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Biomedical subjects

R Vanholder

Publications and source records attributed to R Vanholder.

259 records · Page 15Linked to original sources
PubMedDate not supplied

Relationship between phagocyte metabolic function and years of maintenance dialysis.

An index of the activation of NADPH-oxidase in the production of free radicals is CO2 production by the hexose monophosphate shunt of polymorphonuclear cells (PMN). 14CO2 production from glucose-1-C14 was studied as an indicator of PMN function after addition of latex or zymosan to predialysis whole blood, and correlated with the years spent on hemodialysis. In a series of 49 patients, a nadir in PMN metabolic activity, when compared with healthy controls, was reached in a subgroup treated for less than 24 months (n = 24, latex: 109.5 +/- 10.1 vs. 233.7 +/- 11.8; zymosan: 181.9 +/- 18.9 vs. 407.8 +/- 19.3 DPM/10(3) PMNs; p less than 0.01). In patients treated by dialysis for longer than 24 months, PMN metabolic function was significantly better, resulting in partial correction of the defect for both latex and zymosan. Phagocyte CO2 production in response to latex or zymosan correlated significantly with years of dialysis treatment (r = 0.63 and 0.56, respectively, n = 49; p less than 0.001). These findings may have implications for phagocyte reactivity towards infection, bioincompatible dialyzer membranes, and renal transplantation.

Energy Metabolism↗
PubMedDate not supplied

In vivo solute extraction by a new polysulphone membrane with low ultrafiltration capacity.

High flux polysulphone (PS600, Fresenius) is a highly biocompatible membrane, but the high ultrafiltration (UF) capacity limits its clinical applications. In the present study a new PS (PS400) with an UF coefficient in the range of cuprophan (CU) but a biocompatibility like high flux PS was evaluated. Dialysis efficiency with PS400 was compared to dialyzers with the same surface, at similar blood flows. Overall extraction of UV-absorbing compounds was higher with PS400 (P less than 0.01). The extraction of the individual compounds, hippuric acid and parahydroxy-hippuric acid was also higher for PS400 (P less than 0.01 resp. less than 0.05). The fall in white blood cells after 15 min. of dialysis was from 6.5 +/- 1.5 to 1.7 +/- 0.6 for CU (-83%), and from 8.6 +/- 1.7 to only 7.4 +/- 1.7 x 10(3) cells/mm3 (-14%) for PS400 (P less than 0.01 versus CU). Ultrafiltration characteristics were similar for both dialyzers.

Biocompatible Materials↗
PubMedDate not supplied

The pathophysiology of lupus erythematosus.

Systemic lupus erythematosus disseminatus in addition to the more restricted, lupus-like syndromes, is the consequence of an attack by the immune system on the cellular and nuclear structures of the body. These disorders are also frequently associated with disturbances of the coagulation cascade. In this review paper, the factors that provoke or enhance these disturbances are considered, as well as the way by which this provocative effect is exerted. An intermutual relation between various elements is described, whereby congenital factors (heredity, race) and non-congenital factors (sex hormones, pregnancy, environment, ultraviolet light, drugs, infection) play a role. These factors induce the activation cascade of the disease, via two different axes: on the one hand modifications in the DNA structure, on the other immune stimulation. This eventually results in tissue damage.

Causality↗
PubMedDate not supplied

The need for a center-tailored treatment protocol for peritonitis.

OBJECTIVE: Despite many improvements in connectology, peritonitis continues to be a major burden in peritoneal dialysis. Because of the high variety in causative organisms and of the differences in their sensitivity patterns, surveillance of the epidemiology of peritonitis and the appropriate adaptation of the therapy are necessary. This study was performed to evaluate the influence of the nature of causative bacteria on the effectiveness of empirical treatment protocols. Based on this information, a new empiric treatment protocol was proposed. SETTING: Peritoneal dialysis program of a university hospital. DESIGN: All episodes of peritonitis at the University Hospital Gent between 1 January 1994 and 31 December 1996 were analyzed retrospectively. Results of microbiological cultures, microscopic evaluation of dialysate, and clinical course were noted. RESULTS: During 1240 patient-months at risk, 50 episodes of peritonitis with identifiable responsible bacteria were observed. Gram-positive organisms were cultured in 34 episodes, and gram-negative organisms were found in 16 episodes. No responsible organism could be identified in 25 additional cases. Resistance to methicillin was registered in 33% of the cultures with staphylococci. There was no resistance to vancomycin. A new empirical treatment protocol was proposed, using a single dose of vancomycin and gentamicin intraperitoneally the first day, followed by oral treatment with ciprofloxacin. With this protocol, a 96% coverage rate is obtained, as opposed to a 78% coverage by using the Ad Hoc Advisory Committee protocol (p < 0.01). CONCLUSION: Individual centers should continue to monitor the epidemiology of peritoneal dialysis-related peritonitis and the epidemiology of the causative organisms and their sensitivity patterns in order to adapt general guidelines into a center-tailored empirical treatment protocol.

Anti-Bacterial Agents↗