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At least 19 recordsLinked to original sources
PubMed1987

Polygeline.

Polygeline is a polymer of urea and polypeptides derived from degraded gelatin. The mean molecular weight of the polygeline molecules is 35000 with a range of 5000 to 50000. It is available as a 3.5 percent solution in 500 ml plastic bottles (Haemaccel) and in addition to the polygeline there is sodium, potassium, calcium and chloride ions. Polygeline is readily excreted in the urine so has a short half life of about 3-6 hours. This half life increases in patients with impaired renal function to about 16 hours. Polygeline is used in the initial management of hypovolaemia where its dose is limited by the degree of haemodilution which can be tolerated by the patient. In adults this amounts to about 1,500 ml. Histamine release has been reported with polygeline and this may result in hypotension, bronchospasm and skin rash. Recent alterations in its preparation have reduced the incidence of reactions to 0.78 percent.

Hemodilution↗
PubMed1985

Myocardial perfusion imaging in humans by contrast echocardiography using polygelin colloid solution.

This study evaluated the myocardial contrast effect and safety of polygelin colloid solution selectively injected into the coronary arteries in 25 patients during two-dimensional echocardiography. Six patients (group I) had selective intracoronary injections of nonagitated and 19 (group II) of hand-agitated polygelin colloid solution. Myocardial contrast was seen on two-dimensional echocardiographic cross sections in three patients of group I and in all patients of group II; in 16 patients it was also seen on M-mode echocardiograms. The contrast effect lasted for 15 to 60 seconds. The intensity of myocardial opacification was not significantly influenced by the amount of polygelin colloid solution injected, heart rate or cardiac size. The total number of contrast-enhanced segments after right and left coronary artery injections delineated the entire cross-sectional area in any given view. None of the patients developed symptoms during or immediately after the injections. One patient had transient second degree atrioventricular block after a right coronary wedge injection, one patient showed a QRS axis shift and two others had transient T wave changes. There were no aortic blood pressure changes and no significant serum enzyme (creatine kinase [CK], CK-MB fraction, glutamic oxaloacetic transaminase) elevation or alterations of left ventricular function assessed echocardiographically. It is concluded that hand-agitated polygelin colloid solution is a useful and safe intracoronary contrast agent for delineating myocardial perfusion areas on two-dimensional echocardiography in humans.

Adolescent↗
PubMed1992

Colloid solutions in the critically ill. A randomised comparison of albumin and polygeline. 1. Outcome and duration of stay in the intensive care unit.

All patients admitted to an Intensive Care Unit were randomised to receive all volume replacement fluid as either human albumin solution or a synthetic colloid. A total of 475 patients were admitted during the study period. Patients' age, sex, APACHE score and calculated risk of death were assessed on admission. Outcome was assessed as length of Intensive Care stay and mortality. There was no difference between the groups. Subgroups of patients with APACHE score greater than 10, calculated risk of death greater than 50% and length of stay greater than 5 days were also evaluated but not significant differences were found between treatment groups. The use of albumin rather than 3.5% polygeline for volume replacement in the Intensive Care Unit has no influence on outcome.

Adolescent↗
PubMed1992

Colloid solutions in the critically ill. A randomised comparison of albumin and polygeline 2. Serum albumin concentration and incidences of pulmonary oedema and acute renal failure.

All patients admitted to an Intensive Care Unit were assigned randomly to one of two groups, A and B. Group A received colloid volume replacement as 4.5% albumin whilst group B received a synthetic colloid, polygeline. This study describes the changes in serum albumin concentration in survivors and nonsurvivors in the two groups during their stay in the Intensive Care Unit. The incidences of renal failure and pulmonary oedema were also assessed. Serum albumin concentration decreased in all nonsurvivors. In survivors the serum albumin concentration decreased to a greater extent in the synthetic colloid group than in the albumin group. Despite the differences in serum albumin concentration there were no significant differences between the groups in the incidences of pulmonary oedema or renal failure.

