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At least 109 records · Page 6Linked to original sources
PubMed1998

Retrograded high-amylose corn starch reduces cholic acid excretion from the small bowel in ileostomy subjects.

OBJECTIVE: To study the short-term effect of resistant starch (RS) from retrograded high-amylose corn starch (HACS) on the excretion of bile acids and nutrients from the small bowel in humans. DESIGN: Seven healthy ileostomists were given a controlled, constant diet during three days. On days 2 and 3, 100 g/d of one of two test-products--drum-dried ordinary corn starch and autoclaved retrograded HACS, providing 5 and 39 g RS/d, respectively--was given, in random order. Ileostomy effluents were collected for 24 h per day and analysed for wet weight, dry weight, energy, bile acids and nutrients. SETTINGS: In-patient study at the metabolic ward, Department of Clinical Nutrition, Sahlgrenska University Hospital, Göteborg. RESULTS: Consumption of retrograded HACS caused (1) a 42% lower mean excretion of cholic acid (P = 0.024); (2) a 42% lower mean wet weight concentration of bile acids (P < 0.001); (3) a 70% increased excretion of dry weight (P = 0.001); and (4) a 41% increased excretion of energy (P= 0.036) compared with consumption of drum-dried ordinary corn starch. CONCLUSION: The reduced ileal excretion and concentration of cholic acid would be protective regarding colon cancer risk in addition to the increased fermentation substrate provided by RS and other energy-yielding components.

Adult↗
PubMed2005

NF-kappaB in tracheal lavage fluid from intubated premature infants: association with inflammation, oxygen, and outcome.

OBJECTIVES: To determine if tracheal lavage concentrations of the transcription factor NF-kappaB, which is activated by risk factors associated with bronchopulmonary dysplasia (BPD) and induces expression of cytokines associated with BPD, is related to BPD in premature infants. DESIGN: Serial tracheal lavage samples from intubated premature infants were analysed for cell count and concentrations of interleukin (IL)8 and NF-kappaB, corrected for dilution by secretory component concentrations. SETTING: Level III university hospital neonatal intensive care unit. PATIENTS: Thirty three intubated infants (mean (SD) birth weight 903 (258) g, median gestation 27 weeks (range 24-31)) in the first 14 days of life. MAIN OUTCOME MEASURES: Tracheal effluent NF-kappaB, IL8, and cell counts, corrected for dilution by secretory component measurement. RESULTS: Square root transformed NF-kappaB concentrations were significantly related to signs of inflammation (cell count, p = 0.002; IL8, p = 0.019) and to simultaneous fraction of inspired oxygen in samples from the first 3 days of life (r = 0.512, p<0.003). Of the 32 subjects with samples in the first 3 days of life, the half who either died or had BPD had higher NF-kappaB concentrations than those without BPD (square root concentration 0.097 (0.043) v 0.062 (0.036) microg/microg protein/microg secretory component, p = 0.018). CONCLUSIONS: Tracheobronchial lavage NF-kappaB concentrations are related to lung inflammation, oxygen exposure, and pulmonary outcome in intubated preterm infants. NF-kappaB activation may be an early critical step leading to BPD.

Biomarkers↗
PubMed1976

Pseudomonas cepacia in an intensive care nursery.

A small epidemic of Pseudomonas cepacia infection in an intensive care nursery was associated with contaminated, distilled water. This appeared to have occurred because of a leak in the distiller, contaminating its effluent. The distilled water was not subsequently sterilized, nor were the bottles used to distribute it. The epidemic was promptly terminated by substitution of sterile, distilled water distributed in sterile containers. Both professional and nonprofessional hospital personnel failed to oversee the appropriateness of handling of patient care materials.

Aged↗
PubMed2004

Salt reduction in municipal sewage allocated for reuse: the outcome of a new policy in Israel.

Israel is presently reusing about 70% of its sewage and the buildup of salts in soils has been detected in some areas of the country. Prevention of sewage salt enrichment is one of the most immediately available solutions. The discharge of brines to municipal sewers is now prohibited and they are discharged to the sea. Discharge of brines to the sea has increased from 580,000 m3 in 1999 to more than 700,000 m3 in 2002. These salts are thus definitively taken out of the reuse cycle, year after year. The concentration of salts in industrial effluents is presently limited by the national water law and a unique regulation limiting the Boron and Sodium content in detergents has been implemented. Israeli industry has undergone a radical change in recent years. Many factories and all the hospitals have adopted K or Ca for softening and neutralization, while others have shifted to reverse osmosis. The concentration of Cl and Na in the sewage reaching treatment plants is declining. The addition of Cl to sewage has dropped from 120 mg/l to 70 mg/l. The average Boron concentration in sewage has dropped from 0.6 mg/l to 0.3 mg/l and should reach 0.2 mg/l by 2008.

