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Biomedical subjects

Z Korzets

Publications and source records attributed to Z Korzets.

At least 55 records · Page 3Linked to original sources
PubMed1996

Nonocclusive mesenteric infarction in continuous ambulatory peritoneal dialysis.

Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.

Adult↗
PubMed1996

Efficacy of low felodipine dose monotherapy in mild-to-moderate hypertension: a comparison between office and ambulatory blood pressure monitoring.

The efficacy and tolerability of felodipine, in a low dose of 5-10 mg daily was assessed in 32 patients with mild-to-moderate hypertension, aged 53 +/- 11 years. The results of office vs 24 h ambulatory blood pressure measurements (ABPM) were compared. Inclusion criteria included an office systolic and diastolic blood pressure (SBP/DBP) > 140/90 mm Hg and a 24 h ABPM SBP/DBP > 135/85 mm Hg. Felodipine was initiated at a dose of 5 mg daily. At day 28 of the study, if office DBP > 90 mm Hg, the dose was doubled to 10 mg daily. At the end of the study (day 84), 24 h ABPM was done again. Side effects were noted throughout the study. Four patients dropped out during the study (two due to headache, one due to pedal edema and one rejected further participation). Of the remaining 28 patients, at day 28, 12 required an increased dose of 10 mg/day. At the end of the study, office BP was below 140 90 mm Hg in 71% of the patients. In the whole group BP decreased from 158 +/- 15/101 +/- 8.4 to 138 +/- 9/85 +/- 5 mm Hg, P < 0.001. ABPM showed that BP was normalized in 82% of the patients. It decreased from 146.8 +/- 9.56/94.8 +/- 7.4 to 130.2 +/- 10.6/83 +/- 6.3 mm Hg, P < 0.001. BP was similarly reduced in working and sleeping hours, with preservation of the circadian rhythm. Heart rate was unaffected by the drug. Five patients showed persistently elevated SBP on office measurements while on ABPM, the values were within normal limits. This finding confirms the existence of a white coat effect in patients with proven hypertension and the superiority of ABPM over office BP measurements in clinical investigations. In summary, ABPM showed that the antihypertensive effect of felodipine was sustained throughout normal 24 h, including the critical (as regards cardiovascular morbidity) awakening hours.

Adult↗
PubMed1995

[Acute renal failure due to non-traumatic rhabdomyolysis in a cocaine addict].

Nontraumatic rhabdomyolysis in drug abusers is well-known, with cocaine and parenteral heroin the most frequent causative agents. Rhabdomyolysis is thought to result from compromised vascular supply to dependent muscles, due to prolonged pressure during long periods of depressed consciousness and immobility. However, recent work in rats has shown marked vasodilatation in areas of injured muscle, mediated by the nitric oxide pathway. Acute renal failure occurs in about 2/3 of the cases of cocaine-associated rhabdomyolysis. The usual clinical picture is that of a mentally obtunded drug addict presenting with swelling and tenderness of the muscles of a limb. However, these findings may be absent or overlooked. Characteristic laboratory features include elevated serum creatinine phosphokinase (CPK) (in excess of 90,000 IU/L) and myoglobinuria. We present a 33-year-old male addict who developed acute renal failure due to cocaine- and heroin-associated rhabdomyolysis. He had marked edema and tenderness of his right leg and was initially erroneously diagnosed as suffering from deep venous thrombosis. Only when the CPK was found to be 47,300 U/L, was the correct diagnosis made. Massive fluid replacement and alkalinization of the urine resulted in rapid improvement in renal function.

Acute Kidney Injury↗
PubMed1995

Successful treatment of Finnish congenital nephrotic syndrome with captopril and indomethacin.

Two infants with biopsy-proven microcystic Finnish congenital nephrotic syndrome (onset at birth) were treated with a combination of captopril and indomethacin for 2 1/2 and 2 years, respectively; they had a marked reduction of urinary protein excretion without further need for albumin infusions. One infant has end-stage renal disease; the other infant's glomerular filtration rate has remained within normal limits.

Captopril↗
PubMed1995

Inhibition by uraemic sera of CD4+ T-cell adhesion to extracellular matrix components.

BACKGROUND: T-cell-mediated immune responses are impaired in patients with chronic renal failure. The migration, proliferation, differentiation, biological functioning, and interaction with other T cells are mediated by cell surface adhesion proteins, which include integrins. METHODS: To elucidate how uraemia can impair T-cell-mediated responses in vivo, the effects of sera from uraemic patients on T-cell proliferation and adhesion to extracellular matrix (ECM) components were examined. RESULTS: Preincubation of human CD4+ T cells with sera from undialysed and dialysed (haemodialysis or peritoneal dialysis) uraemic patients inhibited the capacity of the cells to be stimulated by phytohaemmagglutinin and by anti-CD3 monoclonal antibody plus immobilized fibronectin (FN). Sera from uraemic and dialysed patients, but not from healthy individuals, inhibited significantly, and in a dose-dependent fashion, human CD4+ T cell adhesion to immobilized FN and laminin (LN). The degree of inhibition of adhesion was similar whether the sera were continuously present, even during the adhesion assay, or removed by washing. The adhesion inhibiting capacity of the uraemic sera was not due to modification of the expression of beta 1 integrins on the surfaces of the T cells. CONCLUSIONS: These results suggest that uraemia can impair the proliferative capacity and adhesion of immune cells, and thus may affect normal immune processes and contribute to the overall immune deficiency observed in patients with renal failure.

