Serum middle molecule levels in uremia during long term intermittent hemoperfusions with the acac (coated charcoal) microcapsule artificial kidney.
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The addition to charcoal treated normal and charcoal treated uremic plasma of four metabolites which accumulate during uremia--uric acid, beta -phenylpyruvic acid, guanidinosuccinic acid, and p-hydroxyphenylacetic acid--failed to produce a warfarin binding defect. Charcoal treatment corrected the warfarin binding defect in uremic plasma, however it diminished the extent of warfarin binding to normal plasma. These observations rule out the possibility that uric acid, beta -phenylpyruvic acid, guanidinosuccinic acid, or p-hydroxyphenylacetic acid contribute to the warfarin binding defect in uremia, and suggest that free fatty acids have no role in the warfarin binding defect.
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Guest Editor's Introduction: Activated charcoal has a microporous structure and a large surface area that nonspecifically adsorbs the substances in the molecular weight range of 100–5,000, including hepatoxins, uremic toxins and drugs. The success of the first clinical trial for the treatment of chronic renal failure with an activated charcoal column was carried out by Yatidis in 1964, but the clinical application for the charcoal column has not been possible. This is because the charcoal presented major problems such as the release of microparticles and platelet activation. Chang solved these problems by developing the activated charcoal which was microcapsulated by biocompatible materials. Since then, many kinds of activated charcoal columns have been commercialized for blood purification use and are still widely utilized. This paper which describes the first clinical use of microcapsulated charcoal was printed in Trans Am Soc Artif Intern Organs, vol 16, page 141–148 (1970) and is reprinted here with permission.
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The Skeggs-Leonards artificial kidney and related methods were applied by the author in about thirty instances in patients with various kinds of renal disease. The treatment brought about clinical improvement of varying degree and appeared to be life-saving in four of five patients with acute renal failure. Treatment with the artificial kidney is indicated for patients with acute renal failure who develop clinical signs of uremia. The artificial kidney should be applied before the patient's condition has become irreversible. Removal of edema fluid is possible with modern artificial kidney equipment and appears to extend the therapeutic possibilities of the procedure. The artificial kidney may be of help in barbiturate and other intoxications. It affords temporary palliation in certain patients with chronic uremia; it may be used to overcome acute exacerbations of chronic renal disease; it may make it possible to operate on uremic patients who otherwise could not withstand operation.
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Address of Welcome.- Reviews of Hemodialysis, Dialysate Regeneration, Hemofiltration and Oxystarch.- The Present Status and Perspectives of Hemodialysis.- Current Status of Dialysate Regeneration for the Treatment of Chronic Uremia.- Devising a Practical Suitcase Hemodialyzer.- Present Status of Hemofiltration.- Oxystarch and Other Polyaldehydes: The Present Status in the Treatment of Uremia.- Microencapsulated Adsorbent Hemoperfusion.- Artificial Cells for Artificial Kidney, Artificial Liver and Detoxification.- Clinical Experience of Bead-Shaped Charcoal Haemoperfusion in Chronic Renal Failure and Fulminant Hepatic Failure.- Hepatic Assist System Using Bead-Type Charcoal.- Extracorporeal Immunoadsorbents for Specific Extraction of Circulating Immune Reactants.- Evaluation of Charcoal Hemoperfusion in Uremia.- Charcoal Hemoperfusion: Georgetown University Hospital Experience.- Treatment of Fulminant Hepatic Failure by Charcoal Haemoperfusion and Polyacrilonitrile Haemodialysis.- Use of Activated Adsorbent Haemoperfusion in Acute Intoxication.- Clinical Experience with Cellulose-Coated Carbon Hemoperfusion.- Hemoperfusion and Removal of Endogenous Uremic Middle Molecules.- Charcoal Hemoperfusion in Mushroom Poisoning: Amanita Phalloides.- Biocompatibility Studies of Hemoperfusion Systems for Liver and Kidney Support.- Other Adsorbent Hemoperfusion Approaches.- The Use of Membranes and Sorbents for Blood Detoxification: Cuprophan Sorbent Membranes.- Combination of Hemodialysis and Hemoperfusion in a Single Hollow-Fiber Unit for Treatment of Uremia.- The B-D Hemodetoxifier: Particulate Release and Its Significance.- Fixed-Bed Charcoal Hemoperfusion in the Treatment of Drug Overdose and Chronic Renal Failure.- Experience with Resin Hemoperfusion.- Strathclyde Approach Towards Artificial Kidney, Artificial Liver and Detoxification.- Communications.- Assessment of Two Rat Models of Fulminant Hepatic Failure for Testing Artificial Liver Devices.- Use of Albumin-Cellulose Nitrate Microencapsulated Charcoal Hemoperfusion: In Acute Digoxin Toxicity in Dogs.- Conversion of Urea and Ammonia to Amino Acid Using Sequential Enzymatic Reaction with Microencapsulated Multi-Enzyme Systems.- Microencapsulated Charcoal Hemoperfusion for Galactosemia.- The Filtration of Plasma from Whole Blood: A Novel Approach to Clinical Detoxification.- Ionsiv F-80 and Ionsiv W-85: Molecular Sieve Zeolite NH4+ Ion Exchangers for Removal of Urea Nitrogen.- Panel and General Discussions.- Chronic Renal Failure and Future Approaches.- Status of Artificial Liver Support: 1977.- Treatment of Acute Intoxication.- Interrelation of Hemoperfusion, Plasma Clearance and Half Life.- General Discussion.- Invited Speakers, Session Chairmen and Organizing Committee.
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Journal Article Serum Acetaminophen Assay Using Activated Charcoal Adsorption and Gas Chromatography Without Derivatization Get access Malayappa Jeevanandam, Malayappa Jeevanandam Toxicology Section of the Clinical Laboratories, Bergen Pines County Hospital, Paramus, New Jersey 07652 Search for other works by this author on: Oxford Academic PubMed Google Scholar Betty Novic, Betty Novic Toxicology Section of the Clinical Laboratories, Bergen Pines County Hospital, Paramus, New Jersey 07652 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ronald Savich, Ronald Savich Toxicology Section of the Clinical Laboratories, Bergen Pines County Hospital, Paramus, New Jersey 07652 Search for other works by this author on: Oxford Academic PubMed Google Scholar Edward Wagman Edward Wagman * Toxicology Section of the Clinical Laboratories, Bergen Pines County Hospital, Paramus, New Jersey 07652 *Send reprint requests to: Edward Wagman, M.D., Director of Laboratories, Bergen Pines County Hospital, Paramus, New Jersey 07652 Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Analytical Toxicology, Volume 4, Issue 3, May-June 1980, Pages 124–126, https://doi.org/10.1093/jat/4.3.124 Published: 01 May 1980 Article history Received: 24 October 1979 Published: 01 May 1980
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