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L Heilmann

Publications and source records attributed to L Heilmann.

At least 19 recordsLinked to original sources

[Rheology and gravidic hypertension].

Gestational hypertension is the development of hypertension and proteinuria after the 20th week of gestation. The most common causes of increased peripheral resistance are the vasoconstriction and hemoconcentration with plasma volume contraction. Additional rheological parameters are an elevated red blood cell aggregation and impaired erythrocyte deformability. Preeclamptic patients showed a significantly low cardiac output and central venous pressure than normal pregnant women. It has already been shown by the studies by Hytten and Paintin (1963) and also by the subsequent studies by Garn et al. (1981), Murphy et al. (1986) that a strong correlation exists between newborn weight and plasma volume. Other authors (Gallery et al. (1979/1981)) show the possibility that plasma volume contraction plays an even larger role than vasoconstriction in the fetal growth retardation that often accompanies maternal hypertension. This possibility is supported by the finding that hypertension and perinatal complications can be reduced in some pregnant women by the admission of oncotic solutions (i.e. hydroxyethyl-starch) that expand plasma volume. Volume expansion with hydroxyethyl-starch appears to be of therapeutic benefit for hypertensive patients and patients with fetal growth retardation with low cardiac output.

Birth Weight

[Hemostasis and pre-eclampsia].

A longitudinal study has been undertaken in 125 pregnant women between 25 and 40 weeks of gestation, to provide systematic information on the changes that occur in a wide range of haemostasiological and haemorheological variables. Fibrinogen, D-Dimer, Factor VIIIR: Ag, erythrocyte aggregation and plasma viscosity rose markedly throughout pregnancy. Antithrombin III and alpha 2-antiplasmin were unchanged during pregnancy. There were no significant differences between women in the pre-eclamptic group (N = 16) and the control group. HELLP syndrome (N = 7) was associated with high D-Dimer (p less than 0.05), and TAT (p less than 0.05), low antithrombin III (p less than 0.03), protein C (p less than 0.01) and platelets (p less than 0.001). Our results demonstrate that during pregnancy (also, however, in pre-eclamptic women) alterations of the coagulation system occur, but these changes do not affect the overall haemostatic balance. Findings in patients with "true" HELLP syndrome are consistent with an increased tendency for intravascular coagulation.

Blood Coagulation Factors

[Value of hemodilution therapy in pregnancy].

The ability to produce a large increase in plasma volume is one of the hallmarks of a successful pregnancy. Data from Garn et al. (5), Knottnerus et al. (14) and Murphy et al. (15) have shown, that hemoglobin levels above 13 g/dl or hematocrit 38% before admittance to hospital are associated with a high incidence of IUGR (intrauterine growth retardation), gestational hypertension and with a greater perinatal mortality. Patients with an elevated viscosity and hematocrit have increased perinatal risks. In these cases the hemodilution with hydroxy- ethylstarch (HES) improves the blood flow and decreases the incidence of dysmature babies and pregnancy complications. The effect of HES on certain coagulation assays seems qualitatively similar to those of Dextran. In a prospective trial we evaluated the effect of HES in the incidence of thrombosis after cesarean section and we found a 5.9% incidence of thrombosis in patients treated with 6% HES 0.62 compared with a 7.8% incidence in heparin treated patients. Treatment with 1500 ml 6% HES 0.62 before and after cesarean section is similarly effective in preventing deep vein thrombosis as heparin prophylaxis.

Blood Volume

[Accumulation of two different hydroxyethyl starch preparations in the placenta after hemodilution in patients with fetal intrauterine growth retardation or pregnancy hypertension].

