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Biomedical subjects

W K Stewart

Publications and source records attributed to W K Stewart.

At least 55 records · Page 3Linked to original sources
PubMed1989

Chemical reactivity of aluminium-based pharmaceutical compounds used as phosphate-binders.

Several aluminium-containing substances, including antacids used as phosphate-binders in treating renal failure, have been analysed in-vitro under different pH conditions for the release of Al3+ ions and for binding of phosphate. Control experiments on different forms of pure aluminium hydroxide validated the methods. At pH 2 it was the most amorphous forms which released Al3+ most rapidly. These aluminium ions, available for absorption by the patient, were released from all antacids tested, but no firm phosphate-binding was detected while the pH remained at 2. Phosphate was bound at pH 8, by adsorption onto the surface of aluminium hydroxide. No significant amounts of free Al3+ exist in solution at pH 8, since at that pH aluminium hydroxide is precipitated. The most amorphous forms of this solid were the most efficient phosphate-binders. Alumino-silicate salts require prior exposure to acid to produce free Al3+ before they can act as phosphate-binders, whereas amorphous aluminium hydroxide acts as an efficient phosphate-binder without prior exposure to acid. Chemical principles are employed to show why aluminium release and phosphate-binding are separate and independent processes. Methods are proposed for maximizing the activity of phosphate- binders in-vivo, while minimising aluminium release.

Aluminum↗
PubMed1989

Protracted systemic illness and interstitial nephritis due to minocycline.

A severe hypersensitivity-like illness with acute renal failure, lymphadenopathy and skin rash is reported following minocycline treatment in a 16 year old male. Following haemodialysis and steroid therapy his illness remitted, only to recur on withdrawal of the steroids. With further steroid treatment he recovered completely. Lymphocyte function tests, performed in an attempt to positively incriminate minocycline, were inconclusive due to a general suppression of the patient's lymphocytes to in vitro stimulation. Hypersensitivity reactions attributed to minocycline include skin rashes, lymphadenopathy and one previous case of acute interstitial nephritis.

Adolescent↗
PubMed1989

Arterial stiffening and reduced cutaneous hyperaemic response in patients with end-stage renal failure.

Superficial dermal vasodilatory capacity and indirect segmental systolic arterial pressure were measured in 10 patients with end-stage renal failure and 13 controls. Laser-Doppler flowmetry was used to measure skin blood flow on the dorsum of the feet prior to and during local skin heating to 40 degrees C. Basal skin blood flow was not significantly different between the two groups (mean 0.8 +/- (SD) 0.3 vs. 0.7 +/- 0.2 U). Peak stimulated flow at 40 degrees C was significantly greater in the controls than in the azotaemic patients (10.0 +/- 3.5 vs. 3.5 +/- 1.6 U, p less than 0.01). Stiffening of the major limb arteries was detected in the majority of the azotaemic patients (10.0 +/- 3.5 vs. 3.5 +/- 1.6 U, p less than 0.01). Stiffening of the major limb arteries was detected in the majority of the azotaemic patients and may have contributed to the reduction in vasodilatory capacity.

Arteries↗
PubMed1988

Recurrent peritonitis caused by Serratia marcescens in a diabetic patient receiving continuous ambulatory peritoneal dialysis.

A diabetic patient treated by continuous ambulatory peritoneal dialysis for end-stage renal failure had recurrent peritonitis caused by Serratia marcescens. Thirty-eight isolates of S. marcescens recovered over a 14-month period from peritoneal-dialysis effluent, catheter tips and catheter-exit sites were biotyped and serotyped. The finding that most (90%) of these isolates belonged to the same biotype and serotype suggested that the patient had relapsing infections with the same strain. Similar isolates were recovered from the peritoneal dialysates of another two patients in the same ward, neither of whom developed Serratia-associated peritonitis.

Catheters, Indwelling↗
PubMed1988

Symmetric gangrene of the extremities in late renal failure: a case report and review of the literature.

Medical calcification of arteries is common in chronic renal failure. We report on a patient with extensive calcification of the arterial media who developed symmetrical acral gangrene and severe cardiac failure shortly after cadaveric renal transplantation. At necropsy, the medial calcification was found to be accompanied by extensive intimal proliferation and multiple antemortem fractures, some healing by callus formation. Such medial calcification, which is similar to Monckeberg's sclerosis, affected all systemic arteries except the aorta, pulmonary artery and transplanted renal artery. Six years before this terminal illness he had undergone total parathyroidectomy for osteitis fibrosa associated with ruptured tendons. We review previous reports of patients with the syndrome of acral gangrene in azotaemic renal failure and discuss the histopathological features and pathogenesis in relation to the unusual features of our patient.

