS tumor exhibiting high metastatic potential is a rare finding that warrants thorough investigation. A 49-year-old woman presented with a biphasic SS intravascular tumor of the left inguinal area with femoral vessels involvement. Ten cases of intravascular SS have been reported in the literature and contain little information regarding the proper management of a local metastatic disease. Ours is a rare case of SS with an intravascular tumor occupying the femoral-iliac vein (as seen in metastatic disease) that has been treated as a local disease with a multidisciplinary therapeutic approach. As a result, our patient has been disease-free for two years and, during that time, has achieved an acceptable quality of life. We discuss the pertinent clinical findings of this rare tumor and review the literature of tumor thrombus by SS. We also present the multidisciplinary therapeutic approach realized and the history of this disease.

  18. Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose.

    PubMed

    Westrol, Michael S; Awad, Nadia I; Bridgeman, Patrick J; Page, Erika; McCoy, Jonathan V; Jeges, Janos

    2015-09-01

    In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose of cyclobenzaprine. During transport, the patient developed cardiac arrest. He received active rewarming measures, including pleural lavage, gastric lavage, an intravascular heat exchange catheter, and cardiopulmonary bypass. Intravenous lipid emulsion (ILE) was also administered. A discussion of cyclobenzaprine toxicity, hypothermia, ILE, and accidental hypothermic cardiac arrest follows.

  19. A Case of De Novo CD5+ Disseminated Intravascular Large B-Cell Lymphoma Presenting as Multiorgan Failure

    PubMed Central

    Kapuria, Devika; Nanua, Suparna; Gaur, Rakesh

    2016-01-01

    Intravascular large B-cell lymphoma is an extremely rare extranodal lymphoma that proliferates in the lumen of the blood vessels while sparing the organ parenchyma. It usually presents with CNS and skin involvement. A 65-year-old Caucasian female presented with fevers and chills of 3-4 months' duration. Bone marrow biopsy done 3 months prior showed no significant myelodysplasia or lymphoid aggregates. The patient later died due to multiorgan failure. A bone marrow biopsy showed 20–30% CD5+ B cells consistent with infiltrative large B-cell lymphoma. An autopsy performed revealed diffuse intravascular invasion by lymphoma cells. Multiorgan involvement by intravascular B-cell lymphoma is very rare. Based on our literature review and to the best of our knowledge, there are only 5 case reports describing the presentation of this lymphoma with multiorgan failure. The immunophenotypic studies performed revealed that our patient had de novo CD5+ intravascular large B-cell lymphoma which is known to be aggressive with very poor prognosis. Although it is an extremely rare lymphoma, it should be considered as a potential cause of multiorgan failure when no other cause has been identified. A prompt tissue diagnosis and high-dose chemotherapy followed by ASCT can sometimes achieve remission. PMID:27777803

  20. Intravascular Biphasic Synovial Sarcoma: The Beneficial Role of Adjuvant Treatment Approach in the Pre-metastatic Stage

    PubMed Central

    Farga-Albiol, Dolores; Collado, Erica; Pacheco, Ariel; Zac, Carlos; Diaz, Roberto; Celada, Francisco; Burgos, Javier; Perez, Maria Jose; Tormo, Alejandro

    2016-01-01

    Synovial sarcoma (SS) is a high-grade, rare variant of soft tissue sarcoma (STS). The biphasic subtype is less common than the monophasic subtype. SS is very common around joint cavities in the extremities, but can be present elsewhere in the body. Tumor staging and therapeutic management are usually clear for a localized disease, but the proper management at the metastatic stage can be unclear. According to the literature, the histologic presence of an SS tumor thrombus affects tumor staging, making it unclear whether the tumor stage corresponds to localized or metastatic disease. An intravascular SS tumor exhibiting high metastatic potential is a rare finding that warrants thorough investigation. A 49-year-old woman presented with a biphasic SS intravascular tumor of the left inguinal area with femoral vessels involvement. Ten cases of intravascular SS have been reported in the literature and contain little information regarding the proper management of a local metastatic disease. Ours is a rare case of SS with an intravascular tumor occupying the femoral-iliac vein (as seen in metastatic disease) that has been treated as a local disease with a multidisciplinary therapeutic approach. As a result, our patient has been disease-free for two years and, during that time, has achieved an acceptable quality of life. We discuss the pertinent clinical findings of this rare tumor and review the literature of tumor thrombus by SS. We also present the multidisciplinary therapeutic approach realized and the history of this disease. PMID:27190730

  1. Application of Near Infrared Spectroscopy, Intravascular Ultrasound and the Coronary Calcium Score to Predict Adverse Coronary Events

    DTIC Science & Technology

    2015-10-01

    planned. 15. SUBJECT TERMS coronary artery disease , near infrared spectroscopy, calcium scoring, intravascular ultrasound 16. SECURIY CLASSIFICATION OF...findings and intracoronary ultrasound in predicting those outcomes in #2. 6 Body Revision and review of the original protocol was followed by

  2. Intravascular Imaging

    NASA Astrophysics Data System (ADS)

    de Jong, Nico; Bom, Nicolaas; Schaar, Johannes; Goertz, David; Frijlink, Martijn; Steen, Anton Fw Van Der

    IVUS is used for diagnostics, therapy guidance and scientific purposes. It is the only clinical available technique that can assess plaque burden and free lumen diameter at high accuracy. Contrast angiography, which was the golden standard before IVUS, can only give a shadow projection of the lumen. Especially with the advent of 3D IVUS using pull backs it became an important tool for monitoring treatment and follow up of interventions like balloon angioplasty and placing of stents (wire prostheses that are used to prevent the arterial wall from recoiling). 3D IVUS in combination with biplane angiography allows assessment of true 3D reconstructions of arteries, pre and post treatment. Using computational fluid dynamics the velocity profile and thus the shear stress at the vascular wall can be calculated. This can be related to biological markers, which gives insight in formation of atherosclerosis, restenosis and remodelling.

