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Biomedical subjects

P Kes

Publications and source records attributed to P Kes.

At least 55 records · Page 3Linked to original sources
PubMed1995

Giant peptic ulcers in patients undergoing maintenance hemodialysis.

The aim of the study was to investigate the clinical characteristics of hemodialyzed uremic patients with upper gastrointestinal lesions. A total of 20 (7.2%) out of 276 patients on hemodialysis program underwent endoscopy and rentgenography of the upper gastrointestinal tract. The incidence of peptic ulcer disease in the patients with end-stage renal disease was 4.3%. Six (30%) out of 20 uremic hemodialyzed patients with gastrointestinal complications had giant peptic ulcers of duodenum or prepyloric area. In three (50%) out of six subjects, giant peptic ulcers were located in the second portion of the duodenum. Gastrointestinal hemorrhagic complications occurred in 12 (60%) patients. The most frequent sources of bleeding were duodenal ulcers alone (8 patients) or in combination with gastric and/or duodenal flat erosions (6 patients), angiodysplasia of the duodenum (3 patients) and duodenal erosions (one patient). Two patients with bleeding from giant ulcers died from perforation and hemorrhagic shock. The uremic hemodialyzed patients with giant ulcers were older than 65, had higher basal gastrin concentration (305.3 +/- 183.8 pmol/l), and lower basal (1.6 +/- 0.16 mmol/h) and stimulated gastric acid secretion (14.4 +/- 8.63 mmol/h).

Adolescent↗
PubMed1995

Plasmapheresis and hemodialysis in the treatment of acute renal failure in multiple myeloma.

Two patients with multiple myeloma (IgA-kappa and IgG-lambda) and severe acute renal failure were treated by combined plasmapheresis and hemodialysis. In both patients renal function was restored to normal. The pathogenetic role of M-proteins and the possible mechanisms responsible for renal damage were discussed. While the addition of plasmapheresis has not been shown to extend survival, a reduction in the need for long-term dialysis appears to result from this intervention. It is concluded that the removal of M-proteins by plasmapheresis may be of therapeutic value in multiple myeloma patients.

Acute Kidney Injury↗
PubMed1995

Haemodynamic changes and exercise tolerance in dialysis patients treated with erythropoietin.

The aim of our study was to evaluate cardiovascular function at rest and during exercise in dialysis patients before and after treatment with Epo and to examine the changes in left ventricular mass as the consequence of treatment for anaemia. We applied echocardiography and radionuclide ventriculography at rest and after exercise in our research. Following treatment with Epo there was a decrease in the initially high cardiac output (CO) and cardiac index (CI) from 7.5 to 6.31/min and from 4.3 to 3.61/min/m2 respectively. No changes were noted in mean diastolic (DPB) and mean blood pressure (MBP), as well as the initially increased peripheral resistance index (TPRi) of 2582.3 +/- 2097.3 dyn-s-cm-5.m2. Nevertheless, end-diastolic (EDV) and end-systolic (ESV) volume were significantly decreased (P < 0.05), but the ejection fraction (EF) remained unchanged (73.9%). The decrease in the mean values for left ventricular mass (LVM) was significant only within the subgroup of dialysed patients who initially had larger left ventricular mass (P < 0.01). The functional capacity of the CV system measured during exercise increased from four metabolic equivalents (METs) to 6 METs (P < 0.01). A significant increase in blood volume was also observed following treatment of anaemia. The haemodynamic consequences of Epo therapy for the treatment of anaemia were quite positive. However, we would like to point out certain concerns regarding the dialysed patients with initially lower values for left ventricular mass and cardiac output, since the patients within this group developed left ventricular hypertrophy and an increase in cardiac output.

Adult↗
PubMed1994

Thyroid peroxidase prevails over thyroid microsomal and thyroglobulin antibodies in thyroidal and nonthyroidal illnesses.

Autoimmune thyroid disease is usually related to the presence of autoantibodies (TPO, TMA, TGA, TSH-R) in patients' sera. In this study the presence of autoantibodies in the sera of patients with thyroid disease, patients with end-stage renal disease and in several groups of euthyroid subjects have been evaluated (N = 217). The percentages of positive values detected in six groups ranged: 0-47%, 2-94% and 3-100% for TGA, TMA, and TPO, respectively. Autoantibodies were mostly present in the sera of patients with Hashimoto thyroiditis (TPO 100%, TMA 94%, TGA 47%), and sporadically in the control subjects (TPO 4%, TMA 2%, TGA 0%). Authors's results confirm the prevalence of TPO over TGA and TMA in the sera of all investigated groups. The authors did not find changes in ATA levels during methimazole therapy of their patients with Graves' disease. Some of serum autoantibodies were constantly present or absent in spite of remission.

