Dialytic therapy for irreversible uremia (second of two parts).
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Biomedical subjects
Publications and source records attributed to E A Friedman.
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A matched control study was undertaken in which 156 children were examined between ages 23 and 62 months after births associated with spontaneous labor, oxytocin-induced labor, or prostaglandin E2 (PGE2)--induced labor. Physical development was not adversely affected by labor induction based on height and weight percentiles. The frequency of neurologic or developmental abnormalities not attributable to postdelivery events was the same overall in induced and spontaneous labors (19.2 per 1,000), but those abnormalities occurring after labor induction all followed use of oxytocin. None followed PGE2 despite case-selection criteria which specifically chose PGE2 cases from among those with documented adverse drug-related reactions.
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Tuberculosis was diagnosed in eight patients undergoing maintenance hemodialysis and occurred with an incidence 10 times that of the general population. Dialysis-associated tuberculosis is characterized by intermittent fever, anorexia, weight loss and hepatomegaly. Ascites was present in 50 per cent of the patients. A recently converted positive tuberculin skin test was observed in five of eight patients. Tuberculosis was extrapulmonary in seven of eight cases and consequently the diagnosis was frequently delayed. Over-all mortality was 37.5 per cent and correlated with the duration of symptoms prior to initiation of therapy. A trial of antituberculous therapy is warranted in patients undergoing dialysis in whom fever of unknown origin, anorexia, weight loss and/or hepatomegaly develop particularly in areas endemic for tuberculosis.
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BTG levels are significantly elevated in patients on chronic hemodialysis. The increased levels are not due to turbulent flow within the vascular access, but may be due to platelet aggregation within the hemodialyzer during the first hour of dialysis. This effect is observed with the Travenol CF series hollow fiber (cuprophane) but not the Cordis-dow artificial kidney (regenerated cellulose).
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We analyzed data from 15,846 live-born infants to assess the effect of electronic fetal monitoring on neonatal death rates. The crude neonatal death rate was 1.7 times higher in unmonitored infants than in those monitored. Adjusting for inherent risk and changes in mortality rates and monitoring rates during the years of the study lowered the relative risk to 1.4 (95 per cent confidence interval, 0.85 to 2.45). The estimated yield from monitoring decreased as the inherent risk of the baby declined. Thus, in the highest-risk group 109 lives might be saved for every thousand babies monitored. In the lowest risk group (babies at term with no risk factors) the neonatal death rate is around one per thousand. The absolute benefit for this large group could therefore not exceed one life saved for every thousand babies monitored.