First experience with a ready-for-use rheohemapheresis system.

Rheohemapheresis is increasingly being used for the improvement of microcirculation in numerous diseases. The method is based on the constant-flow separation of plasma by a cell separator and the secondary filtration of plasma through a hollow-fiber membrane. A new CE-marked system has recently been launched for an improved continuous flow blood separator (dideco Excel Pro) that contains a connection kit between the cell separator and a secondary filter and software which includes differential filtration as a standard protocol. The new system was used in our center using ethylenevinylalcohol secondary filters (Evaflux LA4 or LA5). 99 procedures were completed in 47 patients. A median of 2.7 (1.6-4.2) 1 of plasma were processed via the secondary filter in 109 (41-218) min. The values in peripheral blood before and after the treatment were total protein 6.7 (5.8-8.9)/ 5.3 (4.4-6.7) g/dl, fibrinogen 215 (118-480)/110 (37-275) mg/dl and cholesterol 200 (134-254)/92 (69 149) mg/dl. A median platelet loss of 30% in the peripheral blood of the patients was observed partly by platelet content of the separated plasma of 30 g/l after 500 ml of treatment and 10 g/l after 2,500 ml. Major side effects in the patients were not observed. The new differential filtration system already fulfills the demands of a ready-to-use CE-marked rheohemapheresis system but improvements in the details of the treatment protocol are still required and under way.     

First experience with the modified program NHL-BFM-90 application in adult patients with primary diffuse large B-cell gastric lymphosarcoma with unfavourable prognosis

AIM: To assess efficacy of a modified program NHL-BFM-90 in adult patients with primary diffuse large B-cell gastric lymphosarcoms (PDLBGL) with unfavourable prognosis. MATERIAL AND METHODS: Modified courses of NHL-BFM-90 were conducted in 5 patients aged 27-67 years from January 2004 to September 2005. Four patients received chemotherapy of the first line, in one patient block therapy followed monotherapy with chlorambucil and a CHOEP course. All the patients were in a severe clinical condition and had several initial factors of unfavourable prognosis: size of the tumor more than 10 cm; stage IE and more advanced; B-symptoms; proliferative activity above 70%. The program NHL-BFM-90 was modified because of the patients' age. Chemotherapy was conducted according to the middle arm of the original program NHL-BFM-90, but methotrexate was introduced in a dose 1 g/m2 for 12 hours, while leukovorin was given 18 hours after the start of methotrexate injection. In two cases the blocks were enhanced with rituximab, 2 patients had doxorubicin in block A, in one case block C was enhanced with methotrexate. A total of 23 modified blocks NHL-BFM-90 were performed: one patient was given 6 blocks, two patients--5, one patient--4 blocks and one patient--3 blocks. RESULTS: Four patients after block 2 and one patient after block 3 of polychemotherapy NHL-BFM-90 achieved remission of the disease of 6 to 22 months duration which still continues. Infectious complications related to hematological toxicity arose more frequently at the latest courses of chemotherapy. CONCLUSION: Treatment according to the modified program NHL-BFM-90 in adult patients with PDLBGL and unfavourable prognosis is highly effective. For a mean follow-up of 10.2 months no recurrences occurred. The number of courses can be reduced to decrease accumulated hematological toxicity and in case of rapid achievement of remission.     

First experience using the Senhance surgical system in laparoscopic local gastrectomy for gastrointestinal stromal tumor

Various innovative robotic systems have been developed to improve surgery precision. The Senhance Surgical System (SSS) is a digital laparoscopic system offering eye tracking and haptic feedback. Several reports have described application of the SSS to general surgeries, including cholecystectomy and colectomy. However, use of the SSS for gastric tumor has not been reported. We experienced a case of laparoscopic local gastrectomy (LLG) for gastrointestinal stromal tumor (GIST) with the SSS. A 74-year-old man diagnosed with GIST underwent LLG with the SSS. Operation, docking, and console times were 117, 11, and 59 minutes, respectively. No perioperative complications were encountered. This study is the first to report LLG for GIST with the SSS. LLG with the SSS was safe and feasible. The SSS can use reusable forceps and contribute to reducing medical costs. The development of instruments is also progressing, and various kinds of surgery are likely to be indicated.     

