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Biomedical subjects

G L Barbour

Publications and source records attributed to G L Barbour.

14 recordsLinked to original sources
PubMed1979

Effect of parathyroidectomy on anemia in chronic renal failure.

Fourteen patients with chronic renal failure underwent parathyroidectomy. Postoperatively, seven patients exhibited a rise in hematocrit reading, but seven others did not. Responders had more severe bone disease and lower initial hematocrit values than did nonresponders. Marrow fibrosis was slightly more prominent in responders. Current concepts of marrow erythropoietic inhibition in renal failure suggest a toxic serum factor as the cause. This report fails to support parathyroid hormone as the toxic agent directly responsible for marrow inhibition. Rather, parathyroid hormone may contribute to anemia in renal failure by causing marrow fibrosis, a process sometimes reversible by successful therapy of hyperparathyroidism.

Anemia↗
PubMed1979

Measurement of peritoneal clearances in self-dialysis patients.

Twelve chronic peritoneal dialysis patients were studied on 20 occasions to measure peritoneal clearances of creatinine, urea, uric acid, and potassium. Two clearance techniques were employed, the classical type using timed collections and a midpoint blood specimen and an experimental type using calculated dialysate flow and predialysis peritoneal fluid solute concentrations. Comparison of the two techniques demonstrated a close correlation between simultaneously measured clearances and also for repeat measurements in the same patient. The new technique is simple and reproducible, does not require blood sampling, and can be performed in the home by patients treated by self-dialysis using automated peritoneal dialysis equipment. The new technique will allow more frequent monitoring of peritoneal permeance in self-dialysis patients, and necessary adjustments in treatment time can be prescribed without requiring hospitalization.

Ascitic Fluid↗
PubMed1979

Vasopressin-resistant nephrogenic diabetes insipidus. A result of amphotericin B therapy.

Polyuria and polydipsia developed in two cases during amphotericin B therapy for deep mycoses. Neither patient could concentrate his urine in response to water deprivation or exogenous vasopressin. Other causes of vasopressin-resistant nephrogenic diabetes insipidus were not present. Three months after amphotericin B therapy had been discontinued, concentrating ability improved toward normal. A third patient was further observed and demonstrated normal diluting capacity but impaired free-water reabsorption, suggesting a distal tubular defect consistent with nephrogenic diabetes insipidus. Four months after discontinuing therapy, renal concentrating ability was normal. Amphotericin B can induce a reversible form of nephrogenic diabetes insipidus.

Amphotericin B↗
PubMed1978

Videotape aids informed consent decision.

Obtaining informed consent for clinical investigations represents a major legal, ethical, and moral consideration in human experimentation. Mechanisms for informing the patient vary widely, and usually no system exists to confirm the degree of information retained by the patient. A Veterans Administration Cooperative Study, begun in 1975, has used a videotape information package in addition to a standard written consent form to ensure uniformity. Each presentation was followed by a questionnaire to assess the amount of material learned before attempting randomization. Repeated showings were occasionally necessary and did not affect the rate of randomization. A videotape presentation, especially in cooperative studies, ensures uniformity, makes allowance for varying educational levels of patients, and provides documentation of the degree of informed consent.

Audiovisual Aids↗
PubMed1978

Bilateral angiomyolipomas and renal cell carcinoma in polycystic kidney.

A case is presented of a twenty-eight-year-old man in whom renal failure developed at age twenty-four from polycystic kidney disease known to be present since childhood. He also had cutaneous manifestations of the tuberous sclerosis complex. Intrarenal hemorrhage led to bilateral nephrectomy. Microscopic examination disclosed typical polycystic disease and multiple angiomyolipomas in each kidney. In addition several renal cell carcinomas of oncocytic, papillary, and clear cell type were found. Review of the literature disclosed the uncommon coexistence of any two of these lesions and did not uncover any reported case of the simultaneous existence of all three.

Adenocarcinoma↗
PubMed1978

Asymptomatic Bartter's syndrome.

A 63-year-old man had asymptomatic Bartter's syndrome, discovered during evaluation for hypokalemia. Elevated plasma renin and aldosterone levels, angiotension resistance, and elevated urinary prostaglandin excretion were noted. Tubular function studies implicated the proximal tubule as the site of a mild sodium reabsorption defect, and renal wasting of potassium and magnesium were also noted. Indomethacin therapy lowered the urinary prostaglandin excretion and the renin and aldosterone levels but did not correct the hypokalemia. Spironolactone therapy resulted in normalization of serum potassium but not serum magnesium levels. Bartter's syndrome may result from various causes but renal wasting of sodium, potassium and/or magnesium probably exist in all cases. Unexplained, asymptomatic hypokalemia in any age group may be due to Bartter's syndrome.

Angiotensin II↗
PubMed1978

Distal renal tubular acidosis in selective hypoaldosteronism.

