bluuebunny/crossref_metadata_2025 huggingface dataset:
Raynaud Phenomenon After Treatment of Verruca Vulgaris of the Sole with Intralesional Injection of Bleomycin
Authors: Vanhooteghem O. , Richert B. , De La Brassinne M.
Published: March 2003

Abstract: Intralesional injection of bleomycin (BLM) for the treatment of warts resistant to all conventional therapies is of certain interest because of the drug's low toxicity and its efficacy. However, delayed side effects may appear, particularly Raynaud phenomenon. Accordingly, some precautions must be taken in patients with vascular or collagen diseases and, as a precaution, pregnant or lactating women and infants should not be treated with this drug.
Necrobiosis Lipoidica in a 9‐Year‐Old Girl with New‐Onset Type II Diabetes Mellitus
Authors: Szabo Richard M. , Harris Glenn D. , Burke William A.
Published: March 2003

Necrobiosis lipoidica (NL) is an idiopathic dermatologic condition that is strongly associated with, but not pathognomonic for, diabetes mellitus. It is more commonly seen in women than men and in adults than children. We present the youngest child, to our knowledge, diagnosed with NL at initial presentation with type II diabetes mellitus. We review the literature and discuss pathogenesis, clinical features, and treatment options for NL.
Cranioectodermal Dysplasia: A New Patient with an Inapparent, Subtle Phenotype
Authors: Zannolli R , Mostardini R , Carpentieri M L , Gatti M G , Galluzzi P , Vagnoli P. Terrosi , Giorgetti R , Calvieri S , Morgese G
Published: March 2003

Cranioectodermal dysplasia is a rare syndrome characterized by craniofacial and skeletal anomalies and ectodermal dysplasia. Life‐threatening associated conditions (i.e., kidney failure and abnormal regulation of the parathyroid‐bone axis) can also develop. We report a patient whose features are suggestive of an inapparent, subtle phenotype of the syndrome. The patient is a 4‐year‐old girl with only dolichocephaly and clinodactyly; microdontia, hypodontia, and taurodontia (i.e., cone‐shaped teeth); anteverted nares, full cheeks, and everted lower lip; epicanthal folds, hypertelorism and hyperopia; and corpus callosum hypoplasia. She has no rhizomelic limb shortening or hair abnormalities. In view of the rarity of the cranioectodermal dysplasias, the variability of the phenotype, and the uncertain outcome of some previously described patients, we believe this inapparent, subtle case should reported to enable better understanding and treatment of this rare syndrome.
Giant Cell Fibroblastoma in a Child Misdiagnosed as a Dermatofibroma
Authors: Nguyen Chau M. , Burch Joanna M. , Fitzpatrick James E. , Peterson Steven L. , Weston William L.
Published: March 2003

We report a 9‐year‐old African‐American boy with a giant cell fibroblastoma of the shoulder that was incorrectly diagnosed as a keloid and dermatofibroma. Initial misdiagnosis led to a delay of 4 years in the correct diagnosis, with the tumor producing significant local destruction. We review herein the clinical manifestations, histologic findings, histiogenesis, relationship to dermatofibrosarcoma protuberans (DFSP), treatment, and differential diagnosis of giant cell fibroblastoma (GCF). This information is important in correctly diagnosing this uncommon, benign, but locally aggressive and recurrent tumor of childhood. The clinician should consider GCF and DFSP when the pathologic diagnosis of dermatofibroma is made in lesions more than 2 cm in diameter, or when this diagnosis is made in a prepubertal child.
Lichen Planus in Children: A Possible Complication of Hepatitis B Vaccines
Authors: Limas Catherine , Limas Constantinos J.
Published: March 2003

Abstract: Lichen planus (LP) has been reported as a complication of hepatitis B vaccination in both adults and children. According to published observations, an autoimmune reaction may be triggered by the viral S epitope. In children, LP is uncommon and, because of its atypical clinical presentation, definitive diagnosis may require biopsy. We investigated the possible association of recombinant hepatitis B virus (HBV) vaccines with childhood LP or LP‐like eruptions seen in our hospital over the last 3 years. Only biopsy‐confirmed cases in which the clinical history could be thoroughly scrutinized were included. We report five patients less than 16 years of age in whom such an association could be supported by relevant data. Thirteen similar pediatric and 15 adult cases have been reported from various countries in the last 5 years. The data indicate that LP is a complication that rarely occurs in children receiving the HBV vaccine. It appears without known predisposing factors and has variable clinical presentations while the␣histologic findings are consistent and, with minor variations, typical of LP.
The Russell–Silver Syndrome: A Case Report and Brief Review of the Literature
Authors: Perkins CPT Robert M. , Hoang‐Xuan Maj Tuan A.
Published: March 2003

Abstract:The Russell–Silver syndrome's phenotypic features consist of musculoskeletal abnormalities, genitourinary malformations, craniofacial dysmorphy and cutaneous dyschromia, which is usually reported as café au lait spots. We present the first instances of a large, unilateral, achromic patch as an additional cutaneous manifestation of the Russell–Silver syndrome.
Eruptive Pseudoangiomatosis
Authors: Larralde Margarita , Ballona Rosalía , Correa Noemí , Schroh Roberto , Coll N.
Published: March 2003

