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Z Wańkowicz

Publications and source records attributed to Z Wańkowicz.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Continuous ambulatory peritoneal dialysis as a renal replacement therapy in blind diabetics with type 1 diabetes].

UNLABELLED: Controversy around the place of CAPD in renal replacement therapy of blind Diabetics (BD) with type 1 Diabetes induced us to start CADP programme also in this group of patients. In yrs 95-98 we treated with CAPD 5 BD send to our Centre in IV/V phase of diabetic nephropathy (acc. to Mogensen). Duration of D up to 20 yrs, complete blindness in the last 2-10 yrs. Criteria of qualification for CAPD: standard medical +motivation of patient and family helper for self dialysis, unaided everyday life as well as blindness not before maturity. CAPD equipment: twin bag system with special modifications for BD. Own training programme of 2 weeks for patient/family helper modified for BD (without visual aids). We achieved full clinical and biochemical compensation of uremia; KT/Vurea > 1.9, weekly creatinine clearance > 60 1/1.73 sqm, UF > 400 ml. Peritonitis occurred in 2 of 5 patients with ratio 1:28 ptsmnths. IN CONCLUSION: for BD with type 1 Diabetes, leading unaided everyday life, the blindness doesn't seem to be limitation for CAPD, if patients are motivated for self dialysis and the training programme has been specially modified for them.

Adult↗
PubMed1998

[Evaluation of peritoneal solute transport parameters in diabetics treated with continuous ambulatory peritoneal dialysis].

Increasing number of diabetics (D) on CAPD induced us to perform detailed kinetic evaluation of these patients. The purpose of the study was to characterize peritoneal solute transport parameters in diabetics and non-diabetics (ND) treated with CAPD and furthermore to assess clinical implications of eventual differences, especially with regard to programming the long-term CAPD in D. Twelve patients (7D and 5ND) on CAPD for 3-55 months were qualified to the investigation. They were clinically stable, with no impairment of ultrafiltration and free of peritonitis for at least 3 months. Four hours dwell studies with 2.0L of 3.86% glucose dialysis fluid were performed and mass transport coefficients (KBD) for glucose, potassium, sodium, total protein, urea and creatinine were calculated. No statistical differences for KBD between D and ND were found. However for every solute the average KBD values were higher in D that in ND. The observed differences do not justify any different treatment modality for D on peritoneal dialysis (PD). However high SD values, resulting from differences of peritoneal solute transport between patients, indicate the necessity of individualization of PD program.

Adult↗
PubMed1998

[The value of urine sediment cytomorphology in the ambulatory differential diagnosis of hematuria].

In order to improve early diagnosis of urotheliale neoplasms (UN) in nephrology outpatient clinic, 274 patients (221 male and 53 female, mean age 54 yrs), with recurrent hematuria (> 5 E/hpf) were investigated in years 1994-1998. The following examinations of fresh urine sediment were performed: in 114pts (group 1) erythrocytes of urine sediment examined with phase-contrast microscopy (PCM); in 129pts (group II) urine sediment examined with classical oncological cytology; in the III-rd group of 31pts (29M and 2F, aged 61-72), both methods were used because of high suspicion on UN on the ground of initial result of PCM, precisely clinical anamnesis as well as predominance of men in advanced age. Results were as follows. In the I-st group, in 6 from 42pts with urological hematuria in PCM, what means 5.2% of the whole group and 14% of the subgroup with urological hematuria, in further standard urological examination bladder carcinoma was found. In the II-nd group, positive result of urinary cytology (GI to GIII) was found in 7pts, what means 5.4% of the whole group. Results of urine cytology were confirmed later in the standard urological examination, which detected bladder carcinoma in all these patients. In the III-rd group, bladder carcinoma was found in all 22pts with urological hematuria in PCM. In 19 patients from this subgroup, urinary cytology was positive for UN (GI to GIII). In the remaining 3pts results of urinary cytology were false negative. False positive result of urinary cytology occurred in one from 9pts with glomerular hematuria and clinical or morphological (in renal biopsy) evidence of glomerulonephritis. On the results of the study, we propose--as an obligatory--in every case of recurrent hematuria of urological origin in PCM, examination of fresh urinary sediment with classical oncological cytology, especially if the patient belongs to the high risk group for urotheliale neoplasms.

Adult↗
PubMed1998

[Influence of alphacalcidole on selected markers of the bone turnover in hemodialysed patients with secondary hyperparathyroidism].

