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Biomedical subjects

J Cunningham

Publications and source records attributed to J Cunningham.

At least 55 records · Page 3Linked to original sources
PubMed1988

Aluminium chelation therapy in dialysis patients: evidence for inhibition of haemoglobin synthesis by low levels of aluminium.

To investigate the possibility that aluminium may exacerbate anaemia in dialysis patients with only modest aluminium accumulation, 15 patients whose exposure to aluminium had been low were treated for three months with the aluminium chelating agent desferrioxamine, 30 mg/kg intravenously at the end of each dialysis session. Serum aluminium concentrations before treatment were 5-125 micrograms/ml. After one month of desferrioxamine, serum aluminium (including the chelate) had risen from 54.6 (SEM 11.2) to 167.0 (27.5) micrograms/l; and after three months haemoglobin had risen from 8.46 (0.70) to 10.43 (0.80) g/l. Mean cell volume and mean cell haemoglobin concentration also increased significantly. The maximum rise in haemoglobin correlated with the patients' aluminium burden as estimated by the mean serum aluminium concentration after one month of desferrioxamine therapy (r = 0.85). The greatest response to desferrioxamine occurred in patients with a baseline serum aluminium of 15-75 micrograms/l (mean increase in haemoglobin 38%). The results indicate that even the modest aluminium accumulation found in most dialysis patients has a pronounced inhibitory effect on haemoglobin synthesis. The possible toxic effect of aluminium should be considered in all anaemic dialysis patients.

Adult↗
PubMed1988

Use of mass spectrometry in the identification of in vivo and in vitro metabolites of dihydrotachysterol3 in the rat.

The metabolism of dihydrotachysterol3 (DHT3), a vitamin D analogue, has been investigated in vivo in the rat after intraperitoneal injection, and the metabolism of the 25-hydroxylated metabolite of DHT3 was studied in vitro in the isolated perfused rat kidney. A large number of metabolites have been obtained and some have been identified. The rat plasma or kidney perfusate were extracted and the metabolites separated by high-performance liquid chromatography (HPLC) in straight- and reverse-phase systems and using cyano columns. Metabolites were identified, using a photodiode array assembly which monitored the HPLC eluate, by the characteristic ultraviolet spectrum of DHT compounds. Tentative structures were assigned to some of the metabolites obtained on the basis of their mobility in the various HPLC systems used in comparison to that of known metabolites of vitamin D. Gas chromatography/mass spectrometry (GC/MS) and direct probe mass spectrometry have been used to confirm the identity of seven metabolites formed in vitro, of which only two have been definitely shown also to be formed in vivo. GC/MS was carried out after derivatization forming trimethylsilyl ethers, n-butyl boronate cyclic esters, and N-O-methyl oximes before and after oxidation with sodium periodate and/or reduction with sodium borohydride. Molecular ions of these compounds are usually of low abundance and characteristic mass fragments at m/z 273, 255 and 121 are always seen with metabolites of DHT.

Animals↗
PubMed1988

Biliopleural fistula as a complication of percutaneous biliary drainage: experimental evidence for pleural inflammation.

We describe 3 patients in whom biliopleural fistulae complicated percutaneous biliary drainage. All patients had complete obstruction of their biliary tree because of malignancy. Biliopleural fistulae developed as a complication of inadvertent catheter removal in 2 patients and of catheter dysfunction in the third. Early reinstitution of biliary drainage and successful drainage of the pleural space led to complete recovery in all patients. An animal model to evaluate the effects of bile in the pleural space in normal rabbits revealed rapid absorption of bilirubin, the production of a polymorphonuclear-predominant exudative effusion with extremely high LDH levels, and resolution with a macrophage influx. We conclude that biliopleural fistulae are heterogeneous in their presentation, depending upon the persistence of biliary drainage into the pleural space, the volume of exudative effusion, and the presence of suppurative complications.

Aged↗
PubMed1987

Serum aluminum levels and erythrocyte dihydropteridine reductase activity in patients on hemodialysis.

Aluminum intoxication due to aluminum-containing antacids or dialysate can cause encephalopathy in patients undergoing hemodialysis, but the biochemical mechanism has not been defined. The enzyme dihydropteridine reductase (DHPR) is essential for the maintenance of normal brain concentrations of tetrahydrobiopterin, which is itself required for the synthesis of specific neurotransmitters. This enzyme is also present in erythrocytes. We measured erythrocyte DHPR activity and concentrations of the biopterin derivatives of its substrate and of aluminum in 38 patients on hemodialysis who had no clinical evidence of encephalopathy. Serum aluminum levels ranged from 15 to 190 micrograms per liter (mean, 67.6 +/- 7.7) as compared with 4.9 +/- 0.99 micrograms per liter in normal subjects. DHPR activity was inversely related to the serum aluminum concentration (r = -0.61, P less than 0.001) and was less than the activity predicted from the hemoglobin concentration in these patients. Serum concentrations of biopterin derivatives were markedly elevated. Eighteen patients were given the aluminum-chelating agent deferoxamine in a single dose, after which DHPR activity doubled. These studies suggest that aluminum inhibits DHPR activity in erythrocytes and that aluminum chelation reverses this effect. Although we did not directly measure DHPR activity in the brains of dialysis patients without encephalopathy, we propose that the reduction in activity in erythrocytes may reflect a similar reduction in the brain. Our findings could help to explain the encephalopathy associated with aluminum intoxication.

