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U Binswanger

Publications and source records attributed to U Binswanger.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Is hemofiltration following acute kidney failure in elderly cardiovascular surgery patients justified?].

In a retrospective study, 47 patients with acute renal failure following cardiovascular surgery were evaluated in the Cardiovascular Surgery ICU of the University Hospital, Zurich, from 1991 to 1994. The object of the study was to investigate the contribution of hemofiltration for acute renal failure following cardiovascular surgery. The aim was further to identify risk factors which impair survival. We found that overall mortality was 70.2%, but was influenced by the patients' age. In patients under 60 (n = 9) the mortality rate was 55.6%; in patients from 60 to 69 (n = 19) the mortality rate was 57.9%. However, in patients aged 70 and over (n = 19), there was an increase in mortality to 89.5%. Specifically, the outcome was tested in a stepwise logistic regression and we found that recovery of renal function following hemofiltration was the most important factor favoring survival (p < 0.001). Further statistical analysis revealed that age 70 years or over was one of the main risk factors leading to death (p < 0.03), whereas preoperative renal insufficiency had no influence on postoperative outcome (p < 0.29). We conclude that postoperative renal function represents the crucial factor in survival. Although hemofiltration achieved adequate results in all groups, the patients of 70 years and more experienced a significantly higher mortality rate. This suggests that the increased mortality of the elderly was not due to renal failure in itself but rather was related to polymorbidity. Hence we propose that in the latter group of elderly patients candidates for hemofiltration are to be very carefully selected, particularly if they have additional complications.

Acute Kidney Injury↗
PubMed1996

A novel dextran 40-based preservation solution.

Although the University of Wisconsin (UW) solution has become the standard solution for the preservation of kidneys for transplantation, the importance of the colloid hydroxyethylstarch (HES), one of the key compounds of the UW solution, has been questioned repeatedly. It is now established that HES is not necessary for routine kidney preservation. However, colloids may still be advantageous in UW like solutions for the purpose of multiorgan procurements and the preservation of organs from marginal donors. It has been shown in various experimental models that dextran 40 may successfully substitute for HES. Dextran 40 is not only cheaper but also has a variety of biological effects that may be beneficial during the graft reperfusion phase. The aim of this clinical study was to examine the efficacy of a dextran 40-based preservation solution (Dex-PS) for its use in human kidney graft preservation and to compare the transplantation results with kidneys preserved with UW solution. A total of 87 kidneys were preserved with Dex-PS and matched with 87 kidneys preserved with UW solution. Both groups were comparable in terms of donor and recipient characteristics and both had a high proportion of kidneys from nonheart-beating donors. Patient survival and graft survival after 1 year were 95% and 86% for the Dex-PS group and 94% and 90% for the UW group, respectively (P = NS). Primary nonfunction, delayed graft function, postoperative need for dialysis, and follow-up of serum creatinine were statistically comparable between these two groups. We conclude that dextran 40 can safely replace HES in UW solution for the purpose of clinical kidney preservation. There were no statistically detectable differences in graft performance between the kidneys preserved with UW and those preserved with Dex-PS.

Adenosine↗
PubMed1996

1,25-dihydroxyvitamin D3 and the synthetic vitamin D analogue, KH 1060, modulate the growth of mouse proximal tubular cells.

