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Biomedical subjects

J M Lazarus

Publications and source records attributed to J M Lazarus.

At least 91 records · Page 5Linked to original sources
PubMed1985

Surgery for diverticulitis in renal failure.

Twenty-five patients were operated on at the Brigham and Women's Hospital for colonic diverticulitis complicating treated renal failure during the period 1951 to 1983. Twelve patients had functioning renal allografts (eight cadaver, four living-related); 13 were on dialysis therapy. Six patients had polycystic kidney disease. The majority of patients had acute abdominal pain. Four had histories of chronic abdominal pain; nondiagnostic exploratory laparotomies were performed on two of these patients, who developed localized tenderness. The overall mortality in this series was 28 percent, with sepsis being the most common cause of death. Six of seven patients who died had free colonic perforations at surgery. Mortality correlated with age, with six of 14 patients (43 percent) over age 50 dying, as compared with one of 11 patients (9 percent) under age 50. There was no correlation between survival rate and type of surgery performed, dose of prednisone or azathioprine used, or type of treatment received for renal failure.

Aging↗
PubMed1985

Successful management of thrombocytopenia, microangiopathic anemia, and acute renal failure by plasmapheresis.

We report on the outcome of six consecutive adult patients who presented with microangiopathic anemia and thrombocytopenia. Clinical parameters on admission included platelet counts less than 45,000/mm3, microangiopathic red blood cell morphology, mental status abnormalities, and in three, rapidly progressive azotemia requiring dialysis. All patients underwent plasma exchange therapy as part of their treatments. Patients with renal failure underwent plasma exchange with a hollow fiber plasma separator, while those without renal failure were treated with a cytocentrifuge. All received fresh frozen plasma as replacement solution and were treated with glucocorticoids as well. For all six patients, plasmapheresis and conventional drug therapy resulted in remission that has lasted for 16 +/- 5 months (range 8 to 24 months). Early cessation of plasmapheresis in two patients resulted in rapid relapse. Patients who required dialysis now have a mean creatinine of 2.0 +/- 0.9 mg/dL (range 1.2 to 3.5). With similar volumes of exchange, and the same number of treatments, less fresh frozen plasma was used in the three patients treated with the hollow fiber separator than in patients treated with the cytocentrifuge (6.3 +/- 3.7 v 14.8 +/- 4.3 U/exchange, P less than 0.05). We conclude that plasmapheresis is a useful therapeutic modality for the treatment of thrombocytopenia and microangiopathic hemolytic anemia. In addition the use of a hollow fiber plasma separator for plasmapheresis is safe and efficient, particularly when concurrent dialysis is required.

Acute Kidney Injury↗
PubMed1985

Effects of acetate and bicarbonate dialysate in stable chronic dialysis patients.

The effects of acetate and bicarbonate dialysate on the biochemical and clinical parameters of 16 stable chronic hemodialysis patients were investigated in a double-blind crossover study. A central delivery system was used for both types of dialysates with identical sodium concentrations (138 mEq/liter) and osmolality in a single-pass dialysate flow. The results indicate that dialysis with bicarbonate leads to significantly less hypoxemia (P less than or equal to 0.001) and hypotensive episodes (P less than or equal to 0.002) than with acetate. Pre- to post-dialysis blood pressure changes were also more marked during acetate dialysis. Older patients with recurrent hypotension on acetate benefit most from bicarbonate dialysate. This group of patients appears to metabolize acetate more slowly and has a significantly lower post-dialysis bicarbonate concentration (P less than or equal to 0.005) than asymptomatic patients during dialysis with acetate dialysate.

Acetates↗
PubMed1985

Vascular access for hemodialysis. Patency rates and results of revision.

Over a 4-year interval, 324 arteriovenous conduits were created in 256 patients with end-stage renal disease as access for chronic hemodialysis. These included 154 Cimino fistulae, 163 polytetrafluoroethylene (PTFE) grafts, and seven miscellaneous grafts. Satisfactory patency rates were demonstrated for as long as 4 years for both Cimino fistulae and PTFE grafts by life-table analysis. Failures of Cimino fistulae usually occurred early in the postoperative period, secondary to attempts to use inadequate veins. Thrombosis caused the majority of PTFE graft failures and was generally the result of venous stenosis. Correction of such venous stenosis is mandatory to restore graft patency and can result in prolonged graft survival.

Adolescent↗
PubMed1985

Stability of renal allograft recipients after conversion from cyclosporine to azathioprine.

