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Biomedical subjects

J A Lorch

Publications and source records attributed to J A Lorch.

7 recordsLinked to original sources
PubMed1993

Laparoscopic management of peritoneal dialysis catheters.

Laparoscopic surgical techniques were used for peritoneal dialysis catheter placement or for revision in patients with previous extensive abdominal surgical treatment, multiple prior catheter insertions or dysfunctional catheters with outflow obstruction. Nineteen laparoscopic procedures were performed upon 16 patients between July 1990 and January 1992. All patients were chosen for the laparoscopic approach because of the complicated nature of previous incisions or in an attempt to salvage existing catheters. In five patients, open laparoscopy was performed with the blunt Hasson trocar, and in the remaining patients, closed techniques were used to establish the pneumoperitoneum. Dysfunctional catheters were revised by adhesiolysis, partial omental resection and subtotal omentectomy. New catheters were easily placed percutaneously, sometimes after extensive adhesiolysis, using direct laparoscopic guidance. All patients had functioning catheters postoperatively. Two catheters subsequently failed because of dislodgement and recurrent obstruction. The overall success rate for the entire series was 75 percent. We conclude that laparoscopy will be a useful addition to the surgical armamentarium in managing patients on peritoneal dialysis, particularly as this mode of renal replacement therapy rapidly expands.

Adult↗
PubMed1985

Effect of variations in dietary sodium intake on sodium excretion in mature rats.

Sprague-Dawley rats weighing 400 g or more were studied to determine whether their continued weight gain affects renal sodium handling. Rats maintained on a wide range of sodium intakes gained 3.9 +/- 0.4 g/day. The intercept of a linear regression of intake against urinary excretion provided an estimate of the minimum daily requirement for sodium intake of 247 +/- 33 microEq/day. When more than this required amount was ingested, the animals excreted the excess quantitatively in the urine. When less was ingested they continued to gain weight at a slower rate, 1.6 +/- 0.6 g/day, and remained in positive sodium balance. Nonetheless, they developed a sodium deficit manifested as retention of a sodium challenge. Thus, on an adequate dietary intake the normal physiological state of Sprague-Dawley rats of this size is one of chronic sodium retention rather than neutral sodium balance. In contrast, when inadequate sodium is ingested a deficit develops in the absence of external losses. These observations have important implications for the interpretation of studies of renal sodium handling in these animals.

Animals↗
PubMed1979

Fungal infections of dialysis fistulae.

Bacterial infections of dialysis access fistulae are well known in patients with end-stage renal disease, but fungal infections of these prostheses have not been reported. Two patients who presented with recurrent infections and thromboses of their grafts grew Staphylococcus aureus and Cephalosporium species. This new entity suggests a different approach to the management of clotted grafts in patients with end-stage renal disease. If fungus is isolated from the graft, extirpation of the graft and amphotericin B therapy are suggested. We review here the mycology of Cephalosporium species, in-vitro sensitivity studies, and previous reports of infection with this fungus.

Acremonium↗
PubMed1979

Hemoperfusion to treat intoxications.

Hemoperfusion is being increasingly proposed and used for the treatment of a large variety of exogenous intoxications. This procedure has been shown to achieve high clearance rates of most common intoxicants, and case reports have claimed that its application has been, on occasion, life-saving. We tabulated our experience in the treatment of 94 consecutive patients with severe intoxications who were treated with supportive management only; this group constituted 25% of all patients admitted with a diagnosis of drug overdose. Of the 94 patients only one died; all others were discharged without sequelae resulting from the intoxication or its complications; only 21% required more than a 48-hour stay in the intensive care unit. We propose that supportive management must remain the mainstay of therapy even in severely intoxicated patients; with few exceptions, hemoperfusion must be considered an as yet unproven form of therapy; further controlled studies are necessary to establish its range of indications, potential benefits, and cost effectiveness.

Adolescent↗