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Biomedical subjects

E Ring

Publications and source records attributed to E Ring.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Continuous arteriovenous hemofiltration in childhood. Indications and technics].

CAVH is an extracorporal treatment modality by which fluid and solutes can be removed from the body by convective transport. Without using a blood pump the blood passes through the hemofilter driven only by the arteriovenous pressure gradient. From May 1985 to October 1986 18 critically ill children with a mean age of 5.1 years (range 10 days to 18 years) and a mean body weight of 20.8 kg (range 3 to 80 kg) were treated by CAVH. Indications for CAVH were: acute renal failure, multiple organ system failure, diuretic-resistant hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. Five different hemofilter systems with a membrane surface of 0.015 m2 to 0.6 m2 and an extracorporal filling volume of 9 to 70 ml were used. Mean duration of CAVH was 132 h (range 10 to 432 h), for a total time of 2344 h. Mean ultrafiltration rates ranged from 0.34 +/- 0.1 (SD) ml/min (Amicon Minifilter 0.015 m2) to 9.1 +/- 1.47 (SD) ml/min (Gambro FH55 0.6 m2). The application of a continuous negative pressure of 200 mmHg onto the ultrafiltrate line the ultrafiltrate increased from 3.96 +/- 0.62 (SD) ml/min to 13.4 +/- 1.63 (SD) ml/min. CAVH allowed good compensation of azotemia in critically ill children with acute renal failure, rapid correction of severe hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. It was well tolerated by all children. The only complication due to hemofiltration was a femoral artery thrombosis which needed surgical revision.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1987

Arteriovenous hemofiltration in children with multiple organ system failure.

In the last year nine critically ill children with multiple organ system failure (MOSF) were treated by continuous arteriovenous hemofiltration (CAVH). The mean number of organ systems involved was five per patient (range 4 to 7). Mean duration of hemofiltration was 136 hours (range 10 to 432 h.). Mean ultrafiltration rates of 6.4 +/- 3.0 ml/m2 b.s./min achieved mean serum creatinine levels of 2.39 +/- 1.49 mg/dl. Hypervolemia and pulmonary edema were corrected rapidly by CAVH. Total parenteral nutrition with a mean caloric intake of 62 +/- 15 kcal/kg b.w./day was provided throughout the hemofiltration period. In addition high ultrafiltration rates allowed delivery of large amounts of i.v. medications. CAVH is an ideal extracorporeal renal replacement system to control azotemia, fluid, electrolyte, and acid-base status in critically ill children. It carries the potential to improve survival rate in children with MOSF.

Adolescent↗
PubMed1987

Continuous arteriovenous renal replacement therapy.

As urea and creatinine clearances achieved by continuous arteriovenous hemofiltration tend to be low, efforts were made to increase urea and creatinine elimination by modifying the original continuous arteriovenous hemofiltration system. We investigated the urea and creatinine clearances of different continuous renal replacement therapy systems. Urea clearance achieved by spontaneous arteriovenous hemofiltration was 9.1 ml/min, suction-supported arteriovenous hemofiltration 15.3 ml/min, arteriovenous hemodiafiltration 15.4 to 19.3 ml/min, arteriovenous hemodialysis 18.9 to 22.1 ml/min. Creatinine clearances ranged between 11.1 (spontaneous arteriovenous hemofiltration) and 25.1 ml/min (arteriovenous hemodialysis). Continuous arteriovenous hemodialysis seems at present to be the ideal renal replacement therapy system to compensate azotemia in hypercatabolic patients. Its urea and creatinine clearances are high, its clinical tolerance good and it is simple and safe.

Child↗
PubMed1987

[Use of the calcium-creatinine ratio in diagnosis and therapy].

Hypercalciuria is a major cause of urolithiasis in adults and has reached increasing attendance in childhood. Traditionally urinary excretion of calcium is evaluated by 24-hour urine collection. Previous reports proposed the urinary calcium/urinary creatinine ratio (Ca/Cr-ratio) to diagnose hypercalciuric states. In 10 children with normocalciuria and 8 children with hypercalciuria the values of calcium excretion and Ca/Cr-ratio in a 24-hour urine collection were compared. 40 analyses showed a significant correlation (p = 0.001, r = 0.91) and hypercalciuria (urinary calcium greater than 4 mg/kg/day) is present if the Ca/Cr-ratio exceeds 0.23 (mg/mg). In 10 of the 18 patients the Ca/Cr-ratio of the 24-hour collection was compared with the Ca/Cr-ratio of a random urine sample collected 3 hours after breakfast. No significant difference was present. In 9 of 10 patients the correct diagnosis (normocalciuria or hypercalciuria) was possible by evaluation of this random urine sample. Our studies indicate that the evaluation of Ca/Cr-ratio in a random urine sample is a simple and reliable method to detect hypercalciuria and should be performed in all children with urolithiasis or unexplained hematuria. It is also a simple test for early detection of hypercalciuria in patients with long-term administration of vitamin D metabolites.