Forty-eight patients with stable renal function after allotransplantation have been converted from CsA/prednisone to azathioprine/prednisone to assess the short- and long-term effects upon renal function. Virtually all patients show an initial improvement in serum creatinine levels. Three patients developed chronic renal failure after 12 to 21 months, and three died of pneumonia 7, 12, and 19 months later. The mean serum creatinine level at latest follow-up (seven to 36 months) was 2.5 +/- 1.5 mg/dL for all 48 patients. Of interest, a control group of 21 patients not converted to azathioprine had serum creatinine levels of 2.5 +/- 0.8 mg/dL, over a follow-up period of five to 25 months. It is not immediately apparent that either group will have a superior overall outcome, although patients on azathioprine seem to have more of a risk for graft loss. More data are needed with various dosage schedules, and with randomized controls.

Acute Disease↗
PubMed1984

Complement activation and hypersensitivity reactions to dialysis membranes.

Certain patients receiving hemodialysis experience recurrent chest pain, dyspnea, and hypotension during exposure to new cuprophane-membrane dialyzers (the "first-use syndrome"). Because activation of complement may be involved in these events, we examined in vivo complement activation with new cuprophane membranes and in vitro activation by zymosan in 6 such patients, and compared them with 10 patients who did not have symptoms during dialysis. All patients with the first-use syndrome had maximal complement activation 10 minutes after initiation of dialysis, with C3a des-arginine (desArg), the stable metabolite of C3 activation, equal to 8533 +/- 157 ng per milliliter (mean +/- S.E.M.). In asymptomatic patients the maximal C3a desArg value occurred at 15 minutes and was only 2907 +/- 372 ng per milliliter (P less than or equal to 0.0001). At a concentration of 3.8 x 10(-5) g of zymosan per milliliter, patients with the first-use syndrome had a C3a desArg level of 29.6 +/- 1.4 micrograms per milliliter, whereas it was only 16.6 +/- 2.3 micrograms per milliliter in asymptomatic patients (P less than or equal to 0.0001). Two other patients, who experienced cardiopulmonary collapse during the first two minutes of dialysis, had a C3a desArg level of 18,900 and 7800 ng per milliliter, respectively. We conclude that the occurrence of adverse symptoms associated with new cuprophane-membrane dialyzers correlates with complement activation.

Adult↗
PubMed1984

Biocompatibility of dialysis membranes: effects of chronic complement activation.

The ability of three dialysis membranes (cuprophane, cellulose acetate, and polymethylmethacrylate) to activate complement was studied prospectively in ten chronic dialysis patients using new and reused membranes. Patients were dialyzed for 1 month with each type of membrane. New cuprophane membranes caused the most intense activation, while polymethylmethacrylate (PMMA) surfaces caused the least degree of complement activation. Reuse decreases the capacity of the cuprophane membrane to activate complement but does not significantly alter the capacity of cellulose acetate membranes. The extent of complement activation paralleled the ability of these membranes to induce neutropenia. Recurrent dialysis with new cuprophane and cellulose acetate membranes leads to a decrease in pre-dialysis and "rebound leukocytosis" neutrophil count, as well as a more intense activation of complement and an enhanced endogenous clearance of products of complement activation. The clinical sequelae of recurrent complement activation are discussed.

Biocompatible Materials↗
PubMed1982

Cardiovascular instability during hemodialysis.

The major point of contention in the discussions following the formal panel presentation, both among members of the panel and the audience, was the role of sodium and its proper control while evaluating the effect of hemofiltration, sequential dialysis, and/or bicarbonate dialysis on cardiovascular instability. It appears that studies, carefully controlling the level of dialysate sodium, have not been performed, or reported in the literature. Hemodiafiltration, sequential dialysis, increased sodium dialysate and bicarbonate dialysate all seem to reduce the incidence and intensity of hypotension; however, the mechanisms have not yet been elucidated. Complications from these changes, particularly increased sodium must be considered. Methods of evaluation of underlying cardiac disease, autonomic neuropathy and hormonal changes were suggested. Use of equipment with newer membrane material, alterations of dialysis technique, were agreed as likely methods to combat the incidence and severity of cardiovascular instability. It is apparent from the discussion that there remain a number of areas to be investigated in evaluating the causes of hemodialysis-induced hypotension. Controlled studies, dissecting out each of the above noted factors, will be important in determining their relative importance in modification of future therapy.

