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Biomedical subjects

V Parsons

Publications and source records attributed to V Parsons.

At least 91 records · Page 5Linked to original sources

Progression of diabetic nephropathy.

Although deterioration of renal function in diabetic nephropathy varies considerably from one diabetic to another, its rate is constant in individuals. For each patient there is a linear relation between period (months) which elapses from the time serum creatinine becomes greater than 200 mumol/l and the inverse the inverse of the serum-creatinine. The observation is of practical importance in predicting the time at which end-stage renal failure will develop, so that treatment can be planned in advance.

Adult↗

Therapeutic effect of cimetidine in patients undergoing haemodialysis.

Blood concentrations of cimetidine were measured and the therapeutic effect of the drug assessed patients undergoing maintenance haemodialysis. Thirteen patients were given a single oral 200-mg dose of cimetidine a mean of 2.7 hours before the start of dialysis. Dialysing for 6--12-6 m2 hours led to a mean fall of 71% in blood cimetidine concentration during haemodialysis. Nine patients with various upper gastrointestinal lesions diagnosed endoscopically were treated for up to six weeks with a reduced cimetidine dose of 200 mg 12-hourly; two patients received two courses of treatment. Repeat endoscopy after treatment disclosed satisfactory healing, and the drug did not accumulate. This lower dose regimen is recommended for patients receiving dialysis who develop upper gastrointestinal lesions for which a histamine H2-receptor antagonist is indicated.

Adult↗

A case of poisoning with mercuric chloride.

A male patient was admitted to hospital 12 h after self-poisoning with mercuric chloride. He suffered multiple complications including acute renal failure, ulcerative colitis, anaemia, disseminated intravascular coagulation, chronic sepsis and severe weight loss. Initially he responded well to resuscitative measures and intensive supportive therapy, which included ventilation of the lungs, haemodialysis, dimercaprol, antibiotics, parenteral feeding and gastrointestinal surgery. Unfortunately the sepsis was never satisfactorily eradicated despite satisfactory serum concentrations of the appropriate antibiotics. On day 43 after poisoning he had a grand mal fit; after this there were focal neurological signs and on lumbar puncture he was found to have a raised protein concentration and raised pressure in his cerebrospinal fluid. The condition of the patient rapidly deteriorated and on day 47 he died. Post-mortem examination revealed a large cerebellar abscess. The literature on mercury poisoning is reviewed.

Acute Kidney Injury↗

The prevalence of psychiatric illness among patients on home haemodialysis.

An entire population of 32 patients on regular dialysis treatment (RDT) in their own homes were ranked according to their present mental state as assessed by a standardized semi-structured interview. The point-prevalence of psychiatric morbidity was 31% which compares closely with that of patients attending a general practitioner's surgery who were assessed by the same method. The 10 patients who were psychiatrically ill had more organic symptoms and their spouses were less able to tolerate RDT in the home.

Adult↗

Survival on home haemodialysis: its relationship with physical symptomatology, psychosocial background and psychiatric morbidity.

An entire group of 32 home dialysis patients from one hospital renal unit was assessed for psychiatric morbidity on a standardized interview of proven reliability. A rating of physical symptomatology and an enquiry into the childhood and psychosocial background were made at the same time. Psychiatric morbidity, physical symptomatology and a history of good relationships with both natural parents in childhood were inter-related. They were all related to survival on haemodialysis 3 1/2 years later. Survival was also associated with a coping spouse and full-time employment or housework by the patient. These findings are discussed in the light of current concepts of the psychosocial setting for physical illness.

Adaptation, Psychological↗

The pathology of intrarenal vascular lesions associated with the loin-pain-haematuria syndrome.

The histological appearances of the proximal and peripheral intrarenal arteries and renal cortex have been examined in 3 patients who underwent nephrectomy for intractable pain associated with the loin-pain-haematuria syndrome. Marked 'atherosclerotic' changes were noted to involve segmental, lobar, interlobar and arcuate arteries with evidence in one kidney of early microaneurysmal formation. These lesions of the more proximal intrarenal arteries were associated with occlusive lesions of the interlobular arteries, areas of cortical ischaemia and cortical infarcts consistent with the changes resulting from microemboli. The histological appearances correlated well with previously described angiographic findings.

Adult↗

Reduction of dialyzer fibrin deposition with sulphinpyrazone.

To determine whether sulphinpyrazone reduces thrombus formation within artificial kidneys, dialyzer 125I-fibrinogen and platelet and fibrinogen levels during dialysis were compared during a non-treatment control period and while patients were receiving sulphinpyrazone. Mean fibrin deposition within the dialyzers, measured as gram X 10(-3) of clottable fibrinogen, was significantly less during sulphinpyrazone treatment (2.5) than during the control period (5.3). Arterial blood platelet counts and plasma fibrinogen levels during dialysis were higher on treatment despite similar predialysis values during control and treatment periods. The results indicate that sulphinpyrazone reduces fibrin formation within artificial kidneys and, since the reduction in deposition of fibrin alone is insufficient to explain the higher plasma fibrinogen levels during treatment with sulphinpyrazone, suggests that this therapy reduces fibrinogen consumption within the patient during hemodialysis.

Blood Platelets↗

Labetalol in severe and resistant hypertension.

1 The efficacy of labetalol in the treatment of severe hypertension (diastolic greater than or equal to 115 mm Hg) was studied retrospectively. Ten patients were followed for more than 6 months. At 6 months, eight were well controlled and the mean dose in those was 975 mg daily. Four of these were receiving labetalol alone; two were on labetalol and diuretic only. 2 Three patients were resistant to doses of 1600, 1800 and 2400 mg daily respectively; two of these were controlled with increased doses of vasodilator drugs. In two cases labetalol had produced large falls in the standing BP while not influencing the supine BP. 3 Three other resistant patients were seen, of whom one merely required an increase in dose to 2200 mg daily and the addition of a diuretic. Both the others were elderly, had severe vascular disease, and suffered disabling postural hypotension on a dose of labetalol which did not influence the supine BP. 4 Labetalol can control severe hypertension. There remain patients whose supine BP is not influenced by a dose of labetalol which produces marked postural hypotension.

Adult↗

Renal reflux, scarring, cystometrography and tissue types.

Four families with a variety of renal tract abnormalities including reflux, cortical scars, atrophy and duplex systems are described. Cystometrograms in eight with reflux and scars did not show any evidence of outflow high pressure systems. Tissue typing was carried out in a proportion of affected and unaffected family members, and with the addition of another reported family that had been tissue typed, showed an increase in A9, B8 and homozygosity in the families with these abnormalities. A retrospective survey of transplanted patients with tissue type A9 showed a higher prevalence of pyelonephritis and associated abnormalities than other diseases leading to end stage renal failure.

Cicatrix↗

Cimetidine: prophylaxis against upper gastrointestinal haemorrhage after renal transplantation.

The incidence of upper gastrointestinal haemorrhage within four months of renal transplantation was studied in two groups of patients. Thirty patients who received prophylactic cimetidine suffered no episodes of upper gastrointestinal haemorrhage, while six of the 33 patients who did not receive cimetidine suffered haemorrhages and one of them died as a result. The difference between the groups was significant. The results suggest that the prophylactic use of cimetidine in patients receiving renal transplants is worth while.

Adolescent↗