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1.

001-es BibID:BIBFORM073440
Első szerző:Csorba Roland (szülész-nőgyógyász, gyermeknőgyógyász)
Cím:Air travel during pregnancy / Csorba Roland, Panagiotis Tsikouras
Dátum:2018
ISSN:1108-4189
Tárgyszavak:Orvostudományok Klinikai orvostudományok levél
air travel
pregnancy
miscarriage
preterm delivery
thrombosis
Megjelenés:Hippokratia. - 21 : 1 (2018), p. 62. -
További szerzők:Tsikouras, Panagioti
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2.

001-es BibID:BIBFORM072240
Első szerző:Csorba Roland (szülész-nőgyógyász, gyermeknőgyógyász)
Cím:Correlation of rheological parameters in maternal and fetal blood at term / Csorba Roland, Soliman Amr A., Wieg Christian, Tsikouras Panagiotis, Rath Werner, von Tempelhoff Georg-Friedrich
Dátum:2014
ISSN:1476-7058 1476-4954
Megjegyzések:Objective: An association between maternal and fetal blood rheology has not yet been investigated nor is it known whether and to what extent fetal blood rheology may be affected by maternal conditions. Methods: At delivery, blood was drawn from the cubital vein of 4985 consecutive mothers and from the umbilical cord during birth for determination of blood rheological parameters (erythrocyte aggregation stasis [E0], low shear [E1], plasma viscosity [Pv]) in addition to hemoglobin (Hb) values and hematocrit (Hct). Results: Maternal and newborn Pv (r = 0.2; p < 0.0001) correlated statistically significant. There was a remarkable correlation between fetal Pv and gestational age (r = 0.197; p < 0.001). Iron supplementation during pregnancy led to increased fetal Hb, Hct as well as E0 and E1 (p < 0.0001), did not have a significant impact on neonatal Pv (p = 0.068). Smoking mothers gave birth to neonates with significantly higher Pv (p = 0.049), E0 (p = 0.016) and E1 (p = 0.013). Conclusions: The increase of fetal plasma viscosity at advanced delivery time-points refers to a more gaining protein synthesis by the fetal liver and thus maturity of the fetus. Iron supplementation as well as smoking during pregnancy is associated with a relative hyper-viscosity in the fetus at delivery.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Fetal maturity
Plasma viscosity
Pregnancy
Red blood cell aggregation
Rheology
Megjelenés:The Journal of Maternal-Fetal & Neonatal Medicine 28 : 8 (2014), p. 969-976. -
További szerzők:Soliman, Amr A. Wieg, Christian Tsikouras, Panagioti Rath, Werner Tempelhoff, Georg-Friedrich von
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3.

