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Biomedical subjects

David Goldsmith

Publications and source records attributed to David Goldsmith.

26 records · Page 2Linked to original sources
PubMed2003

Drug interaction in a renal transplant patient: cyclosporin-Neoral and orlistat.

An overweight 56-year-old type II diabetic on peritoneal dialysis (body mass index 35 kg/m(2)) was taking Orlistat for some months up until live-unrelated renal transplantation. Despite oral cyclosporin A (CyA) for 48 hours pretransplantation, it was very difficult to achieve adequate CyA blood levels for the first week postengraftment despite the use of much larger oral CyA doses. After opening his bowels on day 7, and the use of 3 days intravenous CyA, good CyA blood levels were achieved then maintained with conventional oral doses. The authors believe that this case shows important interactions between CyA and Orlistat.

Administration, Oral↗
PubMed2003

Assessing glycemic control in patients with diabetes and end-stage renal failure.

Blood glucose monitoring is important in optimizing long-term outcomes in diabetic patients. Reliance on near-patient testing and the use of longer term measures of glycation are the current cornerstones. However, as this review details, there are significant problems using blood tests as measures of metabolic control in uremic diabetic patients.

Blood Glucose↗
PubMed2002

Differential effects of T-cell activation on gastric and small bowel permeability in alcohol-consuming mice.

BACKGROUND: A number of variables influence the effect(s) of alcohol on distinct segments of the intestine. In these studies, we examined the effect of T-cell activation on gastric and small bowel permeability in alcohol-fed mice. METHODS: Gastric permeability was assessed using sucrose absorption, whereas small bowel permeability was followed using the ratio of lactulose to mannitol absorption and inulin absorption. T cells were activated by injecting antigen OVA(323-339) into DO11.10 T-cell receptor transgenic mice. RESULTS: T-cell activation increased gastric and small bowel permeability through a pathway mediated by interferon-gamma and tumor necrosis factor. In mice that were fed a liquid diet that contained 30% ethanol-derived calories for 2 weeks, T-cell activation increased gastric permeability to levels greater than that observed in solid diet or pair-fed, liquid control diet. By comparison, changes in small bowel permeability induced by T-cell activation were abrogated in alcohol-fed mice. Analysis of intestinal cytokine mRNA levels (interferon-gamma and tumor necrosis factor) indicated that relevant mucosal T-cell function was preserved in alcohol-fed mice. CONCLUSIONS: Overall, these data suggest that alcohol potentiates the effects of T-cell activation on gastric permeability, at the same time blunting effects on small bowel permeability

Alcohol Drinking↗
PubMedDate not supplied

Ambulatory blood pressure monitoring in hemodialysis patients: a critique and literature review.

Ambulatory blood pressure (ABP) monitoring has been in use for nearly four decades. In that time, the advantages of using a more reproducible and accurate method to assess the true contribution of blood pressure to the cardiovascular risk profile of patients have steadily become more clearly established, balanced by the additional expense and expertise involved. In nephrology, and in particular in dialysis patients, there are significant difficulties in accurately registering truly representative blood pressure values and understanding the relationship between blood pressure, end-organ damage, and patient mortality. This arises because of the way in which hemodialysis acutely changes blood pressure values as well as the widespread abnormality of diurnal blood pressure rhythm seen in dialysis patients. Use of ABP monitoring can go some way to overcoming these obstacles. In this review we critically examine the use of ABP monitoring in the understanding of blood pressure control in dialysis patients.

Blood Pressure↗
PubMedDate not supplied

Inflammation and coronary calcification in renal patients--factors that may explain increased cardiovascular risk, and poorer results of coronary interventions?

Cardiovascular disease (CVD) is one of the major causes of mortality in patients with renal diseases, with increased odds ratio of mortality with risk factors as diverse as cholesterol, vascular stiffness, chronic inflammation and hyperhomocysteinemia. Several factors have been incriminated to explain the increase in coronary vascular calcification (CVC) in this particular population. Increased duration of dialysis, dyslipidemia, altered calcium-phosphorus metabolism, and chronic inflammation have all been associated with increased CVC. We present here four case reports illustrating the differences in the pathophysiology, therapy and prognosis of calcific coronary heart disease seen in uremic patients.

Adult↗
PubMedDate not supplied

New immunosuppressive therapies in renal transplantation: monoclonal antibodies.

Remarkable advances in understanding the mechanisms of immune recognition and allograft rejection have been made in the past few years, leading to the development of innovative immunosuppressive strategies in the field of renal transplantation. Monoclonal antibodies (mAbs) have emerged as a new class of immunosuppressive agents, which appear to be effective (in both the treatment and the prevention of acute rejection) and well-tolerated in renal transplant recipients. The highly specific effects of these drugs make them less toxic than the oral long-term maintenance agents such as corticosteroids and the calcineurin inhibitors. Some of these mAbs have already confirmed their efficacy in preventing acute rejection in clinical phase III studies, and are now part of the well-established immunosuppressive regimens; these are the anti-CD25 mAbs (basiliximab and daclizumab). Other recently developed mAbs, like anti-CD52 (Campath-1H), anti-CD20 (rituximab), anti-LFA-1, anti-ICAM-1 and anti-tumour necrosis factor (TNF)-alpha (infliximab), are currently being tested, and show encouraging immunosuppressive potential. Blocking either the binding of cell-surface molecules or intracellular signal transduction, these mAbs could become an effective method to promote the holy grail of solid-organ transplantation, antigen-specific tolerance.

Antibodies, Monoclonal↗