  3. Intravascular ultrasound

    MedlinePlus

    ... which blood vessel is involved in aortic dissection Risks There is a slight risk of complications with ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  4. Intravascular Ultrasound

    MedlinePlus

    ... your heart. The pictures come from inside the heart rather than through the chest wall. The sound waves are sent with a device ... is threaded through an artery and into your heart. The sound waves bounce off of the walls of the artery and return to the transducer ...

  5. Comparison of intravascular optical frequency domain imaging versus intravascular ultrasound during balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

    PubMed Central

    Kubota, Shuji; Okazaki, Toru; Hara, Hisao; Hiroi, Yukio

    2016-01-01

    Objectives The aims of this study are (1) to evaluate the safety and feasibility of using optical frequency domain imaging (OFDI) during balloon pulmonary angioplasty (BPA) procedures, (2) to assess the correlations between the vessel area (VA) and luminal area (LA) obtained by OFDI and intravascular ultrasound (IVUS), and (3) to compare inter‐ and intra‐observer variability among measurements taken from OFDI and IVUS images. Background The BPA in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is an evolving procedure. Methods Twenty‐three consecutive attempts of pair of OFDI and IVUS during BPA were evaluated. All complications that occurred during‐BPA and up to 48 hr post‐BPA were recorded. Using side branches as landmarks, 48 pairs of regions were chosen to compare measurements of VA and LA. Results OFDI images can be obtained without any procedurally related complications. Although the VA and LA measurements obtained by OFDI were smaller than those obtained by IVUS, high correlations were found (VA: r = 0.78, P < 0.0001 and LA: r = 0.75, P < 0.0001). Less inter‐ and intra‐observer variability was found when using measurements taken from OFDI versus IVUS images. Conclusions OFDI during BPA was safe and feasible. The reproducibility of OFDI imaging was excellent and offered a favorable addition to the BPA procedures. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc. PMID:26991798

  6. Hyponatremia and hypoglycemia in acute Sheehan's syndrome.

    PubMed

    Bunch, T J; Dunn, W F; Basu, A; Gosman, R I

    2002-10-01

    We report the case of a 23-year-old Saudi Arabian woman who presented to the medical intensive care unit with severe hyponatremia and hypoglycemia following a Cesarean section delivery complicated by hemorrhage due to disseminated intravascular coagulopathy. She was treated successfully for adrenal insufficiency acutely, and was later discharged on hormone replacement therapy. To our knowledge, this is the first case report of acute Sheehan's syndrome presenting with both hyponatremia and suggestive hypoglycemia. Pituitary necrosis is an uncommon complication of peripartum hemorrhagic shock. Since the initial description by Sheehan in 1937, the incidence of the syndrome has gradually declined through improved management of hemodynamic complications leading to the infarction of the gland. There are many studies describing complications of late Sheehan's syndrome; however, relatively few contain descriptions of the acute phase. In addition, the diagnosis of this syndrome is often determined after resolution of the acute process with resultant lack of data regarding immediate endocrine and imaging abnormalities. In this report, we describe the complete endocrine and imaging assessment of a patient presenting in critical condition due to necrosis of the pituitary gland in the immediate postpartum period.

  7. Anxiety and depression following preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. A systematic review.

    PubMed

    Delahaije, Denise H J; Dirksen, Carmen D; Peeters, Louis L; Smits, Luc J

    2013-07-01

    Women who suffered from pregnancy complications are at increased risk for anxiety and depression. The aim of this study was to evaluate whether having suffered from preeclampsia (PE) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is associated with anxiety and depression, and whether PE/HELLP is an independent risk factor for developing anxiety and depression. Systematic search on PubMed and PsycInfo with no time limit. Studies presenting original data, including women with a history of PE/HELLP and at least one comparison group of women without PE/HELLP, reporting the results for each group separately or in a multivariate regression analysis with PE/HELLP as an independent variable. Study characteristics and outcomes were extracted using a prespecified form. If necessary, additional calculations were performed. The search yielded 267 articles, with only six being suitable for inclusion in this review. Studies on depression (six studies) showed generally positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three studies were not statistically significant. Studies addressing anxiety (two studies) did not show significant associations between PE/HELLP and anxiety scores. Associations between post-traumatic stress and PE/HELLP, investigated in four studies, were often nonsignificant. Due to heterogeneity of study methods, a meta-analysis of the results was not possible. In most studies, confounder control was poor. Evidence is mixed but generally points to positive associations between various forms of psychopathology and previous PE/HELLP. Causality of the associations can, however, not be judged adequately.

  8. Characterization of signal properties in atherosclerotic plaque components by intravascular MRI.

    PubMed

    Rogers, W J; Prichard, J W; Hu, Y L; Olson, P R; Benckart, D H; Kramer, C M; Vido, D A; Reichek, N

    2000-07-01

    Magnetic resonance imaging (MRI) is capable of distinguishing between atherosclerotic plaque components solely on the basis of biochemical differences. However, to date, the majority of plaque characterization has been performed by using high-field strength units or special coils, which are not clinically applicable. Thus, the purpose of the present study was to evaluate MRI properties in histologically verified plaque components in excised human carotid endarterectomy specimens with the use of a 5F catheter-based imaging coil, standard acquisition software, and a clinical scanner operating at 0.5 T. Human carotid endarterectomy specimens from 17 patients were imaged at 37 degrees C by use of an opposed solenoid intravascular radiofrequency coil integrated into a 5F double-lumen catheter interfaced to a 0.5-T General Electric interventional scanner. Cross-sectional intravascular MRI (156x250 microm in-plane resolution) that used different imaging parameters permitted the calculation of absolute T1and T2, the magnetization transfer contrast ratio, the magnitude of regional signal loss associated with an inversion recovery sequence (inversion ratio), and regional signal loss in gradient echo (gradient echo-to-spin echo ratio) in plaque components. Histological staining included hematoxylin and eosin, Masson's trichrome, Kossa, oil red O, and Gomori's iron stain. X-ray micrographs were also used to identify regions of calcium. Seven plaque components were evaluated: fibrous cap, smooth muscle cells, organizing thrombus, fresh thrombus, lipid, edema, and calcium. The magnetization transfer contrast ratio was significantly less in the fibrous cap (0.62+/-13) than in all other components (P<0.05) The inversion ratio was greater in lipid (0.91+/-0.09) than all other components (P<0.05). Calcium was best distinguished by using the gradient echo-to-spin echo ratio, which was lower in calcium (0.36+/-0.2) than in all plaque components, except for the organizing thrombus (P<0

