Search PubMed⌕ Search

Biomedical subjects

J Zingraff

Publications and source records attributed to J Zingraff.

At least 91 records · Page 5Linked to original sources
PubMed1986

The role of parathyroid function and parathyroidectomy in the outcome of aluminium-related dialysis encephalopathy.

Aluminium (Al) intoxication in patients with chronic renal failure may lead to osteomalacia, microcytic anaemia, and encephalopathy. It has been suggested that the expression of Al toxicity may be related to the function of the parathyroid glands. The purpose of this study was to determine whether the functional state of the parathyroids influenced the evolution of Al-related encephalopathy in Al-intoxicated haemodialysed patients. The patients were subdivided into two groups according to outcome: group I patients (n = 6) had died with the clinical feature of severe cerebral dysfunction; group II patients (n = 15) had a favourable outcome with partial or complete recovery. The degree of hyperparathyroidism, as evaluated by plasma biochemistry and bone histology, was comparable in both groups. Three patients of group I and five of group II underwent parathyroidectomy. Before the clinical onset of encephalopathy the duration of Al overload in group I was not different from group II, but after its onset patients of group I were intoxicated significantly longer (8 months +/- 6.6) than those of group II (1.5 months +/- 1.9). This study shows that, in uraemic patients with Al-related encephalopathy, parathyroid function and parathyroidectomy do not play an essential role in clinical outcome. The duration of Al intoxication following the first signs of encephalopathy appears to be the major prognostic element.

Adult↗
PubMed1986

[Arthropathies of patients on hemodialysis for more than 10 years: retrospective study].

Joint problems have been retrospectively analyzed in 10 uremic patients (mean age, 61.9 years; range, 50-70) undergoing long-term hemodialysis treatment for more than 10 years. All the patients suffered from arthralgias which were mainly localized in the shoulder region (9 patients). The arthralgias began 2-9 years after the initiation of intermittent hemodialysis. Eight out of the 10 patients had the carpal tunnel syndrome. Only three patients had evidence of marked secondary hyperparathyroidism but nine had aluminum intoxication. Juxta-articular calcium deposits were observed in 8 patients one of whom had pseudo-tumoral calcifications made of hydroxyapatite crystals. These soft tissue calcium deposits occurred 1-8 years after starting hemodialysis. Conspicuous X-ray abnormalities were found in 8 patients: destructive arthropathy in 5 cases, arthropathies of large joints in 5 cases consisting of sub-chondral lacunae and joint space narrowing or even disappearance. Prosthetic joint replacement was required in 4 patients: replacement of the hip in 3 and of the knee in 1. Massive amyloid deposits could be demonstrated in removed joints of 3 patients and in carpal tunnel of the 7 patients operated upon. They were located in the synovium, articular capsula and juxta-articular epiphyseal bone. It is probable that this is a new type of amyloidosis made of beta 2-microglobulin. The underlying pathogenetic mechanisms of these arthropathies remain to be defined by further studies.

Aged↗
PubMed1986

[Diagnostic and therapeutic problems in a severe case of hyperparathyroidism with renal insufficiency].

It may sometimes be difficult to distinguish primary from secondary hyperparathyroidism when advanced renal failure coexists. We report here the case of a patient with end-stage renal failure who had severe hyperparathyroidism. Cervical exploration revealed only the presence of four parathyroid glands normal in size and histological appearance which were removed. Because the existence of severe hyperparathyroidism had been firmly established based on biochemical and radiological evidence, the diagnosis of primary hyperparathyroidism due to an ectopic adenoma became obvious. Digital angiography and computerized tomography were then carried out. The results of angiography were inconclusive but computerized tomography revealed and precisely localized a mediastinal adenoma which was subsequently removed via sternotomy. The existence of a hypoparathyroid state was confirmed over the following two months. Reimplantation of parathyroid fragments which had been cryopreserved during the first operation, was then performed with success.

Adenoma↗
PubMed1985

Synovial amyloidosis in patients undergoing long-term hemodialysis.

