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Biomedical subjects

B Hulme

Publications and source records attributed to B Hulme.

10 recordsLinked to original sources
PubMed1992

Magnetic resonance angiography of renal transplants.

Stenosis of the artery of transplanted kidneys is an important cause of graft dysfunction. Diagnosis and follow-up of this condition normally requires intra-arterial digital-subtraction angiography (IADSA), which is invasive and may cause complications. A possible alternative to IADSA is magnetic resonance angiography (MRA), and we have assessed this technique in 50 renal transplant patients who were referred for investigation of possible renal arterial stenosis. In every patient, MRA was compared prospectively with conventional IADSA. Compared with IADSA, MRA had a sensitivity of 83% and a specificity of 97%, and when all images were graded retrospectively for severity of stenosis, the two techniques showed a significant correlation (r = 0.74, p less than 0.001). MRA can provide an accurate image of the renal transplant artery in a non-invasive manner with a high sensitivity and specificity.

Angiography, Digital Subtraction↗
PubMed1992

Regulation of iron absorption in iron loaded subjects with end stage renal disease: effects of treatment with recombinant human erythropoietin and reduction of iron stores.

The effects on iron absorption of variation in erythroid activity, haemoglobin and iron stores were studied in six anaemic dialysis-dependent subjects in whom iron stores were increased from previous red cell transfusions. Gastrointestinal mucosal uptake and whole body retention of oral iron were measured at the beginning of the study, after starting treatment with recombinant erythropoietin (but before significant increase in haemoglobin), after partial correction of anaemia, after further reduction of iron stores by repeated phlebotomy, and when erythropoiesis decreased from the discontinuation of treatment with erythropoietin. Between successive measurements, valid comparisons were made in five subjects. Correction of anaemia decreased whole body retention of iron through decreased mucosal uptake (P = 0.032). Further reduction in iron stores through repeated phlebotomy whilst the increase in haemoglobin was maintained by treatment with erythropoietin, tended to increase whole body retention of iron through an increase in mucosal transfer (P = 0.010). With initial enhancement of erythropoiesis in anaemic iron-loaded subjects there was no change in any measured component of iron absorption. However, after correction of anaemia and reduction of iron stores, a decrease in erythropoiesis was associated with decreased whole body iron retention in all subjects through decreased mucosal transfer (P = 0.028). The data suggest that anaemia upregulates mucosal iron uptake, and that erythroid activity upregulates mucosal transfer but that this latter effect may be counter-balanced by iron overload which downregulates mucosal transfer.

Adult↗
PubMed1992

Endoscopic placement of CAPD catheters: a review of one hundred procedures.

One hundred consecutive endoscopically placed peritoneal dialysis catheters inserted in 95 patients over an 18-month period have been reviewed. All catheters were placed for chronic dialysis (CAPD). Following insertion there were five early catheter failures (4 failed to drain, 1 perforated viscus) and 13 early complications (7 leaks, 3 tunnel bleeds, 2 scrotal oedema, 1 wound infection). In the long term six patients required transfer to haemodialysis (2 recurrent peritonitis, 2 pain on outflow, 1 unable to cope, 1 persistent vomiting). Overall probability of catheter survival as predicted by Kaplan-Meier analysis was 0.85 at 18 months. These results confirm that endoscopic placement of CAPD catheters is safe and reliable. In addition there is a low early failure rate and the long-term catheter survival figure is comparable with the best series reported. This procedure allows direct visualization of the peritoneal cavity, thus minimizing the risk of visceral damage. Furthermore, the procedure is well tolerated under local anaesthesia and allows early institution of dialysis because of the extremely low leakage rate (11%). Endoscopic placement of CAPD catheters is now the procedure of choice in our centre. General anaesthetic and mini-laparotomy are thus avoided in most of this high-risk group.

Adolescent↗
PubMed1978

Effects of azathioprine therapy on the MCV of patients with renal grafts: evidence for alterations in the kinetics of erythropoiesis over a prolonged period.

The changes in MCV at various times after renal transplantation were studied in a group of patients with functioning cadaveric renal grafts who had received azathioprine from the time of transplantation and in a constant dose from 2-8 weeks later. A post-transplantation increase in the MCV was seen in the majority of the cases studied and in these cases the MCV did not reach a maximum value until as long as 11-40 months after transplantation. In most cases the MCV then feel although frequently not to within the normal range and in some cases it showed further fluctuations. These data suggest gradual alterations over a period of years in the various cytokinetic changes which serve to maintain a reasonably high output of red cells from the marrow despite the cytotoxic effects of azathioprine.

Azathioprine↗
PubMed1975

Absorption of enteric and non-enteric coated prednisolone tablets.

1. Relative rates of absorption of enteric and non-enteric preparations of prednisolone were measured in five renal transplant recipients. 2. The absorption of the enteric coated preparation is delayed and the peak plasma concentration is much lower than that attained using the same dose of the uncoated material. 3. The therapeutic implications of these observations are discussed.

Adolescent↗
PubMed1975

Studies on glomerular permeability using inert polymers.

Dextrans and other macromolecular inert polymers such as polyvinyl pyrrolidone fulfil all the criteria of an ideal test material for measuring glomerular permeability. Following a single intravenous injection of radioactively labelled polydisperse material serial plasma and urine samples can be analysed by gel filtration chromatography and the polymer fractionated into its constituent molecular sizes. Polymer of molecular size 24 A is capable of passing through the glomerulus as readily as water while material larger than 60 A is affectively excluded from the glomerular filtrate and one can determine the clearance of 20--30 intermediate molecular sized fractions. The accumulated data can be analysed by a number of different theoretical mathematical models; furthermore the technique can be employed in the study of proteinuria induced by vasoactive amines such as renin or angiotensin.

Animals↗
PubMed1975

5-Fluorocytosine treatment of candidiasis on a patient receiving regular hemodialysis.

A patient developed a severe urinary infection with Candida albicans following a cadaveric renal transplant operation. It was necessary to remove the graft and return the patient to regular hemodialysis treatment. The fungi infection was successfully eradicated by a single oral dose of 5-Fluorocytosine (20 mg/kg) after each dialysis treatment. Pharmacokinetic studies revealed that the drug had a dialyzate clearance ratio of 0.66 when compared with creatinine; the drug was not metabolized and there was no other route of elimination.

Adult↗