Adolescent↗
PubMed1986

Arteriovenous haemofiltration in hypervolaemia.

Arteriovenous haemofiltration was used for removal of fluid overload in a 9 month old burned infant with diuretic resistant hypervolaemia. After 60 hours of arteriovenous haemofiltration hypervolaemia had disappeared. Arteriovenous haemofiltration proved to be a safe and simple extracorporal method of managing severe fluid overload.

Blood↗
PubMed1985

[Diagnosis and therapy of fetal kidney and urinary tract malformations].

Of 23 patients with abnormal prenatal sonographic findings 17 also showed malformations of the kidneys and urinary tract in the postpartal period. Although even minor abnormalities could be detected by antenatal ultrasound, the identification of the abnormal findings was not possible in every case. Diagnostic problems arose in 8 foetuses showing mild dilatation of the collecting system, since it was not possible to distinguish between functional dilatation and dilatation from vesicoureteral reflux or minimal ureteral obstruction. Difficulties in identification of large malformations also occurred in 3 other patients, if the first sonographic examination was performed in a late stage of pregnancy, so that no follow-up of the sonographic picture was possible. In one of these children a huge right-sided multicystic kidney resulted in compression of the contralateral ureter with hydronephrosis, damaging the other kidney. Early delivery should, therefore, be considered in all children showing large cystic abdominal masses and no identifiable normal kidney, so that adequate obstetric treatment of these patients can be initiated in time.

Female↗
PubMed1983

[Sonographic diagnosis of nephrourologic diseases in infants and childhood].

Ultrasound is a harmless and renal function-independent screening procedure to detect malformations of the urinary tract, that need surgical intervention. Because of the paucity of symptoms concomitant with congenital malformations it is important to use this non-invasive exploration method frequently in the early course of the diagnostic investigations. Pathologic sonographic findings should be followed by radiologic exploration. In case of normal renal sonography in patients suffering from first urinary tract infection, further radiologic exploration of the upper urinary tract can be withheld, however ultrasound does not replace radiologic studies of the lower urinary tract. Complications after surgical procedures are readily depicted by sonography, thus avoiding the need for numerous post-operative radiologic study.

Child↗
PubMed1981

Value of routine vascular laboratory studies to identify vein graft stenosis.

Thirty-three stenotic lesions were found in 30 vein grafts (17 femoral-popliteal, 13 femoral-tibial) 3 months to 8 years postoperatively--77% appeared within 1 year of surgery. Seventeen (57%) of the patients presented with normal distal pulses, and a similar number were asymptomatic. Only eight (26%) presented with unequivocal clinical evidence of graft stenosis based on decreased pulses and return of ischemic symptoms. Forty percent were completely asymptomatic with normal distal pulses. The mean postoperative ankle systolic pressure index (ASPI) was 0.83 +%- 0.03 (SEM); it fell to 0.57 +/- 0.04 (SEM) when stenosis developed. The peripheral vascular laboratory measurements were the key factor influencing the decision for repeat arteriography in many of these patients and reinforced the need for a repeat arteriogram when the clinical diagnosis was unclear. Early diagnosis of vein graft lesions prior to graft occlusions allowed 24 of 30 of these stenotic grafts to be treated primarily by percutaneous transluminal angioplasty (PTA); 80% remained patent 24 months after PTA. Since most vein graft stenoses can be treated by such a simple, nonoperative technique (PTA), every effort should be made to diagnose and treat lesions prior to graft occlusion. Our experience indicates that frequent vascular laboratory measurements of ASPI are more sensitive then clinical examinations in detecting early vein graft stenosis.

Angioplasty, Balloon↗
PubMed1979

The management of some special problems with renal neoplasm.

Simultaneous bilateral renal cell carcinoma has been treated in 5 patients at our hospital during the last 6 years. Improvements in radiologic diagnostic techniques are responsible for the increased detection of these lesions. Results of surgical management are reported. Angiographic embolization of renal cell carcinoma has proved to be a useful method to manage patients with solitary kidneys or those with severe medical problems contraindicating an operation, and our results with this approach are described.

Adenocarcinoma↗
PubMedDate not supplied

[Which therapy is necessary for prenatally diagnosed multicystic kidney dysplasia?].

