RESUMEN
Chemical and UV light-based pathogen reduction technologies are currently in use for human platelet concentrates (PCs) to enhance safety from transfusion-transmitted infections. Relative to UV light, 405 nm violet-blue light in the visible spectrum is known to be less harmful. Hence, in this report for the first time, we have assessed the global hemostasis activity of PCs stored in plasma and the activities of six plasma coagulation factors (CFs) as a measure of in vitro hemostatic activity following exposure to the microbicidal 405 nm light. Apheresis PC samples collected from each screened human donor (n = 22) were used for testing of PCs and platelet poor plasma (PPP). Both PCs and PPPs were treated for 5 h with 405 nm light to achieve a previously established microbicidal light dose of 270 J/cm2. Activated partial thromboplastin time and prothrombin time-based potency assays using a coagulation analyzer and hemostatic capacity via Thromboelastography were analyzed. Thromboelastography analysis of the light-treated PCs and plasma present in the PCs showed little difference between the treated and untreated samples. Further, plasma present in the PCs during the light treatment demonstrated a better stability in potency assays for several coagulation factors compared to the plasma alone prepared from PCs first and subjected to the light treatment separately. Overall, PCs stored in plasma treated with 405 nm violet-blue light retain activity for hemostasis.
Asunto(s)
Plaquetas , Hemostasis , Rayos Ultravioleta , Humanos , Plaquetas/efectos de la radiación , Hemostasis/efectos de la radiación , Tromboelastografía , Luz , Tiempo de Tromboplastina Parcial , Tiempo de Protrombina , Coagulación Sanguínea/efectos de la radiación , Coagulación Sanguínea/efectos de los fármacos , Factores de Coagulación Sanguínea/metabolismoRESUMEN
BACKGROUND: We previously reported a flow path-ultraviolet C (UVC) irradiation system for platelet concentrates (PCs) with platelet additive solution (PAS) to minimize contamination by bacteria. Here, we investigated functionalities of irradiated platelets (PLTs) in in vitro thrombus formation and in vivo hemostasis. STUDY DESIGN AND METHODS: PAS-PCs were irradiated with flash UVC using the flow path system. Their variables (PLT count, mean platelet volume, pH, glucose, lactate, glycoprotein [GP] Ib, and activated integrin αIIbß3) were evaluated. Static adhesion to collagen or fibrinogen was analyzed using fluorescent microscopy. Thrombus formation under flow conditions was assessed using a collagen-coated bead column. Adenosine diphosphate (ADP)-induced Akt phosphorylation was determined by western blot. In vivo hemostasis and circulatory survival of PLTs were assessed with a rabbit bleeding model. RESULTS: All variables, except for GPIb expression, were slightly, but significantly, impaired after flash UVC irradiation throughout the 6-day storage period. No difference was observed in static adhesion to either collagen or fibrinogen between irradiated and nonirradiated PAS-PCs. In vitro thrombus formation of flash UVC-irradiated PAS-PCs was significantly greater than that of nonirradiated PAS-PCs. ADP-induced Akt phosphorylation was enhanced in irradiated PAS-PCs. In vivo hemostatic efficacy was comparable between the groups on Day 1. The efficacy declined in nonirradiated PAS-PCs on Day 5, while it was retained in flash UVC-irradiated PAS-PCs. Circulatory survival of PLTs was lower in irradiated PAS-PCs. CONCLUSIONS: PAS-PCs irradiated with UVC from xenon flash have favorable properties to achieve hemostasis compared with nonirradiated PAS-PCs.
