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Biomedical subjects

G W Rutecki

Publications and source records attributed to G W Rutecki.

29 records · Page 2Linked to original sources
PubMed1989

Transluminal angioplasty in patients with bilateral renal artery stenosis or renal artery stenosis in a solitary functioning kidney.

Renal angioplasty in patients with bilateral renal artery stenosis or with renal artery stenosis in a solitary functioning kidney has been thought to be relatively contraindicated. We report the results of renal artery angioplasty in 18 patients, 10 with severe bilateral renal artery stenosis and eight with severe renal artery stenosis in a solitary kidney. Twenty-five (89%) of 28 angioplasties were successful, with a mean improvement of the degree of stenosis from 85% to 18% after angioplasty and a restoration of renal blood flow. A significant drop in mean blood pressure at admission of 187/101 mm Hg to 154/87 mm Hg at discharge, 152/86 mm Hg at 3-month, and 146/82 mm Hg at 1-year follow-up was seen. Because of the decrease in blood pressure, 11 of the patients decreased or stopped taking diuretics and 15 decreased or stopped taking antihypertensive medications. Although no significant change in renal function was found by measuring mean serum creatinine levels over time, no patient had an elevated serum creatinine level at follow-up, indicating preservation of renal function. One major complication, cholesterol embolization to the bowel, was seen. Our results suggest that angioplasty is an acceptable treatment of hypertension in patients with bilateral renal artery stenosis or renal artery stenosis in a single kidney.

Aged↗
PubMed1982

Studies of the effects of essential fatty acid deficiency in the rat.

We report a model of prostaglandin depletion induced in rats by fasting for 11 days, followed by institution of an essential fatty acid-deficient diet. Urinary prostaglandin E, 2 weeks after this diet had been implemented, was 22 +/- 2 ng/24 hours compared to 113 +/- 8.5 ng/24 hours in controls (P less than 0.01). There was no difference in 24-hour urine volume or solute excretion in controls and essential fatty acid-deficient rats. Five hours after administration of NaCl, 10 mM/kg, essential fatty acid-deficient diet rats excreted 1.85 +/- 0.78 ml urine compared to 6.42 +/- 2.26 ml in control (p less than 0.01) with Na+ excretion 447 +/- 273 muEq in essential fatty acid-deficient rats vs 1483 +/- 366 muEq in control (P less than 0.01). Intravenous isotonic NaCl, 1.5% body weight, resulted in increased urine flow rate in control rats from 8.3 +/- 2 microliter/min to 28.7 +/- 8.8 microliter/min with sodium excretion increasing from 0.19 +/- 0.2 to 3.3 +/- 0.9 muEq/min. In the essential fatty acid-deficient diet animals, there was no significant change in flow rate, 6.07 +/- 2.43 to 9.85 +/- 4.29 microliter/min, or sodium excretion, 0.09 +/- 0.03 to 0.40 +/- 0.24 muEq, after saline infusion. There was no difference in the glomerular filtration rate of plasma aldosterone in the two groups after the salt load. When given a water load, 3 ml/100 g body weight, essential fatty acid-deficient diet rats excreted 2.5 +/- 0.7 ml in 5 hours compared to 6.3 +/- 1.4 ml in controls (P less than 0.01). The defect in water excretion was not due to increased sensitivity to antidiuretic hormone, since similar sensitivity to this hormone was demonstrated in the essential fatty acid-deficient diet and control rats during a water diuresis. When isotonic saline was substituted for drinking water, there was an increase in systolic blood pressure in essential fatty acid-deficient diet rats from 124 +/- 2 to 142 +/- 3 mm Hg over 9 days (P less than 0.01) compared to 122 +/- 2 before and 122 +/- 2 mm Hg after saline drinking in controls. The administration of linoleic acid for 4 days increased urinary prostaglandin E excretion to 114 +/- 15 ng/24 hours from 23 +/- 4 (P less than 0.01), and the alterations in the ability to excrete a sodium and water load were reversed. In essential fatty acid-deficient diet animals made hypertensive by 9 days of saline drinking, the institution of linoleic acid to the diet normalized the blood pressure despite the continued administration of saline. These studies demonstrate that essential fatty acid-deficient diet animals develop salt-sensitive hypertension with a combined defect in both sodium and water excretion which is reversed following correction of the essential fatty acid deficiency.

Animals↗
PubMed1982

Urinary concentrating ability and antidiuretic hormone responsiveness in the potassium-depleted dog.

