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Biomedical subjects

R S Rodger

Publications and source records attributed to R S Rodger.

At least 55 records · Page 3Linked to original sources
PubMed1991

Gentamicin and vancomycin removal by continuous venovenous hemofiltration.

The dispositions and dose requirements for vancomycin and gentamicin were investigated in a 58-year-old man who was receiving long-term continuous venovenous hemofiltration. Estimates of clearance were obtained using a Bayesian parameter estimation program and stayed remarkably consistent throughout the therapy. Single daily doses of both vancomycin and gentamicin generally maintained the profiles for both drugs around the target ranges of peak 5-10 mg/L (gentamicin) and 25-40 mg/L (vancomycin) and trough less than 2 mg/L (gentamicin) and less than 10 mg/L (vancomycin).

Bayes Theorem↗
PubMed1991

Increased salivary concentration of human epidermal growth factor in patients undergoing CAPD.

Epidermal growth factor (EGF) was measured in the saliva of 36 patients with chronic renal failure (CRF) and 29 matched control subjects. Salivary EGF in controls was 0.65 +/- 0.009 nmol/L compared with 0.99 +/- 0.24 nmol/L in nondialyzed CRF patients, 1.15 +/- 0.23 in hemodialyzed patients and 1.96 +/- 0.25 (p less than 0.01, Wilcoxon Rank Sum Test) in CAPD-treated patients. On Sephadex chromatography, the major peak of immunoreactive EGF from patient and control saliva samples coeluted with purified human EGF. We conclude that salivary concentrations of human EGF are significantly elevated in end-stage renal failure, particularly in patients treated by CAPD.

Adult↗
PubMed1991

Renal dialysis.

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Humans↗
PubMed1990

Low calcium dialysate and high-dose oral calcitriol in the treatment of secondary hyperparathyroidism in haemodialysis patients.

We treated nineteen haemodialysis patients with secondary hyperparathyroidism with increasing oral doses of 1,25 dihydroxycholecalciferol (calcitriol) over a 12-week period and used low calcium dialysate (1.0 mmol/l) to prevent hypercalcaemia. Nine patients received daily calcitriol and ten received calcitriol thrice weekly, and at the end of the study the mean doses were 2.0 micrograms daily and 2.6 micrograms thrice weekly respectively. The regimen was well tolerated with nine episodes of mild hypercalcaemia, none of which were symptomatic. Mean PTH and alkaline phosphatase concentrations decreased from 62.0 pmol/l (15-125) to 22.0 pmol/l(1-70) (P less than 0.01), and 144 IU/l (48-461) to 123 IU/l (61-346) (P less than 0.05) respectively. Mean serum calcium increased from 2.33 mmol/l (2.05-2.55) to 2.52 mmol/l (2.26-2.67) (P less than 0.01). There were no significant changes in serum phosphate, magnesium, or aluminium concentrations and there were no significant differences in outcome between patients receiving daily therapy compared to those receiving it thrice weekly. A combination of high-dose oral calcitriol and low calcium dialysate can reverse secondary hyperparathyroidism without causing hypercalcaemia and these results suggest a benefit over conventional low-dose calcitriol.

Administration, Oral↗
PubMed1990

Pulsatile bioactive luteinizing hormone secretion in men with chronic renal failure and following renal transplantation.

We have measured plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (To) by radioimmunoassay (RIA) and bioactive LH (B-LH) by in vitro bioassay at 10-min intervals over 6 h in men treated by haemodialysis for renal failure and in men after renal transplantation. Eleven normal male volunteers acted as controls. Immunoreactive LH (I-LH) and FSH levels were elevated (p less than 0.03) in uraemia (mean +/- SE; 10.0 +/- 1.0 and 4.6 +/- 0.7 IU/l for LH and FSH, respectively) and following renal transplantation (8.1 +/- 1.2 and 5.3 +/- 0.5 IU/l) compared to controls (C) 4.9 +/- 0.5 and 2.7 +/- 0.4 IU/l) whereas B-LH [17.3 +/- 2.5, 14.8 +/- 1.8 and 12.9 +/- 1.3 IU/l in dialysis (D), transplant (T) and C groups, respectively] levels were normal. Prolactin levels were elevated (p less than 0.03) in the D group (median 348, range 162-1,780 mU/l) compared to the T group (161, 91-206 mU/l) and controls (163, 124-312 mU/l) whereas total To levels (mean +/- SE; 17.3 +/- 4.8, 15.5 +/- 1.3 and 19.6 +/- 2.1 nmol/l in the D, T and C groups, respectively) were similar as was the free To index. B-LH (median frequency, 2 and range 1-3 pulses/6 h) and I-LH (median frequency, 2 and range 1-2 pulses/6 h) was pulsatile in all the C group but B- and I-LH pulses were absent in 2 of the 5 subjects treated by dialysis. Following renal transplantation B-LH pulses were detected in all subjects, whilst I-LH pulses were absent in 1 subject.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The pulsatile secretion of bioactive luteinising hormone in normal adult men.

