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Biomedical subjects

J M Bargman

Publications and source records attributed to J M Bargman.

At least 37 records · Page 2Linked to original sources
PubMed1994

Diagnosis of lymphoma in a continuous ambulatory peritoneal dialysis patient by peritoneal fluid cytology.

A 72-year-old woman with diabetic nephropathy receiving continuous ambulatory peritoneal dialysis for 1 year presented with recurrent episodes of sterile cloudy dialysate. Abdominal ultrasound and computed tomography demonstrated retroperitoneal masses. Cytology of the dialysis fluid revealed large atypical lymphocytes with light chain restriction, strongly suggestive of lymphoma. Fine-needle aspiration of the retroperitoneal masses showed cells with identical cytologic and immunocytochemical staining characteristics. This is the first report of de novo lymphoma diagnosed in a continuous ambulatory peritoneal dialysis patient by cytologic analysis of the dialysis effluent.

Aged↗
PubMed1994

IgG heavy-chain deposition disease.

A 51-yr-old man presented with renal failure, proteinuria, hematuria, and hypertension. The serum contained two monoclonal protein spikes, an IgG4 lambda and free lambda light chains. Free gamma heavy chains were absent from serum. A bone marrow biopsy did not show evidence of a plasmalymphocytic dyscrasia. Renal biopsy showed a nodular glomerulopathy with linear deposits of gamma 4 heavy chains alone along glomerular, tubular, and vascular basement membranes and in mesangial regions. No light chains were detected in the kidney despite staining with antisera directed against both free and bound light chains and the F(ab')2 fragment of IgG. The term heavy-chain deposition disease is appropriate in view of the above features.

Heavy Chain Disease↗
PubMed1994

Intraperitoneal versus subcutaneous insulin in patients on nighttime IPD.

For the diabetic patient on peritoneal dialysis, the intraperitoneal administration of insulin can lead to improvement in glycemic control while eliminating uncomfortable subcutaneous injections. Furthermore, the relatively higher portal vein concentrations of insulin compared to peripheral levels is reminiscent of the physiologic state in which the portal vein carries the insulin secreted by the pancreas. The pharmacokinetics of intraperitoneal insulin depends upon whether the insulin is administered along with the usual volume of dialysis fluid or is given undiluted. This variability has important implications for glycemic control in the patient receiving cycler peritoneal dialysis, particularly if the abdomen is dry for prolonged periods during the day. Recommendations are made based on the known pharmacokinetics of intraperitoneal insulin in both the dry and filled peritoneal cavity.

Diabetes Mellitus↗
PubMed1994

The effect of in vivo erythropoietin on cytokine mRNA in CAPD patients.

There is increasing evidence that erythropoietin (EPO) affects immune function in addition to its well-known effects on the erythrogenesis. However, many of the studies examining the immunomodulatory capacity of this hormone have been in vitro. We examined mRNA signal for three important cytokines, interleukin 1(IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-alpha), in stable continuous ambulatory peritoneal dialysis (CAPD) patients at baseline, and again at 2, 4, and 6 months after treatment with EPO. Significant changes were noted in all three cytokine mRNA signals in the majority of patients treated with this hormone. We conclude that EPO has significant immunomodulatory effects in vivo as defined by changes in cytokine mRNA compared to control. The significance of these changes, and their relationship to well-being and altered immune function remain to be better defined.

Adult↗
PubMed1992

The pharmacokinetics of intraperitoneal erythropoietin administered undiluted or diluted in dialysate.

OBJECTIVE: To compare the bioavailability of intraperitoneal erythropoietin (EPO) administered undiluted versus diluted in 2 L of dialysis fluid. DESIGN: Group 1 patients received one dose of EPO, 400 U/kg BW given with vehicle only. This dwelled for 8 hours after which 2 L of dialysate were infused. Group 2 patients received the same dose of EPO diluted in 2 L of dialysate which dwelled for 8 hours. Both groups resumed their CAPD regimen after the first 8 hours. Blood levels of EPO were measured for 24 hours in both groups. SETTING: The Home Peritoneal Dialysis Unit, Toronto Hospital, Western Division. PATIENTS: The participants were on CAPD for at least three months, free of peritonitis, and had no abnormalities of peritoneal transport. Three patients took part in both arms of the study, and there were 6 patients altogether in each group. RESULTS: When EPO was administered undiluted, there was a greater than ninefold increase in bioavailability of the hormone as measured by the area under the curve (AUC), compared to when the same dose was diluted in 2 L of dialysis fluid. CONCLUSIONS: The previous studies that reported low bioavailability of intraperitoneal EPO used the hormone diluted in dialysate. The current findings suggest that if EPO is given in the dry peritoneal cavity, the bioavailability is greatly improved and may be clinically effective. Intraperitoneal instillation may prove to be an alternative route for EPO in the peritoneal dialysis patient unable or unwilling to receive subcutaneous injections. We are currently studying the effectiveness of undiluted intraperitoneal EPO in CAPD patients.

