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Mechanisms of toxicity, clinical features, and management of acute chlorophenoxy herbicide poisoning: a review.

INTRODUCTION: Chlorophenoxy herbicides are used widely for the control of broad-leaved weeds. They exhibit a variety of mechanisms of toxicity including dose-dependent cell membrane damage, uncoupling of oxidative phosphorylation, and disruption of acetylcoenzyme A metabolism. Between January 1962 and January 1999, 66 cases of chlorophenoxy herbicide poisoning following ingestion were reported in the literature. FEATURES FOLLOWING INGESTION: Adjuvants in the formulations may have contributed to some of the features observed. Vomiting, abdominal pain, diarrhea, and, occasionally, gastrointestin

Examination of particulate macroporous hydrogels in an extracorporeal rat haemoperfusion model.

A series of macroporous hydrogels has been synthesized, selected from a range of such materials in which the presence of functional groups has been shown to produce sorbent properties with respect to molecules having clinical significance in the field of liver support. The use of freeze thaw polymerization, together with inverse suspension polymerization in hexane, or in brine, enables macroporous beads ranging in size from 150 to 2000 microm, to be prepared from functional monomers exhibiting a range of chemical functionalities and aqueous solubilities. In order to investigate the behaviour o

Circulating stem cells, HIF-1, and SDF-1 in septic abdominal surgical patients: randomized controlled study protocol.

BACKGROUND: Sepsis caused by complicated intra-abdominal infection is associated with high mortality. Loss of endothelial barrier integrity, … tients treated with standard conventional therapy alone (CT) or with the addition of extracorporeal hemoperfusion therapy (HCT). METHODS/DESIGN: Patients undergoing major abdominal surgery will be allocated into groups: postoperative non-septic patients in an emergency surgical ward (group C) and postoperative septic patients in an intensive care unit (group S …

Extracorporeal blood detoxification by sorbents in treatment of hepatic encephalopathy.

Extracorporeal blood detoxification by sorbent therapy long has been applied in treatment of hepatic failure and encephalopathy, starting with hemoperfusion columns and more recently with the currently marketed Liver Dialysis Unit. Liver Dialysis employs hemodiabsorption (dialysis of blood against powdered sorbents including charcoal and cation exchanger) to remove selectively numerous small-molecular-weight toxins of hepatic failure. Liver Dialysis is used in treatment of acute hepatic encephalopathy (AHE) because of decompensation of chronic liver disease (A-on-C) or fulminant hepatic failur…

Intraoperative endotoxin adsorption for visceral malperfusion complicating acute type A aortic dissection.

A 65-year-old man presenting with visceral malperfusion complicating acute type A aortic dissection underwent emergent surgery. Bypass grafting from the right common iliac artery to the superior mesenteric artery was performed prior to central aortic repair because intestinal ischemia caused hemodynamic instability. Subsequently, the ascending aorta was replaced with a Dacron graft under a condition of circulatory arrest with selective cerebral perfusion. Endotoxin adsorption was carried out intraoperatively in parallel with cardiopulmonary bypass to prevent postoperative end-organ failure. Th

Blood Purification With CytoSorb in Critically Ill Patients: Single-Center Preliminary Experience.

The CytoSorb adsorber, a blood purification therapy, is able to remove molecules in the 5-60 kDa range which comprises the majority of inflammatory mediators and some endogenous molecules. We aimed to evaluate CytoSorb therapy on clinical outcomes in critically ill patients. A retrospective case series study, from February 2016 to May 2017, was performed in 40 patients with multiple organ failure who received CytoSorb treatment. There were 28 patients with cardiogenic shock, 2 with septic shock, 9 with acute respiratory distress syndrome, and 1 with liver failure. Nineteen patients (47%) under

Charcoal haemoperfusion in amitriptyline poisoning: experience in 20 children.

AIM: Tricyclic antidepressant (TCA) toxicity is common among children and adults due to widespread use. Amitriptyline (AT) is one of the most commonly prescribed TCAs. Current guidelines do not recommend charcoal haemoperfusion (HP) for AT overdose due to high protein binding and large volume of distribution. However evidence regarding the efficacy of charcoal HP in addition to supportive measures is accumulating in the published reports. METHODS: Here we report our experience in 20 children (15 girls, 5 boys) with acute AT overdose aged between 1.5 and 15 years, successfully managed with HP

Mechanism of Xiaozhiling injection in the treatment of internal hemorrhoids based on changes in perianal blood flow and rectal submucosal fibers.

BACKGROUND: Based on the traditional Chinese medicine theory that "acid can astringe and consolidate", Xiaozhiling Injection is a multi-awar … nuses of the rats gradually decreased. Laser speckle blood flow imaging revealed that the anorectal hemoperfusion flow first increased but then decreased, and microvascular dilation first increased but then decreased. Microscopy revealed vascular dilation of the submucosal interstitium, and the thickness of the submucosa first increased but then decreased. Immu …

The International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock.

BACKGROUND: The international prospective COSMOS Registry (NCT05146336) collects real-world data on CytoSorb® (CS) hemoadsorption utilizatio … res of 4 [2,6]. CS therapy was applied as part of kidney replacement therapy (KRT, 85%), standalone hemoperfusion (10%) or extracorporeal membrane oxygenation (ECMO, 5%). On average, each patient received 2.8 ± 2.2 adsorbers, with 47% receiving three or more. CS therapy was associated with a significant reduction in interleukin (IL)-6 levels (from 2,013 [219, 3 …

[Effect and safety of double plasma molecular absorption in treatment of patients with severe wasp stings injury: a multicenter historical cohort study].

