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Biomedical subjects

R Rault

Publications and source records attributed to R Rault.

36 records · Page 2Linked to original sources
PubMed1986

Renal osteodystrophy in patients on hemodialysis for more than 10 years.

We performed bone biopsies on 13 patients who had been on dialysis from 11.1 to 17.6 years (mean 14.5 +/- 2.1 years) to evaluate renal osteodystrophy in long-term dialysis patients. Seven patients had osteitis fibrosa and 6 had a mineralization defect. Stainable bone aluminum was present in 9 of the patients. Serum phosphorus and parathyroid hormone levels were higher and bone aluminum lower in patients with osteitis fibrosa compared to those with a mineralization defect. Those seriously disabled with decreased mobility due to bone pain (7 of 13) had more bone aluminum than those patients with minimal or no disability (1.55 +/- 1.0 mm/mm2 vs. 0.11 +/- 0.18, respectively, p less than 0.01). A history of fractures during the years on dialysis was also associated with elevated stainable bone aluminum (p = 0.04). We conclude that in long-term dialysis patients aluminum-related osteodystrophy results in greater morbidity than osteitis fibrosa. We recommend that aluminum-containing phosphate binders be used sparingly in patients who are to remain indefinitely on dialysis.

Adult↗
PubMed1985

Severe reactions during hemodialysis.

Severe reactions during dialysis occurred in 1.7% of hemodialysis patients. Respiratory distress, agitation, pruritus, and alterations in BP were the dominant clinical findings, and one patient suffered a respiratory arrest. It is not clear whether this syndrome is due to toxic substances or to an allergic reaction, although the presence of eosinophilia in three of five affected patients would suggest the latter mechanism. Disconnecting the patient from the extracorporeal circuit invariably improved the symptoms. Current evidence implicates the dialyzer as the most likely culprit, and our experience suggests that none of the commonly used dialysis membranes are truly biocompatible.

Adolescent↗
PubMed1985

Effects of end-stage renal disease and aluminum hydroxide on temazepam kinetics.

The kinetics of temazepam, 30 mg, were evaluated in 11 patients with end-stage renal disease. Age ranged from 18 to 65 years. On two occasions separated by 1 week, single oral 30 mg doses of temazepam were given once with water (TM) and once with 3600 mg aluminum hydroxide gel (TM + AHG). There were no significant differences in the maximum plasma concentration, the time to reach maximum concentration, or elimination rates between TM and TM + AHG dosing. In approximately half the subjects there were secondary temazepam peak concentrations. In the remaining subjects, temazepam elimination was biphasic, with the terminal t1/2 ranging from 11 to 77 hours. There was a lag time before absorption in all subjects. The percent free temazepam in plasma from dialysis subjects ranged from 4.4% to 8.8% (mean = 5.9%). Compared with literature reports of subjects with normal renal function, the maximum plasma concentration was lower and the percent free temazepam was higher in dialysis subjects. When sedation score was plotted against plasma temazepam concentration, there was clockwise hysteresis consistent with tolerance or adaptation to effects of the drug. Thus aluminum hydroxide gel does not affect temazepam absorption. The clinical significance of the low plasma concentrations and high free temazepam fraction in dialysis subjects is uncertain.

Absorption↗
PubMed1985

Effects of end stage renal disease and aluminium hydroxide on triazolam pharmacokinetics.

Triazolam 0.5 mg was administered to 11 dialysis patients and 11 age, weight and sex matched controls. Peak plasma concentrations (Cmax) were higher in control subjects, but there were no other differences between the groups. When dialysis patients took triazolam with 3600 mg aluminum hydroxide suspension, Cmax and AUC were increased into the range observed in control subjects. It appears that triazolam can be used at normal doses in patients with renal dysfunction, without regard to interaction with aluminum hydroxide gel, or to alterations in elimination.

Adolescent↗
PubMed1984

Triazolam protein binding and correlation with alpha-1 acid glycoprotein concentration.

