Aluminium sucrose biscuit fillings to control hyperphosphataemia in patients undergoing dialysis

Aluminium hydroxide is used to prevent hyperphosphataemia in patients undergoing dialysis, but many standard preparations are unpalatable. In this study hydrated aluminium sucrose was suspended in synthetic cream and used as a biscuit filling. Six patients undergoing dialysis took part in five five-week study periods comparing different forms of treatment. No significant difference was found between serum phosphate concentrations measured during standard treatment and those measured during treatment with aluminium sucrose biscuits. There was no significant difference in serum phosphate concentrations when the patients were given placebo biscuits and when they received no treatment. Aluminium sucrose presented in this form was an adequate phosphate binder and was acceptable to the patients.

[Profilographic studies with 99mTc-pertechnetate in joint diseases in children]

The inflammatory activity of joints can be stated after intravenous administration of 99mTc-pertechnetate by demonstration of an enrichment of isotope. In 85 out of 111 patients (77%) a good accordance between profilogram and clinical finding could be seen. "False positive" results could be found in juvenile rheumatoid arthritis, ulcerative colitis, reactive arthritis and juvenile gout. In some cases of juvenile rheumatoid arthritis the clinical finding is later obvious than the demonstration by nuclear medicine. "False negative" results mainly can be seen at the wrists of patients with juvenile rheumatoid arthritis and tendosynovitis as well as in already existing radiological changes of the bones. Differential diagnostical evidences of profilography cannot be expected with the investigation technique used here. It, however, may contribute to assure the diagnosis in non-inflammatory joint diseases ("psychogenic rheumatism", lymphatic oedema).

Acute interstitial nephritis complicating Legionnaires' Disease

An acute interstitial nephritis was found in a patient with sudden renal failure and lung infection caused by Legionella pneumophilia. Our patient regained and maintained normal renal function after a short period of dialysis support. The diagnosis should be considered in any patient with a chest infection complicated by acute renal failure especially if confusion is disproportionate to the degree of uremia.

Acute nephrotic syndrome with reversible renal failure after phenylbutazone

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Comparison of the chronic effects of bendrofluazide, bumetanide and frusemide on plasma biochemical variables

Eleven plasma variables have been studied in 18 elderly patients with cardiac oedema treated with bendrofluazide, frusemide and bumetanide, using a fully balanced, cross-over trial design. Bumetanide caused the least disturbance of plasma potassium and bendrofluazide the greatest. Frusemide produced an intermediate effect. The difference between the changes in plasma potassium produced by bumetanide and bendrofluazide was significant (P less than 0.02).

Chronic granulocytic leukaemia in a patient with chronic renal failure on dialysis

A diagnosis of chronic granulocytic leukaemia was made in a man who had been haemodialysed for three years. The association between leukaemia and chronic renal failure is rare.

[Clearance determination with 131I-labelled hippurate (author's transl)]

The effect of the iodine not bound to the nuclear drug 131I hippurate on nuclear medical renal diagnosis by means of whole body clearance has been investigated. The results show that whatever clearance method is used, the tubular secretion performance decreases with increasing free iodine. This results in considerable error if the free iodine in the nuclear drug is not taken into account in the clearance calculation.

Removal of metronidazole by haemodialysis

The removal of the anti-anaerobic antibiotic metronidazole has been studied in oliguric patients. The drug and its principal metabolite are rapidly removed by haemodialysis so that the plasma concentration quickly falls below the therapeutic range. Hence a further dose of metronidazole would be needed after dialysis to restore an adequate plasma concentration.

Candida utilis as a convenient and safe substitute for the pathogenic yeast C. albicans in Daniels' phototoxicity test

Candida utilis is a safe and convenient substitute for the pathogenic yeast C. albicans in phototoxicity tests. With both organisms 8-methoxypsoralen and a-terthienyl give positive results while photodynamic compounds give negative results.

Raynaud's phenomenon in hypertensive dialysis patients taking a sustained-release propranolol formulation

Five dialysis patients with residual hypertension were treated with a new sustained-release formulation of propranolol (160 mg per capsule) in a dosage of 1 to 2 capsules per day. Four of these patients developed persistent cold, numb, blue and clumsy fingers. The symptoms resolved when the drug was withdrawn.

Poor hypotensive response and tachyphylaxis following intravenous labetalol

Three renal patients with transplant kidneys and uncontrolled hypertension were treated with intravenous doses of labetalol. Only minor depressor effects were noted and tachyphylaxis developed in 1 patient. Other parenteral hypotensive agents reduced blood pressure satisfactorily.

Reversible hypertension and hyperreninaemia after accidental ureteric ligation

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Prognostic considerations in the management of left ventricular aneurysms

This report summarizes a four-year experience with 60 patients who had left ventricular aneurysm (LVA) resection and bypass of all significantly diseased coronary arteries, with an operative and late mortality of 3.3 and 8.3%, respectively. Their cardiac catheterizations were reviewed, and the only values that seemed to reflect prognosis were preoperative cardiac index and the presence of absence of septal motion. The lower the cardiac index, the less likely the patient was to do well postoperatively. There were now survivors who had lacked septal motion by left anterior oblique ventriculogram. Patients without septal motion are therefore no longer considered surgical candidates. If septal motion is present, resection of LVA carries no more risk than myocardial revascularization without LVA.

Increased incidence of malignancy in chronic renal failure

We have analysed the causes of death in a group of patients with chronic renal failure--serum creatinine more that 225 mumol/l (2.5 mg/100 ml)--and find that there is an increased incidence of malignancy when compared with the fatality rates for cancers in England and Wales (p less than 0.0005). No patient in the series had received a transplant kidney or was therapeutically immunosuppressed for other reasons.

Experience with internal mammary artery grafts in 298 patients

The internal mammary artery (IMA) was used as a graft in 298 patients undergoing coronary bypass procedures. Two patients died during the operative period and 2 others died one year later. Most of the survivors are free of angina. Of the IMAs restudied 9 to 24 months postoperatively, 95% were patent. This group included nearly all the patients having angina after operation. There are some situations in which the IMA may have inadequate flow in comparison to the vein graft. These results suggest the IMA is an excellent graft in most coronary bypass procedures.

Control of hypertension with single daily doses of sotalol hydrochloride

A study was carried out in 12 previously untreated hypertensive patients to assess the efficacy of sotalol given in a once-daily dosage regimen. After an initial dosage titration period (mean 3 weeks) during which diastolic pressure was stabilized at less than 100 mmHg, all patients were satisfactorily maintained on a constant once-daily dose of sotalol for 3 months. Eight of the 12 patients required 320 mg or less daily (mean dose 190 mg). Whilst blood pressure remained controlled for at least 26 hours after daily doses the pulse rate, counted at the same time, showed escape from beta-blockade. Side-effects (vivid dreams) were reported in only 1 patient.

Virus infections and acute renal transplant rejection

The date of onset of 360 acute renal transplant rejection episodes from 1969 to 1973 have been compared with the prevalence of various common viral infections and infections due to Mycoplasma pnuemoniae. A positive correlation was found for influenza B infections (r=0.43, p less than 0.01) up to 5 months before transplantation and for adenovirus infections (r=0.32, p less than 0.05) at 1 month before kidney grafting.