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Biomedical subjects

R Gokal

Publications and source records attributed to R Gokal.

At least 163 records · Page 9Linked to original sources
PubMed1983

Continuous ambulatory peritoneal dialysis: three years' experience.

We review the experience of the Renal Unit at Newcastle upon Tyne over the three years 1979-1981, during which 122 patients with chronic renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD). Advantages of the technique included wide acceptability to a cross-section of patients reaching the renal unit, including the elderly and diabetics. Patients who experienced both techniques preferred CAPD to haemodialysis because of the greater freedom and sense of well-being. Patient survival was 94 per cent at two years and rehabilitation was as good as could be expected for the age and primary medical complications of the patients. Control of plasma potassium and phosphate was easier than with haemodialysis. Renal osteodystrophy responded well to a combination of CAPD and alfacalcidol therapy over the two year period for which we have performed serial bone biopsies. Serum aluminium was slightly raised as a result of consumption of phosphate binders and presumed uptake from dialysis fluid but no aluminium related disease has yet been encountered. Anaemia was partly corrected by CAPD with haemoglobin rising to about 10 g/dl on average. CAPD was less costly than home haemodialysis over the first three years and has been adopted as our standard treatment for patients who can expect an early transplant. Disadvantages were persisting problems with peritonitis which still occurred at an incidence of one attack per 39 patient weeks over the last two years, and an actuarial success rate for the technique of only 63 per cent at two years. Twenty patients developed hernias. Weight gain was common and occasionally gross. There was a significant rise in serum cholesterol. The arrival of CAPD has allowed us to increase the intake to our renal failure programme by 50 per cent. However, continued expansion of the technique demands advances in prevention of peritonitis, adequate facilities for admission and particularly an expanding hospital haemodialysis programme to accept the less successful patients from CAPD.

Adolescent↗
PubMed1982

Peritonitis in continuous ambulatory peritoneal dialysis. Laboratory and clinical studies.

During a three year period, 1979-81, 82 patients were treated by continuous ambulatory peritoneal dialysis (CAPD). The incidence of peritonitis was reduced significantly during the three years from one episode per 20 patient-weeks to one episode every 37 patient-weeks. 83% of the 136 episodes of peritonitis were treated successfully by antibiotic therapy alone. 62% of the total episodes were managed successfully with intraperitoneal cefuroxime. in 13 (16%) patients, CAPD failed because of peritonitis. Hospital admission for peritonitis has been reduced to a mean of 4.3 days per patient per year of CAPD. Fron January to September, 1982, Clostridium-difficile colitis developed in 13 patients. This complication was associated with considerable mortality and morbidity and has prompted a change in antibiotic policy. Patients with peritonitis are now given intraperitoneal netilmicin and intravenous vancomycin. Peritonitis remains the main complication of CAPD, but can be minimised by development of adequate facilities for performing CAPD.

Adolescent↗
PubMed1982

Paediatric continuous ambulatory peritoneal dialysis.

Ten children in end-stage renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD). This represents a total of 3.4 patient years. Biochemical control was good, and parent and patient acceptability high. Peritonitis was the chief complication, but after the institution of a specific CAPD education and training programme the incidence declined 10-fold. We regard CAPD as an effective short- and medium-term treatment for children with end-stage renal failure as part of an integrated dialysis and transplant programme, but it requires a devoted and enthusiastic trained staff to ensure success.

Adolescent↗
PubMed1981

The pharmacokinetics of single doses of metoclopramide in renal failure.

The pharmacokinetics of metoclopramide have been studied after intravenous and oral dosing (10 mg) to 6 patients with chronic renal failure. The mean terminal half-life was 13.9 h after intravenous and 14.8 h after oral administration. Total body clearance after i.v. dosing was 16.7 l/h. Oral bioavailability was 71.8%. In comparison to previous studies on normal subjects these results indicate that clearance of metoclopramide in renal failure is approximately 30% of normals. This difference is not accounted for by the change in renal clearance and suggests impaired metabolism or an alteration in enterohepatic circulation of metoclopramide in renal failure.

Adult↗
PubMed1981

Renal transplantation in patients on continuous ambulatory peritoneal dialysis.

Over a two year period 15 patients on CAPD and 65 patients predominantly treated by haemodialysis received first grafts. There was no difference in graft survival in these two groups. In the continuous ambulatory peritoneal dialysis (CAPD) patients there were no post operative episodes of peritonitis, apart from one patient who had peritonitis at the time of transplantation. No technical difficulties were encountered at the time of grafting. CAPD is not a contraindication to transplantation.

Adolescent↗
PubMed1981

"Eosinophilic" peritonitis in continuous ambulatory peritoneal dialysis (CAPD).

Three cases of "sterile" peritonitis in CAPD patients are discussed, where the predominant white cell type in the peritoneal dialysis fluid was the eosinophil. No bacterial or fungal organism was isolated on repeated culture of the dialysis fluid and all had a benign course. The eosinophilic response appears to occur very soon after starting CAPD, is relatively asymptomatic and does not require antibiotic therapy. It is suggested that the eosinophilia is related to allergy to some constituent of the peritoneal dialysis system.

Adult↗
PubMed1980

Continuous ambulatory peritoneal dialysis: one year's experience in a UK dialysis unit.

Thirty-two patients aged 8-63 years trained to manage themselves by continuous ambulatory peritoneal dialysis for end-stage renal failure achieved better steady-state serum biochemistry and much higher haemoglobin and lower serum phosphate concentrations than during treatment with haemodialysis up to one year before. Two patients, however, returned to intermittent haemodialysis because of recurrent peritonitis. Costs of the technique during the first year were less than half those incurred in the first year of home haemodialysis. Nevertheless, the major advantage was the ease with which patient independence and rehabilitation could be achieved. This technique is an appreciable advance over other forms of management for end-stage renal failure. Nevertheless, until it is more refined and long-term problems have been assessed it should probably be used only in established renal units where back-up treatments are available.

Adolescent↗
PubMed1980

Gastrin levels in chronic renal failure, hemodialysis and renal transplant patients.

Basal serum gastrin levels have been studied in chronic renal failure (CRF), hemodialysis (MHDT) and renal transplant patients. There was no significant difference between the levels in CRF and controls and between anephric and nephric MHDT patients. However, levels in transplant patients were lower than those in the other groups. There was no relationship between fasting gastrin levels and peptic ulceration in any of the groups studied. It is doubtful whether basal gastrin estimations are of much value in management of these patients.

Gastrins↗