On two occasions separated by a minimum of 1 wk, plasma was obtained from 12 patients (aged 18 to 73 yr) on dialysis after an overnight fast. Samples were assayed for albumin and alpha 1-acid glycoprotein (AGP) concentrations. 14C-Triazolam was added to each sample to a final concentration of 5 ng/ml. Protein binding was determined by equilibrium dialysis. Unbound triazolam ranged from 6.4% to 15.4% (mean = 10.0%). AGP concentrations ranged from 71.8 to 205.1 mg% (mean = 123.4 mg%). Triazolam binding ratio (bound/unbound concentration) correlated with AGP concentration (r2 = 0.69) but not with albumin concentration, age, or sex. This correlation was verified by adding AGP in varying amounts to control plasma.

Adolescent↗
PubMed1984

Upper arm graft fistula for hemodialysis.

The repeated failure of forearm hemodialysis access grafts in patients with end-stage renal failure often requires the use of an upper arm graft fistula. During a 7-year period, 20 upper arm graft fistulas were placed in 15 patients. The 5-year patency rate by life-table analysis, including graft fistula salvage by thrombectomy, is 53%. The mean survival from graft insertion until revision or thrombectomy is 36 months. Twenty of the twenty-two thrombectomies performed (91%) were successful in reestablishing graft fistula patency. Six grafts required more than one thrombectomy, and seven grafts required revision of the venous anastomosis. Only one arterial anastomosis required revision. We conclude that the upper arm graft fistula is an acceptable method of hemodialysis access in those patients without suitable forearm access sites. However, an aggressive approach to both graft fistula thrombectomy and the revision of stenotic anastomoses is necessary to maintain a satisfactory patency rate.

Adult↗
PubMed1984

Symptomatic urinary tract infections in patients on maintenance hemodialysis.

15 episodes of symptomatic urinary tract infection are described in 11 patients on maintenance hemodialysis. The diagnosis was confirmed by clean-catch or simple voided urine samples where possible, urethral catheterization and bladder washout being used only in anuric patients. Treatment with oral antibiotics proved successful in 13 episodes but 2 patients with polycystic kidneys were admitted to hospital for intravenous therapy. Urinary tract infections are common in dialysis patients including those who are anuric, and patients with polycystic kidneys have an increased risk of serious complications.

Anti-Bacterial Agents↗
PubMed1983

Hearing loss and erythromycin pharmacokinetics in a patient receiving hemodialysis.

A left upper lobe pneumonia developed in a patient who was receiving hemodialysis; he was treated intravenously with 1 g of erythromycin lactobionate every six hours. After five doses, hearing loss was noted; this was later documented by audiogram. Erythromycin serum concentrations as high as 100 mg/L and a half-life more than three times longer than normal were observed. To our knowledge, this represents the first report of reversible hearing loss associated with elevated serum erythromycin concentrations and prolonged serum half-life.

Adolescent↗
PubMed1982

Perianeurysmal fibrosis and ureteric obstruction: case report and review of literature.

A case of ureteric obstruction due to perianeurysmal fibrosis is reported and the literature reviewed. Reports of 56 previous cases showed striking male predominance, the presenting symptoms being abdominal pain, flank pain and back pain with radiation to the groin or leg. Anuria occurred in 14.2%, and an abdominal mass was palpable in 45%. The pathogenesis and pathology of perianeurysmal fibrosis is discussed. The treatment of choice is bilateral ureterolysis and resection of the aneurysm, but in elderly, sick or uremic patients more limited procedures may be indicated.

Anuria↗
PubMed1975

Absorption of enteric and non-enteric coated prednisolone tablets.

1. Relative rates of absorption of enteric and non-enteric preparations of prednisolone were measured in five renal transplant recipients. 2. The absorption of the enteric coated preparation is delayed and the peak plasma concentration is much lower than that attained using the same dose of the uncoated material. 3. The therapeutic implications of these observations are discussed.

Adolescent↗
PubMedDate not supplied

Efficacy of different hepatitis B vaccination strategies in patients receiving hemodialysis.