Acute Kidney Injury↗
PubMed1989

[The effect of subtherapeutic quantities of native gelatin and Haemaccel 35 (polygeline) on the fibronectin level and wound healing. An experimental animal study in rats with burn wounds].

Posttraumatically, opsonic plasma fibronectin is consumed by collagen-like degradation products that enter the vascular system. Additional administration of gelatin (= denatured collagen) results in an essential lack of fibronectin with subsequent retardation of wound healing even when subtherapeutic amounts are given. Therefore, in an experiment with rats we studied the question of whether similar effects are evoked by equal amounts of Haemaccel 35 (cross-linked polypeptides from degraded gelatin). The animals received standardized third degree burn injuries of about 1% of body surface. Immediately after wounding and on the following 2 days native gelatin or Haemaccel was applied intraperitoneally in 2 different dosages (61 mg/kg and 122 mg/kg). The burn injury by itself did not cause a significant decrease of plasma fibronectin. After injection of gelatin a dramatic deprivation of plasma fibronectin occurred and, in consequence, a delay of the healing process. After administration of equal amounts of Haemaccel 35, however, there was neither a depletion of plasma fibronectin nor any significant effect on wound healing.

Animals↗
PubMed1990

Reduction of complement activation during bypass by prime manipulation.

Complement activation is believed to be of importance in the development of complications arising after cardiopulmonary bypass. The effect on complement activation of priming the extracorporeal circuit with crystalloid alone, crystalloid plus albumin, or crystalloid plus the plasma expander polygeline was assessed in 36 patients undergoing coronary artery operations with cardiopulmonary bypass using a bubble oxygenator. Activation of the alternative and common complement pathways was monitored before, during, and after the bypass period by measuring concentrations of factor B and its fragment Ba and C3 and its fragment C3d. Complement activation occurred in all three groups of patients, with no difference between the crystalloid and crystalloid-albumin groups. In contrast, Ba fragment concentrations were persistently and significantly lower during and after bypass in the polygeline group, denoting reduced complement activation. C3d levels also showed a tendency to be lower in this group. Our results indicate that addition of polygeline to the priming solution reduces complement activation. Because complement activation is associated with morbidity after cardiopulmonary bypass, addition of polygeline to the priming solution may offer an inexpensive method of reducing morbidity after cardiopulmonary bypass.

Albumins↗
PubMed1988

Decrease of angiotensin-converting enzyme activity after plasma exchange.

We measured sequential changes in serum angiotensin-converting enzyme (ACE) in 12 ICU patients undergoing plasma exchange (PE) with plasma substitutes (albumin-Polygelin). A dramatic decrease in serum ACE activity was observed after each of the 51 PE procedures. Repeated PE procedures resulted in almost a total depletion of serum ACE, which returned to normal ranges in 4 to 10 days. No ACE change was observed during hemodialysis or hemofiltration. ACE activity increased after PE with fresh frozen plasma replacement. ACE changes were compared with IgG, antithrombin III, and fibronectin changes. Extraction ratio comparisons were consistent, with a loss in removed plasma accounting for 50% to 70% of the observed ACE decrease. Plasma zinc levels were not modified after PE. Mixing experiments with increasing volumes of plasma substitutes showed ACE inhibition by Polygelin. In vivo infusion of Polygelin had the same effect. The renin-induced aldosterone response studied in six exchanged patients was consistent with a relative hyperreninemic hypoaldosteronism after repeated PE. These findings may be of clinical relevance during acute hypovolemia and dehydration after PE or Polygelin infusion and in patients with impaired lung endothelial function.

Adult↗
PubMed1975

Carrier solutions for low-level intravenous insulin infusion.

