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PubMed1993

Poor response to oral ciprofloxacin in the treatment of peritonitis in patients on intermittent peritoneal dialysis.

OBJECTIVES: To assess the clinical value of oral ciprofloxacin in the treatment of peritonitis in an intermittent peritoneal dialysis (IPD) population. DESIGN: Open nonrandomized prospective study. SETTING: Nephrology Peritoneal Dialysis Unit in a tertiary care, teaching hospital of the University of Toronto. PATIENTS: Subjects were participants of the IPD program with an acute episode of peritonitis defined as at least two of the following: 1. signs and symptoms of peritonitis, 2. cloudy peritoneal fluid with a white blood cell count of > 100/microL, 3. demonstration of bacteria in peritoneal effluent by gram stain or culture. Ten patients were enrolled in the study, but two were withdrawn because of side effects and growth of a resistant bacteria. INTERVENTIONS: Ciprofloxacin 750 mg po q12h for 2 doses, then 750 mg daily or 500 mg twice daily for 10 days. MAIN OUTCOME MEASURES: Efficacy was determined by clinical and microbiological assessment. Cure was defined as resolution of signs and symptoms with eradication of the causative organism. Peritoneal effluent and blood samples were analyzed for ciprofloxacin concentration. RESULTS: Ciprofloxacin was effective in treating only one of ten episodes of peritonitis. Seven patients were defined as microbiological failures (persistence or relapse of organisms). The signs and symptoms of peritonitis improved in 2 patients, but the remaining 5 failed clinically. Only Gram-positive organisms were cultured. CONCLUSIONS: Ciprofloxacin cannot be recommended for the treatment of intermittent peritoneal dialysis-related Gram-positive bacterial peritonitis.

Acute Disease↗
PubMed1992

Microbial growth and blockage of sub-floor drains in a renal dialysis centre: a problem highlighted.

The accumulation of microorganisms embedded in biofilm within the drainage pipework leading from individual dialysis monitors in a renal dialysis centre, represents a significant threat to the safe operation of the whole centre due to blockage of the pipes and overflow of waste water. Attempts to disperse the growth with chemicals and disinfectants have been unsuccessful. Only mechanical rodding has removed the deposit, and regrowth has occurred. Those planning new dialysis centres should ensure that effluent pipework is readily accessible with multiple rodding eyes and is made of material able to withstand rodding and chemicals.

Bacteria↗
PubMedDate not supplied

Objective determination of the optimal red blood cell count in diagnostic peritoneal lavage done for abdominal stab wounds.

The purpose of this study was to determine objectively the optimal value or positivity criterion for red blood cell counts in diagnostic peritoneal lavage in stab wounds to the anterior abdomen. Our study group consisted of 91 consecutive adults with abdominal stab wounds who underwent peritoneal lavage. We excluded those patients who met criteria for immediate laparotomy and those with negative stab wound exploration. We divided the patients into two groups based on outcome. Group 1 consisted of those who had undergone laparotomy and had findings that required surgical intervention. Group 2 patients had either undergone laparotomy but had no injury requiring surgical intervention or had no surgery and a benign hospital course and follow-up. Receiver operator characteristic analysis was done on the diagnostic peritoneal lavage RBC counts for both groups. The overlap between the groups was minimal, with 75% of patients in Group 1 having > 120,000 RBC/mm3 and 75% of patients in Group 2 having < 486 RBC/mm3 in the lavage effluent. Using the observed probability of 23.1% of patients with abdominal stab wounds requiring surgery, a RBC count of 50,000/mm3 discriminated best those patients who required surgery from those who did not.

Abdominal Injuries↗
PubMed2000

Concentration of atmospheric pollutants in the gaseous emissions of medical waste incinerators.

The purpose of this paper is to quantify the production of medical waste from a general hospital and to evaluate the atmospheric pollutant concentrations in gaseous emissions associated with its incineration. A 3.8 kg (bed.day)-1 production of medical waste was estimated for 1998; its incineration is related with an ash production of 0.3-0.4 kg (bed.day)-1. The concentrations of atmospheric pollutants were estimated using emission factors, comparing the effluents with and without control of atmospheric pollutants. The calculated concentrations were compared with the emission limits established by Portuguese legislation. The results indicate that, if there is no control of atmospheric pollutants, their concentrations exceed the established limits. This is observed even if correct operation and maintenance procedures are used. The emission concentrations of dioxins are higher than the Portuguese emission limit, which is particularly worrying due to the high toxicity of some of these compounds. Generally, it is possible to reduce pollutant concentrations if appropriate control equipment is used. The conclusions obtained clearly justify the great concern regarding air pollution associated with medical waste incinerators currently operating in Portugal.

