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At least 19 recordsLinked to original sources
PubMed1992

Reduction of ischemia with a new flow-adjustable hemoperfusion pump during coronary angioplasty. The Coronary Hemoperfusion Ischemia Prevention Study (CHIPS) Investigators.

A new flow-adjustable pump for coronary hemoperfusion to prevent ischemia during routine coronary angioplasty was evaluated in a multicenter prospective study of 110 patients. The protocol included patients who had angina or ST segment elevation during a control balloon inflation of less than or equal to 3 min. Hemoperfusion was performed by means of a new large lumen angioplasty catheter utilizing the patient's renal vein or femoral artery blood. Vessels perfused were the left anterior descending coronary artery (n = 74), right coronary artery (n = 39), left circumflex artery (n = 9) and coronary vein grafts (n = 15). Mean (+/- SD) perfusion flow was 41 +/- 9 ml/min (range 17 to 70); mean perfusion time was 9.3 +/- 4 min (median 8.5, range 2 to 30). Chest pain score (0 to 4) decreased from 2.9 +/- 1 to 1.4 +/- 1 during hemoperfusion (p less than 0.001); ST segment elevation score (0 to 4) decreased from 2.6 +/- 1 to 0.7 +/- 1 (p less than 0.005) and inflation time increased from 1.3 +/- 0.9 to 7 +/- 4 min, (p less than 0.001). At least a 50% increase in tolerated inflation time was obtained in 104 patients (95%). Free plasma hemoglobin and creatine kinase levels did not increase significantly over baseline values. Angioplasty was successful in 107 patients (97%), with mean stenosis reduced from 87 +/- 11% to 20 +/- 17%; 3 patients had urgent bypass surgery, 2 (1.8%) had a myocardial infarction (1 Q wave, 1 non-Q wave) and 2 (1.8%) died later in the hospital of probable noncoronary causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Efficacy of single or repeated hemoperfusion in a canine model of paraquat poisoning.

Although hemoperfusion has been used to treat paraquat poisoning, its efficacy has been widely debated. This study examines the kinetic and pathologic correlates of paraquat toxicity and hemoperfusion and the efficacy of hemoperfusion in four groups of four dogs. This species was chosen because the kinetics and toxicity of paraquat are similar to those in the human. All dogs given a lethal dose of paraquat dichloride producing 100% mortality as a 2-hr infusion (7.48 mg of paraquat ion per kg) developed the typical clinical, laboratory and pathologic features of paraquat toxicity and died within 5 to 7 days. All dogs given paraquat and hemoperfused for 8 hr daily, beginning at 12 hr, died within 3 to 6 days. Two of four dogs which were hemoperfused once, beginning at 2 hr, survived. One dog in the repeated hemoperfusion only group died from blood loss. Negligible amounts of paraquat (0.4-2.0% of the total dose) were adsorbed during repeated hemoperfusion because of extensive excretion of paraquat in urine and sequestration in peripheral tissues from which redistribution was slow. The efficacy in the single early hemoperfusion group can be attributed to removal of 25% of the dose by the procedure in the two survivors. We conclude that single hemoperfusion may have some clinical application in patients who present within a few hours of the ingestion and have not ingested a dose of paraquat that is multiples of the lethal dose producing 100% mortality. It is doubtful if there is any role for repeated hemoperfusion.

Absorption↗
PubMed1978

Solute, amino acid, and hormone changes with coated charcoal hemoperfusion in uremia.

This investigation assesses the effect of two-hour activated charcoal hemoperfusion using a column containing 300 g of acrylic hydrogel-coated activated charcoal either alone or combined with hemodialysis on small and "middle molecule" removal in uremic patients. Comparison was made with standard five-hour hemodialysis. Two patients with dialysis encephalopathy were treated with four-hour combined hemoperfusion/hemodialysis without beneficial clinical effects. Hemoperfusion increased the clearance rates of creatinine and urate when combined with dialysis. Hemoperfusion alone removed 1.3 +/- 0.6 g (mean +/- SD) of creatinine and 0.6 +/- 0.2 g of urate, while combined hemoperfusion/hemodialysis removed 1.7 +/- 0.6 g of creatinine and 1.0 +/- 0.5 g of urate in a two-hour period. Both treatment schedules removed less solute than standard five-hour hemodialysis but were associated with comparable "middle molecule" removal. Hemoperfusion accounted for additional amino acid removal when combined with hemodialysis, while hemoperfusion alone produced significant reduction only in the amino acid cystine. Changes in the hormones thyroxine, triiodothyronine, human growth hormone, and insulin were noted during the procedures. Acceptable falls in platelet counts and fibrinogen occurred with hemoperfusion. Coated charcoal hemoperfusion may prove to have a role in the management of uremic patients, although the acrylic hydrogel-coated charcoal hemoperfusion device requires combination with techniques allowing fluid and electrolyte removal.

