Hypertriglyceridemia Causing Continuous Renal Replacement Therapy Dysfunction in a Patient with End-stage Liver Disease.

Hypertriglyceridemia is infrequently reported as a cause of suboptimal delivery of dialytic therapy in critically ill patients. We report the case of a critically ill liver transplant patient in the Intensive Care Unit who was found to have recurrent filter clotting during continuous renal replacement therapy (CRRT). The patient had increased serum triglycerides (TGs), which was identified approximately 2 weeks into hospitalization and initially believed to be due to prolonged propofol use. The patient's elevated TGs ultimately caused her blood to become lipemic, causing the dialytic circuit to become nonfunctional and placed the patient in imminent danger due to hyperkalemia and metabolic acidosis. Therapeutic plasma exchange was emergently used to lower TG levels, and renal replacement therapy was resumed without any other issues. The patient's persistent hypertriglyceridemia was attributed to a combination of adverse effect of medications and liver graft failure. The high TG level and abnormal liver functions improved after a repeat liver transplantation.

Multiple myeloma patients receiving large volume leukapheresis efficiently yield enough CD34+ cells to allow double transplants.

Current protocols for myeloma patients require more than one autologous transplant. We performed a retrospective study to determine the cost-effectiveness of large volume leukapheresis (LVL) compared with standard volume leukapheresis (SVL) collection when two transplants are required. We evaluated 87 patients who underwent a cumulative total of 260 LVL and SVL collections. The median product volume per collection was 356 ml for LVL, and this was significantly higher than the median product volume per collection for SVL (median 149.5 ml, P < 0.001). The median total CD34+ cell yield/kg was 6.4 x 10(6) for LVL and 5.2 x 10(6) for SVL. This difference was statistically significant (P = 0.005). Because the target CD34+ cell dose for a single transplant was 3 x 10(6)/kg at our institution, overall the LVL yields enough CD34+ cells that could allow for two transplants. Therefore, more patients in the LVL group were able to undergo a potential second transplant. Because of the reserved cells for a second transplant, LVL patients received significantly less CD34+ cell/kg per transplant than the patients in SVL group (P = <0.001). As a result, LVL group had statistically significant but clinically insignificant delay in neutrophil (P = <0.001) and platelet (P = 0.02) engraftments. Additionally, using LVL instead of SVL to collect >or=6 x 10(6)/kg CD34+ cells may potentially save $7,497 per patient. We therefore conclude that LVL is the method of choice for collection of multiple myeloma patients when two transplants are anticipated.

[Perinatal mortality in twin pregnancy. 576 case histories (author's transl)]. / La mortalité périnatale dans la grossesse gémellaire. Etude de 576 observations.

The authors report on the result of a retrospective survey which they carried out in 8 Hospital Centres in the West of France between 1975 and 1978 and these were concerned with 576 twin pregnancies. This study confirms that the fetal prognosis in twins is precarious. The perinatal mortality is high and is made up at the same time of a stillbirth rate of 5 per cent and a neo-natal mortality rate of 6 per cent, which is mainly due to prematurity (49.6 per cent) and to intra-uterine growth retardation in 19.3 per cent. Studying these results and the figures given in the literature, the authors analyse the ways in which this mortality can be reduced: early diagnosis, rest, screening for fetal low growth and a sensible broadening of the indications for Caesarean section. This broadening appears to them to merit consideration especially in three circumstances: intra-uterine growth retardation, premature labour between the 31 and 33 week after the last period and transverse presentation of the second twin that cannot be turned.