Adult↗
PubMed1992

IgA nephritis in HIV-positive patients: a new HIV-associated nephropathy?

Four HIV-positive patients were shown to have IgA-associated nephritis on biopsy, including one with anaphylactoid purpura. Three were homosexuals, while the fourth acquired the infection from his mother. All had hematuria, a variable degree of proteinuria and renal disease with a benign course. Serologic studies showed elevated levels of IgA as well as IgA immune complexes and rheumatoid factor. IgA antibodies to multiple HIV antigens were detected by Western blot. Pathologic studies showed tubuloreticular inclusions in endothelial cells and nuclear bodies in interstitial cells in all cases. HIV antigens were not detected in kidney biopsies by monoclonal antibodies nor was HIV viral genome demonstrated by in situ hybridization. The possibility that this represents a unique type of IgA-associated HIV nephropathy is discussed.

AIDS-Associated Nephropathy↗
PubMed1991

Renal cortical nephrocalcinosis: a manifestation of extrapulmonary Pneumocystis carinii infection in the acquired immunodeficiency syndrome.

A 38-year-old man with acquired immunodeficiency syndrome (AIDS) demonstrated atypical nephrocalcinosis on abdominal x-ray. Computed tomography (CT) scanning showed the calcifications to be predominantly in a cortical distribution. The patient had evidence of disseminated Pneumocystis carinii infection, and histologically the renal calcifications occurred in areas of renal Pneumocystis infection. Intrarenal infection with Pneumocystis carinii can be added to the causes of nephrocalcinosis. However, the radiologic picture is so unique that it should suggest the diagnosis in the appropriate patient.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Characterization of peritoneal transport in patients with failed renal allografts receiving CAPD.

Many patients with failed renal transplants elect to receive continuous ambulatory peritoneal dialysis (CAPD) as their modality of dialysis. For others, cardiovascular considerations or access difficulties make CAPD a necessary option when these patients return to dialysis. It is unclear what effects renal transplantation, chronic immunosuppressive therapy and graft rejection might have on the integrity of the peritoneal membrane. We report on thirteen patients receiving CAPD who had peritoneal equilibration test (PET) studies after a failed renal transplant. Three of these patients had studies done pre and post transplantation. Our solute equilibration studies demonstrated that for 10 patients studied with the older 4.25% technique the mean post transplantation D/P creatinine was 0.688 (SE:0.039) on the border of high and low average, and the mean D/Do glucose was 0.228 (SE:0.024) in the high transporter range. Three patients tested pre and post transplantation (upon their return to CAPD after graft failure) had no change in these values. From the above data, 13 patients with peritoneal equilibration testing post transplantation have well-functioning peritoneal membranes allowing for adequate dialysis and flexibility in dialysis prescription. We conclude that renal transplantation does not adversely affect peritoneal membrane function if these patients return to CAPD after graft failure.

Biological Transport↗
PubMed1991

Is intraperitoneal tobramycin ototoxic in CAPD patients?

In 40 CAPD patients treated for peritonitis, the authors did a prospective study of ototoxic effects of intraperitoneal tobramycin. They evaluated cochlear function in pure-tone threshold audiograms over a range of frequencies from 250-10,000 Hz, in the speech-reception threshold test and in the speech-discrimination test. These tests were performed within 48 hours of initiation of tobramycin treatment and within 2 or 3 weeks of the drug's discontinuation. With the aminoglycoside doses used in this study, no statistical difference between the mean baseline and mean follow-up hearing levels was seen in these 40 patients. However, according to the standard criteria of ototoxicity, the hearing in 10 of 40 patients (25%) deteriorated after tobramycin, while it improved in seven patients (17.5%). In the remaining 23 (57.5%), hearing remained stable. With respect to the risk factors for ototoxicity such as advanced age, increased duration of treatment, elevated plasma aminoglycoside levels, concomitant treatment with other ototoxic drugs, pre-existing hearing loss, renal dysfunction and hyperthermia, no statistically significant difference was demonstrated between the patients with deteriorated, stable or improved hearing. The results of this study do not confirm that tobramycin given intraperitoneally to CAPD patients produces auditory toxicity. The hearing deterioration observed in 10 patients may be due to synergistic factors. The improvement observed in 7 patients could not be explained.

Audiometry, Pure-Tone↗
PubMed1990

Fibrillary glomerulonephritis in a patient with metastatic carcinoma of the liver.

A 61-year-old women presented with nephrotic syndrome and progressive renal failure associated with metastatic adenocarcinoma of the liver. Renal biopsy revealed marked widening of the basement membrane and nonamyloidotic fibrillary deposits composed chiefly of polyclonal IgG. This is the first reported case of Congo-red-negative fibrillary glomerulopathy in association with adenocarcinoma of the liver.