Multicystic dysplastic kidneys (MCD) were found in 17 of 114 neonates with prenatal diagnosis of urinary tract malformations. Distribution of side and of sex was not different. Contralateral malformations were present in 3 infants. One of them with contralateral renal dysplasia and cardiac malformation died at the age of 4 weeks. All other children so far have a normal renal function. Three neonates presented with a palpable abdominal mass, 2 infants had urinary infections during the first year of life. Two neonates had obstruction of the contralateral kidney caused by the giant MCD which relieved after nephrectomy. Hypertension or development of malignancy were not noted. Nephrectomy was performed in 10 infants at the mean age of 3.2 months. Six infants had conservative treatment and a complete regression was noted in 5 of them within a period of 8 to 18 months. Prenatal diagnosis of MCD enables early recognition of contralateral urinary malformations and of problems caused by the MCD itself. Conservative treatment is recommended in all asymptomatic patients. Studies of the natural history may show that regression of MCD is the rule and could account for many cases with apparent unilateral renal agenesis.

Female↗
PubMedDate not supplied

[Prenatal diagnosis of primary megaureter].

22 of 114 infants with prenatal diagnosis of urinary tract malformations (15 boys) had obstruction of the ureterovesical junction caused by primary megaureter (n = 14), ureterocele (n = 7), or ectopic ureter (n = 1). Infants with infravesical obstruction or refluxing systems were excluded. All infants had a normal renal function and probably only 5 of them (23%) would have been diagnosed during infancy without prenatal diagnosis. A total number of 26 renal units was evaluated. Six infants had ipsilateral duplication with additional contralateral duplication (n = 2) or vesicoureteric reflux (n = 2). A nonfunctioning kidney or upper pole of duplication was noted in 7 units (5 with ureteroceles); in two instances a moderately dysplastic kidney was present. One boy with urinary infections developed renal scarring during follow-up. Conservative treatment was performed in 14 renal units while 12 units of 11 children had 22 operations (9 temporary diversions) at a mean age of 4,6 months. A severe operative complication was noted in one infant. Conservative treatment is justified in many infants with primary obstructive megaureters but severe renal dysplasia may be present even neonatally. Yet we feel that prenatal diagnosis benefitted most infants, especially those with the most severe malformations.

Female↗
PubMedDate not supplied

[Ultrasonography in urinary tract infection in infancy].

In a prospective study 77 infants (35 boys) with a mean age of 5.23 months were studied to determine the value of sonography for detection of renal parenchymal involvement in urinary tract infection (UTI). Sonography was performed during UTI and about one month later. UTI was classified as upper and lower UTI according to the clinical and laboratory findings; radiological investigations (voiding cystoureterography = MCU) were performed in all infants. 40 infants were classified to have upper UTI. There was a high sensitivity (80%) and specificity (97%) for detection of renal involvement by sonography. Incidence for vesicoureteral reflux (VUR) was significantly higher in infants with repeated pathological findings on sonography. In contrast, no VUR was detected on MCU in all 12 infants with normal findings in both sonographic examinations. Yet, sonography without catheterization could not detect VUR in all infants with radiologically confirmed reflux. Our results show, that sonography is of definite value in infants with UTI, but cannot replace radiological work up.

Female↗
PubMedDate not supplied

[Use of continuous arteriovenous hemofiltration in diuretic-resistant hypervolemia and electrolyte disorders].

CAVH was carried out in 10 olig/anuric children with diuretic resistant hypervolemia. In addition, three children had hypercalcemia and one child hypernatremia. All but one needed artificial ventilation for pulmonary edema and positive inotropic cardiac support. Mean duration of CAVH for correction of fluid- and electrolyte imbalance was 51.5 hours (range 20-144 hours). The mean fluid removal of 1715 +/- 1479 (SD) ml decreased mean body weight from 21.4 +/- 18.9 (SD) kg to 19.2 +/- 17.0 (SD) kg. The electrolyte disorders were corrected within 18-24 hours. After correction of fluid overload and electrolyte imbalance 7 children could be extubated and cardiac support could be stopped. Two children died because of multiple organ system failure. CAVH was well tolerated by all children, no hemofiltration related complications occurred. CAVH is an effective and safe extracorporal renal replacement therapy system to correct fluid- and electrolyte imbalances in critically ill children. It can be installed easily and quickly, can be performed in every pediatric intensive care unit and is well tolerated even by small children.

Anuria↗
PubMedDate not supplied

Amyloid goiter in a child with familial Mediterranean fever.

A 7 year-old Turkish boy presented with a euthyroid goiter, which was noted during evaluation of familial Mediterranean fever. Amyloid deposits in the thyroid were found on fine-needle aspiration biopsy. Slight involution of the goiter within seven months may be attributed either to colchicine therapy or to treatment with levothyroxine and iodide.

Child↗