Isolated reduction of haematocrit does not compromise in vitro blood coagulation.

Low haematocrit values are generally well tolerated in terms of oxygen transport but a low haematocrit might interfere with blood coagulation. We thus sampled 60 ml of blood in 30 healthy volunteers. The blood was centrifuged for 30 min at 2000 g and separated into plasma, which contained the platelet fraction, and packed red blood cells. The blood was subsequently reconstituted by combining the entire plasma fraction with a mixture of packed red blood cells, 0.9% saline, so that the final haematocrit was either 40, 30, 20, or 10%. Blood coagulation was assessed by computerized Thrombelastograph analysis. Data were compared using repeated measures analysis of variance and post-hoc paired t-tests with Bonferroni correction. Decreasing the haematocrit from 40 to 10% resulted in a shortening of reaction time (r) and coagulation time (k), and an increase in angle alpha, maximum amplitude (MA) and clot strength (G) (all P<0.02). This pattern represents acceleration of blood coagulation with low haematocrit values. The isolated reduction in haematocrit, therefore, does not compromise in vitro blood coagulation.

Dose-finding study with bopindolol in arterial hypertension.

Bopindolol is a new beta blocker with a long duration of action which exerts antihypertensive effects at very low dosage. The aim of this study was to define the optimal dosage of bopindolol in outpatients with mild to moderate hypertension and to compare it to atenolol in term of tolerance and efficacy, both administered once daily. Forty physicians (the Swiss Cooperative Study Group) participated as investigators in this study. They had recruited 257 hypertensive patients whose diastolic blood pressure was between 95 and 105 mm Hg (age 19-69 years; mean +/- SD, 49.3/49.9 +/- 10/11) in a multicentric double-blind study. After a 2-week placebo period patients were randomized to one of four treatment groups: bopindolol 1 mg, bopindolol 2 mg, atenolol 50 mg, and atenolol 100 mg. After 4 weeks of active treatment, if diastolic blood pressure was above 90 mm Hg, the dosage was doubled. A detailed evaluation was performed after 8 weeks of active treatment. If necessary, a diuretic was then added and patients were followed for the next 10 months in an open study. Compared to placebo, blood pressure was significantly lowered in the four treatment groups. At 4 weeks, 8 weeks, and 12 months, there was no significant difference between the blood pressures of the treatment groups. Bopindolol was as well tolerated as atenolol. Bradycardia was more common with atenolol. During this 12-month study, bopindolol 1 mg per day appeared to be an effective and a safe antihypertensive treatment. With the exception of the lower incidence of bradycardia, bopindolol is indistinguishable from atenolol in terms of side effects pattern and frequency.

Minimal intermittent heparinization during hemodialysis.

Minimal dose heparinization inhibiting clotting factor IXa, Xa, XIa, as monitored by the activated partial thromboplastin time, was compared with conventional intermittent, continuous and regional heparinization during hemodialysis treatment. Blood loss in coil dialyzers was the same. Heparin dosage was reduced markedly. Protamine sulfate and infusion equipment were not required. No bleeding problems were encountered in high-risk patients.

[Spontaneous hemobilia in the differential diagnosis of upper gastrointestinal hemorrhages]. / Die spontane Hämobilie in der Differential-diagnose der oberen Gastrointestinalblutung

Hemobilia, biliary tree hemorrhage, is characterized by melana and/or haematemesis, biliary colic and clinical jaundice. The rare cause of gastrointestinal bleeding probably accounts for quite a large percentage of gastrointestinal hemorrhages of undetermined source. In the evaluation of gastrointestinal bleeding the hepato-biliary system is seldom examined unless trauma has occurred. However, 10-15% of cases with hemobilia are non-traumatic. Three cases are presented illustrating three different causes of non-traumatic hemobilia observed during the last three years. The diagnostic problems and the therapeutic possibilities are described.