Monitoring attentional style and medical regimen adherence in hemodialysis patients.

Previous research involving individuals facing chronic health problems suggests that an attentional style characterized by pronounced monitoring of threat-relevant information is associated with poorer behavioral and emotional adjustment. This study examined the hypothesis that a pronounced monitoring style would be associated with poorer medical regimen adherence in a sample of 51 chronic hemodialysis patients. Hierarchical regression analyses (controlling for demographic factors and trait anxiety) revealed that "high monitors" exhibited higher interdialysis weight gains and higher serum K values reflecting poorer adherence to fluid-intake and dietary restrictions. However, monitoring was not associated with a measure of medication adherence. Partial support was found for a model suggesting that a lack of perceived control is responsible for the relationship between higher monitoring and poorer adherence.

The effects of calciferol and its metabolites on patients with chronic renal failure. II. Calcitriol, 1 alpha-hydroxyvitamin D3, and 24,25-dihydroxyvitamin D3.

The available data with regard to the use of calcitriol, 1 alpha-hydroxyvitamin D3 (1 alpha-OH D3), and 24,25-dihydroxyvitamin D3 (24,25-[OH]2D3) in the management of chronic renal insufficiency are reviewed. Patients with mild to moderate osteitis fibrosa experience substantial improvement with either calcitriol or 1 alpha-OH D3 therapy. However, few patients experience a reversal to normal in histologic characteristics of bone. The conditions of patients with osteomalacia do not respond to either calcitriol or 1 alpha-OH D3 therapy. The bone lesion appearing in these patients is most likely a toxic effect of aluminum. The prognosis is usually poor, but the conditions of some patients may respond to administration of 24,25-(OH)2D3 together with calcitriol. Preliminary data suggest that use of chelating agents may be beneficial. In this group of patients, 24,25-(OH)2D3 administration together with calcitriol may be beneficial.

The effects of calciferol and its metabolites on patients with chronic renal failure. I. Calciferol, dihydrotachysterol, and calcifediol.

The available data with regard to the use of calciferol, dihydrotachysterol, and calcifediol in the management of renal insufficiency are reviewed. Very limited data are available with regard to calciferol therapy; with the advent of more active metabolites, the use of calciferol is not warranted. Dihydrotachysterol seems to be effective in the treatment of renal patients with osteitis fibrosa; its low cost makes therapy with this compound a reasonable alternative, although it should not be used in the treatment of patients with liver disease. Calcifediol seems to be effective in patients with osteitis fibrosa; however, limited data on histologic characteristics of bone are available. Detailed prospective studies are necessary to establish the therapeutic benefit of calcifediol.

Efferent pathways of the coronary chemoreflex.

This study was performed to identify the efferent pathways which mediate vasodilation during activation of the coronary chemoreflex and to compare the reflex responses in vessels in skeletal muscle and skin. Reflex vasodilator responses (decreases in perfusion pressure) were measured in innervated, perfused gracilis muscle and hindpaw of dogs during activation of the coronary chemoreflex with intracoronary injections of nicotine. Reflex vasodilator responses to intracoronary nicotine (1.25 and 2.50 mu-g per kilogram) averaged -14 plus or minus 5 (S.E.M.) and -34 plus or minus 6 mm. Hg, respectively, in muscle, but only -5 plus or minus 2 and -10 plus or minus 4 mm. Hg, respectively, in paw. Atropine, tripelennamine, and propranolol did not alter the vasodilation. Guanethidine blocked reflex vasodilation in muscle. The reflex vasodilator responses in paw were slight and were not significantly attenuated by guanethidine. The results indicate that sympathetic cholinergic pathways to skeletal muscle do not participate in the coronary chemoreflex. The reflex vasodilation in muscle results from withdrawal of adrenergic constrictor tone. The efferent pathway demonstrates that the coronary chemoreflex does not produce striking withdrawal of adrenergic tone in paw. The results indicate, therefore, that activation of the coronary chemoreflex results in greater withdrawal of adrenergic constrictor tone and greater vasodilation in muscle than in skin.