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Biomedical subjects

J L Vanherweghem

Publications and source records attributed to J L Vanherweghem.

At least 73 records · Page 4Linked to original sources
PubMed1989

Increased serum levels of endopeptidase 24.11 ('enkephalinase') in patients with end-stage renal failure.

Endopeptidase 24.11, a widely distributed membrane-bound peptidase is found in low levels in the serum of normal individuals. Although increased levels of the enzyme have been found in sera of patients with sarcoidosis and adult respiratory distress syndrome, the cellular origin of circulating endopeptidase 24.11 remains unknown. As the brush border of the proximal tubular epithelial cells have the highest endopeptidase specific activity, we investigated the possible contribution of the kidney to the release of endopeptidase 24.11 in the systemic circulation. Therefore, we measured serum levels of the enzyme in patients with end-stage renal failure (ESRF) treated by haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Increased serum levels of endopeptidase 24.11 were observed both in HD patients (mean +/- SEM: 74.6 +/- 20.9 ng/ml) and in CAPD patients (mean +/- SEM: 45.1 +/- 8.1 ng/ml) as compared to normal individuals (mean +/- SEM: 13.6 +/- 1.4 ng/ml). Endopeptidase levels remain stable during haemodialysis sessions on two different dialysis membranes. Finally, serum levels of the enzyme in anephric patients tend to be lower than in ESRF patients, suggesting that the kidney may contribute to the generation of the circulating form of endopeptidase 24.11.

Humans↗
PubMed1989

Central venous access for haemodialysis using the Hickman catheter.

One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device.

Catheterization, Central Venous↗
PubMed1989

Adsorption of beta 2-microglobulin on dialysis membranes: comparison of different dialyzers and effects of reuse procedures.

In order to measure beta 2-microglobulin adsorption on dialysis membranes, uremic plasma was passed through different dialyzers in a simulated hemodialysis circuit in which both plasma and dialysate compartments were organized as closed loops, the ultrafiltration pressure being adjusted to minimize water shifts. Under these conditions, comparison of the amounts of beta 2-m in the plasma and dialysate compartments allowed us to calculate the binding of beta 2-m to the membrane at different times of the procedure. Whereas cuprophane membrane (Gambro gf 180m, 1.8m2) did not bind beta 2-m, AN69 (Filtral, 1.1 m2), high flux polysulfone (F60, 1.2m2) and modified polyamide (Polyflux 130, Gambro, 1.3m2) were found to adsorb 49 +/- 8 mg (mean +/- SEM), 17 +/- 5 mg and 38 +/- 4 mg of beta 2-m, respectively. These data were confirmed in trace labeling experiments with 125I-beta 2-m. Adsorption was a saturable phenomenon occurring during the first 90 min of in vitro dialysis. After reuse with peracetic acid, the adsorption capacity of AN69 membrane was lowered to 20 +/- 4 mg of beta 2-m, contrasting with the unchanged adsorption after reuse with sodium hypochlorite. These data indicate that adsorption significantly contributes to beta 2-m removal during hemodialysis with certain dialyzers and that reuse procedures may affect the propensity of dialysis membranes to bind beta 2-m.

Adsorption↗
PubMed1989

Red blood cell destruction in single-needle dialysis.

A high incidence of hemolytic episodes has been documented by increased lacticodeshydrogenase levels after dialysis. When symptomatic, these episodes presented frequently with nausea and abdominal or back pain occurring typically in the last hour of the dialysis session. A prospective study, comparing two different access devices (needle and catheter) and three double-pump systems, demonstrated the critical role of the access device configuration. In addition, the neccessity to monitor the pressures in the arterial and venous lines when working with high blood flow rates is also stressed. By comparison, red blood cell destruction is negligible in conventional double-needle dialysis.

Adult↗
PubMed1988

Effects of chronic renal failure and hemodialysis on hormonal evaluation of pregnancy.

Different hormonal parameters are studied in a pregnant woman with chronic renal failure undergoing hemodialysis. Serum concentrations of human chorionic gonadotropin, progesterone, 17-hydroxyprogesterone, alpha-fetoprotein, human placental lactogen were all higher than the normal range. This is probably related to a decreased metabolic clearance rate of these hormones. Dehydroepiandrosterone sulfate (DHEAS), which is low before pregnancy and during the first week of gestation, tends to increase later. Serum estradiol is lower than the normal range. This decrease probably results from the low concentration of DHEAS available to placental aromatization. Finally, pregnancy-specific beta 1-glycoprotein concentration follows the normal range and may be considered as the most reliable parameters to evaluate the fetoplacental well-being in these high-risk pregnancies.