In the use of low-level intravenous insulin infusion for treating diabetic hyperglycaemia and ketoacidosis adsorption of insulin to containers or plastic infusion apparatus results in significant losses of 60-80% of insulin in dilute physiological saline solution (40 U/l). It is therefore necessary to add protein to the carrier solution to minimize losses and maintain a constant delivery rate. Recovery studies showed that 3.5% w/v polygeline solution (polymer of degraded gelatin) was a suitable medium for this purpose, offering some advantages over human serum albumin. A minimum concentration of 0.5% polygeline was required to ensure adequate delivery of insulin to the patient.

Biological Availability↗
PubMed1992

Effect on primary haemostasis of prophylactic regimens of low molecular weight heparin, unfractionated heparin, dextran and their combinations. An animal experimental study.

The aim of the study was to determine whether an impairment of the haemostasis could be observed experimentally when thromboprophylactic substances, which act differently on the haemostatic mechanism, were given single or in combination in prophylactic doses. In 36 rabbits we measured the primary haemostatic plug formation time (PHT), rebleedings and total haemostatic plug formation time (THT) after transection of venules and arterioles using an intravital microscope. We combined unfractionated heparin (UH) and low molecular weight heparin (LMWH) in low dose with either dextran 70 or polygeline (placebo volume expander) in a randomized double-dummy set up. In the placebo group (NaCl and polygeline) the median PHT was 55 and 101 seconds for arterioles and venules respectively, which are well-comparable to earlier results from our group. Most prolonged PHT and THT for arterioles were seen for dextran+NaCl, actually less prolongation was seen for UH+dextran. We did not observe any differences, except for a prolongation of THT for venules in rabbits given dextran+NaCl (p less than 0.05). Thus, in thromboprophylactic doses used, there does not seem to be an impaired or additive effect between heparins and dextran 70 in primary haemostasis in rabbits.

Animals↗
PubMed1985

Anaphylactoid reactions to plasma substitutes.

Anaphylactoid reactions have been reported in association with all of the currently available plasma substitutes. The clinical picture ranges from skin reactions only to severe and life-threatening complications, which can be conveniently classified into four grades of severity. The pathomechanism of these anaphylactoid reactions varies for the different colloids. Anti-dextran antibodies (most likely IgG) seem to be responsible for severe DIAR representing an immune complex anaphylaxis. IgE has not been implicated in reactions of this type. Skin tests seem to be of limited value in the diagnosis of dextran reactions and should be performed with great caution. Administration of a specific hapten (low-molecular-weight dextran) prior to dextran infusion reduces the frequency of DIAR in animals and humans. The principal mediator of anaphylactoid reactions due to gelatin infusion is histamine, and this has been established for urea-linked gelatin. It is likely that the diisocyanate present in some polygeline batches is the histamine-releasing substance. Better purification of polygeline and pretreatment with histamine H1-receptor and H2-receptor antagonists have both substantially reduced the frequency of clinical reactions. Changes in plasma complement levels have been observed in patients with anaphylactoid reactions to HES. Antibodies against HES have been detected in humans, but no correlation has been found between the titer of antibodies and anaphylactoid reactions to HES. A further problem with repeated HES infusions is its potentially irreversible storage. Anaphylactoid reactions to colloids should be treated according to the grade of severity. Epinephrine should only be given in severe (grades III and IV) reactions. The early application of glucocorticosteroids (500-1,000 mg of prednisolone equivalent) also may be helpful.

Anaphylaxis↗
PubMed1987

Resuscitation in haemorrhagic shock--pulmonary and renal effects: an adverse effect of stabilised plasma protein solution on renal function?

In a model of severe canine haemorrhagic shock, greyhound dogs were randomly allocated to resuscitation with 0.9% saline, polygelin, hetastarch, or stabilised plasma protein solution (SPPS). Resuscitation was continued back to baseline pulmonary artery wedge pressure, and extravascular lung water (EVLW) and urine output were measured. EVLW following resuscitation was higher in the saline group than in any of the three colloid groups. Urine output following resuscitation was significantly lower in the SPPS group than in any other group. The results suggest that SPPS has an adverse effect on renal function in this model.

