The role of micro-emboli in the production of carditis in hypersensitivity experiments

Platelet activation during myocardial ischaemia: a contributory arrhythmogenic mechanism

Experimental and clinical observations of the involvement of platelets in the pathophysiology of myocardial ischaemia indicate the importance of interactions between these formed elements and the heart. The aim of this review is to outline evidence linking platelet activation, myocardial ischaemia and infarction, and to present evidence for a link between platelet activation, arrhythmogenesis and sudden death. A brief review of platelet physiology and pharmacology is provided, with a review of the cardiac electrophysiological effects of ischaemia and the electrophysiological effects of platelet-derived substances. The concept that platelet activation during myocardial ischaemia is a contributory arrhythmogenic mechanism is discussed.

Effects of hypomagnesemia on reactivity of bovine and ovine platelets: possible relevance to infantile apnea and sudden infant death syndrome

Blood platelet function and possible involvement in death of hypomagnesemic ruminants was investigated with 26 Angus cows, 15 mature Hampshire wethers, eight Finnish-Hampshire ewes, and 36 growing Dorset lambs. Hypomagnesemia was induced by feeding vegetative spring tall fescue to 13 cows and semipurified diets low in Mg to nine wethers, four ewes, and 18 lambs. In comparison with controls, dietary treatments reduced plasma Mg concentrations 55% in cows, 36% in wethers, 66% in ewes, and 78% in lambs. Hypomagnesemia reduced in vitro reactivity of cow and lamb platelets to thrombin, ADP, and platelet active collagen, but in vitro tests may not accurately reflect in vivo platelet reactivity. Microscopic examination of platelet-rich plasma revealed a threefold increase in clumped platelets from four hypomagnesemic ewes compared to four normomagnesemic ewes. This suggests that in vivo activation and exhaustion of platelets may have contributed to reduced in vitro platelet reactivity. Six of 18 hypomagnesemic lambs died spontaneously in tetany after 2-12 months on low-Mg diets. Heart and lung lesions were markedly similar to pathological changes induced in other lambs by intravascular activation of platelets with 500 micrograms of vascular collagen fibrils per kg body weight injected intravenously. These results suggest the possibility of abnormal blood platelet activation as a significant mortality risk factor in severe hypomagnesemia.

Platelet function in bilateral acute retinal necrosis

We tested platelet function in seven patients (four men and three women, ranging in age from 26 to 57 years) with bilateral acute retinal necrosis. Hyperaggregation was detected in six of the seven. Antiplatelet therapy (aspirin, 500 mg/day) together with corticosteroids or other drugs produced satisfactory results. Despite administration of antiplatelet drugs, two retinal detachments developed; both were surgically repaired. A lower dosage of antiplatelet agents in one case and late administration of it in another were thought to have caused the retinal detachments. After the acute stage was over or the retina was reattached, there were no further recurrences during a follow-up period of more than one year.

Regional lung function following prosthetic hip replacement surgery

With a Xenon133 radiospirometric technique the regional lung function was evaluated before and after prosthetic hip arthroplasty performed in the lateral decubitus position with either respirator-controlled neuroleptic anesthesia or epidural anesthesia with spontaneous breathing. Regional lung function measured in a supine position 1, 20 and 72-96 hours postoperatively revealed a reduction of the perfusion, ventilation and volume of ventilated alveoli on the dependant lung. The reduction was most pronounced immediately postoperatively, especially following respirator-controlled anesthesia. There was also an increase of pulmonary blood volume and a decrease of total lung volume in this group. The changes of lung function are probably caused by congestive atelectasis, secondary to impaired ventilation of the dependent lung. Peroperatively induced microembolism might have potentiated the effect.

Thromboembolism: a manifestation of the response of blood to injury

Thromboembolism may be considered as one of the manifestations of the response of blood to injury. Other manifestations of this include hemostasis, increased vessel permeability, and vasculitis; disturbances of the microcirculation may lead to tissue injury and organ dysfunction. The factors that can initiate these changes by stimulation of platelets are exposure of subendothelial tissue (collagen, basement membrane) and intravascular stimuli such as antigen-antibody complexes, viruses, bacteria, and endotoxin. These stimuli have a number of effects on blood; the interaction of the platelets with the above stimuli leads to the release of platelet constituents including ADP; the ADP causes the platelets to adhere to each other; the aggregated platelets cause acceleration of clotting; this and changes in blood flow promote the formation of fibrin around the platelet aggregates. Some of the stimuli such as collagen and antigen-antibody complexes also activate blood coagulation through factor XII; some of the materials released from these platelets affect the vessel wall. The initial platelet mass is transformed to a fibrin mass. There are compounds that inhibit the platelet release reaction, platelet aggregation, and blood coagulation and activate the fibrinolytic mechanism. It appears that by the selective use of these compounds we can improve our management of all aspects of thromboembolic disease related to vascular and intravascular stimuli.

The localization of circulating immune complexes in experimental serum sickness. The role of vasoactive amines and hydrodynamic forces

In serum sickness, mechanisms by which circulating immune complexes become localized in the walls of vessels and glomeruli have been studied. In affected arteries, morphologic observations showed that circulating marker particles of carbon would rapidly deposit along the luminal surface of the internal elastic lamina. This, as in previous studies, suggested an increase in vascular permeability during which large molecules were capable of being trapped by a filtering membrane in the vessel wall. In attempts to prevent the increase in vascular permeability, rabbits were treated with antagonists of histamine and serotonin. Such treatment markedly inhibited the localization of immune complexes in glomeruli, the development of proteinuria, and glomerular endothelial proliferation. Cardiovascular lesions also were largely prevented from developing. Depletion of platelets, the principal reservoir of vasoactive amines, had a similar though less pronounced effect. While the deposition of immune complexes was inhibited, allergic inflammation in general was not, since normal rabbits treated as above were found capable of developing full Arthus reactions and acute nephrotoxic nephritis. Hydrodynamic factors were noted to be important in determining the location of arterial lesions. Studies of aortas from unmodified rabbits and from those with surgically induced coarctations of the abdominal aorta revealed intimal lesions concentrated at areas of high turbulence, such as at branches, bifurcations, outflows and zones of configurational change. Lesions in these areas were also largely inhibitable by depletion of platelets or by antagonists of histamine and serotonin.