Air Pollutants, Occupational↗
PubMed2004

Bioavailability of selenium from bovine milk as assessed in subjects with ileostomy.

OBJECTIVE: To assess the absorption of dietary selenium in humans, especially of milk selenium. DESIGN: : 1-day meal studies in subjects with ileostomy. SETTING: Hospital outpatient clinics. SUBJECTS: Three subjects in the pilot study and nine subjects in the main study (eight men/ four women). INTERVENTION: Different beverages, 1 l/day, were given in addition to basal diets (soft drink, 1 week; low-fat milk, 3 weeks; fermented low-fat milk, 3 weeks and soft drink, 1 week). Ileostomy effluents were collected during the last 2 days in each of the four periods. RESULTS: On days when the subjects were given 1 l of low-fat milk, the estimated fractional absorption of total dietary selenium was 65.5 (2.3)% (mean (s.d.), n=18), which was similar to the value when fermented low-fat milk was given (64.1 (3.2)%). However, both the calculated amount of milk selenium absorbed (10.9 (2.4) vs 9.4 (1.7) microg selenium) and its fractional absorption (73.3 (16.1) vs 64.1 (11.2)%, n=18) were significantly higher for milk than for fermented milk. CONCLUSIONS: Selenium from milk and other sources is well absorbed in subjects with ileostomy. The real absorption may be even higher than the values shown.

Adult↗
PubMed2001

Pharmacokinetics of ciprofloxacin in ICU patients on continuous veno-venous haemodiafiltration.

OBJECTIVES: To investigate the pharmacokinetics of intravenous ciprofloxacin 200 mg every 8 h in critically ill patients on continuous veno-venous haemodiafiltration (CVVHDF), one form of continuous renal replacement therapy (CRRT). DESIGN AND SETTING: Open, prospective clinical study in a multidisciplinary, intensive care unit in a university-affiliated tertiary referral hospital. PATIENTS: Six critically ill patients with acute renal failure on CVVHDF. INTERVENTIONS: Timed blood and ultrafiltrate samples were collected to allow pharmacokinetics and clearances to be calculated of initial and subsequent doses of 200 mg intravenous ciprofloxacin. CVVHD was performed with 1 l/h of dialysate and 2 l/h of predilution filtration solution, producing 3 l/h of dialysis effluent. The blood was pumped at 200 ml/min using a Gambro BMM-10 blood pump through a Hospal AN69HF haemofilter. MEASUREMENTS AND RESULTS: Ten pharmacokinetic profiles were measured. The CVVHDF displayed a urea clearance of 42 +/- 3 ml/min, and removed ciprofloxacin with a clearance of 37 +/- 7 ml/min. This rate was 2-2.5 greater than previously published for ciprofloxacin in other forms of CRRT. On average the CVVHDF was responsible for clearing a fifth of all ciprofloxacin eliminated (21 +/- 10%). The total body clearance of ciprofloxacin was 12.2 +/- 4.3 l/h. The trough concentration following the initial dose was 0.7 +/- 0.3 mg/l. The area under the plasma concentration time curves over a 24-h period ranged from 21 to 55 mg.h l-1. CONCLUSIONS: Intravenous ciprofloxacin 600 mg/day in critically ill patients using this form of CRRT produced adequate plasma levels for many resistant microbes found in intensive care units.

Acute Kidney Injury↗
PubMed2004

Severe acute respiratory syndrome in dialysis patients.

