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Biomedical subjects

B H Scribner

Publications and source records attributed to B H Scribner.

At least 55 records · Page 3Linked to original sources
PubMed1979

Effect of residual renal function on minimum dialysis requirements.

In two groups of haemodialysis patients, the effect of residual renal function (RRF) on motor nerve conduction velocity (MNCV) was prospectively studied. Patients belonging to Group I had stable GFR of greater than 1 ml/min while Group II patients had gradually declining GFR. As a result, the dialysis index for middle molecules, DI(MM), remained above 1.0 in Group I despite dialysis schedules as short as 6 hr/wk. DI(MM) in Group II fell gradually below 1.0 as renal function deteriorated on equally short dialysis schedules. None of the five patients in Group I developed neuropathy during 1.2-4.1 years of reduced dialysis. However, all four patients belonging to Group II developed significant (p less than .01) slowing of MNCV when their GFR declined below 0.5 ml/min. Neuropathy in this group was arrested or reversed by increasing DI(MM). It is, therefore, proposed that residual renal function is a major determinant of dialysis requirements.

Glomerular Filtration Rate↗
PubMed1978

Uremic neuropathy: evidence of middle molecule toxicity.

Ten dialysis patients were followed in a prospective study to determine the neurotoxicity of metabolites in the middle molecule (MM) molecular weight (mol wt) range of 500-200 daltons/molecule. In the absence of readily available direct serum measurements of MM concentrations, a theoretically calculated dialysis index, D1(MM), which included the combined effects of dialysis and residual glomerular filtration rate (GFR) on MM removal was used to estimate changes in their predialysis concentrations. The ten patients were dialyzed on protocols which yielded a D1(MM) less than 1.0. Evidence of uremic neuropathy developed in six of these ten patients, and five of these six also developed a progression in their anemia. Two additional patients with no signs of neuropathy developed a progression in their anemia. One patient developed pericarditis with tamponade. A total of eight patients developed complications. One additional patient developed increased weakness, tiredness and general malaise without change in objective findings. When the dialysis therapy to reduce MM concentrations by increasing the D1(MM) above 1.0 was instituted, the complications were reversed. Our data support the findings of others, namely, that there are toxic substances in the MM mol wt range of 500-2000 daltons/molecule. However, a synergism between elevated concentrations of small molecules and MM cannot be ruled out.

Blood Urea Nitrogen↗
PubMed1978

Less dialysis-induced morbidity and vascular instability with bicarbonate in dialysate.

We devised three protocols to test the postulate that increased morbidity during high-efficiency dialysis with large-surface-area units (LS) might be due in part to the increased flux of bicarbonate out and acetate into the patient inherent is LS dialysis. The first protocol showed that with LS-acetate dialysis there was a marked fall in plasma bicarbonate and Pco2 during the first 3 to 4 h, followed by a rapid rise in bicarbonate above normal and return to control in Pco2. With LS-bicarbonate dialysis, these oscillations were largely eliminated. A second double-blind protocol showed that central nervous system-type symptoms noted during and after LS-acetate dialysis were reduced significantly by switching to LS-bicarbonate dialysis. The third protocol showed that with LS-carbonate the tolerable rate of ultrafiltration could be increased 67% compared with LS-acetate dialysis.

Acetates↗
PubMed1977

Clinical use of a totally heparin grafted hemodialysis system in uremic patients.

1. A totally heparin grafted dialysis system shows great promise in the treatment of chronic uremia associated with bleeding risk. 2. Long-term treatment of chronic uremia with this system has to await: a) Further studies of the chronic toxicity of CPC. b) Evaluation of performance which may be achieved by using a more homogeneous heparin with higher bioactivity. 3. Detailed studies of platelet factor 4 release with subsequent heparin neutralization to determine the importance of this variable in its effect on system performance.

Blood Coagulation Disorders↗
PubMed1977

Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis.

Six patients developed spontaneous retroperitoneal bleeding while on maintenance dialysis (3% of all patients so treated). At the time of the bleeding episode, four patients were receiving Coumadin for prevention of recurrent clotting problems in external shunts. In three patients, including two who had not received Coumadin, bleeding developed while on dialysis. The presenting common symptoms and signs of retroperitoneal bleeding included sudden and progressive abdominal pain with blood pressure drop and subsequent development of an abdominal mass. These symptoms were associated with a falling hematocrit without any documented external blood loss and with suggestive X-ray changes, including absence of psoas shadow with soft tissue density. All six patients recovered. Treatment included blood transfusions, temporary regional heparinization, withdrawal of Coumadin, and bed rest. Surgical exploration was undertaken in two patients, but no obvious bleeding source was found. Anticoagulation therapy and functional platelet abnormalities may be contributory causes.

Abdomen↗
PubMed1977

Iron balance in hemodialysis patients.

