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Biomedical subjects

L Revert

Publications and source records attributed to L Revert.

At least 91 records · Page 5Linked to original sources
PubMed1990

Ocular and auditory toxicity in hemodialyzed patients receiving desferrioxamine.

During an 18-month period of study 41 hemodialyzed patients receiving desferrioxamine (10-40 mg/kg BW/3 times weekly) for the first time were monitored for detection of audiovisual toxicity. 6 patients presented clinical symptoms of visual or auditory toxicity. Moreover, detailed ophthalmologic and audiologic studies disclosed abnormalities in 7 more asymptomatic patients. Visual toxicity was of retinal origin and was characterized by a tritan-type dyschromatopsy, sometimes associated with a loss of visual acuity and pigmentary retinal deposits. Auditory toxicity was characterized by a mid- to high-frequency neurosensorial hearing loss and the lesion was of the cochlear type. Desferrioxamine withdrawal resulted in a complete recovery of visual function in 1 patient and partial recovery in 3, and a complete reversal of hearing loss in 3 patients and partial recovery in 3. This toxicity appeared in patients receiving the higher doses of desferrioxamine or coincided with the normalization of ferritin or aluminium serum levels. The data indicate that audiovisual toxicity is not an infrequent complication in hemodialyzed patients receiving desferrioxamine. Periodical audiovisual monitoring should be performed on hemodialyzed patients receiving the drug in order to detect adverse effects as early as possible.

Adult↗
PubMed1990

[Acute kidney insufficiency in ethylene glycol poisoning].

A case of severe ethylene-glycol intoxication is presented in which there were potentially fatal plasma levels, neurological manifestations and acute renal failure and which was treated with ethanol and hemodialysis. Crystal deposits, normal glomeruli and severe tubular affectation suggestive of direct cytotoxic action, were found in renal biopsy, which was performed during the anuric phase. The evolution was favorable with no neurologic sequelae, diuresis re-onset on day 17 and return of normal renal function.

Acute Kidney Injury↗
PubMed1990

Bronchial reactivity in patients with chronic renal failure undergoing haemodialysis.

We hypothesized that patients with chronic renal failure may present nonspecific bronchial hyperreactivity due to subclinical interstitial lung oedema. To assess lung function disturbances and methacholine (MTH) bronchial responsiveness in this condition, we studied 12 patients (9 men and 3 women; 41.8 +/- 13.3 yrs (SD] with chronic renal failure undergoing regular haemodialysis (HD). Before HD, mean results of conventional lung function tests were within the normal range: forced expiratory volume in one second (FEV1), 89 +/- 12.9% predicted; forced mid-expiratory flow (FEF25-75), 81 +/- 36.7% predicted; total lung capacity (TLC), 94 +/- 14.6% predicted, but 3 subjects presented mild reduction in lung volumes and 5 individuals showed mild obstructive ventilatory impairment. After HD, maximal expiratory flow rates increased significantly (FEV1, + 8.2 +/- 5.1% (p less than 0.005); FEF25-75, +26.2 +/- 25.9% (p less than 0.005]. Interestingly, these increases in FEV1 after HD correlated with body weight loss during HD (r = 0.74, p less than 0.01). In contrast, pre-HD bronchial reactivity was within the normal range (mean % change in FEV1 after MTH, -3.7 +/- 4.5%; range, +1- -14%) without significant changes in methacholine bronchial responsiveness after HD. We speculate that interstitial lung oedema may play a significant role in lung function impairment observed in patients with chronic renal failure. This study shows that nonspecific bronchial hyperreactivity is not present in clinically stable patients with this disorder.

Adult↗
PubMed1989

[Prospective study of 75 episodes of sepsis in hemodialysed patients].

