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Biomedical subjects

R A Gutman

Publications and source records attributed to R A Gutman.

At least 19 recordsLinked to original sources
PubMed1992

Variable mortality rates among dialysis treatment centers.

OBJECTIVE: To examine the variation in the risk for mortality among patients treated at renal dialysis facilities within a defined geographic area. SETTING: All free-standing and hospital-based dialysis facilities in a single southeastern state reported to the registry. DESIGN: Cohort of dialysis patients followed for 1 year by an end-stage renal disease registry. PATIENTS: Patients (n = 3612) aged 20 years and older receiving treatment at the dialysis facilities reporting to the registry during 1987. MEASUREMENTS: Demographic, comorbid, and severity of illness indicators were abstracted from patient records. Facility-specific risk estimates were derived from a Cox proportional hazards model. RESULTS: Facility-specific mortality rates ranged between 2.0 and 10.5 deaths per 10,000 patient days. Mortality rates were higher among older persons; whites; those with a history of diabetic nephropathy, angina, or congestive heart failure; and patients with either nutritional or functional status impairment. Facility-specific prevalence of each mortality risk factor varied widely. The unadjusted risk for death in a facility at the 75th percentile of risk was 1.3 times that of a facility at the median, whereas at the 25th percentile, it was 0.68 times as likely--a twofold range of risk. Controlling for differences in the prevalence of patient characteristics did not change the interquartile range in risks, and a facility's adjusted risk estimate showed a strong correlation with its unadjusted estimate (R2, 0.566; P less than 0.0001). CONCLUSIONS: Patient attributes associated with increased risk for mortality vary widely among dialysis facilities. Adjustment for these differences did not, however, substantially change either the degree of variation in mortality risks or the relative ranking of a facility's mortality.

Adult↗
PubMed1992

[Intensified insulin therapy in the management of gestational diabetes].

A total of 35 pregnancies in 28 Pregestational Diabetic Patients (PDP) were followed with the goal of achieving and maintaining near normoglycemia (as many pre-postprandial glycemias as possible between 60-140 mg/dl); 13 patients (16 pregnancies) were assigned to Subcutaneous Continuous Preprogrammed Insulin Infusion (SCII) because of high risk pregnancies (HRP) (at least one of the following: former history of spontaneous abortions, stillbirths, premature deliveries and/or sterility). The remaining 12 PDP's (15 pregnancies with no past history of the above nature) were treated with Multiple Conventional Insulin Injections (MCII). Both groups were comparable regarding the following clinical parameters: age, time of onset and class of diabetes. All patients were instructed in performing 3 to 7 daily Self Capillary Blood Glucose controls (SCBG). Mean follow-up observation period was (mean +/- SEM) 28.5 +/- 2.5 weeks for SCII and 3.2 MCII and 28.8 +/- 3.2 weeks for MCII. All the 3 PDP drop out's (4 pregnancies) belonged to the CMII group. No drop out's were recorded in the SCII group. Both insulin therapy approaches were similarly effective in improving metabolic control in that comparable levels of mean blood glucose (MBG) and HbA1 were attained by SCII and MCII (Fig. 1). Compliance, as evidenced by average of daily SCBG was also similar in both groups (Fig. 2). Such satisfactory metabolic control was achieved mostly because of an increase in the percentage (65%) of "fair" glycemias (60-139 mg/dl) and not because of an increase in hypoglycemias (< 60 mg/dl) which could have canceled out an undesirable degree of hyperglycemias thus rendering "false satisfactory" MBG's and HbA1 (Fig. 1). With the above degree of metabolic control obtained there occurred no severe hypoglycemic episodes requiring medical intervention. All newborns to the PDP's who remained under treatment showed an adequate APGAR (X +/- SEM, 9.5 +/- 0.2) regardless of the modality (SCII or MCII) of insulin delivery used (Tables 1, 2). The single malformed baby found in this series was born to a patient on SCII who happened to start on the intensified insulin treatment rather late in her pregnancy (21st week) and, in addition, the patient self medicated with high doses of chlorpromazine because of recurrent vomiting episodes. Incidence of neonatal hypoglycemia (HY) or macrosomy (MS) was comparable in both groups (Tables 1, 2). It is to be pointed out, however, that PDP's who bore the babies with no HY or MS had presented a larger number of low glycemic values than mothers who bore the babies with HY and/or MS.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1990

H-ras protooncogene mutations in human thyroid neoplasms.

