Endoscopic transduodenal removal of an hepatic artery infusion catheter.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
G Ramirez
Publications and source records attributed to G Ramirez.
Membranous nephropathy: a concern for malignancy.
Numerous authors have long felt that there is an association between malignancy and membranous glomerulonephritis. Most physicians have not noticed this association since the number of patients that they clinically observe is so low that such a relationship might not be obvious. The present study was undertaken to establish whether the relationship is real and to determine exactly how prevalent. Our results indicate the relationship definitely does exist, confirming studies that have shown a relationship based on positive staining for cancer antigens in kidney biopsy specimens. In addition, the study indicates that malignancy will become detectable within a relatively short period after the diagnosis of membranous glomerulonephritis, and that the malignancy rate is five times greater than the incidence in a baseline population. This risk is also highest in the elderly.
Adolescent↗
Proteinuria in hypertension.
It had been previously thought that protein excretion in hypertensive nephrosclerosis was less than 0.5 to 1.0 g/24 h. Furthermore, it was believed that proteinuria in the nephrotic range associated with hypertension was probably due to primary renal disease, malignant hypertension, renal artery stenosis, or pheochromocytoma. We report eight patients with biopsy-proven hypertensive nephropathy and heavy proteinuria in the absence of malignant hypertension or renal artery stenosis. The 24-hour protein excretion ranged from 2.7 to 4.3 g. All patients had renal insufficiency, with serum creatinine ranging from 2.0 (176.8) to 7.8 mg/dL (689.5 mumol/L). Renal function worsened in most patients during the follow-up period despite adequate control of the hypertension, and three patients had to be started on hemodialysis. Three patients died during the follow-up period. We conclude that hypertensive nephrosclerosis must be included in the differential diagnosis of marked proteinuria in patients with essential hypertension and that heavy proteinuria, along with renal insufficiency, are poor prognostic indicators in such patients.
Adult↗
Testicular defect: the primary abnormality in gonadal dysfunction of uremia.
Gonadal dysfunction is a common problem in end-stage renal disease. We decided to test the ability of the male gonads to respond to exogenous stimuli. The patients receiving chronic hemodialysis showed abnormally low levels of total testosterone and free testosterone in the presence of normal testosterone-binding globulin. Furthermore, the exogenous administration of human chorionic gonadotropin failed to elicit a normal response from the male gonads of hemodialyzed patients. Although basal serum prolactin levels are elevated, we do not believe that elevation is of the magnitude expected to produce testicular failure. Thus we believe that the primary testicular failure is part of the uremic syndrome, and is not corrected by dialysis.
Adult↗
Incidence of renal artery stenosis in a population having cardiac catheterization.
Patients with renovascular hypertension comprise only a small percentage of those with hypertension. In our study 102 consecutive patients who had cardiac catheterization were screened at the time of the procedure for renal artery stenosis. Only 65 (64%) of the 102 patients were hypertensive, and 14 of the total population (13.7%) had renal artery stenosis. Of these 14 patients, only five had more than 50% narrowing of the arterial lumen. By renal vein renin determination, only four of the five patients with significant renal artery stenosis had lateralizing renins. The frequency of significant renovascular hypertension does not justify the routine search for this problem during catheterization procedures, though it may be worthwhile if the patients are hypertensive. This area deserves further evaluation.
Adult↗
Nephrotic syndrome and renal failure in an elderly man.
Explore the source record for details and available documents.
Aged↗
Hypocomplementemic vasculitis and renal involvement.
Hypocomplementic urticarial vasculitis is a disorder that not only affects the skin, but other organs as well. We are describing a patient with this rare disorder and serious renal involvement that was treated with immunosuppressive therapy with good response and stabilization of the renal function. We emphasize the fact that renal involvement can occur with this disease and that the renal involvement is of the immune-mediate type and cannot be considered as benign as thought in the past.
Complement C3↗
Dialysate concentrate: a potential source for lethal complications.
Explore the source record for details and available documents.
Acetates↗
Immunologic competence of hemodialysis patients following withdrawal of vitamin C supplement.