Apart from its classical role in bone and mineral metabolism, 1,25-dihydroxyvitamin D3 (1,25-vitamin D3) has recently been shown to affect cell growth and differentiation from a variety of tissues primarily not involved in mineral metabolism and to provide immunomodulatory functions. Findings in human mesangial cells in vitro as well as in rat model of compensatory renal growth in vivo suggest that renal cells are a target for 1,25-vitamin D3. In the present study the effects of 1,25-vitamin D3 and a synthetic vitamin D analogue, KH 1060, on proliferation and protein synthesis were investigated in a mouse proximal tubular cell line (MCT). 1,25-vitamin D3 and KH 1060 inhibited cell proliferation dose dependently (10(-7) to 10(-12) M) and specifically as assessed by 3H-thymidine incorporation (DNA synthesis) and cell counting. The cellular protein concentration, protein synthesis (3H-methionine incorporation) and protein/DNA ratio were not influenced by 1,25-vitamin D3 and KH 1060. By analyzing c-fos and c-myc expression using semiquantitative RT-PCR, a constant basal expression of both protooncogenes, even under serum-free conditions, was found in MCT cells. Phorbol 12-myristate 13-acetate (TPA) further stimulated c-fos and c-myc expression, whereas treatment with 1,25-vitamin D3 (10(-7) M) it had no effect either in unstimulated or in TPA-stimulated cells. In conclusion, 1,25-vitamin D3 and a synthetic vitamin D analogue, KH 1060, provide growth-regulating effects on renal proximal tubular cells in vitro. These effects are not mediated by regulation of c-fos and c-myc. Further studies will have to clarify whether 1,25-vitamin D3 plays a physiologic role in renal development and growth in vivo.

Animals↗
PubMed1996

Comparison of two antilymphocyte globulins replacing cyclosporin A after first kidney allotransplantation and prolonged graft ischemia.

ATG/Fresenius (5 mg/kgBW) and ATGAM (Upjohn, 12.5 mg/ kgBW) replacing cyclosporin A were given during 7 d after transplantation to 20 patients in 1992 and 30 patients in 1993, respectively. Numbers of mismatches, combined kidney-pancreas transplantation and severe infections were not different for the two groups. However, prednisone pulse therapies and additional antilymphocyte globulin treatments were more frequent after ATGAM than after ATG induction (p < 0.01, chi 2-test).

Antilymphocyte Serum↗
PubMed1996

Thirty-two years of renal transplantation in Zurich.

This overview of the last 3 decades of renal transplantation at our center depicts the development from the early phase of clinical transplantation to the development of a standardized multiorgan transplant program. Between 1964 and 1996, a total of 1,703 kidney transplants were performed at the University of Zurich Hospital in Switzerland. Due to a relatively active program in the early years of renal transplantation our data provide some useful information on the long-term results of renal transplantation. We observed a steady improvement in outcomes following transplantation during the first 2 decades of our program paralleled by an improvement in graft half-life. In the last decade, however, the demographic characteristics of our recipient population have changed gradually, leading to an increased proportion of diabetics and elderly patients. Thus, during the past decade, transplant outcomes, in terms of early graft and patient survival, have stagnated. The increased proportion of diabetics being accepted for transplantation has helped to establish simultaneous kidney and pancreas transplantation as a routine procedure, thereby offering these patients the prospect of long-term rehabilitation. In order to increase the number of available kidneys for transplantation we have adopted 2 strategies. First, we have successfully used donor kidneys from non-heart-beating donors. Results achieved with this method can be equivalent to transplantation of organs from heart-beating donors when certain criteria are respected. Second, we are increasingly performing kidney transplants from living-related donors and hope to further expand our activities in this direction in the future.

Adolescent↗
PubMed1995

Pneumocystis carinii pneumonia during immunosuppressive therapy for antineutrophil cytoplasmic autoantibody-positive vasculitis.

We describe two human immunodeficiency virus-negative patients who developed Pneumocystis carinii pneumonia (PCP) during immunosuppressive therapy for antineutrophil cytoplasmic autoantibody-positive vasculitis and review the literature regarding the pathogenesis and frequency of PCP. The recent application of DNA amplification techniques suggests that PCP developing in immunocompromised individuals does not necessarily result from reactivation of a dormant focus, but may arise as de novo infection after exposure to an exogenous source of P carinii. In addition, several reports about clusters of PCP cases raise concern about the risk of a nosocomial transmission of P carinii. Therefore, PCP should be added to the list of bronchopulmonary complications in patients with antineutrophil cytoplasmic autoantibody-positive vasculitis who are receiving long-term steroid therapy.

Aged↗
PubMed1995

[Electrolyte changes during and after voluntary hyperventilation].

