Biomedical subjects
Publications and source records attributed to H Graf.
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The therapy of secondary hyperparathyroidism in chronic renal disease has been improved by the availability of active 1-alpha-hydroxylated vitamin D derivatives. However, in cases with progressive secondary hyperparathyroidism which have not been brought under control conservatively, surgical intervention is still required. Total parathyroidectomy with autologous transplantation of parathyroid tissue in the forearm has recently been recommended as the optimum surgical approach to secondary hyperparathyroidism. Recent literature is reviewed and personal clinical experience is reported in this paper, followed by a presentation and discussion of the pathophysiology of hyperparathyroidism in chronic renal failure, various means of conservative treatment, indications for parathyroidectomy, surgical aspects and technique of cryopreservation, as well as a standardized therapeutic regimen for pre- and postoperative treatment with calcium and 1-alpha-hydroxylated vitamin D analogues.
Aluminum kinetics were studied in 24 patients on chronic hemodialysis. All patients had elevated predialytic serum concentrations of aluminum (mean, 3.44 mumoles/liter), which correlated significantly with the ingestion of aluminum hydroxide (P less than 0.01). Simultaneous measurements of aluminum in plasma and ultrafiltrate revealed an ultrafiltrability of about 20% of total plasma aluminum, thus suggesting that 80% of aluminum is protein bound. When a dialysate with a very low aluminum content (varying from 0.1 to 0.3 mumoles/liter) was used, mean values across the dialyzer were 3.20 and 2.67 mumoles/liter, respectively, showing a significant decrease of plasma aluminum during dialyzer passage (P less than 0.0001). It could be shown that dialysance of aluminum depends on the concentration gradient between the free diffusible plasma aluminum and the dialysate aluminum concentration. After 6 hours of dialysis, plasma aluminum concentrations were significantly lower than were predialysis values (P less than 0.0001). We conclude that a negative aluminum balance during hemodialysis can be assumed as long as the aluminum concentration of free diffusible plasma aluminum lies above the aluminum concentration of the dialysate.
1 alpha-hydroxycholecalciferol was tried as a therapy for renal phosphate wasting in kidney allograft recipients with normal parathyroid gland activity. During a 3-week period of treatment we observed a significant rise in renal phosphate threshold concentrations and plasma phosphate levels paralleled by a significant decrease in serum immunoreactive parathyroid hormone levels and a significant increase in intestinal calcium absorption. It is suggested that 1 alpha-hydroxycholecalciferol acts on renal phosphate handling in a dual fashion: one is by suppression of parathyroid hormone and the other by restoration of 1,25-dihydroxycholecalciferol levels to an appropriate level.
Two groups of patients with multiple injuries were treated with high-caloric parenteral nutrition over a period of 10 days. One group received amino acids (1 g/kg BW/day) and dextrose (2.0 x resting metabolic rate calories). In the other group dextrose was partially substituted by an isocaloric amount of lipids (2 g/kg BW/day). As for blood and serum glucose, pyruvate, lactate, triglycerides, cholesterol, phosphatides, free fatty acids, glycerol, acetoacetate and beta-hydroxybutyrate there were no significant differences between the two groups. Nevertheless, in the lipid group more balanced blood-sugar levels were seen with smaller amounts of insulin to be needed. This suggests a beneficial effect on the carbohydrate metabolism.
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The effects of desferrioxamine administration of aluminium kinetics during haemodialysis were studied. Desferrioxamine leads to an increase of plasma aluminium levels in patients on chronic haemodialysis which could be attributed to mobilisation of tissue aluminium. Furthermore the ultrafiltrable function of plasma aluminium was greatly enhanced thus increasing the effective concentration gradient of aluminium between plasma and dialysate. Desferrioxamine therefore leads to increased aluminium removal during haemodialysis and should be considered in the therapy of aluminium toxicity syndromes.