Iron deficiency is a frequent complication in chronically hemodialyzed patients because of the significant blood losses associated with this technique. Quantitating iron stores (by marrow examination or serum iron and total iron-binding capacity) on a repetitive basis had been difficult or unreliable, often resulting in failure to recognize iron deficiency superimposed on the existing anemia of chronic renal failure, or overtreating, which can lead to iron excess. Use of the serum ferritin allows easier quantitation of iron stores and, when measured serially in dialysis patients, can predict the emergence of iron deficiency. There was no correlation between serum ferritin levels and serum iron, total iron-binding capacity, or percent transferrin saturation. Iron absorption studies show that food iron absorption is physiologic, increasing when the serum ferritin is below 30 ng/ml, decreasing when more than 300 ng/ml. Treatment of iron deficiency with oral iron compounds increases serum ferritin levels and usually can maintain iron balance.

Ferritins↗
PubMed1977

Treatment of Crohn's disease with home parenteral nutrition.

Home parenteral nutrition was used to treat 9 patients with severe Crohn's enterocolitis. Seven patients had a short bowel syndrome after multiple resections of bowel. In 2 patients home parenteral nutrition was used as primary therapy. The treatment was well tolerated and proved successful in 8 of 9 patients. Three patients have been able to discontinue parenteral infusions and currently are in remission. The main complications were associated with the access device which was replaced in 3 patients. Five patients currently have abnormal liver function tests without progressive liver disease. It is concluded that home parenteral nutrition is an important new therapeutic modality which can reduce or even eliminate the need for repeated or prolonged hospitalization of patients with short bowel syndrome complicating severe Crohn's disease. In addition, the technique of home parenteral nutrition, because it is relatively simple and safe, lends itself to early intervention in severe fulminant cases of Crohn's disease. This approach can result in healing of fistulae and abscesses and greatly shortening the period of hospitalization. The patient is more rapidly rehabilitated, and his fear of early relapse and recurrent malnutrition is minimized, thus facilitating a prolonged period of bowel rest which can lead to eventual remission. Home parenteral nutrition should be kept in mind as a possible alternative to early surgical intervention in selected cases of severe Crohn's disease.

Crohn Disease↗
PubMed1976

The role of Intralipid in prolonged parenteral nutrition. I. As a caloric substitute for glucose.

Three stable patients were studied in order to assess the role of intravenous fat solutions (Intralipid) in long-term home parental nutrition. The standard source of nonprotein calories (NPC) in these patients was 60% glucose. Replacing 40% of NPC by Intralipid was effective in maintaining nitrogen balance and allowed total infusion time to be reduced from 12 hr to 8 hr. The serum triglyceride level was significantly elevated when glucose was used as the sole source of NPC, whereas serum cholesterol was significantly elevated when 40% of NPC were supplied by Intralipid.

Catheterization↗
PubMed1976

Whole blood trace element concentrations during total parenteral nutrition.

Samples of whole blood in eight patients on long-term total parenteral nutrition (TPN) and in four who served as controls were analyzed for trace element concentrations of Au, Br, Cu, Mn, Cr, Sb, Fe, Zn, Co, Hg, Rb, and Se. The concentrations of essential elements in the patients deviated significantly from those in the control group. The Mn concentration in blood was consistently higher in patients, owing to the high Mn concentration in the nutrient solutions. A reciprocal relationship between Cu and Zn was demonstrated in one patient. Some trace element concentrations are correlated with the duration of malabsorption and the amount of oral intake during TPN. This study shows that patients on TPN may have abnormal trace element profiles and that TPN currently does not supply the necessary concentrations of trace elements.

Adolescent↗
PubMed1976

Five years' experience with a right atrial catheter for prolonged parenteral nutrition at home.

The results with a cuffed silicon rubber right atrial catheter for prolonged parenteral nutrition are reported. In 43 patients, 78 catheters were inserted; of these, 52 were removed for various reasons. The mean duration of catheter patency in 26 patients currently infusing at home is 9.4 months. The high incidence of catheter-related septicemia previously reported by others has been reduced to one for every 5.5 patient years. The combination of soft Silastic material, catheter design, localization and easy handling by the patient have all contributed to its longer life span. It can be used with impunity whenever long term access to the circulation is needed.

Adolescent↗
PubMed1976

Successful use of a totally heparin grafted hemodialysis system in sheep.

A total of 33 totally heparin-grafted dialysis systems using HFAK Cordis Dow Models 3 and 4 have been compared to a total of 23 nongrafted systems. The comparison of deltap, flow rate, FBVL and macroscopic inspection showed highly significant differences in favor of the heparin-grafted systems. The antithrombogenic performance of the totally heparin-grafted systems is mainly due to a small leakage of heparin during the experiments. A minimum of 1.35 X 10(-8) Gm/cm2/min of heparin is sufficient to prevent clotting at the blood-polymer interface.

Animals↗