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Biomedical subjects

T Busch

Publications and source records attributed to T Busch.

71 records · Page 4Linked to original sources
PubMed1997

In vivo and in vitro effects of amino-acid-based and bicarbonate-buffered peritoneal dialysis solutions with regard to peritoneal transport and cytokines/prostanoids dialysate concentrations.

BACKGROUND: Increasing evidence suggests that conventional PD solutions are detrimental to host defence mechanisms of peritoneal cells. We tested a new amino-acid-based and bicarbonate-buffered PD solution under in vivo and in vitro conditions. METHODS: During a prospective, cross-over randomized, intraindividual study 10 CAPD patients were investigated with three different solutions: Amino/Bic, 1% amino acid, 34 mmol/l bicarbonate; Glu/Bic, 1.5% glucose, 34 mmol/l bicarbonate; and Glu/Lac, 1.5% glucose, 35 mmol/l lactate. A PET was performed and transport properties (clearance, D/P ratio, MTAC) were calculated. Prostanoid and cytokine concentrations were measured in serum and the 6 h effluent. Using an in vitro model, mononuclear leukocytes of healthy donors were also incubated with the test fluids. In vivo results. Peritoneal clearance and MTAC of small solutes (creatinine, urea) were not significantly altered by amino acids or bicarbonate. Peritoneal permeability and transperitoneal excretion of higher-weight protein molecules (beta 2-microglobulin, albumin, IgG) were increased with Amino/Bic compared to Glu/Lac (P < 0.05) (D/P ratio albumin: Amino/Bic, 0.027 +/- 0.003; Glu/Bic, 0.023 +/- 0.003; Glu/Lac, 0.022 +/- 0.002). Application of Amino/Bic was accompanied by an increased effluent concentration of Il-6, Il-8, TNF alpha, PGE2, and 6-keto-PGF1a (P < 0.05). Dialysate nitrite/nitrate and cGMP concentrations (as indicators of NO generation) did not differ between the solutions. In vitro results. Both bicarbonate fluids demonstrated a better preservation of the mitochondrial dehydrogenases activity (MTT assay) compared to Glu/ Lac (P < 0.01) (Amino/Bic: 80.6 +/- 3.2%; Glu/Bic: 86.0 +/- 1.8%; Glu/Lac, 64.9 +/- 2.3%, referred to RPMI as control). Constitutive and LPS stimulated release of Il-1 beta and Il-6 was less suppressed with both bicarbonate fluids (P < 0.05) (LPS-stim. Il-6 release: Amino/Bic, 33.0 +/- 6.6%; Glu/Bic, 65.5 +/- 10.3%; Glu/Lac, 1.5 +/- 0.7% referred to RPMI). CONCLUSION: Application of an amino-acid/bicarbonate solution resulted in a small but significant increase in peritoneal permeability. Also increased concentrations of various cytokines/prostanoids were measured in the effluent. According to in vitro testing with mononuclear phagocytes both bicarbonate-buffered fluids were to the same extent less inhibitory to certain cell functions than lactate-buffered solution.

Adult↗
PubMed1996

[Automatic peritoneal dialysis--an adequate therapy option for the treatment of terminal kidney failure. First experiences with a new, pneumatically operated cycler].

OBJECTIVE: To determine whether (1) the recently developed pneumatic cycler for automatic peritoneal dialysis (APD) achieves individually adjustable adequate dialysis efficacy, and (2) changing from continuous ambulatory peritoneal dialysis (CAPD) to APD results in an appropriate increase of dialysis efficacy. PATIENTS AND METHODS: Between July 1994 and August 1995 dialysis treatment for chronic renal failure was performed in 17 patients (four women, 13 men: mean age 42.9 +/- 11.6 years). Ten patients decided primarily on APD, seven changed over from CAPD to APD because of inadequate dialysis efficacy. Adequacy of dialysis was judged by clinical criteria, weekly creatinine clearances (wCcr) and urea levels (urea elimination related to distribution volume [wKT/V]). RESULTS: Mean treatment period with APD was 7.9 +/- 0.3 hours, dialysate volume 19.4 +/- 2.3 1. An ultrafiltration of 1253 +/- 643 ml was achieved. Mean serum creatinine was 13.1 +/- 3.5 mg/dl, mean serum urea-nitrogen 61 +/- 15 mg/dl. wCcr was 78.6 +/- 27.2 1, wKT/V 2.21 +/- 0.33. All patients were adequately dialysed with various forms of APD. In those patients who changed from CAPD the dialysis efficacy, judged by weekly urea-nitrogen elimination, increased by 50% from 1.42 +/- 0.29 to 2.14 +/- 0.20 (P < 0.05). With the pneumatic cycler the different dialysis modes were achieved without problem. CONCLUSION: APD with the new pneumatic cycler provided an adequate and attractive option, from both medical and psychosocial aspects, in the dialysis of patients in chronic renal failure. Changing from CAPD to APD in certain patient groups clearly increased dialysis efficacy so that changing over to haemodialysis can often be avoided.

