Experiments with Continuous Hemofiltration and Hemofiltrate Regeneration in the Rat
Morten BøttcherD. FalkenhagenBarbara NebeM HoltzJulia E. NeumannC. J. RyanP W WüstenbergE DörpH Klinkmann
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Abstract:
Experimental studies were made with continuous hemofiltration treatment for bilaterally nephrectomized rats and initial observations regarding the effects of such treatment on leukocyte and thrombocyte counts are reported. Hemofiltration of unanesthetized rats able to move freely within their cage could be continued for up to 30 h using a pump-driven ECC system. Blood parameters recorded during this treatment indicate that the detoxification was effective. In another series of experiments the water and electrolyte reabsorption capacity of the colon ascendens of healthy rats was tested by continuously supplying NaCl solution into the colon via a fistula. A large proportion, if not all, of the hemofiltrate can be discharged into the colon without diarrhoea. A final series of experiments showed that the three-stage operation (implantation of permanent catheters, connection of a permanent intestinal fistula and bilateral nephrectomy) is possible with the rat.Keywords:
Hemofiltration
Detoxification
DETOXIFICATION FROM ALCOHOL: A COMPARISON OF HOME DETOXIFICATION AND HOSPITAL-BASED DAY PATIENT CARE
An uncontrolled study was carried out to examine two types of ambulatory care for patients undergoing detoxification from alcohol. The safety, efficacy, and acceptability of home detoxification was compared to detoxification within a day hospital setting. Seventy-nine per cent of home detoxification patients, many of whom had major alcohol-related problems and were severely dependent on alcohol, were successfully detoxified at 10 days. The day hospital group overlapped in severity with the home group and 78% completed detoxification. At 60 days, 45% of home detoxification patients and 31% of the day hospital group showed significant improvements in a range of alcohol-related difficulties. Improved outcome was associated with attendance for further treatment for both groups. Both home and day hospital detoxifications were viable alternatives to in-patient detoxification for selected groups of patients.
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In this study, 20 subjects who had home detoxification with supervision and support from the Western Australian Alcohol and Drug Authority Community Nursing Service were matched with 20 subjects who had inpatient detoxification in the Authority's detoxification facility. Subjects were interviewed between nine and 22 months (mean 15.5 months) after detoxification to compare client outcomes and the costs of home and inpatient detoxification. The results indicate that, for suitable clients, home detoxification was at least as beneficial as inpatient detoxification and that it was achieved at a much lower cost than inpatient care.
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Based on the present status of chromium containing slag′s detoxification,the detoxification mechanisms,specifications and the feasibility of the methods,including chemical detoxification,detoxification by microwave radiating and biological detoxification,are introduced and compared.Finally the prospect of the technology on detoxification of the chromium containing slag is also proposed.
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A new detoxification method for GHB dependence was developed recently in the Netherlands. The method involves the use of pharmaceutical GHB.To describe the characteristics of GHB dependent inpatients, the course of the detoxification process and patients' progress in the three months following inpatient detoxification.229 GHB dependent patients were monitored during and after inpatient detoxification. Records were kept of the psychiatric symptoms, withdrawal symptoms and relapses.The average age of the patients was 29 years; 69% of the patients were male. They reported severe symptoms of co-occurring depression and anxiety. Detoxification was successful in 86% of the patients and, on a whole, the procedure ran smoothly, without complications. However, within three months following detoxification two-thirds of the patients had relapsed and were again taking GHB.Pharmaceutical GHB can be used as an alternative to the benzodiazepine method for detoxifying patients with GHB dependence. However, the high relapse rates following detoxification are of great concern.
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In order to compare the effectiveness of aluminum removal in uremic patients during extracorporeal treatment, 17 patients with endstage renal failure were given a desferrioxamine infusion of 40 mg/kg body weight after an ordinary dialysis treatment. Forty-eight hours later 7 patients were treated with hemodialysis, 6 with hemofiltration and 4 with a combination of hemodialysis and hemoperfusion. The clearance of aluminum was measured at different intervals. It was found that the aluminum clearance was 75 + 18 ml/min in hemofiltration compared to 30 ± 10 ml/min in hemodialysis (p < 0.001). A combination of hemodialysis and hemoperfusion with a charcoal column containing 100 g activated charcoal in series gave a total aluminum clearance of 56 ± 11 ml/min. The total amount of aluminum in the ultrafiltrate after hemofiltration was found to be approximately 3 times as high (1,728 ± 156 μg) as the total amount of aluminum in the hemodialysis water that had passed a single pass system during a 4-hour dialysis (576 ± 104 μg). Our results indicate that hemofiltration or a combination of hemodialysis and hemoperfusion should be used to remove aluminum in patients with signs of severe aluminum accumulation such as encephalopathy or painful bone disease, because these methods are 2–3 times as effective as ordinary hemodialysis. In patients where aluminum has been accumulated but no severe symptoms occur hemodialysis gives a significant clearance of the aluminum desferrioxamine complex.
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A study comparing abrupt and gradual opiate detoxification which identified the efficacy by means of computer-assisted pupilometry and rating of withdrawal distress is presented. This paper concentrates on the efficacies of these two detoxification modes with regard to the identical results after successful opiate detoxification treatment. The findings of the present investigation support the hypothesis that withdrawal distress returns to a normal level after rapid naloxone withdrawal treatment within 6 days. Similar results can be seen for inpatient methadone withdrawal after 3 weeks of treatment. These results indicate that by rapid detoxification therapy, the time of withdrawal can be effectively shortened. Considering the low dropout rate and the high degree of acceptance during rapid detoxification, the rapid detoxification regimen is an effective and economic alternative to gradual withdrawal treatments.
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Hemofiltration and hemodialysis were performed simultaneously with the Polyacrylnitrile membrane in a single pass dialyzate flow system. Due to the combination of convective mass transfer and diffusion, the clearances of both small and large molecules were significantly higher than during hemofiltration or hemodialysis alone. The removal of excess water was better tolerated than during hemodialysis. Six patients have been treated by this technique for 6 months 3 X 3 hr/week without side effects, and the new procedure appears to be the method of choice to shorten dialysis time.
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