Amino Acids↗
PubMed1978

Hemoperfusion removal of digoxin from dogs.

Removal of digoxin by XAD-4 hemoperfusion columns was tested after four dogs were given 0.06 mg/kg of digoxin i.v. Dogs were perfused for 4 to 5 hr at a flow of 105 ml/min through a 100 gm XAD-4 column 16 hr after the dose. Pharmacokinetic analysis of digoxin levels was performed with a three-compartment model. The apparent postdistribution t1/2 was 16.0 +/- 2.9 (S.D.) hr and decreased to 7.1 +/- 2.1 hr during perfusion. Digoxin perfusion clearance was 46 ml/min. An average of 51 microgram of digoxin was recovered from used columns. CP of digoxin calculated from the total R was 127.5 +/- 13 ml/min or 2.3 times greater than plasma flow. With the use of 3H-digoxin, canine blood was found to contain 2.5 times as much digoxin as did plasma. After perfusion there was an increase in serum digoxin levels in all dogs. Computer analysis showed that the increase in plasma digoxin levels immediately after hemoperfusion occurred because the central compartment, which was depleted of digoxin during hemoperfusion, was refilled from peripheral compartments. This study demonstrated that (1) XAD-4 hemoperfusion doubles the rate of removal of digoxin from dogs, (2) dog whole blood contains more than twice as much digoxin than does plasma, so that hemoperfusion clearance exceeds plasma flow, and (3) a multicompartmental pharmacokinetic model explains the increase in serum digoxin concentrations observed at the completion of hemoperfusion.

Animals↗
PubMed1978

Hemoperfusion for methotrexate removal.

Removal of methotrexate by Amberlite XAD-4 hemoperfusion was determined in a patient with metastatic breast carcinoma. During 4 hr of hemoperfusion the plasma concentration of methotrexate fell from 5.5 x 10(-7) M TO 3.1 x 10(-7) M. After hemoperfusion methotrexate concentration increased as a consequence of multicompartmental pharmacokinetics to 5.5 x 10(-7) M and then slowly declined. Plasma methotrexate clearance decreased from 79 ml/min 30 min into hemoperfusion to 28 ml/min at the conclusion. In vitro clearance of methotrexate by 17 artificial kidneys, Amberlite XAD-4, and uncoated charcoal was determined. Uncoated charcoal had the greatest clearance of methotrexate of all the devices tested. We conclude that: (1) Amberlite XAD-4 transiently reduces plasma methotrexate concentration; (2) in vitro, charcoal hemoperfusion is more effective than XAD-4 in removing methotrexate; (3) as a consequence of the multicompartmental pharmacokinetics of methotrexate a postperfusion rebound in plasma methotrexate concentration is to be expected.

Charcoal↗
PubMed1992

Combined high-efficiency hemodialysis and charcoal hemoperfusion in severe N-acetylprocainamide intoxication.

Several extracorporeal techniques have been used to remove N-acetylprocainamide (NAPA), the major metabolite of procainamide, in patients intoxicated with this substance. We report a patient with life-threatening NAPA intoxication who was rapidly and successfully treated with combined high-efficiency hemodialysis and charcoal hemoperfusion. The hemodialyzer and hemoperfusion cartridge were placed in series such that the patient's blood was dialyzed before reaching the cartridge. Overall clearance of NAPA was 153 mL/min, with clearance due to hemodialysis averaging 102 mL/min and that due to hemoperfusion averaging 88 mL/min. Thus, addition of the hemoperfusion cartridge into the extracorporeal circuit resulted in a 50% increase in clearance over that obtainable by high-efficiency hemodialysis alone. In comparison to other modalities, this technique is more effective than either hemodialysis or charcoal hemoperfusion alone and can achieve a more rapid reduction of serum NAPA levels than that observed with slow continuous hemofiltration or hemodiafiltration.

Acecainide↗
PubMed1977

Effect of hemoperfusion of clearance of gentamicin, cephalothin, and clindamycon from plasma of normal dogs.

Nine normal dogs were divided into three groups of three. Group 1 was given an overdose of gentamicin; group 2, cephalothin; and group 3, clindamycin. Group 1 had hemoperfusion with Amberlite XE-336, and groups 2 and 3 with Amberlite XAD-4 resin adsorbents, for 6 hr with a blood flow rate of 300 ml/min. The plasma clearance and removal rates of antibiotics by the hemoperfusion columns were high. The clearance rate of gentamicin from plasma (mean +/- standard deviation) ranged from 59 +/- 30 to 199 +/- 6 ml/min, of cephalothin from 66 +/- 14 to 157 +/- 8 ml/min, and of clindamycin from 55 +/- 9 to 125 +/- 16 ml/min. Of the total dose of antibiotic administered, the hemoperfusion columns removed 67% from theplasma in group 1, 41% in group 2, and 18% in group 3. The fact that antibiotics may be rapidly removed from the blood during hemoperfusion should be considered in calculation of the therapeutic dose of antibiotic required for patients who receive this preocedure. Also, hemoperfusion can effectively and rapidly remove certain antibiotics from the blood of patients who have had a potentially toxic overdose.