We describe two children with acute onset and spontaneous resolution of angioma‐like papules during a viral illness. The biopsy specimens from both patients showed a unique histologic appearance consisting of dilated dermal blood vessels with plump, hobnail‐shaped endothelial cells. On the basis of the natural history and the histopathologic features we suggest the diagnosis of eruptive pseudoangiomatosis.
Sequential Plasmapheresis and Intravenous Immunoglobulin Therapy for Refractory Myasthenia Gravis: Case Report
Authors: Yeh Jiann‐Horng , Chiu Hou‐Chang
Published: March 2003

Immunotherapy is currently the standard therapy for myasthenia gravis (MG) although some patients may be refractory to treatment. We describe the use of sequential plasmapheresis and intravenous immunoglobulin (IVIG) therapy for treatment of advanced MG in a patient refractory to all forms of medical treatment including corticosteroids, immunosuppressants, and intermittent plasmapheresis. The patient, a 37‐year‐old woman with systemic lupus erythematosus (SLE), had initially responded well to treatment with high dose corticosteroids and intermittent plasmapheresis, with the duration of response ranging from 3 to 4 months. However, after 18 months of therapy, the duration of response had gradually decreased to 1 month. She responded well to a 5 day trial of plasmapheresis followed by high dose IVIG, and the duration of response increased to 6 months. The SLE activity was relatively silent during each relapse. This report indicates the potential usefulness of sequential plasmapheresis and IVIG in the treatment of patients with refractory MG and SLE.
Therapeutic Plasma Exchange and Cyclosporine in the Treatment of Systemic Lupus Erythematosus
Authors: Schiel Ralf , Bambauer Rolf
Published: March 2003

Despite treatment with intensive immunosuppressive drug regimens, often the prognosis of patients suffering from systemic lupus erythematosus (SLE) is poor. Side effects such as infections and malignant tumors often occur. In the present trial, 21 patients (4 male and 17 female, aged 37.9 ± 12.8 years) suffering from SLE for 9.4 ± 2.6 years, were treated for 2.3 ± 1.8 years with drug regimens of corticosteroids, azathioprine and/or cyclophosphamide. Then, over a period of up to 8 years, in addition to conventional therapies, especially in active stages of the disease with extremely high concentrations of anti‐DNA‐, antinuclear antibodies and circulating immunocomplexes, therapeutic plasma exchange (TPE) sessions were carried out depending on symptomatology. In addition patients received 2.5 ± 0.6 mg cyclosporine/kg body weight/day. Compared to previous treatment modalities, clinical symtoms improved more quickly and more effectively (p = 0.046). After 5 to 48 (17.5 ± 13.8) months, cyclosporine was established as a monotherapy for 8 of 21 patients. In the other cases, corticosteroids, azathioprine and cyclophosphamide were reduced by 40 to 100%. No severe side effects were seen. In acute stages of SLE and in forms with persistently high antibody levels, the addition of TPE sessions and cyclosporine as the basic immunosuppressive drug is usually very effective with regard to improving clinical symptomatology.
Coronary Risk Factor Management for the Prevention and Treatment of Graft Vessel Disease in Heart Transplant Patients
Authors: Jaeger Beate Roxane , Schirmer Johannes , Thiery Joachim , Meiser Bruno M. , Überfuhr Peter , Kreuzer Eckart , Reichart Bruno , Seidel Dietrich
Published: March 2003

There is increasing evidence that atherogenic risk factors largely contribute to the pathogenesis of graft vessel disease (GVD) after heart transplantation. Initial endothelial damage of the transplant heart derives from reperfusion ischemia during operation, repeated infections, and rejection episodes. Immunosuppressive medication considerably increases low density lipoprotein (LDL) cholesterol, lipoprotein(a), and fibrinogen blood levels, which in turn further damage the endothelium of the graft coronaries. Probably, this interplay of immunological and atherogenic factors accounts for the rapid development of GVD and its poor prognosis. The rapidity of the disease process makes it necessary to eliminate important risk factors as early and as efficiently as possible. Therefore, we studied whether heart transplant patients could benefit from a combined treatment of statins and apheresis heparin extracorporeal LDL/fibrinogen precipitation (HELP), which has already been shown to be beneficial for the treatment of advanced coronary artery disease. Such a combined treatment allows simultaneous and drastic reduction of LDL, lipoprotein(a), and fibrinogen blood levels and significantly prevented GVD. Moreover, it did not affect the prevention of rejections and infections, respectively.
The Effect of Combination Therapy with Interferon and Cryofiltration on Mesangial Proliferative Glomerulonephritis Originating from Mixed Cryoglobulinemia in Chronic Hepatitis C Virus Infection
Authors: Kiyomoto Hideyasu , Hitomi Hirofumi , Hosotani Youko , Hashimoto Mayuko , Uchida Kouichi , Kurokouchi Kazutaka , Nagai Masami , Takahashi Norihiro , Fukunaga Megumu , Mizushige Katsufumi , Matsuo Horohide , Yuasa Shigekazu
Published: March 2003