OBJECTIVE: To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury. METHODS: Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was…

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair.

Open thoracoabdominal aortic aneurysm (TAAA) repair is a complex and challenging operation with a high incidence of serious complications, a … a. The ultrafiltration can diminish the consequent hemodilution of hemorrhage and rapid infusion. A hemoperfusion cartridge also can be added to reduce the systemic inflammatory during operation. The circuit can meet the needs of LHB and quickly switch to conventional CPB. No oxygenator was required during LHB, which reduce the use of heparin and reduce the ris …

Disseminated zoster in an adult patient with extensive burns: a case report.

BACKGROUND: Shingles (localized zoster) and disseminated zoster are caused by the reactivation of latent varicella zoster virus (VZV). React … inuous hemodialysis and filtration (CHDF) combined with polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) therapy was used for cytokine modulation. Autologous and allogeneic skin grafting was performed. On day 15, multiple-drug-resistant Pseudomonas aeruginosa (MDRP) was detected from a blood specimen, and the patient developed multiple organ …

Case Report: Massive sustained-release valproate overdose with prolonged gastric tablet retention and partial pharmacobezoar formation managed by endoscopic removal and delayed extracorporeal therapy.

BACKGROUND: Valproate poisoning is a potentially life-threatening condition that may result in central nervous system depression, hyperammon … proximately 62 h after ingestion and 56 h after hospital admission. Two consecutive 2-h sessions of hemoperfusion combined with CVVH were followed by CVVH alone until 08:30 on June 2. The serum valproate concentration decreased from 397.05 μg/mL before extracorporeal treatment to 12.72 μg/mL during ongoing CVVH and was 8.61 μg/mL approximately 70 h after treatm …

Higher fibrinogen-to-albumin ratio is associated with the severity of toxin associated acute kidney injury in high-altitude (3650 m) population: A retrospective analysis.

BACKGROUND: Few reports used acute kidney injury concept in the area of toxic kidney damage, especially in highland areas. Recent evidence s … ld, including 40 females (61.5%). Thirty-four patients (52.3%) underwent blood purification, mainly hemoperfusion (n = 33). Medicine poisoning accounts for 53.8% (n = 35), including antipsychotic sedatives (n = 14) and Tibetan medicine (n = 9). Pesticide poisoning ranks the second (27.7%, n = 18). And the last was toxic substances eaten as food (n = 12). Among …

[Application of continuous renal replacement therapy in the rescue of MODS patients].

OBJECTIVE: To investigate the effect of continuous renal replacement therapy (CRRT) on patients with emergency and serious diseases. METHOD … A. Among the 9 patients with poisoning, 7 were alleviated completely and 2 died after the CRRT plus hemoperfusion (HP). The survival time of patients was lengthened in Group A. No blood or bleed aggravation occurred in patients with bleeding inclination or 48 h before the operation after using the method of heparin soaking the blood filter. CONCLUSION: CRRT ha …

Liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions.

Clinically, it is highly challenging to promote recovery in patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). Despite recent advances in understanding the underlying mechanisms of ALF and ACLF, standard medical therapy remains the primary therapeutic approach. Liver transplantation (LT) is considered the last option, and in several cases, it is the only intervention that can be lifesaving. Unfortunately, this intervention is limited by organ donation shortage or exclusion criteria such that not all patients in need can receive a transplant. Another option is to

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… Hemadsorption Direct hemoperfusion (Cytosorb): Small-scale studies have been conducted on Cytosorb hemoperfusion. It consists of a synthetic membrane with biocompatible polystyrene beads that have a large surface area and can remove molecules up to 55 kDa[ 38 - 40 ]. … Toxic plasma is separated and cleansed by perfusion over the two hemoperfusion columns and subsequently recirculated to the body[ 43 ]. …

[Case of sever septic shock following transurethral lithotripsy].

A 62-year-old man was scheduled for transurethral lithotripsy. Systemic shivering, vomiting and decreased blood pressure occurred after extubation. Blood gas analysis showed metabolic acidosis. After 45 minute observation, he became unconsciousness. He was reintubated. Elevated procalcitonin (PCT) and endotoxin activity assay (EAA) brought us to the diagnosis of severe septic shock. He was treated by a standard therapy conforming to early goal direct therapy and PMX-DHP with CHDF. He showed full recovery, and was discharged 9 days after the procedure. TUL is commonly performed, but it seldom l

Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases.

INTRODUCTION: This retrospective observational study examined the clinical features, the degrees of toxic hepatitis, physiological markers and clinical outcomes after intentional paraquat poisoning and sought to determine what association, if any, might exist between these findings. METHODS: A total of 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Patients were categorized into two groups according to their hepatic complication, i.e. with (N = 87) or without (N = 100) toxic hepatitis. Demographic, clinical and laboratory data were obtained

Artificial liver support with Cytosorb and continuous veno-venous hemodiafiltration versus advanced organ support (ADVOS) for critically ill patients with hyperbilirubinemia and acute-on-chronic liver failure (ACLF).

BACKGROUND: As many as 30% of critically ill patients in intensive care units experience acute liver dysfunction with hyperbilirubinemia as … b. Additional prospective randomized controlled trials are warranted to investigate the efficacy of hemoperfusion with CytoSorb for liver disease indications among critically ill patients. CLINICAL TRIAL NUMBER: Not applicable.