[Experience with the multiple use of dialyzers]. / Ob opyte mnogokratnogo ispol'zovaniia dializatorov.

Biocompatibility assessed by values of dialysis leukopenia, complement system activation, that of blood elements was compared in the first and second use of capillary dialyzers equipped with various membranes. In the dialyzers re-use biocompatibility improved. Electron microscopy of hollow fiber sections suggested the role of protein layer safety on the membrane surface in biocompatibility under successive employment of the dialyzers. Treatment of the latter with acetic and peracetic acids mixture proved advantageous against other methods. Clinical effect due to dialyzer re-use changed positively.

[A study of the Limulus amebocyte lysate-reactive substances flushed from cellulose hemodialysis membranes]. / Izuchenie limulius-amebolizatreaktivnykh veshchestv, vymyvaiushchikhsia iz tselliuloznykh membran.

It is shown that substances washed from cellulose hemodialysis have no pyrogenic activity, react positively in Limulus-amebolysate test used for bacterial endotoxin assay. Dialyzers are compared by the yield of washed compounds, the importance of the dialyzer sterilization method is pointed out. The influence of chemical processing in repeated usage of dialyzers on the yield of the washed from the membranes compounds and time course of their washing in long-term cleaning of dialyzers and during hemodialysis have been outlined. The compounds were found active in relation to human complement system.

[Kidney and pancreas transplantation in patients with insulin-dependent diabetes mellitus]. / Transplantatsiia pochki i podzheludochnoi zhelezy bol'nym insulinzavisimym sakharnym diabetom.

The article analyses the results of one-stage transplantation of the kidney and pancreas in three patients suffering from insulin-dependent diabetes mellitus with diabetic nephropathy in the stage of terminal renal failure which called for programmed hemodialysis. The specific features of early postoperative management of patients are described, particularly the various routes of drug administration.

[Continuous sterilization of peritoneal dialysate using ultraviolet rays]. / Protochnaia sterilizatsiia peritoneal'nogo dializata ul'tra- fioletovym oblucheniem.

A unit for continuous ultra-violet sterilization on the basis of a mercury-UV low-pressure lamp was devised and tested. It differs from the known analogs in the capacity of separating into layers of the monolithic flow of a solution and of using the entire arsenal of direct rays emitted by the source. The output is 400 ml/min. The irradiation dose exceeds 163 times the optimal one for spores. The authors provide a mathematic depiction of the unit operation. A linear relationship was established between the growth of optical density of the solution and the irradiation dose. About 100 tons of the peritoneal and replacement (for hemofiltration) solutions were sterilized and utilized.

[The mechanisms of the disorder of calcium homeostasis in terminal kidney failure and the allotransplantation of a cadaver kidney]. / Mekhanizmy narusheniia gomeostaza kal'tsiia pri terminal'noi pochechnoi nedostatochnosti i allotransplantatsii trupnoi pochki.

Overall 34 patients with terminal renal failure (TRF) and 81 recipients of the allotransplanted cadaveric kidney (ACK) were examined. It has been established in in-vitro experiments with modulated by additions of EDTA to the plasma and CaCl2 hypo- and hypercalcemia that the magnitude of bound calcium (standardized at the concentration of ionized calcium-Ca++1 mmol/l) decreased in the blood plasma in 65 and 61% of cases. Besides protein-bound calcium dropped in 94 and 91% of cases; the total buffer capacity of the plasma and buffer capacity of proteins fell in 59 and 87% of cases in TRF and ACK, respectively. The rise of the Ca++ content on an empty stomach seen in 21 out of 99 patients with TRF and in 42 out of 98 recipients of the ACK was caused by a decrease of calcium binding in the blood plasma, not made for by the fall of calcium supply to the blood because of "tertiary" hyperparathyroidism. Hypocalcemia detected in 38% of TRF patients was consequence to the rise of calcium binding not made for by the increased calcium supply to the blood provoked by bone resistance to parathyroid hormone.

[Use of the equipment for hemodialysis in the diagnosis of calcium metabolism disorders in terminal chronic renal failure]. / Ispol'zovanie apparatury dlia gemodializa v diagnostike narushenii obmena kal'tsiia pri terminal'noi khronicheskoi pochechnoi nedostatochnosti.