Abstract: Cryofiltration, which has developed from double filtration plasmapheresis (DFPP) with a cooling unit, is an on‐line technique to remove cryoglobulin. We report on a patient who suffered from progressive edema and renal insufficiency caused by cryoglobulinemic membranoproliferative glomerulonephritis (MPGN), probably due to chronic hepatitis C virus (HCV) infection. To remove cryoglobulins and terminate the HCV infection, we utilized combination therapy with cryofiltration and interferon‐α injection with corticosteroids. Interferon‐α was capable of decreasing proteinuria but not diminishing cryoglobulin. Additional cryofiltration could remove cryoglobulin to an undetectable level. This combination therapy was partially successful to reduce proteinuria and prevent the progressive deterioration of renal function. The major adverse effects of this therapy were bleeding and myelosuppression. We conclude that this combination therapy may be effective and should be considered as treatment for cryoglobulinemic MPGN.
Evaluation of Efficacy in Platelet Collection by the Haemonetics Component Collection System
Authors: Omokawa Susumu , Takada Goro , Watanabe Emiko , Tanaka Kimiko , Abe Makoto , Osato Noriko , Kawakami Keizou
Published: March 2003

Abstract: Platelet concentrate product derived from plateletpheresis from a single donor is preferable in terms of reducing the risks of adverse reactions in platelet transfusion. This study evaluated the status of platelet transfusion and the efficacy and safety of plateletpheresis machines. The average number of donors of platelet product per patient has been decreasing and recently reached nearly 1.0; however, some patients still receive multiple random donor platelet products. Platelet collection efficacy was comparable between the Haemonetics Component Collection System (CCS) and the Multi Component System (Multi). However, the CCS has been shown to be effective in terms of processed blood volume and procedure time, especially in donors with lower hematocrits. These results suggest that the CCS may be preferable and safer for donors with lower hematocrits and lighter body weights. Blood centers should collect platelets more effectively to achieve platelet transfusion with the use of platelets derived from a single donor using effective equipment.
Plasma Exchange for Acquired Hemophilia: A Case Report
Authors: Ogata Hiroaki , Sakai Sadako , Koiwa Fumihiko , Tayama Hironori , Kinugasa Eriko , Ideura Terukuni , Akizawa Tadao
Published: March 2003

Abstract: A patient with acquired hemophilia complicated with chronic renal failure and lung tuberculosis was successfully treated by consecutive plasma exchange (PE). A 71‐year‐old man with serious bleeding tendency showed low coagulation factor levels and a high titer of factor VIII (FVIII) inhibitor, and he was diagnosed with acquired hemophilia. Because of the complication of active lung tuberculosis, instead of immunosuppressive therapy, he undertook a series of PE with fresh frozen plasma replacement for 3 months. After the start of PE, his bleeding symptoms and activated partial thromboplastin time (APTT) improved gradually according to the decrease in FVIII inhibitor levels . These results suggest that PE is an effective therapeutic tool for refractory acquired hemophilia.
Balancing (Yin‐Yang) Hypothesis for Assessment of Effective Apheresis Therapies
Authors: Nosé Yukihiko
Published: March 2003

Abstract: In the past, the therapeutic effects of apheresis were thought to be due to effective removal of pathological macromolecules and leukocytes. However, the removal of these components did not necessarily produce a lower level of these components in circulating blood. Very often a rebound phenomenon took place, particularly in leukocyte kinetics after apheresis procedures, and an increased level of circulating leukocytes was demonstrated. Thus, the assessment of the clinical effects of apheresis procedures was very difficult to discuss in terms of the removal of pathological macromolecules and/or leukocytes alone. A balancing (yin‐yang) hypothesis is thus proposed to be able to understand more realistically the clinical efficacy of therapeutic apheresis.
Low Density Lipoprotein Apheresis in Treatment of Hyperlipidemia: Experience with Four Different Technologies
Authors: Bambauer Rolf , Schiel Ralf , Latza Reinhard
Published: March 2003

Abstract: The prognosis of patients suffering from severe hyperlipidaemia (HLP), sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease (CHD) refractory to diet and lipid lowering drugs is poor. A new therapeutic option for such patients is regular treatment with low density lipoprotein (LDL) apheresis. In total 33 patients (16 males, 17 female, aged 43.8 ± 14.3 years), suffering from severe HLP resistant to diet and lipid lowering drugs, were treated for 62.3 ± 21.3 (range, 1–113) months with LDL‐apheresis. Four different LDL‐apheresis systems were used: the dextran sulfate adsorption for 28 of 33 (Liposorber, Kaneka, Japan), immunoadsorption for 2 of 33 (Therasorb, Baxter, Germany), LDL‐hemoperfusion for 2 of 33 (Dali, Fresenius, Germany), and the immunoadsorption system with special anti‐lipoprotein (a) columns for 1 of 33 patients (Lipopak, Pocard, Russia). Before applying LDL‐apheresis, 27 of 33 patients suffered from CHD with severe angina pectoris symptoms, a history of myocardial infarction or coronary artery venous bypass (CAVB). With LDL‐apheresis, reductions (p < 0.05) of 46% for total cholesterol, 49% for LDL, 28% for Lp(a), and 38% for triglycerides were reached. Severe side‐effects, such as shock or allergic reactions, were very rare (0.5%). In the course of treatment an improvement in general well‐being and increased performance were experienced in 29 of 33 patients. In 23 of 27 patients suffering from CHD, a reduction of 60 to 100% of nitrate medication was observed. Regarding the different apheresis systems used, there were no significant differences with respect to the clinical outcome and concerning total cholesterol, LDL, HDL, and triglyceride concentrations. But, in respect to elevated lipoprotein (a) levels, the immunoadsorption method using special anti‐lipoprotein (a) columns seems to be the most effective (−57% versus −25%[Kaneka, p < 0.05] or −23%[Baxter, p < 0.05]). The present data clearly demonstrate that treatment with LDL‐apheresis in patients suffering from severe HLP, refractory to maximum conservative therapy, is effective and safe in long‐term application.
An Evaluation of Polymethylmethacrylate Plasma Separator by Animal Experiment
Authors: Iizuka Ichiro , Yamazaki Zenya , Fujimori Yoshizo , Takahama Tatsuhiko , Kanai Fukuei , Wada Tatsuo , Inoue Noboru , Sonoda Takeshi , Nogi Tachio , Kimura Mutsumi
Published: March 2003

