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We report on a 39-year-old woman suffering from deep venous thrombosis due to a heterozygous factor-V-Leiden mutation with resistance to activated protein C. Four months after beginning oral anticoagulation, generalized jaundice appeared. Subsequently, subacute liver failure developed necessitating an orthotopic liver transplantation. Histopathology showed features of extensive liver cell necrosis without evidence of a substantial inflammatory infiltrate. Based on histopathology and exclusion of other liver diseases, phenprocoumon-induced liver failure was diagnosed. Five months after transplantation the patient is well with normal liver function tests. Because of the widespread use of oral anticoagulants, not only bleeding complications but also hepatotoxicity should be considered in therapy supervision.

High clearance continuous renal replacement therapy with a SLOW CONTINUOUS DIALYSIS modified dialysis machine. Recent studies suggest that the dial-We used a modified dialysis machine, the 2008H (Freysis dose significantly affects survival in acute renal failure senius Medical Care, Lexington, MA, USA), for SCD. (ARF) patients and that bicarbonate dialysate improves acidbase balance during continuous renal replacement therapy Special software was developed to permit dialysate flow (CRRT). These data inspired us to use slow continuous dialysis rates down to 100 ml/min (range 100 to 800 ml/min) (SCD) in the treatment of ARF. SCD is defined by the followwhile maintaining temperature control. ing parameters: (a) blood flow (Q B ) ϭ 100 to 200 ml/min, (b) Patients were treated continuously with a blood flow dialysate flow (Q D ) ϭ 100 to 300 ml/min, (c) the use of a (Q B ) of 100 to 200 ml/min and a dialysate flow (Q D ) modified hemodialysis machine with controlled ultrafiltration and online production of bicarbonate-based dialysate, and (d) of 100 ml/min. F40 or AV400S polysulfone hemofilters continuous or extended daily treatment for 8 to 24 hours. SCD (Fresenius Medical Care), each with surface areas of 0.7 provides a urea clearance in the 70 to 80 ml/min range. Prelimim 2 and standard dialysis tubing, were used. The hemonary data from an ongoing clinical trial demonstrate the safety,filter and blood lines were changed every 24 to 36 hours efficiency, and simplicity of the treatment.

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