Biomedical subjects
Publications and source records attributed to R G Walker.
A case of renal infection with Mycobacterium chelonei is described. The infection probably occurred via haematogenous spread from an infected arteriovenous shunt in a uraemic woman. Prolonged treatment with intravenous cefoxitin combined with oral erythromycin and rifampicin eradicated the organism from the urine. Although renal function stabilised for one year, gradual deterioration to end-stage renal failure occurred.
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Our experience of 54 patients with end-stage renal failure, who were treated with intermittent peritoneal dialysis and compared with patients maintained by haemodialysis over the years 1972 to 1978, has been reviewed. All patients received peritoneal dialysis for more than six weeks. The total experience was 32.8 patient dialysis-years, 48% as home dialysis. Peritoneal dialysis was used as an interim procedure in 19 patients who were waiting for haemodialysis. However, in 35 patients (particularly in the very young and elderly, and in situations of poor social support), recurrent peritoneal dialysis was chosen as the definitive dialysis therapy. Dialysis was assessed as "adequate" in all, but two, patients. The major complication of peritoneal dialysis was peritonitis, although its over-all incidence of 1.31 episodes per patient dialysis-year was low. An attack of peritonitis occurred every nine months of patient exposure, though the incidence of bacterial peritonitis averaged only once every 26 months. Fifty per cent of patients never had an episode of peritonitis. Intermittent peritoneal dialysis was associated with greater morbidity and mortality than haemodialysis, perhaps due, in part, to the older age of the peritoneal dialysis group. Intermittent peritoneal dialysis is a valuable adjunct to haemodialysis and transplantation in the treatment of end-stage renal failure.
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Two intersex dogs with various degrees of mosaicism in the somatic tissues are described. Normal female cells as well as Y-bearing cells with aneuploidy and other abnormalities were involved. In the Red setter an ovarian cortex had developed in mosaic gonads with 8 and 10% of Y-bearing cells. Slight masculinization of the medullae corresponded with some external virilization. These observations support the existence of a threshold proportion of Y-bearing cells for testicular differentiation. Fragments of chromatin in 36% or fewer of the cells in the Cocker spaniel may have been translocated Y-chromosome material.
Our experience of CAPD in 21 patients over a total period of 118 patients months has been evaluated and compared with intermittent peritoneal dialysis (IPD). CAPD was associated with greater clearance of urea creatinine and phosphate, higher concentrations of haemoglobin, improved control of hypertension and saline overload, and better patient acceptance than IPD. It is concluded that CAPD is an effective form of dialysis with many advantages over IPD, although the incidence of peritonitis is still twice that IPD.
Nine patients with various forms of glomerulonephritis were treated by repeated plasmapheresis which was combined with immunosuppression, and anticoagulant therapy. Improvement in renal function occurred in the seven patients in whom there had been rapid deterioration in renal function. Two patients with gradually deteriorating renal function failed to respond. Plasmapheresis may exert its beneficial effects both by depletion of circulating immune complexes or autoantibodies, and by depletion of important mediators of injury such as fibrinogen and complement.
Four patients who presented with severe proliferative glomerulonephritis associated with linear deposition of IgG on the basement membrane have been treated by intermittent massive plasmapheresis. Two patients had all the features of Goodpasture's syndrome. In the other two cases, the characteristic renal lesion was present but there was no pulmonary involvement. In all cases, renal function improved after plasmapheresis while in two, renal function deteriorated after plasmapheresis was stopped. On of these patients responded to a second course of plasmapheresis but failed to respond to a third. This study supports previous reports of the value of plasmapheresis in patients with Goodpasture's syndrome and renal failure in whom recovery without plasmapheresis has not been recorded. The present study emphasizes the importance of continuing treatment for a period of weeks to permit prolonged remission. If treatment is withdrawn too early, rapid deterioration in renal function may result, and unless plasmapheresis is recommenced at once the renal failure may then prove irreversible.
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