51
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Kaye M. Hyperparathyroidism and parathyroidectomy in renal failure. Int J Artif Organs 1990; 13:787-9. [PMID: 2289829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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52
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Avashia JH, Walsh TD, Thomas AJ, Kaye M, Licata A. Metastatic carcinoma of the prostate with hypercalcemia. Cleve Clin J Med 1990; 57:636-8. [PMID: 2225449 DOI: 10.3949/ccjm.57.7.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A patient presented with advanced cancer of the prostate and underwent bilateral orchiectomy. After 2 years, hypercalcemia developed and was managed successfully with saline diuresis, furosemide, and oral glucocorticoid therapy. It is believed that the patient's hypercalcemia was caused by a metabolic complication of progressive, advanced disease.
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Affiliation(s)
- J H Avashia
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Ohio 44195-5236
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53
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Kaye M, Fischer D. Changes in intact parathyroid hormone levels during hemodialysis following exposure to either differing dialyzate calcium concentrations or calcium-free dialysis with varying calcium infusion rates. Clin Nephrol 1990; 34:84-7. [PMID: 2225558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To determine the optimal infusion rate for calcium, when using a dialyzate which was calcium free, six patients were treated sequentially, in random order, with six different dialyzates. Three were calcium free and they were infused with replacement calcium at either 10, 15 or 20 ml/hour using 10% CaCl2. The other three used standard bicarbonate dialyzate with either 1.25, 1.5 or 1.75 mmol/l calcium. Ionized calcium and intact parathyroid hormone (Nichols IRMA PTH) were measured at the start and end of each dialysis. Ionized calcium rose slightly with 15 ml/hour calcium infusion and PTH fell 137 +/- 111 pg/ml. These changes were similar to those of 1.5 mmol/l calcium in standard bicarbonate. More PTH suppression and higher end dialysis calcium resulted from 20 ml/hour infusion or 1.75 mmol/l dialyzate calcium. It was concluded that 15 ml/hour is a suitable calcium infusion rate under normal conditions when using calcium-free dialyzate.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Quebec, Canada
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54
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Kaye M. An RRSP (registered retirement savings plan) for health care: the registered investment health plan. Hosp Trustee 1990; 14:4-5. [PMID: 10107316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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55
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Wiegmann TB, Kaye M. Malabsorption of calcium and phosphate in chronic renal failure: 32P and 45Ca studies in dialysis patients. Clin Nephrol 1990; 34:35-41. [PMID: 2387101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A modified double-isotope method was used to determine the absorption of calcium and phosphate in patients with chronic renal failure. Eight hemodialysis patients and six healthy control subjects received an intravenous dose of 45calcium and 32phosphate and an oral tracer dose of 45Ca and 32P was administered two weeks later. Timed plasma samples were obtained on each occasion to determine fractional absorption rates and cumulative absorption of either tracer from both tracer sets with deconvolution analysis. Stool collections were analyzed. Calcium absorption in normal subjects peaked at 12% over fifteen minutes at one hour and declined rapidly thereafter. Absorption was essentially complete at four hours and cumulative absorption at this time was 72 +/- 6%. The pattern of phosphate absorption was similar and cumulative absorption at 4 hours was 80 +/- 3%. Calcium absorption in dialysis patients was significantly impaired with a flattened profile, a maximal 15-min absorption rate of 2% and cumulative 4-h absorption of 20 +/- 2%. Phosphate absorption in dialysis patients was also impaired to a comparable degree with a maximal rate of 3.6% and a more delayed cumulative total of 35 +/- 5%. Stool data showed good agreement with deconvolution analysis in volunteers but always overestimated absorption in patients. Sequential double isotope analysis provided a simple and convenient method for the concurrent estimation of calcium and phosphate absorption in humans.