  9. Acute Bronchitis

    MedlinePlus

    ... can also cause acute bronchitis. To diagnose acute bronchitis, your health care provider will ask about your symptoms and listen to your breathing. You may also have other tests. Treatments include rest, fluids, and aspirin (for adults) or ...

  10. Acute renal failure following massive attack by Africanized bee stings.

    PubMed

    Bresolin, Nilzete L; Carvalho, Lígia C; Goes, Eduardo C; Fernandes, Regina; Barotto, Adriana M

    2002-08-01

    Bee venom is a complex substance, which acts in several tissues. Although severe allergic reactions have occurred after one or more stings, several deaths have been reported without allergic manifestations, emphasizing the toxic effects of massive poisoning. A number of about 500 stings have been considered necessary to cause death by direct toxicity, but as few as 30-50 stings have proved fatal in children. Among the major toxic effects are hemolytic anemia, acute renal failure (ARF), and shock. ARF may be due to a common toxic-ischemic mechanism with hypovolemic or anaphylactic shock, pigment tubulopathy (myoglobinuria and hemoglobinuria), or acute tubular necrosis (ATN) from a direct kidney toxicity of the venom. We present a case of rhabdomyolysis and hemolysis with consequent ARF which developed after about 800 bee stings. The patient recovered completely after peritoneal dialysis.

  11. Caring for the woman with acute fatty liver of pregnancy.

    PubMed

    Holub, Karen; Camune, Barbara

    2015-01-01

    Acute fatty liver of pregnancy, although rare, is usually a third trimester of pregnancy occurrence that may be life threatening for both the pregnant woman and the fetus. Often, the onset resembles gastroenteritis or cholecystitis and correct diagnosis is delayed. Because it can also present with preeclampsia and eclampsia, it may be mistakenly diagnosed as hemolysis, elevated liver enzymes, low platelet syndrome. This article presents diagnostic differences between liver conditions that can complicate pregnancy and management strategies for treating and maintaining the well-being of pregnant women, fetuses, and infants who are affected by acute fatty liver of pregnancy. Early recognition and rapid intervention from antepartum diagnosis through delivery and the postpartum period are required by the nursing team and medical providers to reduce maternal and neonatal morbidity and mortality.

  12. Impact of device geometry on the imaging characteristics of an intravascular photoacoustic catheter.

    PubMed

    Wu, Min; Jansen, Krista; Springeling, Geert; van der Steen, Antonius F W; van Soest, Gijs

    2014-12-01

    A basic requirement for intravascular photoacoustic (IVPA) imaging catheters is that the delivery of light lies within the ultrasonic field of view. Size and manufacturing constraints favor probe designs with offset optical and acoustic beams. This noncollinear dual beam arrangement leads to a curved PA point spread function (PSF). In this work, we characterize the three-dimensional shape of the PSF for IVPA imaging in clear and optically scattering media. We show that the product of the two beam profiles can accurately model the measured peak response in clear and scattering media. We discuss the impact of the PSF shape and its relation to probe construction. We test the imaging capability of the catheter on a phantom and a human artery ex vivo.

  13. A state-of-the-art review on segmentation algorithms in intravascular ultrasound (IVUS) images.

    PubMed

    Katouzian, Amin; Angelini, Elsa D; Carlier, Stéphane G; Suri, Jasjit S; Navab, Nassir; Laine, Andrew F

    2012-09-01

    Over the past two decades, intravascular ultrasound (IVUS) image segmentation has remained a challenge for researchers while the use of this imaging modality is rapidly growing in catheterization procedures and in research studies. IVUS provides cross-sectional grayscale images of the arterial wall and the extent of atherosclerotic plaques with high spatial resolution in real time. In this paper, we review recently developed image processing methods for the detection of media-adventitia and luminal borders in IVUS images acquired with different transducers operating at frequencies ranging from 20 to 45 MHz. We discuss methodological challenges, lack of diversity in reported datasets, and weaknesses of quantification metrics that make IVUS segmentation still an open problem despite all efforts. In conclusion, we call for a common reference database, validation metrics, and ground-truth definition with which new and existing algorithms could be benchmarked.

  14. Development of a Mechanical Scanning-type Intravascular Ultrasound System Using a Miniature Ultrasound Motor

    NASA Astrophysics Data System (ADS)

    Tanabe, Masayuki; Xie, Shangping; Tagawa, Norio; Moriya, Tadashi; Furukawa, Yuji

    2007-07-01

    Intravascular ultrasound (IVUS) plays an important role for the detection of arteriosclerosis, which causes the ischemic heart disease. In mechanical scanning-type IVUS, it is necessary to rotate a transducer or a reflecting mirror. A method that involves rotating the transducer using a torque wire causes image distortion (NURD: non uniform rotation distortion). For a method that involves placing an electromagnetic motor on the tip of an IVUS probe is difficult to miniaturize the probe. Our objectives are to miniaturize the probe (1 mm in diameter, 5 mm in length) and to remove NURD. Therefore, we conducted a study to assess the feasibility of attaining these objectives by constructing a prototype IVUS system, in which an ultrasound motor using a stator in the form of a helical coil (abbreviated as CS-USM: coiled stator-ultrasonic motor) is incorporated, and to clarify problems that need to be solved in constructing the probe.