Reviewed are the clinical features and outcome of 12 chronic dialysis patients (six men) who contracted severe acute respiratory syndrome (SARS) compared with 23 sex- and age-matched nonuremic SARS patients as controls. Eight were on peritoneal dialysis (PD) and four on hemodialysis. Mean age was 58 +/- 12 yr for the dialysis patients, and 57 +/- 12 yr for the controls. The presenting symptoms of dialysis patients were similar to the controls. With appropriate protection measures, hemodialysis was performed in a dedicated area of the SARS isolation ward, while PD was continued as intermittent PD. In all seven patients with PD effluent tested, SARS-related coronavirus (CoV) could not be identified by polymerase chain reaction (PCR) or viral culture. Three dialysis patients had persistent positive stool PCR after 5 wk, whereas all nondialysis patients had negative stool PCR after 1 wk. Despite dosage adjustment, ribavirin-induced hemolytic anemia was more severe in the dialysis patients. Dialysis patients required longer hospitalization than the controls, but the mortality was similar. With appropriate protective measures, dialysis could be safely performed. Dialysis patients with SARS often require prolonged hospitalization. Furthermore, these patients may have an extended period of viral shedding, which should be carefully monitored for the purpose of infection control.

Aged↗
PubMed1994

Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction.

BACKGROUND: Age is a predictor of cognitive dysfunction after cardiac surgery, but the mechanism is unknown. The purpose of our study was to determine whether age-related decrements in cognition are associated with cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB). METHODS AND RESULTS: Cognitive function testing was completed before surgery and before hospital discharge in 215 patients undergoing elective coronary artery bypass grafting (CABG) surgery. The battery consisted of seven tests with nine measures designed to evaluate memory, mood changes, and visuomotor speed and function. Pressure-flow and metabolic-flow cerebral autoregulation during hypothermic cardiopulmonary bypass were determined using the 133Xe clearance CBF method and radial artery and jugular bulb effluent to calculate cerebral metabolic rate (CMRO2) and cerebral AV difference (C[AV]O2). Pressure-flow autoregulation was tested by using two CBF measurements at stable hypothermia: one at stable mean arterial pressure (MAP) and the second 15 minutes later when MAP had increased or decreased > or = 20%. Metabolism-flow autoregulation was tested by varying the temperature (CMRO2) and measuring the coupling of CBF and CMRO2. Individual patient autoregulation was correlated with changes in cognitive measures. Cognitive performance declined in 6 of 9 measures after CABG surgery. Age predicted cognitive decline in 7 of 9 measures; short-term memory showed the greatest effect of age. Pressure-flow autoregulation during hypothermic CPB showed a small but significant (P < .0001) effect of pressure on CBF. There was no effect of age on the slope of CBF response to changes in MAP (pressure-flow autoregulation). There was a major effect of temperature on CBF during CPB (P < .0001). Coupling CBF and CMRO2 with changing temperature was unaffected by age. Changes in cognition were not associated with measures of cerebral autoregulation. However, increasing C(AV)O2 is associated with cognitive deficits in 5 of 9 measures; these associations were independent of age. CONCLUSIONS: Increased age predisposes to impaired cognition after cardiac surgery. This decline in cognitive function in the elderly is not associated with age-related changes in cerebral blood flow autoregulation. The association of increased oxygen extraction with decline in some measures of cognitive function suggests that an imbalance in cerebral tissue oxygen supply, which is unrelated to age, contributes to acute cognitive dysfunction after cardiac surgery. Cognitive dysfunction after CPB in the elderly cannot be explained by impaired CBF autoregulation.

Aging↗
PubMed1991

Treatment and disposal of clinical and laboratory waste.

There are no entirely satisfactory definitions of clinical waste; nor are there methods in general use that are safe and environmentally acceptable for the storage, transport and final disposal of the ever-increasing volume of such waste that is generated by the health services. Hazardous, potentially infectious and aesthetically objectionable waste has been found on beaches and exposed on domestic refuse landfill sites, causing public disquiet about health hazards and environmental pollution. Landfill is officially discouraged, where not illegal, and many older-type incinerators can not now be used because their effluent pollutes the atmosphere. Modern and efficient incinerators are expensive and the parochial nature of health service management and accounting mitigates against their installation and use. Laboratory waste, however, can be rendered safe and unobjectionable, aesthetically and environmentally, if the requirements and recommendations of the several Codes of Practice and technical advice, which are simple and inexpensive, are implemented by laboratory and hospital managers.

Hazardous Waste↗
PubMed1999

Hepatic and splanchnic oxygenation during liver transplantation.

