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Biomedical subjects

E A Friedman

Publications and source records attributed to E A Friedman.

At least 19 recordsLinked to original sources
PubMed1992

Changes in left ventricular size, wall thickness, and function in anemic patients treated with recombinant human erythropoietin.

Left ventricular size and function were evaluated in 15 anemic chronic hemodialysis patients before and after the administration of recombinant human erythropoietin (rHuEPO). All patients were studied with two-dimensional and M-mode echocardiographic examinations before the initiation of rHuEPO (T1) and at 28 +/- 7 weeks of rHuEPO therapy (T2). The two-dimensional targeted M-mode echocardiographic measurements obtained were: end-diastolic dimension (EDD); end-systolic dimension (ESD); stroke dimension (SD); dimensional shortening (SD/EDD); systolic posterior wall thickness (PWs); diastolic posterior and interventricular septal thickness; end-systolic wall stress (ESWS); and left ventricular mass. Mean hematocrit in these patients increased almost 50%. The EDD decreased from a mean value (+/- SEM) of 6.41 +/- 0.33 to 4.93 +/- 0.21 cm (p less than 0.05). ESD decreased from a mean value of 4.16 +/- 1.2 to 2.77 +/- 0.06 cm (p less than 0.05). The calculated mean SD decreased slightly but not significantly from 2.21 +/- 0.69 to 2.19 +/- 0.60 cm. The calculated SD/EDD increased from a mean 0.35 +/- 0.09 to 0.44 +/- 0.07 (p less than 0.05). ESWS fell from 59.2 +/- 12.2 to 37.6 +/- 9.3 gm/cm2 (p less than 0.01), and left ventricular mass fell (p less than 0.05) from 347 +/- 15.2 to 227 +/- 59 gm. There was no significant difference in resting heart rate or systolic blood pressure between T1 and T2. The increase in dimension shortening reflects afterload reduction, as indicated by the fall in end-systolic wall stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Effects of alloxan-induced diabetes on hemorheology in rabbits.

Plasma viscosity (PV), apparent whole blood viscosity (WBV), relative blood viscosity (RV) and erythrocyte deformability (filterability) (EDF) were determined in 13 New Zealand White (NZW) rabbits with alloxan induced-diabetes (AID) and 8 normal NZW rabbits, matched for age, sex and weight. AID rabbits were divided into two groups depending on the duration of hyperglycemia (long-term, greater than 6.0 months (n = 7), and short-term, less than or equal to 3.0 months of hyperglycemia, n = 6). Comparing long-term AID rabbits to normal animals, we found significant increases in WBV (P less than 0.001, 0.005 for high and low rates of shear, respectively), and a marked reduction in EDF (P less than 0.001). There was no significant difference in PV between long-term AID and normal rabbits. Conversely, PV was significantly increased in rabbits with short-term diabetes (P less than 0.01) while there was a concurrent significant increase in WBV measured at high and low rates of shear (P less than 0.001, 0.001, respectively). No difference was detected in EDF between normal and short-term AID rabbits. Furthermore, in long-term AID rabbits there was a strongly positive correlation between RV and reduced erythrocyte deformability (r = 0.94, P = 0.006) while WBV strongly correlated with PV (r = 0.92, P = 0.004) in the short-term AID subgroup. We conclude from these data: (1) elevated blood viscosity in long term AID rabbits is associated with reduced erythrocyte filterability; and (2) elevated WBV in short-term AID rabbits is associated with increased PV.

Animals↗
PubMed1992

Unrecognized pseudohyperkalemia as a cause of elevated potassium in patients with renal disease.

Pseudohyperkalemia, defined as serum to plasma potassium difference of more than 0.4 mmol/l, occurs when platelets, leukocytes or erythrocytes release intracellular potassium in vitro, leading to falsely elevated serum values. Pseudohyperkalemia has been observed in myeloproliferative disorders [1], including leukemia [2] and infectious mononucleosis [3] as well as in rheumatoid arthritis [4]. We present 2 patients with renal disease and thrombocytosis in whom pseudohyperkalemia was recognized only after common therapeutic measures and/or dialysis failed to effect a decrease in serum potassium. In patients with renal disease and thrombocytosis, plasma as well as serum potassium should be routinely measured prior to instituting aggressive therapy or altering dialysis prescription in order to avoid potentially dangerous overtreatment with resulting hypokalemia.

Adult↗
PubMed1992

Aggressive ophthalmological management in diabetic end-stage renal disease: a study of 31 consecutively referred patients.

We prospectively followed the course of eye disease in patients with diabetic end-stage nephropathy from the time of initial referral by the renal unit. A total of 31 patients (62 eyes)--9 of whom had functioning renal transplants and 22 of whom were on maintenance dialysis--were consecutively evaluated for 6-24 months (mean follow-up of 18 months). Visual acuity and diabetic retinopathy stabilized or improved in all 18 eyes of the transplant patients and in 41 of 44 (93%) eyes of the dialysis patients. When first evaluated, economically useful vision (20/200 or better) was present in 11 of 18 (61%) eyes in the transplant group and in 25 of 44 (57%) eyes in the dialysis group. At the most recent evaluation, economically useful vision was present in 13 of 18 eyes (72%) in the transplant group versus 28 of 44 eyes (64%) in the dialysis group. Ambulatory vision (counting fingers or better) was present in 15 of 18 eyes (83%) in the transplant group versus 37 of 44 eyes (84%) in the dialysis group.

