Biomedical subjects
Publications and source records attributed to B Branger.
Two cases of Mycobacterium haemophilum infection in renal-transplant patients occurred in the same hospital department. This raised the possibility that infection may have been acquired in hospital.
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Since the identification of beta 2-microglobulin as a major component of 'dialysis amyloid', concern about its removal by different dialysis methods has been raised. Haemodialysis with regenerated cellulose membranes increases serum beta 2-microglobulin by 10-15%. Serial measurements show a very early increase during cuprophan haemodialysis, the mechanism of which is as yet unknown. After cuprophan haemodialysis, serum values return to the initial pretreatment concentrations by the time of the next haemodialysis. In contrast to regenerated cellulose, dialysis with polycarbonate lowers serum beta 2-microglobulin by 8%, and dialysis with polysulphone by 53%. As opposed to cuprophan, after polysulphone haemodialysis the serum concentrations have not returned to the initial pretreatment levels within 48 h. Comparison of beta 2-microglobulin removal using the same polysulphone membrane for haemodialysis and haemofiltration shows that beta 2-microglobulin is more effectively removed by convection than by diffusion when both treatment modes are matched for blood flow and urea clearance. Therefore, in contrast to haemodialysis with regenerated cellulose membranes, where a transient, intradialytic release of beta 2-microglobulin is induced, significant removal is observed using higher permeable membranes. These findings may have implications for the generation of 'dialysis amyloid'.
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The case is presented of a renal-transplant patient in Europe with a Mycobacterium haemophilum infection in association with M. xenopi infection. Clinical signs suggested the diagnosis of mycobacteriosis, which was confirmed by a skin biopsy. Despite antitubercular treatment which rapidly eliminated M. xenopi, the patient's condition did not improve until M. haemophilum was identified. Minimal inhibitory concentrations of various antimicrobial compounds showed a lack of efficacy of isoniazid, and rifampin had no clinical effect. The patient recovered only after careful surgical drainage of the lesions and the administration of minocycline. The pathogenesis of such mycobacterioses is discussed, with focus on the immunodepressive status which in our patient may have been partially induced by a cytomegalovirus reinfection.
In this one-year prospective study, the biocompatibility of blood lines used for acetate haemodialysis treatment was evaluated in 12 patients. These blood lines, polyvinyl chloride (PVC) and polyurethane extruded PVC (PE) respectively were compared in a schedule of four alternating three-month periods of treatment: PVC/PE/PVC/PE. White blood cell count, complement, IgE and thromboxane values were recorded monthly. A reduction in white blood cell and polymorphonuclear counts after 30 minutes of dialysis was significantly less during period 2 than period 1. Pre-dialysis eosinophil counts varied in a seasonally dependent pattern. We conclude that in spite of their small area, blood lines have some effect on biocompatibility and that the season of the year has to be considered in biocompatibility studies involving eosinophils.
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99mTechnetium-201Thallium subtraction scanning was performed in 24 patients with primary (N = 5) and secondary (N = 19) hyperparathyroidism. The preoperative scintigraphy (N = 12) detected 21 of 23 enlarged glands surgically removed and was helpful for detecting abnormal location especially in the mediastinum. Postoperative scanning in patients with recurrent hyperparathyroidism confirmed the excessive growth of the remaining half parathyroid after subtotal parathyroidectomy or a missing fifth parathyroid after total parathyroidectomy and autotransplantation. False negative results were due to tumor hyperplasia. The technique is recommended prior to repeated exploration in patients presenting persistent disease to predict the location of adenomas generally unsuccessfully detected by ultrasonography and computed tomography.
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The background of this study is the occurrence during acetate hemodialysis (HDA) of arterial hypoxemia associated with well described vasodilatator hemodynamic changes. Our aim was to evaluate the relationship between these 2 phenomena. Eleven patients (7 males, 4 females, mean age 54 years) were compared in a protocol of HDA and bicarbonate hemodialysis (HDB) as regards their cardiac output measured by the dye dilution method, blood gases and respiratory gas measurements made at the bedside. The results show significant hypoxemia with hypocapnia as soon as the 30th minute of HDA and no significant variation of cardiac index. No significant variation of respiratory response was noted. Arterial prostaglandin levels rose significantly higher during HDA (+ 302%) than HDB (+ 163%; 2 alpha less than 0,05). The absence of a correlation between arterial hypoxemia and hemodynamic changes in HDA compared to HDB suggests that the phenomena are not interdependent. The importance of increased thromboxane activation in HDA will require further investigation.
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To evaluate middle molecule (MM) accumulation in relation with patients' well-being, plasma MM were analyzed in 115 uremic patients by using the two-step chromatographic technique described by Fürst et al. Unexpectedly, most of the patients exhibited small or undetectable subpeaks 7a, 7b, 7c, 7d. However, patients on regular dialysis treatment tend to present higher MM concentrations when a complication, such as infection, hyperparathyroidism, symptomatic neuropathy, or intercurrent disease occurs and peak 7d was very prominent after radio-contrast media administration. No correlation was found between plasma MM and small molecule accumulation (urea, creatinine, and uric acid) or residual renal function or hematocrit. An unexpected correlation was found between some MM fractions and serum PTH. These results indicate that MM do not accumulate in plasma only as a result of impaired renal function. This suggests considerable variations in their generation rates may be due to unknown misleading artifacts, PTH breakdown products, or other factors.