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H Borberg

Publications and source records attributed to H Borberg.

At least 37 records · Page 2Linked to original sources
PubMed1996

Clinical efficacy of haemorheological treatment using plasma exchange, selective adsorption and membrane differential filtration in maculopathy, retinal vein occlusion and uveal effusion syndrome.

The aim of the study was to test the clinical efficacy of haemorheological treatment with extracorporeal techniques in ocular diseases. We treated patients suffering from maculopathies of different origin: age-related (AMD, n = 17), uveitis-associated (n = 14) and myopia-associated maculopathy (n = 5). We also treated patients with uveal effusion syndrome (n = 3) and central retinal vein occlusion (n = 4) resistant to haemodilution or steroid therapy. The treatment consisted of plasma exchange, selective adsorption with a tryptophan-polyvinylalcohol adsorber and membrane differential filtration. Maculopathy patients underwent two treatments while the other patients received between 1 and 7 treatments. Pulsatile ocular blood flow was measured in 10 patients before and after therapy. The main parameter for evaluating clinical outcome was the change in visual acuity. Severe side-effects did not occur. The rheological parameters including plasma viscosity, whole blood viscosity and erythrocyte aggregation were statistically significantly lowered. Of 36 patients suffering from maculopathy, 25 showed an improvement of at least 1 line of visual acuity after therapy, 7/17 patients in AMD, 6/14 in uveitis and 0/5 in myopia improved 3 lines or more. All patients suffering from retinal vein occlusion improved at least 1 line and two showed an improvement of 3 lines or more. In uveal effusion syndrome, an improvement of 3 lines or more was reached in all patients. Plasma exchange, selective adsorption and membrane differential filtration are effective rheological treatment approaches to improving visual acuity in patients suffering from maculopathy except myopia-associated maculopathy. Efficacy in patients suffering from central retinal vein occlusion and uveal effusion syndrome was proven, even when the patients were resistant to previous haemodilution or steroid therapy. We conclude that a rheological approach should be considered before invasive methods such as laser coagulation, radiation therapy or surgery are applied.

Hemofiltration↗
PubMed1996

Changes of haemorheological parameters when using plasma exchange, selective adsorption and membrane differential separation.

At present, conventional haemorheotherapy consists of changes in life-style, drug therapy and haemodilution. Extracorporeal therapy has been considered only for the treatment of hyperviscosity syndromes. However, a wide range of viscosity-related syndromes may be amenable to rheological therapy if appropriate techniques were available. According to our data, plasma exchange, selective adsorption and membrane differential filtration may lead to an improvement of haemorheology and clinical conditions. For reasons of economy and feasability, membrane differential filtration is favoured over other techniques of differential separation therapy.

Blood Viscosity↗
PubMed1995

Pilot study of a new treatment concept for acute Guillain-Barré syndrome.

The pathogenesis of acute Guillain-Barré syndrome (GBS) is unknown as yet. Numerous clinical and experimental data suggest an autoimmune disorder. Controlled multicenter trials have demonstrated the efficacy of plasma exchange and intravenous immunoglobulin (IgG). A combination of these treatments appears to be a promising concept. We assume that initial selective adsorption treatment eliminates the postulated circulating pathogenetic agent and thereby allows for a more effective immunomodulation by the subsequent administration of i.v. IgG. In a pilot study of 30 patients (11 plasma exchange, 7 selective adsorption, and 12 patients treated with selective adsorption and subsequent administration of i.v. IgG) we found no significant differences for the variables including disability on admission, maximal disability, change of disability during treatment, and disability on discharge. Moreover, we found no apparent differences with respect to tolerance of the procedures or procedural side-effects. We conclude from these preliminary findings that these treatment regimens are viable and safe procedures and result in similar clinical improvement. Statistical evaluation of the efficacy of this treatment concept can only be done after a multicenter study of a large patient group.

Acute Disease↗
PubMed1995

Change in hemorrheological and biochemical parameters following membrane differential filtration.