Adult↗
PubMed1992

Diabetic nephropathy. Management of the end-stage patient.

Diabetic nephropathy is currently the leading cause of new patients requiring dialysis in the United States. Management of the diabetic patient with ESRD is complicated by the frequent coexistence of complications affecting other organ systems, including retinopathy, cardiovascular disease, peripheral neuropathy, or autonomic neuropathy, manifested as gastroparesis, diarrhea or obstipation, cystopathy, or orthostatic hypotension. Associated clinical syndromes must be followed and treated, if possible, while preparing the patient to receive renal replacement therapy. Both the clinical condition and the psychosocial environment are key factors in choice of ESRD therapy for an individual patient. Rehabilitation data are best for patients who undergo kidney transplantation, but these data are confounded by the fact that the healthiest patients are referred for this treatment modality. Living, related kidney transplant is the preferred initial choice for the diabetic patient with kidney disease. At most centers, both in the United States and abroad, the cadaveric transplant is the second choice for uremia therapy. At the appropriate institution, the patient with type I diabetes may also be considered for a simultaneous cadaveric pancreas transplant. While awaiting cadaveric transplantation, or if contraindication to transplantation is present (chronic infection, recent malignancy, or severe cardiac disease), diabetic patients with severe impairment of the glomerular filtration rate (less than 10-15 ml/min) are referred for vascular access placement and/or insertion of a peritoneal catheter. The decision regarding the choice of CAPD vs. hemodialysis must be made on an individual basis. Rehabilitation and survival data for these therapies are similar, although technique survival rates for CAPD decline dramatically as time progresses because of infectious complications. In-center hemodialysis has the worst survival and rehabilitation profile, but the sickest, most debilitated patients with the highest number of comorbid conditions tend to be referred for that therapeutic modality. Most studies of rehabilitation were performed before use of recombinant human erythropoietin, and comparison between ESRD treatment modalities will have to be reevaluated now that the drug is routinely used.

Diabetic Nephropathies↗
PubMed1991

Treatment of azotemic, nonoliguric, anemic patients with human recombinant erythropoietin raises whole-blood viscosity proportional to hematocrit.

It has been reported that patients with azotemia have reduced red blood cell (RBC) deformability. Since this is a major determinant of whole-blood viscosity (WBV) and rigid RBCs increase WBV disproportionately relative to the level of hematocrit, it is conceivable that sustained improvement of hematocrit with recombinant human erythropoietin (rhEPO) therapy in azotemic patients might result in abnormally raised WBV. To address this concern, WBV and plasma viscosity (PV) were measured in 9 adult patients (4 men, 5 women) with anemia (mean hematocrit 29.2 +/- 2.7%) and azotemia [mean serum creatinine concentration 339.85 +/- 102.44 mumol/l (3.8 +/- 1.1 mg/dl)] before and after 6 months of treatment with rhEPO (50-175 U/kg given intravenously thrice weekly). Baseline and post-treatment hematocrit, WBV and PV were compared to values derived in 50 normal adult subjects with normal renal function [25 women, 25 men; mean serum creatinine concentration 79.56 +/- 8.84 mumol/l (0.9 +/- 0.1 mg/dl), mean hematocrit 42.4 +/- 3.7%]. To compare rheologic factors at subnormal hematocrits, blood from subjects with normal renal function was diluted with autologous plasma to achieve a range of hematocrits from 20 to 50%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Infant outcome following labor induction.

A matched control study was undertaken in which 156 children were examined between ages 23 and 62 months after births associated with spontaneous labor, oxytocin-induced labor, or prostaglandin E2 (PGE2)--induced labor. Physical development was not adversely affected by labor induction based on height and weight percentiles. The frequency of neurologic or developmental abnormalities not attributable to postdelivery events was the same overall in induced and spontaneous labors (19.2 per 1,000), but those abnormalities occurring after labor induction all followed use of oxytocin. None followed PGE2 despite case-selection criteria which specifically chose PGE2 cases from among those with documented adverse drug-related reactions.

Abnormalities, Drug-Induced↗
PubMed1979

Tuberculosis in patients undergoing maintenance hemodialysis.

Tuberculosis was diagnosed in eight patients undergoing maintenance hemodialysis and occurred with an incidence 10 times that of the general population. Dialysis-associated tuberculosis is characterized by intermittent fever, anorexia, weight loss and hepatomegaly. Ascites was present in 50 per cent of the patients. A recently converted positive tuberculin skin test was observed in five of eight patients. Tuberculosis was extrapulmonary in seven of eight cases and consequently the diagnosis was frequently delayed. Over-all mortality was 37.5 per cent and correlated with the duration of symptoms prior to initiation of therapy. A trial of antituberculous therapy is warranted in patients undergoing dialysis in whom fever of unknown origin, anorexia, weight loss and/or hepatomegaly develop particularly in areas endemic for tuberculosis.

Adult↗
PubMed1979

Effect of hemodialysis on plasma beta thromboglobulin levels.

BTG levels are significantly elevated in patients on chronic hemodialysis. The increased levels are not due to turbulent flow within the vascular access, but may be due to platelet aggregation within the hemodialyzer during the first hour of dialysis. This effect is observed with the Travenol CF series hollow fiber (cuprophane) but not the Cordis-dow artificial kidney (regenerated cellulose).

Beta-Globulins↗