Circulating immune complexes in dialyzed patients waiting for renal transplantation.
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Biomedical subjects
Publications and source records attributed to M Leski.
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In order to evaluate the effects of haemofiltration (HF) on blood pressure control, hyperparathyroidism and hypertriglyceridaemia, the relevant clinical and biological parameters were compared under haemodialysis (HD) and under haemofiltration using a substitution fluid (SF) acetate. Blood pressure control was achieved with HF in only one of 14 hypertensive patients. In 17 patients, with the same doses of Al (OH)3, plasma phosphate levels were similar under HD (63 mg/l) and HF (67 mg/l). In 3 patients, measurements of plasma parathyroid hormone (PTH) levels in the presence of increasing concentrations of SF calcium showed that a concentration of 90 mg/l was required to obtain a positive calcium balance and a decrease in PTH levels. After 6 months, PTH levels under HD and under HF were comparable. In 20 patients, there were no significant differences between HD and HF in mean plasma concentration values of total lipids, cholesterol and triglycerides. Finally, HF was better tolerated than HD in 58% of the cases and less well tolerated in 8%.
10 patients entered a controlled 4-week study to evaluate the effect of a glucose-enriched dialysate (400 mg/100 ml) on hemodialysis tolerance. Headache during and after dialysis and post-dialysis fatigue decreased in a statistically significant manner. The average glycemia was only moderately increased with an adequate insulin response. Blood cholesterol and triglycerides did not vary signifcantly during this short study period.
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Seven ESRD patients were treated by hemofiltration (HF) for 3--4 months using an experimental HF machine and RP6 filters (Hospal). Ultrafiltration flow was 56--85 ml/min. Data of this treatment period were compared with a similar period of customary hemodialysis (HD). With HF, blood creatinine was identical but BUN was higher than with HD. Hematocrit, plasma sodium, potassium, bicarbonate, calcium, phosphorus, alkaline phosphatases, uric acid, and cholesterol did not differ during the two periods. HF did not produce a significant lowering of blood pressure. Clinical tolerance was markedly better with HF.
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The non-transfusion policy for potential recipients of kidney allografts that has been followed in recent years has not proven successful. There is now ample clinical evidence of improved transplant function in the transfused recipients category. This has also been confirmed in recipients of a first cadaver kidney in Basel and Geneva. If the conditions valid for human kidney transplantation are matched as closely as possible in animal experiments, prolongation of graft function rather than accelerated rejection is usually observed after blood transfusions. Potential kidney graft recipients should be more liberally transfused and experimental evidence ought to be accumulated in order to establish a rationale for optimal host conditioning, while avoiding the hazards of blood transfusions to the greatest extent possible.
The tissular pharmacokinetics of antibiotics were studied by sacrificing rats in groups of 6 at various intervals after the injection of ampicillin, cephalothin, doxycycline, gentamicin and sisomicin. A microbiological method was used to determine levels in 10 organs. The antibiotic penetrated rapidly into all the tissues but with very different affinities depending on the organ involved. The concentration of doxycycline in the tissues was always higher than in the serum and this relationship was maintained throughout the investigation. This was not true of ampicillin which disappeared a little more slowly from the organs, particularly the renal medulla, than from the serum. The aminosides showed a marked accumulation and prolonged persistence in the renal cortex: 4 weeks after injection concentrations were found which were above the maximum levels in the serum. When daily injections of 4 mg/kg aminoside were given, concentrations above 350 mug/g were found after 7 days. These findings permit a better understanding of antibiotic effectiveness and toxicity.
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Three cases of intoxication due to ingestion of Cortinarius orellanus are presented. The hallmark of the clinical picture is acute tubulo-interstitial nephritis appearing about 10 days after ingestion of the mushrooms. This time lag is specific for intoxication by Cortinarius orellanus. In all the three cases, acute gastroenteritic disorders and hepatocellular damage were observed initially and disappeared spontaneously. Histological examination reveals acute tubulointerstitial nephritis. Experimental data are discussed in regard to the clinical observations.
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