Conservation of Natural Resources↗
PubMed1995

Splenorrhaphy for splenic damage in patients with multiple injuries.

OBJECTIVE: To evaluate the results of splenorrhaphy by a 'figure of eight' suture in patients with multiple injuries. DESIGN: Open clinical study. SETTING: University hospital, Greece. SUBJECTS: 25 patients with multiple injuries after blunt abdominal trauma, 11 of whom were children. There were 2 grade II, 20 grade III, and 3 grade IV injuries. INTERVENTIONS: Diagnostic peritoneal lavage resulted in blood-stained effluent in all cases. A 'figure of eight' suture technique with size 0 chromic catgut mounted on a hepatic needle was used. A thin layer of sterile oxidised cellulose (Surgical) was placed over the laceration and round each knot. MAIN OUTCOME MEASURES: Mortality, morbidity, incidence of reoperation, measurements of splenic function, and adequacy of repair as judged by scintigraphy, ultrasonography, and computed tomography. RESULTS: There were no deaths as a result of splenic injury. Haemorrhage from the spleen was controlled in 23 patients. The remaining two, both of whom had grade IV injuries, required ligation of the vessels of the lower pole and hemisplenectomy combined with suture. Two patients with grade III injuries bled subsequently and required splenectomy. Splenic function was good in all patients. Examination by imaging techniques showed intact and functioning splenic parenchyma. CONCLUSION: The 'figure of eight' suture technique is a safe and reasonably successful way of controlling bleeding from a damaged spleen in a patient with multiple injuries.

Abdominal Injuries↗
PubMed2000

Assessment of the effectiveness, safety, and biocompatibility of icodextrin in automated peritoneal dialysis. The Dextrin in APD in Amsterdam (DIANA) Group.

OBJECTIVE: Our study assessed the efficacy, safety, and biocompatibility of icodextrin (I) solution compared to glucose (G) solution as the daytime dwell in continuous cycling peritoneal dialysis (CCPD). DESIGN: In a randomized, open, prospective, parallel group study of two year's duration, either I or G was used for the long daytime dwell in CCPD patients. METHOD: The study was carried out in a university hospital and teaching hospital. Established CCPD patients and patients new to the modality were both included. Clinic visits were made at three-month intervals. In all patients, clinical data were gathered; ultrafiltration (UF) was recorded; and serum, urine, and dialysate samples and effluents were collected. Peritoneal defense characteristics and mesothelial markers were determined. Every six months, peritoneal kinetics studies were performed, and serum samples for icodextrin metabolites were taken. RESULTS: Thirty-eight patients (19 G, 19 I) started the study. The median follow-up was 16 months and 17 months respectively (range: 0.5 - 26 months and 3 - 26 months, respectively). Daytime UF volumes increased significantly (p < 0.001), and 24-hour UF tended to increase from baseline in the I group. Dialysate creatinine clearance increased non significantly in both groups over time. In I patients, serum disaccharides (maltose) concentration increased from 0.05+/-0.01 mg/mL [mean+/- standard error of mean (SEM)] at baseline, to an average concentration in the follow-up visits of 1.15+/- 0.04 mg/mL (p <0.001). At the same time, serum sodium levels decreased from 138.1 +/- 0.7 mmol/L to an average concentration in the follow-up visits of 135.9 +/- 0.8 mmol/L (p < 0.050). At 12 months, the serum sodium concentration increased to a non significant difference from baseline. Serum osmolality increased, but did not differ significantly from G users at any visit. During peritonitis (P), daytime dwell UF decreased significantly compared to non peritonitis (NP) episodes in G patients (p < 0.0 01), but remained stable in I patients. Total 24-hour UF also decreased in G patients (p < 0.001), but not in I patients. In these I patients, serum disaccharides increased from 0.05 +/- 0.01 mg/mL to 1.26 +/- 0.2 mg/mL during follow-up. During peritonitis, serum disaccharides concentration did not increase further (1.47 +/- 0.2 mg/mL, p= 0.56). Thirty P episodes occurred during follow-up: 16 in G patients and 14 in I patients (1 per 17.6 months and 1 per 21.9 months, respectively.) After one year, absolute number and percentage of effluent peritoneal macrophages (PM phi s) were significantly higher in I patients than in G patients. The difference in percentage persisted after two years. The phagocytic capacity of PM phi s decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci phagocytosis (p=0.005) and a significant difference for E. coli phagocytosis (p <0.05) in favor of I patients. PM phi oxidative metabolism, PM phi cytokine production, and effluent opsonic capacity remained stable over time with no difference between the groups. Mass transfer area coefficients (MTACs) and clearances were stable and appeared unaffected by G or I treatment. Effluent cancer antigen 125 (CA125) was stable in G users and tended to decrease in I users. Effluent interleukin-8 (IL-8), carboxy-terminal propeptide of type I procollagen (PICP ), and amino-terminal propeptide of type III procollagen (PIIINP) did not change over time and did not differ between the groups. CONCLUSION: The use of I for the long daytime dwell in CCPD led to an increase in total UF of at least 261 mL per day, which was maintained over at least 24 months. During I treatment, serum I metabolites increased significantly and serum sodium concentrations decreased initially. As a result, serum osmolality increased slightly. Clinical adverse effects did not accompany these findings. The UF gain in the I patients was even higher during P, without a