First experience of clopidogrel application in the treatment of acute myocardial infarction with ST-elevation

AIM: To examine efficacy of clopidogrel before thrombolytic therapy (TLT) in patients with acute myocardial infarction (AMI). MATERIAL AND METHODS: A total of 72 patients (48 males and 24 females) admitted to hospital within 6 hours since the onset of acute myocardial infarction (AMI) were divided into three groups. Group 1 and 2 patients (n = 38 and 20, respectively) were given a prehospital stress dose of aspirin (250-500 mg), group 3 patients (n = 14) received this dose at admission. TLT with streptokinase or actilise (1,500,000 IU and 100 mg, respectively) was given to all the patients. Before TLT group 2 received a stress dose of clopidogrel (300 mg), after TLT--75 mg/day. 12-Lead ECG, CFK activity and troponine content examinations were made. The patients were observed for 30 days. The recovery of coronary circulation (CC) was evaluated by dynamics of a total lowering of the elevated ST segment. RESULTS: CC completely recovered 60 min after TLT in 16, 10 and 7% patients of groups 1, 2 and 3, respectively. CC recovered partially in 24, 55 and 7% patients, respectively. In 90 min after TLT partial recovery of CC was observed in 21, 31 and 43%, respectively; in 180 min the effect was absent in 19, 15 and 38%, respectively. 30-Day lethality was 11.1% and was high in group 3. No lethal outcomes were seen in group 2. CONCLUSION: It is possible to achieve better myocardial reperfusion after TLT and improve 30-day outcomes in MI patients given combined antithrombocytic therapy.     

First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention

Objectives  

We investigated our experience with combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as an alternative strategy in high-risk patients.     

Time needed for a regional emergency medical system to implement resuscitation Guidelines 2005—The Netherlands experience

Introduction

In December 2005, updated resuscitation Guidelines (G) were introduced worldwide and will be revised again in 2010. This study sought to elucidate how long it takes to implement new guidelines.

Methods

This was a prospective observational study. From July 2005 to January 2008, we included all patients with an out-of-hospital cardiac arrest of suspected cardiac cause. We analyzed Emergency Medical System (EMS) Guideline usage via defibrillator recordings of the continuous ECG and impedance signals. We excluded patients with missing or otherwise unusable ECGs. All shocks and CPR cycles were individually classified. The same Guideline needed to be applied for at least 75% of all shocks and CPR cycles. If no shocks had been given, continuous ECGs were classified by its CPR status only. Continuous ECGs were classified as G1992, G2000 or G2005. If at least 75% of the shocks were given according to G2000 and at least 75% of the CPR was according to G2005, the Guideline protocol was classified as intermediate. All analyses that did not fulfil any Guideline criteria were classified as indeterminate.

Results

Of 1672 analyzable resuscitations, 31 (2%) used G1992, 826 (49%) G2000, 608 (36%) G2005, and 125 (7%) intermediate Guidelines. The Guideline protocol could not be identified for the remaining 81 (5%) patients. It took 17 months (from publication) until EMS personnel applied GL2005 in over 80% of cases.

Conclusion

Our experience shows it took one-and-a-half years to effectively implement new resuscitation Guidelines. We believe improvements in implementation can shorten this to six months.     

First experience of using CoolGard system in intensive care patients after neurosurgical interventions: series of 10 observations

