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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal transplantation offers the patient with end stage renal disease an alternative treatment to dialysis. A successful graft can lead to a greatly improved quality of life. Physicians, staff and patients often do not anticipate the adverse post-operative psychological reactions. At some stage, practically all patients experience episodes of anxiety, depression and anger secondary to complications, painful treatments, drug therapy, fear of death, etc. This article explores the psychological stages a renal transplantee goes through in the first few months post-operatively. Additionally, the role of the mental health consultant is examined.
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PMID:Psychological aspects of renal transplantation. 675 48

Serum 3'monoiodothyronine (3'-T1) levels were estimated by means of a specific radioimmunoassay (RIA) preceded by an ethanol extraction. The recovery of 3'T1 was in mean (+/-SEM) 110 +/- 9%, and the lower detection limit was 23 pmol/l. Serum levels of 3'T1 in 34 euthyroid healthy subjects were (median (range)) 55 pmol/l (less than 23 - 168 pmol/l), in 13 hyperthyroid patients 133 pmol/l (70 - 265 pmol/l) (P less than 0.01) and in 13 hypothyroid patients less than 23 pmol/l (less than 23 - 68 pmol/l) (P less than 0.01). In 11 patients with chronic renal failure serum 3'-T1 levels were highly increased 285 pmol/l (115 - 1538 pmol/l) (P less than 0.01) and correlated inversely to creatinine clearance (R = -0.68, P less than 0.05). In patients with liver cirrhosis serum 3'-T1 levels were unaffected, whereas in 19 patients with endogenous depression studied before and after recovery from the depression serum levels decreased from 70 pmol/l (less than 23 - 248 pmol/l) to 30 pmol/l (less than 23 - 95 pmol/l) (P less than 0.01). Administration of propranolol 40 mg b.i.d. for 2 weeks did not affect serum 3'-T1 levels. The study shows that 3'-T1 is present in serum from euthyroid man and varies with thyroid function. Further, it is suggested that 3'-T1 in contrast to other iodothyronines primarily is eliminated by the kidneys.
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PMID:Serum 3'-monoiodothyronine levels in normal subjects and in patients with thyroid and non-thyroid disease. 727 5

Avulsion of the triceps tendon should be suspected in patients who have pain about the elbow following a deceleration stress to the upper extremity. In three cases, the avulsion occurred both with or without a concomitant blow to the posterior aspect of the arm. Examination revealed pain, swelling, and a palpable depression just proximal to the olecranon. Roentgenograms showed avulsed osseous material. In the evaluation and management of triceps avulsion, it was important to differentiate between complete and partial tears. Careful examination of active range of motion of the elbow was the most important factor in making this determination. An avulsion was considered partial only if normal elbow motion and extension against resistance were found on follow-up examination a few days postinjury. Nonoperative management was successful in one case of partial tear (Case 2). Surgical therapy was advisable for complete avulsions. Surgical repair was successful using heavy nonabsorbable suture through olecranon drill holes. Injuries of tendon avulsion and rupture are likely to become more common as the number of patients with chronic renal failure, on dialysis, increases. Tendo-osseous weakness and related musculoskeletal disorders in renal osteodystrophy patients are unsolved problems.
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PMID:Avulsion of the triceps tendon. 730 86

A state of 131-albumin metabolism has been investigated in 70 patients with some diffuse renal disease. In patients with chronic renal insufficiency an intravascular albumin mass was in the normal limits, while an albumin concentration was decreased because of an anemia. A depression of albumin catabolism has been noticed in azotemia as well as in albuminuria. A conclusion has been made that serum albumin concentration cannot be a reliable index of the state of protein metabolism in patients with chronic renal failure.
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PMID:[Albumin metabolism in chronic renal insufficiency]. 734 14

1. Baroreflex sensitivity was evaluated in 22 non-dialysed patients with chronic renal failure secondary to chronic glomerulonephritis. Baroreflex sensitivity was judged by the slope of the linear regression of the pulse interval on the rise in systolic blood pressure with injection of phenylephrine or reduction by amyl nitrite inhalation. 2. Baroreflex sensitivity was reduced in these patients as compared with normal controls. Reduction of baroreflex sensitivity was significantly greater in nine hypertensive than 13 normotensive patients with chronic renal failure. 3. A significant positive correlation was found between baroreflex sensitivity and motor nerve conduction velocity measured on ulnar nerve in 13 patients examined. 4. Saline was given with high dietary salt intake to seven normotensive patients with chronic renal failure for 2 or 5 days in order to determine whether the severe depression of baroreflex sensitivity can be an initiating factor for hypertension. Blood pressure was raised to hypertensive levels within 5 days in two patients in whom baroreflex sensitivity was nearly as low as that of hypertensive patients, but not in five cases whose baroreflex sensitivity was normal or only mildly depressed. Plasma volume increased to the same degree in both groups. Baroreflex sensitivity did not change in the former two cases despite blood pressure elevation. 5. It is concluded that reduced baroreflex sensitivity in chronic renal failure correlated with the prescence ofhypertension, as well as uraemic neuropathy, and may be one of the pathogenetic mechanisms of hypertension in end-stage chronic glomerulonephritis.
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PMID:Baroreflex sensitivity in renal failure. 735 50

Various symptoms are discussed which are of importance in patients undergoing maintenance dialysis for chronic renal failure, such as depression, organic brain syndrome, ambiguity regarding a chronic "incurable" disease, sexual dysfunction and suicidal behaviour. A number of criteria that should be considered at the beginning and termination of regular dialysis treatment are described. Six case reports of selected patients with chronic renal failure and psychiatric problems are discussed. For psychiatric reasons one female patient was not started on maintenance dialysis. One of the patients, a female, did well on maintenance dialysis. One patient died due to medical complications for which treatment was withheld. Two patients decided to quit maintenance dialysis with their doctor's approval. One patient committed suicide unexpectedly.
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PMID:[Psychiatric aspects in the starting and ending of chronic dialysis]. 739 82