Adult↗
PubMed1997

Inulin and oligofructose do not influence the absorption of cholesterol, or the excretion of cholesterol, Ca, Mg, Zn, Fe, or bile acids but increases energy excretion in ileostomy subjects.

OBJECTIVE: To investigate the effects of inulin and oligofructose on cholesterol absorption and excretion of cholesterol, bile acids, energy, nitrogen and minerals in man. DESIGN: Double-blind cross-over study. SETTING: Metabolic kitchen with policlinic visits, Sahlgrenska Hospital, Göteborg, Sweden. SUBJECTS: Patients with conventional ileostomy because of ulcerative colitis. INTERVENTIONS: 7 g of inulin, 17 g of oligofructose and 7 g of sucrose were added to a controlled diet during three experimental periods of three days each. Ileostomy effluents were collected and analysed. Differences between experimental and control diet were investigated with the Wilcoxon's sign and values test. RESULTS: Inulin and oligofructose were recovered in the ileostomy effluent to 88% (95% CI, 76-100%) and 89% (64-114%) respectively. Dry solid excretion increased by 14.4 g (11.3-17.5) on inulin, and by 14.7 g (13.0-16.4 g) on oligofructose and energy excretion increased 245 kJ (190-307 kJ) on inulin and 230 kJ (214-315 kJ) on oligofructose compared to control diet (P < 0.05). Cholesterol absorption, excretion of cholesterol, bile acids, nitrogen, fat, calcium, magnesium, zinc and iron were not affected by inulin and oligofructose. CONCLUSIONS: Inulin and oligofructose are not digested in the small intestine. They do not affect mineral excretion and hence hardly mineral absorption. They do not increase fat or nitrogen excretion from the small intestine. Any physiological effect of inulin and oligofructose is probably mediated through other mechanisms than altered excretion from the small intestine.

Adult↗
PubMed1994

Urea removal during continuous hemodiafiltration.

OBJECTIVE: To compare urea nitrogen removal by continuous hemodiafiltration vs. functional native kidneys in critically ill, septic patients receiving > 2 g of amino acids/kg body weight per day. DESIGN: Prospective, comparative, unblinded study. SETTING: Trauma critical care units of a Level I adult trauma hospital. PATIENTS: Fifteen septic patients with multiple organ failure including renal failure who were receiving continuous hemodiafiltration; 11 septic patients with multiple organ failure without renal failure (control group). Ages of patients ranged from 18 to 60 yrs. INTERVENTIONS: Collection of effluent (dialysate + ultrafiltrate) from hemodiafilters. Collection of urine from control patients. MEASUREMENTS: Urea nitrogen and creatinine concentrations in blood, urine, and the hemodiafiltration effluent, measured every 24 hrs for 6 days. Effluent and urine volumes were measured. MAIN RESULTS: Hemodiafilters were operational for 21.8 +/- 3.0 hrs/day. Mean urea nitrogen removal in the renal failure group was 28 +/- 10 g/day. Blood urea nitrogen was stable over the 6-day study period. In control subjects, urea nitrogen removal was 27 +/- 9 g/day, which was not significantly different from the continuous hemodiafiltration group. Blood urea nitrogen concentrations in control patients increased over the 6-day study period (p < .05). Urea nitrogen removal correlated moderately well with amino acid intake in the control group (r2 = .30), but not in the continuous hemodiafiltration group (r2 = .0004). In patients receiving continuous hemodiafiltration, effluent volume was most significantly correlated with urea nitrogen removal (r2 = .69). CONCLUSIONS: The technique of continuous hemodiafiltration can remove substantial amounts of urea nitrogen, similar to that of normal native kidneys. In addition, at amino acid intake rates of > 2 g/kg body weight/day, urea nitrogen removal during continuous hemodiafiltration remains a function of effluent volume, so there is no need to restrict amino acid intake in acute renal failure patients supported with continuous hemodiafiltration.

