Renal replacement treatment in patients with spina bifida or spinal cord injury.
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Adolescent↗
Biomedical subjects
M E Allison
Publications and source records attributed to M E Allison.
Community attitudes to cystic fibrosis carrier testing in England: a pilot study.
Inexpensive and accurate carrier testing for cystic fibrosis (CF) will be possible in the near future. There are no existing studies on the attitudes of English persons in the community to carrier testing for CF or any other recessive disorder. We have conducted a trial study of 166 persons at two schools, two doctors' surgeries, and a family planning clinic. Only a minority had clear pre-existing knowledge of cystic fibrosis and its genetic nature. However, over 80 per cent of those questioned expressed interest in knowing their carrier status. Although it is well known that uptake can only be assessed when a service is in place, and while further studies are required to confirm that testing will be of interest to couples of reproductive age with no previous knowledge of CF, the data strongly suggest that there will be interest in community-wide testing for CF carrier status when such a test becomes available in the United Kingdom.
Attitude to Health↗
Regulation of peripheral blood B-cell IgA production in alcoholic cirrhosis.
In alcoholic cirrhosis, high levels of serum IgA make a prominent contribution to hyperglobulinaemia. Kinetic studies indicate that this predominantly reflects enhanced IgA synthesis rather than catabolism. Increase IgA synthesis might reflect increased antigenic load, diminished T-cell suppression, or T-cell independent B-cell stimulation (for example by lipopolysaccharide). To investigate this we studied T-cell control of IgA production by peripheral blood cells. Six patients with alcoholic cirrhosis were compared with six normal individuals. Serum IgA levels were significantly higher in the patients (6.6 mg/ml, SD 2.8 cf 1.7 mg/ml, SD 1.2). Seven day unstimulated cultures of peripheral blood mononuclear cells yielded supernatant IgA concentrations of 1,025 ng/ml (SD 600) in patients and 363 ng/ml (SD 222) in controls. T-cell control of IgA synthesis was explored by rosetting out T-cells, and reconstituting cultures at varying T:non-T cell ratios. Similarly shaped curves relating IgA per million non-T cells to the T:non-T cell ratio were found, with maximum IgA production at a T:non-T ratio of 8:2 in each group. IgA production at this ratio was 6.4 micrograms/ml/million non-T cells (SD 3.2) in cirrhosis of 3.2 (SD 1.0) in controls. T-cell control of IgA production thus appears normal, though set at a higher level, implying enhanced T-cell independent drive to IgA production in alcoholic cirrhosis.
B-Lymphocytes↗
Henoch Schonlein purpura presenting with pulmonary haemorrhage.
A young woman presented with arthralgia, a rash and dramatic haemoptysis, and renal involvement was indicated by proteinuria, haematuria and a rising serum creatinine. A systemic vasculitic disorder was suspected initially, but the diagnosis of Henoch-Schonlein purpura was established by the finding of mesangial IgA deposits on renal biopsy. Immunofluorescent study of renal biopsy material is vital to diagnosis where the clinical features of Henoch-Schonlein purpura and those of the systemic vasculitides with renal involvement prove to be indistinguishable.
Adolescent↗
Improving the prognosis in acute renal and respiratory failure.
We have achieved smooth homeostasis in patients with acute renal and respiratory failure by means of machine-controlled, continuous ultrafiltration and simultaneous bicarbonate hemodialysis with a polysulfone, biocompatible membrane (CUPID). No adverse effects were seen, even after 22 days of continued treatment. Mortality was reduced (7/14) when compared to that of a similar group given short conventional daily acetate hemodialysis and ultrafiltration with a cuprophane membrane (12/18).
Adult↗
Ultrafiltration in diuretic-resistant cardiac failure.
Ultrafiltration was performed in 13 patients with diuretic-resistant cardiac failure. All patients had severely distressing peripheral edema and ultrafiltration was successfully completed in 12 patients, all of whom sustained symptomatic improvement. The volume of fluid removed ranged from 3.7 to 23 L, mean 11.8 L. Weight reduction produced by ultrafiltration continued over the following week, indicating an improved response to diuretic therapy. Ultrafiltration is an effective therapeutic intervention in the management of a small but well-defined group of patients with diuretic-resistant cardiac failure.
Aged↗
Epikeratophakia without annular keratectomy.
Nineteen patients (20 eyes) underwent epikeratophakia for correction of high myopia. In contrast to the conventional surgical method utilizing an annular keratectomy, no keratectomy was performed in these patients. The surgical procedure is discussed. Preliminary results (up to six months) indicate that the omission of an annular keratectomy has no effect on graft clarity or viability. The weighted-average percent correction over six months postoperatively was 102%.
