Gregory J. Beirne

Hyperviscosity syndrome in multiple myeloma

Abstract A patient with multiple myeloma had severe epistaxis and retinal hemorrhages. The relative serum viscosity and concentration of serum proteins were markedly increased. Immunologic studies and ultracentrifugal analysis revealed 7S IgG myeloma protein without aggregates. Plasmapheresis was the effective immediate treatment of the hyperviscosity syndrome. Treatment with cyclophosphamide further lowered the concentration of myeloma protein and the relative serum viscosity and then maintained them at asymptomatic levels. Concomitantly, sludging of red blood cells in conjunctival vessels decreased and retinal hemorrhages cleared. Treatment also markedly improved the concentrating and diluting abilities of the kidney.

Immunohistology of the Lung in Goodpasture's Syndrome

Abstract Immunofluorescent studies of the lung of a patient who died from Goodpastures syndrome revealed linear deposition of immunoglobulin G (IgG) and beta1C-globulin along the basement membrane...

Androgen-Induced Increase in Red-Cell 2,3-Diphosphoglycerate

Abstract The administration of testosterone enanthate to six patients with chronic renal failure on biweekly hemodialysis increased erythrocyte 2,3-diphosphoglycerate (2,3-DPG) in all patients. Whereas the value was 5670 ± 550 (mean ± S.E.) nmoles per milliliter of red blood cells before treatment, it was 9097 ± 760 after 12 weeks of androgen therapy. This increase was statistically significant (p less than 0.01). None of a group of seven similarly affected patients who did not receive androgens and were followed within the same period showed any increase in red-cell 2,3-DPG. The shift in oxygen equilibrium curve to the right that results from testosterone enanthate should greatly enhance the unloading of oxygen to the tissues.

Pseudomonas aeruginosa bacteremia in a dialysis unit: I. Recognition of cases, epidemiologic studies and attempts at control

Infections commonly occur in patients undergoing dialysis and have been related to diminished host resistance of uremic patients, the arteriovenous fistulas and bacteriologic contamination of dialysis fluids. The occurrence of four cases of bacteremia due to Pseudomonas, three of which were type 7, and the presence of this serotype in the dialysis fluids suggested an important association between infection and growth of bacteria in the fluids. Attempts to reduce levels of bacteria in the dialysis fluid were unsuccessful using dialysate free of glucose in clinical trial, despite in vitro studies demonstrating poor growth of Pseudomonas in this medium. A filter placed with the recirculating system was only partially successful. The second paper of this series traces the portal of entry of bacteria from dialysate to the blood through reutilized coils.

Pseudomonas aeruginosa bacteremia in a dialysis unit: II. Relationship to reuse of coils

Blood for culture was obtained over a six week period from 17 patients undergoing long-term hemodialysis. Bacteremia was detected during 18 of 201 dialyses. Blood drawn during fifteen of these dialyses contained pseudomonas aeruginosa. Ten of the 17 patients (59 per cent) had a Pseudomonas bacteremia some time during the study. Only one patient was symptomatic. The frequency of positive cultures was related to reuse of coils. No cultures were positive until after the fifth use, but by the tenth use, 41 per cent of the dialyses were associated with bacteremia. All coils that were used repeatedly and 32 of 48 of those used only once, grew Ps. aeruginosa when filled with media and incubated. This suggests that the coils were inoculated during dialysis and that benzalkonium chloride, the sterilizing agent, was unable to eradicate this organism. With repeated uses, the number of residual bacteria in the coil became large enough to cause detectable bacteremia during dialysis.

“Spontaneous” Atheroembolic Disease As a Cause of Renal Failure in the Elderly*

An 86‐year‐old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal‐sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patients renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.

Tocainide pharmacokinetics during continuous ambulatory peritoneal dialysis

Abstract Tocainide hydrochloride is a class IB antiarrhythmic agent that has a long duration of action and a narrow therapeutic to toxic ratio. Although tocainide resembles lidocaine structurally, it differs in potency, lipophilicity, metabolism and pharmacokinetic profile. Tocainide is almost completely absorbed after oral administration and has a bioavailability approaching 100%. 1 It is both metabolized and excreted unchanged by the kidney. The metabolites do not exert cardioprotective or cardiotoxic effects. 2 In patients with normal renal function, the biologic half-life of tocainide is about 15 hours. 1 However, in patients with end-stage renal disease, the half-life is prolonged to approximately 23 hours. 3 Hemodialysis removes about 25% of tocainide from the body, decreasing the half-life to about 5 hours. 3 Nonrenal elimination of tocainide in end-stage renal disease appears unaffected. 3 The effect of continuous ambulatory peritoneal dialysis (CAPD) on the elimination of tocainide is unknown. This study examined selected tocainide pharmacokinetic variables in patients undergoing routine CAPD.