CD4-Positive T-Lymphocytes↗
PubMed1994

Antiviral activity of mice with chronic renal failure--an assessment using peritoneal effluents.

Antiviral activity (AVA) determined by the inhibition of the cytopathic effect (CPE) of vesicular stomatitis virus (VSV) on mice fibroblasts, was measured in the peritoneal effluent of mice. Four groups of animals (each group numbering 30 mice) were studied. Group 1 consisted of sham operated mice and served as the control group. Group 2 underwent implantation of silastic matter (of which the Tenckhoff catheter is made). In group 3, chronic renal failure was induced. Group 4 comprised those mice in which both chronic renal failure was induced and silastic matter implanted. Optical density readings, directly related to the inhibition of CPE were 0.66 +/- 0.01, 0.59 +/- 0.08, 0.85 +/- 0.06 and 0.86 +/- 0.13 for groups 1, 2, 3 and 4, respectively (p < 0.01 for groups 1 and 2 versus 3 and 4). Virus control readings indicative of the CPE of VSV without the presence of peritoneal effluent were 0.58 +/- 0.07, not significantly different from those obtained in groups 1 and 2. They were, however, significantly below values from groups 3 and 4 (p < 0.05). These data show that AVA is undetectable in the peritoneal effluent of normal mice. Chronic renal failure produces an enhancement of AVA. Silastic matter (Tenckhoff catheter) implantation does not play a role in the production of AVA.

Animals↗
PubMed1994

Does diurnal variation in blood pressure exist in CAPD patients?

The existence of diurnal variation in CAPD remains controversial. We therefore attempted to delineate the blood-pressure (BP) pattern in CAPD patients by ambulatory blood-pressure monitoring (ABPM). Initially ABPM was performed in 31 patients (21 M, 10 F), mean age 65.4 years (26-87) using the Spacelabs model 90207. The maximal normal BP preset on the recorder was 140/90 mmHg. Daytime and night-time readings, recorded every 30 min, were defined as those from 0600 to 2100 and 2100 to 0600 hours respectively. Mean duration of dialysis was 15.2 months (3-76). There were 14 hypertensive patients, defined as a basal BP > 140/90 mmHg, or those on antihypertensive medications. Taking the group as a whole a significant difference between day and night-time readings was found as regards minimal systolic BP (118 versus 107.6 mmHg), maximal systolic BP (181.6 versus 171.2 mmHg), mean diastolic BP (83.9 versus 79.6 mmHg), and maximal diastolic BP (121.7 versus 104.5 mmHg), P < 0.05. Diurnal variation, defined in the initial study as a 10% decrease of MAP occurring during any consecutive 4-h period, was present in 21 patients. In three the diurnal variation manifested as a paradoxical reduction of BP during the day. The only significant difference between those with diurnal variation and those without was the duration of dialysis, being 19.2 +/- 19.9 versus 13.3 +/- 17.3 months respectively, (P < 0.05). In a second study 18 hypertensive CAPD patients were subjected to ABPM. Nine of them had participated in the first study. These patients were specifically asked to detail their periods of sleep and arousal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Is renal biopsy justified for the diagnosis and management of the nephrotic syndrome in the elderly?

During the past decade, controversy has raged about the necessity of renal biopsy for the management of the idiopathic nephrotic syndrome. The debate has centered on whether a precise diagnosis is imperative for steroid treatment or whether such therapy can be given blindly. The above question has not been addressed in the elderly. In this retrospective study 30 patients aged > 60 years, all of whom underwent a renal biopsy for an unexplained nephrotic syndrome, were categorized according to histological findings and clinical evolution of their disease. The spectrum of histology was diverse, the most common renal lesion diagnosed being membranous glomerulopathy (MGN) (23%). At variance with other works is the relatively high incidence of membranoproliferative glomerulonephritis (MPGN) (20%) found by us. Minimal change disease (MCD) and amyloidosis were encountered in 5 (17%) and 4 patients (13%), respectively. Specific therapy (steroids) was administered in 11 patients. No benefit of steroid treatment was shown in patients with either MGN or MPGN. The only lesion which responded to steroids was MCD (3 complete remissions, 1 partial). Only one biopsy was complicated by a clinically significant perirenal hematoma requiring blood transfusion. No surgical intervention was necessary. Our findings tend to favor a positive approach to the performance of a renal biopsy in the management of the nephrotic syndrome in the elderly.

Aged↗