Twelve stable nondiabetic patients on chronic hemodialysis were studied for their immunobiologic competence while receiving vitamin C supplement and 1-2 months following its withdrawal. These subjects, on prescribed diets, were checked for their food intake at the beginning of the study and at 1-month intervals thereafter. Immunological parameters tested were: (1) plasma vitamin C levels; (2) number of mononuclear cells isolated from blood and their vitamin C contents; (3) lymphocyte blastogenic response to mitogens; (4) leukocyte metabolic functions in presence of endotoxin by nitroblue tetrazolium reduction test, and (5) delayed hypersensitivity to skin-testing antigens, e.g. Candida and mumps antigens and purified protein derivative. Patients on vitamin C had significantly higher plasma ascorbic acid levels compared to normal healthy subjects. These decreased to low normal levels 1 month following withdrawal of the supplement and stayed comparable thereafter, up to 12 months of the study period. Ascorbic acid contents in the isolated mononuclear cells remained unchanged in patients on or off vitamin C. The number of blood mononuclear cells isolated and mitogenic responses to concanavalin A and phytohemagglutinin did not change following withdrawal of vitamin C supplement. All patients had positive delayed hypersensitivity to Candida, 60% to mumps and all were unresponsive to purified protein derivative. Leukocyte metabolic functions by nitroblue tetrazolium reduction test were higher in patients on vitamin C than when off, but this was not statistically significant. Vitamin C supplement is not necessary in hemodialysis patients when they are on an adequate diet.
Aged↗
Increase in P50 with the use of bicarbonate hemodialysis.
We studied the effect of bicarbonate and acetate on oxygenation during dialysis in ten male chronic dialysis patients. The dialysis delivery system and dialysate constituents were identical except for the use of either bicarbonate or acetate. We found no hemodynamic differences between the two kinds of dialysis. Blood PO2 fell by a similar amount, but blood PCO2 was higher during bicarbonate dialysis. The blood pH became alkalotic by the second hour of bicarbonate dialysis and remained so throughout the dialysis, whereas blood pH became alkalotic only at the end of acetate dialysis. The P50 increased significantly only during bicarbonate dialysis, but 2.3 DPG concentration did not change. Red cell volume, assessed by the mean corpuscular hemoglobin concentration, was unchanged. Without changes in the red cell volume we cannot explain the observed changes in P50 in the absence of concomitant changes in 2.3 DPG concentration.
2,3-Diphosphoglycerate↗
Glucose concentration in the dialysate and lipid abnormalities in chronic hemodialysis patients.
In order to assess the effect of varying glucose concentrations on plasma lipids, we first compared the hormonal response of nine non-diabetic patients during dialysis with a high (200 mg/dl) and a low (100 mg/dl) glucose bath. Insulin and growth hormone production increased (p less than 0.05) only with the high glucose bath, and no hemodynamic differences were noted during either dialyses. We then compared lipid profiles of 18 patients for 6 months, changing the glucose dialysate concentrations in each patient after three months. We found that all patients had hypertriglyceridemia, mild hypercholesterolemia, low HDL, normal LDL, and high VLDL cholesterol. We therefore conclude that episodic hyperinsulinemia and episodic excessive growth hormone secretion do not contribute significantly to the lipid abnormalities of the dialysis patients.
Adult↗
Prostatic cancer in patients 80 years of age.
Thirty patients with adenocarcinoma of the prostate, Grade III-V, Stage IV, 80 years of age or more have been studied. Survival rate at 12 months was 19/30 (63.3%). Survival rate at 3 years was 18/30 (60%). The results of this study show that in spite of being a selected group of patients with high grade, high stage tumors, the survival rate at three years was even better when compared to a heterogeneous group of patients ten years younger (57.75%).
Adenocarcinoma↗
A phase I/II investigation of trioxifene mesylate in advanced breast cancer. Clinical and endocrinologic effects.
Tamoxifen and trioxifene are antiestrogens that appear to have different endocrine effects when tested in rats. Whereas tamoxifen has considerable clinical activity, trioxifene is a new antiestrogen with undefined clinical activity. Thirty-six patients were treated with graded doses of trioxifene. The low-dose group (0.5 to 12 mg/m2 twice daily) had a 21% response rate in 24 subjects, and the high-dose group (40 to 100 mg/m2 twice daily) had a 33% response rate in 12 patients (P = 0.13). The time to treatment failure was 67 days and 178 days for the low- and high-dose groups, respectively. Toxicities were non-dose dependent; those of moderate frequency included leukopenia (41%) and nausea (31%). Tamoxifen reduced both prolactin and inducible growth hormone (GH). Trioxifene, although reducing prolactin, differed from tamoxifen in that an increase in inducible GH occurred. Furthermore, a striking dose-dependent decrease in luteinizing hormone and lesser decrease in follicle-stimulating hormone occurred only in the trioxifene-treated patients. This implies an intrinsic estrogenic action of trioxifene in man. Trioxifene is no more efficacious than tamoxifen and has more toxicity.
