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Biomedical subjects

P Aljama

Publications and source records attributed to P Aljama.

At least 19 recordsLinked to original sources
PubMed1992

Influence of vitamin D on parathyroid function in the elderly.

UNLABELLED: The effect of age and vitamin D status on parathyroid function was studied in 129 healthy subjects between 20 and 89 yr old, with normal serum creatinine (less than 0.11 mmol/L), and living in Cordoba, Spain. Serum calcium and phosphorus as well as 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D [1,25-(OH)2D] decreased, whereas serum alkaline phosphatase increased, with age. Serum PTH also increased significantly with age when measured with either a carboxyl-terminal (cPTH) or an intact [PTH(1-84)] assay. The increase in cPTH, however, exceeded largely the increase in PTH(1-84) (+120% and +30% in subjects above 80 yr vs. young adults, respectively). Serum PTH(1-84) was negatively correlated with serum (ionized) calcium, 25OHD, and insulin-like growth factor I (IGF-I) but not with serum 1,25-(OH)2D. Serum 1,25-(OH)2D decreased with age and was highly correlated with serum 25OHD, cPTH, and IGF-I. In multiple regression analysis 50-60% of the variation of total and free 1,25-(OH)2D could be explained by serum 25OHD, PTH(1-84), and especially IGF-I, suggesting a possible role of decreasing GH and IGF-I concentrations in the mineral homeostasis of the elderly. Calcium infusion (1.5 mg/kg body weight over 10 min) decreased serum PTH(1-84) to below normal concentrations in young adults (nadir 14% of basal concentration), whereas the nadir in elderly subjects with secondary hyperparathyroidism was only 32% of basal concentration. The relative decrease was, however, identical in both age groups when simultaneous changes in ionized calcium were taken into account. Basal serum PTH(1-84) in selected elderly subjects (50 +/- 10 ng/L or 5 +/- 1 pmol/L, n = 10) decreased significantly (2.7 +/- 0.9 pmol/L, P less than 0.01) after 3 iv injections of 1,25-(OH)2D during 1 week without changes in serum (ionized) calcium. The PTH suppressibility after calcium infusion did not further improve. IN CONCLUSION: elderly patients with normal serum creatinine had a small (+30%) but significant increase in intact serum PTH concentration but the mean concentration still remained within the normal range. The PTH secretion remained normally suppressible by acute calcium infusion. Treatment with 1,25-(OH)2D decreased basal calcium-PTH setpoint without further additional effects during calcium infusion.

Adult↗
PubMed1991

Biocompatibility of dialysis membranes: a comparative study.

White blood cell counts and plasma C5a anaphylatoxin values were studied during haemodialysis with cuprophane, ethylenevinylalcohol, polycarbonate, polymethylmethacrylate, acrylonitrile, polysulphone and polyacrylonitrile membrane dialysers. Cuprophane induced marked leukopenia with striking plasma generation of C5a. Ethylenevinylalcohol, polycarbonate, polymethylmethacrylate and acrylonitrile promoted an intermediate degree of leukopenia with mild but significant complement activation; however, leukopenia and C5a generation were not time-related with some of these membranes. In contrast, polysulphone and polyacrylonitrile showed neither leukopenia nor C5a increase. These data suggest that although there must be further factors involved, complement-derived anaphylatoxin C5a generation may have a relevant role in the mechanism of haemodialysis-induced leukopenia. At the present time evaluation of the leukopenic effect and the C5a generation capability of a membrane seem worthwhile for estimating its degree of biocompatibility.

Anaphylatoxins↗
PubMed1990

Effect of calcitriol on insulin secretion in uraemia.

To evaluate the role of calcitriol on insulin secretion in uraemia, nine patients on maintenance haemodialysis, never treated with vitamin D nor with calcium-channel blockers, were studied. Baseline glucose, insulin, C peptide, calcium, intact PTH, and calcitriol serum values were measured, and after an oral load of 75 g glucose, insulin and C peptide were also determined at 15, 30, 45, 60, and 120 min. Following 14 days of treatment with oral calcitriol (0.5 microgram/day), the same study protocol was applied. Serum calcitriol values, which were low as expected, increased after therapy, but did not reach the values observed in healthy controls. Despite no change in total serum calcium, intact PTH values decreased significantly (182 vs 88.3 ng/ml, P less than 0.003). Baseline serum insulin was significantly increased after calcitriol (7.5 vs 35 microU/ml, P less than 0.001). Similarly, an enhancement in insulin secretion following calcitriol was observed at 15 min (34 vs 70, P less than 0.01) and 30 min (57 vs 96 microU/ml, P less than 0.01). Computation of the total area under the curve confirmed these results. Changes in C peptide profile paralleled those described for insulin. These data confirm that vitamin D modulates pancreatic beta-cell secretion and suggest that calcitriol may regulate insulin release in uraemic patients.