Cornea↗
Sodium excretion in young children.
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Child, Preschool↗
The sodium and potassium intake of 3 to 5 year olds.
The sodium intake of preschool children in their home environment was investigated and the major sources of sodium other than added table salt identified. Thirty five children from a Southampton general practice were studied. Twenty four hour urinary sodium excretion was measured as a reliable indicator of daily total sodium intake. The daily intake of sodium other than that from added table salt, and of potassium and other nutrients, was also calculated from three day dietary diaries collected using the household measures method. Median excretion of sodium was 62 mmol/24h (range 28-105, 28 urine collections) and of potassium was 25 mmol/24 h (range 14-46). The sodium:potassium ratio was 2.7 (1.4-5.2). From the diaries, the average daily intake of sodium was 68 mmol (32-98) and of potassium was 47 mmol (24-95), and the sodium:potassium ratio was 1.4 (0.5-2.7) (median and ranges, 35 children). Foods contributing more than 30 mmol sodium to one day's intake were mainly processed convenience foods.
Child, Preschool↗
Ultrafiltration in the management of refractory congestive heart failure.
Ultrafiltration was performed in nine patients with congestive cardiac failure that was refractory to conventional medical treatment. A mean of 12 X 7 litres of fluid was removed, and there was a sustained symptomatic improvement in all patients. Weight loss continued after ultrafiltration and a sustained increase in serum sodium concentration was also noted. A transient fall in right atrial pressure was seen only at four hours after ultrafiltration. No adverse haemodynamic effects were seen four and eighteen hours after fluid removal. Intracardiac dimensions measured by echocardiography remained unchanged. Ultrafiltration can be used to relieve symptoms in patients with refractory congestive heart failure and gross oedema.
Blood Pressure↗
Pterygia as cause of post-cataract with-the-rule astigmatism.
Pterygia often induce with-the-rule astigmatism as they invade the cornea. Significant amounts of astigmatism occur long before a pterygium encroaches on the visual axis. We present an example in which a 3.3-mm pterygium resulted in 9 diopters (D) of with-the-rule astigmatism. Six weeks after the pterygium removal, the patient's cornea became spherical, but by three months the pterygium had recurred 2.2 mm onto the cornea and induced 4 D of with-the-rule astigmatism. Since the second removal and the application of beta irradiation, there has been no recurrence. The final correction was -1.00 + 1.00 X 127 degrees with a visual acuity of 20/20 +3. Characteristic keratoscopic photographs are shown and contrasted with surgically induced with-the-rule astigmatism.
Astigmatism↗
Prolactin and the rat kidney: a clearance and micropuncture study.
PRL is a pituitary hormone with important osmoregulatory properties in lower vertebrates and has been reported to decrease renal water and electrolyte excretion in mammals. Although several studies have suggested that the proximal tubule is the major site of action of PRL, no direct examination of such an effect has been made. In the present study we used micropuncture and clearance techniques to examine the effect of ovine PRL (oPRL) infusion on single nephron and whole kidney function in anesthetized volume-expanded rats pretreated with bromocriptine to suppress endogenous PRL release. oPRL infusion was associated with a significant reduction in urinary sodium, potassium, and water excretion compared to changes seen in the control group. There was no significant effect of oPRL on whole kidney glomerular filtration rate, renal plasma flow, filtration fraction, renal blood flow, renal vascular resistance, or arterial pressure compared to those in control rats. Single nephron studies failed to detect any significant effect of oPRL on single nephron glomerular filtration rate and absolute or fractional reabsorption by the proximal convoluted tubule. Although arginine vasopressin was detected in the oPRL preparation, the quantity infused was negligible compared to the plasma levels found in anesthetized rats prepared for kidney micropuncture. Our results suggest that oPRL exerts a renal tubular action separate from arginine vasopressin to decrease water and electrolyte excretion which occurs beyond the last superficial convolution of the proximal convoluted tubule.
Animals↗
Arteriovenous haemofiltration.
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Acute Kidney Injury↗
Goldmann applanation tonometry in patients with regular corneal astigmatism.
By averaging vertical and horizontal applanation readings from the Goldmann tonometer, we developed a simple technique that accurately measures intraocular pressure in patients with regular corneal astigmatism. This procedure eliminates the need for keratometry and oblique alignment of the applanator. When the applanator is oriented normally, with the mires displaced horizontally, intraocular pressure is underestimated for with-the-rule corneal astigmatism and overestimated for against-the-rule corneal astigmatism. The error is approximately 1 mm Hg for every 4 diopters of astigmatism. For oblique axis corneal astigmatism, the error is smaller and approaches zero when the axis is either 45 or 135 degrees.