Asunto(s)
Plaquetas/metabolismo , Hemostasis/fisiología , Trombosis/metabolismo , Rayos Ultravioleta/efectos adversos , Xenón/efectos adversos , Adenosina Difosfato/metabolismo , Animales , Bacterias/efectos de la radiación , Plaquetas/efectos de la radiación , Colágeno/metabolismo , Colágeno/efectos de la radiación , Fibrinógeno/metabolismo , Fibrinógeno/efectos de la radiación , Hemostasis/efectos de la radiación , Humanos , Masculino , Volúmen Plaquetario Medio/estadística & datos numéricos , Microscopía Fluorescente/métodos , Modelos Animales , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/metabolismo , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/efectos de la radiación , Complejo GPIb-IX de Glicoproteína Plaquetaria/metabolismo , Complejo GPIb-IX de Glicoproteína Plaquetaria/efectos de la radiación , Plaquetoferesis/métodos , Conejos , Xenón/efectos de la radiaciónRESUMEN
Laser therapy has been widely used to treat port-wine stain (PWS) and other cutaneous vascular lesions via selective photothermolysis. High incident laser fluence is always prohibited in clinic to prevent the thermal damage in normal skin tissue, leading to insufficient energy deposition on the target blood vessel and incomplete clearance of PWS lesion. In this study, repeated multipulse laser (RMPL) irradiation was proposed to induce acute thermal damage to target blood vessels with low incident fluence (40 J/cm2 for 1064-nm Nd:YAG laser). The feasibility of the method was investigated using animal models. Repeated multipulse irradiation cycles with 10-min intervals were performed in RMPL. A hamster dorsal skin chamber model with a visualization system was constructed to investigate the instant generation of thermal coagulum and relevant hemostasis by thrombus formation during and after irradiation under 1064 nm Nd:YAG single multipulse laser (SMPL) and RMPL irradiation. The diameter of the target blood vessel and the size of thermal coagula were measured before and after laser irradiation. The reflectance spectra of the dorsal skin were measured by a reflectance spectrometer during RMPL. Stasis thermal coagula that clogged the vessel lumen were generated during SMPL irradiation with low incident fluence. However, there was no acute thermal damage of blood vessels. Reflectance spectra measurement showed that the generation of thermal coagula and subsequent thrombus formation increases blood absorption by more than 10% within the first 10 min after laser irradiation. Acute vessel thermal damage could be induced in the target blood vessel by RMPL with low incident fluence of 40 J/cm2. Compared with our previous SMPL study, nearly 30% reduction in incident laser fluence was achieved by RMPL. Low fluence RMPL may be a promising approach to improve the therapeutic outcome for patients with cutaneous vascular lesions by improving energy deposition on the target blood vessel.
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Vasos Sanguíneos/efectos de la radiación , Hemostasis/efectos de la radiación , Láseres de Estado Sólido/uso terapéutico , Piel/irrigación sanguínea , Piel/efectos de la radiación , Temperatura , Animales , Cricetinae , Femenino , Humanos , Ratones , Mancha Vino de Oporto/cirugíaRESUMEN
Bleeding can cause significant morbidity in patients with upper gastrointestinal malignancies. Palliative radiotherapy can palliate bleeding effectively across numerous cancer sites such as the lung and rectum. The data available regarding the role in bleeding from upper gastrointestinal cancers are limited to a single meta-analysis, a phase 2 trial, eleven retrospective cohorts and two case reports, with the majority focusing on gastric cancer. From the data available radiotherapy appears to be a well-tolerated, effective haemostatic agent that should be considered in all patients with bleeding from an upper gastrointestinal malignancy. Questions remain regarding the radiobiology of haemostasis and the optimum fractionation schedule. There is no convincing evidence that protracted higher dose regimens provide additional benefit. Commonly used fractionation schedules use 1, 5 or 10 fractions. Short fractionation schedules have been used in patients with deteriorating performance status.
