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Biomedical subjects

R Gokal

Publications and source records attributed to R Gokal.

At least 181 records · Page 10Linked to original sources
PubMed1979

Hyperlipidaemia following renal transplantation. A study of the prevalence, 'natural history' and dietary treatment.

In a study of 70 renal transplant patients, the prevalence of hyperlipidaemia eight to 28 months following transplantation was found to be 59 per cent. High density lipoprotein (HDL) cholesterol levels were normal but low-density-lipoprotein (LDL) cholesterol levels were significantly elevated compared with controls. Lipid levels, measured before and sequentially after transplantation for 22 months in 10 patients were elevated over the first six to 10 months. Thereafter the lipid values returned to normal in most patients. This change coincided with the attainment of maintenance steroid dosage (usually prednisolone 10 mg. daily; mean 12.5 mg). A diet designed to decrease cholesterol and increase polyunsaturated fat intake, resulted in a significant reduction of serum cholesterol levels but not of triglyceride values over a four week period. The results suggest that the hyperlipidaemia in the initial months after transplantation may well be related to the high dose steroid therapy during this period, and the levels of lipid return to normal once low dose maintenance therapy is attained. Lipid profiles and levels in the first eight to 12 months are variable and should not form the basis for therapy or assessment. Dietary modification alone is unlikely to be an effective form of treatment of severe hyperlipidaemia in these patients.

Adolescent↗
PubMed1979

Iron induced increase in red cell size in haemodialysis patients.

In a group of haemodialysis patients who were iron loaded secondary to parenteral iron administration a slight but significant increase in red cell size was noted when compared to a normal population. This macrocytosis was not related to serum B12 or folate levels, or to the reticulocyte count. On stopping iron therapy both mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) values declined significantly as did serum ferritin and iron levels. Bone marrow smears were of normal or increased cellularity. When iron therapy was discontinued there was a steady fall in serum ferritin levels without a drop in haemoglobin values suggesting that the excess iron was available for haemopoiesis. These findings suggest that the increase in red cell size in this group of patients may have been induced directly by iron overload.

Adolescent↗
PubMed1977

Comparison between the plasma insulin and glucose responses to five different insulin regimes in diabetic patients.

Diurnal plasma insulin and glucose concentrations were studied in six diabetic patients, each treated with five different insulin regimes. Subcutaneous soluble insulin was too slow and long acting for physiological replacement of the normal insulin response to meals, but the peak insulin levels were higher than the postprandial levels of normal subjects. Intramuscular insulin, though absorbed more quickly than subcutaneous insulin, was not clinically advantageous. Three rather than two injections of soluble insulin gave improved blood glucose control but two combined injections of short and medium acting insulins gave nearly as good results. A long acting insulin was needed to prevent raised plasma glucose levels overnight.

Adult↗
PubMedDate not supplied

Long term peritoneal dialysis--is it a reality?

The use of peritoneal dialysis (PD) has increased dramatically over the last two decades since the introduction of continuous ambulatory peritoneal dialysis (CAPD). With this has also been the improvement in outcomes. In the medium term (up to five years), there is no difference in patient survival when CAPD is compared with hemodialysis (HD); PD technique survival is also improving, though is somewhat less than on HD. Problem areas for PD appear to be peritoneal membrane related changes, residual function, and peritonitis and these would need to be impacted on to improve outcome and long-term survival on PD. Current data would suggest that not many patients continue on peritoneal dialysis beyond ten years. However there are developments which show promise and are likely to enhance the outcome. It is possible to maximise renal replacement therapy by using peritoneal dialysis as the initial therapy. Arguments that favour this are discussed.

Humans↗
PubMedDate not supplied

Outcome of peritonitis treated with intraperitoneal (i.p.) weekly vancomycin and i.p. daily netilmicin.

The treatment of peritoneal dialysis related peritonitis has been streamlined by the recommendations of an ad hoc committee, which has advocated avoidance of vancomycin as an empirical therapy because of the prevailing problems of vancomycin resistant enterococci (VRE). This report relates to the continued use of vancomycin combined with netilmicin in our programme as empiric therapy for CAPD peritonitis and reports on favorable results of over 80% cure rate using this regimen. The need for change to vancomycin avoiding regimes has to be related to the knowledge of local prevalence of VRE and staphylococcal sensitivity patterns.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comparative evaluation of CAPD and PD-plus effectiveness.

Decline in residual renal function in CAPD patients often leads to reduced overall solute clearances. Inadequate dialysis has been linked to malnutrition and increased morbidity and mortality rates. Achieving dialysis adequacy targets is often difficult by the conventional method of increasing CAPD exchange volumes. In comparison, substantial increases in solute clearances can be achieved with the use of automated peritoneal dialysis with large fill volumes and an extra daytime exchange.

Adult↗
PubMedDate not supplied

Peritonitis occurrence in a multicenter study of icodextrin and glucose in CAPD. MIDAS Study Group. Multicenter Investigation of Icodextrin in Ambulatory Dialysis.

OBJECTIVE: To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). DESIGN: Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. SETTING: Eleven CAPD units in U.K. teaching hospital. PATIENTS: A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twenty-three control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. INTERVENTION: Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). MAIN OUTCOME MEASURES: The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. RESULTS: Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patient-year, respectively. DURING STUDY: There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patient-year, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean +/- SD) declined slightly from 218 +/- 354 mL to 185 +/- 299 mL (NS) in the control group, but increased in the icodextrin group from 570 +/- 146 mL to 723 +/- 218 mL (p < 0.01). CONCLUSIONS: Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.

Chlorides↗