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Biomedical subjects

G Offermann

Publications and source records attributed to G Offermann.

At least 73 records · Page 4Linked to original sources
PubMed1988

Increased procollagen III production in patients with kidney disease.

Measurements of elevated procollagen III peptide (PIIIP) levels are used to monitor fibrosing activity in hepatic and various other diseases. Elevated PIIIP levels have also been reported in renal failure patients without such diseases. Therefore, the serum levels and renal clearance of PIIIP were investigated in 17 healthy volunteers and 100 patients with different types of acute (n = 15) and chronic (n = 85) kidney disease. PIIIP was measured by conventional and Fab radioimmunoassays. Median PIIIP levels in serum (18, range 5-55 ng/ml) and urine (34, range 1-110 micrograms/day) were significantly higher in kidney patients than serum (9, range 6-14 ng/ml) and urine levels (17, range 6-24 micrograms/day) in normal volunteers (p = 0.01). No significant differences (Kruskal-Wallis H test) were found, however, within the different kidney disease groups (acute, chronic/glomerulonephritis, interstitial nephritis). Median renal clearance of PIIIP-related peptides in kidney patients (1.5, range 0.5-2.4 ml/min) did not differ significantly (Wilcoxon U test) from that in normal volunteers (1.3, range 0.4-2.2 ml/min). These findings indicate that PIIIP elimination does not depend on renal function. PIIIP-related peptides in serum and urine, however, increase with renal failure irrespective of the activity or type of renal disease. This can be explained most probably by enhanced turnover of collagen type III by the affected kidney itself.

Adult↗
PubMed1988

Characteristics and clinical course of hemodialysis patients with analgesic-associated nephropathy.

The knowledge of some characteristic findings on the personality of patients with analgesic-associated nephropathy (AAN) may facilitate diagnosis of the disease at an early stage. We therefore investigated the 144 patients at our hemodialysis center and compared the AAN patients (33%) with those having other kidney diseases (controls). Patients with AAN were older (60 +/- 10 vs 52 +/- 15 years, p less than 0.001) and predominantly women. Acetaminophen and metamizol metabolites were detected more frequently in blood from the AAN patients than in that from the controls (25% vs 3%, p = 0.002). More AAN patients were smokers, and they more frequently complained of vague symptoms (pain, sensitivity to changes in weather, insomnia) and also more frequently requested prescriptions for analgesics, hypnotics, laxatives, stomachics and antipruritics. Because they were older, AAN patients had fewer occupational and financial problems. The compliance of the AAN patients was significantly better with respect to important dialysis parameters such as weight gain between dialysis treatments (3.6 +/- 1.3 vs 4.0 +/- 1.3% body weight, p less than 0.05) and diastolic blood pressure (81 +/- 12 vs 86 +/- 12 mmHg, p = 0.025). Despite an older age and higher morbidity, the cumulative 17-year survival rate of the AAN patients did not differ from that of the controls. We conclude that AAN patients have characteristic personality traits. Their better compliance, adjustment to the hemodialysis situation and social conditions are responsible for their good survival on hemodialysis.

Acetaminophen↗
PubMed1988

Heparin-free hemodialysis with prophylactic change of dialyser and blood lines.

Heparinization during hemodialysis may cause severe bleeding complications in patients with high bleeding risk. Heparin-free hemodialyses (n = 208) were performed in 46 unselected patients with high bleeding risk after kidney transplantation (n = 25), after major surgery (n = 10), and with bleeding disorders (n = 11). Dialyser and blood lines were primed without heparin. In addition to the established measures (high blood flow, intermittent rinsing), system clotting was prevented by prophylactically changing the dialyser and blood lines in 107 of 208 dialyses (52 percent). Total system clotting with blood loss ranging from 100 to 250 ml occurred in six cases (3 percent). Mean hemodialysis time (+/- SD) was 4.1 hours (+/- 0.4), rising volume of the extracorporeal system 1.4 liters/hour (+/- 0.6), blood flow 244 ml/min (+/- 38), clotting time 12 min (+/- 4), and weight loss 2.5 kg (+/- 1.5). Mean hemodialysis creatinine clearance was 110 ml/min (+/- 34) and BUN clearance 138 ml/min (+/- 48). Heparin-free hemodialysis with prophylactic change of system is thus a safe and practical method of treatment for patients at high bleeding risk, but it is less effective, more expensive and the patient requires closer care.

Blood Coagulation↗
PubMed1987

Effect of digitoxin on cardiac arrhythmias in hemodialysis patients.

