Mycoplasma pneumoniae infection complicated by paroxysmal cold hemoglobinuria with anti-P specificity of biphasic hemolysin.

A 7-year-old boy with Mycoplasma Pneumoniae infection complicated by transitory paroxysmal cold haemoglobinuria (PCH) is described. The Donath-Landsteiner-antibody exhibited anti-P specificity; hemolytic activity was partially inhibited against papainized erythrocytes at 0 degrees C incubation temperature and increased from 8 degrees C upwards. The association of Mycoplasma pneumoniae infection with PCH has been described 4 times only and in one instance where specificity was stated it was anti-I

Fenoldopam and gastric tonometry during ortothopic liver transplantation

The aim of this study was to evaluate the effects of continuous infusion of fenoldopam on splanchnic perfusion in orthotopic liver transplant (OLT) recipients. Patients and Methods. We enrolled 40 patients of mean age 57 16 years who underwent (OLT). They were randomly divided into two double blinded groups; continuous fenoldopam (0.06 mcg/kg per minute) or placebo infusion. Hemodynamics, gastric tonometry, urine output, renal function parameters, and diuretics use were collected during selected phases of the surgery and postoperatively every 12 hours for 72 hours in the intensive care unit. Results. No significant differences were observed between the two groups concerning hemodynamics, though in the fenoldopam group we observed increased splanchnic perfusion during the whole study period but particularly after arterial unclamping (pHi 7,31 0.04 vs 7.28 0.05; P .05) and at 48 hours after surgery (pHi 7.49 0.15 vs 7.39 0.15; P .05). Creatinine and blood urea nitrogen values were slightly higher in the placebo group, but this data did not reach statistical significance, while higher doses of furosemide were administered to the placebo group to maintain a urinary output over 200 mL/hour during the whole study. Discussion. In this study we observed that continuous fenoldopam infusion (0.06 mg/kg per minute) improved splanchnic perfusion without affecting systemic pressure. Conclusion. Patients undergoing OLT have altered splanchnic perfusion related to cirrhosis, surgical manipulation, and fluid shifts during and after surgery. The use of a splanchnic vasodilator drug improved outcomes in these patients

Activated recombinant factor VII in orthotopic liver transplantation

Orthotopic liver transplantation (OLT) is affected by important alterations of hemostasis. The aim of this study was to evaluate the efficacy of recombinant factor VII activated (rFVIIa) to reduce intraoperative bleeding during OLT. Methods. Twenty OLT patients were assigned in double-blind way to a rFVIIa group or a control group. Inclusion criteria were hemoglobin 8 g/dL: INR 1,5 and fibrinogen 100 mg/dL. We administered a single bouls of rFVIIa (40 g/kg) or placebo. We determined INR, partial thromboplastin time, fibrinogen, ATIII, and blood cell counts. Blood products were administered as follows: 4 units of fresh frozen plasma when INR 1.5, and 1 unit of RBC for Hb 10 g/dL. The study ended 6 hours after the bolus. Results. No thromboembolic events occurred. The INR was different between rFVIIa group and the controls at T0 (1.9 vs 1.6 P .021) and during T1 (1.2 vs 1.6 P .004). The total transfused red blood cells was 300 mL 133 in rFVIIa group and 570 mL 111 in control group (P .017). The total fresh frozen plasma was 600 mL 154 in rFVIIa group and 1400 mL 187 in control group (P .001). Total blood loss was greater in the control group than the rFVIIa group: 1140 mL 112 vs 740 mL 131 (P .049). Discussion. The use of rFVIIa during OLT can reduce the risk of bleeding during surgery. The literature has described cases who did not benefit from the treatment. An adequate cut-off of INR, allowed us to treat only patients at greater bleeding risk

Modifications of intracranial pressure after molecular adsorbent recirculating system treatment in patients with acute liver failure: Case reports

Cerebral dysfunction may be fatal in patients with acute liver failure (ALF); intracranial pressure (ICP) monitoring may be mandatory to direct measures to prevent further cerebral edema. Recently the introduction of dialysis with the molecular adsorbent recirculating system (MARS) has improved the outcomes among patients with ALF. The aim of this study was to evaluate ICP changes after MARS treatment among patients with ALF. Methods. Three patients—14, 18 and 16 years old—were admitted to the ICU for acute liver failure induced by HBV in two cases and by acetaminophen in the other one. Because of Glasgow Coma Score (GCS)8, they were intubated and ventilated to protect the airway and maintain moderate hypocapnia. Invasive monitoring of intracranial pressure MARS treatments were performed in all patients. Results. The patients received MARS treatments every day after their admission to liver transplantation. After MARS therapy the ICP decreased on average from 21 to 7 mm Hg. Significant hemodynamic modifications were not observed and their neurogical conditions improved. Conclusion. MARS treatment improved the clinical pictures of these patients increasing the available time to obtain an urgent liver graft

Clinical effects of direct hemoperfusion using a polimyxin-B immobilized column in solid organ transplanted patients with signs of severe sepsis and septic shock. A pilot study.

Abstract: Background: Polymyxin B (PMX-B) is a polycationic antibiotic, known to bind the lipid A portion of endotoxin, a cell wall component found exclusively in gram negative bacteria (GNB). An extracorporeal hemoperfusion device (TORAYMYXIN) has been developed. PMX is covalently bound on the surface of an insoluble carrier material so that the endotoxin can be inactivated in the blood without exerting its toxicity on the brain and kidney. The aim of this study was to clarify the efficacy, safety and clinical effects of direct hemoperfusion with an immobilized polymyxin-B fiber column (DHP-PMX) in solid organ transplanted patients with severe sepsis or septic shock. Methods: From June 2004 to May 2005, 15 patients (10 men and 5 women), mean age 55 years old (46-65 range), underwent kidney or liver transplantation and developed severe sepsis or septic shock, as defined by the Consensus Conference of American College Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria. GNB were detected in all the patients receiving conventional treatments including antibiotic therapy, vasopressive or inotropic agents, and ventilation support. The DHP-PMX treatment was performed three times in each patient. Hemodynamic and respiratory parameters, dosage of vasopressor/inotropic drugs were assessed at baseline and after each treatment. Results: No adverse events occurred. From baseline to 3rd treatment, mean arterial pressure (MAP) was increased (from 63+/-5 to 83+/-4 mmHg), while the dosage of dobutamine (from 7.5+/-3 to 3+/-2 mcg/kg/min) and noradrenaline (from 1.3+/-0.45 to 0.05+/-0.02 mcg/kg/min) were reduced. The PaO2/FiO(2) ratio increased (from 234+/-38.47 to 290+/-107.48 mmHg). Conclusion: The use of DHP-PMX in association with conventional therapy may be an important aid in patients with sepsis