OBJECTIVE: To evaluate hepatic and splanchnic oxygenation during liver transplantation. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Ten adult patients undergoing liver transplantation. INTERVENTIONS: Standardized surgery and anesthesia without venovenous bypass. MEASUREMENTS AND MAIN RESULTS: Hepatic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in hepatic venous blood. Splanchnic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in portal venous blood and by gastric tonometry. Before reperfusion, the grafts were flushed with 1000 mL of acetated Ringer's solution and 400 mL of portal venous blood. The effluent blood from the graft was wasted and showed a mean pH of 6.86 and a lactate concentration of 9.4 mmol/L. Five minutes after portal reperfusion, most of the grafts produced lactate. Portal-hepatic venous P(CO2) difference ranged from 3 to 16 torr (0.4-2.1 kPa). By the time of restoration of the infrahepatic caval flow mean 24 mins later, eight of the grafts had stopped producing lactate. Mean hepatic venous oxygen tension was 47 torr (6.3 kPa), stabilizing to 41 torr (5.5 kPa) at the end of surgery. Acidosis resolved without pharmacologic interventions. Mean gastric mucosal pH was 7.29 during the anhepatic phase and 7.40 at the end of surgery. One of the patients developed hepatic arterial thrombosis intraoperatively. Her data were analyzed separately. Later, the other patients recovered with good liver function, whereas the patient with hepatic arterial thrombosis was successfully retransplanted. CONCLUSIONS: The liver grafts received well-oxygenated portal venous blood during reperfusion, despite the low values of gastric mucosal pH immediately before reperfusion. Hepatic oxygenation became adequate soon after reperfusion. In the patient with hepatic arterial thrombosis, the recovery of hepatic oxygenation was impaired and lactic acidosis persisted.

Adult↗
PubMedDate not supplied

Influence of plasticizer-free CAPD bags and tubings on serum, urine, and dialysate levels of phthalic acid esters in CAPD patients.

OBJECTIVES: To evaluate the impact of a plasticizer-free device on exposure to di-(2-ethylhexyl) phthalate (DEHP) and its major metabolites in patients on continuous ambulatory peritoneal dialysis (CAPD). DEHP is the most commonly used plasticizer in polyvinyl chloride (PVC) products; it is added to CAPD bags in order to improve the flexibility of the material. Since DEHP leaches out of the plastic matrix, patients on CAPD are exposed to considerable amounts of DEHP and its metabolites. DESIGN: A prospective cross-over study. SETTING: Department of nephrology in a teaching hospital. PARTICIPANTS: Six patients (4 female, 2 male) stable on peritoneal dialysis (PD) for at least 6 months. INTERVENTIONS: Patients were switched from a plasticizer-containing PVC CAPD system (A.N.D.Y. Plus, Fresenius Medical Care, Bad Homburg, Germany) to a polyolefine-made plasticizer-free system (stay-safe, Fresenius). MAIN OUTCOME MEASURES: Prior to and 42 days after the switch, 24-hour effluent dialysate and urine collections were performed and 10 mL blood was drawn. Concentrations of DEHP, mono-(2-ethylhexyl) phthalate (MEHP), phthalic acid (PA), and 2-ethylhexanol (2-EH) in urine, dialysate, and serum were determined using gas chromatography/mass spectrometry. RESULTS: Complete data were obtained from 5 patients. Serum levels of PA decreased significantly during the study period (0.137 +/- 0.078 mg/L vs 0.124 +/- 0.049 mg/L, p = 0.04), and the respective levels of DEHP decreased insignificantly (0.097 +/- 0.076 mg/L vs 0.069 +/- 0.046 mg/L, p = 0.07), whereas the concentrations of MEHP and 2-EH remained unchanged. Urine concentrations of PA were high (0.81 +/- 0.69 mg/L) but did not change substantially (0.70 +/- 0.50 mg/L). Effluent dialysate concentrations of MEHP and PA decreased significantly (0.0176 +/- 0.004 mg/L vs 0.0040 +/- 0.0007 mg/L, p = 0.043 and 0.158 +/- 0.056 mg/L vs 0.111 +/- 0.051 mg/L, p = 0.043, respectively). CONCLUSIONS: Although PD patients seem to be exposed to other sources of phthalates in addition to dialysis, use of plasticizer-free devices may help to reduce potentially immunosuppressive exposure to phthalate esters.

