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    Cardiovascular Disturbances In Hemodialysis-Patients - the Importance of Volume Overload
    (Wichtig Editore, 1995) Mees, Ejd; Ozbasli, C; Akcicek, F
    This review concentrates on the pathophysiology of cardiovascular changes in hemodialysis and attempts to identify regions deserving more attention. Some of the links constituting the volume/blood pressure relationship still await further elucidation. Whether volume retention is an independent risk factor has not yet been completely analysed. The existence of a specific toxic cardiomyopathy is debated, since a similar picture can result from long-standing hypertension and volume expansion. The relative contribution of plasma renin to the hypertension of many HD patients is still unknown. Consequently the place of converting enzyme inhibition in the treatment of these patients has yet to be established. Taken together the evidence available indicates that better volume control could considerably improve cardiovascular morbidity in a large part of the HD population.
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    Comparison of the Effects of Enalapril and Theophylline on Polycythemia After Renal-Transplantation
    (Williams & Wilkins, 1995) Ok, E; Akcicek, F; Toz, H; Kursat, S; Tobu, M; Basci, A; Mees, Ejd
    Posttransplant erythrocytosis (PTE) is a potentially serious complication for which (apart from phlebotomy) two alternative treatments have been proposed: theophylline (Theo) and angiotensin-converting enzyme inhibitors. We investigated 28 patients with PTE, who were assigned to 3 matched groups. Group 1 (10 patients) received 10 mg of Enalapril (Ena)/day. After 2 months, mean hematocrit (Ht) had dropped from 0.57 (range 0.52-0.62) to 0.45 (0.34-0.49), Ena was stopped and, after a period of 3.8+/-0.3 months, Ht had risen again to baseline values (0.56, range 0.52-0.61) in 8 of them, These 8 patients were then given 5 mg/day Ena. Ht decreased more slowly, and after 3 months reached a mean of 0.49 (0.44-0.54). Group 2 (9 patients) received 600 mg/day Thee in 2 doses. After 2 months, Ht had decreased from 0.56 (0.52-0.61) to 0.52 (0.46-0.63), but in 5 patients, Ht remained above 0.51. After I month discontinuation of treatment, PTE persisted in 7 patients. These patients were given 10 mg/day Ena, whereupon Ht decreased from 0.55 (0.52-0.64) to 0.46 (0.40-0.53) after 2 months and to 0.41 (0.33-0.47) after 3 months. Group 3 did not receive medical treatment, After 3 months, PTE persisted in 8 out of the 9 patients and remained unchanged during the following 3 months. Mean values for Ht were: baseline, 0.55 (0.52-0.58); after 3 months, 0.56 (0.53-0.59); and after 6 months, 0.55 (0.52-0.60). We conclude that Ena is superior to Theo in the treatment of PTE, There were no resistant patients, but individual sensitivity differs, Its effect is dose dependent, reversible, and reproducible, Excessive Ht decrease may occur; thus, doses should be titrated individually.
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    Diuretic Effect of Frusemide In Patients With Nephrotic Syndrome - Is It Potentiated By Intravenous Albumin
    (British Med Journal Publ Group, 1995) Akcicek, F; Yalniz, T; Basci, A; Ok, E; Mees, Ejd
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    Diuretic Effects of Intravenous Furosemide (F), Albumin (A) and the Combination (F+A) In Massive Edema Due To Nephrotic Syndrome (Ns)
    (Blackwell Science Publ Inc Cambridge, 1995) Acicek, F; Basci, A; Ozbasli, C; Yalniz, Mt; Coker, C; Zirek, O; Tanyilmaz, A; Mees, Ejd
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    Malignant Hypertension In a Hemodialysis Patient Treated By Ultrafiltration
    (Oxford Univ Press United Kingdom, 1995) Ok, E; Akcicek, F; Mees, Ejd; Basci, A; Mir, S; Kursat, S; Unsal, A
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    Paradoxical Rise In Blood-Pressure During Ultrafiltration In Dialysis Patients
    (Oxford Univ Press United Kingdom, 1995) Cirit, M; Akcicek, F; Terzioglu, E; Soydas, C; Ok, E; Ozbasli, Cf; Basci, A; Mees, Ejd
    In some hypertensive haemodialysis (HD) patients, blood pressure rises further during ultrafiltration (UF). We investigated seven such patients, who were not responsive to hypotensive drugs, including converting enzyme inhibitors. All had marked cardiac dilatation, but most were non-oedematous. They were treated with repeated intense UF while monitoring cardiac function by echocardiography. After a variable time period they all. became (near) normotensive without medication. Mean systolic and diastolic blood pressure decreased by 46+/-18 and 22+/-9 mmHg respectively while bodyweight decreased by a mean of 6.7+/-3.0 kg. Plasma volume decreased by 22%, and mean albumin increased from 3.9+/-0.3 to 4.2+/-0.3 g/dl. Cardiothoracic index decreased from a 0.56+/-0.02 to 0.45+/-0.03. Mitral and tricuspid insufficiency was present in four patients and improved or disappeared in all of them. Diameters of the inferior vena cava, left atrium, and end systolic and diastolic left ventricle markedly decreased in all patients. Ejection fraction increased, but remained subnormal in some patients, while cardiac output increased in five and decreased in two patients. We conclude that paradoxical blood pressure rise with UF usually occurs in the presence overhydration and cardiac dilatation and should be treated by intensified UF. The explanation of this phenomenon remains speculative.
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    Understanding the Nephrotic Syndrome - Whats New In a Decade
    (Karger, 1995) Mees, Ejd; Koomans, Ha
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    Volaemia and Blood-Pressure In Renal-Failure - Have Old Truths Been Forgotten
    (Oxford Univ Press United Kingdom, 1995) Mees, Ejd