As many as 18 patients with terminal chronic renal failure were treated by program hemodialysis. The initial concentration of ionized calcium in those patients' blood plasma amounted to 1.06 +/- 0.22 mmol/l. To assess function of the systems counteracting hypocalcemia, use was made of a session of hemodialysis against calcium-free dialysate. 2/3 of the patients demonstrated satisfactory function of the homeostatic system, maintained by a high secretion of PTH and involvement into regulation processes of the extraplasmic system marked by higher buffer capacities and a large pool of metabolism-capable calcium and apparently localized in the skeleton. In 1/3 of the patients, homeostatic function turned out to be dramatically impaired, which was provoked by inhibition of the secretory capacity of the parathyroid glands and manifested clinically by low tolerance to calcium losses and osteomalacia.

[The general principles of the diagnosis of dialysis osteomalacia by the results of the histomorphometry of spongy bone]. / Obshchie printsipy diagnostiki dializnoi osteomaliatsii po rezul'tatam gistomorfometrii gubchatoi kosti.

Biopsy specimens of the bone were examined and then subjected to morphometry in 49 patients with terminal renal failure. 43 patients were on chronic hemodialysis and 6 had undergone renal transplantation. Histomorphometry permitted calculating the relative area of the bone girdles in the preparation (in %), the relative resorption area (in %), and the osteocyte count per mm2 bone girdle. It is concluded that if the area of the bone girdle in the preparation is less than 23.8%, the patient on hemodialysis may be diagnosed as having dialysis osteomalacia. The reduction of the relative reabsorption area in patients with dialysis osteomalacia is insignificant and can be used as an auxiliary sign in differential diagnosis of renal osteopathies in patients on dialysis.

[The effect of the primary and repeated use of dialyzers with different membranes on the degree of dialysis-induced leukopenia]. / Vliianie pervichogo i povtornogo ispol'zovaniia dializatorov s razlichnymi membranami na stepen' dializnoi leikopenii.

The degree of leukopenia that occurs during hemodialysis is one of the main parameters characterizing biocompatibility of the dialysis membranes. It has been demonstrated that the use of the DIP-03-02 dialyzer fitted with a membrane manufactured from Soviet polysulfone produces much less remarkable leukopenia as compared to the use of dialyzers fitted out with conventional cellulose membranes. It has also been shown that the repeated use of dialyzers brings about a decrease in leukopenia and that the method of washing off dialyzers influences the degree of leukopenia.

[Results of test-bed and clinical trials of DIP-03-02 dialyzers manufactured by the West German firm Frezenius using polysulfone hollow fibers]. / Rezul'taty stendovykh i klinicheskikh ispytanii kapilliarnykh dializatorov DIP-03-02 proizvodsta firmy "Frezenius" (FRG) na osnove polykh volokon iz polisul'fona.

The authors provide the results of the clinical trial of the dialyzers DIP-03-02 manufactured by the USSR in cooperation with the FRG (Frezenius Company). In accordance with clearances of low-, medium- and high-molecular compounds as well as with the ultrafiltration characteristics, DIP-03-02 are similar to the modern capillary dialyzers from hollow fibers on the basis of cellulose membranes with an analogous surface. During manufacture of the dialyzers DIP-03-02, the polysulfone membrane possessing low permeability for liquid was obtained for the first time. The tentative data on biocompatibility (the complement activation test) are positive.

[Algorithms and computation methods of diagnostic coefficients in dynamic scintigraphy of skeleton and skeletal muscles]. / Algoritm i metodika rascheta nekotorykh diagnosticheskikh koéffitsientov pri dinamicheskoi stsintigrafii skeleta i skeletnykh myshts.

The paper is concerned with a program for data processing of dynamic scintigraphy of the skeleton and skeletal muscles using 99mTc-sodium 1-hydroxy-ethane-1, 1-diphosphonate. Employing gamma-chamber computer the program enables rapid and precise computation of the coefficient of RP elimination from the blood and the coefficients of RP accumulation by the bones and muscle tissue. Based on those coefficients one can make diagnosis and follow the time-course of pathological changes occurring in the skeleton during endocrine diseases.