Asunto(s)
Neoplasias Esofágicas/complicaciones , Hemorragia/etiología , Hemorragia/radioterapia , Neoplasias Gástricas/complicaciones , Fraccionamiento de la Dosis de Radiación , Neoplasias Esofágicas/patología , Hemostasis/efectos de la radiación , Humanos , Estudios Retrospectivos , Neoplasias Gástricas/patologíaRESUMEN
BACKGROUND: Extending the platelet (PLT) shelf life and enhancing product safety may be achieved by combining cryopreservation and pathogen inactivation (PI). Although studied individually, limited investigations into combining these treatments has been performed. The aim of this study was to investigate the effect of PI treating PLTs before cryopreservation on in vitro PLT quality and function. STUDY DESIGN AND METHODS: ABO-matched buffy coat-derived PLTs in PLT additive solution (SSP+; Macopharma) were pooled and split to form matched pairs (n = 8). One unit remained untreated and the other was treated with the THERAFLEX UV-Platelets System (UVC; Macopharma). For cryopreservation, 5% to 6% dimethyl sulfoxide was added to the PLTs, and they were frozen at -80°C. After being thawed, untreated cryopreserved PLTs (CPPs) and UVC-treated CPPs (UVC-CPPs) were resuspended in plasma. In vitro quality was assessed immediately after thawing and after 24 hours of room temperature storage. RESULTS: UVC-CPPs had lower in vitro recovery compared to CPPs. By flow cytometry, PLTs demonstrated a similar abundance of GPIX (CD42a), GPIIb (CD41a), and GPIbα (CD42b-HIP1), while the activation of GPIIb/IIIa (PAC-1) was increased in UVC-CPPs compared to CPPs. UVC-CPPs demonstrated greater phosphatidylserine exposure (annexin V) and microparticle shedding but similar P-selectin (CD62P) abundance compared to CPPs. UVC-CPPs displayed similar functionality to CPPs when assessed using aggregometry, thromboelastography, and thrombin generation. CONCLUSIONS: This study demonstrates the feasibility of cryopreserving UVC-PI-treated PLT products. UVC-PI treatment may increase the susceptibility of PLTs to damage caused during cryopreservation, but this is more pronounced during postthaw storage at room temperature.
Asunto(s)
Plaquetas , Conservación de la Sangre/métodos , Criopreservación , Rayos Ultravioleta , Inactivación de Virus/efectos de la radiación , Crioprotectores/farmacología , Citocinas/metabolismo , Dimetilsulfóxido/farmacología , Hemostasis/efectos de los fármacos , Hemostasis/fisiología , Hemostasis/efectos de la radiación , Humanos , Activación Plaquetaria/efectos de los fármacos , Activación Plaquetaria/fisiología , Activación Plaquetaria/efectos de la radiación , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/metabolismo , Complejo GPIb-IX de Glicoproteína Plaquetaria/metabolismo , Glicoproteína IIb de Membrana Plaquetaria/metabolismo , Control de CalidadRESUMEN
Background Hypercoagulability is a leading factor in diabetes and cardiovascular disease. Retinal vessel responses to flickering light are an important tool for assessing ocular function. We hypothesised a significant relationship between systemic markers of haemostasis and retinal vessel function. Methods Intra-ocular pressure and retinal microcirculation function were measured in 116 patients with diabetes and/or cardiovascular disease using unstimulated and stimulated arterial and venous retinal vessel responses to flickering light. Haemostasis was evaluated by platelet microparticles, soluble P selectin, and five functional markers of fibrin clot formation and lysis, hyperglycaemia by HbA1c. Results Intra-ocular pressure was linked to the rates of clot formation (p = 0.006) and clot dissolution (p = 0.013) whilst central retinal vein equivalent was linked to HbA1c (p = 0.017). In the first of three flickering light cycles only, arterial baseline diameter fluctuation was linked to the lag time to clot formation (p = 0.017), whilst maximum venous dilatation was linked to HbA1c (p = 0.001) and clot density (p = 0.011). HbA1c was linked to venous dilatation amplitude (p = 0.003). There were no significant links between any ocular index and any platelet index. Conclusions In addition to glycaemia, several haemostasis measures, but no measures of platelet activity, are linked to ocular and retinal blood vessel indices in patients with diabetes and/or cardiovascular disease. These associations may have pathophysiological significance.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Complicaciones de la Diabetes/sangre , Diabetes Mellitus/sangre , Vasos Retinianos/metabolismo , Trombofilia/sangre , Anciano , Biomarcadores/sangre , Plaquetas/patología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/patología , Complicaciones de la Diabetes/complicaciones , Complicaciones de la Diabetes/patología , Diabetes Mellitus/patología , Ojo/irrigación sanguínea , Ojo/patología , Femenino , Hemoglobina Glucada/metabolismo , Hemostasis/efectos de la radiación , Humanos , Presión Intraocular/efectos de la radiación , Luz , Masculino , Persona de Mediana Edad , Retina/patología , Retina/efectos de la radiación , Vasos Retinianos/patología , Trombofilia/patología , Trombosis/patologíaRESUMEN
Laser treatment on a large size of prostate gland often encounters significant bleeding that can prolong the entire procedure and cause urinary complications. The current study investigates the feasibility of dual-wavelength (532 and 980 nm) application to achieve rapid hemostasis for 532-nm laser prostatectomy. Porcine kidney and bleeding phantom models were tested to quantify the degree of the irreversible tissue coagulation and to estimate the time for the complete hemostasis, respectively. The ex vivo kidney testing verifies that the dual-wavelength created up to 40% deeper and 25% wider coagulation regions than a single wavelength does. The bleeding phantom testing demonstrates that due to the enhanced thermal effects, the simultaneous irradiation yields the complete photocoagulation (~11 seconds) whereas 532 or 980 nm hardly stops bleeders. Numerical simulations validate that the combined optical-thermal characteristics of both the wavelengths account for the augmented thermal coagulation. The dual-wavelength-assisted coagulation can be a feasible treatment to entail the rapid hemostasis and to facilitate the laser prostatectomy in an effective manner.
