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Biomedical subjects

U Hedner

Publications and source records attributed to U Hedner.

At least 181 records · Page 10Linked to original sources

Fibrinolytic activity in wound secretions.

Debrisan, a highly hydrophilic dextran polymer, was previously shown to be effective in cleaning infected wounds. The dry beads remove wound secretions from the wound surface under gel formation. The gel can then be analysed. A high fibrinolycic activity on fibrin plates and high levels of fibrin/fibrinogen degradation products were found in the secretions from 12 wounds. Low of plasminogen, antithrombin III and the absence of coagulable fribinogen also indicated a high fibrinolytic activity. A higher fibrinolytic activity on heated than on unheated fibrin plates, and the insignificant effect of local application of EACA suggest the presence of other proteolytic enzymes than plasmin.

Dextrans↗

Gastric fibrinolysis.

Gastric juice from 15 normals, 20 patients with gastric ulcer and 14 patients with erosive haemorrhagic gastroduodenitis was investigated in respect of its activity on unheated and heated fibrin plates and its content of FDP and plasminogen or plasmin with immunochemical methods. Gastric juice from normals showed no activity on unheated and heated fibrin plates, and no FDP or plasminogen could be demonstrated. In the patients with gastric ulcer the gastric juice showed little or no fibrinolytic activity on fibrin plates except in 2, who had regurgitation of duodenal juice and neutral pH of the juice. These patients had equally high activity on heated as on unheated plates and no plasmin could be demonstrated. It was shown that this activity was not due to fibrinolysis, but to non-specific proteolytic activity (probably trypsin). The patients with erosive haemorrhage gastroduodenitis exhibited quite a different picture. The gastric juice from these patients showed extremely high activity on fibrin plates, the activity was higher on unheated than on heated plates. The activity was inhibited in vitro by addition of EACA and in vivo after administration of AMCA. The occurence of plasmic could be demonstrated directly immunologically in the gastric juice. By comparsion of plasmin and trypsin in various assays it could further be improved that the gastric juice in these cases contained plasminogen activator and plasmin. The patients with erosive haemorrhagic gastroduodenitis showed no increase in fibrinolysis in the blood, but low values for plasminogen and alpha2-M, and the serum contained FDP. These findings in the blood and gastric juice were interpreted as signs of local fibrinolysis in the stomach and duodenum. There is reason to assume that this gastric fibrinolysis contributes substantially to the bleeding tendency. The effect of administration of AMCA on fibrinolytic activity and the haemorrhage lends support to the assumption of such a mechanism.

Aged↗

The effect of dextran on the lysability of ex vivo thrombi.

The lysability was determined of thrombi formed in Chandler tubes before and after infusion of 500 ml dextran 70 to patients undergoing cholecystectomy. 125I-labelled fibrinogen was given the day before operation. Following incubation of the thrombi formed in plasmin, radioactivity remaining in the thrombi and released to the supernatant was determined, as well as fibrinolytic degradation products in the supernatant, using an immunoelectrophoretic method. The dextran infusion was found to increase the radioactivity released from the thrombi to the supernatant from 15.5 plus or minus 7.6% to a maximum of 27.3 plus or minus 8.2% four hours after the infusion (P less than 0.001). A corresponding significant rise of the FDP concentration in the supernatant from 16.8 mug/ml to 44.1 mug/ml was found at the same time. After 24 hours the radioactivity had returned to initial values. The results indicate that dextran infused into patients during surgery increases the lysability of thrombi. It is suggested that this finding at least partly explains the antithrombotic effect of dextran.

Cholecystectomy↗

Erosive hemorrhagic gastroduodenitis with fibrinolysis and low factor XIII.

Four patients with erosive hemorrhagic gastroduodenitis were found to have high fibrinolytic activity of the gastric juice. No increase in the fibrinolytic activity could be demonstrated in the circulating blood, but the values found for fibrinogen, plasminogen and alpha2-macroglobulin were low. A high content of FDP was found in the serum. All patients had a markedly decreased content of factor XIII. Platelet count and other coagulation components were normal. These findings were interpreted as signs of local fibrinolysis in the diseased parts of the gastrointestinal canal. The bleeding stopped after oral and intravenous administration of a fibrinolytic inhibitor (AMCA Cyclokapron) and of factor XIII-containing concentrate. In bleeding from gastroduodenal ulcer and esophageal varices, no increase in gastric fibrinolytic activity was found. It is suggested that the high local fibrinolytic activity in the stomach in erosive gastritis together with the low content of factor XIII contributes substantially to the hemorrhage in this condition. These observations may lead to a revision of the treatment of such cases.

