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Biomedical subjects

R Bambauer

Publications and source records attributed to R Bambauer.

69 records · Page 4Linked to original sources
PubMed1984

[Enzyme determination in the urine for the evaluation of kidney tolerance of the water-soluble roentgen contrast medium iopamidol].

The renal toxicity of the ionic, very hyperosmolaric megluminamidotrizoate was compared with the toxicity of the non-ionic, slightly hypertonic iopamidol after intravenous injection of 0.7 ml/kg body weight (i.e. about 300 mg iodine/ml) in a randomized study of 20 individuals with normal kidneys. Quantitative measurements of the excretion of the enzymes, lactate dehydrogenase (LDH), alkaline phosphatase (AP), and N-acetylglucosaminidase (NAG) in 24-h urine samples, serum creatinine, and the endogeneous creatine clearance were conducted to determine the possible renal damage. All 20 subjects tolerated both contrast mediums well. Reduced renal function as measured by the creatinine blood level and the endogeneous clearance did not occur. The ionic, hyperosmolaric megluminamidotrizoate++ caused significantly elevated enzymuria of NAG, AP, and LDH (P less than 0.01) following tubular irrigation, whereas iopamidol showed no significant enzymuria. Therefore, it appears that the non-ionic contrast medium, iopamidol, is less toxic for kidneys than the ionic megluminamidotrizoate.

Acetylglucosaminidase↗
PubMed1983

Use of large-bore catheters in the internal jugular vein as an access route for emergency hemodialysis.

Our experience with catheterization, mainly of the internal jugular vein, using a large-bore catheter (Shaldon catheter) with 279 patients and a total of 359 catheter placements, is reported. The subclavian vein was used for vascular access in 57 additional patients (80 catheters) and the femoral vein in four patients (six catheters). Percutaneous puncture of the jugular, subclavian and femoral veins in a total of 340 patients (445 catheters) was necessary for emergency hemodialysis, hemofiltration, hemoperfusion, plasmapheresis or, in the case of patients on regular hemodialysis, for temporary vascular access while awaiting the availability of another access site. Complications were less frequent with the internal jugular point of entry than with others, based on our experience and the literature published. Cannulation of the superior vena cava through the internal jugular vein therefore appears to be a most appropriate route for rapid vascular access when emergency extracorporeal blood treatment is required.

Adult↗
PubMed1982

[Use of large-bore catheters inthe internal jugular vein as an access for acute hemodialysis (author's transl)].

For almost 2 decades, the chosen method for hemodialysis has been the transcutaneous Seldinger technique, using large-bore catheters. Traditionally, the femoral or subclavian veins have been used. We report our experience on introducing the catheter (Shaldon Catheter) into the internal jugular vein in 237 cases in 194 patients. the percutaneous insertion was necessary for acute hemodialysis, hemofiltration, hemoperfusion, or for temporary vascular access. This method was using for plasmapheresis, too. Major complications did not occur, which is in agreement with other authors, where by the frequency of complications relating to the catheter itself has been lower using this approach. It thus seems that the cannulation of the superior vena cava through the internal jugular vein is a suitable means of obtaining fast vascular access for the purposes of hemodialysis, hemofiltration, hemoperfusion or plasmapheresis.

Blood↗
PubMedDate not supplied

[Single-needle diafiltration and single-needle plasmapheresis in premature infants].

Extracorporal detoxication methods in newborns are most unavailable, contraindicated because of technical problems. We report our experiences with a blood pump unit developed by our-selves for diafiltration and plasmapheresis in newborns. In 6 newborns with acute renal failure, Rh-ery-throblastosis and hypoproteinemia, 13 single-needle-diafiltrations and 6 single-needle-plasmapheresis were performed with the self-constructed double head pump, special tube systems and small models. Our results show that all extracorporal detoxication methods can be carried without problems.

Acute Kidney Injury↗
PubMedDate not supplied

Ultrafiltration of dialysis fluid for hemodialysis.

Since the quality of water in dialysis fluid varies considerably, and, in view of the fact that endotoxin or active derivatives can cause acute side effects in patients, the dialysis fluid must be sterile. The predialyzer fluid in 20 hemodialysis patients was investigated. Bacterial loading was between 5/ml and 5,000/ml, and the endotoxin concentration was high and extremely variable. After ultrafiltration of the dialysis fluid by a polyamide hollow fiber membrane, all samples were free of bacteria, and the concentration of endotoxin was lower than the detectable limit. With this procedure we can obtain sterile dialysis fluid, which is endotoxin free.

Colony Count, Microbial↗
PubMedDate not supplied

Hemofiltration and plasmapheresis in newborns using a small blood pump system.

Extracorporeal detoxification methods in newborns and premature infants are unavailable and contraindicated because of technical problems. The authors' experiences with a blood pump unit that was miniaturized for hemodialysis, hemofiltration, and plasmapheresis in newborns are reported. In 28 newborns and premature infants, 32 hemofiltrations, 3 hemodialyses, and 57 plasmaphereses were carried out for different diseases. Thirteen of 28 patients died despite hemofiltration and/or plasmapheresis as a result of their primary disease and/or immaturity, and 15 patients improved.

