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Biomedical subjects

D S Silverberg

Publications and source records attributed to D S Silverberg.

At least 91 records · Page 5Linked to original sources
PubMed1976

Clinical evaluation of an automated cleaning device for dialyzers.

This paper describes the clinical evaluation of dialyzer efficiency after cleaning and sterilization using an automated dialyzer cleaner. In vivo clearance measurements of small molecules and an in vitro measurement of BSP showed no diminution after 5 uses, and ultrafiltration rate did not decrease with an increase in dialyzer use. Scanning and transmission electron microscopy of the membrane showed an increase in accumulation of cellular debris and fibrin with increasing use. Our experience using the automated dialyzer clearner for more than one year leads us to conclude that it is an effective way to clean dialyzers and that no patient ill-health occurs as a result of re-using dialyzers cleaned by this technique.

Automation↗
PubMed1976

Blood access in hemodialysis.

Four hundred seventy blood access procedures performed on 170 dialysis patients during the period 1962-1975 have been analyzed according to survival of access with respect to age, sex and cause of failure. Subcutaneous forms of blood access have a significantly longer life and are more free of complications than external shunts. Although the mode of access can now be tailored to the individual patient, the arterio-venous fistula remains the least expensive and simplest surgical procedure. It should therefore remain as the first choice of access for most patients.

Adolescent↗
PubMed1975

Screening for hypertension in a high school population.

Of 15 594 high school students (ages, 15 to 20) whose blood pressure was measured in a screening program, 350 (2.2%) has hypertensive readings (150 mm Hg or more systolic, or 95 mm Hg or more diastolic, or both). The mean blood pressure for the boys was 125.0 plus or minus 12.1/71.8 plus or minus 10.9 mm Hg, and for the girls, 119.8 plus or minus 10.2/72.3 plus or minus 9.2 mm Hg. The parents of the students with hypertensive readings were advised to send their children to a physician. By 6 months, of the 232 who were followed up, 156 (67.2%) has visited a physician and in 19 cases (12.2%) the physician had confirmed the hypertensive readings. Only one student, an asymptomatic 17-year-old boy whose hypertension had not previously been detected, was found to have secondary hypertension, which was relieved surgically. Of the 18 hypertensive students 4 are currently receiving antihypertensive medication and 8 continue to have their blood pressure monitored. The mean blood pressures recorded in the physicians' offices averaged 23.7/11.1 mm Hg less than those recorded in the schools. One reason for this was that none of the physicians used pediatric cuffs, but these were required by 62.4% of the students at the screening. Hence, the intravascular blood pressure was probably underestimated in a number of cases in the physicians' offices.

Adolescent↗
PubMed1975

Effect of I,25-dihydroxycholecalciferol in renal osteodystrophy.

A 23-year-old man with medullary cystic disease had been undergoing hemodialysis for 5 years and had become confined to a wheelchair because of renal osteodystrophy. He was treated with 125-dihydroxycholecalciferol, 2.0 mug (later 1.0 mug) three times a week, administered by way of the venous end of the dialysis machine. Within 1 month bone pain lessened and his ability to stand and walk improved. By 3 months he was walking short distances and by 5 months, long distances. Calcium balance was near zero before treatment and was strongly positive during treatment. Bone mineral content in the lower femur, measured by photon absorptiometry, increased at a rate of 32.2% per year. In contrast, 26 other patients on long-term hemodialysis had a mean loss of bone mineral content of 14.0% per year. Radiographs taken during treatment showed a decrease in subperiosteal bone resorption and healing of a pseudofracture. A significant decrease in the mean serum alkaline phosphatase value was noted during treatment, but no significant changes in mean serum calcium or phosphorus values were seen.

Adult↗
PubMed1975

The influence of chronic uremia on hepatic glycogen in the rat.

Long term maintenance of male Wistar rats following sub-total nephrectomy has been shown to alter carbohydrate metabolism. These rats frequently became hypoglycemic and concurrently demonstrated increased hepatic glycogen stores. Chemical analysis of glycogen revealed a significant increase in branching, with a concomitant decrease in glucose residues per segment. The influence of food intake and glycosuria are discussed. Decreased glycogen autolysis is attributed to increased glycogen branching in the uremic liver.

Animals↗
PubMed1975

Carbohydrate metabolism in the chronically uremic rat.

The glycogen cycle enzymes amylo1,6-glucosidase, glycogen synthetase (I and D forms) and alpha-glucan phosphorylase (a and b forms) have been assayed for activity in skeletal muscle and hepatic tissues of chronically uremic rats. Significant decreases in muscle amylo-1,6-glucosidase (41%), hepatic phosphorylase (30%) and hepatic synthetase D (30%) activities were observed in uremics, as compared to both sham operted and destricted diet intake controls. Changes in phosphorylase "a" to "b" activity ratios and synthetase I to D activity ratios were found in the uremics. The biochemical significance of these alterations are discussed.

Animals↗
PubMed1974

Use of shopping centres in screening for hypertension.