Adult↗
PubMed1989

The effect of calcitriol on natural killer cell activity in hemodialyzed patients.

We report the effect of calcitriol on natural killer (NK) cell activity in patients with chronic renal failure undergoing long-term hemodialysis. Natural killer cytotoxicity was significantly decreased in these patients when compared to healthy control subjects (13.1 +/- 1.3 vs 38.8 +/- 2.4%, P less than 0.001). These patients also have decreased levels of calcitriol (17 +/- 3 vs 36 +/- 3 pg/ml, P less than 0.001). After 14 days of oral treatment with calcitriol at a dose of 0.5 micrograms per day, a significant increase in NK activity was observed (20.2 +/- 1.6%, P less than 0.001). This increase was maintained after 28 days of treatment (21.1 +/- 2%, P less than 0.001). These results suggest that the decreased serum calcitriol might contribute to the diminished NK activity found in hemodialyzed patients, and suggests a new potential therapeutical utility of calcitriol as modulator of the immune function in these patients.

Adult↗
PubMed1989

Factors affecting beta 2-microglobulin plasma concentration during hemodialysis.

We studied ten patients on hemodialysis (HD) treated in sequence with cuprophan (CU), ethylenevinylalcohol (EVAL), polyacrylonitrile (A-69) and polysulphone (PSP) membrane dialyzers. beta 2-microglobulin (beta 2m) was measured by radioimmunoassay in plasma and dialysate samples. Plasma concentrations were corrected for changes in extracellular volume (ECV). We also studied adsorption in vitro by incubating the above membranes with I-125-labelled beta 2m. There were no changes in beta 2m plasma concentration after HD with CU dialyzers, but a significant decrease was observed with the other membranes tested. Filtration of beta 2m across the dialyzer was absent with CU and minimal with EVAL. However, large amounts were recovered from dialysate with the high-permeability dialyzers, AN-69 and PSP. In vitro studies showed that maximal adsorption capacity was obtained with AN-69 (13%) compared to 9% with CU, 4% with EVAL and 7% with PSP. In summary, beta 2m clearance with PSP is achieved through greater removal of this protein by mass transport across the membrane. The mechanism by which beta 2m is removed from blood during AN-69 dialysis seems to include both adsorption to and filtration by the membrane itself.

Adolescent↗
PubMed1989

[Colorectal tuberculosis].

Intestinal tuberculosis has been a clinical rarity in the western world since the tuberculostatic agents were discovered. The most common location of these lesions is usually the ileocecal region, lesions of the transverse colon being much less frequent and perforation of this viscus being exceptional. The etiological diagnosis is usually difficult because there are no specific radiological signs and false negatives are often found in biopsy material obtained by colonoscopy since the process is mainly submucous. This disease is often diagnosed during operation so treatment is usually resection. Should a preoperative diagnosis be made, the picture generally responds to tuberculostatics.

Adult↗
PubMed1986

Behaviour of the contact phase of blood coagulation in the adult respiratory distress syndrome (ARDS).

In order to assess the role of the kallikrein-kinin (K-K) system in the pathogenesis of the adult respiratory distress syndrome (ARDS) we have prospectively determined coagulation contact phase, blood gas and hemodynamic parameters in patients with ARDS at 0, 36 and 72 h from diagnosis. Compared to normal values, significantly lower mean levels of factor XII (71.4 +/- 9.8%, p less than 0.0005), prekallikrein (PPK) (52 +/- 5.7%, p less than 0.0005), high molecular weight kininogen (HMWK) (73 +/- 2%, p less than 0.0005) and alpha 2-macroglobulin (alpha 2-M) (51 +/- 7.1%, p less than 0.0005) were found in ARDS patients. The functional kallikrein inhibitory activity (KKI) and C1-esterase inhibitor antigenic (CIINH) were significantly higher in these patients (113.2 +/- 5, p less than 0.005 and 124.7 +/- 7.6, p less than 0.0005 respectively) compared with normal values during the entire study period. The KKI/CIINH ratio decreased significantly in our ARDS patients at 0, 36 and 72 h (p less than 0.025; p less than 0.05 and p less than 0.005 respectively). We found a significant correlation between PPK levels and oxygenation index (r = 0.69, p less than 0.001), PPK and the static thoracic compliance values (r = 0.64, p less than 0.001). There was also a significant correlation between PPK levels and Qs/Qt (r = -0.89, p less than 0.001). ARDS patients that survived presented a stability in the PPK values in successive tests. Nevertheless non-survivors showed a progressive decrease in PPK levels during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Anaphylatoxin C5a generation and dialysis-induced leukopenia with different hemodialyzer membranes.

