Tissue Factor, Tissue Factor Pathway Inhibitor and Vascular Endothelial Growth Factor-A in Carotid Atherosclerotic Plaques

OBJECTIVE

To determine the concentration of tissue factor (TF), tissue factor pathway inhibitor (TFPI) and vascular endothelial growth factor A (VEGF-A) in carotid plaques.

MATERIALS AND METHODS

Thirty-eight consecutive patients (20 symptomatic, 18 asymptomatic) undergoing carotid endarterectomy were enrolled into the current study. The concentration of TF, TFPI and VEGF-A in carotid plaque homogenates and blood plasma was measured using enzyme immunoassay.

RESULTS

The concentration of TF in carotid plaque homogenates was 60 fold higher than in blood plasma. There were no statistically significant differences between the concentration of TF, TFPI and VEGF-A in symptomatic and asymptomatic plaques. Carotid plaques of diabetic patients contained an increased level of TF and VEGF-A ( p = 0.002, p = 0.005). The plaque concentration of VEGF-A was elevated among older patients ( p = 0.02). Carotid plaques of non-smokers contained an increased level of TFPI ( p = 0.03). The concentration of TF, TFPI and VEGF-A in carotid plaques correlated positively with plasma level of these factors ( R = 0.86; p < 0.0001; R = 0.91; p < 0.0001; R = 0.80; p = 0.001, respectively). A highly positive correlation between concentration of VEGF-A and TF, TFPI in carotid plaques was also observed ( R = 0.75; p < 0.001; R = 0.62; p < 0.001, respectively).

CONCLUSIONS

TF, TFPI and VEGF-A concentrations do not differ in atheroma removed from symptomatic and asymptomatic patients but are higher in diabetic patients. There is a highly positive correlation between the level of VEGF-A and TF, TFPI in carotid plaques.

Selected Haemostatic Factors in Carotid Bifurcation Plaques of Patients Undergoing Carotid Endarterectomy

OBJECTIVE

To determine the concentration of selected haemostatic factors (HFs): thrombin-antithrombin complexes (TAT), antithrombin (AT), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1) and D-dimers in carotid bifurcation plaques and to compare plaque composition in different subgroups of patients (mainly those with symptomatic and asymptomatic carotid stenosis).

MATERIALS AND METHODS

Thirty-eight consecutive patients (20 symptomatic, 18 asymptomatic) undergoing carotid endarterectomy were enrolled in the study. The concentration of selected HFs in carotid plaques was measured using mainly enzyme immunoassay (ELISA). Simultaneously, the concentration of HFs in plasma was also obtained.

RESULTS

Symptomatic plaques contained significantly more TAT complexes (p=0.03). AT was found only in nine out of 38 carotid plaques and was present mainly in symptomatic carotid plaques (n=8/9)(p<0.006). No significant differences were found between symptomatic and asymptomatic carotid plaques with respect to t-PA, PAI-1 and D-dimers concentration. There was an increased concentration of TAT (p<0.001), t-PA (p<0.02) and D-dimers (p<0.02) in carotid plaques of diabetic patients. Patients with coexisting intermittent claudication had elevated levels of D-dimers in carotid plaques (p<0.02). The only positive correlation was demonstrated between the concentration of AT in plasma and carotid plaques (R=0.76; p=0.02).

CONCLUSIONS

All the evaluated HFs are the components of a carotid plaque. Symptomatic patients have increased concentration of TAT complexes in a carotid plaque. The symptomatic carotid plaque contains AT more frequently, which correlates positively with AT plasma levels. The most marked changes in the carotid plaque haemostatic composition (expressed by elevated levels of TAT, t-PA and D-dimers) have diabetic patients.

[Endothelin in the plasma and cerebrospinal fluid of patients after head injury]

Endothelin (ET) is identified as a potent vasoconstrictor peptide. It can cause a cerebral vasospam after subarachnoid hemorrhage. Its long-lasting vasoconstricting activity has been well documented. The role of ET in response to head injury is not clear. ET can participate in astrocyte activation and oxidative stress after trauma. The aim of this presentation was to investigate ET in the plasma and cerebrospinal fluid of patients after head injury and estimation of relation between the ET csf level and clinical condition of the patients and also relation of ET csf level and changes in the CT-scan and usefulness of ET as independent prognostic factor. We examined 30 patients at Day 1 after trauma (28 male, 2 female, aged 19-34 y, mean 30, 4, GCS ranged 8-15). CT-examination showed post-traumatic changes in 19 cases (11 with brain edema only, 8 with brain contusion). We measured ET by immunoenzymatic method using standard kits (Biomedica). The ET plasma level reached 1.12 +/- 0.63 fmol/ml (in the control group--0.44 +/- 0.19 fmol/ml) and c ET csf level 1.03 +/- 0.49 (in the control group--0.07 +/- 0.09 fmol/ml). W confirmed the correlation between the ET level and patients consciousness (by GCS) (p < 0.01). The ET csf level was highest in the patients with brain contusion in CT-scan (p < 0.02). Using multivariate analyses, we showed that ET can be used as a prognostic factor of results of treatment (p < 0.02).

CONCLUSIONS

The ET level is elevated in the plasma of patients after head injury. ET is also present and strongly elevated in the cerebrospinal fluid of the same patients. The ET level in cerebrospinal fluid is associated with clinical condition of patients and elevated in cases with brain edema and structural brain damage. The ET level in cerebrospinal fluid is related to post-traumatic changes of the brain such as oedema and structural damage present in the CT-scan. ET can be used as a prognostic factor of results of treatment.