Paresthesia and tetanic finger cramps during hyperventilation-induced respiratory alkalosis are believed to derive from a pH-dependent decrease of ionized serum calcium. In the study reported here, ionized serum calcium, total calcium and total protein were measured during a three-minute hyperventilation period in ten volunteers. During hyperventilation finger paresthesias appeared in all probands without proof of any significant change in ionized serum calcium (1.26 +/- 0.05 mmol/l at the end of the three-minute hyperventilation period). Total protein increased as a consequence of hyperventilation-induced transient hemo-concentration. Paresthesias and tetanic finger cramps during the three-minute hyperventilation could not be related to changes of ionized serum calcium; however the other electrolytes, i.e. sodium, magnesium, potassium, chloride, phosphate and bicarbonate, showed, with the exception of sodium, significant changes.

Adult↗
PubMed1995

Stimulation of Na+/H+ exchange activity by endothelin in opossum kidney cells.

Endothelin-1 (ET-1) controls multiple aspects of kidney function. In this study we have analysed the effects of ET-1 on apical Na+/H+ exchange activity in opossum kidney (OK) cells. ET-1 (at 10(-10) M and 10(-8) M) activated Na+/H+ exchange activity within 5 min of exposure. ET-1 (10(-8) M) prevented PTH-induced (parathyroid hormone; 10(-8) M) inhibition of Na+/H+ exchange activity; it also abolished transport inhibition in response to 10(-3) M IBMX (isobutyl-methylxanthine) and 3 x 10(-7) M TPA (phorbol 12-myristate 13-acetate), but had no effect on the 8-bromo-cAMP-induced (10(-4) M) decrease of transport rate. Basal cAMP content, IBMX- and PTH-stimulated cAMP production were unaffected by ET-1 (10(-8) M). The stimulatory action of ET-1 (10(-8) M) on Na+/H+ exchange activity was prevented by calphostin C (10(-8) M). These data document that OK cells might serve as a useful in vitro model for analysis of cellular mechanisms involved in endothelin action; proteine kinase C activation seems to participate in the observed endothelin effects.

1-Methyl-3-isobutylxanthine↗
PubMed1995

[Does the primary disease recur in kidney transplantation?].

Improved graft survival is accompanied by complications which interfere with the long-term function of the allograft. Recurrence of the primary renal disease in the graft is well recognized and is found in 10 to 20% of all recipients; however, graft loss due to recurrent disease is reported in less than 5% of all cases. The most frequent cause of recurrence is glomerulonephritis: Membrano-proliferative GN type II, IgA nephritis and focal sclerosis are frequently observed. Among metabolic disorders linked to graft disease, diabetic nephropathy has to be mentioned first. Primary oxalosis is a rare disorder, but it is related to a very high risk of recurrent disease in the transplant. Combined kidney-liver transplantation seems to offer a valuable alternative for these patients. The high risk of recurrence of certain diseases, i.e. membrano-proliferative GN type II, focal-segmental glomerulosclerosis, primary oxalosis, should prevent living donation. In addition, there are some reports suggesting that living-related donation might increase the recurrence rate of hemolytic-uremic syndrome, membranous GN and Schönlein-Henoch purpura. Recurrent disease might not only affect the outcome of the transplant, but can provide insight into the nature and pathogenesis of the primary disease. Currently there are no conclusive reports indicating that chronic immunosuppression, especially cyclosporin-A treatment, reduces recurrence rates; however the clinical course might be ameliorated.

Glomerulonephritis↗
PubMed1994

[Kidney replacement therapy 1993].

The continuous rise in the number of patients treated for chronic renal failure is due to improved technique, demand for treatment and an increased incidence of certain renal diseases in the elderly. Preventive measures and a discussion of socio-ethical problems are needed.

Humans↗
PubMed1994

Relation of cyclosporine blood levels to adverse effects on lipoproteins.

