Internal knotting of a guidewire: a complication of subclavian vein cannulation.
Explore the source record for details and available documents.
Catheterization↗
Biomedical subjects
L R Baker
Publications and source records attributed to L R Baker.
Cognitive function in hemodialysis patients.
Cognitive function was assessed in two groups of hemodialysis patients exposed to relatively low concentrations of aluminum in source water used to manufacture dialysate. One group of patients (long-term group) had been on dialysis for 5 years or more, the other (short-term group) for less than 5 years. Group comparison showed no significant differences of any cognitive measure. However, calculating an index of deterioration based on the discrepancy between current reading skills and current performance on the Wechsler Adult Intelligence Scale, five patients in the long-term group and two in the short-term group could be identified as functioning below their predicted premorbid optimum level. There was no correlation between cumulative exposure to water-born aluminum and any of the measures of cognitive function in either of the groups. There was a statistically significant negative correlation between the cumulative amount of aluminum prescribed to be taken orally and performance on cognitive tests in the long-term group. This observation strengthens the case for minimizing the prescription of aluminum-containing gut phosphate binders.
Adult↗
Proguanil poisoning in a hemodialysis patient.
Explore the source record for details and available documents.
Acute Disease↗
A double-blind study comparing an acellular pertussis-component DTP vaccine with a whole-cell pertussis-component DTP vaccine in 18-month-old children.
An acellular pertussis-component diphtheria-tetanus-pertussis (AC-DTP) vaccine was compared with a currently licensed, whole-cell pertussis-component DTP (WC-DTP) vaccine for reactogenicity and immunogenicity when given as the fourth DTP immunization in sixty 18- to 24-month-old children. Reactions over the first 48 hours were significantly less common in the AC-DTP vaccine recipients, as follows (WC-DTP/AC-DTP): fever, 85%/5%; redness, 70%/12.5%; tenderness, 100%/22.5%; swelling, 35%/10%; fretfulness, 70%/12.5%; anorexia, 35%/2.5%; and vomiting, 10%/0%. Antibody responses to pertussis antigens (agglutinogens, lymphocytosis-promoting factor, and filamentous hemagglutinin), diphtheria toxoid, and tetanus toxoid in AC-DTP vaccine recipients were comparable with those in WC-DTP vaccine recipients. The AC-DTP vaccine evaluated in this trial seems to be as immunogenic as WC-DTP vaccine while being markedly less reactogenic.
Agglutinins↗
The Gy mutation: another cause of X-linked hypophosphatemia in mouse.
An X-linked dominant mutation (gyro, gene symbol Gy) in the laboratory mouse causes hypophosphatemia, rickets/osteomalacia, circling behavior, inner ear abnormalities, and sterility in males and a milder phenotype in females. Gy maps closely (crossover value 0.4-0.8%) to another X-linked gene (Hyp) that also causes hypophosphatemia in the mouse. Gy and Hyp genes have similar quantitative expression in serum phosphorus values, renal excretion of phosphate, and impairment of Na+/phosphate cotransport by renal brush-border membrane vesicles. These findings indicate that independent translation products of two X-linked genes serve phosphate transport in mouse kidney and thereby control phosphate content of extracellular fluid. The Gy translation product, unlike the Hyp product, is also expressed in the inner ear. These findings have implications for our understanding of the human counterpart known as "X-linked hypophosphatemia."
Alkaline Phosphatase↗
Controlled trial of calcitriol in hemodialysis patients.
We report on a 5-year, prospective, double-blind trial of 1,25 dihydroxycholecalciferol (calcitriol) versus placebo in 76 hemodialysis patients without biochemical or radiological evidence of bone disease. Calcitriol, 1 microgram daily, regularly induced hypercalcemia. Doses of 0.25 microgram daily or less proved satisfactory in most patients. During calcitriol treatment, plasma calcium concentration was significantly higher and serum parathyroid hormone concentration significantly lower than on placebo. There was no difference in the rates of development or of progression of vascular calcification in the two groups. Significantly more patients on placebo (17 vs. 6, p less than 0.05) developed a sustained elevation of plasma alkaline phosphatase concentration. Calcitriol appeared to protect against the development of histological evidence of osteitis fibrosa but not of osteomalacia, but accumulation of aluminum in bone occurred during the study. We conclude that calcitriol delays and may prevent the development of osteitis fibrosa in patients receiving regular hemodialysis and may reasonably be prescribed routinely in hemodialysis patients without biochemical or radiological abnormality, unless there is a substantial prospect of early renal transplantation.
Adolescent↗
The use of D-penicillamine in patients with rheumatoid arthritis undergoing hemodialysis.
