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Biomedical subjects

J L Vanherweghem

Publications and source records attributed to J L Vanherweghem.

At least 91 records · Page 5Linked to original sources
PubMed1986

Pellagra: unusual cause of paranoid delirium in dialysis.

A 60-year-old woman treated by maintenance haemodialysis refused to take part of the usual vitamin supplements for many years. After an intercurrent illness with profound malnutrition, she developed a paranoid delirium and some behavioural disorders; concomitant diarrhoea and a skin rash were noted. Parenteral nicotinamide (500 mg/day) resulted in a complete recovery from the mental disorders after five days. Other causes of mental disturbance as a result of dialysis could be ruled out. However an asymptomatic underlying hypothyroidism may have been one of the conditioning factors as well as the failure to administer nicotinamide supplements during an acute illness. Neurological pellagra could thus be considered as a rare but reversible cause of mental disorders in patients on maintenance haemodialysis.

Delirium↗
PubMed1986

Impairment of phagocyte oxidative metabolism in hemodialyzed patients with iron overload.

In order to study the influence of iron overload on the polymorphonuclear leucocyte (PMN) metabolism of patients on chronic hemodialysis, generation of superoxide anion (O2-) by PMN in whole blood was compared in two groups of hemodialyzed patients: group A consisted of twenty-one individuals with serum ferritin levels above 1000 ng/ml and group B of nineteen individuals with serum ferritin levels below 1000 ng/ml. Whereas basal production of O2- was similar in the two groups (6.3 +/- 4.6 vs 11.5 +/- 8.3 nmoles O2- 10(6) granulocytes-1 15 min-1) (mean +/- s.e.m.), PMN response to opsonized zymosan was significantly lower in group A as compared with group B (86.5 +/- 6.3 vs 120.4 +/- 8.2 nmoles O2- 10(6) granulocytes-1 15 min-1) (p less than 0.01). Superoxide anion generation induced by the dialysis procedure was reduced in eight patients from group A (89.2 +/- 32.1) as compared with eight patients from group B (374.3 +/- 100.0 nmoles O2- 10(6) granulocytes-1 15 min-1) (p less than 0.05). These data suggest that iron overload may be involved in the impairment of neutrophil phagocytosis in patients on chronic hemodialysis.

Blood Transfusion↗
PubMed1986

Analgesic nephropathy: an underestimated cause of end-stage renal disease.

Addiction and abuse of antipyretic analgesics has been recognized early after the turn of this century. The incidence markedly increased and the syndrome spread over many countries in the first half of the 20th century. The syndrome and its pathology, consisting of renal papillary necrosis and tubulo-interstitial nephritis, was first described in the medical literature in the early 1950's in Switzerland by Spühler and Zollinger, who rightly suspected chronic analgesic (Saridon) intoxication as being the cause in their cases. Clinically the disease is characterized by slowly progressive renal failure with renal colics from passage of necrotic papillae. Death from uremia is common unless dialyzed. The disease has been particularly prevalent in certain areas of Australia, Belgium, Western Germany, in Switzerland and some other countries. The nephrotoxic agents are mixtures of salicylates (aspirin) with phenacetin or acetaminophen. The principal nephrotoxic compound is probably aspirin--the aminophenol derivatives increasing its nephrotoxicity. However, all these components alone may cause--exceptionally--the syndrome. Rarely some newer, nonsteroid analgesics (NSAID's) can also be nephrotoxic. Phenacetin has--in particular in compound mixtures--mood-altering (euphoric) properties, giving rise to craving, addiction and chronic abuse. Addiction has been greatly facilitated by the over-the-counter availability of these cheap analgesic mixtures. Mass addiction--and abuse--may occur in all kinds of communities, in factories or families because of the euphoric effect, taking away fatigue and weariness and increasing productivity. There is a relation between the per capita consumption of antipyretic analgesics and analgesic nephropathy in several countries and in certain districts. The pattern of sales and mass consumption (and the incidence of nephropathy) is substantially promoted by the local presence of production facilities, usually accompanied by vigorous sales and advertising policies. Individual addiction usually occurs in psychoneurotic females often with social and marital problems and mental instability, often with long histories of headaches, backpains, and other, often psychogenic disorders. Analgesic nephropathy is often complicated by anemia, peptic ulcer, premature aging and atherosclerosis and in 8-10% by uro-epithelial carcinoma (the so called analgesic syndrome). The diagnosis depends largely on the history of chronic abuse of analgesics, which is often doggedly denied, hampering the diagnosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Analgesics↗
PubMed1986

Can a diagnosis be made in retrospect? The case of Desiderius Erasmus.