Animals↗
PubMed1987

Systemic haemodynamic and metabolic effects of deliberate hypotension with isoflurane anaesthesia or sodium nitroprusside during total hip arthroplasty.

Isoflurane (ISO) was examined as an alternative hypotensive agent to nitroprusside (SNP) in 16 patients (mean age: 60 years) anaesthetized for total hip arthroplasty. MAP was decreased to 50 per cent of the awake level by infusion of SNP in Group I (n = 8) and with ISO in Group II (n = 8). Fentanyl (10-16 micrograms X kg-1) was administered to both groups. Haemodynamic measurements were repeated in the lateral position before, during and after hypotension. Polygeline and fresh frozen plasma were infused throughout the study period in volumes sufficient to maintain pulmonary capillary wedge pressure in the 7-9 mmHg range. The MAP decrease was the same in both groups, as were perioperative blood replacement (mean 500 ml), and postoperative haematocrits. Total perioperative fluid replacement was higher (p less than 0.01) in Group I (mean 2500 ml) than in Group II (mean 1300 ml). Venous tone was more affected by SNP than by ISO. ISO decreased the systemic vascular resistance index and oxygen consumption (VO2) without any change in CI or in Qs/Qt, in contrast to SNP which increased CI, VO2 and Qs/Qt.

Adult↗
PubMed1990

Basal prostaglandin synthesis by the isolated perfused rat kidney.

In order to assess the main characteristics of the prostaglandin (PG) biosynthesis by the isolated perfused rat kidney, the urinary and venous outputs of PGE2, PGF2alpha, 6-keto-PGF1alpha and of thromboxane (Tx)B2 were followed during 120 min after an equilibration period of 30 min. Single pass kidneys were perfused with a Krebs-Henseleit solution added with Polygeline at a constant flow rate providing a perfusion pressure about 90 mm Hg. From the beginning of the study, major differences could be observed in the renal biosynthetic rate of the 4 PG studied which were mainly excreted into the venous effluent. During the perfusion, urinary and venous outputs of PGE2, PGF2alpha and of TxB2 remained stable whereas those of 6-keto-PGF1alpha sharply increased and were found inversely related to the glomerular filtration rate (r = -0.95; p n 0.001). Finally, the urinary and venous outputs of each of the four PGs studied were found positively related. It is concluded that the isolated perfused rat kidney is a valuable preparation for studying the biosynthesis of PGs and that, at least in thi model, the urinary excretion of PGs is a good index of their renal synthesis.

Animals↗
PubMed1989

Crystalloid or colloid: does it matter?

The modern version of the crystalloid-colloid debate has continued for more than 25 years, and a current appraisal of the debate is presented here. Although the effect of crystalloids and colloids on intravascular volume is important, their effect on interstitial fluid volume after hemorrhage and hemorrhagic shock is central to the debate. If reduced, crystalloids are appropriate as part of the resuscitation regime; if increased, colloid therapy is more logical. A brief review of the distribution of crystalloids and currently used colloids (albumin, polygeline, dextran 70, and hydroxyethyl starch) is presented. The problems of pulmonary and peripheral edema also are presented, as is an appraisal of adverse reactions to colloids together with a cost comparison of crystalloids and colloids. The results of a survey of attitudes at the major Australian anesthetic departments are given, and a personal approach to fluids in resuscitation is outlined.

Colloids↗
PubMed1987

Hemodynamic effects of continuous norepinephrine infusion in dogs with and without hyperkinetic endotoxic shock.