Adult↗
PubMed1987

Ciprofloxacin in plasma and peritoneal dialysate after oral therapy in patients on continuous ambulatory peritoneal dialysis.

The quinolone antibiotic ciprofloxacin offers the possibility of effective oral treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) if a sufficiently high concentration is attained in peritoneal dialysate. The pharmacokinetics of oral ciprofloxacin have been studied in ten CAPD patients given 250 mg qds for two days. Five patients were being treated for peritonitis with gentamicin and cefuroxime; the remaining five were receiving inpatient training for CAPD or were being treated for other problems. Ciprofloxacin concentration in plasma and in dialysate were determined by HPLC. There were not differences in plasma and dialysate kinetics in patients with and without peritonitis. Plasma levels were higher and the elimination half-life was longer than those reported for healthy subjects. Dialysate and plasma levels were significantly correlated (r2 = 0.87, P = 0.001), with dialysate levels consistently lower than plasma levels. Dialysate levels exceeded 1 mg/l in seven patients. The mean peak dialysate level (2.17 +/- 1.63 mg/l) exceeded the MIC of ciprofloxacin for 32 of 34 bacterial strains responsible for peritonitis. Ciprofloxacin shows promise as a useful oral treatment of CAPD-associated peritonitis.

Administration, Oral↗
PubMed1987

Orofaciodigital syndrome type I associated with polycystic kidneys and agenesis of the corpus callosum.

We report a female case of orofaciodigital syndrome type I (OFD I) associated with polycystic kidneys and agenesis of the corpus callosum. She had chronic renal failure requiring maintenance dialysis and significant neurological deficits. Her mother had less severe OFD I associated with polycystic kidneys but her renal function was normal and there was no clinical or radiological evidence of a structural abnormality of the brain.

Abnormalities, Multiple↗
PubMed1987

Perthshire pioneer of anti-inflammatory agents (Thomas John Maclagan).

The achievements of Thomas John Maclagan (1838-1903) include the first specific use of salicin to cure acute articular rheumatism. He began salicin treatment in 1874 in Dundee, where he was a medical practitioner from 1869 to 1879. Maclagan was also the resident medical superintendent at Dundee Royal Infirmary from 1864-1866, where he was the first in Scotland to make investigative use of the clinical thermometer during the fever epidemics. From 1879-1903 he maintained a fashionable practice in London. His contributions to medicine and in particular to the development of aspirin, once ranked as equivalent to the achievements of Lister and Simpson, have now largely been forgotten. This account is a tribute to a life rich in individual endeavour, observation and effort before the "teamwork" era began.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

Pancreatitis causes brownish-black peritoneal dialysate due to the presence of methaemalbumin.

Two patients treated with continuous ambulatory peritoneal dialysis had striking brownish-black coloured peritoneal dialysate concomitant with underlying pancreatitis. Examination of the second patient's dialysate by recording spectrophotometry showed the discoloration to be due to methaemalbumin. Haemorrhagic pancreatitis, by releasing proteolytic enzymes and perhaps by using the lesser sac as an anatomical cul-de-sac for chemical reaction, provides a suitable milieu for the production of methaemalbumin from red blood cells in dialysate.

Adult↗
PubMed1986

Patient load and medical staffing in adult dialysis units in the United Kingdom.

A survey of medical staffing in 50 adult dialysis units in the United Kingdom in 1986 showed a wide range of patient to staff ratios or staffing score ratios. The total patient load (patients receiving haemodialysis in hospital and at home and those receiving continuous ambulatory peritoneal dialysis) varied from 12 to 270 per unit. Patients receiving acute haemodialysis or who had received a transplant were not included. The unit staffing score, on a weighted scale based on experience, varied from 6.0 to 40.5. Previous surveys have all been regionally or nationally based so criteria for assessing the adequacy of staffing in single units do not exist. This survey attempts to provide a guideline by describing the range of medical staffing compared with patient load in single dialysis units. No unit considered itself to be overstaffed, and several considered themselves to be greatly understaffed. Individual dialysis units should plead their own case in the light of their own circumstances and up to date information provided in nationwide staffing surveys such as this one.

Data Collection↗