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Biomedical subjects

G Woodrow

Publications and source records attributed to G Woodrow.

At least 37 records · Page 2Linked to original sources
PubMed1996

Influence of changes in peritoneal fluid on body-composition measurements by dual-energy X-ray absorptiometry in patients receiving continuous ambulatory peritoneal dialysis.

The effect of the presence of intraabdominal fluid on measurement of body composition by dual-energy X-ray absorptiometry (DXA) was determined by scanning 14 patients who were receiving continuous ambulatory peritoneal dialysis (CAPD) before and after the drainage of peritoneal dialysate, resulting in a mean (+/- SD) weight loss of 1.81 +/- 0.34 kg. DXA showed changes in whole-body soft tissue, which were correctly localized to the trunk region on regional analysis. Changes in DXA estimates of mean total lean tissue, 1.78 +/- 0.94 kg, and trunk lean tissue, 1.87 +/- 0.84 kg, were very similar to the actual change in body weight. However, the DXA estimate of change in total soft tissue, 2.11 +/- 0.44 kg, was significantly greater than the change in body weight by 0.3 kg (P < 0.005); the difference was accounted for by a tendency for a reduction in the estimate of body fat affecting the trunk region after drainage of dialysate. DXA was also less good at detecting changes in individual subjects. Estimates of total and regional bone mineral content and bone mineral density were not affected by the drainage of the dialysis fluid.

Absorptiometry, Photon↗
PubMed1996

Serum hyaluronan concentrations predict survival in patients with chronic renal failure on maintenance haemodialysis.

BACKGROUND: Malnutrition and wasting are common in chronic renal failure and are adverse prognostic features. The underlying mechanisms are complex and not fully understood. Hyaluronan is present in increased concentrations in chronic renal failure and may be associated with adverse features of chronic renal failure. METHODS: We have investigated the relationship of this abnormality to long-term survival. Outcome of 81 patients of median of 5.6 years (3.9-6.8) after measurement of hyaluronan was determined. RESULTS: Survival analysis by the Cox regression model showed that increased concentrations of hyaluronan (P < 0.0001). There was also a weak but significant negative correlation between hyaluronan concentrations and serum albumin concentrations (rs = - 0.27, P = 0.02). CONCLUSIONS: We conclude that serum hyaluronan is a strong independent predictor of long-term survival in CRF may reflect abnormal connective tissue metabolism in this condition.

Adult↗
PubMed1996

Measurement of body composition in chronic renal failure: comparison of skinfold anthropometry and bioelectrical impedance with dual energy X-ray absorptiometry.

OBJECTIVE: To compare the validity of skinfold anthropometry (SFA) and bioelectrical impedance (BIA) for the measurement of body composition in patients with chronic renal failure (CRF). DESIGN: We compared measurement of % total body fat (%TBF) and fat-free mass (FFM) by BIA and SFA, with dual energy X-ray absorptiometry (DEXA) as the criterion method to determine their value in groups of patients with CRF and a group of normal controls. SETTING: Renal Unit, Leeds General Infirmary and Centre for Bone and Body Composition Research, University of Leeds, UK. RESULTS: 95% levels of agreement of BIA and SFA with DEXA (using the method of Bland & Altman) showed considerable variation, which was greater for both techniques in CRF patients than in a normal control group. In normal subjects, BIA derived values for % TBF and FFM showed a closer agreement with DEXA than did SFA (% TBF BIA-DEXA -8.2 to +3.8%; %TBF SFA-DEXA -4.6 to +12.1%; FFM BIA-DEXA -2.5 to +5.8kg; FFM SFA-DEXA -7.9 to +3.8 kg). However, in CRF patients no differences in the 95% levels of agreement were observed for % TBF or FFM derived from BIA or SFA compared with DEXA (%TBF BIA-DEXA -13.7 to +8.3%; %TBF SFA-DEXA -13.0 to +9.4%; FFM BIA-DEXA -5.1 to +9.6 kg; FFM SFA-DEXA -5.6 to +9.1 kg). CONCLUSIONS: In CRF, errors of both BIA and SFA in comparison with DEXA are greater than in normal subjects. The magnitude of the limits of intermethod difference are relatively much greater for measurement of % TBF than FFM for both BIA and SFA in CRF patients and control subjects.

Absorptiometry, Photon↗
PubMed1996

Whole body and regional body composition in patients with chronic renal failure.