Serum thyroid stimulating hormone (TSH) levels were measured in 127 patients with varying grade of chronic renal failure (CRF). Sensitive immunoradiometricassays (IRMA) were used so that small changes in TSH levels if any, could be appreciated, and to see if such alterations exhibit some relationship with those in thyroid hormone levels. Mean serum TSH levels in the patient group of 2.33 microU/ml (0.07-7.3) was significantly higher in comparison to 1.73 microU/ml (0.25-4.6) in normal subjects (p < 0.001). However, they were not significantly different when measured by radioimmunoassay (RIA) as compared to normals. Serum triiodothyronine (T3), thyroxine (T4) and free triiodothyronine (FT3) levels of 72 +/- 32 ng/dl, 7.4 +/- 2.6 micrograms/dl and 2.9 +/- 0.9 pg/ml were significantly lower than in normal subjects, whereas serum free thyroxine (FT4) showed a slight though not significant elevation. When patients were divided in three subgroups according to the degree of renal insufficiency, TSH levels showed a gradual rise with corresponding depression in their T3, FT3 and T4 levels. In 19 patients who were on hemodialysis (HD) and subsequently received successful renal transplantation, most of the thyroid function parameters returned towards the normals with TSH undergoing significant depression from their pretransplant levels as well as from normal levels. The results indicated that a slight but significant elevation in TSH levels could be revealed by sensitive IRMA in patients with CRF. Rising TSH levels with increasing renal insufficiency and its inverse relationship with T3 and T4 levels suggest maintenance of pituitary thyroid axis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Measurement of serum thyrotropin levels using sensitive immunoradiometricassays in patients with chronic renal failure: alterations suggesting an intact pituitary thyroid axis. 752 29

We have studied the pharmacodynamics of the 1R cis-1'R cis isomer of atracurium (51W89) in 15 healthy subjects and in 17 patients with chronic renal failure using a bolus dose of 51W89 0.1 mg kg-1 (2 x ED95). Fifteen patients with normal renal function were investigated also using an approximately equipotent dose of atracurium (0.4 mg kg-1). The compound surface action potential of the adductor pollicis muscle, in response to train-of-four stimulation of the ulnar nerve at the wrist, was recorded until recovery of the height of the first response of the train-of-four compared with baseline (T1:T0) had reached at least 85% and the train-of-four ratio (T4:T1) at least 80%. In the healthy and renal failure patients who received 51W89, there were no significant differences in any of the onset or recovery variables except for the time to 90% depression of T1:T0, which was longer in patients with renal failure (mean 3.7 min vs 2.4 min; P < 0.05). Of the healthy patients who were given either 51W89 or atracurium, there were no significant differences in the onset data, except for time to maximum block, which was longer in the 51W89 group (mean 7.7 min vs 6.2 min; P < 0.01). The mean times to 10%, 25%, 50% and 75% recovery of T1:T0 and the time for T4:T1 > 70% were significantly longer in patients receiving 51W89.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacodynamics of the 1R cis-1'R cis isomer of atracurium (51W89) in health and chronic renal failure. 773 58

The validity of a recently developed measure of disease severity, the End-stage Renal Disease Severity Index (Craven et al. 1991) was examined in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients (total N = 82). Scores on the ESRD Severity Index were compared with three commonly identified components of disease severity: physiological indices of severity, functional status, and psychological burden of illness. For the entire group of subjects, scores on the ESRD Severity Index were negatively associated with functional ability and positively related to physiological severity. ESRD Severity Index scores showed a weaker relationship with psychological burden of illness which depended in part on treatment mode. Disease severity scores were positively related to depression in CAPD patients but not in HD patients. These findings suggest that the ESRD Severity Index is a valuable research tool with construct validity.
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PMID:Measuring disease severity in patients with end-stage renal disease: validity of the Craven et al. ESRD Severity Index. 779 54

During episodes of acute infection there is a reduced response to epoetin therapy. It is well known that "endogenous pyrogens," such as interleukin-1 (IL-1) and tumor necrosis factor, inhibit erythropoiesis when administered exogenously. To determine whether there is a relationship between these observations, serum samples were obtained from nine patients with chronic renal failure maintained by continuous ambulatory peritoneal dialysis, during and after recovery from bacterial peritonitis, to study the effect of circulating factors on erythropoiesis. Normal human bone marrow-derived erythroid progenitors were cultured in vitro in 5% and 10% patient serum. Depression of the growth of late progenitors, colony-forming units-erythroid (at 10% serum, P = 0.005; 95% confidence intervals, 6.2 and 24.4, respectively), was observed but there was no effect on the earlier progenitors, burst-forming units-erythroid (at 10% serum, P = 0.7; 95% confidence intervals, -18.5 and 13, respectively). The effect was not prevented by antisera to IL-1. Similarly, when added to cultures, IL-1 inhibited the colony-forming units-erythroid and the effect was abrogated by IL-1 antisera. These findings suggest that a circulating soluble factor that is inhibitory to erythropoiesis and may contribute to loss of response to epoetin therapy, is present in cases of peritonitis in continuous ambulatory peritoneal dialysis patients.
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PMID:Serum from continuous ambulatory peritoneal dialysis patients with acute bacterial peritonitis inhibits in vitro erythroid colony formation. 794 11


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