  15. (100)-Textured KNN-based thick film with enhanced piezoelectric property for intravascular ultrasound imaging

    PubMed Central

    Zhu, Benpeng; Zhang, Zhiqiang; Ma, Teng; Yang, Xiaofei; Li, Yongxiang; Shung, K. Kirk; Zhou, Qifa

    2015-01-01

    Using tape-casting technology, 35 μm free-standing (100)-textured Li doped KNN (KNLN) thick film was prepared by employing NaNbO3 (NN) as template. It exhibited similar piezoelectric behavior to lead containing materials: a longitudinal piezoelectric coefficient (d33) of ∼150 pm/V and an electromechanical coupling coefficient (kt) of 0.44. Based on this thick film, a 52 MHz side-looking miniature transducer with a bandwidth of 61.5% at −6 dB was built for Intravascular ultrasound (IVUS) imaging. In comparison with 40 MHz PMN-PT single crystal transducer, the rabbit aorta image had better resolution and higher noise-to-signal ratio, indicating that lead-free (100)-textured KNLN thick film may be suitable for IVUS (>50 MHz) imaging. PMID:25991874

  16. (100)-Textured KNN-based thick film with enhanced piezoelectric property for intravascular ultrasound imaging

    NASA Astrophysics Data System (ADS)

    Zhu, Benpeng; Zhang, Zhiqiang; Ma, Teng; Yang, Xiaofei; Li, Yongxiang; Shung, K. Kirk; Zhou, Qifa

    2015-04-01

    Using tape-casting technology, 35 μm free-standing (100)-textured Li doped KNN (KNLN) thick film was prepared by employing NaNbO3 (NN) as template. It exhibited similar piezoelectric behavior to lead containing materials: a longitudinal piezoelectric coefficient (d33) of ˜150 pm/V and an electromechanical coupling coefficient (kt) of 0.44. Based on this thick film, a 52 MHz side-looking miniature transducer with a bandwidth of 61.5% at -6 dB was built for Intravascular ultrasound (IVUS) imaging. In comparison with 40 MHz PMN-PT single crystal transducer, the rabbit aorta image had better resolution and higher noise-to-signal ratio, indicating that lead-free (100)-textured KNLN thick film may be suitable for IVUS (>50 MHz) imaging.

  17. Intravascular immunity as a key to systemic vasculitis: a work in progress, gaining momentum

    PubMed Central

    Ramirez, G A; Maugeri, N; Sabbadini, M G; Rovere-Querini, P; Manfredi, A A

    2014-01-01

    Vascular inflammation contributes to the defence against invading microbes and to the repair of injured tissues. In most cases it resolves before becoming apparent. Vasculitis comprises heterogeneous clinical entities that are characterized by the persistence of vascular inflammation after it has served its homeostatic function. Most underlying mechanisms have so far remained elusive. Intravascular immunity refers to the surveillance of the vasculature by leucocytes that sense microbial or sterile threats to vessel integrity and initiate protective responses that entail most events that determine the clinical manifestations of vasculitis, such as end-organ ischaemia, neutrophil extracellular traps generation and thrombosis, leucocyte extravasation and degranulation. Understanding how the resolution of vascular inflammation goes awry in patients with systemic vasculitis will facilitate the identification of novel pharmacological targets and bring us a step closer in each patient to the selection of more effective and less toxic treatments. PMID:24128276

  18. Comparison of Angiography and Intravascular Ultrasound Before and After Balloon Angioplasty of the Femoropopliteal Artery

    SciTech Connect

    Lankeren, Winnifred van; Gussenhoven, Elma J.; Pieterman, Herman; Sambeek, Marc R.H.M. van; Lugt, Aad van der

    1998-09-15

    Purpose: To compare angiographic and intravascular ultrasound (IVUS) data before and after balloon angioplasty (PTA) of the femoropopliteal artery. Methods: Qualitative and quantitative analyses were performed on corresponding angiographic and IVUS levels obtained from 135 patients. Results: IVUS detected more lesions, calcified lesions, and vascular damage than angiography. Sensitivity of angiography was good for the presence of a lesion (84%), moderate for eccentric lesions (53%) and for vascular damage (52%), and poor for calcified lesions (30%). The increase in angiographic diameter stenosis was associated with a decrease in lumen area and increase in percentage area stenosis on IVUS. Conclusions: Angiography is less sensitive than IVUS for detecting lesion eccentricity, calcified lesions, and vascular damage. Presence of a lesion and amount of plaque were underestimated angiographically. Only before PTA was good agreement found between angiographic diameter stenosis and lumen size on IVUS.

  19. A system for intravascular, radially orientation-independent electromagnetic flow- and diameter-sensing.

    PubMed

    Kolin, A

    1977-11-25

    The difficulty of optimally orienting an intravascular loop probe of an extracorporeal field electromagnetic flow meter is circumvented by uniting 2 mutually perpendicular loop sensors into a single flow-diameter probe. When one of the loops is unfavorably oriented in the magnetic field, the orientations of the other loop is more favorable. The most unfavorable case is a 45 degrees angle between the magnetic field and the planes of the loops, when the signal drops to 70.7% of the optimal value. By taking the square root of the sum of the squares of the 2 loop transducer signals, one obtains an output for flow and diameter measurements which is independent of the probe orientation. This operation can be accomplished electronically.

