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Biomedical subjects

E Tiula

Publications and source records attributed to E Tiula.

At least 19 recordsLinked to original sources
PubMed2001

Elimination of the piperacillin/tazobactam combination during continuous venovenous haemofiltration and haemodiafiltration in patients with acute renal failure.

The elimination of the piperacillin/tazobactam combination was studied in six patients with acute renal failure undergoing either continuous venovenous haemofiltration (CVVH) or continuous venovenous haemodiafiltration (CVVHDF) at 1 L/h and 2 L/h for 12 h. Piperacillin 4 g/tazobactam 0.5 g was given iv on three successive treatment periods and their concentrations in plasma, ultrafiltrate/dialysate and urine were determined for 12 h after each dose. The elimination half-life of piperacillin during CVVH (7.7 +/- 2.3 h; mean +/- s.d.) was significantly longer than during CVVHDF 1 L/h (6.7 +/- 1.9 h) or 2 L/h (6.1 +/- 2.0 h) (P< 0.05). Corresponding values for tazobactam were 13.9 +/- 3.9, 11.6 +/- 3.3 and 9.4 +/- 2.4 h, respectively (P< 0.05). Total piperacillin clearance during CVVH (3.89 +/- 1.23 L/h) was significantly lower than during CVVHDF 1 L/h (5.06 +/- 1.68 L/h) or 2 L/h (5.48 +/- 2.11 L/h) (P< 0.05). The corresponding tazobactam clearance values were 2.42 +/- 0.75, 3.13 +/- 0.66 and 3.75 +/- 1.43 L/h, respectively. The mean 12 h elimination of piperacillin and tazobactam in ultrafiltrate/dialysate was 29% and 37% during CVVH, 42% and 57% during CVVHDF (1 L/h), and 46% and 69% during CVVHDF (2 L/h). We recommend 8 hourly dosing of patients with renal failure on CVVH or CVVHDF with dialysis flow rates of 1 or 2 L/h treated with piperacillin 4 g/tazobactam 0.5 g.

Acute Kidney Injury↗
PubMed2001

Intermittent hemodiafiltration in acute renal failure in critically ill patients.

AIMS: The objective was to study the effects of daily intermittent on-line predilution hemodiafiltration (IHDF) on laboratory parameters, and on multiple organ dysfunction score (MODS), compared with intermittent hemodialysis (IHD). MATERIAL DESIGN: Prospective, randomized, non-blinded study. SETTING: A 10-bed medical-surgical intensive care unit in a tertiary-care hospital, 39 patients with acute renal failure. METHODS: IHDF or IHD was performed daily with the same equipment: AK 100 Ultra, and Polyflux 17 hemodiafilter up to day 30. Laboratory parameters, MODS, survived days free of acute renal failure treatment, number and complications of treatments, and hospital mortality were recorded. RESULTS: Effects of treatments were equal as to urea reduction ratio and changes in serum creatinine, calcium, phosphate and bicarbonate. Survived days free of acute renal failure treatment were fewer for the IHDF (4.8 vs. 10.3 days for the IHD, p = 0.036, Mann-Whitney test). The overall hospital mortality of all patients was 34% (95% CI 18-50%). CONCLUSIONS: This study demonstrated equal control of azotemia, acidosis, and calcium-phosphate balance in both treatment groups with no treatment-specific complications of IHDF.

Acute Kidney Injury↗
PubMed2000

Elimination of meropenem during continuous veno-venous haemofiltration and haemodiafiltration in patients with acute renal failure.

Meropenem elimination was studied in six patients with acute renal failure on continuous venovenous haemofiltration (CVVH) or continuous veno-venous haemodiafiltration (CVVHDF) 1 L/h and 2 L/h for 12 h. Meropenem 1 g was given iv over three dialysis periods, and plasma, ultrafiltrate/dialysate and urine concentrations of meropenem were determined. The half-life of meropenem was significantly longer (P < 0.05) during CVVH (7.5 +/- 2.0 h; mean +/- S.D.) than during CVVHDF 1 L/h (5.6 +/- 1.4 h) or 2 L/h (4.8 +/- 1.2 h). Meropenem clearance was 3.27 +/- 2.30 L/h, 4.72 +/- 2.69 L/h and 5.71 +/- 3.58 L/h in CVVH, CVVHDF 1 L/h and CVVHDF 2 L/h, respectively (P < 0.05 between CVVH and CVVHDF). Patients with renal failure on CVVHDF 1 or 2 L/h should be treated with meropenem 1 g bid; 500 mg tid may be enough for patients on CVVH.

