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Biomedical subjects

F O Finkelstein

Publications and source records attributed to F O Finkelstein.

At least 55 records · Page 3Linked to original sources
PubMed1988

Pseudomonas peritonitis associated with continuous ambulatory peritoneal dialysis: a six-year study.

In a population of 214 patients on continuous ambulatory peritoneal dialysis (CAPD), 415 peritoneal infections occurred between 1980 and 1986. Fourteen of these infectious events were caused by Pseudomonas aeruginosa (3.4%). None of those patients with P aeruginosa peritonitis were cured by medical therapy alone. Peritoneal catheter removal was necessary to achieve resolution of the infection. Significant patient morbidity from Pseudomonas infection included loss of peritoneal space for further dialysis and abscess formation. Our data suggests that prompt catheter removal should be seriously considered for chronic ambulatory peritoneal dialysis patients who develop P aeruginosa peritonitis.

Adult↗
PubMed1987

The spectrum of renal histopathology in patients with significant proteinuria in Vanuatu.

Renal biopsies were performed on 21 of 27 Melanesian patients presenting with significant proteinuria in Vanuatu from 1983 to 1985. All patients had more than 2 g of proteinuria per 24 hours or clinical evidence of the nephrotic syndrome. The average age of the patients who were biopsied was 31 years. Three of the 21 patients had evidence of active malaria at the time of presentation, and all of these patients had Plasmodium falciparum. Renal histopathology revealed that six patients (29%) had amyloidosis and five patients (24%) had mesangiocapillary glomerulonephritis (type 1). Of particular note was the fact that only one patient had membranous glomerulonephropathy and only one patient had minimal change nephrotic syndrome, the two most common lesions reported in nephrotic patients in Europe and the United States. Thus, the spectrum of renal histopathology in patients presenting in Vanuatu with significant proteinuria is very different from that seen in Western Countries.

Amyloidosis↗
PubMed1980

Renal function in rats with acute medullary injury.

Acute, reversible renal failure affecting primarily medullary structures, was produced by feeding rats a diet containing 5% oxonic acid and 2.5% uric acid for 7 days. Inulin clearance and selected tubular transport processes were studied and compared to controls. At the time of maximal renal injury, inulin clearance was reduced to 40% of control values, in association with a 60% reduction in urine concentrating ability, a 50% reduction in potassium excretion and a 56% reduction in ammonium excretion. During a 7-day recovery period, inulin clearance increased to 70% of control and potassium excretion returned to normal while the other tubular transport functions remained impaired. Thus, in acute renal failure, tubular functional impairments may recover at different rates.

Acute Kidney Injury↗
PubMed1978

Symptomless acute renal transplant rejections. Occurrence six months or more after transplantation.

A total of 22 cases of acute rejection episodes occurring six months to five years after renal transplantation were retrospectively reviewed for the presence of fever, graft tenderness, increase in blood pressure, declining urine output, falling urine sodium level, change in WBC count, and patient's response to antirejection therapy. A total of 13 episodes were not associated with any of these symptoms or signs of an acute rejection episode; seven episodes were associated with an increase in blood pressure alone and only two episodes were associated with fever. Nineteen rejection episodes were confirmed by biopsy. In 16 of these late-rejection episodes, the patient had complete or partial response to therapy. Acute rejection episodes can occur months to years after transplantation; patients are typically asymptomatic; many patients do respond to therapy; and biopsy is often helpful in establishing the diagnosis.

Acute Disease↗
PubMed1978

Effect of hypertonic dialysate and vasodilators on peritoneal dialysis clearances in the rat.

A model for performing peritoneal dialysis in the rat was established which permitted the consistent measurement of dialysis clearances. The effects on urea and inulin clearances of interperitoneal vasodilators and 4.25% dextrose were compared. Isoproterenol, nitroprusside, histamine, and bradykinin, when added to 1.5% dextrose dialysate for three consecutive exchanges, all produced approximately a 20% increase in urea and inulin dialysis clearances. These increases in clearances persisted in the three subsequent exchanges when no drugs were added to the dialysate. The addition of isoproterenol, nitroprusside, or histamine to six consecutive exchanges did not produce a further increment in clearances. The use of 4.25% dextrose dialysate for three exchanges produced approximately a 50% increase in urea and inulin clearances. Clearances remained about 35% greater than control values in the subsequent three 1.5% dextrose exchanges.