Guest Editor's Introduction: This paper was presented at the first plasmapheresis symposium organized by the International Society for Artificial Organs and the International Center for Artificial Organs and Transplantation on April 3, 1982, Cleveland, Ohio. This paper was printed in the proceedings of this symposium: Plasmapheresis: Therapeutic Application and New Technologies, edited by Y. Nosé and PS Malchesky, JW Smith, and RS Krakauer, Raven Press, New York, 1983, p. 93–98. This is the first technical paper on the polymethylmethacryate (PMMA) plasma separator manufactured by Toray Medical Inc., Tokyo, Japan. The PMMA membranes had already been utilized as hemodialysis membranes. This paper deals with the PMMA hollow fiber plasma separator from its efficiency to filtrate plasma and for blood compatibility.
Evaluation of a Filtration Lymphocytapheresis (LCP) Device for Use in the Treatment of Patients with Rheumatoid Arthritis
Authors: Kondoh Takefumi , Hidaka Yasuo , Katoh Hitoshi , Inoue Noboru , Saito Shirao
Published: March 2003

Abstract: Guest Editor's Introduction: Cell adhesion on a material is caused by the interaction between them and related to the material characteristics including chemical structure, surface charge, wettability, smoothness, and microstructure such as microdomain structure. In addition, Nishimura of Asahi Medical Co. found that the size of the material is important particularly in the case of lymphocyte adhesion. Based upon this result Asahi Medical Co. developed lymphocyte removal filters by use of ultra fine fibers having a diameter of 1.7 μm. The filter was first used for leukocyte filters for blood transfusion, and then applied for therapeutic use in the treatment of patients with various hematological and autoimmune diseases. This paper describes the specification of the filter and clinical application for the treatment of rheumatoid arthritis. This paper was printed in Artificial Organs, vol. 15, page 180–188 (1991) and reprinted here with permission.

A practical on‐line lymphocytapheresis (LCP) system using a leukapheresis filter (Cellsorba, Asahi Medical Co.) was evaluated in six patients with refractory rheumatoid arthritis. This filter consists of nonwoven fine polyester fiber wound around a porous cylinder. The blood was passed through the polyester fiber at a flow rate of 50 ml/min for 60 min. LCP was carried out once a week in the first month and biweekly in the next 2 months. An average of 98% of the leukocytes that entered the filter (1.27 × 1010 cells) and 100% of the lymphocytes that entered the filter (3.66 × 109 cells) were removed in the first LCP. A total of 96.6% of the platelets and 2.7% of the erythrocytes that entered the filter were also removed. All of the patients showed clinical improvement in morning stiffness, Lansbury articular index, and functional capacity, with no adverse reaction. The number of circulating lymphocytes erythrocytes, and platelets and the concentration of various serum components showed no significant change during the treatments. This LCP system required no fresh frozen plasma, albumin, or other blood transfusion. The number of circulating lymphocytes decreased to 65–70% of the pretreatment circulating lymphocyte count at the last procedure, with a decrease in the ratio of Leu3a positive cells to Leu2a positive cells. The proliferative response to phytohemagglutinin and concanavalin A was improved. These data suggest that LCP to remove ∼3 × 109 lymphocytes once a week or biweekly has an immunomodulatory effect.
Treatment of Amanita Phalloides Poisoning: I. Retrospective Evaluation of Plasmapheresis in 21 Patients
Authors: Jander S. , Bischoff J.
Published: March 2003

Abstract: Amanita phalloides poisoning is the most common cause of lethal mushroom poisoning (lethality >20% in adults). A specific antidote against the amanitin toxins is not available. This retrospective study reports results in 21 patients (12 males, 9 females; ages 9–59 years) treated for amanita phalloides poisoning between 1984 and 1993. Plasmapheresis was carried out using a commercial plasma protein solution (Biseko, Biotest, Dreieich, Germany) in 17 patients, fresh plasma in 2 patients, and human albumin/Ringer's solution in 2 patients. Ancillary drugs, including penicillin and silibinin, also were used for detoxification, correction of blood‐clotting deficiencies, and hepatic protection. One patient died of acute hepatic failure. The results, assessed using mortality (4.8% overall) and frequency of complications, indicate that plasmapheresis is a safe and effective treatment for amanita phalloides poisoning but that further investigations are needed, especially involving measurements of efficacy and the efficiency of toxin removal.
Current Topics on Centrifugal Plasmapheresis Technologies
Authors: Omokawa Susumu
Published: March 2003

