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  • 1
    ISSN: 1433-8491
    Keywords: Vasospasm ; Subarachnoid hemorrhage ; Arachidonic acid metabolism ; Arachidonsäuremetabolismus ; Prostacyclin ; Thromboxan A2 ; Subarachnoidalblutung ; Vasospasmus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der gestbrten Homöostase zwischen den Arachidonsauremetaboliten Prostacylin (PGI2) and Thromboxan A2 (TXA2) kommt nach experimentellen Untersuchungen eine wesentliche Bedeutung fur die Entstehung cerebraler Vasospasmen nach Subarachnoidalblutung zu. Um die klinische Relevanz dieser Hypothese zu überprüfen wurden bei 12 Patienten nach Aneurysmaruptur die prä- und postoperativen Serum- and Liquorspiegel von PGI2 and TXA2 untersucht. Die Konzentrationen beider Substanzen wurden als Funktion ihrer stabilen Abbauprodukte 6-Keto-PGF1α(PGI2) und Thromboxan B2 (TXA2) mittels eines hochspezifischen Radioimmunoassays bestimmt. Die Serumspiegel beider Metaboliten waren bei der Hälfte der Patienten prä- und postoperativ deutlich erhöht, zeigten aber insgesamt einen unspezifischen Verlauf ohne erkennbare Beziehung zum klinischen Krankheitsablauf. Demgegenuber fand sich eine eindeutige Korrelation zwischen der Höhe der initialen Liquorkonzentration von TXB2 and dent Ausmaß der comutertomographisch nachweisbaren Subarachnoidalblutung. Einem sekundaren postoperativen Thromboxan B2 Anstieg im Liquor kommt dariiberhinaus offensichtlich eine Bedeutung in der Entwicklung cerebraler Gefaf3spasmen mit nachfolgender klinischer Verschlechterung zu. Die 6-Keto-PGF1α-Spiegel waren prä- und postoperativ nur leicht bis mäßig erhöht und wurden von den gesteigerten TXB2-Konzentrationen signifikant übertroffen. Es wird geschlossen, daß dem prä- und post-operativen Monitoring von Arachidonsäuremetaboliten eine mögliche Bedeutung in der Überwachung von Patienten nach Subarachnoidalblutung zukommt, insbesondere im Hinblick auf eine frühzeitige Erkennung insipienter cerebraler Vasospasmen.
    Notes: Summary Imbalance between the two arachidonic acid metabolites, prostacyclin (PGI2) and thromboxane A2 (TXA2), is thought to be at least in part responsible for the development of cerebral vasospasm following aneurysm rupture. In 12 patients with subarachnoid hemorrhage the pre- and postoperative serum and CSF levels of PGI2 and TXA2 were measured as a function of their stable hydrolysis products, 6-Keto-PGF1α (PGI2) and thromboxane B2 (TXA2), with a highly specific radioimmunoassay. Serum levels of both metabolites were elevated in half of the patients, but no correlation to the clinical course could be found. However, TXB2 concentration in the CSF was significantly increased preoperatively with close correlation to the amount of intracisternal blood, as detected by CT scan. Furthermore, it could be demonstrated that the post-operative course of the TXB2 concentrations in the CSF reflects the clinical course in such a way that a characterstic secondary rise of TXB2, concentration postoperatively is closely related to the occurrence of cerebral vasospasm and clinical deterioration. The conclusion is drawn that measurement of arachidonic acid metabolites in the CSF may provide important information concerning the pathophysiological events following subarachnoid hemorrhage, especially with regard to incipient cerebral vasospasm.
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  • 2
    ISSN: 0942-0940
    Keywords: Cerebral vasospasm ; experimental subarachnoid haemorrhage ; basilar artery ; ultrastructural studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Recent experimental studies have shown, that the endothelium of cerebral vessels undergoes significant changes after subarachnoid haemorrhage which may lead to biochemical changes at the endothelial surface with disturbance of the delicate homeostasis of vasodilating and vasoconstricting mechanisms which are thought to be responsible for preservation of the tones of the cerebral vasculature. Ultrastructural studies incorporating different forms of microscopic observations of the endothelium after SAH representing a prerequisite for further investigations on the pathogenesis of cerebral vasospasm are scarce. This experimental study was performed in order to investigate and define more precisely the pathomorphological changes at the endothelial surface of the basilar artery of dogs after experimental SAH. Two separate injections of autologous blood into the cisterna magna within 72 hours resulted in extensive angiographic narrowing of the diameter of the basilar artery of all animals. Histological studies of the basilar artery including light microscopic, transmission electron microscopic, scanning electron microscopic and freeze cracking microscopic examinations demonstrated severe pathomorphological changes at the endothelial surface. These consisted mainly of infolding and corrugation of the endothelium, disorientation and desquamation of endothelial cells as well as of vacuolation and ingrowth of fibrous tissue between the endothelial and muscular layer. No pathomorphological changes could be observed in the muscular layer. As the described post-haemorrhagic ultrastructural changes of the endothelium of cerebral vessels in spasm are likely to represent the morphological basis of the delayed form of cerebral vasospasm future research on its pathogenesis should primarily focus on the structural and biochemical changes taking place at the endothelial surface of the cerebral vasculature after SAH.
    Type of Medium: Electronic Resource
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