Structural alterations of protooncogene sequences may be involved in the pathogenesis of human neoplasms. We screened 54 thyroid tumors (36 benign and 18 malignant) for gene rearrangements of the protooncogenes c-myc, c-myb, c-fos, c-erb-B1, c-erb-B2, c-erb-A, N-ras, K-ras, and H-ras. Only mutations of H-ras were observed. None of the 15 colloid adenomas examined had detectable H-ras rearrangements. Of the remaining tumors, we observed mutations of H-ras in 4 benign and 4 malignant neoplasms. Gene amplification was found in 5 tumors. An aggressive recurrent papillary carcinoma had a marked amplification of one of the H-ras alleles. The amplified allele was truncated, in that the 3' variable tandem repeat was not a part of the amplification unit, and contained a codon 12 point mutation leading to a valine for glycine substitution. We also observed the association of low copy gene amplification with a codon 12 valine for glycine mutation in a follicular adenoma. Two tumors contained H-ras EcoRI polymorphisms not present in the DNA of normal thyroid from the same individuals, and one follicular carcinoma showed loss of an H-ras allele. Ras protooncogenes may become transforming by quantitative mutations, leading to increased expression, or qualitative mechanisms, through activating point mutations. Both of these appear to coexist in thyroid neoplasms, and it may be that a combination of both mechanisms is capable of inducing a more complete spectrum of neoplastic phenotypes.

Base Sequence↗
PubMed1987

Long-term hypertriglyceridemia and glucose intolerance in rats fed chronically an isocaloric sucrose-rich diet.

We have previously shown that short-term feeding [20 to 25 day induction period (IP)] normal rats a sucrose-rich diet (SRD) results in an increase of plasma (P), liver (L), and heart (H) triacylglycerol (TG) levels, accompanied by a drop in plasma postheparin total (T-TGL) and hepatic (H-TGL) triglyceride lipases activities, IV glucose intolerance (low Kg) and hyperinsulin responses both in vivo and in vitro, suggesting that a state of insulin resistance had developed. Since normalization of P-TG ensued in the medium term [40 to 55 day adaptation period (AP)] we decided to carry out a longitudinal, long-term (90 to 120 day) follow-up study to observe the dynamic behavior of the above metabolic and hormonal parameters as compared to the appropriate time course control rats were fed the standard chow (STD).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Optimizing glycemic control: can insulin dependent diabetic patients rely on their perception of blood glucose fluctuations in order to make therapeutic decisions?

30 insulin dependent diabetic (IDD) patients without clinically evident autonomic neuropathy were asked on 128 occasions to estimate quantitatively what they believed their capillary blood glucose (CBG) to be (predicted blood glucose--PBG) immediately before an actual CBG measurement was performed (real blood glucose--RBG). A statistically significant correlation was found between the pooled RBG's and PBG's of our patient population (r = 0.57, p less than 0.001). However, there was a notable skewing of the RBG/PBG curve, evidencing a tendency of our patients' predictions to be closer to normality. This is further documented by the fact that the mean M value of the RBG's of each of the 11 patients with more than 6 predictions was significantly greater than the mean M value of the corresponding PBG's. Within the ranges of hypoglycemia (RBG less than or equal to 3.3 mmol/l) and of normoglycemia (3.4-7.8 mmol/l) there was no correlation between RBG's and PBG's. With RBG's greater than or equal to 7.8 mmol/l the correlation was statistically significant (r = 0.41, p less than 0.01). When the pooled predictions were analyzed according to qualitative accuracy for different ranges of RBG the following trend emerges: for RBG's less than or equal to 3.3 mmol/l (60 mg%), 2/11 predictions were accurate (18%), for RBG's greater than or equal to 12.3 mmol/l (221 mg%), 30/37 (81%) and for RBG's between 3.4 and 12.2 mmol/l (61-220 mg%), 44/80 (55%). In conclusion, our patients as a whole showed an ability to discriminate between high, normal and low levels of blood glucose, albeit with a strong bias to predict values closer to the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Hypophosphatemia in long-term renal transplant recipients: effects on bone histology and 1,25-dihydroxycholecalciferol.