Adolescent↗
PubMed1994

Reprocessing and multiple use of hemodialyzers: a critical appraisal.

Economic considerations have made the reuse of hemodialyzers desirable, particularly with the introduction of expensive devices, such as large surface area or high-flux dialyzers, hemodiafilters and hemofilters. Recent studies have shown that certain reprocessing techniques confer improved biological properties on dialyzers compared with new membranes. Several investigators observed certain symptoms which occurred with greater frequency in patients receiving first use dialyzers as opposed to patients receiving dialysis treatment with reused dialyzers. Despite the potential advantages of more biocompatible membranes, and less expensive dialyzers, the safety and efficiency of reuse is the subject of some controversy. The article critically reviews the available scientific information on the risks and benefits of reprocessing.

Biocompatible Materials↗
PubMed1994

Spontaneous hypoglycemia associated with chronic renal failure--a preventable life-threatening complication.

Hypoglycemia has been reported in three non-diabetic uremic patients undergoing maintenance hemodialysis. There were one female and two males, ranging in age from 26 to 45 years. Only one hypoglycemic episode per patient was documented, and measured blood glucose levels were less than 1.1 mmol/L. Contributing factors of hypoglycemia in CRF patients were hepatic dysfunction, and drug side effects (isoniazid, rifampin and propranolol). The treatment of choice was intravenous hypertonic glucose administration. Proper nutrition, the judicious use of any medication that has the potential for inducing hypoglycemia, the early detection and treatment of associated diseases, and the use of dialysate fluid with glucose in hemodialysis patients can diminish the risks of this potentially lethal complication.

Adult↗
PubMed1992

Phagocytic function in patients with recurrent urinary tract infections.

Phagocytes play an essential role in the host's defence against uropathogenic bacteria which are mostly extracellular pathogens. The functional capacity of peripheral blood phagocytes (predominantly polymorphonuclears, PMN) was investigated in 47 patients (urethrocystitis, acute or chronic pyelonephritis) and in healthy persons. The random mobility of phagocytes was determined by measuring their spontaneous migration from a capillary tube. Using radioactively labelled sheep erythrocytes as targets and the phagocytes as effector cells, ingestion, digestion and extracellular cytotoxicity were determined. All the four phagocytic functions in patients were significantly lower than in healthy controls, especially in patients with chronic pyelonephritis. These results link reduced phagocytosis by blood phagocytes with recurrent urinary tract infections (UTI). Whether the defect is primary or secondary to infection (and only transient) should be the object of further studies.

Adult↗
PubMed1992

Serum gastrin concentration in chronic renal failure.

On the basis of the existing experimental and clinical studies about the factors affecting the appearance of hypergastrinemia in renal failure, it can be concluded that the kidney plays an important, but not the only, role in the degradation of endogenous gastrin in humans. In this process the key role is played by the blood flow through the kidney, the preservation of the peritubular capillary system, and the functional kidney mass. Glomerular filtration has no particular importance in the extraction of gastrin from the circulation, while through the urine only a small amount of gastrin is excreted. In the decomposition of a part or at least some molecular gastrin forms, an important role is played by the capillary systems of extra-renal tissue. One further conclusion is that hypergastrinemia in patients with renal failure is the result of the combined effects of the reduced catabolism of gastrin in the kidney and its increased synthesis which is for the most part connected with hypochlohydria and secondary hyperparathyroidism. In patients with renal failure there exists the inhibition of the gastrin acid secretion which is the cause of the weakening of the mechanism of the feedback connection between HCl and gastrin, while because of a permanent stimulation of G-cells, the hyperplasia of these cells develops, as well as the increased secretory activity, and hypergastrinemia. Parietal cells become less sensitive to a permanently increased serum gastrin concentration but still capable of reacting to the maximal stimulus. In patients with renal failure, especially those with extreme hypergastrinemia, there develops the increased concentration of large, mainly biologically inactive (big big gastrin, component I) molecular forms of gastrin.

Animals↗
PubMed1990

[Small gastrin (G-17) serum levels after stimulation with food during conservative treatment of patients with chronic renal insufficiency].