Asunto(s)
Hemostasis/efectos de la radiación , Terapia por Láser , Hiperplasia Prostática/fisiopatología , Hiperplasia Prostática/terapia , Temperatura , Animales , Coagulación Sanguínea/efectos de la radiación , Riñón/fisiología , Riñón/efectos de la radiación , Masculino , PorcinosRESUMEN
BACKGROUND: Plasma thawed and stored at 1 to 6° C for up to 5 days (thawed plasma [TP]) provides rapid availability in emergencies and reduces plasma waste, but it carries risks of coagulation factor loss or activation, bacterial outgrowth, and viral contamination. We characterized changes in amotosalen/ultraviolet A (UVA) light pathogen-reduced, fresh-frozen plasma (FFP) and plasma frozen within 24 hours (PF24) with post-thaw storage. STUDY DESIGN AND METHODS: Amotosalen/UVA light-treated FFP and PF24 were thawed after approximately 3 to more than 12 months of frozen storage and held at 1 to 6° C for 5 days. Global assessments of coagulation and hemostatic, antithrombotic, and activation markers indicative of function were assessed. RESULTS: Day 5, thawed amotosalen/UVA light-treated FFP and PF24 contained levels of Factors II, V, VIII, IX, X, von Willebrand factor ristocetin cofactor (vWF:RCo), fibrinogen, antithrombin III (ATIII), protein C, and protein S similar to the levels measured in Day 5 TP, as described in the Circular of Information. Thrombin generation was robust on Day 5 (amotosalen/UVA: FFP = 1866 ± 402 nM/minute; PF24 = 1800 ± 277 nM/minute). Most factor activities on Day 5, including von Willebrand factor-cleaving protease (ADAMTS-13), were more than 90% of Day 0 values, except for known labile Factors V and VIII and protein S. All units contained greater than 0.4 IU/mL protein S and α2 plasmin inhibitor on Day 5. Global functional indices, including thrombin-antithrombin complexes, nonactivated thromboplastin time, and thrombin-generation peak height, did not indicate activation of the coagulation cascade, although isolated units showed raised levels of Factor VIIa and Complement 3a. CONCLUSION: Amotosalen/UVA light-treated FFP and PF24 demonstrated retention of procoagulant and antithrombotic activity after 5 days post-thaw storage at 1 to 6° C.
