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Biomedical subjects

J Erben

Publications and source records attributed to J Erben.

At least 19 recordsLinked to original sources
PubMed1996

[Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of symptomatic portal hypertension].

BACKGROUND: A transjugular intrahepatic portosystemic shunt (TIPS) is the creation of a percutaneous portosystemic anastomosis which is used as an alternative method of surgical portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.

Adolescent↗
PubMed1995

Kinetics of phenols in body fluid compartments during hemodialysis.

On the basis of direct quantification of hemodialysis (HD), the kinetics of phenols (Ph) were followed in 13 patients on regular HD treatment. The average plasma levels of Ph before and after HD were 627 +/- 109 mumol/L and 416 +/- 81 mumol/L, respectively. The total amount of Ph removed during 5-h HD was 7,481 +/- 1,894 mumol. For calculation of the generation rate (G), a new formula has been derived not requiring knowledge of the corresponding volume of distribution. The G of Ph was 2.9 +/- 0.7 mumol/min on average. The mean dialysis clearance (K) of Ph was 48.2 +/- 10.2 ml/min.

Adult↗
PubMed1994

[Changes in amino acids in a regular dialysis program].

BACKGROUND: Dialyzed patients are chronically in a state of negative nitrogen balance, and amino acids, their building stones, are also significantly affected by dialysis. The purpose of the present investigation was to assess whether they should be supplied, how frequently and for how long and how they are influenced by the usual diet of patients. METHODS AND RESULTS: The examination was made in a group of 13 patients included in a regular haemodialysis programme. Their mean age was 53.2 +/- 12.4 years, they were dialyzed for an average period of 55 months, maximum 163 months. The patients were dialyzed three times per week for four hours, bicarbonate dialysate was used. The patients' diet was not modified in any way. A total of 52 haemodialysis were examined: losses of alpha-amino nitrogen were monitored as well as changes of serum concentrations of different amino acids. Their mean losses were 119 +/- 54.69 mmol/4 h: this corresponds to 10.5 +/- 4.8 mg amino acids. The dialysis clearance was on average 122.7 +/- 63.2 ml/min. This value did not differ significantly from the dialysis clearance of urea, but it was significantly higher than creatinine clearance (p < 0.05). During dialysis a significant drop (p < 0.001) of the plasma concentration of amino nitrogen occurred, however, the changes of serum concentrations of amino acids differed. A significant drop was recorded in serum concentrations of histamine, lysine, cysteine, methionine, tyrosine, glycine, asparagine, citrullin, glutamine, taurine. Before the beginning of dialysis the values of valine, lysine, threonine, serine, alanine and asparagine were lower than corresponds to the reference interval in healthy subjects. CONCLUSIONS: Changes of serum concentrations of individual amino acids are significantly influenced not only by their losses into the dialysate but also by their shift from cells into the extracellular fluid and by resorption from the digestive tract during protein intake in the course of dialysis. An adequate supply of high quality protein can compensate for these losses. Investigation of serum concentration of individual amino acids does not record their kinetic changes but can give an idea on the effectiveness of the dietary regime.

Amino Acids↗
PubMed1993

[Determination of urea distribution space on the basis of hemodialysis quantification].

By using direct dialysis quantification--DDQ--in 124 haemodialyses made in 14 patients the authors assessed the urea output in mmol in the dialyzation fluid collected after every dialysis. The evaluation of total body fluids, which accounts roughly for 60% of the total body weight, was replaced by a calculated distribution space of urea (Vu) according to the Du/Ppre--Ppost formula. This equation was modified with regard to the degree of ultrafiltration and urea formation. The authors found a 5% difference between the values of the modified Vu equation and total body fluids corresponding to 60% of the body weight.

Adult↗
PubMed1992

[Determination of lactoferrin in the diagnosis of pancreatopathy in patients with chronic kidney failure].

The authors investigated in patients with renal disease the lactoferrin content in duodenal aspirate. The aspirate was obtained after previous stimulation of the pancreas with pancreozymin. Lactoferrin estimation is described in the literature as a sensitive examination of changes of exocrine pancreatic secretion. The authors provided evidence that by assessing lactoferrin it is possible to detect initial changes of reduced exocrine pancreatic capacity already in subjects who are on the waiting list of chronic intermittent haemodialyzation programmes (CHIDP); maximum increase of the lactoferrin content in the duodenal aspirate corresponds with the severity of chronic renal failure. Transplantation of the kidneys leads to normalization of the amount of lactoferrin secreted by the pancreas which is evidence of normalization of pancreatic secretion. In patients with chronic renal failure lactoferrin is a sensitive marker of developing uraemic pancreatopathy.

