Tourniquet Test Research Articles

THE ANALGESIC EFFECT OF HALOTHANE

The effect of halothane on experimental ischaemic muscle pain has been studied in 18 human volunteers. The submaximum effort tourniquet test was used in this investigation because it has been shown by previous workers to be a sensitive experimental test of analgesia. Two concentrations of halothane (0.25 and 0.35%) were compared with nitrous oxide (30%) in a controlled experiment. It was found that halothane 0.35% is of the same order of effectiveness as an analgesic as is nitrous oxide 30%. Halothane 025% appeared to have no analgesic action, and the possibility of a slight antanalgesic action at this concentration could not be eliminated. The practical effects of this finding are reviewed, and it is suggested that this finding taken with the work of other investigators indicates that halothane should be considered as an analgesic drug, and that the application of the term antanalgesic to this agent is misleading.

Effect of alpha- and beta-blocking drugs on the clotting and fibrinolytic response to venous status in man.

Summary. The changes in coagulability and in fibrinolytic activity induced in local blood by venous stasis in man are not prevented by blocking of alpha‐ and beta‐adrenergic receptors.Administration of l‐propranolol and of l‐propranolol plus phentolamine in adequate doses just before the execution of a tourniquet test failed to inhibit the major changes, i.e. rise in factor‐VIII level, shortening of partial thromboplastin time (PTT) and euglobulin lysis time (ELT), hypercoagulable pattern on thromboelastogram, following venous stasis. Some other clotting tests remained unchanged in all experimental conditions.Physiopathological implications of these results are discussed, taking into account the possible role of the adrenergic system in the control of a postulated equilibrium between blood coagulation and fibrinolysis.

Febrile penicillamine eruption.

SEVEN of 21 Chinese patients with Wilson's disease had an acute febrile reaction five to ten days after starting penicillamine therapy. This included a maculopapular (morbilliform) rash, fever, lymphadenopathy, increase in size of the spleen and liver, edema, weight gain, microscopic hematuria and minimal proteinuria, coryza, inflamed throat, and positive tourniquet tests. A similar reaction occurred in a normal volunteer subject. Petechiae and decreases in white blood cell and platelet counts occurred in patients treated the longest after onset of symptoms. Eosinophilia was minimal. Skin biopsies from three patients demonstrated chronic inflammatory cells distributed particularly around small blood vessels, and were compatible with a drug reaction. Abnormal findings cleared three to five days following discontinuation of penicillamine. In three patients symptoms recurred when penicillamine was reinstituted at the same dosage. Desensitization was accomplished by starting at low doses and increasing at weekly intervals. On every occasion the program was

The vascular component in hemostasis.

ACCORDING to the concept that hemostasis is the resultant of an evolutionary development,1 vascular contraction was the first and the most primitive phase. This was followed by the appearance of a blood cell possessing the property of agglutination, and the final phase was the acquisition of the ability to form a fibrin clot. Even today, the role of the vascular component is still poorly defined, and only two simple tests are available to the clinical laboratory for study of the vascular response when injury occurs — the bleeding time and the tourniquet test. Neither procedure has been rigidly standardized and . . .

Clinical Profile of Dengue Fever in Children

Background: Dengue infection has become endemic in Bangladesh since it hasbeen broken out in June 2000. Although children are the usual victim of dengueinfection, there is paucity of published data regarding dengue infection in children inour country.Objectives: This study was designed to document the presenting features and outcomeof Dengue infection in children.Materials and Methods: This cross sectional study was done among the childrenhaving Dengue infection. Fifty four consecutive patients were enrolled. Purposivesampling was done. In every patient a detailed history was taken. Clinical examinationsand relevant investigations were done. Data were collected in a predesigned structuredquestionnaire. Data were analyzed with the help of descriptive statistics and Chisquare(x2) Test.Results: The mean age of the patients was 6.5±3.5 years with equal male and femaleratio. Among 54 patients, 40.7% presented with dengue fever (DF), the rest (59.3%)presented with dengue haemorrhagic fever (DHF). Most of the patients presented withhigh grade continued type of fever (75.9%), followed by abdominal pain (59.3%),vomiting (57.4%). Itchy rash and fever were the most important characteristic signs(75.9% each). Flushed appearance observed in 68.4% and 59.3% patients showedbleeding manifestation of which sub-conjunctival haemorrage was the commonestform (33.3%). Leucopenia were present in only 9.3% of the patients. Platelet countless than 100×109/L were found in 68.5% patients. Tourniquet test was positive in31.5% of cases. All of the patients had packed cell volume (PCV) less than 45%.Raised serum alanine aminotransferase (ALT) was observed in 40.7% of children.IgM and/or IgG antibodies for dengue virus were positive in 96.29% patients. Majority(94%) of the patients completely recovered from the disease and only 6% died.Conclusion: High grade continued fever, vomiting with abdominal pain and itchy skinrash (with normal platelet count) were the presenting features. Commonest form ofbleeding manifestation was subconjunctival haemorrhage. Bleeding manifestationhad a significant association with the degree of thrombocytopenia but no corelationwas observed with tourniquet test positivity.Key words: Dengue fever (DF); dengue haemorrhagic fever (DHF); paediatric.DOI: 10.3329/bjch.v33i2.5678Bangladesh Journal of Child Health 2009; Vol.33(2): 55-58