Asunto(s)
Conservación de la Sangre , Criopreservación , Desinfección/métodos , Furocumarinas/farmacología , Hemostasis , Rayos Ultravioleta , Femenino , Hemostasis/efectos de los fármacos , Hemostasis/efectos de la radiación , Humanos , Masculino , Factores de TiempoRESUMEN
La ecografía se ha convertido en una herramienta sumamente útil en la valoración de masas y lesiones en la cabeza y el cuello. Permite determinar la localización anatómica, así como las características del tejido que compone las lesiones en estudio. De esta manera conseguimos orientar el diagnóstico diferencial hacia lesiones inflamatorias, neoplásicas, congénitas, traumáticas o vasculares. Sí es cierto que para establecer la extensión completa de determinadas lesiones hay que apoyarse en el escáner o la resonancia. Los procedimientos intervencionistas, gracias a la guía ecográfica principalmente, han visto crecer sus indicaciones, por lo que actualmente pueden realizarse biopsias, drenajes, infiltraciones, tratamientos mediante esclerosis y ablaciones de tumores (AU)
Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation (AU)
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Humanos , Masculino , Femenino , Traumatismos del Cuello/cirugía , Traumatismos del Cuello , Cuello/cirugía , Cuello , Cara/cirugía , Cara , Diagnóstico Diferencial , Ablación por Catéter/métodos , Biopsia/métodos , Esclerosis/terapia , Analgesia , Biopsia Guiada por Imagen/instrumentación , Biopsia Guiada por Imagen/métodos , Hemostasis/efectos de la radiación , Hemostasis QuirúrgicaRESUMEN
The aim of this research is to determine the characteristics of endothelial factors and the hemostatic system conditions with malignant neoplasms patients, which were exposed to ionizing radiation. Total number of examined people is 223, 153 of them are patients with gastrointestinal tract oncopathology. The article presents the results of the analysis of numerical indicators of endothelial condition and platelet hemostasis of patients, who had cancer. They lived in the regions of Kazakhstan, subjected to contamination of radionuclides as a result of nuclear weapons tests, which took place in this region from 1949 to 1989. These results then were compared to cancer patients and healthy individuals with no radiation risk. The study revealed the presence of higher levels of endothelial dysfunction and following trigger of the hemostatic system in patients with malignant tumors of the gastrointestinal tract. In particular, the defined high degree of endothelial dysfunction include endothelium- dependent vasodilation, content desquamated endothelial cells in peripheral blood and von Willebrand factor. These indicators have a clear correlation with the degree of disorder of studied parameters of the hemostasis, which can cause the development of thrombotic complications.
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Endotelio Vascular/patología , Neoplasias Gastrointestinales/patología , Radiación Ionizante , Anciano , Estudios de Casos y Controles , Endotelio Vascular/efectos de la radiación , Femenino , Estudios de Seguimiento , Neoplasias Gastrointestinales/irrigación sanguínea , Neoplasias Gastrointestinales/metabolismo , Neoplasias Gastrointestinales/radioterapia , Hemostasis/efectos de la radiación , Humanos , Kazajstán , Masculino , Persona de Mediana Edad , Pronóstico , Factor de von Willebrand/metabolismoRESUMEN
OBJECTIVES: Microbubble-enhanced therapeutic ultrasound (MEUS) can block the blood flow in the organs. The aim of this study was to evaluate the hemostatic effect of microbubble-enhanced pulsed, low-intensity ultrasound in a New Zealand White rabbit model of avulsion trauma of the liver. The therapeutic ultrasound (TUS) transducer was operated with the frequency of 1.2 MHz and an acoustic pressure of 3.4 MPa. Microbubble-(MB) enhanced ultrasound (MEUS) (nâ=â6) was delivered to the distal part of the liver where the avulsion was created. Livers were treated by TUS only (nâ=â4) or MB only (nâ=â4) which served as controls. Bleeding rates were measured and contrast enhanced ultrasound (CEUS) was performed to assess the hemostatic effect, and liver hemoperfusion before and after treatment. Generally, bleeding rates decreased more than 10-fold after the treatment with MEUS compared with those of the control group (P<0.05). CEUS showed significant declines in perfusion. The peak intensity value and the area under the curve also decreased after insonation compared with those of the control group (P<0.05). Histological examination showed cloudy and swollen hepatocytes, dilated hepatic sinusoids, perisinusoidal spaces with erythrocyte accumulation in small blood vessels, obvious hemorrhage around portal areas and scattered necrosis in liver tissues within the insonation area of MEUS Group. In addition, necrosis was found in liver tissue 48 h after insonation. We conclude that MEUS might provide an effective hemostatic therapy for serious organ trauma such as liver avulsion injury.
