SummaryTo assess the role of the fibrinolytic system in the pathogenesis of restenosis after percutaneous transluminal coronary angioplasty (PTCA), we determined the components of this system in a retrospective study, including 16 patients with restenosis (gr. A) and 19 patients with long-term success (gr. B). In both groups at baseline fibrinolytic activity (FA) is unchanged, whereas tissue plasminogen activator antigen (tPA-Ag) is significantly increased (gr. A: 147.0%; gr. B: 139.8%; p <0.01). Fibrinolytic capacity (FC) and tPA-Ag release are significantly reduced in the restenosis group (FC: 46.5%, p <0.05; tPA-Ag release: 48.3%, p <0.01) compared to normal controls as well as to gr. B (FC: 84.3%, p <0.05; tPA-Ag release: 79.0%, p <0.05).Relating to the contact activation system, F XII (79.5%, p <0.05) is significantly, and F XI (82.3%) is clearly reduced in gr. A. Protein C (PC) is significantly elevated in gr. B (117.5%, p <0.05). There is a negative correlation between plasminogen activator inhibitor (PAI 1) and HDL-cholesterol (r = 0.37, p <0.05).It appears, that there is a typical pattern of defective fibrinolysis in patients with restenosis after PTCA and that this might be a pathogenetic factor in the development of restenosis.

Coagulation studies were performed in a patient who had been bitten by a snake of the species Bothrops neuwiedi. The patient presented with hemorrhagic necrosis at the envenomization site and considerable bleeding from venous puncture sites. He developed a severe defibrination syndrome with a clottable fibrinogen level of approximately 0.1 g/l. Fibrinogen was not measurable by clotting time assay. Fibrin degradation products were greatly elevated. Treatment with antivenom caused an anaphylactic reaction within ten minutes and serum sickness after three days. In vitro experiments revealed that B. neuwiedi venom directly activates Factors II and X, but does not activate Factor XIII. In vivo consumption of Factor XIII after B. neuwiedi envenomization is ascribed to the action of Factor IIa. At low venom concentrations clotting is initiated by activation of prothrombin by the venom either directly or via Factor X activation. Treatment with heparin might be beneficial in coagulopathy secondary to snake bite by reducing circulating active thrombin. The venom contains thrombin-like proteases which cause slow clotting of fibrinogen, and plasmin-like components causing further proteolysis of fibrinogen and fibrin. Antivenom has no effect on the proteolytic action of the snake venom. The in vivo effects of antivenom are presumably caused by acceleration of the elimination of venom components from the circulation. Intravenous administration of antivenom caused normalization of blood coagulation parameters within 48 h.

Summary. Background: In recent years it has become clear that the molecular investigation of hypofibrinogenemia provides unique insight into regions of the fibrinogen molecule that are important in molecular assembly, secretion and stability. Objectives: To investigate a case of hypofibrinogenemia at the molecular level. Patients and methods: The study was conducted on a 37-year-old woman from Mannheim, Germany, who had an antigenic plasma fibrinogen concentration of 0.86 g L )1. Mutation screening was performed by DNA sequencing and the effect of the identified mutation was investigated at the protein level. Results: Analysis of exon 8 of the fibrinogen c gene identified a heterozygous CAT fi TAT transition at codon 307. This novel His fi Tyr substitution was not detected when plasma fibrinogen was analyzed by electrospray ionization mass spectrometry. The mutation predicts a mass increase of 26 Da in the c chain, but purified c chains had a normal mass, indicating non-expression of the c Tyr307 chain in plasma fibrinogen. Conclusions: This work reports a novel c307 His fi Tyr mutation (fibrinogen Mannheim II) that causes hypofibrinogenemia. Crystal structures show that His307 is located immediately adjacent to three residues that have been implicated in fibrin polymerization at the D:D interface. However, the histidine residue appears critical in maintaining structure of the fibrinogen cD domain, rather than in determining function.

