Atypical electrolyte kinetics during an emergency dialysis session in a patient with Leriche syndrome.

A hemodialysis patient suffered from circulation failure due to a low output syndrome caused by a hyperkalemia (9.9 micromol/l) with typical ecg signs. An emergency hemodialysis was started. After 2 h ecg signs of hypokalemia (2.1 micromol/l) were detectable. Hemodialysis was stopped. 2 h later, serum potassium rose to 6.2 micromol/l. An obturation of the aorta and the inferior caval vein with perfusion through collateral vessels of the lower body side was obvious, resulting into a faster electrolyte correction in the upper and a delayed correction in the lower body side with a rebound in the upper compartment. Dialysis time and dialysate potassium (4.0 micromol/l) were increased. Furthermore no potassium problems occurred.

[Changes in the blood surface-active properties during the correction of hemorheological disorders in patients with occlusive lesions of the abdominal aorta and arteries of the extremities]. / Izmenenie poverkhnostno-aktivnykh svoistv krovi pri korrektsii gemoreologicheskikh narushenii u bol'nykh s okkliuziruiushchimi porazheniiami briushnoi aorty i arterii konechnostei.

Significant hemorheologic disorders were demonstrated in 68 patients with Leriche's syndrome and 50 patients with Raynaud's disease, as compared to 42 normal controls. Plasma and erythrocyte membrane surface tension (ST) was measured, using a surface balance, in 29 patients with Leriche's syndrome, 26 patients with Raynaud's disease and 24 normal subjects. In both kinds of vascular abnormality, major parameters of erythrocyte membrane adsorption film ST remained unchanged, yet the areas of their adsorption hysteresis loops increased. In patients with Raynaud's disease, the minimal plasma ST increased, while the stability index and the hysteresis loop area declined. In patients with Leriche's syndrome, those were unchanged. The control of hemorheologic disorders by moderate hemodilution using albumin, rheopolyglucin, antiaggregants and fibrinolytic agents resulted in the normalization of plasma ST parameters in Raynaud's disease, and a greater hysteresis loop area in both kinds of vascular disease. Major parameters of erythrocyte membrane adsorption film ST remained unchanged, while the area of their hysteresis loops decreased.

[The efficacy of ticlid in treating intermittent claudication in atherosclerotic stenosis of the arteries of the lower extremities]. / Effektivnost' tiklida pri lechenii peremezhaiushcheisia khromoty u bol'nykh s ateroskleroticheskim stenozirovaniem arterii nizhnikh konechnostei.

Serious affections of hemostasis were found in hemostatic examinations involving 67 intermittent claudication patients resistant to longterm vasodilative drugs. A 4-6-month course of tiklid (500 mg daily) induced a significant fall in platelet aggregation and an increase in the blood fibrinolytic activity, decreased foot chilliness, pain while walking. 73% of the patients could cover longer distances without pain complaints.

Extracellular-purine metabolism in blood vessels (part I). Extracellular-purine level in blood of patients with abdominal aortic aneurysm.

Adenosine and adenosine derivatives are the main regulators of purinoceptors (P1 and P2) mediated hemostasis and blood pressure. Since impaired hemostasis and high blood pressure lead to atherosclerosis and to the development of aneurysm, in this study we tested and compared the concentration of extracellular purines (e-purines) in the blood in of patients having abdominal aortic aneurysm with that from healthy volunteers. Whereas adenine nucleosides and nucleotides level in human blood plasma was analysed using reverse phase high performance liquid chromatography (HPLC), cholesterol concentration was estimated by an enzymatic assay. We did not find any correlation between e-purines concentration and the age of healthy volunteers. Furthermore, the sum level of e-purines (ATP, ADP, AMP, adenosine, and inosine) in the control group did not exceed 70 microM, while it was nearly two-fold higher in the blood of patients having abdominal aortic aneurysm, (123 microM). In a special case of people with Leriche Syndrome, a disease characterized by deep atherosclerotic changes, the e-purines level had further increased. Additionally, we also report typical atherosclerotic changes in the aorta using histological assays as well as total cholesterol rise. The significant rise in cholesterol concentration in the blood of the patients with abdominal aortas aneurysm, compared with the control groups, was not unique since 23% of the healthy people also exceeded the normal level of cholesterol. Therefore, our results strongly indicate that the estimation of e-purines concentration in the blood may serve as another indicator of atherosclerosis and warrant further consideration as a futuristic diagnostic tool.

Extracellular purine metabolism in blood vessels (Part II): Activity of ecto-enzymes in blood vessels of patients with abdominal aortic aneurysm.

Both platelet aggregation and high blood pressure are associated with development of atherosclerosis. Among other factors that modulate platelet aggregation and blood pressure, extracellular purines (e-purines) influence these processes via purinoceptors P1 and P2 for which they are natural ligands. We hypothesized that ecto-enzymes such as nucleoside triphosphate diphosphohydrolases (NTPDases), adenylate kinase, 5'-nucleotidase, and adenosine deaminase that regulate the level of e-purines may be involved in the development of atherosclerosis. The enzymatic assays were performed either on the fragments of human abdominal aortas obtained after death or on abdominal aneurysm samples collected during surgery. The substrates and products such as adenine nucleosides and nucleotides were analyzed using reverse phase high-performance liquid chromatography (HPLC) method. Here, we estimated and demonstrated the activities of these ecto-enzymes in the patients with atherosclerosis or atherosclerosis-like diseases such as abdominal aneurysm, myocardial infarction, or Leriche syndrome (LS) with worse thrombosis of extremities. In particular, we noticed reduction in activity of NTPDase1(app), NTPDase2(app), ecto-adenylate kinase( app), and ecto-adenosine deaminase(app); however, ecto-5'-nucleotidase(app) that hydrolyzed e-adenosine monophosphate (e-AMP) into e-adenosine did not show any significant changes. This led us to suggest that alteration of the activity of examined ecto-enzymes is responsible for the development of atherosclerosis or atherosclerosis-like diseases.

[Acute Leriche's syndrome in a patient undergoing coronary artery bypass grafting with extracorporeal circulation]. / Akutes Leriche-Syndrom bei Aorto-Coronarer-Bypass-Operation mit Extrakorporaler Zirculation.

We are reporting a case of an acute thromboembolic obstruction of the aortic bifurcation in a 66-year-old patient undergoing coronary artery bypass grafting with extracorporeal circulation. After declamping of the aorta, the arterial pressure measured in the femoral artery suddenly dropped, whereas the pressure measured in the aortic cannula and in both radial arteries stayed normal. Transoesophageal echocardiography was performed to exclude an acute aortic dissection. While the patient always had a constant sinus rhythm, an angiography following the end of surgery, showed a complete obstruction of the abdominal aorta. Subsequent embolectomy through bifemoral arteriotomies was performed and a histologically fresh embolus (6,5 g in weight) was extracted. Neither the pre- and intraoperative echocardiography, nor the preoperative ventriculography showed signs of an intracardiac thrombus. Insufficient anticoagulation and a lack of inhibitor potential were almost excluded. Considering the histological findings, we assumed that the embolus was formed intraoperatively. Without further complications the patient left our department on the 8th postoperative day.