Search

Pyridostigmine was first used extensively during Operation Desert Storm for prophylaxis against the effects of nerve agents. After initial reports of asthma exacerbations following its use, we gave 10 asthmatic and 6 non-asthmatic soldiers a 30-mg dose of pyridostigmine. We found no changes in forced vital capacity in any of the soldiers, but observed exacerbation of asthma symptoms in seven of the asthmatics. Severity of the exacerbation correlated best with severity of asthma in the desert and inversely with body weight. The irritant effect of the dust may predispose asthmatics to worsen after pyridostigmine, an effect not seen in the laboratory.

To examine the effect of membrane characteristics on radiocontrast mass transfer, we studied in vitro clearances with cuprophane and polyacrylonitrile (PAN) dialyzers and with polysulfone hemofilter. A perfusate of saline at 37 degrees C, with 7.5 mmol/l (45 mg/dl) of urea and either Renografin (molecular weight 723) or Hexabrix (1405), was pumped through the blood path of dialyzers at 200 ml/min for 5 min. Each radiocontrast agent (RCA) and dialyzer was tested at 0, 150, and 250 or 300 mm Hg transmembrane pressure. In experiments with the use of hemofilter, clearances were tested at the perfusate flow of 50, 100 and 150 ml/min. RCAs were measured by fluorescent excitation analysis of iodine. Mean urea clearance was 16% higher in PAN than in cuprophane dialyzers. Clearance of RCAs was 1.5-3 times higher in PAN than cuprophane dialysers. With the latter, increases in transmembrane pressure resulted in a small amount of ultrafiltration (UF) and little increment in RCA clearance. With the former, increases in transmembrane pressure resulted in massive UF and remarkable increases in RCA clearance. Renografin clearance generally exceeded that of Hexabrix, which we attributed to Renografin's lower molecular weight. With the hemofilter, sieving coefficients were approximately 0.8 for each RCA. Yet, because of the lack of diffusive transport and a small surface area even at the highest perfusate flow rates, RCA clearance by the hemofilter was 20-50% less than that of cuprophane dialyzers. We conclude that PAN dialyzers are more efficient for RCA removal than cuprophane dialyzers or polysulfone hemofilters.

Although previously reported in the literature, the existence of chemical peritonitis due to vancomycin in patients on peritoneal dialysis remains controversial. We report four similar episodes of sterile peritonitis in three patients receiving intraperitoneal (IP) vancomycin. The prior report implicated a change in the brand of vancomycin preparation, from Vancocin to Vancoled, as a contributing factor. We noted the occurrence of such episodes following a switch from Vancocin to a generic preparation from Abbott Laboratories. High-performance liquid chromatographic (HPLC) profiles of the three preparations show Vancocin to have a lower level of impurities than the other two; the presence of certain contaminants in the other brands may be contributing to the clinical difference observed. We conclude that chemical peritonitis due to IP vancomycin administration does occur, and that increased awareness of this entity could allow other cases to be identified.

From 1980 to 1985, we performed biopsies on 87 adults with nephrotic syndrome (NS). The patients were tested for whether serologic studies obtained routinely at biopsy added to clinical diagnostic accuracy. Using history, physical examination, complete blood cell count (CBC), chemistry panel, urinalysis, and urine creatinine and protein, four nephrologists each predicted whether the patient had primary NS (PNS) or secondary NS (SNS), and the most likely histopathologic entity. Six months later, each nephrologist used this information, with results of tests of sera for fluorescent antinuclear antibody (FANA), rheumatoid factor (RF), complement components, hepatitis B surface antigen (HBsAg), venereal disease research laboratory serology (VDRI), cryoglobulins and protein electrophoresis (SPEP), with an erythrocyte sedimentation rate (ESR) and protein electrophoresis of the urine (UPEP), to make identical predictions. Histopathology was established by renal biopsy. We analyzed the concordance between nephrologists' choices and biopsy results both before and after serologic tests were available with a kappa statistic. Preserology concordance was moderate (kappa = 0.52), and identical to postserology concordance (kappa = 0.51) for both PNS versus SNS and actual histopathology. Serologies were rarely abnormal without clinical suspicion. These results suggest routine serologic testing does not improve diagnostic accuracy in adult NS.

The authors analyzed data from 106 adults with chronic renal failure [(CRF), serum creatinine (Scr) greater than 132.6 mumol/l (1.5 mg/dl)], to define the precision of, and effects of covariables on, the relationship between anemia and CRF. We excluded dialyzed or patients who had received transplants and those with obvious potential nonrenal causes of anemia. Hct was a linear function of BUN and Scr (r = -0.48, and r = -0.67, respectively), and a curvilinear function of creatinine clearance (r = 0.68), all p less than .0001. Confidence interval analysis revealed a +/- 10 volume percent variation in Hct at any level of renal function. Sex was the only covariable that affected Hct independently of CRF. This study suggests that CRF may have a different effect on Hct in males and females and indicates that the range of Hct possible at a given level of CRF precludes attributing anemia to CRF with assurance.

Intraperitoneal cisplatin has been used for localized tumor control to attain high intraperitoneal concentrations while minimizing systemic toxicity. We report on a woman who developed permanent renal failure following a single intraperitoneal dose of cisplatin. Probable factors contributing to this toxicity were mild renal insufficiency from prior intravenous cisplatin and failure to maintain brisk diuresis in the face of volume depletion due to severe vomiting. Although intraperitoneal cisplatin results in high intraperitoneal drug levels, serum levels similar to those seen with intravenous therapy may contribute to severe nephrotoxicity.

Various indwelling venous catheters have been used in hemodialysis patients after failure of traditional angioaccess. Thrombosis of the subclavian vein occurs with these cannulae and is usually asymptomatic. Such thromboses rarely cause significant pulmonary embolism. We describe a thrombus in the inferior vena cava due to an indwelling hemodialysis catheter, a site with potential for fatal pulmonary embolism.