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Biomedical subjects

B Wikström

Publications and source records attributed to B Wikström.

At least 91 records · Page 5Linked to original sources
PubMed1989

Four years' experience of long-term hemofiltration in a Swedish center.

Thirty patients with end-stage renal disease were switched from maintenance hemodialysis to postdilution hemofiltration and observed for long-term effects. The study comprised totally 496 months of hemofiltration. Uremic and biochemical control was similar in the hemofiltration and in the hemodialysis period. Of the small molecules, only serum creatinine showed slight increase after 3 months. No other significant changes in creatinine, serum urea or potassium levels were associated with long-term hemofiltration. During each hemofiltration session there was significant decrease of serum parathyroid hormone (PTH) and serum beta 2-microglobulin, but over the first 8 months of hemofiltration the beta 2-microglobulin values did not fall, and significant PTH reduction was found only after 12 months. Although uremic control was similar with both methods, there were fewer complications of hemofiltration, which was preferred by the patients. Because it is currently more expensive, however, hemofiltration should be reserved for patients with dialysis related problems, that are not helped by other changes in the dialysis technique, such as sequential ultrafiltration changes in the dialysis membranes and in the dialysis buffer from acetate to bicarbonate.

Female↗
PubMed1989

Outcome of continuous arteriovenous haemofiltration (CAVH) in one centre.

Continuous arteriovenous haemofiltration (CAVH) has been adopted as the treatment of choice for acute renal failure (ARF) in critically ill patients in the intensive care units of Uppsala University Hospital since 1982. To know the outcome of CAVH during the last one and a half year this retrospective study was done on those patients seen in July 1987-December 1988. Forty patients aged 2 months-84 years (mean 57 years) were included. Treatment duration was 1-31 days (mean 10 days, patients with treatment duration less than 24 h were excluded). The majority of ARF causes were due to major surgery because there are two big cardiothoracic and vascular surgical centres with a high turnover in this hospital. In this study CAVH was found useful in the management of ARF in critically ill patients within the limits of its capacity of urea clearance. There is a notable improvement in the number of survivors in this study (55%) when this is compared to a previous study (45%) in a similar group of patients and in the same centre.

Acute Kidney Injury↗
PubMed1989

Continuous arteriovenous hemofiltration in the treatment of 100 critically ill patients with acute renal failure: report on clinical outcome and nutritional aspects.

The clinical outcome for 100 consecutive patients with multiorgan failure including acute renal failure (ARF) was studied. Fifty-eight of the patients had acute renal failure due to complications during and after major surgery. Seventy-three of the patients had a urine output of less than 400 ml/24 hours. The majority of the patients also had complications such as septicemia or respiratory insufficiency and required vasopressor infusions. All patients were treated with continuous arteriovenous hemofiltration (CAVH). The duration of the CAVH treatment varied between a few hours and 90 days, with a mean of 8 days. The mean ultrafiltration volume per 24 hours was, on the average, 12 liters. CAVH resulted in adequate uremic control in 89 cases, but additional treatment with intermittent hemofiltration was necessary in 11 patients. The total survival rate was 45% including survival rates as high as 54% in patients with ARF complicating abdominal aortic surgery. Only three patients were referred for chronic dialysis therapy. In a subgroup of 17 patients with ARF complicating abdominal aortic surgery the nutritional aspects during CAVH were studied. It is concluded that during CAVH therapy it is possible to give adequate nutritional support even to hypercatabolic and anuric patients.

Acute Kidney Injury↗
PubMed1988

Early relapse of acute inflammatory polyradiculoneuropathy after successful treatment with plasma exchange.

Symptoms reappeared within 2-4 weeks in 6 of 23 patients with acute Guillain-Barré syndrome who had demonstrated significant clinical improvement following plasma exchange therapy; all however improved to full recovery after a second series of plasma exchanges. The procedure appears to be associated with increased risk of early relapse. Our observations suggest that a relationship may exist between rapid removal of large amounts of plasma and the possibility of relapse.

Acute Disease↗
PubMed1988

Pharmacokinetics of intravenous cefuroxime during intermittent and continuous arteriovenous hemofiltration.

The pharmacokinetics of cefuroxime were determined in ten patients during intermittent hemofiltration (IHF) and in three patients during continuous arteriovenous hemofiltration (CAVH). All patients received a bolus dose of 1.5 g of cefuroxime intravenously and the concentrations of cefuroxime in serum and ultrafiltrate were followed during the hemofiltration period and up to 16 hours after injection of cefuroxime. During IHF the mean terminal half-life of cefuroxime was 1.6 +/- 0.3 hours compared with a terminal half-life of 21.7 +/- 5 hours after treatment. The total cefuroxime clearance was 120 +/- 22 ml/min. The hemofiltration clearance represented 86% of the total clearance and the hemofiltration process removed in average 63% of the dose. During CAVH the terminal half-life of cefuroxime was 7.9 +/- 2.2 hours. The total plasma clearance for cefuroxime was 32 +/- 7.5 ml/min where the CAVH-treatment represented only 34% of the total clearance. From these data we suggest that a full loading dose (1.5 g of cefuroxime) should be given after each intermittent hemofiltration treatment when performed every second day. In CAVH, where nonrenal clearance will influence the dosage scheme significantly, we suggest an initial dose of 1.5 g of cefuroxime to be followed by a supplementary dose of 750 mg every 20-24 h.

