This paper describes an unusual complication of membrane dysfunction during extracorporeal membrane oxygenation (ECMO) for treatment of neonatal respiratory distress. A 2.8-kg term infant presented to our facility in severe respiratory distress and was diagnosed with primary pulmonary hypertension. After routine priming of the extracorporeal circuit, the patient was placed on veno-arterial ECMO with 8 F arterial and 12 F venous cannulae. Transfusion criteria were established which included trigger values of the following: platelet count 100,000/microliters, fibrinogen 150 mg/dl, haematocrit 40%. The ECMO course was uneventful until approximately the 132nd hour on support when the patient developed a consumptive coagulopathy, as evidenced by 55-60% reductions in both platelet count and fibrinogen concentrations, despite transfusion therapy. Total autogeneic blood product transfusion during the first 120 h of ECMO averaged 4.4 +/- 2.2 ml/h, while the transfusion rate for the final 35 h was 7.8 +/- 3.5 ml/h. Coinciding with this rise in transfusion requirements was an increase in transmembrane pressure from 0.29 to 1.52 mmHg/ml blood flow. The patient was separated from ECMO after 175 h due to a continuing coagulopathy and haemothorax. The patient was then treated with nitric oxide therapy before succumbing on the twelfth postoperative day due to refractory respiratory failure. The circuit was dissected and significant clots found in both the venous bladder and oxygenator. In addition, approximately one-third of the membrane compartment had a 'fused' circumferential pattern of dessicated clot which interrupted blood path continuity. In conclusion, this report describes an unusual complication of the ECMO oxygenator that occurred during long-term extracorporeal life support which most likely resulted from a coagulopathy.
In an attempt to make cardiopulmonary bypass (CPB) less traumatic for patients undergoing cardiac surgery, extracorporeal circuits (ECC) have been modified to achieve this goal. Poly(2-methoxyethylacrylate) (PMEA, X-coating™) is a new polymer coating used in the ECC. PMEA studies have shown excellent biocompatibility with the components of blood. In this evaluation, PMEA-coated ECC were compared with control (CTR) circuits with emphasis on hematological parameters, perioperative homologous blood product usage, and clinical outcomes. Patients undergoing elective coronary artery bypass grafting were randomized to either a PMEA group (n = 30) or a CTR group (n = 30). Extracorporeal circuit components in the PMEA group were coated except for the cardioplegia delivery device and cannulas. Patients in the CTR group had just the arterial line filter coated. The following hematological parameters were measured: platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC), and hematocrit (Hct). Blood product usage was observed along with clinical outcomes for the following parameters: ventilation time, mediastinal tube output, intensive care unit (ICU) and hospital lengths of stay. The preoperative patient profiles were comparable between the two groups. The PMEA group had marginally higher CPB times (134 ± 31.9 vs. 118 ± 33.7 minutes) and cross clamp times (83.9 ± 21.3 vs. 73.7 ± 21.6 minutes), however no significant differences were reached. Platelet count, RBC, and Hct levels were also comparable between groups with no significant differences. However, there was a significant difference in WBC between groups (p = 0.041). Less platelets were administered both intraoperatively and 48 hours postoperatively in the PMEA group. The authors evaluated PMEA-coating by measuring clinical outcomes, such as ventilation time, ICU and hospital lengths of stay, and homologous blood utilization. PMEA patients trended towards less homologous blood transfusions, which helped save an average of $83.41 per patient. Further clinical studies are needed to evaluate the benefits of this new polymer coating.
e15119 Background: Prostate cancer is the second leading cause of male cancer deaths in the U.S. There are significant racial differences in prostate cancer incidence and mortality. Methods: The SEER Database for 2008 was analysed for designated areas: Connecticut, Detroit, and Hawaii, assuming that these areas are surrogates for whites, blacks, and Asians, respectively. Results: Incidence and mortality (see Table). Conclusions: Assuming that the geographic SEER areas (Conn, Det, Ha) are surrogates for whites, blacks, and Oriental populations, we conclude that the incidence and mortality rates for blacks are higher than those for whites and Orientals. [Table: see text]
14034 Background: Antisense oligos against TGF-a (MR1), EGFR (MR2), and bcl-2 (MR4) are efficacious against prostate tumors. Methods: To enhance activity “bispecifics” were constructed. A pair recognized TGF-a and EGFR mRNA binding sites (TGF-a/EGFR [MR12] and EGFR/TGF-a [MR21]), another pair EGFR and bcl-2 (EGFR/bcl-2 [MR24] and bcl-2/EGFR [MR42]). Pairs differ in 5’ to 3’ binding site orientation, and were tested in vitro against prostate tumor cells. Following cell attachment, incubations were for 2 days with the agents followed by 2 days in their absence. Results: Bispecifics (6.25uM) are at least as effective as monospecifics and EGFR contributed to most first pair activity. Against PC-3 and LNCaP cells, MR2, MR4, MR12, MR21, MR24 and MR42 significantly inhibited growth. PC-3 cells were then incubated ± a chemotherapeutic agent. With LD50 Cytoxan, MR2, MR4, MR24, MR42 significantly inhibited 47.3, 45.7, 68.3 and 64.9%; with LD50 Taxol MR2, MR4, MR24, MR42 significantly inhibited 49.8, 45.8, 64.1 and 59.2%; and with LD50 DES MR2, MR4, MR24, MR42 significantly inhibited 66.6, 67.6, 64.3 and 67.2% respectively. Each agent significantly increased the inhibition produced by either oligo alone. LNCaP cells were also incubated with mono- and bispecific oligos ± chemotherapeutics. MR2, MR4, MR24, MR42 produced significant inhibitions of 57.4, 58.4, 69.4 and 68.6% for Cytoxan; 70.4, 70.1, 73.6 and 74.0% for Taxol; and 49.8, 50.1, 59.6 and 53.9% respectively for DES. A complete PC-3 experiment compared MR1, MR2, MR4, MR12, MR21, MR24 and MR42 in the presence of LD50 Cytoxan. Each oligo combined with Cytoxan significantly inhibited: MR1 by 51.0, MR2 by 55.0, MR4 by 58.0; MR12 by 56.0; MR21 by 61.1, MR24 by 65.5 and MR42 by 66.0%. Bispecifics directed against two different pathways, MR24 and MR42 were the most effective. A complete LNCaP experiment compared the same series of oligos in the presence of LD50 Cytoxan. Each oligo combined with Cytoxan significantly inhibited: MR1 by 49.0, MR2 by 50.0, MR4 by 53.0; MR12 by 52.0; MR21 by 58.6, MR24 by 53.9 and MR42 by 58.0%. Conclusions: Bispecific oligos significantly advance antisense technology and could play a role treating prostate cancer, particularly when combined with chemotherapy. Bispecifics against proteins associated with different growth pathways may be best. No significant financial relationships to disclose.
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