Our study shows that ASDH because of boxing is characterized by bleeding from bridging or cortical veins, and that the site of bleeding is a significant determinant of their prognosis.

We investigated whether direct hemoperfusion with a polymyxin B column (DHP-PMX) was able to decrease macrophage and monocyte activity in patients with sepsis. Nineteen patients with sepsis were enrolled in the study. They all had signs of systemic inflammatory response syndrome (SIRS) due to infection and a mean arterial blood pressure > or =65 mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP-PMX for intravenous infusion, and DHP-PMX was performed twice within 24 h for 3 h each time. Serum neopterin was measured four times: before DHP-PMX, and 24, 48, 72 h after it had begun. The serum concentrations of neopterin were 654 +/- 234 nmol/L prior to DHP-PMX vs. 573 +/- 196 nmol/L at 24 h, 452 +/- 161 nmol/L at 48 h, and 372 +/- 139 nmol/L at 72 h, showing a significant decrease from 48 h onwards compared with before treatment. These data suggest that DHP-PMX decreases macrophage and monocyte activity.

The optimum time for commencement of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) in patients with sepsis remains unclear. We retrospectively studied the response to DHP-PMX in relation to parameters of oxygen metabolism in 48 patients with sepsis who were divided into two groups. In the effective group (N = 36), the mean blood pressure increased by at least 10 mm Hg after DHP-PMX. Patients who did not show such a blood pressure elevation were assigned to the non-effective group (N = 12). Before the start of therapy, various parameters (mixed venous oxygen saturation, oxygen delivery index, oxygen consumption index (VO(2)I), oxygen extraction ratio, gastric mucosal-arterial PCO(2) difference, age, systemic vascular resistance index, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score were measured in both groups. These parameters were then compared between the two groups. Only VO(2)I showed a significant difference between the two groups, and all patients in the effective group had a VO(2)I of 100 mL/min/m(2) or more. Based on these results, DHP-PMX should be introduced during the period when VO(2)I is still equal to or greater than 100 mL/min/m(2).

This study had two purposes. One was to assess gastric intramucosal pH (pHi) after early goal-directed therapy in patients with sepsis and septic shock. The other was to determine whether direct hemoperfusion with a polymyxin B fiber column (DHP-PMX) could improve the pHi if it remained low after early goal-directed therapy. The subjects were 32 patients who underwent early goal-directed therapy within 6 h of a diagnosis of sepsis or septic shock, and who achieved the following conditions: (i) central venous pressure of 8-12 mm Hg; (ii) mean arterial blood pressure >or=65 mm Hg; (iii) urine output >or=0.5 mL/kg/h; and (iv) mixed venous oxygen saturation >or=70%. A gastric tonometer was inserted in each patient and the pHi was measured before DHP-PMX, and at 24, 48, and 72 h after the start of treatment. The pHi was 7.22 +/- 0.04 immediately before DHP-PMX, 7.28 +/- 0.03 (P < 0.05) at 24 h, 7.32 +/- 0.03 (P < 0.01) at 48 h, and 7.34 +/- 0.02 (P < 0.01) at 72 h, showing a significant increase from 24 h onward compared with the pretreatment value. In patients with sepsis and septic shock, the pHi remained low after early goal-directed therapy; however, it was significantly improved from 24 h after the start of DHP-PMX and was normalized from 48 h onwards. These findings suggest that DHP-PMX improves pHi. Because this was a prospective uncontrolled observational study on a limited number of patients, larger multicenter clinical trials are required to more accurately assess the benefits of DHP-PMX.

We investigated whether hemoperfusion with a polymyxin B column (DHP-PMX) was able to improve coagulation abnormalities in patients with sepsis. Sixteen patients with sepsis were enrolled in the study. They all had signs of systemic inflammatory response syndrome due to infection and a mean arterial blood pressure > or =65mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP-PMX for intravenous infusion, and DHP-PMX was performed twice within 24 h for 3 h each time. Circulating levels of thrombin-antithrombin complex (TAT), plasmin-alpha2 plasmin inhibitor complex (PIC), the TAT/PIC ratio, and plasminogen activator inhibitor-1 (PAI-1) were measured six times. Before DHP-PMX, the TAT level was 24.5 +/- 8.3 ng/mL, the PIC level was 2.5 +/- 1.1 microg/mL, the TAT/PIC ratio was 13.9 +/- 3.5, and the PAI-1 level was 143.0 +/- 24.4 ng/L. The TAT level, TAT/PIC ratio, and PAI-1 were all significantly lower (P < 0.05) after 48 hr compared with before DHP-PMX, but no significant change of PIC was observed. In these patients with sepsis, fibrinolysis was inhibited by PAI-1, whereas clotting activity was significantly increased. This coagulation/fibrinolysis imbalance was improved by DHP-PMX. The present results suggest that indirect inhibition of clotting activity can be achieved in patients with sepsis through adsorption of lipopolysaccharide by DHP-PMX.

The purpose of this study was to summarize the historical changes in the list of plasma fractionation products (PFP) placed on the Model List of Essential Medicines (EML) issued by the World Health Organization (WHO). PFP such as albumin, blood coagulation factors, and immunoglobulins are derived from blood collected from thousands of people. PFP have been listed since theˆrst edition of the EML (1977). However, the PFP listed on the EML have changed dramatically because EML's selection process has changed from experience-based to evidence-based. For example, albumin, which had been listed since the 2nd edition (1979), was deleted in the 11th edition (2000) because of the uncertainty of its e‹cacy. Human immunoglobulin normal, which had been deleted from the 13th edition (2003), was relisted in the 15th edition (2007). Moreover, the WHO has issued several resolutions and guidelines regarding PFP production, quality, and safety in order to promote the establishment of blood programmes in every nation. The focus of WHO's EML selection process has changed over 30 years. In the 20th century, WHO mainly focused on PFP e‹cacy, quality, and safety problems. However, currently the focus is on the problem of PFP accessibility, especially in developing countries. Therefore, it would be important to know how to capitalize on established knowledge and production technology to increase the accessibility of PFP worldwide.