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Biomedical subjects

R Uldall

Publications and source records attributed to R Uldall.

17 recordsLinked to original sources

An enzymatic method for measuring serum mannitol and its use in hemodialysis patients.

We evaluated two chemical methods for quantifying mannitol in serum, based on the oxidation of mannitol by periodate, and measurement of the formaldehyde formed with chromotropic acid (colorimetry) or acetylacetone (fluorometry). We found interference in these methods by serum glycerol. Additionally, a high-performance liquid chromatography (HPLC) method was evaluated and found to be specific but impractical for routine use. We therefore, developed an enzymatic fluorometric procedure, based on the oxidation of mannitol by beta-NAD to fructose and NADH, in the presence of the enzyme mannitol dehydrogenase (MD). MD is not commercially available and was partially purified from cultures of Leuconostoc mesenteroides. This new method is specific, sensitive, simple, and accurate and is proposed as the method of choice for measuring mannitol in the serum of patients who received this sugar alcohol during routine hemodialysis treatment.

Chromatography, High Pressure Liquid

The use of nuclear magnetic resonance imaging in monitoring total body iron in hemodialysis patients with hemosiderosis treated with erythropoietin and phlebotomy.

Two hemodialysis patients with hemosiderosis were treated with combined erythropoietin and repeated phlebotomy. Serial nuclear magnetic resonance (NMR) imaging and serum ferritin levels were used to monitor the efficacy of treatment. This treatment modality has definite advantages over chronic deferoxamine therapy. NMR image-derived parameters offer an objective, accurate, and noninvasive indication of tissue iron stores.

Adult

Septicemia in long-term jugular hemodialysis catheters; eradicating infection by changing the catheter over a guidewire.

By convention, septicemia occurring from an infected vascular catheter is treated with antibiotics and removal of the catheter. This approach, used with surgically implanted long-term catheters would be expected to result in loss of the vascular access site. During a 57 month period, we treated 21 episodes of septicemia secondary to infection of long term indwelling double lumen jugular venous catheters in our hemodialysis unit. Seventeen of 21 episodes were managed successfully by changing the catheter over a guidewire, thus preserving the access site. No relapse was observed after the antibiotic therapy was stopped. Only four patients required complete removal of the catheter and subsequent use of another site.

Actuarial Analysis

Simultaneous aortic and renal artery reconstruction for acute arterial occlusion in solitary kidney.

A case is described of the onset of acute renal failure due to renal artery occlusion in a solitary kidney of a sixty-six-year-old woman. She had been treated for severe hypertension due to renal artery stenosis. An aortorenal bypass to revascularized the kidney was combined with repair of an abdominal aortic aneurysm. There was early and full recovery of renal function in the single kidney, and the patient was completely rehabilitated. Review of the literature shows that an aggressive surgical approach to the management of renal artery occlusion is usually followed by excellent results. The pre-existence of renal artery stenosis encourages the formation of a collateral arterial supply which maintains the nutrition of the kidney almost indefinitely, after renal artery occlusion. Revascularization will result in prompt recovery of renal function.

Acute Kidney Injury

Prevention of thrombosis in arteriovenous fistulas.

To prevent thrombosis in arteriovenous fistulas it is necessary to obtain the knowledgeable cooperation not only of the whole health care team, but also of the patient. The first step is preservation of forearm veins by avoiding unnecessary venipunctures in patients with chronic renal failure. Fistulas should be constructed well in advance of need and use natural rather than prosthetic veins whenever possible. Major surgery elsewhere is a potential cause of fistula thrombosis. Fistula construction is often best delayed till major surgery is over and until the veins have recovered from the effects of systemic steroid therapy. Avoidance of premature fistula cannulation and correct needling techniques help to prevent vein wall damage. Alertness to the presence of high venous pressures on dialysis and observation of inefficient dialysis due to recirculation should lead to detection of narrowed segments which can be surgically corrected before thrombosis occurs. Antiplatelet drugs are of proven value in the prevention of recurrent thrombotic episodes.

Arteriovenous Shunt, Surgical

Simplified arteriovenous fistula construction with tissue adhesive.

A technique is described for the construction of A-V fistulae for hemodialysis by performing an end-to-end anastomosis between artery and vein by means of a cyano-acrylate tissue adhesive. The method is quick and easy, provides for good results, and has been free of complications.

Arteriovenous Shunt, Surgical

Nurses for nursing.

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Economics, Nursing