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Biomedical subjects

T H Goodship

Publications and source records attributed to T H Goodship.

63 records · Page 4Linked to original sources
PubMed1986

Continuous ambulatory peritoneal dialysis after the honeymoon: review of experience in Newcastle 1979-84.

Two hundred and twenty nine consecutive patients (129 men, mean age 45) were reviewed 12 to 65 months after starting treatment with continuous ambulatory peritoneal dialysis (CAPD) from January 1979 to December 1983. They received CAPD for a mean of 19.8 (range 0.5-62) months. Actuarial patient survival was 79% at 24 months and 72% at 36 months. Half of the 46 deaths were related to cardiovascular disease, while eight patients died of abdominal complications, including three patients with peritonitis. Peritonitis occurred at a rate of one episode per 35 patient weeks, and 88% of episodes were cleared by one or more courses of antibiotics. This still left peritonitis as the commonest cause of failure of CAPD, leading to a permanent change of treatment in 44 patients and temporary interruption in a further 25. CAPD remains a reasonable medium term treatment in chronic renal failure. Despite the persisting problem of peritonitis the results are comparable with those achieved by haemodialysis, and CAPD has become the treatment of first choice for end stage renal failure in Newcastle. In younger patients judged unsuitable for transplantation and facing long term dialysis, however, haemodialysis is preferred.

Actuarial Analysis↗
PubMed1986

Enhanced rectal potassium secretion in chronic renal insufficiency: evidence for large intestinal potassium adaptation in man.

The role of the large intestine in K+ excretion in chronic renal insufficiency was studied with a rectal dialysis technique in 14 normal subjects and eight normokalaemic, normotensive patients with chronic renal insufficiency. At initial intraluminal K+ concentrations of 10, 20, 30 and 45 mmol/l, net K+ secretion in patients with renal insufficiency was significantly greater than in normal subjects by approximately 1.8 mumol h-1 cm-2. The increase in net K+ secretion was more marked in those patients with creatinine clearances of less than 10 ml/min. In contrast, there were no significant differences in net Na+ and water transport, transmucosal potential difference and plasma aldosterone concentrations between the two groups. With an initial intraluminal K+ concentration of 30 mmol/l, the addition of amiloride (final concentration 1 mmol/l) to the rectal lumen decreased net Na+ absorption and transmucosal potential difference in normal subjects by 69% (P less than 0.005) and 31% (P less than 0.005) respectively, and in patients with renal insufficiency by 75% (P less than 0.05) and 36% (P less than 0.05) respectively, but there was no change in net K+ secretion in either group. These results indicate that the K+ secretory capacity of the rectal mucosa increases in chronic renal insufficiency, and the large intestine may therefore contribute to the maintenance of K+ homoeostasis as renal K+ excretion declines. Increased rectal K+ secretion in renal insufficiency occurs independently of changes in plasma K+ and aldosterone concentrations, net Na+ absorption and transmucosal potential difference, and may reflect stimulation of an active K+ secretory process.

Adult↗
PubMed1986

Effects of somatostatin analogue SMS 201-995 in normal man.

Long-acting somatostatin analogues may be of benefit in certain hypersecretory endocrine and gastrointestinal disorders. The 24 h hormonal and metabolic profiles of six normal male subjects receiving a twice daily subcutaneous injection of one such analogue SMS 201-995, 50 micrograms, has been compared to that obtained following placebo injection. Spontaneous daytime peaks of GH secretion were delayed until 1400 h following SMS 201-995 but nocturnal and total 24 h GH secretion were unaffected. The nocturnal rise in thyrotrophin was abolished by SMS 201-995 but thyroid function was unaffected. Insulin levels were suppressed following SMS 201-995 and the response to meals was inhibited. Glucose intolerance followed main meals. Glucagon levels were suppressed for up to 6 h. Circulating alanine levels were raised between 1200 h and 0600 h and there were intermittent elevations in lactate, pyruvate, glycerol and 3-hydroxybutyrate. Amino acid levels, including branched chain amino acids, were also increased. All six subjects suffered gastrointestinal side-effects. SMS 201-995, 50 micrograms, given twice daily shortly before meals does not suppress 24 h GH secretion, but demonstrates significant effects on metabolism and causes side effects in normal subjects.