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Affiliation(s)
- T B Wiegmann
- Division of Nephrology, Montreal General Hospital, McGill University, Quebec, Canada
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56
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Abstract
Fourteen individuals on long term hemodialysis, with varying amounts of aluminum in bone from 11 to 296 mg/kg by flameless atomic absorption spectrophotometry, were examined to see whether the aluminon or acid solochrome azurine (ASA) staining reactions best approximated the chemical determination. Correlation coefficients were 0.78 for aluminon and 0.88 for ASA. Together with 11 additional patients morphometric parameters were compared with the two aluminum stains. The aluminon stain gave satisfactory results in the osteomalacic group but underestimated the amount of aluminum present in those with hyperparathyroid, mixed or aplastic disease. Some individuals showed a striking difference between the two techniques which could have led to an erroneous conclusion regarding the amount of aluminum present. The aluminon stain was pH dependent and together with ASA could be enhanced by prior heat treatment of the sections. It is recommended that ASA either replace aluminon for routine use or be used together with the aluminon stain, particularly for bones without osteomalacia or with mild to moderate aluminum storage.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Quebec, Canada
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57
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Bonser R, Fischel R, Fragomeni L, Kaye M, Burdine J, Friese C, Kriett J, Shumway S, Jamieson S. Successful human double-lung transplantation after five and one-half hours of preservation. J Thorac Cardiovasc Surg 1989. [DOI: 10.1016/s0022-5223(19)34275-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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58
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Bonser RS, Fischel R, Fragomeni L, Kaye M, Burdine J, Friese C, Kriett J, Shumway S, Jamieson SW. Successful human double-lung transplantation after five and one-half hours of preservation. J Thorac Cardiovasc Surg 1989; 98:942-4. [PMID: 2811425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Successful clinical double-lung transplantation after 5 1/2 hours of pulmonary ischemia is reported. Static hypothermic preservation with a high-volume, high flow rate-modified Collin's solution pulmonary artery flush was used. Excellent early and late pulmonary function demonstrates the efficacy of the technique that is described in detail. Lung transplantation remains limited by the lack of reliable methods of long-term storage of donor organs, but refinement of current techniques may soon allow its wider application.
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Affiliation(s)
- R S Bonser
- Minnesota Heart and Lung Institute, University of Minnesota, Minneapolis 55455
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59
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Kaye M. Parathyroidectomy in end-stage renal disease. J Lab Clin Med 1989; 114:334-5. [PMID: 2677194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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60
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Cartier P, Gault H, Kaye M, Uldall R. Saving money by reusing dialyzers. Dimens Health Serv 1989; 66:11, 35. [PMID: 2612752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- P Cartier
- l'Hôpital du Sacré-Coeur de Montréal
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61
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Abstract
Ten patients are reported following parathyroidectomy (PTX). In 9 all identifiable parathyroid tissue in the neck was deliberately removed, and in the tenth (operated 14 years ago) the remnant which had been left probably did not function. Their post-operative course resembled that of patients treated conventionally, and their subsequent course was likewise uneventful with disappearance of all symptoms associated with their osteodystrophy. All patients required oral calcium supplementation but none were given vitamin D compounds after the initial period of repletion following surgery. Mean serum values were (before PTX and current) for calcium 2.63 +/- 0.14 and 2.33 +/- 0.08 mmol/liter, P = NS, for phosphorus 1.96 +/- 0.13 and 1.38 +/- 0.09 mmol/liter, P less than 0.01, and for alkaline phosphatase 713 +/- 191 and 101 +/- 14 IU, P less than 0.05. Evidence for residual parathyroid tissue was present in each case; one patient remained mildly hyperparathyroid and several were mildly hypoparathyroid by the IRMA PTH assay. Bone histomorphometry in five subjects post-PTX showed either normal or low turnover. Radiologically, striking remineralization was seen with disappearance of all erosive changes. We suggest that residual areas of parathyroid tissue are stimulated and continue to secrete hormone even when all the discrete glands have been removed. It is recommended that when indicated, and in the absence of aluminum excess, total PTX without autotransplant should be the preferred form of therapy for long-term dialysis patients.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Quebec, Canada
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62
