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Biomedical subjects

F Finkelstein

Publications and source records attributed to F Finkelstein.

At least 19 recordsLinked to original sources
PubMed2005

A trial of detecting impending access-graft failure by simplified weekly flow monitoring.

Access graft failure is a major problem in hemodialysis. Monitoring the flow through the access so that impending failure can be detected and prevented seems reasonable, but recent clinical trials have failed to show any benefit of such monitoring. Described here are plans for a clinical trial of a new flow monitoring procedure that measures access flow weekly instead of monthly and, being performed before dialysis, avoids the dialysis-induced changes in graft flow that may have affected earlier trials. The planned trial is to be carried out in two stages, the first to establish the sensitivity and specificity of the new method, and the second (if the results of the first stage warrant it) a controlled trial comparing access-costs and hospitalization days between a monitored group and a matched standard care control group. It is hoped that this trial of the new method will establish it as an effective means of extending access-graft life.

Arteriovenous Shunt, Surgical↗
PubMed2000

A multicenter study of noncompliance with continuous ambulatory peritoneal dialysis exchanges in US and Canadian patients.

Recent evidence suggested that noncompliance (NC) with continuous ambulatory peritoneal dialysis (CAPD) exchanges may be more common in US than in Canadian dialysis centers. This issue was investigated using a questionnaire-based method in 656 CAPD patients at 14 centers in the United States and Canada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of their individual results. Mean patient age was 56 +/- 16 years, 52% were women, and 39% had diabetes. The overall admitted rate of NC was 13%, with a rate of 18% in the United States and 7% in Canada (P < 0.001). NC was more common in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and Hispanic than in Asian and white patients (P < 0.001). NC was more common in patients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than four exchanges per day, black race, being employed, younger age, and not having diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors.

Adult↗
PubMed1999

Once-daily intraperitoneal cefazolin and oral ciprofloxacin as empiric therapy for the treatment of peritonitis.

The Ad Hoc Advisory Committee on Peritonitis Management has recommended intraperitoneal (i.p.) cefazolin and an aminoglycoside as empiric therapy for the treatment of peritonitis. Because most of our patients are on continuous cycler therapy, we developed a strategy of once-daily i.p. cefazolin and oral ciprofloxacin as empiric therapy. All patients in our unit that developed peritonitis were given a once-daily 2 g load of i.p. cefazolin, plus 500 mg ciprofloxacin orally, twice daily. Ciprofloxacin was given two hours after any phosphate binder or iron supplement. The i.p. cefazolin was allowed to dwell for at least six hours. The dialysate was then drained and chronic peritoneal dialysis (CPD) resumed. Organisms sensitive to cefazolin were treated for 14 days with once-daily cefazolin alone; resistant organisms were treated with alternative antibiotics. A total of 40 patients were treated with this empiric regimen. Of these, 35 (88%) successfully continued CPD therapy, 1 (2%) transferred to hemodialysis, and 4 (10%) expired two weeks after the onset of peritonitis. A total of 22 patients (55%) were treated successfully with once-daily i.p. cefazolin. Although once-daily i.p. cefazolin and oral ciprofloxacin permitted continuation of CPD therapy in most patients in this study, the therapy was not optimal. While vancomycin may have provided better coverage, recent reports of vancomycin-resistant enterococci and Staphylococcus aureus present a major concern.

Administration, Oral↗
PubMed1998

Differing outcomes of gram-positive and gram-negative peritonitis.

Peritonitis remains the leading cause of patient dropout from continuous peritoneal dialysis (CPD) therapy. Few studies have compared patient morbidity, mortality, and outcome for patients undergoing CPD who develop gram-positive and gram-negative peritonitis. We retrospectively reviewed the charts of patients who developed either gram-positive or gram-negative peritonitis between January 1, 1993, and December 31, 1995. Three hundred seventy-five patients who developed 415 episodes of gram-positive and gram-negative peritonitis were maintained on CPD therapy during this time period. There was no difference in age, race, and sex between patients who developed gram-positive or gram-negative peritonitis. More patients with diabetes developed gram-negative peritonitis than gram-positive peritonitis (53% v 40%, respectively; P < 0.05). Coagulase-negative staphylococcal species accounted for 47% of all gram-positive episodes, whereas Klebsiella organisms, Escherichia coli, and Enterobacter organisms accounted for 63% of all gram-negative episodes. Significantly more patients who developed gram-positive peritonitis continued CPD therapy 2 weeks and 6 months after the onset of peritonitis than patients who developed gram-negative peritonitis (97% v 73%; P < 0.05 at 2 weeks and 81% v 58% at 6 months; P < 0.05, respectively). Nine percent of the patients who developed gram-positive peritonitis died within 6 months after the onset of peritonitis, whereas 21% of the patients who developed gram-negative peritonitis died (P < 0.05). Patients who developed gram-negative peritonitis were significantly more likely to require hospitalization than patients who developed gram-positive peritonitis (74% v 24%; P < 0.001). More patients with gram-negative peritonitis required peritoneal catheter removal than patients with gram-positive peritonitis (18% v 4%; P < 0.001). Thirty-two percent of the patients who developed gram-positive peritonitis re-developed an episode of peritonitis with the same organism compared with only 9% of the patients who developed gram-negative peritonitis. Furthermore, peritonitis recurrence with the same organism within 6 months after the initial episode was noted in 60% of the patients with peritonitis caused by Staphylococcus aureus compared with 24% of patients with peritonitis caused by other gram-positive organisms (P < 0.05). We conclude that the outcomes of gram-positive and gram-negative peritonitis are different. When rates of peritonitis are used to predict outcome, it appears that gram-positive and gram-negative peritonitis rates need to be examined separately.