Adult↗
PubMed1996

Evidence of nitric oxide in the exhaled gas of Asian elephants (Elephas maximus).

Nitric oxide (NO) produced in the respiratory tract is released into the respiratory gases of humans, rabbits, guinea-pigs, and rats. We analysed the NO concentrations in the exhaled gas of four awake Asian elephants. Two methods were employed: (1) exhaled gas was sampled from the elephants' trunks with a 1 L syringe and analysed for NO concentrations by chemiluminescence; (2) respiratory gas was continuously aspirated via a thin plastic tube positioned within the trunk and on-line analysed for NO concentrations by chemiluminescence. Syringe sampling (n = 4), when corrected for dilution by ambient air using linear regression analysis, revealed a mean NO concentration of 31 parts per billion (ppb); highest exhalatory concentrations measured during continuous suctioning were 27 and 28 ppb (n = 2). The exhaled NO concentrations in elephants are similar to those found in humans measured with a comparable technique. This supports the hypothesis that a size-independent 'normal value' of endogenous NO is provided in the airways which may contribute to regulation of pulmonary ventilation and perfusion by autoinhalation in some mammals.

Animals↗
PubMed1995

[Correlation between laser tyndallometry and protein concentration in the anterior eye chamber].

The laser flare cell meter (LFCM) is introduced as an instrument that quantifies noninvasive anterior chamber protein. The relationship between laser flare measurement and actual protein concentration in vivo and in vitro was assessed. The intensity of light scattering by helium neon laser beam is measured by LFCM and depends on protein concentration and molecular size. Total protein, albumin and transferrin were measured using nephelometry and the Coomassie method. We tested 63 patients undergoing routine cataract surgery. Laser flare measurements were made before surgery. The mean in vivo flare was 8.25 photons/ms, standard deviation 9.57 photons/ms. Before surgery paracentesis was performed in 61 patients. In vitro aqueous flare was 10.55 +/- 7.68) photons/ms. Biochemical analysis showed a mean anterior chamber protein concentration in 51 patients of 33.65 (+/- 27.36) mg/dl, a mean albumin concentration in 38 patients of 15.78 (+/- 11.03) mg/dl, and a mean transferrin concentration in 33 patients of 2.01 (+/- 0.88) mg/dl. Up to a "cell" count of 40/0.075 mm3 there is a statistically significant correlation. Laser flare values compared with biochemical analysis showed for total protein a correlation coefficient of r = 0.695 in vivo and r = 0.753 in vitro. A "cell" count higher than 40/0.075 mm3 produces marked overestimation of protein concentration by laser flare values. There is a statistical significant linear correlation between photon count by LFCM and total aqueous protein concentration by biochemical analysis in vivo and in vitro in normal cataractous eyes.

Adult↗
PubMed1989

[Chronic aluminum poisoning in continuous ambulatory peritoneal dialysis: treatment with deferoxamine].

