Drug intoxication: influence of hemoperfusion on human plasma fibronectin

Hemoperfusion for the treatment of poisoning: technology, determinants of poison clearance, and application in clinical practice

Hemoperfusion is an extracorporeal treatment based on adsorption, historically reserved for the treatment of acute poisonings. Its use was popularized in the 1970s after several in vitro and animal experiments had demonstrated its efficacy, and was even preferred over hemodialysis in the management of overdosed patients. With the advent of new and more efficient dialytic modalities, hemoperfusion is now less frequently performed in the Western world. However, hemoperfusion still remains popular in developing countries. The present article reviews the technique of hemoperfusion, the factors influencing poison clearance through adsorption and its current applications.

Plasma fibronectin depletion after cardiac surgery in children with or without cardiopulmonary bypass

Plasma fibronectin depletion decreases resistance to sepsis. After cardiac surgery, septic complications occur more frequently when the surgical procedure is managed with a cardio-pulmonary bypass than when it is not. To determine whether cardio-pulmonary bypass produces a greater decrease in plasma fibronectin than surgery without cardio-pulmonary bypass, we studied plasma fibronectin concentrations in two groups of children operated for congenital heart diseases. Group I: 10 children undergoing surgery with cardio-pulmonary bypass. Group II: 11 children undergoing surgery without cardio-pulmonary bypass. Plasma fibronectin was monitored pre-operatively (t 1) and post-operatively at the 6th hour (t 2), 1st (t 3) and 7th (t 4) days. In both groups, plasma fibronectin concentration dropped at (t 2) and (t 3) and rose again at (t 4). There was no significant difference in plasma fibronectin levels between the two groups at any time. We conclude that the plasma fibronectin decline alone cannot explain why septic complications after surgery are more frequent with cardio-pulmonary bypass than without.

Plasma fibronectin in various hemopathic diseases

Plasma fibronectin was determined by laser nephelometric immunoassay in two populations: (a) healthy subjects separated into three age groups (16-29 yr, 30-50 yr and over 50 yr) and, (b) patients with various hemopathic diseases without any infection or any therapy. Results showed that fibronectin levels in a healthy population were strongly influenced by age. An increase of human plasma fibronectin was shown to occur with age. Results in hemopathic patients were expressed in terms of percentage of mean deviations as compared to normal mean values for the corresponding age range. We found that plasma fibronectin was significantly decreased in acute myeloblastic leukemia, especially in transfused patients, polycythemia vera, osteomyelofibrosis. Waldenström disease, benign dysproteinemia, refractory anemia and stage IV non-Hodgkin malignant lymphoma. Plasma fibronectin-decreased levels appear to be of prognostic value in the evolution of malignant hemopathic diseases.