Visceral leishmaniasis is an infectious disease that occurs only rarely in recipients of solid organ grafts but is associated with an elevated mortality rate despite proper treatment. We report five cases diagnosed in our hospital. All the patients were men aged 30 to 60 years who had undergone kidney transplantation (3 patients), heart transplantation (1), or liver transplantation (1). Three of the patients died, one had multiple recurrences, and one developed post-kala-azar cutaneous leishmaniasis. We review the clinical features, treatments, and outcomes of 26 previously reported cases, pointing out the lower cure rate associated with human immunodeficiency virus infection.
Adsorption in hemodialysis. The use of sorbents in different are used to eliminate excess of calcium and to avoid hard blood purification techniques is reviewed. The sorbents used water syndrome [2]. In medicine, sorbents have been in these therapies are divided into two groups: (1) Adsorption used to rapidly eliminate both industrial and pharmacooccurs fundamentally because of the hydrophobic properties logical exogenous toxins, as well as some endogenous of the sorbents. In this group, the sorbents used in different toxins such as bilirubin or porphyrines. dialysis techniques are charcoal and nonionic macroporous resins. (2) Adsorption occurs by chemical affinity, such as ion Sorbents can be divided into large categories: (1) those exchange resins and chemisorbents. Sorbents were initially that have hydrophobic properties and therefore adsorb used in hemoperfusion, which caused many adverse events; the molecules dissolved in the solution in contact with the later, with the use of coated charcoal, these undesired effects sorbent, and (2) those that eliminate solutes by chemical decreased or disappeared, but the adsorptive properties, water control, and acid-base balance still created problems. For these affinity [3]. Within the first category, hydrophobic sorreasons, the use of sorbents in the treatment of chronic renal bents, there are two subgroups: charcoal and nonionic failure was almost totally discontinued. Little by little, interest macroporous resin. Charcoal is produced both from bioin these substances has reappeared, and at present, they have logical substances such as coconut shells or peach pits been used in combination with other blood purification techand from nonbiological substances, such as petroleum.niques such as hemodialysis, hemofiltration, peritoneal dialysis, and finally, hemodiafiltration. Within the various hemodiafil-Again, according to the definitions of the "Consensus Conference on Biocompatibility," hemoperfusion is the
Paired filtration dialysis (two-chamber haemodiafiltration) was evaluated as a short, highly efficient renal replacement therapy in 35 uraemic subjects belonging to three different dialysis centres. The study period was 1 year. Patients were divided into two groups according to their body-weight and drinking habits. The smaller patients underwent 150-min dialysis sessions three times weekly. The larger patients underwent 3-h treatments thrice weekly. The treatment was adequate in all patients according to the KT/V criteria of adequacy. The intradialytic symptomatology was remarkably low and the treatments were well tolerated in all patients. The study confirms the reliability of paired filtration dialysis as a short dialysis technique. In some patients 150 min may be insufficient to achieve an adequate dialysis efficiency and 180 min may be required for the majority of the population.
Paired filtration dialysis (PFD) is the only hemodiafiltration (HDF) technique in which ultrafiltrate (Uf) is obtained continuously with a similar composition to plasma. It has been proved that Uf is regenerated when it passes through an uncoated adsorbent charcoal cartridge: this one removes medium-to-large solutes and small toxines (except for urea and phosphates), but not the electrolytes and bicarbonate. This regenerated Uf can be used like replacement fluid, using the same Uf pump as the infusion pump; this makes the HDF technique easier and more reliable. During 12 months (3 h/3 sessions/week), we treated 13 patients with this PFD-Charcoal technique. These patients were previously on conventional PFD for at least 6 months. The biochemical results were excellent with a stabilization of all parameters (urea, creatinine, uric acid, Na, K, Cl, Ca, phosphates, beta 2-microglobulin, beta 2M, etc.) and a better control of acidosis (statistically significative after 6 months). The clinical tolerance was also excellent, and the technique was greatly simplified. We conclude that PFD-Charcoal is a good HDF technique that avoids the use of exogenous replacement fluid by using the regenerated Uf itself as an endogenous substitution fluid with bicarbonate.
To overcome reciprocal interaction between convection and diffusion occurring in hemodiafiltration, we separated the two processes in a new dialysis technique called paired filtration dialysis (PFD). In this technique, convection and diffusion take place separately on two capillary membranes: a polysulfone hemofilter and a hemophan dialyzer. The depurative effectiveness of PFD with respect to small (blood urea nitrogen, creatinine, uric acid, phosphate) and large (β2-microglobulin) molecules was acutely assessed in 6 patients on maintenance acetate hemodialysis. Despite a 3-hour treatment time, a high mass removal of small and large solutes was found in PFD without high ultrafiltration rates or blood flows in excess of 300 ml/min. There was no significant difference in solute removal between the two different depurative sequences adopted in PFD, i.e., convection followed by diffusion or vice versa. A significant reduction in β2-microglobulin serum levels was observed in both PFD modes. Twenty patients, on a 12-month period of 3-hour PFD treatment, maintained an unaltered metabolic, clinical, and acid-base status, and cardiovascular stability was not affected. PFD thus provides excellent depurative results, along with simple technical features that are particularly useful in treating patients with high depurative needs and yet are unable to tolerate high-flux techniques.
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