Adolescent↗
PubMed2005

Efficient and quick inactivation of SARS coronavirus and other microbes exposed to the surfaces of some metal catalysts.

OBJECTIVE: To study the two metal catalysts Ag/Al2O3 and Cu/Al2O3 that interdict the transmission pathway for SARS and other respiratory infectious diseases. METHODS: Two metal catalysts Ag/Al2O3 and Cu/Al2O3 were pressed into wafers. One hundred microL 10(6) TCID50/mL SARS-CoV, 100 microL 10(6) PFU/mL recombinant baculovirus expressing hamster's prion protein (haPrP) protein and roughly 10(6) E. coli were slowly dropped onto the surfaces of the catalyst wafers and exposed for 5 and 20 min, respectively. After eluted from the surfaces of wafers, the infectivity of viruses and propagation of bacteria were measured. The expression of PrP protein was determined by Western blot. The morphological changes of bacteria were observed by electronic microscopy. RESULTS: After exposure to the catalysts surfaces for 5 and 20 min, the infectivity of SARS-CoV in Vero cells and baculovirus in Sf9 cells dropped down to a very low and undetectable level, and no colony was detected using bacteria culture method. The expression of haPrP protein reduced to 21.8% in the preparation of Sf9 cells infected with recombinant baculovirus exposed for 5 min and was undetectable exposed for 20 min. Bacterial membranes seemed to be cracked and the cytoplasm seemed to be effluent from cell bodies. CONCLUSION: Exposures to the surfaces of Ag/Al2O3 and Cu/Al2O3 destroy the replication and propagation abilities of SARS-CoV, baculovirus and E. coli. Inactivation ability of metal catalysts needs to interact with air, utilizing oxygen molecules in air. Efficiently killing viruses and bacteria on the surfaces of the two metal catalysts has a promising potential for air-disinfection in hospitals, communities, and households.

Aluminum Oxide↗
PubMed1999

Time-dependent efficacy of initial reperfusion with 2,3 butanedione monoxime (BDM) on release of cytosolic enzymes and ultrastructural damage in isolated hearts.

BACKGROUND: Reperfusion injury after cardioplegia may not be sufficiently addressed by conventional cardioplegic techniques in open heart surgery. 2,3-butanedione monoxime (BDM) has the potential to reduce myocardial reperfusion injury by uncoupling myocyte contraction from the intracellular calcium concentration, thus reducing reperfusion contracture. The aim of this study was to investigate the effects of different application periods of BDM during initial reperfusion on myocardial tissue injury after cardioplegia. METHODS: Isolated guinea-pig hearts underwent 50 min of cardioplegic arrest in St. Thomas' Hospital II solution at 37 C. Control hearts (n = 8) were immediately reperfused with normal Krebs-Henseleit solution for 30 min. In the therapy groups BDM-5, BDM-20, and BDM-40 (n = 8, each), hearts were initially reperfused with BDM (20mmol/L) for either 5, 20, or 40 min, respectively, followed by 30 min of reperfusion with normal Krebs-Henseleit solution. Coronary venous effluent was collected to estimate myocardial tissue damage through release of cytosolic enzymes (LDH and CK) and cardiac troponin 1. Ultrastructural alterations were qualitatively assessed by electron microscopy. RESULTS: Initial reperfusion with BDM markedly reduced LDH and CK release, as long as BDM was present. After washout of the protective agent a rebound of enzyme release occurred in BDM-5 hearts which was effectively reduced in BDM-20 and BDM-40 hearts. Troponin I release was similarly increased in all groups at the onset of reperfusion and rapidly decreased thereafter. Myocardial ultrastructural damage was most pronounced in control hearts, intermediate in BDM-5 and BDM-40 hearts, but markedly attenuated in BDM-20 hearts. CONCLUSIONS: Both 20 and 40 min of initial reperfusion effectively protected the hearts from reperfusion damage as indicated by cytosolic enzyme release, while 5 min of treatment were clearly insufficient. Toxic effects of BDM during the longer treatment period of 40 min or induction of edema by the long-term perfusion of non-beating hearts in this group may account for the worse preservation of myocardial ultrastructure in BDM-40 hearts. Thus, contraction uncoupling during initial reperfusion by BDM or similarly acting drugs may prove a viable principle for reduction of myocardial reperfusion injury. However, the ideal duration of treatment for the best therapeutic effect must be carefully evaluated.