Abstract: In the field of plasmapheresis centrifugal technology has recently focused on the collection of peripheral blood stem cells (PBSCs) for both autologous and allogeneic transplantation in patients with malignancies or hematological diseases and on donor plasmapheresis. PBSC transplantation is rapidly replacing bone marrow transplantation in such patients. Various kinds of apheresis equipment were applied and described for PBSC collection. Comparison among machines is described. Allogeneic PBSCs were collected from healthy normal donors. Specific attention to the dose and administration duration of granulocyte colony‐stimulating factor and a careful apheresis procedure should be made for donor safety. In platelet transfusion practice, a platelet concentrate product derived plateletpheresis from a single donor is preferable to minimize and to prevent adverse transfusion reactions. The status of platelet collection and its efficacy by various kinds of plateletpheresis equipment are discussed. The Amicus and CCS might be preferable plateletpheresis machines because of their collection efficiencies and wider indication for donors. With the limited number of donors, it is essential that plateletpheresis should be more effectively performed and managed by each regional blood center. The status of plasma and red cell collection by apheresis technologies is described also briefly.
Heparin‐Induced Extracorporeal Low‐Density Lipoprotein Precipitation Apheresis: A New Therapeutic Concept in the Treatment of Sudden Hearing Loss
Authors: Suckfüll Markus
Published: March 2003

Abstract:Vascular events, immunological processes, and viral infections have to be considered as pathomechanisms for most cases of sudden hearing loss (SHL). In order to clarify predisposing conditions for vascular events, hemorheological parameters have been studied in 53 patients suffering from SHL within 5 days of onset, along with a control group. The striking result was a significantly elevated level of plasma fibrinogen leading to a significantly increased erythrocyte aggregation and plasma viscosity. No significant difference could be found in all other parameters of clinical chemistry, hematology, and hemostasis. These results encouraged us to use heparin‐induced extracorporeal low‐density lipoprotein (LDL) precipitation (HELP) apheresis, which acutely and drastically reduces LDL, fibrinogen, and lipoprotein (a) in the treatment of patients suffering from sudden hearing loss and hyperfibrinogenemia or hypercholesterolemia. In a pilot study including 30 patients, we found a better recovery of hearing in the patients treated with a single HELP apheresis when compared to conventional treatment for 10 days with prednisolone and dextranes. Currently, we verify these results in a larger multicenter trial in patients regardless of their fibrinogen or LDL levels. In the future, there will be different specific treatments of sudden hearing loss based on the different pathomechanisms. The clinical impression and first controlled data make it likely that HELP apheresis is useful in the therapy of sudden hearing loss with suspected vascular origin.
Effective Maintenance Leukocytapheresis for Patients with Steroid Dependent or Resistant Ulcerative Colitis
Authors: Kondo Kenji , Shinoda Toshio , Yoshimoto Hiroshi , Takazoe Masakazu , Hamada Tsutomu
Published: March 2003

Abstract: We prospectively examined the effect of leukocytapheresis (LA) on the maintenance of remission in 7 patients with ulcerative colitis (UC) who were initially refractory to corticosteroid therapy (steroid resistant or steroid dependent). The patients with refractory UC had been in remission due to LA (induction LA) in combination with the steroid therapy. They were then treated with LA once or twice a month for the purpose of maintaining remission (maintenance LA). The maintenance LA was performed by either a centrifuge method in 5 patients or a polyester adsorbent column method in 2 patients. Steroid dosage was gradually tapered as little as possible without recurrence based on clinical and/or colonoscopical judgments. Four patients were maintained in remission without steroids over 12 months. Recurrence was observed in 3 patients at 3, 3, and 6 months after the beginning of the maintenance LA, respectively. Two of the 3 patients were again conducted to remission by the second induction LA and maintained in remission by the second maintenance LA. Two patients finally underwent total colectomy because of recurrence of UC in a severe form. It is concluded that the maintenance LA therapy might be effective in some patients with steroid dependent or resistant UC for the maintenance of remission without steroids.
Powdered Sorbent Liver Dialysis and Pheresis in Treatment of Hepatic Failure
Authors: Ash Stephen R.
Published: March 2003

Abstract: The Liver Dialysis Unit (the Unit) is a liver‐assist device that employs hemodiabsorption (dialysis of blood against powdered sorbents) to selectively remove numerous small molecular weight toxins of hepatic failure. The Unit has been cleared by the Food and Drug Administration and is indicated and marketed for treatment of acute hepatic encephalopathy (AHE) due to decompensation of chronic liver disease (A‐on‐C) or fulminant hepatic failure (FHF). Controlled, prospective, and randomized studies of liver dialysis were conducted at several centers, enrolling 56 patients with AHE, grades II–IV with or without renal and respiratory insufficiency or failure. Liver dialysis treatments were for 6 h daily, 1–5 days with similar observation periods for control patients. Physiologic status, neurologic status, and outcome (recovery of hepatic function, improvement for transplant, or death) were measured, and results were compared for treated patients versus controls for patients with A‐on‐C and patients with FHF. Liver dialysis resulted in physiologic and neurologic improvement of patients with AHE, regardless of etiology. Liver dialysis significantly improved the incidence of positive outcomes (recovery of hepatic function or improvement for transplant) of A‐on‐C patients versus controls (71.5% treated, 35.7% control, p = 0.036), but had an insignificant improvement in the outcome of patients with FHF as compared with the control group. Among the overall 31 treated patients, 51.6% survived. Outcome was not negatively affected by the presence of kidney failure or respiratory failure. The plasmafilter unit (PF‐Unit) combines hemodiabsorption with push‐pull sorbent‐based pheresis (the PF add‐on module, with powdered sorbent surrounding plasmafilters). At blood flow rates of 200 ml/min, the system clears creatinine and aromatic amino acids at 120–160 ml/min, unconjugated bilirubin at 20–40 ml/min, and cytokines at 15–25 ml/min. The PF‐Unit has been tested in a few patients with hepatic failure with Grades III and IV encephalopathy, and respiratory, and kidney insufficiency. Treatment appeared to be safe, and there were no significant hematologic changes. Physiologic changes included improved blood pressure, and encephalopathy, and stable urine output. Chemical changes included a decrease in the plasma levels of bilirubin, aromatic amino acids, ammonium, creatinine, and IL‐1β. The PF add‐on module adds the capability to the Unit to remove bilirubin and other strongly protein‐bound toxins from treated patients and may be of clinical benefit in the management of patients with the most severe hepatic failure and encephalopathy, including patients with FHF or concomitant sepsis.
Experience with Artificial Liver Support in 16 Living Related Liver Transplant Recipients
Authors: Kawagishi Naoki , Ohkohchi Nobuhiro , Fujimori Keisei , Orii Takashi , Koyamada Nozomi , Kikuchi Hiroyuki , Satomi Susumu
Published: March 2003

