Biomedical subjects
Publications and source records attributed to C Rotellar.
We have described a case of pulmonary hemorrhage and idiopathic crescentic glomerulonephritis unrelated to anti-glomerular basement membrane antibodies and/or immune complexes. Although pulmonary hemorrhage was controlled dramatically with high doses of corticosteroids, renal function declined rapidly.
Six patients who underwent bilateral nephrectomy for renal carcinoma were placed on maintenance dialysis; of these, 1 patient had a renal transplant. A 5-year 44% survival of these patients was observed. We feel that radical nephrectomy followed by chronic dialysis is a reasonable alternative and offers a fair prognosis to patients with bilateral renal cancer in which partial nephrectomy is not possible.
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Continuous ambulatory peritoneal dialysis (CAPD) is an effective long-term treatment for renal failure. Sclerosing encapsulating peritonitis (SEP) is a rare but devastating complication of CAPD and may be caused by long-term peritoneal antiseptic exposure. We examined the peritoneal injury resulting from daily inoculations of moderately high concentrations of the following antiseptics: povidone-iodine, Dakin's solution, Amuchina, and Ampercide. After 4, 8, and 12 weeks of daily intraperitoneal injections in rats, a 10% solution of povidone-iodine in dialysis fluid caused a condition that mirrors human SEP. Animals had poor early weight gain, and gross necropsy examination revealed intestinal adhesions and a mesothelium that was sclerotically thickened. From 4 to 8 weeks the 10% povidone-iodine-injected animals showed progressive conditions and the prevalence of multiple encapsulating adhesions increased from 0/6 to 4/4, p = 0.005. Marked visceral mesothelial thickening in the 10% povidone-iodine-injected animals was quantitated after 4, 8, and 12 weeks at 92.0 +/- 11.6, 151.5 +/- 28.8, and 206.0 +/- 36.2 micron, respectively. Rats injected with dialysis fluid (controls) had normal-appearing mesothelial surfaces measured at 1.8 +/- 0.2, 2.4 +/- 0.2, and 2.2 +/- 0.2 micron after 4, 8, and 12 weeks, respectively. The marked thickening of the mesothelium in the 10% povidone-iodine group compared with the controls was highly significant, p less than 10(-8). We conclude that povidone-iodine, the most commonly used antiseptic in CAPD, caused severe tissue injury, whereas other antiseptic solutions, Dakin's, Amuchina, and Ampercide, at the similar dilution did not appear to cause mesothelial injury.(ABSTRACT TRUNCATED AT 250 WORDS)
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Direct immunofluorescence studies of graft biopsies from 662 renal transplant recipients demonstrated linear IgG deposition along tubular basement membranes (TBM) in 18 cases. In ten of them, circulating anti-TBM antibodies, whose detectable levels varied from 1/4 to 1/100, were demonstrated by indirect immunofluorescence on normal human kidneys. These antibodies reacted with every human kidney tested and in two cases, it could be demonstrated that they recognized the TBM of the patient's own end-stage kidney. Hence, they reacted as autoantibodies. Circulating anti-TBM antibodies were detected within the first 6 months after transplantation, remained present for an average of 3 months, and never recurred once they had disappeared. Serial biopsies demonstrated the loss of IgG linear fixation on TBM. Neither tubular nor interstitial injury was significantly associated with the presence of anti-TBM antibodies, and the transplant survival was not different in these patients who developed anti-TBM antibodies compared to our entire population of transplant biopsies.
This manuscript consists of a study of the results of 26 end stage renal failure (ESRF) patients, who commenced regular haemodialysis treatment (RHDT) from the age of 65 onwards (65-85) and who have been undergoing this treatment for periods ranging from 7 years to 3 months. These results are to be compared with those obtained from another group of 26 patients whose age ranged between 40 and 55 and who were treated with the same policy. The following parameters are compared: mortality, morbidity, life-style, cardiovascular situation, hypotension in haemodialysis, vascular access, anaemia, osteoarticular and peripheral nervous disorders, hypertension. We have not found any significant differences between both groups, besides a higher morbidity for patients over 65. Therefore, we recommend the inclusion of the older patients into RHDT programmes.
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We present here a case describing the gestation and delivery in a patient who had been on regular dialysis therapy for 3 years. She gave birth to a girl in the 28th week of pregnancy, who died 8 h later.
The acute response to nifedipine 5 mg was studied in 11 young normotensive subjects and 18 older normotensive subjects who were age matched with 33 patients with uncomplicated essential hypertension. There was an immediate fall in blood pressure which was significantly greater in the hypertensive subjects--10.4%--compared to the normotensive subjects where it was only 4.7%. The best predictor of response both in the hypertensive and normotensive subjects was the pre-treatment mean blood pressure. Multiple regression analysis showed that the addition of age and plasma renin activity made little effect. These results clearly demonstrate that, at least acutely, nifedipine becomes more effective the higher the blood pressure. They are compatible with the idea that nifedipine is partly working on a mechanism which is responsible for the high blood pressure and therefore becomes more effective the higher the blood pressure.
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Nifedipine was given to 15 patients with essential hypertension for 6 weeks and to 8 normotensive subjects for 5 days. In the hypertensives, 30 min after the first dose of nifedipine (5-mg capsule), there was a 13.9% fall in mean blood pressure (p less than 0.001), and, at the 6th week of treatment at the maximum dose of 20 mg t.d.s., a 20.6% fall in mean blood pressure (p less than 0.001). In the normotensive subjects, 30 min after the first dose of 5 mg of nifedipine, there was a 2.3% fall in mean blood pressure (NS), and on the 5th day with the maximum dose of 20 mg t.d.s., the fall was 2.2% (NS). In view of the difference in age between these normotensive and hypertensive subjects, a larger group of patients with essential hypertension and older normotensive subjects were also studied acutely after a single 5-mg capsule of nifedipine. Thirty minutes after the first dose of nifedipine in the larger group of hypertensives, there was a significant fall in mean blood pressure (10.4%; p less than 0.001, n = 33). In the normotensive subjects, there was also a significant fall in mean blood pressure (4.7%; p less than 0.01, n = 29). This was significantly less than in the hypertensives (p less than 0.001). In both the normotensive and hypertensive subjects, there was a significant correlation between pretreatment blood pressure and percentage decrease in blood pressure with nifedipine. Nifedipine, therefore, has a greater blood pressure-lowering effect the higher the initial blood pressure. This finding is compatible with the idea that nifedipine reveals a functional abnormality of vascular smooth muscle that becomes greater the higher the blood pressure.