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AbstractBackground/Aims: Hemofiltrate reinfusion (HFR) is characterized by the use of regenerated ultrafiltrate as replacement fluid. We set up a new technique, postdilution HFR (PD-HFR), aiming at increasing purification efficiency, treatment tolerance and at reducing inflammatory states. Methods: We performed PD-HFR in 6 uremic patients during 1 year. Dialysis efficacy, dialyzer blood loss and the behavior of cytokines were evaluated. Results: No pyrogenic reactions or other adverse events were recorded. Treatment tolerance was excellent. We observed high urea extraction rates and optimal Kt/V values, high β2-microglobulin (β2m) extraction rates and a decrease in dialyzer blood loss; also IL-6 and TNF-α decreased significantly. Conclusions: Inversion of the standard HFR configuration has allowed us to improve the removal of both urea and β2m, and to decrease dialyzer blood loss, with an optimal tolerance. Moreover, the decrease in cytokine levels might attenuate the uremic microinflammatory state.Copyright © 2004 S. Karger AG, Basel

Two series of experiments were performed to determine whether nicregoline possesses an alpha-adrenergic blocking action on the lower urinary tract musculature in dogs and humans. One series consisted of in vivo studies of urethral pressure profile recordings in 19 female dogs, and their responses to adrenergic stimulation with noradrenaline or methoxamine, alone and following administration of nicergoline. The other series consisted of in vitro isometric studies of 61 strips of human prostate, and the establishement of dose response curves to nor-adrenaline alone and in the presence of various concentrations of nicergoline. In both sets of experiments clear evidence of an alpha-adrenergic blocking effect was obtained. From the in vitro experiments, the Kb of nicergoline was calculated as =9x10-9 M.

A double-blind crossover study of the alphablocker Nicergoline was carried out in sixteen patients affected by benign prostatic bladder outflow obstruction. The “irritative” symptoms of prostatic hypertrophy, including nocturnal frequency and dysuria, were improved after Nicergoline significantly more than after placebo. In 10 further patients with prostatic hypertrophy, peak and mean flow rates increased by 50% and 77% respectively after the acute administration of Nicergoline. No side effects were detected. In conclusion Nicergoline seems to be active and well tolerated in the treatment of benign prostatic obstruction.

Adverse reactions to general anaesthetics are quite rare, but may be very severe and even lethal. Unfortunately, the diagnosis is frequently based on medical history and few laboratory tests are reliable. A clinical case is presented: a patient, 75 years of age, was a candidate for urgent coronary artery bypass graft surgery due to the results of the coronary angiogram (severe stenosis of the main stem). The patient reported cardiac arrest in both operations with general anaesthesia, but there was a lack of clinical documentation. Thus, sulfidoleukotriene assay (CAST-ELISA, Bühlmann Laboratories) was used to determine the tolerability of general anesthetics in a single patient. The results of this in vitrotest was useful in discriminating and excluding the administration of some widely-used standard anaesthetic agents.