Abstract: This study was a retrospective investigation about the indication and efficacy of artifical liver support for liver transplant recipients. Apheresis was performed in 16 of 41 patients subjected to living related liver transplantation (LRLTx) as articial liver support, including plasmapheresis (PP) in 13 cases, continuous hemodiafiltration (CHDF) in 7 cases, and plasma adsorption (PA) in 2 cases. One patient with cryptogenic liver cirrhosis was subjected to PP before the LRLTx, and the result was satisfactory. On the contrary, the results of PP and CHDF for graft, respiratory, or cardiac failure were not acceptable. Only 1 patient survived despite multiple organ failure. Both PP and PA for patients with hyperbilirubinemia were effective and improved their critical conditions. We conclude that apheresis for liver transplant patients is effective to treat hyperbilirubinemia, but it is not indicated for respiratory and cardiac failure nor for hepatic failure.
Apheresis as Therapy for Patients with Severe Sepsis and Multiorgan Dysfunction Syndrome
Authors: Stegmayr Bernd G.
Published: March 2003

Abstract: Progressive multiorgan dysfunction syndrome may occur in the course of sepsis and septic shock as well as after various intoxications, pancreatitis, crush injuries, and major surgery. Despite conventional intensive care therapies, the prognosis in these patients is still poor. Apheresis, which uses more selective adsorption techniques, can lower the extent of toxins and cytokines in blood. This is achieved in clinical practice by, e.g., using polymyxin B as adsorbent. Although significantly lowered, the mortality is still about 50% with this technique. By unselective plasma exchange, the mortality is reduced down to 20 to 40%. A controlled and randomized study has shown a significant benefit. The centrifugation technique may be favorable over plasma filtration. Not only removal but also replacement with plasma seems important. In the future, probably selective techniques will be used in the early stages of sepsis while unselective plasma exchange may be useful in a disseminated situation.
The Role of Rheology in Hemapheresis
Authors: Borberg H. , Brunner R. , Gaczkowski A. , Michel M. , Schreiner T. , Tauchert M.
Published: March 2003

Abstract:Rheological therapy attempts to favorably influence the blood flow mechanics for the treatment of diseases, mainly of the microcirculation but also of the macrocirculation. Hemapheresis, originally used only for the elimination of an excess of cellular or plasmatic components, was shown to also influence the hemorheology favorably. As extracorporeal therapy affects the rheology much more than conventional hemorheotherapy, not only cellular or plasmatic hyperviscosity syndromes but also many more diseases associated with organ perfusion problems due to diseases of the micro‐ and macrocirculation, especially in the elderly, were and are increasingly considered to be indicated. Technical progress led away from plasma exchange as an unspecific and unselective procedure to plasma differential separation using precipitation, adsorption, and filtration. With our recent development, we demonstrated that rheohemapheresis is the most advanced technical procedure. The mechanism of action can well be related to a synergetic consideration of rheology. However, one has to keep in mind that the elimination of blood components such as lipids, immunoglobulins, and endothelial factors may well contribute to the explanation and understanding of the positive clinical effects observed. These speculative aspects need further investigation.
Plasmapheresis in the University of Malaya Medical Centre, Malaysia
Authors: Chong Heng Thay , Tan Chong Tin
Published: March 2003

Abstract: Over the past 3 decades, plasmapheresis has been used more extensively for a variety of neurological and hematological disorders. We undertook a retrospective review to ascertain its safety, efficacy, and factor(s) that predispose to poor outcome. We reviewed 117 plasma exchanges in 24 patients with a mean age of 43 ± 15 years; half were male. A total of 79% of the patients had neurological diseases, and the most common were chronic inflammatory demyelinating polyneuropathy, Guillain‐Barré syndrome, and myasthenic crisis. Plasmapheresis was effective in 79% of the patients, especially for neurological indications. Complications occurred in 23% of the exchanges affecting 58% of the patients. Most complications were mild; sepsis was the most common (9.4% of exchanges), especially catheter related sepsis (6%), rash (4.3%), and hypotension (4.3%). Only 2 (8%) patients had severe complications that required mechanical ventilation. There were 5 mortalities (21%), 3 due to sepsis and 2 due to myocardial ischemia and arrhythmia, none of which occurred within 48 h of the last exchange. Patients with poor renal function had higher mortality. Overall, our figures agree with those from other institutions and indicate that plasma exchange is an effective and safe procedure, especially for a variety of neuroimmunological conditions.
Effects of Direct Adsorption of Lipoproteins Apheresis on Lipoproteins, Low‐Density Lipoprotein Subtypes, and Hemorheology in Hypercholesterolemic Patients with Coronary Artery Disease
Authors: Otto Carsten , Geiss H. Christian , Laubach Ester , Schwandt Peter
Published: March 2003