Animals↗
PubMed1979

Digoxin removal from a patient with renal failure by hemoperfusion with Amberlite XAD-4 resin.

A digitoxic patient with severe renal failure underwent two hemoperfusion treatments with Amberlite XAD-4 resin. Digoxin clearances calculated from plasma flow rates and plasma digoxin concentrations, as well as from the amount of digoxin eluted from the used columns, were superior to those previously described for peritoneal dialysis, hemodialysis and charcoal hemoperfusion. There was a temporary improvement in the patient's life-threatening digitoxic cardiac rhythm with the first hemoperfusion, and a permanent improvement after the second hemoperfusion. It is submitted that hemoperfusion with this resin may significantly lessen manifestations of digoxin poisoning and may hasten digoxin elimination in digitoxic patients with renal failure.

Aged↗
PubMed1979

Influence of hemoperfusion on the concentrations of calcitonin, testosterone and cortisol in blood plasma.

The influence of hemoperfusion with a cellulose-acetate-coated charcoal column (Adsorba 300-C, Gambro, Lund, Sweden) on plasma concentrations of calcitonin, testosterone and cortisol was studied in five psoriatic patients during 12 treatment periods. Calcitonin, testosterone and cortisol were effectively removed from blood plasma by the charcoal column with average plasma clearances of 34.0, 14.5 and 27.6 ml/min, respectively, at 30 minutes of hemoperfusion, and 4.9, 15.4 and 24.4 ml/min, respectively, at 180 minutes of hemoperfusion. After three hours of hemoperfusion, significant decreases of testosterone and cortisol were found in peripheral venous blood, while calcitonin fell insignificantly. It remains to be elucidated whether long-term use of hemoperfusion would require a detailed control of possible effects on the endocrine status of patients.

Acetates↗
PubMed1990

Sequential and simultaneous "in series" hemodialysis and hemoperfusion in the management of theophylline intoxication.

Hemodialysis and hemoperfusion have been evaluated, and both are effective in removing theophylline. We report two consecutive cases of theophylline intoxication in which the sequential treatment of charcoal hemoperfusion and hemodialysis is contrasted to the simultaneous "in series" treatment of hemodialysis and charcoal hemoperfusion. Analysis of the two methodologies shows that the combined in series technique offers several advantages, including increased extraction efficiency, decreased time of hemoperfusion cartridge saturation, and rapid correction of electrolyte and acid-base abnormalities, and that it is well tolerated clinically. Simultaneous hemodialysis and charcoal hemoperfusion should be considered in cases of extreme theophylline intoxication.

Charcoal↗
PubMed1991

The cytochemical changes and the adherence of neutrophil during cross-linked agarose encapsulated activated charcoal hemoperfusion.

After one hour cross-linked agarose encapsulated activated charcoal hemoperfusion, there was slight increase of total white cells and neutrophil count, but the neutrophil adherence was 16.87 +/- 5.26% and marked lower than that before hemoperfusion (59.91 +/- 5.26%, p less than 0.05). Using glassball hemoperfusion as control, the neutrophil adherence also decreased but not so obvious as the former. Adherence is a cell property that may affect granulocyte margination, diapedesis, chemotaxis and phagocytic function, so the above investigations showed that both the hemoperfusion process and the charcoal itself may reduce the host defence mechanism. There were no change of the peroxidase and alkaline phosphatase activities of neutrophils during one hour cross-linked agarose encapsulated activated charcoal hemoperfusion.

Alkaline Phosphatase↗
PubMed1992

[Secondary decontamination: when are hemodialysis and hemoperfusion indicated?].

Invasive methods of active removal, i.e., hemodialysis and hemoperfusion, are indicated for severely poisoned patients with substances causing tissue damage. Both methods will only be efficacious if the relative contribution of the extracorporal clearance to the overall elimination for a given substance is high and if the toxin has a relatively low apparent volume of distribution and a low tissue binding. Hemodialysis is recommended in severe life threatening intoxications with methanol, ethylene glycol, isopropyl alcohol, salicylates and lithium. Hemoperfusion is effective in removing theophylline and barbiturates. Patients with severe acute theophylline intoxication will benefit from hemoperfusion. Despite the very high clearance rates of barbiturates that can be obtained with hemoperfusion, the clinical usefulness of hemoperfusion remains to be proven.

1-Propanol↗
PubMed1979

[Is hemoperfusion effective in the treatment of digoxin intoxication? (author's transl)].

