Intravenous abuse of transdermal fentanyl therapy in a chronic pain patient.
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Administration, Cutaneous↗
Biomedical subjects
G Peer
Publications and source records attributed to G Peer.
Retrospective study comparing the pathophysiology of antibiotic-treated and untreated Escherichia coli- and Staphylococcus aureus-infused baboons.
Escherichia coli and Staphylococcus aureus are the most common pathogens encountered in septic shock. This is a descriptive study in which the pathophysiologic response to infusions of LD100 concentrations of E. coli and S. aureus are staged and compared. Equivalent concentrations of both organisms were infused over a 2 hr period into antibiotic-treated and untreated animals with the following results: 1) The apparent clearance of E. coli was less than that of S. aureus over the 2-hr infusion period, but far greater during the next 8 hr in both antibiotic-treated and untreated animals. Thus the clearance of E. coli fits a one-compartment (intravascular), and that of S. aureus fits a two-compartment (intra- and extravascular) model. 2) The intensity of the cardiovascular, temperature, and metabolic response to E. coli was greater, whereas that of the disseminated intravascular coagulant (DIC) response to S. aureus was greater. We conclude, therefore, that the response to E. coli consists of four stages with no invasion and colonization of tissues, whereas the response to S. aureus consists of two stages with invasion and colonization of tissues.
Animals↗
Effect of verapamil on disposition of intravenous potassium in diabetic anephric uremic rats.
Calcium channel blockers decrease the plasma potassium concentration in acutely nephrectomized rats exposed to an acute potassium load. We examined the effect of verapamil on the plasma potassium concentration during an acute potassium load in anephric-uremic diabetic and non-diabetic rats. The plasma potassium concentration was measured at 15-min intervals during 60 min of continuous KCl infusion, with and without verapamil. The baseline potassium concentrations were higher in diabetic rats vs. nondiabetic controls. Verapamil blunted the increase in plasma potassium in diabetic and nondiabetic rats compared with the respective controls. The pH and hematocrit were similar in all groups. We conclude that the effect of verapamil on extrarenal potassium disposal are independent of insulin and the renin angiotensin system in the uremic state.
Animals↗
Anticoagulant and fibrinolytic activities are promoted, not retarded, in vivo after thrombin generation in the presence of a monoclonal antibody that inhibits activation of protein C.
This study examines the assumption that both the anticoagulant and fibrinolytic activity that follow the generation of thrombin induced by infusion of factor Xa/PCPS are due to generation of activated protein C. Untreated controls or animals given unrelated antibody were compared with animals pretreated with a specific monoclonal antibody to protein C (HPC4). Compared with untreated controls excess HPC4 substantially reduced the level of protein C activation as observed by protein C immunoblotting and enzyme-linked immunosorbent assay for antitrypsin/activated protein C complexes. Despite this, the anticoagulant activity as reflected by the decline of factors Va and VIIIa levels (as observed by coagulation assays and by factor V immunoblotting) was significantly greater than controls. The fibrinolytic activity (as observed by assays of tissue plasminogen activator, D-Dimer, alpha 2-antiplasmin) also was significantly greater than controls. We conclude that neutralization of the protein C anticoagulant system while resulting in a significantly more intense coagulant response to Xa/PCPS does not preclude inactivation of factors Va and VIIIa and the full expression of the fibrinolytic response. We conclude further that after thrombin generation in vivo, protein C activation is not a prerequisite for the promotion of the fibrinolytic response previously observed, and that the inactivation of factors Va/VIIIa may be mediated by enzymes other than activated protein C. The reduction in alpha 2-antiplasmin levels in association with increased tissue plasminogen activator activity suggests that plasmin is a likely candidate.
Animals↗
Severe defect in clearing postprandial chylomicron remnants in dialysis patients.
