摘要:

This article reviews the local and systemic effects of crush injury. Within minutes to hours after extrication of survivors trapped under fallen masonry (and immediately following decompression of limbs), a massive volume of extracellular fluid is lost into the injured muscles, leading to circulatory failure. Solutes leaking out of damaged muscles cause a spectrum of metabolic disturbances. Chief among them are hyperkalemia and hypocalcemia which, synergistically, have a lethal cardiotoxic potential, particularly in hypotensive patients. Early volume replacement, preferably already started at the rescue site, may combat shock and correct the hyperkalemia. If urine flow is established, this regimen should be followed by a forced solute-alkaline diuresis for the prevention of myoglobinuric and uricosuric acute renal failure, which is a common and ominous late complication of crush injury. Preparation for future catastrophes occurring particularly in remote regions where an ‘epidemic’ of crush syndrome may be forecast, should include the setting up of a radio communications network to coordinate rescue and salvage operations and the forwarding of intravenous fluid bags and lines to the disaster site. Also, it is advisable to prepare artificial kidney devices which do not require pumps and electricity and which utilize a low dialysate volume for emergency temporary use, until conventional definitive medical facilities and services have been reestablis

ISSN:1660-8151    

DOI:10.1159/000185934

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Destructive spondyloarthropathy has been increasingly recognized in dialysis patients. We have reviewed 39 observations published in the literature and added 11 personal cases in order to define the clinical and radiological presentation of the disease. The many hypotheses that have been proposed for its pathogenesis are discussed, including secondary hyperparathyroidism, microcrystal deposition, β2-microglobulin-associated amyloidosis and aluminum intoxication

ISSN:1660-8151    

DOI:10.1159/000185935

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Specific receptors for calcitriol (1,25-dihydroxyvitamin D) have been found in immune cells, such as monocytes and activated lymphocytes, suggesting that calcitriol may play an immunoregulatory role. In fact, a marked increase in lymphocyte proliferation has been reported after treating hemodialyzed patients with 1α-hydroxyvitamin D3, a precursor of calcitriol. We have studied in vitro the effect of calcitriol depletion and calcitriol addition on the phytohemagglutinin-induced mitogenesis of peripheral blood mononuclear cells from 14 healthy subjects and 8 hemodialyzed patients. The calcitriol depletion of culture medium did not modify cell proliferation. The addition of calcitriol in concentrations about the physiological range (10-11M) induced a small, marginally significant, 11% increase in the poliferation of lymphocytes from hemodialysis patients. Supraphysiological concentrations (10-9-10-7 M) induced a marked inhibition (up to 60% of control values) of cell mitogenesis, both in patients and in healthy subjects. These results suggest that the increase in lymphocyte proliferation observed in vivo after treatment with calcitriol precursors is not mediated by a direct effect of calcitriol on circulating mononuclear cells

ISSN:1660-8151    

DOI:10.1159/000185936

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

To determine the clinical and echocardiographic outcome of left ventricular hypertrophy a prospective study was undertaken of 104 nondiabetic dialysis patients without dilated cardiomyopathy, who were followed for 3–5 years. 33% of patients had normal echocardiogram, 41% mild and 21% 1.4 cm in diastole). In the first 2 groups 16%o progressed to severe hypertrophy, 23% were admitted with congestive heart failure after starting dialysis therapy, and 2-year cumulative survivals were 97 and 85%. In the group with severe hypertrophy 88% already had severe hypertrophy on starting dialysis therapy, it was persistent in 87%, 50% were admitted at least once with congestive heart failure, and the 2-year cumulative survival was 53%. 71% of those who died in the severe group died from cardiac or cerebrovascular causes compared to none of those with normal echocardiogram, which accounted for the significantly worse (p = 0.001) survival. We conclude that severe left ventricular hypertrophy occurs frequently in dialysis patients, is often present at the start of end-stage renal disease therapy, is persistent, may predispose to congestive heart failure, and is associated with a high mortalit