[Von Willebrand factor in patients with subarachnoid hemorrhage]

Von Willebrand factor (vWF) plays an important role in the coagulation system. It affects platelet aggregation in the place of vessel endothelium damage. The importance of vWF in cerebrovascular disease is not clear. The aim of this presentation was to evaluate the vWF level in the plasma and cerebrospinal fluid of patients after subarachnoid hemorrhage including cases with cerebral vasospasm and cerebral infarct. We investigated 66 patients (38 persons graded I-III H&H and 28 persons graded IV H&H). The control group consists of 8 subjects. VWF was measured by ELISA method using standard kit Asserachrom (Boehringer). The vWF level in the plasma reached 288.81 +/- 99.66% (in the control group, 98.84 +/- 14.53%) without significant differences regarding clinical condition of patients. In the cerebrospinal fluid the vWF level was significantly different in I-III H&H patients and in IV H&H patients (1.21 +/- 0.52% and 9.18 +/- 7.58%, respectively, p < 0.001) and in the control group (0.13 +/- 0.33%). Our data indicate that there is correlation (Pearson, p < 0.01) between the level of vWF and neurological condition (GCS) of patients. There is also correlation (p < 0.01) between the level of VWF and the presence of clinical disorders (cerebral vasospasm, delayed neurological deficit (DIND) and cerebral infarct). Based on multivariate analysis, we confirmed that vWF is an independent prognostic factor of cerebral vasospasm (p < 0.01) and ischemic complications (p < 0.02).

CONCLUSIONS

vWF is elevated in the plasma of patients after subarachnoid hemorrhage in early stage of the disease. VWF is present in the cerebrospinal fluid of patients with SAH and its level is higher in patients with poor neurological condition. The VWF elevation in csf is correlated with clinical condition of patients and also the presence of cerebral vasospasm and cerebral infarct. VWF can be used as an independent prognostic factor of cerebral vasospasm and ischemic complications.

[Levels of soluble thrombomodulin in blood of patients with lung cancer]

Thrombomodulin /TM/ is a surface glycoprotein involved in the regulation of blood coagulation and fibrinolysis. TM has been reported to be expressed in variety of tumors. The purpose of this study was to evaluate the concentration of soluble TM in patients with planoepithelial lung cancer. Study group consisted of 33 patients aged 51 years in IB /15/ and IIIB /18/ stage of cancer and 20 adults as control. Concentration of TM in plasma with ELISA method was performed. Mean level of TM in lung cancer patients was 4.98 +/- 0.94 ng/ml and was similar to control--4.60 +/- 0.88 ng/ml. No significant differences were found between patients with IB and IIIB stage of cancer.

Effects of retinal detachment surgery on protein C antigen level

BACKGROUND

The purpose of the study was to evaluate perioperative changes in protein C antigen (PC Ag) in patients undergoing retinal detachment surgery under general or local anesthesia.

MATERIAL AND METHODS

Prospective study of 39 patients: 27 patients, 14 male, 13 female, age from 15 to 78 (mean: 50.8, SD=18.6), undergoing retinal detachment surgery (encirclement with scleral buckling) performed under general anesthesia (group A), and 12 patients, 5 male, 7 female, age from 25 to 78 (mean: 52.9, SD=19.2), operated under local anesthesia (group B). Patients with venous or arterial disease or other factors which could affect the evaluated parameters were excluded from the study. Blood samples were collected from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after the completion of the operation but before the termination of anesthesia, and after surgery (on the 1st and 4th day). The PC Ag concentration was measured in the citrate plasma of the patients studied, utilizing a commercially available enzyme-linked immunosorbent assay.

RESULTS

In both groups, the pattern of changes in perioperative PC antigen was similar. A trend towards moderately lower intraoperative levels of PC Ag could be observed. In both groups, PC Ag concentration increased on the first postoperative day, but a significant change was noted only in general anesthesia group.

CONCLUSIONS

Retinal detachment surgery evokes a less than statistically significant decrease in intraoperative PC antigen levels in systemic circulation, and these changes are not affected by the type of anesthesia. An increase in PC Ag was observed on the 1st postoperative day, but this was statistically significant only in the general anesthesia group.

Von Willebrand factor in subretinal fluid

PURPOSE

To measure the vWF antigen concentration (vWF Ag) in subretinal fluid (SRF) and blood plasma.

METHODS

Prospective study of 30 patients, aged from 15 to 78 years (mean 52.7 years), undergoing retinal detachment surgery. Excluded were patients with venous or arterial disease or any other factors that could affect the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. VWF in plasma and in SRF and its relation to patients' age, sex, the duration and extent of retinal detachment, number of retinal tears, and cryopexy application were evaluated.

RESULTS

The median level of vWFAg in 30 samples of SRF was 6.3%. The median level of vWF Ag in blood plasma was 70.34%. The levels of vWF Ag in SRF were significantly lower than in blood plasma (p<0.00001). We found no correlation between the vWF Ag concentration in plasma or in SRF and sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and the use of cryopexy.

CONCLUSIONS

Determination of vWF Ag showed that this factor in SRF is unrelated to patients', sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and use of cryopexy.

[Serine protease inhibitors in plasma of patients with ulcerative colitis]

Serine protease inhibitors (serpins) are the important factors regulating hemostasis and inflammatory mediators activity. The aim of this study was to determine relationships between plasma serine protease inhibitors activities and the course of ulcerative colitis (uc).

