Filtration-assisted exchange transfusion using alpha alpha Hb, an erythrocyte substitute

1991 ◽  
Vol 70 (4) ◽  
pp. 1639-1644 ◽  
Author(s):  
J. R. Hess ◽  
C. E. Wade ◽  
R. M. Winslow
Keyword(s):  
Hollow Fiber ◽  
Blood Viscosity ◽  
Continuous Flow ◽  
Volume Expansion ◽  
Exchange Transfusion ◽  
Volume Loss ◽  
Intravascular Volume ◽  
Hemodynamic Stability ◽  
The Face ◽  
Hb Concentration

A method for improving the efficiency of exchange transfusion to evaluate hemoglobin- (Hb) based erythrocyte substitutes is described. The method uses a continuous-flow hollow-fiber plasma separation filter to remove the erythrocytes while returning 75% of the plasma. The removed volume was replaced with a 14-g/dl solution of human Hb cross-linked between the alpha-chains with bis(3,5-dibromosalicyl)fumarate (alpha alpha Hb). Filtration of 2.76 blood vol in anesthetized swine resulted in a 95% reduction of hematocrit and produced a plasma Hb concentration of 7.63 g/dl. Hyperoncotic Hb solutions cause volume expansion, which reduces the efficiency of exchange but provides hemodynamic stability in the face of decreasing blood viscosity and subsequent intravascular volume loss with Hb redistribution. Filtration-assisted exchange transfusion is rapid, conserves valuable modified Hb, and ensures continuous adequate oxygen delivery.

Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation

1990 ◽  
Vol 73 (3) ◽  
pp. 368-374 ◽  
Author(s):  
Gerrit J. Bouma ◽  
J. Paul Muizelaar
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Output ◽  
Cerebral Blood Flow ◽  
Blood Viscosity ◽  
Volume Expansion ◽  
Physiological Mechanism ◽  
Brain Regions ◽  
Intravascular Volume ◽  
Wide Range

✓ Intravascular volume expansion has been successfully employed to promote blood flow in ischemic brain regions. This effect has been attributed to both decreased blood viscosity and increased cardiac output resulting from volume expansion. The physiological mechanism by which changes in cardiac output would affect cerebral blood flow (CBF), independent of blood pressure variations, is unclear, but impaired cerebral autoregulation is believed to play a role. In order to evaluate the relationship between cardiac output and CBF when autoregulation is either intact or defective, 135 simultaneous measurements of cardiac output (thermodilution method) and CBF (by the 133Xe inhalation or intravenous injection method) were performed in 35 severely head-injured patients. In 81 instances, these measurements were performed after manipulation of blood pressure with phenylephrine or Arfonad (trimethaphan camsylate), or manipulation of blood viscosity with mannitol. Autoregulation was found to be intact in 55 of these cases and defective in 26. A wide range of changes in cardiac output occurred after administration of each drug. No correlation existed between the changes in cardiac output and the changes in CBF, regardless of the status of blood pressure autoregulation. A significant (40%) increase in CBF was found after administration of mannitol when autoregulation was defective. These data support the hypothesis that, within broad limits, CBF is not related to cardiac output, even when autoregulation is impaired. Thus, the effect of intravascular volume expansion appears to be mediated by decreased blood viscosity rather than cardiac output augmentation.

Intravascular Volume Expansion as Therapeutic Approach to the Underfill State of Preeclampsia

1989 ◽  
pp. 111-113
Author(s):  
P. Stratta ◽  
C. Canavese ◽  
L. Gurioli ◽  
M. Porcu ◽  
M. Dogliani ◽  
...  
Keyword(s):  
Therapeutic Approach ◽  
Volume Expansion ◽  
Intravascular Volume

Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 337???43 ◽  
Author(s):  
N F Kassell ◽  
S J Peerless ◽  
Q J Durward ◽  
D W Beck ◽  
C G Drake ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Volume Expansion ◽  
Intravascular Volume

Jaundice

2021 ◽  
pp. 257-288
Keyword(s):  
Volume Expansion ◽  
Exchange Transfusion ◽  
Neurological Dysfunction ◽  
Total Serum ◽  
Case Scenario ◽  
Test Volume ◽  
Transcutaneous Bilirubin ◽  
Treatment Thresholds ◽  
Scoring Tool ◽  
Severe Hyperbilirubinemia

The jaundice chapter illustrates how to stabilize newborns with hyperbilirubinemia—a common condition—and avoid their developing severe hyperbilirubinemia. Prevention is accomplished by transcutaneous bilirubin testing, total serum bilirubintests, and the use of nomograms to evaluate risk for hyperbilirubinemia and direct appropriate care. Specific risk factors for jaundice and hyperbilirubinemia, treatment thresholds for phototherapy treatment or exchange transfusion, and a bilirubin-induced neurological dysfunction scoring tool for assessing severity in acute bilirubin encephalopathy cases are included. Related procedures, such as the direct antiglobulin test, volume expansion, and intravenous immunoglobulin administration are described. Focal skills, such as plotting and interpreting the nomograms, are applied in the case scenario.

