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At least 163 records · Page 9Linked to original sources
PubMed2002

The influence of sediment and feeding on the elimination of polycyclic aromatic hydrocarbons in the freshwater amphipod, Diporeia spp.

The elimination of non-polar organic contaminants from sediment dwelling aquatic invertebrates was thought to be dominated by fecal elimination. This was particularly thought to be the case for the amphipod, Diporeia spp. that encapsulates the fecal material in a peritrophic membrane. The elimination of selected PAH congeners by Diporeia spp. was determined in the presence of three solid substrates and under water only conditions. The elimination was generally enhanced by the presence of a solid substrate whether or not the organism employed the material as a food source. The greater the sorptive capacity of the substrate, the greater its influence on the elimination process. Elimination via the fecal route was generally insignificant except for the elimination of BaP in the presence of sediment. In this case, the fecal elimination accounted for up to 40% of the total elimination, and the extent of elimination via the fecal route increased with the amount of fecal material produced. Thus, it is clear from the above effort that the main mechanism for elimination of contaminants in the presence of a substrate is primarily via passive diffusion from the organism with subsequent sorption to the solid substrate, which maintains the chemical activity gradient between the organism and the water. This effort refutes the earlier hypothesis that fecal elimination is the dominant route of elimination for Diporeia spp., and that the peritrophic membrane plays any substantial role in the elimination process.

Adsorption↗
PubMed2003

Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis.

BACKGROUND/AIMS: The mortality of patients with severe acute alcoholic hepatitis (AH) remains high, leading to interest in the use of extracorporeal liver support. The molecular adsorbents recirculating system (MARS) is a liver support device based upon a hollow fibre module in which the patient's blood is dialyzed across an albumin-impregnated membrane. The aim of this paper is to assess the safety, efficacy and feasibility of using MARS in patients with severe AH. METHODS: Eight patients (all encephalopathic; hepatorenal syndrome: Type 1, five patients; Type 2, two patients) were treated with MARS. Clinical, biochemical and haemodynamic assessments were done. RESULTS: Five patients were discharged from hospital, and four are alive at 3 months of follow-up, compared with an estimated survival of about 20%. There were significant improvement in serum bilirubin (P=0.008), creatinine (P=0.02), prothrombin time (P=0.04), and grade of encephalopathy (P=0.05). Sustained improvements in mean arterial pressure, systemic vascular resistance and cardiac output were observed. Thrombocytopaenia was the only MARS-related adverse event observed. CONCLUSIONS: MARS resulted in improved liver biochemistry, cardiovascular haemodynamics, renal function and encephalopathy in patients with severe AH, with an apparent reduction in mortality. On this basis, a multi-centre, randomized clinical trial has been initiated.

Acute Disease↗
PubMed1998

Two siblings poisoned with diphenhydramine: a case of factitious disorder by proxy.

We report a case of factitious disorder by proxy (FDBP), formerly known as Munchausen syndrome by proxy, in which 2 siblings were poisoned with diphenhydramine. Although diphenhydramine is a readily available medication, no report of its use as the sole agent in an FDBP case was found in a literature search. Although sibling involvement in FDBP is well documented, this is the first case report of 2 siblings hospitalized simultaneously because of intentional poisoning with the same substance. Finally, the use of physostigmine to definitively diagnose anticholinergic poisoning in a case of FDBP has not previously been described.

Antidotes↗
PubMed1996

Bowel as a kidney substitute in renal failure.

Maintenance peritoneal dialysis and hemodialysis sustain the lives of approximately 250,000 uremic patients in industrialized nations worldwide. The cost of uremia therapy, however, exceeds health care budgets in developing countries. As a consequence, most of those alive today have no chance of effective treatment should their kidneys fail. Extraction, modification, or recycling of nitrogenous wastes by the gastrointestinal tract is a potentially low-cost means of substituting for missing renal function. Multiple approaches to the bowel as a substitute kidney have been attempted. Direct removal of nitrogen-containing compounds by an external gut fistula, gastric, ileal, or colonic gavage (dialysis) or induced diarrhea extract water and urea but only minimal amounts of larger molecules such as creatinine. Binding of nitrogen compounds to inert orally administered sorbents such as charcoal or oxystarch has been pursued in advanced uremia. Modification of nitrogen compounds by ingesting enzymes derived from soil bacteria or packaged in artificial cells is an approach that, although exciting, is incompletely evaluated. Evidence indicates that strains of bacteria can be induced to synthesize enzymes that recycle urea and other nitrogen compounds retained by uremic individuals. Clinical trials to substantiate uncontrolled trials of bowel substitution in renal failure will, if positive, accelerate development of a practical regimen to extend life where no other means are possible.