After six years of home haemodialysis and two years of continuous ambulatory peritoneal dialysis a 59-year-old woman developed an aluminium-induced osteopathy, myopathy and normochromic anaemia. She was at first treated with intravenous, then peritoneal, deferoxamine, 1 g every other day. Before treatment, 15.8 micrograms aluminium (Al) had been eliminated daily, with a peritoneal clearance of 0.3 ml/min; after intravenous deferoxamine a mean of 774.3 +/- 102.3 micrograms Al was eliminated per day, after peritoneal deferoxamine 646.7 +/- 89.6 micrograms of Al per day, with a peritoneal clearance of 2.2 +/- 0.9 (intravenous) and 1.9 +/- 0.7 ml/min (intraperitoneal). After four months of deferoxamine administration, mostly intraperitoneally as an out-patient, the osteomalacia clearly improved, as did the myopathy and anaemia.

Aluminum↗
PubMed1989

[Elimination of aluminum via continuous ambulatory peritoneal dialysis].

Aluminum concentrations in the dialysate and serum of 14 patients on CAPD were measured every six months. Additionally, in ten of the patients Al elimination was measured after a bolus ingestion of 1800 mg aluminium-chloride-hydroxide-complex. There was no significant difference between serum Al concentrations initially (47.3 +/- 8.2 micrograms/l), at six months (55.4 +/- 9.5 micrograms/l), and after 12 months (44.3 +/- 10.1 micrograms/l) although the Al concentration in the dialysate had been decreased from 16.6 +/- 2.3 micrograms/l to 1.5 +/- 0.2 in the last six months. The Al concentrations in the effluent dialysate were 14.5 +/- 1.3 micrograms/l initially, 15.6 +/- 1.2 micrograms/l after six months and 11.9 +/- 2.6 micrograms/l after 12 months. During kinetic studies a constant rise of serum Al concentration was found until the fifth hour, from 29.9 +/- 2.5 to 42.5 +/- 4.0, and a decline after 24 hours to 32.4 +/- 3.0 micrograms/l. The quantity of Al eliminated was 41.1 +/- 8.7 micrograms/24 h, equivalent to 1.2% of the ingested dose. In patients with residual renal function, renal Al clearance was almost double the peritoneal one. These results indicate that Al elimination by CAPD is not efficient and ingestion of Al-containing phosphate binders can result in Al accumulation.

Adolescent↗
PubMed1989

Scalp hair as an indicator of aluminium exposure: comparison to bone and plasma.

1. Aluminium concentrations were measured in hair, plasma and bone samples from different groups of chronic renal insufficient patients and from a control group (75 healthy volunteers plus 21 deceased subjects). A cross-sectional study with 40 haemodialysis patients and two longitudinal studies were undertaken, the first comprising of 12 home haemodialysis patients and the second 16 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). 2. Before introduction of water treatment by reverse osmosis, the hair aluminium levels of home haemodialysis patients were elevated compared to controls. Aluminium in the hair of all other groups were within the normal range. Hair aluminium levels were not related to the daily aluminium intake, nor to the cumulative aluminium intake, nor to bone and plasma aluminium concentrations. 3. Plasma aluminium concentrations in all patients were higher than in the controls. Dialysis without reverse osmosis water treatment increased aluminium plasma levels. After installation of reverse osmosis units there was a decrease in the aluminium concentrations in plasma. In CAPD patients insignificant increases in the aluminium levels in plasma were observed. When low contaminated dialysis fluid was available the plasma aluminium concentrations returned to the initial level. 4. Aluminium concentrations in bone were increased in renal insufficient patients compared with controls. Aluminium bone content increased with increasing cumulative aluminium intake by phosphate binding therapy. 5. Hair analysis is of very limited value for the diagnosis of aluminium exposure. Bone analysis is suitable for the assessment of the individual body burden.

Adult↗
PubMed1989

Randomized double-blind trial of tromantadine versus aciclovir in recurrent herpes orofacialis.