Synovial amyloid deposits were found in 18 patients with end-stage renal failure due to various nonamyloid nephropathies, who had been treated with long-term, periodic hemodialysis (mean 116 months). All patients had carpal tunnel syndrome, which was bilateral in 14 of them; 4 patients also had finger flexor tenosynovitis. In 2 patients, destructive arthropathies required surgical replacement of the hip. Amyloid deposits were demonstrated by light microscopy in the synovium of the finger flexor tendon and/or transverse carpal ligament of all patients who had surgery for carpal tunnel syndrome, and in the synovium and capsula of the 2 surgically removed hips. Transmission electron microscopy of synovial samples from 6 patients demonstrated the characteristic fibrillar ultrastructure of amyloid deposits, the biochemical nature of which is still unknown. In addition, 9 patients had cystic radiolucencies of bone, which were interpreted as having resulted from local amyloid deposits, involving carpal bones, humeral heads, femoral heads, acetabula, or tibial plateaus. Our results show that amyloidosis is a frequent histologic finding in dialysis patients receiving surgical management of carpal tunnel syndrome, and that it can also be associated with cystic radiolucencies of bones and with destructive arthropathies.

Adult↗
PubMed1985

Hemodialysis membrane-induced activation of phagocyte oxidative metabolism detected in vivo and in vitro within microamounts of whole blood.

The production of reactive oxygen species by phagocytes from uremic patients undergoing hemodialysis was monitored by chemiluminescence (CL) within microamounts of whole blood or isolated polymorphonuclear (PMN) cells, and compared on the basis of the dialysis membrane, cuprophane (CUP) or polyacrilonitrile (PAN). Compared to control subjects, resting and stimulated CL (with latex, zymosan, phorbol myristate acetate (PMA) but not formyl-methionyl-leucyl-phenylalanine (FMLP) were decreased in 10(-2) diluted blood sampled before dialysis. After 15 min of dialysis (ti), resting whole blood (10(-1) and 10(-2) diluted) CL increased sharply in patients dialyzed with the CUP but not the PAN membrane, while it returned to its predialysis level at the end of the session. This sharp resting CL increase found in whole blood at ti was not observed in isolated PMN cells except when tested with ti plasma from CUP dialyzed patients, suggesting that it was mediated via activated plasma compounds. In vitro treatment of normal blood, plasma, and isolated PMN cells with CUP membrane fragments reproduced this in vivo dialysis-induced activation of phagocyte oxidative metabolism strikingly and demonstrated additionally the requirement of complement for its induction. We propose this model as an effective means of evaluating dialysis membrane biocompatibility.

Acrylic Resins↗
PubMed1984

[Hyperparathyroidism secondary to renal insufficiency: anatomo-clinical relations and the potential role of an aluminum overload].

Severe secondary hyperparathyroidism is still observed at present in 5-10% of haemodialysis patients. It requires surgical correction. Fifty-eight haemodialysis patients had neck surgery and their 222 parathyroid glands analysed. The individual gland weight was comprised between 22 and 3880 mg (mean +/- SEM, 689 +/- 62 mg). Mean total parathyroid gland weight per patient was comprised between 2 and 3 g. Schematically, 4 types of gland architecture could be distinguished: diffuse hyperplasia alone; diffuse hyperplasia associated with incipient nodule formation; hyperplasia with pronounced nodule formation; and nodule formations alone. Total gland weight was significantly higher for the latter two histological forms than for the former suggesting transformation with time of pure hyperplasia to nodular hyperplasia. Patients with chronic pyelonephritis had a mean gland weight higher than that of patients with chronic glomerulonephritis (3308 +/- 498 mg versus 1824 +/- 358 mg, p less than 0.01). No relation was found between total gland weight and plasma calcium, phosphate or alkaline phosphatases. However, a weak relation existed between total gland weight and plasma immunoreactive parathyroid hormone. In addition, a negative relation was observed between highest prior plasma aluminium and gland weight when considering only patients with a gland weight less than 2000 mg. Parathyroid gland aluminium content was significantly higher in haemodialysis patients than in nonuraemic patients with primary hyperparathyroidism. A direct relation was found between parathyroid gland and bone aluminium. In conclusion, in haemodialysis patients with evolving hyperparathyroidism initially diffuse gland hyperplasia appears to be associated progressively with nodule formation. Circulating immunoreactive parathyroid hormone is positively related to total gland weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Different patterns of uremic polyneuropathy: clinicopathologic study.

