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Biomedical subjects

H Goslinga

Publications and source records attributed to H Goslinga.

11 recordsLinked to original sources
PubMed1992

[Individualized hemodilution in acute brain infarct using a 20% albumin solution and physiological saline solution].

OBJECTIVE: To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident. DESIGN: Prospective, randomized clinical trial. SETTING: St Lucas Hospital, Amsterdam. METHOD: Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20% solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infarction. All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg (SD 3) and a haematocrit (Ht) of 0.32 l/l (SD 0.02). The control group only received individually dosed rehydration with crystalline infusion fluids. Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning. RESULTS: The results in the total haemodilution group and the control group did not differ significantly. However, in the subgroup with normal Ht (< 0.45 l/l; n = 201) there was a significant reduction (p < 0.05) of the mortality after 3 months (27% and 16%, respectively) and an increase of independence at home (35% and 48%, respectively) due to a reduction of the viscosity by means of haemodilution with albumin (a specific viscosity effect in the normovolaemic group). In the control group with raised Ht (dehydration; Ht > or = 0.45 l/l; n = 50) there was a significant decrease (p < 0.005) of the mortality after 3 months (27% and 8%, respectively) and an increase of independence at home (35% and 59%, respectively) compared with the control group with normal Ht without signs of dehydration (Ht < 0.045 l/l; n = 102), due to rehydration exclusively with crystalline infusion fluids (a specific rehydration effect in the dehydrated group). CONCLUSION: In cerebrovascular accident patients haemodilution should be adjusted individually; in normovolaemic patients haemodilution should be carried out with an albumin solution; the higher the Ht, the more rehydration with crystalline infusion fluids is to be carried out.

Activities of Daily Living↗
PubMed1992

Custom-tailored hemodilution with albumin and crystalloids in acute ischemic stroke.

BACKGROUND AND PURPOSE: Hemodilution in the acute phase of ischemic stroke is still controversial. Multicenter studies have failed to demonstrate any benefit. The present study focuses attention on analysis of circulation in stroke and on individual restabilization of circulation. METHODS: The Amsterdam Stroke Study is a prospective, single-center, randomized clinical trial (n = 300). Normovolemic hemodilution is accomplished in a customized procedure by administration of 20% albumin plus crystalloids under hemodynamic and rheological monitoring in the acute phase of stroke. All patients receive general intensive care treatment and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy is guided on the basis of a target pulmonary capillary wedge pressure (12 +/- 3 mm Hg) and hematocrit (0.32 +/- 0.02). The control group receives only customized rehydration by infusion of crystalloids. RESULTS: We obtained significant (p less than 0.05) reduction in mortality at 3 months (from 27% to 16%) and an increase in independence at home (from 35% to 48%) after viscosity reduction by means of hemodilution with albumin in the subgroup with a hematocrit less than 0.45 (n = 201) (specific viscosity effect). We also obtained a significant (p less than 0.005) reduction in mortality at 3 months (from 27% to 8%) and an increase in independence (from 35% to 59%) after only rehydration with crystalloids in the subgroup with overt dehydration (hematocrit greater than or equal to 0.45; n = 51) as compared with the normal-hematocrit group without signs of dehydration (hematocrit less than 0.45; n = 103) (specific rehydration effect). CONCLUSIONS: This study may provide an explanation for the failures in former hemodilution trials and may re-establish proper hemodilution and rehydration as a valuable therapy in the acute phase of stroke, thus reducing mortality and improving independence after 3 months.

Acute Disease↗
PubMed1991

Hemodilution and rehydration in acute ischemic stroke. A preliminary report on the Amsterdam Stroke Study.

The Amsterdam Stroke Study was a prospective, single-center, randomized clinical trial, investigating the effect of normovolemic hemodilution and rehydration with albumin 20% and crystalloids. All patients (n = 300) received general intensive care treatment and monitoring with a pulmonary artery catheter. The therapy was individually "customized" and guided on the pulmonary capillary wedge pressure of 12 +/- 3 mm Hg and for the hemodilution group on a hematocrit of 0.32 +/- 0.02 l/l. The significant differences in the subgroups emphasize the importance of a differentiation between a viscosity effect and an effect in hemodilution therapy, sometimes intensifying, sometimes counteracting each other.