In 19 chronically hemodialysed patients (11M + 8F, mean age 52 +/- 15 yrs) with secondary hyperparathyroidism (sHP), selected markers of bone turnover in the course of pulsative treatment with alphacalcidol were evaluated. Alphakalcidol was given 3 times per week after hemodialysis. Every 3-rd month of therapy we measured serum concentration of procollagen type I carboxy-terminal propeptide PICP as a marker of bone formation as well as carboxy-terminal telopeptide type I collagen ICTP and iPTH as markers of bone resorption. The results were as follows. During 12 months of controlled treatment of sHP with alphacalcidol, statistically significant decrease of serum iPTH (from 393 +/- 145 pg/ml to 246 +/- 172 pg/ml) with simultaneous increase of serum PICP (from 235 +/- 168 mg/L to 414 +/- 168 mg/L) were obtained. Serum ICTP levels, although significantly increased in comparison to normal values, did not change under influence of alphacalcidol therapy. The mean weakly dosis of alphacalcidol of 2.27-2.39 mg successfully suppressed process of bone resorption evaluated by iPTH giving predominance to bone formation expressed by PICP. Serum levels of ICTP appeared to be of no value in monitoring treatment efficacy of alphacalcidol in hemodialysed patients with secondary hyperparathyroidism.

Adjuvants, Immunologic↗
PubMed1998

[Successful aorto-coronary bypass in the care of unstable heart ischemia in the course of irreversible renal failure treated by repeated hemodialyses].

Cardiovascular diseases especially coronary heart diseases are responsible for high rate (about 50%) of deaths in the group of patients with irreversible renal failure treated with hemodialysis. Coronary artery bypass grafting is recommended as a method of choice in symptomatic patients with coronary heart disease being the candidate for renal transplantation. On the basis of recently observed patient successfully treated with coronary artery bypass grafting pre- and and postoperative dialysis protocol is presented and discussed with literature.

Clinical Protocols↗
PubMed1998

[Acute intermittent porphyria: actual problems of clinical and laboratory diagnosis].

On the case of 27 old woman with clinical symptoms of acute abdomen, severe electrolyte disturbances and attacks of grand mal seizures, different clinical masks and actual treatment guidelines of acute intermittent porphyria are presented. Among laboratory methods detecting precursors of hem in the urine, high-performance liquid chromatography (HPLC) as the most sensitive and specific method is recommended. Proper prophylaxis against new episodes of acute intermittent porphyria as well as long lasting ambulatory care of the patient are emphasized. Special attention should be paid to all close relatives of the patient, who need to be send to specialistic laboratories for exclusion of enzymatic defects of hem synthesis.

Adult↗
PubMed1998

[Retroperitoneal fibrosis with antiphospholipid syndrome: a coincidence or common autoimmunological etiology?].

The term "retroperitoneal fibrosis" means pathophysiologically differentiated entities which are leading to development of pathological masses of connective tissue in retroperitoneal space. The etiology of the disease has not been clearly established up to now. Recently advanced hypothesis suggests that existence of the pathological masses of connective tissue in retroperitoneal space is a consequence of autoimmunological response to insoluble, oxidized lipoprotein of atheromatous plaque called ceroid, penetrating into periaortal space through atheromatic wall of aorta. On the basis of recently observed case of 43-years old woman with retroperitoneal fibrosis and antiphospholipid syndrome the possibility of common autoimmunological etiology of both entities is discussed.

Adult↗
PubMed1998

[Sulodexide in the treatment of right hand necrosis in diabetic patient performing exchanges of continuous ambulatory peritoneal dialysis (CAPD) by himself].

The usefulness of sulodexide in the treatment of severe necrosis of right hand in 42 diabetic patient performing by himself CAPD exchanges is described. Very good results of this treatment, induced us to discuss clinical indications for this drug, which--according to our opinion--is particularly recommended for treatment of severe vascular complications in patients with diabetes and irreversible renal failure.

Adult↗
PubMed1997

[Evaluation of the treatment efficacy of secondary hyperparathyroidism with oral pulse doses of alphacalcidol].

The purpose of the study was to evaluate the effectiveness of the oral pulse therapy with high doses of alphacalcidol (1 alpha(OH)D3) in secondary hyperparathyroidism. 16 hemodialysis patients with 4 to 9-fold iPTH serum elevation were given ones in week oral 1 alpha(OH)D3 in doses from 5.0 to 7.0 micrograms (0.1 microgram/b.m.) according to serum levels of calcium, phosphate, activity of alkaline phosphatase with its bone fraction. Serum iPTH levels were measured every 3rd month of the treatment. The dialysate calcium was reduced to 1.25 mmol/l. CaCO3 was used as a main phosphate binder in doses from 3.0 to 9.0 g/day. After first three months of treatment the serum iPTH levels decreased from 486.0 +/- 200 pg/ml to 218.0 +/- 117 pg/ml (p = 0.0001). Calcium levels increased from 2.39 +/- 0.2 mmol/l to 2.52 +/- 0.29 mmol/l (p > 0.05). Phosphate levels increased from 2.15 +/- 0.67 mmol/l to 2.17 +/- 0.62 mmol/l (p > 0.05). Alkaline phosphatase levels decreased from 35.2 +/- 17.3 IU/l to 31.1 +/- 7.78 IU/l (p > 0.05). Bone isoenzyme of alkaline phosphatase decreased from 19.2 +/- 13.4 IU/l to 15.5 +/- 7.51 IU/l (p > 0.05). Because of early serum hypercalcemia, doses of 1 alpha(OH)D3 had to be reduced in 2 patients. In 8 patients (50%) demonstrating decrease of serum iPTH levels (below 200 pg/ml) after first 3 months of treatment doses of 1 alpha(OH)D3 were reduced in the following months. We conclude that oral 1 alpha (OH)D3 pulse therapy is effective for parathyroid activity suppression in patients with severe hyperparathyroidism. To avoid dangerous hypercalcemia and adynamic bone disease serum iPTH and calcium levels should be strictly monitored.