  20. Intravascular Ultrasound and Histology in In Vitro Assessment of Iliac Artery Angioplasty

    SciTech Connect

    Lankeren, Winnifred van; Gussenhoven, Elma J.; Qureshi, Akeel; Lugt, Aad van der

    1999-01-15

    Purpose: Intravascular ultrasound (IVUS) was used to assess in vitro the morphologic and quantitative effects of balloon angioplasty (PTA) of the iliac artery. Methods: Forty human iliac arteries ({>=} 30% area stenosis) were studied with IVUS in vitro before and after PTA and the findings were validated with histology. Results: The sensitivity of IVUS for dissection was 74% and for media rupture 59%. The incidence of vascular damage was higher when the whole segment was analyzed rather than the target site alone. Dissections occurred at the thinnest region of the plaque, unrelated to plaque calcification. Following PTA, quantitative changes at the target site were greater compared with the overall data derived from all cross-sections. The increase in lumen area was caused solely by an increase in vessel area. Conclusions: IVUS is sensitive in detecting dissections, which occurred irrespective of calcification at the thinnest region of the plaque. The increase in lumen area after PTA was caused by stretching of the vessel.

  1. Primary antiphospholipid syndrome and chronic disseminated intravascular coagulation: the differences and the similarities.

    PubMed

    Lee, H C; Groothuis, J S; Schlueter, W J; Laya, M B

    1992-01-01

    A middle aged woman with a medical history of recurrent spontaneous abortions and chronic leg ulcers presented with a pulmonary embolism and inferior vena caval thrombosis. Primary antiphospholipid syndrome (PAPS) was diagnosed by evidence of extremely high titers of anticardiolipin IgG and IgM, typical clinical features and the absence of other autoimmune diseases. Multiple coagulation parameters suggested chronic disseminated intravascular coagulation (DIC). It is important to distinguish PAPS from true chronic DIC as the underlying causes, treatment and prognosis differ greatly. In describing this case of PAPS presenting hematologically as a chronic DIC, we offer a discussion of the means to distinguish between these two coagulopathies and briefly discuss their treatments.

  2. Three-dimensional segmentation of luminal and adventitial borders in serial intravascular ultrasound images

    NASA Technical Reports Server (NTRS)

    Shekhar, R.; Cothren, R. M.; Vince, D. G.; Chandra, S.; Thomas, J. D.; Cornhill, J. F.

    1999-01-01

    Intravascular ultrasound (IVUS) provides exact anatomy of arteries, allowing accurate quantitative analysis. Automated segmentation of IVUS images is a prerequisite for routine quantitative analyses. We present a new three-dimensional (3D) segmentation technique, called active surface segmentation, which detects luminal and adventitial borders in IVUS pullback examinations of coronary arteries. The technique was validated against expert tracings by computing correlation coefficients (range 0.83-0.97) and William's index values (range 0.37-0.66). The technique was statistically accurate, robust to image artifacts, and capable of segmenting a large number of images rapidly. Active surface segmentation enabled geometrically accurate 3D reconstruction and visualization of coronary arteries and volumetric measurements.

  3. Intravascular low-intensity He-Ne laser irradiation therapy on idiopathic edema

    NASA Astrophysics Data System (ADS)

    Gao, Yunqing; Liu, T. C.; Tang, Xiang-Jun

    1998-11-01

    194 patients with psoriasis were treated by intravascular low level laser irradiation combined with Vit C 2.0g iv and O2 inhale to the nose. An hour once a day, for 5-40 times, and 13.06 times in average, ten times with 4-7 days intervals. The results: cured 23 cases, good effected 61 cases, improved 110 cases, relapsed 10 cases. Curative effect was related to treatment times, cured and good effected 5 times 12.5 percent, 10 times 31 percent, 15 times 94 percent. A matched control group in 17 patients was treated by drug. The results: good effected 1 case, improved 13 cases, not effected 3 cases.

  4. Near-infrared spectroscopy-intravascular ultrasound: scientific basis and clinical applications.

    PubMed

    Kilic, Ismail Dogu; Caiazzo, Gianluca; Fabris, Enrico; Serdoz, Roberta; Abou-Sherif, Sara; Madden, Sean; Moreno, Pedro R; Goldstein, James; Di Mario, Carlo

    2015-12-01

    Coronary angiography underestimates the magnitude of the atherosclerotic burden and cannot detect the presence of disease in the early phases. Recognition of these inherent limitations of angiography has been an impetus for the development of other coronary imaging techniques. The novel near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) catheters can detect and quantify the presence of lipid core in the atherosclerotic plaque and associate it with other features such as lumen size and plaque architecture. Lipid-rich plaques are known to pose a higher risk of distal embolization during interventions and plaque disruption. The aim of this manuscript is the review of the potential clinical and research applications of this technology as highlighted by recent studies.

  5. Optical coherence tomography – near infrared spectroscopy system and catheter for intravascular imaging

    PubMed Central

    Fard, Ali M.; Vacas-Jacques, Paulino; Hamidi, Ehsan; Wang, Hao; Carruth, Robert W.; Gardecki, Joseph A.; Tearney, Guillermo J.

    2013-01-01

    Owing to its superior resolution, intravascular optical coherence tomography (IVOCT) is a promising tool for imaging the microstructure of coronary artery walls. However, IVOCT does not identify chemicals and molecules in the tissue, which is required for a more complete understanding and accurate diagnosis of coronary disease. Here we present a dual-modality imaging system and catheter that uniquely combines IVOCT with diffuse near-infrared spectroscopy (NIRS) in a single dual-modality imaging device for simultaneous acquisition of microstructural and compositional information. As a proof-of-concept demonstration, the device has been used to visualize co-incident microstructural and spectroscopic information obtained from a diseased cadaver human coronary artery. PMID:24514658

  6. Distribution of intravascularly injected lanthanum ions in ganglia of the autonomic nervous system of the rat.

    PubMed

    DePace, D M

    1984-12-01

    Intravascular injection of lanthanum revealed that tight junctions of capillaries in sympathetic ganglia are impermeable to small ions and thus behave like capillaries of the blood-brain barrier. The failure of lanthanum to accumulate in the extracellular space suggests that fenestrated capillaries are not as ion-permeable as use of horseradish peroxidase (HRP) by some authors has indicated. A possible toxic action associated with high concentrations of HRP may be responsible for the high permeability of this substance. Testing with lanthanum demonstrated that sympathetic ganglia possess anatomic features that provide a hematic barrier. The blood-ganglion barrier resembles, but has not yet been demonstrated to be as absolute as the blood-brain barrier.