[Dynamic scintigraphy with sodium 1-hydroxy-ethane-1,1 diphosphonate for the differential diagnosis of osteomalacia in patients in the terminal stage of chronic kidney failure]. / Ispol'zovanie dinamicheskoi stsintigrafii s 1-gidroksi-étan-1,1 difosfonatom natriia dlia differentsial'noi diagnostiki osteomaliatsii u bol'nykh v terminal'noi stadii khronicheskoi pochechnoi nedostatochnosti.

A total of 28 patients were examined. Of them 17 were exposed to systematic hemodialysis, 11 examinees sustained transplantation of the kidney. Dynamic scintigraphy was performed with a computerized gamma-camera. The authors studied the kinetics of the blood discharge of Tc99m-labelled sodium 1-hydroxyethane-1,1 diphosphonate and its accumulation in the osseous tissue. In supine position of the patient a collimator could demonstrate simultaneously pelvic spines, ortal bifurcations and femoral trochanters. Immediately after the administration of the agent the recording was started: 8 frames for the first 2 min, then 38 frames for 38 min by the matrix 64 X 64. Blood REP levels were found by subtraction of the value of its activity in the projection of postero superior pelvic spine from the values in the site of the aortal bifurcation. The authors revealed that in case of osteomalacia the REP blood elimination coefficient (K1) was less than 0.1 min-1 and proposed to use it for distinguishing osteomalacia from other patterns of renal osteodystrophy. Factors that could change the amount of K1 values are discussed.

[Calcium salts retention in the skeletal muscles of patients on hemodialysis]. / O zaderzhke solei kal'tsiia v skeletnykh myshtsakh u bol'nykh, nakhodiashchikhsia na gemodialize.

Deposition of amorphous calcium salts in muscle tissue is not only of pathogenic but also of compensatory adaptive character. This occurs in response to bone exclusion from the system of regulation of calcium homeostasis (aluminum or severe uremic intoxication). Apparently, amorphous depositions of calcium salts may buffer fluctuations in ion concentration. Their accumulation is a marker of the weakening of the cellular mechanisms and enhancement of the physicochemical ones by which calcium homeostasis is maintained.

[Diagnosis of osteomalacia using dynamic scintigraphy with diphosphonate in terminal renal insufficiency]. / Diagnostika osteomaliatsii po metodu dinamicheskoi stsintigrafii s difosfonatom pri terminal'noi pochechnoi nedostatochnosti.

In the diagnosis of osteomalacia in patients with terminal renal insufficiency after the method of dynamic scintigraphy with diphosphonate major emphasis should be placed on the coefficient of RP blood elimination (C1). The disease should be diagnosed in C1 below 0.1 min.-1. A relative increase in the coefficient of cumulative RP in the bones (C2) as compared to C1 (greater than 2-fold) should be regarded an accessory sign in the diagnosis of osteomalacia.

[Differential diagnosis of osteomalacia and other forms of renal osteodystrophy in terminal renal failure by dynamic scintigraphy with diphosphonate]. / Differentsial'naia diagnostika osteomaliatsii s drugimiformami pochechnoi osteodistrofii pri terminal'noi pochechnoi nedostatochnosti metodom dinamicheskoi stsintigrafii s difosfonatom.

During osteomalacia in patients with terminal renal failure, the coefficient of diphosphonate elimination from the blood bed (K1) was less than 0.1 min-1, which was determined by the rise of the concentration of uremic toxins, inhibiting interaction of the radiopharmaceutical with the bone, in the patients' tissues. Dynamic scintigraphy permits one to study the pharmacokinetics of diphosphonate in every patient and thus can be used for differential diagnosis between osteomalacia and other forms of renal osteodystrophy.

[Radioimmunologic evaluation of the evolution and nature of hyperparathyroidism following allotransplantation of the kidney]. / Radioimmunologicheskaia otsenka évoliutsii i kharakter giperparatireoza posle allotransplantatsii pochki.

A study of the level of immunoreactive parathyrin in the peripheral blood of 81 patients after kidney allotransplantation (53 patients with satisfactory graft function and 28 patients after graft rejection) revealed hyperparathyroidism in 69.2% of the patients with satisfactory function and in 100% of the patients with chronic rejection of the kidney graft. With an increase in the postoperative period the involution of hyperparathyroidism was found only in half of the patients. In 66.1% of the patients hyperparathyroidism was of secondary nature, in 20.3%--of "tertiary" nature, and relative pseudohypoparathyroidism was observed in 13.5%.