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Biomedical subjects

A R Eiser

Publications and source records attributed to A R Eiser.

32 records · Page 2Linked to original sources
PubMed1985

Pulmonary gas exchange during hemodialysis and peritoneal dialysis: interaction between respiration and metabolism.

This review concerns the alterations in pulmonary gas exchange during hemodialysis and peritoneal dialysis. The occurrence of hypoxemia during hemodialysis has led to numerous studies that now provide sufficient data to explain this complex phenomenon. The role of substrate metabolism during hemodialysis and peritoneal dialysis are explored as it relates to alterations in ventilation. Comparison to similar types of ventilatory changes occurring during total parenteral nutrition are discussed. The effect of peritoneal dialysis on pulmonary function is also described.

Acetates↗
PubMed1984

Hodgkin's lymphoma in an adolescent with systemic lupus erythematosus.

An adolescent female with systemic lupus erythematosus (SLE) with diffuse proliferative lupus nephritis subsequently contracted Hodgkin's lymphoma, mixed cellularity type. Prior to the diagnosis of Hodgkin's lymphoma, hypogammaglobulinemia developed with IgG deficiency. The nephritis, which improved on steroid therapy, remitted entirely after nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) therapy. The hypogammaglobulinemia also remitted after chemotherapy for Hodgkin's lymphoma. The literature concerning the association of SLE and Hodgkin's lymphoma is reviewed. The significance of this concurrence is discussed in regard to the possible pathophysiology and the clinical management.

Adolescent↗
PubMed1984

Gastrointestinal telangiectasias. A source of bleeding in patients receiving hemodialysis.

Endoscopy was used over a five-year period to determine the cause of acute or chronic gastrointestinal (GI) tract bleeding in 46 patients receiving long-term hemodialysis. Nine (19%) of the patients were found to be bleeding from telangiectasias. We observed the occurrence of such lesions in the stomach, the small bowel, and the colon. Endoscopic cauterization of the lesions in three patients and jejunal resection in another stopped previously recurrent GI tract bleeding.

Aged↗
PubMed1983

Patients surviving 10 years of hemodialysis.

Experience with 37 patients surviving 10 years of hemodialysis therapy was reviewed. These patients were compared with 103 patients who began hemodialysis between 1967 and 1971 and who subsequently died. Males had an excess risk of death. Patients with polycystic kidneys survived longer. There was more uncontrolled hypertension among a control group than in 10-year survivors. In survivors, the hematocrit level increased over time and averaged 30.4 percent at 10 years. Over 10 years, many complications arose including parathyroidectomy (24), pericarditis (13), gastrointestinal bleeding (11), myocardial infarction (10), septicemia (eight), and active tuberculosis (six). Despite complications, most patients are now stable. Between their eighth and 10th years they required an average of only one hospitalization with a mean stay of 9.7 days. Eighteen patients were not hospitalized. Excluding housewives, 67 percent of patients between ages 20 and 59 years are employed full-time and 10 percent part-time. Patients surviving 10 years are not progressively deteriorating and may look to the future with cautious optimism.

Adolescent↗
PubMed1983

Angiographic visualization for percutaneous renal biopsy.

Fifteen patients underwent visualization of the kidney for percutaneous biopsy by selective renal angiography. Biopsies were performed in 11 patients, and adequate renal tissue was obtained in all instances. Postbiopsy angiogram revealed pinpoint bleeding in ten patients and significant extravasation in one case, which was controlled with a selective epinephrine infusion. In four cases, biopsy was not performed when the cortex was found to be less than 5 mm thick.

Angiography↗
PubMed1983

Nephronophthisis with massive proteinuria.

A 23-year-old male whose uncle died of nephronophthisis, and whose pathology is also discussed, presented with 5 g of protein in a 24-hour urine collection. Nephrogenic diabetes insipidus and salt wasting were present in addition to azotemia. Characterization of the proteinuria, including elevated alpha globulins by electrophoresis and markedly elevated urinary beta-microglobulins by radioimmunoassay (49.55 mg/L) indicated predominantly tubular proteinuria. A percutaneous renal biopsy showed normal glomeruli, interstitial inflammation and fibrosis, and tubular atrophy. Electron microscopy revealed notable alterations of the tubular basement membrane.

Adult↗
PubMed1982

Cure of cryptococcemia in an immunocompromised patient with lupus nephritis.

The first documented cure of cryptococcosis with cryptococcemia is reported. The patient had systemic lupus erythematosis and had received corticosteroids and immunosuppressive drugs for diffuse proliferative nephritis. She had additional poor prognostic factors including high serum cryptococcal antigen titer, low cerebrospinal leukocyte count, and absence of anticryptococcal antibody. Pulmonary tuberculosis was diagnosed concurrently and subsequently she developed disseminated herpes zoster. During amphotericin B therapy, renal function worsened. Cure of cryptococcosis with cryptococcemia was accomplished despite multiple concurrent infections and transient worsening of renal function.

Adult↗
PubMed1982

Contrasting alterations in pulmonary gas exchange during acetate and bicarbonate hemodialysis.