The present study represents the first randomized, double-blind trial comparing the clinical efficacy of tromantadine (Viru-Merz) vs aciclovir. Both medication groups contained 60 patients. The inclusion criteria required that patients show a history of recurrent manifestations of herpes orofacialis and that they not be recruited later than 24 h following the initial prodromal symptoms. Medication was dispensed randomly in identical tubes to cover a treatment period of up to 5 days. The patients were instructed to keep the tubes close at hand, to initiate therapy as soon as possible after experiencing the first symptoms of the recurrence and to visit the company physician within 24 h after the onset of symptoms. The herpes lesions were assessed daily by the same doctor for 14 days, except on weekends. The data of 119 patients (59 treated with tromantadine, 60 treated with aciclovir) were evaluated. The average time between the first signs of a new recurrence and the beginning of treatment was 7 hours in both treatment groups. The course of the healing process was rated by 4 subjective symptoms (itching, burning, skin tautness and pain) and by the following objective criteria: number of days in the vesicular stage and duration of complete healing, abortive lesions and new lesions. The results of these assessments showed no differences between the medication groups. Global clinical efficacy and tolerance were rated as being "very good" and "good" in more than 83% by patients and doctor in both groups. The results show that it is the early application of the virustatic that is important for successful treatment--regardless of the choice of agent tested.

Acyclovir↗
PubMed1989

Calcium alginate, an aluminum-free phosphate binder, in patients on CAPD.

Since dialysis solutions in CAPD are now nearly aluminum free, the only source for elevated aluminum levels are aluminum-containing phosphate binders. Elimination with CAPD is insufficient to prevent aluminum accumulation. Therefore, we investigated a phosphate binder consisting of calcium alginate, a natural polyuronic acid, containing 100 mg calcium/g substance in 14 patients on CAPD over a period of one year. The patients had previously been treated with aluminum-containing phosphate binders for a period of 24.3 +/- 21.3 months. During a period of 3 weeks before changing to the new phosphate binder the mean (+/- SD) serum phosphorus concentration was 1.8 +/- 0.4 mmol/l, while at the end of one year of treatment with calcium alginate the concentration was 1.6 +/- 0.4 mmol/l. In order to lower serum phosphorus to this level, it was necessary to increase the mean (+/- SD) amount of calcium alginate from 6.9 +/- 1.3 g per day at the beginning of the study to 8.3 +/- 2.1 g per day at the end. The mean (+/- SD) serum calcium concentration did not change throughout the study period. Serum levels of alkaline phosphatase, 1.25 (OH)2 vitamin D3, and intact parathyroid hormone did not change as well. The mean (+/- SD) serum aluminum level declined from 36.0 +/- 20 to 14.0 +/- 11.3 micrograms/l after 6 months (p less than 0.001). In conclusion, calcium alginate is a good alternative to aluminum-containing phosphate binders and to phosphate binders on a calcium base as it does not lead to hypercalcemia. It prevents aluminum intoxication and has no serious side effects.

Alginates↗
PubMed1988

Elimination of absorbed aluminum in patients undergoing continuous ambulatory peritoneal dialysis.

Intestinal absorption of aluminum (Al) from the phosphate binder aluminum-hydroxide-chloride (PhosphonormR) and successive renal and peritoneal Al elimination were studied in 11 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Al was measured by atomic absorption spectrometry in serum, urine, and dialysis fluid. Al levels in serum of all patients increased in average from 28.6 micrograms/l immediately before to a peak level of 41.6 microgramsWl 4 h after intake of 342 mg Al. After 24 h serum Al (34.0 micrograms/l) was still increased. Elimination across the peritoneum increased from 5.6 micrograms Al during the first 4 h to peak levels of 12.9 micrograms between hour 8 and 12 and decreased to 8.1 micrograms during the last 12 h. The Al clearance of the peritoneum was 0.43 ml/min. In the 6 patients with residual diuresis the renal Al excretion was higher than the peritoneal removal (48.1 micrograms/24 h vs. 24.8 micrograms/24 h). The renal Al clearance amounted to 1.6 ml/min. Assuming a gastrointestinal absorption quotient of 0.1% it is concluded that Al removal by CAPD in patients receiving 342 mg Al/day is not sufficient to prevent Al accumulation. In patients with remaining diuresis, the renal Al elimination exceeds the Al removal by the peritoneum.

Administration, Oral↗
PubMedDate not supplied

[Intraoperative coronary angioscopy after unsuccessful percutaneous dilatation angioplasty and the implantation of an intracoronary stent].

