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Biomedical subjects

T S Ing

Publications and source records attributed to T S Ing.

At least 91 records · Page 5Linked to original sources
PubMed1990

Colon-cancer screening in dialysis patients.

The usefulness of colon-cancer screening using stool-guaiac testing has been established in large control populations, but not in dialysis patients. In 72 asymptomatic dialysis patients [51 treated with hemodialysis (HD), and 21 with peritoneal dialysis (PD)] who underwent outpatient stool occult blood testing, the test result was positive in 11 (15%) patients (8 HD and 3 PD). Eight of the 11 were investigated further by colonoscopy and, when deemed necessary by the treating physician, esophagogastroduodenoscopy and/or barium enema were also performed. A site of active bleeding was identified in three of the eight patients (hemorrhoids, telangiectasia, ulcerative colitis). In each of the five other patients, potentially bleeding lesions were identified: colonic polyps (two malignant and two benign) in four patients. Barrett's esophagus in one, diverticulosis in two, and colonic vascular deformities in two. These results were compared with those of a large ongoing fecal occult blood screening program in which the prevalence of positive stool occult blood tests is 5% and in which 42% of the positive patients have colonic neoplasms. Thus, although the baseline incidence of positive guaiac tests may be higher in dialysis patients than in nonuremic controls, our results suggest that stool guaiac testing of dialysis patients may not only be useful in detecting colonic polyps, but may also identify other previously unsuspected causes of gastrointestinal bleeding.

Adult↗
PubMed1990

Effects of hypertonic peritoneal dialysis solutions on neutrophil superoxide production.

Superoxide produced by neutrophils plays an important role in the killing of bacterial pathogens. The effects of glucose-containing peritoneal dialysis solutions on superoxide production by canine and human neutrophils were studied. A significant decrement in superoxide generation was noted with the 2.27% and 3.86% glucose solutions. The results suggest that hypertonic peritoneal dialysis solutions curtail neutrophil superoxide generation.

Animals↗
PubMed1990

Asymptomatic, nonketotic, severe hyperglycemia with hyponatremia.

We describe five patients with asymptomatic, nonketotic, severe hyperglycemia (serum glucose concentrations between 45.8 and 92 mmol/L) in the face of renal insufficiency are described. As opposed to most of the previously described patients with hyperglycemic, nonketotic, hyperosmolar coma, our patients were hyponatremic. The lack of symptoms in our patients may be related to the absence of cerebral cellular dehydration. Aggressive treatment of hyperglycemia in such patients is unnecessary. Attention to the serum sodium level as well as to the serum glucose concentration will allow recognition of this clinical entity.

Acute Kidney Injury↗
PubMed1989

L-lactate for high-efficiency hemodialysis: feasibility studies and a randomized comparison with acetate and bicarbonate.

We evaluated the feasibility of using L-lactate as a base for hemodialysis. In one study, acid-base changes using 40 mM L- or DL-lactate were compared. In a second study, acid-base status using various amounts of L-lactate exclusively was studied. The third study compared symptoms and acid-base changes during 9 weeks of high-efficiency dialysis when using L-lactate, acetate, or bicarbonate as base. In the first study, plasma bicarbonate changes were equivalent with 40 mM L-lactate and 40 mM DL-lactate, but overall correction of acidosis appeared to be suboptimal. In the second study, when compared to a bicarbonate control period, correction of acidosis was reduced when using 40 mM L-lactate + 4 mM acetate solution, but increased when using a 46 mM L-lactate + 4 mM acetate solution. In the third study, correction of acidosis was comparable when using 42 mM L-lactate + 4 mM acetate, 39 mM acetate, or 35 mM HCO3 + 4 mM acetate. Whereas 46% +/- 12 (SEM) treatments "failed" because of symptoms when using acetate, the percentages of "failed" treatments were only 7% +/- 4.2 with L-lactate (p less than 0.05) and 11% +/- 4.2 with bicarbonate (p less than 0.05). The results suggest that L-lactate is a suitable dialysis solution base that is capable of correcting chronic uremic acidosis. During high-efficiency dialysis, the incidence of intradialytic symptoms with L-lactate is comparable to that with bicarbonate and less than that with acetate.

