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Biomedical subjects

D G Struijk

Publications and source records attributed to D G Struijk.

At least 109 records · Page 6Linked to original sources
PubMed1990

Oral treatment of CAPD-peritonitis with ciprofloxacin.

Peritonitis is still a major problem in CAPD. The synthetic chemotherapeutic quinolone ciprofloxacin offers new possibilities for oral treatment of this complication. The efficacy of ciprofloxacin as first-line antibiotic was investigated in five consecutive peritonitis episodes of five patients. The dosage was deduced from a pilot study and consisted of an intra-peritoneal loading dose during the first 24 hours. Simultaneously ciprofloxacin was given orally and thereafter only the oral medication was continued. The causative microorganisms in the 5 episodes were (MIC90 in brackets): nonfermentative Gram negative rod, group IVc-2 (0.6 micrograms/ml), S. aureus (0.25 micrograms ml), Strep. faecalis (0.4 micrograms/ml), S. aureus + S. epidermidis (both 0.25 micrograms/ml) and S. aureus (0.13 micrograms/ml). The clinical course was uncomplicated and all episodes were cured with ciprofloxacin monotherapy. In 4 patients all dialysate concentrations exceeded 2.3 micrograms/ml (mean 5.8 micrograms/ml). In one patient dialysate concentrations varied between 2.2 and 7.5 micrograms/ml during the first 24 hrs and between 0.4 and 1.2 micrograms/ml thereafter. Despite these low dialysate concentrations, the episode caused by S. aureus (MIC90 0.25 micrograms/ml) was cured uneventfully. We conclude that ciprofloxacin may be useful for the treatment of CAPD peritonitis. Large interindividual differences in dialysate concentrations should be taken into account.

Administration, Oral↗
PubMed1990

Accuracy of erythropoietin determination in the dialysate of CAPD patients.

In vitro experiments were performed to analyze problems with the determination of erythropoietin in dialysate. Human recombinant erythropoietin (EPO; 4000 U/L) was added to several fluids, to glass or polystyrene tubes with or without addition of bovine serum albumin (BSA) and to dialysate bags. The recovery in peritoneal effluent was 4120 +/- 203 U/L (mean +/- SEM). The recovery in the other fluids was less than 50% but in glass tubes it increased to 96% after addition of BSA. Binding was also found to the dialysate bag, therefore reducing the amount available for absorption. We recommend that EPO samples from the dialysate are drawn within BSA coated glass tubes.

Dialysis Solutions↗
PubMed1990

Indirect measurement of lymphatic absorption with inulin in continuous ambulatory peritoneal dialysis (CAPD) patients.

To elucidate the importance of possible trapping of macromolecules in peritoneal tissue on the calculation of peritoneal lymphatic drainage, we compared the transport of inulin administered i.v. and i.p. in nine continuous ambulatory peritoneal dialysis (CAPD) patients on two separate days. In the intraperitoneal study inulin (5 g) was added to the dialysate and in the intravenous study inulin (5 g) was given i.v. 3 h before the test. No differences were found in the mass transfer area coefficients (MTC) of urea, creatinine, and glucose between the two tests. The MTC after inulin i.p. was 3.2 +/- 0.7 mL/min (mean +/- SD) and after inulin i.v. 1.8 +/- 0.5 (p less than 10(-5]. As the difference in transport kinetics between i.v. and i.p. administration is likely to be caused by lymphatic absorption, a mean lymphatic flow of 1.4 mL/min could be calculated. This value corresponds to the data obtained with macromolecules. Our results therefore favor the hypothesis that no local accumulation of macromolecules in the peritoneal tissues takes place and that their disappearance from the peritoneal cavity represents lymphatic absorption.

Biological Transport↗
PubMed1989

The time course of peritoneal transport kinetics in continuous ambulatory peritoneal dialysis patients who develop sclerosing peritonitis.

