These studies were undertaken to investigate the effect of acute bacterial infections on the absolute number of peripheral blood lymphocytes (PBL) in an elderly population and to evaluate the prognostic significance of a decreased number of PBL in critically ill aged patients. The results show that a significant lymphopenia develops in elderly patients during the course of an acute bacterial infection whereas the same type of acute illness has no effect on the PBL count of younger subjects. The lymphopenia is not related to a particular localization of the infection nor to the type of bacterial pathogen. The prognosis of the bacterial infection is closely linked to the severity of the lymphocyte depletion and its outcome can nearly be predicted by monitoring the variation of the number of circulating lymphocytes during the early course of the disease.
I" 1 1 0 -E E a -105-W 2 100u) W CT P 95;To the Editor:As pioneered by Bergstrom, sequential dialysis involves separating diffusion and ultrafiltration and performing them sequentially during a dialysis treatment session ( 1). By providing isolated ultrafiltration, one can reduce the problem of intradialytic hypotension. This blood pressure stabilization may result from a decrease in the drop in intravascular osmolality which results in less of a shift of intravascular fluid to the extravascular compartment. In an attempt to further study the relationship between osmolality changes and mean arterial pressure changes, we utilized four different protocols in 10 stable chronic hemodialysis patients in a cross-over design. Patients were treated with 4 hours of regular hemodialysis (RHD); standard sequential dialysis-3 hours of RHD following by 1 hour of ultrafiltration (SSHD): reverse sequential hemodialysis-1 hour of ultrafiltration followed by 3 hours of RHD (RSHD); and modified sequential hemodialysis-45 minutes of dialysis followed by 15 minutes of ultrafiltration each hour for 4 hours (MSHD). In order to exacerbate any decline in blood pressure due to a falling osmolality. a dialysate sodium of 133 mEq/L was used with a Gambro 1.0 m7 dialyzer. P.s shown in Figure 1 there was no statistically significant difference (by repeated measures analysis of variance) in mean arterial pressure (measured every 15 min), between any of the methods of dialysis studied. Utilizing hourly osmolality measurements for each patient in each protocol (549 data points), a correlation coefficient of r = 0.67 was found between mean arterial pressure and plasma osmolality E < I -9 0 ~~P = 1 . 2 1 8 ( O s r n ) -264.88
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