PATIENTS AND METHODS

42 patients with uc, 21 in active and 21 in inactive disease phase, and 26 healthy persons (control group) were studied. In all investigated persons activities of alpha 1-proteinase inhibitor (alpha 1-PI), alpha 2-macroglobulin (alpha 2-M), alpha 2-antiplasmin (alpha 2-AP), antithrombin III (ATIII) and plasminogen activator inhibitor type 1 (PAI-1) were determined.

RESULTS

Patients with uc had higher level of alpha 1-PI than control group. In patients with active uc lower alpha 2-M activity was found than in patients with us remission. Alpha 2-M activity below 100% had 58% sensitivity and 71% specificity, and predictive value (odds ratio = 6.25) for histologic appearance of active uc. The correlation between alpha 2-M value and uc activity and time of symptoms duration before the study start was found. Patients with inflammatory process beyond sigmoid had lower alpha 2-AP activity than patients with less extended inflammatory process.

CONCLUSIONS

Inflammatory process in large bowel changed the level of plasma serine protease inhibitors activities, what was a result of acute phase reaction (alpha 1-PI) and inhibitors consumption in inflammatory processes (alpha 2-M, alpha 2-AP).

[Thrombin-antithrombin III complexes in plasma and subretinal fluid in patients with perforated retinal detachment]

PURPOSE

To study the thrombin generation in plasma and subretinal fluid (SRF) by evaluation of thrombin-antithrombin III complexes (TAT) and antithrombin III (AT III) activity in patients with rhegmatogenous retinal detachment.

MATERIAL AND METHODS

Prospective study of 54 patients subjected to retinal detachment surgery. Patients with vein or arterial disease and with other factors which could change evaluated parameters were excluded. Subretinal fluid samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein to natrium citrate solution (9:1) immediately after induction of anaesthesia but before surgery. TAT concentration in citrate plasma and in SRF was assessed in 22 patients aged from 15 to 78 years (mean: 49.5 years). AT III activity in blood plasma and SRF was measured in 32 patients aged from 20 to 77 years (mean: 53.8). The correlations between the TAT concentration in SRF were evaluated as well as AT III activity in SRF, and age, sex of patients, the duration and extent of retinal detachment, number of retinal tears and the cryopexy application.

RESULTS

The median value of TAT concentration in citrate plasma was 9.08 micrograms/l (interquartile range: 59.3 micrograms/l). In 20 cases out of 22 eyes studied TAT levels were higher than 60 micrograms/l. The mean level of AT III activity in blood plasma was 105% (SD: 24.0%). The median level of AT III activity in 32 samples of SRF was 16.5% (interquartile range: 14.5%). The levels of AT III in SRF were significantly lower than AT III values in blood plasma (p < 0.001). We found no correlation between the levels of AT III activity in plasma and AT III activity in SRF nor between TAT concentration, AT III activity in SRF and sex, age of patients, the degree of myopia, the duration and extent of retinal detachment, nor retinal degenerative changes and cryopexy application.

CONCLUSION

Our study revealed high TAT concentration and AT III activity and in all studied samples of SRF disclosing the signs of thrombin generation in SRF.

Thrombomodulin--endothelial thrombin receptor in blood of patients with unstable angina pectoris

BACKGROUND

Thrombomodulin (TM) a membrane receptor for thrombin generated in blood in vivo, is present on the surface of vascular endothelium cells. The aim of our work was the determination of thrombomodulin in the blood of patients with unstable angina pectoris.

MATERIAL AND METHODS

In the study took part 87 patients with unstable angina pectoris (40 women and 47 men) at age 41-79 years. Thrombomodulin was determined in citrated blood plasma with the use of enzyme immunoassay ELISA with the diagnostic kit manufactured by American Diagnostica.

RESULTS

Statistically significant higher thrombomodulin concentration (sTM) was found in the patients when compared with the values recorded in control group. Elevated sTM levels depended on patients age and they were significantly higher in patients over 50 years old. There were no statistically significant differences with respect to patients gender and coexistent risk factors such as arterial hypertension, diabetes or smoking, but significantly higher sTM concentration was observed in patients with high serum cholesterol level.

CONCLUSION

Elevated sTM concentrations result from the damage to vascular endothelium cells by the atheromatous process manifested in unstable angina pectoris.

Fibrinolytic response to retinal detachment surgery under general or local anesthesia

PURPOSE

To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery under general or local anesthesia.

PATIENTS

Prospective study of 81 patients (43 male, 38 female), aged from 15 to 82 (mean 50.7 SD = 17.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia (group A), and 14 patients (6 male, 8 female) aged from 15 to 78 (mean 52.9, SD =19.8) years, operated under local anesthesia (group B). Excluded were patients with venous or arterial disease or other factors that could change the parameters investigated.

METHODS

Blood was sampled from a cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and after the operation (on days 1 and 4). In patients' citrated plasma, tissue plasminogen activator antigen (t-PA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and activity (PAI-1), fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured. RESULTS. The pattern of changes in perioperative fibrinolytic activity was similar in both groups. Intraoperative levels of FDP were significantly higher and ELT shorter than preoperatively. In both groups t-PA Ag concentration was significantly increased on the first postoperative day. There were no changes in PAI-1 in both groups. Postoperatively, the FDP concentration was reduced and ELT prolonged.

CONCLUSIONS

Retinal detachment surgery induces intraoperative activation of fibrinolysis in the systemic circulation regardless of the type of anesthesia.

Alterations in antithrombin III activity and other blood coagulation parameters after retinal detachment surgery

PURPOSE

To evaluate perioperative changes in blood coagulation in patients undergoing retinal detachment surgery.