The effects of long-term hypophosphatemia were studied in 10 renal transplant recipients with persistent hypophosphatemia. The renal transplant recipients are 3-14 years (mean 8.7 +/- 4 years) post transplantation. The mean (+/- SD) serum calcium, phosphate, and creatinine levels are 9.66 +/- 0.42, 2.29 +/- 0.16, and 1.47 +/- 0.23 mg/dl, respectively. Carboxy (C)-terminal parathyroid hormone (PTH) is elevated in 8 hypophosphatemic renal transplant recipients. The mean 1,25-dihydroxycholecalciferol [1,25(OH)2D3] level is 33 +/- 20 pg/ml (normal 19-55 pg/ml) compared to 42 +/- 0.6 pg/ml (NS) in 4 normophosphatemic renal transplant recipients with comparable renal function. The 1,25(OH)2D3 level correlates with C-PTH (p less than 0.01) but not serum phosphate. Anterior iliac crest bone biopsies were obtained in all 10 hypophosphatemic renal transplant recipients. Histomorphometric analysis of osteoblastic osteoid, total surface osteoid, bone-osteoclast interface, total resorption, osteoclasts/mm2, osteoid seam width, and relative osteoid volume are not significantly different from normals. Trabecular bone volume is decreased (15.6 +/- 5.7 vs. 23 +/- 5%, p less than 0.01). Comparison of dynamic parameters with normal reveals no differences in appositional and bone formation rate. In summary, in hypophosphatemic renal transplant recipients: hypophosphatemia does not produce osteomalacia; hyperparathyroidism is often observed, and plasma 1,25(OH)2D3 levels, in general, remain in the normal range.

Adult↗
PubMed1985

The quality of life of patients with end-stage renal disease.

We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.

Adult↗
PubMed1985

[Immune response in rabbits to tumoral tissue extracts of human colon].

Carcinoembryonic antigen (CEA) was purified after perchloric acid extraction of glycoprotein from human normal and tumoral colon. Antibodies against those extracts as well as purified CEA were raised in rabbits. Sera obtained from animals immunized with tumoral extract in protracted schemes showed disperse behavior on polyacrylamide gel electrophoresis (PAGE) for proteins in the area with gamma, mobility which were markedly increased. In addition, a large increase of proteins with a mobility comparable to alpha 2 proteins was observed. The latter increase was not present in sera of rabbits immunized with normal colon extracts. Low titer antisera were obtained after immunization with either antigen as revealed by immunodiffusion. The relatively highest titers were seen against the glycoprotein fraction of tumor extracts which had previously been enriched by isoelectric focusing. Immunoelectrophoresis of tumor extracts against homologous antisera revealed bands with beta mobility due to the presence of CEA antibodies only in the sera of animals injected with tumor extracts. Antibody titers assayed by radioimmunoassay (RIA) revealed that the highest titers were obtained from tumor glycoprotein extracts was used as an immunogen. Measurements of CEA concentrations in serum of patients with low and high levels of CEA showed non significant differences by statistical analysis, when antisera obtained from different bleedings of the same animals were used. It is concluded that in order to establish a CEA RIA for clinical purposes it is necessary to purify up to the isoelectric focusing step the material to be labelled as tracer or used as standard. Antibody reagent may be obtained by immunizing schemes or protracted schemes using crude perchloric acid extracts of colon tumor.

Adult↗
PubMed1979

Cytomegalovirus infection and chronic hemodialysis.

Serologic and virologic studies of cytomegalovirus (CMV), a virus infection often disseminated in immunosuppressed patients, were initiated among hemodialysis patients, home dialysis partners, hemodialysis center personnel, and several groups of patients. No evidence was found of activation or persistence of CMV infections in connection with chronic renal disease or in association with hemodialysis. Evidence of increased CMV activation and/or infection was found among individuals who had re-entered the dialysis program following renal allograft rejection. The data indicate that dialysis personnel and home dialysis partners are not at increased risk for CMV infection. The findings of this study, which contrast with those pertaining to hepatitis B infection, suggest that different mechanisms are responsible for establishing both infection and persistence of CMV and hepatitis B.

Adult↗
PubMed1978

Automated peritoneal dialysis for home use.

In order to provide an alternative to maintenance home dialysis for patients remotely situated or who had vascular access failure, a parallel peritoneal dialysis (PD) program was developed in March 1972. Over four years, 36 patients started PD with the intention of carrying out home treatments. Thirty of the 36 succeeded and 22 completed at least six months of home treatments, seven have so far been treated for over one year. No neuropathy developed except in diabetic patients. No patient, including four who had undergone bilateral nephrectomy, was depenedent on blood transfusions. Predialysis serum creatinine values were questionably higher (p less than 0.07) in a group of six patients who at another time had been maintained on hemodialysis (HD). In this group serum albumin was (mean +/- 1 S.D.) 3.3 +/- 4 g/100 ml on PD and 3.8 g/100 ml on HD (p less than 0.05). Sixteen of the 36 patients had bacterial peritonitis on 22 occasions; the average incidence was once every 14 months of patient exposure. An epidemic of sterile peritonitis involving 40 episodes in 16 patients was resolved after machine techniques were changed. Catheter failure occurred in 15 of the 22 patients in the long-term group, but catheter replacement was not difficult.

Adult↗