During a 38-month period the bacteremias developing in patients on hemodialysis from three centers of the Barcelona area were evaluated to assess their incidence, characteristics, and response to therapy. In the overall 13376 months of hemodialysis of the study, 75 episodes of bacteremia were detected in 64 patients; this amounts to an incidence of 5.6 episodes per 1000 hemodialysis months. The most common sources of becteremia were intravenous catheters (44%), which were mainly used as temporary vascular access, followed by the definitive vascular access (26%), the genitourinary system (10%), and the lung (6%). Twenty-seven episodes of bacteremia developed in 24 patients in whom dialysis had been started in the two previous months (11% of the overall number of new patients), and, in them, 77% originated in an intravenous catheter, while this was the origin of bacteremia in only 23% of the remaining patients. 72% of bacteremias were caused by gram positive organisms, particularly Staphylococcus aureus and Staphylococcus epidermidis (60%), followed, in frequency order, by aerobic gram negative bacilli (25%), particularly Escherichia coli and Pseudomonas. Stpahylococci were significantly associated with the vascular access, either if this was a catheter or not (81% of instances), while gram negative bacilli were associated with sources different from the vascular access (48% of instances). Severe complications included 2 cases of aortic valve endocarditis, one hemorrhagic shock caused by rupture of an infected vascular access, and one suppurative phlebitis associated with a hemodialysis catheter. Staphylococcal sepsis was randomly treated with vancomycin or vancomycin plus gentamicin, without differences in the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Treatment of hyperkalaemia in renal failure: salbutamol v. insulin.

Three groups of patients with acute or chronic renal failure (GFR less than 5 ml/min) and hyperkalaemia (K+ greater than or equal to 6 mEq/l), similar in age, serum creatinine and pretreatment K+. Group A (n = 24) received salbutamol 0.5 mg i.v. in 15 min, group B (n = 10) received glucose 40 g i.v. plus 10 units insulin i.v. in 15 min, and group C (n = 10) received salbutamol 0.5 mg i.v., glucose 40 g i.v. and insulin 10 units i.v. over a 15-min period. Serum potassium was measured at 30, 60, 180 and 360 min after administration of treatment. All treatments reduced serum potassium, maximal at 30 or 60 min, and ranging from -0.5 +/- 0.1 to -1.5 +/- 0.2 mEq/l; patients in group C exhibited a significantly greater decrement in serum potassium, when compared to group B at 60 (-1.5 +/- 0.2 vs -1 +/- 0.1 mEq/l, respectively; P less than 0.01) and 180 min (-1.2 +/- 0.2 vs -0.7 +/- 0.1 mEq/l, respectively; P less than 0.05). There were no significant differences between groups A and C. Patients from group C had moderate tachycardia and more prolonged hyperglycaemia than those from group B, but all treatments were well tolerated.

Acute Kidney Injury↗
PubMed1989

Electrographic alterations induced by hyperkalaemia simulating acute myocardial infarction.

In general, severe hyperkalaemia produces classic electrocardiographic manifestations including tenting of T waves, widening of the QRS complex, loss of P waves, and eventually, sine waves and asystole. This report concerns a patient with chronic renal failure on maintenance haemodialysis who developed a severe hyperkalaemia associated with chest pain, manifested electrocardiographically by elevation of the S-T segment resembling acute myocardial infarction. After haemodialysis, serum potassium decreased and the electrocardiogram returned to normal. We review the literature and discuss the possible physiology of this electrocardiographic alteration.

Diagnosis, Differential↗
PubMed1989

Infection of hemodialysis catheters: incidence and mechanisms.

Fifty-three consecutive subclavian or jugular hemodialysis catheters inserted into 41 patients were prospectively studied over a period of 8 months in order to determine the incidence of infection and its mechanisms. The intravascular, intradermal and the Y catheter segments as well as both connections were cultured using a quantitative technique for the intraluminal surface. In addition, the intravascular and intradermal portions of the catheter were cultured using a semiquantitative technique for the external surface. Skin smears of the catheter entry site were also cultured, and blood cultures were similarly obtained if fewer developed. Twenty-nine of the 53 catheters (55%) were significantly colonized by one (19 cases) or more (10 cases) microorganisms. The source of the colonizing microorganisms was the skin in 17 cases (58%), intraluminal in 5 (17%), both routes in 5 (17%) and others in 2 (6.8%). Staphylococcus epidermidis (22 cases) and Staphylococcus aureus (4 cases) were the bacteria most frequently isolated. Nine of the 53 catheterizations (17%) were complicated by catheter-related septicemia due to S. aureus in 4 cases, S. epidermidis in 3 cases, Streptococcus faecalis in 1 and Proteus vulgaris in 1. Catheter-related bacteremia contributed to a patient's death in 1 case. Suppurative local infections of the catheter entry site developed in 3 cases, 2 of them with septicemia. We conclude that the rate of infection due to subclavian or jugular hemodialysis catheters is very high and that the skin is the most frequent origin of the microorganisms.

Catheterization, Central Venous↗