Outpatients outclassed.
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Appointments and Schedules↗
Biomedical subjects
H Moore
Publications and source records attributed to H Moore.
Central versus peripheral effects of muscarinic antagonists: the limitations of quaternary ammonium derivatives.
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Animals↗
Sieving and reflection coefficients for sodium salts and glucose during peritoneal dialysis in rats.
The two-part studies reported herein address peritoneal membrane ultrafiltrate (UF) characteristics during peritoneal dialysis exchanges in rats. In the studies of part 1, the sieving coefficients for sodium, chloride, and total solutes during hydrostatic UF after instillation of rat serum into the peritoneal cavity of rats were calculated. Thirty-six rats were divided into six groups (N = 6) according to the following peritoneal dialysis exchange cycle times: 60, 120, 180, 240, 480, and 960 min. Thirty milliliters of pooled rat serum were infused i.p. with the animal being conscious except during infusion and drainage. The study showed in the early phase of exchanges, when oncotic and osmotic pressure gradients were absent, net UF presumably due to capillary hydrostatic pressure and sodium sieving during such UF. Sieving coefficients for sodium (0.72), chloride (0.77) and total solutes (0.73) were determined by using standard formulae. In the second part of these studies, the kinetics of fluid movement after the instillation of 5% dextrose solution into the peritoneal cavity of rats were analyzed. A very low UF rate was observed early in the exchange when the glucose gradient between the dialysis solution and blood was at its peak. The UF rate gradually increased as the sodium entered the dialysis solution from the blood. At the time of low UF rate with high glucose gradient, presumably the osmotic pressure generated by the glucose in the dialysis solution was countered by the osmotic pressure of solutes in plasma, i.e., sodium and its anions.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Effect of peritonitis on insulin and glucose absorption during peritoneal dialysis in diabetic rats.
The intraperitoneal route is frequently used for the administration of insulin in diabetic continuous ambulatory peritoneal dialysis patients. However, there is conflicting evidence as to whether the dosage of intraperitoneal insulin should be increased or decreased during peritonitis in these patients. Glucose and insulin absorption and glycaemic control were evaluated in 2-hour exchanges using 15 ml of 2.5% dextrose dialysis solution in diabetic rats with (group 1) and without (group 2) peritonitis. Fasting blood glucose values at the beginning of the study exchanges were mean +/- SD 17.9 +/- 3.3 mmol/l in group 1 and 18.2 +/- 3.5 mmol/l in group 2. Even though group 1 had a higher percentage absorption of dialysate glucose (65 +/- 19 vs. 47 +/- 7%; p less than 0.05) and higher percentage absorption of dialysate insulin (49 +/- 12 vs. 44 +/- 14%; p less than 0.1), the hypoglycaemic response to the standard intraperitoneal dose of insulin was similar in each group. Plasma C peptide levels remained very low in both groups, thus excluding significant endogenous release of insulin. These data indicate that peritonitis per se does not change intraperitoneal insulin requirements during standardized peritoneal dialysis exchanges in diabetic rats. Insulin requirements may also be unaltered during peritonitis in diabetic continuous ambulatory peritoneal dialysis patients, provided that dialysate glucose load and oral carbohydrate intake are kept constant.
Absorption↗
Defining adequacy of CAPD with urea kinetics.
The purpose of this paper is to explore the validity of applying urea kinetic indices to CAPD. According to the peak concentration hypothesis, the values of Kt/V required for adequate dialysis are lower for CAPD than for hemodialysis because of the continuous steady state nature of CAPD. Pilot clinical studies were undertaken in 19 patients to correlate the (Kt/V)urea index with clinical assessment of adequacy based on a 12 parameter score. The data shows that the correlation between serum urea nitrogen (Kt/V)urea and protein catabolic rate (PCR) are in keeping with the theoretical predictions of the urea kinetic model. PCR and dietary protein are well correlated. Also, PCR and Kt/V had a high degree of positive correlation. Serum creatinine was inversely correlated with (Kt/V)creatinine. In 74% of the patients, the clinical assessment of adequacy was in agreement with the (Kt/V)urea domains of adequacy established from the peak concentration hypothesis and the urea kinetic model. The lack of correlation in the remaining 26% is being investigated.