Humans↗
PubMed1992

[Hemorrhage into the digestive tract as a cause of death in patients after kidney transplantation].

The authors investigated the prevalence, cause and possible prevention of haemorrhage into the gastrointestinal tract in 218 patients after transplantation of the kidney (TK). 1. Haemorrhage into the gastrointestinal tract after TK occurred in 32 patients incl. 53.1% who died. In the total mortality after TK haemorrhage into the gastrointestinal tract account for 15.7%. 2. The danger of haemorrhage into the gastrointestinal tract is increased in particular: in the early postoperative period (within one month after transplantation of the kidney), during acute rejection with declining function of the graft, in infectious complications, after graftectomy, in preexisting peptic ulcers. 3. The most frequent cause of haemorrhage were duodenal ulcers. The authors elaborated a system of preventive provisions which involve: a) medicamentous prophylaxis by administration of H2 blockers and antacids not only at the time of transplantation of the kidney and during the early postoperative period but also when there is an increased risk, b) detailed gastroenterological examination before transplantation of the kidney, c) in case of relapsing peptic ulceration in the case-history or haemorrhage into the gastrointestinal tract, subject patients on the waiting list for transplantation of the kidneys during the dialyzation period to proximal gastric vagotomy, or so-called highly selective vagotomy.

Gastrointestinal Hemorrhage↗
PubMed1991

[The critical value of residual kidney function in patients with chronic kidney failure from the viewpoint of the concentration of urea and potassium in the plasma].

Residual kidney function was examined in 10 patients with chronic renal insufficiency under balance conditions and in 30 outpatients on the basis of urea clearance (Curea) and potassium clearance (CK). Protein intake was 35-40 g/day (0.5 g/kg/day) and potassium intake was 30-40 mmol/day. Under these conditions the critical values of residual kidney function were as follows: 1) plasma urea concentration (Purea) did not exceed 30 mmol/l if Curea did not drop below 3.8 ml/min; 2) plasma potassium concentration (PK) did not exceed 5 mmol/l if CK did not decrease below 4.1 ml/min. Clinical examination of Curea and CK provides additional information to the examination of creatinine clearance (Ccr) or its plasma concentration (Pcr). Our results suggest that the critical value of residual kidney function cannot be defined only on the basis of examination of Ccr or Pcr. Examination of Curea and CK can help in the interpretation of very high Purea and hyperkalemia in patients with chronic renal insufficiency.

Ambulatory Care↗
PubMed1990

[Visual function in patients with neuroretinopathy on regular dialysis treatment].

Eight patients included in a regular dialyzation programme who developed neuroretinopathy were subjected to improved dialyzation treatment. It involved variation of sodium and variation of ultrafiltration. After regression of acute symptoms on the fundus in all patients a vision of 6/6 was achieved. Patients with neuroretinopathy have a markedly reduced contrast sensitivity. The latter increases considerably after absorption of the oedema, although it does not attain values recorded in healthy subjects.

Adult↗
PubMed1990

Residual kidney function and plasma urea concentration in patients with chronic renal failure.

The relationships between the plasma levels of urea (P(urea)), renal clearance of urea (C(urea)) and creatinine (Ccr) at an intake of 0.5 g protein/kg body weight/day were followed in 10 patients with chronic renal failure (CRF) under balance conditions. Under these conditions, P(urea) attained a value of 30 mmol/l when C(urea) had decreased below 3.8 ml/min. By contrast, no correlation could be demonstrated between P(urea) and Ccr under these conditions. The same relationships were followed in another group of 30 outpatients with CRF. Even in patients not followed under balance conditions, C(urea) determination makes it possible to establish whether the high increase in P(urea) is due to the decrease in residual renal function below the critical level or whether extrarenal factors are involved. Likewise, no significant correlation between P(urea) and Ccr could be demonstrated under these conditions. The findings suggest that C(urea) measurement in CRF patients helps to assess residual renal function in terms of P(urea) regulation and provides information that cannot be obtained by Ccr measurement.

Blood Urea Nitrogen↗
PubMed1990

Occurrence of neuroretinopathy in dialyzed patients.

In the last 11 years, the neuroretinopathy is reported to occur in 26 dialyzed patients, what represents 5.3% of all patients treated. During the last 4 years, the occurrence rate showed the decrease to 1.6%. The mentioned disease occurs most frequently by the first two years of treatment with dialysis. The averaged survival rate after the onset of neuroretinopathy is ranged as 19.4 mos. in 16 died patients. The disease occurred in 13 patients under the condition of normal diastolic pressure. Metabolic disorder characterized with high levels of serum nitrogenic substances may be further factor inducing the onset of neuroretinopathy backgrounded by cerebral oedema. Since neuroretinopathy consequentially worsens both the subjective (visual acuity, sensitivity to the contrast) and objective (electric activity) sight functions, the appropriate attempt is to be made in achieving rapidly retrogression of pathologic retinal changes by modification of dialysis process.