  7. Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict

    PubMed Central

    Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel

    2014-01-01

    Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis. PMID:24713715

  8. Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict.

    PubMed

    Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel

    2014-04-08

    Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis.

  9. Real-time volumetric lipid imaging in vivo by intravascular photoacoustics at 20 frames per second

    PubMed Central

    Wu, Min; Springeling, Geert; Lovrak, Matija; Mastik, Frits; Iskander-Rizk, Sophinese; Wang, Tianshi; van Beusekom, Heleen M. M.; van der Steen, A. F. W.; Van Soest, Gijs

    2017-01-01

    Lipid deposition can be assessed with combined intravascular photoacoustic/ultrasound (IVPA/US) imaging. To date, the clinical translation of IVPA/US imaging has been stalled by a low imaging speed and catheter complexity. In this paper, we demonstrate imaging of lipid targets in swine coronary arteries in vivo, at a clinically useful frame rate of 20 s−1. We confirmed image contrast for atherosclerotic plaque in human samples ex vivo. The system is on a mobile platform and provides real-time data visualization during acquisition. We achieved an IVPA signal-to-noise ratio of 20 dB. These data show that clinical translation of IVPA is possible in principle. PMID:28270995

  10. Functional assessment of coronary artery disease by intravascular ultrasound and computational fluid dynamics simulation.

    PubMed

    Carrizo, Sebastián; Xie, Xinzhou; Peinado-Peinado, Rafael; Sánchez-Recalde, Angel; Jiménez-Valero, Santiago; Galeote-Garcia, Guillermo; Moreno, Raúl

    2014-10-01

    Clinical trials have shown that functional assessment of coronary stenosis by fractional flow reserve (FFR) improves clinical outcomes. Intravascular ultrasound (IVUS) complements conventional angiography, and is a powerful tool to assess atherosclerotic plaques and to guide percutaneous coronary intervention (PCI). Computational fluid dynamics (CFD) simulation represents a novel method for the functional assessment of coronary flow. A CFD simulation can be calculated from the data normally acquired by IVUS images. A case of coronary heart disease studied with FFR and IVUS, before and after PCI, is presented. A three-dimensional model was constructed based on IVUS images, to which CFD was applied. A discussion of the literature concerning the clinical utility of CFD simulation is provided.

  11. Monte Carol-Based Dosimetry of Beta-Emitters for Intravascular Brachytherapy

    SciTech Connect

    Choi, C.K.

    2002-06-25

    Monte Carlo simulations for radiation dosimetry and the experimental verifications of the simulations have been developed for the treatment geometry of intravascular brachytherapy, a form of radionuclide therapy for occluded coronary disease (restenosis). Monte Carlo code, MCNP4C, has been used to calculate the radiation dose from the encapsulated array of B-emitting seeds (Sr/Y-source train). Solid water phantoms have been fabricated to measure the dose on the radiochromic films that were exposed to the beta source train for both linear and curved coronary vessel geometries. While the dose difference for the 5-degree curved vessel at the prescription point of f+2.0 mm is within the 10% guideline set by the AAPM, however, the difference increased dramatically to 16.85% for the 10-degree case which requires additional adjustment for the acceptable dosimetry planning. The experimental dose measurements agree well with the simulation results

  12. Massive haematuria successfully managed by intravesical Ankaferd in a haemodialysis patient complicated with disseminated intravascular coagulation.

    PubMed

    Solak, Yalcin; Gaipov, Abduzhappar; Ozbek, Orhan; Hassan, Mustafa Aziz; Yeksan, Mehdi

    2012-12-23

    Massive haematuria is a life-threatening condition, demanding immediate management of bleeding. The mortality is very high in the case of delayed management of bleeding, especially in elderly patients with concomitant comorbidity. The treatment options of haematuria are wide, and depend on underlying conditions. However, therapeutic choices are limited in the presence of massive and intractable haematuria caused by disseminated intravascular coagulation (DIC). Ankaferd blood stopper (ABS) is a novel, commercially available, haemostatic agent, which has been approved by the Ministry of Health for local use in Turkey. Here, for the first time in the literature, we report a case of diffuse intravesical bleeding stopped by intravesical use of ABS in a 72-year-old man, haemodialysis patient complicated with sepsis and DIC.

  13. Acute Pancreatitis after Percutaneous Mechanical Thrombectomy: Case Report and Review of the Literature

    SciTech Connect

    Hershberger, Richard C. Bornak, Arash; Aulivola, Bernadette; Mannava, Krishna

    2011-02-15

    Purpose: We describe a case of severe acute pancreatitis after percutaneous mechanical thrombectomy (PMT) and review the literature for the occurrence of this complication. Materials and Methods: A 53-year-old man with a history of bilateral external iliac artery stent placement sought care for acute onset of lifestyle-limiting left claudication. Angiography confirmed left external iliac stent occlusion, and PMT with the AngioJet Xpeedior catheter (Possis Medical, Minneapolis MN) was performed. Results: After PMT of the occluded external iliac artery, a residual in-stent stenosis required the placement of a second iliac stent. The procedure was complicated by severe acute pancreatitis. Other causes of pancreatitis were eliminated during the patient's hospital stay. A literature review revealed nine cases of acute pancreatitis after PMT. Conclusion: Although rare, pancreatitis can be a devastating complication of PMT. The development of pancreatitis seems to be related to the products of extensive hemolysis triggering an inflammatory process. To prevent this complication, we recommend that close attention be paid to the duration and extent of PMT, thereby avoiding extensive hemolysis and subsequent complications.