INTRODUCTION: The elimination of high molecular weight proteins may have a positive influence on disorders of the microcirculation due to an improvement in rheological parameters. We therefore attempted to evaluate the rheological efficacy of membrane differential filtration (MDF). PATIENTS AND METHODS: Ten patients suffering from macular disease underwent MDF. Rheological and biochemical parameters as well as visual acuity were determined one day before and after therapy: The study aimed at a reduction in plasma viscosity, standardized whole blood viscosity at hematocrit 0.45 and erythrocyte aggregation at hematocrit 0.3. RESULTS: Severe side-effects were not observed. The rheological parameters were significantly reduced. In detail the posttreatment values were reduced as compared to the pretreatment values as follows: plasma viscosity 85%, standardised whole blood viscosity 86% (hematocrit 0.45), erythrocyte aggregation 59% (hematocrit 0.3), total protein 81%, IgG 66%, IgA 59%, IgM 33%, alpha-2-macroglobulin 30%, triglycerides 102%, total cholesterol 47%, VLDL cholesterol 94%, LDL cholesterol 33%, HDL cholesterol 62%. Visual acuity was improved in 7/10 patients. CONCLUSIONS: MDF is a safe and highly effective method for lowering biochemical and improving rheological parameters which led to improvement in visual acuity. We have already replaced plasma exchange with MDF in our clinical practice of hemorrheological therapy.

Aged↗
PubMed1994

The effect of LDL apheresis on progression of coronary artery disease in patients with familial hypercholesterolemia. Results of a multicenter LDL apheresis study.

This study investigated the effect of extracorporal lipid-lowering therapy by low-density lipoprotein (LDL) apheresis on coronary artery disease in a population characterized by early development and rapid progression of atherosclerosis. We treated 32 patients aged between 15 and 63 years with drug-refractory familial hypercholesterolemia, treated once a week by immuno-specific LDL apheresis for 3 years in a controlled prospective and non-randomized trial; 25 patients (14 females and 11 males) completed the study. Noninvasive data were obtained by physical examination, 12-lead ECG and exercise testing. Invasive cardiological data were obtained by cardiac catheterization according to a standardized protocol in four cardiological centers. Left ventricular ejection fraction was calculated using planimetry. Coronary stenoses were measured quantitatively in 23 defined coronary segments by a panel of four investigators with an electronic digital caliper. In addition, overall coronary atherosclerosis was visually qualified. Final decisions on a classification into one of three groups (regression, no change, progression) of coronary atherosclerosis were based on panel consensus. Six cardiac events occurred throughout the study: percutaneous transluminal coronary angioplasty in one patient, coronary bypass grafting in three and two deaths. Statistical analysis of exercise testing yielded no significant change for maximum power and work capacity during the study period. Hemodynamic data revealed no significant change; mean ejection fraction was calculated as 65.8 +/- 15.9% at study entry and 67.0 +/- 12.7% at completion. Quantitative measurement of 111 circumscribed coronary stenoses showed a mean stenosis degree of 45 +/- 26% at entry cineangio-film and 43 +/- 22% at final cineangio-film demonstrating no significant change.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Treatment of autoimmune disease by immunomodulation through extracorporeal elimination and intravenous immunoglobulin.

If customary drug mediated immunosuppressive therapy leads to intolerable side effects or is inefficient, extracorporeal elimination and untargeted or targeted immunoglobin therapy modulating the immune response are taken into consideration for the treatment of patients with autoimmune diseases. Both elimination and immunoglobulin therapy, are not alternatives but appear to act complementary, if sequentially applied. Selective immunoadsorption is increasingly applied for extracorporeal elimination and is able to replace plasma exchange therapy. Both, hydrophobic interaction chromatography and affinity chromatography are effective in given clinical conditions. Therapeutic affinity chromatography appears to be superior to hydrophobic interaction chromatography, if an effective, rapid elimination of the disease promoting agent is desired. Experience with therapeutic chromatography collected in the past, indicates that a rapid elimination of immunoglobulins and the subsequent intravenous infusion of 7S immunoglobulin is superior to elimination or untargeted immunomodulation alone. These experimental approaches lead to an extension of the available treatment modalities. However, controlled trials rather than anecdotal reports are needed, to provide substantial information.

Adsorption↗
PubMed1994

Technical and clinical experience with protein A immunoadsorption columns.

Protein A adsorption (Immunosorba, Excorim, Sweden) is a potent tool for the rapid removal of antibodies from the circulation. In comparison to conventional plasma exchange therapy, Protein A adsorption offers the advantage of processing large amounts of plasma, removing up to 87% of the initial level of IgG in one session without a clinically significant loss of fibrinogen. So far 61 treatments have been carried out in our department without serious side effects.

