Fibrinogen adsorption in the diabetic foot syndrome and peripheral arterial occlusive disease: first clinical experience.

The elimination of fibrinogen from plasma improves plasma viscosity and whole-blood viscosity. For extracorporeal adsorption of fibrinogen, the pentapeptide gly-pro-arg-pro-lys was coupled to sepharose CL-4B3. Adsorbers containing 135 ml of coupled sepharose CL-4B were used to eliminate fibrinogen from the plasma of 7 men and 3 women (48-75 years old). Nine patients suffered from diabetes mellitus, 1 patient from peripheral arterial occlusive disease, and 5 patients were on regular hemodialysis. Treatments were scheduled on Days 1, 2, 4, 6, 8, 10, 13, 16, 19, 22, 25, and 28. One hundred forty-four treatments with fibrinogen adsorption were performed. No clinical side effects due to the fibrinogen adsorption procedure were observed. In these 10 patients, fibrinogen concentration before the first treatment was 473.7 +/- 183.7 mg/dl. In the first treatment session, fibrinogen concentration was lowered to 241.4 +/- 125.8 mg/dl by treating 4,270 +/- 1,180 ml of plasma. In the following 134 treatments, the pretreatment concentration of fibrinogen was 262.6 +/- 83.4 mg/dl, and the posttreatment concentration was 120.6 +/- 37.2 mg/dl. The mean amount of plasma treated was 3,737 +/- 1,643 ml, and the mean duration of a treatment session (except first treatment) was 143.7 +/- 63.1 min. In 7 patients, a mean posttreatment fibrinogen concentration of < or = 123 mg/dl was obtained; in the other patients, concentrations of 133, 177, and 184 mg/dl were obtained. Yet, the decrease of fibrinogen concentration was also pronounced in these 3 patients: -82%, -67%, and -73%, respectively. During the treatment period of 28 days, wound healing was observed in 9 of the 10 patients. In conclusion, affinity chromatography using the pentapeptide gly-pro-arg-pro-lys is an effective, selective, and safe procedure to lower fibrinogen concentration in plasma. It could be a therapeutic option in severe blood vessel disease in which drug therapy is not sufficient and invasive procedures such as bypass or angioplasty cannot be applied. Yet, more information is needed, for example, about the fibrinogen concentration that has to be reached to get the maximal improvement of micro- and/or macrocirculation.

[Survival time and causes of death in dialysis patients]. / Uberlebenszeit und Todesursachen bei Dialysepatienten.

Renal dialysis was performed, between 1973 and 1983, in 431 patients in terminal renal failure. Of these, 223 (51.7%) are still in treatment, 21 (4.9%) have a functioning transplant. 22 patients (5.1%) have changed to another treatment centre. Three (0.7%) are in uraemia not requiring dialysis. The cumulative survival time for the whole group was 91% at the end of one year, 84% after the second, 78% after the third, 73% after the fourth and 69% after the fifth year. In those over 65 years and those with hypertension or diabetes survival chances were least favourable. Among this group, 5-year survival time was 51, 55 and 46%, respectively. The most frequent cause of death among 162 patients were cardiovascular and cerebrovascular diseases (35 and 23%, respectively).

[Behavior of serum IgE in patients with atopic extrinisic asthma. Studies with a modified radioimmunologic sorbent technic, Phadebas-IgEtest].

Serum IgE levels were measured by radioimmunosorbent techniqueera from patients with atopic extrinsic asthma, from patients with chronic bronchitis and from healthy adults. 51 of 65 patients with atopic extrinsic asthma had IgE values above the mean normal. Patients who were hypersensitive to different allergens commonly showed higher IgE concentrations than those who were hypersensitive to a single allergen only. Compared with IgE values found in patients with chronic bronchitis the differences were statistically highly significant. However the measurement of serum IgE may be a valuable diagnostic tool but only in supplement to other clinical investigations.