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Isaac Teitelbaum

Publications and source records attributed to Isaac Teitelbaum.

12 recordsLinked to original sources
PubMed2006

Cloudy peritoneal dialysate: it's not always infection.

BACKGROUND/AIMS: Turbid peritoneal dialysate is most commonly due to bacterial peritonitis. However, not all instances of cloudy dialysate are due to infection. This paper will review the various non-infectious causes of cloudy dialysate fluid. METHODS: Literature review and synthesis. RESULTS: Cloudy dialysate may be due to pathologic increases of either cellular or non-cellular constituents of peritoneal fluid. Polymorphonuclear leukocytes may be increased due to either intra- or juxtaperitoneal inflammation or drug-induced chemical peritonitis. Increased eosinophils often represent a response to intraperitoneal air or an allergy to a component of the dialysis system. Red blood cells may be present due to one of many causes. Monocytes or malignant cells are relatively uncommon. The differential for the non-cellular causes of culture-negative cloudy dialysate is limited to elevated fibrin or triglycerides. The latter may be due to lymphatic obstruction, pancreatitis, catheter trauma, dihydropyridine calcium channel blockers, or the superior vena cava syndrome. CONCLUSION: After ruling out atypical infectious etiologies, a diverse set of aseptic causes remains in the differential diagnosis. Use of an organizational scheme based upon identification of the cellular or non-cellular constituent producing dialysate turbidity facilitates appropriate diagnostic and therapeutic interventions.

Dialysis Solutions↗
PubMed2006

Peritoneal dialysis is appropriate for elderly patients.

BACKGROUND/AIMS: The utilization of peritoneal dialysis decreases with age. A number of concerns have been raised regarding the suitability of peritoneal dialysis for elderly patients. The purpose of this review is to determine whether these concerns are medically valid. METHODS: Literature review and synthesis. RESULTS: Most elderly patients possess the manual and cognitive skills necessary to perform peritoneal dialysis. Elderly patients on peritoneal dialysis exhibit excellent compliance with their treatment regimen and display no increase in the rate of infectious complications though they may have a slight increase in hospital days. They easily achieve adequacy targets, experience good technique survival and their nutritional status is at least as good as that of their hemodialysis counterparts. Patient survival varies around the world but is overall comparable to that of age-matched patients on hemodialysis. Quality of life may be somewhat superior to that of older hemodialysis patients. CONCLUSION: Elderly patients with end-stage renal disease are appropriate candidates for peritoneal dialysis. It is not medically justifiable to exclude them from consideration for this therapeutic modality.

Aged↗
PubMed2005

Pulmonary capillaritis in lung transplant recipients: treatment and effect on allograft function.

The clinical outcomes of lung transplant recipients presenting with post-transplant pulmonary capillaritis have not been well described. We retrospectively reviewed 40 cases of biopsy-proven pulmonary capillaritis in lung transplant recipients. Patients presented with a clinical syndrome characterized by dyspnea, hypoxemia, abnormal chest X-ray, and a decrease in forced expiratory volume in 1 second (FEV1); 25% presented with hemoptysis, and 18% with fulminant respiratory failure. Therapy with intravenous corticosteroids resulted in clinical improvement in 17 cases (43%). A response to plasmapheresis was seen in 12 (67%) of 18 cases refractory to corticosteroids. There were 5 deaths within 3 months of diagnosis. Nine (82%) of 11 lung transplant recipients who presented with capillaritis within 4 weeks post-transplant were alive at 1 year; all but 1 patient achieved expected percent predicted FEV1 values. Only 3 (14%) of 21 who presented with capillaritis > 1 month after transplant had a >20% decrease in the FEV1 after 12 months. These results suggest that post-transplant pulmonary capillaritis is (1) likely a form of acute allograft rejection clinically and histologically distinct from typical acute rejection, (2) less responsive to corticosteroid therapy than typical acute rejection, and (3) not associated with long-term adverse effects on allograft function.

Capillaries↗
PubMed2005

Pharmacokinetics and pharmacodynamics of imipenem during continuous renal replacement therapy in critically ill patients.