Blood Component Removal↗
PubMed1994

[Selective adsorption of cryoglobulins from plasma of three patients with mixed type II cryoglobulinemia].

A new immunoadsorption column using Sepharose CL 4B as carrier material and IgG as covalently bound ligand was applied for the treatment of three patients with mixed type II kryoglobulinaemia. The titers of rheumatoid factors and cryoglobulins could be significantly decreased during each treatment. The removal of both correlated with the clinical improvement. Skin ulcers, refractory to conventional therapy and arthropathical complaints decreased considerably or disappeared. Further studies evaluating the pathomechanisms and the predictivity of the results must be performed.

Cryoglobulinemia↗
PubMed1993

Adsorption therapy with tryptophan-conjugated polyvinyl alcohol gels in 10 patients with acute Guillain-Barré syndrome.

In 10 cases of acute Guillain-Barré syndrome selection adsorption (SEA) of immunoglobulins was performed with IM TR350 columns (Asahi Medical, Japan). During this therapy the symptoms of 8 patients were reduced. Side effects were moderate and not specific for SEA. The columns removed large amounts of immunoglobulins, but also eliminated other plasma components.

Acute Disease↗
PubMed1993

Plasma exchange and selective adsorption in Guillain-Barré syndrome--a comparison of therapies by clinical course and side effects.

Selective adsorption is a new method of treating Guillain-Barré syndrome. Its therapeutic effects and its concomitant side effects were compared between plasma exchange and symptomatic treatment only. The clinical study of three groups of 10 Guillain-Barré patients, each matched for age and maximal disability, was analyzed. Selective adsorption compared favorably with plasma exchange in shortening the time to first improvement and duration of in-hospital treatment. Side effects were similar in both groups. Symptomatic arteriosclerosis should be considered a relative contraindication for selective adsorption.

Adsorption↗
PubMed1993

Improvement of separation efficiency and concentrate purity of the Fresenius cell separator AS 104: results of a multicenter study. Haemapheresis Scientific Workshop Group of DGTI.

The aim of this multicenter study, initiated by the Haemapheresis Scientific Workshop Group of the DGTI was to evaluate separation protocols for the cell separator AS 104, marketed by Fresenius, using modified software and parameters which were believed to allow a more effective platelet collection with a significantly lower leukocyte contamination of the concentrates. Plateletpheresis data from 950 runs in ten hemapheresis centers, using virtually the same equipment, identical pheresis protocols, and cell counting methods were registered and statistically analyzed for each center and machine-related differences. Additionally, the counting methods of the centers were controlled by bi-weekly external cell count trials, and the plateletpheresis data were corrected using the results of these cell count trials, to obtain a comparison of the two versions of the protocol independent of the center effect. For protocol (or software version) 4.1, 610 runs were registered. The results of cell countings (chamber) are (given as means+/-standard deviations) 3.452x10 11+/-1.009x10 11 for the platelet yield (or thrombocyte yield), 9x10 6+/-23x10 8 for leukocyte contamination, and 17x10 6+/-70x10 6 for the erythrocyte contamination, and 53%+/-13.5% for the extraction efficiency, respectively. For software version 4.4 with 340 runs, the results are 3.642x10 11+/-0.974x10 11 for the platelet yield, 15x10 6+/-74x10 8 for leukocyte contamination, 20x10 6+/-44x10 6 for erythrocyte contamination, and 59%+/-12.4% for the extraction efficiency, respectively. For the leukocyte and erythrocyte contaminations, the means and standard deviations must be interpreted carefully since the statistical distribution showed a considerable skewing of the data. From the automatic counts, marginally smaller means were found. The data were corrected by the values from the ring study; and for these mathematically corrected data, statistical tests showed a significant improvement in the extraction efficiency from software version 4.1 to 4.4. At the same time, the leukocyte contamination was significantly lower with version 4.4.

Blood Component Removal↗
PubMed1993

German multicenter studies on plateletpheresis from healthy donors. German Hemapheresis Study Group.