Animals↗
PubMed1998

Prehospital gastrointestinal decontamination of toxic ingestions: a missed opportunity.

The purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac. No patient received activated charcoal. The median transport time was 25 minutes (range, 5 to 66 minutes). Follow-up data on patients transported to the university hospital revealed that 30 of 43 (70%) patients who might have been suitable candidates for prehospital activated charcoal actually received activated charcoal in the ED. Median time to activated charcoal in the ED was 82 minutes (range, 32 to 329 min). Use of activated charcoal in the field appears to be deferred despite its known loss of efficacy over time. The failure to start activated charcoal in the field contributes to the delay in initiating activated charcoal therapy.

Administration, Oral↗
PubMed1999

ECG abnormalities in tricyclic antidepressant ingestion.

The tricyclic antidepressant (TCA) agents are recognized for their potentially lethal cardiovascular and neurological effects in poisoned patients. The 12-lead electrocardiogram (ECG) has emerged as a popular bedside tool in the evaluation of TCA toxicity. Although the history and physical examination play a key role in the assessment of the patient with potential TCA poisoning, the presence or absence of features of the TCA toxidrome are not sufficient to detect or exclude toxicity from this class of drugs. A variety of ECG findings occur with TCA toxicity. Aside from the sinus tachycardia due principally to anticholinergic effects, TCA-toxic changes seen on the ECG are attributable primarily to the sodium channel blockade caused by these agents. The majority of patients at significant risk for developing cardiac or neurological toxicity will have a QRS complex greater than 0.10 seconds or a rightward shift of the terminal 40 ms of the frontal plane QRS complex vector. The majority of these patients will also display these changes early in their emergency department stay. However, the appearance of these findings, either alone or in combination, does not mean the patient will develop significant cardiac or neurological toxicity. The ECG can neither unequivocally rule in nor rule out impending toxicity; recognizing these limitations, the emergency physician can use this bedside tool in combination with other clinical data during the assessment of the poisoned patient.

Adolescent↗
PubMed2002

Hepatorenal syndrome. Definition, pathophysiology, and intervention.

Hepatorenal syndrome is a well characterized entity in which vasodilation of splanchnic vessels and intense constriction of the renal cortical vasculature occur in concert. The condition is often fatal unless orthotopic liver transplantation (OLT) is performed. Many extracorporeal blood purification techniques exist which can be offered to patients awaiting OLT. Continuous hemofiltration, with or without other modalities such as therapeutic plasma exchange and hemoperfusion, may be helpful in improving the level of consciousness of these patients. Unfortunately, mortality and hepatic regeneration do not appear to be affected by such interventions. The development of a hybrid bioartifical liver support system and pharmacologic manipulation of the hemodynamic perturbations that occur in HRS provide particularly appealing prospects as a means of providing a bridge to liver transplantation in the future.

Ascites↗
PubMed2002

Extracorporeal therapies for acute intoxications.

Intoxications frequently perturb acid-base and electrolyte status, intravascular volume, and renal function. In selected cases, extracorporeal techniques effectively restore homeostasis and augment intoxicant removal. The use of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, is a new and effective treatment for patients exposed to toxic alcohols. In this section, practical approaches to commonly encountered intoxicants and the use of extracorporeal techniques are critically reviewed.

Alcohols↗
PubMed1997

Poisoning and drug overdose.

Poisoning is a common cause for intensive care unit admission for both children and adults, and most poisoning victims are effectively treated using standard decontamination measures and supportive care. For a small number of poisons, acceleration of toxin removal with hemodialysis or hemofiltration is indicated. Similarly, specific antidotes are indicated in a few selected circumstances. Rarely, patients may benefit from more aggressive supportive techniques such as cardiopulmonary bypass.

Adult↗
PubMed2000

[Acute verapamil poisoning. A proposal of a strategy for therapeutic management].

Verapamil poisonings are rare, but are associated with a high proportion of deaths. The authors present a case of acute poisoning by verapamil associated with collapsus and a high degree of heart block. They propose a strategy for therapeutic management based on the study of calcium-channel blocker mechanisms of toxicity.

Acute Disease↗
PubMed2001

Entrapment of white-rot fungus Trametes versicolor in Ca-alginate beads: preparation and biosorption kinetic analysis for cadmium removal from an aqueous solution.

