Plasmapheresis as treatment for hyperlipidemic pancreatitis.

BACKGROUND: Severe hypertriglyceridemia with an accumulation of chylomicrons and triglyceride figures >1000 mg/dL can cause acute pancreatitis, a potentially fatal complication. The option of rapid reduction in triglyceride concentrations is attractive and possible with plasmapheresis. METHODS: We present the results of an analysis of 11 patients admitted to the intensive care unit with severe hypertriglyceridemic pancreatitis and treated with plasmapheresis. The procedure was repeated until serum triglycerides were below 1000 mg/dL. We recorded anthropometric, clinical data as well as final outcome. RESULTS: In eight patients a single plasma exchange was sufficient to reduce triglyceride figures <1000 mg/dL. Only three patients died, all with the worst severity indexes and who experienced the longest delay before the procedure. CONCLUSIONS: Our results, together with a review of the literature, confirm the need for a randomized clinical trial to compare conventional treatment vs. plasmapheresis in patients with severe hypertriglyceridemic pancreatitis.

[Utility of plasmapheresis in intensive care]. / Utilidad de la plasmaféresis en cuidados intensivos.

We discuss the plasmapheresis (PE) carried out in an 18-bed polyvalent intensive care unit between the years 2003-2007. This article aims to report our experience in plasmapheresis performed with specific monitors for continuous renal replacement therapy (CRRT) that shows the versatility of the use of these procedures in intensive care. The utility of these procedures include many different critical disease settings in our units (neurology, hematology, and rheumatology patients). In short, our experience in PE has led us to the conclusion that plasmapheresis is a simple extracorporeal depuration treatment that can be performed by staff trained in intensive care at any moment within a wide spectrum of clinical indications, with CRRT monitors and with minimum adverse effects.

[Cor pulmonale-PHT secondary to crest syndrome. Treatment with slow continuous ultrafiltration]. / Cor pulmonale hipertensión pulmonar secundaria a síndrome crest. Tratamiento con ultrafiltración lenta continua.

Pulmonary hypertension is a severe disease with complex treatment based on general measurements, anticoagulation and use of specific vasodilator drugs. Right heart failure initiated in final stages of the disease is treated with diuretics. We present the case of slow continuous ultrafilitration as treatment in right heart failure secondary to pulmonary hypertension associated to collagen disease refractory to diuretic treatment.