In a prospective clinical study the safety of two hydroxyethylstarch preparations (HES steril 10%, Fresenius AG, Oberursel = HES-A; Haemufusin, Kabi-Pfrimmer, Erlangen = HES-B) were assessed. In 60 patients with fetal growth retardation and/or gestational hypertension, hematocrit, aPTT, factor VIIIR: Ag, fibrinogen, uric acid, cord blood hemoglobin, hematocrit, pH-value and the fetal/maternal hydroxyethylstarch concentration before and after eight (HES-B) or nine (HES-A) days of treatment were monitored. 500 ml HES-A (n = 36) or HES-B (n = 24) together with the same volume electrolyte solution, were infused daily. Both substances lowered significantly the maternal and fetal hematocrit. Histopathological changes of placenta (trophoblast cells and stroma) taking place after the infusion of HES-A or HES-B were depicted by light microscopy. Administration of HES-A or HES-B was associated with lower values of factor VIIIR: Ag and a prolongation of aPTT, but only HES-B demonstrated a significant effect (31% vs. 12%, p less than 0.01). We observed in 4 (16.7%) cases severe uterine bleeding complications and one woman (4.2%) with abruptio placentae in the group HES-B. Light microscopy shows vacuoled trophoblast and stroma cells after HES infusions. The marked vacuolisation of the placenta after HES-B is due to differences in the physicochemical characteristics of HES-A and HES-B. For this reason, we prefer to administer HES-A in the dilution treatment of patients with placental insufficiency.

Adolescent

[Hemodynamic and hemorheologic findings in patients with pregnancy-induced hypertension: comparison of pre-eclampsia and chronic hypertension].

Forty-five women with preeclampsia and 39 woman with chronic hypertension in pregnancy were studied by catheterization of the superior vena cava and by impedance cardiography before therapy was started. An initial hemorrheology and hemostaseologic protocol was prepared which included hematocrit, erythrocyte aggregation, erythrocyte deformability, plasma viscosity, colloid osmotic pressure, serum osmolality, uric acid, fibronectin, antithrombin III and fibrinogen. The hematocrit and the peripheral resistance were greater in preeclampsia than in essential hypertension. Moreover, preeclamptic patients showed a significantly lower cardiac output and central venous pressure than women with chronic hypertension. On the other hand, the plasma viscosity of women with essential hypertension increased, whereas patients with preeclampsia showed a lower erythrocyte deformability and a higher concentration of leukocytes. Finally, volume expansion with Hydroxyethyl-starch appears to be of therapeutic benefit for hypertensive patients with low cardiac output.

Adolescent

[Prevention of thrombosis in gynecology: double-blind comparison of low molecular weight heparin and unfractionated heparin].

The safety and efficacy of low molecular heparin (Sandoz AG, Nürnberg), given 1500 aPTT once daily (and two placebo injections), in preventing postoperative venous thromboembolism, was assessed against sodium heparin at a dose of 5000 IU three times daily, in a unicenter double-blind randomized study. 300 patients, scheduled for major gynecological surgery, were included in this study. Two patients (1.3%) of 150 patients developed deep vein thrombosis in the LMWH-group, the corresponding figure for sodium heparin was 6 patients (4.0%). There was no statistically significant difference between the two groups in respect to the bleeding variables such as postoperative drainage, blood transfusions and haematoma. The antithrombotic effects were assessed with the anti-Xa assay and LMWH-fractions have shown a high antifactor Xa/activated partial thromboplastin time (aPTT) specific activity (2:1) compared to unfractionated heparin (1:1). It is concluded that one single daily injection of LMWH (without dihydergot) provides a convenient safe and effective prophylaxis against thromboembolism in gynecological surgery.

Adult

Simultaneous investigations of maternal cardiac output and fetal blood flow during hypervolemic hemodilution in preeclampsia--preliminary observations.

