Peritonitis, a frequently lethal complication of intermittent and continuous ambulatory peritoneal dialysis.
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Biomedical subjects
Publications and source records attributed to B Branger.
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Because of the known presence of aluminium oxide in the Redy cartridge and the increased solubility of aluminium (A1) in alkaline solution, an in vitro study was performed to measure the release of A1 from the Redy cartridge and its potential transfer across a dialyser membrane. The use of bicarbonate rinsed Redy cartridges was associated with significant release of A1 and its subsequent transfer across the cellulose acetate membrane. Bicarbonate dialysis with the Redy system is not recommended for maintenance haemodialysis.
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Since 1980 we have refined a procedure for renal needle biopsy with continuous ultrasonic guidance (USRNB) which facilitates control of the needle progression through the soft tissues to the lower pole of the kidney. The advantage of this method is evident in a selected population (major obesity, small kidneys). We compared this procedure to the conventional blind biopsy in a series of 32 nonselected patients. Tissue samples with more than 10 glomeruli were obtained in 87% of patients with 2.8 punctures using USRNB, the difference was significant when compared to a blind technique (56%, 4.0, respectively, p less than 0.05). USRNB has been performed in 108 patients with 2 failures due to a poor echographic contrast. Reasons why this procedure should be substituted for the blind technique include: (i) Less morbidity, (ii) improvement of the quality of renal tissue, (iii) better comfort for both patient and physician, and (iv) less technical restriction of the biopsy indication when compared to blind renal needle biopsy.
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Encapsulating peritonitis has been recognized as a life threatening, evolutive complication of chronic ambulatory peritoneal dialysis. Three cases are reported. Etiological factors are multiple, the diagnosis is suspected on peritoneal clinical signs, partial small bowel obstruction and impaired ultrafiltration. Barium studies and CT scan show small bowel enclosed within a peritoneal cocoon, prolonged transit time, wall thickening and a trabeculated fluid collection. Laparotomy confirms the diagnosis and reveals the pathological stage of disease. The surgical treatment consists of striping away the encapsulating membrane if possible while multiple incisions and loops release are indicated in other cases. The prognosis is poor unless an early surgical treatment is done.