George E. Schreiner

Determination of Inulin by Means of Resorcinol

Summary A simplified method, based on Roes resorcinol method and avoiding the use of yeast, is described for the determination of inulin in plasma and urine. The method has been applied under clinical conditions to clearance determinations in patients with renal disease, and shown to yield results in good agreement with the diphenylamine method.

The Carbohydrate Intolerance of Uremic Patients

Excerpt During the past half century a substantial number of clinical investigators have observed hyperglycemia in patients with renal failure and azotemia (1-3). The present investigation of this ...

THE NEPHROTOXIC LESION OF ETHYLENE GLYCOL

Excerpt Needle biopsy of the kidney affords a unique opportunity to study the pathology of renal disease in the living patient.1This relatively new and valuable investigative tool was employed in o...

Clinical and histologic spectrum of the nephrotic syndrome

Abstract 1.1. The nephrotic syndrome is defined as a clinical state characterized by excretion into the urine of 3.5 or more gm. of protein per day, together with doubly refractile or oval fat bodies. There is a variable tendency toward edema, hypoproteinemia and hyperlipemia, possibly dependent on the amount and duration of protein loss. 2.2. Clinical and laboratory studies on fortynine patients with a nephrotic syndrome are correlated with thirty-six renal biopsies and nine autopsies. 3.3. The histologic classification of the forty-five nephrotic patients is divided into eight categories: membranous glomerulonephritis (ten patients), acute and chronic glomerulonephritis (twenty-one), intercapillary glomerulosclerosis (three), amyloid disease (four), disseminated lupus erythematosus (four), sickle cell disease (one), interstitial nephritis with a diffuse and local membranous glomerulonephritis (one) and probable renal vein thrombosis (one). 4.4. Correlation of clinical and laboratory findings with renal histology has been found necessary, not only in research but also for the proper diagnosis and treatment of the patient.

Bilateral renal cortical necrosis

Abstract Bilateral renal cortical necrosis is a pathological diagnosis of a clinical entity characterized by the abrupt onset of gross hematuria, oliguria and anuria, usually in individuals without known renal disease, and proceeding to a uremic syndrome with a predominantly fatal outcome. Pathologically, there is a patchy to diffuse bilateral ischemic coagulative cortical necrosis, with characteristic sparing of the renal medulla. Its greatest incidence is in pregnant women with accidental hemorrhage (abruptio placentae) in the last trimester. It may also occur in infants and children, usually as a result of diarrhea and dehydration, while in men it usually occurs as a result of infections or poisons. Its main clinical feature is the sudden onset of oliguria and anuria. The clinical diagnosis is difficult but is aided by percutaneous renal needle biopsy. Experimentally, it has been produced in animals principally by intravenous injection of bacterial toxins and vasoconstrictor substances. Although it is believed to result from spasm of renal interlobular arteries and afferent arterioles, its exact pathogenesis remains obscure. The treatment is similar to that employed in other causes of acute renal insufficiency. Proper management makes survival possible.

THE DIALYSANCE OF ETHANOL AND METHANOL: A PROPOSED METHOD FOR THE TREATMENT OF MASSIVE INTOXICATION BY ETHYL OR METHYL ALCOHOL

Previous studies from this laboratory (1) have cited a time-dose-cytotoxic relationship and a high dialysance 1 as important theoretical criteria for the selection of dialyzable poisons. Small molecular size, high solubility, clinical correlation with blood level and a primary distribution in the fluid phase of the body would suggest ethanol and methanol as ideal dialyzable toxins. Because of the time lag between ingestion of methanol and production of its lethal metabolites such as formic acid, early dialysis would seem critical in cases of methanol poisoning. Since each metabolite of methanol is more toxic, removal of the parent compound offers a unique leverage and constitutes preventive medicine as well as specific therapy.

The Nephrotoxicity of Analgesic Abuse

Excerpt Abuse of analgesic tablets and powders has received increasing attention as a possible cause of uremia and papillary necrosis. Spuhler and Zollinger (1), during a systematic investigation o...

Reassurance in the Management of Benign Hypertensive Disease

The therapeutic improvement achieved by administration of drugs in arterial hypertension and other disease states is widely recognized to be due to the potency of reassurance and suggestion as well as the possible pharmacologic action of the drugs employed. In this article Dr. Goldring and his associates evaluate the effectiveness of a calculated and deliberately dramatized regimen of reassurance on the blood pressure and on the symptoms in patients with benign hypertensive disease. These results help to explain why nonscientific treatment sometimes seems to be crowned with therapeutic success.

Periureteral fibrosis, with a diabetes insipidus-like syndrome occurring with progressive partial obstruction of a ureter unilaterally

Abstract Three cases of periureteral fibrosis are reported. The impaired concentrating capacity, poor response to Pitressin and renal hypertension noted in one case suggest damage to the nephron with progressive obstruction of the urinary tract similar to that reported after release of obstruction. Twenty-four other cases in the English literature are reviewed, with correlation of the clinical and pathologic features. Periureteral fibrosis is conceived to be an exaggerated fibrocytic response to varied stimuli. In Case I an adenocarcinoma was probably responsible; in other cases the proliferation seemed to be a response to chronic ureteritis and smouldering pyelonephritis.

Cardiac Output, Central Volume and Dye Injection Curves in Traumatic Arteriovenous Fistulas in Man

Although arteriovenous fistulas are frequent in wartime, few measurements of cardiac output have been carried out by direct methods. Analysis of the curve obtained after rapid injection of T-1824 shows the feasibility of this method in patients with arteriovenous fistulas. Such patients have elevated cardiac indices, enlarged central blood volumes and acceleration of peak and manifest recirculation times. The abnormalities are corrected by surgery. Diagnostic use of the dye curve is suggested.