The pharmacokinetics of imipenem were studied in adult intensive care unit (ICU) patients during continuous venovenous hemofiltration (CVVH; n=6 patients) or hemodiafiltration (CVVHDF; n=6 patients). Patients (mean+/-standard deviation age, 50.9+/-15.9 years; weight, 98.5+/-15.9 kg) received imipenem at 0.5 g every 8 to 12 h (total daily doses of 1 to 1.5 g/day) by intravenous infusion over 30 min. Pre- and postmembrane blood (plasma) and corresponding ultrafiltrate or dialysate samples were collected 1, 2, 4, and 8 or 12 h (depending on dosing interval) after completion of the drug infusion. Drug concentrations were measured using validated high-performance liquid chromatography methods. Mean systemic clearance (CL(S)) and elimination half-life (t1/2) of imipenem were 145+/-18 ml/min and 2.7+/-1.3 h during CVVH versus 178+/-18 ml/min and 2.6+/-1.6 h during CVVHDF, respectively. Imipenem clearance was substantially increased during both CVVH and CVVHDF, with membrane clearance representing 25% and 32% of CL(S), respectively. The results of this study indicate that CVVH and CVVHDF contribute to imipenem clearance to a greater degree than previously reported. Imipenem doses of 1.0 g/day appear to achieve concentrations adequate to treat most common gram-negative pathogens (MIC up to 2 microg/ml) during CVVH or CVVHDF, but doses of 2.0 g/day or more may be required to adequately treat and prevent resistance in pathogens with higher MICs (MIC=4 to 8 microg/ml). Higher doses should only be used after consideration of potential central nervous system toxicities or other risks of therapy in these severely ill patients.

Adult↗
PubMed2003

Peritoneal dialysis.

Explore the source record for details and available documents.

Bacterial Infections↗
PubMed2003

Assessing renal function in cirrhotic patients: problems and pitfalls.

Assessment of glomerular filtration rate (GFR) by common creatinine-based methods potentially is very inaccurate in patients with cirrhosis. Cirrhotic patients have several underlying conditions that contribute to falsely low serum creatinine concentrations, even in the presence of moderate to severe renal impairment, and often cause creatinine-based methods to overestimate true GFR. Such underlying conditions include decreased creatinine production secondary to decreased hepatic creatine synthesis, increased tubular creatinine secretion, and decreased skeletal muscle mass. These factors all contribute to serum creatinine concentrations that often do not accurately reflect renal function. Serum creatinine level, measured creatinine clearance, and calculated creatinine clearance may all significantly overestimate GFR; the degree of GFR overestimation was a median of 95% in published studies. Until more accurate methods of estimating GFR in cirrhotic patients are adequately validated, care should be exercised in the management of these patients because of the potential for severely impaired renal function, even in the face of normal serum creatinine concentrations.

Glomerular Filtration Rate↗
PubMed2003

Discrepancies in serum albumin measurements vary by dialysis modality.

BACKGROUND: Serum albumin level is an important prognostic marker in patients with chronic renal failure. However there are discrepancies in the methods of estimation of serum albumin. The objective of this study is to evaluate the magnitude of the discrepancy in the serum albumin levels as measured by Bromcresol Green (BCG) and Bromcresol Purple (BCP) dye methods in patients on hemodialysis (HD) and peritoneal dialysis (PD) and to ascertain the clinical determinants of the discrepancy (deltaSA = BCG-BCP; g/dL) in each of the modalities. METHOD: We measured serum and plasma albumin levels by BCG and BCP methods in 19 adult HD patients and 18 adult PD patients treated in the dialysis units of the University of Colorado Health Sciences Center. Similar measurements were performed in 10 normal adult subjects. In all groups, paired blood samples were taken to estimate the albumin in both serum and plasma. Nephelometry (NM) was subsequently performed on the serum of 13 of the HD patients, 14 of the PD patients, and each of the 10 normal subjects. RESULTS: We found that for both the dye methods serum and plasma albumin levels are almost identical in each of the three subject groups. In the normal subjects serum albumin estimated by BCP is in good agreement with NM values but BCG overestimates the albumin levels. In the PD group the discrepancy between the BCG and BCP (deltaSA) is statistically significant with the BCG averaging 0.59 +/- 0.12 g/dL more than the BCP. The BCG values are closer to those obtained by the "gold standard", NM. In the HD group the deltaSA is significantly (p < 0.001) less than in the PD group (0.34 +/- 0.11 g/dL). As for PD, BCG values are closer to NM values. Increasing age, female gender, and higher dialysis adequacy are associated with higher deltaSA in the HD but not in the PD group. Utilizing linear regression analysis we developed equations for each dialysis modality to convert albumin measurements from one method to the other. CONCLUSION: We confirm that a discrepancy exists between the commonly used dye methods (BCG and BCP) for serum albumin estimation. This discrepancy is significantly lower in HD patients than in PD patients. Nephrologists should be aware of this discrepancy and appropriate corrections should be made during quality improvement analysis.

