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Biomedical subjects

A Pasternack

Publications and source records attributed to A Pasternack.

At least 109 records · Page 6Linked to original sources
PubMed1996

Measurement of serum ionized versus total levels of magnesium and calcium in hemodialysis patients.

Until recently, only techniques for measuring total magnesium have been available. Now commercially available instruments using new ion-selective electrodes (ISE) for Mg+2 have made possible reliable measurement of ionized magnesium also in clinical practice. We measured changes induced by a hemodialysis session in serum ionized and total pools of magnesium and calcium using ISE methods. When compared with levels in age- and sex-matched control subjects, both serum ionized magnesium (0.68 +/- 0.11 vs. 0.56 +/- 0.06 mmol/l, p < 0.001) and total magnesium (1.00 +/- 0.19 vs. 0.82 +/- 0.08 mmol/l, p < 0.001) were higher in hemodialysis patients. The fraction of ionized Mg was 68.6 +/- 2.9% in hemodialysis patients, and did not differ significantly from that in controls (68.7 +/- 5.3%). The postdialysis value was 68.1 +/- 7.7%. The corresponding ratios of calcium (ionized/total) were 51.0 +/- 2.8% pre- and 50.9 +/- 4.6% postdialysis. Both prior to and after dialysis the correlation between ionized and total magnesium was high (r = 0.976, p < 0.001, and r = 0.925, p < 0.001, respectively). The corresponding ionized versus total calcium correlations were r = 0.724 (p < 0.001) before and 0.423 (p = 0.003) after dialysis. The changes induced by a hemodialysis session in serum concentration of ionized magnesium and calcium were dependent on the concentration of the cation in the dialysate. The change in PTH (suppression or stimulation) was very closely related to the changes in the serum concentration of ionized calcium. We concluded that measurement of ionized magnesium using ion-selective electrodes for Mg++ is an interesting new method in evaluating body magnesium status. Its definitive role in clinical practice cannot be judged on the basis of the results of the present study, but it will probably not achieve the same importance as the measurement of ionized calcium in clinical nephrology.

Calcium↗
PubMed1996

Pulmonary involvement in nephropathia epidemica: radiological findings and their clinical correlations.

Nephropathia epidemica (NE) is a hemorrhagic fever with renal syndrome (HFRS) normally taking a benign clinical course. The etiologic agent, Puumala hantavirus is genetically closely related to Sin Nombre virus, which causes a frequently lethal febrile syndrome with pulmonary involvement (hantavirus pulmonary syndrome, HPS). HPS is characterized by acute respiratory distress, non-cardiogenic pulmonary edema and severe and hypotension, but usually no significant renal involvement. Pulmonary involvement and respiratory symptoms also occur in NE. To understand the mechanisms of pulmonary involvement in NE, we studied the clinical records and chest X-rays of 125 hospital-treated acutely ill NE patients. Twenty-eight percent of the patients had disease-related changes in their chest radiographs. Pleural effusion and atelectasis were the most common X-ray findings, whereas frank pulmonary edema was rare. The patients with pathologic X-ray findings had a more marked hypoproteinemia (lowest measured serum protein concentration 54 +/- 1 g/l) than those with normal X-ray (62.1 +/- 0.9 g/l, p < 0.001) and leukocytosis (highest measured blood leukocyte count 14.1 +/- 0.9 x 10(9)/l vs. 10.6 +/- 0.6 x 10(9)/l, p < 0.001) and more severe renal insufficiency (highest measured serum creatinine 590 +/- 60 mumol/l vs. 356 +/- 29 mumol/l, p < 0.05). Hypoproteinemia best predicted the occurrence of abnormal chest X-ray findings in NE. This suggests, that capillary leakage and inflammation may play a role in the pathogenesis of NE lung involvement, similarly as in HPS. Differently from HPS, the fluid volume overload associated with renal insufficiency seemed to contribute strongly to the chest X-ray changes in NE.