The time course of measurements of peritoneal solute transport in four continuous ambulatory peritoneal dialysis (CAPD) patients who developed sclerosing peritonitis is described. Loss of fluid removal capacity was found in all of them. In three, this loss was associated with an increase in peritoneal absorption of glucose from the dialysate and an increase in the transperitoneal transport rates of low-molecular-weight solutes and proteins. In the other patient a decrease in all these parameters was found. This seems to imply that the effective peritoneal surface area was increased in three patients and decreased in one. Peritoneal permeability to macromolecules remained unchanged as judged by the ratio between the clearance of IgG and albumin. Among the possible factors that contribute to the development of sclerosing peritonitis, some are likely to lead to a larger effective peritoneal surface area, like prostacyclin and the formation of new capillaries in poorly vascularized parts of the peritoneum. Others, such as extensive formation of collagen, could lead to a smaller effective surface area. Individual differences in susceptibility to these factors may lead to an increase or decrease in peritoneal solute transport rates. Follow-up measurements of peritoneal solute kinetics are necessary to identify those patients who are at risk.

Adult↗
PubMed1989

The peritoneal transport of serum proteins and neutral dextran in CAPD patients.

The peritoneal transport of five serum proteins and intravenously-administered neutral dextran was studied in 13 CAPD patients. In all patients a study was done three hours after the administration of dextran. In nine the study was repeated after 14 hours, and in six also after 38 hours. Using gel permeation chromatography of serum and dialysate it was possible to calculate fractional (relative to inulin) clearances for dextran fractions with Einstein-Stokes radii ranging from 30 to 90 A. In contrast to glomerular transport, we found that peritoneal clearances of serum proteins and corresponding dextran fractions were of a similar magnitude up to a radius of 90 A, especially in the follow-up studies. No evidence was found for a charge-selective barrier function of the peritoneum. It appeared likely that the peritoneal interstitium is probably a third compartment between blood and dialysate in which equilibrium with blood and dialysate is present for serum proteins, but initially not for dextran. For dextran this equilibrium is probably approached 14 to 38 hours after administration. The linear relationship between the reciprocal of fractional clearances and Einstein-Stokes radii indicates that restricted diffusion is the main transport mechanism of macromolecules across the peritoneal membrane. The slopes of the linear regression between the reciprocal of fractional clearances and radii ranged from 0.32 to 6.95 (slope for free diffusion 0.07) and provided an index of the permeability characteristics of the peritoneal membrane.

Adult↗
PubMed1988

Differences in the peritoneal transport of water, solutes and proteins between dialysis with two- and with three-litre exchanges.

In eight, CAPD patients who either had insufficient results of dialysis treatment (six) or loss of ultrafiltration (two) on a normal scheme (4 X 2-1), the effects of a 3-1 dialysate exchange on the in situ intraperitoneal volume, solute mass transfer, and mass transfer area coefficients were compared with a 2-1 exchange. The solutes investigated were urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG. The time course of the intraperitoneal volume showed marked interindividual variations. However, delta mean volume was lower with the 3-1 exchanges than with 2-1. This was the result of an increased water reabsorption rate during 3-1 (2.18 ml/min vs 0.94 ml/min, P less than 0.01), probably caused by increased lymphatic absorption. Peritoneal mass transfer of low-molecular-weight solutes (up to 500) was increased with the 3-1 exchange, but there was no evidence of any alteration in effective peritoneal surface area or peritoneal permeability. By comparing the mass transfer area coefficients of the various solutes to their free diffusion coefficients, it appeared likely that the diffusion of the low-molecular-weight solutes was unrestricted by membrane permeability and only hampered by the effective peritoneal surface area. For the proteins a size-selective restricted diffusion was found.

Adult↗
PubMed1987

Antifungal treatment of Candida peritonitis in continuous ambulatory peritoneal dialysis patients.

Nine peritonitis episodes caused by Candida sp were diagnosed in eight continuous ambulatory peritoneal dialysis (CAPD) patients. Treatment with intraperitoneal administration of amphotericin B and 5-fluorocytosine while the peritoneal catheter was left in situ was effective in six episodes in five patients. Of the three other patients, two started again with CAPD after peritonitis had been cured, but one patient preferred to stay on hemodialysis. In four episodes, peritoneal white cell counts remained high during treatment despite negative cultures. This was probably the result of irritation of the peritoneal membrane caused by the antifungal treatment, possibly by amphotericin B. Persistently-elevated leukocyte counts during antifungal therapy, with or without signs and symptoms of peritonitis, are not necessarily an indication of treatment failure.

Aged↗