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Biomedical subjects

J M Lazarus

Publications and source records attributed to J M Lazarus.

At least 109 records · Page 6Linked to original sources
PubMed1978

Conservative management of uremic pericardial effusions.

Although there has been a recent trend toward early operative treatment of uremic pericardial effusions unresponsive to intensified dialysis, this approach may be unnecessarily aggressive. Review of 787 patients in our chronic dialysis program since 1969 has shown 54 patients (6.9 percent) to have developed 56 episodes of large pericardial effusion. All were managed by increasing the frequency of dialysis. If the effusion failed to diminish or if life-threatening signs of tamponade developed, pericardiocentesis was performed. In 63 percent (35/56) the effusion resolved with increased dialysis. In 37 percent (21/56), pericardiocentesis was performed, with 57 percent (12/21) requiring only one aspiration. During a mean follow-up of 34 months (2 to 100 months) only 5.5 percent (3/54) have undergone operation: one partial pericardiectomy incidental to pulmonary decortication and two pericardiectomies for late (3 months and 5 months, respectively) constriction. There were five complications of pericardiocentesis: one pneumothorax, one pneumoperitoneum, one costochondritis, and two myocardial punctures without sequelae. The one death related to pericardial effusion in this series occurred in a home-dialysis patient who arrived in the emergency room moribund. Our experience suggests that the great majority of uremic pericardial effusions can be effectively controlled with simple needle aspiration by experienced personnel and that pericardial resection is usually not necessary.

Adolescent↗
PubMed1978

Initial clinical evaluation of the Hospal artificial kidney system.

A high flux artificial kidney system, which permits control over ultrafiltration, has been developed and patients are now being treated with it at a large outpatient kidney center. The basic operating characteristics have been described and some preliminary clinical results mentioned. Characteristics of the Hospital Artificial Kidney System are: 1. Higher clearances for middle molecules than conventional systems; 2. Adequate clearances for small solutes such as urea; 3. Predictable control of ultrafiltration with discrepancies between actual weight loss and theoretical weight loss on the order of 0.7 to 1.3 ml/min, when the system is operated in the designated manner.

Evaluation Studies as Topic↗
PubMed1977

Controlled ultrafiltration (UF) with hemodialysis (HD): analysis of coupling between convective and diffusive mass transfer in a new HD-UF system.

A convertible and versatile dialysis system consisting of a PMMA hollow fiber unit and UFR controller is shown to be useful for evaluating the effect of solute and fluid removal rates on adequacy of dialysis. Post-dilution mode where high UFR is applied to the patient with matching or comparable dilution rate is concluded to be most effective modification for enhancing the clearance for "middle molecules", without sacrificing the removal rates for the small solutes.

Creatinine↗
PubMed1976

Hyperlipidemia after renal transplantation in children.

A cross-sectional survey of 32 children who received renal allografts was undertaken to evaluate lipid profiles in a pediatric transplant population. Ages ranged from 8 to 18 years, and serum creatinine concentrations varied from 0.5 to 5.6 mg/100 ml (mean, 1.4 mg/100 ml). Fifty percent of patients showed an abnormal lipoprotein electrophoresis, and these were evenly divided between type II and type IV patterns. The data suggest that patients with type II pattern tend to be receiving higher doses of prednisone, and increasing levels of cholesterol and triglyceride are also associated with higher corticosteroid dosages. In contrast to the observations of others in dialysis patients, measurements of glucose metabolism such as fasting blood sugar and fasting insulin levels were not associated with lipid abnormalities in this population. Lipid abnormalities following renal transplantation in children are similar to those described in adults, and may contribute to morbidity in the years following successful renal transplantation.

Adolescent↗
PubMed1976

Factors in the dialysis regimen which contribute to alterations in the abnormalities of uremia.

While hemodialysis therapy in its present form is capable of sustaining life, dialysis patients are not metabolically normal and we are unable to say what technical factors contribute adequate therapy. Recent efforts to resolve these problems have led to the assumption that substances in the molecular weight range of 800 to 3000 daltons may be pathogenic in uremia and these may not be effectively removed by dialysis. Accordingly, four groups of patients (ten each) underwent changes in their routine which were theoretically designed to alter independently the concentration of small (urea) and "middle" molecules in the blood. In two groups, the concentration of urea was theoretically increased or decreased while the concentration of so-called middle molecules was maintained unchanged. In the remaining two groups, middle molecule concentration was theoretically increased or decreased while small molecule concentration was unchanged. Patients were evaluated prior to and after completing altered dialysis therapy. The results suggest three related conclusions. First, the uremic syndrome may be viewed as a constellation of abnormalities which can be subgrouped by association so that azotemia may be correlated with neuropathic disease and hypertension with weight gain or body size, for example. Second, those physiologic variables which changed after altered dialysis tended to deteriorate with increasing concentration of small molecules in the blood and remained independent of theoretical changes in middle molecules. Finally, when patients are relatively under-dialyzed, they may spontaneously modulate the reduced removal of metabolites such as urea by decreasing the dietary intake of nutrients.

Adult↗
PubMed1975

Hemodialysis for acute anuric uric acid nephropathy.