We have studied bioactive and immunoreactive LH pulsatility in 11 normal men. The temporal relationship of plasma LH, testosterone, and FSH were also investigated. Blood samples were taken at 10-minute intervals for 6 h and bioactive LH levels were determined using an in vitro mouse Leydig cell bioassay. Testosterone, LH and FSH were determined by standard radioimmunoassay. Twenty-two bioactive LH pulses were detected (amplitude 8.5 +/- 4.9 IU/l, mean +/- SD) with a frequency of 2 +/- 0.8/6 h compared with only 18 immunoreactive LH pulses (amplitude of 3.6 +/- 1.8 IU/l) and a frequency of 1.6 +/- 0.5/6 h. Bioactive:immunoreactive LH ratios increased (p less than 0.01) from the preceding pulse nadirs (2.26, range 1.66-4.28) to the pulse peaks (2.71, range 1.99-4.67). Twenty FSH pulses (seen in all but one subject) of low amplitude (0.7 +/- 0.6, median 0.5 IU/l) were also present. There was a close temporal relationship between testosterone and FSH secretion with bioactive and immunoreactive LH pulses with lags of 30-60 and 0 min, respectively. We conclude that immunoreactive LH pulses are discordant from bioactive LH pulses in 18% of occasions. Further, the mean amplitude of bioactive episodes were approximately 2.6 times greater than that of immunoreactive episodes, whereas interpulse period and pulse duration were similar. The increase in bioactive:immunoreactive ratio at pulse peaks may indicate that in normal men LH pulses are enriched with a more biopotent form of the molecule.

Adult↗
PubMed1989

Zinc deficiency and hyperprolactinaemia are not reversible causes of sexual dysfunction in uraemia.

We selected a group of male dialysis patients complaining of sexual dysfunction in whom penile vascular insufficiency and drug-induced impotence had been excluded. Monitoring of nocturnal penile tumescence was used to confirm organic disturbance. Patients with normal serum prolactin concentrations (n = 18) had significantly lower serum zinc values than normal controls (P less than 0.001) and were entered in a 6-month double-blind study comparing oral zinc acetate with placebo. Patients with elevated prolactin concentrations (n = 8) were entered in a 3-month double-blind crossover study comparing oral pergolide mesylate with placebo. In the zinc study, serum zinc concentrations increased (P less than 0.05) in the zinc-treated but not the placebo-treated group. One of nine patients receiving zinc reported improved sexual function, as did two of nine patients receiving placebo. There were no significant changes in sperm counts, nocturnal penile tumescence, testosterone, sex hormone binding globulin or gonadotrophin concentrations in either treatment group. In the pergolide study, serum prolactin values decreased (P less than 0.01) in the pergolide but not in the placebo treatment period. One patient reported improved sexual function during the pergolide treatment period and two during the placebo period. There were no significant changes in sperm counts, nocturnal penile tumescence, testosterone, sex hormone binding globulin or gonadotrophin concentrations after pergolide. These studies show no benefit of zinc or pergolide compared with placebo in the treatment of uraemic impotence.

Acetates↗
PubMed1989

Indirect inguinal hernia in CAPD patients with polycystic kidney disease.

We have experienced a high incidence of indirect inguinal hernias occurring in the first few months of starting CAPD in male patients with autosomal dominant polycystic kidney disease (PKD). Out of 13 patients with P.C.K. on CAPD one (7.7%) had inguinal herniorraphy at an early age and six (46.2%) developed bilateral indirect inguinal hernia during CAPD. In comparison only one of 30 other male patients on CAPD developed indirect inguinal hernia and none had any evidence of previous inguinal herniorrhaphy or of indirect inguinal hernia on clinical examination. Five out of seventeen (29.4%) male patients with P.C.K. on hemodialysis or conservative treatment of renal impairment had history of inguinal herniorrhaphy or an evidence of inguinal hernia on clinical examination. This compares with a rate of herniorrhaphy performed for indirect inguinal hernia approximately 1.5 per 1000 population. In one patient on CAPD a peritoneogram using 99m Tc sulfur colloid suggested a patent processes vaginalis to account for scrotal edema on one side; the patient subsequently developed an indirect inguinal hernia on the other side just a few months after the repair. In view of high association of patent processus vaginalis with P.C.K. we recommend it is routinely searched in this group of patients and repaired at time of CAPD catheter insertion.

Hernia, Inguinal↗
PubMed1987

Factors influencing haematological measurements in healthy adults.

