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Biomedical subjects

S J Fleming

Publications and source records attributed to S J Fleming.

At least 37 records · Page 2Linked to original sources
PubMed1991

Dialyser reprocessing with Renalin.

We evaluated the dialyser reprocessing agent Renalin in a 6-month prospective study of 2,759 dialyses on 59 patients. Dialysers were withdrawn after a maximum of 6 uses, and the average number of uses achieved was 4.5 Dialyser survival varied with the type of dialyser but was unaffected by the dialysate base. In vivo clearances of urea, creatinine and phosphate were not altered by reuse, but there was a small decrease in ultrafiltration characteristics of used dialysers. No clinically significant adverse event was attributed to reuse. Blood pressure was better preserved with used dialysers, and patients experienced significantly fewer intradialytic symptoms. Savings of over +A 25,000 were achieved during the study.

Acetates↗
PubMed1990

Use of aminohydroxypropylidene bisphosphonate (AHPrBP, "APD") for the treatment of hypercalcemia in patients with renal impairment.

Aminohydroxypropylidene bisphosphonate (AHPrBP, "APD") is a relatively new bisphosphonate which has been shown to be effective for control of hypercalcemia due to a variety of causes. Renal impairment has been reported following the use of other bisphosphonates and pre-existing renal impairment has been regarded as a contraindication to the use of AHPrBP. We report the successful use of intravenous AHPrBP to control hypercalcemia in three patients with renal impairment, one of whom was dialysis-dependent. No significant side effects were noted; in particular, there was no further deterioration in renal function. Intravenous AHPrBP may be a safe and effective agent for the control of hypercalcemia in patients with renal impairment.

Acute Kidney Injury↗
PubMed1989

Bone cysts and haemodialysis-related amyloidosis.

Carpal tunnel syndrome and arthropathy are frequent complications of long-term haemodialysis. Both are associated with cystic lesions of bone and are related to synovioarticular deposition of a new type of amyloid derived from circulating beta 2-microglobulin. Retrospective analysis of the radiographic skeletal surveys of all 58 patients on haemodialysis for 6 or more years revealed one or more cystic bone lesions in 36% of patients. Radiographic analysis indicated that a number of these cysts were due to hyperparathyroid bone disease or joint degeneration, but a majority showed features suggesting an arthropathy of another aetiology. We present evidence that the development of these latter cysts in an individual on long-term dialysis is an indicator of the presence of synovioarticular amyloidosis of the beta 2-microglobulin type. The radiographic characteristics and development of these cysts, which we believe are due to bony infiltration from synovioarticular amyloid are described.

Adult↗
PubMed1989

Urokinase: a treatment for relapsing peritonitis due to coagulase-negative staphylococci.

Four consecutive patients with relapsing peritonitis due to coagulase-negative staphylococci have been successfully treated by the addition of urokinase to their treatment regime, having failed to respond to appropriate antibiotic therapy alone. The organisms isolated from each episode of peritonitis in an individual patient were shown to be identical by antibiotic sensitivity, phage typing, slime production and immunoblot analysis. The action of urokinase is unknown but it may act by fibrinolysis, allowing antibiotics access to a source of infection previously protected by fibrin. The technique described is a simple, safe and effective treatment of relapsing peritonitis due to coagulase-negative staphylococci, and its use can markedly reduce the morbidity associated with this infection.

Bacterial Typing Techniques↗
PubMed1988

Anti-glomerular basement membrane antibody-mediated nephritis complicating transplantation in a patient with Alport's syndrome.

Loss of an allograft caused by anti-GBM antibody-mediated nephritis is a rare complication of renal transplantation in Alport's syndrome. We describe a patient in whom this occurred. He belongs to the subgroup of patients with hereditary nephritis and deafness with an abnormal Goodpasture antigen, and he developed a high level of circulating anti-GBM antibodies within 20 days of transplantation of a kidney with a presumably normal Goodpasture antigen. The antibody titer fell, only to rise again when he developed evidence of acute infection with CMV. Coincident with this second rise in antibody titer he developed an anti-GBM antibody-mediated crescentic nephritis with resultant loss of graft function and transplant nephrectomy. This case provides support for the hypothesis that the abnormality in the basement membrane in some patients with Alport's syndrome involves the Goodpasture antigen, and raises the possibility that viral infection may have triggered autoantibody production.

Adult↗
PubMed1988

Blood volume change during isolated ultrafiltration and combined ultrafiltration-dialysis.

Despite extensive study of the difference in the cardiovascular response to ultrafiltration in isolation and during haemodialysis, there is still disagreement in the literature as to whether or not there is a difference in the efficiency of plasma refilling between the two procedures. We believe that this results both from the use of inadequate techniques to measure change in blood volume and shortcomings in experimental design. We have employed novel methods in ten patients to study plasma refilling during isolated ultrafiltration and dialytic ultrafiltration. Measurement of blood pressure and heart rate confirmed the inferior cardiovascular tolerance to haemodialysis observed by others. However, no difference in the rate of plasma refilling could be demonstrated. Our observations suggest that the superior tolerance to isolated ultrafiltration is not explained by differences in vascular refilling.

