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Biomedical subjects

F C Whittier

Publications and source records attributed to F C Whittier.

At least 37 records · Page 2Linked to original sources
PubMed1992

Searching for a pattern: repeat suicide attempts.

1. Although there is a large population of unsuccessful suicide attempts and the same patients are often admitted repeatedly, little investigation has been done to understand this group. 2. Prescription drugs were almost always used in overdose attempts. There was no indication that physicians successfully intervened in preventing abuse of prescribed medication among patients with a history of overdose suicide attempt. 3. Most people choose a method for suicide and repeatedly use the same method (physical versus overdose). The majority of repeat attempts occurred among young people, and alcohol use was especially high when physical methods were used. Identification of these trends could lead to effective intervention.

Alcohol Drinking↗
PubMed1989

Transluminal angioplasty in patients with bilateral renal artery stenosis or renal artery stenosis in a solitary functioning kidney.

Renal angioplasty in patients with bilateral renal artery stenosis or with renal artery stenosis in a solitary functioning kidney has been thought to be relatively contraindicated. We report the results of renal artery angioplasty in 18 patients, 10 with severe bilateral renal artery stenosis and eight with severe renal artery stenosis in a solitary kidney. Twenty-five (89%) of 28 angioplasties were successful, with a mean improvement of the degree of stenosis from 85% to 18% after angioplasty and a restoration of renal blood flow. A significant drop in mean blood pressure at admission of 187/101 mm Hg to 154/87 mm Hg at discharge, 152/86 mm Hg at 3-month, and 146/82 mm Hg at 1-year follow-up was seen. Because of the decrease in blood pressure, 11 of the patients decreased or stopped taking diuretics and 15 decreased or stopped taking antihypertensive medications. Although no significant change in renal function was found by measuring mean serum creatinine levels over time, no patient had an elevated serum creatinine level at follow-up, indicating preservation of renal function. One major complication, cholesterol embolization to the bowel, was seen. Our results suggest that angioplasty is an acceptable treatment of hypertension in patients with bilateral renal artery stenosis or renal artery stenosis in a single kidney.

Aged↗
PubMed1988

Acute effects of nifedipine on renal electrolyte excretion in normal and hypertensive subjects.

The role of renal calcium handling in the hypotensive response to calcium channel blockers has not been investigated previously. The acute vasodilatory effect of calcium channel blockers may be accompanied by changes in renal electrolyte handling that are important in renal electrolyte handling that are important in producing the hypotensive response seen with these agents. Nifedipine has been shown to cause acute and chronic natriuresis and diuresis, which are important in the ability to use nifedipine chronically in essential hypertension. We prospectively investigated the acute effect of 10 mg of nifedipine orally on renal cation handling in normotensive and untreated essential hypertensive subjects during a standard oral water load. At baseline there was no difference between normotensives and hypertensives in serum ionized calcium or magnesium, or in the urinary fractional excretion of these two cations. Oral nifedipine acutely increased the fractional excretion of sodium without changing the fractional excretion of calcium or magnesium. Nifedipine did not alter the serum concentrations of sodium, calcium, or magnesium. Augmented sodium excretion may play a role in the acute hypotensive response to oral nifedipine. The acute hypotensive response does not seem to be caused by altered renal handling of calcium or magnesium. Counterbalancing effects of nifedipine on proximal and distal nephron calcium handling may explain the disassociation of augmented sodium excretion and no net change in calcium excretion.

Calcium↗
PubMed1986

Severe recurrent alkalemia in a patient undergoing continuous cyclic peritoneal dialysis.

Chronic renal failure is commonly associated with acid-base disorders that are corrected with the institution of maintenance peritoneal dialysis. Severe shifts in systemic pH that occur in patients undergoing peritoneal dialysis are usually acidemic shifts due to inadequate replacement of the kidney's ability to excrete acid and regenerate bicarbonate. This report describes a severe alkalemic shift in pH in a patient undergoing continuous cyclic peritoneal dialysis due to a failure of dialysis to substitute for the kidney's normal response to simple respiratory alkalosis. This case emphasizes that in patients undergoing peritoneal dialysis, physicians must actively provide the "renal compensation" for an acid-base disorder and change the dialysis prescription.