Digitoxin is considered a risk factor for ventricular arrhythmias in hemodialysis patients. In a randomized, crossover controlled study, 55 hemodialysis outpatients with sinus rhythm were prospectively investigated in two 48-h periods of electrocardiographic monitoring, one on and one off digitoxin or vice versa. The frequency of ventricular ectopic beats (mean +/- SD) which were found in 31 of 55 patients (56%), was slightly higher on hemodialysis (10 +/- 28 beats/h) than in the following 20 h (5.4 +/- 10 beats/h) and the next day off hemodialysis (3.6 +/- 6.6 beats/h); however, no difference was seen in patients on digitoxin during hemodialysis (10 +/- 29 beats/h), in the following 20 h (4.8 +/- 15 beats/h) and on the next day off hemodialysis (1.2 +/- 6.6 beats/h). The frequency of ventricular bigemini, polymorphous ectopies, couplets, more than 30 ectopies/h, salvos and tachycardias (10 vs 9 patients) on and off digitoxin was about the same (n.s., Fisher test). Supraventricular bigemini, salvos, tachycardias, and atrial fibrillation, however, occurred in significantly fewer patients on digitoxin (3 vs 13) than in those off digitoxin (P = 0.01, Fisher test). It is concluded that digitoxin does not increase the risk of ventricular arrhythmias in hemodialysis patients. Digitoxin, however, may have a beneficial effect on the supraventricular arrhythmias frequently observed in these patients.

Adult↗
PubMed1987

[Effect of diltiazem on blood cyclosporin levels].

The simultaneous administration of the calcium channel blocker diltiazem and cyclosporin results in a significant increase of RIA cyclosporin blood levels. The HPLC cyclosporin levels are not influenced.

Acute Kidney Injury↗
PubMed1987

Osteomalacia of the mother--rickets of the newborn.

During the last 4 years we observed four cases of neonatal rickets. The mothers of the infants suffered from osteomalacia for 1-3 years prior to its diagnosis shortly after the birth of their children. All four infants were born with craniotabes, and one infant had, in addition, a radial fracture. The diagnoses were confirmed by radiological and laboratory tests which revealed a rarefied bone structure, decreased serum 25-hydroxy-vitamin D and increased alkaline phosphatase levels in all patients. The disorder regressed under low-dose vitamin D3 therapy. As osteomalacia seems to be predominant in oriental women living in Berlin, it is necessary to consider vitamin D deficiency when clinical symptoms of this disease arise and to treat these women at least during pregnancy.

Cholecalciferol↗
PubMed1987

Therapeutic aminoglycoside monitoring in renal failure patients.

In patients with normal renal function, defined peak (5-10 mg/L) and trough levels (less than 2 mg/L) for gentamicin, tobramicin, and netilmicin are considered therapeutic. Netilmicin peak and trough levels were investigated in 50 patients requiring hemodialysis due to acute (70%) or permanent (30%) renal failure. Netilmicin was given at a dosage interval of 24 h, with a loading dose on the first day (1.5 mg/kg) and a reduced daily maintenance dose (0.5 mg/kg) supplemented to the posthemodialysis dosage (1.3 mg/kg) after each hemodialysis. As compared with studies on patients not requiring hemodialysis, mortality (44%) was higher, mainly due to uncontrolled infection, whereas ototoxicity (17%) was not. Peak (5.9 +/- 1.7 mg/L) and trough plasma levels (3.0 +/- 0.9 mg/L) were significantly lower in patients who did not respond and died than were peak (8.2 +/- 2.5 mg/L) and trough (3.8 +/- 1.2 mg/L) levels in patients responding to aminoglycoside treatment. In renal failure patients, there is obviously not only the risk of overdosing and toxic side effects but also the risk of insufficient bactericidal effect as a result of underdosing. Consequently, by use of an aminoglycoside dosage similar to the present schedule, peak levels (5-10 mg/L) as desired in normal subjects but trough levels (2.5-5 mg/L) that are considerably higher than in normal subjects should be the target concentrations for patients with advanced renal failure.

Acute Kidney Injury↗
PubMed1987

Human immunodeficiency virus transmission by organ donation. Outcome in cornea and kidney recipients.

The human immunodeficiency virus (HIV) is reportedly transmitted by sexual contact, sharing of infected needles among intravenous drug abusers, blood and blood products, artificial insemination, and kidney transplantation. This study reports on cornea and kidney recipients of two HIV-infected donors. HIV was transmitted to two kidney recipients who developed symptoms of acute HIV infection (i.e., fever, leukopenia, mild thrombopenia, splenomegaly) starting 12 days after transplantation. These signs of acute infection ended with seroconversion of HIV antibodies on approximately the 56th day after transplantation. The three cornea recipients showed no signs of acute infection and no HIV antibodies were detected up to three years after transplantation. The nontransmission observed in our cases, however, may not be representative of cornea transplantations in general. HIV is neurotropic in the later stages of the disease, and transmission of other neurotropic viruses like rabies and Creutzfeldt-Jakob disease by cornea transplantation has been reported. All tissue and organ donors should be tested for anti-HIV prior to donation.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Aluminium load in patients with analgesic nephropathy.