Acute Kidney Injury↗
PubMed2000

Identification of drugs ingested in acute poisoning: correlation of patient history with drug analyses.

The aim of this study was to assess the reliability of patient history in the identification of the drugs taken by patients who have an acute drug overdose. To this end, a prospective study involving 51 cases of acute, deliberate drug poisoning was carried out (patients with ethanol as the only apparent cause of intoxication were excluded). Information based on interviews with the patients and their companions or on circumstantial evidence (e.g., drug containers found) was compared with the results from drug analyses of various body fluids. The information obtained on admission was completely in accordance with the laboratory findings in only 27% of the cases. Minor discrepancies between the history and the results from drug analyses concerning the identity of the drugs taken were found in 55% of the cases. In 18% of the cases, the discrepancies were considered clinically important. Serious symptoms occurred in approximately 20% of the patients, but none of them were the result of incorrect information obtained on admission. All the patients survived. These results support the prevailing view that rapid identification of the drugs taken in overdose by means of comprehensive drug screens would have little effect on the treatment of most cases of acute poisoning. However, such assays would enable optimal treatment of many cases of acute poisoning by reducing the need for supervision and costly treatments and facilitating the identification of cases that would require prompt drug-specific treatment.

Acute Disease↗
PubMed1997

Effect of continuous venovenous haemofiltration and haemodiafiltration on the elimination of fluconazole in patients with acute renal failure.

The elimination of fluconazole was studied in six patients with acute renal failure undergoing continuous venovenous haemofiltration (CVVH) for 24 h, continuous venovenous haemodiafiltration (CVVHD) 1 L/h for 24 h and CVVHD 2 L/h for 24 h. Fluconazole 200 mg once daily was given intravenously on three successive days and the concentrations of fluconazole in serum, ultrafiltrate/dialysate and urine were determined for 24 h after each dose. The half-life of fluconazole in patients during CVVH (83.5 +/- 30.1 h; mean +/- S.D.) was significantly (P < 0.05) longer than that during CVVHD 1 L/h (30.4 +/- 5.0 h) or CVVHD 2 L/h (21.8 +/- 3.5 h). The total fluconazole clearance was 0.57 +/- 0.16 L/h, 1.50 +/- 0.24 L/h and 1.85 +/- 0.17 L/h in CVVH, CVVHD 1 L/h and CVVHD 2 L/h, respectively, and there was a significant difference (P < 0.05) between all these treatments. Daily renal excretion of fluconazole was minimal, ranging from 0.002 mg to 11.2 mg in different patients with different treatment modes. The methods tested increased the elimination of the unchanged drug 20- to 400-fold in patients with acute renal failure. Patients undergoing CVVHD therapy with a dialysis flow rates of 1 or 2 L/h should be treated with a daily dose of at least 200 mg of fluconazole to maintain therapeutic drug concentrations. However, in patients on CVVH therapy smaller doses of fluconazole may be enough.

Acute Kidney Injury↗
PubMed1997

Pharmacokinetics of diltiazem in massive overdose.

Several cases of poisoning with diltiazem have been described in the literature, but information about the pharmacokinetics of diltiazem in overdose is sparse. The authors report pharmacokinetic and clinical observations in a patient who ingested 7.2 g of slow-release dilitiazem. Grave, persistent hypotension was the overriding clinical manifestation, but the patient eventually survived with aggressive cardiovascular support. No serious conduction abnormalities were seen. Blood samples were taken repeatedly for 2-3 days for analysis of serum diltiazem and desacetyldiltiazem and desacetyldiltiazem concentrations. The serum diltiazem concentration measured in the first sample taken (16.5 h postingestion), 3,171 ng/ml, is one of the highest concentrations reported in a patient who survived. The half-life was 13.3 h for diltiazem and 10.5 h for desacetyldiltiazem. Charcoal hemoperfusion had no apparent effect on the elimination of either compound. The relatively long half-life of diltiazem may have resulted from rate-limiting absorption and probably does not indicate saturation of diltiazem metabolism. The patient was discharged with no apparent neurological or cardiological deficits.

Adult↗
PubMed1995

Effects of hypertension and dyslipidemia on the decline in renal function.