Acute Kidney Injury↗
PubMed1998

Did Milwaukee experience waterborne cryptosporidiosis before the large documented outbreak in 1993?

The patterns of incidence and pathways of spread for cryptosporidiosis are poorly understood. In this study, we explored the possibility that drinking water caused significant waterborne cryptosporidiosis in Milwaukee well before the massive documented outbreak in April 1993. We generated time series of daily counts of emergency room visits and hospital admissions for gastroenteritis in Milwaukee using the billing records of the Medical College of Wisconsin for January 1, 1992, through May 3, 1993. The Milwaukee Water Works provided us with data on drinking water turbidity for the same period. The service area of the South Plant experienced a sharp rise in turbidity just before the outbreak. During the outbreak period, gastroenteritis events were most strongly associated with turbidity at a lag of 7 days in children and 8 days in adults. It is reasonable to conclude that these lag times reflect the incubation period of Cryptosporidium. During the 434 days before the outbreak, gastroenteritis events were most strongly associated with turbidity at a lag of 8 days among children and 9 days among adults in the service area of the North Plant, the plant that experienced the highest effluent turbidity during this period. These findings are consistent with the conclusion that waterborne cryptosporidiosis was occurring in Milwaukee for more than a year before the documented outbreak.

Adult↗
PubMed1981

Peritoneal dialysis fluid as a source of hepatitis antigen.

An epidemic of HBsAg positive hepatitis involving the dialysis unit of the Seattle Veterans Administration Medical Center is described. 6 patients and 4 staff members were affected: there were four patient deaths. The source of HBsAg was identified as a chronic in-center peritoneal dialysis patient in whom both serum and peritoneal fluid were persistently HBsAg positive. Surveillance data documented heavy population exposure to HBsAg at the time of this patient's presence in the dialysis setting. We have subsequently identified 2 other patients with HBsAg positive peritoneal effluent. Peritoneal dialysis of HBsAg positive individuals represents a significant risk for the transmission of HBsAg and clinical hepatitis.

Carrier State↗
PubMedDate not supplied

Selenium metabolism in patients on continuous ambulatory peritoneal dialysis.

BACKGROUND: Selenium is an essential trace element for living organisms. In many publications, researchers express concern about a possible Se deficiency in patients with end-stage chronic renal failure (ESCRF) undergoing continuous ambulatory peritoneal dialysis (CAPD). However, in a number of published articles, the data provide no evidence that patients under CAPD develop Se deficiency. OBJECTIVE: We investigated Se metabolism in ESCRF patients on CAPD. SETTING: The study was carried out at the Department of Propaedeutic Surgery, Athens University; the Laboratory for Material Analysis of the Nuclear Physics Institute; and the State General Hospital, Athens, Greece. PATIENTS AND METHODS: The study group included 24 patients on CAPD treatment, 14 ESCRF patients, and 17 healthy controls. We measured the Se and Fe content of serum, blood, and erythrocytes. We also measured hematocrit, serum total proteins and albumins, and Se in dialysate effluent. RESULTS: As compared with healthy subjects, the ESCRF and CAPD patients exhibited reduced serum concentrations of Se. However, considering the difference in hematocrit values, the total serum-transported Se per liter of blood was close to normal. Erythrocyte Se proved normal for both groups. The measured Se in the spent effluent indicates that patients under CAPD receive approximately 100 microg Se from their daily diet, as normal subjects do. The Se measurement data from the effluent indicate that 90% of the Se carried by the serum is bound to albumins and that only the remaining 10% is in the form of low molecular weight selenate, free to pass the peritoneal membrane. Of the 24 CAPD patients studied, 4 patients (all women) showed extremely low Se serum levels. Data suggest that those low levels are more likely due to the significantly lower serum albumin levels in the 4 patients than to an insufficient dietary intake. CONCLUSIONS: Data from the present experimental work suggest that patients undergoing CAPD receive the necessary quantities of Se from their regular diet. The data contradict statements in the relevant literature that CAPD patients develop Se deficiency.