Adult↗
PubMed2003

Is it safe to simultaneously remove and replace infected peritoneal dialysis catheters? Review of the literature and suggested guidelines.

Since the introduction of Y-connector technology and the subsequent reduction in the frequency of peritonitis, catheter-related infections have become the primary infectious complication in patients on peritoneal dialysis (PD). Such infections may lead to prolonged morbidity, recurrent peritonitis, and catheter failure. Despite appropriate treatment of catheter-related infections, removal of the catheter is sometimes necessary. The timing of catheter removal and replacement has been the focus of significant discussion. The International Society for Peritoneal Dialysis recommends a 3-week interval, but also allows for individualized timing. Long staging periods present problems that simultaneous removal and replacement (SRR) of the catheter may obviate. Here, we review a body of literature on SRR and present guidelines as to when SRR of an infected PD catheter may be considered a safe alternative to a staged procedure.

Bacterial Infections↗
PubMed1994

Coarctation of the Aorta in the Elderly: Case Report and Review of the Literature.

Coarctation of the thoracic aorta is a rare condition in the elderly population. Approximately 90% of untreated patients die by the age of 50. The complications of persistent coarctation include cerebrovascular accidents, congestive heart failure, intracranial aneurysms, endocarditis, aortic valve disease, myocardial infarction, aortic rupture, and aortic dissection. We report the case of a 62-year-old man who presented with complete aortic occlusion distal to the left subclavian artery. The effect of antihypertensive therapy on renal function in patients with coarctation is discussed, and the literature regarding elderly patients with coarctation of the aorta is reviewed.

Journal Article↗
PubMedDate not supplied

Renal replacement therapy in patients with chronic liver disease.

As the prevalence of chronic liver disease and chronic kidney disease (CKD) increase, clinicians are likely to be increasingly faced with difficult diagnostic, treatment, and ethical challenges when facing both of these diseases in a single patient. Alterations in creatinine formation and elimination in cirrhotic patients render creatinine-based estimates of glomerular filtration rate and dialysis adequacy less accurate in this population. Furthermore, differentiating signs and symptoms of uremia from hepatic disease may be difficult and clear indications for renal replacement therapy (RRT) in these patients have not been defined. Hemodialysis is associated with a high rate of complications and has not been shown to prolong life in cirrhotic patients with acute renal failure (ARF), but has not been carefully examined in those with CKD. Peritoneal dialysis is, similarly, unhelpful in chronic liver disease complicated by ARF, but has been found to be a viable option in some cirrhotic patients with CKD. Continuous RRT is generally tolerated by patients with decompensated cirrhosis and either acute or chronic renal failure and may act to bridge patients to liver transplantation. Given the poor underlying survival of cirrhotic patients with renal failure, clinicians should carefully consider the utility of RRT in each patient.

Chronic Disease↗
PubMedDate not supplied

Patient characteristics associated with defects of the peritoneal cavity boundary.

BACKGROUND: Conflicting literature exist regarding the patient characteristics that may confer an increased risk for anatomic complications of the peritoneal cavity boundaries. METHODS: We collected data from 75 randomly selected units in the United States and Canada, representing a total of 1864 peritoneal dialysis (PD) patients. RESULTS: 200 of these patients experienced a total of 217 anatomic complications between July 2000 and June 2001; 16 patients had more than 1 complication. Hernias comprised 60.4% of all complications: 24.9% inguinal, 18.9% umbilical, 13.8% ventral, 2.3% femoral, and 0.5% intrathoracic. Other complications included pericatheter or subcutaneous leak (25.3%), hydrothorax (6.0%), and miscellaneous (8.3%). Peritoneal dialysis modalities in use at the time of complication were automated PD (52.3%), continuous ambulatory PD (38.6%), and nocturnal intermittent PD (9.1%). The overall incidence of hernias was 7%. CONCLUSIONS: Logistic regression analysis found no association between hernias and age, body surface area, PD modality, volume of dialysate, time of largest dwell (day/upright vs night/recumbent), or type of catheter used. Cystic disease conferred a 2.5-fold increase in risk for anatomic complications (p < 0.001); female gender conferred an 80% reduction in risk (p < 0.0001), and Kt/V > or = 2.0 conferred a 52% reduction in risk (p < 0.05) for hernia.

Canada↗