ABSTRACT
Hemopure (hemoglobin glutamer-250 [bovine]; HBOC-201) is a hemoglobin (Hb)-based oxygen carrier registered with the Medicines Control Council of South Africa. It is indicated for the treatment of adult patients who are acutely anemic, for the purpose of maintaining tissue oxygen delivery thus eliminating, delaying, or reducing the need for allogeneic red blood cells (RBCs). Hemopure is a volume expander, and circulatory volume must be carefully monitored for signs of fluid overload. Hemopure is not as effective as RBCs for restoring Hb content and concentration, but in cases of severe anemia where allogeneic blood is not an option or is unavailable, it may offer an immediate alternative for improving oxygen transport. This document provides clinical recommendations on the safe and effective use of Hemopure based on the postmarketing experience in South Africa as well as a better understanding of Hemopure properties reflected in recent publications.
Subject(s)
Hemoglobins/therapeutic use , Animals , Blood Substitutes/therapeutic use , Cattle , Consensus , Erythrocyte Transfusion/methods , Humans , Oxygen/metabolism , Practice Guidelines as Topic , Product Surveillance, Postmarketing , South AfricaABSTRACT
This case presentation concerns a woman known to have fibromuscular dysplasia (FMD) who presented with an acute coronary syndrome (ACS). The coronary angiogram was considered to be normal. However, as spontaneous coronary artery dissection (SCAD) has a close association with FMD, subsequent meticulous review of the angiogram revealed a dissection within the circumflex coronary artery. SCAD causes 10% of ACS seen in women under 55 years of age. Both FMD and SCAD are underdiagnosed and SCAD may be overlooked or misdiagnosed on coronary angiography. The recommended management of SCAD differs from that of the usual presentations of ACS. For this reason, one should be alert to the possibility of SCAD when confronted by ACS in a younger woman, especially when she is known to have FMD.
Subject(s)
Coronary Vessel Anomalies/diagnosis , Fibromuscular Dysplasia/diagnosis , Myocardial Infarction/diagnosis , Vascular Diseases/congenital , Acute Disease , Adrenergic beta-Antagonists/administration & dosage , Coronary Angiography , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/drug therapy , Disease-Free Survival , Estrogen Replacement Therapy , Female , Fibromuscular Dysplasia/complications , Fibromuscular Dysplasia/drug therapy , Humans , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/etiology , Platelet Aggregation Inhibitors/administration & dosage , Vascular Diseases/complications , Vascular Diseases/diagnosis , Vascular Diseases/drug therapy , Withholding TreatmentABSTRACT
BACKGROUND: We present the results of a previously unpublished hemoglobin-based oxygen carrier (HBOC) study conducted in 1998-1999. METHODS: In a multicenter, randomized, single-blind, comparative study of HBOC-201 versus allogeneic red blood cell (RBC) transfusions, no-cardiac surgery patients received HBOC-201 to a maximum of 7 units (n = 83) or RBCs (n = 77). Patients could be switched to RBCs for safety or any other reason. The efficacy end points were elimination and/or reduction of allogeneic RBC transfusions for 28 days. RESULTS: The proportion of patients in the HBOC-201 group that avoided RBC transfusion was 0.427 (95% confidence interval, 0.321-0.533). Subjects in the HBOC-201 group received on average 3.2 units of RBCs versus 4.4 units in the control arm (P = 0.004). Seventy-nine (95.2%) subjects in the HBOC-201 group and 72 (93.5%) in the RBC group experienced adverse events (AEs), judged to be associated with study treatment in 59 (71.1%) and 18 (23.4%) subjects, respectively. Thirty-day mortality, 5 (6.0%) vs 4 (5.2%) patients (P = 1.00), incidence of serious AEs, 24 (28.9%) vs 20 (26.0%) (P = 0.73), or time to intensive care unit (log-rank P = 0.15) or hospital discharge (log-rank P = 0.53) were similar for the HBOC-201 and RBC groups, respectively. CONCLUSIONS: Up to 7 units of HBOC-201 infused over the course of 6 days resulted in RBC transfusion avoidance in 43% of patients. There were no notable differences in mortality and serious AEs incidence. The use of HBOC-201 was associated with a notable excess of nonserious AEs.