Ten patients with a uremic polyneuropathy were investigated. Chronic renal failure was associated with a variety of neuropathies, including an acute axonal neuropathy, a progressive axonal neuropathy with secondary segmental demyelination, and a predominantly demyelinative neuropathy. All patterns were associated with distal degeneration of fibers evidenced by axonal sprouting observed on single-fiber preparations. The etiology of such variations in pathology of uremic neuropathy is still not clearly understood.

Adolescent↗
PubMed1983

Secondary hyperparathyroidism in chronic haemodialysis patients: a clinico-pathological study.

Fifty-eight patients on intermittent haemodialysis underwent parathyroidectomy because of severe secondary hyperparathyroidism. Mean individual parathyroid gland weight was 689 +/- 62 (SEM) mg. Mean total gland weight per patient was between two and three grams. Increasing nodule formation within hyperplastic glands appeared to develop with increasing time of duration of hyperparathyroidism. Patients with chronic pyelonephritis had a higher gland weight than those with chronic glomerulonephritis. A direct relationship was found between gland weight and circulating immunoreactive parathyroid hormone, but an inverse relationship between gland weight and plasma aluminium concentration. The higher the parathyroid gland aluminium, the higher was the bone aluminium concentration.

Adolescent↗
PubMed1983

Aluminium-induced, reversible microcytic anemia in chronic renal failure: clinical and experimental studies.

Ten chronic hemodialysis patients with severe aluminium (Al) intoxication developed a microcytic anemia despite oral iron supplementation. Their microcytosis was reversible after deionization of the dialysis water. Ten age and sex matched hemodialysis patients who were not Al intoxicated but who had a comparable treatment schedule and time on dialysis had no such microcytosis. In order to investigate a possible direct role of Al we intoxicated uremic rats by daily (6/7 days a week) intraperitoneal injections of 30 nmoles/day of aluminium. After 3 months, the Al-intoxicated uremic rats had a significantly lower hematocrit (34.7%), hemoglobin (12.0 g/dl), and MCV (52.5 fl) than the control, vehicle-injected uremic animals (37.4%, 13.1 g/dl and 60.4 fl., respectively). The reticulocyte counts of the intoxicated rats were increased. Serum iron and transferrin iron binding capacity were unchanged. Thus aluminium intoxication of the uremic organism leads to a microcytic anemia possibly by interfering directly with normal hemoglobin synthesis.

Adult↗
PubMed1982

Pituitary and ovarian dysfunctions in women on haemodialysis.

28 female uraemic patients treated by chronic haemodialysis were studied. Of these patients, 6 had regular cycles, 6 irregular cycles, 7 were amenorrhoeic and 9 post-menopausal. Plasma gonadotropins (FSH and LH) were determined in all patients. Plasma concentrations of oestradiol and progesterone were determined only when of possible interest. LRH stimulation test was performed in 5 amenorrhoeic patients. In 19 pre-menopausal women baseline plasma FSH values were always normal, but LH concentrations were above normal in 5. In all 9 post-menopausal women both FSH and LH were markedly higher than in the pre-menopausal patients., either healthy or uraemic. Persistent oestrogen activity was found in the 6 regularly menstruating women as well as in the 5 women with oligomenorrhoea. Luteal phase plasma progesterone was in the low normal range in 3 patients and was markedly depressed in the others. A prolonged rise in LH and to a lesser extent in FSH was observed in 4 of the 5 patients studied after 100 micrograms of LRH were administered intravenously. These results suggest that the defect underlying gonadal dysfunction in uraemic women treated by chronic haemodialysis is mainly of suprahypophyseal origin.

