[Pneumococcal vaccination following transplantation].
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Biomedical subjects
Publications and source records attributed to J B Siegmund.
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This study compares three different pacing system analyzers, which measure impedance at different points during an impulse, with measurements telemetered from implanted pacemakers from four different manufacturers. Measurements were obtained at the time of implantation in a group of 103 patients. The measurements obtained by these different methods differ significantly from each other; the later during the impulse the impedance is measured, the higher in general its value. Interpretation of impedance values should take into account the technique of measurement.
UNLABELLED: Toxic phytanic acid concentrations in patients with Refsum's disease can be reduced by plasma separation, performed either as plasmapheresis, or as cascade filtration. The latter procedure is as efficient and safe as plasmapheresis, and eliminates the need for albumin replacement. This study investigates the loss of immunoglobulins associated with the procedure. MATERIAL AND METHODS: Immunoglobulin- and phytanic acid serum concentrations before and after cascade filtration (n = 16) were measured in a patient with Refsum's disease and their removal determined. Filters with sieving coefficients for immunoglobulin G of 70% and 30% were compared with each other and with historical data on plasmapheresis. RESULTS: While differences in immunoglobulin M loss are negligible, the loss of immunoglobulin G in cascade filtration is significantly less than that reported for plasmapheresis and depends upon the pore size of the employed filters. The loss is least with larger pore size, but this advantage becomes statistically insignificant if immunoglobulin G loss is related to the lesser decrease in phytanic acid concentration that was achieved simultaneously in this study. CONCLUSION: Unless transplantation of a-hydroxylase containing tissue can be established as treatment for Refsum's disease, cascade filtration appears to be the treatment of choice in order to avoid loss of albumin and to reduce the loss of immunoglobulin G.
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When a pacemaker is implanted, several electrophysiological parameters are measured using pacing system analyzers (PSA). Different PSAs may use different filter settings and measuring techniques when compared to the implanted pacemaker. In order to determine if there were significant differences in measurements obtained with different PSAs, we obtained measurements in a group of 99 patients with three different PSAs and a manual method. The results show that with each of the three different PSAs tested, different amplitudes of intracardiac electrograms are obtained and that they are usually higher than those obtained by manual measurement of recorded electrograms. Despite significant differences, however, all methods correlate well with each other. Following common practice of pacemaker programming, the use of a PSA for the implantation of a pacemaker that uses different sensing technique does not lead to clinical complications.
We report a case of lidocaine toxicity with seizures that appears to represent a drug interaction with amiodarone. A toxic lidocaine level and reduced lidocaine clearance were documented 65 h after amiodarone was added to the treatment regimen. This is the first report of increased levels and serious clinical toxicity of lidocaine due to amiodarone. The mechanism appears to be altered hepatic metabolism of lidocaine caused by amiodarone.
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