Jessie E. Hano

Hypercalcemia Associated with Silicone-Induced Granulomas

HYPERCALCEMIA occurs in a variety of chronic granulomatous diseases, such as sarcoidosis,1 2 3 4 tuberculosis,5 , 6 and berylliosis.7 Except in sarcoidosis, the mechanism for the hypercalcemia obse...

In vivo effects of acute changes in osmolality and sodium concentration on myocardial contractility

Effects of acute changes in osmolality and sodium concentration (Na) on myocardial contractility (MC) were examined in anesthetized dogs. Using a carotid to left anterior descending bypass, 4 cc of NaCl and/or dextrose of varying osmolality as injected and the percentage of change in MC measured. At Na = O mEq/L, a positive inotropic response occurred, which varied inversely as osmolality increased from 300 (MC = 100 +/- 23%) to 700 mOsm/L (MC = 39 +/- 10%, p less than 0.01). Similar ranges of positive responses of lesser magnitude were noted at Na = 75 mEq/L. At Na = 150, 190, or 350 mEq/L, similar increments in osmolality caused an increasingly negative inotropic response. An inverse relationship between Na and MC was noted with osmolality held constant. Injections of the nonionic contrast agent, P297, in 5% dextrose or 0.9% NaCl, resulted in 28 +/- 3% or -17 +/- 4% (p less than 0.01) change in MC, respectively. Sodium concentration and osmolality have independent effects on MC. Hyperosmolality/hypernatremia causes a negative inotropic response while hyponatremia causes a positive one.

Intractable hypoglycemia in a patient with renal failure.

A patient with chronic renal failure developed intractable hypoglycemia after 2 1/2 years of dialysis. Metabolic studies did not suggest that malnutrition, substrate limitation, hormone deficiency, or insulin excess were responsible for the low blood glucose level. Impaired gluconeogenesis may have been an important factor, but studies in this patient suggest that enhanced glucose utilization may also play a role in the pathogenesis of hypoglycemia in renal failure.

Amantadine Hydrochloride Pharmacokinetics in Hemodialysis Patients

To study the fate of amantadine hydrochloride in patients with renal failure, we gave 100 mg orally to 12 such patients immediately after hemodialysis. Plasma levels did not decrease between 24 and 44 hours after drug ingestion, suggesting an extremely poor total body clearance. Apparent volume of distribution was 5.1 +/- 0.2 (SEM) L/kg of body weight. Between 44 and 48 hours, as a result of 4 hours of hemodialysis, the mean plasma drug level decreased from 268 to 225 ng/mL (P less than 0.001). Dialyzer clearance was 67.0 +/- 3.9 mL of plasma per minute. The total quantity of drug removed by the dialysis treatment, however, was only 3.9 +/- 0.25 mg. The average half-life of amantadine in eight patients studied while receiving maintenance hemodialysis was 24.3 +/- 2.4 h of dialysis administered over approximately 13 days. Plasma half-life in six nonuremic control subjects was 12.2 +/- 1.6 h. Amantadine is poorly excreted in dialysis patients and has a large volume of distribution. The amount removed by a single dialysis is only a small fraction of the total body store.

Systemic lymphoblastic response to antithymocyte globulin in renal allograft recipients: An initial report

Abstract Three renal transplant recipients developed marked, multiple lymph node enlargement during or soon after intensive horse antihuman thymocyte globulin (ATG) therapy. This lymphoproliferative disorder is morphologically indistinguishable from malignant lymphoma of histiocytic type but is clinically different since rapid regression occurred without antitumor therapy. The disease exhibited a benign clinical course.

Contralateral Hemothorax Secondary to Chronic Subclavian Dialysis Catheter

Subclavian vein catheterization offers a rapid, safe method for providing acute or short term hemodialysis. The technique has been associated with very few complications. 3 patients are described who developed hemothorax several weeks after the placement of a subclavian catheter. Perforation of the superior vena cava by the tip of the cannula could be demonstrated only by the injection of contrast media into the catheter.

Successful revascularization of an occluded renal artery after prolonged anuria

Renal atherosclerosis and fibromuscular dysplasia are the most common causes of curable human renovascular hypertension and renal failure. Vascular reconstruction often preserves renal function, but renal failure is rarely reversed, especially after days of anuria. We report a case of a 23-year-old woman who as a child underwent a nephrectomy for congenital hydroureter and renal hypoplasia. She later experienced fibromuscular dysplasia of the remaining renal artery, which ultimately progressed to a complete occlusion and 31 days of total anuria. The patient was revascularized, and within 2 months renal function returned with a blood urea nitrogen and creatinine of 9.0 and 1.0 mg/dl, respectively. After a follow-up of 6 months the patients blood pressure remained 120/80 to 130/80 mm Hg without administration of hypertension medication. In this report we emphasize that under selected circumstances a kidney can survive prolonged ischemia and that delayed revascularization may reestablish renal function.

Treatment of Metabolic Alkalosis with Hemofiltration in Patients with Renal Insufficiency

Hemofiltration using the postdilution technique and a modified saline solution as the replacement fluid succeeded in treating the metabolic alkalosis of two patients with renal failure.

B-cell directed antibodies and delayed hyperacute rejection: a case report.

Transplantation in the presence of a conventional positive lymphocytotoxic crossmatch has been contraindicated for a number of years [3, lo]. With modification of this assay so that cytotoxicity to the T or B cell can be determined, a number of groups have been undertaking renal transplantation in the presence of presensitization to the B cell, with conflicting results [4, 8, 91. Delayed hyperacute rejection in the presence of such a B-cell directed alloantibody forms the basis of this article.

Rapid Access for Emergency Dialysis

Vascular access for acute hemodialysis or ultrafiltration in critically ill patients frequently requires cannulation of large-caliber veins. Repeated cannulation of these vessels present a finite risk of hemorrhage or hematoma. A teflon catheter introducer sheath system (TIS) allows for repeated use of the central circulation, requires only one major vascular entry, and can be adapted for either hemodynamic monitoring or emergency hemodialysis. Forty-six acute hemodialysis have been performed in 25 critically ill patients who have had TIS in place for hemodynamic monitoring. Dialysis was performed by inserting a femoral dialysis catheter through the TIS in place of the Swan-Ganz catheter. We have had no complications using the approach for emergency hemodialysis, and adequate dialysis was accomplished.