Adult↗
PubMed1988

Dialysis-induced change in erythrocyte volume: effect on change in blood volume calculated from packed cell volume.

Blood volume (BV) change during hemodialysis is often monitored by packed cell volume (PCV). This assumes erythrocyte volume is constant. We tested this by dialyzing 5 patients for 2 hours against high (154 mmol/l), normal (140 mmol/l) and low (126 mmol/l) dialysate sodium concentrations. Erythrocyte water content, calculated from measured blood and plasma water contents, decreased with high and increased with low dialysate sodium concentrations. Erythrocyte volume, calculated from mean corpuscular hemoglobin concentration (MCHC) decreased 3.8% with high concentration dialysate and increased 2.5% when dialysate concentration was low. These changes correlated significantly (r = 0.80, p less than 0.01) with alterations in plasma sodium. Mean corpuscular volume (MCV), measured with a Coulter-S Plus Counter did not alter because of a methodological artefact. BV change can be calculated from PCV when plasma concentrations of osmotically active substances are changed only if allowance is made for altered erythrocyte volume.

Adult↗
PubMed1987

Effect of dialysate composition on intercompartmental fluid shift.

Effect of dialysate composition on intercompartmental fluid shift and hemodynamics was studied in 12 patients during 1.5 or 2 hours of hemodialysis without net ultrafiltration, using high (H;Na 154 mmol/liter), normal (N;Na 140 mmol/liter) or low (L:Na 126 mmol/liter) concentration dialysate. H dialysate was associated with a small (0.9%) increase in blood volume, a larger increase in plasma volume and a decrease in erythrocyte volume. L dialysate resulted in a 2.3% decrease in blood volume, a larger decrease in plasma volume and an increase in erythrocyte volume. N dialysate gave results which were intermediately between the other two dialysis conditions. There was no difference in the post-dialysis mean arterial pressure between the groups, although heart rate increased more during H dialysis than during the other two conditions. Change in blood and erythrocyte volume correlated significantly with change in plasma Na concentration and osmolality, but not with change in plasma urea concentration. We conclude that dialysate composition affects the movement of water into and out of the plasma and erythrocytes in a manner that can be accounted for by altered plasma concentrations of osmotically active substances.

Adult↗
PubMed1987

Familial dysalbuminaemic hyperthyroxinaemia.

Familial dysalbuminaemic hyperthyroxinaemia (FDH) can be confused with thyrotoxicosis if clinical signs and laboratory tests are misinterpreted. We describe three members of the same family with FDH who were erroneously treated for thyrotoxicosis. Screening of other family members resulted in the discovery of a further six patients at risk of being misdiagnosed as thyrotoxic. Clinical and biochemical findings relevant to the diagnosis of FDH are discussed.

Adult↗
PubMed1985

Parathyroid carcinoma associated with chronic renal failure and previous radiotherapy to the neck.

Carcinoma of the larynx was treated by irradiation followed by laryngectomy in a man who had been receiving regular haemodialysis for two years. At least one, and probably two, parathyroid glands were removed at this time, and the remaining two were removed three years later for tertiary hyperparathyroidism. A portion of one gland was implanted into the forearm. The forearm implant was resected the following year for recurrent hypercalcaemia. Six years later, again with recurrent hypercalcaemia, he died of bronchopneumonia. Metastatic parathyroid carcinoma was found in the apex of the left lung. The source of this parathyroid tissue and the possible role of irradiation in the pathogenesis of parathyroid cancer in this patient were investigated.

Adult↗
PubMed1985

Improved cardiac function after renal transplantation.

There are few reports of the outcome of renal transplantation in patients with severe left ventricular (LV) impairment. We describe three men with chronic disabling heart failure associated with LV dysfunction in whom a remarkable improvement in cardiac function followed renal transplantation. Transplantation may offer the prospect of successful rehabilitation in these circumstances. Undue pessimism as to the prognosis in such patients is unwarranted.

Adult↗
PubMed1984

Survival in elderly patients presenting with uraemia.

A retrospective study was made of 93 patients aged 60 years or greater presenting with renal failure between 1976 and 1981 to assess survival and analyse the factors influencing it. Two-year survival of 28 patients with acute renal failure was 50 per cent and of 65 patients with chronic renal failure it was 40 per cent. Higher initial plasma urea and creatinine values and increasing age had a significantly adverse effect on survival. Patients requiring dialysis likewise fared less well although only one patient succumbed as a direct result of the dialysis procedure. The study reveals a worthwhile survival in both acute and chronic renal failure even though during the period under consideration long-term dialysis of patients in this age group with terminal chronic renal failure was rarely undertaken.

Acute Kidney Injury↗