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Biomedical subjects

P Hirszel

Publications and source records attributed to P Hirszel.

At least 37 records · Page 2Linked to original sources
PubMed1981

Glycosylated hemoglobin in patients treated by chronic dialysis.

A glycosylated hemoglobin (HbA1) test was used to evaluate the role of dialysate glucose in the development of carbohydrate intolerance and hyperlipidemia in chronic hemodialysis patients and chronic peritoneal dialysis patients. HbA1 levels were significantly elevated in all groups of patients. HbA1 levels were not ameliorated with 8 weeks of glucose-free hemodialysis. There was no correlation between HbA1 and serum glucose, triglycerides, or cholesterol. Thus, HbA1 elevation cannot be explained solely by glucose reabsorption from dialysate. This test is helpful in the detection of carbohydrate intolerance, but its usefulness in evaluation of hyperlipidemia of dialysis patients is uncertain.

Adolescent↗
PubMed1980

Peritoneal dialysis in the treatment of severe hypercalcemia.

A 56-year-old man with multiple myeloma and compromised renal function underwent peritoneal dialysis for the treatment of severe hypercalcemia. During dialysis, peritoneal clearances of total calcium, unbound calcium, urea, and creatinine were assessed. Clearances of total calcium (4.8 +/- 0.4 ml/min) and unbound calcium (7.8 +/- 0.5 ml/min) were shown to vary directly with the clearances of urea (15.5 +/- 1.3 ml/min) and creatinine (8.5 +/- 0.8 ml/min). Despite relatively low clearances of all these solutes, during the period of 42 hours, 1,638 mg of calcium was removed in the dialysate and total serum calcium decreased from 17.6 mg/dl to 10.2 mg/dl. Our data indicates that peritoneal dialysis is an effective adjunct in controlling severe hypercalcemia and should be considered when other forms of therapy are inadequate.

Acute Disease↗
PubMed1979

Effects of gastrointestinal hormones on transport by peritoneal dialysis.

Because the gastrointestinal hormones are known to dilate the splanchnic vasculature, their effects on transport of water and solutes during peritoneal dialysis were studied in an experimental model, the rabbit. In unanesthetized rabbits, dialysate volume was calculated by isotope dilution, and clearances were estimated by dialysate/plasma concentration ratio factored by minute volume. With isotonic dialysis solution, the mean increment in dialysate volume per minute of intraperitoneal dwell was 0.19 ml/kg/min, and mean clearances of creatinine and urea were 0.71 and 0.90 ml/kg/min, respectively. When administered intravenously, secretin significantly augmented osmotically induced water flux, but not when given intraperitoneally. Neither glucagon nor cholecystokinin affected dialysate volume. Intravenously, but not intraperitoneally, glucagon increased peritoneal clearances of creatinine and urea to more than 150% of control values. Neither cholecystokinin nor secretin augmented significantly peritoneal mass transport when given by either route. The data suggest that the site of acton is the endothelial surface of the membrane, that the mechanisms of augmenting transport involve increased permeability and/or surface area, and that agents which combine an increase in mass transport and capillary filtration coefficient may be clinically useful.

Animals↗
PubMed1979

Divergent effects of catecholamines on peritoneal mass transport.

In rabbits, intravenous vasopressor doses of dopamine augmented peritoneal clearances of creatinine and urea, suggesting increased mesenteric blood flow and possibly augmented permeability. Intraperitoneal dopamine also accelerated peritoneal transport of urea. Solute transport across the peritoneum was decreased by intravenous infusion of 1-norepinephrine. Intraperitoneal administration of the alpha-adrenergic antagonist phentolamine partially abolished the augmentation of peritoneal clearances induced by intravenous dopamine. The results suggest that in patients undergoing peritoneal dialysis who require vasopressor therapy, dopamine should be preferred to norepinephrine.

Animals↗
PubMed1979

Prediction of solute transport during peritoneal dialysis.

Solute transport, predominantly diffusion, across the peritoneum correlates inversely with molecular weight. Provided that the solute is water soluble, not protein bound, not of unusual density, not ionized, does not have a large hydration shell, and is transported from plasma to dialysate, the peritoneal clearance is predictable over the molecular weight range from 60 to 11,000 daltons. Transport reates that deviate from the predicted can be explained by known physical properties of particular solutes.

Animals↗
PubMed1979

Augmentation of peritoneal mass transport by dopamine: comparison with norepinephrine and evaluation of pharmacologic mechanisms.

The effect of catecholamines on transport during peritoneal dialysis was studied in unanesthetized rabbits. Intravenous I-norepinephrine consistently decreased peritoneal clearances of urea and creatinine to 84% of control values or less but did not affect osmotically induced water flux. Comparable pressor doses of dopamine increased clearances of urea and creatinine to 145% of control values, whereas osmotic fluid flux increased only slightly. Dopamine also increased urea transport when administered intraperitoneally. The augmentation of solute transport by dopamine was unaffected by simultaneous administration of propranalol, was decreased by phentolamine, and was abolished by haloperidol. Dopamine may be preferable toI-norepinephrine when vasopressor therapy is required during peritoneal dialysis. The augmented transport with dopamine appears to depend on the action of dopamine receptors causing mesenteric vasodilation and in part on alpha-adrenergic receptors simultaneously increasing blood pressure while mesenteric blood flow is maintained.

Animals↗
PubMed1978

Augmented peritoneal mass transport with intraperitoneal nitroprusside.

Lightly restrained, alert New Zealand white rabbits underwent peritoneal dialysis by percutaneous instillation of standard dialysis solution with or without intraperitoneal nitroprusside. Corrected to a mean intraperitoneal dwell time of 36 minutes, mean clearances of creatinine and urea were 0.74 and 0.90 ml/kg/min in six rabbits. With intraperitoneal nitroprusside, 1.13 mg/kg clearances increased to 1.13 and 1.30 ml/kg/min (p less than 0.01) respectively. The 53% increment in creatinine clearance maintained the ratio clearance larger/smaller solute suggesting increased peritoneal permeability and/or area. Lower nitroprusside doses were less effective and not significantly above control. Nitroprusside also increased clearances during hypertonic peritoneal dialysis, but had no effect on osmotically induced water flux. Lavage studies demonstrated a persistent effect of nitroprusside after a single exposure and a sustained effect with repeated use.

Animals↗