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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a series of polybrominated biphenyl (PBB) feeding trials in White Leghorn cockerel chicks, the effects of PBB on various physiological parameters and organ weights were determined. These measurements included: growth, thyroid function, ECG, cardiac output, blood pressure, hematocrit, erythropoietin levels, and spleen, bursa of Fabricius, thyroid, testes, comb, liver weights. In addition, tissues were histologically examined. PBB, in the commercial grade form of hexabromobiphenyl, was administered continuously in the diet at levels ranging from 50 to 250 ppm. Pair-feeding studies were conducted to ascertain the effects of the drug per se since preliminary trials indicated that PBB administration resulted in decreased feed intake. Chronic administration resulted in depressed body weight as a result of decreased feed intake; decreased comb, testes, spleen, and bursa weights; increased liver and thyroid weight; hydropericardium and ascites; decreased hematological values due to depressed plasma erythropietin levels; decreased heart rate, packed cell volume, hemoglobin and cardiac output; decreased voltage amplitude of the ECG and a shift in the mean electrical axis. No significant differences were found in blood pressure (mean arterial and pulse pressure), stroke volume, or respiratory rate.
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PMID:PBB fed to immature chickens: its effect on organ weights and function and on the cardiovascular system. 20 83

Physical performance and haemodynamic parameters at rest and with exercise were compared in a prospective, cross-over fashion in 12 anaemic haemodialysis patients (Hb 6.4 +/- 0.5, mean +/- SEM) at two levels of haemoglobin (Hb 9 and 12 g/dl) before and after long-term treatment with recombinant human erythropoietin (rHuEpo). Patients were divided into two groups and measurements made prior to treatment, upon reaching, and after 4 months at the first target Hb (9 g/dl group A, 12 g/dl group B), and after 4 months at the alternative target Hb. Tests included an exercise radionuclide ventriculogram, Doppler echocardiogram, and respiratory function exercise test. Compared to pretreatment, there was a significant reduction in resting pulse rate (P < 0.001), and in pulse rate (P < 0.001) and arterial lactate (P < 0.01) concentrations at specified levels of exercise. Work capacity improved 60% (P < 0.001), and left ventricular mass fell by 26% (P < 0.001). Although cardiac output (CO) during and after exercise was reduced (P < 0.05), resting CO, cardiac index, stroke volume and ejection fraction (rest and exercise) were not significantly altered. There appeared little benefit in having the higher target Hb: no significant difference could be found between target levels for almost any measure. In addition, despite marked improvement from pretreatment levels, performance parameters were still below those of non-uraemic age-matched controls. These results demonstrate the beneficial but incomplete effect of rHuEpo on resting and exercise-related factors, and suggest that most improvement is achieved with modest increments in haemoglobin.
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PMID:Haemodynamic changes and physical performance at comparative levels of haemoglobin after long-term treatment with recombinant erythropoietin. 133 60

Left ventricular size and function were evaluated in 15 anemic chronic hemodialysis patients before and after the administration of recombinant human erythropoietin (rHuEPO). All patients were studied with two-dimensional and M-mode echocardiographic examinations before the initiation of rHuEPO (T1) and at 28 +/- 7 weeks of rHuEPO therapy (T2). The two-dimensional targeted M-mode echocardiographic measurements obtained were: end-diastolic dimension (EDD); end-systolic dimension (ESD); stroke dimension (SD); dimensional shortening (SD/EDD); systolic posterior wall thickness (PWs); diastolic posterior and interventricular septal thickness; end-systolic wall stress (ESWS); and left ventricular mass. Mean hematocrit in these patients increased almost 50%. The EDD decreased from a mean value (+/- SEM) of 6.41 +/- 0.33 to 4.93 +/- 0.21 cm (p less than 0.05). ESD decreased from a mean value of 4.16 +/- 1.2 to 2.77 +/- 0.06 cm (p less than 0.05). The calculated mean SD decreased slightly but not significantly from 2.21 +/- 0.69 to 2.19 +/- 0.60 cm. The calculated SD/EDD increased from a mean 0.35 +/- 0.09 to 0.44 +/- 0.07 (p less than 0.05). ESWS fell from 59.2 +/- 12.2 to 37.6 +/- 9.3 gm/cm2 (p less than 0.01), and left ventricular mass fell (p less than 0.05) from 347 +/- 15.2 to 227 +/- 59 gm. There was no significant difference in resting heart rate or systolic blood pressure between T1 and T2. The increase in dimension shortening reflects afterload reduction, as indicated by the fall in end-systolic wall stress.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changes in left ventricular size, wall thickness, and function in anemic patients treated with recombinant human erythropoietin. 138 84