Clinical Profile and Outcome of Dengue Hemorrhagic Fever in a Tertiary Care Hospital in Dhaka

Background: Dengue has become endemic in Bangladesh since 2000. The cases are being encountered each year particularly in urban areas. Thus, Dhaka, Chittagong, Rajshahi, Khulna and other cities are commonly affected areas. We sought to get a profile of dengue hemorrhagic fever (DHF) in a tertiary care hospital in the Dhaka city.Methods: This direct observational study was undertaken from June to October 2008 among the hospital admitted patients with a diagnosis of DHF.Result: Out of 55 patients with DHF, 87.27% came from urban areas. About 43.64% patients showed various types of active bleeding in association with different clinical features. 100% patients had relative bradycardia. Tourniquet test was positive in 43.63% patients. IgM and/or IgG antibody titer to dengue virus were positive in 85% cases.Conclusion: The clinical picture of Dengue is not as diverse as other regions of the world and the National guideline is till now found to be effective in adequate management, Â doi:10.3329/jom.v10i1.1996 Â J Medicine 2009; 10: 12-15 Â

Dengue d chikungunya virus infection in man in Thailand, 1962-1964. II. Observations on disease in outpatients.

A clinical and virologic investigation of the amount and nature of disease caused by infection with dengue and chikungunya viruses in 323 outpatients in Bangkok Children's Hospital was done during 1962–1964. For 317 patients, attempts to isolate enterovirus and arbovirus and arbovirus serologic studies were done. Of these patients, 26 (8.0%) had chikungunya and 94 (29.1%) had dengue infection. Of the latter, 66% had secondary type of group B antibody responses. A positive tourniquet test, cool extremities, and palpable liver were seen with equal frequency in patients with either primary or secondary dengue infections. Thrombocytopenia was observed only during secondary dengue infection. Males predominated in all etiologic categories except secondary dengue infections. Nearly 50% of patients with chikungunya or with primary or secondary dengue infections had a clinical diagnosis of “upper-respiratory illness.” We concluded that 1) capillary damage and moderate liver enlargement may be a part of the “normal” pathologic response to primary dengue infection in children; 2) during secondary dengue infections there may be a clinical continuum from attenuated illness to “normal” dengue to disease characterized by severe capillary damage and abnormalities in the blood-clotting mechanism (hemorrhagic fever); 3) secondary dengue infections are more severe in females than males; and 4) chikungunya and dengue viruses are a cause of outpatient “upper-respiratory illness” at epidemic proportions.

Dengue and chikungunya virus infection in man in Thailand, 1962-1964. I. Observations on hospitalized patients with hemorrhagic fever.

A 3-year clinical, virologic, and serologic study of 639 children admitted to Children's Hospital and the SEATO Clinical Research Center, Bangkok, was undertaken to define the entity “Thai hemorrhagic fever” as diagnosed by house staff. Two groups of control patients were studied to measure “background” dengue and chikungunya infections in the hospital population. Of 628 patients with hemorrhagic fever with specimens adequate for study, 32% were in shock, 83 and 7.6% had dengue and chikungunya illnesses, respectively, and no etiology could be established in 12%. In each year, more than 80% of patients with hemorrhagic fever had confirmed dengue infections, but only 19% of febrile patients admitted for diagnoses other than hemorrhagic fever had dengue, and 4% may have contracted dengue in hospital. More than 85% of patients with dengue had a secondary type of antibody response to other group B arboviruses. In chikungunya disease, the onset of symptoms was more abrupt, the febrile course shorter, and maculopapular rashes, conjunctival injection, and arthralgia were more common than in dengue; the frequency of a positive tourniquet test, scattered petechiae, and epistaxis was similar, but shock and gastrointestinal hemorrhage occurred only in dengue patients. We concluded that Thai hemorrhagic fever had a varied etiology and diverse clinical manifestations. A redefinition of “hemorrhagic fever” to include only shock cases excluded chikungunya cases. When the illness was characterized by fever and mild hemorrhagic manifestations, it was impossible to distinguish in the individual case among dengue, chikungunya, and other infections.

