[Description of the hemodynamic and respiratory effects of hemoperfusion treatment with polymyxin B in patients with abdominal septic shock]

The objective of this study is to describe the hemodynamic effects, inotropic and vasoactive drug dependence, and to analyze the PO2/FiO2 ratio in 13 patients with septic shock of abdominal origin after hemoperfusion treatment with polymyxin-B. Treatment with polymyxin hemoperfusion therapy is indicated for patients with severe sepsis/septic shock of abdominal origin who do not respond adequately to conventional therapy. Two complete cycles with polymyxin cartridge were performed on 11 of the 13 patients, and a single cycle on the other O2. After treatment, the mean airway pressure (MAP) was increased (P=.003), the need for norepinephrine decreased (P=.003), and the PO2/FiO2 ratio increased (P=.02). The use of polymyxin hemoperfusion in patients with septic shock of intra-abdominal origin can significantly improve hemodynamic and respiratory functions.

Nutritional support in chronic renal failure: systematic review

BACKGROUND AND AIMS

The purpose of this systematic review was to locate and assess in patients with chronic renal disease the quality of scientific evidence to establish graded recommendations based on the efficacy and effectiveness of nutritional support.

METHODS

Computerized and online versions of MEDLINE (from 1989 through March 1999) and EMBASE (from 1988 through January 1999) were consulted. The Cochrane Library and the online Healthstar (from 1975) databases were also searched for clinical trials. A total of 593 studies were assessed. Following methodological review (primary reviewer), only 45 studies reviewed met criteria for selection and were analyzed by a group of experts (secondary reviewer). A final consensus was reached between the co-ordinators, experts and methodologists.

RESULTS AND CONCLUSIONS

Low and very low-protein diets associated with specific enteral supplements are indicated in most patients with chronic renal disease and in patients with incipient diabetic nephropathy to slow progression of disease and to improve their overall status, contributing to improved survival (grade A recommendation). The use of protein-restricted diets in diabetic nephropathy is only indicated in type I diabetes mellitus (grade A recommendation). An improvement in nutritional parameters was found when specific diets were given in chronic renal disease (grade C recommendation).

[Role of hepatitis C virus in porphyria cutanea tarda hepatopathy]

BACKGROUND

Porphyria cutanea tarda has been classically considered as an acquired disorder due to the exerted influence of several factors (such as viral infections) on its fenotipic expression. The aim of the present study has been focussed on the prevalence analysis and the hepatotoxic role of the hepatitis C virus (HCV).

PATIENTS AND METHODS

By means of a second generation ELISA test, serum antibodies against hepatitis C virus was studied in 132 patients with porphyria cutanea tarda. The polymerase chain reaction (PCR) was assayed in 55 cases to detect serum viral RNA. A liver biopsy was performed in 93 cases.

RESULTS

The 64.4% of the studied patients were seropositive and PCR for HCV was positive in the 83% out of the 55 studied cases. The group of 19 patients suffering from familial porphyria cutanea tarda showed a similar prevalence to the group of 113 patients with sporadic porphyria (47.3% vs 67.2%). In 82% out of the total cases, risk factors for HCV infection were not found. In seropositive cases, both transaminases were more frequently altered than in seronegative ones. The univariant study was not able to demonstrate the relationship between seropositivity, and transaminases, urinary porphyrins alcohol consumption, frequency of antibodies against hepatitis B virus, relevance of the histological hepatic damage or incidence of porphyria relapses. Nevertheless, a multivariant analysis on 93 patients with liver biopsy showed that the risk to suffer from severe liver disease increases 2.8 times in seropositive patients, 3.13 times in those presenting high levels of serum ferritin and 9.25 times in patients up to 65 years old.

CONCLUSIONS

The frequent hepatitis C virus infection in patients with porphyria cutanea tarda must be considered as a precipitating factor for the disease and as an aggravating factor of its associated liver damage.