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Biomedical subjects

P Fiegel

Publications and source records attributed to P Fiegel.

17 recordsLinked to original sources
PubMed1992

[Opisthorchis felineus--the cat liver fluke. Differential diagnosis of right-side upper abdominal pain].

For several weeks a 58-year-old woman had suffered from intermittent right upper abdominal and flank pain, loss of appetite, weight loss (2 kg in 8 weeks), as well as constipation. She had a mild eosinophilia of 0.48/nl, while the blood picture and differential count were normal. There was no evidence of cholestasis, liver disease or an inflammatory process. Upper abdominal ultrasound examination demonstrated a gall-bladder polyp with cholelithiasis and sludge. Although the intrahepatic biliary tract was normal, the gallbladder was much enlarged and contracted only moderately after a test meal. A parasitological disease was included in the differential diagnosis because the patient had lived in Tomsk, Siberia, until the previous year. Examination of faeces and duodenal secretion discovered eggs of Opisthorchis felineus, a liver fluke especially common in Siberia and the Ukraine. It was successfully treated by a single-day administration of praziquantel, 3 times 25 mg/kg after meals. A week later the patient was symptom-free and no eggs were found in the stool.

Abdominal Pain↗
PubMed1992

Low-molecular-weight protein-permeable cuprammonium rayon haemofilter.

Searching for a dialyser membrane with a cut-off similar to that of the human glomerulus, a modified cuprammonium rayon (AM-75-UP) and a polyacrylonitrile (PAN-15-DX) haemofilter were tested in vivo for the ability to eliminate substances of a molecular weight (MW) of 10-65 kilodaltons (kDa). Endogenous marker substances of a defined MW (beta-2-microglobulin 11.8 kDa; retinol binding protein 21 kDa; alpha-1-microglobulin 26.7 kDa; alpha-1-glycoprotein 41 kDa; alpha-1-antitrypsin 54 kDa; albumin 66.3 kDa) were measured by laser nephelometry or immunosorbent assay; sieving coefficients (SC) and protein elimination (PE) per 20 l haemofiltration were calculated for each low-MW protein. The PAN haemofilter shows elimination characteristics comparable to those of earlier tested haemofilters (polysulphone, AN69, cellulose triacetate) with a sharp cut-off in the MW range of 10-15 kDa. The cuprammonium rayon haemofilter is permeable for proteins with a higher MW; especially for alpha-1-microglobulin a relevant removal (SC 0.2; PE 0.56 g/20 l) was established. This membrane has a cut-off more similar to that of the human glomerulus; but far from the demanded quality with a relevant removal of substances in the MW range up to 60 kDa. Calculated albumin loss (2.4 +/- 0.2 g/20 l) seems to be tolerable for stable haemodialysis patients.

Acrylic Resins↗
PubMed1989

Pharmacokinetics of intravenous enoximone in dialysis patients.

The new vasodilator and inotropic drug enoximone was given to dialysis patients as a single intravenous dose of 1 mg/kg. Plasma concentrations were measured up to 240 min. The mother compound enoximone reached a high plasma concentration intravenously, followed by a quick decline of the plasma concentration curve (t1/2 = 1.5 h), comparable to that of normal volunteers. The sulfoxide metabolite, however, had a tremendously prolonged half-life (t1/2 = 7.8 h) in comparison to healthy volunteers (t1/2 = 2.2 h). The volume of distribution of enoximone varies from 0.7-4.8 L/kg with a mean of 2.11 L/kg in comparison to 1.6 L/kg in healthy individuals. The area under the curve (AUC) of enoximone was 815.2 ng/ml/h, and that of the sulfoxide metabolite was 10,200.1 ng/ml/h.

Aged↗
PubMed1989

Allergy to dialysis materials.

