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Biomedical subjects

J L Vanherweghem

Publications and source records attributed to J L Vanherweghem.

At least 109 records · Page 6Linked to original sources
PubMed1982

Acetate-induced myocardial depression during hemodialysis for acute renal failure.

We studied the cardiovascular effects of hemodialysis in five critically ill patients with ultrafiltration using, alternately, bicarbonate and acetate in the dialysate. After 3 hr of dialysis with acetate, significant decreases in both arterial pressure and stroke volume resulted in lowered left ventricular stroke work (P less than 0.025). This effect persisted 30 min after the end of the dialysis (P less than 0.025). Differences in the patients' cardiac preload were ruled out by similar pulmonary artery balloon-occluded pressures during both types of dialysis. These observations suggest that dialysis with acetate can result in myocardial depression. The use of bicarbonate dialysate is thus advisable for acute hemodialysis in critically ill patients.

Acetates↗
PubMed1982

Epidemiology of analgesic nephropathy in Belgium.

The incidence of analgesic nephropathy in patients with terminal renal failure (AN-TRF) was evaluated by questioning all the dialysis units in Belgium. The results were analyzed with respect to the distribution of the analgesic market in Belgium. Replies were received from 46 of the 49 dialysis units for adults. Of the 1,400 patients treated in these units, 258 (18.4%) have AN. Furthermore, AN was more frequent in the neighbourhood of Antwerp than in the other Belgian provinces (100 AN-TRF/million adults vs 19; 36% of TRF vs 14%, P less than 0.001). The number of patients treated by hemodialysis per million adults was correlated well with the number of AN-TRF/million adults in the various areas of Belgium (r = 0.73, P less than 0.05). 265 tons of analgesics (35 g/adult/year), including 55 tons of phenacetin (7 g/adult/year) are sold each year in Belgium. Among the five most popular drugs in Belgium, three are analgesics containing acetylsalicylate-phenacetin or phenazone or paracetamol-caffeine. These three analgesics are made in the neighbourhood of Antwerp, no such analgesics are made in other areas of Belgium. No correlation exists between the geographic distribution of AN-TRF and the distribution of other widely-used over-the-counter drugs such as laxatives, non-phenacetin-containing analgesics and even analgesics which contain phenacetin but which are not made in Belgium. Conversely, the distribution of AN-TRF was well correlated with that of the sale of an analgesics made in the neighbourhood of Antwerp (r = 0.79, P less than 0.001). Belgium thus has, after Australia, the second highest incidence of analgesic nephropathy in the world. The geographic distribution of AN-TRF inside Belgium correlates with the existence of analgesic factories in the neighbourhood of Antwerp.

Acetaminophen↗
PubMed1981

Predictive value of 99mTc pyrophosphate bone scintigraphy for vitamin D trials in uraemia.

The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow up of 21 haemodialysed patients without clinical or radiological evidence of osteodystrophy. 99mTc-PPi bone scintigraphy was semi-quantitatively analysed using Fogelman's score. Patients were randomised to receive vitamin D analogues (1 alpha hydroxyvitamin D3 or dihydrotachysterol, n = 12) or to serve as controls (n = 9), both groups being given oral calcium supplements. Bone scintigraphy deteriorated in patients only on calcium therapy but not in patients treated by vitamin D-analogues. Vitamin D therapy reduced secondary hyperparathyroidism in all cases but induced rapid intoxication with normal doses in 4 of the 12 treated patients. Since intoxicated patients had significantly lower Fogelman's score than the patients who tolerated the treatment well, 99mTc-PPi bone scintigraphy is proposed as a screening test before vitamin D-analogues trials.

Bone and Bones↗
PubMed1979

[The role of prostaglandins in the renal regulation of blood pressure (author's transl)].