MATERIALS

Prospective study of 56 patients, aged from 19 to 82 (mean +/- S.D. 53 +/- 16.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia. Excluded were patients with venous or arterial disease and any other factors that could affect the parameters under consideration.

METHODS

Blood was sampled from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and on days 1 and 4 after the operation. We measured antithrombin III activity (AT III), platelet count, fibrinogen concentration, activated partial thromboplastin time (aPTT) and prothrombin time (PT).

RESULTS

Intraoperative AT III activity and platelet count were significantly lower, aPTT was shortened and PT prolonged, although all values remained within the normal range. These results indicate moderate activation of coagulation during retinal detachment surgery. On the first postoperative day coagulation activity was reduced, with increases in AT III activity, fibrinogen concentration and platelet count and prolongation of aPTT.

CONCLUSIONS

During retinal detachment surgery there is moderate activation of coagulation in the systemic circulation.

Antithrombin III activity in subretinal fluid

PURPOSE

To evaluate antithrombin III (AT III) activity in subretinal fluid (SRF) and blood plasma.

METHODS

Prospective study of 32 patients, aged from 20 to 77 years (mean 53.8 years), undergoing retinal detachment surgery. Patients with vein or arterial disease or any other factors that could affect the parameters evaluated were excluded. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. AT III activity in citrated plasma and in SRF and its relations to patients' age, sex, duration and extent of retinal detachment and degenerative changes of the retina, were evaluated.

RESULTS

The median level of AT III activity in 32 SRF samples was 16.5% (lower quartile 8.5% and upper quartile 23%). The mean level of AT III activity in plasma was 105% (SD 24%). AT III levels in SRF were significantly lower than in plasma (p < 0.0001). We found no correlation between AT III activity in SRF and plasma, and age, sex, the degree of myopia, the duration and extent of retinal detachment, or retinal degenerative changes.

CONCLUSIONS

In this study we detected AT III activity in all 32 SRF samples.

[Blood coagulation activation in patients with ulcerative colitis]

Hemostasis disturbances in patients with ulcerative colitis (uc) can result from quantity and quality changes in blood coagulation factors synthesis (acute phase reaction) as well as their consumption in inflammatory processes affecting in large bowel. The aim of this study was to estimate a coagulation system activation in patients with uc.

PATIENTS AND METHODS

42 patients with uc, 21 in active and 21 in inactive disease phase as well as 26 healthy persons were studied. In all concentration of thrombin-antithrombin III complexes (TAT), antithrombin III and prekallikrein activities, von Willebrand factor (vWf) and fibrinogen concentrations, kaolin-kephalin time (aPTT), prothrombin level and platelets count were determined.

RESULTS

In patients with uc higher level of TAT, fibrinogen and platelets count, lower level of prekallikrein activity and shorter aPTT were found than in control group. No significant differences in obtained results of hemostatic parameters between patients with active and inactive uc were found. Whereas, it was disclosed lower platelets count and fibrinogen concentration in cases with inflammatory process only to rectum limited in comparison with more extended inflammatory changes. Using multiple regression method it was found that in studied group the TAT concentration, marker of thrombin in vivo generation, was determined by: aPTT, fibrinogen level, disease severity, inflammatory process extension in large bowel, systemic acute phase reaction.

CONCLUSIONS

1) In patients with uc independently of activity and extension of inflammatory process, the increase of in vivo throminogenesis expressed by higher TAT level was found. 2) Observed coagulation system disturbances may exert an influence on inflammatory process affecting large bowel and increase the risk of thrombotic complications in the course of uc.

Fibrinolytic activity of subretinal fluid after cryopexy

PURPOSE

To measure the tissue plasminogen activator antigen (t-PA Ag) content and plasminogen activator inhibitor type 1 (PAI-1) activity of SRF and blood.

METHODS

22 patients aged from 20 to 77 years (median: 57.3 years), were studied, undergoing retinal detachment surgery. Excluded were patients with vein or arterial disease and any other factors that could change the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery, after cryopexy. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. T-PA Ag concentration and PAI-1 activity in subretinal fluid and citrated plasma and their relation to patients' age and sex, the duration and extent of retinal detachment, and degenerative changes of the retina were assessed.

RESULTS

The median t-PA Ag concentration in 22 samples of SRF was 6.7 ng/ml (interquartile range 3.6 ng/ml) and PAI-1 activity 14.0 IU/ml (interquartile range 7.5 IU/ml). The median levels of t-PA Ag and PAI in plasma were respectively 10.7 ng/ml (interquartile range 8.6 ng/ml) and 15.7 IU/ml (interquartile range 12.2 IU/ml). There were no differences between the t-PA Ag concentration and PAI-1 activity in SRF and blood. We found no correlation between the levels of t-PA Ag and PAI-1 activity in SRF and age, sex, the degree of myopia, the duration and extent of retinal detachment, or retinal degenerative changes.

CONCLUSIONS

The parameters of the fibrinolytic cascade studied here indicated the presence of high levels of t-PA Ag and PAI-1 activity in SRF.

The influence of retinal detachment surgery on perioperative blood fibrinolysis

PURPOSE

To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery.

MATERIAL

Prospective study of 56 patients (30 male, 26 female), aged from 19 to 82 (mean: 53, SD = 16.8) years, subjected to retinal detachment surgery (encirclement with scleral buckling) performed under general anaesthesia. Excluded were patients with vein or arterial disease and with other factors which could change evaluated parameters.

