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Biomedical subjects

C G Winearls

Publications and source records attributed to C G Winearls.

At least 73 records · Page 4Linked to original sources
PubMed1986

Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis.

Ten patients with end-stage renal failure and anaemia (mean haemoglobin 6.1 g/dl, range 4.6-8.8 g/dl) on thrice-weekly haemodialysis were treated with human erythropoietin derived from recombinant DNA (rHuEPO). This was given as an intravenous bolus after each dialysis in rising doses within the range 3-192 IU/kg. All patients showed increases in reticulocyte numbers and haemoglobin concentration and after the first week of treatment none of the four previously transfusion-dependent patients needed further transfusions. In nine patients treated for 12 weeks haemoglobin rose to a mean of 10.3 g/dl, range 9.5 to 12.8 g/dl. Thereafter the dose of erythropoietin was adjusted to avoid a further rise in haemoglobin. During treatment one patient had an episode of hypertensive encephalopathy and two had clotting in their arteriovenous fistulas (complete in one). rHuEPO is an effective treatment for the anaemia of end-stage renal failure but longer-term observations are needed on the consequences of increasing the haematocrit.

Adult↗
PubMed1986

Malignant hypertension due to a renin-secreting renal cell carcinoma--an ultrastructural and immunocytochemical study.

This is a case report of a 14-year-old girl who presented with malignant hypertension. She had high plasma levels of both active and inactive renin and investigation revealed a renal tumour. The tumour, a renal cell carcinoma, was removed by nephrectomy following which the blood pressure and the plasma renin levels fell to normal. An immunocytochemical study using an antibody to pure human renin showed no detectable renin in the kidney but the tumour contained a population of granular cells which showed strong positive staining for immunoreactive renin. We present the clinical, biochemical, histological, immunocytochemical and ultrastructural features of this case as evidence that this was a renin-secreting renal cell carcinoma.

Adolescent↗
PubMed1985

Osteoporosis of pregnancy.

Eight women with pregnancy-associated osteoporosis were studied for up to ten years. Back pain and vertebral collapse usually occurred in the first pregnancy and did not recur in two subsequent pregnancies. Except in one patient, bone histology showed no increase in resorption. Plasma concentrations of 1,25-dihydroxyvitamin D tended to be low whereas those of calcitonin were, with one exception, normal. It is suggested that in these patients there may have been a transient failure of the usual changes in calciotropic hormones to prepare the maternal skeleton for the stress of childbirth. However, subsequent pregnancies in such patients are not necessarily contraindicated.

Adult↗
PubMed1985

Correlation of disease activity in systemic vasculitis with serum C-reactive protein measurement. A prospective study of thirty-eight patients.

In a prospective study over 2 years, serum C-reactive protein (CRP) concentration and erythrocyte sedimentation rate were measured serially in thirty-eight patients with various types of necrotizing systemic vasculitis. The CRP concentration was always elevated in patients with active vasculitis and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. In contrast the sedimentation rate responded more slowly to changes in disease activity and did not necessarily reflect the level of inflammation at a particular time. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial measurement of the serum CRP fills the urgent need for an objective index of the activity of the systemic vasculitides and their response to therapy.

Blood Sedimentation↗
PubMed1985

Serum C-reactive protein concentration in the management of infection in patients treated by continuous ambulatory peritoneal dialysis.

In a prospective study over 21 months, serum C-reactive protein (CRP) concentration was measured serially in 39 consecutive patients undergoing continuous ambulatory peritoneal dialysis. All patients with peritonitis mounted a CRP response, and the height of the response correlated well with the severity and extent of the peritoneal damage. Patients who recovered uneventfully after antimicrobial treatment showed a prompt fall in CRP from its peak value towards normal. In contrast, each patient in whom the serum CRP value remained raised after antimicrobial treatment had a complicated course. During routine outpatient follow up the serum CRP value remained within the normal range in the absence of intercurrent complications. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial CRP measurements may be useful in monitoring the efficacy of antimicrobial treatment during episodes of peritonitis and in the recognition of intercurrent complications in patients undergoing continuous ambulatory peritoneal dialysis.

Adult↗
PubMed1985

Pneumocystis carinii pneumonia in renal transplant recipients--clinical and radiographic features, diagnosis and complications of treatment.

Six episodes of Pneumocystis carinii pneumonia in five renal transplant patients on low dose maintenance prednisolone are described. The infection was rare, occurring in 3 per cent of the recipients transplanted between 1978 and 1984. Diagnosis and treatment were not straightforward. Fever was the earliest evidence of illness, and in three episodes the chest radiograph was normal at presentation. At diagnosis, two to 16 days later, all had pulmonary infiltrates and severe hypoxia. Diagnosis was confirmed by cytological examination of bronchial lavage (two), transbronchial biopsy (one), open lung biopsy (one), and for two episodes clinically, from the rapid and complete resolution of fever, pulmonary infiltrates and hypoxia following a therapeutic trial of high dose cotrimoxazole. Pneumocystis antibody titres were low during the illness and in convalescence and did not contribute to diagnosis. Three patients had serological evidence of recent cytomegalovirus infection. All episodes responded to treatment with high dose cotrimoxazole. All the patients survived the illness but one died a year after recovery. The major complications of treatment were thrombocytopenia (three cases) and neutropenia (two cases) which did not respond to folinic acid.

