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  • 1
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    German Medical Science; Düsseldorf, Köln
    In:  51. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie; 20060910-20060914; Leipzig; DOC06gmds257 /20060901/
    Publication Date: 2006-09-25
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    ISSN: 1365-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To study the immunoreactivity genes in a heterogeneous human population needs a large number of individuals. Associations between HLA antigens and immunoresponse to viral or bacterial antigens have been studied with controversial results. As a homogeneous population, the MHC class I, II and III allele distribution was studied in 153 end-stage renal disease patients (ESRD, average duration of renal replacement: 8.2+5.1 years) immunized with a recombinant hepatitis B vaccine in accordance to the standard vaccination schedule. Thirty-four patients with an antibody titre of less than 10 U/l following the last booster injection were considered as non-responders while 119 patients with antibody titre equal to or more than 10 U/l were considered as responders. The responder group was divided into two subgroups: low responders (antibody titre: 〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03009475:SJI60:les" location="les.gif"/〉 1000 U/l) and high responders (antibody titre: 〉 1000 U/ 1). Marked differences were observed between responders and non-responders in the occurrence of carriers of different MHC class I, II and III alleles. Homozygotes for HLA—A1, HLA—B8, HLA—DR3 and HLA—DQ2 were found almost exclusively in the non-responder group and significantly more heterozygotes for these alleles were found in the non-responder group compared to the responders. Similar albeit less marked differences were found in the frequency of some MHC class III alleles (C4A*6, C4A*QO, Bf*F, BPS0.7). Within the responder group, carriers of HLA—A2, HLA—B7 and HLA—DR4 were found to be clustered in the low responder sub-group whereas carriers of HLA—A1, HLA—B27, HLA—Cw2, C4A*6 and Bf*F were observed more frequently in the group of high responders. Similar differences were found with extended haplotypes as well. For example, the extended haplotypes HLA—Al, B8, BfS, C4AQO, C4B1, DR3, DQ2 and HLA—A1, B8, BfF, C4A6, C4B2, DR3, DQ2 were present in nine of 34 cases of non-responders but only in one of 119 case of responders (P 〈0.000001). These observations indicate that the presence or absence of certain MHC alleles even in heterozygous form determine the responsiveness to hepatitis B vaccination in end-stage renal disease patients, and among responders, the intensity of antibody response is also markedly influence by immunogenetic factors.
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  • 3
    ISSN: 1432-1440
    Keywords: Human recombinant erythropoietin (rHuEPO) ; Adrenoceptors ; Anemia, renal ; Hypertension, arterial ; Catecholamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nine patients on maintenance hemodialysis and transfusion-demanding renal anemia (group A) were treated with rHuEPO 120 IU/kg i.v. three times per week. Hemoglobin-content was raised from 7.2±0.9 to 10.4±0.8 g/dl. In all patients blood pressure rose, three patients developed arterial hypertension. Mean diastoloic blood pressure was 66±12 and 78±16 mmHg (p〈0.001) before and after rHuEPO. Rise in blood pressure was accompanied by a significant fall in plasma-noradrenaline-levels (from 498±100 to 383±75 pg/ml;p〈0.05) and alpha2-adrenoceptor-density (from 574±76 to 384±49;p〈0.05). Compared to nine patients on maintenance hemodialysis and hematocrit over 30% (group B), patients with severe renal anemia (group A before treatment) had higher densities of alpha2-adrenoceptors (574±76 vs. 218±32;p〈0.001) despite higher plasma-noradrenaline-levels (498±100 vs. 399±63; n.s.). We suppose a anemia-related disturbance of alpha2-receptor-function with the result of abolished receptor down-regulation and impaired vascular reagibility to vasoconstricting stimuli. With the correction of anemia receptor-function improves, receptor down-regulation as well as vascular reagibility is re-established resulting in augmented vascular resistance and higher blood pressure.
