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Biomedical subjects

M Samama

Publications and source records attributed to M Samama.

At least 127 records · Page 7Linked to original sources
PubMed1988

[Acquired factor VII inhibitor: treatment using high-dose immunoglobulins, corticotherapy and plasma exchange].

A 62 year old man presented a diffuse hemorrhagic syndrome related to the presence of an acquired factor VII inhibitor (proconvertin). Autoantibodies were of the IgG class and no subjacent disease was detected during a 7-month follow up. Treatment with high-dose polyvalent immunoglobulins was ineffective, and the onset of an intracerebral hemorrhage required therapy by a series of plasma exchanges combined with immunosuppressive treatment. The plasma inhibitor was no longer present after the first exchange and clinical and biological remission was rapid.

Cerebral Hemorrhage↗
PubMed1987

[Hereditary protein S deficiency and recurrent venous thrombosis. Study of a family].

Hereditary protein S deficiency was detected in three subjects belonging to three generations of one single family. The deficiency was heterozygous and was associated with recurrent venous thromboembolism in two of the subjects affected. Plasma analysis by two-dimensional immunoelectrophoresis showed that the protein S fraction bound to C4b-binding protein was quantitatively normal, whereas the free protein S fraction was much reduced. Since it has been well established that only free protein S intervenes in the regulation of blood coagulation, any quantitative deficiency, even moderate, in protein S resulting in redistribution of its free and bound fractions will have major functional repercussions.

Adult↗
PubMed1987

Fibrinogen Haifa: fibrinogen variant with absence of protective effect of calcium on plasmin degradation of gamma chains.

The abnormal fibrinogen Haifa is characterized by the fact that calcium present during enzymatic digestion by plasmin does not protect the Haifa D gamma chain against further plasmin attack as it does in normal molecules. Since calcium binding to fibrinogen, ADP--platelet aggregation cofactor activity and gamma dimerization process induced by factor XIIIa are normal for fibrinogen Haifa, the corresponding sequences in the gamma chain are not involved. It seems rather that the anomaly resides near the gamma 302 plasmin cleavage site that is protected when calcium is bound to the gamma chain and that this affects the availability of the polymerization site located in the C terminal part of the chain.

Adult↗
PubMed1987

Antithrombotic activity of a synthetic heparin pentasaccharide in a rabbit stasis thrombosis model using different thrombogenic challenges.

A synthetic pentasaccharide, representing the critical sequence required in heparin for binding to antithrombin III (AT III), produces strong anti-factor Xa activity in vitro in the presence of AT III and is devoid of any activity directed towards thrombin. This pentasaccharide provides a unique tool to study the question of whether an agent capable of inhibiting factor Xa but devoid of anti-factor IIa activity in vitro, has the capacity to produce an antithrombotic effect in vivo. We have previously demonstrated in a rabbit stasis thrombosis model using a human serum challenge, a significant antithrombotic effect of the pentasaccharide. This finding and discrepancies with some earlier reports on the antithrombotic actions of other oligosaccharide fragments, led us to extend these studies. Four modifications of the stasis thrombosis model were developed using the following thrombogenic challenges selected for their specified induction sites of thrombosis, thromboplastin, an activated prothrombin complex concentrate, a non-activated prothrombin complex concentrate administered simultaneously with Russell's viper venom, and factor Xa. Dose-dependent antithrombotic responses were obtained in all four systems with ED50 values between 25-43 ug/kg for pentasaccharide as compared to 16-47 ug/kg for heparin. Complete inhibition of induced thrombosis was obtained in all four systems for pentasaccharide. Ex vivo analysis revealed expected anti-factor Xa levels but no anti-factor IIa activity. It is concluded that an oligosaccharide with high anti-factor Xa activity and devoid of anti-factor IIa activity is capable of inhibiting thrombosis induced in rabbit stasis models, but that higher dosages than heparin are required for this effect.

Animals↗
PubMed1987

Laboratory monitoring of a low molecular weight heparin (enoxaparin) with a new clotting test (Heptest).

A new simple clotting test (Heptest) for low molecular weight heparins was compared to anti-Xa determination by an amidolytic assay in volunteers and in patients receiving standard calcium heparin or low molecular weight (LMW) heparin (Enoxaparin) by subcutaneous administration. The results obtained with both methods are in very good agreement. It seems that the Heptest, although influenced by various other clotting parameters, is nevertheless relatively specific for anti-Xa activity. Despite our positive first impression, we object to expressing the results in micrograms of heparin per milliliter or anti-Xa units. Until rigorous standardization is possible, we prefer to express the results as clotting times. Preliminary results warrant a more extensive study in order to assess the clinical relevance of Heptest in patients receiving unfractionated or LMW heparins.