Adult↗
PubMed1987

Effect of dietary acid and calcium on 25-hydroxyvitamin D metabolism by chick kidney.

Studies of the effects of acidosis and dietary calcium on 25-hydroxyvitamin D3 (25OHD3) metabolism were conducted utilizing assays of mitochondrial 1-hydroxylase and 24-hydroxylase activity following 96 hours of acid loading. The results showed decreased 1-hydroxylase (206 +/- 6 vs. 132 +/- 22 fmol min-1 mg/mitochondrial protein-1, p less than 0.01), augmented 24-hydroxylase (48 +/- 14 vs. 180 +/- 30 fmol min-1 mg-1, p less than 0.001) and increments in plasma calcium and phosphate following acidosis. High calcium diet also increased 24-hydroxylase activity (48 +/- 14 vs. 160 +/- 24 fmol min-1 mg-1, p less than 0.001) and plasma calcium, but decreased plasma phosphate. The extramitochondrial concentrations of calcium, potassium, and phosphate which maximally stimulated the hydroxylases in vitro were not altered by the in vivo dietary perturbations. The increments in 1-hydroxylase and 24-hydroxylase resulting from the presence of calcium, potassium, or phosphate in optimal concentrations (10(-5) M, 100 mM, and 100 mM, respectively) were changed by both acid loading and high calcium diet, decreasing in the case of 1-hydroxylase and increasing in that of 24-hydroxylase. The data indicate that the suppression of 1-hydroxylase and augmentation of 24-hydroxylase following these dietary perturbations may depend on both changed total enzyme capacity and altered enzyme sensitivity to extramitochondrial ions and are consistent with mediation by calcium of the effects of acidosis.

Acidosis↗
PubMed1987

Simulated acidosis does not impair 1,25-dihydroxyvitamin D3 production by cultured kidney cells.

Cultured mouse kidney cells grown in serum-free medium were used to assess the metabolism of 25-hydroxyvitamin D3 in the presence of simulated metabolic acidosis. Kidney epithelial cells isolated from 4-6 week old mice were grown to confluence in a defined serum-free medium at pH 7.4. The confluent monolayers were incubated with tritiated 25-hydroxyvitamin D3 for 6 hours, the samples were extracted, and vitamin D metabolites were separated and quantitated by high pressure liquid chromatography (HPLC). The pH of the incubation medium was set at 6.9, 7.1, 7.4, or 7.7 by adjusting the bicarbonate concentration, using chloride as the balancing anion at constant Pco2. When pH was altered at the beginning of the 6 hour assay, production of 1,25-dihydroxyvitamin D3 was the same at each pH. More prolonged pH perturbation for a total of 30 hours likewise had no influence on 1,25-dihydroxyvitamin D3 production. These results confirm that intact mammalian kidney cells in serum-free culture possess an active 25-hydroxyvitamin D3-1-hydroxylase and that the activity of the enzyme is unaffected by pH over the range 6.8-7.7. In experiments where acidosis has been shown to alter 1,25-dihydroxyvitamin D3 production, the mechanism was probably indirect.

25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗
PubMed1987

Residual renal function in hemodialysis patients may protect against hyperaluminemia.

We investigated 106 home hemodialysis patients whose mean [+/- SEM] serum aluminum (Al) concentration was 60.9 +/- 4.1 micrograms/liter. Serum Al concentration was inversely related to daily urine output (r = -0.52, P less than 0.001). Urine volume and measurements of Al exposure were included in a multivariate analysis of serum Al concentration in the 62 patients whose urine output was greater than 10 ml/day. The multiple correlation coefficient (r) was 0.70 (P less than 0.001) and the percentage contributions to r2 (indicating the relative importance of each factor) were: urine output 57%, oral Al intake 36%, total dialysis hours 7%. The additional contribution from cumulative water Al was negligible. In a subgroup of 26 patients with a urine output exceeding 10 ml/day, urinary Al excretion averaged 15.4 micrograms/day, and renal Al clearance and serum Al concentration were inversely related (r = -0.69, P less than 0.001). We conclude that Al-containing phosphate binders were a more important source of Al than was dialysate in these patients and that residual renal function can reduce the severity of hyperaluminemia in hemodialysis patients.