Albumins↗
PubMed1987

Whole blood viscosity during normal pregnancy.

In a serial study the changes in whole blood viscosity at different shear rates and its major determinants were determined in 24 healthy women with normal pregnancies. Whole blood viscosity and plasma viscosity were measured with a rotational viscometer. Red cell aggregation was measured by syllectometry. During normal pregnancy we found a decrease in whole blood viscosity at all shear rates until 29 weeks gestation, followed by a smaller increase between 30 and 37 weeks, which was most pronounced at higher shear rates, especially in nulliparae. The changes in whole blood viscosity were to a great extent determined by the changes in haematocrit and plasma viscosity. Haematocrit was more important for whole blood viscosity at lower shear rates, while plasma viscosity had more influence on high shear blood viscosity. The continuous increase in red cell aggregation had no demonstrable influence on low shear blood viscosity as measured in vitro in a rotational viscometer.

Blood Viscosity↗
PubMed1985

Blood and plasma viscosity measurements in patients with glaucoma.

Blood viscosity at 10 shear rates, plasma viscosity, packed cell volume, plasma fibrinogen, serum alpha 2-macroglobulin, and serum proteins were measured in 83 patients with low-tension glaucoma (LTG) and 23 patients with 'high-tension glaucoma' (HTG: at least one IOP reading above 40 mmHg) and compared with those in 50 controls. Blood and plasma viscosity values and packed cell volume were significantly higher in the LTG group than those in controls. The HTG and the LTG groups differed only in plasma viscosity, but smoking and drinking habits in the HTG patients were greatly different from those in LTG patients and controls, thus preventing interpretation of data in the HTG group. Within the LTG group viscosity values were highest in a subgroup designated earlier by us as focal ischaemic LTG, whereas another subgroup, senile sclerotic LTG, did not show significant differences compared with controls. These findings may indicate a factor in the pathogenesis of visual field defects and disc cupping in some patients with LTG.

Aged↗
PubMed1985

Comparison of the rheological behavior of hemocytometry controls and fresh patient EDTA-anticoagulated blood specimens.

For rheological reasons high viscosity specimens are more sensitive to deficiencies, if any, in the aspiration systems of whole blood flow cytometers and consequently are more likely to give erroneous values. For this reason the rheological behavior of hemocytometry controls was compared with that of patient blood specimens. It is shown that the behavior of controls and patient specimens of comparable hematocrit is similar at shear rates that are probably occurring during aspiration (exceeding approximately 40 s-1). The hematocrit is shown to be a major determinant of the viscosity of both controls and patient specimens. The results suggest that from the rheological point of view the fundamental IFCC premise is met, "that errors detected by means of control specimens exactly mirror errors occurring with patients' specimens", provided their hematocrits are taken into account.

Anticoagulants↗
PubMed1978

Hemodynamic and metabolic consequences of hemodilution with different diluents.

Hemodilution was performed with the crystalloid Ringer's lactate (n = 6) and the colloid Haemaccel (n = 5) in dogs during automatically controlled total cardiopulmonary bypass with constant arterial and venous pressures. Single observations were made with Macrodex and Rheomacrodex hemodilution. Hemoglobin concentration and hematocrit were used as parameters for hemodilution. Total plasma protein proved to be unsuitable. The volume needed to induce the same level of hemodilution with lactated Ringer's and Haemaccel was twice the volume needed with Macrodex and Rheomacrodex. The volume shift from intravascular to extravascular was larger during Ringer's lactate hemodilution than during Haemaccel hemodilution. The amount of volume shift was clearly related to changes in colloid osmotic pressure. Lowering of total peripheral vascular resistance, with increased arterial line flow during controlled constant arterial and venous pressures was seen during hemodilution with each of the above materials. Potassium and calcium concentrations in the blood increased significantly during hemodilution with Haemaccel. Base excess was constant during hemodilution with lactated Ringer's but decreased in all other cases. A decrease in oxygen consumption was common, and most pronounced during hemodilution with Haemaccel.

Animals↗