Animals↗
PubMed1999

Mycobacterium fortuitum peritonitis in two patients receiving continuous ambulatory peritoneal dialysis.

We present two cases of non-resolving peritonitis treated with a standard peritonitis protocol. The organism identified from the peritoneal effluent was Mycobacterium fortuitum, a group IV (Runyon's classification) rapidly growing, nontuberculous mycobacterium. M. fortuitum is ubiquitous and can be isolated from a number of natural sources. Risk factors these two patients had for developing M. fortuitum peritonitis included underdialysis, the immunocompromised state associated with end stage renal disease, prior or prolonged broad spectrum antibiotic treatment, and possible exposure to environmental factors, since both were hospitalized at about the same time. The isolates were resistant to the conventional antibiotics recommended for the treatment of this mycobacterium. Both patients, however, responded to catheter removal and antibiotics administered according to the sensitivities of the mycobacterium isolated.

Adult↗
PubMed1993

Kinetic modelling and underdialysis in CAPD patients.

Kinetic analysis was performed in all 58 patients undergoing standard CAPD. The urea distribution volume was estimated from anthropomorphic measurements (Watson formulae). Normalized protein catabolic rate (NPCR), daily protein leak (PL), urea and creatinine Kt/Vs, clearances and peritoneal mass transfer coefficients (Kp) were calculated from measurements on serum, 24-h urine and PD fluid effluent. The mean total (renal+PD) daily creatinine and urea Kt/Vs (KT/V) were 0.31 (range 0.15-0.79) and 0.31 (0.18-0.65). There was no relationship between KT/V and serum urea or Kp. The strongest determinant of the urea KT/V was the residual renal urea clearance (KrU)(R = 0.79, P < 0.001) which decreased with time on dialysis (R = -0.38, P < 0.005). There was a significant correlation between the hospital admissions per year and both the urea and creatinine KT/V and KrU (R = -0.30, -0.32, P < 0.05). Patients with urea KT/V < 0.25 (n = 22) had more hospital admissions/year than those with KT/V > 0.25 (mean of 2.6 versus 1.5, P < 0.05). NPCR correlated with urea KT/V (R = 0.62, P < 0.001) but not with serum albumin or the PL. Patients identified by UKM to be less well dialysed have a lower residual renal function and are more likely to be hospitalized. Undernutrition in CAPD patients appears to be related to underdialysis rather than protein loss.

Creatinine↗
PubMed2006

The usefulness of drain data to identify a clinically relevant pancreatic anastomotic leak after pancreaticoduodenectomy?

Pancreatic anastomotic leak (leak) remains a persistent problem after pancreaticoduodenectomy (PD). Recent reports indicate a mean occurrence of 10% with a range of 2%-28% of patients. However, valid comparisons for these studies cannot be made because the definition of leak is variable, and many patients deemed to have a leak are not sick. The aim of this study was to determine the meaning of the volume and amylase content of the effluent from surgical drains by comparing these values to actual clinical outcomes. From January 1996 to July 2002, 207 consecutive patients underwent PD. We considered a leak to be present if greater than 30 ml/day of drainage was observed from drains and if that drainage contained an amylase-rich fluid (greater than 5X serum) on or after postoperative day (POD) 5. Cases were then divided into three groups-no leak, chemical leak only (leak but asymptomatic), and a clinical leak group (leak that required therapeutic intervention, reoperation, readmission, or prolonged length of stay). Then the drainage volume and its amylase concentration for every postoperative day were compared between the three groups. There were no operative or hospital deaths, and the mean length of stay (LOS) was 11.2 +/- 6.1 days. Prolonged LOS was set at greater than 17 days (one standard deviation beyond the mean LOS for all cases). Leak was observed in 14% of cases (n = 29) and the patients were subsequently divided into these groups: no leak (n = 178), chemical leak only (n = 12), and clinical leak (n = 17). Surprisingly, the daily drain amylase values did not differ between the chemical leak group and the clinical leak group. The daily volume of drainage on POD 5-8 for the clinical leak group was significantly greater than the volumes of the other two groups, so that a combination of greater than 200 ml/day of drainage on POD 5 with an amylase greater than 5X serum had a positive predictive value (PPV) of 84% and a negative predictive value (NPV) of 99% for a clinically relevant leak. We used broad criteria from drainage effluent to include as many potential leaks as possible. This broad definition of leak selected 14% of the PD patients as having a leak; within this group, all of the clinical complications of leak occurred. By increasing the volume criteria from greater than 30 ml per day to greater than 200 ml per day, the PPV was increased from 59% to 84% while keeping NPV at 99%. Drain data based on the volume and amylase criteria of this study may be useful for early detection of a leak that will have clinical impact. This study's criteria for leak may be a good definition to design a clinical trial.