Adolescent↗
PubMed1981

Aluminum localization in bone from hemodialyzed patients: relationship to matrix mineralization.

It has been suggested that in uremic bone, aluminum interferes with normal mineralization. Aluminum content and aluminum localization were studied in iliac crest biopsies of two groups of patients on regular hemodialysis; one group had histologic osteomalacia, and little or no bone resorption (group 1); the other, osteitis fibrosa and no mineralization defect (group 2). Group 1 patients had significantly higher plasma aluminum concentrations than those of group 2. No difference was found in bone aluminum content, which was above normal in both groups. In the bone samples of the osteomalacic subjects, aluminum was mainly localized at the limit between osteoid and calcified tissue, the site where the bone mineral is normally first deposited. Osteomalacia could not be related to hypocalcemia or to phosphate depletion. Active vitamin D derivatives (25-hydroxycholecalciferol and 1alpha-hydroxycholecalciferol) failed to prevent or to improve the bone disease. In the bone samples of group 2 subjects, aluminum could not be localized by the methods used, except in the two cases with greatly elevated bone aluminum, where it was mainly localized on cement lines. In group 2 subjects, immunoreactive parathyroid hormone plasma concentration, osteoclast surface, and marrow fibrosis were significantly higher than they were in group 1 subjects. It is concluded that in bone from uremic patients on regular dialysis, aluminum can induce a particular form of osteomalacia, resistant to the vitamin D active derivatives. The bone disease is only observed in the absence of severe secondary hyperparathyroidism. This suggests that parathyroid hormone may be involved in the development of the aluminum-induced mineralization defect.

Adult↗
PubMed1980

[Secondary hyperparathyroidism: subtotal parathyroidectomy versus total parathyroidectomy with parathyroid autotransplantation (author's transl)].

Between 1967 and 1978, among more than 1 000 patients under haemodialysis, 66 who had severe secondary hyperparathyroidism, underwent parathyroidectomy (PTx). Subtotal PTx's were performed in 57 patients and total PTx's immediately followed by autotransplantation of parathyroid gland fragments in 9 patients. The patients operated upon by these two methods since 1976 were compared. Among the 10 patients who had undergone subtotal PTx recurrence of severe biological hyperparathyroidism was observed in four cases and permanent hypoparathyroidism in two cases. Among the 9 patients with total PTx and immediate autotransplantation only one was considered as suffering from recurrent hyperparathyroidism on account of increased plasma parathyroid hormone concentrations; none of the other patients in this group had hypoparathyroidism. On follow-up, the clinical and radiological findings were comparable in both groups. At the present moment, our choice of surgical method remains arbitrary. Total PTx with immediate autotransplantation is carried out in all cases of reexploration of the neck, in patients who do not comply with the proposed medical treatment and when surgery reveals grossly enlarged parathyroid glands. In all other cases we continue to perform subtotal PTx.

Humans↗
PubMed1980

Uremic neurotoxin in the middle molecular weight range.

Among the middle molecule fractions obtained by high performance gel chromatography on Sephadex G-15 combined with gradient ion exchange chromatography on DEAE Sephadex A-25 from plasma ultrafiltrates of six polyneuropathic patients, only peak b4-2 was at a significantly higher concentration than that obtained from uremic patients with neuropathy. Purification of the b4-2 solute allows its quantitative determination in biological fluids. The b4-2 plasma concentrations are 1 mg/L in healthy subjects (n=30), 4.6 +/- 0.2 mg/L in uremic patients (n=67) and 13-19 mg/L in six polyneuropathic patients. The 24-hr urinary excretion is 13 +/- 1 mg. The weekly removal rates in hemofiltration or in hemodialysis, using high permeability membrane three times a week, are 38-40 mg. In an in vitro sural nerve test for the evalution of middle molecule neurotoxicity, the b4-2 solute exhibits a neurotoxic effect at concentrations similar to those found in plasma of neuropathic patients. Preliminary results of an attempt to identify the neurotoxin indicate that it is an acid-polyol derivative.

Action Potentials↗