Adult↗
PubMed2002

Diagnostic peritoneal lavage in the evaluation of abdominal trauma using the dipstick.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

Abdominal Injuries↗
PubMed1990

Anatomic considerations in extraperitoneal approach to radical nephrectomy.

The interrelationship between the lateral and posterior portions of the peritoneum and Gerota's fascia allows them to be separated from each other, permitting ready visualization of the major renal vessels. The posterior relationship between Gerota's fascia and the transversalis fascia overlying the more posterior psoas muscle can be used to advantage in exposing the renal vessels posteriorly. That the fascial layers defining the retroperitoneal spaces might therefore be used in dissecting the renal hilum and vessels in the performance of radical nephrectomy prompted the present investigation. Twenty patients underwent this approach for radical nephrectomy for varying stages of renal cell carcinoma involving either upper, mid, or lower portion of right or left kidney. Postoperative recovery appeared to be shortened because of the lesser interval of ileus than had previously been encountered using a transperitoneal approach. Despite the minimal manipulation of the kidney prior to ligation of the renal vessels, there was no apparent increased tumor dissemination as detected clinically, and experimentally there appeared to be no increase in tumor cells in the venous effluent. Operative time, blood loss, and postoperative complications were comparable to those reported for the transperitoneal approach. This means of performing radical nephrectomy, based on the relationship of fascial layers in the retroperitoneum thus appeared to lend itself to easier dissection as well as lesser postoperative ileus and corresponding shorter hospital stays.

Abdomen↗
PubMed1992

Intraperitoneal administration of phosphatidylcholine improves ultrafiltration in continuous ambulatory peritoneal dialysis patients.

Reports in the literature have linked a low phosphatidylcholine content in continuous ambulatory peritoneal dialysis (CAPD) effluent to ultrafiltration loss. Clinical evidence suggests that adding phosphatidylcholine to the dialysis solution enhances ultrafiltration. A clinical study has been designed to clarify the effect of phosphatidylcholine on ultrafiltration in CAPD patients with normal ultrafiltration. A weekly measurement of the peritoneal equilibration test was conducted per patient in the hospital. A comparison between the control dialysis solution (three-week period) and the phosphatidylcholine premixed solution (three-week period) was performed on a total of 12 patients. This study shows that a phosphatidylcholine premixed dialysis solution significantly enhances ultrafiltration. Since ultrafiltration per osmotic driving force (mL/g glucose) is enhanced, the patient's glucose load per day is reduced to achieve equal ultrafiltration. In the presence of phosphatidylcholine, peritoneal permeability remained unchanged, as indicated by membrane transport characteristics. No side effects were observed.

Biological Transport↗
PubMed1994

An outbreak of fatal fluoride intoxication in a long-term hemodialysis unit.

OBJECTIVE: To determine the cause of an outbreak of acute illness and death in a long-term hemodialysis unit. DESIGN: A retrospective cohort and case-control study of patients receiving hemodialysis and a laboratory study of a model deionization system to purify water for hemodialysis. SETTING: An outpatient hemodialysis unit of a university hospital. PATIENTS: 12 patients who became severely ill after hemodialysis treatment and 20 patients who did not become ill after receiving hemodialysis treatment in the same unit. MEASUREMENTS: Medical and dialysis unit records were reviewed to identify and characterize cases. Fluids for dialysis were tested for toxic substances, and fluoride was measured in patients' serum. Resistivity and fluoride were measured in effluent from a model deionization system operated in the same way as the system associated with illness. RESULTS: During five consecutive hemodialysis shifts, 12 of 15 patients receiving dialysis treatment in one room became acutely ill, with severe pruritus, multiple nonspecific symptoms, and/or fatal ventricular fibrillation (3 patients). None of 17 patients treated in the adjacent room became ill (P < 0.0001). Death was associated with longer hemodialysis time and increased age compared with other patients who became ill. Serum concentrations of fluoride in the sick patients were markedly increased to as high as 716 mumol/L, and the source of fluoride was the temporary deionization system used to purify water for hemodialysis only in the affected room. Operation of a model deionization system showed how fluoride was adsorbed and then displaced in a massive efflux. CONCLUSIONS: Because deionization systems are used widely in hemodialysis and can cause fatal fluoride intoxication, careful design and monitoring are essential.