One hundred and six unselected patients were screened for allergic symptoms, specific IgE against ethylene oxide (ETO), isocyanates (ISO), formaldehyde (FA), phthalates (PHT), total IgE and eosinophil count. Complement activation was measured during cellulosic dialysis in atopic patients and in a control group. Sixteen patients demonstrated mild allergic symptoms during dialysis treatment. Ten of them had IgE elevation and eosinophilia. Eight of these patients had positive RASTs (ETO: n = 5, ETO-ISO(?)-FA: n = 2, ISO-PHT: n = 1) against dialysis material. All eight had an eosinophilia and seven showed an IgE elevation. An amelioration of symptoms could be obtained in three patients with elevated (greater than 15%) ETO-binding values after switching to ETO-free dialysers; avoiding PHT- and ISO-containing dialysis materials allergic symptoms remained constant. Cuprammonium rayon-induced complement activation had a more rapid onset and was more pronounced in atopic patients. The study confirms the role of ETO, but not of the other dialysis materials in the allergic sensitisation of haemodialysis patients.

Complement Activation↗
PubMed1979

Dissociation in the excretion of different aldosterone metabolites and unmetabolized ('free') aldosterone in hypertension.

1. The determination of aldosterone-18-glucuronide (pH 1-labile aldosterone) was complemented by concomitant measurements of free urinary aldosterone and tetrahydroaldosterone in 307 patients, most of whom were hypertensive. In 38 cases (12.3%) the normal, aldosterone-18-glucuronide concentration was clinically misleading, but increased free aldosterone and/or tetrahydroaldosterone values suggested the presence of hyperaldosteronism, which in many of these cases was confirmed by elevated excretion of the possible major aldosterone precursor 18-hydroxycorticosterone (18-OH-B). 2. Of 224 patients with essential hypertension and normal or low plasma renin activity 18 had an elevated free aldosterone and/or tetrahydroaldosterone excretion without increased aldosterone-18-glucuronide. These cases may represent early or pre-symptomatic forms of primary hyperaldosteronism. In other cases, particularly when tetrahydroaldosterone was increased alone, abnormalities of aldosterone metabolism were suspected. 3. In two out of 15 patients with primary hyperaldosteronism, aldosterone-18-glucuronide values were frequently found to be normal, although elevations were noted in other variables. However, no relation to the morphological abnormality (adenoma versus hyperplasia) was seen.

18-Hydroxycorticosterone↗
PubMed1978

Pharmacokinetics of azlocillin in persons with normal and impaired renal functions.

The pharmacokinetics of azlocillin, a new wide-spectrum antibiotic of the N-substituted group of ureidomethyl penicillins, was investigated in 10 subjects with normal and in 32 subjects with impaired renal functions. After intravenous injection of 2 g of azlocillin, serum concentrations of drug were measured microbiologically. The half-lives of azlocillin were 47 +/- 8.8 min in patients with normal renal function, and 293.3 min in patients with severely impaired renal function. The correlation of half-life to renal functions is shown by the equation: t/2 = 425.03.Cl(In) (-0.4509), where Cl(In) is inulin clearance. The volume of distribution of the azlocillin was 17.7% of the body weight. Protein binding was similar in patients with normal renal function and in those with severely impaired renal functions. The urinary excretion rate of azlocillin in patients with normal renal function was 64.8 +/- 8.8% in 24 h.

Adolescent↗
PubMed1977

Vascular calcifications under maintenance hemodialysis.

In a cross-sectional study X-rays of the forefoot and the pelvis of 101 adult dialysis patients were taken. Vascular calcifications (forefoot) were observed in 20 patients. The incidence was higher in patients who had been started on dialysis several years ago. However, in a longitudinal prospective study de novo appearance of vascular calcificaitons was observed only in 1 out of 50 dialysed patients, although hyperparathyreoidism and moderate hyperphosphatemia persisted. Vascular calcifications were seen only once in 138 uremic children (56 uremic children without dialysis; 82 uremic children on maintenance hemodialysis). However at autopsy visceral calcifications of the lung were found in three (out of 11) children who did not have vascular calcificaitons on X-rays.