In response to ischaemic or vasoconstrictor stimuli the kidney reacts by synthesising prostaglandins (PG) which modify local vascular tone. They induce a compensatory vasodilatation and direct the blood flow towards the internal cortex. It is thus not necessary to attribute a systemic role to PG in order to understand their haemodynamic action. This explains the natriuresis following the injection of PG both in the animal and in man. Nevertheless the direct effet of PG upon the tubular reabsorption of sodium remains controversial since very different experimental models lead to contradictory conclusions. Despite these disparate data, it is probable that PG are intimately involved in the pathogenesis of hypertension. A lack of PG or a deficiency in their metabolism may be responsible in essential hypertension.

Angiotensin II↗
PubMed1979

Liver disease in patients undergoing hemodialysis and kidney transplantation.

Liver dysfunction was observed in 33% of patients treated by hemodialysis and kidney transplantation. Fifty-eight percent of these cases of hepatitis occurred in patients with past or present HBs antigenemia, and 77% of HBsAg-positive patients showed evidence of LD. However, during the course of a program conducted from 1969 to 1976 and involving 267 patients, the decrease in the prevalence of HBs antigenemia observed during the last two years did not lead to any reduction in LD incidence. In a small number of patients, potentially hepatotoxic drugs could be incriminated, but in our experience azathioprine never appeared to be involved. In a few patients, LD was due to granulomatous disease of the liver, such as tuberculosis and schistosomiasis. Twenty-one (7%) of the 267 patients at risk developed chronic hepatitis, which contributed to death in nine patients. In 12 cases (three deaths), this form of hepatitis occurred in HBsAg-positive patients, and in nine cases (six deaths), in HBsAg-negative patients. In three of these latter individuals, cytomegalovirus could be incriminated. Routine monthly screening for CMV in kidney recipients confirmed the high incidence of this viral infection in such patients. Studies on murine CMV infection have demonstrated that this infection can be enhanced by histoincompatible graft or by cyclophosphamide in a model that is very close to the kidney recipient. As in mice, CMV infection in kidney recipients apparently results from reactivation of a latent infection. It seems to play a major role in the LD observed and could apparently lead to chronic hepatitis and even to cirrhosis of the liver. Finally, the occurrence of LD in HBsAg-, anti-HBs- and antiCMV-negative patients would suggest the responsibility of other viruses for the pathogenesis of liver disease in patients treated by hemodialysis and kidney transplantation. Besides Epstein-Barr virus, other viruses, such as hepatitis C virus, should be thoroughly scrutinized.

Adult↗
PubMed1979

Comparison of three hemodialysis procedures with unipuncture.

Dialysis efficiency estimated by the decrease in urea, creatinine and phosphorus serum concentrations is higher with the double-lumen single-needle method, compared to the single-lumen needle unipuncture methods. This increased efficiency is related to a higher blood flow rate through the dialyser. Provided the superficial veins are not too small and/or tortuous, the double-lumen needle appears as a safe, simple and rewarding device and may be used in most patients on regular dialysis treatment.

Adult↗
PubMed1979

Haemodialysis in schizophrenia: a double blind study - preliminary report.

The therapeutic effects of haemodialysis were evaluated in schizophrenic patients using a double blind procedure. Twelve patients were diagnosed as acute schizophrenics according to Feighner's criteria for psychopathology. After obtaining informed consent, the patients were randomly assigned to active haemodialysis (AD) or sham dialysis (SD). An 8 days "drug washout period" was followed by AD or SD treatment of 4 weeks (two 5 hours sessions per week) and psychopathological evaluations were performed regularly in a blind fashion using the Brief Psychiatry Rating Scale (BPRS) and the Comprehensive Psychopathological Rating Scale (CPRS). Nine of the 12 patients were improved by both extracorporeal procedures with or without active dialysis. No significant difference appeared however between both groups in the rate and degree of improvement of nuclear symptoms of schizophrenia. Nevertheless, AD was significantly more efficient in relieving affective symptomatology, suggesting the potential involvement of some endogenous dialysable substance (s) in the pathogenesis of mood disturbances in schizophrenia.

Adult↗