Animals↗
PubMed1978

Peritoneal dialysis clearances. A practical approach to the measurement of small- and middle-molecule clearances.

This study was designed to (1) develop a simple technique of estimating 'middle-molecule' clearances in peritoneal dialysis patients using vitamin B12 as a marker; (2) evaluate changes in small- and middle-molecule clearances during a single 24- or 36-hour peritoneal dialysis, and (3) determine if using 4.25% rather than 1.5% dextrose exchanges alters the clearances of small and middle molecules. Measurement of clearance following the intramuscular injection of vitamin B12 was found to be a reliable method of estimating the clearance of middle molecules. Small- and middle-molecule clearances remain constant throughout an individual 24- or 36-hour dialysis. In addition, small-molecule clearances increase significantly with 4.25% dextrose dialysate but return to prior values when 1.5% dextrose dialysate is reinstituted.

Humans↗
PubMed1978

Treatment of end-stage renal failure in a defined geographic area.

The treatment of end-stage renal failure was studied in southern Connecticut from 1967 to 1975 by (1) calculating survival rates for center and home dialysis patients and cadaver and living related donor transplant recipients and (2) assessing the quality of life with structured interviews and psychological tests. While the survival rate for our home dialysis and transplant recipients were similar to previously reported data, mortality for our center dialysis patients was slightly higher than previously reported. Quality-of-life testing, disclosed that dialysis patients had a substantial impairment in all parameters. Transplant recipients achieved a better degree of rehabilitation. Physicians and patients should be aware of the problems that they are likely to face; otherwise, expectations and goals may be raised to unreachable and ultimately frustrating levels.

Adult↗
PubMed1977

Renal extraction of glucagon in rats with normal and reduced renal function.

To examine the role of the kidney in the mechanism of impaired metabolic clearance of glucagon in renal failure, the renal handling of endogenous pancreatic glucagon was studied in rats with normal renal function and rats with renal insufficiency produced by 70% surgical ablation. Mean +/- SE renal extraction of glucagon in animals with normal renal function was 39 +/- 5%. Urinary losses of glucagon accounted for less than 2% of renal extraction. In contrast, in the animals with renal insufficiency (glomerular filtration rate reduced to one-third of normal), arterial glucagon increased 40% and renal extraction and extraction rate per gram kidney weight of glucagon were negligible, despite filtered loads of 204 +/- 42 pg/min per g kidney wt. These findings indicate a major role of the kidney in the metabolic clearance of glucagon under normal conditions and suggest that during renal insufficiency elevated plasma levels of glucagon occur, at least in part, as a result of a decreased renal turnover of the hormone.

Animals↗
PubMed1977

Sequential clearance and dialysance measurements in chronic peritoneal dialysis patients.

The long-term efficiency of chronic peritoneal dialysis was investigated during a 10-months follow-up period in eight patients with indwelling Tenckhoff catheters by determining sequential urea, creatine and glucose clearances. Dialysis was performed in the hospital with nurses changing commercially prepared 2-liter dialysate bottles. Mean +/- SE urea clearance declined from an initial valua of 23.6 +/- 1.5 ml/min to 17.7 +/- 1.2 at the termination of the study. The mean glucose and creatinine clearance also decreased from 14.1 +/- 0.9 to 10.2 +/- 0.7 and from 17.5 +/- 1.9 to 12.9 +/- 1.0, respectively. All of these decreases were statistically significant (p less than 0.05) by paired t testing analysis. It is concluded that the efficiency of chronic peritoneal dialysis may decline during maintenance therapy and that sequential clearance measurements should be obtained in all chronic peritoneal dialysis patients.

Adult↗
PubMed1977

Diagnostic problems in pulmonary-renal syndromes.

A 25-year-old woman survived a fulminant epidose of rapidly progressive renal failure with severe hemoptysis initially suspected of being Goodpasture's syndrome. Four years later the patient was diagnosed as having Wegener's granulomatosis.

Adult↗
PubMed1976

Influence of rejection on graft survival after renal transplantation.

