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Biomedical subjects

E G Lowrie

Publications and source records attributed to E G Lowrie.

At least 73 records · Page 4Linked to original sources
PubMed1979

Bacteremic infection in hemodialysis.

This is a retrospective study of 133 episodes of bacteremic infection in 112 hemodialysis patients. The frequency of bacteremic infection was 9.5% in patients with chronic renal failure and 10.9% in patients with acute renal failure. In patients with acute renal failure, pneumonia and intra-abdominal abscess were the most frequent sources of septicemia. Sepsis was usually due to Gram-negative organisms and mortality was high. In patients with chronic renal failure, infection of the shunt or fistula was the most common cause, was frequently due to Staphylococcus organism, and had a more favorable survival rate. Gram-negative septicemia from a nonaccess source in patients with chronic renal failure was associated with a higher mortality. Bacterial endocarditis and septic pulmonary emboli occurred in 3.6% of septic episodes and 0.35% of patients at risk and had very low mortality. A low threshold for obtaining blood cultures and early antibiotic treatment are believed to be important in the treatment of bacteremic infections in patients undergoing long-term hemodialysis.

Acute Kidney Injury↗
PubMed1978

Vestibular toxicity of gentamicin. Incidence in patients receiving long-term hemodialysis therapy.

Twenty-three patients on long-term hemodialysis regimens who received gentamicin sulfate were reviewed retrospectively to assess the incidence of ototoxicity and to identify potential risk factors. Dosage of gentamicin sulfate was 1.0 to 1.5 mg/kg intravenously three times weekly. Serum gentamicin levels were monitored in 21 cases. Seven patients developed signs and symptoms of vestibular dysfunction. Statistically significant differences were found between the ototoxic and nonototoxic groups with respect to age (P less than .001), total dose (milligrams per kilogram) (P less than .001), and duration of therapy (P less than .001). The total dose per kilogram of body weight contributed most heavily to ototoxicity, and regression analysis suggests that the critical cumulative dose is about 17.5 mg/kg. The two groups did not differ with respect to mean peak and valley serum levels. We conclude that this population is at high risk of developing gentamicin-related vestibular dysfunction specifically when the cumulative dose exceeds 17.5 mg/kg.

Adult↗
PubMed1978

High Rates of controlled ultrafiltration combined with optimal diffusion: recent advances in hemodialysis technique.

A system which permits high rates of middle molecule removal while preserving the removal of low molecular weight substances is described. It consists of a high fluid flux hollow fiber artificial kidney and an ultrafiltration controller. When used in combination, high rates of convective transport can be achieved through rapid ultrafiltration and reconstitution of blood with physiologic salt solutions. The theoretical impact of changing from conventional dialysis to this form of therapy on the body burden of middle molecules is estimated.

Diffusion↗
PubMed1978

A longitudinal study of bone disease after successful renal transplantation.

A retrospective study of 100 patients followed for 1-4 years after successful renal transplantation was undertaken to assess the amelioration of previously present metabolic bone disease and to determine the risk factors associated with the development of osteonecrosis. 42% of patients showed some evidence of bony abnormality. Following transplantation, there was slow but progressive resolution in the X-ray changes of hyperparathyroidism but not of osteoporosis. 14% of patients developed osteonecrosis in the posttransplant period with the femoral head the most common site involved (72% of patients). Osteonecrosis could not be related to average steroid dose, number of steroid pulses, or the preexistence of metabolic bone disease.

Adult↗
PubMed1978

Initial clinical evaluation of the Hospal artificial kidney system.

A high flux artificial kidney system, which permits control over ultrafiltration, has been developed and patients are now being treated with it at a large outpatient kidney center. The basic operating characteristics have been described and some preliminary clinical results mentioned. Characteristics of the Hospital Artificial Kidney System are: 1. Higher clearances for middle molecules than conventional systems; 2. Adequate clearances for small solutes such as urea; 3. Predictable control of ultrafiltration with discrepancies between actual weight loss and theoretical weight loss on the order of 0.7 to 1.3 ml/min, when the system is operated in the designated manner.

Evaluation Studies as Topic↗
PubMed1977

Controlled ultrafiltration (UF) with hemodialysis (HD): analysis of coupling between convective and diffusive mass transfer in a new HD-UF system.

A convertible and versatile dialysis system consisting of a PMMA hollow fiber unit and UFR controller is shown to be useful for evaluating the effect of solute and fluid removal rates on adequacy of dialysis. Post-dilution mode where high UFR is applied to the patient with matching or comparable dilution rate is concluded to be most effective modification for enhancing the clearance for "middle molecules", without sacrificing the removal rates for the small solutes.

Creatinine↗
PubMed1976

Hyperlipidemia after renal transplantation in children.