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  • 4
    ISSN: 1432-1440
    Keywords: Herbizide ; Paraquat ; Vergiftung ; Hämoperfusion ; Herbicides ; Paraquat ; Intoxication ; Hemoperfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary “Continuous hemoperfusion” (8 h/day for 2–3 weeks) was performed in two patients suffering from severe paraquat intoxication. On account of paraquat plasma concentrations a fatal outcome due to pulmonary fibrosis would have been expected in both cases. However, both patients survived following “continuous hemoperfusion” therapy. Coated activated charcoal seems to have a higher affinity for paraquat than lung tissue.
    Notes: Zusammenfassung „Kontinuierliche Hämoperfusion“ (ca. 8 h täglich während 2–3 Wochen) wurde wegen Paraquatvergiftung an zwei Patienten durchgeführt, bei denen aufgrund der Höhe der Paraquat-Plasma-Spiegel mit der Entwicklung einer letalen Lungenfibrose gerechnet werden mußte. Beide Patienten konnten durch diese Maßnahme der „Kontinuierlichen Hämoperfusion“ gerettet werden. Beschichtete Aktivkohle scheint eine größere Affinität für Paraquat zu haben als die Lungen.
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  • 5
    ISSN: 1432-1440
    Keywords: Uremic autonomic neuropathy ; Baroreflex ; Efferent sympathetic limb ; Circulatory regulation ; Urämische autonome Neuropathie ; Baroreflex ; Sympathicus ; Kreislaufregulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die urämische autonome Neuropathie führt zu Störungen der Funktion des Baroreflexes. Aus der Literatur geht hervor, daß die wesentlichen Defekte den afferenten Reflexbogen sowie den efferenten cardialen Vagus betreffen, während die sympathische Funktion des efferenten Schenkels intakt bleibt. Eigene Befunde, an chronischen Hämodialysepatienten während Orthostase und Volumenentzug erhoben, belegen ebenfalls eine qualitativ und quantitativ adäquate Antwort des efferenten Sympathicus sowie eine erhaltene Ansprechbarkeit der Rezeptoren des Endorgans. Die autonome Neuropathie disponiert zur symptomatischen Hypotension bei Volumenentzug während der Dialysebehandlung. Zusätzlich führt die Hämodialysebehandlung selbst zu einer noch ungeklärten Hemmung der sympathischen Reaktion auf Volumenentzug. Die autonome Neuropathie disponiert bei Volumenbelastung zur arteriellen Hypertonie.
    Notes: Summary Uremic autonomic neuropathy leads to impaired function of the baroreflex. The main defect, according to literature, is located in the afferent limb of the reflex arc and in the efferent cardiac vagus nerve, whereas the sympathetic part of the efferent arc is still intact. Own results, obtained in hemodialysis patients during orthostasis and volume removal induced sympathetic stimulation, showed a qualitatively and quantitatively adequate sympathetic response and also an adequate end organ receptor response. Autonomic nervous neuropathy predisposes to volume removal related symptomatic hypotension during hemodialysis treatment. In addition hemodialysis treatment per se induces a so far unexplained interference with sympathetic response to volume removal. The autonomic neuropathy also predisposes to development of hypertension in response to volume load.
