Although at present there is no prospective randomized study which could show significantly better survival of patients on continuous procedures, the majority of intensivists advocate this technique of renal function replacement due to generally accepted opinion that it has less effect on circulation of already hemodynamically unstable patients. In our prospective randomized study with 104 patients, we also did not observe any difference in 28 days survival, in total survival, as well as in circulatory instability between two treatment modalities. Even in subgroup of 80 patients with sepsis and septic shock there were no difference in survival. Sepsis was the underlying disorder in 52 and septic shock in 28 patients out of 104 patients analyzed in this study. Our prospective randomized study did not show a statistically significant difference between the two methods of renal replacement therapy. Survival rates were not affected and neither was the occurrence of hemodynamic instability. We believe that both methods are complementary; IHD for faster elimination of electrolytes and waste products elimination, CRRT for regulation of higher calories requirements and for hemodynamically unstable patients. The expectations that one method is superior to the other in the term of better survival have not been corroborated by the current data available in the literature. The choice of the method should be individualized. ARF, which is an integral part of MOF, is a problem frequently encountered in critically ill patient treated in the ICU, but outcome of these patients depends closely on the control of basic event. Evaluation of each of the supportive procedures is therefore hindered by the fact that the underlying disease has the crucial effect on survival and the type of supportive procedure less so.

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Results of treatment of 18 patients fulfilling the criteria for TTP are presented. Thrombocytopenia was present in all patients (100%). Sixteen of the 18 patients (88.8%) had mental status changes, and seven of the 18 patients (38.8%) had renal impairment. One patient had a secondary type of TTP, caused by non-Hodgkin's lymphoma of the large intestine (that was diagnosed later) and was excluded from the study. Immunosuppresive therapy with steroids, plasma exchange and replacement of removed volume with fresh frozen plasma in a dosage of 25 ml/kg body weight resulted in a statistically significant increase of platelet count (P = 0.00222), and a significant improvement in consciousness defined by increased GCS after 2 weeks (P = 0.00222). In two patients renal function recovered, and in one of them hemodialysis was no longer needed. This improvement in a small group of patients had no statistical significance. TTP recurred in seven patients. High doses of steroids caused serious side effects in two patients: in one patient, steroid diabetes, and in the other one, intestinal perforation.

Background: There is a need for a reliable biological indicator for assessing Mg and Ca nutritional status for precision personalized medicine. Objective: In this study, we used the long-term biological indicator tissue of hair to assess Mg and Ca nutritional status. Design: Hair Mg and Ca were analyzed in 1073 healthy white adult Caucasians [734 women (♀) and 339 men (♂)] with the ICP MS. The log-transformed data were analyzed with median derivatives bioassay. Results: The hair median values (µg•g-1) were W (♀) Mg 254 and M (♂) Mg 137.2 and W (♀) Ca 1721.4 and M (♂) Ca 492.0, respectively. The linear (adequate) range limiters of the sigmoid saturation curve for magnesium were W (♀) Mg 29.7-270.6 and M (♂) Mg 20.5-90.2, whereas these adequate range limits for calcium were W (♀) Ca 487.7-4456.8 and M (♂) Ca 26.1-816.4. The hair Mg/Ca ratio was stable in women but tends to grow from the start to the end of the linear adequate range segment for these two elements. Conclusions: Hair deposition of both Mg and Ca was about 2.5 times higher in the hair of women than in men. Hair median derivatives bioassay of Mg and Ca provides a reliable, non-invasive bioindicator tissue for assessing their human nutritional status beyond the Recommended Dietary Allowances.