D-penicillamine and its major metabolites cysteine-penicillamine disulphide (CP) and penicillamine disulphide (P2) concentrations were measured in plasma from a hemodialysis patient with rheumatoid arthritis. CP and P2 alone were measured in plasma and a plasma ultrafiltrate from a second patient. On penicillamine 250 mg thrice weekly taken after dialysis pre-dialysis penicillamine concentrations were in the range 5.9-9.9 mumol/l. CP and P2 concentrations remained stable (range 139-197 mumol/l and 10-20 mumol/l) over 5 weeks and were of the same order as previously found in patients with normal renal function on higher doses of the drug. On penicillamine 250 mg daily concentrations of metabolites CP and P2 reach 193 mumol/l and 59.2 mumol/l after 2 and 3 weeks respectively. Concentration of metabolites fell by about half and of penicillamine by about a third after dialysis. Concentration of metabolites in ultrafiltrate were on average 75% lower than in plasma. Penicillamine 250 mg thrice weekly given after dialysis appears to be an appropriate dose for hemodialysis patients with rheumatoid arthritis.
Arthritis, Rheumatoid↗
Parathyroid carcinoma associated with chronic renal failure and previous radiotherapy to the neck.
Carcinoma of the larynx was treated by irradiation followed by laryngectomy in a man who had been receiving regular haemodialysis for two years. At least one, and probably two, parathyroid glands were removed at this time, and the remaining two were removed three years later for tertiary hyperparathyroidism. A portion of one gland was implanted into the forearm. The forearm implant was resected the following year for recurrent hypercalcaemia. Six years later, again with recurrent hypercalcaemia, he died of bronchopneumonia. Metastatic parathyroid carcinoma was found in the apex of the left lung. The source of this parathyroid tissue and the possible role of irradiation in the pathogenesis of parathyroid cancer in this patient were investigated.
Adult↗
Improved cardiac function after renal transplantation.
There are few reports of the outcome of renal transplantation in patients with severe left ventricular (LV) impairment. We describe three men with chronic disabling heart failure associated with LV dysfunction in whom a remarkable improvement in cardiac function followed renal transplantation. Transplantation may offer the prospect of successful rehabilitation in these circumstances. Undue pessimism as to the prognosis in such patients is unwarranted.
Adult↗
An open study evaluating the reactogenicity and immunogenicity of a DTP vaccine containing an acellular pertussis component in four to six year old children.
Acellular pertussis vaccines have been used for mass immunization of children in Japan since the fall of 1981, but until recently they have not been evaluated in the United States. We report a trial with a DTP vaccine containing an acellular pertussis component in 36 four to six year old children who had previously received four doses of United States DTP licensed vaccine with a whole cell pertussis vaccine component. The study vaccine contained diphtheria and tetanus toxoids and 300 HA units of Takeda acellular pertussis component. The principle immunizing antigens in the pertussis component of the vaccine were lymphocytosis promoting factor (LPF) and filamentous hemagglutinin (FHA). Local and systemic reactions were monitored during the first 48 hours after vaccination, and pre-immunization and one month post-immunization serum specimens were obtained for antibody assay. The following reaction rates were noted: redness 50%, tenderness 50%, swelling 41%, fever (greater than or equal to 38 degrees C) 3%, drowsiness 17%, fretfulness 14%, anorexia 11%, and vomiting 6%. Pertussis antibody values (preimmunization/postimmunization) were as follows: agglutinin GMT, 1:21/1:100; FHA mean ELISA u, 28 +/- 6/greater than or equal to 229 +/- 47; LPF mean ELISA u, 176 +/- 59/1732 +/- 280. The pertussis component of the study vaccine would appear to be less reactogenic than United States whole cell pertussis vaccines but still immunogenic when given as a booster immunization to four to six year old children. Further studies are needed to assess reactions and immunogenicity in younger and previously unimmunized children.
Anorexia↗
Cytomegalovirus infection in dialysis patients.
We have studied cytomegalovirus (CMV) infection in 197 patients on regular dialysis treatment and 170 healthy platelet donors. Evidence of past CMV infection was found significantly more often in patients than in controls (137 of 197 v 60 of 170; p less than 0.001) at the commencement of the study. During a 12 month period 4 of the 60 dialysis patients initially found to be seronegative, but none of the 110 seronegative controls, developed primary CMV infection. Five of the 137 dialysis patients and one of the 60 controls initially found to be seropositive showed evidence of recurrent infection. Typically, there was only a transient elevation of CMV IgM antibody titer in both primary and recurrent infection. However, one dialysis patient with recurrent infection and another 5 initially seropositive patients showed persistence of CMV:IgM antibody production suggesting that they were experiencing chronic active infection. Neither primary nor recurrent infection was invariably a consequence of transfusion of blood or blood products. There were no clear-cut clinical sequelae from any of the three forms of infection documented.
Adolescent↗
Assessment of arteriovenous fistulae from pressure and thermal dilution studies: clinical experience in forearm fistulae.