METHOD

Blood was sampled from cubital vein one day before surgery, immediately after induction of anaesthesia but before surgery, immediately after the completion of the operation but before the termination of anaesthesia and after operation (on the 1(st) and 4(th) day). In the citrate plasma of patients studied, tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1), plasmin-alpha(2)-antiplasmin (PAP) complexes, fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured.

RESULTS

In the group studied intraoperative values of t-PA Ag, PAP and FDP were significantly higher, PAI-1 Ag concentration decreased and ELT was reduced. These results indicate a significant activation of fibrinolysis during the retinal detachment surgery. On the first postoperative day the fibrinolytic activity was reduced (decrease in t-PA Ag and FDP concentration and prolongation of ELT).

CONCLUSION

During retinal detachment surgery the patients reveal activation of fibrinolysis in systemic circulation.

[Urokinase plasminogen activator /U-PA/in blood of patients with lung cancer]

Clinical and experimental studies suggest that urokinase plasminogen activator/u-PA/ is associated with cancer invasion and metastasis. The aim of study was to evaluate the concentration and activity of u-PA in the plasma of patients with planoepithelial lung carcinoma. The examined group consisted of 40 patients/33 men, 7 women/aged 58 years with lung cancer in II, IIIa and IIIb stage of disease and 30 healthy adults as control. In citrate plasma concentration and activity of u-PA with ELISA method were performed. Concentration of u-PA was significantly lower in cancer patients then in controls. No associations between sex, age and plasma levels of u-PA were observed. Concentration and activity of u-PA in patients with IIIb stage of cancer were significantly decreased in comparison to patients with IIIa stage.

[Von Willebrand factor in plasma of patients with rheumatoid arthritis and lupus erythematosus]

The plasma levels of von Willebrand factor antigen (vWf:Ag) were evaluated for groups of 31 patients with rheumatoid arthritis and 34 patients with lupus erythematosus. The control group consisted of 34 healthy volunteers. In both groups the levels of vWf:Ag were increased to 243% and 240% respectively. The levels of vWf:Ag were also analysed statistically for the correlation with age of patients, time of the duration of disease and fibrinogen levels. No correlations were found. Obtained results suggest that measurements of vWf:Ag concentrations may be useful as potential marker of endothelial injury.

[Tissue and urokinase plasminogen activators (t-PA, u-PA) and their inhibitor PAI-1 in blood of patients with laryngeal neoplasms]

Plasminogen activators and inhibitors regulate a variety of physiological and pathological processes involved in tissue morphogenesis, cell differentiation, migration, cancer cell invasion and metastasis. Several reports have shown the decrease of fibrinolytic activity in the blood of cancer patients. In this study we measured the concentrations of tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA), activity of plasminogen activator inhibitor type 1 (PAI-1) and euglobulin lysis time (ELT) in the blood of 20 men aged 42-75 years old with planoepitheliale larynx carcinoma, and 10 healthy persons in similar age. In this study the mean values of t-PA, u-PA concentrations, PAI-1 activity and ELT in the blood of patients with larynx carcinoma were similar to the examination results of healthy persons, but 40% of our cancer patients have increased activity of PAI-1.

[The effect of laryngectomy on the fibrinolysis process in the blood of patients with laryngeal neoplasms]

Some data in the literature indicate on the influence of different kind of surgery on the fibrinolytic process. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1)--play important role in regulation of fibrinolysis. The aim of our work was to evaluate the influence of laryngectomy on fibrinolytic potential in the blood of operated patients with larynx carcinoma. Study group consisted of 20 men aged 42-75 years old with larynx carcinoma subjected to total laryngectomy. In the blood of patients we measured the concentration of t-PA:Ag, fibrinogen and FDP levels, PAI-1 activity, and ELT. The increase of t-PA and FDP concentrations, decrease of PAI-1 activity and fibrinogen level with simultaneous ELT shortening indicate on the fibrinolysis activation during the laryngectomy.

[Fibrinolysis process in blood of patients with bladder carcinoma]

In patients with bladder carcinoma a shorter ELT, and increased concentrations of EDP and t-PA were observed. These indicate on fibrinolysis activation caused by the released of t-PA. The increased fibrinolytic activity can be a cause of hemorrhagic complication occurring sometimes in bladder carcinoma. We observed much stronger activation of fibrinolysis in patients with an advanced bladder carcinoma.

[Tissue type plasminogen activator antigen in urine of patients with bladder cancer]

In urine of 25 patients with bladder carcinoma the antigen of tissue type plasminogen activator (t-PA) was assessed. The level of t-PA was much higher in patients with bladder carcinoma in comparison with a control group. We also analyzed the level of t-PA between patients with superficial and invasive bladder carcinoma the level of t-PA was higher. In conclusion, there is t-PA in urine of patients with bladder carcinoma and its level is correlated with staging of neoplasm.

[Activity of antithrombin III in the blood of patients with bladder cancer]

The activity of antithrombin III (AT III) in the blood of patients with bladder carcinoma was examined. It was shown an increase of AT III activity in comparison with control group. The changes of AT III activity in the blood of patients with bladder carcinoma can be the symptoms of an increased risk of haemorrhagic or thromboembolic complications.

[Tissue plasminogen activator in urine of patients with prostatic carcinoma and benign prostatic hyperplasia]

In the 20 patients with prostatic carcinoma (PC) and the 18 with benign prostatic hyperplasia (BPH) the level of tissue type plasminogen activator (t-PA:Ag) was examined. As a compared group consisted of 24 healthy volunteers. In the urine of examined patients with PC and BPH and control the t-PA:Ag was absent or present only in trace amounts. We concluded that the t-PA:Ag in the urine of patients with PC can not be as a marker in the diagnosis of prostatic diseases especially in the prostatic carcinoma.