Blood Urea Nitrogen↗
Treatment of recurrent spontaneous abortion by immunization with paternal lymphocytes: correlates with outcome.
Previous observations have suggested that defective recognition of fetal alloantigens by the maternal immune system is associated with recurrent pregnancy failure and that this may be prevented by boosting the maternal immune system with paternal or pooled third-party leukocytes. The mechanism whereby this process achieves success is not clear, and accordingly to explore this we immunized 28 couples with recurrent fetal loss with 80 x 10(6) paternal peripheral blood mononuclear leukocytes (PBML) and followed various immunological parameters. The couples studied, in whom 55% achieved a successful pregnancy, showed no increase in sharing of human lymphocyte antigen (HLA)-A, -B, or -DR antigens and no consistent evidence of a decreased mixed leukocyte reaction (MLR) or MLR plasma-blocking factors compared with control couples. Immunization did not alter these parameters but did induce antipaternal lymphocytotoxins, although the presence of the latter did not correlate with pregnancy outcome. There was a correlation between rapid conception after immunization and a subsequent successful pregnancy. A successful pregnancy also correlated with sustained postimmunization, postconception maternal antipaternal allospecific CD-8+ suppressor T cells. Although these findings provide overall evidence that immunization produces changes in the way in which the maternal immune system interacts with the fetus, larger numbers of couples and a higher dose of paternal lymphocytes will be needed to establish clearly whether this therapy works and its mechanism of action.
Abortion, Spontaneous↗
Health, nutrition and agricultural development in northern Zambia.
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Adult↗
Kinetics of peritoneal dialysis in children: role of lymphatics.
Intraperitoneal fluid is absorbed continuously by convective flow into the peritoneal cavity lymphatics. We evaluated the role of lymphatic absorption in the kinetics of peritoneal dialysis during standardized four hour exchanges in six children using 40 ml/kg of 2.5% dextrose dialysis solution. Cumulative lymphatic absorption averaged 10.4 +/- 1.6 ml/kg and reduced the total net transcapillary ultrafiltration during the dwell time by 73 +/- 10%. Due to the considerable lymphatic absorption rate, maximum intraperitoneal volume was observed before osmolar equilibrium. Extrapolated to four study exchanges per day, lymphatic absorption decreased the potential daily drain volumes in the children by 27 +/- 5% and daily peritoneal urea and creatinine clearances by 24 +/- 4% and 22 +/- 5%, respectively. Compared with four hour exchanges using two liters of 2.5% dextrose dialysis solution in 10 adult CAPD patients with average peritoneal transport, the children had more rapid equilibration of urea, greater absorption of dialysate glucose, higher lymphatic absorption and lower net ultrafiltration (P less than 0.01 to P less than 0.05). Lymphatic absorption therefore causes a relatively greater reduction in net ultrafiltration and solute clearances in children than in adults.
Adolescent↗
Long-term outcome following programmed electrical stimulation in patients with high-grade ventricular ectopy.
To determine if programmed electrical stimulation (PES) could be utilized to identify patients with high-grade ventricular ectopy at low- or high-risk for sudden cardiac death, we performed PES in 40 patients with high-grade ventricular ectopy refractory to conventional antiarrhythmic agents. Twenty-one patients had a previous myocardial infarction, five had cardiomyopathy, six had hypertension, three had valvular heart disease and five had no known structural heart disease. The mean age was 50 years (range, 18 to 76). During programmed ventricular stimulation, eight patients had inducible sustained (more than 30 seconds) monomorphic ventricular tachycardia (Group I) but in 32 patients sustained ventricular tachycardia was not inducible (Group II). None of the five patients without structural heart disease were inducible while seven out of 21 (33%) patients with previous myocardial infarction had inducible ventricular tachycardia (VT). Antiarrhythmic therapy was instituted in patients with inducible VT; patients without inducible VT did not receive antiarrhythmic agents. In Group I, seven of the eight patients are alive (mean follow-up, 16 months) and in Group II, 28 of the 32 patients are alive (mean follow-up, 17 months). None of the five deaths were sudden. We conclude that in the absence of antiarrhythmic therapy, the incidence of sudden cardiac death is very low in patients with high-grade ventricular ectopy who do not have inducible monomorphic ventricular tachycardia during programmed ventricular stimulation.