Adult↗
PubMed1990

[The critical level of renal function in patients with chronic renal failure from the aspect of maintaining normal levels of potassium in the blood].

In 29 subjects with chronic renal failure (Pkr = 826 +/- 69 mumol/, Ckr 0.128 +/- +0.039 ml/s) treated by conservative therapy the urinary excretion and residual renal potassium clearance (CK) was investigated. In 17% of these patients the plasma potassium level (PK) was higher than 5 mmol/l. The PK levels were not significantly related to the value of the residual diuresis, to the daily urinary potassium excretion nor the value of residual creatinine clearance. A significant relationship was found between values PK and CK. The critical CK value where PK rises above 5 mmol/l (under conditions of reduced protein intake 0.5 g/kd/day and a potassium intake not exceeding 40 mmol/l/24 hours) suggests the participation of extrarenal factors (excessive K intake or it's increased shift from cells to extracellular fluid).

Adult↗
PubMed1989

[Complications of subclavian and femoral cannulas].

In the course of 15 years in the author's department some 15,000 cannulas were inserted into the subclavian or femoral vein. This number included cca 2300 cannulas inserted to dialyzed patients. 213 patients (inl. 28 dialyzed) died with the inserted cannula. In these patients the incidence of complications was evaluated. A parietal thrombosis was the most frequent complication and was recorded in 119 cases, i.e. in 56% (in non-dialyzed in 57% and in dialyzed in 50%). In two non-dialyzed patients it was the cause of embolization into the lungs. In the incidence of complications there is no significant difference in dialyzed and non-dialyzed patients. For completeness the authors present a preliminary calculation per approximate number of inserted cannulas during this period. From the total number of 15,000 inserted cannulas fatal complications occurred in 0.06% (in dialyzed in 0.13% and non-dialyzed in 0.047%).

Catheterization, Peripheral↗
PubMed1989

[Neuroretinopathy in dialyzed patients].

Over the past 11 years, neuroretinopathy was seen in 26 hemodialyzed patients, in an average 5.3% of the patients receiving treatment. During the past 4 years, the rate of incidence had dropped to 1.6%. Neuroretinopathy is most likely to develop in the first two years of artificial kidney treatment. The mean survival time following an attack of neuroretinopathy in 16 decreased patients was 19.4 months. Three patients underwent successful kidney transplantation, 50% were normotensives. As part of the subsequent search for other pathogenetic factors, a high incidence of pathological values of nitrogenous substances was found (urea in 77%, creatinine in 76%, uric acid in 42%). 85% suffered from electric retinal function impairment.

Adult↗
PubMed1989

The plasma concentration and renal elimination of phenols in patients with chronic renal insufficiency.

The plasma concentration and renal elimination of phenols was studied in 32 individuals with various renal insufficiency (CRI) and in 30 healthy subjects. In patients with chronic renal insufficiency the increase in P phenols values correlated directly with Per and P urea. Daily urinary excretion of phenols in patients with CRI is only mildly decreased compared with that in healthy controls. Renal clearance (C phenols), 8.52 (+/- 2.69) ml/min on an average, decreases significantly in patients with CRI. While fraction excretion of phenols (FE phenols) was 9.53 (+/- 4.14) % on an average in healthy persons, patients with CRI displayed a significant increase. A significant linear correlation in the values of FE phenols and FEH2O and those of FE phenols and FE urea was documented. Our findings support the assumption that phenols are excreted by the kidney by a mechanism similar to that of urea excretion. Filtration of phenols in the glomeruli is followed, in healthy volunteers, by their significant reabsorption which is a flow-dependent process. In the residual nephrons of patients with CRI, the tubular reabsorption of phenols is decreased, a mechanism largely compensating the effect of decreased filtration of phenols on their total urinary excretion.

Adult↗
PubMed1989

[Determination and interpretation of carboxyhemoglobin in traces of biological material].

The author investigated the possibility of assessment of the carboxy haemoglobin level in blood stains and particles of tissues which contain at least minimal amounts of blood pigment. For the examination methods were modified which are used for similar estimations in blood. In the blood stains the decline of carboxy-haemoglobin was investigated in relation to some external influences. The author investigated also the ability of haemoglobin to react with carbon monoxide at different periods after the development of blood stains.

Blood Stains↗