Acetates↗
PubMed1981

Glomerulonephritis in a patient with sarcoidosis. Report of a case and review of the literature.

A 38-year-old woman who had severe impairment of renal function displayed crescentic glomerulonephritis on a renal biopsy specimen. Chest roentgenogram showed bilateral hilar adenopathy. A biopsy specimen of a hilar lymph nodes showed many noncaseating granulomas, consistent with sarcoidosis. Therapy with plasmapharesis, cyclophosphamide, and corticosteroids was associated with improvement of renal function and disappearance of hilar adenopathy. Based on this case and a review of the literature, sarcoidosis should be considered when studying crescentic glomerulonephritis.

Adult↗
PubMed1980

Femoral triangle sepsis in dialysis patients: frequency, management, and outcome.

Prosthetic devices for dialysis access sometimes have to be implanted in the groin. Infections are frequent there, and when they occur their management is influenced by the patients' need for continued dialysis, and often, by the presence of concomitant diseases. We report implantation of 161 dialysis access devices of various types, all utilizing the femoral vessels. Twenty-seven femoral triangle injections eventually occurred. Both the approach to their treatment and outcome were influenced by mode of presentation, localized infection being most favorable, and fever without localized signs least. The compromise surgical procedures made necessary by the patients' precarious medical status were successful in most instances but overall mortality was 18%, and the amputation rate 22%.

Arteriovenous Shunt, Surgical↗
PubMed1980

Acute renal failure following cardiac operations.

The incidence and course of acute renal failure following cardiopulmonary bypass (CPB) was retrospectively analyzed. The incidence of oliguric acute renal failure was 1.5% and the mortality rate was 27%, a figure substantially lower than previously reported. Both peritoneal dialysis and hemodialysis were initiated early, with a mean of 3.6 days between the onset of acute renal failure and initiation of dialysis. Survivors had a mean duration of acute renal failure of 24 days. Deaths were caused by cardiac failure (one) and sepsis (two). Mortality rate from acute renal failure complicating CPB resembles that from acute renal failure related to other causes and may be lowered by early aggressive dialysis.

Acute Kidney Injury↗
PubMed1980

Pericardial effusion associated with minoxidil therapy in dialyzed patients.

Pericardial effusion, diagnosed clinically or by echocardiography, was found in 13 of 16 regularly dialyzed patients (81%) receiving minoxidil for refractory hypertension. In a comparable group of 125 patients not receiving minoxidil, 28 patients (23%) had evidence of pericardial effusion, the difference between the groups being highly significant (p less than 0.0005). In minoxidil treated patients, the effusions resolved spontaneously in 4 (3 remaining on treatment), required pericardiocentesis (3), or pericardiectomy (1), and persisted in 4 (3 remaining on treatment). It is suggested that minoxidil treated dialysis patients be regulary examined for the development of potentially threatening pericardial effusions.

Adult↗
PubMed1979

Diffuse pulmonary hemorrhage and rapidly progressive renal failure. An uncommon presentation of Wegener's granulomatosis.

A 57 year old woman presented with rapidly progressive renal failure and diffuse pulmonary hemorrhage and life-threatening respiratory failure promptly developed; these conditions resolved after bilateral nephrectomy. Renal pathology revealed rapidly progressive glomerulonephritis and vasculitis with granular deposition of immunoglobulin on immunofluorescent staining. One year later, multiple nodular cavitating pulmonary infilrates developed, and lung biopsy was diagnostic of Wegener's granulomatosis. Therapy with cyclophosphamide resulted in resolution of the pulmonary lesions. Diffuse pulmonary hemorrhage and rapidly developing renal failure mimicking Goodpasture's syndrome was the initial manifestation of Wegener's granulomatosis in this patient.

Acute Kidney Injury↗
PubMed1978

A longitudinal study of bone disease after successful renal transplantation.

A retrospective study of 100 patients followed for 1-4 years after successful renal transplantation was undertaken to assess the amelioration of previously present metabolic bone disease and to determine the risk factors associated with the development of osteonecrosis. 42% of patients showed some evidence of bony abnormality. Following transplantation, there was slow but progressive resolution in the X-ray changes of hyperparathyroidism but not of osteoporosis. 14% of patients developed osteonecrosis in the posttransplant period with the femoral head the most common site involved (72% of patients). Osteonecrosis could not be related to average steroid dose, number of steroid pulses, or the preexistence of metabolic bone disease.

Adult↗