INTRODUCTION: Amanita phalloides poisoning is a potentially fatal cause of acute liver failure. The aim of this study was to analyze the impact of initial patients' characteristics and different treatment modalities on the outcome of patients with liver failure caused by Amanita poisoning. MATERIAL AND METHODS: We retrospectively evaluated 23 patients admitted to our center between July 2007 and August 2016. RESULTS: Mean time interval between Amanita phalloides ingestion and the onset of gastrointestinal symptoms was 12.48 ± 9.88 hours and the interval between ingestion and hospital admission 26.26 ± 15.14 hours. The treatment was intiated by oral decontamination using activated charcoal followed by intravenous rehydration and high doses of intravenous N-acetylcysteine and silibinin. Fourteen patients (61%) underwent extracorporeal elimination method. Ten patients had plasmapheresis, 1 patient had hemoperfusion, and 5 patients had fractionated plasma separation and adsorption. Seven patients who met King's College Criteria were listed for urgent liver transplantation; one of them died before transplantation. Six patients underwent liver transplantation; the mean waiting time was 6.5 ± 12.0 days (range, 1-31 days). One patient died 2 months afterward. All 16 patients who did not meet King's College Criteria and received conservative treatment survived. CONCLUSION: Our results documented a good prognostic value of standard King's College Criteria for indication of urgent liver transplantation in acute liver failure caused by Amanita phalloides poisoning. Fractionated plasma separation and adsorption may contribute to low mortality on the waiting list. Intensive care and extracorporeal elimination methods seem to be crucial points of the conservative treatment.
- MeSH
- acetylcystein aplikace a dávkování MeSH
- akutní selhání jater etiologie terapie MeSH
- Amanita MeSH
- antidota aplikace a dávkování MeSH
- antioxidancia aplikace a dávkování MeSH
- dialýza ledvin metody MeSH
- dospělí MeSH
- dřevěné a živočišné uhlí aplikace a dávkování MeSH
- hemoperfuze metody MeSH
- konzervativní terapie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- otrava houbami komplikace terapie MeSH
- péče o pacienty v kritickém stavu metody MeSH
- plazmaferéza metody MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- seznamy čekatelů mortalita MeSH
- silymarin aplikace a dávkování MeSH
- stupeň závažnosti nemoci * MeSH
- tekutinová terapie metody MeSH
- transplantace jater metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
BACKGROUND: Hyperchloremia produces renal vasoconstriction and fall in glomerular filtration rate. In 90% of brain-dead organ donors, diabetes insipidus develops, characterized by inappropriate diuresis, hyperosmolality, and hyperchloremia. The aim of this study was to determine the relationship between the serum concentration of chlorides of the donor and the onset of the function of the kidney allograft in the recipient. METHODS: We retrospectively studied 213 donors and kidney allograft recipients. Serum creatinine concentrations and glomerular filtration rates on the 1st, 7th, and 30th days after transplantation of the recipients from hyperchloremic donors were compared with the recipients from normochloremic donors, as well as the incidences of acute tubular necrosis and delayed graft function. RESULTS: On the 1st day, serum creatinine concentrations of the recipients from hyperchloremic and normochloremic donors, respectively, were 448.2 ± 212.1 μmol/L and 502.2 ± 197.8 μmol/L (P = .1), on the 7th day, 168.6 ± 102.6 μmol/L and 196.9 ± 120.6 μmol/L (P = .13), and on the 30th day, 129.4 ± 43.3 μmol/L and 131.8 ± 43.6 μmol/L (P = .73). The differences were statistically significant. The groups also did not differ significantly in glomerular filtration rates and incidences of acute tubular necrosis and delayed graft function. CONCLUSIONS: In this study, no significant correlation between serum chloride concentrations of the organ donors and the onset of the function of kidney allografts in the recipients was found.
- MeSH
- acidóza komplikace patofyziologie MeSH
- akutní tubulární nekróza krev epidemiologie etiologie MeSH
- alografty patofyziologie MeSH
- chloridy krev fyziologie MeSH
- dárci tkání * MeSH
- dospělí MeSH
- hodnoty glomerulární filtrace MeSH
- incidence MeSH
- kreatinin krev MeSH
- ledviny patofyziologie MeSH
- lidé MeSH
- mozková smrt patofyziologie MeSH
- opožděný nástup funkce štěpu krev epidemiologie etiologie MeSH
- pooperační komplikace krev epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- transplantace ledvin * MeSH
- vyšetření funkce ledvin MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The diagnosis of sepsis is difficult in immunocompromised patients owing to their modified response to infection. Our experiment in minipigs was designed to compare responses to sepsis between experimental groups of septic minipigs with and without immunosuppression. METHODS: Minipigs with identical baseline parameters were randomized into 3 groups: Sepsis (n = 10); immunosuppression (n = 11), including cyclosporine, methylprednisolone, and mycophenolate mofetil treatment before surgery, and a sham group (n = 6). Sepsis was induced by cecal ligation and puncture (CLP). We recorded selected clinical and laboratory parameters up to 24 hours postoperatively. RESULTS: All CLP animals developed septic shock with a febrile response, tachycardia, and hypotension requiring noradrenaline administration. The hemodynamic responses to sepsis in septic groups with and without immunosuppression were similar. Noradrenaline infusion was started on average later in the immunosuppression than in the group without immunosuppression; however, the difference was not significant. The kinetics of the plasma levels of most selected cytokines and C-reactive protein were similar in both septic groups. At 10 hours after surgery, the immunosuppression group showed significantly lower interleukin (IL)-6 levels compared with the sepsis group. At 19, 22, and 25 hours after surgery immunosuppressed animals displayed significantly greater increases in IL-10 levels compared with the cohort without immunosuppression. CONCLUSIONS: CLP is a simple, reproducible model of sepsis in minipigs. All CLP animals developed sepsis within 24 hours on average. Significant differences in IL-6 and IL-10 plasma levels were recorded between septic animals with versus without immunosuppression.
- MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- cékum mikrobiologie chirurgie MeSH
- cyklosporin farmakologie MeSH
- hemodynamika MeSH
- imunokompromitovaný pacient * MeSH
- imunosupresiva farmakologie MeSH
- kardiotonika farmakologie MeSH
- kyselina mykofenolová analogy a deriváty MeSH
- ligace MeSH
- mediátory zánětu krev MeSH
- methylprednisolon farmakologie MeSH
- miniaturní prasata MeSH
- modely nemocí na zvířatech MeSH
- noradrenalin farmakologie MeSH
- prasata MeSH
- punkce MeSH
- sepse krev farmakoterapie imunologie mikrobiologie patofyziologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