We studied 10 patients during acetate and 10 patients during bicarbonate hemodialysis to assess changes of minute ventilation; oxygen consumption (VO2); and carbon dioxide production (VCO2) as well as pO2, pCO2 and pH. We also measured the extent of pulmonic shunting by administering 100% O2. Our studies revealed that VO2 increased significantly during acetate dialysis, while it decreased slightly during bicarbonate dialysis. Since VCO2 decreased with both baths, the respiratory exchange ratio (R) decreased during acetate dialysis but did not change during bicarbonate dialysis. By the alveolar gas equation, these changes in R could account for a difference in alveolar pO2 and consequently arterial pO2. The fact that pO2 fell during bicarbonate dialysis may relate to decreased minute ventilation paralleling decreases in VCO2. The degree of intrapulmonic shunting was not altered during dialysis with either bath. We conclude that hypoxemia during dialysis relates to decreases in minute ventilation and that a greater decrease during acetate dialysis is a consequence of enhanced VO2 and its effect on R. Bicarbonate dialysis does not increase VO2.

Acetates↗
PubMed1982

Reversible nephrotic range proteinuria with renal artery stenosis: a clinical example of renin-associated proteinuria.

Nephrotic range proteinuria occurred in a 60-year-old woman with renal artery stenosis and marked hyperreninemia. Treatment by nephrectomy produced resolution of both proteinuria and hypertension. The gradual resolution of the proteinuria postoperatively suggested the proteinuria, at least in part, came from the contralateral kidney. Foot process fusion in the nephrectomy specimen suggested it too was a source of proteinuria. A marked degree of hyperreninemia, as was present in this case, may be necessary before massive proteinuria occurs in renal artery stenosis.

Female↗
PubMed1982

Acute myoglobinuric renal failure. A consequence of the neuroleptic malignant syndrome.

Neuroleptic malignant syndrome and acute myoglobinuric renal failure developed in three patients after they had received a combination of a major tranquilizer and a tricyclic antidepressant or after a large dose of haloperidol. Rhabdomyolysis was demonstrated by biochemical methods as well as by a muscle biopsy. Myoglobinuria was confirmed by radioimmunodiffusion and also was verified in a necropsy specimen. Dehydration and drug interaction with tricyclic antidepressants seem to be predisposing factors. Renal function recovered when the patient survived the acute episode, but neurologic sequelae persisted. Recommendations that may avert further cases are made.

Acute Kidney Injury↗
PubMed1981

A comparison of androgens for anemia in patients on hemodialysis.

To compare the erythropoietic effects of nandrolone decanoate, testosterone enanthate, oxymetholone, and fluoxymesterone, we performed a randomized clinical trial in patients with anemia who were receiving maintenance hemodialysis (the women were not given testosterone enanthate). After a control period of at least two months, patients received one of the drugs for six months and then returned to control status; a second and third drug were administered in a similar fashion. Seventy-seven patients completed the first drug period, 56 the second, and 35 the third. The response to nandrolone and testosterone enanthate, the two drugs given by injection, was clearly superior to the response to oxymetholone or fluoxymesterone, given by mouth, in terms of the percentage of patients responding and the mean rise in hematocrit. Approximately half the patients had an increase of at least 5 percentage points in hematocrit after an injectable androgen was given; more than half the women responded. Patients who required transfusions regularly and those who had bilateral nephrectomies did not respond.

Administration, Oral↗
PubMed1979

Clinically occult diffuse proliferative lupus nephritis. An age-related phenomenon.

Thirteen patients with systemic lupus erythematosus (SLE) who had normal results of urinalysis, absence of proteinuria, and normal serum creatinine values underwent renal biopsy. Three of 13 patients had diffuse proliferative glomerulonephritis (group 1). Biopsy specimens showed segmental fibrinoid necrosis, diffuse mesangial hypercellularity, and substantial immunoglobulin deposition. Group 2 comprised those patients whose histologic findings did not portend a poor prognosis. Four had mesangial proliferative glomerulonephritis, three had focal proliferative glomerulonephritis, and three had minimal mesangial widening. The values of inulin clearance in group 1 did not differ significantly from those in group 2. Patients in group 1 had a mean age of 19 years, a value significantly lower than in group 2 (41.8 years). Review of previous reports also supports the thesis that this phenomenon is age related. Our study underscores the importance of renal biopsy in patients with SLE despite the absence of clinical evidence of renal involvement, particularly in patients under 30 years of age.

Adult↗
PubMedDate not supplied

The patient physician relationship in the Internet age: future prospects and the research agenda.

In the "Internet Age," physicians and patients have unique technological resources available to improve the patient physician relationship. How they both utilize online medical information will influence the course of their relationship and possibly influence health outcomes. The decision-making process may improve if efforts are made to share the burden of responsibility for knowledge. Further benefits may arise from physicians who assist patients in the information-gathering process. However, further research is necessary to understand these differences in the patient physician relationship along with their corresponding effects on patient and physician satisfaction as well as clinical outcomes.

Decision Making, Computer-Assisted↗