MARS procedure as a bridge to combined liver-kidney transplantation in severe chromium-copper acute intoxication: a paediatric case report.

We describe a case of multi-organ failure (liver-kidney insufficiency and brain oedema) caused by accidental, acute intoxication with a chromium and copper-containing substance, as an example of the introduction of the new extracorporeal procedure MARS (molecular adsorbents recirculating system) in a girl 3.5 years old.

[Recurrent purulent bacterial meningoencephalitis]. / Nawrotowe bakteryjne ropne zapalenie opon mózgowo-rdzeniowych i mózgu.

During the period of 25 years there were 55 patients treated in our Institute because of recurrent purulent bacterial meningoencephalitis(rpbme). This group consisted of 42 males (76%) and 13 (24%) females, the prevalent number (53%) of patients being under 21 years of age. The diagnosis of rpbme was based on the commonly accepted criteria and confirmed by the laboratory results of CSF examination. The cause of the recurrences was established considering the skull X-ray examination, CT and MRI. The evaluation of the clinical status was based on the Glasgow Coma Score (GCS). During the first hospitalisation, severe or critic clinical status was noted in 42 patients (76%) and moderate in 13 (24%). The subsequent recurrences were mostly moderate, rarely severe or mild. The number of recurrences varied from 1 to 9. During the first hospitalisation, the etiologic factor was detected in 39 patients (71%), i.e. Streptococcus pneumoniae in 28 (51%), Neisseria meningitidis in 8 (14%), Pseudomonas aeruginosa and Staphylococcus aureus in 2 and 1 patients respectively. In 37 patients (67%) rpbme developed following cranial trauma, in 18 cases (33%) with single or comminuted fractures of the anterior cranial fossa (in 4 cases accompanied by CSF nasal exsudate). In 4 it followed neurosurgical intervention, in 3 it accompanied recurrent purulent highmorities, in 1 case--after removal of the nasal polyps and subsequent CSF nasal exsudate, and in 1 patient with recurrent mastoiditis. In 6 cases (11%) the cause of the recurrences remained unelucidated. The clinical signs and symptoms, diagnostic difficulties and the causative treatment of rpbme are discussed. In the authors' opinion, surgical treatment of the communication between the CSF and the external environment prevents the recurrences and is the only successful way of treatment. Special attention is drawn to the great diagnostic value of CT and MRI. The use of other modern techniques, e.g. positron emission tomography (PET) is recommended, because it is useful not only in the functional evaluation of the cerebral tissue after the injury, but also in assessing the dynamics of pathologic changes.

[Sepsis--generalized infection. The treatment of adults based on personal observations]. / Posocznica--zakazenie uogólnione. Leczenie u doroslych na podstawie doswiadczen wlasnych.

Basing on the own experience, the authors discuss causative treatment of sepsis, mainly of unknown etiology. Emphasis is on the depression of immunological system in the acute phase of the disease. Therefore, a combined treatment with 2, often 3 or even 4 bacterial antibiotics is recommended, together with passive immunotherapy, and in certain cases surgical removal of the infection foci.

[Sepsis--a generalized infection. Etiopathogenetic, diagnostic and clinical problems in adults based on personal experiences]. / Posocznica--zakazenie uogólnione. Problemy etiopatogenetyczne, diagnostyczne i kliniczne u doroslych na podstawie do swiadczen wlasnych.

Etiopathogenetic, diagnostic, and clinical problems seen in the adult patients with sepsis have been discussed. An emphasis is on the diagnostic problems in an early stage of infection as well as bacteriological findings. The authors stress that sepsis usually develops in patients with depressed immunological system.

[Blood-cerebrospinal fluid barrier in purulent cerebrospinal meningitis]. / Bariera krew-plyn mózgowo-rdzeniowy w ropnych zapaleniach opon mózgowo-rdzeniowych i mózgu.