001-es BibID:BIBFORM048836
Első szerző:Csorba Roland (szülész-nőgyógyász, gyermeknőgyógyász)
Cím:Rheological parameters in the umbilical cord blood in moderate and severe forms of preeclampsia / Roland Csorba, Asli Yilmaz, Panagiotis Tsikouras, Christian Wieg, Alexander Teichmann, Georg-Friedrich von Tempelhoff
Dátum:2013
ISSN:1386-0291
Megjegyzések:Previous studies have dealt with maternal blood rheology in preeclampsia (PE), but only a few focused on the fetal rheological parameters in this maternal state. PE is one of the most common severe complications of pregnancy world-wide associated with high maternal morbidity and mortality and intrauterine fetal growth restriction. Our objective was to explore the rheological parameters in the umbilical cord blood at term in the presence of moderate and severe forms of PE.METHODS:A subgroup analysis was performed in a community based retrospective study of 4,951 consecutively recorded singleton pregnant women of whom 423 had PE. In the latter, umbilical cord blood was collected during delivery for testing of hematological and blood rheological parameters of their fetus. Fetal results from uneventful pregnancy were compared with those associated with preeclampsia. Furthermore, results were also evaluated in the presence of moderate and severe forms of PE. Plasma viscosity (pv) was examined using KSPV 1 Fresenius and Red Blood Cell (RBC) aggregation (stasis: E0 and low shear: E1) using MA1-Aggregometer; Myrenne.RESULTS:According to the definition of the German Society of Gynecology and Obstetrics (DGGG) 314 women had moderate (74.2%), while 109 had severe forms of PE due to the presence of a blood pressure > 170/110 mmHg (n = 41; 9.7%), and/or IUGR < 5th percentile (n = 28; 6.6%), and/or HELLP-Syndrome (n = 10; 2.4%), and/or proteinuria ? 5 g/24 h (n = 30; 7.1%). When comparing the fetal results from pregnancies with and without preeclampsia mean hemoglobin values (p < 0.001) and hematocrit (p < 0.001) were markedly higher, while plasma viscosity (p = 0.006) and erythrocyte aggreagtion (stase: p = 0.35; low shear: p = 0.08) were lower in association with preeclampsia. Gestational age, fetal birth-weight and umbilical arterial cord blood pH in women with severe PE was statistically significant lower as compared to those with moderate disease (p < 0.001). Mean hemoglobin level and hematocrit were higher in fetus from women with severe compared to moderate PE, while plasma viscosity (1.03 ? 0.07 mPas vs. 1.05 ? 0.07; p = 0.05) and erythrocyte aggregation in stase (2.3 ? 2.47 vs. 2.41 ? 2.46; p = 0.11) as well as under low shear (7.86 ? 4.63 vs. 8.06 ? 4.60; p = 0.15) were lower. HELLP-Syndrome was associated with the lowest plasma viscosity (1.00 ? 0.07 mPas; p = 0.019) and erythrocyte aggregation (low shear: 5.1 ? 5.0; p = 0.04) in fetus.CONCLUSION:The results of this study including a notable number of patients with PE and their newborns revealed an in part statistically significant association between variables of blood rheology and the presence, severity and type of preeclampsia with a trend towards hyper viscosity in severe forms of preeclampsia. The behaviour of blood rheological components in the neonate is remarkable since the number of red blood cells is raised while RBC aggregability and plasma viscosity is low.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Pregnancy
fetal hemorheology
plasma viscosity
preeclampsia
red blood cell aggregation
Megjelenés:Clinical Hemorheology and Microcirculation 55 : 4 (2013), p. 391-401. -
További szerzők:Yilmaz, Asli Tsikouras, Panagioti Wieg, Christian Teichmann, Alexander Tempelhoff, Georg-Friedrich von
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4.

001-es BibID:BIBFORM036885
035-os BibID:PMID:22395864
Első szerző:Csorba Roland (szülész-nőgyógyász, gyermeknőgyógyász)
Cím:The sexual abuse of female children in Hungary : 20 years' experience / Roland Csorba, Panagiotis Tsikouras, Rudolf Lampé, Robert Poka
Dátum:2012
ISSN:0932-0067 (Linking)
Megjegyzések:INTRODUCTION: The purpose of this study is to describe the characteristics offemale children who experience sexual abuse and explore common features that mayassist in developing prevention strategies. MATERIALS AND METHODS: Between 1990and 2010, 266 girls under the age of 18 years, suspected of being sexuallyabused, visited the Department of Adolescent Gynecology. We retrospectivelycollected data illustrating the features of all cases. Seventy-eight percent ofthe victims were primary school students, and 45% of them were between 11 and 14years of age. RESULTS: The perpetrator knew the victim in 67% of the cases andwas a stranger in 33%. Seventy-five (28%) perpetrators were members of thevictims' families. In 14% of cases, the perpetrator was the victim's father andin 9% her stepfather. The abuse had occurred on multiple occasions in 29% of thecases. The occurrence rate of abuse was highest in the summer season (54%). Asmuch as 63% of children experienced vaginal penetration, while 37% experienced avariety of sexual contact that did not involve penetration. Eighty-five victimswere physically injured, and in 40 cases the presence of sperm was confirmed invulvo-vaginal smears. A high proportion of female child sexual abuse takes placewithin the family and is revealed only after multiple episodes. The trueprevalence of sexual abuse is being appreciated now that Hungarian law andsociety have recognized this societal problem. CONCLUSION: Prevention requires asystematic and lifelong approach to educating children about personal space andprivacy and is the responsibility of parents and professionals.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:Archives of Gynecology and Obstetrics. - 286 : 1 (2012), p. 161-166. -
További szerzők:Tsikouras, Panagioti Lampé Rudolf (1983-) (szülész-nőgyógyász) Póka Róbert (1960-) (szülész-nőgyógyász, klinikai onkológus)
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5.

