ISSN:0250-8095    

DOI:10.1159/000168338

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The incidence of the 7 tumor markers carcinoembryonic antigen (CEA), α-fetoprotein (AFP), squamous cell carcinoma-related antigen (SCC), neuron-specific enolase (NSE), CA 125, CA 19–9 and CA 15–3 was studied before and after hemodialysis (HD) in 144 uremic patients who had no malignancies. Before HD, of all tumor markers, the mean concentration of SCC only exceeded the normal value. The positive rate was highest in SCC (95.1 %), and that of CEA and NSE was 25.7 and 10.6%, respectively. However, AFP was within the normal range in all cases. Among CA antigens, the positive rate of CA 125 was 7.6%, of CA 19–9 was 6.3% and of CA 15–3 was 3.5%. After HD, the incidence as well as the mean concentration of all tumor markers increased. A parallel increment of total protein was observed after HD. The membrane filter used in HD appears to be insufficient to remove tumor marker proteins during HD. It is necessary to consider the clinical interpretation of elevated tumor markers in patients with uremia.

ISSN:0250-8095    

DOI:10.1159/000168339

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Fifty-one consecutive vascular access procedures were randomized to either the Medtronic plasma TFE or Gore-Tex polytetrafluoroethylene (PTFE) conduits in patients requiring immediate dialysis from December 1989 to April 1990. There were 49 forearm loop fistulas and 2 upper arm grafts. Fifty of these fistulas were cannulated within 48 h of placement to avoid use of subclavian venous catheters for hemodialysis. Complications related to the early cannulation of these fistulas included 2 hematomas in the plasma TFE group, and 3 hematomas in the Gore-Tex group (p = 1.00). Two patients with Gore-Tex grafts were systemically heparinized prior to hematoma formation after thrombectomy of their accesses. There were no adverse sequelae in these 5 patients, and none of the hematomas interfered with further dialytic therapy. One patient in the plasma TFE group and 3 patients in the Gore-Tex group developed cellulitis within the first month of placement (p = 0.65). All were treated with intravenous vancomycin with resolution of the erythema. None of the plasma TFE and 3 of the Gore-Tex fistulas thrombosed within 30 days of placement (p = 0.22). All were salvaged by thrombectomy. Both the plasma TFE and Gore-Tex vascular conduits may be used after surgical placement for early dialytic therapy and are associated with minimal early complications. The early use of these fistulas may eliminate the need for subclavian venous cannulation in most patients with renal failure, thus diminishing the incidence of subclavian venous stenosis and thrombosis. Further observation of these grafts will be necessary to determine the effect of immediate cannulation on their long-term performance for hemodialysis.

ISSN:0250-8095    

DOI:10.1159/000168340

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

From January 1987 to July 1988, 30 patients suffering from end-stage renal disease were treated with continuous ambulatory peritonitis dialysis (CAPD) therapy. Serial cell number, size and cycle of the peritoneal macrophage (PM) in these patients were measured before and during episodes of peritonitis from the time they started CAPD therapy. Patients with peritonitis were divided into high peritonitis occurrence (HPOG) and low peritonitis occurrence (LPOG) groups. Both before and during occurrence of peritonitis, there were no significant differences in the number of PM cells in the dialysate taken from patients in the HPOG and LPOG. When peritonitis occurred, the size and cell cycle S/G0-G1 ratio decreased about 3 days after the onset of peritonitis. It progressed to the lowest level 7–10 days later, then progressively recovered. However, the dialysate PM cells from the HPOG took a much longer time to recover to the preperitonitis size. When dialysate PM cells from patients without peritonitis were put into the dialysate of HPOG patients on day 10 of peritonitis and incubated for 24 h, an obvious decrease in cell size could be identified. On the other hand, when the PM cells from HPOG patients with peritonitis on day 10 were incubated 24 h with the dialysate from patients without peritonitis, there were obvious increases in cell size. These results suggest there may be a substance (or substances) in the peritonitis dialysate, which contribute(s) to the shrinkage of PM cell siz

ISSN:0250-8095    

DOI:10.1159/000168341

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

High dietary protein intake, in the past recommended for nephrotic syndrome, does not improve hypoproteinemia and may accelerate progressive renal damage. In contrast, low-protein diets reduce proteinuria and preserve renal function in experimental renal models of nephrotic syndrome. In this study, 20 steroid-resistant, nephrotic patients were treated with a pure vegetarian, low-protein diet, supplemented with essential amino acids and ketoanalogues (supplemented vegan diet, SVD) for 4.6 ± 3.1 months. Before the study, these patients followed an unrestricted protein, low-sodium diet (LSD). Proteinuria, daily urea nitrogen excretion and creatinine clearance decreased significantly on SVD. A similar lowering effect of SVD was observed on serum total cholesterol. Seven of the 20 patients changed from LSD to SVD and vice-versa on 3 occasions, and in all cases, we found an increase of proteinuria during the LSD period. Serum albumin, HDL cholesterol, triglycerides and anthropometric measurements did not change on SVD. Our data suggest that SVD exerts a favorable effect on proteinuria and hypercholesterolemia in nephrotic patients, without inducing clinical or laboratory signs of malnutrition

