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Biomedical subjects

C W Trygstad

Publications and source records attributed to C W Trygstad.

At least 19 recordsLinked to original sources
PubMed1983

Cross-cultural family medicine residency training.

Over the past four years the University of California, San Diego (UCSD), Family Medicine Residency Program has developed a cross-cultural training program. The goal of the program is to prepare residents to function as effective health care providers in medically underserved areas with ethnically diverse patient populations. The required training activities include (1) a Spanish language course, (2) a clinical rotation in a community health clinic serving a Hispanic, medically underserved population, (3) a preceptorship in home-based health education and counseling for Spanish-speaking families, and (4) a set of cross-cultural sensitivity training activities that are part of the Residency Behavioral Science Program. The UCSD Cross-Cultural Family Medicine Training Program is described here as a prototype for consideration by other family medicine residency programs.

Asian↗
PubMed1980

Serum concentrations of immunoglobulins E and G and alpha 2-macroglobulin in childhood renal disease.

Serum concentrations of IgE, IgG, and alpha 2-macroglobulin (alpha 2-M) were determined in 67 children with renal disease and in appropriate controls. IgE concentrations were significantly elevated in patients with renal disease and proteinuria, including those with minimal change nephrotic syndrome (MCNS). IgG concentrations were lower and alpha 2-M concentrations higher in patients with proteinuria than in patients without proteinuria. In 16 patients with nephrotic syndrome who had a decrease in proteinuria with therapy, there was a concomitant decrease in mean serum IgE level. All nine with MCNS had a decrease in serum IgE following therapy whereas eight of the nine had a concomitant increase in serum IgG. The findings suggest the possibility that IgE may play an etiologic role in the proteinuria of childhood nephrotic syndrome, and that both elevated serum IgE and proteinuria may represent unusual responses to antigens that are seldom identified. Elevations of IgE secondary to lowered IgG or to entirely nonspecific alterations in IgE metabolism in proteinuric renal disease are other possibilities. Further studies to elucidate the role of IgE in renal disease, including the nature of the altered metabolism of this immunoglobulin, are warranted.

Adolescent↗
PubMed1978

Autosomal dominant Fanconi syndrome with early renal failure.

The "idiopathic" Fanconi syndrome occurs mostly sporadically, occasionally as an autosomal recessive trait. However, few instances of autosomal dominant inheritance have been reported. We described a father and son with the Fanconi syndrome, ie, with renal glycosuria, generalized aminoaciduria, phosphaturia, metabolic acidosis, and bone disease. No other causes of the Fanconi syndrome were found. Both father and son developed end stage renal disease. Aminoaciduria in excess of that seen in renal insufficiency is shown by comparison with published data for amino acid excretion in uremia. Renal transplantation in the father has improved kidney function with no evidence of Fanconi syndrome. This family is unique in that there are no other reports of autosomal dominant Fanconi syndrome with progression to early renal failure.

Adolescent↗
PubMed1977

Unilateral renal hypoplasia with associated venous anomaly and hypertension. A study of the juxtaglomerular cells.

A child with unilateral renal hypoplasia, high plasma renin levels and hypertension was found to have large numbers of juxtaglomerular granular cells in the affected kidney. They were seen adjacent to and sometimes in the interior of hyalinized glomeruli or, in loose nests scattered in the interstitium. Ultrastructurally they contained large numbers of crystalline protogranules in the Golgi region and also displayed other features suggestive of hyperactivity. Atrophic tubules, smooth muscle and mast cells were present in considerable numbers. Well-preserved renal cortex remained in the affected kidney with no demonstrable juxtaglomerular granularity. After unilateral nephrectomy the patient became normotensive and plasma renin levels became normal. Thus it appears that the juxtaglomerular cells are able to produce and release renin independent of the structural integrity of the juxtaglomerular apparatus and renal glomerulus.

Child↗
PubMed1977

Glomerular filtration rate during the period of adaptation to extrauterine life.