The effects of potassium depletion on urine concentration ability, renal PGE2 excretion, and ADH release were studied in 28 female dogs made K depleted by oral K-exalate and a K-free diet. After K depletion was established (serum K 2.9 +/- 0.1 mEq/L), urine volume increased from control measurements, 596.4 +/- 34.0 to 1201.5 +/- 96.9 ml/24 hr (p less than 0.001); urine PGE2 excretion increased, 985.4 +/- 91.1 to 2122.0 +/- 328.5 ng/24 hr, (p less than 0.001); and Umax decreased, 2006 +/- 74.0 to 1186 +/- 71.9 mOsm/kg H2) (p less than 0.001). Indomethacin (5 mg/kg/day, s.c.) administered on 3 consecutive days after K depletion had been established, resulted in no significant improvement in Umax, 1186.8 +/- 71.9 to 1341.8 +/- 105.6 mOsm/kg H2O. Release of ADH from the neurohypophysis was evaluated by measuring plasma ADH during graded increases in serum tonicity with intravenous hypertonic saline before and after K depletion. Although ADH increased with increasing serum tonicity during both control and K depletion periods, there was a blunting of ADH release during K depletion. The regression coefficient of plasma ADH and serum tonicity was significantly lower during K depletion, 0.24, than in the control period, 0.65, (p less than 0.01). After 3 days of indomethacin (5 mg/kg/day, s.c.) ADH release from the neurohypophysis in response to graded increases in serum tonicity was partially normalized in the K-depleted animals without changes in serum K (regression coefficient, 0.53). K depletion in dogs therefore leads to an increase in the urine volume and an increase in renal PGE synthesis associated with a decrease in Umax. The increase in PGE2 synthesis is not responsible for the defect in Umax, since it is not corrected with indomethacin. The release of ADH in response to raising serum tonicity is blunted during K depletion, which is partially corrected by indomethacin. These data suggest an inhibiting role for PGE2 in the release of ADH from the neurohypophysis during K depletion.

Animals↗
PubMedDate not supplied

The pathogenesis of beta(2)-microglobulin-induced bone lesions in dialysis-related amyloidosis.

Dialysis-related amyloidosis (DRA), also referred to as beta(2)-microglobulin amyloidosis (A beta(2)M), is an important cause of morbidity in patients with chronic renal failure and in those who are on dialysis. Although DRA deposits from affected joints have been characterized as a unique amyloid fibril protein, beta(2)M, less is known about the pathologic role of beta(2)M as a mediator of bone and joint disease. Potential mechanisms for beta(2)M pathologic interaction in bone include bone growth factors, cytokines, and advanced glycation end products (AGEs). It appears that DRA is the result of a complex interaction between bone resorption and surrounding tissue destruction culminating in beta(2)M deposition and amyloid formation. More work is required to elucidate the relationship between beta(2)M accumulation and progressive tissue destruction.

Amyloidosis↗
PubMedDate not supplied

Dialysis leg cramps. Efficacy of quinine versus vitamin E.

A controlled randomized double-blind study was done to determine the frequency and severity of leg cramps in 40 patients on dialysis with a history of leg cramps. All patients entered a 2 month placebo washout and were randomized into a 2 month double-dummy phase of quinine 325 mg at bedtime versus vitamin E 400 IU at bedtime. Of the 29 patients completing the study, 16 received quinine and 13 vitamin E. During placebo washout, the vitamin E group had a mean of 10.4 leg cramps per month, and the quinine group had a mean of 10.9. The vitamin E and quinine groups had a 1 month reduction in leg cramps to 3.3 and 3.6, respectively (p < 0.0005 for both groups combined); this was sustained at 2 months. A severity of pain index showed a statistically significant decrease for both groups. The 95% confidence interval for the difference between the number of leg cramps after vitamin E versus quinine treatment (95% confidence interval, -3.8, +3.2) suggests similar efficacy. Quinine and vitamin E were effective treatments for leg cramps in these patients. Considering the potential toxicity of quinine, vitamin E is recommended as the initial treatment of choice for patients on dialysis with leg cramps.

Adult↗
PubMedDate not supplied

End of life issues in ESRD. A study of three decision variables that affect patient attitudes.

The substantial end-stage renal disease (ESRD) mortality rate reflects an older population, worsening comorbidity, and increased cardiovascular disease. Advance directives in ESRD may simplify issues such as cardiopulmonary resuscitation (CPR) and dialysis discontinuation. However, ESRD patients with advance directives may change their mind or allow surrogate leeway for override of end-of-life decisions. Three decision variables (requesting CPR, discontinuation of dialysis with depression, or discontinuation with dementia) were studied in 141 ESRD patients through a 47 item questionnaire. Duration of dialysis (> or = 4 years) (P = 0.002) and prior CPR experience (P = 0.02) increased the probability of refusing CPR by 12 times. The use of surrogates and substituted judgement for dialysis discontinuation with depression was more likely in women (P = 0.0006) and in patients with higher levels of education (P = 0.003). The odds of deciding to discontinue given dementia were three times greater for hemodialysis than peritoneal dialysis patients (P = 0.03). Eighty-three percent of the patients requested that physicians periodically check with them to determine if their advance directives had changed. The authors conclude that advance directives may assist ESRD patients, families, and staff with end-of-life decisions. Three end-of-life decision variables are significantly affected by duration and type of dialysis, previous CPR, gender, and level of education.

Adult↗
PubMedDate not supplied

An approach to clinical acid-base problem solving.

This article demonstrated a systematic approach to acid-base problem solving through the application of the so-called "Rules of Five." This technique was compared with other options for acid-base problem solving, namely, clinicians' use of gestalt or an acid-base map. The superiority of the systematic approach in uncovering triple acid-base disorders was shown.

Acid-Base Imbalance↗