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Biomedical subjects

D G Oreopoulos

Publications and source records attributed to D G Oreopoulos.

At least 181 records · Page 10Linked to original sources
PubMed1986

Osmotic agents for peritoneal dialysis.

Glucose has more advantages than drawbacks and is now the sole agent used in clinical practice. Yet there is interest in finding a substitute for glucose as an osmotic agent in peritoneal dialysis solution. Work has identified several promising agents such as albumin, amino acids, gelatin and glycerol but it appears that every one of them, including glucose, would be useful for a short-dwell or for a long-dwell exchange but not for both. Some of them, such as albumin and the amino acids, are close to being an ideal osmotic agent but are prohibitively costly to manufacture. We predict that interest in the future will focus on dialysis solutions containing a mixture of osmotic agents. Such a solution would be acceptable for both short and long-dwell exchanges. It will have a sufficiently low concentration of different agents to minimize toxicity and long-term undesirable side effects. We expect that solutions will be available to better meet patients needs in the near future.

Albumins↗
PubMed1985

Changes in left ventricular hypertrophy and function in hypertensive patients started on continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) often leads to better control of hypertension. In order to evaluate the effects of such improved blood pressure control on left ventricular (LV) hypertrophy and LV function, a group of 18 patients with a history of hypertension were followed for changes in LV anatomy and function (with M-mode echocardiography) over a 6 to 12 month period after initiation of CAPD. All patients had echocardiographic evidence of increased LV mass related to concentric and eccentric hypertrophy. On CAPD, blood pressure decreased (greater than 5 mm Hg) in 12 patients. LV mass decreased in 15 patients and increased in one. A decrease in both wall thickness and LV dimension contributed to the fall in LV mass on CAPD. Initially, LV dimension exceeded normal in 9 out of 18 patients. On CAPD, LV dimension decreased to near normal in size in six, and no patient developed LV dilation on CAPD. Four patients initially had a decreased fractional shortening and ejection fraction; three of these normalized while on CAPD and no patient deteriorated. These results indicate that CAPD improves LV hypertrophy by normalizing both volume and pressure overload. These effects may prevent deterioration in LV function in patients with still normal LV function, and may improve LV function in patients who already exhibit decreased LV performance.

Adult↗
PubMed1985

Spontaneous remission of nephrotic syndrome in IgA glomerular disease.

We report two cases of adult onset nephrotic syndrome with pathologic features of minimal change disease but a predominance of IgA in mesangial regions. Both cases underwent spontaneous remission despite an episode of recurrent nephrotic syndrome in one patient. The relationship of the glomerular disease to minimal change and IgA nephritis is discussed.

Adult↗
PubMed1985

Skeletal muscle function in chronic renal failure: an index of nutritional status.

To determine whether skeletal muscle function testing (SMF) provides an index of nutritional status in patients with chronic renal failure (CRF), two groups with comparable CRF were studied. In 48 well-nourished (WN) and 17 malnourished (MN) patients with stable CRF, and in 33 WN nonazotemic controls, adductor pollicis function was assessed. The force at 10 Hz was expressed as a % of force at 100 Hz (F10/F100), and maximal relaxation rate (MRR) as % force loss/10 ms. Standard nutritional assessment was also performed. The WN group was not significantly different from controls for either F10/F100 or MRR. The F10/F100 of the MN group was significantly greater than either the WN group or controls (p less than 0.001), while MRR was less (p less than 0.001). Significant malnutrition by conventional parameters was shown in patients with abnormal F10/F100, and also in patients with abnormal MRR. Hence, SMF as described is unaffected by azotemia, and provides a functional measure of nutritional status in CRF.

Adult↗
PubMed1985

Quantitative radionuclide scanning in metabolic bone disease.

A simple method of quantifying skeletal uptake of 99Tcm-methylene diphosphonate, using a rectilinear scanner and a simultaneously image standard, is described. The pattern of quantified uptake in ten regions of the skeleton, the sacro-iliac joints and kidneys in 57 controls and 54 patients with various metabolic bone disease is presented. This method distinguishes patients with primary hyperparathyroidism and osteomalacia from controls with a sensitivity adequate for clinical purposes. In primary hyperparathyroidism the increased skull uptake of tracer correlated well with levels of serum alkaline phosphatase, plasma parathyroid hormone, urinary hydroxyproline excretion and the degree of intracortical resorption in the metacarpal bones. The skull uptake in oestoporosis was normal or moderately elevated and correlated well with bone mass density measurements of the radius. Patients with osteomalacia also showed the greatest increase in tracer uptake in the skull. Patients with thyrotoxicosis differed from most other patients by showing moderately increased uptake in shafts of long bones. We propose our method of quantitative bone uptake as a useful noninvasive test to detect metabolic bone disease and to monitor responses to therapy of bone disease.

Adolescent↗
PubMed1985

The reduction in the peritonitis rate among high-risk CAPD patients with the use of the Oreopoulos-Zellerman connector.

We have described a prospective controlled study of the Oreopoulos-Zellerman peritoneal dialysis connection system which is based on the principle of chemical sterilization of the connector between each dialysis exchange. This system, in a short-term study of 27 high-risk patients, has resulted in a fourfold difference in the peritonitis rate between the concurrent control group (1/8.8 patient months) and the O-Z group (1/35.7 patient months). The probability of developing peritonitis by 6 mos was 0.15 using the O-Z connector and 0.46 in the control group.

Adult↗
PubMed1985

Peritoneal access for chronic peritoneal dialysis.