It is well-known that plasma aluminium in haemodialysis patients increases with the amount of aluminium hydroxide consumption. In a cross-sectional study at our haemodialysis centre we found that mean plasma aluminium levels are significantly higher in haemodialysis patients with analgesic-associated nephropathy (AAN) than in haemodialysis patients with other kidney diseases (controls) (logarithmic mean +/- SD = 1.93 +/- antilog 0.32 versus 1.21 +/- antilog 0.31 mumol/l; p = 0.001). AAN patients consume a significantly higher amount of aluminium-containing phosphate binders than the controls (21 +/- antilog 0.3 versus 13 +/- antilog 0.4 g/kg body weight/year; p = 0.007). These findings may be explained by the higher incidence of peptic ulcer disease in AAN patients, since hyperacidity decreases the phosphate-binding effect. Analgesic patients also need more aluminium-containing stomach medication than do patients with other kidney diseases (0.21 +/- antilog 1.15 versus 0.03 +/- antilog 0.87 g/kg body weight/year; p = 0.0001). A statistically significant correlation was obtained between bone aluminium and duration of phosphate binder consumption (r = 0.6459; n = 14; p less than 0.05). There was no correlation between plasma aluminium and bone aluminium. Anaemia was more pronounced in the AAN patients than in the others (mean haemoglobin 8.4 +/- 1.9 vs. 9.2 +/- 2.0 g%; p less than 0.02). Dialysis dementia was observed in 4 AAN patients. We conclude that the higher plasma aluminium levels in AAN patients represent a higher aluminium load which may be followed by higher aluminium toxicity.

Aluminum↗
PubMed1986

[Prevalence of antibodies against LAV/HTLV-III in patients with terminal renal insufficiency treated with hemodialysis and following renal transplantation].

Sera of 1046 patients undergoing haemodialysis for terminal renal failure or after renal transplantation were tested with the ELISA screening test for anti-LAV/HTLV-III and, if positive, the Western blot and ELAVIA tests. Four patients (0,38%) had "true" antibodies against LAV/HTLV-III, confirmed by the Western blot and ELAVIA tests. These patients had definite signs of cellular immune defects. They had received transplants from drug addict donors. Such kidneys should therefore no longer be used for transplantation. In addition, 29 patients (2.8%) had "false-positive" antibodies against LAV/HTLV-III in the ELISA test, unconfirmed in the Western blot and ELAVIA tests. The "false-positive" result was presumably due to cross-reaction with HLA antibodies. Sera of dialysis and transplantation patients who had received many blood transfusions should therefore be especially carefully tested before a diagnosis of infection with LAV/HTLV-III is made.

Antibodies, Viral↗
PubMed1986

[Preventive use of antibiotics in kidney transplantation].

Antibiotic prophylaxis in kidney transplantation is controversial. In a prospective controlled study, 34 cadaveric kidney transplant recipients were investigated. Antibiotic prophylaxis was given in a random order to 16 patients whereas 18 without prophylaxis served as controlls. In 4 of 20 investigated clinical parameters statistically significant differences were found between both groups: the controlls happened to have better initial conditions; perioperative and postoperative better initial conditions; perioperative and postoperative infections were less frequent in the prophylaxis group and more antibiotics postoperatively were needed in the controlls. These findings indicate that antibiotic prophylaxis has a beneficial effect in kidney transplantation.

Bacteriological Techniques↗
PubMed1985

[Characteristics of terminal analgesics-induced nephropathy].

The diagnosis of analgesic-associated nephropathy (AAN) may be missed because of the patients denial or regular analgesic intake. We therefore performed a cross-sectional study of the 144 patients of our hemodialysis center to investigate differences between the 48 patients with AAN (33%) and patients with other kidney diseases who served as controls. The aim was to find other attributes of analgesic users relating to social history, habits and morbidity. Dialysis patients with AAN were significantly older (60 +/- 10 versus 52 +/- 15 years) and more frequently women (65% versus 37%) compared with controls; they often had a family history of analgesic abuse. Comparison with an age-matched control group of hemodialysis patients with other kidney diseases showed that AAN patients smoked, used hypnotics and laxatives, and required prescriptions significantly more frequently; they were less frequently willing to undergo renal transplantation. With regard to accompanying diseases, they suffered significantly more often than the age-matched controls from anemia, renal osteodystrophy, peptic ulcer disease, diverticulosis, hemorrhoids, atrial fibrillation, coronary heart disease, hyperlipidemia, carpal tunnel syndrome, and urinary tract infections. The characteristic pattern of habits, social history and accompanying diseases may facilitate the diagnosis of AAN even in cases where analgesic consumption is denied.

Age Factors↗
PubMed1985

Low cyclosporin A blood levels and acute graft rejection in a renal transplant recipient during rifampin treatment.

Cyclosporin A trough blood levels were unusually low during rifampin treatment in a kidney transplant patient. Simultaneously, acute graft rejection occurred. Pharmacokinetic investigation revealed a rapid turnover of cyclosporin A leading to low blood levels. Cessation of rifampin therapy reversed these changes. Rifampin substantially reduces the bioavailability of cyclosporin A and should not be used in transplant recipients on cyclosporin A.

Adult↗