Three years of experience with on-line preparation of sterile pyrogen-free infusate for haemofiltration.
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Biomedical subjects
Publications and source records attributed to G Deschodt.
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The response of arterial pressure to an infusion of saralasin was compared to the effect of surgical correction of renal vascular lesions (3 to 6 months after surgery) in eleven patients whose hypertension was associated with uni or bilateral stenosis of renal artery. Saralasin was infused after four days of dietary sodium restriction (10-40 mEq/day). An excellent correlation (r = 0.83, p less than 0.005) between the effects of saralasin and surgery was obtained. There was no correlation between the response to saralasin or to surgery and the ratio of renal vein renin activities. It is suggested that saralasin may be a good tool for predicting the effect of surgery in renovascular hypertension, when infused in moderately sodium depleted patients.
The effects on arterial pressure of saralasin and short-term (seven days) administration of the cardioselective beta-blocker atenolol were compared in 21 patients with various forms of hypertension. During saralasin administration mean arterial pressure (MAP) decreased by 8.8 +/- 2.1 per cent. Atenolol administration was associated with a MAP fall of 23.6 +/- 2.9 per cent. The change in MAP induced by atenolol was higher than that produced by saralasin (P less than 0.001) and no significant correlation (r = 0.40, P greater than 0.05) between their respective effects was found. These results suggest that the antihypertensive action of atenolol is not related to pre-treatment activity of the renin-angiotensin system as estimated by the hypotensive effect of saralasin. Other mechanisms should be sought in order to explain the effectiveness of this betablocker in hypertensive patients.
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The response of arterial pressure to an infusion of saralasin was compared to the effect of surgical correction of renal vascular lesions (3 to 6 months after surgery) in eleven patients whose hypertension was associated with uni or bilateral stenosis of renal artery. Saralasin was infused after four days of dietary sodium restriction (10--40 mEq/day). An excellent correlation (r = 0.83, p less than 0.005) between the effects of saralasin and surgery was obtained. There was no correlation between the response to saralasin or to surgery and the ratio of renal vein renin activities. It is suggested that saralasin may be a good tool for predicting the effect of surgery in renovascular hypertension, when infused in moderately sodium depleted patients.
A sorbent system (Redy D 11 cartridge) capable of on-line regeneration of ultrafiltrate during hemofiltration (Amicon 0.5 m2) has been developed and applied on a 3 X 4 hr/week schedule to three patients with end-stage renal failure previously treated for up to six months with hemodialysis. Total experience, to date, is sixteen patient months (three to seven months). Tolerance to fluid removal improved with the new system. Patient well-being and rehabilitation have been maintained. The system offers the potential of hemofiltration without sterile replacement fluid or expensive fluid-balancing machines.
The "effective" contribution of angiotensin II in blood pressure regulation was investigated in 6 patients on maintenance hemodialysis who were hypertensive at the time of the study (MAP 133 +/- 5 mmHg). Saralasin, a specific angiotensin II inhibitor, was infused at 0.5 and 2.5 microgram/kg/mn three hours before andone hour after hemodialysis. Before hemodialysis, a mean arterial pressure decrease of 13.2 to 19 p. 100 was obtained in 5 patients, arterial pressure being normalized in three of them. After hemodialysis, saralasin induced a normalization of arterial pressure in these 5 subjects. One patient, who was resistant to the saralasin infusion before and after the hemodialysis procedure, can be considered as purely volume-dependent. The renin-angiotensin system is probably one of the primary determinant of dialysis-resistant hypertension. However, a negative response to saralasin should encourage to control hypertension by more vigorous ultrafiltration during dialysis.
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A sorbent system (Redy D11 cartridge) capable of 'in line' regeneration of ultrafiltrate during haemofiltration (Amicon 0.5 m2) has been developed and applied on 3 X 4 hr/week schedule to 3 patients with end stage renal failure previously treated for up to 6 months with haemodialysis. Total experience, to date, is 8 patient months. Tolerance to fluid removal improved with the new system. Patient well being and rehabilitation has been maintained. The system offers the potential of haemofiltration without sterile replacement fluid or expensive fluid balancing machines.
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