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  • 6
    ISSN: 1432-1440
    Keywords: Hyperlipidaemia ; Cholesterol ; Triglycerides ; Uraemia ; Regular haemodialysis treatment ; Bezafibrate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Hyperlipidaemia may contribute to the high rate of cardiovascular complications in patients on chronic haemodialysis (CHD). However, possibilities of lipid lowering therapy in CHD are still limited. The applicability of bezafibrate (BF), a recently developed clofibrate analogue, was investigated in patients on CHD with triglyceride and/or total cholesterol levels above 300 mg/dl. The lipid lowering effect was studied in a placebo-controlled trial over 6 months in 19 patients. Long-term effect was followed in six patients over a mean period of 29 months. Elimination half-life and mean therapeutic serum concentration were calculated by 72-h BF serum profiles, obtained after the first drug administration of a single 200-mg dose and during steady state after 12 weeks of treatment. Elimination half-lives were 17 h at start and 22 h after 12 weeks compared with 2 h in subjects with normal renal function. Dose reduction to 200 mg every 3rd day was necessary and resulted in a mean therapeutic serum concentration of 3.4 mg/l, which was similar to 3.0 mg/l of normal subjects, who received the dose optimal for lowering of lipids (200 mg 3 × /day). The protein-bound serum fraction of BF was decreased to 8% in CHD patients, compared with 95% found in normal subjects. BF therapy resulted in a marked reduction of serum triglycerides from 478 mg/dl by 31% and total cholesterol levels from 311 mg/dl by 19% as well as β-Lp-cholesterol from 178 mg/dl by 17%, whereas the initially low α-Lp-cholesterol increased significantly from 18,3 mg/dl by 58%. Under long-term therapy not only continuously low triglyceride and cholesterol levels could be maintained, moreover a further decline (−20% and −7%) could be achieved. Safety laboratory controls, comprising haemoglobin, bilirubin, liver enzymes, CK and albumin, showed no significant changes apart from a slight reversible increase in CK and a decrease in gamma-GT and alkaline phosphatase. Subjective side effects were not reported. Under this dosage schedule, BF therapy was thus effective and safe, improving potentially atherogenic disturbances of lipid metabolism.
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  • 7
    ISSN: 1432-1424
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology
    Notes: Summary The transport theory of Kedem and Katchalsky which was derived for passive transport in a two-compartment system is generalized for a multicomponent system with active transport, so that it can be applied to more complicated biological membranes. Equations have been derived to describe the transport of urea through the proximal convolution of the rat kidney and the permeability and the reflection coefficient have been determined. The permeability coefficient $$(\tilde P_u )$$ measured with the microperfusion and stop flow microperfusion methods, was found to be 6.0 and 5.2×10−5 mm2/sec, respectively. The reflection coefficient (σ) was determined in a stationary state situation and found to be 0.68. Earlier free flow micropuncture results together with theP u andσ u of this study indicate that 50% of the filtered urea is reabsorbed proximally and that approximately half of this amount is reabsorbed by solvent drag and the rest by diffusion. In the Appendix, a theoretical treatment of nonelectrolyte transport in a multicomponent system with active transport is given.
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  • 8
    ISSN: 1432-2013
    Keywords: Countercurrent System ; CO2-Pressure ; Bicarbonate ; Carbonic Anhydrase ; Micro-pH-Electrode ; Gegenstromsystem im Nierenmark ; $$P_{{\text{CO}}_{\text{2}} }$$ ; Bicarbonat ; Kohlensäureanhydratase ; Mikro-pH-Elektrode
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1432-2013
    Keywords: Micropuncture ; Functional Isolated Collecting Ducts ; Sodium Transport ; Sodium Permeability ; Aldosterone ; Mikropunktion ; funktionell isoliertes Sammelrohr ; Natriumtransport ; Natriumpermeabilität ; Aldosteron
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Durch Mikropunktion und -perfusion der Vasa recta an der freigelegten Nierenpapille von Wistarratten wurde es möglich, die schwankenden Harnstoff- und Natriumkonzentrationen im Interstitium des Nierenmarks zu beseitigen und definierte Versuchsbedingungen für die Sammelrohre zu schaffen. An diesen „funktionell” isolierten Sammelrohrabschnitten wurdenin situ sowohl die Gleichgewichtskonzentrationsdifferenz bei fehlendem Nettosubstanz-und -volumenfluß (ΔC Na) als auch der Nettonatriumtransport (Φ Na) bei gleicher Natriumkonzentration auf beiden Seiten der Sammelrohrwand gemessen. Es konnte gezeigt werden, daß unter diesen Versuchsbedingungen, bei denen die Tiere in Antidiurese sind, die Natriumrückresorption aus den Sammelrohren isoton abläuft. Die Versuche wurden an vier Tiergruppen durchgeführt: an adrenalektomierten Tieren, an normal ernährten Tieren, an salzarm ernährten Tieren und an normal ernährten Tieren, die zusätzlich Aldosteron bekamen. Φ Na iso war bei adrenalektomierten Tieren 1,2·10−5 bei normal ernährten Tieren 3,1·10−5, bei salzarm ernährten Tieren 4,1·10−5 und bei normal ernährten Tieren unter Aldosteronsubstitution 4,2·10−5 μÄq·mm−2·sec−1. Die entsprechenden ΔC Na werte waren 4, 31, 98, 93 mÄq/l. Unter der Annahme, daßΦ Na iso die Transportkapazität des Systems angibt und daß ΔC Na bei gegebenemΦ Na iso umgekehrt proportional der Leckpermeabilität für Natriumionen ist, kann man aus den vorliegenden Daten schließen, daß Aldosteron am Sammelrohr nicht nur die innere Transportkapazität für Na erhöht, sondern auch die Leckpermeabilität für Na herabsetzt.