A patient with acute oliguric uric acid nephropathy was treated with hemodialysis. Recovery in this disorder is based on treatment of both the uremic state and the intrarenal crystal obstruction. Hemodialysis with high uric acid clearance is much more efficient than other forms of therapy in this disorder.

Abdominal Neoplasms↗
PubMed1975

Hemorrhagic pleural effusion in patients undergoing chronic hemodialysis.

Three patients maintained on chronic hemodialysis developed hemorrhagic pleural effusion. The effusions seemed to be solely related to the uremic state, other causes having been excluded. Pulmonary restriction requiring decortication occurred in one patient. We concluded that hemorrhagic pleural effusion may be a complication of uremia in the chronically dialyzed patient and that fibrous pleuritis causing pulmonary restriction may result.

Adult↗
PubMed1975

Cardiovascular disease in uremic patients on hemodialysis.

In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment. Hypertensive patients should be screened for excessive renin secretion because of its possible role in unresponsive hypertension in patients on dialysis. Nephrectomy should be used when necessary, where dialysis and antihypertensive medication have not adequately controlled blood pressure. Patients must be monitored for the presence of pericardial disease to avoid subsequent pericardial effusion and the development of constrictive pericarditis with its adverse effect on myocardial function. When constrictive pericarditis is present, it obviously should be relieved by appropriate surgery. Efforts should be made to minimize cardiac output in hemodialysis patients. Whether or not routine transfusions to maintain a higher hematocrit are indicated is a question that cannot yet be answered. However, patients with marginal cardiovascular function who are accepted on hemodialysis and must have an arteriovenous shunt should be supported in any manner to minimize an increase in cardiac output. Early and aggressive treatment of known episodes of sepsis is important in the elimination of valvular endocarditis in this patient population. Perhaps one of the finer indicators of adequacy of hemodialysis will be K rate and peak immunoreactive insulin levels. Continued abnormality of these parameters may contribute to cardiovascular disease. Clearly, further study of the effect of abnormal carbohydrate metabolism on lipid metabolism is in order. Serum triglyceride, serum cholesterol and lipid electrophoretic pattern should be followed to evaluate the beneficial effects of drug therapy and changes in dialytic technique on the development of cardiovascular disease. Careful monitoring of calcium, phosphorus, bone films and parathyroid hormone levels is indicated to assess parathyroid status. The use of aluminum binders and parathyroidectomy to prevent vascular and myocardial calcification is important in the therapy of these patients. The use of cardiac catheterization, coronary artery arteriography, and possibly cardiac vascular repair, should be considered in the chronic hemodialysis patient with coronary artery disease if he is otherwise well. Adequacy of hemodialysis perhaps can be evaluated through its effect on all of the above parameters. Whether or not changes in artificial kidney treatments can correct the final vascular disease remains to be seen.

Antigens↗
PubMed1975

The effects of varying dialysis regimens on lymphocyte stimulation.

A protocol was designed to alter mean time average serum concentrations of "middle" (B12) and "small" (urea) molecules. Serum before and after studies was tested for its effect on the blastogenic response to PHA. From this study we have concluded that: 1. Serum of patients on hemodialysis inhibits the mitogenic response of normal lymphocytes to PHA when compared to normal sera. 2. This phenomenon is not responsive to pertubations in dialysis designed to alter the concentration of ""middle'' and ""small'' molecules. 3. The inverse correlation between PHA response and serum PO4 and likewise the inverse correlation with changes in bone X-rays suggest that PTH, fragments thereof, or other factors related to bone and calcium metabolism, could conceivably be involved. This could mediated via cyclic AMP.

Adult↗
PubMed1975

The influence of serum calcium and parathyroid hormone upon glucose metabolism in uremia.

The alterations in carbohydrate metabolism which attend the uremic syndrome have been recognized for some time. Recently, an interaction between hyperparathyroidism and these alterations in intermediary metabolism has been postulated. To further define any such interaction, 6 stable dialysis patients with significant secondary hyperparathyroidism were studied prior to and after subtotal parathyroidectomy. Glucose utilization and insulin secretion were estimated by use of a standard intravenous glucose tolerance test and the resistance of peripheral tissues to exogenous insulin was evaluated by insulin tolerance testing. All of peripheral tissues to exogenous insulin was evaluated by insulin tolerance testing. All patients were studied under baseline conditions, as well as induced hyper- and hypocalcemia, prior to and at least 2 months after surgery. Parathyroidectomy, per se, had no significant effect upon glucose utilization, insulin secretion, or the resistance of peripheral tissues to the action of exogenous insulin. Both induced hyper- and hypocalcemia, on the other hand, significantly diminished glucose utilization as judged by a reduced glucose disappearance rate during intravenous glucose tolerance testing. Hypocalcemia was associated with a markedly reduced insulin secretory response and normal tissue insulin sensitivity, while hypercalcemia was associated with a normal insulin response but reduced tissue sensitivity. The data suggest that calcium ion concentration may affect both glucose utilization and insulin secretion. As such, it must be adequately controlled in furture metabolic studies.

Adult↗