001-es BibID:BIBFORM073115
035-os BibID:(Scopus)85045203225 (WOS)000434868800140 (cikkazonosító)701
Első szerző:Enyedy Andrea (szülésznő, egészségügyi menedzser)
Cím:Medical and Legal Aspects of Child Sexual Abuse : a Population-Based Study in a Hungarian County / Andrea Enyedy, Panagiotis Tsikouras, Roland Csorba
Dátum:2018
ISSN:1661-7827 1660-4601
Megjegyzések:BACKGROUND:Very few studies focus on childhood sexual abuse in middle European countries.AIM:The purpose of our study is to describe the medical and legal characteristics of children who experience sexual abuse and explore common features that may result in strategies for prevention.METHODS:Between 2000 and 2015, 400 girls and 26 boys under the age of 18, suspected of being sexually abused, visited one of the four hospitals in a Hungarian county.RESULTS:Mean age at onset was 10.81 years for boys, 13.46 years for girls. In 278 cases (65.3%), the perpetrator was known to the victim, and a stranger was suspected in 148 cases (34.7%). In 79 cases (30.7% of boys and 17.7% of girls), a family member was the accused perpetrator. In more than one-third (boys) and in one-fifth (girls) of cases, sexual abuse had occurred on multiple occasions. In the case of boys, child and adolescent sexual abuse (CSA) included oral genital, genital touching and genital to genital contact in 14 cases (53.8%) and anal intercourse in 12 (46.2%) cases. In case of girls, sexual abuse included coitus in 219 (54.8%), oral genital, genital touching, genital to genital contact in 164 (41.0%), anal abuse in 14 (3.5%) cases, physical injury was incurred in 15 cases. Legal proceedings followed the CSA in 205 (48.1%) cases.CONCLUSION:The results highlight the urgent need to address the issue of sexual abuse in Hungary and minimize its impact. Prevention requires a systematic and lifelong approach to educating children about personal space safety and privacy to reduce vulnerability and is the responsibility of parents and professionals.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
child sexual abuse
adolescents
gender differences
legal proceedings
child-friendly justice
prevention
Megjelenés:International Journal of Environmental Research and Public Health. - 15 : 4 (2018), p. 1-9. -
További szerzők:Tsikouras, Panagioti Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász)
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6.

001-es BibID:BIBFORM048861
Első szerző:Koukoulomati, A.
Cím:Diagnostic approach and therapeutic management in early-stage endometrial cancer / A. Koukoulomati, P. Tsikouras, N. Tsagias, R. Csorba, A. Liberis, A. T. Teichmann, V. S. Liberis, G. Galazios
Dátum:2013
ISSN:0392-2936
Megjegyzések:OBJECTIVE:The effectiveness of pelvic and para-aortic lymphadenectomy in the morbidity of patients affected by early-stage endometrial carcinoma (EC) is the subject of this study.STUDY DESIGN:Ninety-two cases with endometrial cancer that underwent para-aortic and pelvic lymphadenectomy, from June 1995 to June 2006, were studied and compared with 30 cases of patients with endometrial cancer without lymphadenectomy.RESULTS:According to the results, systematic pelvic and para-aortic lymphadenectomies improved disease-free and overall survival rates among the patients with endometrial cancer. The mean number of removed para-aortic lymph nodes was 19.01 +/- 5.88, whereas the mean number of removed iliac lymph nodes was 32.94 +/- 6.69. Forty-two and 31 metastatic iliac and para-aortic nodes were found, respectively. No surgery-related deaths and major intraoperative injuries occurred. The frequency and the type of postoperative complications were not affected by the performance of lymphadenectomy. The morbidity rate was 6.2%, similar to the group without lymphadenectomy (5.79%). No recurrence occurred in the group with lymphadenectomy, while in the other group the recurrence rate was 23.3%.CONCLUSIONS:Lymph nodes metastases can be observed in early stages of EC. Pelvic and para-aortic lymphadenectomies seems to provide profound information about the Stage of the disease and the patient's survival, identifying which patients are suitable for supplementary treatment, without significant clinical increase of morbidity.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Endometrial cancer
Paraortal iliac lymphadenectomy
morbidity
early stages
Megjelenés:European Journal of Gynaecological Oncology. - 34 : 4 (2013), p. 319-321. -
További szerzők:Tsikouras, Panagioti Tsagias, Nikolaos Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász) Liberis, Anastasios Teichmann, Alexander Liberis, V. S. Galazios, Georgios
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7.