Inulin clearance (Cin) was measured in 20 infants of 27--43 weeks of gestation during the first 24 hr of their extrauterine life. Cin ranged from 0.7--4.7 ml/min and correlated with gestational age (P less than 0.05). In 18 infants of similar gestational ages studied after 2--3 days of extrauterine adaptation, the Cin ranged from 1.1--17.9 ml/min and also correlated with gestational age (P less than 0.01). By day 2--3, the infants of near term gestational age achieved a greater increase in Cin than did the markedly preterm infants, as reflected by a significantly different slope of the regression line for Cin and gestational age for the infants studied at 1 vs. 2--3 days of age (P less than 0.001).

Gestational Age↗
PubMed1976

The effects of large volume intravenous fluid infusion on neonatal renal function.

Twenty healthy infants weighing less than 2,000 gm were studied at low (3.6 ml/kg/hr) or high (10.3 ml/kg/hr) rates of intravenous infusion. Inulin clearance determined by the constant infusion method was greater at the high rate of infusion (p = less than 0.05). Inulin clearance in two groups of infants over 2,000 gm studies at the same low or high rates of infusion did not increase at the higher rate of infusion. Since the GFR in infants less than 2,000 gm depends partially on the rate of intravenous infusion, small, healthy preterm infants may benefit from a rate of fluid administration greater than the low rate. When studies at low and high rates of infusion were compared in the 20 infants less than 2,000 gm, the fractional urinary sodium excretion increased with the increased fluid load. Delivery of fluid from the proximal tubule (CH2O =Na per dl GFR) increased (p less than 0.005). Free-water clearance and the absolute volume of urine increased at the high rate of infusion. These data indicate that the healthy preterm infant less than 2,000 gm, like the adult, compensates by increasing free-water clearance and urine volume when challenged with a large fluid load. Although fluid changes of short duration are appropriately handled, the effect of continuous rapid infusion on water and sodium balance in infants of this size remains to be determined.

Body Fluids↗
PubMed1976

Inulin clearance in the newborn infant: relationship to gestational and postnatal age.

Thirty-eight healthy newborn infants with gestational ages ranging from 25 to 42 weeks were studied at 2 days to 9 weeks postnatal age to evaluate the rate of glomerular maturation after birth. Glomerular function was assessed by a constant infusion method for inulin clearance (Cin). Cin was nearly identical when measured by the traditional clearance method and by the constant infusion technique. The Cin of 22 infants 2-3 days old ranged from 0.6 to 17.9 ml/min and was directly related to gestational age (r = 0.81, P less than 0.001). For 26 infants studied at 1-9 weeks of age, Cin was directly proportional to conceptual (gestational and postnatal) age (r = 0.89, P less than 0.001), and approximated that of infants of similar gestational age studied at 2-3 days of age.

Aging↗
PubMed1975

Extracapillary proliferative glomerulonephritis in children.

The clinical course and renal pathology of 17 children with acute extracapillary proliferative glomerulonephritis is reported. Patients with systemic diseases associated with renal involvement were excluded. The onset followed streptococcal infection in ten; of these, four have died, one has been transplanted, and the remaining five have completely healed. The mean follow-up of the latter five patients was 32 months (range, 18 to 57 months). Of the other seven patients without evidence of precedeing streptococcal infection, two have died, two have been transplanted, and the remaining three all have hypertension, proteinuria, and reduced creatinine clearance. The mean follow-up of the latter three patients was 29 months (range, 14 to 38 months). The initial renal histopathologic changes and their progress in later renal biopsies is described. The role of various therapeutic agents is discussed. The prognosis in acute extracapillary proliferative glomerulonephritis following streptococcal infection appears to be better than in ones without preceding streptococcal infection.

Acute Disease↗
PubMed1974

Inheritance of idiopathic nephrotic syndrome.

The inheritance of idiopathic nephrotic syndrome of childhood was studied in 51 families. The estimate of recurrence risk for sibs of affected patients was .06 as compared to the incidence in the state of Indiana of 6.9 X 10(-5). A polygenic inheritance was most consistent with the data although several genetic models were considered. There were no significant histologic or clinical differences between patients with affected sibs and simplex patients.

Adolescent↗