Influence of hemosorption on hemostasis in patients with sepsis

The changes in the system of hemostasis were studied in 36 patients with sepsis managed with sorptive detoxication. The starting status of the system of hemostasis in patients with favorable outcome of the disease can be considered as the 2d stage of the disseminated intravascular coagulation (DIC), and in patients with the unfavorable outcome--as the 3d (hypocoagulative) stage. The sorptive detoxication provides the treatment of the DIC syndrome in favorable outcome, as well as further progression of the process in unfavorable outcome of sepsis. Conservative treatment provides stabilization of the hemostatic system and gives opportunity to perform delayed hemosorption with a positive clinical result.     

Efficacy of immunosorption in patients with systemic lupus erythematosus: double blind controlled trial

Efficacy of immunosorption (IS) employing perfusion of whole blood through activated charcoal containing DNA was studied in 11 patients with systemic lupus erythematosus (SLE). 11 SLE patients exposed to hemosorption on charcoal free from DNA served as controls. When used in combination with intensive therapy (corticosteroids and cytostatic immunosuppressant), IS produced a positive effect on lupus nephritis symptoms in 8 out of 10 patients with kidney affection. AntiDNA antibodies blood level decreased by 53.6% after two IS procedures, while only by 36.4% after nonselective hemosorption. Reduced count and functional activity of B-cells recorded after IS contribute much to final outcome of the treatment.     

The evaluation of the efficacy of hemosorption and plasmapheresis in IHD complicated by chronic heart failure

Hemosorption and plasmapheresis were studied for effects on lipid peroxidation, antioxidant blood activity, platelet hemostasis, microcirculation, myocardial contractility and intracardiac hemodynamics. The results demonstrated that antioxidant blood response is a key criterion responsible for decreased efficacy of hemosorption and plasmapheresis in patients with progressive angina pectoris with chronic heart failure. The results of hemosorption and plasmapheresis in the above patients may become better if an adjuvant antioxidant therapy is used.     

Traditional and "lesser" hemosorption in the treatment of bronchial asthma patients]

Based on a comprehensive comparative characterization relying on clinical, functional and allergological indices in 110 patients with bronchial asthma, a conclusion was drawn to the effect that traditional hemosorption (HS) involving the use of a sorbent 400 ml in capacity is more efficient procedure than commonly named "lesser" hemosorption with a 100 ml capacity sorbent. It is advisable that in patients with bronchial asthma, HS should be done only with 400 ml volume sorbents.     

The clinico-immunological parallels of hemosorption using different sorbents in the treatment of bronchial asthma patients

A comprehensive clinical and functional and allergo-immunological comparative evaluation was done of hemosorption involving the KAU, SKN hemosorbents, "Gemosfer" and a DNA-containing sorbent in 341 patient with bronchial asthma. SKN sorbent were found out to have a more pronounced positive effect on clinical signs and functional activity of immunocompetent cells. The above sorbents appeared to significantly enhance sensitivity of bronchial beta-adrenoreceptors; besides, they allow the dosages of systemic corticosteroids to be substantially brought down. The KAU and "Gemosfer" hemosorbents caused, to a certain degree, a blockade of the phagocyte system of blood, and, to a considerably lesser extent, affected the level of autoimmune processes. Thus, hemosorption should involve SKN sorbents or an SKN-based DNA-containing sorbent.     

Hemosorption and transfusion therapy in diffuse peritonitis

A combination of the transfusion therapy and hemosorption for the treatment of patients with diffuse peritonitis was followed by a considerable improvement of the general state of the patients and a pronounced regression of peritoneal symptoms. The complex therapy in addition to the desintoxication effect was found to result in an improvement of rheological properties of blood which opens new prospects in the treatment of patients with peritonitis.     

Synchronous intensive treatment for patients with systemic lupus erythematosus having poor life prognosis]

Synchronous intensive treatment (SIT) involving two-stage programmed use of pulse therapy (PT), plasmapharesis (P) or hemosorption with methylprednisolone and cyclophosphamide was performed in 56 patients with systemic lupus erythematosus (SLE). All the patients were found to have a combination of factors showing a poor life prognosis: the onset of SLE in adolescence or youth (52%), nephritis (70%), arterial hypertension (54%), cerebropathy (50%), generalized vasculitis (34%), cryoglobulinemia (66%). After a year therapy, remission and the minimum progression were observed in 19.6 and 53.6%, respectively. The highest effect of SIT was found in the patients with SLE of duration of under a year and with the highest progression. A long-term follow-up that lasted 78 +/- 24 months revealed persistent improvement, the minimum activity and remission in 71% of patients. The synchronous programmed use of P and PT produces a rapid and effective impact on clinical and laboratory manifestations and improves life prognosis in patients with SLE.     