Hemostatic risk: Preoperative assessment

Routine preoperative assessment of hemostatic risk is recommended. From 1964 to 1969 approximately 1 per cent of the patients were found preoperatively to have abnormal bleeding problems which could have gone undetected if they had not been specifically looked for. The significance of the history, physical examination, complete blood count (including estimate of platelets), partial thromboplastin time test, prothrombin time test, and tourniquet test is discussed. Some illustrative cases are presented.

Von Willebrand's disease: Report of a case

A case of Von Willebrand's disease has been presented. This familial disorder of great variability is characterized by prolonged bleeding time and a deficiency of a coagulation factor. A careful history is important in helping to determine the presence of a bleeding disorder. Repeated bleeding time determinations (Ivy method) and tourniquet tests are recommended for any patient whose history is suggestive of a bleeding disorder. An assay of Factor VIII is necessary before a diagnosis of Von Willebrand's disease can be made. Surgical procedures can be carried out safely if fresh frozen plasma is given preoperatively and immediately postoperatively. Continued transfusions usually are not required.

Thrombocytopathies in patients with open-heart surgery. Preoperative treatment with corticosteroids.

THE DEVELOPMENT of a hemorrhagic diathesis following an open-heart operation is a serious complication. 1 Hemorrhagic disease may develop as a function of: (1) abnormalities directly related to extracorporeal circulation such as thrombocytopenia, defibrination, or fibrinolysis, 2 (2) depressed coagulation factors associated with hepatic decompensation, (3) occult thrombocytopenia occurring in the setting of congestive splenomegaly or drug purpura, 3 and (4) subclinical qualitative defects of platelet function. Combinations of these abnormalities may also occur. In order to decrease the possibility of hemorrhagic complications following openheart procedures, a comprehensive coagulation study has been performed upon all adult patients at The New York Hospital-Cornell Medical Center who were candidates for open-heart surgery over the past 3½ years. Included in the comprehensive coagulation study have been the following determinations: clotting time (Lee-White), bleeding time (Duke), tourniquet test (Rumpel-Leede), clot retraction (Qualitative), platelet estimate (blood smear), platelet count (Phase), fibrinogen (Fowell), fibrinolysis (Euglobin), prothrombin

Technique and Practical Problems: The Tourniquet Test the Influence of Age or Hemorrhagic Disorders on the Distribution and Size of Petechiae

(1965). Technique and Practical Problems: The Tourniquet Test the Influence of Age or Hemorrhagic Disorders on the Distribution and Size of Petechiae. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 17, No. 6, pp. 607-613.

Technique and Practical Problems: The Tourniquet Test the Influence of Age or Hemorrhagic Disorders on the Distribution and Size of Petechiae

Technique and Practical Problems: The Tourniquet Test the Influence of Age or Hemorrhagic Disorders on the Distribution and Size of Petechiae

FAMILIAL SCHAMBERG'S DISEASE.

Schamberg's disease, an uncommon disorder of the skin, is manifested by asymptomatic brown macules and petechiae distributed primarily on the lower extremities. 1-3 Since the disease is of a benign nature, it is important to distinguish it from the more serious disorders which produce bleeding in the skin. Except for a positive tourniquet test in about half the patients, 3 no hematologic abnormalities have been described. The histopathologic picture is characterized by inflammation of the capillaries in the upper dermis, diapedesis of red cells, and the deposition of hemosiderin. Although the changes in the skin may last for months, the prognosis for complete recovery is excellent. The etiology remains obscure, but there have been reports suggesting that irritation from chemicals in clothing may play a role in some patients. 4 The purpose of this paper is to describe a previously unreported finding in this disorder, its occurrence in two members

Coexistence of von Willebrand's disease and hemophilia in a family.

In the family of a woman who has von Willebrand's disease and who is a hemophilia carrier, two daughters have hemophilic sons. One of her sons, two daughters, and one granddaughter have von Willebrand's disease. None is known to have inherited both diseases. The coexistence in one individual of the hemophilic carrier state and von Willebrand's disease does not appear to accentuate the bleeding tendency. Hemophilia was diagnosed by the prolonged clotting time and the defective prothrombin consumption time, with both the basic and the modified (with added hemolysate and aged serum) methods. Von Willebrand's disease was diagnosed by the type of bleeding, the hereditary pattern of an autosomal dominant, a prolonged bleeding time, and a positive tourniquet test. In both diseases, good therapeutic results were obtained by transfusions of fresh frozen plasma.

The Detection of platelet defects in patients with mild bleeding disorders: Use of a quantitative assay for platelet factor 3

Eight patients with mild bleeding disorders were investigated. Routine studies of hemostasis which included platelet count, prothrombin time, thromboplastin generation test, clot retraction and bleeding time gave normal results. In several of the patients, mild or variable abnormality was noted in the tourniquet test or serum prothrombin time, and in one patient the bleeding time was prolonged on two occasions. Using a quantitative assay for platelet factor 3 in which platelet suspensions of constant, low concentration were used in the thromboplastin generation test, all were found to have decreased factor 3 activity. Other platelet functions were normal. A comparison of these patients with previously reported cases of platelet defects and with the von Willebrand syndrome is made.