Renal mechanisms for metabolic acidosis in selective hypoaldosteronism were investigated in a patient with marked renal insufficiency. Studies demonstrated a distal hydrogen ion secretory defect. Control of elevated serum potassium levels did not normalize urinary acid excretion, but systemic acidosis was improved. Mineralocorticoid therapy normalized serum potassium without increasing urinary potassium. Hyperkalemia did not directly affect renal acid handling, and extrarenal mechanisms for potassium excretion are suggested. Measurement of rectal mucosal potential difference suggests this test may be of value in detecting a wide range of abnormalities in aldosterone metabolism.

Acidosis, Renal Tubular↗
PubMed1978

Hemosiderosis secondary to chronic parenteral iron therapy in maintenance hemodialysis patients.

Autopsy data on 24 chronic maintenance hemodialysis patients who had received varying doses of parenteral iron as the iron-dextran complex were reviewed for evidence of iron overload (hemosiderosis) and tissue fibrosis or organ dysfunction (hemochromatosis). Hemosiderosis was frequent in patients who received high total doses of iron but absent in those who received little or no iron. The degree of tissue iron did not increase with increased iron administration above a total of 2.5 g. Hemochromatosis or organ dysfunction secondary to tissue iron deposition was not noted in any patient. Chronic parenteral iron administration may improve anemia and result in tissue iron deposition but does not lead to hemochromatosis.

Adult↗
PubMed1978

In vitro permeability studies of peritoneal (P), cuprophan (C), and polycarbonate (PCM) membranes.

A unique dialysis device was developed to allow direct comparison of permeability characteristics of different membranes to various solutes under identical conditions. Studies with Cuprophan (CM), polycaronate (PCM), and peritoneal membrane (P) yielded the following results: 1. PCM is similar to CM in permeability to low molecular weight solutes. 2. PCM is significantly more permeable to middle molecular weight substances than CM or P. 3. P is more permeable to middle molecules than CM.

Animals↗
PubMed1977

Parathyroid autotransplantation.

Autotransplantation of the parathyroid to the forearm has been performed in eight patients following total or subtotal parathyroidectomy. The mass of gland implanted was approximately one half that used in other series. Bilateral simultaneous parathormone levels drawn at three months after autografting several higher levels in the autografted arm in every patient examined. Replacement calcium and vitamin D therapy were withdrawn from two patients within eight months after transplant, and it is anticipated that all patients will be off maintenance at 12 months. Electron and light microscopy of grafted tissue has revealed viable glands with intracellular secretory granules, many mitochondria, and little fat. Indications for autotransplantation include patients with refractory renal osteodystrophy, reoperations for primary hyperparathyroidism, and extensive extirpative cancer surgery of the head and neck.

Biopsy↗
PubMed1977

Failure of histidine supplementation to improve anemia in chronic dialysis patients.

Failure of histidien supplementation to improve anemia in chronic dialysis patients was seen in six patients after a study period of 8 weeks. Serum amino acid levels were elevated to normal by supplementation with 1 g of oral histidine/day in all patients. There was no significant change in serum iron or transferrin levels, hematocrit, or red cell mass in five of the six patients. Histidine supplementation may raise serum amino acid levels, but does not cause any increase in red cell mass or improve the anemia in patients on chronic dialysis who are ingesting adequate dietary protein.

Adult↗
PubMed1976

Hyperlipidemia due to oxymetholone therapy. Occurrence in a long-term hemodialysis patient.

Marked hypertriglyceridemia and hypercholesterolemia accompanied by angina and a left cerebral thrombosis occurred in a long-term hemodialysis patient following 5 1/2 weeks of oral treatment with oxymetholone, 100 mg/day, a synthetic androgen. After androgen therapy was discontinued, over a three-month period, plasma lipid values progressively decreased below pretreatment values, and clinical symptoms disappeared. During rechallenge with oxymetholone, serum lipid values increased substantially, and the lipoprotein pattern changed from a type IV to a type V. Detailed lipid studies showed subnormal postheparin lipolytic activity and a fast-migrating pre-beta-lipoprotein in a very-low-density lipoproteins (VLDL) fraction. Because of the data linking lipid abnormalities to atherosclerosis and the acceleration of atherosclerosis in long-term hemodialysis patients, great caution should be exercised in administering androgenic steroids to these patients.

Acute Kidney Injury↗
PubMed1975

Tuberous sclerosis complex and renal angiomyolipoma. Collective review.

Numerous case reports of renal angiomyolipoma with or without tuberous sclerosis continue to be published with increasing frequency in the urologic literature. The need for a comprehensive and updated review of the subject is timely. A collective pathologic, clinical, and radiologic review of the subjects of tuberous sclerosis complex and renal angiomyolipoma is presented; and a plan for the urologic management is discussed.

Blood Vessels↗