Knowledge of useful fistula flow (UFF), the maximum blood flow available using twin needles within acceptable pressure limits and without recirculation, is essential for the optimal management of patients receiving maintenance hemodialysis or hemofiltration. A technique for the measurement of UFF employing thermal dilution for the detection of recirculation has been developed. Using this technique, 94 studies were carried out in 69 forearm fistulae. UFF exceeded 400 ml/min in 45 fistulae. In these satisfactory fistulae a normal range was defined for basal intrafistula pressures (60 mmHg being the approximate upper limit of normal). Analysis of arterial and venous line pressure recordings with increasing extracorporeal blood flow and knowledge of the presence or absence of recirculation allowed us to define the functional problem in unsatisfactory fistulae. The functional diagnosis was supported in 16 of 24 fistulae by angiography or surgery or both. In all but two of the remainder, satisfactory UFF was obtained by repositioning the patients' needling sites. Fistulae were divided into different clinical groups. Of 35 fistulae which were thought to be clinically acceptable, 7 were found to be unsatisfactory. In 17 fistulae in patients with poor biochemical control, recirculation was detected in 8. Of 11 fistulae reported to produce poor flows on dialysis, 4 had UFF above 400 ml/min. Of 6 fistulae in patients experiencing needling difficulties, 5 had satisfactory UFF. These studies which take only a few minutes and can be carried out immediately preceding a routine dialysis session not only identify unsatisfactory fistulae, but yield valuable diagnostic information in these cases. This has reduced dependence on angiography and has led to more careful selection of patients for surgery.
Arteriovenous Shunt, Surgical↗
Identification of two intestinal vitamin D-dependent calcium-binding proteins in the X-linked hypophosphataemic mouse.
Two vitamin D-dependent calcium binding proteins (CaBP) of molecular weight approximately 10,000 and 30,000 daltons have been identified in the intestinal mucosal cell cytosol of genetically hypophosphataemic (Hyp) male mice and their normal littermates. Similar amounts of vitamin D-dependent CaBP were found in the two groups of animals. The possible significance of this observation is discussed.
Animals↗
Parathyroid surgery in chronic renal failure: subtotal parathyroidectomy or autotransplantation?
In the period 1970-1983, 27 patients with end stage renal failure underwent neck exploration for hyperparathyroidism. In 1977 the operative policy changed from subtotal parathyroidectomy to total parathyroidectomy and autotransplantation. Eight patients underwent subtotal parathyroidectomy while fifteen patients underwent total parathyroidectomy and autotransplantation. All were cured of their symptoms and hypercalcaemia was resolved. There was no significant difference in the requirement for postoperative calcium and vitamin D supplements between the two groups. Recurrent hypercalcaemia developed in one patient who had undergone total parathyroidectomy and autotransplantation. Resolution followed removal of approximately half the transplant. There were four deviations from the operative policy.
Adult↗
Formaldehyde concentrations in workrooms resulting from off-gassing from sandpaper.
Formaldehyde was found to off-gas from flint sandpaper that contained an urea-formaldehyde resin as the minor component in a double glue system. Approximately 2000 sheets of sandpaper in a 115 m3 (4050 ft3) ship's storeroom with no mechanical ventilation produced a formaldehyde concentration of at least 4.5 ppm that was uniform throughout the compartment. A contributing factor was elevated compartment temperature due to high ambient temperature and the heating of the ship's steel hull by direct exposure to the sun.
Air Pollutants, Occupational↗
Mefenamic acid-induced interstitial nephritis and renal failure.
Explore the source record for details and available documents.
Acute Kidney Injury↗
Can ultrasound and computed tomography replace high-dose urography in patients with impaired renal function?
Ninety-one patients with unexplained impaired renal function were investigated by high-dose urography, ultrasound and computed tomography (CT) without contrast. The aim was to evaluate the role of ultrasound and CT in renal failure, in particular their ability to define renal length and to show collecting system dilatation. In the majority of patients, renal length could be measured accurately by ultrasound. Measurements were less that those at urography because of the absence of magnification. Renal measurement by CT was not a sufficiently accurate indicator of renal length to be of clinical use. Both ultrasound and CT were sensitive detectors of collecting system dilatation: neither technique missed any case diagnosed by urography. However, in the presence of staghorn calculi or multiple cysts, neither ultrasound nor CT could exclude collecting system dilatation. CT was the only technique which demonstrated retroperitoneal nodes or fibrosis causing obstruction. It is proposed that the first investigation when renal function is impaired should be ultrasound, with plain films and renal tomograms to show calculi. CT should be reserved for those patients in whom ultrasound is not diagnostic or in whom ultrasound shows collecting system dilatation but does not demonstrate the cause. Using this scheme, ultrasound, plain radiography and CT would have demonstrated collecting system dilatation and, where appropriate, shown the cause of obstruction in 84 per cent of patients in this series. Only 16 per cent of patients would have required either high-dose urography or retrograde ureterograms.
Adolescent↗
Survival in elderly patients presenting with uraemia.
A retrospective study was made of 93 patients aged 60 years or greater presenting with renal failure between 1976 and 1981 to assess survival and analyse the factors influencing it. Two-year survival of 28 patients with acute renal failure was 50 per cent and of 65 patients with chronic renal failure it was 40 per cent. Higher initial plasma urea and creatinine values and increasing age had a significantly adverse effect on survival. Patients requiring dialysis likewise fared less well although only one patient succumbed as a direct result of the dialysis procedure. The study reveals a worthwhile survival in both acute and chronic renal failure even though during the period under consideration long-term dialysis of patients in this age group with terminal chronic renal failure was rarely undertaken.
Acute Kidney Injury↗