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Kaye M, Barber E, Vasilevsky M, Langer K. Calcium-free dialyzate: development and applications. Clin Nephrol 1989; 31:132-8. [PMID: 2706810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A calcium-free, bicarbonate-containing concentrate was prepared for hemodialysis, which, after dilution, gave analyzed concentrations of sodium of 146 mmol/l, Cl 110 mmol/l, HCO3 of 35 mmol/l and pH of 8.3. When compared with standard bicarbonate dialysis, no important differences in blood chemistries, symptoms or signs were seen. The solution has been trouble-free in over 300 dialyses. Total amount of calcium lost uncorrected for time, dialyzer or blood flow was 40.6 +/- 1.1 mmol, n = 62. This loss was replaced by a calcium infusion into the venous line giving 40 mmol calcium over 4 h. The dialyzate calcium loss could be accurately predicted by sampling without collecting the total dialyzate volume. The uses of this concentrate for bicarbonate dialysis, citrate anticoagulation and avoidance of hypercalcemia in patients treated with oral calcium for phosphate binding is discussed.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Quebec, Canada
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63
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Kaye M, Henderson J. Direct functional assessment of human osteoblasts by radioautography: methodology and application in end stage renal disease. CLIN INVEST MED 1988; 11:224-33. [PMID: 3402108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fragments approximately 1 mm3 of freshly obtained iliac crest cancellous bone were incubated for 30 minutes at 37 degrees C in Krebs buffer containing 3H-leucine or 3H-proline followed by radioautography. Grains per osteoblast, reflective of protein synthetic activity, were counted in normal controls and patients with end stage renal disease with or without significant aluminum storage in their bones. Compared with control the end stage renal disease patients without significant aluminum storage had more large osteoblasts with increased grain counts which were ascribed to secondary hyperparathyroidism. Cells from patients with greater than 30% surface aluminum had more small osteoblasts with grain counts intermediate between control and less than 2% aluminum, ascribed to an inhibitory effect of aluminum on the secondary hyperparathyroidism. Cell activity did not depend on location next to a tetracycline label or osteoid and it was suggested that all bone lining cells could be considered as osteoblasts. Aluminum storage was associated with impaired mineralisation in the presence of normal or increased osteoblastic protein synthetic activity suggesting that in these patients the mineralisation defect was not primarily due to an abnormality in osteoblast function.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Quebec
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64
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Abstract
Fifty two of 63 patients with renal osteodystrophy had one or more mononuclear cells positive for acid phosphatase in the marrow. These cells are also tartrate resistant and non-specific esterase negative, and are believed to be precursors to osteoclasts and other acid phosphatase positive cells resorbing bone on the trabecular surface.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Quebec, Canada
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65
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Kaye M, Turner M, Ardila M, Wiegmann T, Hodsman A. Aluminum and phosphate. Kidney Int Suppl 1988; 24:S172-4. [PMID: 3163042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M Kaye
- Department of Medicine, Montreal General Hospital, Ontario, Canada
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66
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Abstract
Chronic dialysis patients at risk for aluminum osteomalacia in areas of low water-aluminum content are not well identified. We, therefore, studied retrospectively a cohort of 59 patients who underwent bone biopsy at two hospital-based dialysis centers in Montreal (water aluminum content less than 10 micrograms/L). Overall, 25% of patients biopsied had aluminum-related osteomalacia defined by aluminum staining of more than 30% of the trabecular surface and low levels of bone formation as measured by tetracycline labeling. Multiple linear regression analysis showed high predialysis serum creatinine (P less than .05) and the amount of aluminum prescribed per month (P less than .05) as the most important determinants of aluminum staining. We conclude that aluminum-related osteomalacia can be a frequent disease entity in areas of low water-aluminum content. Our findings also suggest predialysis serum creatinine and the amount of aluminum prescribed per month are risk factors for the development of aluminum-related osteomalacia. Though the relationship between serum creatinine and aluminum staining of trabecular bone is unclear, serum creatinine is probably a marker for adequacy of dialysis in these patients.
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Affiliation(s)
- M W Turner
- Department of Medicine, Royal Victoria Hospital, Montreal, P. Quebec, Canada
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67
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Kaye M. Can "ethical" clinical trials be unethical? CMAJ 1987; 137:988. [PMID: 3676954 PMCID: PMC1267411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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68
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Abstract
Several psychiatric facilities have opened their records partially or completely to patients. The authors report the results of a two-part study in which 20 patients on a minimum-security unit of a forensic center were allowed to read their records and later to write in them. Staff and patient attitudes toward granting patients access to their records were measured before and during the study and were compared with staff and patient attitudes on two units where patients were not granted access. Only eight study patients actually read their charts and none wrote in them, but the majority of both study and control patients felt that access had been helpful. No significant differences in patient behaviors were found on any of the units as a result of access. Staff attitudes toward access did not differ significantly before or after the study, and few differences were found in staff charting practices.