Case-Control Studies↗
PubMed1995

Comparison of intraperitoneal and subcutaneous insulin administration on insulin sensitivity and serum lipids in type I diabetic patients on continuous ambulatory peritoneal dialysis treatment.

1. The metabolic effects of intraperitoneal and subcutaneous insulin delivery were compared in a cross-over manner in six C-peptide-negative diabetic patients with end-stage renal disease on continuous ambulatory peritoneal dialysis. Each treatment period lasted at least 3 months. Hyperinsulinaemic euglycaemic clamp was performed and glucose turnover assessed using [3-(3)H]glucose as a tracer. 2. During intraperitoneal delivery the daily insulin dose was 2.4 times higher than during subcutaneous administration and glycaemic control was significantly better (HbA1c 7.63% +/- 0.46% and 9.52% +/- 0.51% during intraperitoneal and subcutaneous insulin respectively, P < 0.01). The number of hypoglycaemic episodes was lower during intraperitoneal insulin than during subcutaneous therapy. 3. Intraperitoneal insulin resulted in an enhanced glucose disposal rate (P < 0.01) and reduced fasting hepatic glucose production (P < 0.01). High-density lipoprotein-cholesterol decreased and the ratio of low-density lipoprotein/high-density lipoprotein-cholesterol increased significantly (P < 0.05) during intraperitoneal insulin delivery. 4. The results suggest that intraperitoneal insulin, while resulting in better glycaemic control and improved insulin sensitivity than subcutaneous insulin, increases serum triacylglycerol and total cholesterol and reduces high-density lipoprotein-cholesterol, possibly via a direct effect on the liver.

Adult↗
PubMed1995

Albumin excretion rate and its relation to kidney disease in non-insulin-dependent diabetes mellitus.

OBJECTIVE: To estimate the occurrence of increased albumin excretion rate (AER) and its significance as a marker of diabetic kidney disease in non-insulin-dependent diabetic subjects. DESIGN: Population-based, controlled cross-sectional study. SETTING: A primary health care centre in the city of Tampere, south-west Finland. SUBJECTS: Consecutive, recently diagnosed (n = 150) and long-term (n = 146) middle-aged non-insulin-dependent diabetic subjects. Matched non-diabetic control subjects (n = 150). MAIN OUTCOME MEASURES: Albumin excretion rate, fractional AER, microalbuminuria (AER 30-300 mg 24 h-1), clinical nephropathy (AER exceeding 300 mg 24 h-1) and kidney biopsy in diabetic subjects with an AER exceeding 100 mg 24 h-1. RESULTS: Mean (+/- standard deviation [SD]) 24-h AER was increased in recently diagnosed diabetic subjects, 54 (111) mg, and long-term diabetic subjects, 134 (479) mg, compared to non-diabetic control subjects, 16 (19) mg. The fractional AER was 7.5 (18.3) x 10(-6) in recent diabetic subjects, 53.1 (306.9) x 10(-6) in long-term diabetic subjects and 2.8 (3.7) x 10(-6) in non-diabetic control subjects. Microalbuminuria was found in 8% of non-diabetic subjects, in 29% of recent and in 27% of long-term diabetic subjects. The prevalence of clinical nephropathy was 7% in long-term and 4% in recent diabetic subjects, whilst no non-diabetic subject had nephropathy. In 12 of 16 eligible kidney biopsies, diabetic glomerulosclerosis was found, in four subjects the finding was normal. CONCLUSIONS: The AER is clearly increased in recent non-insulin-dependent diabetic subjects and further increased in diabetic subjects with a mean disease duration of 10 years. An increased AER in non-insulin-dependent diabetic subjects suggests diabetic kidney disease.

Adult↗
PubMed1995

Longterm care goes on-line.

With the growing computerization of longterm care, streamlined administration and electronic bridges between healthcare providers is on the horizon. Many facilities already use computers for financial and administrative tasks, while an increasing number use them to track and document patient care. Once patient data has been input, it's an easy step to electronically outputting the MDS.

Aged↗
PubMed1995

Isolated microscopic hematuria in patients with rheumatoid arthritis compared with age and sex matched controls. A population based study.

