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Biomedical subjects

S Waldek

Publications and source records attributed to S Waldek.

At least 37 records · Page 2Linked to original sources
PubMed1989

Relationships between renin, aldosterone, blood pressure and renal function in hypertensive insulin-dependent diabetes mellitus.

A cross-sectional analysis of associations between total plasma renin (TPR) and aldosterone, blood pressure, renal haemodynamics, autonomic function and electrolyte balance was carried out in 35 hypertensive non-azotaemic insulin-dependent diabetics. Supine TPR was increased in 10 subjects and reduced in one, although erect TPR was increased in nine but reduced in 18 subjects. The supine to erect TPR gradient was greater than 40% in all cases. Supine and erect TPR correlated closely (r = 0.99, P less than 0.001). No correlation was found between TPR and age or blood pressure and multiple regression analysis failed to reveal independent predictors for TPR. Supine aldosterone was reduced in two subjects and increased in three, and erect aldosterone levels were reduced in three but increased in eight subjects. However, the postural aldosterone gradient was greater than 40% in only 20 cases. Supine and erect aldosterone correlated with each other (rs = 0.64, P = 0.001) but not with TPR. Aldosterone levels were most strongly related inversely to duration of diabetes, diabetic retinopathy, parasympathetic neuropathy and directly to diastolic blood pressure and glomerular filtration rate. Aldosterone levels correlated negatively with age. This was corrected for in multiple regression analysis which revealed an inverse relationship between supine aldosterone and serum potassium (P less than 0.05) and a direct one with renal plasma flow (P less than 0.007). Erect aldosterone was independently associated with duration of diabetes (P less than 0.005), systolic postural gradient (P less than 0.02), and the postural aldosterone gradient with the presence of parasympathetic neuropathy (P less than 0.004). The observation of elevated TPR in 10 subjects and the lack of relationship between TPR and other variables may reflect the overproduction of inactive relative to active renin in insulin-dependent hypertensive diabetics with autonomic dysfunction. The association between aldosterone and blood pressure, renal haemodynamics and electrolyte balance suggests that mineralocorticoids may be relevant to the natural history of hypertensive diabetic renal disease.

Adult↗
PubMed1988

Pharmacokinetics of flecainide in a patient undergoing continuous ambulatory peritoneal dialysis.

The disposition of flecainide was studied in a 60-year-old, 92 kg man, who was being administered flecainide to control ventricular arrhythmias. The patient was also being treated with continuous ambulatory peritoneal dialysis (CAPD) for end-stage renal disease. The patient was given two single doses of 100 mg and 200 mg of flecainide 1 week apart. Serum, dialysate and urine samples were collected at appropriate times. Areas under the serum concentration-time curves were used to calculate total body clearance, renal clearance and CAPD clearance. The values obtained were 56.6 ml/min, 6.2 ml/min and 2.2 ml/min, respectively. The percentage of a given dose of flecainide removed in 24 h by residual renal function and by CAPD was 4.7% and 1.1% respectively. It is suggested that the dosage reduction required for patients taking flecainide during CAPD should be similar to that for patients with end-stage renal disease but not on dialysis. No dosage change is required during CAPD.

Biological Availability↗
PubMed1988

Cardiac tamponade complicating central venous catheter.

Cardiac tamponade complicating central venous catheters is usually fatal. We present a 23 year old woman who developed cardiac tamponade 12 hours after the insertion of a subclavian line. Early recognition of this complication and urgent pericardiocentesis led to her survival.

Adult↗
PubMed1987

Intravenous or intraperitoneal vancomycin for the treatment of continuous ambulatory peritoneal dialysis associated gram-positive peritonitis?

A clinical and pharmacokinetic study was carried out to determine whether an intraperitoneal (IP) loading dose of vancomycin was as effective as an intravenous (IV) load in the treatment of continuous ambulatory peritoneal dialysis (CAPD)-associated gram-positive peritonitis. Each patient continued a 14-day treatment on IP maintenance doses. All cases of peritonitis (10 in each group) were eradicated. Side effects occurred in 3 patients following IV vancomycin and in none following IP vancomycin. Serum and peritoneal vancomycin concentrations equilibrated fully and rapidly with each route. It is concluded that an IP loading dose of vancomycin, followed by IP maintenance doses, is as effective as and produces fewer side effects than an IV loading dose in the treatment of CAPD peritonitis.

Bacterial Infections↗
PubMed1987

Bioavailability of bumetanide in grossly oedematous patients.

A pharmacokinetic study was undertaken to determine the bioavailability of bumetanide in grossly oedematous patients. Six nephrotic patients were administered bumetanide 2mg orally (as tablets) and intravenously as single doses, in a randomised fashion. Serum bumetanide concentration-time profiles were characterised. Data were fitted to a 2-compartment model (5 patients) and a 3-compartment model (1 patient). Analysis of the areas under the curves showed a bioavailability of 0.84 +/- 0.2, which is similar to that in normal individuals. It is suggested that the bioavailability of oral bumetanide in oedematous patients is not altered significantly and that the apparent resistance to diuretics in such patients may be due to another cause.

Aged↗
PubMed1984

Impact of continuous ambulatory peritoneal dialysis on treatment of renal failure in patients aged over 60.

Thirty eight patients aged over 60 with end stage renal disease were treated by continuous ambulatory peritoneal dialysis for up to three years. Most of these patients, because of their age or coexisting diseases, had been considered to be unsuitable for haemodialysis by the criteria used before the advent of continuous ambulatory peritoneal dialysis in 1980. Actuarial patient survival at one and two years was 72% and 61% respectively, and only two patients were permanently transferred to haemodialysis. Twenty one of the 23 survivors were fully rehabilitated, the remaining two being partially disabled but living at home. Continuous ambulatory peritoneal dialysis permits more liberal selection of patients with end stage renal disease for renal replacement treatment with excellent survival and rehabilitation and without overburdening scarce hospital haemodialysis facilities.

Aged↗