Biomedical subjects
C D Brueggemeyer
Publications and source records attributed to C D Brueggemeyer.
Low-dose captopril scintigraphy in the evaluation of renovascular hypertension.
This study compared the results of renal scintigraphy with simultaneous administration of Tc-99m DTPA and I-131 Hippuran (before and after 25 mg of oral captopril) with the results of the renal arteriogram and renal vein renins (before and after the administration of 25 mg of oral captopril) to evaluate the sensitivity and specificity of renal scintigraphy in the diagnosis of renovascular hypertension. The results of 21 consecutive patients suspected of having renovascular hypertension who underwent scintigraphy and renal arteriography were analyzed. Renal scintigraphy postcaptopril detected all the cases of renovascular hypertension (eight patients) plus two additional patients who had significant renovascular stenosis but no renin overproduction. The results indicate that the renal scintigram, before and after the administration of captopril, is an accurate and sensitive test for the detection of renovascular hypertension and should be used as a screening procedure before arteriography is considered.
Acute effect of captopril on aldosterone secretory responses to endogenous or exogenous adrenocorticotropin.
The aldosterone secretory response to Captopril (12.5 mg, orally) was studied in five normal men. Endogenous ACTH and epinephrine secretion was stimulated by the induction of hypoglycemia. Normally this stimulus increases plasma cortisol, GH, aldosterone, and PRA. Administration of captopril resulted in a blunted plasma aldosterone response to hypoglycemia, but no concomitant blunting of the plasma cortisol response. The responses of other hormones, with the exception of PRA, were not affected. When exogenous ACTH was administered to the same men with and without captopril, the plasma aldosterone response was again blunted by captopril, while the plasma cortisol response was unaffected. We conclude that angiotensin II may be required for ACTH to stimulate aldosterone secretion. Alternatively, the possibility that captopril may selectively inhibit aldosterone secretion at the adrenal cellular level cannot be excluded.
Mononuclear cell phenotyping in a hemodialysis population.
A study of peripheral blood mononuclear cell phenotyping and HIV testing was performed in 39 chronic hemodialysis patients. The following abnormalities were found in comparison to a control population: 1) a lower percentage of lymphocytes in the white blood cell differential count, 2) a lower percentage of total T cells, 3) a lower percentage and absolute number of suppressor T cells and 4) a lower percentage and absolute number of B cells. Both increasing age and blood transfusions were associated with reduced helper cells.
Membranous nephropathy: a concern for malignancy.
Numerous authors have long felt that there is an association between malignancy and membranous glomerulonephritis. Most physicians have not noticed this association since the number of patients that they clinically observe is so low that such a relationship might not be obvious. The present study was undertaken to establish whether the relationship is real and to determine exactly how prevalent. Our results indicate the relationship definitely does exist, confirming studies that have shown a relationship based on positive staining for cancer antigens in kidney biopsy specimens. In addition, the study indicates that malignancy will become detectable within a relatively short period after the diagnosis of membranous glomerulonephritis, and that the malignancy rate is five times greater than the incidence in a baseline population. This risk is also highest in the elderly.
Testicular defect: the primary abnormality in gonadal dysfunction of uremia.
Gonadal dysfunction is a common problem in end-stage renal disease. We decided to test the ability of the male gonads to respond to exogenous stimuli. The patients receiving chronic hemodialysis showed abnormally low levels of total testosterone and free testosterone in the presence of normal testosterone-binding globulin. Furthermore, the exogenous administration of human chorionic gonadotropin failed to elicit a normal response from the male gonads of hemodialyzed patients. Although basal serum prolactin levels are elevated, we do not believe that elevation is of the magnitude expected to produce testicular failure. Thus we believe that the primary testicular failure is part of the uremic syndrome, and is not corrected by dialysis.
Dialysate concentrate: a potential source for lethal complications.
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Longitudinal follow-up of chronic hemodialysis patients without vitamin supplementation.
Vitamin supplementation for dialysis patients is still controversial. In our study, we followed longitudinally over a period of a year, 15 patients on chronic hemodialysis who were deprived of vitamin supplementation. Microbiological assays were used to determine the levels of five vitamins of the B group (folate, niacin, B12, B6, and thiamine). Vitamin C was measured chemically. During the observation period when vitamins were not supplemented, a marked drop of many of these vitamins in blood levels were encountered. For vitamins B12 and C, the plasma levels remained within the normal range in all the subjects studied. For the other vitamins, the blood levels were found to be low in a few patients. Our data suggest that vitamin supplementation is probably not needed in most stable hemodialysis patients as it is recommended now, and that perhaps, if supplementation is indicated, less should be given than is presently prescribed. Further research is needed in this area.
The plasma and red cell vitamin B levels of chronic hemodialysis patients: a longitudinal study.
Plasma B12, folate, B6 and thiamine, and red blood cell folate, thiamine and niacin levels were monitored for a period of 6 months in 15 clinically stable, chronic hemodialysis patients who were not supplemented with the water-soluble vitamins. Microbiological assays were used to determine the blood levels of the water-soluble vitamins. Over the period of 6 months, none of the patients had plasma or red cell vitamin levels below the normal range. No appreciable changes were observed in the plasma and red blood cell vitamin levels before and after dialysis in 5 patients. This study showed that chronic hemodialysis patients are able to maintain normal plasma and red cell levels of some water-soluble vitamins without daily supplementation.
Bromocriptine and the hypothalamic hypophyseal function in patients with chronic renal failure on chronic hemodialysis.
Ten patients with chronic renal failure on chronic hemodialysis had the following tests to evaluate the integrity of the hypothalamic hypophyseal axis: (A) glucose tolerance test, (B) thyrotropin releasing hormone stimulation test, (C) clonidine stimulation test, (D) insulin induced hypoglycemia, and (E) LH/RH stimulation test. The majority of those tests were abnormal and prolactin values were found to be moderately elevated in all the patients. Bromocriptine (1.25 mg twice a day) was given to all the patients for 1 month and then, while on bromocriptine, the tests were repeated. Although there is a decrement in the concentration of serum prolactin level, none of the hypothalamic hypophyseal abnormalities were corrected. However, five of the ten patients reported an improvement of their impotence with bromocriptine. The patients who responded had high levels of FSH and LH with levels of testosterone above 1 mg/mL. The nonresponders had low FSH and LH levels and very low testosterone levels. Therefore, bromocriptine, although possibly beneficial in some dialysis patients, is not a drug that can normalize abnormal functioning of hormones in the dialysis population.
Ankylosing spondylitis and glomerulonephritis. Study of a case.
Ankylosing spondylitis is a seronegative spondyloartropathy associated with IgA glomerulonephritis. We described a case not associated with IgA immunoglobulin deposition in the glomerulus, but with C3 complement deposition. At the same time circulating immune complexed of the IgG type were found. The possible association of glomerulonephritis and seronegative spondyloartropathies are discussed.
Onycholysis associated with captopril.
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Cardiac arrhythmias on hemodialysis in chronic renal failure patients.
A high incidence (40%) of cardiac arrhythmias was found in patients while on dialysis. This incidence was significantly higher than on nondialysis days. A comparison study of patients with significant cardiac arrhythmia and patients with cardiac arrhythmia was made. There was no difference in the echocardiogram, total body potassium, plasma renin activity, aldosterone, catecholamines, serum sodium, potassium and calcium between the two groups. Significant alkalinization occurred in all patients at the end of dialysis. Blood levels of total PTH and C peptide were higher in the arrhythmic patients versus the nonarrhythmic patients. No explanation was found as to why patients developed arrhythmias or what differentiated the two groups.