HIV-related encephalopathy

The questionnaire data of 860 patients with bronchial asthma (BA) and the 7-year catamnestic investigation depth were analysed. According to clinical effect achieved the extracorporal methods of the patients with BA treatment were ranked in such a manner: splenosorption, immunosorption to DNA, which contains the sorpents, the conventional method of hemosorption (HS), using the SKN sorpent, plasmapheresis and the ultra-violet irradiation of blood (UVIB). The applicational efficacy of HS using KAU and "Gemosfer" sorpents is significantly lesser than such of SKN sorpents. UVIB do not effects late follow-up results of the hormonally-dependent patients treatment.     

Hemosorption in the prevention of severe forms of hemolytic disease of the newborn in rhesus sensitization

A total of 164 hemoperfusions were administered to 60 pregnant patients with Rh sensitization and a history of perinatal death of the newborns from hemolytic disease. Hemoperfusion was found to decelerate the progress of hemolytic disease of the newborns promoting delivery of babies with more benign forms of the disease. The method efficacy was 76%. Dynamic follow-up of fetal functional status over the course of hemosorption treatment by examinations of biophysical profiles and ultrasonic dopplerometry has shown no negative effects of this treatment modality on fetal status.     

Intensive care of myelotoxic agranulocytosis using nonselective plasmapheresis

Plasmapheresis had a marked therapeutic effect in 14 cancer patients with grave myelotoxic complications of antitumor therapy: 13 of these patients survived, felt better, isosensitization to drugs and blood preparations was eliminated, the efficacy of common detoxifying and blood-substituting therapy improved. The therapeutic effect of the procedure was obvious even in the patient who died: the anuretic stage of acute renal failure changed for the polyuretic one. Plasmapheresis caused the most pronounced shifts in the system of homeostasis maintenance. The activation of the organism's autocleansing was attended by positive laboratory and clinical shifts.     

The comparative efficacy of hemosorption and xenosorption in bronchial asthma patients

The authors studied comparative clinical, immunologic, laboratory and functional effectiveness of hemosorption (HS) on charcoals and xenosorption (XS) on donor pig spleen in bronchial asthma patients. XS was administered in 60 patients, HS was applied to 91 patient. There was no significant difference in immunologic characteristics between the patient groups. However, XS had a more apparent positive influence on the external respiratory function, degree of allergy and unspecific inflammation, as well as on general clinical effectiveness.     

Implantable catheter systems. Experiences with 1000 patients with central venous ports

OBJECTIVE: To assess retrospectively duration of functioning and rate of complications of a totally implantable venous access system used for long-term chemotherapy. PATIENTS AND METHODS: Between 1985 and 1993, a central venous access system (Port-a-Cath) had been implanted subcutaneously for long-term chemotherapy in 1000 patients (479 males, 521 females; mean age 49 [15-86] years). Follow-up observations lasted until the end of the chemotherapy or the removal of the system. RESULTS: Mean time of functioning of the catheter system was 284 (2-1563) days. The complication rate was 12.8%: catheter infection in 4.9% and catheter thrombosis in 3.2%. A further 4.7% of patients had less common complications (malfunction, catheter dislocation, skin necrosis, catheter break or disconnection, pneumothorax). A total of 119 (11.9%) systems had to be removed because of complications. The rates of infection and of other complications were significantly lower in patients with solid tumours (2 and 4%, respectively) than in those with haematological disease (6 and 8%) (P < 0.05 for each). CONCLUSION: Totally implantable venous access systems are suitable for long-term chemotherapy and cause few complications.     