Alkalosis, Respiratory↗
PubMed1986

Continuous ambulatory peritoneal dialysis for psoriasis. A report of four cases.

Four patients with psoriasis were treated with continuous ambulatory peritoneal dialysis (CAPD). Two were being treated for renal failure; the other two had normal renal function and were being treated exclusively for psoriasis. With CAPD at a rate of three to four exchanges per day, the psoriasis cleared completely in the two patients with renal failure and improved in the other two. In the patients without renal failure, low-flow peritoneal dialysis (one exchange per day) seemed to be of some value in maintaining remission but was ineffective in treating more active disease. Long-term therapy (greater than or equal to 12 weeks) with three or four daily exchanges may be needed for initial complete remission, and continuous treatment may be needed to prevent relapse. Thus, CAPD shows promise for the study of psoriasis and may be a last-resort treatment for severe, disabling cases.

Adult↗
PubMed1985

Pseudouremic pruritus: a scabies epidemic in a dialysis unit.

A scabies epidemic was studied in a university hospital dialysis unit. Itching in patients was initially attributed to uremic pruritus, and diagnosis of the epidemic was delayed until cases occurred among the staff. Sixteen cases (seven patients and nine staff) were identified by survey questionnaire and dermatologic examination. Application of 1% lindane lotion (Kwell, Reed and Carnrick, Piscataway, NJ) to all patients dialyzed in the unit and the entire staff eradicated the epidemic. A dialysis unit-associated nosocomial scabies epidemic has not been reported before and may mimic uremic pruritus in dialysis patients.

Antiparasitic Agents↗
PubMed1985

Nutrition in renal transplantation.

This study was conducted to determine whether a high-nitrogen, low-carbohydrate diet in the immediate post-operative renal transplant period could result in a positive nitrogen balance and fewer cushingoid side effects. Twelve consecutive nondiabetic renal transplant recipients were randomly assigned to the isocaloric control or experimental diet group. The six patients ingesting the experimental diet achieved positive nitrogen balance whereas five of the six patients on the control diet had a negative nitrogen balance. The nitrogen balance varied directly and proportionately with the protein intake. Potassium balance mirrored the nitrogen balance data. Cushingoid side effects did not develop in any of the six experimental diet patients whereas four of the six control diet patients had evidence of severe cushingoid appearance and two had moderate cushingoid appearance (P = .01). Based upon the findings of this study, we suggest that the renal transplant recipient's diet could be altered to provide more protein and less carbohydrate to improve nitrogen balance and prevent cushingoid features. It is possible that a high-protein, low-carbohydrate diet may be used by additional patients taking steroids for other disease states to prevent cushingoid side effects and improve nitrogen balance.

Adult↗
PubMed1983

Peritoneal dialysis for psoriasis: a controlled study.

Sham and real trials of peritoneal dialysis were carried out in a double-blind crossover study design to test the efficacy of peritoneal dialysis as a treatment for psoriasis. The criteria for patients included having severe plaque-type psoriasis unresponsive to all conventional therapy including methotrexate. Patients were randomly assigned to 4 weeks of sham or real dialysis, 8 weeks of observation, 4 weeks of alternative real or sham dialysis and 8 weeks of observation. Topical therapy was continued during the trial. Real dialysis was done for 48 hours weekly with 1.5-hour cycle times and 2-litre exchanges by machine. Sham peritoneal dialysis was done recycling the same 2 litres of 1.5% continuous ambulatory peritoneal dialysis fluid with 1.5-hour cycle times for 48 hours weekly. After real dialysis, two patients completely cleared, two patients had greater than 75% clearing, and one patient had no substantial response. None of the five patients had a response to the sham dialysis procedure (p less than 0.01).

