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Biomedical subjects

S R Ash

Publications and source records attributed to S R Ash.

83 records · Page 5Linked to original sources
PubMedDate not supplied

Neurologic improvement of patients with hepatic failure and coma during sorbent suspension dialysis.

Fifteen patients with acute deterioration of liver function, high serum ammonia, and an average coma level of 3.9 (of 4) were treated for 8-12 hrs daily with a system that uses the membranes of a cellulosic plate dialyzer to pump blood through a single access at 200-225 ml/min, and includes a sorbent suspension as dialysate. Neurologic status of the patients was declining before treatment, but significantly improved during each treatment and over the course of 1-12 (average, 4) treatments. Diastolic blood pressure and pulse rate normalized. For half the patients, treatment with the BioLogic-DT system served as a bridge to liver transplant or liver recovery.

Adult↗
PubMedDate not supplied

Effect of sorbent-based dialytic therapy with the BioLogic-DT on an experimental model of hepatic failure.

An experimental model of hepatic failure in the dog has been developed in which the liver is devascularized in two stages. Under general anesthesia, a portacaval shunt is created, ligatures placed around the hepatic and gastroduodenal arteries, and the dog recovered. Two days later under general anesthesia, the ligatures are pulled, converting hepatic insufficiency to hepatic failure. Five control animals developed hypotension, severe lactic acidosis, hypoglycemia, and increasing liver enzyme levels during 6 hrs of follow-up. The BioLogic-DT system includes a cellulosic plate dialyzer with a suspension of powdered charcoal and cation exchangers as dialysate. Five animals were treated with the BioLogic-DT for 6 hrs after creation of hepatic failure. These animals were more stable physiologically, developed less lactic acidosis and less enzyme elevation, and maintained high normal blood glucose levels. The results help explain the clinical improvement demonstrated in patients with hepatic failure treated by the BioLogic-DT, and confirm that many of the toxins of hepatic failure are dialyzable and bound by simple sorbents such as charcoal and cation exchangers.

Ammonia↗
PubMedDate not supplied

A subcutaneous capillary filtrate collector for measurement of blood chemistries.

The capillary filtrate collector (CFC) contains 30,000 molecular weight cut-off, hollow fiber ultrafiltration membranes that are placed below the skin. A transcutaneous tube leads to an evacuated glass tube that provides a vacuum to pull ultrafiltrate at 40-60 microliters/hr from blood, through the fibers, and past a sampling port to the glass tube. Long-term (1-6 months) animal and clinical studies have shown that the ultrafiltrate concentration of chemicals such as glucose and a variety of drugs is exactly the same as that of the blood plasma water when the ultrafiltrate is created. In this study, the device was placed in six home monitored diabetics and four in-center hemodialysis diabetic patients. Over the following month, blood glucose concentrations were compared to CFC glucose concentrations. In spite of difficulties in diluting and assaying small samples of filtrate, there was a good correlation between blood and CFC glucose levels. A flow-through enzymatic glucose sensor has been tested and shown to accurately measure glucose in CFC filtrate. When placed in the transcutaneous tubing near the skin, this should allow a small external device to continuously monitor glucose levels in brittle or out of control diabetes with high accuracy and little risk, discomfort, or cost.

Blood Chemical Analysis↗
PubMedDate not supplied

Continuous flow-through peritoneal dialysis (CFPD): comparison of efficiency to IPD, TPD, and CAPD in an animal model.

OBJECTIVE: To determine whether continuous flow-through peritoneal dialysis (CFPD), a treatment schedule in which peritoneal dialysate is infused continuously into one part of the abdomen (over the liver) and is drained from a distant part of the abdomen (the pelvis), can provide greater clearance than continuous ambulatory peritoneal dialysis (CAPD), tidal peritoneal dialysis (TPD), or intermittent peritoneal dialysis (IPD). DESIGN: A prospective study comparing four schedules of peritoneal dialysis in the awake, normal dog, using glucose clearance as a substitute for urea clearance. METHODS: We placed two chronic dialysis catheters into the abdomen of anesthetized dogs (with intraperitoneal portions of fluted or miniature column-disc design). On successive days, with the dogs awake and prone, we performed peritoneal dialysis for 4 hours with 1.5% dialysate according to one of four schedules, each with 2 L maximum intraperitoneal volume: CFPD (unidirectional flow at an average of 3.6 L/hr), IPD (2 L/hr), TPD (average of 3.6 L/hr, 1 L residual volume), and CAPD (2 L/4 hr). Glucose and urea clearances were calculated from blood and peritoneal concentrations and dialysate flow rates. RESULTS: Stabilized glucose clearances (from 60 to 240 minutes) averaged 11 +/- 5 mL/min for IPD, TPD, and CFPD, and 5 +/- 2 mL/min for CAPD. However, glucose clearances of CFPD were 13 +/- 6 mL/min when the intraperitoneal volume was maintained at 800-100 mL, and 16.5 +/- 6 mL/min when flow rate was 6 L/hr. Urea clearances were twice the measured glucose clearances. CONCLUSION: When CFPD is performed with an appropriate intraperitoneal volume and flow, it is the most chemically effective method of peritoneal dialysis in removing small molecules like urea.

Animals↗
PubMedDate not supplied

Extracorporeal whole body hyperthermia treatments for HIV infection and AIDS.

Whole body hyperthermia therapy (WBHT) is the elevation of the core body temperature to 42 degrees C. In vitro studies have confirmed that 42 degrees C is cytocidal for virally infected lymphocytes, and even more effective when heating is repeated 4 days later. The safety and efficacy of two successive sessions of WBHT (4 days apart) was evaluated in 30 patients with AIDS (not on protease inhibitors), randomized to: 1) untreated controls, 2) low temperature WBHT for 1 hour at 40 degrees C and repeated 96 hours later, and 3) high temperature WBHT for 1 hour at 42 degrees C and repeated 96 hours later. The sorbent suspension in the ThermoChem System (HemoCleanse, West Lafayette, IN) system automatically controlled blood phosphate, calcium, and other electrolyte concentrations during WBHT. In 1 year of follow-up after WBHT, there were positive effects of the therapy on frequency of AIDS defining events, Karnofsky score, and weight maintenance. However, effects on plasma HIV RNA and CD4 counts were transient. Two successive WBHT treatments were performed in four patients who were on protease inhibitor/triple drug therapy, but had suboptimal response. In follow-up for 6 months, plasma HIV RNA and CD4 improved after WBHT, and the patients remained clinically well. This WBHT may have specific advantages in patients with suboptimal response to protease inhibitor therapy.

Acquired Immunodeficiency Syndrome↗