Asunto(s)
Hemostasis , Hígado/lesiones , Hígado/patología , Microburbujas , Ultrasonido , Animales , Medios de Contraste , Hemostasis/efectos de la radiación , Masculino , ConejosRESUMEN
PURPOSE: The studies reported here were performed as part of a program in space radiation biology in which proton radiation like that present in solar particle events, as well as conventional gamma radiation, were being evaluated in terms of the ability to affect hemostasis. METHODS AND MATERIALS: Ferrets were exposed to 0 to 2 Gy of whole-body proton or gamma radiation and monitored for 30 days. Blood was analyzed for blood cell counts, platelet clumping, thromboelastometry, and fibrin clot formation. RESULTS: The lethal dose of radiation to 50% of the population (LD50) of the ferrets was established at â¼ 1.5 Gy, with 100% mortality at 2 Gy. Hypocoagulability was present as early as day 7 postirradiation, with animals unable to generate a stable clot and exhibiting signs of platelet aggregation, thrombocytopenia, and fibrin clots in blood vessels of organs. Platelet counts were at normal levels during the early time points postirradiation when coagulopathies were present and becoming progressively more severe; platelet counts were greatly reduced at the time of the white blood cell nadir of 13 days. CONCLUSIONS: Data presented here provide evidence that death at the LD50 in ferrets is most likely due to disseminated intravascular coagulation (DIC). These data question the current hypothesis that death at relatively low doses of radiation is due solely to the cell-killing effects of hematopoietic cells. The recognition that radiation-induced DIC is the most likely mechanism of death in ferrets raises the question of whether DIC is a contributing mechanism to radiation-induced death at relatively low doses in large mammals.
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Radiación Cósmica/efectos adversos , Coagulación Intravascular Diseminada/mortalidad , Traumatismos Experimentales por Radiación/mortalidad , Animales , Recuento de Células Sanguíneas , Coagulación Sanguínea , Plaquetas/efectos de la radiación , Causas de Muerte , Muerte Celular , Coagulación Intravascular Diseminada/etiología , Femenino , Hurones , Rayos gamma/efectos adversos , Hemostasis/efectos de la radiación , Dosificación Letal Mediana , Protones/efectos adversos , Dosis de Radiación , Traumatismos Experimentales por Radiación/complicaciones , Actividad Solar , Vuelo Espacial , TromboelastografíaAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Ablación por Catéter/instrumentación , Ablación por Catéter/métodos , Ablación por Catéter , Tratamiento de Radiofrecuencia Pulsada/instrumentación , Tratamiento de Radiofrecuencia Pulsada/métodos , Tratamiento de Radiofrecuencia Pulsada , Hemorragia/complicaciones , Hemorragia/terapia , Ablación por Catéter/normas , Tratamiento de Radiofrecuencia Pulsada/estadística & datos numéricos , Tratamiento de Radiofrecuencia Pulsada/normas , Tratamiento de Radiofrecuencia Pulsada/tendencias , Proctitis/complicaciones , Proctitis/cirugía , Proctitis , Hemostasis/efectos de la radiación , Hemostasis EndoscópicaRESUMEN
BACKGROUND: This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. METHODS: Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. RESULTS: Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37-93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5-45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 ( n = 39), 1 ( n = 12), 2 ( n = 6), 3 ( n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. CONCLUSIONS: Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients.
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Hemorragia/radioterapia , Hemostasis/efectos de la radiación , Neoplasias/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia/métodos , Femenino , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/mortalidad , Cuidados Paliativos/métodos , Estudios Retrospectivos , Enfermo Terminal , Resultado del TratamientoRESUMEN
We studied parameters of hemostatic homeostasis in isolated and combined exposure to low-intensity γ-irradiation in a low dose, hyperbaric oxygenation, and antiorthostatic hypokinesia. Complex effects of the above stress factors are accompanied by a pronounced hypercoagulable shift with signs of thrombinemia against the background of depressed fibrinolysis, which indicates the risk of intravascular blood coagulation.