Adult↗
PubMed1985

Effect of storage on measurement of ionized calcium in serum of uremic patients.

We studied, in 70 acidotic and non-acidotic uremic patients, the analytical variance in serum ionized calcium as related to duration and temperature of storage. Storage of serum or whole blood at 4 degrees C for as long as 6 h did not significantly alter the measured concentration of ionized calcium in the serum. Storage at room temperature for 6 h, or longer at 4 degrees C or -20 degrees C, resulted in inaccuracies in 39 to 79% of the samples of serum and in 38 to 92% of the samples of whole blood. These errors were not negated by correcting the values for ionized calcium to a pH of 7.40. Indeed, corrected values for calcium were even more unreliable in acidotic patients. We conclude that samples from uremic patients should be analyzed for ionized calcium within 2 h, or within 6 h if stored at 4 degrees C.

Acidosis↗
PubMed1984

Factors affecting development of peritonitis in continuous ambulatory peritoneal dialysis.

A questionnaire based survey in patients receiving continuous ambulatory peritoneal dialysis showed that there was an increased incidence of upper respiratory tract symptoms (suggestive of viral illness) in the 14 days before the development of peritonitis. No other factors were identified that might distinguish patients who develop peritonitis. The possibility that viral infections predispose to peritonitis by altering host defence mechanisms in patients receiving this form of renal replacement therapy warrants further study.

Humans↗
PubMed1982

Peritonitis in continuous ambulatory peritoneal dialysis. Laboratory and clinical studies.

During a three year period, 1979-81, 82 patients were treated by continuous ambulatory peritoneal dialysis (CAPD). The incidence of peritonitis was reduced significantly during the three years from one episode per 20 patient-weeks to one episode every 37 patient-weeks. 83% of the 136 episodes of peritonitis were treated successfully by antibiotic therapy alone. 62% of the total episodes were managed successfully with intraperitoneal cefuroxime. in 13 (16%) patients, CAPD failed because of peritonitis. Hospital admission for peritonitis has been reduced to a mean of 4.3 days per patient per year of CAPD. Fron January to September, 1982, Clostridium-difficile colitis developed in 13 patients. This complication was associated with considerable mortality and morbidity and has prompted a change in antibiotic policy. Patients with peritonitis are now given intraperitoneal netilmicin and intravenous vancomycin. Peritonitis remains the main complication of CAPD, but can be minimised by development of adequate facilities for performing CAPD.

Adolescent↗
PubMedDate not supplied

What have isotope studies in humans told us about the nutritional effects of acidosis in dialysis?

In order to understand how acidosis might predispose to loss of lean body mass it is important to recognise that body protein is in a dynamic state with a daily turnover of approximately 300 g of protein in a 60 kg man. This is significantly greater than the daily protein intake at a level of 1 g.kg-1.day-1. Loss of lean body mass occurs when the balance between whole body protein synthesis and breakdown is negative. Measurement of whole body protein turnover is possible using either boluses or primed constant infusions of isotopically labelled amino acids. Previously, a variety of in vitro and in vivo animal studies have shown that acidosis increases protein degradation and amino acid oxidation. Several research groups including our own have used amino acid tracer techniques to examine whether protein degradation is increased in vivo in human subjects with acidosis and chronic renal failure. The results from these studies have shown a remarkable concordance with increased protein degradation in all groups of patients studied. However, the results for protein synthesis have been more difficult to interpret, with only a few studies directly measuring the effects of acidosis on amino acid incorporation into protein.

Acidosis↗