We compared, at constant preload maintained by polygeline (gelatin) infusion, the hemodynamic effects of continuous infusion of norepinephrine (0.5, 1, and 1.5 micrograms/kg X min) in anesthetized dogs with and without hyperdynamic endotoxic shock. In both groups, norepinephrine infusion increased systolic, diastolic and mean aortic BP, cardiac index, stroke index, index of myocardial contractility, and mean pulmonary artery pressure. No significant change in right atrial pressure, left ventricular end-diastolic pressure, heart rate, systemic vascular resistance, or pulmonary vascular resistance was observed. Oxygen consumption index and oxygen extraction ratio remained unchanged. Increases in systolic aortic BP were dose-related, whereas maximal effects on other variables were obtained at 0.5 to 1 microgram/kg X min. The rise in aortic pressure resulted from an increased cardiac index but not from an increased systemic vascular resistance. Stroke index increased as contractility improved. The slight alpha-adrenergic effect of continuous, low-dose norepinephrine infusion did not impede the beneficial effects of the marked beta-adrenergic stimulation on cardiac function. The combination of these two effects improved hemodynamic disturbances of hyperdynamic endotoxic canine shock.

Animals↗
PubMed1992

Pressure independence of renin release by isolated kidneys of Lyon hypertensive rats.

In the present work the influence of perfusion pressure on renal functions and renin release was studied before and after the blockade of thromboxane A2/prostaglandin H2 (TXA2/PGH2) receptors using isolated kidneys from 7-week-old genetically hypertensive (LH), normotensive (LN), and low blood pressure (LL) rats of the Lyon strain. Kidneys were single pass perfused with Krebs-Henseleit solution with a gelatine derivative (Polygeline) added as an oncotic agent. A servocontrolled system stabilized the renal perfusion pressure (RPP) at any chosen (+/- 1 mm Hg) level. In baseline conditions (RPP, 90 mm Hg), LH (n = 7) kidneys differed from LN (n = 6) and LL (n = 8) controls by increased vascular resistance, decreased glomerular filtration rate, and natriuresis. The LH kidney responses to stepwise changes in RPP (between 60 and 170 mm Hg) differed from those of LN and LL rats by a significantly lower perfusion flow, glomerular filtration rate, and natriuresis. Above all, the reduction in RPP, which induced a marked and highly reproducible renin release in LN and LL kidneys, was devoid of effects in LH kidneys. The blockade of TXA2/PGH2 receptors by AH23848 (4 x 10(-6) M) did not change the baseline (RPP, 90 mm Hg) functions of kidneys of the three strains. During changes in RPP, the responses of LN and LL kidneys were not modified, whereas LH kidneys exhibited significant increases in both glomerular filtration rate and natriuresis. Finally, AH23848 significantly decreased the renin release by kidneys of the three strains.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Experimental investigations on the antidotal treatment of nifedipine overdosage.

Rats anesthetized with pentobarbital and ventilated artificially were infused with 0.5 mg/kg X min nifedipine. They exhibited a sharp decline of blood pressure, heart rate, cardiac output and peripheral resistance and died after 62.3 +/- 5.3 min of infusion. In the ECG, sinus bradycardia followed by AV-dissociation and an escape rhythm originating from the AV-node or the bundle of His occurred. The survival time of nifedipine-infused rats increased by 100% and more upon additional infusion with calcium chloride, calcium gluconate, isoproterenol or dopamine and by 50% after prenalterol. Epinephrine, norepinephrine, angiotensin amide and the plasma expander polygeline were ineffective in this respect. All drugs prolonging the survival time elevated the cardiac output. Ca++ and dopamine also increased the blood pressure whereas isoproterenol accelerated the escape rhythm. Similar cardiovascular changes as in rats occurred in rabbits infused with 0.2 mg/kg X min nifedipine, the survival time without antidotal treatment amounting to 46.3 +/- 7.9 min. Calcium chloride more than doubled the survival time in rabbits, too, but isoproterenol and dopamine proved to be ineffective. Excess calcium did not overcome the inhibitory effects of nifedipine on pacemaker activity, atrioventricular conduction and peripheral resistance. The antidotal efficacy of calcium appears to be attributable to a reversal of the negative inotropic activity of nifedipine. In conclusion, Ca++ seems to be the drug of choice for the antidotal treatment of nifedipine intoxication.

Animals↗