Adult↗
PubMed1987

Silicone-induced hypercalcaemia in haemodialysis patients.

Silicone spallation from the roller-pump insert in dialysis blood lines leads to the accumulation of silicone in haemodialysis patients, which in turn leads to a foreign-body reaction with granuloma formation. We have studied two patients in whom documented silicone accumulation has been associated with both granuloma formation and significant, persistent hypercalcaemia. In both patients plasma levels of immunoreactive parathyroid hormone and 1,25-dihydroxyvitamin D were low or undetectable. In one patient, hypercalcaemia responded only partially to corticosteroids, but completely to naproxen. Both patients were changed to silicone-free blood lines and their hypercalcaemia subsequently resolved. The results indicate that in some haemodialysis patients, silicone accumulation and granuloma formation may lead to hypercalcaemia that is independent of 1,25-dihydroxyvitamin D, and that may instead reflect altered prostaglandin metabolism.

Adult↗
PubMed1986

Effects of packed cell volume reduction on renal haemodynamics and the renin-angiotensin-aldosterone system in patients with secondary polycythaemia and hypoxic cor pulmonale.

Polycythaemia was corrected by erythrapheresis in ten patients with hypoxic cor pulmonale who were stable on regular diuretic therapy. Renal haemodynamics, renal function and the renin-angiotensin-aldosterone system were assessed before and afterwards. Before erythrapheresis effective renal plasma flow (ERPF) was reduced (63% predicted) but glomerular filtration rate (GFR) was preserved (88% predicted) by a rise in filtration fraction (FF) (138% predicted). A negative correlation existed between ERPF and packed cell volume (r = -0.723; P less than 0.02) and also between ERPF and PaCO2 (r = -0.710; P less than 0.05). Polycythaemia was sufficient to maintain renal oxygen delivery (97% predicted). After erythrapheresis systemic blood pressure, blood volume and blood viscosity all decreased. ERPF increased by 18% (P less than 0.02). FF fell by 11% (P less than 0.05) and GFR was unchanged. Renal oxygen delivery diminished by 25% (P less than 0.001). Plasma renin activity was increased in five patients and plasma aldosterone increased in two patients before erythrapheresis. No sustained fall occurred in plasma renin activity or plasma aldosterone, possibly because the haemodynamic consequences of the procedure had opposing actions on renin secretion. Although the reduction in FF would per se tend to enhance renal sodium and water excretion, a diuresis or natriuresis did not occur consistently.

Aged↗
PubMed1986

Biliary decompression: an institutional comparison of percutaneous and endoscopic methods.

Endoscopically performed biliary drainage (EPBD) is now an alternative to percutaneous biliary drainage. The morbidity, mortality, and survival statistics of 97 patients with obstructive jaundice who had undergone percutaneous transhepatic biliary drainage (PTBD) and surgery, PTBD alone, EPBD and surgery, or EPBD alone were compared. Overall, the EPBD group had fewer complications and lower mortality than the other groups. When palliative treatment of patients with malignancies was compared, the complication rates associated with EPBD and PTBD were similar; however, mortality was lower with EPBD. No negative effect on survival was found with EPBD. In addition, EPBD offered several additional advantages over PTBD, including fewer bleeding complications, better patient acceptance, and avoidance of external catheter care. EPBD should be considered as a viable alternative to PTBD. Additional studies are needed to determine whether it is to be considered the initial drainage procedure of choice in patients with obstructive jaundice.

Bile Ducts↗
PubMed1986

Partial characterization of the Purkinje cell antigens in paraneoplastic cerebellar degeneration.

Serum from seven patients with paraneoplastic cerebellar degeneration contained anti-Purkinje cell antibodies. The samples were examined by immunoblotting to determine whether they recognized common antigens in isolated human Purkinje cell neurons. Two groups of antigens were detected by all seven sera with Mr 62/64 kd and 34 to 38 kd, both of which contributed to the Purkinje cell antigens detected immunohistochemically. These reactivities were absent from all controls tested. These antibodies may play a role in the pathogenesis of paraneoplastic cerebellar degeneration.

Antibodies↗
PubMed1985

Stimulated release of endogenous GABA and glycine from the goldfish retina.

The release of endogenous gamma-aminobutyric acid (GABA) and glycine from the isolated goldfish retina, measured by high-pressure liquid chromatography (HPLC), was Ca2+-independent when evoked by L-glutamate or L-aspartate and partially Ca2+-dependent when evoked by 50 mM K+. D-Aspartate potentiated GABA and glycine release evoked by L-glutamate and inhibited that evoked by L-aspartate. These data are similar to those reported for radiolabeled GABA and glycine. However, the relative amount released compared to the total amino acid content in the retina was much less (10%) for the endogenous compounds. We suggest that results obtained with [3H]GABA and [3H]glycine can be generalized in a qualitative manner to their endogenous counterparts in goldfish retina.

Animals↗