A retrospective survey of anaphylactoid reactions during dialysis in France was conducted. In 52 of 112 hemodialysis units surveyed 111 patients who had suffered one or more anaphylactoid reactions during dialysis were identified. According to the Hamilton/Adkinson classification, in 31 patients reactions were minor, in 54 patients moderate, and in 26 patients severe. Four patients died of their reactions. A preponderance of reactions (75 and 11%) occurred with cuprammonium cellulose hollow-fiber and plate dialyzers, respectively. Severe dialyzer reactions were found to occur more frequently after the long (weekend) interdialytic interval. In an in vitro study, six brands of cuprammonium cellulose hollow-fiber dialyzers were rinsed with water and the eluates analyzed by size exclusion chromatography for contaminant particles. Substantial variation in the amount of extractable material was found between dialyzers of different brands, despite the fact that all dialyzers used membranes from the same manufacturer. Previous data by others has suggested that this extractable material is a derivative of cellulose. Results of our epidemiologic survey in France are similar to those previously reported in the United States and suggest an increased incidence of dialyzer reactions with ethylene oxide-sterilized cuprammonium cellulose dialyzers. The presence of cellulose-derived particles in the rinsing fluid of such dialyzers and the possible increased incidence of reactions after the long (weekend) interdialytic interval suggest that allergy to cellulose-derived particles eluted from cellulosic dialyzers may contribute to dialyzer hypersensitivity reactions.
Systolic, diastolic BP and heart rate were measured in 106 boys aged between 11 and 16 years old, at rest and during exercise on a bicycle ergometer. The results show: -- at rest: an increase in systolic and diastolic BP with age, and a decrease in heart rate; -- during exercise: an increase in systolic BP without an increase, or with a decrease in diastolic BP. The blood pressure readings were higher in overweight and post pubertal subjects. The value of this study lies in the high number of reproducible readings obtained and in the suppression of the effects of emotivity. It completes the observations made at rest in subjects suspected of having hypertension.
Enoxaparine is a low-molecular-weight-heparin obtained by partial and controlled depolymerization of a heparin of mucosal hog origin. We aimed at the evaluation of the efficacity of a unique injection of Enoxaparine in the prevention of blood clotting in the dialysis circuit in 42 patients with chronic renal failure. Three doses were tested : 0.75, 1.00, 1.25 mg/kg body weight in an open study with a crossing over of the three doses which were randomized according to a latin square design with a one week interval between each dose. None of the dialysis were impaired with clotting of the circuit and never an additional administration of anticoagulant was required in order to achieve the dialysis. Antithrombotic effectiveness was assessed by the quality of arterial and venous lines restitution and by visual inspection of the bubbles trap. No hemorrhagic event occurred. APTT didn’t show residual hypocoagulability at the end of dialysis. Anti-Xa and anti-IIa activities 4 hours after administration were : Anti-Xa and anti-IIa activities exhibited a linear dose level relationship. Efficiency and tolerance were excellent for the three doses. Enoxaparine (LOVENOXR) PHARMUKA S.F.
HLA profile was determined in 121 caucasoid children with rheumatoid purpura: out of those 55 developed nephropathy, of variable severity. HLA A and B were studied in all children, DR in 87. HLA BW 35 was more frequently found in total group of rheumatoid purpura (28,9%) and especially in nephropathies: 38,2% vs 20,4% in controls. However the increase is not significative even in nephropathy. On the other hand BW 35-DR 4 association is significatively higher in rheumatoid purpura with or without nephropathy than in controls. Analysis of 3 families with 2 affected sibs and 7 families with 1 affected child does not show any linkage with HLA. Determination of HLA profile does not allow to predict that the disease will be complicated by a nephropathy.