    Notes: Summary Micropuncture and -perfusion were performed on vasa recta of the exposed renal papilla in Wistar rats in order to abolish uncontrollable changes of sodium and urea concentration within the medullary interstitium. Thereby the collecting tubules could be studied under well defined experimental conditions. The transport of sodium in the absence of a transtubular concentration difference (Φ Na) as well as differences in steady state concentration of sodium (ΔC Na) at zero net flux of water and solutes were measuredin situ in these functionally isolated collecting ducts. Four groups of animals were studied: adrenalectomized rats, control rats on a normal diet, rats on low sodium diet and normally fed rats with additional aldosterone administration. The respectiveΦ Na were 1.2, 3.1, 4.1 and 4.2·10−5 μeq×mm−2×sec−1, while ΔC Na were 4, 31, 98 and 93 meq/l. One may assume thatΦ Na iso is a measure of the transport capacity of the system and that ΔC Na at a givenΦ Na iso is inversely proportional the leak permeability. Under these conditions our data suggest, that aldosterone causes an increase of intrinsic transport capacity and at the same time a decrease of leak permeability for sodium ions.
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  • 10
    ISSN: 1432-2013
    Keywords: Nephron ; Sodium Transport ; Calcium Ions ; Antidiuretic Hormone ; Nierentubuli ; Natriumtransport ; Calciumionen ; Antidiuretisches Hormon
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An proximalen Tubuli und medullären Sammelrohren von Ratten wurde der isotone Natriumtransport ΆNa iso und die Gleichgewichtskonzentrationsdifferenz Δc Na bei Nettosubstanzfluß und Nettovolumenfluß Null gemessen. Die peritubulären Capillaren waren bei diesen Messungen künstlich durchströmt, und zwar in der ersten Serie mit einer Calcium-freien Lösung bzw. einer Lösung, die 3 mÄq Ca++/l enthielt, in einer zweiten Serie mit einer Lösung, die kein ADH bzw. 5 mE/l ADH enthielt. Zugabe von ADH oder Weglassen von Calcium aus dem Perfusat hatten keinen Einfluß auf den isotonen Natriumtransport. Die Natrium-Gleichgewichtskonzentration bei Nettosubstanzfluß Null war jedoch stark erniedrigt. Die Befunde sprechen dafür, daß bei Fehlen von Calcium oder Zugabe von ADH die Permeabilität für Natriumionen erhöht ist, daß aber im Gegensatz zum Verhalten von Amphibienhäuten der aktive Natriumtransport unbeeinflußt bleibt.
    Notes: Summary Isotonic sodium transport, ΆNa iso, and the transtubular concentration difference, Δc Na, at equilibrium under conditions of zero net solvent and solute fluxes were measured in the proximal tubules and medullary collecting ducts of rats. Peritubular capillaries were simultaneously perfused, in the first group of experiments with a solution containing no Ca++ or 3 mEq/l of Ca++, and in the second group with a solution which contained either no ADH or 5 mU/l of ADH. Addition of ADH or omission of Ca++ from the capillary perfusate did not affect isotonic sodium transport. The equilibrium concentration difference of sodium, Δc Na, was, however, greatly reduced under the same conditions. The results indicate that in the absence of Ca++, or in the presence of ADH, the permeability for sodium is increased, but that in contradistinction to the behaviour of amphibian skins, active sodium transport remains unaffected.
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