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Biomedical subjects

W F Pinggera

Publications and source records attributed to W F Pinggera.

At least 19 recordsLinked to original sources
PubMed1985

Glucose metabolism and insulin sensitivity in patients on chronic hemodialysis.

In order to evaluate the potential role of parathyroid hormone on glucose metabolism in patients on chronic hemodialysis hyperglycemic clamp studies were performed in 7 parathyroidectomized and 11 nonparathyroidectomized patients on chronic hemodialysis and in healthy controls. There were no significant differences in the peripheral glucose uptake of the 3 groups. The beta cell response to hyperglycemia during the early phase as well as during the steady state was almost identical in controls and in nonparathyroidectomized uremics, whereas in the parathyroidectomized group a markedly enhanced insulin secretion was found. Calculated tissue sensitivity to insulin therefore was equal in controls and in nonparathyroidectomized uremics, whereas patients after parathyroidectomy had peripheral insulin resistance. Our results demonstrate that patients on chronic hemodialysis apparently have normal peripheral glucose uptake. The subgroup of patients who have undergone parathyroidectomy, however, show an enhanced insulin response to hyperglycemia suggesting peripheral insulin resistance. We conclude that longstanding and severe secondary hyperparathyroidism--the usual cause for parathyroidectomy in these patients--results in irreversible insulin resistance with a compensatory increase of insulin secretion.

Adult↗
PubMed1985

[Chronic periduodenitis as a sonographic mass in the region of the pancreas head].

A 47 year-old male presented with increased stool frequency, abdominal discomfort and weight loss. Two sonographers found independently a "mass" in the region of the head of the pancreas. 8 years before the patient had had a Billroth-II-surgery. Laparatomy revealed a chronic periduodenitis as sonographic substratum. Therefore, basing on sporadic reports, an anamnestic finding of a Billroth-II-surgery should be kept in mind in differential diagnosis of a tumor of the head of the pancreas when employing sonography as a diagnostic tool.

Chronic Disease↗
PubMed1981

[Hyperparathyroidism in chronic renal insufficiency new clinical and surgical aspects (author's transl)].

The therapy of secondary hyperparathyroidism in chronic renal disease has been improved by the availability of active 1-alpha-hydroxylated vitamin D derivatives. However, in cases with progressive secondary hyperparathyroidism which have not been brought under control conservatively, surgical intervention is still required. Total parathyroidectomy with autologous transplantation of parathyroid tissue in the forearm has recently been recommended as the optimum surgical approach to secondary hyperparathyroidism. Recent literature is reviewed and personal clinical experience is reported in this paper, followed by a presentation and discussion of the pathophysiology of hyperparathyroidism in chronic renal failure, various means of conservative treatment, indications for parathyroidectomy, surgical aspects and technique of cryopreservation, as well as a standardized therapeutic regimen for pre- and postoperative treatment with calcium and 1-alpha-hydroxylated vitamin D analogues.

Calcium↗
PubMed1981

Aluminum removal by hemodialysis.

Aluminum kinetics were studied in 24 patients on chronic hemodialysis. All patients had elevated predialytic serum concentrations of aluminum (mean, 3.44 mumoles/liter), which correlated significantly with the ingestion of aluminum hydroxide (P less than 0.01). Simultaneous measurements of aluminum in plasma and ultrafiltrate revealed an ultrafiltrability of about 20% of total plasma aluminum, thus suggesting that 80% of aluminum is protein bound. When a dialysate with a very low aluminum content (varying from 0.1 to 0.3 mumoles/liter) was used, mean values across the dialyzer were 3.20 and 2.67 mumoles/liter, respectively, showing a significant decrease of plasma aluminum during dialyzer passage (P less than 0.0001). It could be shown that dialysance of aluminum depends on the concentration gradient between the free diffusible plasma aluminum and the dialysate aluminum concentration. After 6 hours of dialysis, plasma aluminum concentrations were significantly lower than were predialysis values (P less than 0.0001). We conclude that a negative aluminum balance during hemodialysis can be assumed as long as the aluminum concentration of free diffusible plasma aluminum lies above the aluminum concentration of the dialysate.

