Kinetic basis of hyperhomocysteinemia in patients with chronic renal failure. We investigated the elimination of total homocysteine (tHcy) from plasma after peroral homocysteine (Hcy) loading in ...eight patients with chronic renal failure. Data on bioavailability and distribution volume were obtained from two patients and two healthy controls by performing both intravenous and peroral Hcy loading. Response to high-dose folic acid was studied in six cases. Mean (SD) basal plasma tHcy was 27.4 (11.0) µM at inclusion. The half-life and the area under the curve were about four times higher, and clearance was reduced to 29.8% compared to controls. High-dose folic acid had no influence on half-life for tHcy, but the basal tHcy level declined by 26.8%. The reduction in tHcy was particularly pronounced in three patients with low-normal serum folate, and the enhanced methionine response to Hcy loading after folic acid suggested improved Hcy remethylation in tissues. In conclusion, patients with renal failure had markedly reduced clearance of tHcy from plasma, which probably accounts for their hyperhomocysteinemia. High-dose folic acid reduces fasting tHcy by improving tissue Hcy remethylation without affecting the low renal clearance of tHcy.
Background: Reactions after a blood transfusion could be allergic because of passive transfer of immunoglobulin E (IgE) antibodies from allergic donors.
Aims of the study: To compare spectrum and ...prevalence of IgE antibodies in blood donors from Sweden and Norway.
Methods: Using the ImmunoCAP method, serum samples from 1002 blood donors from Sweden and 500 from Norway were analysed for IgE antibodies to common inhalant and food allergens and allergens common in a hospital environment, such as penicilloyl G and latex.
Results: As many as 23.6–27.3% of the donors had IgE antibodies to at least one of the 14 allergens tested. Of these 6.8–16.7% had extremely high concentrations, i.e. >35 kUA/l corresponding to 100 times the cut‐off for a positive allergy test. Most donors were sensitized to pollens, dander and mite but several had very high levels of IgE antibodies to penicilloyl G, latex and peanut. The pattern of sensitizing allergens differed between Sweden and Norway.
Conclusions: High serum levels of IgE antibodies to various allergens are common among blood donors and the degree of sensitization and spectrum of involved allergen varies between geographical regions. Present routines to identify IgE sensitized, potential risk, donors are not satisfactory; the sensitivity of selection procedures is about 25%.
There is a need for systematic evaluation of methods before their release to the market. We addressed this problem in novel homocysteine assays as part of an European Demonstration Project involving ...six centers in four countries.
Two immunological methods for measurement of plasma total homocysteine (P-tHcy), the fluorescence polarization immunoassay (FPIA) and the enzyme immunoassay (EIA), were compared with two comparison methods, HPLC and gas chromatography-mass spectrometry (GC-MS). All laboratories performed the following procedures: (a) familiarization; (b) determination of linearity and precision by analyzing five plasma samples with interrelated concentrations for 20 days; (c) correlation using patients' samples; and (d) assessment of long-term performance.
Both immunological methods were linear for P-tHcy between 5 and 45 micromol/L. The intralaboratory imprecision (CV) was <5% for FPIA and <9% for EIA used with a sample processor. The bias was -2% to 3% for FPIA and 2-4% for EIA used with a sample processor.
The immunological methods provide results with little bias compared with HPLC and GC-MS. The imprecision of the assays must be considered in the context of their intended use(s).
Background
Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive ...stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm. For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding.
Methods
This is a protocol and statistical analysis plan for a preplanned exploratory substudy of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP‐ICU) randomized clinical trial, comparing intravenous pantoprazole (40 mg once daily) with placebo in 3350 acutely ill adult ICU patients. We will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically important gastrointestinal bleeding according to early vs late bleeding and 90‐day vital status.
Conclusions
The study outlined in this protocol will provide detailed information on patient characteristics and the timing of onset of gastrointestinal bleeding in the patients enrolled in the SUP‐ICU trial. This may provide additional knowledge and incentives for future studies on which patients benefit from SUP.
The general understanding is that a blood sample for analysis of immunoglobulin (Ig) E antibodies to an allergen suspected to cause an anaphylaxis cannot be drawn until several weeks after the ...reaction. As this is most unpractical, the changes in IgE antibody levels during anaphylaxis were studied to evaluate the possibility of using samples drawn at the time of the reaction. Immunoglobulin E antibodies to suxamethonium were quantitated with ImmunoCAP before, during and after an anaphylactic reaction occurring during anaesthesia using neuromuscular blocking agents. Serum IgE antibody concentrations against suxamethonium in blood samples collected up to 6 h after the reaction were not different from those in samples drawn before or days and weeks after the anaphylaxis. A serum sample intended to trace the drug involved in an IgE-mediated anaphylactic reaction can be drawn in direct relation to the reaction.