Blood Coagulation Tests↗
PubMed1987

Biological study of intravenous anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.

An anisoylated plasminogen streptokinase activator complex (APSAC) has been administered as a bolus intravenous injection of 30U to 14 patients with acute myocardial infarction. Systemic effects on coagulation and fibrinolysis were studied. In 1 patient, the treatment produced no biological modification, which could be explained by an increased streptokinase resistance in this patient, apparent from the sample collected before treatment. In the other patients, as expected, fibrinogen, plasminogen, alpha 2-antiplasmin and factors V and VIIIc fell dramatically, while there was an increase in serum fibrinogen degradation product concentrations. In addition, plasma fibrin derivatives increased during APSAC therapy, both in patients who had occluded or patent coronary arteries. Discrepancies were found between methods used to measure fibrinogen: with the Ellis and Stransky method, concentrations were higher than with the Clauss method; and for plasminogen, automated methods using different analysers may give higher results in some patients.

Adult↗
PubMed1987

[Platelet aggregation tests in 26 cases of heparin-induced thrombopenia. Methodological, diagnostic problems and therapeutic aspects].

A diagnosis of heparin induced thrombocytopenia (HIT) in the 26 patients was based on: 1. normal platelet count prior to heparin administration; 2. its fall to less than 100 Giga/l (m = 46 +/- 23) at time of first sample collection for test to detect a platelet aggregation factor (PAF); 3. restoration of normal values after discontinuation of heparin treatment during which the thrombocytopenia had appeared. The result of the first PAF test in these 26 patients was positive in 22 cases, negative in 2; twice the plasma provoked platelet control aggregation without in vitro addition of heparin. The origin, dose and mode of administration of the heparin did not appear determinant in the production of the thrombocytopenia: 16 of the patients were later treated with a low molecular weight heparin (LMWH). An in vitro "compatibility" test was able to be performed 8 times previously and was negative in 7 cases in the 16 patients. Samples were collected during LMWH treatment and were negative in 13 cases, and this in agreement with the increased platelet count after 7 +/- 3 days and the clinical improvement. In 3 patients the test was positive: in one case the count did not return to normal, in the second case this did occur, but slowly (21 days); the PAF test in the last patient was positive prior to LMWH treatment and remained so while the count became normal. Concordance exists therefore between negativity of the test practiced with LMWH and the increase in count when this heparin is administered; inversely, the positivity of the test does not exclude normalization of the platelet count.

Adult↗
PubMed1987

[Biological modifications induced by 3 low molecular weight heparins, PK 10169, Kabi 2165 and CY 216, compared to unfractionated heparin injected subcutaneously in healthy subjects in general surgery and in aged subjects in internal medicine].

Activities of anti-Xaam, anti-IIaam, Heptest and calcium thrombin time (Ca TT) were compared in: 12 male healthy volunteers after increasing doses of 20, 40, 60 and 80 mg/day of Enoxaparine; 76 patients after gynecological surgery treated with 20 mg (12 cases), 40 mg (15 cases) or 60 mg (10 cases) per day of Enoxaparine versus calcium heparin as 5,000 IU x 3/day (39 cases); 68 patients after general surgery treated with 2,500 units Fragmine/day (34 cases) versus calcium heparin 5,000 IU x 2/day (34 cases); 27 patients in a medical ward treated with either 7,500 Choay Institute units/day of Fraxiparine (14 cases) or Cutheparine (magnesium heparinate) (13 cases). In this latter case results of Heptest only are reported. In healthy volunteers and patients after gynecological operations, the Ca TT and anti-IIaam activity were significantly modified after doses greater than or equal to 40 mg. Values for anti-Xaam and anti-IIaam were dose-related but higher in healthy volunteers. The anti-Xa/anti-IIa ratio was 3-4. Correlation between Heptest, a simple test, and anti-Xa activity--both very good markers of low molecular weight heparins (LMWH)--was very good (r = 0.93, p less than 0.02 in healthy volunteers; r = 0.87, p less than 0.01 in operated patients). Peak activity was at about 3 to 4 hours after injection, the half-life of anti-Xa and anti-IIa activities being 4 and 2 hours respectively. After heparin injection, the anti-Xa/anti-IIa ratio was 1 but activities were weak (5,000 IU x 2 = 0.02 +/- 0.02), a little higher with 5,000 IU x 3 (0.05 +/- 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Lipolytic and anticoagulant activities of heparin and one of its low molecular weight derivatives].

