[Humidification assessment of four heat and moisture exchanger filters according to ISO 9360: 2000 standard]

OBJECTIVE

This work consisted of the assessment of humidification parameters and flow resistance for different heat and moisture exchanger filters (HMEF) used in intensive care unit. Four electrostatic HMEF were assessed: Hygrobac S (Tyco); Humidvent compact S (Teleflex); Hygrovent S/HME (Medisize-Dräger); Clear-Therm+HMEF (Intersurgical).

MATERIAL AND METHODS

Humidification parameters (loss of water weight, average absolute moisture [AAM], absolute variation of moisture) have been evaluated on a bench-test in conformity with the ISO 9360: 2000 standard, for 24h with the following ventilatory settings: tidal volume at 500 ml, respiratory rate at 15 c/min, and inspiration/expiration ratio at 1:1. The flow resistance of HMEFs assessed using the pressure drop method was measured before and after 24h of humidification for three increasing air flows of 30, 60, and 90 l/min.

RESULTS

All the HMEFs allowed satisfactory level of humidification exceeding 30 mgH(2)O/l. The less powerful remained the Clear-Therm. Concerning HMEFs flow resistance, results showed a pressure drop slightly more important for the Hygrobac S filter as compared with other filters.

CONCLUSION

This test showed differences between the HMEFs for both humidification and resistance parameters. When compared to the new version of the standards, HMEFs demonstrated their reliability. However, evolution of humidification and flow resistance characteristics over 24h showed a structural degradation of HMEFs, limiting their use over a longer period.

Gemtuzumab ozogamicin-induced sinusoidal obstructive syndrome treated with defibrotide: a case report

New treatments for relapse of acute myeloid leukaemia (AML), include gemtuzumab ozogamicin (GO), an anti-CD33 monoclonal antibody. We describe a second case of GO-induced sinusoidal obstructive syndrome (SOS) effectively treated with defibrotide (DF). No stem-cell transplantation was involved. On day 23 after the first GO dose, a patient presented with ascites, weight gain, liver enlargement and pain in the right upper quadrant. Sudden hepatic cytolysis (transaminases at six times the normal range: grade 3) and cholestasis [alkaline phosphatase ALP and gamma-glutamyltransferase (GGT) respectively at four and eight times the normal range: grade 2] were observed but there was no evidence of increase serum bilirubin. Treatment with DF (Prociclide), Crinos; 10 mg/kg/day, or 200 mg, q.i.d.) improved the hepatic abnormality within a few days (serum transaminases decreased from 312 to 103 IU/L for aspartate aminotransferase (AST) and from 141 to 80 IU/L for alanine aminotransferase (ALT) within 3 days ALP increased from 253 to 383 IU/L and gamma-GT from 238 to 417 IU/L 4 days after administration of DF. The clinical and biological features of our case suggest a direct involvement of GO in causing SOS, even when used as monotherapy, without allogenic stem-cell transplantation. Low dose DF (10 mg/kg/day) given early during the development of SOS associated with GO was effective. Unfortunately, in our case the patient eventually died of multi-organ failure probably because of failure of GO.

[Spontaneously acquired haemophilia: report of a patient with prostatic adenoma]

We report the case of a 86-year-old man admitted in a local hospital with spontaneous haematoma, an isolated prolonged activated partial prothrombin time (114/32 seconds; ratio = 3.6), an anemia and a normal platelet count. Two diagnosis were suspected: a coagulation factor defect, or the presence of a lupus anticoagulant or of anti-factor antibodies. An acquired haemophilia A was confirmed with a factor VIII activity level < 1 U/dL associated with the presence of an anti-factor VIII inhibitor. The factor VIII inhibitor titer reached 195 Bethesda U/mL. A prostatic adenocarcinoma was suspected: a 5 cm prostatic tumour was found and the PSA level was 113 ng/mL. The patient was treated with recombinant factor VIIa: Novoseven (90 microg/kg). None immunosuppressive agents were prescribed in this elderly patient. The patient's disease was identified as a spontaneously acquired haemophilia A associated with prostatic adenocarcinoma.