The clinical course was reviewed of 102 renal allograft recipients between December 1967 and December 1973. Only 4 of 21 patients (19 per cent) who had 2 or more episodes of rejection during the first 2 months had a functioning graft at the end of 1 year, compared to 24 of 30 patients (83 per cent) who had no rejection episodes. A similar trend was seen 2 to 6 months after transplantation. During the first 2 years vigorous immunosuppressive therapy for rejection in the first few months resulted in 12 deaths (44 per cent) of 27 patients. Subsequent to this immunosuppressive therapy was modified and grafts were removed if there was not a prompt recovery of function after treatment, which resulted in a significant decrease in mortality rate to 16 per cent. There also was improvement in the over-all survival of patients with functioning grafts from 37 to 56 per cent. Serious complications and mortality could be related to high dosage of steroids and severe leukopenia. A white blood count of less than 1,000 mm.3 on 3 successive days was associated with a mortality rate of 52 per cent, compared to 15 per cent in those without leukopenia. Serious consideration should be given to early graft removal in patients who have 2 or more episodes of rejection in the first few months after transplantation, particularly when there is not a prompt improvement in renal function after immunosuppressive therapy. High doses of steroids (greater than 1 mg. per kg. for more than 26 days during the first 60 days) should be avoided to decrease morbidity and mortality rates from serious infections. The results of histocompatibility (HL-A) matching in 72 donor-recipient pairs indicated an improved graft survival when there was a match of 2 or more antigens, which is supported by the results recently reported by the Transplant Registry. The results of mixed lymphocyte reactions in 20 live donor-recipient pairs showed a marked improvement in graft survival when there was less than 20 per cent stimulation and it appeared that this reaction was of more important prognostic significance than the results of histocompatibility (HL-A) matching in these patients.

Azathioprine↗
PubMed1976

Kidney transplant biopsies in the diagnosis and management of acute rejection reactions.

In 68 consecutive renal transplant biopsies, histopathologic changes and clinical status of the graft recipient, both at the time of biopsy as well as one month later, were evaluated by independent observers. Nine histologic features were graded semiquantitatively (scale, 0 to 4): glomerular endothelial swelling, proliferation, exudation and necrosis; interstitial edema and infiltrate: vascular endothelial edema, infiltration and necrosis. The total score for each biopsy was termed the acute rejection index (ARI). The validity of the ARI as a means of evaluation rejection reactions was established by correlating the ARI with a second, overall histopathologic categorization. Clinical status at the time of biopsy was classified by retrospective analysis of all clinical data except the biopsy. The mean ARI of patients with an acute clinical rejection was significantly higher than those of patients with just a chronic clinical rejection or no clinical rejection. The utility of the biopsy in predicting the response of the graft recipient to therapy was evaluated in those 46 patients in whom an acute rejection was diagnosed clinically and in whom a full and complete course of therapy for the acute clinical rejection was given. Of the 28 patients whom the pathologist predicted would response to therapy, 27 did show substantial improvement of their renal function up to one month following institution of treatment. Of the 18 patients whom the pathologist predicted would not respond to therapy, 15 had no clinical response. The data suggest that the transplant biopsy is helpful in 1) establishing the diagnosis of an acute rejection and 2) indicating whether or not the graft recipient will respond to standard immunosuppressive treatment for an acute rejection,

Acute Disease↗
PubMed1976

Pharmacokinetics of cefamandole in patients undergoing hemodialysis and peritoneal dialysis.

The pharmacokinetics of cefamandole nafate, a new parenteral cephalosporin derivative, were evaluated in 11 patients with chronic renal failure (creatinine clearance less than 5 ml/min), including five patients during hemodialysis, four patients during routine peritoneal dialysis, and two patients during the interdialytic period. Peak serum levels of cefamandole were comparable to those observed in patients with normal renal function. Clearance of the drug during the interdialytic period and during hemodialysis and peritoneal dialysis was minimal, with a resultant significant prolongation of serum half-life. The nondialyzability of cefamandole is in contrast with reported studies of cephalothin, where significant reduction of the serum half-life was achieved during hemodialysis but not peritoneal dialysis. The concentration of cefamandole in the peritoneal dialysate after parenteral administration was observed to be bactericidal for many gram-negative pathogens and, with the exception of Streptococcus faecalis, most gram-positive organisms found in bacterial peritonitis in patients with severe renal failure. The present data suggest that if stable bactericidal serum levels of cefamandole are to be maintained during hemodialysis and peritoneal dialysis, a parenteral loading dose must be administered followed by one-half the loading dose every half-life.

Cephalosporins↗