Coagulation Disorders in Thrombocythaemia, a Study of Seven Cases

SummaryThe blood coagulation system has been studied in 7 patients with thrombocythaemia. 4 of these patients had thrombocythaemia after splenectomy, 2 of them had thrombocythaemia associated with myeloid leukemia, and 1 thrombocythaemia associated with polycythaemia. Severe bleeding episodes were noted in 5 cases, 2 patients had only mild bleeding symptoms.Each patient was examined several times. The period of observations varied from 2 months to 3 years. Platelet count varied from 350 000 to 3 800 000 per mm3.Bleeding time and tourniquet test were normal in all cases. Routine coagulation and fibrinolysis studies did not reveale characteristic abnormalities in plasma clotting factors. A decrease of prothrombin complex components was observed in 4 cases. This disturbance was due to the coexisting injury of liver parenchyma or myeloid changes but not to an increase of platelets or to the abnormalities in the platelet system.An increase of antiheparin activity was found in the plasma of 4 patients. This activity is probably due to the escape of platelet factor 4 from destroyed or qualitatively changed platelets into plasma.Platelet clotting factors were investigated in isolated platelet suspensions, A significant decrease of platelet factor 1 was observed in all patients and a decrease of platelet factor 4 in 5 patients. In 2 cases platelet factor 4 increased. Platelet thromboplastic activity showed a great variety of disturbances in conformity with other workers observations.Recent views on the pathogenesis of bleedings in thrombocythaemia are discussed. On the basis of their own investigations the authors suggest that the significant disturbances of platelet function may contribute to the development of bleeding, and that the increase of antiheparin activity in plasma may produce hypercoagulability and favorize the formation of thrombi.

The Hemostatic Effect of Adona (AC-17)

SummaryIn normal individuals 50 mg Adona (AC-17) intravenously increased capillary resistance, and slightly shortened the bleeding time. No effect was observed on coagulation or platelets.In patients undergoing prostatic surgery the drug seemed to reduce the blood loss during the operation.50 mg Adona (AC-17) was given to 11 patients with a prolonged bleeding time of various causes, and to 8 patients with a positive tourniquet test. No effect could be demonstrated. However, the drug may be of value in some patients with acquired, ill-defined, presumably vascular diseases.

Hemopericardium with cardiac tamponade in chronic uremia.

DURING the past thirty years the number of diverse clinical manifestations of chronic uremia appearing in the medical literature has steadily increased. Important among these is a hemorrhagic tendency characterized by normal bleeding and clotting times, normal or slightly depressed prothrombin time and prothrombin consumption, normal platelet count and a negative tourniquet test. The 2 cases discussed below represent another example of hemorrhagic tendency associated with chronic uremia — namely, hemopericardium with cardiac tamponade. They are reported because of their interest and because a fatal result may ensue if the hemopericardium is not promptly detected and treated.1 Whereas the hemorrhagic . . .

Studies of Hemostasis in the Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome is a congenital hereditary dystrophic abnormality characterized by (a) fragility of the skin and blood vessels, (b) hyperelasticity of the skin, and (c) hypermobility of the joints, showing additionally at times, pseudotumors over bony prominences, calcified subcutaneous nodules, and skeletal anomalies. Easy bruising of the skin with the formation of hematomas represents one of the more frequent and important manifestations of the syndrome, and may bring the patient to the attention of a hematologist before he is seen by a dermatologist. However, studies of the hemostatic mechanism in this unusual condition are incomplete and inconclusive. Rossi and Angst (1) found no abnormalities of bleeding time, clotting time, prothrombin time, or Rumpel-Leede test. The second case of Ronchese (2) also had a normal bleeding and clotting time. Samuels et al. (3) and Pascher et al. (4) report cases showing positive tourniquet tests. Smith et al. (5) are the only authors who report a prolonged clotting time, found in one patient. Benjamin and Weiner (6) report two children with this diagnosis, in whom the bleeding time, clotting time, clot retraction, and platelet counts were normal. A “test of capillary resistance”, method not described, was done on one patient and found positive. Kanof (7) indicates, in reviewing the chemical and laboratory findings of this syndrome, a number of similarities to hyperadrenocorticism in which capillary fragiUty is also present. He also points out that low vitamin C levels have been reported in attempting to explain the vascular fragiUty. Laane (8) reports an instance of Cushing's syndrome and Ehlers-Danlos syndrome in the same patient, indicating fragiUty of the skin and blood vessels but no laboratory data for hemostasis.