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Affiliation(s)
- R D Miller
- Mendota Mental Health Institute Forensic Center, Madison, Wisconsin 53704
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69
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Abstract
Dialysis patients are at risk for toxicity from formaldehyde used in the reprocessing of dialyzers for reuse; therefore, replacing formaldehyde as a dialyzer sterilant would be advantageous. The potential for RenNew-D as a sterilizing agent was investigated in seven stable in-center hemodialysis patients over 20 consecutive dialyses with cuprammonium cellulose hollow-fiber dialyzers. Treatment with RenNew-D showed no toxicity to patients or dialyzers except for two blood leaks occurring in one patient. The mean number of dialyzer uses was 4.9. In all the dialyzers that passed functional testing small solute clearances were maintained with reuse. The ability of RenNew-D to improve the biocompatibility of reused dialyzers was documented with mean neutrophil counts falling to only 78% of initial values during first reuse of dialyzers processed with RenNew-D compared with a decrease in neutrophil count to 2% of initial values during first use of the same dialyzers. Our results suggest that RenNew-D may be a useful alternative to formaldehyde for the purpose of dialyzer reuse. A reuse procedure that includes processing with RenNew-D is associated with improved biocompatibility, possibly because of maintenance of the blood-derived membrane coating established during prior dialysis.
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70
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Abstract
Should patients be treated when they have specifically refused treatment? Three competent patients are described with end-stage renal disease who, against the advice of their family, friends and care-givers, refused dialysis. Each was treated and subsequently they acknowledged their satisfaction with the outcome. Guidelines for treating patients when consent is refused are discussed and it is suggested that this is permissible in life-saving situations where the patients' refusal is idiosyncratic and irrational.
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Affiliation(s)
- M Kaye
- Division of Nephrology, Montreal General Hospital, Canada
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71
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Abstract
Vitamin D deficiency may depress bone formation but its effect on bone resorption is not well defined. As an index of bone resorption, the activity of acid phosphatase, a lysosomal enzyme found in osteoclasts, was quantitated in situ from a bone tissue smear preparation. Activity of the enzyme, measured by integrative microdensitometry increased linearly from 25 to 60 min. The distribution of activity in osteoclasts quantitated appeared to follow a normal distribution with a median value of 0.19 integrated optical density units. Animals treated with vitamin D or 1,25 dihydroxycholecalciferol had significantly increased activity of acid phosphatase in osteoclasts compared to animals which were vitamin D deficient. The increase of acid phosphatase activity averaged 63%. Vitamin D or its metabolites may have a permissive effect on the action of parathyroid hormone or act directly to increase bone resorption.
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Affiliation(s)
- S F Silverton
- Department of Medicine, Montreal General Hospital, Quebec, Canada
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72
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Gagnon RF, Adkar V, Kaye M. Effect of RenNew-D as a sterilant on the performance of reused dialyzers. Clin Nephrol 1986; 26:297-302. [PMID: 3802596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RenNew-D (Alcide), a novel demand-release sporocidal agent, was employed instead of formaldehyde in the reprocessing for reuse of cuprophan hollow fiber dialyzers (Gambro) and the performance of these dialyzers was evaluated over 40 consecutive dialyses in six patients on maintenance hemodialysis. When RenNew-D was part of automated reprocessing performed with 4.3% bleach as specified by the manufacturer (Lixivitron), dialyzer survival was prolonged (16.7 +/- 7.2 uses) and hemodialysis neutropenia was unchanged with reuse. When RenNew-D was part of manual reprocessing conducted in the absence of bleach, marked improvement in dialyzer biocompatibility was observed but with a decreased survival (4.8 +/- 3.0). The majority of dialyzer failures were due to a fall in fiber bundle volume below a 85% set limit. Small solute clearances were maintained with both types of reprocessing. Dialyses were well tolerated throughout. Our data suggest that RenNew-D is a safe and efficacious product which can serve as a valuable alternative to formaldehyde for the purpose of dialyzer reuse.
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73
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74
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75
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Abstract
One procedural protection that has not generally made the transition from the criminal justice system to involuntary civil commitment is the Fifth Amendment protection against self-incrimination. The authors present the results of a study of the implementation of the right to remain silent, which demonstrate that warning patients that anything they say may be used against them in the commitment hearing has little impact on their willingness to talk to staff or to cooperate with treatment. The authors discuss the possible reasons for their findings.
