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Biomedical subjects

B S Spinowitz

Publications and source records attributed to B S Spinowitz.

16 recordsLinked to original sources
PubMed1991

Impact of epoetin beta on dialyzer clearance and heparin requirements.

The present studies were undertaken to determine whether treatment with recombinant human erythropoietin (epoetin beta [Marogen Sterile Powder, Chugai-Upjohn, Rosemont, IL] ) necessitates an alteration in dialysis prescription or in heparin requirements. All patients had end-stage renal disease (ESRD), were on chronic hemodialysis (either high-flux or conventional) for more than 3 months, and had participated in large-scale, multicenter epoetin beta clinical trials. Nine patients were entered into the clearance study. Blood chemistry values, dialyzer clearances, and hematocrit values were determined before beginning epoetin beta administration and after approximately 40 weeks of treatment. The mean hematocrit value at the beginning of the study was 0.229 (22.9%); by week 40, it averaged 0.313 (31.3%). The mean percent change in urea clearance was -1.9%, and a mean percent change of +12.7% in blood urea nitrogen (BUN) was noted. The mean percent change in creatinine clearance was -15.3, while the mean percent change in serum creatinine was +0.2%. The mean percent change in phosphate clearance was -10.1%, and the mean percent change in serum phosphate was +44.1%. Heparin profiling was performed for nine patients (four participated in the clearance study). Seven patients showed increased requirements for heparin, with a mean percent change of +24.3%. These results underscore the necessity for careful attention to the changing status of the dialysis patient on epoetin beta. While epoetin beta treatment does not, in general, adversely affect either clearance or blood chemistry values, these values may fluctuate in individual patients in response to the increasing hematocrit values and to dietary changes that result from an increased sense of well-being.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia↗
PubMed1990

EPO--one year later: a look at rehabilitation. The impact of long-term epoetin beta therapy on ESRD patient quality of life.

Long-term observational studies such as the one reported here represent the best chance for measuring the effects of epoetin treatment on quality of life as compared with conventional treatment. When scores were adjusted for between-group differences, patients receiving epoetin beta for an average of 18 months demonstrated significantly better quality of life in 16 of the 26 parameters reported. These measures included all global measurements, psychological well-being as measured by IGA, sleep, rest, energy, SIP psychosocial subscale, and total SIP score. While differences were not significant, remaining measurements were higher in the epoetin beta group. On the basis of this study, epoetin beta treatment has a beneficial effect on energy, the ability to work, and participation in activities such as home management, recreation, and pastimes. While the mean score for ability to work was significantly higher in the epoetin beta-treated patients, the work category of the SIP was not significantly different from the untreated population. The fact that the latter scale was completed by only the small proportion of the patients who were actually working may have contributed to this insignificant finding. The current study demonstrates sustained benefit form epoetin beta compared with conventional therapy, even after 18 months. These long-term results validate previously published results of benefits seen during shorter-term epoetin therapy.

Drug Evaluation↗
PubMed1990

Transfusion therapy: associated risks and alternative approaches.

Transfusion therapy has been the mainstay for treating the anemia of end-stage renal disease (ESRD). Recently, several factors, including the awareness of associated risks, especially the transmission of blood-borne diseases and the transient treatment effect with regard to reversal of anemic symptoms, have caused a reassessment of transfusion therapy. Recombinant human erythropoietin (epoetin) has emerged as the alternative treatment, capable of sustained reversal of anemia without the associated risks of transfusions. The result of epoetin therapy has been marked improvement in the quality of life of ESRD patients. However, the advent of this therapy has also changed the nurse's role in caring for ESRD patients, as new medical management issues are identified and supportive care is tailored to the individual patient.

Anemia↗
PubMed1987

Subclavian vein stenosis as a complication of subclavian catheterization for hemodialysis.

Thirteen patients had placement of a subclavian vein catheter for temporary vascular access for hemodialysis. Peripheral venography was performed within two to six weeks of catheter placement. Forty-six percent (six of 13 patients) developed subclavian vein narrowing, which resolved in two patients. The duration of catheter placement had no impact on the incidence of this complication. Subclavian vein catheterization can frequently lead to subclavian vein stenosis, which often will resolve spontaneously. Consideration should be given to placement of subclavian lines on the contralateral side of a planned permanent vascular access.

Catheterization↗
PubMed1986

Comparison of eosinophilia in patients undergoing peritoneal dialysis and hemodialysis.

Eosinophilia (E) has been noted in hemodialysis (HD) patients, but its etiology is not clear. In an effort to clarify this phenomenon, we prospectively studied patients initiating dialysis in our outpatient HD and peritoneal dialysis programs. Rate of E was greatest for a small group of four continuous cycling peritoneal dialysis patients (75%), less for 63 HD patients (41%), and least for 66 continuous ambulatory peritoneal dialysis (CAPD) patients (21%, P less than .05, HD v CAPD). Increasing E rates among the groups paralleled increased frequency of tubing changes. There were no differences in etiology of renal disease, medications, types of dialyzers, types of access, or transfusion frequency that could account for the E. IgE levels did not correlate with E. The data suggest that the dialysis procedure or the tubing changes may be causing the E, but the possibility that uremia, itself, is important in the pathogenesis of dialysis E is also discussed.

Adult↗
PubMed1986

A comparative study of continuous ambulatory peritoneal dialysis and center hemodialysis. Efficacy, complications, and outcome in the treatment of end-stage renal disease.