Acetates↗
PubMed1989

Predicting need for surgical drainage of pericardial effusion in patients with end-stage renal disease.

The best approach to treatment of pericarditis accompanied by substantial pericardial effusion in end-stage renal disease (ESRD) patients is unknown. In a review of our experience, we found that ESRD patients with moderate-to-large or large (circa 250 mL or larger) pericardial effusions usually failed to improve with intensive dialysis and ultimately required surgical drainage of the effusion. Multivariate analysis revealed that effusion size was by far the most important factor predicting need for surgery. Since early pericardial drainage obviates the risk of sudden tamponade, we recommend that surgery without prior intensive dialysis therapy be considered in such patients.

Drainage↗
PubMed1988

Cefoperazone in the treatment of peritonitis in continuous ambulatory peritoneal dialysis patients.

Cefoperazone is a third-generation cephalosporin that is active against a broad spectrum of gram-positive and gram-negative bacteria. We added this antibiotic to peritoneal dialysis solution at a concentration of 62.5 mg/L to treat peritonitis in six continuous ambulatory peritoneal dialysis (CAPD) patients. Serum drug concentrations were obtained at 0, 0.5, 1, 2, 4, and 24 h after instituting antibiotic therapy. Rapid uptake by blood of the antibiotic across the peritoneal membrane occurred when the latter was inflamed. Adequate bactericidal serum levels for many bacteria were obtained in less than 4 h. Cefoperazone effectively eradicated peritonitis in all patients.

Cefoperazone↗
PubMed1988

First-use reactions during hemodialysis: a definition of subtypes.

We believe that it is worthwhile to separate out two distinct types of first-use reactions: a hypersensitivity type (type A) characterized by anaphylactic signs and symptoms and a non-specific type (type B) characterized primarily by chest pain and back pain. Further research is needed to better define the etiology, the epidemiology, and the pathogenesis of these two subgroups of the first-use syndrome.

Anaphylaxis↗
PubMed1987

Plate, coil, and hollow-fiber cuprammonium cellulose dialyzers: discrepancy between incidence of anaphylactic reactions and degree of complement activation.

During the past 10 years, the incidence of severe anaphylactic reactions during dialysis [type A first-use syndrome (FUS)] at our center has been much lower when using cuprammonium cellulose plate (CC-P) dialyzers (0/37, 750 dialyses) or coil (CC-C) dialyzers (0/32, 500) than when using cuprammonium cellulose hollow-fiber (CC-F) dialyzers (8/21,022 dialyses, p less than 0.005 by Chi-square). To determine if the difference in type A FUS incidence between the three dialyzer types could be explained by differences in complement activation, we compared plasma concentrations of C3a des-arginine (des arg) in patients undergoing dialysis with these three varieties of dialyzers. Plasma C3a des arg values increased markedly in the dialyzer outflow blood with the three dialyzer configurations. The levels were similar with the dialyzer types when results were corrected for membrane surface area. Also, the degree of leukopenia was not markedly different with the three dialyzer types. Our findings suggest that complement activation per unit surface area is similar during dialysis with plate, coil, and hollow-fiber cuprammonium cellulose dialyzers. The lack of correlation between the degree of complement activation and the incidence of type A FUS suggests that membrane-induced complement activation is not of primary importance to type A dialyzer hypersensitivity reactions.

Adult↗
PubMed1987

Induction of peritoneal fluid eosinophilia and/or monocytosis by intraperitoneal air injection.

We hypothesized that intraperitoneal air might be one of the causes of peritoneal fluid eosinophilia. To test our hypothesis, we injected 100-500 ml of sterile air intraperitoneally into 5 patients receiving continuous ambulatory peritoneal dialysis (CAPD). All patients responded with a transient increase in peritoneal fluid nonerythrocyte cell count (peak counts ranging from 23 to 335 cells/mm3, mean peak count 140 +/- 125) lasting 4 days (after injection of 100 ml of air) to 7 weeks (after injection of 500 ml of air). In 2 patients, the cells were predominantly monocytes (80 +/- 6.5%), whereas in 3 patients, eosinophils predominated (63 +/- 12%), while monocytes (30 +/- 19%) also increased. Resolution of peritoneal fluid pleocytosis correlated temporally with absorption of subdiaphragmatic air. Our results suggest that intraperitoneal introduction of air into CAPD patients can induce peritoneal fluid eosinophilia and/or monocytosis.