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76
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77
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Gagnon RF, Kaye M. Dialyzer performance over prolonged reuse. Clin Nephrol 1985; 24:21-7. [PMID: 3926361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Studies were performed in patients on maintenance hemodialysis to evaluate the role of prolonged dialyzer reuse in the management of end-stage renal disease. For this purpose the patients were dialyzed without interruption with the same hollow fiber dialyzers (GambroR 120M) reprocessed with the Lixivitron IIR equipment. The data obtained from in vivo clearances in sixteen patients demonstrate that membrane permeability to small solutes (urea, creatinine, phosphate) is maintained up to thirty dialyzer uses. In vitro studies confirmed this observation and established that clearances of larger solutes (vitamin B12) are also maintained over similar extensive dialyzer reuse. Hematological and blood gas studies were performed serially during dialysis in five additional patients. Although circulating leucocyte and neutrophil counts, hemoglobin concentration as well as arterial pH and partial pressures of oxygen and carbon dioxide changed appropriately during dialysis, there was no observable difference from the first to the twentieth use of the same dialyzer. Thus, these results clearly demonstrate that prolonged dialyzer reuse in end-stage renal disease patients constitutes a stable form of renal replacement therapy provided adequate dialyzer reprocessing is applied.
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78
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79
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Abstract
In normal subjects and patients with endstage renal disease, osteoclast cell volumes were constructed using serial 2-micron thick plastic embedded sections from iliac crest bone biopsy specimens. Four cells randomly selected from each of the subjects were analyzed to give both the cell volume from the cumulative areas and thickness of each cell slice and also the cell axes taking the vector along the bone face as width or Y, thickness from the bone surface as breadth or X and vertical dimension length or Z. The mean cell volume was 6,230 microns3 in the control subjects and was significantly larger being 11,730 microns3 and 13,680 microns3 in the two patient groups. The cells showed polarity with the largest axes, Y and Z, being those in apposition to the bone surface. Howship's lacunae were enlarged in the patients and the cross-sectional area of an individual lacuna corresponded to the area of the contiguous osteoclast, r = 0.62, P less than 0.001. All patients had secondary hyperparathyroidism and osteoclast numbers were increased. There was no correlation between osteoclast size and duration of renal failure, previous vitamin D intake, or aluminum exposure. It is suggested that in ESRD, osteoclasts undergo both an increase in number and size and that these cells, being larger, remove more bone than the smaller cells in normal subjects.
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80
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Kaye M, Lella J, Gagnon R, Mulhearn B, Low G. Dialyser reuse: a study in applied medical ethics. Can Med Assoc J 1985; 132:335-6. [PMID: 3971249 PMCID: PMC1345818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A dialysis unit's introduction of automated recycling of dialysers is described. The responses of the staff and the patients are outlined, along with the pertinent ethical issues. Suggestions regarding the educational processes necessary with any innovation in long-term medical care are discussed.
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81
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Abstract
It is argued that consent by the patient to reuse dialyzers which have been mechanically cleansed is not required provided adequate standards of practice and safety are utilized. Based on medical benefits, administrative order and cost saving we propose that specific informed consent for such reuse should not be mandatory and that it could at times be unhelpful, both to care givers and recipients.
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82
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Affiliation(s)
- M Kaye
- Division of Nephrology, The Montreal General Hospital, Montreal, Quebec H39 IA4, Canada
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83
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Abstract
Using acid phosphatase as a marker, osteoclasts were examined from single sections of undemineralised iliac crest biopsies from patients with renal failure and from normal controls. Eighty one per cent of the cells from controls and 56% of the cells from patients with renal failure appeared to be non-nucleated or mononucleated. Serial sections showed, however, that 73% of the control cells were actually multinucleated as were 91% of the patients' cells. Howship's lacunae were present in similar proportions in the controls whether the cells were multinucleated or not, suggesting that they should all be classed as osteoclasts. More multinucleated cells and lacunae were present in the patients with renal failure. It is concluded that all acid phosphatase cells adjacent to bone are osteoclasts and that the presence of more lacunae and multinucleated cells in renal failure is compatible with enhanced cellular resorption.
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84
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Somerville PJ, Kaye M. Effect of calcium-sodium exchange and calcium channel inhibition on calcium release from bone in an in-vitro bone perfusion system. Adv Exp Med Biol 1984; 178:223-31. [PMID: 6507157 DOI: 10.1007/978-1-4684-4808-5_31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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85
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Abstract
A principal components factor analysis of survey data from 393 college student drinkers (178 males) extracted four dimensions from a set of 16 reasons for drinking: avoidance, social, sensation seeking, and enjoyment. Motivational patterns and the relationships with alcohol use were examined with a canonical correlation analysis. Three significant canonical variates were found. The first variate contained students with high scores on all motivational factors. They were heavy drinkers with many alcohol-related problems. The second variate indicated that drinkers who drank primarily for enjoyment tended to be women who drank moderately. Male beer drinkers with strong sensation seeking motivations formed the third variate.