Adult↗
PubMed1987

Clinical significance of blood-device interaction in hemodialysis. A review.

The syndrome of dialysis-associated leukopenia and complement activation by cellulosic membranes, including the so-called "first use syndrome", is reviewed and the pathophysiology of these phenomena is discussed. Subsequently the clinical side effects of hemodialysis, including dialysis-associated hypoxemia, are discussed. The hypoxemia, according to the authors, is mainly related to the loss of carbon dioxide through the dialyser. A minor role may be played by complement activation causing temporary sequestration of leukocytes in the pulmonary capillaries with (asymptomatic) peripheral leukopenia on the one hand and plugging of the pulmonary capillary bed with transient pulmonary hypertension and hypoxemia on the other. The question of dialysis-associated eosinophilia and ethylene oxide hypersensitivity is addressed as also contributing to the first use syndrome. The effects of interleukin release from monocytes and of contamination of the dialysis fluid are briefly discussed. The rare syndrome of silicone rubber spallation with hepato-and splenomegaly is also mentioned and finally the pathogenesis and symptomatology of the beta 2 microglobulin amyloidosis syndrome in long-term dialysis patients is presented.

Hematologic Diseases↗
PubMed1986

Markers of HTLV-III in patients with end stage renal failure treated by haemodialysis.

Patients and members of staff from a haemodialysis unit were tested for markers of infection with human T cell lymphotropic virus type III (HTLV-III), the virus associated with the acquired immune deficiency syndrome (AIDS). An enzyme linked immunosorbent assay showed eight of 100 patients to have antibodies to HTLV-III. In five of these patients past or present infection with HTLV-III was confirmed by Western blot analysis or detection of HTLV-III antigens in lymphocyte cultures, or both. Investigation of other risk factors for AIDS showed that the putative source of HTLV-III was unrelated to dialysis in two patients whereas blood transfusion was the most likely cause of contamination in the others. No member of staff gave a positive result in the enzyme linked immunosorbent assay. Nosocomial transmission of HTLV-III seems unlikely if precautions similar to those recommended for the control of hepatitis B infection are applied.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Complications related to subclavian catheters for hemodialysis. Report and review.

Personal experience with subclavian vein cannulations for hemodialysis are given, and the pertinent literature on the subject is reviewed. Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Immediate complications were two pneumothoraxes and two hemothoraxes due to subclavian artery puncture. Seventeen cases of bacteremia were related to subclavian catheter infections. In 1 case, a complication of sepsis was a vertebral osteomyelitis. Clinical evidences of subclavian vein thrombosis occurred in 5 cases. Life-threatening complications were met in 2 cases: 1 with pericardial tamponade due to right atrium perforation and 1 with mediastinal hematoma and right hemothorax due to superior vena cava perforation. Review of the literature indicates that pneumothoraxes and/or hemothoraxes occurred in 1.7% of the catheter insertions and that sepsis related to subclavian dialysis catheters occurred in 8.9% of the patients. As systematically investigated subclavian vein thrombosis involved at least 50% of the patients. Our 2 personal cases of life-threatening complications and 14 similar cases of the literature were analyzed: left subclavian catheters were associated with superior vena cava perforation with right hemothorax or mediastinal hematoma, while right subclavian catheters gave atrial perforation with pericardial tamponade. Death occurred in 3 of 16 cases, and emergency surgery was required in 5 of 16 cases. Taking into account all these complications, recommendations are made for the use of subclavian dialysis catheters.

Adult↗
PubMed1986

Infections associated with subclavian dialysis catheters: the key role of nurse training.

Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Catheterization time ranged from 1 to 79 days with an average of 14.0 +/- 1.0 days per catheter and 18.9 +/- 1.0 days per patient. Twenty nine catheters were infected, 17 of which were the source of bacteremias due to Staphylococcus epidermidis in 13 cases and to Staphylococcus aureus in 4 cases. The incidence of sepsis was not significantly greater in diabetic patients, in patients with corticotherapy or in patients presenting an underlying systemic disease. On the contrary, the incidence was greater in hospitalized patients (15 bacteremias during 1,948 catheter days) than in ambulatory patients (2 bacteremias during 850 catheters-days) as well as during a period corresponding to a greater number of untrained nurses enrolled in the dialysis team. During this period, 6 sepsies occurred in 19 catheters (other periods: 7 sepsies/116 catheters, p less than 0.01). 6 of 28 nurses had less than 3 months of professional experience (other periods: 1 of 25, p less than 0.01). These data underline the key role of nurse training in the prevention of catheter-related infections.

Catheters, Indwelling↗