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  • 1
    ISSN: 1432-1238
    Keywords: Complications ; Pulmonary embolism ; Pregnancy ; Thromboembolic disease ; Thrombolytic therapy ; Recombinant tissue type plasminogen activator
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a patient with massive pulmonary embolism and circulatory shock during pregnancy (31 st gestational week) and preterm labour who has been successfully treated with recombinant tissue type plasminogen activator. Thrombolysis was performed using 10 mg·h−1 over 4 h followed by 2 mg·h−1 for 1 h 30 min resulting in complete resolution of cardio-respiratory symptoms. Except for slight bleeding from one puncture site no complications occurred. At 48 h after the end of thrombolytic therapy the patient was delivered spontaneously of a male preterm healthy infant. The relevance of this new thrombolytic agent in the treatment of massive life-threatening pulmonary embolism during pregnancy is discussed.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. A650 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Acute respiratory failure ; Anticoagulation ; Artificial lung ; Extracorporeal gas exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Treatment of severe acute respiratory failure with extracorporeal gas exchange necessitating near complete systemic anticoagulation requires a delicate balance to be maintained between disseminated intravascular coagulation and hemorrhagic complications. The present study describes our first experience using a heparin coated extracorporeal artificial lung and circuitry during clinical extracorporeal CO2 removal. In spite of a partial thromboplastin time and activated clotting time within or close to the normal range, neither laboratory evidence for disseminated intravascular coagulation induced by the extracorporeal circuit nor thrombi in the pulmonary vasculature were found. Scanning electron microscopy of the heparin coated hollow fiber gas exchanger demonstrated only minor deposits on the surface. Use of a heparin coated artificial lung may enhance the margin of safety of extracorporeal gas exchange and ultimately broaden its indications.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1435-1803
    Keywords: Blood volume distribution ; splanchnic circulation ; vascular capacitance ; vasopressin ; whole-body scintigraphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In healthy humans, the increase in arterial blood pressure seen in patients with autonomic dysfunction in response to exogenous vasopressin (AVP) is abolished. We tested the hypothesis that redistribution of blood from the intra- to the extrathoracic vascular compartment might contribute to this buffer response. Regional distribution of99mTc labeled autologous red cells was assessed in healthy supine volunteers (n=7) during arginine-vasopressin administration (1 ng·kg−1 bolus i.v. followed by a 14-min infusion of 3 ng·kg−1·min−1), along with arterial and central venous pressures, and heart rate. Exogenous vasopressin increased plasma vasopressin concentration from 4.0±1.4 SEM to 91 pg·ml−1±12. Thoracic counts increased slightly but significantly by 2.2%±0.9, while global abdominal counts remained unchanged. Most surprisingly, counts in the liver markedly increased (+8.1%±1.8, p=0.02), but significantly decreased in the spleen (−3.1%±1.4). Intestinal (−2.5%±2.4) and limb counts did not change significantly. Consistent with the increase in thoracic counts centralvenous pressure increased from 3.6 mm Hg±1 to 4.7±1 (p=0.02), while arterial pressure and heart rate did not change. All changes reversed towards baseline when vasopressin administration ceased. Thus, in humans with an intact autonomic system, vasopressin, at concentrations observed during hypotension, increases liver and, albeit to a small extent, also thoracic blood volume, but decreases splenic blood content. These results 1) are incompatible with the hypothesis that AVP induces a shift of blood from intra- to extrathoracic capacitance vessels, and 2) show that AVP increases rather than decreases central blood volume.
    Type of Medium: Electronic Resource
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