The renal histopathologic findings in this study are consistent with those reported in previous acute studies in rats after PIFE administration. Functional changes in the kidney, as evidenced by serum chemistry and urinalyses, were observed at exposure concentrations that induced morphologic alterations.
The purpose of the present investigation was to determine if RES activity was altered after the infusion (bolus i.v. injection over approximately 3-5 min) of hydroxyethylstarch (HES). RES function was determined by vascular clearance of 51Chromium-labeled sheep erythrocytes and the subsequent uptake into the liver, spleen, lungs, and thymus at 1 hr, 3 hr, 6 hr, 1 day, 3 days, and 7 days post infusion. Infusion with the low doses of HES (20 and 40 ml/kg) produced changes in vascular clearance which were comparable to physiological saline. Infusion with 80 ml/kg HES produced a biphasic response with a modest suppression of vascular clearance (i.e., 151% increase in half life) and hepatic phagocytosis (50%) during the first 6 hours after injection, followed by recovery at 24 hours and a stimulation in hepatic uptake (42%) after 3 days. These effects by HES were compared to those produced by infusion with 80 ml/kg HSA, a comparable colloid and with 80 ml/kg pyran copolymer, a positive control.
Serum, urine, and tissue samples were collected from 42 children undergoing open-heart surgery and analyzed for digoxin by radioimmunoassay. Of these, 24 had been digitalized prophylactically (RECENT) and 18 had been receiving maintenance therapy (MAINT) for one month or longer. Twenty-five percent of the RECENT patients exhibited arrhythmias during the postoperative period as compared to none in the MAINT group. Serum digoxin levels were equivalent in the two groups throughout the study. Although no change in tissue digoxin concentrations occurred during bypass, right atrial appendage concentrations were significantly higher in the RECENT group (109
vs
62 ng/g;
P
< 0.001). This high atrial digoxin concentration presumably resulted from the large doses used for initial digitalization, and concomitant with postoperative hypokalemia and myocardial metabolic changes secondary to perfusion, may have been responsible for the high incidence of arrhythmias in the RECENT group. Both digoxin and creatinine excretion were depressed following bypass. The amount of biotransformation of digoxin was 2-59.
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