Administration, Oral↗
PubMed1996

[Nephropathy after use of Chinese herbs: rapidly progressive interstitial renal fibrosis or renal vasculitis?].

Case of 47 old women with progressive renal failure after chinese herbs and picture of renal interstitial fibrosis in the initial renal biopsy is presented. Pathogenic role of renal limited microscopic vasculitis is discussed on the basis of clinical outcome, high serum levels of p-ANCA as well as complete remission of the disease after long-term cyclophosphamide therapy.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1996

[Acute renal failure in the course of rhabdomyolysis after status epilepticus].

A 24 years old woman with sclerosis multiplex was admitted to our hospital after generalized seizures. In the first days of observation occurred symptoms of acute renal failure and liver damage with hemolysis. The differential diagnosis allowed us to recognize acute renal failure in the course of rhabdomyolysis. After a few hemodialysis normal renal function was achieved.

Acute Kidney Injury↗
PubMed1995

[Infection in the dialysis unit as a contributing factor to the problem of hospital acquired infections].

Hospital acquired infections are especially dangerous for patients with chronic renal insufficiency. An epidemic of hospital acquired infection of dramatic course in described in 13 patients (8 being on haemodialysis (HD) and 5 treated conservatively), with 15 episodes of septic syndrome (12 cases) or septic shock (3 cases). Initial cultures of blood, urine and pharyngeal swabs were positive only in 5 patients treated conservatively. Initial cultures of dialysing fluid from all 12 monitors of HD in our Dialysis Unit revealed the presence of Gram-negative bacteria (Achromobacter) in blood of 3 patients as well as in the dialysing fluid compartments from 2 monitors of Gambro AK 10/100. The possible role of Gram-negative, apparently benign water rods, in the pathogenesis of hospital acquired opportunistic infections in Dialysis Unit were discussed.

Alcaligenes↗
PubMed1994

[Lupus nephritis with nephrotic syndrome successfully treated with plasmapheresis and cyclophosphamide].

In a 45 years woman with advanced nephrotic syndrome in the course of SLE IgM nephropathy, transient renal failure made the continuation of the conventional steroid therapy impossible. Applied as a saving life therapy, plasmapheresis followed by i.v. pulses of cyclophosphamide, caused resolution of lupus nephritis. Since the withdrawal of cyclophosphamide, the patient has been observed for 18 month, showing no evidence of recurrence of lupus nephritis.

Combined Modality Therapy↗
PubMed1993

[Technical complications of peritoneal dialysis due to catheter dysfunction].

The authors analysed causes of Tenckhoff peritoneal catheter dysfunction in 17 patients treated with standard peritoneal dialysis during 23.8 +/- 8.7 months. In 8 cases any catheter dysfunction were observed. Exit-site infection/tunnel infection were observed in 5 cases. Catheter obstruction or one-way obstruction of catheters caused by peritonitis was observed in 6 patients and 1/3 of implanted catheters. 3 of these patients were transferred to hemodialysis. Non-infective complications/caused mainly by catheter migration/was observed in 3 patients and 1/3 of implanted catheters. In all these cases peritoneal dialysis was stopped. Mean one-year catheter survival was 58.8%, and two-year survival was 17.6%. The authors described the technique of catheter implantation and catheter care after operation.

Adult↗
PubMed1992

[Personal experiences in the treatment of peritonitis with a complicated extended program of peritoneal dialysis].

In 37 pts treated with peritoneal dialysis (PD) in years 1980-1990 results of peritonitis (P) treatment were compared between years 1986-90 (cycle II) and years 1980-85 (cycle I). In I cycle 47 episodes of P occurred in 9 of 21 pts treated with PD, and in cycle II 15 episodes of P in 7 of 16 dialysed pts. Treatment of P was as follows: in cycle I, daily standard PD with gentamicin and cephradine added to 2.01 dialysing exchanges; in cycle II, after initial lavage of peritoneum with a few litres of dialysing solution, 1.0 g vancomycin was given iv and continuous PD started using 1.0 litre prolonged exchanges and aminoglycosides added to dialysis solution. Treatment protocol used in cycle II was more effective than the first one: all episodes of P were immediately cured (only 32 of 47 in cycle I), there was only 1 relapse (in cycle I 6/32 cured P), duration of P was shorter (mean 6.5 days/9.8 days in cycle I) and morphological changes of peritoneum were less expressed than in cycle I. Practically important indicator of cure was decline of polynuclear cells in smear of peritoneal effluent sediment (less than 50% of cells). All 9 pts suffering from P in cycle I had to be transferred to HD (43% of all dialysed pts) and only 2 in cycle II (12% of all dialysed pts).

Adult↗