[Plasma serine protease inhibitors in dialyzed patients with chronic renal insufficiency]

In the plasma of fourty dialyzed patients with chronic renal insufficiency in comparison to controls a mild decrease of AT III activity, low activity of PAI-1 and alfa-2 AP with normal activity alfa-2 M. and alfa-1 PI were observed. Hemodialysis with the presence of heparin except of mild shortness of ELT did not influenced the activities of the inhibitors in the plasma of the patients. The decrease of PAI-1 and alfa-2 AP activity with increased FDP concentration in the dialyzed patients can suggests the occurrence of secondary fibrinolysis activation with consumption of these inhibitors.

[The influence of some surgical procedures on the activity of protein C]

Protein C is the important regulating factor of coagulation and fibrinolytic system. It is known that surgery causes disturbances of haemostasis. The aim of work was to study the influence of different kind of surgery on the protein C activity. The study contained 102 operated patients in whom vascular operation (20), operation of prostate because of carcinoma (20) and hypertrophy (40), cholecystectomy (12) and operation of hernia (10) were performed. Protein C activity was measured using Kabi Diagnostika test applying chromogenic substrate. In the most of patients surgery caused on the 0 and 1st postoperative day the decrease of protein C activity and the return to the preoperative values in the next few days. The exception was the hernia operation which did not diminish protein C activity. It seems that the decrease of protein C after surgery was the effect of consumption of it in the extremely activated coagulation and fibrinolytic system during operation.

[The activity of alpha-2 macroglobulin in the blood of patients with prostatic carcinoma]

The activity of alpha 2-macroglobulin in the blood of the patients with prostatic carcinoma (PC) and benign prostatic hyperplasia (BPH) was examined. It was shown an decrease of alpha 2-macroglobulin in patients with prostatic carcinoma in comparison with control group consisted of the patients with benign prostatic hyperplasia. The low activity of alpha 2-macroglobulin in the blood od the patients with PC can be a symptom of an increase risk of haemorrhagic complications.

[The activity of protein C in the blood of patients with bladder carcinoma]

The activity of Protein C in the blood of patients with bladder carcinoma was examined. The average of Protein C activity was similar both in bladder carcinoma and in control group. The disperse of Protein C activity in bladder carcinoma was more greater than in control. In two patients with bladder carcinoma the bleeding with low activity of Protein C was observed. The low activity of Protein C in the blood of patients with bladder carcinoma can be the symptoms of an increased risk of thromboembolic complications.

[Plasminogen tissue activator and plasminogen tissue inhibitor in type II diabetes]

The aim of study was the evaluation of tissue plasminogen activator (t-PA) and its inhibitor (PAI-1) in the II type diabetes on the base of the common fibrinolytic system tests as euglobulin lysis time (ELT) and the concentration of fibrin/fibrinogen products (FDP). The studies were performed in 21 outpatients suffering of II type diabetes aged 38-65 (median 56.0) years treated with diet and sulphonylcarbamide derivates. The control group contained 18 healthy persons aged 33-65 (median 42.0) years. In the blood the following determinations were performed: antigen of t-PA and PAI-1, ELT and FDP. In the blood of patients with II type diabetes increased. t-PA Ag and PAI-1 Ag concentrations were observed.

[Antithrombin III activity in blood of patients with renal cancer]

The activity of antithrombin III (AT III) in the blood of 20 patients with renal carcinoma was examined. An increase of AT III activity in comparison with control group was observed. The increase of AT III activity in the blood of the patients with renal carcinoma can be as a result of compensatory mechanism safing these patients before thromboembolic complication. The measurement of AT III in renal carcinoma can be a prognostic symptom of haemorrhagic and thromboembolic complications.

[Tissue plasminogen activator antigen (t-PA Ag) and tissue plasminogen activator inhibitor (PAI-1) in the course of hemodialysis in patients with chronic renal failure]

In 10 patients with chronic renal insufficiency we are tissue plasminogen activator antigen (t-PA Ag), tissue plasminogen activator inhibitor (PAI-1) and euglobulin lysis time (ELT) designed. This parameters are just before hemodialysis, in 60 minutes and 240 minutes after beginning of dialysis studied. In 60 minutes after the beginning of hemodialysis significant increased tissue plasminogen activator inhibitor antigen, decreased tissue plasminogen activator inhibitor activity and prolonged euglobulin lysis time. The observed increase in plasma t-PA antigen levels during hemodialysis is due to effects of extracorporal circulation on the fibrinolytic system. T-PA release and consequent consumption of tissue plasminogen activator inhibitor due to enhanced fibrinolytic activity during hemodialysis.

[Tissue plasminogen activator and inhibitor and the severity and extensiveness of vascular lesions in peripheral atherosclerosis of the legs]

The aim of work was to study whether activity and antigen level of tissue plasminogen activator (t-PA) and activity of plasminogen activator inhibitor (PAI-1) were related to severity and extensiveness of vascular lesions in peripheral obliterative atherosclerotic disease (POAD). The study group consisted of 25 patients in II (13), III (10) and IV (2) degrees of disease acc. to Fontaine'a. In the blood t-PA activity and antigen and activity of PAI-1 were determined. In the patients with more severe POAD higher t-PA antigen and increased t-PA complexed with PAI-1 were observed. In patients with unisegmental POAD twice t-PA activity than in patients with polysegmental atherosclerotic lesions was detected.