ISSN:0250-8095    

DOI:10.1159/000168342

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Variations in urinary kallikrein in pancreatic diseases were ascertained, and possible influencing factors were investigated. Serum amylase and urinary excretion of glandular kallikrein, pancreatic ribonuclease (RNase),γ-glutamyltransferase (GGT) and amylase were measured in 24 control subjects, 39 patients with pancreatic cancer, 49 with pancreatitis and 63 with extra-pancreatic diseases. Urinary kallikrein was found to be elevated in a substantial number of patients with pancreatitis. Higher levels were detected in patients with a relapse, which was diagnosed using clinical and biochemical examinations. RNase was also increased in a high number of patients with pancreatic diseases, but was not correlated with pancreatic damage. In patients with pancreatitis, a correlation was found between urinary kallikrein and RNase excretions. No correlations were found between kallikrein and serum or urinary amylase and GGT. We can conclude that urinary kallikrein excretion increases in pancreatitis, especially when a phlogistic involvement of the pancreas is present; this condition may lead to a release of this ultrafiltrable enzyme in the circulation. Renal tubular damage, which determines a reduced reabsorption of this enzyme, seems to play a concomitant but minor role in this process

ISSN:0250-8095    

DOI:10.1159/000168343

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Lipid and lipoprotein levels were measured in 118 clinically stable patients who had received a kidney transplant more than 1 year earlier. Seventy-one were treated with ciclosporin (CS), 47 were not. The CS group had significantly higher mean cholesterol (6.54 versus 6.00 mmol/l) and triglyceride (1.83 versus 1.34 mmol/l) concentrations than the non-CS group. LDL/HDL cholesterol ratios were similar in the two groups. The CS patients had higher creatinine and prednisolone doses and used β-blockers and loop diuretics more frequently. Multiple regression analysis did not show an independent correlation between lipid levels and treatment with CS. On the other hand, there was an independent correlation between cholesterol levels and treatment with loop diuretics, suggesting that such treatment contributes to the higher cholesterol levels in kidney transplant recipients. The diabetics had a more favorable lipoprotein profile than the nondiabetics, especially in triglycerides and HDL cholesterol levels. The marked difference in triglyceride levels between the treatment groups prompted us to evaluate the lipoprotein lipase and hepatic lipase activities in 20 hyperlipidemic, nondiabetic patients. Both enzyme activities were moderately reduced with no difference between the treatment groups, suggesting that factors other than CS interfere with the lipase activities in kidney transplant recipients

ISSN:0250-8095    

DOI:10.1159/000168344

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The benefits and disadvantages of hemodialyzer reuse is controversial. While biochemical data have suggested potential benefits from reuse, there is dispute over the clinical impact on the patient. Limited data show that reuse is associated with less intradialytic symptoms compared to first use. We conducted a prospective study of acute symptoms during clinical dialysis using new and reused cellulose acetate membrane hollow-fiber dialyzers. A total of 106 sessions using new dialyzers and 871 sessions employing reused dialyzers were monitored. Dialyzers were processed with an automated machine using hydrogen peroxide and peroxyacetic acid as sterilants. We found that, compared to new ones, reused dialyzers were associated with a similar frequency of overall and specific symptoms. In addition, there was no difference in the magnitude of changes in blood pressure during and after the treatments between the two groups. We conclude that maintenance hemodialysis with reused cellulose acetate membrane dialyzers processed with hydrogen peroxide and peroxyacetic acid was not associated with more or fewer subjective symptoms than dialysis with new dialyzers.

ISSN:0250-8095    

DOI:10.1159/000168345

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

British successors of Richard Bright came to regard the disease which bore his name as consisting of several distinct clinical and pathological types, one of which was referred to as contracted granular kidney. The insidious nature of this form of the disease, the lack of clear-cut precipitating factors and, above all, the associated cardio-circulatory disorders gave rise to much speculation and debate. Whether the renal disease or the vascular disease was the primary and essential change was a question which sharply divided eminent Victorian physicians and gave rise to a bitter quarrel between Sir George Johnson and Sir William Gull. The answer to this conundrum, that the kidney was sometimes the cause and sometimes the consequence of circulatory disease was suggested by Mahomed’s discovery of essential hypertension but confirmation had to await the invention of a clinically useful sphygmomanomete

ISSN:0250-8095    

DOI:10.1159/000168346

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

A patient who had recently been started on digoxin developed acute severe right upper quadrant pain shortly after hemodialysis. He underwent an extensive work-up for abdominal pain but all findings were normal. With reduction of digoxin dosage, a substantial relief of pain was achieved. The pain totally resolved when digoxin was discontinued and recurred when it was restarted. Cardiac glycosides may be a cause of abdominal pain in patients undergoing maintenance hemodialysis and this side effect should be considered before costly work-up is performed.

ISSN:0250-8095    

DOI:10.1159/000168347

出版商:S. Karger AG    

年代:1991

数据来源: Karger