Subject(s)
Blood Substitutes/administration & dosage , Blood Substitutes/adverse effects , Erythrocyte Transfusion/adverse effects , Hemoglobins/administration & dosage , Hemoglobins/adverse effects , Perioperative Care/methods , Adult , Aged , Aged, 80 and over , Drug Evaluation/methods , Erythrocyte Transfusion/methods , Female , Fever/chemically induced , Fever/diagnosis , Follow-Up Studies , Humans , Hypertension/chemically induced , Hypertension/diagnosis , Male , Middle Aged , Perioperative Care/adverse effects , Single-Blind Method , Treatment Outcome , Young AdultABSTRACT
Endovascular techniques are often applied, but they have occasionally been reported in the treatment of popliteal vascular entrapment (PVE). A case of bilateral PVE is presented with an acute occlusion of the right popliteal artery. This was twice unsuccessfully treated with arterial recanalization and stenting at another Institution. The patient required an arterial reconstruction with his reversed saphenous vein, in addition to resection of the medial gastrocnemius muscle laterally inserted on his right limb. The left limb was treated with a simple myotomy. Recanalization and stenting is not recommended for PVE treatment.
Subject(s)
Angioplasty, Balloon/instrumentation , Arterial Occlusive Diseases/therapy , Intermittent Claudication/therapy , Popliteal Artery/surgery , Saphenous Vein/transplantation , Stents , Vascular Grafting , Adult , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/surgery , Constriction, Pathologic , Humans , Intermittent Claudication/diagnosis , Intermittent Claudication/surgery , Magnetic Resonance Angiography , Male , Muscle, Skeletal/surgery , Popliteal Artery/diagnostic imaging , Radiography , Treatment FailureABSTRACT
OBJECTIVE: Nonfunctional popliteal entrapment is due to embryologic maldevelopment within the popliteal fossa. Functional entrapment occurs in the apparent absence of an anatomic abnormality. Gastrocnemius hypertrophy has been associated with the latter. Both forms of entrapment may cause arterial injury and lower limb ischemia. This study assessed the attachment of the medial head of the gastrocnemius muscle in healthy occluders and healthy nonoccluders. METHODS: Provocative tests were used to identify 58 nonoccluders and 16 occluders. Ten subjects from each group underwent magnetic resonance imaging evaluation of the popliteal fossa. The medial head of the gastrocnemius muscle attachment was assessed in the supracondylar, pericondylar, and intercondylar areas. RESULTS: In the occluder group, significantly more muscle was attached towards the femoral midline (supracondylar), around the lateral border of the medial condyle (pericondylar), and within the intercondylar fossa. CONCLUSION: The more extensive midline position of the medial head of the gastrocnemius in occluders is likely to be a normal embryological variation. Forceful contraction results in compression and occlusion of the adjacent popliteal artery. The clinical significance of these anatomic variations remains unclear. However, these new observations may provide insight for future analysis of the causes and natural history of functional compression and the potential progression to clinical entrapment.
Subject(s)
Arterial Occlusive Diseases/pathology , Magnetic Resonance Imaging , Muscle, Skeletal/pathology , Popliteal Artery/pathology , Adult , Arterial Occlusive Diseases/physiopathology , Female , Humans , Male , Muscle Contraction , Muscle, Skeletal/physiopathology , Predictive Value of Tests , SyndromeSubject(s)
Blood Substitutes , Hemoglobins , Blood Donors/supply & distribution , Drug Utilization , Humans , South AfricaABSTRACT
Popliteal vascular entrapment is second only to atherosclerosis as the most common surgically correctible cause of leg claudication in young adults. Affected patients are often athletic individuals who present before the age of 50. This chapter highlights the abnormal developmental anatomy that is now accepted as the cause of popliteal entrapment and serves as the basis for the modern classification system. The importance of the unique histopathological changes observed in arterial entrapment syndromes are summarized, and the natural history of chronic arterial compression is reviewed. The diagnosis, investigation, and treatment proposed are based upon the currently published literature.
