Ulinastatin clearance with continuous hemofiltration Hayakawa, Mineji; Gando, Satoshi; Matsuda, Naoyuki ...
Journal of the Japanese Society of Intensive Care Medicine,
2004/04/01, Letnik:
11, Številka:
2
Journal Article
BACKGROUND To investigate the role of plasma neutrophil elastase (elastase-alpha1-proteinase inhibitor complex), plasminogen activator inhibitor-1 (PAI-1), and disseminated intravascular coagulation ...(DIC) in patients with posttraumatic acute respiratory distress syndrome (ARDS) and to explore the time course of the changes of these factors after trauma, we performed a prospective case-control study.
METHODS The study subjects consisted of 41 trauma patients, 5 with ARDS, 7 at risk for but not developing the syndrome, and 29 control patients without or with no risk for ARDS. Plasma neutrophil elastase, PAI-1 activity, and PAI-1 antigen concentration were measured on the day of the injury and on days 1, 3, and 5 after admission. DIC was measured on the basis of the DIC score. The results of these measurements and demographic data were compared among the three groups.
RESULTS Neutrophil elastase, PAI-1 activity, and PAI-1 antigen concentration for the ARDS patients continued to be markedly high until the fifth day of admission, and the values on the fifth day were significantly higher than those of the other two groups. All patients with ARDS developed DIC. A decrease in the DIC score was found for the control patients and also for the patients at risk for ARDS; however, for the patients with ARDS, the DIC score did not improve during the study period (p = 0.5809).
CONCLUSION We provide precise information on the time course of neutrophil elastase, PAI-1, and DIC in trauma patients with ARDS and those at risk of developing this syndrome. Neutrophil activation and persistent intravascular coagulation as well as impaired fibrinolysis may play a role in the pathogenesis of posttraumatic ARDS.
For rapid and accurate diagnosis of human cytomegalovirus (HCMV) infections, we applied HCMV-DNA amplification by the polymerase chain reaction (PCR) method and compared the sensitivity of this ...method with those of conventional serological and histological examinations in 20 ICU patients. We used blood, urine, and other infected tissues as specimens. Using tissue culture and tissue biopsy as gold standard tests, a nensitivity of 100%, a specificity of 82.4%, a positive predictive value of 50%, and a negative predictive value of 100% were observed with the PCR method. In contrast to the PCR method, conventional serological tests revealed low sensitivity and specificity. An average of more than 18 days was required for conventional serological tests to be reported, but PCR method results were available within 8 days. In conclusion, the PCR method is a useful and rapid method for the detection of HCMV in ICU patients.
A 59-year-old man who had undergone cadaveric renal transplantation received immunosuppression therapy with azathiopurine, predonisolone, and tacrolimus for 9 months. The patient complained of dry ...cough and dyspnea with fever when he saw a doctor and he was hospitalized after wasting one week. A computed tomography showed mild interstitial pneumonia. The patient was tentatively diagnosed as opportunistic infection in a compromized host and treated in empirical way, but he died 4 weeks after admission without any response to our treatment. All of the laboratory tests and pathological findings could not indicate the evidence of any opportunistic infections in the lungs. Azathioprine-induced interstitial pneumonia was a rare complication but a total dose of azathioprine of our patient (15, 750mg) was as much enough as to induce interstitial pneumonia and histologocal findings in autopsy specimen that were usual interstitial pneumonia and diffuse alveolar damage strongly suggested the toxic effects of azathioprine. On the management of respiratory failure in an immunosuppressed host, we should keep in mind azathioprine-induced interstitial pneumonia as well as opportunistic infections.
After intravenous use and ingestion of approximately 0.05g methamphetamine, an 18-year-old girl was admitted to our emergency room in a state of delirium with a temperature above 41°C. Rhabdomyolysis ...with myoglobinuria was diagnosed. On the second day, although she had nearly regained full alertness, she developed disseminated intravascular coagulation. On the third day, she became somnolent and delirious again with remarkable elevations in total birilubin, transaminase and other hepatic enzymes. A biopsy of the liver was performed on the 6th hospital day. Microscopically, submassive hepatic cell necrosis was found around the central veins which was accompanied by sparse inflammatory cell infiltration. On the 20th day she was substantially recovered and her hepatic functions had improved. She was transferred from the ICU to the ward. On the 82nd hospital day liver biopsy revealed good regeneration of hepatic cells. The above described hepatic dysfunction and submassive hepatic cell necrosis are considered to be attributable to three primary causes; viral hepatitis, methamphetamine induced allergic hepatitis or direct liver damage by hyperthermia. We were able to rule out viral hepatitis because of her clinical course, viral studies and pathological findings but differentiating between allergic hepatitis and direct hepatotoxicity was not possible with the clinical and laboratory data available in this case.
Arterial blood gas analysis of 69 patients with acute myocardial infarction were evaluated to provide a basis for respiratory care. Patients were divided into two groups: group A which received ...oxygen therapy only (n = 38) and group B which received oxygen therapy with mechanical ventilation (n = 31). The patients in group B were further divided into surviving cases (n = 14) and fatal cases (n = 17). On admission patients assigned to group B had lower PaO2 values than those placed in group A. In group B, there was no difference in the P/F value before mechanical ventilation of the surviving and the fatal cases, but the survivors demonstrated an improvement of the P/F value and an increase in cardiac index after mechanical ventilation. It may be reasonable to assume that a P/F value of less than 250 serves as an indicator for the initiation of mechanical ventilation. An increase in the P/F value after mechanical ventilation seems to be a valuable index to estimate prognosis in respiratory failure.
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