Background: We report a case of a 69‐year‐old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the ...prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix®).
Incident: A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix®. There was an increase in serum tryptase (almost nine‐fold) and a positive skin prick test to undiluted Hexvix®.
Conclusion: The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non‐immunoglobulin E‐mediated allergic reaction possibly caused by Hexvix®. This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix®.
ARDS acute respiratory distress syndrome, MAP mean arterial pressure, PPV pulse pressure variation, SVV stroke volume variation, TBSA total body surface burn area, UO urine output The results of this ...international survey highlight the use of albumin (> 60%) and vasopressors (80%) during the early resuscitation phase. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. (PDF 155 kb) Authors’ Affiliations (1) Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France (2) Service of Adult Intensive Care Medicine and Burns, University Hospital, 1011 Lausanne, Switzerland (3) Department of Intensive Care and Burns, Ghent University Hospital, Ghent, Belgium (4) Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria (5) Department of Anaesthesiology and Intensive Care, Haukeland University Hospital and University of Bergen, Bergen, Norway (6) Department of Intensive Care Medicine, Academic Medical Center, Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam, The Netherlands (7) Department of Anesthesiology, Red Cross Hospital, Beverwijk, The Netherlands (8) Department of Anesthesiology and Reanimation, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey (9) Burn Unit, Papanikolaou Hospital, Thessaloniki, Greece (10) Burn Centre, Percy Military Hospital, Clamart, France (11) Critical Care and Burn Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Universidad Europea de Madrid, Madrid, Spain (12) Department of Clinical Medicine, Trinity College, Welcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland (13) Department of General Anaesthesiology, Emergency and Intensive Care Medicine, LKH - University Hospital of Graz, Medical University of Graz, Graz, Austria (14) Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy (15) Burn Centre and Intensive Care Department, University Hospital of Liège, Liège, Belgium (16) Departments of Hand, Plastic and Burns and Intensive Care, Linköping University Hospital, Linköping University, 581 85 Linkoping, Sweden (17) Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Hôpital Lariboisière, UMR Institut National de la Santé et de la Recherche Médicale (INSERM) 942, Université Paris Diderot, F-75475 Paris, France Soussi S, Deniau B, Ferry A, Levé C, Benyamina M, Maurel V, et al.
Several studies have recognized neuromuscular blocking agents as the most common cause of anaphylaxis during general anesthesia, but the reported frequencies vary considerably between countries. In ...Norway, the issue has raised special concern because of reports from the Norwegian Medicines Agency that suggest a high prevalence. This article presents the results from a standardized allergy follow-up examination of 83 anaphylactic reactions related to general anesthesia performed at one allergy center in Bergen, Norway.
Eighty-three cases were examined during the 6-yr period of 1996-2001. The diagnostic protocol consisted of case history, serum tryptase measurements, specific immunoassays, and skin tests.
Immunoglobulin E-mediated anaphylaxis was established in 71.1% of the cases, and neuromuscular blocking agents were by far the most frequent allergen (93.2%). Suxamethonium was the most frequently involved substance, followed by rocuronium and vecuronium. The few reactions in which other allergies could be detected were mainly linked to latex (3.6%).
Neuromuscular blocking agents were the dominating antigens causing immunoglobulin E-mediated anaphylaxis in this study. The data could not be used for estimation of the incidence of allergy toward neuromuscular blocking agents in Norway. Larger patient samples, standardization of reporting, and diagnostic protocols should be pursued by network formation to produce data more suitable for epidemiologic research.
Necrotising soft tissue infections Gundersen, Ingunn Margareetta; Bruun, Trond; Almeland, Stian Kreken ...
Tidsskrift for den Norske Lægeforening,
2024-Feb-27, Letnik:
144, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Necrotising soft tissue infections can affect the skin, subcutaneous tissue, superficial fascia, deep fascia and musculature. The infections are severe, they spread quickly and can result in ...extensive tissue loss. Although rare, morbidity and mortality rates are high. Early clinical identification is crucial for the outcome, and rapid infection control through surgery and targeted antibiotic treatment is needed to save lives. Few prospective clinical trials have been conducted for the treatment of this type of infection. Specific challenges include rapid identification of the condition and the uncertain efficacy of the various treatment options. In this clinical review article, we describe clinical characteristics, diagnostics and treatment.
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