Anemia is a common complication of lymphoproliferative syndromes. The exact pathogenic mechanism of this anemia is unclear. Many patients require progressive and persistent blood transfusions. We treated 10 patients (8 with multiple myeloma, 1 with non Hodgkin Lymphoma, 1 with chronic lymphocytic leukemia) by administering low doses of recombinant human erythropoietin (60 U/kg 3 times a week s.c.). All patients presented anemia with hemoglobin levels less than 10 gr/dl; renal function was not impaired (serum creatinine levels less than 1.2 mg/dl or creatinine clearance greater than 60 ml/min). A response was defined as an increase of hemoglobin level of at least 2 gr/dl or stop of red-cell transfusion within the first 3 months of treatment. Nine patients (90%) responded to treatment with a significant increase in the hemoglobin concentration. Two patients presented a cerebral stroke not correlated with erythropoietin administration.
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PMID:[Efficacy of erythropoietin in anemia of patients with immuno-lymphoproliferative disease]. 152 59

Long-term myocardial effects of recombinant human erythropoietin (rhEPO) therapy were investigated in nine hemodialysis (HD) patients greater than 60 years of age. Echocardiographic studies were performed before the administration of rhEPO with a hematocrit of 20.8% +/- 1.9% and repeated after 6 (period I) and 24 months (period II) of treatment, when the hematocrit was increased to 34.1% +/- 2.3% and 32.3% +/- 2.8%, respectively. Left ventricular diameters were not significantly changed by rhEPO, although they tended to decrease at the end of the study (30.6 +/- 5.3 v 27.7 +/- 3.6 mm systole, and 50.3 +/- 3 v 46.5 +/- 3.7 mm diastole). Thickness of the interventricular septum and left ventricular posterior wall remained unaltered, although there was a downward trend (14.5 +/- 5.2 to 12.8 +/- 2.8 mm and 11.7 +/- 1.9 to 10.6 +/- 1.4 mm, respectively). Left ventricular mass index (LVM) progressively decreased from 181.5 +/- 61 to 153.8 +/- 38.3 (period I) and 135.7 +/- 45.6 g/m2 (period II, P less than 0.05). Stroke volume remained unaltered in period I, but it decreased from 93.7 +/- 10 to 65.2 +/- 12.8 mL (P less than 0.001) in period II, resulting in a decrease of cardiac index (CI) from 3.93 +/- 0.86 to 2.54 +/- 0.68 L/min/m2 (P less than 0.001) at the end of the study. Heart rate did not change during the study period. Blood pressure was kept constant, although antihypertensive therapy needed to be adjusted to prevent occurrence or aggravation of hypertension in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term myocardial effects of correction of anemia with recombinant human erythropoietin in aged patients on hemodialysis. 153 83

The objective of this study was to determine the probabilities of specific morbid events or death among patients with end-stage renal disease (ESRD) treated by hemodialysis. A prospective cohort study was performed between March 1988 and September 1989 in 18 hemodialysis centers in 13 Canadian cities, representing about one third of the hemodialysis population in Canada. The inception cohort consisted of 496 patients entering hemodialysis who had survived 1 month. The few new hemodialysis patients who received erythropoietin (EPO) in the last 3 months of the study were excluded. Survival curves were compared using the Cox proportional hazards regression model. Older age and history of cardiovascular disease were independently associated with a greater probability of death. Age and history of cardiovascular disease were also associated with a greater probability of nonfatal circulatory events (myocardial infarction, angina requiring hospitalization, or stroke), while a serum albumin level less than or equal to 30 g/L (3.0 g dL) was associated with an increased probability of pulmonary edema. The probability of surviving 12 months without receiving a blood transfusion was 47.2% for males and 27.5% for females. The incidence of non-A, non-B hepatitis, as estimated by unexplained elevations in serum aspartate aminotransferase (AST) values, was not different between patients receiving and not receiving blood transfusions. The probability of hospitalization for any cause was greater for patients with grafts for vascular access than for those with fistulae, for those with a history of cardiovascular disease, for those with a serum albumin level less than or equal to 30 g/L, and for those with renal disease due to diabetes or vascular disease. Hospitalization due to circulatory disease was more likely among those with a history of cardiovascular disease and among those with a lower serum albumin level. Hospitalization for infectious disease was more likely among those with a lower serum albumin level and less likely among those with a fistula for vascular access. Among all patients receiving hemodialysis treatment for more than 6 months, there were 14.8 hospital days per year.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Canadian Hemodialysis Morbidity Study. 155 66