Adolescent↗
PubMed2003

Transurethral resection of the prostate as catheter-free day-care surgery.

OBJECTIVE: To evaluate the feasibility of transurethral resection of the prostate (TURP) as catheter-free day-care surgery. PATIENTS AND METHODS: The study comprised 64 patients (mean age 62.4 years) with a mean (range) American Urological Association symptom score of 21.4 (9-31) and prostate volume (by ultrasonography) of 32.8 (17-50) mL, and with no significant comorbidity. The patients were admitted on the morning of the surgery and, under brief spinal anaesthesia, underwent standard TURP. After surgery the urethral catheter was removed as soon as the effluent was clear. The patients were discharged after they could pass urine freely and with a good stream. RESULTS: The mean duration of catheterization after TURP was 7.15 h; 59 patients (92%) had their catheter removed within 10 h (mean duration 6.42 h). There were no major complications during or after TURP. After removing the catheter, no patients required its reinsertion for failure to void or for clot retention. The mean hospital stay after TURP was 10.7 h and 98% of patients were discharged within 23 h of surgery. CONCLUSION: TURP can be conducted safely in a day surgery setting in patients with mild to moderate benign prostatic enlargement and no coexisting medical illness.

Aged↗
PubMed2001

Peritoneal transport status correlates with morbidity but not longitudinal change of nutritional status of continuous ambulatory peritoneal dialysis patients: a 2-year prospective study.

Cross-sectional studies show that peritoneal transport status is associated with nutritional status and clinical outcome of continuous ambulatory peritoneal dialysis (CAPD) patients. High transporters often are assumed to have progressive malnutrition as a result of fluid overload and nutrient loss in dialysis effluent. There are few prospective data to confirm this assumption, however. We studied 235 unselected CAPD patients to examine this possibility. There were 58 new cases and 177 prevalent cases. A standard peritoneal equilibration test was performed at enrollment. All patients were followed for 2 years. Dialysis adequacy and nutritional assessment, including serum albumin, protein nitrogen appearance, and lean body mass, were performed at 0, 12, and 24 months. Clinical outcome included hospitalization, actuarial patient survival, and technique survival. The mean age was 51.6 +/- 12.4 years. The mean 4-hour dialysate-to-plasma ratio of creatinine was 0.57 +/- 0.12 for all cases (0.60 +/- 0.12 for new cases). Patients were classified into three groups: high/high-average (H/HA) (63 cases), low-average (LA) (105 cases), and low (L) (67 cases) transporters. Baseline demographic data and total Kt/V were similar in all transport groups. There were weak correlations between 4-hour dialysate-to-plasma ratio of creatinine and baseline serum albumin (r = -0.249, P: < 0.001), protein nitrogen appearance (r = -0.190, P: < 0.01), and percentage of lean body mass (r = -0.194, P: < 0.01). The H/HA group was a specific but not a sensitive predictor of poor baseline nutritional status. There was no significant change in any nutritional indices after 2 years in new cases and prevalent cases, regardless of transport status. The differences in nutritional indices between groups remained unchanged during the study period. There was a significant difference in hospitalization rate among peritoneal transport groups (median 12 versus 7 versus 3 days per year for H/HA, LA, and L groups, Kruskal-Wallis test, P: < 0.05). The difference remained similar when new cases and prevalent cases were analyzed separately. The L group had slightly better 2-year patient survival than the H/HA group (90.2% versus 83.3%), but the result was not statistically significant. We conclude that peritoneal transport status is not associated with longitudinal change of nutritional parameters, although transport status is associated with short-term patient morbidity. Further study is needed to identify the mechanisms of poor clinical outcome in high peritoneal transporters.

Biological Transport↗