Our investigations concerned the blood-brain barrier (b.b.b.) in patients with acute bacterial purulent meningitis. For that purpose concentrations of proteins, which are synthesized beyond the central nervous system and in normal cerebrospinal fluid (CSF) exist only in slight amounts, were determined in CSF and in blood serum. Albumin was examined in the CSF of 59 patients and in the serum of 35 of them, transferrin of 40 and 32 patients, respectively. Etiological verification was obtained in 84.7% of patients. The control group consisted of 20 persons. Quantitative analytical tests were carried out by means of immunochemical, turbidimetric methods. High levels of albumin and transferrin in CSF and low in serum of patients with meningitis were observed. The obtained results, confirmed by statistical analysis, demonstrate that in the acute phase of purulent meningitis b.b.b is impaired, what leads to the transfer of the proteins from the blood serum into the cerebrospinal fluid and that transferrins a better indicator of the damage to blood-brain barrier than albumin.

[C-reactive protein (CRP) and its significance in purulent meningitis]. / Bialko C-reaktywne (CRP) i jego znaczenie w ropnych zapaleniach opon mózgowo-rdzeniowych i mózgu.

CRP level was determined in the cerebrospinal fluid in 40 cases of bacterial meningitis. Similar determination in serum was done in 32 of these patients. Aetiological verification was possible in 90% of cases. Meningitis caused by Str. pneumonia and Neisseria meningitides prevailed (52.5% and 27.5% respectively). The control group comprised 20 subjects. For CRP demonstration immunochemical and turbidimetric methods were used. CRP in CSF was raised in 62.5% of the study cases while in the serum it was raised in all of them. CRP detection in serum in acute phase of central nervous system infection is diagnostically important since CRP increase suggests a purulent process.

[Etiology and clinical course of purulent meningitis and encephalitis in adults]. / Etiologia i klinika ropnych zapalen opon mózgowo-rdzeniowych i mózgu u doroslych.

The authors, basing on the own experience in the treatment of 578 patients with purulent meningitis and encephalitis, discuss etiologic and clinical problems as an early diagnosis of the cause decides on the proper therapy and often on the patient's fate. The authors are convinced that the result of general CSF examination is a crucial diagnostic criterion in meningitis and encephalitis but does not permit identification of the disease causes. Problems with etiological verification is discussed. The authors have found that the infection with N. meningitidis and S. pneumoniae remains the most frequent cause of the disease in adults. However, the cause of the disease cannot be determined in over 50% of patients, and etiological verification of infections caused by H. influenzae and anaerobic organisms is quite unsatisfactory. The authors stress that over 20% of patients had skull injury and meningitis most frequently resulted from the infection with S. pneumoniae in these patients. It is suggested that purulent meningitis and encephalitis as a rule is endogenous disease produced by the activation of endogenous source of the infection.

[Methods and treatment results of purulent meningitis and encephalitis in adults--based on personal observations]. / Metody i wyniki leczenia ropnych zapalen opon mózgowo-rdzeniowych i mózgu u doroslych--na podstawie doswiadczen wlasnych.

The authors present own methods and results of the treatment of 578 patients with suppurative meningitis and encephalitis. Etiologically most frequent infections due to N. meningitidis, S. pneumoniae, and H. influenzae were treated with penicillin and ampicillin; the authors recommend to replace the latter antibiotic with cefotaxime. If meningitis and encephalitis were due to aerobic gram-negative bacilli, a possibility of the simultaneous infection with anaerobic flora was considered, and the drugs active against both types of the organisms were administered. The same was the treatment in case of etiologically confirmed staphylococcal infection. In case of unknown etiology of meningitis and encephalitis therapy was based on clinical data, and laboratory findings.

[Bacterial meningitis in patients with sepsis syndrome]. / Ropne zapalenia opon mózgowo-rdzeniowych i mózgu u chorych na posocznice.