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86
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Abstract
As part of a study to evaluate the safety and efficacy of dialyzer reuse, a comparative study of two methods of dialyzer reprocessing, manual and automated, was conducted. Five stable end-stage renal disease patients on center hemodialysis were evaluated as to hematological and metabolic parameters throughout two series of three consecutive dialyses using first new and then reused dialyzers reprocessed according to each of the two methods. New dialyzers and reused dialyzers following automated reprocessing always induced a profound fall in circulating neutrophil counts shortly after the start of dialysis. Hemodialysis neutropenia was not observed, however, with reused dialyzers reprocessed manually unless the concentration of sodium hypochlorite (bleach) employed was made equal to that required in automated reprocessing by being raised from 1.0 to 4.3%. It would be reasonable to conclude from these results that among the various differences between the two dialyzer reprocessing methods, restoration of the original level of biocompatibility of the reused dialyzer's membrane is related to the concentration of the cleansing agent.
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87
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Abstract
Using the staining method for aluminium with the ammonium salt of aurine tricarboxylic acid, aluminon, 18 patients with end stage renal disease gave positive reactions in iliac crest bone biopsies and 11 of these had positive staining in the bone marrow. In one the marrow was positive and the bone negative. The marrow reaction is putatively regarded as caused by aluminium storage in unidentified cells, possibly of the macrophage system which are strongly fluorescent when examined after prior tetracycline labelling. Marrow storage should be considered when assessing the bone aluminium burden.
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88
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Kaye M. Oral aluminum toxicity in a non-dialyzed patient with renal failure. Clin Nephrol 1983; 20:208-11. [PMID: 6641028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A patient is described with chronic renal failure who developed toxic levels of aluminum in bone after one year of oral aluminum hydroxide ingestion with a total dose of 711 grams. Caution in the use of oral aluminum compounds is recommended in patients with renal failure.
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89
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Gagnon RF, Shuster J, Kaye M. Auto-immunity in patients with end-stage renal disease maintained on hemodialysis and continuous ambulatory peritoneal dialysis. J Clin Lab Immunol 1983; 11:155-8. [PMID: 6604164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Auto-immunity as assessed by rheumatoid factor, anti-DNA, antinuclear, smooth muscle and mitochondrial circulating antibodies was evaluated in 2 groups of 25 patients with end-stage renal disease (ESRD) being maintained either on hemodialysis or on continuous ambulatory peritoneal dialysis (CAPD). In the group of hemodialysis patients, 56% showed at least one serological abnormality on pre-dialysis samples: anti-DNA (8%), antinuclear (8%), smooth muscle (40%) and mitochondrial (4%) antibodies; on post-dialysis samples, 64% of the patients demonstrated abnormalities due to a rise in the incidence of anti-DNA antibodies from 8-24%. In the group of CAPD patients, 44% showed at least one serological abnormality: rheumatoid factor (4%), anti-DNA (16%), antinuclear (24%) and smooth muscle (4%) antibodies. These serological changes were generally scattered randomly within both groups. In the hemodialysis group, 2 abnormalities were present in 1 patient pre-dialysis and in 3 post-dialysis. One CAPD patient had 2 abnormalities. No correlation of these findings with age, sex, duration of dialysis and nature of renal disease could be found. The results are discussed in the context of possible abnormal antigenic stimulation in ESRD patients maintained on either form of dialysis.
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Abstract
A case of hypophosphatemia-induced hypercalcemia during post-traumatic acute renal failure is described. Proposed causes for the hypophosphatemia include changes in tissue distribution of phosphate associated with hyperalimentation and phosphate losses during hemodialysis. In the absence of hyperparathyroidism the hypercalcemia as well as changes in osteoclast morphology found on bone biopsy are ascribed to a direct effect of hypophosphatemia on bone.