Adolescent↗
PubMed1981

Renal phosphate wasting after successful kidney transplantation: 1-alpha vitamin D therapy in patients with normal parathyroid gland activity.

1 alpha-hydroxycholecalciferol was tried as a therapy for renal phosphate wasting in kidney allograft recipients with normal parathyroid gland activity. During a 3-week period of treatment we observed a significant rise in renal phosphate threshold concentrations and plasma phosphate levels paralleled by a significant decrease in serum immunoreactive parathyroid hormone levels and a significant increase in intestinal calcium absorption. It is suggested that 1 alpha-hydroxycholecalciferol acts on renal phosphate handling in a dual fashion: one is by suppression of parathyroid hormone and the other by restoration of 1,25-dihydroxycholecalciferol levels to an appropriate level.

Antigens↗
PubMed1981

[Capacity of work and employment after kidney transplantation (author's transl)].

Employment and capacity of work were assessed in 69 kidney transplant recipients 6 to 144 months after transplantation. The results were correlated with patients age, transplant function and extrarenal complications, respectively. Fifty-one patients were fit for work. In this group 36 patients were fully employed, seven partially employed, one patient out of work and seven received unemployment benefit. Sixteen patients were partially or totally disabled. The age of the patients fit for work was 24 to 35 years and all patients receiving unemployment pay were older than 40 years. Employed transplant recipients formed the group with the best kidney function parameters, patients fit for work but unemployed showed only a slightly reduced transplant function. The results indicate that transplant function is the main precondition for capacity of work and employment. But the resumption of work also depends on the patients age and on the possibility to choose between employment and unemployment benefit.

Adolescent↗
PubMed1980

[Haemodialysis in children (author's transl)].

Thirty four children, aged 2 to 15 years, were treated by haemodialysis between 1967 and 1978. Eleven children suffered from acute renal failure. Twenty three children with end-stage chronic renal disease were treated over periods ranging from 1 week to 19 months. All children were dialysed in a renal unit for adult patients awaiting renal transplantation. Our results refer especially to the technical equipment for paediatric dialysis and to the problems of blood access. The medical problems of chronic uraemia and chronic intermittent haemodialysis in children are discussed. From our experience we conclude that a sufficient degree of rehabilitation can be reached only in a paediatric dialysis unit.

Acute Kidney Injury↗
PubMed1980

[Aluminum-balance during haemodialysis (author's transl)].

Aluminium kinetics in patients with endstage renal failure and chronic intermittent haemodialysis have been studied. All patients revealed elevated predialytic serum aluminum levels. Because of a significant correlation between daily intake of aluminiumhydroxyd and serum aluminium levels it is concluded that the intestinal aluminium absorption plays an etiological role in the development of hyperaluminaemia. Plasma aluminium levels at the end of a regular dialysis procedure are significant lower compared to predialytic values. Similarly a significant decrease of aluminium concentration was observed in the plasma after passage through the dialyzer. This is due to the fact that the aluminium content of the dialysate used in our unit (0.1-0.3 mumol/l) is lower than the ultrafiltrable fraction of the plasma aluminium measured in vivo. Therefore a negative aluminium-balance during haemodialysis has to be assumed in our patients. Extreme aluminium-accummulation seems to be avoided and we therefore never experienced aluminium intoxication and dialysis dementia in our center. To assess a negative aluminium balance during haemodialysis, because of high protein binding of aluminium, a dialysate with an extreme low aluminium content has to be recommended.

Adolescent↗
PubMed1979

[Circulating platelet aggregates during haemodialysis].

In eight chronically haemodialysed patients a significant increase of circulating platelet aggregates (method of Wu and Hoak) was observed immediately after starting haemodialysis. The number of aggregates decreased at the end of haemodialysis reaching the starting values after 360 min. The platelet interaction with the dialysis membrane surface might cause this phenomenon. Anticoagulation with heparin alone was insufficient in preventing aggregate formation during haemodialysis.

Adolescent↗