George Dunea

Dialysis dementia -- the Chicago experience.

In the four years between 1972 and 1976 twenty out of 160 maintenance dialysis patients developed dialysis dementia. Their illness was characterized by an insidious onset of mental deterioration, speech disturbance, apraxia, and myoclonus. The disease progressed inexorably to a fatal outcome, the onset of seizures being an ominous sign, and the average duration of the illness being seven months. Routine biochemical studies were unremarkable, and osteodystrophy was not a prominent feature. Serial electroencephalograms (EEG) showed progressive slowing of the rhythm, usually antedating the neurologic symptoms. Brain scan and flow studies were normal. Radio-iodinated serum albumin (RISA) scans in seven patients showed changes suggesting altered cerebrospinal fluid (CSF) dynamics. Treatment was generally ineffective, but ventriculo-peritoneal shunting produced transient neurologic improvement in one patient. Epidemiologic investigations showed high aluminum levels in city water during the period of the outbreak.

Trial of oral neomycin during peritoneal dialysis.

To determine the value of oral neomycin in preventing peritonitis during peritoneal dialysis, 95 consecutive dialyses were randomly assigned to two groups. One group received neomycin 0.5 gm in suspension every six hours for 48 hours; the other, placebo. The incidence of peritonitis was 8.3 per cent in the neomycin group and 9.7 per cent in the placebo group. The incidence of significant asymptomatic infection, as evaluated by colony counts, was 14.6 per cent and 17 per cent, respectively. It was concluded that oral neomycin in the dosages employed did not prevent peritonitis during dialysis.

EFFECT OF STANDING ON PROTEINURIA IN RENAL DISEASE

Abstract The effect of quiet standing on protein excretion was examined in twenty-two patients with proteinuria in excess of 1 mg. per minute. Proteinuria decreased in 75% of tests. Changes in protein excretion correlated well with changes in creatinine clearance: protein excretion changed least when standing creatinine clearance remained closest to the supine value. These findings suggest that comparable conditions of posture are required when the amount of protein excretion is used as a guide to therapeutic response or prognosis.

Immunocore electrophoresis as a purity test for albumin.

Abstract The purity of human serum albumin was tested by immunoelectrophoresis, electrofocusing and disc electrophoresis, and compared with a new method of immunocore electrophoresis. Conventional methods failed to demonstrate heterogeneity whereas immunocore electrophoresis showed numerous precipitin bands. Immunocore electrophoresis utilizes polyacrylamide for high resolution, and the immunological specificity of proteins for selective detection and extreme sensitivity. If the albumin microheterogeneity evidenced by immunocore electrophoresis is confirmed after subfraction purification, then immunocore electrophoresis is the technique of choice for testing purity of proteins.