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Biomedical subjects

J B Copley

Publications and source records attributed to J B Copley.

46 records · Page 3Linked to original sources
PubMed1983

Renal failure with minimal change nephrotic syndrome: reversal with hemodialysis.

A patient with acute renal failure accompanying nephrotic syndrome associated with minimal change nephropathy acutely reversed with hemodialysis and ultrafiltration. This response is felt to support the interstitial edema tubular obstruction theory of renal failure occurring with minimal change disease. Acute hemodialysis with significant fluid removal may dramatically reverse severe degrees of azotemia in this condition independent of corticosteroid therapy. The latter, however, may be necessary for remission of the nephrotic syndrome.

Acute Kidney Injury↗
PubMed1983

Thrombocytopenia and low-dose heparin.

We present two cases in which thrombocytopenia developed during low-dose heparin therapy. They seem to represent the spectrum of heparin-associated thrombocytopenia described by Carreras. Because of the increasing use of low-dose heparin for thromboembolism prophylaxis, and because patient reexposure to heparin is not uncommon, the identification of even a modest fall in platelet count in association with heparin therapy is important.

Aged↗
PubMed1983

Nephrotic range pseudoproteinuria in a tolmetin-treated patient.

False-positive proteinuria by acid precipitation testing in tolmetin-treated patients has been noted on routine urinalysis screening. However, the magnitude of such false positivity has not been previously reported. We present a patient with systemic lupus erythematosus who presented with nephrotic range pseudoproteinuria using an acid precipitation method of testing. This misleading laboratory result and alternative methods of testing for proteinuria in tolmetin-treated patients are discussed.

False Positive Reactions↗
PubMed1982

The quality of life of hemodialysis and transplant patients.

This study demonstrates the application of a more comprehensive methodology for evaluating quality of life of hemodialysis and transplant patients and provides some heuristic data. Physiologic and psychologic measures were combined to assess the quality of life of 59 patients treated for endstage renal disease (ESRD). Patients with successful cadaveric transplants gave evidence of greater physical and occupational rehabilitation than patients on chronic hemodialysis. On measures of subjective quality of life, however, successful transplant and hemodialysis patients were similar in reporting normal affect whereas failed transplant patients showed a diminished quality of life. These results suggest that cadaveric transplantation may have limited value as an intervention to improve quality of life for patients with ESRD. Moreover, the results demonstrate the usefulness of questionnaire techniques adapted from psychological research for evaluating the quality of life of patients following medical intervention.

Activities of Daily Living↗
PubMed1982

Failure to recover alpha-hemolytic streptococci or malignancy-associated microorganisms from patients with kidney disease and from healthy humans.

We duplicated blood culture techniques and media used by workers reporting alpha-hemolytic streptococci from nephropathy patients as well as from healthy persons. We studied 33 kidney patients presenting 12 diagnosed kidney diseases. The study was expanded to duplicate the experimental blood culture techniques of workers who reported Bacillus licheniformis and Cryptocides tumefaciens from patients with malignancies and, to a lesser degree, from healthy people. Seven culture media and 21 conditions of growth were used. There were no streptococcal isolates, and the few random isolates of other bacteria indicated that they were contaminants. Thus, our study did not corroborate the previous reports.

Adolescent↗
PubMedDate not supplied

The admission urinalysis: impact on patient care.

Although urinalysis is one of the most frequently ordered tests in primary care, its usefulness in screening has not been demonstrated. A retrospective review of 1,607 admission urinalyses for inpatients in a referral/community hospital identified 861 as clinically indicated and 746 as routine. Routine urinalyses were abnormal less frequently than clinically indicated urinalyses (18.1% vs 39.6%) and when abnormal, were responded to less often (33.3% vs 75.4%). Forty-five (6.0%) of the routine urinalyses yielded an abnormality that led to diagnostic action. Of these, 18 were normal on repeat testing and 17 were considered unlikely to represent significant disease. Therefore, only ten (1.3%) of the routine urinalyses affected patient therapy. In eight of these cases, the abnormality was pyuria, of which six proved to be asymptomatic bacteriuria. The admission urinalysis as a routine test had little impact on patient care in the authors' institution.

Adolescent↗
PubMedDate not supplied

Attending rounds: a survey of physician attitudes.

To determine attitudes regarding attending rounds, the authors surveyed all internal medicine residents and attending physicians at the eight Army teaching hospitals. The response rate was 86%, including 166 (76%) of 217 residents and 246 (93%) of 264 attendings. Of 12 educational activities, attending rounds were ranked seventh by residents in their perceived value. Both residents and attendings favored sessions that lasted 90 minutes or less and were held three to four times per week. Most respondents felt case presentations should take 5 minutes or less and be delivered away from the patient's bedside. On average, residents preferred less time at the bedside than did attendings (25% vs. 34% of attending round time). Residents desired substantial control of the agenda for rounds and also wanted to be responsible for one-third of the teaching. The attending-physician attributes that residents valued most highly were fund of knowledge, availability, and relating well to housestaff. Since residents' and attending physicians' attitudes may differ, expectations regarding attending rounds should be clarified at the beginning of a ward rotation so that mutually acceptable goals can be established.

Adult↗
PubMedDate not supplied

Nontransplant therapy for dialysis-related amyloidosis.

There is no specific treatment for dialysis-related amyloidosis (DRA). Available therapy is directed at removal of large quantities of beta(2)-microglobulin (beta(2)M) and palliation of symptoms. Plasma concentrations of beta(2)M in end-stage renal disease (ESRD) depend on the degree of residual renal function, the type of blood purification therapy, and properties of the dialysis filtration membrane. Retention of beta(2)M appears to be a necessary, although not sufficient, condition for DRA. While preserving residual renal function is important, dialysis modality largely determines beta(2)M removal. Convective dialysis treatments (hemofiltration and hemodiafiltration) remove beta(2)M more efficiently than diffusive treatments (conventional dialysis). In addition, column adsorption of beta(2)M can extensively remove the molecule, as can nocturnal hemodialysis. Hemodialysis membrane properties that are particularly important with regard to beta(2)M removal include permeability, adsorptive capacity, and biocompatibility. As such, beta(2)M removal with highly permeable biocompatible membranes such as polysulfone and polyacrylonitrile is relatively large. Several studies have suggested that use of such membranes can significantly delay DRA development and may be useful in ameliorating DRA-associated symptoms. Non-dialysis-related therapy for DRA is palliative and includes both medical and surgical therapies. Medical therapy includes low-dose corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical therapy consists of relief of carpal tunnel syndrome, or palliation of shoulder pain, destroyed weight-bearing joints, or spinal cord compression. DRA is a serious complication of long-term dialysis. It is important for nephrologists to recognize the condition and attempt to slow its progression.

Amyloidosis↗
PubMedDate not supplied

Prospective comparison of peritoneoscopic and surgical implantation of CAPD catheters.

Prospectively collected data were analyzed comparing surgically and peritoneoscopically placed peritoneal dialysis catheters in 88 patients. Peritoneoscopically placed catheters were found to survive longer than surgically placed ones. Rates of exit site infection and pericatheter leaks were found to be similar with both techniques.

Adult↗