Antineoplastic Agents↗
Hypernephroma associated with multiple endocrine neoplasia type I: a case report.
We report a case of multiple endocrine neoplasia type I and hypernephroma. Parathyroid hyperplasia, adrenocortical hyperplasia, a nodular goiter, multiple lipomas, a chromophobe adenoma of the pituitary and hypernephroma had all been diagnosed previously. All but the last are features consistent with the diagnosis of multiple endocrine neoplasia type I (Wermer's syndrome). The association of multiple endocrine neoplasia type I and hypernephroma may represent a new manifestation of this pleiotropic syndrome.
Aged↗
The role of glucose in hemodialysis: the effects of glucose-free dialysate.
Glucose-free dialysate has been traditionally used in patients on chronic hemodialysis, reportedly without any side effects. Although hypoglycemia is not produced, several other metabolic changes must occur to maintain the euglycemic state. We studied ten patients on chronic hemodialysis using both a glucose-free bath and a glucose bath. Without glucose, a drop in osmolality of 20 mosm/kg H2O occurred, whereas a change of only 10 mosm/kg H2O was observed using a glucose bath. Abnormal EEG changes were observed after dialysis without glucose that were not present or were minimal with a glucose bath.
Adult↗
Longitudinal follow-up of chronic hemodialysis patients without vitamin supplementation.
Vitamin supplementation for dialysis patients is still controversial. In our study, we followed longitudinally over a period of a year, 15 patients on chronic hemodialysis who were deprived of vitamin supplementation. Microbiological assays were used to determine the levels of five vitamins of the B group (folate, niacin, B12, B6, and thiamine). Vitamin C was measured chemically. During the observation period when vitamins were not supplemented, a marked drop of many of these vitamins in blood levels were encountered. For vitamins B12 and C, the plasma levels remained within the normal range in all the subjects studied. For the other vitamins, the blood levels were found to be low in a few patients. Our data suggest that vitamin supplementation is probably not needed in most stable hemodialysis patients as it is recommended now, and that perhaps, if supplementation is indicated, less should be given than is presently prescribed. Further research is needed in this area.
Adult↗
Aldosterone response to angiotensin II during hypoxemia.
Exercise in humans causes increases in plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) except when performed at high altitude or while the subjects breathe hypoxic gas. Under those conditions, PRA increases with exercise but PAC does not. We speculated that the PAC suppression during hypoxemic exercise was due to hypoxemia-induced release of a circulating inhibitor of angiotensin II-mediated aldosterone secretion. To test this hypothesis, we measured the PAC response to graded infusions of angiotensin II during hypoxemia and normoxemia. Eight normal volunteers were given increasing doses of angiotensin II (first 2 ng X kg-1 X min-1 and then 4, 8, and finally 12 ng X kg-1 X min-1, each for 20-min periods) on 2 separate days, once while breathing room air and the other day while breathing hypoxic gas adjusted to maintain the subjects' hemoglobin saturation at 90%. The PAC response to different doses of angiotensin II did not significantly differ during hypoxemia from normoxemia. We conclude that our model of hypoxemia does not cause release of an inhibitor of angiotensin II-mediated aldosterone release.
Adult↗
The plasma and red cell vitamin B levels of chronic hemodialysis patients: a longitudinal study.
Plasma B12, folate, B6 and thiamine, and red blood cell folate, thiamine and niacin levels were monitored for a period of 6 months in 15 clinically stable, chronic hemodialysis patients who were not supplemented with the water-soluble vitamins. Microbiological assays were used to determine the blood levels of the water-soluble vitamins. Over the period of 6 months, none of the patients had plasma or red cell vitamin levels below the normal range. No appreciable changes were observed in the plasma and red blood cell vitamin levels before and after dialysis in 5 patients. This study showed that chronic hemodialysis patients are able to maintain normal plasma and red cell levels of some water-soluble vitamins without daily supplementation.
Adult↗