By studying 516 healthy adults normal reference intervals were established for the Coulter "S" haematological indices with the plasma ferritin, B12, folate and red cell folate in a subgroup of 306. Significant sex related differences were found for all measurements other than MCV, MCH and B12. After allowing for these sex related differences, the effects of age, body size, fasting, smoking, alcohol, exercise and contraceptive pill usage on the parameters studied was defined.

Adolescent↗
PubMed1987

HLA-A, B, DR and Bf allotypes in patients with idiopathic membranous nephropathy (IMN).

Fifty-five adult biopsy-proven patients with idiopathic membranous nephropathy were examined for HLA-A, B and DR antigens, and for the Bf allotypes. The phenotype frequencies of HLA-DR3 (52 vs. 23%) and HLA-B8 (46 vs. 24%) showed a significant increase in the IMN patient group compared to those of controls from the same region. The supraphenotype in which the combination of DR3-B8 alleles in Bf SS homozygotes occurred was significantly more common in the patient group than in the controls. A subset of six individuals carrying antigens DR3, B8, and common Bf*S alleles was identified, and the clinical course of those patients was found to be significantly worse compared to the rest of the patients. The present results do not support the existing suggestion that the clinical course of these diseases in Caucasians is determined by antigens B18 and the rare Bf allele (Bf*F1). It seems likely that IMN is not a single disease but a renal lesion that can result from several combinations of genetic predisposition and environmental stimuli.

Adult↗
PubMed1987

Renal replacement therapy in patients aged over 60 years.

The availability of dialysis for patients with end-stage renal failure in the United Kingdom has lagged behind that in most of the rest of Europe and USA, although there has been considerable improvement over recent years. Concern about prognosis and quality of life on renal replacement therapy, together with shortage of facilities has meant that some elderly people have been denied treatment. A retrospective study of all patients commencing renal replacement therapy in Newcastle between 1974 and 1985 was performed. The five year survival of patients aged more than 60 years at the start of treatment (n = 122) was 53%, compared with 68% for a cohort of individuals aged less than 60 years (n = 632). A questionnaire sent to the 62 elderly patients surviving at the end of the follow-up period revealed that most were married, independent, active and lived in their own home. They were not lonely, generally enjoyed life and were happy with their mode of renal replacement therapy. These results show that elderly patients make good dialysis candidates and they should not be denied treatment on the basis of age alone. Greater funding of renal services is necessary to accommodate these patients.

Age Factors↗
PubMed1987

Changing pattern of acute renal failure.

During the four-year period 1981-1984, 250 patients with severe acute renal failure were treated at one centre. There were seven obstetric cases (2.8 per cent) 118 'surgical' cases (47.2 per cent) and 125 medical cases (50 per cent). This is a different pattern from that seen in the majority of earlier reports. In 60 of the 125 medical patients the aetiology of the acute renal failure could only be determined by renal biopsy. This series suggests that with changing medical practice (particularly the improvement in resuscitation) and an ageing population, the pattern of causes of acute renal failure is altering. It also highlights the value of renal histology as a guide to diagnosis and treatment in patients with unexplained acute renal failure.

Acute Kidney Injury↗
PubMed1986

Continuous ambulatory peritoneal dialysis after the honeymoon: review of experience in Newcastle 1979-84.

Two hundred and twenty nine consecutive patients (129 men, mean age 45) were reviewed 12 to 65 months after starting treatment with continuous ambulatory peritoneal dialysis (CAPD) from January 1979 to December 1983. They received CAPD for a mean of 19.8 (range 0.5-62) months. Actuarial patient survival was 79% at 24 months and 72% at 36 months. Half of the 46 deaths were related to cardiovascular disease, while eight patients died of abdominal complications, including three patients with peritonitis. Peritonitis occurred at a rate of one episode per 35 patient weeks, and 88% of episodes were cleared by one or more courses of antibiotics. This still left peritonitis as the commonest cause of failure of CAPD, leading to a permanent change of treatment in 44 patients and temporary interruption in a further 25. CAPD remains a reasonable medium term treatment in chronic renal failure. Despite the persisting problem of peritonitis the results are comparable with those achieved by haemodialysis, and CAPD has become the treatment of first choice for end stage renal failure in Newcastle. In younger patients judged unsuitable for transplantation and facing long term dialysis, however, haemodialysis is preferred.

Actuarial Analysis↗
PubMed1986

C3 and Bf complement types in chronic renal failure.

C3 and BF allele frequencies were studied in 55 patients with idiopathic membranous nephropathy (IMN) and unrelated normal individuals from North-East England. Eighteen of these IMN patients progressed to renal failure and C3*S allele showed a significant increase in these patients. A possible mechanism for this increase is briefly discussed.

Alleles↗