Adult↗
PubMed1995

Comparison of continuous ambulatory peritoneal dialysis-related infections with different "Y-tubing" exchange systems.

Despite several modifications of the continuous ambulatory peritoneal dialysis (CAPD) technique over the last decade, peritonitis remains a major source of morbidity and is the leading cause of dropout for patients maintained on CAPD therapy. Recently, Baxter Healthcare introduced the Ultra Twin bag system, which uses drainage and infusion bags both secured to Y connecting tubing. Previous nonrandomized studies comparing the Ultra Twin bag system with other systems have indicated an improvement in the peritonitis rate with the Ultra Twin bag system. In this study, 82 patients were randomized to use the Ultra Twin bag system or the Ultra Y-set system, which uses only the drainage bag already attached to the Y connecting tubing. Peritonitis rates were significantly lower with the Ultra Twin bag system, one episode per 33.9 patient months, compared with the Ultra Y-set system, one episode per 11.7 patient months (P < 0.05). Furthermore, the 1-yr infection-free survival rates with the Ultra Twin bag system and the Ultra Y-set system were 71 and 40%, respectively. Exit-site infections were lower with the Ultra Twin bag system, one episode per 12.5 patient months, compared with the Ultra Y-set system, one episode per 28.3 patient months, although this difference was not statistically significant (P = 0.084). The effect of the reduction in the infection rate on patient dropout with the Ultra Twin bag system remains to be addressed.

Adult↗
PubMed1995

Sleep apnea in CAPD.

Sleep disturbances are common complaints of dialysis patients, and sleep studies have suggested that sleep apnea may occur frequently. We performed sleep studies on 18 stable continuous ambulatory peritoneal dialysis (CAPD) patients. Our results indicate that 6 of 18 patients (33%) had a respiratory disturbance index (RDI) greater than 15, which indicates severe sleep apnea. Twelve of 18 patients (67%) had an RDI greater than 5, indicating clinically significant sleep apnea. These results suggest that sleep apnea is common in CAPD patients. The impact of sleep apnea on the patients' quality of life remains to be determined.

Aged↗
PubMed1982

Double-blind trial of perioperative intravenous metronidazole prophylaxis for abdominal hysterectomy.

A double-blind trial of perioperative intravenous metronidazole treatment to prevent infections at the operative site and unexplained fever after abdominal hysterectomy was conducted in 106 patients. Metronidazole prophylaxis reduced the rate of recovery of anaerobes from vaginal swabs for several days and prolonged the high rate of vaginal carriage of enterococci and aerobic gram-negative bacilli following hysterectomy. Although the fever index, calculated from the duration of a temperature above 37.3 degrees C, was significantly lower in the metronidazole-treated group than in the placebo-treated group, the frequency of postoperative infections, the proportion of patients requiring antibiotic treatment and the average duration of hospital stay were similar in the two groups. These results do not support the reported value of perioperative metronidazole prophylaxis in patients undergoing abdominal hysterectomy.

Adult↗
PubMed1976

The spouse's role in home hemodialysis.

The role of the spouse as a factor in the success or failure of home dialysis becomes increasingly important as expectations rise that hemodialysis patients be home-trained. Home hemodialysis offers advantages to the patient but may add stress to the spouse. We present cases illustrating the types of responses spouses have to home hemodialysis. Present conditions are such that the spouse's ability to participate in home hemodialysis may be less affected by aspects of the patient-partner's chronic renal disease than the potential change in the marital relationship that can derive from home hemodialysis. Success in home dialysis is at risk when the spouse is naturally dependent on the patient-partner. These spouses will often require special supportive measures.

Adult↗
PubMed1975

Formation of mineralized scar tissue induced by implants containing collagen-calcium phosphate gel.

The ability of a collagen-calcium phosphate gel to induce physiologic closure of subcutaneous polyethylene tube implants was tested. The openings of several tubes that had been filled with the gel were occluded by scars of mineralized connective tissue. Differentiation of cells into palisading fibroblasts and elaboration of a linear collagen matrix at the tissue-gel interface was seen.

Animals↗