Fluconazole dosing in continuous veno-venous haemofiltration (CVVHF): need for a high daily dose of 800 mg

To cover intermediate sensitive Candida glabrata in ICU patients,fluconazole plasma peak levels at least in the range of 16–32µg/ml appear necessary for treatment. Previous studiesdid not reach these fluconazole levels under continuous veno-venoushaemofiltration (CVVHF) with dosages of 200–600 mg fluconzoledaily. In the present study, nine patients simultaneously requiringCVVHF for treatment of acute oligoanuric renal failure and antimycotictherapy of Candida septicemia received fluconazole 800 mg/day.Fluconazole plasma levels were determined to evaluate whetherthis dosage is adequate to reach the advised fluconazole levels.Patients were dialysed on two consecutive days with an ultrafiltrationrate (UF) of 1000 ml/h or 2000 ml/h, respectively, in a randomizedorder. The predilution was 800 ml/h and 1800 ml/h, respectively.The treatment was tolerated without adverse effects. All patientsreached plasma fluconazole concentrations between 16 and 32µg/ml, remaining in this range for a minimum of 1 up to24 h with a mean of 9.6 h and a UF rate of 2000 ml/h, and 15.7h with a UF rate of 1000 ml/h. So far, there are no in vivodata on the fluconazole plasma concentrations required for effectivetreatment. However, our data demonstrate, that at least thefluconazole concentrations desirable on the basis of in vitrosusceptibility testing can be reached in critically ill patientson CVVHF in an ICU setting. However, in these patients, 800mg fluconazole/day are necessary to achieve fungicidal drugconcentrations.     

改良超滤技术在体外循环中的应用

目的　观察改良动、静脉超滤技术在体外循环 (CPB)中作用及效果。方法　 4 8例病人随机分为两组 ,各 2 4例 ,超滤组于CPB停机后 ,待血液动力学基本稳定时 ,使体内血液经动脉供血管经超滤器超滤后进入右房。对照组不行改良动、静脉超滤。结果　术后输入库血量对照组 5 90ml,超滤组 310ml(P <0 .0 1)。超滤组平均滤出液5 4 0ml,术后血细胞比容、血小板、血浆蛋白、纤维蛋白与超滤前比速度增高 (P <0 .0 1)。结论　改良动、静脉超滤技术有利于术后多余水分排出 ,可减少术后并发症和输血量 ,适用于小体重、血液稀释度大的婴幼儿和长时间CPB者。     

Palliative treatment of malignant ascites by intraperitoneal bleomycin after dialytic ultrafiltration with haemofilter

Dialytic ultrafiltration with haemofilter was performed in 16 patients with malignant ascites refractory to treatment with sodium restriction, diuretic and systemic chemotherapy. A continuous flow of ascitic fluid at a rate of 300–400 ml/min through a haemofilter was maintained by a blood pump. The protein-rich ascitic fluid was re-infused into the peritoneal cavity with sodium and water removed. An average of 5.2 1 of filtrate was removed over a mean interval of 3.5 h. Bleomycin (60 mg) was administered intraperitoneally following the procedure. Complete response was observed in six patients (37.25%) and partial response occurred in four (25%). The remaining patients showed no response. Complications of the dialytic ultrafiltration procedure and toxicity of intraperitoneal administration of bleomycin were minimal. The technique of dialytic ultrafiltration is simple, safe and cost-effective and could be used as an adjuvant therapy for intraperitoneal chemotherapy.     

Modified Ultrafiltration Attenuates Dilutional Coagulopathy in Pediatric Open Heart Operations

Background. Extreme hemodilution caused by relatively large prime volumes required for cardiopulmonary bypass in infants causes a dilutional coagulopathy, characterized by low concentrations of fibrinogen and other circulating coagulation factors. Modified ultrafiltration results in hemoconcentration and is associated with decreases in postoperative bleeding and transfusion requirements in children. This study was undertaken to quantify the effect of modified ultrafiltration on concentrations of fibrinogen, plasma proteins, and platelets in infants and small children.

Methods. Twenty patients less than 15 kg were studied. Cardiopulmonary bypass circuits were primed with crystalloid solutions. Red blood cells were added during cardiopulmonary bypass for hematocrits less than 15%. Colloid solutions were not administered. Concentrations of fibrinogen, plasma proteins, and platelets, and hematocrit were measured before cardiopulmonary bypass, before modified ultrafiltration, and after modified ultrafiltration.

Results. Modified ultrafiltration was associated with significant (p < 0.001) increases in hematocrit (19% ± 6% to 31% ± 9%), fibrinogen (65 ± 29 to 101 ± 45 mg/dL), and total plasma proteins (2.7 ± 0.3 to 4.9 ± 0.7 g/dL), but no change (p = 0.129) in platelet count.

Conclusions. We conclude that modified ultrafiltration significantly attenuates the dilutional coagulopathy associated with cardiopulmonary bypass in infants.     