Clinical Trials as Topic↗
PubMed1981

Cadaveric kidneys for transplantation. A paradox of shortage in the face of plenty.

The number of cadaveric kidneys currently available for transplantation is insufficient; therefore, the Center for Disease Control (CDC) undertook a collaborative pilot project to increase the number of cadaveric kidneys available for transplantation. In phase one, a retrospective review of medical records of in-hospital deaths was done to determine the potential number of cadaveric kidney donors and to define the characteristics of potential donors. The medical records of 10,420 (43.1%) of the 24,164 patients who died in 67 acute-care hospitals in Georgia, Kansas, and Missouri were retrieved. In addition to determining suitability for donorship, criteria were developed to reflect the broadest range of criteria in use. By center-specific criteria there were 1.7 potential donors/100 in-hospital deaths, which could make available 109 kidneys/million population. By broad intercenter criteria there were 3.5 potential donors/100 in-hospital deaths, which could provide 232 kidneys/million population. During 1975, by center-specific criteria, kidneys from 19.3% of the suitable potential donors were retrieved. The small number of transplantable cadaveric kidneys retrieved was not attributable to lack of suitable organs but rather the failure to identify suitable donors, obtain consent, and retrieve the kidneys.

Adolescent↗
PubMed1980

The role of the Emergency Medical Services in organ donation.

A potential need for more organ donors has been identified because of the improved survival rates of patients receiving kidney transplants and the reports of improving graft success rates. Because of the development of the EMS trauma program, an awareness of the potential benefit for increased organ donation could be realized by improved working relationship of the EMS trauma unit and the organ recovery agency. In the final analysis, careful planning of a regionwide program for organ recovery by the organ retrieval groups to include the EMS trauma unit should result in an increased number of cadaveric kidneys for transplantation.

Cadaver↗
PubMed1979

Response to influenza A vaccine among high-risk patients.

In recent years, it has been recommended that "high-risk" patients receive influenza immunizations annually. During the 1976 National Influenza Immunization Program, a higher priority was given to these patients than to the general population. The present study was undertaken to compare the antibody response of high-risk patients with that of a group of individuals with no underlying disease after immunization with 0.5 ml of bivalent, split-virus vaccine containing 200 CCA units each of influenza A/New Jersey/76 and A/Victoria/75. Sera were obtained before and after immunization from 41 "healthy" volunteers and from 57 cariology, 31 hematology, 13 hemodialysis, and 16 renal transplant patients. The control, cardiology, and hemodialysis groups responded equally well to A/Victoria/75 antigen, but the hematology and renal transplant groups did not respond as well (P less than .05). Only the hematology patients responded at a significantly lower level (P less than .05) than the control group to A/New Jersey/76. The control and renal transplant groups had a significantly greater response to A/New Jersey/76 antigen than to A/Victoria/75 antigen (P less than .002). Although the same pattern was demonstrated by the other patient groups, the differences were not significant. Because hematology and renal transplant patients responded relatively poorly to influenza immunization, prophylactic administration of amantadine during influenza outbreaks should be considered in patients with renal function adequate to excrete this drug.

Antibodies, Viral↗
PubMed1977

Correlation of spontaneous leukocyte blastogenesis with human renal allograft rejection.

Spontaneous blastogenesis of peripheral blood mononuclear cells in recipients of renal allografts was studied by incorporation of 3H-thymidine. Three different levels of reactivity were observed that correlated with the patient's clinical course. Low levels of blast activity (i.e., median 680 dpm/million cells with 95% confidence interval (CI) of 480 to 880 dpm) were observed in pretransplant patients. A moderate elevation (median 3,00 dpm with CI of 2,300 to 5,300 dpm) was noted post-transplantation during quiescent intervals and following the onset of acute reversed rejection. Marked elevations, i.e., values greater than 10,000 dpm frequently were observed within 6 days prior to rejections (median 21,000 with CI of 7,400 to 34,000 dpm) and during sustained rejections (median 14,000 with CI of 8,800 to 19,600 dpm).

Graft Rejection↗