Experimental evidence suggests that in addition to hypertension, serum lipids might also accelerate the decline in renal function. We tested this hypothesis in 2702 dyslipidemic middle-aged men without renal disease participating in the Helsinki Heart Study, a coronary primary prevention trial. The decline in renal function was estimated from linear regression slopes based on reciprocals of 10 serum creatinine determinations over the study period. Renal function deteriorated 3% on average during the 5-year study, and hypertension accelerated this change. Subjects with an elevated ratio of low- to high-density lipoprotein cholesterol ( > 4.4) had a 20% faster decline than those with a ratio less than 3.2. Both the contribution of the lipoprotein ratio and the protective effect of high-density lipoprotein cholesterol alone remained significant in multiple regression analyses. In the study of joint effects the contribution of lipids was confined to subjects with simultaneous elevation of blood pressure and lipids. The results suggest that in addition to hypertension, blood lipids also modify the decline in renal function.

Adult↗
PubMed1994

Antimyosin scintigraphy in patients with acquired and hereditary muscular disorders.

Scintigraphy with indium-111 labelled antimyosin has an established role in the evaluation of cardiac muscle damage. This antibody has been shown to cross-react with myosin in skeletal muscle. We therefore studied the usefulness of this method for the detection of skeletal muscle lesions in rhabdomyolysis, myositis and hereditary muscular dystrophies. All nine patients with rhabdomyolysis had focal uptake of antimyosin antibody which correlated with the clinical findings of soft tissue damage. However, a number of symptomless lesions were also detected by immunoscintigraphy. In rhabdomyolysis the target to non-target uptake ratios varied from 1.3 to 7.6. Diffuse uptake of antibody in skeletal muscle was observed in all three patients with polymyositis-dermatomyositis and in 12 out of 13 patients with muscular dystrophies. In myositis the intensity of antibody accumulation correlated reasonably well with the magnitude of oedema detected by magnetic resonance imaging (MRI). Most patients with Becker type or non-X-chromosomal muscular dystrophies showed slight or moderate uptake of antibody, mainly in the lower extremities. In these patients more antibody accumulated in the calves than in the thighs, whereas the findings on MRI were more prominent in the thighs than in the calves, presumably because of the better preserved muscle bulk in the calves. We conclude that antimyosin scintigraphy can be used for the detection of muscle lesions not only in acquired muscle diseases but also in hereditary muscular disorders, and that immunoscintigraphy provides information on muscle disease activity not obtainable with MRI.

Adult↗
PubMed1992

Technique of renal biopsy by ultrasound guided percutaneous puncture with a spring loaded "gun".

The study consisted of 89 consecutive patients (mean age = 41.5, range = 16-82, 64 men, 25 women) referred for renal biopsy because of clinical suspicion of renal parenchymal disease. Neither transplant kidneys nor tumour evaluation were included. A biopsy "gun" (Biopty) and 14 (2.0 mm) and 18 (1.2 mm) gauge needles were used with ultrasound guidance. Sixtyseven renal biopsies were guided using a freehand technique 42 using a fixed angle guide attachment. The mean glomerular yield was 9.4 glomeruli. Almost 25% of the 18 gauge needle biopsies (n = 57) had to be repeated and 29.3% of the 14 gauge needle biopsies (n = 75). The yield difference was not statistically significant (Chi-squared = 0.37, p = 0.54). There was no statistically significant difference between the distributions of failure to obtain a significant material for evaluation caused by the biopsy technique used (Chi-squared = 0.08, p = 0.78). When analysing cases of single successful pass the thinner needle produced 6.7 glomeruli (n = 36, SD = 5.08) and the thicker needle 13.8 glomeruli (n = 18, SD = 6.82). No serious complications occurred.

Adolescent↗
PubMed1989

Acute rhabdomyolysis: evaluation with magnetic resonance imaging compared with computed tomography and ultrasonography.