The molecular basis of hypofibrinogenaemia was investigated in a 34-year-old woman and her 10-year-old daughter. DNA sequencing revealed a single heterozygous GCC-->GTC transition in exon 8 of the fibrinogen gamma ?gene in both subjects, predicting a novel gamma289 Ala-->Val substitution. Examination of fibrinogen gamma ?chains by electrospray ionization mass spectrometry failed to detect the variant chain in plasma fibrinogen. Further evidence for its non-expression came from tryptic peptide mapping. The mutation predicts a mass increase of 28 Da in peptide T32, but only the normal (M + 2H) ion was detected at 1418 m/z in the proposita. Our finding that gamma289 is an important determinant of plasma fibrinogen levels highlights the role of mutational analysis in defining structurally important regions of the fibrinogen molecule. This case suggests that the highly conserved Ala(289) is important in maintaining structure of the "a" polymerization site via hydrogen bonding to Thr(371).

We report on the case of a 49-year-old man who presented with increasing dyspnea and a skin rash. The community-acquired pneumonia was initially treated with broad spectrum antibiotics. The patient's respiratory condition rapidly worsened and the clinical picture of Waterhouse-Friderichsen syndrome developed with disseminated intravasal coagulopathy and necrosis of the toes. An infection with Capnocytophaga canimorsus, which had been caused by an initially unmentioned dog bite was confirmed. In view of the fulminant course and the high risk of operative treatment of the ubiquitous necroses in all limbs, a joint decision for deescalation of therapy was made together with relatives. The patient died 14 days after admission to hospital.

Long-term result of pulmonar)', thromboendarterectomyZusammenfassung Die pulmonate Thrombendarteriektomie ist vor einer Lungentransplantation die wichtigste Therapieform fª Patienten mit persistierender pulmonaler Hypertonie nach einer Lungenembolie. Die vorgestellte Kasuistik berichtet ª eine junge Patientin mit juvenilem Diabetes mellitus. W~ihrend eines station~.ren Aufenthaltes kam es katheterassoziiert zu einer Staphylokokkensepsis mit T¡ und nachfolgender ausgedehnter Lungenembolie. Vier Jahre nach dem Ereignis wurde aufgrund einer zunehmend verminderten Belastbarkeit wegen h6hergradiger pulmonaler Hypertonie eine erfolgreich verlaufende pulmonale Thrombendarteriektomie durchgefª Im Langzeitverlauf kam es zu einer deutlichen Besserung der Belastbarkeit und Lebensqualit~it, die Patientin ist wieder voll arbeitsf¡ und konnte nach unproblematischer Gravidit~it ein gesundes Mfidchen gebfiren.Summary Pulmonary thromboendarterectomy presents ah efficient option of treatment for patients with ehronic pulmonary hypertension after pulmonary thromboembolism. We report about the case of a young lady with juvenile diabetes mellitus. During a hospital stay she suffered a catheterassociated endocarditis of the tricuspid valve and pulmonary thromboembolisto. Four years after the event she hada lower exercise tolerance due to pulmonary hypertension and underwent a pulmonary thromboendarterectomy. During long time follow-up her exercise tolerance normalized and she had ah uneventful delivery of a girl, Schlfisselw6rter Pulmonale Thrombendarteriektomiepulmonale Hypertonie -Lungenembolie Key words Pulmonary thromboendarterectomypulmonary hypertension -pulmonary thromboembolism 228 Zeitschrift fª Herz-, Thorax-und GelTJBchirurgie.

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Biochemical hallmark of HANE is a reduction of C1-inhibitor. We observed a family with type II disease ( non-functional protein ), in which 3 of 6 affected members had arterial thromboembolic events at young ages. For evaluation of alterations in the hemostatic system analysis included: fibrinogen, FVII, FVIII, FIX, FXI, FXII, prekallikrein PK, antithrombin III ATIII, protein C PC, α2 antiplasmin α2AP, cl α2 macroglobulin α2 MG, plasminogen activator inhibitor PAI, plasminogen PG, euglobulin clot lysis time ECLT and tissue plasminogen activator tPA at baseline and after venous occlusion. The results are shown in part in the table:There is evidence of nearly no response to venous occlusion in 2 and a diminished response in 1 out of 4 patients.We conclude, that the increased thrombotic tendency in this family is related to the increased potential of prephase coagulation factors and impaired fibrinolytic response to venous occlusion concomitantly with the reduction of the main inhibitor of the contact activation system.