We retrospectively compared 92 patients treated with center hemodialysis (CHD) and 72 patients receiving continuous ambulatory peritoneal dialysis (CAPD) over a 26-month period. The groups were comparable with respect to underlying disease and demographic characteristics. Biochemical control was also similar, with higher bicarbonate levels and hematocrits in patients receiving CAPD, despite fewer transfusions and minimal administration of anabolic steroid and iron therapy. Hospitalization rates were also similar (1.58 +/- 2.89 vs 1.43 +/- 3.35 days per patient month for patients receiving center hemodialysis vs CAPD, respectively). Access complications were the most frequent cause of hospitalization in both groups, but cardiovascular causes were more frequent among patients receiving CHD. Diabetic patients had significantly higher hospitalization rates, which were similar in both groups. Twenty-nine percent of the peritonitis episodes necessitated hospitalization. Mortality and dropout rates were virtually identical in the two groups, with a 70% retention rate during the 26-month study. Continuous ambulatory peritoneal dialysis is comparable with CHD with regard to biochemical results, complications, hospitalization rates, and outcome. It is widely applicable, as 44% of our new patients with end-stage renal disease are being sent home receiving this treatment.

Adolescent↗
PubMed1983

Percutaneous transluminal dilatation for vascular access.

The application of percutaneous transluminal angioplasty to vascular access stenosis is described. These access problems were discovered by the technique of retrograde venous fistulography. 13 dilatations were attempted in 12 patients. Functional success was achieved in seven attempts. This resulted in a significant prolongation of access survival in these patients. Angioplasty is recommended as a nonsurgical approach to vascular access stenosis.

Angioplasty, Balloon↗
PubMed1983

Nondilated obstructive nephropathy.

Three patients had renal failure due to obstructive nephropathy associated with processes that prevented dilatation of the collecting systems. Thus, various radiologic procedures, including renal sonography, angiography, and isotope renography, all failed to identify an obstructing process. Because of the high index of clinical suspicion, surgical exploration and nephrostomy were performed on each patient. This confirmed the presence of obstructive nephropathy and led to marked improvement of renal function in each case. When renal failure develops in a setting with a high probability of ureteral obstruction, this diagnosis should be vigorously pursued despite normal radiologic results.

Acute Kidney Injury↗
PubMed1982

Continuous ambulatory peritoneal dialysis: establishment and growth of a program in a large metropolitan area.

We describe our experience at the Booth Memorial Medical Center with the development and growth of a Continuous Ambulatory Peritoneal Dialysis program. This initial experience includes the training and close follow-up of 41 patients with End Stage Renal Disease over a period of 15 months. The status of our program with respect to medical complications encountered and their management is described. Our results, in terms of biochemical control, success with training, and patient satisfaction with CAPD are outlined.

Adolescent↗
PubMed1982

Eosinophilic peritonitis.

The development of cloudy peritoneal dialysis effluent is of great concern to the patient undergoing therapy with Continuous Ambulatory Peritoneal Dialysis. As described in this study, not all cloudy fluid represents bacterial infection. We describe the occurrence of cloudy fluid in eight patients in whom culture of the dialysate did not yield any growth, and whose cell count was characterized by the presence of significant numbers of the eosinophiles. As outlined, the entity of eosinophilic peritonitis has a characteristic presentation which allows for its distinction from the more common bacterial peritonitis.

Eosinophilia↗
PubMed1982

Technique for implantation of the Toronto-Western catheter at the Booth Memorial Medical Center.

The proper placement of the chronic peritoneal dialysis catheter is pivital to the early, as well as continued success of dialysis therapy with Continued Ambulatory Peritoneal Dialysis. We describe our current technique for the implantation of the Toronto-Western catheter. The success of any particular technique is dependent upon the incidence of complications. The latter is described elsewhere in this symposium.

Anesthesia, Local↗
PubMed1979

Action of adenosine on chloride active transport of isolated frog cornea.

Addition of adenosine (10-7 to 10-4 M) to the tear side of isolated corneas (Rana catesbeiana) produced a rapid, sustained increase in short-circuit current, potential difference, and radioisotopic chloride net flux. The increased net chloride flux accounted for the increased short-circuit current. Adenosine, a known activator of adenyl cyclase in other tissues, exerted its effects on chloride transport through a receptor different from the one described for epinephrine and prostaglandins in the corneal epithelium. Propranolol inhibited the epinephrine response but not the adenosine effect. Dipolyphloretin phosphate inhibited prostaglandin responses but did not affect the adenosine stimulation of chloride transport. Adenine and/or ribose, parts of the adenosine molecule, had no stimulatory effect, but 5'-AMP had a partial effect. The activation of the chloride pump with DBcAMP blocked the response to adenosine. Adenosine interacted with the effects of theophylline. Adenosine, a naturally occurring molecule, stimulated chloride transport by activation of adenyl cyclase through a separate membrane receptor in the corneal eqithelium.

Adenine↗
PubMedDate not supplied

Effect of long-term epoetin beta therapy on the quality of life of hemodialysis patients.

Differences in quality of life were observed using two separate patient populations with end-stage renal disease who were on maintenance hemodialysis. The first population (91 patients) received epoetin beta (Marogen Sterile Powder, Chugai-Upjohn, Inc., Chicago, Ill.) for an average of 18 months. The second population (96 patients) did not receive this therapy. The measured quality of life parameters included a number of global and psychological well-being measurements and the Sickness Impact Profile (SIP), as well as energy, activity levels, appetite, work, and sexual function. When adjusted for covariates (health status and demographics), 16 of 26 parameters were significantly higher (p less than .05) in patients receiving epoetin beta. All mean scores for global measurements were significantly higher. Significantly higher scores were also obtained for total SIP and total psychosocial subscale, as well as for sleep, home management, recreation, emotional behavior, social interaction, ability to work, and energy. While not statistically significant, all of the remaining measurements were higher for epoetin beta than for untreated patients.

Adult↗