The biosorption of cadmium ions onto entrapped Trametes versicolor mycelia has been studied in a batch system. The maximum experimental biosorption capacities for entrapped live and dead fungal mycelia of T. versicolor were found as 102.3 +/- 3.2 mg Cd(II) g(-1) and 120.6 +/- 3.8 mg Cd(II) g(-1), respectively. Biosorption equilibrium was established in about 1 h and biosorption was well described by the Langmuir and Freundlich biosorption isotherms. The change in the biosorption capacity with time was found to fit the pseudo-second-order equation. Since the biosorption capacities were relatively high for both entrapped live and dead forms, those fungal forms could be considered as suitable biosorbents for the removal of cadmium in wastewater-treatment systems. The biosorbents were reused in three consecutive adsorption/desorption cycles without a significant loss in the biosorption capacity.

Absorption↗
PubMed1995

Extracorporeal techniques of endotoxin removal: a review of the art and science.

The incidence of sepsis in the United States has risen in the past few years, and mortality from sepsis has risen over the past several decades. These increases have occurred despite the progress made in antibiotic therapy. The high mortality rate may not be related to the bacteria themselves but rather to the host's response. Of particular concern is the bacterial release of endotoxins, the development of endotoxic shock, and the resulting multiorgan failure, which has a high fatality rate and is the leading cause of death in patients admitted to intensive care units. Removing or neutralizing endotoxins are the two major therapeutic approaches to treating sepsis. To date, pharmacological methods have not been successful. Extracorporeal techniques are based on filtration, sorption, or both. Results with hemofiltration have not been definitive, in part because endotoxin levels have not been measured. Sorption devices, based on polymyxin B and anion exchange matrices, do remove endotoxins. Clinical studies in Japan on septic shock or multiorgan failure with polymyxin-B-bound fibers in direct hemoperfusion continue to suggest the utility of extracorporeal techniques for endotoxin removal. Continued effort is required and warranted to assess the clinical efficacy of these techniques.

Endotoxins↗
PubMed2003

Liver failure: basis of benefit of therapy with the molecular adsorbents recirculating system.

Accumulation of albumin-bound toxins is known to occur in liver failure, and to variable extents is responsible for the associated end-organ dysfunctions (kidney, circulation, brain). The toxin-binding and scavenging functions of albumin are exploited in albumin dialysis for removal of these toxins. The extracorporeal liver support device known as molecular adsorbents recirculating system (MARS) is based on dialysis across an albumin-impregnated membrane, using 20% albumin as dialysate. Charcoal and anion exchange resin columns in the circuit help cleanse and regenerate the dialysate. Clinical studies over the last few years have demonstrated proven reduction in hyperbilirubinaemia, along with an improvement in encephalopathy, systemic haemodynamics and renal function in liver failure patients, as well as apparent improvement in survival. The results of larger controlled clinical trials, as well as studies investigating the pathophysiological basis of its effect, are awaited.

Albumins↗
PubMed2001

Spectroscopic study of nitroaromatic-smectite sorption mechanisms.

Sorption mechanisms of 1,3- and 1,4-dinitrobenzene, 1,3,5-trinitrobenzene (TNB), dinitro-o-creasol, and 6-sec-butyl-2,4-dinitrophenol (DINOSEB) on smectite were investigated using FTIR spectroscopy and HPLC methods. A quantitative method was developed that established a direct link between the HPLC and the FTIR data. Freundlich sorption values ranged from 47 (L g(-1)) for 1,3,5-TNB to 3.7 for DINOSEB and showed that the extent of nitroaromatic compounds (NAC) sorption was strongly dependent on the number and position of the nitro substituents as well as other substituents and steric effects. The amount of 1,3,5-TNB sorbed to smectite was strongly influenced by the nature of the exchangeable cation. Furthermore, the exchangeable cation significantly influenced the positions and relative intensities of the vibrational modes of the -NO2 groups. The strongest perturbations were observed for cations with lower enthalpies of hydration (e.g., K+) and included a red shift of the v(asym)(NO) band, a concomitant blue shift of the v(sym)(NO) band. These changes were accompanied by a 2-fold increase in the relative intensity of the v(asym)(NO) band relative to the intensity of the v(sym) (NO) band. Molecular quantum mechanics calculations were used to rationalize frequency shifts in terms of nitroaromatic interactions with interlayer cations. Results indicate that the sorption of NACs to smectite surfaces is controlled largely by the hydration characteristics of the exchangeable cation, which regulates both cation-nitroaromatic complexation and swelling of the smectite.

2,4-Dinitrophenol↗
PubMed2002

Protective effect of enterosgel on rat liver lysosomes during cytostatic treatment.

Polychemotherapy with a complex of cytostatics (cyclophosphamide, doxorubicin, vincristine, prednisolone) induces progressive damage to hepatocyte membranes, which manifested in labilization of lysosomes and activation of lysosomal enzymes and serum transaminases. Enterosgel stabilized liver lysosomes and reduced manifestation of hepatocyte cytolysis.

Animals↗