A cross-sectional survey of 32 children who received renal allografts was undertaken to evaluate lipid profiles in a pediatric transplant population. Ages ranged from 8 to 18 years, and serum creatinine concentrations varied from 0.5 to 5.6 mg/100 ml (mean, 1.4 mg/100 ml). Fifty percent of patients showed an abnormal lipoprotein electrophoresis, and these were evenly divided between type II and type IV patterns. The data suggest that patients with type II pattern tend to be receiving higher doses of prednisone, and increasing levels of cholesterol and triglyceride are also associated with higher corticosteroid dosages. In contrast to the observations of others in dialysis patients, measurements of glucose metabolism such as fasting blood sugar and fasting insulin levels were not associated with lipid abnormalities in this population. Lipid abnormalities following renal transplantation in children are similar to those described in adults, and may contribute to morbidity in the years following successful renal transplantation.

Adolescent↗
PubMed1976

Factors in the dialysis regimen which contribute to alterations in the abnormalities of uremia.

While hemodialysis therapy in its present form is capable of sustaining life, dialysis patients are not metabolically normal and we are unable to say what technical factors contribute adequate therapy. Recent efforts to resolve these problems have led to the assumption that substances in the molecular weight range of 800 to 3000 daltons may be pathogenic in uremia and these may not be effectively removed by dialysis. Accordingly, four groups of patients (ten each) underwent changes in their routine which were theoretically designed to alter independently the concentration of small (urea) and "middle" molecules in the blood. In two groups, the concentration of urea was theoretically increased or decreased while the concentration of so-called middle molecules was maintained unchanged. In the remaining two groups, middle molecule concentration was theoretically increased or decreased while small molecule concentration was unchanged. Patients were evaluated prior to and after completing altered dialysis therapy. The results suggest three related conclusions. First, the uremic syndrome may be viewed as a constellation of abnormalities which can be subgrouped by association so that azotemia may be correlated with neuropathic disease and hypertension with weight gain or body size, for example. Second, those physiologic variables which changed after altered dialysis tended to deteriorate with increasing concentration of small molecules in the blood and remained independent of theoretical changes in middle molecules. Finally, when patients are relatively under-dialyzed, they may spontaneously modulate the reduced removal of metabolites such as urea by decreasing the dietary intake of nutrients.

Adult↗
PubMed1975

Hemodialysis for acute anuric uric acid nephropathy.

A patient with acute oliguric uric acid nephropathy was treated with hemodialysis. Recovery in this disorder is based on treatment of both the uremic state and the intrarenal crystal obstruction. Hemodialysis with high uric acid clearance is much more efficient than other forms of therapy in this disorder.

Abdominal Neoplasms↗
PubMed1975

Hemorrhagic pleural effusion in patients undergoing chronic hemodialysis.

Three patients maintained on chronic hemodialysis developed hemorrhagic pleural effusion. The effusions seemed to be solely related to the uremic state, other causes having been excluded. Pulmonary restriction requiring decortication occurred in one patient. We concluded that hemorrhagic pleural effusion may be a complication of uremia in the chronically dialyzed patient and that fibrous pleuritis causing pulmonary restriction may result.

Adult↗
PubMed1975

Cardiovascular disease in uremic patients on hemodialysis.

In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment. Hypertensive patients should be screened for excessive renin secretion because of its possible role in unresponsive hypertension in patients on dialysis. Nephrectomy should be used when necessary, where dialysis and antihypertensive medication have not adequately controlled blood pressure. Patients must be monitored for the presence of pericardial disease to avoid subsequent pericardial effusion and the development of constrictive pericarditis with its adverse effect on myocardial function. When constrictive pericarditis is present, it obviously should be relieved by appropriate surgery. Efforts should be made to minimize cardiac output in hemodialysis patients. Whether or not routine transfusions to maintain a higher hematocrit are indicated is a question that cannot yet be answered. However, patients with marginal cardiovascular function who are accepted on hemodialysis and must have an arteriovenous shunt should be supported in any manner to minimize an increase in cardiac output. Early and aggressive treatment of known episodes of sepsis is important in the elimination of valvular endocarditis in this patient population. Perhaps one of the finer indicators of adequacy of hemodialysis will be K rate and peak immunoreactive insulin levels. Continued abnormality of these parameters may contribute to cardiovascular disease. Clearly, further study of the effect of abnormal carbohydrate metabolism on lipid metabolism is in order. Serum triglyceride, serum cholesterol and lipid electrophoretic pattern should be followed to evaluate the beneficial effects of drug therapy and changes in dialytic technique on the development of cardiovascular disease. Careful monitoring of calcium, phosphorus, bone films and parathyroid hormone levels is indicated to assess parathyroid status. The use of aluminum binders and parathyroidectomy to prevent vascular and myocardial calcification is important in the therapy of these patients. The use of cardiac catheterization, coronary artery arteriography, and possibly cardiac vascular repair, should be considered in the chronic hemodialysis patient with coronary artery disease if he is otherwise well. Adequacy of hemodialysis perhaps can be evaluated through its effect on all of the above parameters. Whether or not changes in artificial kidney treatments can correct the final vascular disease remains to be seen.

Antigens↗