The plasma lipolytic and anticoagulant activities following i.v. injection of either standard heparin or low molecular weight heparin (PK 10169) were compared in a study involving 10 healthy volunteers. The total lipolytic activity (lipoprotein lipase + hepatic lipase) released by PK 10169 was similar to that released by standard heparin when low molecular weight heparin was administered in doses 3- to 5-fold higher (by weight) than standard heparin. There was a dose-response relationship between the amount of PK 10169 injected and the level of plasma lipolytic activity. With doses of PK 10169 lower than 20 mg or heparin lower than 6 mg, lipolytic but not anticoagulant activity was observed. With doses higher than 20 mg with PK 10169 and 6 mg with heparin, both lipolytic and anticoagulant activities appeared. In doses where the lipoprotein lipase activities released by the 2 heparins were similar, the hepatic lipase released with low molecular weight heparin was significantly higher than with standard heparin.

Adult↗
PubMed1987

[A specific marker of thrombolysis: DDE complex].

A specific determination of fibrin degradation product (FbDP) is essential for the monitoring of thrombolytic therapy. In patients under thrombolytic therapy, even with tpA (tissue type plasminogen activator) fibrinogen is degraded, and fragment D derived from fibrinogen degradation, is evidenced in the plasma of treated patients. In order to determine specifically the FbDP, even in the presence of fragment D, we take into account the fact that FbDP are complexes such as DDE complex. Therefore a new Elisa technique is proposed. FbDP and fragment D are captured from plasma by immobilized anti D neo monoclonal antibody which recognizes an epitope accessible on fragment D but does not react with undegraded fibrinogen. DDE complexes are then detected specifically using a peroxidase-labelled anti E antibody. The advantage of this technique is discussed in this paper.

Antibodies, Monoclonal↗
PubMed1987

[New thrombolytic agents].

Tissue Plasminogen Activator (t-PA), Single Chain Urokinase Plasminogen Activator or pro-Urokinase (scu-PA or pro-UK) and acyl enzymes are new thrombolytic agents, characterized by a high fibrin affinity, so that they provoke only mild systemic fibrinolytic effect. Their infusion would allie good thrombolytic activity and reduced hemorragic risks, usually related to fibrinogen and others coagulation factors degradation t-PA and scu-PA are natural, physiological substances, obtained by recombinant DNA technology. t-PA infusion in acute myocardial infusion (AMI) has been shown to be at least as efficient than intracoronary Streptokinase (SK) administration, but fibrinogenolysis was much lower as compared to SK. In vitro studies have shown that scu-PA was an efficient thrombolytic agent and has a relative fibrin specificity, at least as similar to t-PA, but much superior to classical Urokinase. The acyl-enzyme APSAC or Eminase is a SK-plasminogen complex in which the proteolytic site has been inactivated with an anisoic-acid. This acyl enzyme has a longer half-life than t-PA and scu-PA, and can be injected as a bolus. Its administration in AMI have shown that APSAC is as effective as SK, but can also provoke severe fibrinogenolysis. These 3 agents seem to have similar thrombolytic activities on coronary thrombi. However, further studies are required to evaluate the bleeding incidence and coronary reocclusion rates associated with their utilisation.

Acylation↗
PubMed1987

Biological and clinical heterogeneity of lupus and lupus-like anticoagulant in fifty-seven patients.

A lupus or lupus-like inhibitor was detected in 57 patients: 24 systemic lupus erythematosus, 9 autoimmune diseases, 10 lymphoproliferative disease, 11 miscellaneous diseases and 3 asymptomatic patients. No hemorrhagic diathesis was observed in spite of major surgery. Thromboembolism occurred in 19 patients. Among them, 5 patients had recurrent abortions. An extensive study of coagulation profile compared different assays to investigate lupus-like inhibitor: the most sensitive assay was the partial thromboplastin time performed without activator. When performed with kaolin, it was the only assay detecting the lupus cofactor. Prothrombin time was prolonged in only 53% of the patients. Factors VIII, IX, XI and XII were in the normal range in 40% of the patients. When decreased, apparent deficiencies were usually not detectable on further dilutions of the test samples. In 7 patients factor XII antigen and activity were both decreased, suggesting an apparent factor XII deficiency. No relationship was observed between thromboembolic events, underlying disease or biological pattern.

Adolescent↗