Leukocyte counts and plasma C5a anaphylatoxin levels were studied during hemodialysis in patients using Cuprophan, polycarbonate and polyacrylonitrile membrane dialyzers. Cuprophan induced a marked leukopenia with significant plasma C5a generation. Polycarbonate promoted the same trend of changes in both parameters but significantly less pronounced, while polyacrylonitrile did not affect leukocyte counts nor plasma C5a levels. These data suggest that complement-derived C5a generation may be an important factor in the mechanism of hemodialysis-induced leukopenia.

Acrylic Resins↗
PubMed1985

Sequential hypertonic dialysis.

We have investigated the usefulness and practicability of the so-called sequential hypertonic dialysis in 2 selected patients with severe hemodialysis-induced hypotension; 190 mmol/l of sodium dialysate during the 1st and 3rd h and 132 mmol/l throughout the 2nd and 4th h were used, with a Drake-Willock-Bi proportionating unit, which was electronically modified for the purpose of the study. Crossover was made, patients serving as their own controls in two consecutive cycles: 3 weeks conventional hemodialysis followed by 4 weeks sequential hypertonic dialysis, using high-flux dialyzers. At the end of sequential hypertonic dialysis a greater weight loss was achieved (p less than 0.001) with absolute stability of blood pressure. There were no significant changes in plasma osmolality and plasma volume during sequential hypertonic dialysis when compared with conventional hemodialysis. Dialysis symptoms and complications were less frequently recorded during sequential hypertonic dialysis (p less than 0.001). At the end of each sequential hypertonic dialysis period, hemoglobin, potassium, and phosphate plasma levels improved significantly and plasma sodium concentrations remained within the normal range. We conclude that sequential hypertonic dialysis is an easy and routine feasible procedure with our methodology. It is possible to achieve the ideal dry weight with no symptomatic hypotension. Sequential hypertonic dialysis constitutes an alternative to sequential ultrafiltration in selected patients, as it minimizes the falloff in plasma volume and osmolality observed during conventional hemodialysis.

Adult↗
PubMed1978

Osteomalacic dialysis osteodystrophy: a trial of phosphate-enriched dialysis fluid.

To assess whether phosphate depletion is an aetiological factor in osteomalacic dialysis osteodystrophy we undertook a prospective trial of phosphate-enriched dialysis fluid, in association with oral 1alpha-hydroxycholecalciferol, for this condition. Thirty patients started the trial; of the 27 who completed more than 6 months' treatment, 14 had iliac crest bone biopsies at the beginning and end of the treatment period. Side effects included pruritus, stiffness, and increase in corneal and vascular calcification. Only one patient showed histological improvement of osteomalacia, and eight deteriorated; in seven the osteitis fibrosa worsened. Myopathy showed some improvement in four patients, but became worse in four. This treatment does not seem to have a place in the routine management of non-hypophosphataemic patients on dialysis.

Adolescent↗
PubMed1978

Determination of serum ionised calcium by ion-exchange electrode in normal subjects.

Serum ionised calcium concentration [Ca2+] was measured with a calcium selective electrode in 65 normal people. A mean value of 1.06 mmol/l (+/- 0.04 S.D.) with an actual range of 0.97 to 1.13 mmol/l was obtained. Serum samples refrigerated at 4 degrees C for 24 h were satisfactory for analysis. Storage of whole blood samples for 6 h at room temperature before separation caused a very small error (+0.04 mmol/l). Mean results and ranges were similar in males and females and there was no significant correlation with age. No significant change in serum [Ca2+] was found following a normal meal. Serum [Ca2+] and total serum calcium showed a very slight correlation (r = 0.35). The method is reproducible and sensitive.

Age Factors↗
PubMed1978

Effect of 1alpha-hydroxycholecalciferol, 1,25-dihydroxycholecalciferol, 3 deoxy-1alpha-hydroxycholecalciferol, 24R, 25-dihydroxycholecalciferol and successful renal transplantation on calcium absorption in haemodialysis patients.

Using a 2-hour 47Ca absorption test, significant depression of active calcium absorption was demonstrated in 48 vitamin D untreated haemodialysis patients. This malabsorption of calcium could be corrected by the daily oral administration of 1--2 microgram of 1alphaOHD3 and 1--1.5 microgram of 1,25(OH)2D3. 5 microgram daily for 2 weeks of 3-deoxy-1alphaOHD3 AND 16 and 64 microgram daily for 1 week of 24R,25(OH)2D3 proved ineffective. In 32 successfully transplanted patients, restoration of normal or near normal renal function (serum creatinine less than 1.9 mg/100 ml) was not always followed by an immediate improvement in active calcium absorption. Calcium absorption, especially in female patients, was adversely affected by the required immunosuppressive prednisone therapy and improvement was slow.

Absorption↗