Acute Kidney Injury↗
PubMedDate not supplied

Surface treated large bore catheters with silver based coatings versus untreated catheters for extracorporeal detoxification methods.

Infection, thrombosis, and stenosis are among the most frequent complications associated with blood contacting catheters. Because these problems are usually related to surface properties of the base catheter material, surface treatment processes, such as ion implantation and ion beam assisted deposition (silver based coatings), can be used to mitigate such complications. Because these ion beam based processes affect only the near-surface region (approximately the outer 1 microm), there is little effect on bulk material properties. This study evaluated silver coated large bore catheters used for extracorporeal detoxification. In a 122 patient prospective study, 156 large bore catheters were inserted into the internal jugular or subclavian veins. Seventy-eight surface treated catheters (SPI-ARGENT, Spire Corporation, Bedford, MA; n = 32 acute catheters, n = 45 long-term catheters) were Bambauer inserted in 55 patients. Seventy-eight untreated catheters placed in 67 patients served as controls (n = 35 acute catheters, n = 43 long-term catheters). After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They were also examined using a scanning electron microscope (SEM). Bacterial colonization was observed in 15.4% of the treated catheters compared with 44.9% of untreated catheters. The SEM investigations showed all treated catheters to possess low thrombogenicity. Results of the study indicate that ion beam based processes can be used to improve thrombus and infection resistance of blood contacting catheters.

Adult↗
PubMedDate not supplied

Evaluation of microparticles released from an adsorber used for low density lipoprotein apheresis.

Microparticle (MP) released from a DALI 750 Adsorber column for low density lipoprotein apheresis, which is used in a direct hemoperfusion system, was evaluated. The numbers of MP were measured by a light blockage method in the effluents from the column during the rinsing (priming) procedure using a priming solution, and the simulated treatment procedure using a physiologic saline solution as a substitute for whole blood. An unacceptable number of MP were released from the column during the simulated treatment after rinsing with an amount of solution prescribed by the manufacturer. MP concentrations (mean values of three experiments) in the initial 300 ml of the effluent were 639.9, 75.1, and 3.6 pieces/ml for > or = 5 microm, > or = 10 microm, and > or = 25 microm, respectively, and neither the result for > or = 5 microm nor for > or = 10 microm meets the requirement for solutions for injection defined in the United States Pharmacopoeia XXIII or the British Pharmacopoeia of 1993. Furthermore, a large number of MP still remained in the column after all the simulated operations. These findings suggest that the column has a potential to release an unacceptable number of MP into the patient during treatment. Further investigation on the influence of the MP released into the patient's circulation is necessary.

Adsorption↗
PubMedDate not supplied

LDL-apheresis as long-term treatment in severe hyperlipidemia using differing methods.

In 34 patients (18 women, 16 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low density lipoprotein (LDL) apheresis was performed during 72.8 + 43.2 months. Four different systems (Liposorber, 28 of 34, Kaneka, Osaka, Japan; Therasorb, 2 of 34, Baxter, Germany; Lipopak 2 of 34, Pocard, Moscow, Russia; Dali, 2 of 34, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 51.9% for total cholesterol, 49.8% for LDL, 69.8% for lipoprotein (a) (Lp(a)), and 58.8% for triglycerides, and an average increase of 9.8% for HDL were reached. Severe side effects such as shock or allergic reactions were very rare (0.5%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 31 of 34 patients. Assessing the different apheresis systems used, at the end of the trial there were no significant differences with respect to the clinical outcome experienced by the patients' total cholesterol, LDL, HDL, and triglyceride concentrations. However, to reduce high Lp(a) levels, the immunoadsorption method with special Lp(a) columns (Lipopak) seems to be most effective: -57% versus -25% (Kaneka), -23% (Baxter), and -29% (Dali). The present data demonstrate that treatment with LDL-apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe, even in long-term application.

Adult↗
PubMedDate not supplied

Apheresis technologies for prevention and regression of atherosclerosis: clinical results.

The objective of this multicenter trial, which included 28 clinical centers, was to determine if repeated low density lipoprotein (LDL)-apheresis using the Liposorber LA-15 system (Kaneka Corporation, Osaka, Japan) could lead to an additional acute and time averaged lowering of total cholesterol (TC) and LDL-cholesterol (LDL-C) in severely hypercholesterolemic patients whose cholesterol levels could not be controlled by appropriate diet and maximal drug therapy. A total of 6,798 treatments were performed on 120 patients, including eight homozygous familial hypercholesterolemia (FH), 75 heterozygous FH, and 37 unclassified FH or other hyperlipidemias, from 1988 through 1994. The mean TC and mean LDL-C levels at baseline were 410.0 and 333.9 mg/dl, respectively. LDL-apheresis was performed once a week or at least once every 2 weeks in all patients. During treatment with the Liposorber system, the mean acute percentage reduction was 52.6% for TC and 63.1% for LDL-C. Very low density lipoprotein cholesterol (VLDL-C) and triglycerides (TG) were also substantially reduced to 60.6% and 47.5%, respectively. Fibrinogen, a potential risk factor for coronary heart disease (CHD), was reduced by 26.2%. In contrast, the mean acute reduction of high density lipoprotein (HDL) was only 3.4%. The adverse events (AE) were those generally associated with extracorporeal treatments. The most common AE was hypotension, with 69 episodes corresponding to 1% of all treatments reported in 44 of the 120 patients treated. All other kinds of AE occurred in <0.2% of the treatments. The treatment with the Liposorber LA-15 system was overall well tolerated. It should be noted, however, that a more severe type of hypotensive reaction was reported in patients taking concomitant angiotensin converting enzyme (ACE) inhibitor medication. With the exception of such anaphylactoid-like reactions associated with the intake of ACE-inhibitors, the Liposorber LA-15 system represents a safe and effective therapeutic option for patients suffering from severe hypercholesterolemia that could not be adequately controlled by diet and maximal drug therapy.

