Continuous venovenous hemodiafiltration (CVVHDF) with citrate anticoagulation in the treatment of a patient with acute renal failure, hypercalcemia, and thrombocytopenia.

A 72-year-old patient with multiple myeloma was admitted to the intensive care unit because of hypercalcemic crisis and acute renal failure. After 7 days of comprehensive therapy including diuretics steroids, calcitonin, and intermittent hemodialysis (IHD) with low-calcium dialysate, calcium still reached high levels between IHD treatments and thrombocytopenia developed after chemotherapy. CVVHDF with calcium-free bicarbonate dialysate was started. Anticoagulation with 2.2% citrate was performed in order to chelate calcium, and thus treat the hypercalcemia, and to provide regional anticoagulation, and thus reduce the risk of bleeding due to thrombocytopenia. CVVHDF with citrate anticoagulation was continued for 6 days, and standard heparin anticoagulation was started when the hypercalcemia and thrombocytopenia abated.

Glutamine and other amino acid losses during continuous venovenous hemodiafiltration.

Serum amino grams and daily losses of glutamine (Gln) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 +/- 0.1 gN) and reached 4.5% of the daily AA substitution. Gln represented 32.7 +/- 5.9% of the total AA losses (0.19 +/- 0.04 gN). Serum levels of Gln (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gln in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gln losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gln metabolism and distribution that are reflected by a decrease of serum Gln levels at the institution of this treatment. Therefore, the need for Gln supplementation in ICU patients is even greater in the first days of CVVHDF.

[The central registry of bone marrow donors and the program for bone marrow transplantation from unrelated donors--20 months' experience]. / Centrální registr dárcu kostní drene a program nepríbuzenských transplantací kostní drene--dvacetimesícní zkusenosti.

The authors describe their 20 months' experience with the establishment of a bone marrow register in the Czech Republic and its practical association with the programme of bone marrow transplantations from non-related subjects. During the 20 months of activity 5455 voluntary bone marrow donors were examined and at present more than 500 new voluntary donors are examined every month. For 21 patients a HLA identical unrelated donor is sought. For four patients a HLA compatible donor was found. The first bone marrow transplantation from a unrelated donor was performed and another patient is prepared for transplantation within the next few days. The authors discuss professional, organizational, moral and ethical problems associated with the elaboration of this medical programme.

[Development of therapy of acute myeloid leukemia at the First Internal Medicine Clinic in Plzen]. / Vývoj lécby akutních myeloidních leukémií na I. interní klinice v Plzni.

The authors summarize the development of diagnosis and treatment of acute myeloid leukaemias (AML) at the First Medical Clinic in Plzen in a (group) of 102 patients treated during 1966-1990. On their own results they demonstrate the importance of intensive post-remission treatment with large doses of cytosine arabinoside (ara-c) which makes possible long survival or complete recovery of some patients, and at the same time the necessity and pretentious character of comprehensive supportive treatment is emphasized.

[Changes in hemostasis in blood donors on the Fenwal CS 3000 separator]. / Sledování zmen hemostázy u dárcu na separátoru FENWAL CS 3000.

During thrombocytophereses on a blood cell FENWAL CS 3000 separator in one group of donors the anticoagulant solution ACD-A recommended by the manufacturer was used, in the other group of donors ACD-A with heparin was used. The authors give an account of the changes in some parameters of haemostasis in these donors on the separator incl. examination of fibrinopeptide A which is the most sensitive indicator of clotting activity during separation. Heparin administration prevented a rise of fibrinopeptide A and did not lead to a reduced platelet yield.

[Comparison of the therapeutic effectiveness of membrane and centrifugation plasmapheresis]. / Srovnání úcinnosti lécebné membránové a centrifugacní plazmaferézy.

The authors compared 10 pairs of membrane plasmaphereses on an apparatus A 2008 PF and filter Plasmaflux P 2 with 10 centrifugation plasmaphereses on an apparatus Fenwal CS 3000. They evaluated the effectiveness by changes of plasma concentrations of total protein, albumin, beta 2 microglobulin, IgG, IgA, C3 complement, IgM, circulating immune complexes, urea, creatinine, uric acid, cholesterol, triacylglycerols and the clearance of these substances. Changes of plasma concentrations caused by plasmapheresis with the methods used did not differ in any of the investigated substances. The clearance of membrane plasmapheresis was for all substances higher than when the centrifugation method was used. Among values from which the clearance is determined no difference was proved between the two methods in the volume of exchanged plasma, the concentration of the substance in the removed plasma and its mid plasma concentration during the operation. The higher clearance of membrane plasmapheresis was due to the more rapid plasma exchange.

[The effect of HLA alloimmunization and other factors on the effectiveness of thrombocyte concentrates]. / Vliv HLA aloimunizace a dalsích faktoru na úcinnost trombokoncentrátu.

Sixteen patients with severe thrombocytopenia and secondary bone marrow inhibition were given 81 thrombocyte concentrates. In 55.6% platelet transfusions led to an adequate posttransfusion rise of platelets, in 44.4% of thrombocyte transfusions the increase of platelets was not satisfactory. The cause of the inadequate posttransfusion rise of platelets in 19.4% were antibodies against HLA antigens. In addition to other known factors which influence the rise of platelets a significant relationship was revealed between administration of Amphotericin B, broad spectrum bactericide antibiotics and the body temperature. To improve substitution of thrombopenic patients by platelet concentrates the authors recommend to create a national register of HLA typed donors.

[Treatment of medium and highly malignant non-Hodgkin's lymphoma with combined chemotherapy using methotrexate, adriamycin, cyclophosphamide, vincristine, prednisone and bleomycin (protocol MACOP-B)]. / Lécba stredne a vysoce maligních nehodgkinských lymfómu kombinovanou chemoterapií metotrexátem, adriamycinem, cyklofosfamidem, vinkristinem, prednisonem a bleomycinem (protokol MACOP-B).

Combined chemotherapy, protocol MACOP-B, was administered to 21 patients with non-Hodgkin lymphoma (NHL) with a medium or high grade of malignity, clinical stage II-IV. Complete remission was achieved in 17 patients (81%), in one instance partial remission was induced. One patient died from a cardiovascular and one from a thromboembolic complication during treatment. In one patient the results were not evaluated. Three patients developed severe granulocytopenia which called for reduction or delay of treatment and a septic condition developed. In addition to myelosuppression the main complications were stomatitis and mycosis. No death caused by infectious or haemorrhagic complications was recorded. The described chemotherapy is recommended in particular in immunoblastic lymphomas, diffuse lymphomas from cleaved and non-cleaved cells and diffuse lymphomas with mixed cellularity.