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Biomedical subjects

R Gokal

Publications and source records attributed to R Gokal.

193 records · Page 11Linked to original sources
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Cadaveric transplantation.

Transplantation is already the optimum treatment for terminal renal failure. Donor organ shortage means that there are large number of patients on dialysis awaiting this treatment. This has in some countries led to unacceptable unscrupulous practices of live non-related graft donation. The outcome of graft and patient after transplantation has improved significantly based on a better understanding of immunopathology, immunosuppression and tissue typing. The future is promising and xenografting may well solve the organ shortage but undoubtedly will raise other issues.

Ethics, Medical↗
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Malignant nephrosis.

Explore the source record for details and available documents.

Adolescent↗
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Peritoneal dialysis-related peritonitis treatment recommendations: 1996 update.

The recommendations provided in this document represent a distillation of various experiences, as well as data obtained from published studies in the setting of substantial changes in antibiotic sensitivity. It is hoped that this revised compilation will provide a basis upon which future developments and advances can be made in the therapeutic approach to infectious complications of peritoneal dialysis.

Anti-Bacterial Agents↗
PubMedDate not supplied

Icodextrin: overview of clinical experience.

OBJECTIVE: To review all clinical studies and experience gained with icodextrin to date; primarily its use in peritoneal dialysis in patients with end-stage renal failure, but also its use as an intraperitoneal vehicle. DATA SOURCES: Peer-reviewed original research articles in the literature; abstracts from international scientific meetings; data generated from the compassionate use programme. STUDY SELECTION: All published studies to date are included, some 10-20 studies being included in this review. DATA EXTRACTION: Data have not been specifically extracted from studies; results have been described in the context of overall experience. RESULTS: Over ten years of clinical experience with icodextrin have now been accumulated, in both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). A small number of patients have received icodextrin for over five years, with no loss of effect. Icodextrin produces sustained ultrafiltration over long dwells while being iso-osmolar, by the process of colloid osmosis. CONCLUSIONS: Icodextrin represents the first viable alternative osmotic agent to glucose, for use in solutions for peritoneal dialysis. It also has a potential use as a vehicle solution for intraperitoneal drug delivery.

Dialysis Solutions↗
PubMedDate not supplied

A randomized controlled trial of a bicarbonate- and a bicarbonate/lactate-containing dialysis solution in CAPD.

OBJECTIVE: To evaluate the safety and efficacy of bicarbonate- and bicarbonate/lactate-based PD fluids. DESIGN: A randomly allocated prospective controlled trial lasting eight weeks. SETTING: Five renal units in Europe. PATIENTS: Individuals who have been treated by CAPD for at least three months and who have had at least one month's therapy with 40 mmol/L lactate PD fluid. Those with recent infection, diabetes or other serious illness are excluded. Forty-seven individuals have entered the study so far. INTERVENTIONS: Patients are randomly allocated to three groups. Group 1 receive 40 mmol/L lactate dialysate, Group 2 are given 38 mmol/L bicarbonate fluid and Group 3 are tested with a 25 mmol/L bicarbonate and 15 mmol/L lactate dialysate. OUTCOME MEASURES: The primary outcome measure is the plasma bicarbonate level. Adverse events and ease of use of the two-chambered bags used by Groups 2 and 3 are also being assessed. RESULTS: To date, plasma bicarbonate levels have been the same in all treatment groups up to the end of the trial period. There are no differences in serum lactate levels. No side effects are attributable to the test fluids. The patients have managed the two-chambered bags successfully. CONCLUSION: This trial is still ongoing, but to date, neutral bicarbonate based fluids have been as effective as lactate dialysate in treating uremic acidosis.

Adult↗
PubMedDate not supplied

Peritoneal dialysate IgG/C3 levels do not predict susceptibility to peritonitis.

OBJECTIVE: To investigate the usefulness of dialysate IgG and C3 concentrations in predicting likelihood of developing peritonitis. DESIGN: Prospective, longitudinal, and comparative study. SETTING: Single university teaching hospital dialysis unit and outpatient clinic. PATIENTS: Thirty-four uremic patients were studied (20 males, 14 females: mean age 47.2, range 20-73 years). Monthly serum and overnight dialysate (eight- to eleven-hour dwell) samples were obtained for IgG and C3 estimations over the first six months of the study, and trimonthly samples were obtained thereafter. All patients performed exchanges using standard transfer sets (Baxter system II, Baxter Healthcare Ltd., Thetford, Norfolk, U.K.), used no hypertonic fluid (3.86%) for overnight exchanges, and were followed up for a minimum of 18 months. OUTCOME MEASURES: Dialysate and serum levels of IgG and C3; peritonitis episodes. RESULTS: Forty-five episodes of peritonitis occurred in 24 patients during the study period. We examined opsonin levels in the group as a whole, and then in two subgroups of patients: those who remained peritonitis-free throughout the study, and those who did not. There were no significant differences between IgG and C3 levels in the two groups at any time point, and large interpatient and intrapatient variation in levels were seen. CONCLUSION: Dialysate levels of IgG and C3 from the overnight dwell are not helpful in predicting the risk of developing continuous ambulatory peritoneal dialysis peritonitis in individual patients. No correlation was found between opsonin levels and onset of clinical peritonitis.

Adult↗
PubMedDate not supplied

Natural history of Staphylococcus aureus nasal carriage and its relationship to exit-site infection.

OBJECTIVE: To study the natural history of nasal carriage of Staphylococcus aureus (SA) and its impact on exit-site infection (ESI). SETTING: A teaching hospital single-center study. DESIGN: A prospective cohort study in prevalent continuous ambulatory peritoneal dialysis (CAPD) patients. PATIENTS: 153 patients (76 male, 77 female; mean age 46 years) with a mean duration of CAPD of 2.4 years. METHODS: Nasal swabs were taken at approximately 2-month intervals over the mean period of follow-up of 22.6 months and cultured for SA. RESULTS: An average of 69% of patients received systemic antibiotics for therapy of ESI, peritonitis, and other infections during the period of the study, but none received local nasal antibiotics. Four groups of patients were identified according to their nasal carriage history: chronic, intermittent, occasional, and noncarriers. The intermittent and chronic carriers had significantly higher SA ESI than the occasional and noncarrier groups. The intermittent group also had the highest percentage of non-SA ES infections. CONCLUSION: Although this study shows that only half of our CAPD patients with nasal carriage were at risk of developing ESI, we recommend that patients with a positive nasal swab at the start of CAPD therapy should be treated with nasal antibiotics or local antibiotics at the exit site.

Catheters, Indwelling↗