Digitalis therapy is frequently accompanied by adverse drug reactions. Severe digitalis intoxications are still a problem. Therapeutical methods, which could be used in the case of a life threatening digoxin intoxication, are known, but not yet generally available. Hemodialysis has only a minor effect on digoxin excretion. This study was planned to test the hypothesis that hemoperfusion across dextran-cocoated charcoal or the resin Amberlite XAD 4 could be more effective in the therapy of digoxin intoxications. The ability of hemoperfusion to eliminate digoxin was tested in a patient who had to undergo treatment beacuse of a severe bromcarbamide intoxication. Additionally we compared the effect of several modifications on this method in 12 dogs, which had received 0.05 mg/kg body weight per day for three days prior to the experiment. Although hemoperfusion across Amberlite XAD 4 may eliminate as much digoxin as normal human kidneys during the few hours of treatment, the amount of digoxin removed after all is only a small percentage of the total body pool. Thus compared to the risks of hemoperfusion as an invasive treatment its effect is small. According to our results, hemoperfusion cannot be recommended as a standard therapy of severe digoxin intoxications.

Adult↗
PubMed1977

[Treatment of the experimental chronic digitalisintoxication by hemoperfusion (author's transl)].

In 5 adult dogs experimental chronic digitalis intoxication was produced by oral administration of different digitalis-types (digoxin, beta-methyl-, beta-acetyl-digoxin, digitoxin). 18 to 24 hours after the last application of digitalis, charcoal hemoperfusion was performed in Dipidolor-N2O-anesthesia and serum digitalis-concentrations in the arterial and venous lines of the hemoperfusion system were determined by RIA J125. The Ecg was registered continuously as a simple clinical parameter of cardiac digitalis intoxication. Initial multiple cardiac arrhythmias (AVII degree, SAII degree, tachycardia of the atrium) subsided in the dogs with digoxin, beta-methyl- and beta-acetyl-digoxin during hemocolperfusion within 130 to 160 min. The disturbances of rhythm persisted up to 200 min after onset of hemoperfusion in the dog intoxicated by digitoxin. The clearances of digoxin and derivatives (35.8--43.1 ml/min) are higher than the digitoxin clearance (17--23.2 ml/min) which is supposed to be the reason for cardiac detoxication in the digoxin-intoxicated dogs. Hemoperfusion using polymer coated charcoal appears to be effective for the elimination of digoxin leading to a marked improvement of cardiac arrhythmias. By contrast digitoxin induced cardiac arrhythmias are not influenced during hemoperfusion.

Animals↗
PubMed1977

[Hemoperfusion with coated activated charcoal for treating acute poisoning by remedies, plant protectants, and fungi. III. Fungi (author's transl)].

Four patients with foudroyant liver dystrophy due to ingestion of fungi of the Amanita phalloides species were treated by hemoperfusion with coated activated charcoal. Three patients survived the poisoning. One patient died in a coma due to hepatic disintegration with cardiac and respiratory insufficiency. One female patient suffering from hemolytic syndrome and acute anuresis due to ingestion of fungi of the Paxillus involutus species recovered completely after treatment of combinated hemodialysis and hemoperfusion. The first hemoperfusion in the patients with Amanita phalloides poisoning were performed two to three days after ingestion of the fungus. At that time there were only traces of amanitines in the blood of one of the surviving patients. These Amanita phalloides toxins were only detected in the first 24-hour urine in the other 3 patients. It is thus not to be expected that toxicologically relevant quanities of the toxins will be eliminated from the blood by hemoperfusion carried out two to three days following ingestion of the fungus, Amanita phalloides. No coherence of restitutio ad integrum and hemoperfusion could be pointed out in the female patients suffering from hemolytic syndrom and anuresis due to Paxillus involutus.

Adult↗
PubMed1976

Efficacy of gut lavage, hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication.

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents. Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1-2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1-2 ppm, the clearance values for hemoperfusion were some 5-7 times higher than those for hemodialysis. In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquats less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

Adult↗
PubMed1976

[Carbromal intoxication: influence of hemodialysis and hemoperfusion].

It has been demonstrated with an in vitro model that hemoperfusion through Amberlite XAD4 or coated charcoal containing cartridges eliminates carbromal and its ureid derivatives more efficiently than hemodialysis. The following clearancs were measured in vitro (blood flow: 200 ml/min): Coil dialyser (1 m2): 55-85 ml/min, charcoal hemoperfusion 100-125 ml/min, Amberlite XAD4 hemoperfusion: 200 ml/min. The data of one patient who had been hemoperfused after the ingestion of 35 g Carbromal with the Haemocol cartridge (SMith & Nephews) are depicted. Our results permit to draw the conclusion that hemoperfusion at this time is the most efficient means to eliminate Carbromal from intoxicated patients.

Charcoal↗