Quetiapine overdose, although rare, is mainly linked with tachycardia, QTc-interval prolongation, somnolence, coma, hyperglycemia, and eventually hepatotoxicity and myocarditis. Extracorporeal techniques for quetiapine removal might be helpful, but only a few cases are reported in the literature. We here describe the case of a 27-year-old healthy woman, admitted to our Intensive Care Unit after voluntary quetiapine intake and successfully treated with CytoSorb hemoperfusion in combination with continuous renal replacement therapy (CRRT), in order to accelerate quetiapine elimination. This is the first published experience about the potential application of hemoadsorption therapies, as CytoSorb sorbent, in large overdoses of quetiapine and this approach might be feasible to rapidly remove the substance from blood, stabilizing the patient condition.

Bacterial meningitis and septicemia are invasive bacterial diseases, representing a significant cause of morbidity and mortality worldwide. Both conditions are characterized by an impressive inflammatory response, resulting rapidly in cerebral edema, infarction, hydrocephalus, and septic shock with multiple organ failure. Despite advances in critical care, outcome and prognosis remain critical. Available adjunctive treatments to control the inflammatory response have shown encouraging results in the evolution of patients with sepsis and systemic inflammation, but meningococcal or pneumococcal infection has not been investigated. We herein report five patients with similar critical pathological conditions, characterized by pneumococcal or meningococcal sepsis and treated with hemoadsorption for cytokine removal. All patients showed a progressive stabilization in hemodynamics along with a rapid and marked reduction of catecholamine dosages, a stabilization in metabolic disorders, and less-than-expected loss of extremities. Therapy proved to be safe and well tolerated. From this first experience, extracorporeal cytokine removal seems to be a valid and safe therapy in the management of meningococcal and pneumococcal diseases and may contribute to the patient stabilization and prevention of severe sequelae. Further studies are required to confirm efficacy in a larger context.

BackgroundWhile chronic renal damage is a condition with low-grade inflammation, the potential role of inflammation in kidney disease as a marker of cardiovascular damage is of current interest. This study analyzed the relationship between renal dysfunction, chronic inflammation, and extension of coronary atherosclerosis in patients with non-ST-segment elevation myocardial infarction (NSTEMI).MethodsThis retrospective study was carried out on consecutive patients presenting with NSTEMI to Maggiore Hospital’s emergency department between January 1, 2010 and December 31, 2011. Patients’ electronic charts were reviewed to gather information on patients’ history, clinical and biochemical variables, with a special focus on inflammatory markers, coronary vessel damage, and drug treatments.ResultsOf the 320 individuals in the study population, 138 (43.1%) had an admission GFR <60 mL/min/1.73 m2. Kidney dysfunction was significantly associated with age (OR = 1.09, 95% CI 1.06 to 1.12), history of heart failure (OR = 2.13, 95% CI 1.08 to 4.17), and hypertension (OR = 2.31, 95% 1.12 to 4.74). C-reactive protein (CRP) and uric acid levels were significantly increased in patients with severe renal dysfunction (SRD) by bivariate and multivariate analyses, adjusted for gender, age and comorbidities at admission. The extent of coronary artery disease (CAD) was significantly higher in the SRD group (p < 0.001). Individuals with SRD were less likely to receive immediate evidence-based therapies (62.9% vs. 76.7% and 82.0% in those with intermediate and no/mild renal dysfunction, p < 0.001). Hospital stay was significantly longer in individuals with a greater extent of CAD, diabetes, and a history of heart failure, and was borderline significantly associated with renal dysfunction (p = 0.08). Older age, CAD severity, and renal function were associated with worsening GFR during hospitalization, whereas immediate evidence-based treatment was unrelated to a GFR change.ConclusionsAmong individuals hospitalized for NSTEMI, those with SRD had a more extensive CAD and a higher prevalence of pre-existing cardiovascular disease. CRP was positively correlated with renal dysfunction and the number of involved coronary vessels, confirming its potential as a biomarker. Uric acid was associated with renal dysfunction but not with the number of diseased coronary vessels.

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Introduction: We report our experience with seven cases of combined heart-kidney transplantation (HKT). Patients and methods: Between January 2003 and December 2009, seven subjects underwent combined HKT, receiving both organs from a single donor. Their age ranged from 30 years to 59 years, six were male. Five patients were dialysis dependent before transplantation and two were in chronic renal failure (serum creatinine levels > 2.6 mg/dL). The heart was transplanted first in all cases. Results: Heart function rapidly re-covered in five of the patients, while two needed temporary inotropic and mechanical support. Diuresis started immediately in four patients. At discharge, all patients had well-functioning grafts (left ventricular ejection fraction 60% ± 6%; serum creatinine 1.4 ± 0.3 mg/dL). After an average follow-up period of 45 ± 24 months no deaths have occurred. Heart allografts are functioning normally in six patients and none of the patients currently require dialysis treatment. The main adverse event noted during follow-up was hypertension in five patients. Four patients were cardiac allograft rejection free and five patients were kidney rejection free. Conclusion: Our results are in line with the data which has been previously reported in the literature and suggest that HKT is a viable therapeutic choice in the treatment of advanced cardiac and renal failure in carefully selected patients.