Adenocarcinoma↗
PubMed1990

Genital swelling as a surgical complication of continuous ambulatory peritoneal dialysis.

Genital edema was seen as a complication of continuous ambulatory peritoneal dialysis (CAPD) in 18 patients, who accounted for 4 per cent of all patients on CAPD. In the majority of patients, the swelling developed suddenly and painlessly in the scrotum, penis or labia majora. Some of the patients noticed ultrafiltration failure. In the majority of these patients, this was a result of fluid leakage through the patent processus vaginalis. In one female patient, fluid leaked through the implantation site of the catheter. A computed tomographic scan using contrast media is a useful diagnostic tool in identifying the side of the defect in patients with generalized scrotal or penile edema. Surgical repair of the hernia and the hole in the processus vaginalis or hernia sac prevented recurrence. A trial of temporary discontinuation of CAPD or intermittent peritoneal dialysis using small volumes of dialysis fluid prevented recurrence while reinstituting CAPD in patients with normal findings from contrast studies. Intermittent peritoneal dialysis using low volumes of dialysis fluid with stepwise increase prevented recurrence while reinstituting CAPD two to three weeks after surgical repair.

Adult↗
PubMed1989

Effect of 1,25-dihydroxyvitamin D3 in vivo on circulating T lymphocytes.

Previous in vitro and animal studies have suggested that 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] has important immunoregulatory properties. In this study, immune parameters were monitored in 16 patients the day before and 14 days after starting therapy with this hormone. Despite the absence of changes in the total white cell count, lymphocyte count and T lymphocyte count, CD4/CD8 ('helper/suppressor') ratio of T lymphocytes increased by 57% from the normal into the elevated range. Furthermore, a downward trend was seen in the percentage of stimulated lymphocytes expressing the interleukin-2 receptor. We conclude that in vivo administration of 1,25(OH)2D3 may have immunoregulatory effects in man. Whether these changes are the result of changes in intracellular or extracellular calcium concentration, parathyroid hormone concentration, or the concentration of 1,25(OH)2D3 itself remains to be answered.

Adult↗
PubMed1989

Subcapsular steatonecrosis in response to peritoneal insulin delivery: a clue to the pathogenesis of steatonecrosis in obesity.

Hepatic steatosis and steatonecrosis occur in nonalcoholic individuals, usually in a setting of obesity, type II diabetes mellitus, and after jejunoileal bypass. We propose an hypothesis for the pathogenesis of these hepatic lesions based on an observation in peritoneal dialysis patients. Hepatic histology was examined at autopsy in 11 patients with type I diabetes mellitus and renal failure who had received i.p. insulin in conjunction with continuous ambulatory peritoneal dialysis (CAPD). Steatosis in a unique subcapsular distribution occurred in 10 of 11 patients treated with i.p. insulin and in 0 of 9 controls receiving CAPD without insulin. Three of the 11 had steatonecrosis, 2 of whom had Mallory bodies. We suggest that insulin has an important role in the pathogenesis of steatosis and steatonecrosis. In CAPD patients the lesions occurred only under the capsule where concentrations of insulin are high secondary to its i.p. administration. In obese patients the lesions occur throughout the liver where insulin concentrations are high because of elevated levels in the portal vein. Free fatty acids (FFA) are oxidized in the liver by a pathway that is blocked by insulin. In the presence of insulin, FFA are preferentially esterified into triglycerides which accumulate in large quantities leading to steatosis; small amounts of FFA escaping local control may lead to membrane injury and steatonecrosis. Steatosis and/or steatonecrosis will occur when there is insulin secretion sufficient to block FFA oxidation but not sufficient to block FFA mobilization from adipose tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Clinical, biochemical, and pathological features in a patient with plasma cell dyscrasia and Fanconi syndrome.

Multiple myeloma is associated with a wide array of renal diseases that include myeloma cast nephropathy, monoclonal immunoglobulin deposition disease, amyloidosis, cryoglobulinemia, tubular dysfunction, pyelonephritis, nephrocalcinosis, urate nephropathy, and infiltration by atypical plasma cells (or myeloma cells). Filtered immunoglobulin light chains may affect both the distal and, more frequently, the proximal tubule. Tubular abnormalities in patients with plasma cell dyscrasia may be more frequent than previously thought. A patient with a plasma cell dyscrasia is described, who presented with biochemical features consistent with Fanconi syndrome. Immunoelectron microscopy performed on the renal biopsy confirmed the presence of kappa light chain immunoglobulin in intracytoplasmic crystals in proximal tubular epithelial cells. This report is one of a few demonstrating the presence of light-chain immunoglobulin in intratubular crystals in a human renal biopsy obtained from a patient with a plasma cell dyscrasia and Fanconi syndrome.

Biopsy↗