Adolescent↗
PubMed1976

[Plasma-cAMP in primary and secondary hyperparathyroidism (author's transl)].

3 patients with operatively proven primary hyperparathyroidism showed normal plasma cAMP concentrations. 5 patients in chronic dialysis treatment independent of the level of parathyroid hormone had increased plasma cAMP concentrations. These observations suggest that there is under these circumstances no regulation of plasma cAMP by the parathyroid hormone.

Cyclic AMP↗
PubMed1975

Effect of diazoxide on left ventricular performance in hypertension.

The effect of diazoxide on left ventricular performance during rest and isometric exercise (handgrip) was examined in 16 unselected hypertensive patients, 6 of whom had been pretreated with the beta-adrenergic blocking agent pindolol. Diazoxide regularly and promptly produced a fall in left ventricle systolic and end diastolic pressures, and an increase in heart rate and left ventricular dp/dtmax. Haemodynamic changes were maximal 2 minutes after injection of the drug and decreased little over the next 8 minutes. After beta-adrenergic blockade, diazoxide caused a more pronounced reduction in left ventricular systolic pressure and a less marked fall in end-diastolic pressure, whilst the diazoxide-induced rise in heart rate was partially and the increase of dp/dtmax was completly inhibited. The increase in systolic pressure during isometric exercise was not influenced by diazoxide, but the positive inotropic reaction was augmented. The findings appear to show that cardiac stimulation by diazoxide is due to a reflex mechanism transmitted by baroreceptors, and that improvement of cardiac performance is mainly due to a reduction of left ventricular after-load.

Adult↗
PubMed1975

[Dosage and elimination of Dextran 40 in patients on hemodialysis (author's transl)].

In 24 patients on regular hemodialysis the serum levels and the half-life of dextran 40 were determined after single or repeated infusion of dextran 40 (Rheomacrodex¿). One group of hemodialysis trainees had a dextran 40 half-life of 2237 +/- 447 min. In contrast, a second group, consisting of hospital dialysis patients, had a dextran 40 half-life of 4283 +/- 510 min, whereas patients with normal renal function had a half-life of 573 +/- 183 min. The difference in dextran half-life between the two groups of hemodialysis patients may be explained by the better residual renal function of our hemodialysis trainees. During hemodialysis no change in serum dextran levels could be observed. Intermitten hemodialysis, also, had no influence on the exponential elimination of dextran over a period of 6.25 days. Since hemodialysis by itself has no effect upon dextran elimination, the dosage fo dextran 40 has to be adjucted to the prolonged elimination time only, disregarding dialysis. After the fourth infusion of 50 g dextran 40 (twice a week 500 ml of 10% dextran 40) serum dextran levels exceeding 50 g/l and cutaneous bleeding were observed. To avoid these complications an initial saturation dose is suggested, followed by a maintenance dose adjusted to the impaired renal function.

Arteriovenous Shunt, Surgical↗
PubMed1975

[The clinical value of sequential renal scans with 131 iodo-hipuran and renal perfusion with 99mtc compounds using computer analysis (author's transl)].

Two methods of sequential scintigraphy are considered critically: a) Quantitative computer evaluation of nephrograms obtained by a gamma camera using 131Iodo-Hipuran. b) Quantitative flow studies of the kidneys after bolus injections of 99mTc preparations. Statistical evaluation of data from 171 patients examined by both methods has shown that the isotope nephrogram is not sufficiently sensitive for diagnostic purposes. Isotope nephrography combined with estimations of effective renal plasma flow on each side separately is of value to the urological surgeon by providing important information regarding severe degrees of renal functional impairment. Perfusion measurements, using a gamma camera and 99mTc preparations, are a promising survey method for the diagnosis of renal artery stenosis. (Much of this work is contained in a dissertation by C. Knick).

Diagnosis, Computer-Assisted↗