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Biomedical subjects

D R Mars

Publications and source records attributed to D R Mars.

15 recordsLinked to original sources
PubMed1993

Laparoscopically assisted percutaneous renal biopsy.

We performed laparoscopically assisted percutaneous renal biopsy on 4 patients with azotemia or renal dysfunction who were believed to be unsuitable candidates for percutaneous renal biopsy. Tissue adequate for diagnosis was obtained in all 4 cases. Complications included subcutaneous emphysema in 1 patient and a small splenic capsular tear in 1, which was managed laparoscopically and did not require transfusion. Bleeding from the renal biopsy occurred in 1 patient and was easily managed laparoscopically. We recommend laparoscopically assisted percutaneous renal biopsy as an alternative method of renal biopsy in patients who can tolerate general anesthesia and who are not candidates for percutaneous renal biopsy.

Adult↗
PubMed1993

Laparoscopic cholecystectomy in a high-risk diabetic CAPD patient.

An obese 48-year-old diabetic woman with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) developed symptomatic cholelithiasis within 2 weeks of initiating CAPD. She was not a good risk for either open cholecystectomy or postoperative hemodialysis, and the relatively noninvasive surgical approach of laparoscopic cholecystectomy was considered to minimize postoperative morbidity and to allow the patient to resume her CAPD treatments after a short postoperative recess from dialysis altogether. The patient tolerated the procedure well with no complications. She resumed routine CAPD on her third postoperative day.

Cholecystectomy, Laparoscopic↗
PubMed1991

Haemodialysis studies with dichloroacetate.

Seven patients undergoing routine thrice weekly haemodialysis for endstage renal failure participated in 12 investigations of dichloroacetate (DCA) pharmacokinetics and pharmacodynamics. DCA doses were 50 mg/kg by i.v. infusion over 30 min. In each investigation single doses were administered to each subject on two consecutive days, one being a day during which the patient was dialyzed. The timing of drug administration, relative to dialysis, was varied to assess the effect of dialysis on the apparent volume of distribution and elimination rate constants of DCA and on its effect on blood glucose and lactate. Dialysis increased the clearance of DCA by approximately 60%, but had no effect on its apparent volume of distribution. Dialysis did not reduce the maximal lactate-lowering effect of DCA, but slightly decreased the duration of this effect. Blood glucose levels were not significantly altered by DCA and no adverse drug effects were observed. We conclude that dialysis increases plasma clearance of DCA, but has little influence on the metabolic effects of the drug when given at 50 mg/kg doses. DCA can safely and effectively be given to hemodialysis patients who may require the drug for treatment of lactic acidosis.

Adult↗
PubMed1991

Quality of life of patients on in-center hemodialysis versus continuous ambulatory peritoneal dialysis.

This study compared chronic hemodialysis and CAPD patients on several quality of life variables: dietary adherence, self-esteem, hope, wellbeing, marital happiness, perceived control over life, marital status, number of emotional support persons, and participation in social, recreational, and work activities. Statistically significant differences in the quality of life variables due to treatment modality or demographic variables were not found. However, CAPD patients did engage in significantly more social and recreational activity, though not more work activity, than did hemodialysis patients. It is noted that 73% of the CAPD patients were Caucasian and that 72% of the hemodialysis patients were of black origin. Similarly skewed racial compositions in preceding research comparing patients on CAPD and hemodialysis suggest that 1. choice of treatment is occurring on the basis of some set of patient characteristics, or 2. systematic assignment is occurring on the basis of race, sex, and/or education. However, given no significant race/demography differences for variables used in this research, it appears that quality of life across racially different groups of hemodialysis and CAPD patients is comparable.

Black or African American↗
PubMed1986

Iodine retention and thyroid dysfunction in patients on hemodialysis and continuous ambulatory peritoneal dialysis.

Povidone-iodine is frequently used as an antiseptic in patients on chronic dialysis. In order to determine if the use of povidone-iodine affects thyroid function in these patients, we measured serum iodine and thyroid hormone levels in dialysis patients prior to and following discontinuation of topical povidone-iodine antiseptics. Serum inorganic iodine levels were elevated initially in nearly 90% of the patients (19 on hemodialysis, 12 on continuous ambulatory peritoneal dialysis [CAPD]). Following discontinuation of povidone-iodine, iodine levels over a 3-month period decreased modestly in patients on CAPD (n = 5) and were unchanged in patients on hemodialysis (n = 5). Total and free thyroxine levels were frequently low but did not correlate with protein-bound or inorganic iodine levels and did not change after discontinuation of povidone-iodine. Thyrotropin levels correlated significantly (r = .62, P less than .01) with inorganic iodine levels in patients on hemodialysis, but not for patients on CAPD. We conclude that abnormal thyroid function tests are common in dialysis patients but are not related to iodine retention or to the routine use of topical povidone-iodine-containing antiseptics.

Adult↗
PubMed1983

Marked azotemia and increase in serum creatinine: case report of an unusual feature of acute ureteral obstruction in a renal allograft recipient.