In all coronary arteries after failed PTCA with subsequent stent insertion the stenosed and dilated part of the vessels were inspected. We found dissections in 17/25 coronary lesions as well as thrombus adherent to the wall of the vessels in 8/25 cases. The morphology of the coronary stenosis was compared with the preoperative cine-angiogram. The angioscopic images after failed PTCA and subsequent stent-insertion showed severe wall dissections which were located beyond the inserted stent. In none of the cases was stent-implantation the sufficient treatment of coronary lesions. In all patients we performed coronary artery bypass grafting (CABG). Every coronary incision was used for peripheral anastomosis of the bypass grafts.

Aged↗
PubMedDate not supplied

Oral versus intraperitoneal application of clindamycin in tunnel infections: a prospective, randomized study in CAPD patients.

OBJECTIVE: To evaluate the potential superiority of either oral or intraperitoneal treatment of catheter tunnel infections (TI), using clindamycin as a first-line antibiotic and ultrasound as a diagnostic tool. DESIGN: This was a prospective, randomized study in continuous ambulatory peritoneal dialysis patients. From August 1993 until August 1995, 16 clinically- and ultrasound-proven episodes of TI were randomly assigned to either an oral or an intraperitoneal (IP) treatment (100 patients, 1414 patient-months). Main criteria for TI diagnosis were purulent drainage from the exit site and/or a positive ultrasound (pericatheter fluid collection of at least 2 mm, 7.5 MHz transducer). Initially, clindamycin (20 mg/kg body weight) was given via the oral (three times per day) or intraperitoneal route (four times per day). In the case of incompatibility or resistance to clindamycin, either oxacillin or ciprofloxacin were used orally or IP. RESULTS: Based on ultrasound criteria, the mean time until a > or = 50% reduction of pericatheter abscess diameter was 26 days (median) (range: 8-28 days) in the oral, and 15 days (8-27 days) in the IP group (p < or = 0.05). Showing no significant difference of pericatheter fluid at study entry with 4 mm (median) (range: 2-6 mm) in the oral group and 4 mm (2-4 mm) in the IP group, the IP treatment resulted in a decrease to 0 mm (0-2 mm) after 28 days (p < 0.05), while the diameter was still 2 mm (0-10 mm) (NS) in the oral group. Disappearance of exit-site infection was also somewhat earlier in the intraperitoneal group (51 vs 15 days, NS). Catheter removal had to be done once in the IP group and twice in the oral group within 6 months after study entry. CONCLUSIONS: The results give evidence for greater efficacy of the IP application of clindamycin as a first-line antibiotic compared to the oral route for the treatment of tunnel infections.

Abscess↗
PubMedDate not supplied

[Myocardial revascularization interventions].

UNLABELLED: Elective coronary artery bypass surgery (CABG) can be performed with low operative mortality. There is a controversial discussion whether short- and long-term results of CABG can justify this procedure even in elderly patients. MATERIAL AND METHODS: We retrospectively evaluated the clinical profile, operative procedure, postoperative short- and long-term results of 1127 patients over 70 years of age who underwent myocardial revascularization between January 1985 and December 1996. RESULTS: Mean age was 73.9 years. In 1996, septuagenarians represented 21.5% of our operated coronary patients, when compared with 6.4% in 1985. Analysis of risk factors showed an increasing prevalence of renal failure, obesity, hyperuricemia and a history of smoking. Preoperatively 87% of our patients were in NYHA-class III and IV. The percentage of emergent operations decreased over the observed period by 10.3%. Internal mammary artery was used with increasing frequency (44.8% in 1985-92 vs. 61.5% in 1993-96). The number of simultaneous valve replacements increased, too. Postoperatively, we noted rising incidence of respiratory failure (17.1%) and neurological disorders (13.7%). On the other hand, the need for intraaortic balloon pumping and hemofiltration declined by 6.6% and 2.9%. Perioperative mortality (< or = 24 h) was 3.65%, hospital mortality (< or = 30 days) was 9.64%. Actuarial 1 year at was 82% (+/- 4.3%), and 65.7% (+/- 3.8%) at 5 years. CONCLUSIONS: Our data suggest that CABG can be performed in septuagenarians with an acceptable operative risk. Since the large majority of patients improve symptomatically, surgery is the recommendable option for a growing number of elderly patients suffering from severe angina.

Age Factors↗