BACKGROUND: Nutritional state is a powerful prognostic factor in chronic renal failure (CRF). Techniques for the assessment of nutrition have limitations which are often most marked in the presence of renal disease. We have used techniques of body composition analysis to assess the nutritional state of groups of patients with CRF. METHODS: Body composition was measured in groups of patients with advanced CRF on conservative treatment, peritoneal dialysis, and haemodialysis and the results compared with a healthy control group. The selection criteria for the CRF patients ensured that they were "stable' with no recent intercurrent illness, and dialysis adequacy was satisfactory according to currently accepted targets. RESULTS: Whole body dual energy X-ray absorptiometry (DEXA) found significant reduction in lean tissue in haemodialysis patients and female peritoneal dialysis patients. Regional analysis with DEXA showed reduction in limb (especially arm), lean tissue in CRF patients, with arm lean tissue being reduced in all three CRF groups for females and both dialysis groups for males. Limb/trunk lean tissue ratios were significantly reduced for all CRF groups. Bioelectrical impedance showed reductions of fat-free mass in the same groups who had reduced whole body lean tissue with DEXA, but skinfold anthropometry failed to detect any significant reduction in fat-free mass. CONCLUSIONS: We conclude that even in "healthy' groups of CRF patients receiving adequate dialytic and dietary management, lean tissue depletion is a common problem. Regional analysis by DEXA, with measurement of limb lean tissue mass is a more sensitive method for the detection of lean tissue depletion than measurement of whole body lean tissue in patients with CRF.

Absorptiometry, Photon↗
PubMed1996

Measurement of total body water by bioelectrical impedance in chronic renal failure.

OBJECTIVE: Abnormalities of body hydration are common in patients with advanced chronic renal failure (CRF) and may be associated with important adverse clinical effects, even in the absence of clinical features of fluid retention or depletion. Bioelectrical impedance analysis (BIA) is a simple, non-invasive method of measuring body water content and thus could be of use in the management and study of patients with CRF. This study was performed to assess the ability of BIA to measure total body water (TBW) in patients with CRF. DESIGN: TBW was measured by two different impedance systems, with comparison of the results with TBW determined by deuterium oxide dilution (D2O). SETTING: Renal Unit, Leeds General Infirmary and Centre for Bone and Body Composition Research, University of Leeds, UK. RESULTS: The range of the 95% limits of method agreement between BIA and D2O expressed as a percentage of the mean for the group was +/- 13.4% for the RJL 101A system and +/- 15.6% for the Holtain system in controls. For the whole CRF group the limits were moderately greater than controls at +/- 17.3% (RJL) and +/- 21.9% (Holtain). Analysis of subgroups of the CRF patients showed the smallest limits in those receiving peritoneal dialysis (+/- 15.5% RJL and 18.2% Holtain). Limits were greater for patients on haemodialysis (+/- 16.0% RJL and +/- 23.8% Holtain) and undialysed patients (+/- 20.1% and +/- 23.0%). CONCLUSIONS: BIA is less accurate for the measurement of TBW in patients with CRF than in healthy subjects, though in some groups of patients the effect of CRF on the validity of this technique may be only mild. Abnormalities of reactance suggest that abnormal variability in the distribution of fluid between intra- and extracellular compartments is the major cause of reduced accuracy of TBW calculated by BIA in CRF patients.

Aged↗
PubMed1995

A randomized placebo-controlled study of enalapril in the treatment of erythrocytosis after renal transplantation.

BACKGROUND: Erythrocytosis is a common complication of renal transplantation with an incidence of up to 17%. It is associated with an increased risk of complications due to thromboembolic events and has traditionally been treated by intermittent venesection. More recently, angiotensin-converting enzyme inhibitors have been shown to cause a fall in haematocrit in a number of groups of subjects and some uncontrolled studies have shown these drugs to be of possible therapeutic benefit in post renal transplant erythrocytosis. METHODS: We performed a randomized double-blind placebo-controlled study in 25 patients with post-transplant erythrocytosis. Subjects received either 2.5 mg of enalapril daily or a placebo for 4 months and all patients completed the study period without any serious adverse effects. RESULTS: Haematocrit fell from 52.7 (+/- SEM 0.7) to 47.1 (+/- 1.8) at 1 month and 46.1 (+/- 1.2) after 4 months in patients receiving enalapril, with no change in the placebo group (P = 0.004). We did not demonstrate any change in serum erythropoietin in either group. CONCLUSIONS: Angiotensin-converting enzyme inhibitors are a safe and effective form of treatment for erythrocytosis developing after renal transplantation. The mechanism of action, however, is not mediated by changes in erythropoietin production and remains uncertain.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1995

Renal cell carcinoma presenting as nephrotic syndrome.