Continuous ambulatory peritoneal dialysis has created a demand for a permanent peritoneal catheter that is safe and can function for a prolonged period. Continuous research and catheter modifications have reduced dialysate leak and catheter obstruction. Exit site infection remains the major cause of morbidity for patients with peritoneal access. Research in catheter technology should be directed at preventing this complication.

Adult↗
PubMed1985

The efficacy and adequacy of continuous ambulatory peritoneal dialysis.

Since it was introduced in 1976, continuous ambulatory peritoneal dialysis (CAPD) has won acceptance in many centres and it is now regarded as an important alternative to haemodialysis. CAPD patients have comparable and, in some circumstances, better survival than those on chronic haemodialysis. It is indicated particularly in patients with diabetes mellitus, cardiovascular instability and at the extremes of life. The success of kidney transplantation is similar in those maintained on CAPD and on haemodialysis. CAPD also achieves satisfactory physical and psychological rehabilitation, and the quality of life, including the level of sexual function, is similar during CAPD and haemodialysis. Women on CAPD menstruate more often than those on haemodialysis. CAPD provides adequate clearance of metabolic wastes, maintains fluid balance and ameliorates neurotoxic cognitive dysfunction. CAPD gives control of hypertension and anaemia which is superior to that on haemodialysis. Neuropathy remains stable but osteitis fibrosa seems to progress. CAPD is the most economical of the various forms of dialysis. We conclude that CAPD is an adequate form of replacement and should be made available in every nephrology centre providing treatment for patients with end-stage renal disease.

Adolescent↗
PubMed1985

Indications for operation when peritonitis occurs in patients on chronic ambulatory peritoneal dialysis.

Although peritonitis is a common complication in patients on CAPD, laparotomy is necessary in only a small proportion of instances. In order to determine the most reliable method to identify which patients require laparotomy, 78 episodes of peritonitis were studied over a 27 month period. History, physical examination and routine laboratory parameters were not useful. If multiple enteric organisms were cultured from a patient and abdominal pain persisted, the results of laparotomy always revealed significant abdominal pathologic findings. No patient required laparotomy if multiple enteric organisms were not recovered. These findings suggest that the only reliable parameter in the selection of patients for laparotomy is the presence of multiple enteric organisms in the dialysate. When abdominal pain persists in a patient with multiple enteric organisms, a laparotomy should be performed.

Bacterial Infections↗
PubMed1985

Improved results with a paramedian technique for the insertion of peritoneal dialysis catheters.

Three hundred and twenty-three permanent peritoneal dialysis catheters were inserted in 233 patients by two different methods (midline and paramedian). The paramedian technique resulted in a reduction in the incidence of dialysate leak, incisional hernia and extrusion of the cuff. These results have led to the abandonment of the midline insertion and the exclusive use of the paramedian technique for permanent dialysis catheter insertion at our institution.

Catheterization↗
PubMed1984

Continuous ambulatory peritoneal dialysis: no longer experimental.

Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months as compared with every 8 initially), and this has allowed chronic complications of CAPD, such as malnutrition and loss of the peritoneum's capacity for ultrafiltration, to come to light. As would be expected, among patients of advanced age and those who have heart disease or diabetes, survival rates tend to be lower than among other CAPD patients. However, hypertension seems to be more easily controlled, pre-existing anemia can be significantly ameliorated, and young children grow more normally than they do with hemodialysis. Diabetes-related changes in vision stabilize in most CAPD patients, and control of the blood glucose level is good; insulin is administered intraperitoneally. CAPD is thus showing itself to be a feasible form of long-term treatment for end-stage renal disease.

Adolescent↗
PubMed1984

The influence of age and sex on bone resorption of secondary hyperparathyroidism in renal osteodystrophy.

The severity and incidence of subperiosteal and intracortical bone resorption were evaluated from fine-detail hand radiographs at X 8 magnification in relation to age and sex in 239 chronically dialyzed adult renal failure patients. The severity of subperiosteal resorption decreased significantly with advancing age in both sexes and the incidence decreased somewhat more in males than in females; no such trends were apparent for intracortical resorption. Although the mean values for the grades of subperiosteal and intracortical resorption were significantly higher in females than in males, when the effect of age and duration of follow-up were taken into consideration, this sex difference remained significant only for intracortical resorption. It is concluded that when studying certain aspects of renal osteodystrophy, differences due to age, sex, and duration of follow-up should be considered in the final interpretation of data.

Adult↗
PubMed1984

Calcium oxalate kidney stones in patients on continuous ambulatory peritoneal dialysis.

Kidney stones were passed by ten out of 186 patients with endstage renal disease who were treated with continuous ambulatory peritoneal dialysis (CAPD). Stones from seven patients were examined by x-ray diffraction. In five of them the stones were composed of calcium oxalate monohydrate. The urine calcium oxalate activity product was determined in 44 CAPD patients, eight of whom were stone formers, and compared to that of 120 normal volunteers. In CAPD patients, mean urine ionic-calcium concentration was lower than in normal subjects whereas mean urine ionic-oxalate concentration was significantly higher than in normal subjects. In normal urine samples, the calcium oxalate activity product showed a significant correlation with both the urine ionic-calcium and the ionic-oxalate concentrations. In contrast, in CAPD patients the calcium oxalate activity product correlated with the ionic-calcium concentration but not with ionic-oxalate. Although the urine ionic-calcium concentration is lower in CAPD patients than in normal subjects, it is the relative increase in its concentration which appears to be associated with the increased risk of kidney stone formation in these patients. This relative hypercalciuria seems to follow 1,25(OH)2 vitamin D3 administration.

Calcitriol↗