In pre-eclampsia hemodynamic alterations are characterized by a lack of plasma volume expansion and a raised peripheral vascular resistance. For the compensation of plasma volume deficit and to restitute blood fluidity the therapeutic use of plasma volume expanders (f.e. low molecular dextran) is recommended. Several groups (Goodlin et al., Cloeren et al., Heilmann et al., Seghal et al., Schröck) have demonstrated benefitial effects on fetal status and development in the course of hypervolemic hemodilution in preeclampsia. This therapeutic procedure presumes the continuous surveillance of maternal hemodynamics to early recognize heart insufficiency or fluid overload in the lungs. We use the noninvasive thoracic impedance cardiography for continuous monitoring of maternal heart performance. The effect of hypervolemic hemodilution on fetal circulation has not been quantitatively investigated yet. Meanwhile pulsed doppler ultrasonography offers the possibility of estimating quantitative changes on fetal blood flow. We used both noninvasive techniques--thoracic impedance cardiography and pulsed doppler imaging system--for the simultaneous evaluation of maternal and fetal hemodynamic parameters during hypervolemic hemodilution. This preliminary report summarizes the investigations in 5 patients with pre-eclampsia (mean arterial blood pressure greater than or equal to 103.3 mm Hg, hemoconcentration with elevated hematocrit levels greater than or equal to 38%). The patients received an infusion of 500 ml dextran 40 over a period of exactly 60 minutes. The simultaneous measurements of maternal and fetal cardiovascular parameters were performed in 15-minutes intervals during dextran application and 15 minutes (p 15), 30 minutes (p 30) and 60 minutes (p 60) after the end of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Mathematical, clinical, and laboratory study of hemodynamic changes in the placental circulation.

Various rheological properties of blood were investigated in pregnant and non-pregnant women of similar age. The results from 27 women with abnormal pregnancies were compared to those obtained from 17 non-pregnant women. In abnormal pregnancies we found a reduction of the erythrocyte filtration and a pathological use in red cell aggregation and in the shear resistance of the aggregates. Fractional light transmission (T7/T0) was higher than 1.0, suggesting that pressure gradients in the capillary circulation are not sufficient to disperse red cell aggregates. Thus, rheological factors may be partly responsible for the clinical consequences of pre-eclampsia. Pathological red blood cell aggregation and stagnation are consequences of the changed flow properties in the microcirculation. Even a small decrease of the local pressure gradients in the microcirculation of patients with pre-eclampsia would impair the dispersal of red blood cells and lead to their increased aggregation. Complete occlusion of the placental circulation by these aggregates would impair oxygen transfer at a speed that has been calculated from a diffusion equation based on the concept of the placenta as a hollow cylinder.

Adult

[Comparative examinations of high-molecular maternal serum protein bodies during pregnancy--a contribution to biochemical pregnancy control (author's transl)].

The maternal Serum concentrations of beta 1 SP 1, IgM and alpha 2-macroglobulin were determined in relation to the gestation age, using the simple radial immunodiffusion method in 102 non-pathologic pregnancies and 35 pregnancies involving risk factors. To assess the clinical relevance of these determinations, we examined to what extent the changes in concentration of beta 1 SP 1 IgM and alpha 2-macroglobulin would permit a prognostically useful conclusion on the placenta function and foetal condition. All patients with lowered beta 1 SP 1-serum concentrations were examined for their antepartua CTG-evaluation, as well as the type of termination of parturition. The normal distribution for beta 1 SP 1 showed a continuous rise in serum concentration up to the 37th pregnancy week. During the last 3 weeks, beta 1 SP 1 remained almost constant. For the cases with EPH-gestosis and placenta insufficiency, a beta 1 SP 1-concentration below the normal distribution level was found in the large majority of all cases. In diabetes mellitus during gravidity, twin gravidity and MHN, the determination of beta 1 SP 1 is not of any decisive prognostic significance. The maternal serum levels of IgM showed no significant differences when comparing normal pregnancy and risk pregnancy. The serum concentration of alpha 2-macroglobulin increased in both groups of patients with increasing gestation age. Of the three examined protein bodies, we consider beta 1 SP 1 to be a good, additional parameter for the assessment of the trophoblast function.