Late complications in patients with pectoral defibrillator implants with transvenous defibrillator lead systems: high incidence of insulation breakdown

As the majority of ICDs with transvenous leads are now implanted in the pectoral region, complications associated with the technique are being identified. To determine the incidence of lead complications in patients with transvenous defibrillator leads and ICDs implanted in the pectoral region, 132 unselected consecutive patients with transvenous defibrillator leads had ICDs implanted in the pectoral region. Three lead systems were used: (1) lead system 1 (45 patients) consisted of a transvenous pacing sensing lead and a superior vena cava coil with a submuscular patch used for defibrillation; (2) lead system 2 (36 patients) utilized a CPI Endotak lead system; and (3) lead system 3 (51 patients) utilized a Medtronic Transvene lead system. Patients were followed for 3-54 months (cumulative 2,269, mean 18 months). The average duration of follow-up with the three systems was 32, 12 and 11 months, respectively. At 30 months follow-up, all three lead systems had a low incidence of complications. However, there was a 13% overall incidence (45% actuarial incidence) of erosion of the insulation of the pacing sensing lead of system 1 at 50 months of follow-up. All lead complications were seen in patients with ICDs whose weights were > 195 g and volumes > 115 cc. The erosion was probably a consequence of the pressure by the large ICD against the lead in the pectoral pocket. Follow-up with lead systems 2 and 3 is relatively short (average 12 months) but no lead erosions were seen. Pectoral implantation of ICDs with long transvenous leads and large generators is associated with a moderate risk of late complications in the form of insulation breaks caused by pressure of the generator against the leads. The use of less redundant leads coupled with smaller ICDs will probably eliminate this complication.     

Perioperative thermal homeostasis. A duty of the anesthesiologist

Anaesthesia, surgical procedures and operating room temperature can deeply alter the human thermoregulatory system. Unexpected and sometimes serious perioperative complications can occur. Many studies have been carried out in order to describe and evaluate the detrimental effects produced by different anaesthesia procedures (whether by general, regional or integrated anaesthesia) on thermic homeostasis. More recently it has also been reported that perioperative hypothermia significantly affects patients' outcome, increasing intraoperative blood losses, incidence of postoperative wound infection, and hospital stay. Italian anaesthetists have still a poor consideration about intraoperative body temperature monitoring and patients' warming as basic important skills for a better anaesthesiologic patients management. According with the literature, we do believe that this is not a right opinion. The purpose of the present paper would be to point out the most important knowledges concerning thermic homeostasis management, in order to increase anaesthesiologist's awareness in this essential field of patients perioperative care.     

Circulating mediators in serum of injured patients with septic complications inhibit neutrophil apoptosis through up-regulation of protein-tyrosine phosphorylation

BACKGROUND: The accumulation of neutrophils at inflammatory sites results in excessive release of toxic metabolites causing tissue injury. Proinflammatory cytokines may cause the breakdown of homeostasis of neutrophil numbers through inhibition of apoptosis. METHODS: Neutrophils were isolated from healthy humans and from patients with multiple injuries on day of admission and during septic complications. Apoptosis was quantitated using propidium iodide fluorescence and the TUNEL method. Tyrosine phosphorylation was measured by flow cytometry. RESULTS: Neutrophil apoptosis was decreased (33.3 +/- 5.5%; p < 0.05) in injured patients with sepsis compared with healthy humans (87.2 +/- 3.0%) and injured patients without sepsis (76.0 +/- 2.0%). Serum from injured patients with sepsis inhibited (p < 0.05) apoptosis of neutrophils from healthy humans in a dose-dependent manner. Serum from healthy humans and from injured patients at admission was ineffective. Neutralization of granulocyte-colony stimulating factor, but not of granulocyte-macrophage-colony stimulating factor, in serum of injured patients with sepsis partially abrogated (+51.2%) serum induced prolongation of neutrophil life span. Reduction of neutrophil apoptosis was concomitant with increased tyrosine phosphorylation. CONCLUSIONS: Septic complications, but not the injury itself, result in inhibition of spontaneous neutrophil apoptosis. Circulating mediators seem to reduce neutrophil apoptosis through up-regulation of tyrosine phosphorylation.     

Ozone therapy of diffuse peritonitis in the early postoperative period

The functional status of the oxidative-antioxidative system was studied in 72 patients after vast cancer operations. Traditional surgical treatment and its combination with intraoperative irradiation were shown to lead to tense antioxidative defense and to suppressed T-cell immunity and to call for antioxidative and immunomodulating therapy. High intraoperative blood loss complicated by hemorrhagic shock injured the oxidative-antioxidative system greatly. The magnitude of this damage correlated with the rate of prehypoxia. Addition of the potent antioxidant Ceruloplasmin to the drug regimen normalized a recovery period, helped to correct posthypoxic multiorgan insufficiency, to recover oxidative-antioxidative balance, and to decrease the incidence of pyoinflammatory complications. Patients with endogenous intoxication showed activated lipid peroxidation, decreased functional activity of antioxidative defense components and of T-cell immunity in homeostasis. The use of Ceruloplasmin and Laprot had pronounced antiinflammatory and detoxifying effects on the patient's body and activated its antioxidative defense.     

