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Biomedical subjects

A Barrientos

Publications and source records attributed to A Barrientos.

At least 109 records · Page 6Linked to original sources
PubMed1991

Post-transplant renal artery stenosis: a possible immunological phenomenon.

A retrospective review of 110 consecutive kidney transplants performed during 4 years revealed the development of renal artery stenosis in 9 patients (8.18%). A comparison of this group with a control group similar in patient age and interval elapsed since transplantation revealed no significant differences in donor and recipient ages, degree of HLA compatibility or serum creatinine levels. However, there was a significant difference in the number of acute rejection episodes. In our series only male patients were affected. A sizable proportion of the patients (50%) had no detectable murmur over the graft area despite high blood pressure and increased creatinine levels. The absence of surgical injury during extraction and implantation of the grafts, together with the anatomical site of the stenosis and correlation with the degree of immunological intolerance suggest an immunological factor as the underlying cause in post-transplant renal artery stenosis.

Adult↗
PubMed1991

Treatment of hyperlipemia in diabetic patients on dialysis with a physiological substance.

Hyperlipemia is a very frequent complication of the diabetic patient on dialysis. There is difficulty of treatment with the diet, because the dietary restriction already imposed on these patients and the secondary effects and toxicity of the available drugs in uremics aggravate the problem. We have treated 22 diabetic patients on dialysis (8 on hemodialysis and 14 on continuous ambulatory peritoneal dialysis) suffering from hyperlipemia with pantethine, a physiological substance and coenzyme A precursor in the Krebs cycle. With the administration of an oral dose of 900 mg/day we obtained a reduction of total cholesterol (275 +/- 72 vs. 231 +/- 54 mg/dl; p less than 0.001), very-low-density lipoprotein (VLDL)-cholesterol (66 +/- 36 vs. 46 +/- 18 mg/dl; p less than 0.01) and triglycerides (332 +/- 182 vs. 227 +/- 90 mg/dl; p less than 0.01) at 2 months. High-density lipoprotein (HDL)-cholesterol did not change, but the total cholesterol/HDL-cholesterol ratio decreased significantly (p less than 0.05). Total cholesterol, VLDL and triglycerides showed a progressive and significant reduction at 4 and 6 months. No changes were observed in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, uric acid, blood glucose and glycosylated hemoglobin. Gastric discomfort in 2 patients and pruritus in another one were the secondary effects related. Pantethine was shown to be a very effective hypolipemic agent in diabetic patients on dialysis with a great tolerance.

Cholesterol↗
PubMed1991

Fructosamine levels in CAPD: its value as glycemic index.

We have studied fructosamine (measured by colorimetric methods) and glycosylated hemoglobin (HbA1c) using a high pressure liquid chromatography (HPLC) in 20 uremic patients managed conservatively (8 diabetics and 12 non-diabetics) and 20 patients treated with continuous ambulatory peritoneal dialysis (CAPD) including 12 diabetics and 8 non-diabetics. Twenty healthy subjects were used as control group. We have correlated the mean blood glucose (MBG) of the preceding days to fructosamine and HbA1c measurements. No differences were detected in mean fructosamine and HbA1c levels in non-diabetics patients in the CAPD or conservatively treated groups compared to controls. In diabetic patients undergoing conservative treatment or CAPD, mean fructosamine and HbA1c values were elevated when compared with control group. Both glycemic indicators were increased in most of the diabetic patients, was higher values in those patients with higher MBG. There was a good correlation in CAPD diabetic patients between fructosamine and HbA1c with MBG of the 21 previous days (r = 0.84, p less than 0.01 and r = 0.74, p less than 0.01 respectively). There was also correlation between fructosamine and HbA1c in CAPD diabetic patients (r = 0.78, p less than 0.01). We conclude that fructosamine does not seem to be influenced by uremia or by CAPD. Fructosamine and also glycosylated hemoglobin, when c-fraction is measured and HPLC method is used, can be utilized as glycemic indexes in CAPD diabetic patients.