Abstract:Direct adsorption of lipoproteins (DALI) apheresis has been shown to reduce effectively low‐density lipoprotein (LDL) cholesterol and lipoprotein (a) concentrations. However, the effects on nontraditional risk indicators such as hemorheology and LDL subtypes have not been investigated so far. Five patients (2 women, 3 men, age 53 ± 8 years) with coronary artery disease and severe LDL hypercholesterolemia regularly treated with other LDL apheresis devices entered the study and were then treated with DALI for the first time. Hemorheological and lipoprotein parameters were measured before and immediately after the initial DALI apheresis as well as before the fourth DALI apheresis. Compared to baseline (before the first DALI apheresis), the following parameters were significantly improved (p < 0.05) after the first DALI apheresis: LDL cholesterol (69 ± 28 versus 208 ± 82 mg/dl) and cholesterol in each LDL subfraction as well as plasma viscosity (1.23 ± 0.04 versus 1.37 ± 0.06 mPa), C‐reactive protein, native blood viscosity, red cell aggregation, and red cell deformability. When parameters before the fourth DALI apheresis were compared to baseline, LDL cholesterol was still lower, and red cell deformability was still improved while cholesterol in each subfraction showed a statistical trend to lower concentrations (0.08 < p < 0.14). In conclusion, DALI apheresis not only reduces LDL cholesterol but also induced a significant reduction of cholesterol in all LDL subfractions and improved various hemorheological parameters.
Meaning of Low‐Density Lipoprotein‐Apheresis for Hypercholesterolemic Patients at High Risk for Recurrence of Coronary Heart Disease
Authors: Koga Nobuhiko
Published: March 2003

Abstract: The goal of cholesterol‐lowering therapy in hypercholesterolemic patients at high risk for recurrence of coronary heart disease (CHD) is the prevention of acute coronary syndrome by stabilization of coronary atheromatous plaque. We often encounter patients in whom it is difficult to maintain the serum cholesterol level at a desirable level with dietary therapy and drug treatment, despite the development and use of statins. For secondary prevention in patients who are at high risk for the recurrence of CHD and whose cholesterol level cannot be controlled by drugs alone, low‐density lipoprotein (LDL)‐apheresis therapy, which involves removal of LDL through extracorporeal circulation, is now available. Many reports concerning improvement of vascular endothelial function, improvement of myocardial ischemia, regression of coronary atherosclerotic lesions, stabilization of coronary plaque, and reduction in the incidence of cardiac events as a result of LDL‐apheresis treatment have been published in various countries. We believe that LDL‐apheresis should be performed on hypercholesterolemic patients with existing CHD for whom diet and maximum cholesterol‐lowering drug therapies have been ineffective or not tolerated and whose LDL cholesterol level is 160 mg/dL or higher.
Plasma Adsorption in Critical Care
Authors: Yang Kwang‐Seok , Kenpe Kazuo , Yamaji Ken , Tsuda Hiroshi , Hashimoto Hiroshi
Published: March 2003

Abstract: Plasmapheresis therapies such as plasma exchange (PE), double filtration plasmapheresis (DFPP), or immunoadsorption plasmapheresis (IAPP) have become therapeutic tools in critical care. PE or DFPP are limited by their non‐ or semiselective removal of all plasma components. Replacement fluids such as fresh frozen plasma and albumin are necessary during PE or DFPP. There is the risk of infection and allergic reactions whenever such fluids are used. On the other hand, IAPP is superior to PE and DFPP because it does not require any replacement fluid. There has been development of many adsorbent columns used for removing specific pathogenic substances, and patients with various kinds of critical illness have been treated with IAPP. However, IAPP can be applied only for certain diseases because of the limitations of the commercially available columns. It is concluded that the development of new adsorption therapy may improve the high mortality and morbidity rate in critically ill patients.
Critical Care by Cytapheresis
Authors: Kawamura Akio , Tsuchihashi Seiichiro , Yonekawa Motoki , Saitoh Masao , Tamaki Tohru , Meguro Jun‐ichi , Kukita Kazutaka
Published: March 2003

Abstract: We report our experience of cytapheresis using a nonwoven polyester fiber filter to treat critical states of immune diseases. In 7 critical states of ulcerative colitis (UC), cytapheresis was effective in improving symptoms of UC. Administration of steroids was important in some cases. In 3 cases of renal transplantation, cytapheresis was also effective in controlling rejection. IgA nephropathy of transplanted cases was well controlled. Furthermore, an original disease such as focal segmental glomerulosclerosis (FCGS) in a transplant patient was well treated by extracorporeal immune modulation of the cytapheresis.
Plasma Exchange for Hypertriglyceridemic Acute Necrotizing Pancreatitis: Report of Two Cases
Authors: Furuya Tomoki , Komatsu Masafumi , Takahashi Kenichi , Hashimoto Naoki , Hashizume Takahiro , Wajima Naoki , Kubota Minoru , Itoh Seiji , Soeno Takehiko , Suzuki Kozo , Enzan Keiji , Matsuo Shigeki
Published: March 2003