Fever is a proven factor in secondary brain damage and worsens outcome in neuro intensive care patients. However, large randomized studies have shown neuroprotective effects of induced hypothermia only in patients with cardiac arrest and in neonates with perinatal hypoxic-ischemic brain damage. Nevertheless, now there is an active search for alternative modes of temperature correction, which would have been effective in other groups of patients with brain damage. Moreover, new management techniques of body temperature are being created. In this paper we presented a series of 10 observations when the used cooling system was CoolGard/CoolLine. 5 patients underwent hypothermia, 5 patients normothermia . Hypothermia was used for cerebroprotection in 1 case and for the correction of resistance to the therapy of intracranial hypertension in 4 cases. Normothermia was used for correction of resistance to pharmacological treatment of fever. In all cases the target temperature was achieved, and only for 1 patient to achieve hypothermia additional external cooling was used. Patients with normothermia did not need sedation, because they have not developed discomfort and muscle tremor. 2 patients died, in one case was due to intracranial hypertension and hemotamponade of brain ventricular system. Cause of second death was pulmonary embolism. Thus, the CoolGard system effectively lowers the body temperature to the target values for neuro intensive care patients. Application of this system is relatively safe. However, the most dangerous are the thromboembolic complications, thus the daily ultrasound scanning of lower limb veins and the possible early use of low molecular weight heparins is crucial.     

First experience with clinical use of intravenous anesthetic recofol: effectiveness and safety]

Clinical trials of a new anesthetic Recofol were carried out. This analog of well-known drug diprivan is characterized by a predominantly hypnotic effect. The effect of recofol on hemodynamics, gas exchange, and EEG was studied in 30 clinical trials during anesthesia for bronchoscopic manipulations and operations on the abdominal and thoracic organs, microsurgery, and during peripheral vessel repair. The results indicate that recofol is virtually identical to diprivan (propofol). Clinical course of induction and anesthesia, hemodynamic reactions and effect on the respiratory system of patients were virtually the same. Recofol was well tolerated, its allergenic activity was relatively low, it was rapidly metabolized, there were virtually no side effects. Positive results of recofol trials carried out by Leiras Oy firm recommend the drug for wide use in anesthesiology.     

Clinical trial experience with the MitraClip catheter based mitral valve repair system

Severe mitral regurgitation (MR) confers a poor prognosis, in particular for patients with heart failure. Based on the results of the Euro Heart Survey, a large proportion of patients with mitral regurgitation is not referred to surgery and many other patients are rejected for cardiac surgery due to the high surgical risk or co-pathologies. Improving ventricular function with ACE inhibitors, beta-blockers and CRT may reduce mitral regurgitation, but for most patients a mechanical intervention is ultimately preferable. Mitral valve surgery is invasive and requires a long recovery period; therefore, less invasive and effective approaches are highly desirable, particularly in high risk patients. Therefore, new techniques have been recently developed to treat MR with percutaneous approach. The MitraClip device (Abbott Vascular, Menlo Park, CA) is used to treat both functional and degenerative mitral valve regurgitation. Its safety and efficacy has been initially tested in the Endovascular Valve Edge-to-Edge REpair Study (EVEREST), while MitraClip has been compared to surgery in the EVEREST II randomized trial. Besides EVEREST trials, safety and efficacy of the device as well as its health economic value is under evaluation in ongoing registries. Although the field of catheter based management of MR is at an early stage, initial clinical results have demonstrated that catheter based approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR.     

阳和汤加减治疗慢性腰肌劳损临床体会

目的观察阳和汤加减治疗慢性腰肌劳损效果。方法内服阳和汤加减方。结果阳和汤加减治疗慢性腰肌劳损67例,治愈率为56.7%,总有效率达92.5%。结论阳和汤加减用于慢性腰肌劳损的治疗疗效明显,值得推广。     

张士芳应用当归拈痛汤加减治疗湿疹的临床经验分析

湿疹是发生于表皮或真皮浅层的一种迟发型变态反应性皮肤炎症疾病,皮损具有多形性、对称性、瘙痒、渗出倾向以及易反复发作等特点.西医多采用糖皮质激素外用法治疗湿疹,但部分患者疗效欠佳,且长时间应用可能出现较多不良反应.张士芳主任是航天中心医院原副院长,2018年北京市中医药管理局薪火传承3+3工程基层老中医.张士芳从医6...     

First experience of autologous peripheral blood stem cell mobilization with biosimilar granulocyte colony- stimulating factor

Introduction  

Mobilization techniques for autologous peripheral blood stem cell (PBSC) collection include chemotherapy followed by hematopoietic growth factors, such as granulocyte colony-stimulating factor (G-CSF). Biosimilar versions of G-CSF are now available in Europe.