Use of the Extracranial-Intracranial Arterial Bypass in the Management of Refractory Vasospasm: A Case Report

Neurosurgery ◽  
1985 ◽  
Vol 17 (3) ◽  
pp. 474-479 ◽  
Author(s):  
Jacob Rosenstein ◽  
Hunt H. Batjer ◽  
Duke S. Samson
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Arterial Hypertension ◽  
Volume Expansion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Collateral Flow ◽  
Intravascular Volume ◽  
Arterial Vasospasm

Abstract Cerebral arterial vasospasm after aneurysmal subarachnoid hemorrhage remains one of the major causes of morbidity and mortality in patients surviving the initial hemorrhage. Once established, no known method has been shown to reverse this process in humans. Although intravascular volume expansion and induced arterial hypertension have been shown to be effective in the reversal of neurological deficits secondary to vasospasm, a large proportion of patients remain refractory to these methods. We report one such case successfully managed by the estalishment of an extracranial-intracranial anastomosis in an attempt to augment collateral flow.

Halos and Asymmetric Triangles: Designing the Eyelids with Volume Using Fillers and/or Fat

2018 ◽  
Vol 34 (02) ◽  
pp. 173-177
Author(s):  
Samuel Lam
Keyword(s):  
Fat Grafting ◽  
Volume Loss ◽  
Lower Face ◽  
New Models ◽  
The Face ◽  
Principal Method

AbstractPeriorbital aging is mainly a product of volume loss, which can be addressed with fillers and/or fat grafting. This stands in contrast to the lower face where a lifting procedure can be the principal method to improve moderate-to-significant aging. New models to explain these concepts of periorbital rejuvenation to both the surgeon and the prospective patient are outlined herein, namely, three facial halos (around the eyes, around the perimeter of the face, and around the mouth) and asymmetric triangles around the eyes. Specific techniques for fillers and fat grafting are also covered separately in detail in this article.

scholarly journals HA Filler Injection and Skin Quality–Literature Minireview and Injection Techniques

2020 ◽  
Vol 53 (02) ◽  
pp. 198-206
Author(s):  
Jui-Hui Peng ◽  
Peter Hsien-Li Peng
Keyword(s):  
Volume Loss ◽  
Quality Change ◽  
Facial Aging ◽  
Filler Injection ◽  
Quality Literature ◽  
The Face ◽  
Filler Injections ◽  
Injection Techniques ◽  
Injection Protocol ◽  
Skin Quality

AbstractAging of the face produces many changes in the structure and integrity of the skin and other anatomical aspects, the three major signs of which are volume loss, sagginess, and skin quality change. Through surgical or nonsurgical procedures, it is possible to slow or even reverse these mechanisms through artificial means, including thread lifting, radiofrequency, or filler injection. Filler injections are particularly popular in recent years, owing to their convenience, efficacy, and long-lasting results. In this minireview, the author outlines the basic mechanisms behind facial aging, discusses current literature on each aspect of facial aging, and offers injection protocol recommendations based on past literature and clinical experience.

Response to Rapid Water, Sodium and Dextran Loads of Intact Ringer's-Infused Unanesthetized Dogs

1958 ◽  
Vol 195 (2) ◽  
pp. 362-368 ◽  
Author(s):  
J. Stamler ◽  
L. Dreifus ◽  
L. N. Katz ◽  
I. J. Lichton
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Injection Site ◽  
Complex Variable ◽  
Volume Expansion ◽  
Venous Pressure ◽  
Intravascular Volume ◽  
Oncotic Pressure ◽  
Variable Response ◽  
Ringer’S Solution

In Ringer's-infused unanesthetized intact dogs, rapid intravascular injections (200 cc) caused an enhanced diuresis, regardless of injection site. Injection of Ringer's solution induced an immediate and sustained increment of H2O, Na and total solute diuresis. These changes were correlated with increases in venous pressure, reductions in hematocrit and in plasma oncotic pressure (except in the dextran experiments). They were not correlated with patterns of GFR, RPF, plasma Na and total solute, filtered electrolyte load, blood pressure of heart rate. Injection of 3.75% glucose-in-water induced a sustained increment of H2O diuresis, with only a transient or no increase in Na and total solute diuresis. Injection of 6% dextran-in-water induced a complex, variable response, with sustained enhanced diuresis of H2O, Na and total solutes in some experiments. It is suggested that two adjustments, volume and composition homeostatic correction, are operative, the former immediate, the latter delayed (possibly hormonal). It is further suggested that the former is a response to circulating intravascular volume expansion, possibly ‘sensed’ by stretch and/or pressoreceptors.

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