Review of data in very old charts sometimes brings new insights and perspectives, and suggests new hypothesis for illnesses of patients long deceased. Such applications can be made if enough information is available, e.g., autobiographical letters, skeletal remains, pictorial representations. Finally the process must be discussed in the context of the major disease processes occurring at that time. When such an approach was applied to Erasmus (Rotterdam c 1466--Basle 1536), the differential diagnosis included gout, syphilitic arthritis and enteric rheumatism.

Arthritis↗
PubMed1986

Subclavian vein thrombosis: a frequent complication of subclavian vein cannulation for hemodialysis.

Subclavian vein cannulation was suggested as a temporary vascular access for hemodialysis since one of its advantages was considered to be no damage to blood vessels. As we observed six patients with symptomatic subclavian vein thrombosis among 148 patients having received subclavian vein cannulation for hemodialysis, we systematically performed subclavian venogram in 42 asymptomatic patients selected on the basis of a history of previous subclavian vein cannulation. Venograms were performed 15.7 +/- 8.9 months after the removal of the last catheter. Eight patients (19%) had complete thrombosis or severe stenosis of the subclavian vein while six patients (14%) had minimal luminal defects. Considering together the 48 patients, the group with thrombosis or severe stenosis (group 1, n = 14) was compared with the group with minimal defects or normal venograms (group 2, n = 34). In group 1, as compared with group 2, there were more female (64% vs 32%, p = 0.02), more cannulations per vein (1.87 +/- 0.35 vs 1.32 +/- 0.08, p less than 0.05) and more cumulative days of cannulation per vein (35.1 +/- 7.9 vs 24.4 +/- 1.1, p less than 0.001). No difference between the two groups was seen for the number of catheter infections, the number of catheters with poor flow or obstruction, the coagulation screening of the patients or the time-length between the removal of the last catheter and the venogram study. Two of the initially asymptomatic patients developed later on clinical problems related to the subclavian vein thrombosis. We conclude that the subclavian vein cannulation leads to significant damages of the vessels, excluding a whole arm, for future vascular access in some patients.

Catheterization↗
PubMed1985

Impaired phagocytic activity of neutrophils in patients receiving haemodialysis: the critical role of iron overload.

The metabolic burst (as measured by the spontaneous and stimulated nitroblue tetrazolium tests), the phagocytosis of heat inactivated bakers' yeast and of Staphylococcus aureus, the killing of Staph aureus, and the myeloperoxidase activity of polymorphonuclear neutrophils were studied in 11 patients receiving maintenance haemodialysis. Of these patients, six were polytransfused and had high serum ferritin concentrations (mean 5940 (SD 2925) micrograms/l; group 1), and five had normal serum ferritin values (mean 171 (116) micrograms/l; group 2). Patients in group 1 had a history of more infectious episodes (0.167 v 0.025 per patient per month) and significantly more genitourinary infections (p = 0.015) than those in group 2. Phagocytosis and myeloperoxidase activity were severely reduced in group 1 but normal in group 2. Percentages of neutrophils ingesting one or more particles together with the index of phagocytosis in patients' serum were inversely correlated with serum ferritin concentrations. Four patients in group 1 were treated with desferrioxamine, and after six to 18 weeks of treatment phagocytosis and myeloperoxidase activity had returned to normal in three of them. These data suggest that in patients receiving haemodialysis iron overload due to multiple transfusions plays an important part in the mechanisms underlying the susceptibility to bacterial infections, mediated at least partially through impaired neutrophil function.

Adult↗
PubMed1985

Usefulness of 99mTc pyrophosphate bone scintigraphy in the survey of dialysis osteodystrophy.