OBJECTIVE: To evaluate the prevalence and causes of isolated microscopic hematuria in patients with rheumatoid arthritis (RA). METHODS: An unselected population of 1018 patients with RA (810 women, 208 men) were studied prospectively (n = 604) or retrospectively (n = 414), and the results were compared with an age and sex matched control population (n = 457; 352 women, 105 men). Hematuria was defined as a positive dipstick result in 2 urine samples, and was regarded as isolated when no concomitant proteinuria was found (urine protein excretion < or = 0.15 g/24 h). To investigate the urological causes of isolated hematuria, urine cytology, renal ultrasound, and urethrocystoscopy were undertaken. Renal biopsy was performed when no urological lesions were found. RESULTS: There was no difference in the prevalence of isolated hematuria between patients with RA and controls (women 10 and 9%, men 5 and 6%, respectively; total 9% for both). Mild mesangial glomerulopathy was the most common renal biopsy finding in patients with RA with isolated hematuria, found in 13 of 15 adequate renal biopsy specimens. The cause of hematuria remained uncertain or unknown in 52% of the patients with RA and in 61% of controls. CONCLUSION: The prevalence of isolated microscopic hematuria was not significantly more frequent in patients with RA than in age and sex matched controls. This result was independent of the definition or grade of hematuria. Mesangial glomerulopathy was the most common renal biopsy finding in patients with RA with isolated hematuria.

Adult↗
PubMed1994

Pharmacokinetics of clodronate in renal failure.

The pharmacokinetic parameters describing the fate of one intravenous clodronate (disodium dichloromethane diphosphonate) dose was studied in 24 normal subjects and in 24 patients with different degrees of renal insufficiency. The aim of the study was to derive data for adjustment of dosage in relation to renal function. Disodium clodronate in serum and urine samples was analyzed by capillary gas chromatography with mass-selective detection. The renal clearance (CLR) of clodronate was highly dependent on renal function and declined successively with declining glomerular filtration rate (GFR). Plasma clearance (CLP) declined, too, but to a lesser degree than CLR. The impairment of renal function resulted in decreased cumulative urinary elimination of clodronate and increased total areas under the serum concentration-time curve (AUC0-infinity). Hence, as the renal elimination of clodronate diminishes with decreasing GFR, there is a related retention of the substance. As a result of the present study, the following dosages are recommended: creatinine clearance (CLCr) from 50 to 80 ml/minute, 75-100% of normal dose; CLCr 12-50 ml/minute, 50-75% of normal dose; and ClCr < 12 ml/minute, 50% of normal dose. The results must be interpreted with caution in patients with malignancy and severe skeletal disease, in whom the nonrenal clearance may vary markedly.

Adult↗
PubMed1994

Improved outcome of renal transplantation in amyloidosis.

We report our results in 96 patients with amyloidosis who received 105 cadaveric renal allografts. The graft survival of amyloidosis patients has improved with time and with improved immunosuppression. The graft survival of amyloidosis patients is comparable to the results in another systemic disease, i. e., diabetes, and only slightly inferior to those in primary renal disease, even though amyloidosis patients tolerate complications poorly and the patients are at high risk of dying during the first 3 months.

Adolescent↗
PubMed1994

Coeliac disease--associated disorders and survival.

The associated diseases in 335 coeliac patients diagnosed 1980-90 were compared with age and sex matched control patients with various gastrointestinal symptoms. Endocrine disorders were found in 11.9% of coeliac and 4.3% of control patients (p = 0.0003). Coeliac patients had insulin dependent diabetes mellitus significantly (p = 0.0094) more often (5.4%) than control patients (1.5%). connective tissue diseases were found in 7.2% of coeliac and in 2.7% of control patients (p = 0.011). Sjögren's syndrome occurred in 3.3% of coeliac patients and in 0.3% of controls (p = 0.0059). Autoimmune thyroid diseases were found in 5.4% and asthma in 3.6% of coeliac patients, but also in 2.7% and 3.6%, respectively, among control patients. The incidences of malignant diseases and the survival rate in coeliac patients were compared with those in the Finnish population. Ten coeliac patients developed a cancer during the follow up (mean 5.3 years, range 1-12) but none had a lymphoma. The risk of malignant diseases in coeliac patients did not differ from that in the Finnish population in general. Eleven coeliac patients died during the follow up. The five year survival rates of coeliac patients did not differ from those in the general population. At least 83% of the coeliac patients adhered strictly to the gluten free diet, which may explain the favourable outcome.

