Biomedical subjects

M L Leu

Publications and source records attributed to M L Leu.

At least 37 records · Page 2Linked to original sources

PubMed1994

Outcomes of severe hyperkalemia in cardiopulmonary resuscitation with concomitant hemodialysis.

OBJECTIVE: To investigate the efficacy of hemodialysis during cardiopulmonary resuscitation as an effective adjunct to the treatment of severe hyperkalemia. DESIGN: A prospective study. SETTING: In hospital dialysis units and intensive care units. PATIENTS: Renal failure patients who developed hyperkalemia induced cardiac arrest and failed to recover from conventional cardiopulmonary resuscitation (CPR) were included. Three patients entered into this study: 2 patients with chronic renal failure maintained on regular hemodialysis and one with acute renal failure who suffered from severe hyperkalemia. INTERVENTIONS: All three patients developed asystolic cardiac arrest with unrecordable blood pressure due to severe hyperkalemia. Aggressive CPR together with intravenous epinephrine, sodium bicarbonate and calcium chloride were instituted. External cardiac massage with cardiac defibrillation was unable to restore spontaneous heart action. After lack or response to intensive resuscitation, hemodialysis was performed concomitant with CPR to eliminate the potassium load. MEASUREMENTS AND RESULTS: Sinus rhythm and blood pressure were restored in all 3 patients but one of them eventually succumbed to her underlying disease. CONCLUSION: Hemodialysis during CPR is probably an effective adjunct to the treatment of severe hyperkalemia in patients with severe hemodynamic compromise and asystolic cardiac arrest.

Adult↗

PubMed1994

Efficacy of intravenous and subcutaneous erythropoietin in patients on hemodialysis and continuous ambulatory peritoneal dialysis.

We carried out our study with 54 hemodialysis patients and 11 CAPD patients. The hemodialysis patients were divided into five groups. Group 1 & group 2 received intermediate doses of erythropoietin ranging from 150 U/Kg/wk to 180 U/Kg/wk. Group 3, group 4 and group 5 received low doses of erythropoietin ranging from 75 U/Kg/wk to 90 U/Kg/wk. While group 1 & group 4 received erythropoietin subcutaneously, group 2 & group 3 received erythropoietin intravenously. The CAPD patients all received subcutaneous erythropoietin. The efficacy of the erythropoietin therapy was evaluated by (1) the early response rate, (2) the late response rate, (3) the time to reach the target hematocrit, (4) the therapeutic cumulative dose, and (5) the maintenance dose. We concluded that: (1) dose is the prime factor determining the rate and ratio of patients response to erythropoietin. (2) subcutaneous administration is more effective than the intravenous route resulting in a 20% to 30% dose-reduction effect, and (3) CAPD patients had a better erythropoietin response than the hemodialysis patients. A larger study is necessary to confirm this finding.

Adult↗

PubMed1993

Erythrocytosis in patients with renal failure on hemodialysis: study of underlying mechanism by in vitro erythroid culture assay.

Five patients with erythrocytosis associated with renal failure on maintenance hemodialysis were investigated for in vitro erythroid progenitor growth and the effect of their uremic sera on normal erythropoiesis. The duration of hemodialysis prior to discovery of erythrocytosis ranged from 1 week to 96 months. None had acquired cystic disease and no other known cause of increased erythropoietin (Epo) production was identified. With the presence of Epo in cultures, all five patients grew erythroid colonies within normal or higher than normal ranges. Three patients formed spontaneous erythroid colonies in the absence of added Epo; all three fulfilled the clinical diagnosis of polycythemia vera (PV). The uremic sera from patients with PV lacked either a stimulating or an inhibiting effect on normal erythropoiesis. The association between renal failure and PV was coincidental. The other two patients without endogenous erythroid colony formation had enhanced erythropoietic activity in their sera, which increasingly stimulated the erythroid colony growth by normal bone marrow cells as the concentration of the uremic serum was increased. The etiology of increased Epo production in these 2 patients remained undefined during long-term follow-up. The present study on five uremic patients with polycythemia showed two different underlying mechanisms of erythrocytosis--characteristic autonomous erythroid proliferation for PV in three patients and inappropriate idiopathic Epo production in two patients.

Aged↗

PubMed1992

Effect of body iron stores on serum aluminum level in hemodialysis patients.

To evaluate the influence of body iron stores on the serum aluminum (Al) level, we studied the correlation between iron status (the serum ferritin, serum iron and transferrin saturation) and serum Al levels in 68 severely anemic hemodialysis patients. Among them, 36 underwent the desferrioxamine (DFO) mobilization test. These 68 patients were divided into three groups according to their serum ferritin level. The basal Al level in the patient group was 41.4 +/- 37.4 micrograms/l (control, 4.1 +/- 2.4 micrograms/l). The serum Al level after DFO infusion of the patient group was 111.1 +/- 86.8 micrograms/l. A significantly higher basal Al and peak Al level after DFO infusion were found in group 1 patients (serum ferritin less than 300 micrograms/l) when compared to group 2 (serum ferritin 300-1,000 micrograms/l) and group 3 (serum ferritin greater than 1,000 micrograms/l) patients. A significant negative correlation between serum ferritin and basal serum Al (r = -0.544, p = 0.0001), as well as peak serum Al after DFO infusion (r = -0.556, p = 0.0001), was noted. Similarly, a negative relationship between serum Al (both basal and peak) and either serum iron or transferrin saturation was noted. However, there was no correlation between the serum Al level and the dosage of aluminum hydroxide. In conclusion, serum ferritin, serum iron and transferrin saturation were inversely correlated with serum Al in our hemodialysis patients. Iron deficiency may probably increase Al accumulation in these patients.

Adolescent↗

PubMed1989

Reiter's syndrome in uremia: report of a case.

A 35-year-old male uremic patient developed the classical presentation of Reiter's syndrome after 3 years of regular hemodialysis. He had painful swelling of the left knee, sacroilitis, urethritis, balanitis, painless oral ulcers, acute uveitis and positive HLA-B27. Disease activity persisted and was aggravated although immune function studies showed depressed cellular immunity. The clinical course of this patient seemed to contradict our belief that activity of immunologically mediated disease will abate after uremia, but it concurred with the report that Reiter's activity was unchanged in AIDS despite the significant immunodeficiency of AIDS patients.

Acquired Immunodeficiency Syndrome↗

PubMed1988