Death, Sudden↗
Pharmacological reduction of lymphatic absorption from the peritoneal cavity increases net ultrafiltration and solute clearances in peritoneal dialysis.
Lymphatic drainage from the peritoneal cavity occurs mainly via the subdiaphragmatic stomata and significantly reduces net ultrafiltration and solute clearances during long-dwell peritoneal dialysis. Intraperitoneal cholinergic drugs constrict these stomata and may reduce peritoneal cavity lymphatic absorption. We evaluated ultrafiltration kinetics, solute transport, and lymphatic drainage during single hypertonic exchanges in rats using 2.5% dextrose dialysis solution with and without added neostigmine. Net ultrafiltration was enhanced in the neostigmine group (p less than 0.01) by a reduction in cumulative lymphatic absorption (p less than 0.01) and without an increase in total transcapillary ultrafiltration during the dwell time. Likewise solute clearances were significantly augmented with neostigmine primarily due to the increase in dialysate drain volume (p less than 0.01) since dialysate/serum solute ratios were unchanged. Pharmacological manipulation of peritoneal lymphatic absorption provides an alternative means of increasing the efficiency of long-dwell peritoneal dialysis without altering peritoneal transport of solutes and water.
Absorption↗
The kinetics of ultrafiltration during peritoneal dialysis: the role of lymphatics.
Net ultrafiltration was measured directly during hypertonic peritoneal dialysis exchanges in rats. Simultaneously, lymphatic absorption was measured by monitoring the disappearance of albumin in the instilled dialysis solution from the peritoneal cavity. The albumin method for measuring lymphatic absorption was also tested in rats absorbing Lactated Ringer's solution from the peritoneal cavity where absorption rate could also be measured directly. The findings suggest the following: 1.) lymphatic absorption rate is similar with both hypertonic dialysis solutions and Lactated Ringer's solution; 2.) lymphatic absorption is substantial and net ultrafiltration is well below true transcapillary ultrafiltration; and 3.) in our model, lymphatic absorption occurs at a relatively constant rate over six hours of dwell time.
Absorption↗
Cutting down trees: women, nutrition and agricultural change in the northern province of Zambia, 1920-1986.
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Diet↗
Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis.
The contribution of peritoneal cavity lymphatic absorption to ultrafiltration kinetics and solute clearances in continuous ambulatory peritoneal dialysis was evaluated in patients with normal (group 1) and high (group 2) peritoneal permeability X area during 4-h exchanges using 2 liters 2.5% dextrose dialysis solution with 30 g added albumin. Cumulative lymphatic drainage in all continuous ambulatory peritoneal dialysis (CAPD) patients averaged 358 +/- 47 ml per 4-h exchange and reduced cumulative net transcapillary ultrafiltration at the end of the exchange by 58 +/- 7.2%. The peak ultrafiltration volume was observed before osmotic equilibrium between serum and dialysate was reached and occurred when the net transcapillary ultrafiltration rate had decreased to equal the lymphatic absorption rate. Thereafter the lymphatic absorption rate exceeded the net transcapillary ultrafiltration rate, and intraperitoneal volume decreased. Extrapolated to 4 X 2 liters, 2.5% dextrose, 6-h exchanges per d, lymphatic drainage reduced potential daily net ultrafiltration by 83.2 +/- 10.2%, daily urea clearance by 16.9 +/- 1.9%, and daily creatinine clearance by 16.5 +/- 1.9%. Although lymphatic absorption did not differ between the two groups, lymphatic drainage caused a proportionately greater reduction in net ultrafiltration in group 2 (P less than 0.025), because these patients had more rapid dialysate glucose absorption (P less than 0.05) and less cumulative transcapillary ultrafiltration (P less than 0.01). These findings indicate that cumulative lymphatic drainage significantly reduces net ultrafiltration and solute clearances in CAPD and that ultrafiltration failure in CAPD occurs when daily lymphatic absorption equals or exceeds daily transcapillary ultrafiltration. Reduction of lymphatic absorption may provide a means for future improvement in the efficiency of CAPD.