In two Edmonton shopping centres 9591 people were screened for hypertension: 3.3% were found to be normotensive but taking antihypertensive medication and another 8.8% were found to have elevated blood pressure. Systolic hypertension alone accounted for 45.3% of the hypertensive cases and diastolic hypertension, with or without systolic, for 54%. Of the group with elevated blood pressure 34.5% had been previously unaware of their condition, 18.7% had never received medication for it, 18.2% had received medication in the past but had discontinued it, 26.1% were still on medication and 2.5% were not taking antihypertensive medication and were uncertain if they had ever done so in the past. Eighty-eight percent of the hypertensives who were receiving no medication went to their physician; 41% were prescribed antihypertensive medication, and 87% were still on treatment three months later and 74% one year after detection. Eighteen percent of those started on treatment had their medication discontinued by their doctor over the next year and 8% stopped treatment on their own. Of those hypertensives already receiving medication 88% went to their doctor and 33% had their medication altered.Physician measurements of blood pressure tended to be lower than those recorded at the screening. At least part of the explanation for this discrepancy is that physicians often used blood pressure cuffs that were too wide for the patient's arm; 25% of the people screened required cuffs narrower than the standard cuff used by most physicians.The prevalence of hypertension was similar among women taking oral contraceptives and women not taking these agents.

Adolescent↗
PubMed1974

City-wide screening for urinary abnormalities in schoolboys.

Screening for urinary tract infection was carried out in 27,722 schoolboys aged 5 to 14 using Uricult to perform urine cultures and Hema-combistix to detect hematuria, proteinuria and glycosuria. Cultures of 10(5) colonies per ml or more on two occasions were found in 40 cases (0.14%), but no case was confirmed by the family physician using standard culture techniques.Proteinuria was found in 136 cases (0.49%) and confirmed in 47 (37%) of the 126 children who were seen by their family physician. In this group 8.8% had evidence of pyelonephritic scarring on intravenous pyelograms without a positive urine culture.Hematuria was found in 19 children and confirmed in 10 (59%) of the 17 children who were seen by their family physician. No abnormalities were detected on intravenous pyelography in any case.Glycosuria was found in 12 cases and confirmed in five. Three of these children had renal glycosuria and two had previously undetected diabetes.

Adolescent↗
PubMed1974

Arteriovenous fistula and prolonged hematuria after renal biopsy: treatment with epsilon aminocaproic acid.

A patient with membranoproliferative glomerulonephritis and mild hypertension is described who, after a renal biopsy, developed an arteriovenous fistula and then severe continuous hematuria from the seventh to the 38th postbiopsy day. Treatment with epsilon aminocaproic acid was associated with rapid and permanent cessation of bleeding, gradual improvement in renal function, and disappearance of the renal artery bruit. No complications were encountered.

Aminocaproates↗
PubMed1973

City-wide screening for urinary abnormalities in schoolgirls.

Screening for urinary tract infection was carried out in 23,427 schoolgirls, aged 5 to 14 years, using Uricult and, for hematuria, glycosuria and proteinuria using Hema-combistix. Cultures of 10(5) colonies per ml. or more on two occasions were obtained in 2.3% and a positive culture was confirmed by the family physician using standard culture techniques in 82.7% of cases, giving an overall incidence of infection of 1.9%. Fifty-eight percent of these children had no previous history of any urinary tract symptoms. Of the infected group 9.5% had pyelonephritic scarring, 58.7% chronic cystitis and 58.7% urethral stenosis. Two additional cases had unilateral ureteropelvic junction obstruction with hydronephrosis. Reflux occurred in 26.6% of those investigated by voiding cystogram. In 58% of cases the urinary tract infection was not accompanied by significant proteinuria, hematuria or pyuria.Proteinuria was detected on two occasions in 1.6% of the children and confirmed by the family physician in 33% of cases, giving an overall incidence of 0.5%. In this group 9.2% had evidence of pyelonephritic scarring without a positive urine culture.Hematuria was detected on two occasions in 0.6% of the children and was confirmed by the family physician in 53%, giving an overall incidence of 0.3%. Only one case with pyelonephritic scarring was seen in this group.Of the 25 cases with pyelonephritic changes only six had been previously diagnosed radiologically.Four previously unrecognized diabetics were also detected.

Adolescent↗
PubMed1973

Effects of chronic hemodialysis on thyroid function in chronic renal failure.

Thyroid function was studied in 54 patients undergoing chronic hemodialysis. Serum thyroxine, triiodothyronine and free thyroxine and the free thyroxine index were significantly lower than normal. The levels of both serum thyroxine and the free thyroxine index tended to fall progressively the longer the patients were on hemodialysis. These findings, in association with low serum TSH levels and normal increase in radioactive iodine uptake by the thyroid after TSH injection, suggest that a defect in pituitary secretion of TSH may be responsible. Although some patients experienced symptomatic improvement after treatment with L-thyroxine the efficacy of this form of treatment in patients on chronic hemodialysis has not yet been established.

Adolescent↗
PubMed1970

Experiences with high doses of furosemide in renal disease and resistant edematous states.

Six cases of edema, three due to the nephrotic syndrome, one to congestive heart failure and two to chronic renal failure, are reported in which furosemide was administered in oral doses higher than those usually prescribed (up to 720 mg. a day), in order to obtain a satisfactory diuresis. In one case of severe prerenal failure secondary to cardiogenic shock and in one case of acute tubular necrosis secondary to hypotension at the time of operation, intravenous doses up to 990 and 1400 mg. per day respectively were able to reverse the oliguria. In eight additional patients who were on chronic hemodialysis, furosemide was administered to the amount of 1000 mg. per day orally in divided doses for two weeks, and produced a moderate diuretic response.The use of high doses of furosemide in edema and renal failure resistant to the usual therapeutic measures appears to be safe and effective.

Adult↗