Adult↗
PubMed1991

Peritoneal clearances, protein losses and ultrafiltration in diabetic patients after four years on CAPD.

Peritoneal clearances of urea (C(urea)) and creatinine (Ccr), peritoneal protein losses (PL) and ultrafiltration (UF) were retrospectively evaluated in 12 diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) during a four year study. The average of three determinations each year was calculated. There were not significant differences in C(urea) (ml/24 hours), Ccr (ml/24 hours), PL (g/24 hours) and UF (ml/24 hours) between the four years and basal values or in the year to year studies. Seven patients did not modify their CAPD schedule during the four years study and we did not find any statistical differences in this group in the parameters studied. There was an average incidence of peritonitis of 4.7 episodes, higher in the 2 first years (p less than 0.05). The peritonitis incidence did not affect any of the functional parameters evaluated. The results of our study suggest that C(urea), Ccr, PL and UF in diabetic patients are not affected by long-term CAPD or by the peritonitis incidence.

Creatinine↗
PubMed1990

Partial substitution of sodium lactate for sodium acetate in the bath fluid for hemodialysis.

To the authors knowledge, lactate (LA) has never been used in hemodialysis concentrates. A new concentrate has been designed in which a low acetate (AC) concentration is complemented with LA up to standard quantities of buffer with the aim of minimizing the side effects of AC. In 14 classically AC-intolerant hemodialysis patients (low body surface area of 1.47 +/- 0.15 m2, decrease of serum bicarbonate level during hemodialysis by 2 mmol/L or more, and postdialysis hyperacetatemia of greater than 7.0 mmol/L) a concentrate with LA was used (Na, 138; K, 1.5; Ca, 1.75; Mg, 0.75; Cl, 109.5; AC, 17.5; and D,L-lactate, 17.5 mmol/L) and compared with the same bath with only AC as a buffer (35 mmol/L). Patients were blindly and randomly assigned to either the AC or the LA bath during six hemodialyses. Blood gases, AC, and L-LA levels were measured before and after dialysis. The number of symptomatic hypotension episodes and other symptoms such as vomiting, headache, or cramps were recorded in each dialysis. The postdialysis pH showed the same increase with both concentrates. The AC dialysis caused a significant decrease in PCO2 (26.05 +/- 2.48 versus 34.37 +/- 2.24 mm Hg; p less than 0.001) and bicarbonate level (15.84 +/- 2.12 versus 19.82 +/- 1.45 mmol/L; p less than 0.001). Dialysis with LA showed a smaller decrease in PCO2 (31.60 +/- 2.00 versus 35.45 +/- 2.25 mm Hg; p less than 0.01), and the bicarbonate level remained stable (19.43 +/- 1.85 versus 20.02 +/- 1.91 mmol/L; NS). Final acetatemia was lower in LA dialysis (3.12 +/- 1.6 versus 9.73 +/- 1.6 mmol/L; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1990

Diabetic patients on CAPD need less aluminum hydroxide as a phosphate binder than non-diabetics.

A retrospective study was done in 86 patients on dialysis in order to evaluate the doses of aluminum hydroxide (OH3 Al) received to achieve a better serum phosphate control. Thirty-seven patients were treated with continuous ambulatory peritoneal dialysis (CAPD) divided in 22 diabetics and 15 non-diabetics. Forty-nine patients were treated with hemodialysis (HD), 12 diabetics and 37 non-diabetics. The doses of 1-25 Dihidroxycholecalciferol (1-25 DOH-D3) were similar in all patients. The serum phosphate levels were similar in CAPD and HD patients with smaller doses of OH3 AL in CAPD patients (p less than 0.001). Diabetics on either technique need less OH3 AL in CAPD (CAPD p less than 0.01; HD p less than 0.05) to achieve the same or better control of serum phosphorus than non-diabetics. The overload of glucose on CAPD and the maintained hyperglycemia on diabetes mellitus would shift phosphorus into the cell and could explain these results. Finally, the less needs of aluminum hydroxide on diabetic patients could contribute to their protection against aluminum deposition and its effects.