Analysis of Variance↗
Endotoxemia, disturbance of coagulation, and obstructive jaundice.
A prospective study of coagulation disturbances and endotoxemia in 42 patients having major pancreatic or biliary surgery was performed. Endotoxin, soluble fibrin, and fibrin degradation products were measured before and after operation in 28 patients with obstructive jaundice and in 14 nonjaundiced controls. In the control group there was one death and no unexplained fever or postoperative hemorrhage. The jaundiced group had more complications: seven deaths, nine episodes of fever, and six episodes of hemorrhage. Soluble fibrin was detected only in patients with obstructive jaundice, in whom it occurred in 38 percent before operation. Positive endotoxin assay was as common in control patients as in the jaundiced group, but in the latter endotoxin was associated (p less than 0.05) with increased FDP and soluble fibrin. Patients with endotoxin or increased FDP levels before operation for jaundice carry a poor prognosis (7 of 11 died). Preoperative bowel preparation in 16 of the jaundiced patients did not affect the outcome.
Adult↗
Effects of bromocriptine on single nephron and whole-kidney function in rats.
Bromocriptine (BRC) is a semisynthetic ergot alkaloid possessing dopamine agonistic activity. We had previously observed significant changes in renal hemodynamics in rats pretreated with BRC to suppress endogenous prolactin plasma levels. To investigate further the effects of BRC on single nephron and whole-kidney function, micropuncture and clearance experiments were performed on euvolemic and volume-expanded rats pretreated with BRC (1 mg i.p.) or solvent. Both groups of BRC-pretreated rats had a significantly higher renal plasma flow and a lower arterial pressure, filtration fraction and renal vascular resistance than control (solvent-treated) rats. In volume-expanded rats, BRC caused a small but significant decrease in whole-kidney glomerular filtration rate (GFR) and an increase in superficial single nephron GFR; BRC did not affect GFR or single nephron GFR in euvolemic rats. Proximal tubular reabsorption and urinary excretion of water and electrolytes were not altered by BRC under conditions of euvolemia or volume expansion. It was concluded that BRC exerts a dopamine agonist-like effect to increase renal plasma flow and suppress endogenous plasma prolactin levels, whereas the urinary water and electrolyte excretion and superficial proximal tubular reabsorption are not altered appreciably. The increased ratio of single nephron GFR/GFR suggests that in volume-expanded rats, BRC redistributes glomerular filtration to superficial nephrons, possible by preferential dilation of superficial afferent arterioles.
Animals↗
Prolactin status in experimentally induced acute renal failure in the rat.
Serum prolactin levels were elevated in male Sprague-Dawley rats with acute renal failure induced by glycerol administration. Specific prolactin binding to kidney membrane preparations was reduced in glycerol and antirat glomerular basement membrane serum-treated rats, after morphological and biochemical acute renal failure was evident. Extensive tubular damage after glycerol administration may account for loss of renal binding, since prolactin receptors are mainly tubular in localization. However, the predominant glomerulopathy, with less severe tubular lesions, after antirat glomerular basement membrane serum suggests that reduced renal prolactin binding in these animals is unlikely to be due to tubular destruction alone. Thus, alterations in prolactin status occur with development of experimentally induced acute renal failure and suggest altered renal responsiveness to prolactin in uraemia.
Acute Kidney Injury↗
Renal function and other factors in obstructive jaundice.
Renal function and other factors that possibly affect the outcome of operation were measured in 24 patients with obstructive jaundice and in 15 non-jaundiced controls. The preoperative features that were associated with a poor postoperative recovery from obstructive jaundice were a raised serum fibrinogen/fibrin degradation product concentration, infection, hypoalbuminaemia and a low glomerular filtration rate. Preoperative serum fibrinogen/fibrin degradation product concentrations were raised in 4 of the 6 jaundiced patients who died after surgery but in none of the controls, in whom there was no mortality. In the jaundiced patients there was a greater incidence of postoperative renal impairment than in the controls. All patients were given mannitol during operation. Further mannitol was required after surgery in 13 of the 24 jaundiced patients in order to maintain urine flow rate despite adequate intravenous fluids being given. In contrast, only 1 of the 15 control patients required post operative mannitol. It is emphasized that repeated doses of mannitol can lead to a profound natriuresis and adequate intravenous saline should be given.
Cholestasis↗