001-es BibID:BIBFORM072233
Első szerző:Liatsikos, Spyros A.
Cím:Inherited thrombophilia and reproductive disorders / Liatsikos Spyros A., Tsikouras Panagiotis, Manav Bachar, Csorba Roland, Tempelhoff Georg Friedrich von, Galazios Georgios
Dátum:2016
ISSN:1309-0399 1309-0380
Megjegyzések:Apart from its established role in the pathogenesis of venous thromboembolism (VTE), inherited thrombophilia has been proposed as a possible cause of pregnancy loss and vascular gestational complications. There is a lot of controversy in the literature on the relationship between inherited prothrombotic defects and these obstetric complications. This is a review of the literature on inherited thrombophilia and reproductive disorders. Factor V Leiden, prothrombin G20210A mutation, and protein S deficiency seem to be associated with late and recurrent early pregnancy loss, while their impact on other pregnancy complications is conflicting. No definite association has been established between protein C and antithrombin deficiency and adverse pregnancy outcome, primarily due to their low prevalence. Screening is suggested only for women with early recurrent loss or late pregnancy loss. Anticoagulant treatment during pregnancy should be considered for women with complications who were tested positive for thrombophilia.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Inherited thrombophilia
Recurrent pregnancy loss
Reproductive disorders
Megjelenés:Journal of the Turkish German Gynecology Association 17 : 1 (2016), p. 45-50. -
További szerzők:Tsikouras, Panagioti Manav, Bachar Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász) Tempelhoff, Georg-Friedrich von Galazios, Georgios
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8.

001-es BibID:BIBFORM072237
Első szerző:Soliman, Amr A.
Cím:Antiphopholipid antibodies and functional activated protein C resistance in patients with breast cancer during anthracycline-based chemotherapy administered through an intravenous port-catheter device / Soliman A. A., Csorba R., Ullrich A., Tsikouras P., Rath W., von Tempelhoff, G.-F.
Dátum:2014
ISSN:1076-0296
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Clinical And Applied Thrombosis-Hemostasis 20 : 3 (2014), p. 338-340. -
További szerzők:Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász) Ullrich, A. Tsikouras, Panagioti Rath, Werner Tempelhoff, Georg-Friedrich von
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9.

001-es BibID:BIBFORM048838
035-os BibID:(WoS)000429590100003 (Scopus)85047832575
Első szerző:Soliman, Amr A.
Cím:Neonatal blood rheological parameters at delivery in healthy neonates and in those with morbidities / Amr A. Soliman, Roland Csorba, Pagnaioti Tsikouras, Christian Wieg, Harald Harnack, Georg-Friedrich von Tempelhoff
Dátum:2018
ISSN:1386-0291 1875-8622
Megjegyzések:Rheological blood parameters of neonates are different form those of adults. Many authors have studied changes in blood rheology in neonates in different clinical disorders. To-date, no one set the normal values for blood rheological parameters in healthy neonates. The aim of this study is to set the norm for rheological blood parameters in healthy newborns and to describe the changes in those parameters in common clinical disorders that affect the newborns. We recruited all the neonates born to mothers experiencing un eventful pregnancies, blood was taken from the umbilical cord right after the delivery. In this time period we recruited 4985 neonate. From this huge database we were able to set the standards for blood rheology in neonates, namely plasma viscosity of 1.06 ? 0.072 mPa, erythrocyte aggregation at stasis of 2.41 ? 2.74 s-1 and erythrocyte aggregation under low shear forces of 8.51 ? 6.38 s-1. These values changed significantly in some diseased neonates. This is the largest study investigating normal rheological parameters and deviations from the norm in common clinical disorders occurring in this early stage of life.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Neonate
blood rheology
SGA
LBW
red blood cell aggregation
Megjelenés:Clinical Hemorheology and Microcirculation. - 68 : 4 (2018), p. 335-345. -
További szerzők:Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász) Tsikouras, Panagioti Wieg, Christian Harnack, Harald Tempelhoff, Georg-Friedrich von
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10.

