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Biomedical subjects

B H Scribner

Publications and source records attributed to B H Scribner.

At least 19 recordsLinked to original sources
PubMed1986

Hypertension and a digoxin-like substance in the plasma of dialysis patients: possible marker for a natriuretic hormone.

Maintenance hemodialysis patients were randomly assigned to two groups based on the presence or absence of predialysis hypertension. Clinical profiles of the patients in the two groups were comparable except that there were more Blacks in the hypertensive group and that all the patients in this group received antihypertensive medications. Despite not taking any digitalis preparations, 10 of 12 hypertensives had measurable digoxin-like immunoreactive substance (DLIS) in their plasma. None of the 11 normotensives had detectable DLIS. Significantly higher (p less than 0.03) systemic vascular resistance was noted in hypertensives with DLIS compared to normotensives and hypertensives without DLIS. We propose that DLIS itself may be or may represent a marker for some vasopressive substance, possibly natriuretic hormone.

Adult↗
PubMed1979

Effect of hypertonic glucose on the muscular cramps of hemodialysis.

The effect of hypertonic (50%) glucose injected for relief of hemodialysis-induced muscular cramps was studied in 15 chronically uremic, nondiabetic patients who experienced a total of 44 cramp episodes. In a double-blind trial either 50 mL (or less) of hypertonic glucose or physiologic (0.9%) saline solution was injected, and the therapeutic response was evaluated. Of a total of 44 episodes of cramps, 26 were treated with hypertonic glucose and 18 with normal saline. Treatment with hypertonic glucose relieved 17 of 26 episodes, in contrast to only five of 18 episodes relieved with 50 mL of normal saline (P less than 0.016). No complications related to hypertonic glucose administration were observed. Hypertonic glucose seems to be safe and effective for the relief of dialysis-induced cramps. It also avoids undesirable loading with sodium and mannitol, which have been suggested for treatment of dialysis-induced cramps.

Clinical Trials as Topic↗
PubMed1979

The influence of acetate versus bicarbonate on patient symptomatology during dialysis.

The effect of large-surface area dialysis (LS) using dialysate containing both acetate and bicarbonate (LS-C) on a patient's symptomatology was compared with that noted with acetate (LS-A) or bicarbonate (LS-B) in the dialysis fluid. Patients experienced significantly more symptoms and deterioration of objective performance test scores with both LS-A and LS-C than LS-B. Furthermore, a correlation was seen between plasma acetate level at the end of dialysis and decrement in the performance test scores. The results suggest that accumulation of acetate rather than acute alteration in acid-base status is primarily responsible for the morbidity.

Acetates↗
PubMed1979

Effect of residual renal function on minimum dialysis requirements.

In two groups of haemodialysis patients, the effect of residual renal function (RRF) on motor nerve conduction velocity (MNCV) was prospectively studied. Patients belonging to Group I had stable GFR of greater than 1 ml/min while Group II patients had gradually declining GFR. As a result, the dialysis index for middle molecules, DI(MM), remained above 1.0 in Group I despite dialysis schedules as short as 6 hr/wk. DI(MM) in Group II fell gradually below 1.0 as renal function deteriorated on equally short dialysis schedules. None of the five patients in Group I developed neuropathy during 1.2-4.1 years of reduced dialysis. However, all four patients belonging to Group II developed significant (p less than .01) slowing of MNCV when their GFR declined below 0.5 ml/min. Neuropathy in this group was arrested or reversed by increasing DI(MM). It is, therefore, proposed that residual renal function is a major determinant of dialysis requirements.

Glomerular Filtration Rate↗
PubMed1978

Uremic neuropathy: evidence of middle molecule toxicity.

Ten dialysis patients were followed in a prospective study to determine the neurotoxicity of metabolites in the middle molecule (MM) molecular weight (mol wt) range of 500-200 daltons/molecule. In the absence of readily available direct serum measurements of MM concentrations, a theoretically calculated dialysis index, D1(MM), which included the combined effects of dialysis and residual glomerular filtration rate (GFR) on MM removal was used to estimate changes in their predialysis concentrations. The ten patients were dialyzed on protocols which yielded a D1(MM) less than 1.0. Evidence of uremic neuropathy developed in six of these ten patients, and five of these six also developed a progression in their anemia. Two additional patients with no signs of neuropathy developed a progression in their anemia. One patient developed pericarditis with tamponade. A total of eight patients developed complications. One additional patient developed increased weakness, tiredness and general malaise without change in objective findings. When the dialysis therapy to reduce MM concentrations by increasing the D1(MM) above 1.0 was instituted, the complications were reversed. Our data support the findings of others, namely, that there are toxic substances in the MM mol wt range of 500-2000 daltons/molecule. However, a synergism between elevated concentrations of small molecules and MM cannot be ruled out.

Blood Urea Nitrogen↗
PubMed1978

Less dialysis-induced morbidity and vascular instability with bicarbonate in dialysate.

We devised three protocols to test the postulate that increased morbidity during high-efficiency dialysis with large-surface-area units (LS) might be due in part to the increased flux of bicarbonate out and acetate into the patient inherent is LS dialysis. The first protocol showed that with LS-acetate dialysis there was a marked fall in plasma bicarbonate and Pco2 during the first 3 to 4 h, followed by a rapid rise in bicarbonate above normal and return to control in Pco2. With LS-bicarbonate dialysis, these oscillations were largely eliminated. A second double-blind protocol showed that central nervous system-type symptoms noted during and after LS-acetate dialysis were reduced significantly by switching to LS-bicarbonate dialysis. The third protocol showed that with LS-carbonate the tolerable rate of ultrafiltration could be increased 67% compared with LS-acetate dialysis.

Acetates↗
PubMed1977

Clinical use of a totally heparin grafted hemodialysis system in uremic patients.

1. A totally heparin grafted dialysis system shows great promise in the treatment of chronic uremia associated with bleeding risk. 2. Long-term treatment of chronic uremia with this system has to await: a) Further studies of the chronic toxicity of CPC. b) Evaluation of performance which may be achieved by using a more homogeneous heparin with higher bioactivity. 3. Detailed studies of platelet factor 4 release with subsequent heparin neutralization to determine the importance of this variable in its effect on system performance.

Blood Coagulation Disorders↗