Aged↗
PubMed1987

Ceftazidime as prophylactic treatment in renal stone surgery. Clinical evaluation and pharmacokinetics in renal tissue.

The effect of ceftazidime in surgery of renal stones associated with urinary tract infection was investigated and its pharmacokinetics in serum and renal tissue was compared in 14 patients (15 kidneys) operated on for renal calculi associated with multiple urinary tract infection. Two to four days preoperatively ureteric catheterization was performed to localize the level of the infection and 2 g of ceftazidime was given intravenously twice daily for 10 days. Renal biopsy, serum samples and in one patient renal lymphatic fluid were taken simultaneously for antibiotic assay. Urine cultures were performed at regular intervals pre- and postoperatively. Ten patients had bacterial growth in the stone-carrying renal pelvis. The same strain was found in the bladder as in the pelvis. Nine patients had sterile urine after 3-5 days of treatment. One patient with bilateral stones did not get sterile urine until after seven days of treatment. Bacterial growth was found in two out of six cultured stones obtained from patients with bacterial growth in the pelvis. The decreases in concentration of ceftazidime in serum and renal tissue seemed to be parallel. Slight reversible elevation of liver transaminases was noted in 5/14 patients. It is concluded that the concentration of ceftazidime in serum parallels that in renal tissue. Ceftazidime seems to be an effective prophylactic in renal stone surgery and the preoperative dose should be given close to the operation.

Adult↗
PubMed1986

Crystal inhibition: the effects of polyanions on calcium oxalate crystal growth.

The inhibition of calcium oxalate crystal growth by the glycosaminoglycans, chondroitin sulphates and heparin, by the low-molecular-weight heparin analogue pentosan polysulphate and by Tamm-Horsfall glycoprotein extracted from human urine, was measured by using a seeded crystal procedure and compared with the inhibition by pyrophosphate. It was found that the most pronounced inhibition was obtained with the polyanions with the highest charge density, i.e., heparin and pentosan polysulphate. Tamm-Horsfall glycoprotein caused an inhibition of a similar magnitude as urinary chondroitin sulphates. Urinary polyanions with a high affinity to Sepharose 4B were more efficient inhibitors than those with a low or no affinity to the gel. It is concluded that urinary polyanions are important inhibitors of calcium oxalate crystal growth and that the potency of inhibition increases with the charge density.

Anions↗
PubMed1986

Stereological studies on the epiphyseal growth cartilage and characterization of costal cartilage proteoglycans in the achondroplastic (cn/cn) mouse.

The achondroplastic mouse is a dwarf mouse in which the endochondral growth of the skeleton is disturbed. The main morphological characteristic of the affected growth cartilage is an underdeveloped hypertrophic zone. The pattern of matrix mineralization seems to be unaffected, even in areas where hypertrophic chondrocytes are completely absent. The present stereological results indicate a disturbance of the cn/cn cartilage already in the proliferative zone. At the electron microscopical level a clearly abnormal spatial distribution of matrix vesicles was observed in the affected growth cartilage. The vesicle concentration of the cn/cn cartilage was increased, but the mineralizing cartilage showed a decrease of vesicles similar to that in the normal tissue. Parallel biochemical characterization of the proteoglycans and glycosaminoglycans of the cn/cn costal cartilage revealed normal conditions, also in the growth region, which was sampled as a separate tissue fraction. Thus the biochemical results provide no evidence of disturbed glycosaminoglycan metabolism.

Achondroplasia↗
PubMed1986

Binding of glycosaminoglycans to sodium urate and uric acid crystals.

The binding of heparin, chondroitin sulphate and the low molecular weight heparin analogue pentosan polysulphate to sodium urate and uric acid crystals was studied by the use of radioactively labelled glycosaminoglycans were used in the binding step, and varying amounts of unlabelled glycosaminoglycans for the competition experiments. The experiments were carried out in 140 mmol/l NaCl at pH 6, with or without 5 mmol/l CaCl2 in the solution. A reversible and almost complete binding of heparin and chondroitin sulphate to sodium urate crystals did occur in the presence of calcium, whereas pentosan polysulphate bound incompletely. The binding was much less pronounced in the calcium-free conditions. Uric acid crystals did not bind any of the three inhibitors, not even with calcium present. The clinical relevance depends on whether sodium urate microcrystals are present in the urine of calcium stone patients, to cause a binding and thereby a masking or inactivation of these inhibitors in the urine, which seems to be possible in the presence of calcium. However, the potential of pentosan polysulphate for the treatment of calcium stone patients does not seem to be at risk from this effect.

Binding, Competitive↗
PubMed1986

Enzymatic determination of urinary chondroitin sulphate: applications in renal stone disease and acromegaly.

A method was developed for the determination of urinary chondroitin sulphate (CS), including dermatan sulphate and chondroitin 4 and 6-sulphates, using an enzymatic degradation with chondroitinase-ABC followed by precipitation with Alcian blue, whereby CS was determined as the difference between undigested and chondroitinase digested material. The method was linear in the range 0-100 mg l-1 with a detection limit of 1 mg l-1 and allowed determinations on small urine volumes without pretreatment of the urine. It could be demonstrated that males excreted more CS than females, and growing children had the highest urinary content of CS. Renal calcium stone formers did not differ from healthy controls in urinary CS. Patients with acromegaly had a higher excretion of CS compared with controls. There was also, in these patients, a positive correlation between the serum growth hormone levels and the urinary CS, indicating that CS-excretion may be an estimate of the activity of the pituitary disorder.

Acromegaly↗