Progressive advances in perfusion technology and perioperative supportive management have made it possible for members of the Jehovah's Witnesses religious group to undergo open cardiac operations with remarkable safety. However, hospital mortality remains high in (1) patients requiring reoperation (in whom both technical and bleeding problems tend to be more frequent) and (2) patients with significantly compromised cardiac performance requiring urgent or emergency operation. Employing a number of perioperative measures designed to minimize blood loss and maintain hematocrit levels (including use of the recently available recombinant human erythropoietin in two patients whose cases are reported herein), 13 reoperations and five urgent or emergency operations were performed. The one death in the entire series occurred in a patient (reoperation group) who died of a cerebrovascular accident of presumed embolic etiology, having undergone combined debridement of a stenotic heavily calcified aortic valve and a second coronary artery revascularization procedure. None of the patients required surgical exploration for bleeding. We suggest that currently available methodology permits Jehovah's Witnesses to undergo reoperation, emergency surgery, or urgent open cardiac operation at a level of risk not dissimilar to that seen in patients who permit use of homologous blood and products in their treatment.
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PMID:Reoperation, emergency and urgent open cardiac surgery in Jehovah's Witnesses. 162 95

The aim of the study was to evaluate, before and after hemodialysis (HD), the effects of partial correction of anemia with erythropoietin on: cardiac index (CI), stroke index (SI), heart rate (HR), ventricular ejection index (EVI), mean arterial pressure (PAM) and systemic vascular resistance index (SVRI). Cardiac parameters were gathered by means of transthoracic bioimpedance (BoMed). Twelve patients (6 M, 6 F) aged 50.6 +/- 5 years, on HD for 92.8 +/- 15.9 months, were studied twice (basal, end of follow-up). Before rHuEPO therapy, 6 patients had a "pathologic" cardiac response to HD (defined as an increase of CI despite the reduction of pre-load). After rHuEPO, 5 out of 6 patients with a "pathologic" response reverted to a "normal" response, and 1 hypertensive patient from a "normal" to a "pathologic" response. The EVI, CI and SI of patients with "pathological" response significantly improved after rHuEPO as compared with pre rHuEPO values (EVI 1.36 +/- 0.14 vs 1.07 +/- 0.08, p = 0.023; CI 3.18 +/- 0.24 vs 1.78 +/- 0.27, p less than 0.01; SI 43 +/- 3.7 vs 24 +/- 3.8, p less than 0.01). In conclusion, partial correction of anemia with rHuEPO induces an improvement of myocardial performance, without significant hemodynamic adverse effects. Our results suggest also that anemia could play a significant role in the pathogenesis of myocardial disfunction in HD patients.
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PMID:[Effects of erythropoietin on the cardiovascular system and the intradialytic hemodynamic behavior]. 181 33

The substitution of recombinant human erythropoietin (rhEPO) in chronic hemodialysis patients is often associated with the development of severe hypertension. In the present study, a systematical echocardiographic analysis was performed in 25 patients on maintenance hemodialysis during rhEPO therapy for at least 4 months. Referred to the total group, indices of left ventricular size decreased significantly. Left ventricular total volume and left ventricular mass were reduced considerably. Fractional fiber shortening and ejection fraction showed an impressing improvement. At a constant heart rate, stroke volume and cardiac output were reduced. Myocardial thickness did not alter under chronic rhEPO therapy. When subgroups were formed with respect to changes in blood pressure, all parameters investigated behaved very similar to the total group, irrespective of changes in blood pressure. Five patients with coronary heart disease and clinical signs of myocardial insufficiency were evaluated separately. These patients showed a decrease in left ventricular size and no evidence of a deterioration of myocardial function. We conclude from our results that rhEPO therapy in patients on maintenance renal replacement therapy has beneficial effects on left ventricular size and function; these effects are not significantly counteracted by the development of hypertension.
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PMID:Therapy with recombinant human erythropoietin reduces cardiac size and improves heart function in chronic hemodialysis patients. 182 50

Evolution of cardiac index in 12 patients with severe renal anemia on regular hemodialysis (hematocrit 19.9 +/- 2.8%) was studied during the first 4 months of treatment with recombinant human erythropoietin (rhEPO). At the end of the study period, hematocrit rose to 31.1 +/- 3.5% (p less than 0.001) and cardiac index significantly decreased (5.34 +/- 1.25 vs. 3.81 +/- 0.84 liters/min/m2, p less than 0.001). Cardiac index fell mainly because of reduction of stroke volume (108 +/- 27 vs. 81 +/- 25 ml, p less than 0.001), while heart rate did not change during the study period. Before starting rhEPO cardiac index was elevated in 11 out of the 12 patients, whereas after 4 months of treatment this was only maintained in 4 of them. We conclude that substitution with rhEPO in hemodialysis patients significantly decreases cardiac index, confirming anemia as the main factor for hyperdynamic circulatory state in these patients. Whether this reduction in cardiac index will ameliorate cardiac morbidity or not and hematocrit levels for achieving the major benefits require further studies.
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PMID:Hemodynamic changes in hemodialyzed patients during treatment with recombinant human erythropoietin. 186 67


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