IgE-type antibodies to human serum albumin/ethylene oxide conjugates were determined in 153 patients (140 unselected, 13 selected for presence of eosinophilia) on regular dialysis treatment by radioallergosorbent test (RAST) techniques. In 10.7% of unselected patients and 30.8% of selected patients, RAST values suggested ethylene oxide sensitisation. High RAST values were commonly associated with anaphylactoid reactions during dialysis and with chronic asthma. Ethylene oxide antibodies should be sought routinely in patients presenting with these symptoms and the necessity of ethylene oxide sterilisation of disposable dialysis equipment should be re-evaluated.

Adult↗

PubMedDate not supplied

Long-term clinical experience with HELP-LDL-apheresis in combination with HMG-CoA-reductase inhibitors for maximum treatment of coronary heart disease associated with severe hypercholesterolemia.

Extracorporeal low density lipoprotein (LDL)-apheresis offers an adjunctive therapy to diet and drug treatment for reducing LDL concentrations in patients with excessively high cholesterol levels and those at high coronary risk. After nearly 4 years experience with the heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) system, based on heparin induced LDL precipitation at acidic pH, over 7,000 single aphereses have been performed on more than 100 patients in several clinics. Due to the simultaneous removal of LDL and fibrinogen, regular HELP-LDL-apheresis can normalize hemorrheologic parameters, thus explaining the observation of a rapid and lasting clinical improvement in signs and symptoms of coronary heart disease (CHD). The use of Simvastatin in combination with HELP significantly augments the reduction in LDL cholesterol to a level where regression of atherosclerotic lesions might be expected.

Adult↗

PubMedDate not supplied

[Panhypogammaglobulinemia: a rare complication of parenteral gold therapy].

Secondary antibody deficiency is one of the rare adverse effects of chrysotherapy in rheumatoid arthritis. The plasma levels of all immunoglobulins fall into ranges significantly lower than the tolerable physiological minimum. The long-lasting panhypogammaglobulinemia can increase the risk of infection in the patient and, therefore, should be closely monitored. Hence, a record of immunoglobulin levels before and during therapy with gold compounds seems to be mandatory.

Agammaglobulinemia↗

PubMedDate not supplied

Low molecular weight heparin versus standard heparin. A long-term study in hemodialysis and hemofiltration patients.

The influence of low molecular weight (LMW) heparin (Braun 21-23, Mulsungen, West Germany) and unfractionated standard heparin (SH) on blood clotting and other routine laboratory parameters was investigated in a 30 week cross-over study in 30 hemodialysis patients. The LMW heparin dose necessary (anti FXa-activity) for effective anticoagulation was two thirds of the standard heparin dose. Using these doses, both substances displayed identical antithrombotic effects. Complications were not seen in either group. PTT and thrombin time were only marginally effected by LMW heparin, whereas they were markedly prolonged by SH heparin. Factor VIII activity was significantly lower in the LMW heparin group as compared to the standard heparin group after 18, 24, and 30 weeks. Antithrombin III, fibrinogen, fibrin monomers, plasminogen, and alpha 2-antiplasmin were comparable in both groups. Creatinine, urea, hemoglobin, and hematocrit were also unchanged, excluding differences in dialysis efficacy or occult blood loss. Equal numbers of blood transfusions were necessary, but bleeding complications did not occur in either group. In conclusion, safe and effective dialysis can be performed using this low molecular weight heparin for anticoagulation in hemodialysis and hemofiltration. The possible benefits of LMW heparin (reduced frequency of bleeding, alleviation of hypertriglyceridemia) were not, however, apparent, possibly because of the short observation period and the low incidence of hemorrhagic complications in routine dialyses.

Aged↗

PubMedDate not supplied