Hyperlipidemia is common in renal allograft recipients. To elucidate the role of cyclosporine in posttransplant hyperlipidemia, we measured lipids, lipoprotein lipids, and apolipoproteins of thirty-five renal allograft recipients and evaluated their relation to trough cyclosporine blood levels. All patients were on a triple immunosuppressive regimen with equal doses of prednisone and azathioprine, and had stable graft function. Cyclosporine blood levels were significantly correlated to total plasma cholesterol (P = 0.028), low-density lipoprotein cholesterol (P = 0.022), apolipoprotein B (P = 0.017), and the cholesterol/high-density lipoprotein cholesterol ratio (P < 0.002), but not to plasma triglycerides. Significant inverse correlations were found between cyclosporine blood levels and high-density lipoprotein cholesterol (P = 0.034), high-density lipoprotein3 cholesterol (P = 0.025), and apolipoprotein A-1 (P = 0.047), but not high-density lipoprotein2 cholesterol. The independent relation of cyclosporine blood levels to each of the measured lipid parameters was investigated by a stepwise regression model including age, body mass index, interval from transplantation, diabetes mellitus, plasma creatinine, and intake of diuretics and beta-blockers. After correction for these 7 variables, cyclosporine blood levels remained significantly associated with high-density lipoprotein cholesterol, high-density lipoprotein3 cholesterol, apolipoprotein A-1, apolipoprotein B, low-density lipoprotein cholesterol, and the cholesterol/high-density lipoprotein cholesterol ratio. These data suggest that cyclosporine causes atherogenic dyslipidemia.

Adult↗
PubMed1994

Late complications after total hip replacement in renal allograft recipients.

Seventy nine hips in 53 recipients of renal allografts were treated by cemented total hip replacement for avascular necrosis of the femoral head between 1972 and 1992. Eight hips in 6 patients required revision for aseptic loosening after a mean of 11.2 years. Three replacements in 3 patients became infected with salmonella enteritidis after a mean of 6.2 years. One was revised, one had a disarticulation of the hip, and the third was treated with long term antibiotics. Survivorship analysis for total hip replacement and the renal allografts showed a hip reoperation rate of 9.9% at 10 years and 54.6% at 15 years with mortality rates of 32.2% and 42.2% respectively. Thus patients surviving 15 years are at a higher risk of failure of the prostheses than of dying.

Adult↗
PubMed1994

Serum hippuric acid concentration in renal allograft rejection, ureter obstruction, and tubular necrosis.

Plasma from 35 renal allograft recipients (21 males and 14 females) was sampled daily and analyzed for hippuric acid (HA) by high-performance liquid chromatography (HPLC) and serum creatinine. Twelve of these patients experienced an acute renal allograft rejection or a ureter obstruction as proven by clinical signs and biopsy, as well as by radiography or ultrasound, respectively. Two patients suffered from tubular necrosis followed by rejection during the postoperative period. Mean serum HA increased by 39.9 mumol/l from baseline (range 20.4-115.5 mumol/l) in patients with acute rejection 3 days after an initial increase that was observed 24 h before the mean serum creatinine increased by 107.1 mumol/l (range 21-193 mumol/l). In cases of ureter obstruction, HA rose by 1.6 mumol/l (range 1-8.2 mumol/l), significantly less than elevations due to rejection. The increase in creatinine, however, amounted to 65.3 mumol/l (range 22-140 mumol/l) and was not different from the change in rejecting patients. Successful antirejection treatment coincided with a decrease in serum HA starting 24 h earlier than the decrease in the serum creatinine concentration. Of special interest was the observation of a parallel decrease in HA with creatinine concentration in patients with tubular necrosis after allotransplantation; HA increased in cases of an additional rejection. Our data suggest that HA, which is excreted by tubular secretion and glomerular filtration, could be a sensitive and early marker of acute allograft rejection. Furthermore, it seems to discriminate between acute renal allograft rejection and ureter obstruction. It might, therefore, be of value in the diagnosis of rejection complicating tubular necrosis after transplantation.

Acute Disease↗