ISSN:1660-8151    

DOI:10.1159/000185937

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

We have performed a retrospective review of the incidence and etiologies of acute renal failure (ARF) in 105 adult patients receiving liver transplants. The prevalence of chronic renal failure was also determined. ARF occurred in 94.2% of these patients. Acute tubular necrosis was the leading cause of ARF and was associated with the highest mortality. Factors associated with increased mortality included: (1) peak serum creatinine > 3 mg/dl, (2) multiple liver transplants and (3) the need for dialysis. Pretransplant renal failure did not increase mortality. Chronic renal failure developed in 83% of patients at latest follow-up (mean: 30.5 ± 7.9 months)

ISSN:1660-8151    

DOI:10.1159/000185938

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Clinical data from 105 biopsied cases with chronic glomerulonephritis (CGN) were analyzed to determine factors contributing to blood pressure (BP) levels. Significant univariate correlations were found between BP and 11 parameters such as age, body mass index, pathological subgroup of CGN and creatinine clearance (Ccr). These were used as independent variables in multiple regression analysis, where five factors including Ccr and subgroups of CGN were significantly associated with BP. The results indicate that glomerular filtration and glomerular pathology contribute independently to BP levels in CGN.

ISSN:1660-8151    

DOI:10.1159/000185939

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

The therapeutical effect of keto acids on bone histology was investigated in a prospective randomized controlled study of 40 patients. A marked improvement in osteofibrotic as well as in osteomalacic changes was found in bone biopsies after 12 months of treatment with keto acids.

ISSN:1660-8151    

DOI:10.1159/000185940

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

We investigated the influence of thymopentin as an adjuvant for hepatitis B vaccination on in vitro monocyte and T cell function and in vivo antibody response in a prospective, placebo-controlled double-blind trial in 20 low- and nonresponders to hepatitis B vaccination on chronic hemodialysis. 50 mg thymopentin was given subcutaneously twice per week for 3 weeks, followed by 1 intramuscular injection of 40 μg HB-Vax and 3 subsequent injections of thymopentin. After 1 month, the patients were boostered with 40 μg HB-Vax. There was no significant difference in T cell and monocyte function after administration of thymopentin, as determined in vitro. After 3 months, 3 patients in the placebo and 2 patients in the thymopentin group had antibody titers greater than 10 U/l. In both groups only patients with normal or slightly impaired monocyte function responded to vaccination. Thus, we were not able to demonstrate a beneficial effect of thymopentin on hepatitis B vaccination in nonresponders on chronic hemodialysis. Furthermore, functional tests were not able to identify a subpopulation of uremic nonresponders who would benefit from thymopenti

ISSN:1660-8151    

DOI:10.1159/000185941

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Torasemide, a new loop diuretic, was administered in 9 hospitalized patients with chronic renal failure to treat both arterial hypertension and peripheral edema. The urine of 5 patients was collected over 12-hour periods to assess the long-lasting diuretic activity of torasemide. Torasemide induced a significant decrease in blood pressure and reversion of peripheral edema in all patients without adverse effects. Torasemide is a high-ceiling loop diuretic, useful in correcting extracellular fluid volume expansion in patients with chronic renal failure.

ISSN:1660-8151    

DOI:10.1159/000185942

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Acute renal failure induced by leptospirosis was studied in 56 patients. A higher frequency of nonoliguric renal failure was observed with lower morbidity and mortality rates than in oliguric forms. In addition, 45% of the patients in this series were hypokalemic, and no hyperkalemic patients were seen. A prospective study in 11 patients showed an initially elevated urinary fractional potassium excretion that fell simultaneously with the high urinary fractional sodium excretion and the urinary K/Na ratio, suggesting an increased distal potassium secretion due to an increased distal sodium delivery consequent to functional impairment of the proximal reabsorption of sodium.

ISSN:1660-8151    

DOI:10.1159/000185943

出版商:S. Karger AG    

年代:1990

数据来源: Karger