Lipid abnormalities have been suggested as a major cause of the accelerated atherosclerosis and the high incidence of coronary heart disease in chronic renal failure patients. In the present work the postprandial lipoprotein metabolism was studied in chronic dialysis patients with or without fasting hypertriglyceridemia using the vitamin A loading test. This method investigates specifically postprandial lipoprotein metabolism. The determination of vitamin A ester level retinyl palmitate (RP) differentiates the circulating plasma chylomicron and chylomicron remnant fractions from the endogenous VLDL and IDL. Subjects with normal renal function with or without fasting hypertriglyceridemia served as control groups. Dialysis patients have significantly higher level of chylomicron remnants for a more prolonged period of time than controls, irrespective of their fasting triglyceride levels. The area below retinyl palmitate chylomicron remnants curve was 26308 +/- 12422 micrograms/liter.hr in the normolipidemic dialysis patients, significantly higher than (6393 +/- 2098 micrograms/liter.hr; P < 0.0001) in the normolipidemic controls. The retinyl palmitate chylomicron remnants curve of the hypertriglyceridemic dialysis patients was 21021 +/- 4560 micrograms/liter.hr, which was higher than 12969 +/- 2215 micrograms/liter.hr (P < 0.0001) in the hypertriglyceridemic controls. Moreover, the hypertriglyceridemic dialysis patients had an additional defect in the lipolysis metabolic step, that is, accumulation of chylomicrons in circulation. These findings show a severe defect in postprandial lipoprotein metabolism in chronic renal failure patients. The prolonged exposure of the vascular wall to high chylomicron remnant concentrations might be an important pathogenetic factor in the accelerated atherosclerosis seen in chronic dialysis patients.
Adult↗
Early diagnosis of gram-negative peritonitis in continuous ambulatory peritoneal dialysis patients with the Lymulus amebocyte lysate assay.
The treatment of peritonitis in continuous ambulatory peritoneal dialysis patients is empiric until the bacteriological results are available. The Lymulus amebocyte lysate assay (LAL) is a very sensitive method for the detection of endotoxin, a structural component of gram-negative bacteria. We performed the LAL assay in a prospective study in 36 consecutive episodes of peritonitis. The LAL assay was positive in all 10 episodes of gram-negative peritonitis (100% specificity). Treatment directed specifically against gram-negative or -positive infection was started based on the LAL assay result. In 26 episodes with LAL-negative test, a gram-positive bacterium was cultured in 23 episodes, in 1 there was fungal infection and 2 were sterile. In summary: the LAL assay is a rapid (1 h) and sensitive method for the differentiation of gram-positive or -negative peritonitis and enables starting an immediate and more appropriate antibiotic therapy.
Endotoxins↗
[Therapy of metabolic acidosis].
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Acidosis↗
Effects of dichloroacetate and bicarbonate on haemodynamic parameters in healthy volunteers.
1. It has been shown that sodium bicarbonate has no effect or could even be detrimental in various forms of metabolic acidosis. Dichloroacetate, a stimulator of the pyruvate dehydrogenase complex, might offer an alternative treatment. The present study therefore examines the metabolic and haemodynamic effects of dichloroacetate and sodium bicarbonate in healthy volunteers. 2. On 2 different days, sodium dichloroacetate (50 mg/kg body weight) or sodium bicarbonate (1.5 mmol/kg body weight) was given intravenously as a single bolus in 10 healthy volunteers. Haemodynamic parameters were measured using a microprocessor-controlled system. Measurements were performed before and 30 and 60 min after infusion. 3. After administration of dichloroacetate, cardiac index increased from 2.3 +/- 0.03 to 2.7 +/- 0.1 1 min-1 m-2 (P less than 0.05), peripheral vascular resistance decreased from 266 +/- 9.7 to 240 +/- 1.7 kPa s l-1 (2662 +/- 97 to 2398 +/- 169 dyn s cm-5, P less than 0.05), oxygen availability increased from 442 +/- 16 to 535 +/- 30 ml min-1 m-2 (P less than 0.05) and serum lactate concentration fell from 1.4 +/- 0.14 to 0.6 +/- 0.1 mmol/l (P less than 0.05). With infusion of sodium bicarbonate there were no significant effects on any of these variables. 4. Our results show that dichloroacetate administered intravenously reduces the serum lactate concentration. The main effects of dichloroacetate itself are on the haemodynamic variables. Dichloroacetate increases cardiac index and oxygen availability and decreases peripheral vascular resistance, whereas sodium bicarbonate has no effect on haemodynamic or metabolic parameters. These data give some further insights in the actions of dichloroacetate and support the use of dichloroacetate as alternative therapy in various forms of metabolic acidosis.