Female

[Erythrocyte alteration in long standing labor inhibition with a beta-sympathicomimetic drug (Partusisten) (author's transl)].

The relative flow rate of the red blood cells in a hematocrit of 10% was measured with a 5 mu nuclepore filter system. The influence of Partusisten was determined by the alteration of the red blood cells. The in vitro concentration of 0.1 ng Partusisten/ml blood resulted in a relative improvement of the flow rate, which we also found in normal pregnancies. However, in a vivo concentration of 4 microgram intravenous Partusisten/min for 48 h, the red cell alteration properties decreased. After a greater time interval, the red blood cells alteration was about the same as in the pre-drug level. The uteroplacental perfusion changed in dependence to the concentration of the beta-mimetic drug (Partusisten). The presence of rigid red blood cells can be first seen in the microcirculation impairment. Depending on the concentration of Partusisten, a protective effect on the flow properties of the red blood cells could be achieved, which altered during pregnancy. However, in late gestosis, a lower dosage should be administered than in labor inhibition.

Erythrocytes

[The therapy of the hypertensive form of late gestosis (author's transl)].

Based on five cases of intrauterine death associated with preeclamptic toxemia, a possible relationship between the antihypertensive treatment with Catapres and the fatal outcome of the fetus is discussed. Catapres is known to decrease cardiac output and, in addition, diminishes the utero-placental circulation. For effective prevention of hemodynamic failure in such cases, it is advisable to use Catapres only in combination with adequate intravenous infusion therapy. Further investigations concerning this possible relationship should be done to determine sufficiently whether or not Catapres can be used without risk as a hypertensive drug in late gestosis.

Adult

[Changes in the blood rheology and their influence on the oxygen diffusion in normal and pathological pregnancies (author's transl)].

Blood viscosity studies were carried out at regular intervals in 51 patients with normal pregnancy and in 27 patients with high risk pregnancy, i.e. with EPH-gestosis and placental insufficiency. During gestation the relative blood viscosity is significantly increased compared to 15 normal non-pregnant women. At a corrected hematocrit of 45% we found a direct correlation to plasma fibrinogen and to the blood sedimentation rate. Although the whole blood viscosity does not indicate any change in normal pregnant women, there is, however, a viscosity increase in the last trimester of high risk pregnancies. Additionally a mathematical model of the oxygen diffusion in the placental cotyledo demonstrates rapid decrease of the oxygen partial pressure in the maternal intervillous channel if the microcirculation of the "Placenton" is impaired.

Blood Sedimentation

A reflection on the oxygen diffusion of the terminal villus of the human placenta (author's transl).

By using a simple model, transformed to cartesian coordinates, we examined the behavior of the fetal and maternal oxygen partial pressure on the terminal villus of the human placenta during a constant arteriovenous oxygen difference. For this purpose we divided the flow length of the cotyledon in central and a peripheral part. We found that the oxygen exchange takes place at a lower utero-umbilical oxygen pressure gradient it the reduction of the maternal blood flow velocity amounts to 30% of the normal value and if the diffusion distance is doubled. However under these circumstances a sufficient the oxygen supply of the fetal organism. This is the case with the total flow length of a single cotyledon, but some of the terminal villi in the periphery of the cotyledon, could receive at the same time a diminished oxygen supply leading to degenerative cell changes. At a progression of these morphological changes or during labor the oxygen transport can get insufficient.

Chorionic Villi

[A simple filtration technique for the observation of the deformation of human erythrocytes during pregnancy (author's transl)].

A simple rheological test method, as developed by Reid and Dormandy, was applied. In a group of pregnant women (n = 25) without pathological conditions the filtrability of whole blood and of a 10% erythrocyte suspension was determined. The control is a group of healthy nonpregnant patients (n = 7) at different times of the ovulatory cycle. Compared with the control group the flow rate of whole blood in the pregnant state is decreased about 30%, whereas that of the erythrocyte suspension about 40%.

Erythrocytes