Abstract: We report two cases of hypertriglyceridemic necrotizing pancreatitis treated by plasma exchange (PE). The outcome of each case was quite different according to the timing of PE. A 36 year old man presented with abdominal pain, and a diagnosis of severe acute pancreatitis was made. His serum triglyceride (TG) level was 6,460 mg/dl. He did not undergo PE at first, however, his condition never improved and PE was performed 20 days after the onset of his illness. Finally, he died of multiple organ failure and sepsis. In contrast, a 52 year old man with acute necrotizing pancreatitis was referred to our department. He received PE quickly after hospital admission. His serum TG level, which was 3,540 mg/dl at hospital admission, dramatically returned to normal limits, and he was discharged from the hospital 62 days after admission. The prognosis of severe necrotizing pancreatitis due to hypertriglyceridemia is extremely poor. PE should be applied for the treatment of hypertriglyceridemic necrotizing pancreatitis immediately after its onset.
Vegetation Similarity and Avifaunal Food Value of Restored and Natural Marshes in Northern New York
Authors: Brown Stephen C.
Published: March 2003

Measuring the success of wetland restoration efforts requires an assessment of the wetland plant community as it changes following restoration. But analyses of restored wetlands often include plant community data from only one time period. We studied the development of plant communities at 13 restored marshes in northern New York for 4 years, including 1 year prior to restoration and 3 years afterwards. Restored wetlands ranged in size from 0.23 to 1.70 ha. Four reference wetlands of similar basin morphology, soil type, and size (0.29–0.48 ha) that occurred naturally in the same area were studied as comparisons. Dike construction to restore hydrology disturbed the existing vegetation in some parts of the restored sites, and vegetation was monitored in both disturbed and undisturbed areas. Undisturbed areas within the restored sites, which were dominated by upland field grasses before restoration, developed wetland plant communities with lower wetland index values but comparable numbers of wetland plant species than the reference wetlands, and they lagged behind the reference sites in terms of total wetland plant cover. There were significantly more plant species valuable as food sources for wetland birds, and a significantly higher percent cover of these species, at the undisturbed areas of the restored sites than at the reference wetlands. Areas of the restored sites that were disturbed by dike construction, however, often developed dense, monospecific cattail stands. In general, the plant communities at restored sites became increasingly similar to those at the reference wetlands over time, but higher numbers of herbaceous plants developed at the restored sites, including food plants for waterfowl, rails, and songbirds. Differences in shrub cover will probably lessen as natural recolonization increases shrub cover at the restored sites. Natural recolonization appears to be an effective technique for restoring wetlands on abandoned agricultural fields with established plant cover, but it is less successful in areas where soil has been exposed by construction activity.
An Experimental Assessment of Slag as a Substrate for Mangrove Rehabilitation
Authors: Day S. , Streever W. J. , Watts J. J.
Published: March 2003

Rehabilitation of mangrove habitat has become common practice, but few studies have investigated the growth and survival of mangrove on artificial substrates. Managers attempting to plant mangrove in sites containing artificial substrates must remove substrates or risk poor performance of rehabilitation efforts. This study compared propagule retention, early survival, growth, flowering success, and nutrient concentrations of Avicennia marina (grey mangrove) grown on sand, naturally occurring substrate, and rock blast furnace slag over two growing seasons at an experimental site near Newcastle, Australia. Nutrient concentrations of experimental plants were also compared to those of naturally occurring plants. Experimental results showed significant differences (p < 0.05) in short‐term survival, growth over the two growing seasons, and carbon and nitrogen concentrations between plants grown on different substrates. Comparison of plants grown in slag and plants from reference sites suggests, however, that slag does not lead to anomalies in nutrient concentrations of young mangroves. Although the results identified some differences between plants grown on river sand, naturally occurring substrate, and slag substrate, the absence of consistent differences suggests that mangroves planted in slag are under no greater risk of future failure than mangroves planted in naturally occurring substrate.
Effects of Municipal Waste Leachate on Seed Germination in Soil‐Compost Mixtures
Authors: Marchiol L. , Mondini C. , Leita L. , Zerbi G.
Published: March 2003

The goal of revegetation projects on degraded or polluted lands is to create a near‐natural, stable, and quick‐response ecosystem that does not require particular management after establishment and that is compatible with the surrounding landscape. Municipal waste compost (MWC) is commonly used in revegetation projects as a source of organic matter. The aim of this study was to investigate the germination percentage and average time of germination of 23 species (12 cultivated grasses and legumes and 11 native herbs) as affected by the leachates from soil, three different mixtures of soil‐compost, and pure compost. The treatments influenced the average time of germination (ATG); legumes were the most affected species, followed by grasses and wild herbs. The percentage of germination of Festuca arundinacea was not affected by the presence of compost leachate, while Lolium multiflorum was the most sensitive species. A higher content of compost in the mixture caused a delay in germination of all the grasses. Most of the legumes were able to germinate in the leachate of the soil‐compost mixtures, but their germination was delayed; Trifolium pratense had the highest sensitivity in terms of average time of germination. The native herbs Lepidium sativum, Matricaria chamomilla, and Sanguisorba officinalis germinated without any adverse effect when treated with leachate from high levels of MWC; the germination of Amaranthus cruentus was influenced by all levels of MWC in substrates, suggesting a high specific sensitivity for toxic components of leachate from MWC‐soil mixtures.