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Hemostasis/efectos de la radiación , Estrés Oxidativo/efectos de la radiación , Animales , Fibrinólisis/efectos de la radiación , Rayos gamma , Oxigenoterapia Hiperbárica , Masculino , Ratas , Ratas WistarRESUMEN
No disponible
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Humanos , Femenino , Persona de Mediana Edad , Aneurisma/diagnóstico , Neoplasias de la Parótida/diagnóstico , Neoplasias de la Parótida/cirugía , Adenoma Pleomórfico/diagnóstico , Adenoma Pleomórfico/cirugía , Adenolinfoma/complicaciones , Adenolinfoma/diagnóstico , Adenolinfoma/cirugía , Aneurisma/cirugía , Aneurisma , Neoplasias de la Parótida , Adenoma Pleomórfico/fisiopatología , Adenoma Pleomórfico , Hemostasis/fisiología , Hemostasis/efectos de la radiaciónRESUMEN
OBJECTIVES: The purpose of this study was to compare the effectiveness of an antibacterial and hemostatic agent to diode laser irradiation in the healing of mechanically exposed porcine pulps. MATERIALS AND METHOD: The experiment required three adult swine (Sus scrofa domestica, Yorkshire) with 36 teeth prepared with occlusal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the pulps were exposed using high speed instrumentation with rubber dam isolation and a disinfected field. Following instrumentation the coronal pulpal tissue was amputated and immediately treated with ferric sulfate and chlorhexidine semi-gel (12), diluted Buckley' formocresol solution (12) for 5 minutes or laser irradiation with a diode laser (12). After treatment, hemostasis was obtained and a ZOE base applied to the treated pulps (36). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at 4 weeks (28 days). Following fixation, the samples were de-mineralized, sectioned, stained and histologically graded with a scale of 0-4. RESULTS: The treatment groups were statistically different with the Laser Treated Group demonstrating the least inflammation. CONCLUSION: Pulpotomy treatment with the KaVo Gentle Ray Diode Laser demonstrated significantly less inflammation than the other two pulpal therapy modalities. The ferric sulfate and chlorhexidine mixture demonstrated the greatest inflammation as histologically graded. Also, the histological sections of pulpotomized swine teeth treated with the ferric sulfate and chlorhexidine mixture presented with black pigmented areas in the pulp and surrounding tissue. The formocresol group (clinical standard) and the diode laser group did not present with the black precipitate.
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Antiinfecciosos/uso terapéutico , Exposición de la Pulpa Dental/terapia , Pulpa Dental/efectos de la radiación , Hemostáticos/uso terapéutico , Terapia por Láser/métodos , Láseres de Semiconductores/uso terapéutico , Animales , Materiales Biocompatibles/uso terapéutico , Clorhexidina/uso terapéutico , Pulpa Dental/efectos de los fármacos , Recubrimiento de la Pulpa Dental/métodos , Exposición de la Pulpa Dental/tratamiento farmacológico , Exposición de la Pulpa Dental/radioterapia , Combinación de Medicamentos , Compuestos Férricos/uso terapéutico , Formocresoles/uso terapéutico , Cementos de Ionómero Vítreo/uso terapéutico , Hemostasis/efectos de los fármacos , Hemostasis/efectos de la radiación , Pigmentación/efectos de los fármacos , Pulpotomía/métodos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Porcinos , Cemento de Óxido de Zinc-Eugenol/uso terapéuticoRESUMEN
Normal haemostasis relies on the complex interactions of the coagulation cascade, platelets, and the endothelium. In this review, the roles of each of these elements are described as well as common causes for their derangement. Haemostasis may be manipulated via pharmacological means and in recent years there has been a significant increase in the number of agents available for influencing haemostatic mechanisms. It is essential that radiologists are aware of these mechanisms and drugs if they are to perform image-guided procedures safely. In addition to describing the relevant pathways and drugs, practical tips are provided.