Adolescent↗
PubMedDate not supplied

Frequency, therapy, and prevention of infections associated with large bore catheters.

Since the introduction of large bore catheters for acute hemodialysis 30 years ago, many problems with handling, material, and contamination of these catheters existed. Nevertheless, the catheterization of the inferior and superior vena cavae with a large bore catheter has proved to be suitable as a rapid connection process for hemodialysis, hemofiltration, hemoperfusion, plasmapheresis, plasmaperfusion, etc. In a retrospective study with 2,626 large bore catheters in 1,627 patients, the frequency of infections, thrombosis, bleeding, and other side effects was investigated. All complications and side effects are presented dependent upon vascular access route. In total, the complication rate was 44.2% higher in subclavian puncture than in internal jugular puncture at 23.9%. The highest complication rates in both vascular access routes were infections or septicemia; infections were observed in 22.8% of subclavian catheters versus 9.5% of internal jugular catheters. Three different catheter materials (Teflon, polyurethane, and polypropylene) were investigated with scanning electron microscopy after removal. The advantages and disadvantages of the different materials are presented.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comparison of low molecular weight heparin and standard heparin in hemodialysis.

The anticoagulant and antithrombotic effect of heparin has been known for many decades. Since low molecular weight heparin has been available, several advantages over standard heparin were observed, especially in long-term use during hemodialysis. In 27 patients, we found a lower bleeding risk, a lower need for erythrocyte transfusions, a lesser increase in activity of various coagulation factors, and lower triglyceride levels. Therefore, low molecular weight heparin would appear to be a good alternative to standard heparin in dialysis patients.

Blood Coagulation Factors↗
PubMedDate not supplied

Sterile versus non-sterile dialysis fluid in chronic hemodialysis treatment.

As the quality of water in the dialysis fluid varies considerably, and in view of the fact that endotoxin or active derivatives can cause acute side effects in patients, the dialysis fluid must be sterile. Therefore, we introduced ultrafiltration of dialysis fluid before entering the dialyzer. Fifteen patients, (ten women, five men) were treated for 4 weeks with nonsterile, and then with sterile dialysis fluid. The bacterial loading in the dialysis fluid before hemodialysis was 1.34 X 10(5)/ml, and after hemodialysis 2.9 X 10(3)/ml; the endotoxin concentration was high and varied between less than 1 EU/ml and greater than 10 EU/ml before and after hemodialysis. After ultrafiltration of the dialysis fluid by a polyamide hollow fiber membrane, all samples were free of bacteria and the concentration of endotoxin was lower than the detectable limit (less than 0.03 and less than 0.5 EU/ml). With ultrafiltration of dialysis fluid we can obtain sterile dialysate, which is endotoxin free. Interleukin-1 and tumor necrosis factor in the patients with ultrafiltration was significantly lower than without ultrafiltration.

Adult↗
PubMedDate not supplied

Contamination of dialysis water and dialysate. A survey of 30 centers.

The concentration of bacteria and endotoxin in dialysis water and dialysate of 30 dialysis centers in western Germany was examined. Water samples were obtained after treatment by reverse osmosis or other processing methods. Collection of dialysis samples for bacterial, fungal, and endotoxin analysis was conducted before and 2 hours after start of hemodialysis. In 17.8% of all water samples analyzed, the AAMI standard was exceeded and bacterial and fungal counts greater than 200 colony forming units/ml were found. In 11.7% of all dialysate samples, higher contamination than the recommendations for dialysate of 2000 colony forming units/ml were found. The concentration of endotoxin in water and dialysate varied between 0 and 95 endotoxin units in the water samples and 0 and 487 endotoxin units/ml in the dialysate samples. In 12.2% of all water sampled, and 27.5% of all dialysate samples, values of 5 endotoxin units/ml were found. No correlation was found between the level of contamination of either water or dialysate in a specific center and the following factors: water processing method (reverse osmosis or others), type of dialysate (acetate of bicarbonate), type of dialysate machine, or method of machine disinfection. In view of these results it is suggested that endotoxin testing, especially in the dialysate, be a part of regular quality control in dialysis.

Bacteria↗