Adult↗
PubMed2005

Argatroban and renal replacement therapy in patients with heparin-induced thrombocytopenia.

BACKGROUND: Argatroban, a direct thrombin inhibitor, is an effective anticoagulant for patients who have heparin-induced thrombocytopenia (HIT). Anticoagulation is usually required for renal replacement therapy (RRT). OBJECTIVE: To prospectively evaluate the pharmacokinetics, pharmacodynamics, and safety of argatroban during RRT in hospitalized patients with or at risk for HIT. METHODS: Five patients with known or suspected HIT underwent hemodialysis (n = 4) or continuous venovenous hemofiltration (CVVH, n = 1), while receiving a continuous infusion of argatroban 0.5-2 microg/kg/min. Activated partial thromboplastin times (aPTTs), activated clotting times (ACTs), argatroban concentrations (plasma, dialysate, CVVH effluent), and safety were assessed before, during, and after a 4-hour session of RRT. Systemic and dialytic argatroban clearances were calculated. RESULTS: Among the 4 hemodialysis patients, aPTT, ACT, and plasma argatroban concentrations remained stable during RRT, with respective mean +/- SD values of 74.3 +/- 34.2 seconds, 198 +/- 23 seconds, and 499 +/- 353 ng/mL before RRT, and 70.6 +/- 21.4 seconds, 181 +/- 12 seconds, and 453 +/- 295 ng/mL 2 hours after starting RRT (p values NS). Systemic clearance was 17.7 +/- 12.8 L/h before hemodialysis and 17.0 +/- 9.5 L/h during hemodialysis (n = 2). The dialyzer clearance (dialysate recovery method) was 1.5 +/- 0.4 L/h (n = 4). Generally similar responses occurred in the CVVH patient: systemic argatroban clearance was 4.8 L/h before CVVH and 4 L/h during CVVH. The hemofilter argatroban clearance was 0.9 L/h. No bleeding or thrombosis occurred. CONCLUSIONS: Argatroban provides effective alternative anticoagulation in patients with or at risk for HIT during RRT. Argatroban clearance by high-flux membranes during hemodialysis and CVVH is clinically insignificant, necessitating no dose adjustment.

Adult↗
PubMed1980

Peritonitis during continuous ambulatory peritoneal dialysis.

We initiated a therapeutic program of continuous ambulatory peritoneal dialysis for patients with chronic renal failure. Our program resulted in many episodes of peritonitis arising from contamination due to the technical aspects of the procedure. Microbiologic evaluation showed that 73% of 97 episodes were culture positive, with gram-positive organisms causing most of the cases, especially early in dialysis. Gram-negative rods tended to occur later. Gram stains of dialysate effluent resulted in a disappointingly low yield of only 9% positivity. Cell counts were a dependable indicator of the presence of peritoneal inflammation and also of therapeutic success. Most patients responded well to intraperitoneal cephalothin, 125 mg/L for 10 to 14 d. The occurrence of peritonitis resulted in 0.93 years of hospitalization during the total of 15.45 patient-years on dialysis, which essentially negated the financial advantages of this method of treatment of chronic renal failure. For this to be a successful mode of therapy, advances in the prevention of peritonitis must be made.

Adult↗
PubMed1996

Validation of an automatic urea analyser used in the continuous monitoring of hemodialysis parameters.

The validation of an automatic urea analyser used in the monitoring of hemodialysis processes is reported. The analyser can indirectly determine dialysis parameters as dialysis delivery (KT/V) and protein catabolism (PCRn). These parameters are useful for the prescription and optimization of hemodialysis. The analyser, based on a previously-reported flow-injection analytical biosystem, was connected on-line to the effluent of a dialysis machine during several hemodialysis sessions. The urea concentration data were continuously processed and dialysis parameters were obtained in quasi real time by means of the integration of an adjusted time-dependent exponential function. These values were compared with those obtained by applying the methods traditionally employed in hospital laboratories. The evaluation comprised 24 data sets from several patients of different gender and age. No significant differences were found between the KT/V and PCRn results obtained with the usual method and those results produced by the analyser proposed here.

Humans↗