001-es BibID:BIBFORM072235
Első szerző:Tempelhoff, Georg-Friedrich von
Cím:Thrombelastometric results and platelet function during pregnancy in women receiving low molecular weight heparin with a history of recurrent/late abortion : a retrospective analysis / von Tempelhoff Georg-Friedrich, Schelkunov Olga, Demirhan Attila, Tsikouras Panagiotis, Rath Werner, Velten Eva, Csorba Roland
Dátum:2015
ISSN:1386-0291
Megjegyzések:In women with a history of recurrent/late abortion and confirmed genetic/acquired thrombophilia, LMWH was given during subsequent pregnancy and serial coagulation testing was performed. In 82 consecutive pregnant women with recurrent (?2) and/or late abortion (>12 GW) in the presence of single (n = 62; 75.6) or combined (n = 20; 24.4) genetic and/or acquired thrombophilia, Thromboelastometry (n = 50; ROTEM, TEM) and closure-time (n = 82; PFA-100; Siemens) underwent serial testing before and during pregnancy while receiving LMWH and puerperal. Throughout pregnancy, clotting-time (CT) after intrinsic and extrinsic induced coagulation activation in Thromboelastometry remained unchanged. TF-induced coagulation activation resulted in statistically significantly decreased mean clot-formation-times (CFT) (Trim I: 108.9 ? 5.2 S to Trim III; 81.7 ? 5.4 S; p = 0.001), whereas after contact activation (Intem-S: Trim I: 70.1 ? 4.0 S to Trim III: 65.4 ? 6.8; n.s.) CFT remained unchanged. Mean maximal-clot-firmness (MCF) continuously increased in the Intem-S and Extem-S during each trimester and decreased until 4th puerperal week (Extem-S: Trim I: 61.9 ? 1.0 S; Trim II: 65.4 ? 0.58 S; Trim III: 68.3 ? 1.1 S; p < 0.001; Intem-S: Trim I: 64.1 ? 0.6 S; Trim II: 66.8 ? 0.5 S; Trim III: 69.5 ? 1.2 S; p < 0.001). Mean Closure-times after Epinephrine/ADP/Collagen stimulation remained unchanged during pregnancy. In women with different thrombophilia receiving LMWH at prophylactic dose a significant increase in MCF was accompanied by barely unchanged CT after intrinsic and extrinsic coagulation activation and platelet mediated closure-times in the course of the pregnancy. Decrease in CFT was only seen after extrinsic coagulation activation, whereas unchanged CFT after intrinsic coagulation activation may be the result of LMWH given at low dose.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
low-molecular-weight-heparin
platelet-function-analyser
Pregnancy
recurrent abortion
Thromboelastometry
Megjelenés:Clinical Hemorheology And Microcirculation 61 : 1 (2015), p. 99-110. -
További szerzők:Schelkunov, Olga Demirhan Attila Tsikouras, Panagioti Rath, Werner Velten, Eva Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász)
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11.

001-es BibID:BIBFORM072234
035-os BibID:(Wos)000371008900006 (Scopus)84959020058
Első szerző:Tempelhoff, Georg-Friedrich von
Cím:Correlation between blood rheological properties and red blood cell indices(MCH, MCV, MCHC) in healthy women / von Tempelhoff Georg-Friedrich, Schelkunov Olga, Demirhan Attila, Tsikouras Panagiotis, Rath Werner, Velten Eva, Csorba Roland
Dátum:2016
ISSN:1386-0291
Megjegyzések:OBJECTIVE: Structure and mechanical properties of red blood cells are markedly influenced by pathophysiology of many diseases which in turn potentially impair microcirculatory blood flow. The physiological association between blood rheological parameters and red blood cell indices was investigated in otherwise healthy unselected mid-age women prior to elective gynaecological surgery. METHODS: Red Blood Cell-deformability (RBC 1.2, 3.0; 6.0, 12.0; 30.0, 60.0) during exposure to low (RBC 1.2, 3.0), moderate (RBC 16.0, 12.0) and high shear forces (RBC 30.0, 60.0; Rheodyn; Myrenne), -aggregation (MA1; Myrenne) during low shear (E1; 4-1 S) and in stasis (E0) and plasma viscosity (Pv; KSV 1; Fresenius) were correlated with red blood cell indices (RBC-I: MCV, MCH and MCHC) and subjects' characteristics in 286 healthy women the day before undergoing gynaecologic standard surgery. Women with known pregnancy, malign-, infective-, chronic-disease or extreme BMI (<16; >40 Kg/m2) were excluded from this trial. RESULTS: From June 2014 to December 2014 a total of 286 healthy women (age: 46.5?17.6 y; BMI: 25.5?5.2 kg/m2) were eligible for inclusion into this prospective evaluation. Pv (mean?SD: 1.17?0.12 mPa s) and RBC aggregation (E0:12.6?6.3; E1:17.9?7.3) were not significantly correlated with RBC-I but with age and BMI. In contrast, RBC-deformability correlated significantly with MCV and MCH but significantly inversely correlated with MCHC. Deformability significantly increased with age but was unaffected by BMI of women. The correlation between RBC-I and RBC deformability was most remarkable during moderate shear force exposure. Neither haemoglobin nor haematocrit were correlated with RBC deformability or RBC-I. CONCLUSIONS: Cell volume and haemoglobin content had a strong impact on deformability in apparently healthy mid age women, whereas low MCHC and large MCV were associated with an increase in deformability while high MCHC and small MCV correlated with increased rigidity of RBC. BMI had no impact on deformability while age was associated with an increase in all determinants of blood viscosity. RBC aggregability was not affected by MCV, MCHC or MCH in mid-age women.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
MCHC
MCV
Plasma viscosity
red blood cell aggregation
red blood cell deformability MCH
Megjelenés:Clinical Hemorheology And Microcirculation. - 62 : 1 (2016), p. 45-54. -
További szerzők:Schelkunov, Olga Demirhan Attila Tsikouras, Panagioti Rath, Werner Velten, Eva Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász)
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12.