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91
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Abstract
Investigations of the alcohol-related disinhibition of responses to deviant sexual stimuli suggest that the pharmacological actions of ethanol have little influence on the disinhibition process. The mere belief that alcohol is consumed is sufficient to induce increased sexual arousal. Studies with conventional stimuli, however, suggest that interactions occur between the pharmacological presence of ethanol and the psychological expectations of its presence. Thus, this article examines the contribution of pharmacological, cognitive, and environmental variables to perceived sexual arousal. A balanced-placebo design varied drink instruction and drink content independently. Pictures that elicited either a low or moderate level of self-reported sexual arousal were viewed and evaluated by men (n = 64) and women (n = 64) after completing their drinks. The evaluations and arousal measures suggested significant Instruction X Content X Arousal interactions. The strongest perceptions of arousal occurred among individuals who did not know they were drinking alcohol (i.e., subjects who were told that their alcoholic drinks did not contain alcohol). Apparently, when drinkers were unaware of the alcohol intoxication, the pharmacological excitation induced by alcohol transferred to the perception and evaluation of the slides.
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92
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Abstract
A bone perfusion system using isolated rat tails was developed to study the action of inorganic phosphorus (Pi) on calcium (Ca) release in bone. Rats were either pre-labelled with 45Ca to study calcium removal from bone or 45Ca was added to the perfusate to study Ca deposition into bone. When perfusate Pi was increased from 3.5 to 5.25 mg/dl, a marked inhibition of 45Ca release was demonstrated. 85Sr microspheres, used to demonstrate differences in the flow of perfusate between bone and soft tissue, showed that the Pi effect was not due to alterations in perfusate flow to bone. Increasing the perfusate Pi concentration from 3.5 to 7 mg/dl did not increase 45Ca deposition into bone, nor did it affect baseline or PTH-stimulated cyclic AMP production. The Pi effect was inhibited by reducing the perfusate temperature to 4 degrees C, by using an anerobic perfusate, adding iodoacetate to the perfusate, and finally, by pre-treating the rats with actinomycin D prior to the experiment. Thus, in this model an increase in the Pi concentration of the perfusate inhibits Ca release from bone but does not increase Ca uptake by bone. The inhibitory effect appears to be dependent on normal cell metabolism.
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Abstract
Investigations of the alcohol-related disinhibition of responses to deviant sexual stimuli suggest that the pharmacological actions of ethanol have little influence on the disinhibition process. The mere belief that alcohol is consumed is sufficient to induce increased sexual arousal. Studies with conventional stimuli, however, suggest that interactions occur between the pharmacological presence of ethanol and the psychological expectations of its presence. Thus, this article examines the contribution of pharmacological, cognitive, and environmental variables to perceived sexual arousal. A balanced-placebo design varied drink instruction and drink content independently. Pictures that elicited either a low or moderate level of self-reported sexual arousal were viewed and evaluated by men (n = 64) and women (n = 64) after completing their drinks. The evaluations and arousal measures suggested significant Instruction X Content X Arousal interactions. The strongest perceptions of arousal occurred among individuals who did not know they were drinking alcohol (i.e., subjects who were told that their alcoholic drinks did not contain alcohol). Apparently, when drinkers were unaware of the alcohol intoxication, the pharmacological excitation induced by alcohol transferred to the perception and evaluation of the slides.
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95
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Wright J, James EP, Kaye M, Buckmaster J. Civil Service medical officers' pay. West J Med 1982. [DOI: 10.1136/bmj.284.6312.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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96
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Gagnon RF, Ballermann B, Bourgouin P, Herba MJ, Kaye M. Transcatheter embolization in the management of intractable uremic epistaxis. Can Med Assoc J 1982; 126:158-9. [PMID: 7059892 PMCID: PMC1862916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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97
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Gagnon RF, Dufresne LR, Duguid WP, Reid EC, Kaye M. High output cardiac failure on maintenance hemodialysis secondary to a post-biopsy renal arteriovenous fistula. Clin Exp Dial Apheresis 1982; 6:53-63. [PMID: 7094415 DOI: 10.3109/08860228209050813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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98
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Gagnon RF, Straaton K, Herba MJ, Kaye M. Resolution of massive renal artery thromboembolism with conservative therapy. Can Med Assoc J 1981; 125:1341-3. [PMID: 7326646 PMCID: PMC1862766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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99
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Ernst P, Kaye M. Recognizing hyperparathyroidism caused by ectopic production of a substance resembling parathyroid hormone. Can Med Assoc J 1981; 125:857-9. [PMID: 7306896 PMCID: PMC1862707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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100
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