Patients with end-stage renal disease have an impaired immune response to vaccination against Hepatitis B. The efficacy of different vaccines and vaccine schedules was studied in a group of patients receiving long-term hemodialysis. All patients received an initial 6 month course of intramuscular vaccine with either three doses of Recombivax (48 patients) or four doses of Engerix B (50 patients). This was successful in 71% and 74% of patients, respectively. In 10 patients unresponsive to 4 doses of Engerix B, a second course (2-4 doses) was successful in 5, thus increasing the overall success rate to 84%. Repetitive doses of vaccine intradermally were used as an alternative approach in eight patients who were unresponsive to intramuscular vaccination resulting in seroconversion in six. Finally, booster doses of intramuscular Engerix B have been used in 26 patients who lost their antibodies after successful vaccination.

Adult↗
PubMedDate not supplied

The effect of parathyroidectomy on hematocrit and erythropoietin dose in patients on hemodialysis.

Hyperparathyroidism has been implicated as a cause for resistance to erythropoietin therapy, based on a limited number of studies. The authors retrospectively surveyed the effects of parathyroidectomy on hematocrit and erythropoietin dose in patients with end-stage renal disease. The study group included 10 patients (4 men, 6 women) on long-term hemodialysis, 9 of whom were receiving erythropoietin intravenously during dialysis. Parathyroidectomy resulted in a decrease in mean parathormone levels from 15 times normal preoperatively to 2.3 times normal at follow-up. The hematocrit values increased, and the weekly erythropoietin dose decreased significantly when values 1 month before surgery were compared with those 6 months after surgery. From this, the authors conclude that secondary hyperparathyroidism is a cause of worsening anemia and increased erythropoietin requirements in patients on hemodialysis, and that parathyroidectomy is effective in reversing these abnormalities.

Adult↗
PubMedDate not supplied

Fever of unknown origin.

Explore the source record for details and available documents.

Fever of Unknown Origin↗
PubMedDate not supplied

Optimal dialysate bicarbonate during hemodialysis.

Eleven stable hemodialysis patients were treated with acetate dialysate, then changed to bicarbonate dialysate at three different concentrations. Blood was drawn from the arterial limb of the arteriovenous fistula before and after dialysis for pH, partial pressure of carbon dioxide, bicarbonate radical, and partial pressure of oxygen. Both acetate (35 mEq/L) and the lowest bicarbonate concentration (25 mEq/L) resulted in inadequate control of acid-base balance. Using a bicarbonate concentration of 30 mEq/L, mild predialysis acidosis was still present; this could be abolished using 35 mEq/L, but only at the cost of postdialysis alkalosis and mild hypoxemia.

Acetates↗
PubMedDate not supplied

Characterizing sleep disorders in chronic hemodialysis patients.

Forty-eight chronic hemodialysis (HD) patients (pts) completed questionnaires that used linear analogue scales (LAS), yes/no responses, and demographic data collection to characterize sleep disorders. Twenty-five pts (52%) reported problems sleeping. These pts graded sleep problems significantly higher than those without sleep problems (6.5 +/- 3 vs. 1.8 +/- 2, p less than 0.001 by LAS). Those with sleep disorders were more likely to smoke cigarettes (13/25 vs. 6/23, p less than 0.05) and have bone pain (14/25 vs. 6/23, p less than 0.05). No differences among pts with and without sleep problems were seen in age, gender, time on dialysis, caffeine intake, pruritus, feelings of sadness, worry, or anxiety, or Kt/V values (1.5 +/- 0.2 vs. 1.4 +/- 0.2, p less than 0.13). Restless legs (84%), onset insomnia (76%), and nighttime (76%) and early A.M. waking (72%) characterized the sleep disorders; symptoms suggesting nocturnal myoclonus were less common (20%). We conclude that sleep disorders are common in HD pts and may be exacerbated by tobacco use, bone pain, and restless legs. Kt/V does not correlate with sleep disorders. Further examination of this problem, including formal sleep studies, is needed.

Adult↗