Fogelman's score (FS) was used to determine the usefulness of 99mTc pyrophosphate (Tc-PP) bone scintigraphy in the evaluation of dialysis osteodystrophy. FS correlated well with bone 47Ca accretion rate. It remained stable after six months in patients treated with 1 alpha (OH)D3 and increased significantly in a randomised group of untreated patients. It decreased after two years of 1 alpha (OH)D3 therapy while serum calcium increased and iPTH and alkaline phosphatases decreased. Patients with low FS, treated by 1 alpha (OH)D3, rapidly developed hypercalcaemia. In cases of spontaneous hypercalcaemia, parathyroidectomy did not normalise serum calcium in patients with low FS despite a significant decrease in serum iPTH. Lower FS were associated with a higher increase in serum aluminium after desferrioxamine (DFO) administration and in two cases of proven aluminium osteomalacia, DFO therapy was followed by a dramatic increase in FS.

Bone and Bones↗
PubMed1985

Cyclosporine nephropathy after heart and heart-lung transplantation.

Cyclosporine nephrotoxicity after heart transplantation can lead to acute renal failure requiring haemodialysis. In four long-term heart-transplant survivors, cyclosporine nephropathy was characterised by extensive fibrosis, with uraemia, hypertension and/or anaemia. In contrast, the long-term survivor of heart-lung transplantation who had received her graft for accelerated respiratory failure, did not develop chronic renal disease. Thus, chronically reduced renal perfusion before heart transplantation may play a critical role in the development of chronic cyclosporine nephropathy.

Adult↗
PubMed1984

Prostaglandin-9-ketoreductase activity in erythrocytes of normal and hypertensive subjects.

The PGE2/PGF2 alpha balance, controlled in part by prostaglandin-9-ketoreductase, seems to be involved in the regulation of sodium excretion by the kidney. A decreased PGE2/PGF2 alpha ratio has been observed in the urine of hypertensive subjects. This suggests that an alteration of prostaglandin metabolism might be involved in the pathogenesis of essential hypertension. In order to test this hypothesis, prostaglandin-9-ketoreductase (PG-9-KR) and prostaglandin-15-dehydrogenase (PG-15-DH) activities were measured in erythrocytes of normotensive controls and patients with essential hypertension. The two enzyme activities were highly correlated in the two groups, supporting the hypothesis that they are alternate expressions of a single enzyme. These two enzyme activities were not significantly different in hypertensive subjects as compared to controls. Human essential hypertension does not appear to be linked to a generalized defect of prostaglandin catabolic enzymes.

Adult↗
PubMed1984

[Comparative effects of oral water load of different mineral compositions on the excretion of ions and oxalic acid].

The effects on urinary excretion of a 1500 ml daily load of three drinking waters with different ionic contents were studied in six normal subjects. Diuresis was similarly increased by the three waters of an amount equal to the load. Urine output of urea, creatinin, uric acid, phosphate, potassium, magnesium was not significantly modified by the three waters as compared to a control period. Natriuresis was significantly increased following the intake of the water which contained sodium as well as calciuria with the water containing calcium. Urine output of oxalate was increased by the three waters in correlation with the free water content of the load. This effect is probably due to a reduction in passive tubular reabsorption of oxalate since a similar effect was observed with an equivalent water load given by intravenous route. Nevertheless, due to the dilution of urine, the index of urine saturation for calcium oxalate was diminished by the three waters.

Absorption↗
PubMed1983

Hemodialysis in schizophrenics. A double-blind study.

The therapeutic effects of hemodialysis were evaluated in 19 schizophrenics with random assignment to active (n = 10) or sham (n = 9) dialysis. Evaluations were done before and after one month of treatment by an investigator blind to the type of dialysis using four rating scales. Five of the ten patients undergoing active dialysis and three of the nine patients undergoing sham dialysis showed clinical improvement on the psychiatric rating scales. There were no significant differences between the two groups in the magnitude of this improvement. For three patients treated by active dialysis after sham dialysis, there were no significant differences. Three other patients whose conditions dramatically improved by active dialysis did not confirm such a beneficial effect with a second period of active dialysis. Transient improvement of some schizophrenic patients cannot thus be explained by blood clearance through dialysis.

Adult↗