A patient is described who presented with late ureteral necrosis following renal transplantation, a complication that usually is seen in the early perioperative period. The patient was anuric with azotemia and a high serum creatinine. Response to surgical correction of ureteral obstruction was excellent and renal function returned to normal within 6 days postoperatively.

Adult↗
PubMed1980

Severe hypernatremia complicating urinary tract obstruction.

Severe hypernatremia and hyperosmolar dehydration developed in a patient with partial urinary tract obstruction. The urine was initially hypotonic, and there was no response to exogenous vasopressin. These abnormalities resolved with relief of the urinary tract obstruction and replacement of the water deficit. This case documents lower urinary tract obstruction as a cause of nephrogenic diabetes insipidus and severe hypernatremia and illustrates its reversible nature.

Dehydration↗
PubMed1980

The role of various risk factors in living related donor renal transplant success.

Assessment of living related donor (LRD) survival statistics offers the opportunity to gauge the effects of recipient characteristics without the perturbations of viability, function, and antigen sharing that are inherent in cadaveric organ grafting. From January 1, 1969 to January 1, 1979, 167 LRD grafts were performed. Crude patient survival at one year is 92% and 84% at five years. Graft function at one year is 79%, and at five years it is 64%. One year patient survival has steadily improved: 1969-73: 83%, 1973-75: 91%, 1975-79: 98%. Graft survival improved during the first two periods and has since remained unchanged. HLA identical grafts showed the expected advantage compared with single haplotype grafts (93 vs 74%). Recipient age was without effect until 50 years, all younger subgroups having one-year patient survival of 92-95%, while those older than 50 had a one-year survival of 60%. Juvenile diabetes was associated with a one-year patient survival of 85% and graft survival of 74%. Glomerulonephritis did not affect early graft survival statistics, but there was a greater frequency of graft loss after 2.5 years, with function at five years of 51 versus 68% for recipients with all other diagnoses. Cadaveric graft statistics vary with recipient race when adjusted to exclude older patients and diabetics, white recipient one-year graft survival 74%, black 38%. No meaningful difference exists among LRD recipients as to graft function, but there is a trend toward improved black patient survival. This suggests that there is not an inherent difference in immune response to genetically similar grafts, but that the disparate results with racially mixed donor-recipient combinations rests with other factors.

Adolescent↗
PubMed1980

Reversible acute renal failure secondary to acute pyelonephritis.

We have described a case of reversible acute renal failure caused by acute pyelonephritis. In this entity, the kidneys are swollen by an interstitial infiltrate and edema, and white cell tubular casts and microabscesses may be present. Fractional excretion of sodium is high, and nephrotic proteinuria may occur without glomerular abnormalities. Recovery of renal function may occur if antibiotics are promptly instituted. Renal size generally decreases after recovery.

Acute Disease↗
PubMed1980

Thrombotic thrombocytopenic purpura after a dogbite.

A man bitten by a pet dog had fulminant thrombotic thrombocytopenic purpura within 72 hours. Rhabdomyolysis was severe and acute anuric renal failure was present. The suspected causative agent was Pastuerella multocida or clostridia with possible endotoxemia, though early treatment precluded a definitive diagnosis. The patient responded dramatically to a combined therapeutic approach of antibiotics, steroids, splenectomy, and supportive hemodialysis.

Animals↗
PubMed1980

Proliferative glomerulonephritis with crescent formation in behcet's syndrome.

Behcet's syndrome is a multisystem disease complex, the major manifestions of which are oral and genital ulcers, arthritis, uveitis, and skin eruptions. Less frequently, CNS disturbances, colitis, thrombophlebitis, large-vessel vaculitis, and myocarditis occur. If renal involvement does occur, it is usually manifested by asymptomatic microhematuria and/or proteinuria. Recently, renal amyloidosis and focal necrotizing glomerulonephritis with immune complex deposition have been described. We describe a patient with Behcet's syndrome who experienced diffuse proliferative glomerulonephritis with epithelial cell crescent formation in 75% of glomeruli examined. Immune complexes were not identified. Renal function, impaired on admission, improved with no therapy.

Behcet Syndrome↗
PubMed1979

Thyroid antigen associated immune complex glomerulonephritis in Graves' disease.

A 60 year old hyperthyroid black woman with long-standing Graves' disease treated with methimazole presented with anasarca and congestive heart failure. She was found to have the nephrotic syndrome with a urinary protein excretion of 32 g/day. Light and electron microscopy revealed a stage II membranous glomerulopathy. Direct and indirect immunofluorescence demonstrated immunoglobulin G (IgG), immunoglobulin M (IgM), third component of complement and thyroglobulin in a granular diffuse pattern consistent with an immune complex glomerulonephritis. Total thyroidectomy led to a decrease in proteinuria with little change in glomerular filtration rate during an 11 month follow-up period. We believe this to be the first report of immune complex glomerulonephritis associated with thyroid antigen in Graves' disease.

Antigen-Antibody Complex↗