Drug Combinations↗
PubMed1985

Microscopic polyarteritis: presentation, pathology and prognosis.

We have described 34 patients with microscopic polyarteritis, all of whom had clinical evidence of a systemic small vessel vasculitis predominantly affecting the skin and musculoskeletal systems accompanied by a focal necrotising glomerulonephritis with renal impairment. Thirty three patients received immunosuppressive treatment, comprising prednisolone, azathioprine, cyclophosphamide and plasma exchange in various combinations. The five-year actuarial patient and kidney survival rates were 65 and 55 per cent respectively, suggesting that aggressive immunosuppressive therapy in these patients is beneficial.

Adolescent↗
PubMed1984

Objective monitoring of disease activity in polyarteritis by measurement of serum C reactive protein concentration.

Serial measurements of the serum concentration of C reactive protein were made in 27 patients with polyarteritis over six years. The concentration was invariably raised when the disease was active, even in patients receiving immunosuppressive treatment, and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. The correlation between C reactive protein concentration and disease activity was much closer than that between erythrocyte sedimentation rate and disease activity. These results indicate that serial measurement of the serum C reactive protein concentration fills the urgent need for an objective index of the activity of polyarteritis and its response to treatment.

Adolescent↗
PubMed1984

Acute renal failure in the elderly can have a good prognosis.

Acute renal failure in the elderly is generally held to have a poor prognosis. Since January 1982, 22 patients aged 65 or over have presented acutely in renal failure requiring dialysis. Although nine of these patients had an underlying malignancy, the outcome was favourable, with survival in 14 (64%) patients, 12 of whom achieved an independent existence. As a significant number of these patients can survive with a good quality of life, and there are particular problems with their assessment and management, early referral to a renal unit is warranted.

Acute Kidney Injury↗
PubMed1984

Studies of the hypercalcaemia of sarcoidosis: effect of steroids and exogenous vitamin D3 on the circulating concentrations of 1,25-dihydroxy vitamin D3.

Hypercalcaemia in six patients with sarcoidosis was associated with elevated circulating 1,25-dihydroxy vitamin D3 (187-475 pmol/l): the concentration of this metabolite of vitamin D was a function of the concentration of its precursor, 25-hydroxy vitamin D which remained within the normal range. Corticosteroids, in reducing serum calcium, eliminated this abnormal substrate--product relationship by rapidly reducing circulating 1,25-dihydroxy vitamin D3 while having no effect on 25-hydroxy vitamin D. The fall in circulating 1,25-dihydroxy vitamin D3 preceded the fall of calcium. Studies on the clearance of exogenous 1,25-dihydroxy vitamin D3 indicated that during hypercalcaemic episodes, the plasma disappearance time of the sterol was delayed and that this reverted to normal with steroid therapy. Administration of vitamin D3 to these patients with sarcoidosis increased the circulating concentration of 1,25-dihydroxy vitamin D3 and this resulted in hypercalcaemia, thus accounting for their hypersensitivity to vitamin D and sunlight.

Adult↗
PubMed1984

Acute renal failure due to leptospirosis: clinical features and outcome in six cases.

Six cases of severe leptospiral infection with renal failure are described. Five of the six patients had acute oliguric renal failure requiring dialysis. Renal function recovered over three weeks and by two months all patients had plasma creatinine levels less than 200 mumol/litre. The initial diagnosis of leptospirosis depended on clinical and epidemiological features because serological confirmation was not possible during the first week of the illness. All the patients had either high risk occupations or a history of exposure to external sources of infection. All had fever, myalgia, jaundice and muscle tenderness. Although bilirubin levels were high (greater than 350 mumol/litre in five) the elevations of aspartate transaminase and alkaline phosphatase levels, and prolongations of prothrombin times were relatively slight. Thrombocytopenia occurred in five of the six cases. Leptospira complement fixation tests were weakly positive or negative on admission in five cases but rose to significant levels subsequently. Penicillin treatment resulted in Jarisch-Herxheimer reactions in three cases. The important complications were: upper gastro-intestinal haemorrhage (five cases), thrombocytopenia less than 30 000 platelets/mm3 (four cases), atrial fibrillation (three cases), drowsiness with asterixis (four cases). All six patients were seriously ill and required intensive supportive therapy. All survived.

Acute Kidney Injury↗
PubMed1984

Objective monitoring of activity in Wegener's granulomatosis by measurement of serum C-reactive protein concentration.

Serial measurements of the serum concentration of C-reactive protein were made in 38 patients with Wegener's granulomatosis during a period of 6 years. The concentration was always elevated when the disease was active, even in patients receiving immunosuppressive treatment, and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. The correlation between C-reactive protein level and disease activity was much closer than that between erythrocyte sedimentation rate and disease activity. These results indicate that serial measurement of the serum C-reactive protein fills the urgent need for an objective index of the activity of Wegener's granulomatosis and its response to therapy.

Adolescent↗