We measured the intracranial pressure (ICP), using a subdural catheter in nine patients admitted with grade 4 hepatic encephalopathy due to fulminant hepatic failure complicated by oliguric renal failure. Six patients received daily machine haemofiltration and four patients were treated with continuous arteriovenous haemofiltration (CAVHF). The mean ICP increased during the first hour of machine haemofiltration from 9 +/- 1.4 mmHg to 13 +/- 1.8 mmHg (P less than 0.05), and there was a reduction in the mean arterial pressure from 92.4 +/- 2.7 mmHg to 81 +/- 3.2 mmHg (P less than 0.05) resulting in a reduction in cerebral perfusion pressure of up to 30%. The group treated by CAVHF, although having a greater mean ICP prior to treatment (19 +/- 4.8 mmHg) and a lower mean arterial pressure (66 +/- 3.6 mmHg) and consequently a lower cerebral perfusion pressure, did not show any increase in ICP or reduction in mean arterial or cerebral perfusion pressure. There was a significant reduction in serum osmolality during the first hour of treatment in the machine haemofiltration group (314 +/- 4 mOsm/kg to 309 +/- 4 mOsm/kg, P less than 0.05), whereas there was no corresponding change in the CAVHF group. This suggests that CAVHF is to be preferred for the treatment of acute renal failure in such patients who are at considerable risk of developing cerebral oedema.

No abstract

We propose a new semiparametric model for functional regression analysis, combining a parametric mixed-effects model with a nonparametric Gaussian process regression model, namely a mixed-effects Gaussian process functional regression model. The parametric component can provide explanatory information between the response and the covariates, whereas the nonparametric component can add nonlinearity. We can model the mean and covariance structures simultaneously, combining the information borrowed from other subjects with the information collected from each individual subject. We apply the model to dose-response curves that describe changes in the responses of subjects for differing levels of the dose of a drug or agent and have a wide application in many areas. We illustrate the method for the management of renal anaemia. An individual dose-response curve is improved when more information is included by this mechanism from the subject/patient over time, enabling a patient-specific treatment regime.

The prevalence of Helicobacter pylori was determined using an ELISA technique for IgG antibodies to H. pylori in 76 patients with end-stage renal failure who were receiving regular haemodialysis and 202 patients with functioning renal transplants. Twenty-seven (34%) of the haemodialysis group and 58 (29%) of the transplant group were positive for H. pylori IgG antibodies, and the prevalence did not differ significantly from that in 247 age-matched healthy controls. In the haemodialysis group, patients positive for H. pylori were older, median age 60 years (range 22–73), compared to those patients without H. pylori antibodies, median age 52 years (range 22–75), p < 0.05, more suffered from dyspeptic symptoms, 35 vs. 10% (p < 0.01), yet fewer had been prescribed aluminium-containing antacids, 38 vs. 78% (p < 0.01). In the transplanted group, those positive for H. pylori were more symptomatic for dyspepsia, 30 vs. 11% (p < 0.01), and had lower serum creatinine values, 136 ± 10 μmol/l (mean ± SEM) vs. 172 ± 12 μmol/l (p < 0.05), compared to those without H. pylori antibodies. Almost all the transplant patients with H. pylori antibodies were taking steroids (98%) compared to 84% of those without antibodies (p < 0.05). The prevalence of antibodies to H. pylori in this study was increased in symptomatic dyspeptic subjects and reduced in those patients prescribed aluminium-containing phosphate binders.

. (1973). Archives of Disease in Childhood, 48, 279. Interrelations of plasma calcium, inorganic phosphate, magnesium, and protein over the first week of life. Plasma levels of calcium, magnesium, phosphate, and protein were measured on the first day of life (cord blood) and at the age of 1 week, in infants fed on breast milk or on one of three cow's milk preparations.The plasma calcium fell in all patients over the first 24 hours. Breast-fed infants, in all but three instances, showed a rise of calcium in the following 5 to 7 days. There was no mean change in calcium concentration for the other feeds over this period, and about a third of these infants showed a fall: in 9 % to below 7-5 mg/ 100 ml.There was a positive correlation between concentrations of calcium and magnesium in the plasma, but an inverse relation between those of calcium and phosphate, at 1 week of age. The concentration of calcium at 1 week of age was related to that of the first day, which in turn was related to that in cord blood. The changes in calcium observed between the age of 1 day and 1 week were inversely related to changes in the plasma phosphate. A direct correlation was also found between changes in calcium and changes in magnesium concentration. All groups of infants showed an increase in plasma phosphate over the first day of life and a further increase by 1 week of age. This rise, however, was significantly smaller in breast-fed infants than in those receiving cow's milk, probably due to the much higher phosphate content of the latter. The hypocalcaemia which occurs at 1 week of life in some infants receiving cow's milk may be due to an inability of the neonatal kidney to dispose of the excessive phosphate loads in these feeds.Convulsions associated with a low plasma calcium concentration were observed in 13 newborn infants over a period of 4 months. All 13 had been fed with an evaporated milk formula at a 1 in 3 dilution. This was the only artificial feed used in the nursery at that time. Examination of the food intake, the rate of weight gain, and the perinatal history failed to reveal a difference between the 13 who convulsed and the large number who did not do so.The purpose of the present study was two-fold. The first part was a cross-sectional study to establish normal values of plasma calcium, inorganic phosphate, total proteins, and magnesium for infants fed on 4 separate milk feeding regimens.