超滤膜分离技术在植酸酶浓缩中的应用

目的 利用超滤法在低温下操作,生物活性物质不易失活的特点,探讨超滤法代替薄膜蒸发法浓缩植酸酶发醇液的技术可行性,以降低能耗。方法 采用截留分子量为２００００的ＰＵ－２０Ｋ－ＰＳ管式超滤膜系统浓缩１～５批次的植酸酶发醇液,测定浓缩倍数、浓缩收率和截留率并观察超滤过程的膜通量及其变化。结果 植酸酶的浓缩倍数为６．５３倍,浓缩收率为９９．６９％,截留率为９９．９３％,系统可以在植酸酶的工艺条件下连续浓缩〉１０ｈ,且经过简单清洗后,膜通量基本恢复。结论 用ＰＵ－２０Ｋ－ＰＳ管式超滤膜系统缩植酸酶发醇液在技术上可行。     

腹腔巨噬细胞产生一氧化氮对腹膜透析失超滤的作用

目的 研究腹腔巨噬细胞产生的一氧化氮（ＮＯ）对腹膜淋巴孔的作用,探讨腹膜淋巴孔的淋巴重吸收对长期腹膜透析失超滤的影响。方法 应用腹透液建立腹宁的小鼠模型,用全自动酶标仪动态测定怛,用扫描电镜观察不同时间点腹膜间皮超微病理变化,使用计算机与扫描电镜联机的图象处理系统,测定不同腹膜透析时间点腹膜淋巴孔的变化。结果 腹腹膜管析时程延长,透析组有大量巨噬细胞从腹膜淋巴孔游出,在腹膜表面形成许多乳斑。巨噬细     

丙烯腈/丙烯酰胺/苯乙烯三元共聚超滤膜材料的制备和表征

以偶氮二异丁腈为引发剂,采用溶液聚合法制备了丙烯腈、丙烯酰胺、苯乙烯三元共聚物,并用红外光谱(IR)、示差扫描量热(DSC)、热重分析(TG)等手段对共聚物进行了结构和性能表征。结果表明:苯乙烯的加入使得参加环化反应的氰基和酰胺基的数目减少,保留了更多作为功能基团的酰胺基。用相转化法制备得到超滤平板膜,膜的渗透通量为2.63 mL/(cm2.h),对聚乙二醇20000(PEG 20000)的截留率为96.95%。     

盐酸去氢骆驼蓬碱血浆蛋白结合率的测定

目的:测定盐酸去氢骆驼蓬碱的血浆蛋白结合率.方法:采用超滤法和高效液相色谱法对盐酸去氢骆驼蓬碱的血浆蛋白结合率进行测定.结果:盐酸去氢骆驼蓬碱与小牛血清白蛋白、人血清白蛋白和正常人血浆的蛋白结合率分别为( 74.6 ± 9.8 )%、( 69.1 ± 8.7 )%、( 87.1 ± 5.3 )%.结论:盐酸去氢骆驼蓬碱与血浆蛋白具有中等强度的结合.     

超滤法在海洋真菌多糖分离纯化工艺中的应用

目的用超滤法代替透析法去除海洋真菌多糖提取液中的单糖等小分子杂质。方法采用中空纤维超滤膜 ,对多糖去蛋白质后的提取液通过超滤去除小分子杂质 ,同一批提取液中取出部分用透析法处理 ,作平行对照。结果原液浓度、操作压力等影响参数优化后得到的产品 ,多糖得率和含量都不低于对照组 ,而且洗脱曲线也与对照组相似。结论超滤法适用于海洋真菌多糖的分离纯化 ,可供中试生产使用     

Bilateral Lower Extremity Sequential Compression Devices (SCDs): A Novel Approach to the Management of Intra-Dialytic Hypotension in the Outpatient Setting—Report of a Case Series

Intra-dialytic hypotension (IDH) affects as many as 15–50% of patients during hemodialysis. Several treatment approaches and preventative methods are available. These therapeutic options are often ineffective and cumbersome, and some of the causative factors such as poor cardiac reserve are commonly not amenable to any therapy. Enhanced external counter pulsation (EECP) is increasingly being utilized by cardiology services as an adjunct to the long-term management of chronic congestive heart failure as well as in the management of otherwise refractory angina. EECP works by mechanistically improving venous return, enhancing peripheral resistance, and ultimately improving the cardiac index. We speculated that bilateral lower extremity sequential compression devices (SCDs), commonly used in the inpatient setting for DVT prophylaxis, could indeed serve as mini-EECP devices. We carried out an outpatient pilot study of its use to prevent IDH in three patients who otherwise had failed other treatment approaches. The SCDs were effective, convenient, and safe. We were able to achieve ultrafiltration (UF) goals of 1–3 kg during hemodialysis sessions in all three patients, consistently, for months, a feat that was not possible previously. This novel modality of managing IDH is complementary to other standard therapies. Larger multi-center studies are warranted.