A 64-year-old woman presenting with a history of increasing oedema was found to have nephrotic syndrome with a 24-hour urinary protein excretion of 20.7 g and renal impairment with an initial serum creatinine level of 197 mumol/l (2.16 mg/dl). A renal tumour was demonstrated by ultrasound scanning and subsequent nephrectomy revealed a renal carcinoma extending as far as the resected end of the renal vein. Histology of the kidney not involved by the tumour showed normal light microscopic appearances, with electron microscopy demonstrating foot process fusion, suggesting a diagnosis of minimal-change nephropathy. Nephrotic syndrome is a rare complication of renal cell carcinomas, and it is particularly uncommon for minimal change nephropathy to be associated with solid tumours.

Carcinoma, Renal Cell↗
PubMed1995

The clinical and biochemical features of acute renal failure due to rhabdomyolysis.

Rhabdomyolysis caused 28 out of 903 (3.1%) of cases of severe acute renal failure (ARF) treated at Leeds General Infirmary over a 14-year period (1980-1993). The commonest cause of rhabdomyolysis was muscle compression, usually due to drug- or alcohol-induced coma. Other causes included fits, infection, acute limb ischemia, trauma, and heat stroke. Prognosis was relatively good, with a 78.6% survival rate and recovery of renal function to normal in all survivors who were followed up. The creatinine/urea ratio was higher in ARF due to rhabdomyolysis than in an unselected group of patients with other causes of ARF but not when the comparison was with sex- and age-matched controls with ARF. This suggests that this previously described feature of rhabdomyolysis simply reflects the increased muscle mass of a younger group of patients, rather than a specific effect of muscle damage. Clinical features of muscle damage were often absent and so the possibility of rhabdomyolysis should be considered in appropriate settings if the diagnosis is to be made early enough to administer treatment that may prevent ARF and the consequences of the compartment syndrome.

Acute Kidney Injury↗
PubMed1995

Safety, immunogenicity, and pilot efficacy of Plasmodium falciparum sporozoite and asexual blood-stage combination vaccine in Swiss adults.

This study was part of a larger program to develop a vaccine effective against Plasmodium falciparum infection caused by sporozoites and clinical malaria caused by asexual blood stages. In a phase 1 study of safety and immunogenicity, two recombinant proteins (Ro 46-2717, a circumsporozoite [CS] protein) construct with a molecular mass of 35 kD, and Ro 46-2924, a merozoite surface antigen [MSA-2] construct with a molecular mass of 25 kD) adsorbed onto alum were injected in two low (20 micrograms) or two high (100 micrograms) doses in the right and left deltoid muscles of 33 healthy Swiss volunteers; six other volunteers received a placebo (alum alone). Twenty-six participants reported 51 immunization-related adverse events, mainly pain at the injection site. Mean antibody titers to CS protein and MSA-2 in an indirect immunofluorescence assay peaked four weeks after the second immunization without evidence of boosting (i.e., sharp increase in titer). By that time, 56% and 31% of the vaccinees seroconverted to CS protein and MSA-2, respectively, with the increase in MSA-2 titer being weaker than that for the CS protein. After a third immunization, five vaccinees volunteered to be challenged by three or four infective bites of Anopheles stephensi. Prepatent and incubation periods in all five were comparable with unvaccinated historic controls challenged under similar conditions, and all had symptoms of clinical falciparum malaria. We conclude that the vaccine components were safe and immunogenic but there was no evidence that this immunization regimen with the CS protein plus MSA-2 component was able to prevent infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

A unique interhelical insertion in plasminogen activator inhibitor-2 contains three glutamines, Gln83, Gln84, Gln86, essential for transglutaminase-mediated cross-linking.

Plasminogen activator inhibitor type 2 (PAI-2) prevents fibrinolysis by blocking plasminogen activators. It is expressed principally by trophoblast cells and macrophages. PAI-2 in trophoblast membranes has been found cross-linked to large complexes apparently catalyzed by trophoblast transglutaminase (Jensen, P. H., Lorand, L., Ebbesen, P., and Gliemann, J. (1993) Eur. J. Biochem. 214, 141-146). Recombinant human PAI-2 was labeled with [14C]putrescine catalyzed by guinea pig liver transglutaminase. The [14C]putrescine-labeled PAI-2 was digested with cyanogen bromide and trypsin, and the peptides were purified by reverse-phase high performance chromatography. Amino acid sequencing and plasma desorption mass spectrometry of the labeled peptides revealed [14C]putrescine incorporation at Gln83, Gln84, and Gln86. These residues are present in a PAI-2-specific region of 33 amino acids that is inserted between helices C and D and which probably represents a unique solvent-exposed domain. A PAI-2 mutant lacking this insertion was determined not to be a substrate for transglutaminase by [14C]putrescine incorporation and could not form transglutaminase-catalyzed polymers. Thus, the unique PAI-2 insertion represents a functional domain that, by virtue of its transglutaminase acceptor sites, allows participation in binding reactions without affecting the inhibitory function of PAI-2.