Aluminum Hydroxide↗
PubMed1989

[Morbidity and mortality of diabetic patients on dialysis in a 10-year program: value of combined treatment].

Morbidity and mortality derived from the employed techniques after ten year experience in treating patients afflicted with end-stage diabetic nephropathy by means of dialysis are evaluated. Hemodialysis (HD) was applied to 24 patients, continuous ambulatory peritoneal dialysis (OCPD) was employed in 33 patients and intermittent peritoneal dialysis (IPD) in nine patients. Cumulated experience with each technique was 529, 644, and 107 months, respectively. Ten patients were treated with a combination of two or three techniques. Hospitalization rate in patients receiving CAPD was 32 days/year, peritonitis was the most frequent condition leading to admittance (54.8%), followed by cardiovascular alterations (14.4%) and gastrointestinal complications (10.5%). On hemodialyzed patients, hospitalization rate was 24.7 days/year and complications derived from vascular access were the most frequent admittance cause (34%), followed by cardiovascular complications (20.4%) and hypertension (11.3%). Peritonitis (45%), vascular complications (15%) and metabolic impairment (15%) were the most frequent causes of admittance in IPD patients; hospitalization rate was 88 days/year. Actuarial survival in patients on CAPD was 92% during first year, 79% during second, and 64% during third and fourth years. On hemodialyzed patients, 90% of patients survived during first year and 80%, 48%, and 36% during second, third, and fourth years, respectively. On IPD, survival during first year was 63% and 12% at 18 months. By combinating two or the three methods, survival was 100% at 12 months and 88% at 4 years. Although CAPD as isolated technique may offer to diabetic patients a longer survival and HD a lower hospitalization rate, combined treatment (HD-CAPD-IPD) may provide a survival matchable to that achieved in renal transplantation.

Adult↗
PubMed1989

Analysis of factors in the prognosis of diabetics on continuous ambulatory peritoneal dialysis (CAPD): long-term experience.

After five years of treating diabetics by continuous ambulatory peritoneal dialysis (CAPD), we analyzed the factors involved in prognosis. Forty-one patients were included in the study, with a cumulative experience of 784 months. Good control of blood glucose was obtained with intraperitoneal (i.p.) insulin and the blood pressure was controlled in 87% of patients without medication, which probably favored the stabilization of visual acuity in 60% of 15 patients evaluated after two years. The follow-up of patients was longer in those who began CAPD with a higher residual creatinine clearance. In spite of large number of patients who were blind or had very poor vision, 83% of all patients were self-sufficient and well-trained for CAPD, and 39% were able to work full time. The incidence of peritonitis declined to 1 episode per 17.5 patient months associated with the introduction of new preventive measures. Patients over 50 years old had the highest mortality rate and myocardial infarction was the main cause of death. Patient survival at 6, 12, 24, 36, and 42 months was 100, 90, 80, 62, and 62%, respectively. Age and cardiac problems are important factors in survival. Self-sufficiency, rehabilitation, and low incidence of peritonitis are also important factors in the life quality of diabetic patients on CAPD.

Diabetic Angiopathies↗
PubMed1989

[Infection in severe neutropenia: analysis of 140 episodes].

We analyzed infections complicating 140 episodes of severe neutropenia in 86 patients. The underlying diagnosis was acute leukemia in 64, lymphoma in 12 and isolated cases of bone marrow aplasia, agranulocytosis, dysmyelopoiesis and solid tumors. No fever developed in 35 (25%) episodes. No cause for the fever was identified in 40% of the remaining episodes. Clinical evidence of an infection was present in 20%, with positive bacteriologic findings in 27%. Respiratory infection (16%), pneumonia (11%) and sepsis (10%) were the most common infectious processes. Infectious agents isolated were gram negative bacilli (72%), gram positive cocci (19%) and fungi (9%). The association of amikacin and carbenicillin or cephalosporins proved to be superior to gentamycin-penicillin (p less than 0.01). 16 patients died for an overall mortality of 11%. Pneumonia and infection by K pneumoniae or C albicans were associated to a poorer prognosis.