Adult↗
[The significance of erythropoietin for nephrology].
The analysis of the structure of erythropoietin and the subsequent production of recombinant human erythropoietin opened a new era in the understanding of the pathogenesis and therapy of renal anaemia. From the diagnostic point of view sufficiently accurate radioimmunoassays are currently available to throw new light on the pathogenesis of renal anaemia, and enable pharmacokinetic studies of the recombinant hormone to be carried on. For the first time a causal therapy is available for renal anaemia. The following review summarizes the consequences of these innovations on the different aspects of nephrology.
Anemia↗
[Sodium dichloroacetate--a substance with manifold therapeutic potential].
The therapeutic potential of sodium dichloroacetate (DCA) formerly called vitamin B 15, has already been under investigation for the past few years. The predominant property of DCA underlying its therapeutic action is activation of pyruvate dehydrogenase. The potential therapeutic use of DCA in the treatment of lactic acidosis and type II diabetes mellitus related directly to its stimulatory effect on this enzyme. Additional favourable effects of DCA on cardiac performance in states such as ischaemia, where glucose becomes a major energy-yielding substrate, have also been demonstrated. Treatment of lipid disorders might become further indications for the implementation of this substance. DCA inhibits hydroxy-methyl-glutaryl CoA reductase, thus lowering cholesterol and triglyceride levels. Earlier suggestions that DCA produced a major degree of acute toxicity were not confirmed in recent studies using DCA of established purity and homogeneity. These findings and recent evidence suggesting a potentially important role of DCA in the treatment of lactic acidosis are the reason and basis for a review of the established actions of this substance.
Acetates↗
Natural autoantibodies against Tamm-Horsfall glycoprotein in normal individuals in relation to age and in adult patients with kidney diseases.
IgM and IgG natural antibodies to Tamm-Horsfall glycoprotein (THP) were found in serum samples of all healthy individuals tested by the ELISA technique. The IgM anti-THP antibody level was higher in the group 1-20 years old than the IgG anti-THP. The IgG anti-THP rose with increase in age (greater than 21 years old groups) and then the IgG and IgM anti-THP activity over aging remained constant. The natural anti-THP antibodies possess a lower degree of specificity and/or avidity than induced antibodies. The antibody titers against THP determined in 61 adult patients with chronic kidney diseases was significantly lower than that in adult controls. This low level of naturally occurring THP antibodies appears to be a general phenomenon. In these patients, diminished antibody levels appeared against a panel of self (collagen, fibronectin, THP) and non self (bovine gamma globulin (BGG), ovalbumin (OVA)) antigens as compared with normal controls. The low levels of these antibodies are not associated with a concomitant drop of IgG and IgM in their sera.
Adolescent↗
Hyponatremia in internal medicine ward patients: causes, treatment and prognosis.
A prospective study among unselected patients hospitalized in an internal medicine ward showed that 46 patients, 6.9% of total admissions, had serum concentrations of sodium less than 132 mEq/l. In 28.3% of hyponatremic patients (n = 13), the cause was the syndrome of inappropriate antidiuretic hormone secretion; 21.7% of the cases (n = 10) developed hyponatremia during hospitalization, mainly because of hypotonic solution administration. The mortality rate among the hyponatremic patients was high (30.4%) and was not influenced by treatment of hyponatremia. In our opinion, the high mortality reflects the severity of the underlying diseases, although 82.5% of the patients were asymptomatic or had mild neurological signs. There was no significant correlation between the degree of hyponatremia and neurological signs, or mortality.