  14. Intravascular electric impedance spectroscopy of atherosclerotic lesions using a new impedance catheter system.

    PubMed

    Süselbeck, T; Thielecke, H; Köchlin, J; Cho, S; Weinschenk, I; Metz, J; Borggrefe, M; Haase, K K

    2005-09-01

    Newer techniques are required to identify atherosclerotic lesions that are prone to rupture. Electric impedance spectroscopy (EIS) can characterize biological tissues by measuring the electrical impedance over a frequency range. We tested a newly designed intravascular impedance catheter (IC) by measuring the impedance of different stages of atherosclerosis induced in an animal rabbit model. Six female New Zealand White rabbits were fed for 17 weeks with a 5% cholesterol-enriched diet to induce early forms of atherosclerotic plaques. All aortas were prepared from the aortic arch to the renal arteries and segments of 5-10 mm were marked by ink spots. A balloon catheter system with an integrated polyimide-based microelectrode structure was introduced into the aorta and the impedance was measured at each spot by using an impedance analyzer. The impedance was measured at frequencies of 1 kHz and 10 kHz and compared with the corresponding histomorphometric data of each aortic segment.Forty-four aortic segments without plaques and 48 segments with evolving atherosclerotic lesions could be exactly matched by the histomorphometric analysis. In normal aortic segments (P0) the change of the magnitude of impedance at 1 kHz and at 10 kHz (|Z|(1 kHz) - |Z|(10 kHz), = ICF) was 208.5 +/- 357.6 Omega. In the area of aortic segments with a plaque smaller than that of the aortic wall diameter (PI), the ICF was 137.7 +/- 192.8 Omega. (P 0 vs. P I; p = 0.52), whereas in aortic segments with plaque formations larger than the aortic wall (PII) the ICF was significantly lower -22.2 +/- 259.9 Omega. (P0 vs. PII; p = 0.002). Intravascular EIS could be successfully performed by using a newly designed microelectrode integrated onto a conventional coronary balloon catheter. In this experimental animal model atherosclerotic aortic lesions showed significantly higher ICF in comparison to the normal aortic tissue.

  15. Cyanoacrylate tissue adhesives - effective securement technique for intravascular catheters: in vitro testing of safety and feasibility.

    PubMed

    Simonova, G; Rickard, C M; Dunster, K R; Smyth, D J; McMillan, D; Fraser, J F

    2012-05-01

    Partial or complete dislodgement of intravascular catheters remains a significant problem in hospitals despite current securement methods. Cyanoacrylate tissue adhesives (TA) are used to close skin wounds as an alternative to sutures. These adhesives have high mechanical strength and can remain in situ for several days. This study investigated in vitro use of TAs in securing intravascular catheters (IVC). We compared two adhesives for interaction with IVC material, comparing skin glues with current securement methods in terms of their ability to prevent IVC dislodgement and inhibit microbial growth. Two TAs (Dermabond, Ethicon Inc. and Histoacryl, B. Braun) and three removal agents (Remove™, paraffin and acetone) were tested for interaction with IVC material by use of tensile testing. TAs were also compared against two polyurethane (standard and bordered) dressings (Tegaderm™ 1624 and 1633, 3M Australia Pty Ltd) and an external stabilisation device (Statlock, Bard Medical, Covington) against control (unsecured IVCs) for ability to prevent pull-out of 16 G peripheral IVCs from newborn fresh porcine skin. Agar media containing pH-sensitive dye was used to assess antimicrobial properties of TAs and polyurethane dressings to inhibit growth of Staphylococcus aureus and Staphylococcus epidermidis. Neither TA weakened the IVCs (P >0.05). Of removal agents, only acetone was associated with a significant decrease in IVC strength (P <0.05). Both TAs and Statlock significantly increased the pull-out force (P <0.01). TA was quick and easy to apply to IVCs, with no irritation or skin damage noted on removal and no bacterial colony growth under either TA.

  16. Controlled pitch-adjustment of impeller blades for an intravascular blood pump.

    PubMed

    Throckmorton, Amy L; Sciolino, Michael G; Downs, Emily A; Saxman, Robert S; López-Isaza, Sergio; Moskowitz, William B

    2012-01-01

    Thousands of mechanical blood pumps are currently providing circulatory support, and the incidence of their use continues to increase each year. As the use of blood pumps becomes more pervasive in the treatment of those patients with congestive heart failure, critical advances in design features to address known limitations and the integration of novel technologies become more imperative. To advance the current state-of-the-art in blood pump design, this study investigates the inclusion of pitch-adjusting blade features in intravascular blood pumps as a means to increase energy transfer; an approach not explored to date. A flexible impeller prototype was constructed with a configuration to allow for a variable range of twisted blade geometries of 60-250°. Hydraulic experiments using a blood analog fluid were conducted to characterize the pressure-flow performance for each of these twisted positions. The flexible, twisted impeller was able to produce 1-25 mmHg for 0.5-4 L/min at rotational speeds of 5,000-8,000 RPM. For a given twisted position, the pressure rise was found to decrease as a function of increasing flow rate, as expected. Generally, a steady increase in the pressure rise was observed as a function of higher twisted degrees for a constant rotational speed. Higher rotational speeds for a specific twisted impeller configuration resulted in a more substantial pressure generation. The findings of this study support the continued exploration of this unique design approach in the development of intravascular blood pumps.

  17. Virtual angioscopic visualization and analysis of coronary aneurysms using intravascular ultrasound images

    NASA Astrophysics Data System (ADS)

    Ayeni, Tina A.; Holmes, David R., III; Robb, Richard A.