The authors discuss problems connected with diagnosis, management and treatment of bacterial meningitis among patients with the sepsis syndrome. Considering secondary organ changes bacterial meningitis belongs to the severest one and as a life-threathing sequel of sepsis demands immediate use of proper casual treatment. The authors show the therapeutic difficulties in this group of patients particularly when the etiological organism is unknown. They discuss this problems and present their own schemes of tretment. They indicate the value of passive immunotherapy and surgical removal of the primary source of infection. They emphasize final result depends on secondary organ changes, age, immunity of patient and the kind of etiological agent.

[Tubercular meningitis and encephalitis in adults--own experience]. / Gruzlicze zapalenie opon mózgowo-rdzeniowych i mózgu u doroslych--doswiadczenia wlasne.

Diagnostic, clinical and therapeutical problems of tuberculous meningitis and encephalitis have been discussed on a basis of clinical observation of 67 patients. In the early phase of disease the diagnosis is based on clinical parameters and results of cerebrospinal fluid examinations. Authors suggest a shortage of time treatment under 12 months.

[Effect of Bioglobulin on the clinical course of selected diseases of viral and bacterial etiologies]. / Wplyw Bioglobuliny na przebieg kliniczny wybranych chorób o etiologii wirusowej i bakteryjnej.

The therapeutic effect of Bioglobulin was studied in some diseases of viral or bacterial etiology. It was found favorable as it seemed to lessen the clinical and the shorten the acute as well as the hospitalisation periods. Because in the very serious and serious diseases of viral or bacterial etiology the antibodies deficiency, absolute or relative, total or selective is common, Bioglobulin may be a valuable agent in the comprehensive treatment.

[Etiology, clinical course, and the methods and results of the treatment of suppurative meningoencephalitis in adults--personal observations data]. / Etiologia, klinika, metody i wyniki leczenia ropnych zapalen opon mózgowo-rdzeniowych i mózgu u doroslych--na podstawie danych z wlasnych obserwacji.

The authors discuss problems connected with the clinical, aetiological diagnosis, methods and results of treatment of purulent meningoencephalitis in adults. The basis for the discussion were own experiences obtained during hospitalization of 578 patients in the period 1981-1990. As a results of this analysis the authors found that the organisms causing this disease most frequently were, as previously, Neisseria meningitidis and anaerobic Haemophilus influenzae were still highly unsatisfactory. Complete recovery was obtained in 73.3% of cases, 6.6% were discharged with various neurological sequelae, and 29.1% died. Cases of pneumococcal origin, frequent after cranial trauma, showed the most severe course, had the highest percent of psychoneurological complications and recurrences with the highest death rate.

[CEFOBID in the treatment of respiratory tract infection (preliminary report)]. / CEFOBID w leczeniu zakazen narzadu oddychania (doniesienie wstepne).

The therapeutical efficacy of CEFOBID (Pfizer) a third generation cephalosporine (natrium cephaperasone salt) was studied in 10 patients with acute respiratory infections including 6 with pneumonias. The therapeutical effect was arbitrarily judged according to the applied three point scale--"good", "satisfactory", "lack of effect". A "good" effects was seen in 6 patients, in 2 "satisfactory", in further two "lack" of effect was observed. Thus CEFOBID proved to be of beneficial effect in eight out of ten patients. One should stress that in the group that responded to treatment were all cases of pneumonia. CEFOBID was well tolerated. In this preliminary study the beneficial therapeutical effect in Gram negative opportunistic infections is stressed.

[Extremely severe respiratory failure complicated by lactic acidosis]. / Skrajnie ciezka niewydolnosc oddychania powiklana kwasica mleczanowa.

A case of a 48-year male patient with chronic cor pulmonale is presented. Exacerbation of the chronic respiratory failure was caused by pneumonia. The patient was treated with artificial ventilation for 22 days and stimulating aggressive antibacterial therapy. An improvement was achieved. Indications to the use of respirator in the exacerbated chronic respiratory failure have been discussed together with problem of the potential reversibility of the cause, gas and lactic acidosis and an important clinical problem of the respiratory muscles exhaustion.