Biomedical subjects
Publications and source records attributed to G Digenis.
Struvite stones are caused by urea-splitting, usually gram-negative, organisms. A case of aggressive struvite stone production caused by Corynebacterium group F1 is reported that responded to the appropriate antibiotic treatment. To our knowledge this organism has never been associated previously with struvite stone formation.
The long-term effect of an AA solution based on Travasol, a solution for total parenteral nutrition, given intraperitoneally over a 6-month period was studied in 5 patients 22 to 75 years old, having been on continuous ambulatory peritoneal dialysis (CAPD) for 3 to 57 months. A low oral protein intake (less than 0.8 g/kg bw/day) and/or a low serum albumin (less than 35 g/L) were used as inclusion criteria. Two liters of 1% AA solution were infused overnight, while a glucose Dianeal was used for the other exchanges. During the study, BUN increased from 22.04 mM/L to 28.06 mM/L the first month and remained at these levels, indicating the increased protein intake. However, average oral total energy and protein intake, body weight (bw), serum creatinine, cholesterol, triglycerides, total proteins, albumin, transferrin, skinfold thickness, total body potassium, and plasma AA levels remained basically unchanged. The average total body nitrogen decreased from 1.746 to 1.554 Kg, but this decrease did not reach statistical significance (p greater than 0.05). We conclude that intraperitoneal overnight administration of 2 L of 1% AA based on Travasol over 6 months did not improve the nutritional status of CAPD patients. This ineffectiveness might be due to the AA composition of the solution, the timing of administration, or to a low caloric intake and/or that our patients were not severely malnourished.
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Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months as compared with every 8 initially), and this has allowed chronic complications of CAPD, such as malnutrition and loss of the peritoneum's capacity for ultrafiltration, to come to light. As would be expected, among patients of advanced age and those who have heart disease or diabetes, survival rates tend to be lower than among other CAPD patients. However, hypertension seems to be more easily controlled, pre-existing anemia can be significantly ameliorated, and young children grow more normally than they do with hemodialysis. Diabetes-related changes in vision stabilize in most CAPD patients, and control of the blood glucose level is good; insulin is administered intraperitoneally. CAPD is thus showing itself to be a feasible form of long-term treatment for end-stage renal disease.
Kidney stones were passed by ten out of 186 patients with endstage renal disease who were treated with continuous ambulatory peritoneal dialysis (CAPD). Stones from seven patients were examined by x-ray diffraction. In five of them the stones were composed of calcium oxalate monohydrate. The urine calcium oxalate activity product was determined in 44 CAPD patients, eight of whom were stone formers, and compared to that of 120 normal volunteers. In CAPD patients, mean urine ionic-calcium concentration was lower than in normal subjects whereas mean urine ionic-oxalate concentration was significantly higher than in normal subjects. In normal urine samples, the calcium oxalate activity product showed a significant correlation with both the urine ionic-calcium and the ionic-oxalate concentrations. In contrast, in CAPD patients the calcium oxalate activity product correlated with the ionic-calcium concentration but not with ionic-oxalate. Although the urine ionic-calcium concentration is lower in CAPD patients than in normal subjects, it is the relative increase in its concentration which appears to be associated with the increased risk of kidney stone formation in these patients. This relative hypercalciuria seems to follow 1,25(OH)2 vitamin D3 administration.
Twenty diabetics with end-stage renal disease who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis for periods of two to 36 months (average, 14.5). Intraperitoneal administration of insulin achieved good control of blood sugar. Even though creatinine clearance decreased significantly (P = 0.001), control of blood urea nitrogen and serum creatinine was adequate. Hemoglobin and serum albumin levels increased significantly (P = 0.005 and 0.04, respectively). Similarly, there was a significant increase in serum triglycerides and alkaline phosphatase (P = 0.02 and 0.05). Blood pressure became normal without medications in all but one of the patients. Retinopathy, neuropathy, and osteodystrophy remained unchanged. Peritonitis developed once in every 20.6 patient-months--a rate similar to that observed in nondiabetics. The calculated survival rate was 93 per cent at one year; the calculated rate of continuation on ambulatory peritoneal dialysis was 87 per cent. We conclude that continuous ambulatory dialysis with intraperitoneal administration of insulin is a good alternative treatment for diabetics with end-stage renal disease.
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By now many patients have been successfully maintained on CAPD for five years or more, thus demonstrating that CAPD is a viable long-term treatment for end-stage renal disease. Peritonitis--the main concern of the earlier years--is now a less frightening complication. We know better how to treat peritonitis and its incidence has decreased from one episode every 8 months initially to one episode every 18 months now. In addition, several innovations, which have been or soon will be introduced, promise to decrease the frequency of peritonitis to an even lower rate. The problem of peritonitis is now being replaced by the chronic complications of CAPD, predominantly malnutrition and decrease in peritoneal ultrafiltration. CAPD has become an important adjunct in the treatment of children with ESRD, especially the very young. Even though not normal, their growth on CAPD is better than that of children on hemodialysis and as good as that after a successful transplant. CAPD has become a promising treatment for the diabetic with ESRD. This experience has stimulated interest and research in the role of intraperitoneal administration of insulin for blood glucose control. With the present worldwide experience of CAPD, this treatment has ceased to be experimental. A percentage of patients requiring dialysis will be better off on CAPD than on hemodialysis. Even though this percentage will vary among various countries, the nephrologist who wants to provide the best treatment for each patient must be well experienced in and have all treatments at his disposal including CAPD.