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J Grau

Publications and source records attributed to J Grau.

32 records · Page 2Linked to original sources
PubMed1991

Extracorporeal CO2 removal with hemodialysis (ECBicCO2R): how to make up for the bicarbonate loss?

Hemodialysis is a powerful tool for extracorporeal CO2 removal, because CO2 can be eliminated both as gas and as bicarbonate with blood flow rates as low as 10-15 ml/kg/min. An unsolved problem remains, however: how to make up for the bicarbonate loss. In an animal model we investigated three methods of realkalinisation: a) indirect alkalinisation with salts of organic anions (acetate, lactate, citrate, pyruvate, fumarate, succinate, malate) b) direct realkalinisation with hydroxyl ions (NaOH) c) direct alkalinisation with TRIS as "CO2-buffer". a) The decrease of pulmonary CO2 elimination depended on metabolism: acetate and lactate were metabolized at a rate of 1.8-3.5 mmol/min, thus allowing a steady-state elimination of 40-75 mmol CO2/min (25-40% of CO2 production). The other organic acids were not metabolized sufficiently to achieve a measurable reduction of pulmonary CO2 elimination. CO2 removal was quantitatively the same as during routine acetate hemodialysis and could not be increased using other organic acids. b) NaOH alone, through theoretically the best substitute for NaHCO3, had serious side effects and led to an increase in pulmonary artery pressure. c) with TRIS at a rate of 5 mmol/min, all metabolic CO2 could be removed for up to seven hours without clinical side effects, but not for longer periods. We conclude that a combination treatment for realkalinisation has to be worked out to compensate for the bicarbonate loss.

Acetates↗
PubMed1990

[Pulmonary tuberculosis: effectiveness and tolerance of a 6-month treatment schedule using 4 drugs].

255 patients diagnosed of pulmonary and/or pleural tuberculosis are prospectively studied. All patients received four drugs: isoniazine (INH), rifampin, pirazinamide and ethambutol during the first two months of treatment. Afterwards they continued for four months with two drugs in order to complete the six month treatment period. This schedule has been effective (0.7% of failures) in 99.3% of the patients. Two relapses were detected in the 229 patients who completed the two years follow up. 72 patients (28.2%) presented clinical secondary effects due to the treatment (40 cases of cutaneous affectation, 23 of gastrointestinal intolerance and 8 arthralgias respectively). Also, hyperuricemia was detected in 83% of the patients and a high transaminases level in 42.3%. In 13 patients treatment was cancelled or modified due to the secondary effects. In summary, this schedule of treatment has proved to be effective without an important frequency of serious secondary effects which can be objectively seen in the classical schedules of 9 months with 3 drugs (INH, RF, ET), nevertheless an increased frequency of minor secondary effects were detected.

Adolescent↗
PubMed1989

Septic shock and bacteremia associated with laparoscopic guided liver biopsy, report on two cases.

Two cases of infectious complications after liver biopsy are reported. Klebsiella pneumoniae and beta-hemolytic Streptococcus were cultured. In both cases the biopsy was obtained under laparoscopic control. A 28-year-old woman with liver cirrhosis died 24 hours after liver biopsy as a result of septic shock and disseminated intravascular coagulation. A 67-year-old man with hepatic fibrosis suffered from transient bacteremia and recovered uneventfully after antibiotic therapy. In these patients, there was evidence to implicate pre-existing cholangitis as factor predisposing to postbiopsy bacteremia.

Adult↗
PubMed1978

Open renal biopsy technique: results in 202 patients.

Two hundred five cases of open renal biopsy using a muscle-splitting technique have been performed over the past seven years. Eighty-seven per cent were done under local anesthesia. Tissue for routine histology, immunofluorescence staining and electromicroscopy were obtained in all cases. Morbidity was low, and there were no deaths attributed to the procedure.

Abdominal Muscles↗
PubMedDate not supplied

[Antiganglioside antibodies: when, which and for what].

BACKGROUND: We report our experience in the study of antiganglioside antibodies and define their clinical value establishing associations between clinical syndromes and immunological findings. METHODS: We analysed 275 sera: Guillain-Barré syndrome (GBS) (78), Miller-Fisher syndrome (MFS) (37), chronic inflammatory demyelinating polyneuroapthy (CIDP) (17), multifocal motor neuropathy (NMM) (42), chronic axonal mixed polyneuropathy (PNP) (54), amyotrophic lateral sclerosis (ALS) (28) and lower motor neuron disease (LMND) (17). We have studied the presence of IgG and IgM antibodies to 9 gangliosides using ELISA and TLC. RESULTS: We have detected anti-GQ1b antibodies in 36/37 (97,3%) of patients with MFS, being undetectable after 4 weeks in 83%. A 34 % (26/78) of patients with GBS were positive for several antiganglioside specificities being GalGalNAc the most frequent (54%). Two out of three sera positive for GD1a corresponded to axonal Guillain-Barré. IgM class anti-GM1 antibodies were positive in 10/12 patients with MMN, while only a 3-9% of patients with ALS, CIDP, PNP and LMND presented antiganglioside antibodies. CONCLUSIONS: Analysis of anti-GQ1b antibodies confirms the diagnosis of MFS, excluding other acute brainstem pathologies and, in this study, detection of anti-GD1a antibodies indicates axonal damage in GBS and suggest a worse prognosis. IgM anti-GM1 antibodies are only found in MMN. These findings confirm a disease specific correlation between specific neuropathies and antiganglioside antibodies clinically useful.

Amyotrophic Lateral Sclerosis↗
PubMedDate not supplied

Hemodialysis for extracorporeal bicarbonate/CO2 removal (ECBicCO2R) and apneic oxygenation for respiratory failure in the newborn. Theory and preliminary results in animal experiments.

Extracorporeal techniques for respiratory support in the newborn are feasible, as the growth of neonatal extracorporeal membrane oxygenation (ECMO) has demonstrated. It has been shown, however, that even in severely damaged lungs, sufficient oxygenation and gas exchange can be maintained only by removing CO2 in an extracorporeal circuit, i.e., extracorporeal CO2 removal (ECCO2R). To demonstrate the effectiveness of CO2 removal in a bicarbonate-free hemodialysis procedure, CO2 removal was measured during routine acetate hemodialysis in 22 patients on renal replacement therapy for end-stage renal disease. By comparison of predialyzer and postdialyzer total CO2, an overall CO2 removal of 79.1 +/- 15.1 ml/min was measured in the blood and 77.0 +/- 19.5 ml/min in the dialysate; this was approximately one third of the entire metabolic CO2 production and probably accounted for the secondary hypoxia during acetate hemodialysis. To use bicarbonate-free hemodialysis for total metabolic CO2 removal, acetate dialysate was modified with lactate, phosphate buffer, and sodium hydroxide to compensate for the bicarbonate loss. In sheep, apneic oxygenation could be achieved with blood flow rates as low as 10-15 ml/kg/min for 4-6 hours. These preliminary data suggest that a hemodialysis procedure for bicarbonate and CO2 elimination (ECBicCO2R) could be an efficient method for CO2 removal requiring much lower blood flow rates than techniques presently in use.

Animals↗