It is reported on two German Multicenter Plateletpheresis Studies with the Fresenius AS 104 cell separator accompanied by a Multicenter Counting Study. 15 centers participated, a total of 1884 separations were evaluated. It could be shown that multicenter studies help to give a more objective opinion about a cell separator and the separation protocol used if it is possible to improve the counting methods and to eliminate individual center effects by an accompanying Multicenter Counting Study. The AS 104 proved to be a good cell separator for platelet collection regarding platelet yields (3.1 x 11" from 3.5 I citrated blood), separation efficiency (about 45%), yield prediction (SD = not equal to 15%) and leukocyte contamination (median WBC 47 x 10(6)).

Blood Donors↗
PubMed1992

Anticoagulation-dependent inhibition of in vitro complement activation by anti-apo-B sepharose 4B CL.

During LDL apheresis, various combinations of heparin and citrate are used for anticoagulation. With an in vitro batch system we examined whether heparin/citrate combinations can be optimized in terms of complement activation inhibition without the loss of anticoagulant potency. Plasma anticoagulated by using six clinically applicable regimens was incubated with anti-apo-B antibody-coupled Sepharose 4B CL, and the anaphylatoxin content of the supernatant was investigated. A significant dose-dependent reduction of complement activation was achieved by anticoagulating whole blood with 10 U/ml heparin (p < 0.05) if compared with serum whereas citrate inhibited more effectively the generation of C5a (desarg) even at a low concentration (ACD-B 1:20) (p < 0.01). The lowest anaphylatoxin level was generated when heparin (10 U/ml) plus citrate (ACD-B 1:10) were applied, although such an approach may be of limited clinical interest. The empirically chosen heparin plus citrate ratio (2 U/ml, 1:20, respectively) provides for an optimal and almost ideal inhibition of complement activation and contributes considerably to the good tolerability of the immunoadsorbent.

Apolipoproteins B↗
PubMed1992

Anaphylatoxin generation and distribution during in vitro LDL apheresis.

The extent of anti-apo-B IgG-Sepharose-induced complement activation in serum and plasma (heparin 2 U/ml and ACD-B 1:20) was investigated using an in vitro model of LDL apheresis. The total volume of serum or plasma loaded to the chromatography column was collected in defined aliquots. The washing, desorption and regeneration fluids were processed in the same way. From the obtained values of generated complement split products C3a (desarg), C4a (desarg), C5a (desarg) and complement proteins C3, C4, C5, the conversion rates of the precursor were calculated. In the experiments with serum, 19% of C3, 8% of C4 and 2.3% of C5 were converted by the immunoadsorbent, whereas with plasma 7, 6, and 0.6%, respectively, were found. Furthermore, only 60-74% of total anaphylatoxins were found in the effluent during the loading process. The residual 26-40% was removed from the column with the subsequent washing fluids. Therefore, in the clinical routine, only a reduced part of generated anaphylatoxins will be retransfused to the patient. The fact that C5 is converted to the most limited extent to its biologically active fragment additionally contributes to the understanding of the good clinical tolerability of the LDL apheresis.

Anaphylatoxins↗
PubMed1992

Evaluation of the Haemonetics V50--time saver protocol.

196 platelet apheresis procedures using the cell separator Haemonetics V 50 were performed applying 8 cycles under varying conditions. The anticoagulant ACD-A was used in a whole-blood to anticoagulant ratio of 8:1. The flow rate was selected for a range of 40-70 ml/min and the centrifuge speed was established at 4,800 and 4,400 rpm. The PWC factor was chosen between 0 and 4. 162 procedures could be statistically evaluated. 34 apheresis were accompanied with technical complications. The mean yield was (4.3 +/- 1.05) x 10(11) platelets, and the average of extraction efficiency (EE) was 53.9 +/- 8.2%. An analysis of variance confirmed that a higher flow rate decreased the EE (p < 0.002) and also the leukocyte counts (p < 0.0005). Increasing the PWC factor led to a higher EE; however, the leukocyte counts of the platelet concentrate were also increased (p < 0.0005). The g force has an essential effect. A high g force of the centrifuge permits to obtain a large quantity of platelets which is combined with a higher leukocyte contamination. Decreasing the centrifuge speed to 4,400 rpm by using PWC factors of 0 and 4 with different flow rates (50 and 60 ml/min) decreased the EE and the leukocyte counts in the product.

Adult↗