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Biomedical subjects

A Kaldany

Publications and source records attributed to A Kaldany.

41 records · Page 3Linked to original sources

Psychosocial crisis in diabetic renal failure.

Twenty-nine diabetic renal failure patients suffered a psychosocial crisis at the time when chronic dialysis or renal transplantation was required. These patients could be classified into groups as to the impact of the crisis in terms of participation in life-support therapy. Group 1 consisted of potentially lethal mechanism (9 patients): discontinued dialysis (5); refused to start dialysis (3); overt act to cause personal harm (1). Group 2 contained probably nonlethal mechanism (11 patients): threatened to discontinue dialysis or to never start dialysis if not given a chance for a transplant (5); threatened to discontinue dialysis or to never start dialysis (5); threatened to cause personal harm (1). Group 3 consisted of a combination of mechanisms (9 patients): with drug abuse (4); without drug abuse (5). Important similarities between the groups were easier to document than were subtle differences in the kinds of options in family and employment relationships; in the degree of objective and subjective handicap due to impaired vision; in the level of expectation and/or disappointment following renal transplantation; and in the capacity to cope with changing personal relationships produced by the complications of diabetes.

Adult↗

Improving survival after renal transplantation for diabetic patients with severe coronary artery disease.

After successful renal transplantation, seven diabetic renal failure patients with severe coronary artery disease returned to productive employment. Despite the requirement for additional peripheral vascular or ophthalmologic surgery in four patients, their renal function remained adequate. Following transplantation, diabetic complications included angina in three, myocardial infarction in three, and cerebrovascular accident in two patients. Two patients with adequate renal function died suddenly at 29 and 62 mo. Despite severe coronary artery disease, an increasing number of diabetic dialysis patients may be able to return to work after a successful kidney transplant.

Adult↗

Reversible acute pulmonary edema due to uncontrolled hyperglycemia in diabetic individuals with renal failure.

On eight separate occasions, four functionally anephric diabetic patients (on maintenance hemodialysis) experienced episodes of severe hyperglycemia with acute interstitial and alveolar pulmonary edema demonstrated clinically and by chest x-ray without electrocardiographic or enzymatic evidence of an acute myocardial lesion. Three patients had normal stress 201T1 scanning. The fourth patient, who experienced three such episodes, had normal coronary angiograms and only a mild elevation of the left-ventricular end-diastolic pressure. Clinical and chest x-ray improvement were immediate following insulin therapy and control of hyperglycemia, without phlebotomy or dialysis. Since these episodes were observed during a 1-yr period, this syndrome may be more common than suspected. It is concluded that in functionally anephric diabetic individuals: (1) pulmonary edema can be precipitated by uncontrolled diabetes; (2) endogenous fluid shifts may contribute to the cause of acute pulmonary edema; (3) clinical and radiologic improvement can be achieved with adequate insulin therapy; and (4) blood glucose levels should be monitored and controlled in diabetic patients with renal failure.

Acute Disease↗

Immunoradiometric assay for antibodies recognizing antigenic gangliosides.

An immunoradiometric assay for monoclonal antibodies (MoAb) recognizing gangliosides as antigens (Ag) is described and exemplified by the determination of the immunoreactive fraction of 125I-radiolabeled monoclonal A2B5 and 3G5 IgM antibodies. The assay was performed in 96-well microtiter plates equipped with cellulose filter membranes, using the antigens extracted from cloned rat insulinoma cells (RINm5F). The selectivity of the assay was demonstrated by studying the interactions of A2B5 and 3G5 with specific Ag and irrelevant gangliosides. The binding of 125I-A2B5 and 125I-3G5 to the RINm5F extract containing Ag exceeded 35% of the total applied radioactivity and depended on the degree of protein damage caused by radiolabeling, whereas irrelevant glycolipids bound 0.4% (s.d. 0.3%) of total applied 125I-3G5 and 1.2% (s.d. 0.3%) of 125I-A2B5 regardless of the initial amount of the radiolabeled MoAb used. Additional support for the specificity of this method was acquired in experiments with the A1D2 IgG antibody that interacts with a glycoprotein expressed by RINm5F cells but not with the gangliosidic antigens present in the same cell line. 125I-A1D2 bound neither Ag (0.47%; s.d. 0.12%) nor brain extracts containing irrelevant gangliosides (0.32%; s.d. 0.17%). The data for the specific MoAb-Ag systems were analyzed using a modified Lineweaver-Burk graph. By plotting the reciprocal of the fraction of specifically bound MoAb versus the reciprocal of the antigen concentration, the immunoreactive fraction was determined. The present method is rapid, convenient, and independent of variability in antigen expression on the cell surface.

Antibodies, Monoclonal↗