Ascitic Fluid↗
PubMed1987

Involvement of renal allograft by Fabry's disease.

A man with Fabry's disease received a renal allograft from a heterozygous sister. Renal allograft dysfunction necessitated an allograft biopsy 5.5 years after transplantation. Extensive accumulation of Fabry's disease deposits in the glomeruli, tubules, blood vessels and interstitium was noted.

Adult↗
PubMed1987

Use of lactate as a base in hemodialysis.

The purpose of our study was to investigate the feasibility of using lactate as a complete or partial substitute for acetate in hemodialysis solutions. Six patients, each serving as his own control, were dialyzed once against a dialysis solution containing 40 mM acetate, once against a dialysis solution containing 40 mM DL-lactate and once against a dialysis solution containing 20 mM each of acetate and DL-lactate. Six additional patients underwent hemodialysis using acetate + lactate for a 3-week period, and the blood acid-base values during this period were compared to those obtained during periods when acetate was used. All dialysis treatments were well tolerated without hypotension or other clinical manifestations. When acetate + lactate was used, only a slight delay in the correction of acidosis during dialysis occurred and the net change in the plasma bicarbonate value appeared to be comparable to that measured with acetate. On the other hand, when lactate was used, the increase in the plasma bicarbonate level during and immediately after dialysis was reduced. With acetate + lactate, intradialytic blood D-lactate levels remained between 1 and 2 mM and returned promptly to near baseline within 1 h after dialysis. During 3 weeks of dialysis using acetate + lactate, predialysis plasma bicarbonate values were similar to those achieved when using acetate, but with acetate + lactate, the intradialytic plasma acetate levels were reduced by 50%. The results suggest that DL-lactate merits further evaluation as a potential base for hemodialysis solutions, and that both the D- and the L-lactate isomers are metabolized in maintenance hemodialysis patients.

Acetates↗
PubMed1987

Heparin-associated thrombocytopenia in maintenance hemodialysis patients.

Thrombocytopenia associated with the presence of a heparin-dependent platelet aggregating factor developed in two patients after hemodialysis with heparin. It resolved in one patient after heparin was stopped; but persisted in the other during a two-week heparin-free period and intermittently thereafter. We suggest that when heparin causes thrombocytopenia in dialysis patients the heparin should be stopped whenever possible, but this may not be necessary in all patients.

Heparin↗
PubMed1987

Hemodynamic effects of bPTH(1-34) and its analogue Nle8,18Tyr34bPTH(3-34) amide.

We examined the vascular effects of bovine PTH(1-34) and of an analogue, Nle8,18Tyr34bPTH(3-34) amide, which inhibits adenylate cyclase activation by bPTH(1-34) in a number of in vitro systems. In the conscious dog. bPTH(1-34) injection produced dose-dependent hypotension associated with increased heart rate and cardiac output. The (3-34) analogue had no hypotensive effect in doses up to 6.0 micrograms/kg (1.5 nM/kg). In vitro studies revealed that bPTH(1-34) relaxed pitressin-contracted helical strips from the rat caudal artery. The (3-34) analogue displayed a weak, but definite inhibitory effect against the vasorelaxant effects of bPTH(1-34) with a pA2 of 5.5. The results further characterize the previously established hypotensive and vasorelaxant actions of bPTH(1-34), and suggest that the (3-34) analogue, which inhibits adenylate cyclase generation by bPTH(1-34) in nonvascular tissues, antagonizes the vasorelaxant effects of bPTH(1-34) as well. The results provide suggestive evidence that the vasorelaxant effects of bPTH(1-34) may be mediated by adenylate cyclase.

Animals↗