    2001-05-01

    Kawasaki Disease is an inflammatory illness of young children that can seriously affect the cardiovascular system. The disease may cause coronary artery aneurysms, a thinning and dilation of the arterial wall when the wall is weakened by disease. Such aneurysms significantly increase the risk of rupture of the arterial wall, an event from which few patients survive. Due to the largely asymptotic nature of coronary aneurysms, diagnosis must be timely and accurate in order for treatment to be effective. Currently, aneurysms are detected primarily using X-ray angiography, MRI, and CT images. Increased insight into the disease and its effects on the arterial wall can be gained by multi-dimensional computerized visualization and quantitative analysis of diagnostic images made possible by the techniques of intravascular imaging and virtual endoscopy. Intravascular ultrasound images (IVUS) of a coronary artery exhibiting aneurysms were acquired from a patient with Kawasaki Disease. The disease is characterized by low luminescent in the IVUS images. Image segmentation of the abnormal, prominent anechoic regions branching from the lumen and originating within other layers of the arterial wall was performed and each region defined as a separate object. An object segmentation map was generated and used in perspective rendering of the original image volume set at successive locations along the length of the arterial segment, producing a 'fly-through' of the interior of the artery. The diseased region (aneurysm) of the wall was well defined by the differences in luminal size and by differences in appearance of the arterial wall shape observed during virtual angioscopic fly-throughs. Erosions of the endovascular surface caused pronounced horizontal and vertical ballooning of the lumen. Minute cracks within the unaffected luminal areas revealed possible early development of an aneurysm on the contralateral wall, originating in the medial section of the artery and spreading

  18. Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

    SciTech Connect

    Zanchetta, Mario Rigatelli, Gianluca; Pedon, Luigi; Zennaro, Marco; Ronsivalle, Salvatore; Maiolino, Pietro

    2003-09-15

    To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 {+-} 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy.

  19. Use of an Intravascular Fluorescent Continuous Glucose Sensor in ICU Patients

    PubMed Central

    Strasma, Paul J.; Finfer, Simon; Flower, Oliver; Hipszer, Brian; Kosiborod, Mikhail; Macken, Lewis; Sechterberger, Marjolein; van der Voort, Peter H. J.; DeVries, J. Hans; Joseph, Jeffrey I.

    2015-01-01

    Background: Hyperglycemia and hypoglycemia are associated with adverse clinical outcomes in intensive care patients. In product development studies at 4 ICUs, the safety and performance of an intravascular continuous glucose monitoring (IV-CGM) system was evaluated in 70 postsurgical patients. Methods: The GluCath System (GluMetrics, Inc) used a quenched chemical fluorescence mechanism to optically measure blood glucose when deployed via a radial artery catheter or directly into a peripheral vein. Periodic ultrasound assessed blood flow and thrombus formation. Patient glucose levels were managed according to the standard of care and existing protocols at each site. Reference blood samples were acquired hourly and compared against prospectively calibrated sensor results. Results: In all, 63 arterial sensors and 9 venous sensors were deployed in 70 patients. Arterial sensors did not interfere with invasive blood pressure monitoring, sampling or other aspects of patient care. A majority of venous sensors (66%) exhibited thrombus on ultrasound. In all, 89.4% (1383/1547) of arterial and 72.2% (182/252) of venous measurements met ISO15197:2003 criteria (within 20%), and 72.7% (1124/1547) of arterial and 56.3% (142/252) of venous measurements met CLSI POCT 12-A3 criteria (within 12.5%). The aggregate mean absolute relative difference (MARD) between the sensors and the reference was 9.6% for arterial and 14.2% for venous sensors. Conclusions: The GluCath System exhibited acceptable accuracy when deployed in a radial artery for up to 48 hours in ICU patients after elective cardiac surgery. Accuracy of venous deployment was substantially lower with significant rates of intravascular thrombus observed using ultrasound. PMID:25972280

  20. Corticosteroid Therapy for Management of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Meta-Analysis.

    PubMed

    Mao, Minhong; Chen, Chen

    2015-12-03

    BACKGROUND Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a severe condition of pregnancy that is associated with significant morbidity and mortality. Corticoteroid (CORT) therapy is common in the management of HELLP syndrome. This study evaluates the efficacy of CORT therapy to patients with HELLP Syndrome. MATERIAL AND METHODS A literature search was carried out in multiple electronic databases. Meta-analyses of means difference and odds ratio were carried under the random-effects model. RESULTS Fifteen studies (675 CORT treated and 787 control HELLP patients) were included. CORT treatment significantly improved platelet count (mean difference between CORT treated and controls in changes from baseline, MD: 38.08 [15.71, 60.45]×109; p=0.0009), lactic dehydrogenase (LDH) levels (MD: -440 [-760, -120] IU/L; p=0.007), and alanine aminotransferase (ALT) levels (MD: -143.34 [-278.69, -7.99] IU/L; p=0.04) but the decrease in aspartate aminotransferase (AST) levels was not statistically significant (MD: -48.50 [-114.32, 17.32] IU/L; p=0.15). Corticosteroid treatment was also associated with significantly less blood transfusion rate (odds ratio, OR: 0.42 [0.24, 0.76]; p=0.004) and hospital/ICU stay (MD: -1.79 [-3.54, -0.05] days; p=0.04). Maternal mortality (OR: 1.27 [0.45, 3.60]; p=0.65), birth weight (MD: 0.09 [-0.11, 0.28]; p=0.38) and the prevalence of morbid conditions (OR: 0.79 [0.58, 1.08]; p=0.14) did not differ significantly between both groups. CONCLUSIONS Corticosteroid administration to HELLP patients improves platelet count, and the serum levels of LDH and ALT, and reduces hospital/ICU stay and blood transfusion rate, but is not significantly associated with better maternal mortality and overall morbidity.