[Tissue plasminogen activator (T-PA) and tissue plasminogen activator inhibitor (PAI-1) in patients after head injury]

The following factors of fibrinolysis: tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor-1 (PAI-1) play an important role in patients after trauma. Their possible mechanisms in head-injured patients remain unknown. We studied the maintenance of those markers of fibrinolysis in the plasma and cerebrospinal fluid of 19 patients after severe head injury (initially GCS less than 8 p) without intracranial haematoma. We measured changes of the level of t-PA antigen and PAI-1 activity in days 0-3, 4-6 and later. T-PA antigen level in the plasma was higher than normally (4-8 ng/ml). T-Pa was present in the cerebrospinal fluid, but its level reached only 30% of the plasma level. In the days following injury the t-PA antigen level decreased. The PAI-1 activity in the plasma was normal (0-15 IU/ml). However, its activity in csf was high and reached, 80% of the plasma level and systematically increase in the following days particularly in patients who died. PAI-1 activity can be connected with the presence of damaged brain tissue and its necrosis and its increase can be a marker of poor prognosis.

[Tissue plasminogen activator (t-PA) in aqueous humor of patients with cataract]

PURPOSE

The purpose of the examination was evaluation of tissue plasminogen activator (t-PA) concentration and plasminogen activator inhibitor (PAI) activity in aqueous humor of the eye and plasma of blood in patients operated on cataract.

MATERIAL AND METHODS

In aqueous humor and citrate plasma of 24 patients undergoing cataract surgery the concentration of t-PA (Imulyse Biopool) and the activity of PAI-1 (Spectrolyse Biopool) were determined.

RESULTS

In aqueous humor of 90% patients the concentration of t-PA-Ag in mean value 1.5 +/- 2.7 ng/ml was ca 20% of the level present in plasma. In aqueous humor of nearly all patients no PAI-1 activity could be detected. In a little group of persons because of small amounts of aqueous humor, other fibrinolytic parameters were also estimated and the presence of urokinase-type plasminogen activator (u-PA), alfa-2 antiplasmin (alfa-2AP) and plasmin-alfa-2 antiplasmin (PAP) complexes but no activity of protein C were observed.

CONCLUSION

The presence of PAP complexes in aqueous humor indicates on intensive plasminogenesis in vivo. Our examinations confirm the role of fibrinolytic process in physiological and pathological processes occurring in the eye.

[Post-mortem concentration of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) in the vitreous body of the human eye]

After sudden death the blood remains fluid and after late death the thrombi are present in heart and vasa. Earlier we observed after sudden death high concentrations of t-PA Ag in plasma with strong activation of fibrinolysis, consumption of PAI-1, plasminogen, fibrinogen, alfa-2 antiplasmin and a big increase of FDP. Fibrinolysis is mainly regulated by t-PA, u-PA and PAI-1.

PURPOSE

The aim of our study was the evaluation of t-PA and PAI-1 in corpus vitreous and plasma of patients after sudden (26) and late death (12).

MATERIAL AND METHODS

The concentration of t-PA Ag was measured with COA SET of Kabi Vitrum and the activity of PAI-1 with reagents of Biopool.

RESULTS

In corpus vitreous the concentration of t-PA after sudden death was 3.65 +/- 1.83 ng/ml and after late death 1.93 +/- 1.63 ng/ml. The activity of PAI-1 was respectively 0.61 +/- 1.2 IU/ml and 2.25 +/- 3.30 IU/ml. After sudden death the concentration of t-PA was twice higher and PAI-1 three times lower as after late death.

CONCLUSION

No dependence of t-PA concentration and the time after death could be observed.

[Activity of alpha 1-antitrypsin in blood of patients operated on for tumor and benign hyperplasia of the prostate]

The activity of alpha 1-antitrypsin in the blood of the patients with prostatic carcinoma and benign prostatic hyperplasia before and after the operation was examined. It was observed an increase of alpha 1-antitrypsin in the blood of patients with prostatic carcinoma and benign prostatic hyperplasia after the operation. In the blood patients of control group an increase of alpha 1-antitrypsin was observed too. The activity of alpha 1-antitrypsin in prostatic carcinoma was the highest during the whole observation period. The similar increase of the activity of alpha 1-antitrypsin after the operation in the blood of all groups of patients is connected with inflammatory reaction. The highest activity of alpha 1-antitrypsin in the blood of patients with prostatic carcinoma is the proof that the malignant neoplasm is associated with much more inflammatory reaction and the further hormonal treatment can be connected with a risk of thromboembolic complications.

[Activity of protein C in blood of patients with prostatic carcinoma]

The activity of Protein C in the blood of the patients with prostatic carcinoma and benign prostatic hyperplasia was examined. It was observed a slightly decrease of activity of protein C in the blood the patients with prostatic carcinoma. The observation of the activity of Protein C is useful because it allow to differentiate from patients with prostatic carcinoma a group of high risk of haemorrhagic complications. The activity of Protein C may be a prognostic factor of a progress of a prostatic carcinoma.

[Disseminated intravascular coagulation syndrome with secondary fibrinolysis activation in prostatic carcinoma]

We reported on a 74 year old patients with local advanced prostatic carcinoma. Following prostatic surgery an increased bleeding tendency was observed. The patients showed clinical and laboratory evidence for consumption coagulopathy with hyperfibrinolysis. The laboratory data were: marked decrease of AT III, Protein C, increase of thrombin/AT III complex level, fibrin degradation products (FDP) and antigen of t-PA. The treatment was ended successful.