Aged↗
Sclerosing peritonitis. Possible early diagnosis by computerized tomography of the abdomen.
Sclerosing peritonitis (SP) has come to be recognized as a serious complication of peritoneal dialysis (PD). However, diagnosis is often established at a late stage of the disease and at laparotomy. The use of computerized tomography (CT) of the abdomen in 2 patients, clinically suspected of suffering from SP, revealed loculated ascites, adherent bowel loops, bowel lumenal narrowing, and thickening of the peritoneal membrane. Such radiological changes in patients on PD seem highly consistent with a diagnosis of SP. We feel that CT of the abdomen may help in attaining an early, correct, and noninvasive diagnosis of SP. We recommend that CT of the abdomen be performed in any patient on chronic PD who has clinical manifestations suggestive of SP. Early diagnosis of SP can lead to early cessation of PD and hopeful recovery of the peritoneal membranes and space.
Female↗
Prolonged volume depletion imitating end-stage renal failure.
Four patients with chronic renal insufficiency were erroneously diagnosed as reaching the "end stage" of their disease. All of them had had insidious salt and water depletion prolonged over a period of 5 to 8 weeks. The correct diagnosis was missed because the signs and symptoms of slowly developing volume depletion were indistinguishable from the clinical picture of terminal uremia. Correction of the salt and water depletion was followed by marked clinical improvement and return of renal function to baseline values. Postural hypotension and hyponatremia are important clues for the diagnosis of insidiously developing mild or moderate volume depletion super-imposed on chronic renal insufficiency.
Aged↗
Cardiac arrhythmia during chronic ambulatory peritoneal dialysis.
Repeated bouts of ventricular tachycardia were triggered by the inflow of dialysate during acute peritoneal dialysis performed in a 79-year-old woman. Subsequent continuous Holter monitoring of 21 patients, many elderly and with cardiac disease, undergoing chronic ambulatory peritoneal dialysis (CAPD) revealed atrial and/or ventricular premature beats in 19 out of them. However, there were no differences in the type and frequency of the extrasystoles between the recordings performed on a day of dialysis or on a day on which dialysis was deliberately withheld. No new arrhythmias were seen in the 2 patients who were previously free of arrhythmias, in whom CAPD was undertaken. It seems that CAPD does not provoke or aggravate arrhythmias, even in elderly or cardiac patients.
Adult↗
Plasma lipid profile in verapamil-treated hypertensive patients.
Plasma lipid profiles were monitored for one year in hypertensive patients treated with verapamil. Elevations of triglyceride and very low density lipoprotein fractions were demonstrated in those patients already hyperlipidemic before commencement of verapamil. Caution may be necessary when giving verapamil to these hyperlipidemic patients. Further larger studies seem warranted.
Cholesterol↗
Bilateral metachronous xanthogranulomatous pyelonephritis in end-stage renal failure.
We report a case of bilateral metachronous xanthogranulomatous pyelonephritis (XGP) in a hemodialyzed patient with end-stage renal failure due to bilateral nephrolithiasis. The XGP was initially diagnosed by computed tomographic (CT) scan, and right nephrectomy was performed. The patient remained clinically stable for the next year. Involvement of the contralateral kidney was again confirmed by CT examination. Both kidneys showed histologic changes compatible with XGP. A coexisting nephrogenic adenoma of the bladder has been attributed to chronic urinary tract infection.
Female↗
Perforation of the esophagus (Boerhaave's syndrome) during hemodialysis.
The first case of spontaneous perforation of the esophagus during hemodialysis is reported. This occurred in a 73-year-old patient, following vomiting, which he frequently experienced during dialysis.
Aged↗