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Biomedical subjects

A M Brownjohn

Publications and source records attributed to A M Brownjohn.

70 records · Page 4Linked to original sources
PubMed1983

Evidence for a hypothalamic disturbance in cyclical oedema.

Fourteen women with cyclical oedema and six healthy female controls were investigated by use of a test in which thyrotrophin releasing hormone and luteinising hormone releasing hormone were given. Significant differences in the responses of prolactin, luteinising hormone, and follicle stimulating hormone were observed in the patients. These findings suggest that there may be a hitherto unrecognised hypothalamic defect in cyclical oedema that may account for some of the previously unexplained clinical features and lead to a more rational therapeutic approach in the management of the disorder.

Adult↗
PubMed1983

Failure of renal dopamine response to salt loading in chronic renal disease.

Eight patients with chronic glomerulonephritis and five age-matched normal volunteers were given additional sodium chloride by mouth under conditions of metabolic balance. Whereas in the normal volunteers plasma renin activity was suppressed and urinary excretion of free dopamine increased, in the patients dopamine was not mobilised and plasma renin activity was not completely suppressed. Abnormal retention of sodium and water in glomerulonephritis may be due partly to a failure to mobilise dopamine in the kidney. Specific renal dopamine agonists may be natriuretic and hypotensive in chronic glomerulonephritis.

Adult↗
PubMed1982

Long-term experience of alfacalcidol in renal osteodystrophy.

Thirteen patients receiving regular haemodialysis, with biochemical or radiological evidence of renal osteodystrophy, were treated with alfacalcidol (1 alpha hydroxy vitamin D3) for four years. During the first eighteen months of treatment plasma alkaline phosphatase and serum parathyroid hormone concentrations fell and subperiosteal phalangeal erosions improved. Thereafter plasma alkaline phosphatase and serum parathyroid hormone concentrations rose and after four years' treatment only four patients had a normal plasma alkaline phosphatase, only five a normal serum parathyroid hormone level and in only six had the erosions healed completely. Hypercalcaemia occurred in twelve patients, plasma calcium exceeding 3.0 mmol/l in ten. Plasma calcium rose abruptly close to the time when plasma alkaline phosphatase became normal and often remained raised despite reduction in dosage of alfacalcidol. We have reservations about the ultimate value of long-term treatment with alfacalcidol in haemodialysed patients with renal osteodystrophy and urge caution in its use.

Adult↗
PubMed1977

1-alpha-hydroxycholecalciferol for renal osteodystrophy.

Fourteen patients with renal osteodystrophy were treated for at least one year with 1-alpha-hydroxycholecalciferol (1-alpha-OHD3) in a dose varying from 1 microgram/week to 3 microgram/day. Plasma calcium and inorganic phosphorus concentrations increased significantly. The plasma alkaline phosphatase concentration fell in 11 of the 12 patients in whom it was initially raised and returned to normal in seven. Serum parathyroid hormone concentrations were initially raised in all patients, but they decreased significantly with treatment and became normal in eight patients within one year. The 10 patients with radiological abnormalities showed some improvement. Hypercalcaemia occurred in 11 patients, and necessitated a reduction in the dose of 1-alpha-OHD3 in some. 1-alpha-OHD3 was effective in reducing the biochemical and radiological abnormalities of renal osteodystrophy, but it should be used wtih care, and plasma calcium concentrations should be monitored.

Adolescent↗
PubMed1977

Hyperparathyroidism in chronic renal failure.

The high circulating concentrations of immunoassayable parathyroid hormone observed in chronic renal failure are due to a number of factors. These include altered metabolism of the hormone and also end-organ unresponsiveness which may, indirectly, cause increased secretion of parathyroid hormone. The response of the overactive parathyroid glands to changes in plasma calcium and magnesium is variable and caution is needed in evaluating the suppressibility of parathyroid hormone secretion in acute studies. 1alpha-Hydroxylated derivatives of vitamin D can effectively suppress parathyroid gland overactivity. This effect may not necessarily be medicated through hypercalcaemia and vitamin D metabolites may act directly on the parathyroid glands.

Calcium↗
PubMedDate not supplied

Technique failure in peritoneal dialysis and its impact on patient survival.

OBJECTIVE: To determine the frequency and causes of continuous ambulatory peritoneal dialysis (CAPD) technique failure and its effect on patient outcome. DESIGN: Retrospective study of CAPD technique and patient outcome. SETTING: Teaching hospital renal unit. PATIENTS: All 221 patients commencing CAPD over a 14-year period. OUTCOME MEASURES: Outcomes assessed included patient survival and technique survival (with change to hemodialysis being considered as technique failure). RESULTS: CAPD failure occurred in 46 patients, with a CAPD technique survival of 93%, 73%, and 63% at 1, 3, and 5 years after start of treatment. Peritonitis was the major cause of technique failure. CAPD system had no effect on technique survival, despite the lower peritonitis rate in patients using Y-connection systems. Overall patient survival was 91%, 72%, and 53% at 1, 3, and 5 years after start of treatment, with increasing age and diabetes being associated with a worse outcome. There was a high early mortality after CAPD failure, with an actuarial survival of only 61% 1 year later. CONCLUSION: Failure of CAPD is an important problem, with peritonitis being the major cause, either directly, or indirectly by the later effects of damage to the peritoneal membrane with loss of dialysis adequacy. The high mortality in the period following CAPD failure warrants careful monitoring of patients during this phase, along with efforts to optimize correctable factors such as nutrition, adequacy of the new form of dialysis, and treatment of residual sepsis.

Adolescent↗
PubMedDate not supplied

Reticulocyte indices in patients with end stage renal disease on hemodialysis.

The diagnosis of iron deficiency anaemia in haemodialysis patients is difficult. Two states of deficiency occur, storage (absolute) and functional iron deficiency. Conventional measures, lack precision in assessing both storage and functional iron deficiency. This study investigated the accuracy of reticulocyte indices in comparison to the conventional haematological measures in the identification of haemodialysis patients with iron deficiency. A cross-sectional study of 72 haemodialysis patients was performed. Mean haemoglobin was 9.6 +/- 0.16 g/dl. Mean haemoglobin content of reticulocytes (CHr) was normally distributed and correlated with MCV, MCH and red cell ferritin. Mean haemoglobin concentration of reticulocytes (CHCMr) correlated with MCH. CHr and CHCMr had positive predictive values of 0.61 and 0.54 respectively. A low CHr or CHCMr identified 5 and 4 and 17 and 21 further patients with iron deficiency with normal serum ferritin or transferrin saturation respectively. Reticulocyte measures provide a direct measure of adequacy of haemoglobin synthesis in haemodialysis patients. In this study their usefulness was somewhat limited, but requires further investigation.

Adult↗