[Activity of alpha 1-antitrypsin in blood of patients with prostatic tumor]

The activity of alpha 1-antitrypsin in patients with prostatic carcinoma and benign prostatic hyperplasia was examined. The activity of alpha 1-antitrypsin was higher in patients with prostatic carcinoma. The higher activity of alpha 1-antitrypsin is good prognostic sign for patients with prostatic carcinoma because it is born of large defense possibilities in these patients against the disease.

[Antithrombin III and alpha 2-antiplasmin in blood of patients operated on for benign prostatic hyperplasia]

The pre- and postoperative activity was studied of antithrombin III (AT III) and alpha 2-antiplasmin (alpha 2-AP) in blood of 40 patients subjected to transurethral prostatic electroresection due to benign prostatic hyperplasia (BPH). For comparison of the obtained results a control group was formed from patients with other diseases of the genitourinary system with exception of neoplasms. The activity of AT III and alpha 2-AP before the operation was similar to that in the control group. Intraoperatively (day 0) and on the first day after the operation, a statistically significantly lower activity of AT III and alpha 2-AP was found in the patients with BPH in relation to the initial value as well as to the control group. On day 5 after the operation, normalization of AT III and alpha 2-AP activity was found. During operations of the prostate a release occurs of thromboplastins and plasminogen activators initiating the activation of blood clotting and fibrinolysis. The decrease of activity of AT III and alpha 2-AP could be caused by AT III and alpha 2-AP use-up in the process of inhibition of the created thrombin and plasmin.

[Levels of plasminogen and alpha 2-antiplasmin in blood of patients with prostatic tumor]

In the blood of 20 patients with prostatic carcinoma the level of alpha 2-antiplasmin and plasminogen were examined. The control group consisted of 20 patients with benign prostatic hyperplasia. The low activity of alpha 2-antiplasmin in the blood of the patients with prostatic carcinoma was observed. The level of plasminogen was similar in both groups and it was in the low part of laboratory normal range. We concluded that the low levels of plasminogen and alpha 2-antiplasmin were a result of their consumption during activation of fibrinolysis process. The measurement of the alpha 2-antiplasmin and plasminogen can be useful to predict a risk of bleeding complications in the patients with prostatic carcinoma and benign prostatic hyperplasia.

[Tissue type plasminogen activator and its inhibition in blood of patients operated on for prostatic carcinoma]

In 30 patients with prostatic carcinoma a higher of t-PA, a low of PAI-1, alpha 2-antiplasmin and plasminogen activity with increased fibrin degradation products (FDP) level and a short euglobulin lysis time (ELT) were observed. Following surgery a further increased of fibrinolytic activity occurred. The activity of t-PA and PAI-1 were higher than before operation. Apart from that we observed a decreased of plasminogen and alpha 2-AP with further increased level of FDP. On 5-th day the values of examined parameters were similar as before the operation.

[Effect of vascular surgery on values of thrombin-antithrombin III complexes in patients with atherosclerosis of lower limb arteries]

In 25 patients with atherosclerosis of lower limb arteries (ALLA) in whom vascular operation was performed, the level of thrombin-antithrombin III (TAT) complexes and antithrombin III (AT III) activity were determined in comprehensive studies of the blood clotting system. The comparative group for the assessment of operation effect on primarily not disturbed haemostasis in humans included 10 men operated on for inguinal hernia, while the control group consisted of 54 healthy people. Blood for the determinations was taken before the operation, on the day of the operation (0-30 minutes after the operation), on the first day after it, and also on the third day in patients with hernia, and on the 7th day in patients with ALLA. In the patients with ALLA, blood hypercoagulation features were found, expressed as increased level of TAT complexes in spite of lack of abnormalities in comprehensive coagulation studies, while in the patients with hernia only increased AT III activity was found. The surgical operation caused in the patients with ALLA enhancing of hypercoagulation which was evidenced by over threefold increase of TAT complexes on the day of the operation.

[Tissue plasminogen activator, its inhibitor and other parameters of fibrinolysis in blood of patients operated for mild hypertrophy of the prostate]

An increased blood fibrinolytic activity manifested by increased tissue plasminogen activator (t-PA) and decreased tissue plasminogen activator inhibitor (PAI-1) and increased FDP levels are seen in 40 patients with mild hypertrophy of prostate. Surgical treatment increased blood fibrinolytic activity manifested in the increase in t-PA, decrease in PAI-1, shortening of ELT, increase in FDP, and decrease in plasminogen and 2-AP activities. Blood fibrinolytic activity was the highest immediately after surgery with tendency to the gradual normalization. Positive ethanol test and decrease in thrombocyte count indicate and activation of blood clotting system induced by the tissue thrombo-elastins released during surgery. Subclinical DCI with the secondary increased fibrinolysis activation is present in patients with mild hypertrophy of the prostate both prior to and after surgery.

[Blood coagulation and fibrinolysis in blood donors after plasmapheresis]

Authors were interested in blood coagulation proteins and fibrinolysis in blood donors following several plasmaphereses. This interest was related to the occurrence of thrombo-embolic and hemorrhagic complications in these subjects. Blood morphology, serum protein, blood coagulation and fibrinolysis have been examined in 40 healthy blood donors, aged between 19 and 46 years, who gave blood plasma by plasmapheresis technique for 1-59 times. Results did not show any significant changes in blood morphology and serum protein levels prior to and after consecutive plasmaphereses. No significant decrease in blood coagulation proteins and fibrinolysis has been noted. However, a significant increase in factors VIII and IX activities was noted in several blood donors, who underwent the largest number of plasmaphereses. It may predispose these donors to thrombo-embolic complications.