Fifteen patients with acute rhabdomyolysis were evaluated with low field magnetic resonance (MR) imaging and the results compared with those obtained using computed tomography (CT) and ultrasonography (US). With MR imaging, abnormal muscles with areas of increased signal intensity were seen in every patient, which probably reflects increased water content or increased mobility of water molecules caused by inflammatory reaction and oedema in the injured and necrotic muscles. Computed tomography without intravenous contrast medium demonstrated abnormal muscles in most patients examined with this modality. The CT findings consisted of areas of focal hypodensity in muscles. With US, abnormal muscles were seen in less than half of the patients studied. The normal structure of striated muscle was focally disturbed and areas of both decreased and increased echogenicity were found. Magnetic resonance imaging had a higher sensitivity in the detection of abnormal muscles than CT or US (100%, 62% and 42%, respectively). The findings of all these modalities are non-specific, but together with the clinical and laboratory data they confirm the diagnosis of rhabdomyolysis. The information gained from imaging studies is useful in the assessment of the extent and distribution of rhabdomyolysis. The precise identification of affected muscle compartments by MR imaging is valuable when surgical fasciotomy is considered for treatment; the procedure can then be appropriately directed to the compartments with clearly abnormal muscles.

Acute Disease↗
PubMed1989

Diagnosis of falciparum malaria delayed by long incubation period and misleading presenting symptoms: life-saving role of manual leucocyte differential count.

In countries where malaria is not endemic the diagnosis of the disease is often delayed or overlooked, particularly if the clinical symptoms are atypical and if automated cell analyzers are used instead of blood films for leucocyte differential counts. We report 2 cases of severe Plasmodium falciparum malaria with unusual clinical features: a 46-year-old man with an exceptionally long incubation period and a 22-year-old woman with presenting symptoms suggesting viral hepatitis. In both cases the diagnosis of malaria was unexpectedly made by observant laboratory technicians examining stained blood films for differential counts.

Adult↗
PubMed1987

Serum protein binding of phenytoin, diazepam and propranolol in chronic renal diseases.

The effect of chronic renal disease on the serum free fraction of phenytoin, diazepam and propranolol was examined in vitro among 60 conservatively treated patients with renal insufficiency of varying degree and different etiology, and in 10 patients with a nephrotic syndrome. The control group comprised 10 age and sex-matched healthy subjects. The free fractions were separated at 37 degrees C using a pressure ultrafiltration method. The highest free fractions of phenytoin and diazepam in uremic patients were 4 to 5-fold the normal. The free fractions were about twice the normal at a creatinine concentration of 800 mumol/l, and 2 to 4-fold at an urea concentration of 20-40 mmol/l. The creatinine and urea correlated with the free fractions of phenytoin and diazepam in a similar manner. The effect of a decreased serum albumin on the free fractions of these drugs was clear when its concentration was under 30 g/l. The creatinine and urea did not correlate with the free fraction of propranolol. However, after mathematically correcting the free fraction of propranolol to correspond to an alpha 1-acid glycoprotein (alpha 1-AGP) concentration of 0.9 g/l, it correlated significantly with creatinine and urea. The concentration of alpha 1-AGP was the most important determinant for the free fraction of propranolol. For practical purposes, the change in the free fractions of phenytoin and diazepam can be adequately predicted by the serum creatinine or urea and serum albumin levels. For propranolol the only parameter which needs to be analyzed is the serum alpha 1-AGP concentration.

Creatinine↗
PubMed1987

Serum protein binding of phenytoin, diazepam and propranolol in age-related decrease in renal function.

The serum protein binding of phenytoin, diazepam and propranolol was investigated in vitro in 32 elderly people with an age-related decrease in renal function by a pressure ultrafiltration method at 37 degrees C. The mean age of the patients was 88 +/- 1 years (mean +/- SE), and their mean 51Cr-EDTA clearance 46 +/- 4 ml/min. The main reason for hospitalization of these patients was their age. The free fraction of phenytoin correlated negatively with the serum albumin concentration, and that of propranolol with the alpha 1-acid glycoprotein (alpha 1-AGP) concentration. The free fraction of diazepam did not correlate with either of these binding proteins. In stepwise multiple regression analysis, the most significant variable for phenytoin free fraction was serum albumin concentration, with the serum urea concentration coming in second place. For the diazepam free fraction, the only significant variable was the serum urea level, although in the correlation matrix the correlation with creatinine was also significant. When the effect of serum albumin level was corrected mathematically, the urea level was the best determinant in regression analysis for both the phenytoin and diazepam free fractions. It can be concluded that an age-dependent decrease in renal function increases the free fraction of phenytoin and diazepam and is, together with hypoalbuminaemia, responsible for the increased free fraction of these drugs in the elderly. For propranolol the only important factor is the serum alpha 1-acid glycoprotein concentration.

Aged↗