Amino Acid Sequence↗
PubMed1994

Acute renal failure in patients with type 1 diabetes mellitus.

Acute renal failure (ARF) is a serious condition which still carries a mortality of around 50%. People with diabetes may be at increased risk of developing ARF, either as a complication of diabetic ketoacidosis or hyperosmolar coma, increased incidence of cardiovascular disease, or due to increased susceptibility of the kidney to adverse effects in the presence of underlying diabetic renal disease. During the period 1956-1992, 1,661 cases of ARF have been treated at Leeds General Infirmary. Of these, we have identified 26 patients also having type 1 diabetes. ARF due to diabetic ketoacidosis is surprisingly uncommon (14 cases out of 23 patients whose notes were reviewed). All cases of ARF complicating ketoacidosis in the last decade have been associated with particularly severe illness requiring intensive care unit support, rather than otherwise 'uncomplicated' ketoacidosis. We discuss the conditions that may result in ARF in patients with diabetes and the particular difficulties that may be encountered in management.

Acute Kidney Injury↗
PubMed1994

Nocturnal intermittent peritoneal dialysis.

Automated methods of peritoneal dialysis have developed as alternative methods of treatment to CAPD. We review our experience of 47 patients treated with nocturnal intermittent peritoneal dialysis (NIPD). Patients receive a nocturnal exchange of 15-25 litres of dialysate with the peritoneum left dry during the day. If biochemical control is inadequate, 1 litre of dialysate is left in during the day. Indications for NIPD included social reasons and CAPD failure due to poor ultrafiltration or problems related to raised intra-abdominal pressure. Some features of biochemical control were less good with NIPD compared with CAPD with higher phosphate (2.18 mmol/l versus 1.83 mmol/l, P < 0.001); creatinine (1256 mumol/l versus 1085 mumol/l, P < 0.001); and potassium (4.92 mmol/l versus 4.64 mmol/l, P = 0.056) in patients changing between CAPD and NIPD. Overall peritonitis rate on NIPD was one episode per 47.1 months compared with a rate of one episode per 17.5 months for patients commencing CAPD over the same period. Conversion from CAPD to NIPD was successful in all six cases for problems related to raised intra-abdominal pressure on CAPD and in six of nine patients transferred due to poor ultrafiltration. NIPD is a useful form of treatment and we believe that the increased cost is offset by the reduced peritonitis rate.

Adult↗
PubMed1993

Asymptomatic acute pyelonephritis as a cause of acute renal failure in the elderly.

Urinary tract infections in the elderly are common, often asymptomatic and usually benign. We report three patients who presented with acute renal failure due to acute pyelonephritis in the absence of clinical findings of infection or urinary tract obstruction. Blood and urine cultures grew Escherichia coli in two of the patients and in two patients renal biopsy confirmed acute pyogenic pyelonephritis. Antimicrobial therapy and haemodialysis led to improvement, though one patient subsequently died from an unrelated cause. We suggest that acute bacterial pyelonephritis should be considered as a cause of acute renal failure in the elderly. Clinical features of infection may be absent despite bacteraemia. Prompt diagnosis and intervention may avoid chronic renal failure in a group that has a less favourable outcome with long-term dialysis.

Acute Disease↗
PubMed1992

Cause of death in acute renal failure.

The cause of 636 deaths during acute renal failure (ARF) occurring between 1956 and 1989 were analysed. Deaths due to haemorrhage and to non-recovery of renal function have declined but cardiovascular deaths and withdrawal of active treatment have increased. The causes of death varied with the clinical situation in which ARF arose. The most important factor contributing to death was the underlying cause of ARF. 67% deaths due to sepsis resulted from infection present at the time of development of ARF. Deaths due to secondary complications have declined, indicating that the precipitating causes of ARF are the main determinant of overall mortality.

Acute Kidney Injury↗