Absorption↗
Determination of bromide ion concentration in greyhound urine by ion chromatography.
An ion chromatographic method was used to determine Br ion in the urine of Greyhounds. Phenol was added to the urine, before filtration through a 30,000-molecular weight cutoff filter and to the eluant (pH 11, NaOH-Na2CO3), as a preservative. Urine from 103 racing Greyhounds resulted in a mean +/- SD of 3.60 +/- 2.72 mg of Br/L of urine. Urine samples obtained from a Greyhound, to which 2 g of KBr was administered, yielded a diurnal elimination pattern with a half-life of 7.6 days.
Animals↗
The clinical value of free phenytoin levels.
The relationship between total and free phenytoin levels and drug toxicity was studied in 80 patients. Twenty-four were taking phenytoin alone. Drug toxicity was assessed by a "blind" rater using an eight-point standardized scoring system. The mean free phenytoin fraction was 0.076 in patients taking phenytoin alone or phenytoin and carbamazepine and 0.11 in patients taking valproic acid (p less than 0.001). The free fraction did not change with the total level over the range tested (6.7 to 39.9 micrograms/ml total phenytoin). There was a strong correlation between free and total levels (r = 0.84). Both free (r = 0.59) and total (r = 0.49) phenytoin levels were positively correlated with the toxicity score. Only total phenytoin levels showed a weak positive correlation with decreasing seizure frequency. Our results suggest that routine free phenytoin level monitoring is not necessary in most clinical situations.
Adolescent↗
FMC-HU-1-B: a lymphoma B-cell line with unusual characteristics.
A cell line (FMC-Hu-1-B) was established from a biopsy of an abdominal mass of a child with non-Burkitt's lymphoma. The establishment of the cell line initially required the presence of normal bone marrow stromal cells and phytohaemagglutinin stimulated leucocyte conditioned medium. The cell line lacked Epstein-Barr virus nuclear antigen and exhibited numerous chromosomal abnormalities. Cell-surface marker analysis using a panel of monoclonal antibodies revealed only markers of the B lineage. Within the B-cell lineage FMC-Hu-1-B seemed to occupy a level of maturation equivalent to normal mature B-cells (surface membrane IgM, secretion of immunoglobulin and FMC-1 positive). However, the cells also weakly expressed the common acute lymphoblastic leukaemia antigen, normally found on early precursors of B-cells. The cells appear to secrete auto-stimulatory growth factor(s).
B-Lymphocytes↗
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↗
Reconstruction of a thyroid gland equivalent from cells and matrix materials.
A living thyroid gland equivalent has been fabricated with a cultivated strain of rat thyroid cells (FRTL), dermal or thyroid fibroblasts, and matrix materials. The mixture becomes tissuelike in vitro by virtue of interactions between fibroblasts and collagen. Initially in vitro the thyroid cells are uniformly distributed as single cells and a small number of clusters containing less than 10 cells. When implanted into thyrodectomized hosts the thyroid cells in the tissue lattice become organized into follicles containing a colloidlike material. The follicles were found in clusters in sizes up to 0.3 mm. The clusters are vascularized. It is thought that they arise within clones rather than by an aggregation process. Using an antithyroglobulin antibody it was shown that both thyroid cells and the colloidlike material within follicles reacted positively. Development of follicles was strictly dependent on whether hosts were thyroidectomized. In nonthyroidectomized hosts no follicles were observed. We conclude that an organotypic structure can develop in vivo from a "gland-equivalent" fabricated with adult cells and matrix materials combined in vitro, and that cells cultivated for years in vitro retain the capacity to express differentiated functions in a reconstituted organ equivalent in vivo.
Animals↗