The physiological release mechanism for gastrin is complex, including both mechanical and chemical stimuli. Distention of the antrum is the main mechanical stimulus, and proteins and their degradation products constitute the most potent chemical stimuli. The aim of the present study was to examine the little gastrin (G-17) response to a test meal and to study the relationship between the G-17 concentration and gastric acid secretion in patients with various degrees of chronic renal failure (CRF). In 14 CRF patients under conservative treatment and 12 healthy control subjects, fasting and stimulated G-17 concentrations, as well as basal (BAO), maximal (MAO) and peak acid secretion (PAO) were measured. Mean fasting serum G-17 in CRF patients was 7.8 +/- 0.8 pmol/L, significantly higher (p less than 0.001) than in control subjects (5.9 +/- 1 pmol/L). However, the range of basal G-17 concentrations in both groups of subjects was not different from the normal values (4.2 +/- 11.3 pmol/L). The serum G-17 response to the food stimulation was significantly higher (p less than 0.001) in the control subjects than in the CRF patients. In normal subjects, the increment in the serum G-17 concentration rose to a peak at 30 min, but in the CRF patients the peak increment occurred at 60 min, and the response was more prolonged. There was a little difference in meal-stimulated serum G-17 concentrations in patients with various degrees of renal functional impairment. Basal acid output (BAO) was significantly higher (p less than 0.001) in the control subjects (2.62 +/- 0.51 mmol/h) than in the CRF patients (1.68 +/- 0.4 mmol/h). No significant difference in both the maximal acid output (MAO) and peak acid output (PAO) was found between the groups of CRF patients and control subjects. There was no relationship between G-17 concentrations and the gastric acid output in the CRF patients. From the results of the present study it is concluded that the human kidney is unimportant in the catabolism of G-17 but that the renal failure seems to decrease the rate of the peripheral extraction of gastrin by other tissues. The raised basal and meal-stimulated G-17 concentrations sometimes seen in CRF patients are associated with decreased rather than increased gastric acid secretions.

Adult↗
PubMed1990

Symptomatic hypomagnesemia associated with gentamicin therapy.

Seven patients (3 females, 4 males) developed symptomatic hypomagnesemia, hypocalcemia, and hypokalemia following gentamicin therapy. The excessive and inappropriate urinary excretion of magnesium and potassium in the presence of subnormal serum concentrations was noted. A significant correlation was found between the total cumulative dose of gentamicin and serum Mg concentration (r = 0.76, p less than 0.05), as well as between the renal wasting of Mg and the total cumulative dose of gentamicin administered (r = 0.89, p less than 0.01). The gentamicin-induced Mg depletion is a very rare but important complication which is most likely to occur when the drug is given to older patients in large doses over extended periods of time.

Aged↗
PubMed1986

[Prevalence of arterial hypertension in patients with radiologic signs of chronic pyelonephritis].

A retrospective study of the prevalence of arterial hypertension in patients with radiological signs of chronic pyelonephritis was done. During six years i.v. urography has been performed in 936 patients, 297 (31.7%) of whom had hypertension, and 123 (13.1%) had radiological signs of chronic pyelonephritis. Out of the patients with chronic pyelonephritis 87 (70.7%) subjects (57 men, 30 women) had arterial hypertension. Bilateral chronic pyelonephritis was radiologically confirmed in 61 (70.1%) and unilateral parenchymal renal disease in 26 (29.9%) of the patients with hypertension. When the diagnosis has been postulated on the basis of radiologically evident changes of kidney parenchym (renal scarring) or the combined calyx-parenchymatous lesions, it could be shown that the frequency of hypertension in these patients was statistically higher (p less than 0.001) than in the group of patients that displayed only isolated calyx lesions. Moderate and pronounced hypertension were more common (52.5%) in patients with bilateral pyelonephritis scarring compared with hypertonic patients having the same, but unilateral changes. Patients with radiological signs of chronic pyelonephritis and hypertension had proteinuria and various degrees of renal failure significantly more often than these with normal blood pressure. On the basis of the presented results the authors concluded that the prevalence of arterial hypertension in patients with chronic pyelonephritis is much higher (70.1%) than in the average population (31.7%). Hypertension is more common and its complications are severe in the patients with chronic fibrose pyelonephritis. In these patients is also frequent chronic renal failure. The observed facts can be explained on the basis of recent knowledge about pathophysiological mechanisms in chronic pyelonephritis (the renin-angiotensin-aldosterone system, renal prostaglandins system and glomerulo-tubular balance).

Adolescent↗