Adolescent↗
PubMed1994

Autoimmune thyroid disorders and coeliac disease.

Eighty-three patients with autoimmune thyroid disorders were screened for coeliac disease. The screening was performed with IgA-class reticulin and endomysium antibody, IgA- and IgG-class gliadin antibody tests, and various biochemical tests for malabsorption. None of the tested subjects had selective IgA deficiency, which excludes the possibility of not detecting positives by an IgA-class test. Of the 83 patients, three asymptomatic coeliac patients were found, and one patient with coeliac disease previously diagnosed, an overall frequency of 4.8%. In addition, 25 patients with a solitary nodule of the thyroid gland were examined and one of them (4%) was found to have coeliac disease. By contrast, one (0.4%) out of 249 age- and sex-matched blood donors was found to have coeliac disease. All newly detected coeliac patients had IgA-class gliadin, reticulin and endomysium antibodies, but none of the patients had any gastrointestinal symptoms or abnormal biochemical findings suggesting coeliac disease. Treatment of thyroid disorders and coeliac disease was successful in these patients. The present results confirm that the frequency of subclinical coeliac disease is increased among patients with autoimmune thyroid disorders. IgA-class reticulin, endomysium or gliadin antibody tests are suitable screening methods for detecting these patients, as far as selective IgA-deficiency is excluded.

Adult↗
PubMed1994

Nephropathia epidemica in Finland: a retrospective study of 126 cases.

A total of 126 (99 males, 27 females) serologically confirmed hospital-treated adult cases of nephropathia epidemica (NE) were studied. The initial diagnosis suggested by the referring physician was correct in only 28%. Some rare clinical manifestations of NE were observed; acute myopericarditis in 3 patients and encephalitis in 1. Pulmonary involvement due to vascular congestion was observed in 16% and liver involvement in 34% of the patients. Thrombocytopenia was present in 75%, leukocytosis in 50% and anemia in 50%. Erythrocyte sedimentation rate (ESR) was 2-108 (mean 38) mm/h and C-reactive protein (CRP) 0-126 (mean 52) mg/l. Proteinuria was observed in 94%, hematuria in 58% and pyuria in 28%. Electrolyte abnormalities (hyponatremia, hypokalemia, hypocalcemia, hyperphosphatemia) were all common but rarely serious. Serum lipid changes caused by the acute infection and renal failure included very low total and HDL-cholesterol as well as high triglyceride levels. Renal function was transiently impaired in 94% of the patients and 7 needed transient dialysis therapy. All recovered.

Adolescent↗
PubMed1994

Renal biopsy findings and clinicopathologic correlations in nephropathia epidemica.

A series of 126 adult patients with a serologically confirmed diagnosis of nephropathia epidemica (NE) were studied during the acute phase of the disease. In 86 cases, renal biopsy was performed. The severity of renal failure correlated slightly with blood inflammatory parameters and the degree of hematuria but not with the amount of proteinuria. The degree of hematuria correlated inversely with the level of thrombocytopenia. The most common histopathologic lesion was acute tubulointerstitial nephritis. Interstitial edema and inflammatory cell infiltrations were most usually present, followed by tubular epithelial and luminal alterations. Slight glomerular mesangial changes were present in 25% of the biopsy specimens. Except for hemorrhage in the outer renal medulla, the histologic lesions were relatively mild and unspecific. Interstitial hemorrhage should remind a pathologist of the possibility of NE. Tubular, interstitial and glomerular histologic damage were but vascular lesions were not associated with the clinical severity of renal failure. Glomerular alterations did not relate to the amount of urine protein excretion. Correlations, however, were so weak that in clinical work renal biopsy is usually not indicated for determination of the severity of renal failure in NE. Intrinsic renal events are probably important in the development of renal failure in NE.

