RESUMEN
A multiple crossover research study was used to evaluate the effect of dialyzer re-use on fever, blood leaks, serum urea and creatinine values and symptoms. Each of 6 crossover periods consisted of 4 weeks on either single-use or re-use, 1 week washout, 4 weeks on the alternative treatment and 1 week washout. The re-use consisted of 6 uses of each dialyzer and the washout weeks consisted of 3 single-use sessions. Analysis of paired observations within rather than between patients showed no effects of time (i.e. among crossover periods 1 through 6) or number of re-uses (i.e. among uses 1 through 6). There was no significant difference for temperature change during dialysis, blood leak rate, or the serum urea and creatinine values before the first dialysis of each washout period. There were no differences for symptoms of pruritus, cramps, nausea, headache, chest pain, backache or fatigue. There were no clinical advantages or disadvantages associated with dialyzer re-use.
Asunto(s)
Diálisis Renal , Celulosa/análogos & derivados , Ensayos Clínicos como Asunto , Creatinina/sangre , Femenino , Humanos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Distribución Aleatoria , Diálisis Renal/efectos adversos , Urea/sangreAsunto(s)
Donantes de Tejidos , Conservación de Tejido , Canadá , Análisis Costo-Beneficio , Instituciones de Salud/provisión & distribución , Prueba de Histocompatibilidad/economía , Humanos , Programas Nacionales de Salud , Conservación de Tejido/economía , Trasplante/economía , Inmunología del Trasplante , Transportes/economíaAsunto(s)
Donantes de Tejidos , Adolescente , Adulto , Anciano , Altruismo , Actitud del Personal de Salud , Actitud Frente a la Salud , Emociones , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mecanismo de Reembolso , Refuerzo Social , Riesgo , Donantes de Tejidos/psicología , Trasplante/economía , Trasplante/psicologíaRESUMEN
In a retrospective study over a 13-year period, data from one of the largest dialysis units in Canada were reviewed. Seven cases of active tuberculosis were identified among a dialysis population of 433 patients. Although this was not a controlled study the data suggests a greater than 10 fold increase in incidence of tuberculosis among patients with end stage renal disease compared to the total population. The majority of patients were over 40 years of age; race and immigrant status appeared to be risk factors, and tuberculin skin tests in the main were unhelpful diagnostically. Symptoms and signs mimicked that of underlying chronic renal disease in most instances, and extrapulmonary disease occurred in 3 of 7 patients. Therapy proved safe and effective in all cases. In terms of the epidemiological and clinical indices the present study tends to support the observations of investigators in other countries.
Asunto(s)
Fallo Renal Crónico/complicaciones , Tuberculosis/etiología , Adulto , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal , Diálisis Renal , Estudios Retrospectivos , Tuberculosis/terapiaRESUMEN
Heat stroke in distance runners is increasing in frequency. A case is reported of a 41-year-old man who collapsed during a 10-km "fun run" held when the temperature was 31.6 degrees C and the humidity 80%. Acute renal failure (serum creatinine level 1530 mumol/l [17.3 mg/dl]), rhabdomyolysis, disseminated intravascular coagulation and hepatic damage complicated the clinical picture. Repeated peritoneal dialysis and one cycle of hemodialysis because of a very high serum level of uric acid (1.23 mmol/l [20.7 mg/dl]) were required. Although the illness was prolonged, recovery was almost complete, and 4 months after the man's collapse the serum creatinine level had fallen to 133 mumol/l (1.5 mg/dl).
Asunto(s)
Traumatismos en Atletas/fisiopatología , Agotamiento por Calor/fisiopatología , Carrera , Lesión Renal Aguda/etiología , Adulto , Traumatismos en Atletas/complicaciones , Análisis Químico de la Sangre , Temperatura Corporal , Coagulación Intravascular Diseminada/etiología , Cardiopatías/etiología , Agotamiento por Calor/complicaciones , Agotamiento por Calor/terapia , Humanos , Hepatopatías/etiología , Masculino , Mioglobinuria/etiología , Manifestaciones NeurológicasRESUMEN
The efficacy of self-recording of blood pressure in the management of hypertension was assessed in a randomized clinical trial involving 140 persons who had been receiving antihypertensive therapy for a year or more, but whose diastolic blood pressure had remained at 95 mm Hg or higher. To control for the increased attention implicit in self-recording, which might affect blood pressure, the patients were assigned at random to one of the four groups: self-recording and monthly home visits, self-recording only, monthly home visits only, and neither self-recording nor monthly home visits. This design also permitted assessment of the effect of home visits. During the 6-month experiment no significant differences were apparent between the groups in either compliance or diastolic blood pressure. However, both self-recording and monthly home visits produced a reduction in blood pressure among patients who admitted to difficulty remembering to take their pills; a reduction was not seen among patients who said they had no such difficulty. This confirmed an earlier observation suggesting that this easily identified group of patients may be the most responsive to intervention programs.
Asunto(s)
Determinación de la Presión Sanguínea/métodos , Hipertensión/tratamiento farmacológico , Monitoreo Fisiológico , Cooperación del Paciente , Dispositivos de Autoayuda , Adulto , Anciano , Antihipertensivos/administración & dosificación , Ensayos Clínicos como Asunto , Estudios de Evaluación como Asunto , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Distribución AleatoriaRESUMEN
Spontaneous perirenal hemorrhage is a rare complication in patients on hemodialysis. Two cases of this condition are described. The diagnosis was confirmed by selective renal arteriogram, and exploration and nephrectomy was the treatment of choice.
Asunto(s)
Hemorragia/etiología , Enfermedades Renales/etiología , Diálisis Renal/efectos adversos , Adulto , Angiografía , Hemorragia/diagnóstico , Hemorragia/cirugía , Humanos , Riñón/irrigación sanguínea , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/cirugía , Fallo Renal Crónico/terapia , Masculino , NefrectomíaAsunto(s)
Resorción Ósea , Hiperparatiroidismo/metabolismo , Adulto , Anciano , Femenino , Osteón , Humanos , Masculino , Persona de Mediana Edad , Osteoclastos/metabolismo , Diálisis RenalRESUMEN
Ten terminal uremic patients seen over the period of one and one-half years have been kept alive by repeated hemodialysis using a modification of the Seattle system, carried out for the most part by nurses and technicians. All the patients had creatinine clearance values below 5 ml./min., and blood urea nitrogen values which ranged between 156 and 453 mg. % before beginning the first dialysis.Selection was based on their ability to co-operate with and to tolerate the regimen. Nine patients were fully rehabilitated.The major complications were those related to shunt-site infections, including septicemia, bacterial endocarditis, septic arthritis, septic pulmonary embolism and mycotic aneurysm.Nevertheless, all patients except one were rehabilitated and resumed their full-time occupations and have continued to lead happy and useful lives.