Aged↗

Intrauterine death and circulating anticoagulant ("antithromboplastin").

A report is presented of a young, otherwise apparently healthy, woman who had three pregnancies which for some unknown reason terminated in intrauterine death (macerated foetuses). During the third pregnancy a coagulation defect was diagnosed, which was characterized by prolonged coagulation times and prolonged one-stage prothrombin time. This defect disappeared after the end of the pregnancy, but returned during the fourth pregnancy. This time a circulating anticoagulant was found, which inhibited the action of thromboplastin. The values found for the various coagulation factors were normal. The anticoagulant titre rose during the pregnancy from 1/2 to 1/10. Leucocyte agglutinating as well as lymphocytotoxic antibodies directed against the husband's cells were demonstrated in the patient during the pregnancy. In this case, by passage of cell fragments and thromboplastic substances to the mother, the foetus had probably induced the development of antibodies against the foetal tissues. The foetus may be regarded as an incompatible transplant. The fourth pregnancy was terminated by caesarean section in the 34th week. The child weighed 1440 g and, after three exchanges of blood, did very well. The placenta was severely infarcted. It is postulated that the development of antithromboplastin during pregnancy may be a contributory cause of intrauterine death.

Adult↗

Factor XIII in a clinical material.

In 339 patients with various diseases factor XIII (FSF) was determined with the specific amine incorporation method of Lorand et al (1969). Normal values were found in patients with renal (216 patients) or liver diseases (33 patients), in 39 patients with recurrent deep venous thrombosis and in 17 children with congenital cyanotic heart disease. Low levels were found in patients with various conditions, such as sepsis, multiple fractures and combustio complicated by an abnormal proteolytic activity (fibrinolysis and/or activation of the coagulation system with signs of disseminated coagulation). No correlation was found between the FSF and the fibrinogen values or the levels of fibrin/fibrinogen degradation products (FDP). Low FSF values were found in 4 patients with erosive gastritis, with gastrointestinal bleedings and a local fibrinolytic activity in the gastric juice. Although the FSF must be very low (smaller than 1%) if it is to cause bleedings, the low levels in these patients with many other coexisting disturbances in the coagulation system and/or an increased fibrinolytic activity most probably contribute to the increased bleeding tendency in such patients.

Disseminated Intravascular Coagulation↗

Generalized proteolysis in a young woman with Weber-Christian disease (nodular nonsuppurative panniculitis).

A patient with Weber-Christian disease (syn. nodular nonsuppurative panniculitis) is reported. The generalized cellular destruction in this patient resulted in liberation of proteolytic enzymes into the circulation, which led to multiple haemostatic disturbances with haemorrhagic diathesis. The most prominent haemostatic defects were thrombocytopenia with a normal life span of isologous platelets, high levels of AHF-related antigen, hypofibronigenaemia with short fibrinogen survival, low levels of Factor XIII (fibrin stabilizing factor = FSF) and increased amounts of fibrin/fibrinogen degradation products (FDP). Proteolytic enzymes, other than thrombin and plasmin which especially degrade Factor XIII and fibrongen, derived from destroyed cells (probably leukocytes) seem to have been involved in the pathogenesis of the bleeding disorder in this patient.

Adult↗

Intravascular coagulation in pregnancy--treatment with heparin.

Two pregnant women with a history of miscarriages or premature labour are described. In the 25-27th week of pregnancy routine examinations showed high levels of FDP in serum. Subsequent extensive coaggulation studies revealed a positive ethanol gelation test, low levels of firbrinogen, plasminogen, alpha2-macroglobulin and P&P and high level of AHF related protein for the stage of pregnancy, i.e. finding indicating abnormal proteolysis with activation of the coagulation and fibrinolytic system. Continuous intravenous heparin treatment caused the coagulation system to return to normal throughout the rest of pregnancy. Both women gave birth to healthy babies without any complications. But the placenta showed numerous infarcts. The heparin treatment may have prevented later developing of placental dysfunction.

Adult↗