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Coagulación Sanguínea , Endotelio Vascular , Hemostasis , Anticoagulantes/farmacología , Coagulación Sanguínea/efectos de los fármacos , Coagulación Sanguínea/fisiología , Coagulación Sanguínea/efectos de la radiación , Trastornos de la Coagulación Sanguínea/etiología , Plaquetas/fisiología , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiología , Endotelio Vascular/efectos de la radiación , Hemostasis/efectos de los fármacos , Hemostasis/fisiología , Hemostasis/efectos de la radiación , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto , Tiempo de Protrombina , Radiología Intervencionista/métodos , Radiología Intervencionista/normas , Trombocitopenia/etiologíaRESUMEN
To investigate whether markers of haemostasis activity increased during preoperative radiotherapy and whether postoperative marker levels were increased in irradiated rectal cancer patients when compared with nonirradiated rectal and colon cancer patients. In 45 rectal cancer patients, we measured plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex, and D-dimer during radiotherapy. Postoperative levels of F1 + 2, thrombin-antithrombin complex, and D-dimer in irradiated patients were compared with postoperative levels in 123 nonirradiated colon and rectal cancer patients. A small oscillation in F1 + 2 levels was observed during radiotherapy among long-term low-intensity radiotherapy recipients. Postoperative levels of F1 + 2 and D-dimer were significantly higher among patients who received short-term high-intensity radiotherapy. This study provided no evidence for activation of the haemostatic system during preoperative radiotherapy in patients with rectal cancer. Some evidence was provided for increased postoperative haemostatic activity among rectal cancer patients who received short-term high-intensity radiotherapy, when compared with patients who received long-term low-intensity radiotherapy, and nonirradiated patients.
Asunto(s)
Proteínas Sanguíneas/análisis , Neoplasias del Colon/sangre , Neoplasias del Colon/radioterapia , Hemostasis/efectos de la radiación , Neoplasias del Recto/sangre , Neoplasias del Recto/radioterapia , Femenino , Humanos , Masculino , Cuidados Preoperatorios , Estudios ProspectivosRESUMEN
BACKGROUND: The aim of this study was to investigate the effect of gamma irradiation with 30 Gy on the coagulation system in leukoreduced fresh-frozen plasma (FFP). STUDY DESIGN AND METHODS: In 74 FFP units that had been stored for 352 +/- 103 days below -30 degrees C, the following variables were determined in parallel in an irradiated and not irradiated half: prothrombin time (PT); activated partial thromboplastin time (APTT); thrombin time; antithrombin III; protein C; protein S; von Willebrand factor antigen; ristocetin cofactor; plasminogen-alpha(2)-antiplasmin; the coagulation factors fibrinogen, factor (F)II, FV, FVII, VIII, F IX, FX, FXI, FXII, FXIII, and activated factor XII (FXIIa); D-dimer; fibrin monomer; thrombin-antithrombin complex; prothrombin fragment 1 + 2 (F1+2); plasmin-alpha(2)-antiplasmin complexes (PAPs); and platelet factor 4. The FVII activity ratio was assayed to quantify activation of FVII. RESULTS: Irradiation with 30 Gy resulted in a reduction of APTT (35.0 +/- 4.1 sec vs. 34.4 +/- 4.1 sec; p = 0.00000006) and PT (89.8 +/- 8.2% vs. 90.7 +/- 8.0%; p = 0.002) and a significant increase of the activities of the coagulation factors FII, FV, FVII, F IX, FX, and FXII. FVIII activity decreased from 118 +/- 31 to 116 +/- 32 percent (p = 0.02). Activation of the coagulation system was shown by an increase in the FVII activity ratio (1.19 +/- 0.29 vs. 1.31 +/- 0.34; p = 0.0000001), FXIIa (0.81 +/- 0.50 ng/mL vs. 0.90 +/- 0.51 ng/mL; p = 0.006), and F1+2 (1.19 +/- 0.20 nmol/L vs. 1.24 +/- 0.20 nmol/L; p = 0.000005) after irradiation with 30 Gy, whereas an increase of PAP (16.2 +/- 11.5 ng/mL vs. 20.2 +/- 12.0 ng/mL; p = 0.0004) demonstrated activation of the fibrinolytic system. No negative influence of irradiation with 30 Gy on inhibitors of coagulation was observed. CONCLUSION: Gamma irradiation of leukoreduced FFPs with 30 Gy results in a significant but very weak activation of the coagulation and fibrinolytic system in FFPs.