Acute Kidney Injury↗
PubMed1993

Cross-reactivity between antibodies to thyroid microsomal antigens and myeloperoxidase.

Antibodies against thyroid microsomal antigen (thyroid peroxidase, TMA/TPO) and myeloperoxidase (MPO) were measured from 115 patients with vasculitic disorders and 144 patients with suspected thyroid disorders. Nineteen patients, three with vasculitis and 16 with thyroid disorders, were shown to have both TPO and MPO antibodies, suggesting cross-reactivity of these antibodies. Their cross-reactivity was further strengthened by studying the capacity of antibodies to tolerate dilution in enzyme immunoassay and reactivity with synthetic TPO/MPO peptides.

Antibody Specificity↗
PubMed1993

Immunoglobulin and complement deposition in glomeruli of 756 subjects who had committed suicide or met with a violent death.

AIMS: To study immune deposits in renal glomeruli. METHODS: Tissue was obtained from 756 necropsy cases from people who had committed suicide or met with a violent death. Glomerular immune deposits were examined by immunofluorescence microscopy and a light microscopy. The clinical histories of all the decreased were studied to ascertain reasons for the deposits. RESULTS: Immune deposits were found in glomeruli in 91 (12%) cases. In 52 (6.8%) cases mesangial IgA was observed as a solitary finding in 34 (4.5%), and was accompanied by other immunoglobulins in 18 (2.4%). Mesangial IgM was present in 19 (2.5%) and IgG in 11 cases (1.5%). Two cases had capillary IgG (0.3%). Light microscopic examination showed mesangial enlargement in eight of the cases with mesangial IgA. These included one with IgA glomerulonephritis diagnosed before death. Two cases with normal glomerular morphology and mesangial IgA deposits had clinical laboratory evidence of renal disease. In two subjects with normal glomerular morphology, mesangial IgM and microscopic haematuria were present. In one case with capillary IgG membranous glomerulonephritis was detected. CONCLUSIONS: Ten cases had mesangial IgA together with morphological or clinical laboratory findings suggestive of renal disease. If all these are regarded as IgA glomerulonephritis, then its prevalence can be estimated at 1.3%. For IgM glomerulonephritis, a prevalence of 0.3% was deduced.

Adolescent↗
PubMed1993

Metabolism of calcium and vitamin D3 in patients with acute tubulointerstitial nephritis: a study of 41 patients with nephropathia epidemica.

We studied serum concentrations of calcium, phosphate, intact parathyroid hormone (PTH) and vitamin D3 metabolites in 41 patients with nephropathia epidemica. Thirty-four of the 41 patients had a mild to moderate, mostly nonoliguric acute renal failure (ARF). Hypocalcemia developed in relation to the severity of renal failure, and parathyroid gland response to hypocalcemia was normal. The serum concentration of 1,25-dihydroxyvitamin D3 was lower than normal in patients who developed ARF. Serum phosphate was the most important factor in regulating the serum 1,25(OH)2D3 level, though only mild phosphate retention was seen in the patients. We observed normal or slightly elevated serum phosphate, hypocalcemia accompanied by elevated PTH levels and a decreased serum concentration of 1,25(OH)2D3 in patients with ARF caused by nephropathia epidemica.

Acute Kidney Injury↗
PubMed1992

Selective IgA deficiency and coeliac disease.

Twenty-five children and adults with concomitant coeliac disease and selective IgA deficiency are described. IgG-class reticulin antibodies were positive in 94%. The clinical course of coeliac disease did not differ from that of patients with normal serum IgA level. Patients with IgA deficiency also had other concomitant diseases, especially autoimmune diseases. Patients with selective IgA deficiency have at least a tenfold risk of coeliac disease compared with the population in general.

Adolescent↗