001-es BibID:BIBFORM072236
Első szerző:Tempelhoff, Georg-Friedrich von
Cím:Rheological, hemostaseological changes during immunetherapy for prevention of HELLP-syndrome in a patient with elevated phospholipid antibodies / von Tempelhoff Georg-Friedrich, Tsikouras Panagiotis, Rath Werner, Velten Eva, Csorba Roland
Dátum:2015
ISSN:1386-0291
Megjegyzések:OBJECTIVE: Patients with a history of severe obstetric complications in the presence of elevated phospholipid antibodies are at high risk for recurrent obstetric debacle. We report a successful immunologic treatment for prevention of HELLP-Syndrome in subsequent pregnancy in a patient with elevated Phospholipid antibodies, while under rheological and hemostaseological monitoring. METHODS: The patient with prior severe HELLP-Syndrome at term in the presence of reconfirmed elevated phospholipid antibodies in her first pregnancy received pooled immunoglobulins (Sandoglobulin 3 g - Novartis) intravenously for immunological treatment every three weeks in addition to low molecular weight heparin (Clexane 40 mg/d s.c.) and Aspirin (100 mg/d from 2nd trimester) during her subsequent pregnancy. Before each of 10 treatment cycles blood rheological parameters (Red Blood cell {RBC} aggregation stasis E0, low shear E1, RBC - deformability low-, moderate-, and high shear force, plasma viscosity {Pv}), as well as thrombelastometry (ROTEM) and in vitro platelet function (PFA-100) for hemostaseological evaluation was performed. At the same times non-invasive, physical thrombosis screening took place using impedance plethysmography (Filtrass) RESULTS: During pregnancy a constant increase in PV and E1 (>45 S-1) was accompanied by a delayed but continuous increase in RBC deformability beginning at the end of the 2nd trimester. Thrombelastometry revealed a continuous reduction of clot formation time (CFT; extem: 84 to 38 sec) and an increase in maximal clot firmness (MCF; extem: 64 to 78 sec) after TF-induced coagulation activation while MCF and CFT after contact activation (intem) was barely unchanged. Platelet bleedingtime after EPI/Coll stimulation was temporary prolonged by the onset of Aspirin intake (>300 sec) but normalized soon after 20th gestational week, while ADP/Coll stimulation revealed a trend towards prolonged bleeding times at the same time. There was a strong and statistically significant inverse correlation between E1 and TF induced CFT (r =-0.82; p = 0.002) and a positive correlation between E1 and TF induced MCF (r = 0.89; p < 0.001), while the correlation between E1 and contact activated CFT and MCF was weak or absent, respectively. Until GW 38th routine laboratory- (Platelet-count, Haptoglobin, liver enzymes) and clinical findings remained normal, without evidence of HELLP-Syndrome reoccurrence or development of thrombosis. CONCLUSIONS: During immunotherapy in this high risk patient HELLP-Syndrome did not reoccur. The aggregability of RBC was closely related with the formation speed and firmness of clot after TF activated coagulation but not after contact activated coagulation. At the beginning of 3rd trimester RBC aggregation remained dramatically higher as compared to the normal value range of pregnant women found in a large recent trial which may have been an early indicator of imminent HELLP-Syndrome.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
antiphospholipid syndrome
HELLP syndrome
immunological treatment
plasma viscosity
platelet function
Pregnancy
red blood cell aggregation
thrombelastometry
Megjelenés:Clinical Hemorheology And Microcirculation 60 : 1 (2015), p. 123-131. -
További szerzők:Tsikouras, Panagioti Rath, Werner Velten, Eva Csorba Roland (1972-) (szülész-nőgyógyász, gyermeknőgyógyász)
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