Anti-Bacterial Agents↗
PubMed1989

[Complications in diabetic patients on dialysis: experiences in 10 years of treatment using 3 technics].

In treated diabetic patients with terminal renal failure we have examined the complications arising from the dialysis technique used. 55 patients were followed up for 1.279 months. Out of the latter, 24 were on hemodialysis (HD) 33 on continuous ambulatory peritoneal dialysis (CAPD) and 9 on intermittent peritoneal dialysis (IPD). Intraperitoneal insulin in patients on CAPD best controlled glycemia. Antihypertensive therapy was not necessary in 86%, 66%, and 46% of the patients on CAPD, IPD and HD respectively (CAPD vs HD, p less than 0.001). Acute myocardial infarction was more common in patients on HD (33%) (p less than 0.05). 22% of the patients on IPD had limb amputation (IPD vs CAPD-HD, p less than 0.05). The type of dialysis method used does not seem to influence the course of the retinopathy. The neuropathy behaved in a similar manner in those on CAPD and on HD when followed up for two years. Vascular complications were frequent in those on HD with one thrombotic event every 9.7 months/patient and a new vascular access every 7.4 months/patient. Peritonitis was the main complication of CAPD and IPD which was found more frequent in the former and longer hospitalization in the latter. The election of the dialysis technique in diabetic patients can directly influence the glycemia levels and blood pressure reading, as well as heart complications and those due to the method used. However they seem to influence less the neuropathy, retinopathy and peripheral vasculopathy.

Adult↗
PubMed1988

Analysis of clomesone in plasma by gas chromatography-electrolytic conductivity detection.

A sensitive and specific gas chromatographic (GC) method with electrolytic conductivity detection (ELD) for the analysis of clomesone (2-chloroethylmethylsulfonylmethane sulfonate), a new experimental antitumor alkylating agent, in plasma has been developed for the first time. Clomesone in plasma containing suitable internal standard was extracted with methylene chloride. After evaporation, the residue was analyzed by GC-ELD. Either a 15-m wide-bore DB-17 or a DB-1 column with the corresponding internal standards of propachlor or butachlor, respectively, was used. For the DB-1 column with butachlor as the internal standard, the routine assay limit was 20 ng/ml with linearity from 10 to 2000 ng/ml monitored. The within-run coefficient of variation of eight replicates at 50 ng/ml was 8.0% and the between-run coefficient of variation was 11% at 120 ng/ml. Using this assay procedure, the stability in several aqueous media and protein binding of clomesone were evaluated. In fresh mouse plasma, the half-life of clomesone was less than 1 h, although in aged pooled human plasma the drug was more stable. The mean protein binding value in mouse and human plasma was about 81-85%.

Animals↗
PubMed1985

Ureolytic Citrobacter freundii infection of the urine as a cause of dissolution of cystine renal calculi.

We report a case of cystinuria with staghorn renal lithiasis in a solitary right kidney and chronic renal failure. Right nephropyelolithotomy was performed and although 29 renal calculi were extracted many stones remained in situ. A permanent nephrostomy was left in the kidney. Several months later the urine was infected chronically with a ureolytic Citrobacter freundii bacteria and urinary pH oscillated between 8.0 and 9.2. Spontaneous dissolution of the cystine calculi was observed and many tiny fragments of cystine were expulsed through the nephrostomy, following which renal function improved. Despite the conditions favoring struvite calculi, formation did not occur.

Citrobacter↗
PubMed1985

Squamous cell carcinoma of the renal pelvis associated with hypercalcemia and the presence of parathyroid hormone-like substances in the tumor.

A case of hypercalcemia associated with documented squamous cell carcinoma of the renal pelvis without bone metastasis is reported. High levels of cross-reacting parathyroid hormone-like material in serum and its presence in tumoral tissue were detected. To our knowledge this is the fourth case described in the literature and the first in which tumoral production of parathyroid hormone-like material is demonstrated.

Calcium↗