Cardiac pacemaker infection: surgical management with and without extracorporeal circulation

BACKGROUND: Pacemaker infections are rare, but serious complications of pacemaker therapy. The generator pocket, the pacing leads, or both may be involved. METHODS: We report on 12 patients with infected pacemaker systems. Four patients suffered from localized generator pocket infections, 6 had infected leads, and 2 patients had both. Pacemaker systems were completely removed in all patients. When the infection was limited to the generator pocket, the pacemaker system was removed at the original implantation site. Extracorporeal circulation was employed for the explantation of infected pacing leads. RESULTS: No complications occurred in patients with localized generator pocket infections. One patient with infected leads who was preoperatively already in a serious clinical condition died of septic shock in the early postoperative period; another patient died of pulmonary complications after tricuspid valve replacement 14 months after pacemaker explantation. No recurrent infections were observed. CONCLUSIONS: Explantation of the complete pacemaker system has proved a reliable method to eradicate infection. Complications have been rare, except in patients in a critically ill state who undergo cardiopulmonary bypass.     

Complications and surgical indications in 144 cases of nonmetastatic osteosarcoma of the extremities treated with neoadjuvant chemotherapy

From September 1986 to December 1989, 144 patients with osteosarcoma of the extremities were treated with combined surgery and neoadjuvant chemotherapy. The disease-free survival was 79% for good responders (necrosis greater than 90%) and 72% for poor responders (necrosis less than 90%), and the local recurrence rate was low. Improvement in long-term prognosis and the increase of limb-sparing surgery determine a higher rate of immediate and late complications. Most of the complications were observed in limb-salvage procedures; 63% of these procedures presented one or more complications. In nine rotationsplasties, there were four complications, and in 13 amputations no complications were observed. Therefore, 55% of patients were affected by surgical complications. Twenty-eight complications were considered minor (not requiring surgery), whereas 77 complications were major. Functional results, evaluated according to Enneking's new system, were higher than 50% in two thirds of the limb-salvage procedures. Complications in limb-salvage procedures are more influenced by the type of reconstruction than by the surgical procedure used. Probably the most troublesome consequence of surgical complications in osteosarcoma is the deviation or delay in administering postoperative chemotherapy, which jeopardizes survival.     

Surgical management of pancreatic necrosis presenting with locoregional complications

BACKGROUND: Local complications of pancreatic necrosis may occur after surgery, but when they occur spontaneously render surgical treatment more hazardous and impair prognosis. METHODS: A retrospective review was carried out of 83 patients who underwent surgery for pancreatic necrosis from 1988 to 1995, to determine the incidence, type, treatment and outcome of locoregional complications caused by pancreatic necrosis associated with acute pancreatitis. RESULTS: Seventeen patients (20 per cent) were identified to have intra-abdominal complications with pancreatic necrosis either before operation or at the time of surgery. The majority of patients had a delay in intervention (mean 46 days). At presentation ten of the 17 patients had one or more organ system failures. Fourteen patients had gastrointestinal tract involvement, two had involvement of the biliary tract and one patient had a splenic rupture. Six patients died. CONCLUSIONS: In patients with pancreatic necrosis, development of locoregional complications is associated with a high mortality rate. The presence of gastrointestinal bleeding, peritonitis, jaundice or pneumoperitoneum in such patients suggests the presence of a complication of the necrotic process and should prompt early intervention. Early referral of patients with severe acute pancreatitis to specialized units may reduce the risk of locoregional complications.     

Infective endocarditis in patients with permanent pacemaker

Five patients who had permanent pacemaker and infective endocarditis were analyzed. Diagnose was confirmed by a positive blood cultures in all patients and 2 of them had identifiable vegetation in the echocardiogram too. The etiologic agent was Staphylococcus aureus in 3, Staphylococcus epidermidis in 1 and Staphylococcus viridans in 1. Three patients were treated with antibiotics alone: one had no clinical conditions to be operated, one died before surgery and one had good response to antimicrobial therapy alone. Two patients were submitted to antibiotic therapy and surgical removal of the pacemaker system, without complications. It was concluded that the surgical removal of the pacemaker system, as soon as possible, is the choice's therapy.