Effective therapy of enteric hyperoxaluria: in vitro binding of oxalate by anion-exchange resins and aluminum hydroxide

Hyperabsorption of dietary oxalate is a major factor in the pathogenesis of enteric hyperoxaluria and a frequent complication of inflammatory bowel disease and ileojejunal bypass surgery. Successful treatment requires reduction in oxalate intake or inhibition of absorption of dietary oxalate by oral ingestion of oxalate binding agents. To identify such agents, oxalate binding by anion-exchange resins, gums, and aluminum hydroxide was measured under conditions that simulated those present in the intestinal lumen. Of the agents tested, those that bound oxalate best were colestipol and aluminum hydroxide. Strongly basic anion-exchange resins readily bound oxalate only in the absence of chloride. These results suggest that colestipol and aluminum hydroxide administration might reduce dietary oxalate absorption in patients with enteric hyperoxaluria.

The bile acid binding and hypocholesterolemic action of two water-soluble polymers

The in vitro bile acid binding properties of 2 water-soluble, linear, cationic resins, poly-[(dimethylimino)trimethylene chloride] or 3,3-ione C1, and poly-diallyldimethylammonium chloride) or CAT-FLOC were determined. Both polymers were substantially more active than cholestyramine. All were compared for hypocholesterolemic effect in normo-cholesterolemic dogs. CAT-FLOC and 3,3-ionene C1, administered at 1.8 and 1.2 g/day, respectively, exhibited cholesterol-lowering action equivalent to cholesteryramine given at 12 g/day. The results of this study suggest that effective reduction of plasma cholesterol may be achieved with significantly lower doses of bile acid sequestrants.

[Hemoperfusion through adsorbents as a method of preoperative preparation of patients with severe form of mechanical jaundice]

The method of haemoperfusion through the ion exchange resin and active carbon was used 15 times in 13 patients with heavy forms of mechanical subhepatogenous jaundice. The haemoperfusion was used as a method of preoperative preparation for reduction of hyperbilirubinemia and cholemic intoxication and for prevention of possible postoperative complications. One patient recovered. One patient died of progressing hepatic insufficiency. The rest of the patients were subjected to surgical interventions for the main disease.

Quantitation of response to therapy in calcium urolithiasis

The physico-chemical basis for the action of various drugs in calcium nephrolithiasis may be described in terms of changes produced in the urinary state of saturation (APR), limit of metastability (FPR), or in crystal growth. The validation of this scheme for drug action requires further correlation of objective responses to drug therapy, described in terms of urinary crystallisation, with the clinical response.

Clinical pharmacology of sodium cellulose phosphate

The safety and effectiveness of sodium cellulose phosphate (SCP) in the treatment of calcium urolithiasis of absorptive hypercalciuria was explored. Eighteen patients with absorptive hypercalciuria with intestinal hyperabsorption of calcium, normal or suppressed parathyroid function, and active stone disease received 10 to 15 Gm SCP daily (2.5 to 5 Gm with meals) and 2 to 3 Gm magnesium gluconate daily (1 to 1.5 Gm twice daily orally separately from SCP) for eight to 54 months, while maintained on a moderate calcium and oxalate restriction. During treatment, serum calcium, immunoreactive parathyroid hormone, and urinary cyclic AMP remained within the normal range. Serum alkaline phosphatase and bone density (measured by photon absorptiometry) did not change significantly or remained within normal limits. Serum concentrations of magnesium, copper, zinc, and iron and blood hematocrit were not significantly altered by therapy. However, urinary calcium returned toward normal, and incidence of renal stone formation markedly decreased. The results suggest that SCP is a safe and an effective drug for absorptive hypercalciuria.

Use of an AR-1 resin column to reduce bilirubin-level in modified ascitic fluid

Intractable ascites has been accompanied by significant jaundice in some patients. In such cases, a newly developed synthetic resin, AR-1, has been successfully employed to reduce excess bilirubin from the ascitic fluid. This resin has proved to be excellent compared with XAD-2, XAD-7 and activated charcoal, for removal of bilirubin from the plasma and ascitic fluid in our experiments. A column containing 100 ml of AR-1 is inserted in the drip infusion line between the modified ascitic fluid reservoir in the Autoascit device and the patient. This method has been used in 7 cases of intractable ascites associated with advanced gastric, pancreatic, hepatic, rectal and ovarian cancers. The column has sufficient capacity to adsorb excess bilirubin from the modified ascitic fluid. Other biochemical parameters were eseentially unchanged from pre-column values.

Calcium oxalate stone disease: effects and side effects of cellulose phosphate and succinate in long-term treatment of absorptive hypercalciuria or hyperoxaluria

Absorptive hypercalciuria was treated in 27 patients with cellulose phosphate. In all patients urinary calcium decreased and stone formation virtually ceased. The most striking side effect was an excessive hyperoxaluria, necessitating withdrawal of the drug in 8 patients. Succinate decreased the hyperoxaluria in 14 of 19 patients. All patients had mild hypercalciuria and hypermagnesiuria. This study was done to determine the therapeutic value and the side effects in the treatment of absorptive hypercalciuria with sodium cellulose phosphate and of hyperoxaluria with succinate.

Abnormal low density lipoproteins in children with familial hypercholesterolemia--effect of polyanion exchange resins

In 20 children and adolescents with familial Type II a hyperlipoproteinemia, serum lipids and lipoproteins were examined before and during treatment with polyanion exchange resins. The composition of LDL was compared to that of helthy siblings. The patients were given Colestyramine (0.6 g/kg body weight) and Colestipol (0.5 g/kg body weight) in a cross-over study for 8 weeks each, after they had been under dietary treatment for at least 12 months. In 6 children, drug treatment had to be stopped due to side-effects. The most common complaints were gastrointestinal discomfort and constipation. Cholesterol, triglycerides and phopholipids were measured in whole serum and cholesterol, triglycerides and Apolipoprotein-B in isolated lipoprotein fractions after ultracentrifugation. Apo-B was determined by radial immunodiffusion. The Apo-B: cholesterol ratio in whole serum and in the LDL fraction was identical in the patients and in the controls. The LDL triglyceride: Apo-B ratio, however, was about 50% lower in the patients. This abnormal LDL composition was not altered by therapy with polyanion exchange resins. HDL cholesterol levels were significantly lower in the patients than in healthy children, and remained low during therapy. The decrease of total and LDL cholesterol (25%) and Apo-B (20%) was similar under both Colestipol and Colestyramine. Triglycerides and phospholipids showed no significant changes in therapy.

[Prevention of urinary calculi with covalitin and by general measures]

The prophylaxis of the urinary lithiasis by means of drugs (alkalinisants, Eisemberg's syrup, allopurinol, etc.) obtains a very good result against uric acid and urate stones. The prevention of stones of oxalates, phosphates, carbonates, etc. is possible by trichlormethiazide (if hypercalciuria is present) and especially by a new drug, the Covalitin. Naturally diet and hydrotherapy. Decalogue for the stone's prophylaxis is done.