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Biomedical subjects

M M Avram

Publications and source records attributed to M M Avram.

At least 55 records · Page 3Linked to original sources
PubMed1989

Variability of peritoneal clearances for apolipoprotein and its relationship to susceptibility for atherosclerotic changes in CAPD.

Apolipoprotein Clearance and Atherogenicity in CAPD: Protein and lipoprotein loss is one of the disadvantages of CAPD. The impact of these losses on serum constituents is not fully understood. Lipoprotein disorders are observed in patients with chronic or acute renal failure or undergoing dialytic therapy with resultant increase in atherosclerotic clinical events yet these phenomenon are poorly understood, underinvestigated and underreported. Thus the impact of dietary and pharmacological steps to prevent these events are limited by lack of clinical facts. The recent emergence of effective lipid lowering agents makes a rapid analysis of parameters important. We studied the relationships between peritoneal clearance of apolipoproteins and serum atherogenicity indicators in a preliminary study of 10 CAPD patients with and without peritonitis. We measured total cholesterol (TC), HDL-Cholesterol (HDL-C), Apo A-I and Apo B and dialysate levels of Apo A-I and Apo B. Apo levels were determined immunotubidimetrically, and dialysate was concentrated by ultrafiltration. A subsequent prospective group of 10 additional patients was studied to test the relationship found in the preliminary study. In both preliminary and prospective nonperitonitis groups, the ratio of peritoneal clearance of Apo A-I to Apo B correlated strongly with the serum TC/HDL-C (r = 0.9 preliminary, r = 0.78 prospective group). There was an inverse correlation between the clearance ratio and both serum HDL-C (r = -0.71 preliminary, r = -0.77 prospective group) and serum Apo A-I/Apo B (r = -0.74 preliminary, r = -0.62 prospective group).(ABSTRACT TRUNCATED AT 250 WORDS)

Apolipoprotein A-I↗
PubMed1984

The natural history of diabetic nephropathy: unpredictable insulin requirements--a further clue.

Diabetic nephropathy has evolved into the single most prevalent cause of uremia among patients sustained by the United States End Stage Renal Disease program. Clarification of the natural history of kidney involvement and insufficiency in Type I and II diabetes has improved substantially over the past 5 years. However, it remains a poorly understood and relatively underreported morbid entity. This report reviews the problem, then reconstructs the natural history of diabetic nephropathy by studying the course of 50 Type I and Type II uremic diabetics treated with hemodialysis at The Long Island College Hospital. It traces the various stages from hyperglycemia to proteinuria to renal failure, and then reports morbidity, including cardiac, eye, stroke, and amputation complications. A new paradox is herein reported--the unpredictable insulin requirement, including new insulin need for the first time once hemodialysis was begun, in 8 of 50 patients studied.

Adult↗
PubMed1983

Medical nephrectomy: the use of metallic salts for treatment of end stage massive proteinuria and renal hypertension.

The first two cases outlined above with intractable massive proteinuria and uremia, were followed and treated with standard medical therapy and dialysis. After a period of study and demonstration of clinical deterioration both patients were given solutions containing sodium mercaptomerin. Within days there was a decline in urine protein excretion and a variable increase in serum protein concentration. The patients demonstrated an increase in blood pressure, which made hemodialysis treatment possible. No deleterious effects from the mercury salts were noted. These observations suggest that in selected cases nephrotoxic agents may be of value in decreasing massive proteinuria, and improving protein homeostasis in uremic patients. The ideal agent should be non-toxic to other organs and produce selective renal ablation (15). Although mercury is not the ideal agent, in these cases it did not produce observable side effects. This new method, applicable to dialysis patients with massive proteinuria, and of help in the control of uncontrollable hypertension in uremia, is an interesting new approach for our therapeutic armamentarium.

Aged↗
PubMed1983

Resection of false aneurysm from angioaccess of forearm.

False as well as true aneurysms occur at needle puncture sites in angioaccess grafts of forearm used for chronic hemodialysis. Thirty-four such aneurysms were resected by a simple technique with use of a pneumatic tourniquet and systemic heparinization. Follow-up examination of these patients showed no unusual problems related to the technique.

Aneurysm↗
PubMed1980

Lower parathyroid hormone and creatinine in diabetic uremia.

Groups of 14 diabetic and 30 nondiabetic patients undergoing maintenance hemodialysis were compared as to levels of serum creatinine, heights of PTH elevation, and finally as to severity of peripheral neuropathy. Diabetics had a statistically lower predialysis serum creatinine, PTH, and MNCV than did nondiabetics. The dual metabolic derangements of uremia and diabetes, along with multiple metabolic aberrations, including PTH, may explain the more severe neuropathy observed in diabetics. A proportionately lower PTH elevation in the diabetic is characteristic of this subgroup of uremic patients.

Calcium↗
PubMed1980

An outbreak of Salmonella enteritis and septicemia in a population of uremic patients. A review of four cases, including infection of an arteriovenous fistula.

An outbreak of enteritis and septicemia caused by Salmonella enteritidis occurred in a population of uremic patients treated in a nephrology unit. In one of the patients, an arteriovenous fistula was infected by this organism. The source of the outbreak was traced to the refrigerator and sink in the unit. This degree of morbidity and mortality far exceeds that previously reported in infections with nontyphoid Salmonella sp and is presumbly related to the decreased immune response seen in uremia.

Adult↗
PubMed1979

Comparative survival of 673 patients with chronic uremia treated with renal transplantation (RT) and maintenance hemodialysis (MD).

We performed a retrospective analysis of 673 patients with chronic uremia treated from 1973 through 1978. While MD had a high mortality during the first year, overall mortality was less than 50% in 5 yrs. Diabetics treated by MD have lower survival than do nondiabetics, though 14% may live for 4 yrs. Our local experience with RT has not been good with only 17% of 69 patients living through their third post-transplant year. Until the reasons(s) for our unsatisfactory transplant experience is discerned and remedies introduced, it can be expected that patient preference will be biased toward MD.

Adolescent↗
PubMed1979

Non-A, non-B hepatitis: a new syndrome in uraemic patients.

One hundred patients on chronic haemodialysis were studied prospectively over one year for evidence of hepatitis and of infection with hepatitis A or B virus. Five patients developed transient elevations of SGPT, accompanied by a consistent pattern of clinical manifestations, including low-grade fever, anorexia, nausea, hepatomegaly, and hypotension during dialysis. None of these patients had a positive test for A or B virus infection. Non-A non-B hepatitis appears to cause a specific syndrome in uraemic patients, and its transmission in a dialysis unit seems unrelated to blood transfusions.

Aged↗