Platelet function and anesthetics in cardiac surgery: an in vitro and ex vivo study.

UNLABELLED: We studied the effects of the anesthetics commonly used in cardiac surgery on platelet function. Fentanyl, droperidol, succinylcholine, pancuronium, thiopental, and diazepam at therapeutic concentrations were tested for their in vitro effects on the expression of platelet membrane glycoproteins Ib and IIbIIIa (GpIb, GpIIb-IIIa) and of P-selectin in anticoagulated whole blood by flow cytometry. The expression of P-selectin was determined under basal conditions, after the incubation of blood with adenosine diphosphate (ADP) 10 micromol/L, and the stable prostaglandin endoperoxide analog U46619 1 micromol/L. No drug affected the expression of P-selectin in unstimulated and ADP- or U46619-stimulated platelets, with the exception of thiopental, which markedly decreased the U46619-induced expression of P-selectin. Thiopental concentration-dependently inhibited U46619-induced and ADP-induced platelet aggregation, with effects on U46619-induced aggregation at therapeutic concentrations. To assess ex vivo effects, the same platelet markers were also assessed in blood obtained from 10 patients undergoing elective coronary surgery. Compared with basal values, platelet response to U46619 was significantly reduced just after the administration of anesthetic drugs, and the effect persisted for 48 h after surgery. Our study suggests that, at therapeutic concentrations, thiopental inhibits U46619-induced platelet activation both in vitro and ex vivo. The mechanisms responsible of this effect, together with its clinical significance, require further investigation. IMPLICATIONS: Thiopental inhibited prostaglandin-induced platelet activation at therapeutic concentrations both in vitro and ex vivo in cardiac surgical patients whereas adenosine diphosphate-induced activation was affected only at supratherapeutic drug concentrations. Thus, administration of sodium thiopental may contribute to the in vivo impairment of platelet function in patients undergoing elective cardiac surgery.

[Fetal hemolytic disease in a patient immunized by six antibodies: diagnosis and treatment]. / Malattia emolitica fetale in una paziente immunizzata da sei anticorpi: diagnosi e trattamento.

A case of severe haemolytic disease of the fetus due to six rare alloantibodies is described. In a pregnant women at 23 weeks gestation after the finding of a positive indirect Coombs test maternal antibodies have been precisely identified and titrated: anti-I: 1/23, anti-c: 1/64, anti-S: 1/16, anti-Fya: 1/128, anti-M: 1/64, anti-Jka: 1/32000. Fetal blood group, free and red blood cell adherent antibodies have been investigated on fetal blood samples obtained by means of cord centesis. A compatible donor has been found. Severe fetal anemia has been corrected by ultrasound guided intrauterine transfusions (one abdominal and two intravascular transfusions) with positive outcome of the pregnancy.

[New trends in the treatment of trophic sequelae post-phlebitic syndrome]. / Nuovi orientamenti nel trattamento delle sequele trofiche della sindrome post-flebitica.

Authors analyses most recent concepts on pathogenesis of trophic changes in post-phlebitic syndrome: particularly they consider the role of extravascular fibrin deposition, in patients with depressed plasmatic fibrinolytic activity. In this patients, according to recent reports, it seems useful a fibrinolytic therapy to improve trophic conditions of the post-phlebitic limb, particularly in respect to dermatoliposclerosis. Authors refer their experience on a double blind study with stanozolol an anabolizing steroid with fibrinolytic activity: in all treated patients good clinical results were obtained; however no enhancement of plasmatic fibrinolytic activity was demonstrated.

[Interaction between anti-aggregating and anticoagulant agents. A double blind study on the concomitant administration of nicergoline and acenocoumarols]. / Wechselwirkung zwischen Aggregationshemmern und Antikoagulantien. Eine Doppelblindstudie bei gleichzeitiger Applikation von Nicergolin und Acenocoumarol.

A double blind study was carried out comparing 10-methoxy-1,6-dimethyl-ergoline-8 beta-methanol-(5-bromonicotinate) (nicergoline, Sermion) and placebo in 60 thromboembolic patients on long-term controlled acenocoumarol treatment. Aim of the trial was to assess the hypothesis of an interaction on both the coagulatory parameters and the clinical findings. No significant variations of the acenocoumarol daily dose were required in nicergoline treated group and no interaction was demonstrated in coagulatory parameters. Prothrombin activity and thrombo-test evaluated fortnightly were not statistically different in nicergoline and placebo groups while the platelet antiaggregating activity of nicergoline was confirmed after a three months' treatment. Bleeding time was unaffected. Minor differences in clinical findings were observed in the two groups.

[Nicergoline and platelet aggregation. A review of experimental and clinical studies (author's transl)]. / Nicergolin und Thrombozytenaggregation. Ein Uberblick über experimentelle und klinische Studien.

10-Methoxy-1,6-dimethyl-ergoline-8 beta-methanol-(5-bromonicotinate) (nicergoline, Sermion), an ergoline derivative in clinical use for syndromes related to cerebral and peripheral vascular insufficiency, displays a platelet antiaggregating effect which may be important for its therapeutic effect. This paper reviews the present experimental and clinical evidence relating to the platelet antiaggregating activity of nicergoline and its mechanisms of action is discussed in detail. Since the platelet antiaggregating effect of nicergoline is mainly related to its alpha-adrenolytic activity, the importance of catecholamines for the behaviour of both human platelets and endothelium as well as their interference with the prostaglandin/prostacycline system is also discussed.

[Physiopathology of the inner ear and therapy of presbyacusis (author's transl)]. / Physiopathologie des Innenohres und Therapie der Perzeptionstaubheit.

Many experimental investigations have shown that labyrinthine fluids play a basic role in the physiology of the inner ear. Modifications of perilymphatic fluids have been demonstrated in perceptive deafness (otosclerosis, Ménière's disease, tympanolabyrinthosclerosis). Vasoactive agents fail to markedly affect the exchange between labyrinthine fluids, so that perceptive syndromes are generally regarded as unresponsive to treatment. Several studies have shown the effectiveness of 10-methoxy-1,6-diemthyl-ergoline-8 beta-methanol-(5-bromonicotinate) (nicergoline, Sermion) in various conditions of the inner ear. In this investigation, 30 patients with presbyacusis were treated with 30 mg/day p.o. for 30 days. Speech audiometric curves were improved in 4 out of 18 cases of physiological presbyacusis and in 6 out of 12 cases of accelerated presbyacusis. These results are very interesting, since few effective therapies are available to treat these conditions.