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Biomedical subjects

L J Gibel

Publications and source records attributed to L J Gibel.

At least 19 recordsLinked to original sources
PubMed1994

Magnetic resonance microscopy of water diffusion and edema during hypothermic preservation of rat kidneys.

Kidney degradation during hypothermic storage was studied on rat kidneys, using magnetic resonance microscopy. Poor storage, modeled by storage with lactated Ringer's solution, resulted in rapid kidney swelling, together with increased signal intensity and water diffusion coefficient in the cortical and medullary regions. Storage of kidneys in Euro-Collins solution resulted in slower swelling and no significant change in signal intensity and in the water diffusion coefficient. Storage with Belzer's solution resulted in shrinkage of the kidneys and no significant change in the diffusion coefficient of water over time. These changes correlated well with kidney degradation observed by histology, and show the potential of magnetic resonance imaging in quality assessment of kidney transplants.

Animals↗
PubMed1993

Persistence of positive dialysate cultures after apparent cure of CAPD peritonitis.

Clinical features, diagnosis and outcomes of persistently positive dialysate culture (PPDC) after apparent cure of continuous ambulatory peritoneal dialysis (CAPD) peritonitis were investigated in 16 PPDC episodes observed in 16 elderly (age 62 +/- 8 years) men who had been on CAPD for 14 +/- 9 months. Seven patients (46.7%) were diabetic. Peritonitis was caused by S. aureus in 14 cases and S. epidermidis in 2 cases. Preexisting or simultaneous infectious foci were present in 15 cases, exit-site infection in 5, tunnel infection in 13, and intra-abdominal abscess in 2 cases. Indium scans were positive in 6/9 cases (67%). Two patients died with the peritoneal catheter in situ, one from intercurrent myocardial infarction and one from S. aureus sepsis with pneumonia. In another 14 cases the peritoneal catheters were removed because of either tunnel abscess (8 cases) or peritonitis recurrence (6 cases). PPDC following apparent cure of CAPD peritonitis is almost always associated with exit-site, tunnel, or intra-abdominal abscess and leads invariably to catheter loss. Associated mortality is substantial.

Adult↗
PubMed1993

Peritonitis associated with intra-abdominal pathology in continuous ambulatory peritoneal dialysis patients.

Features helpful in diagnosis and associated with death were evaluated in 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) in continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, increasing free air in the abdominal cavity) were infrequently found. A comparison of patients who died (n = 11, 42%) and those who survived revealed that death was associated with bowel gangrene (5/6 died), recovery of bacteroides from the dialysate, more frequent and severe comorbid conditions (bacteremia, pneumonia, intra-abdominal and intracerebral bleeding, septic shock, hepatic failure), the development of severe malnutrition and thrombocytopenia during infection, and multiple surgical procedures until the diagnosis was established. Peritonitis associated with intra-abdominal pathology in CAPD patients is a severe infection with considerable diagnostic difficulty and high mortality. Early exploratory laparotomy upon suspicion of the nature of the peritonitis, usually raised by the recovery of enteric pathogens from the dialysate, may improve mortality.

Gastrointestinal Diseases↗
PubMed1991

Intraperitoneal thrombolytic agents in relapsing or persistent peritonitis of patients on continuous ambulatory peritoneal dialysis.

Urokinase or streptokinase was instilled intraperitoneally as an adjunct to the antibiotic therapy in 16 episodes of relapsing or persistent peritonitis in CAPD patients. In eight patients the combination of antibiotics and intraperitoneal thrombolytic agents resulted in clearing of the infection with no recurrences. The treatment failed in eight other patients, who had their peritoneal catheters removed. Six of the last eight patients had either abdominal wall abscesses or persistence of the bacteria on the wall of the peritoneal catheter. Elevated post-intraperitoneal instillation peritoneal fluid neutrophil counts and positive post-instillation peritoneal fluid cultures predicted failure of the intraperitoneal instillation of thrombolytic agents in most instances. Intraperitoneal instillation of urokinase or streptokinase may help cure approximately 50% of the episodes of relapsing for persistent peritonitis. Post-instillation peritoneal fluid cell counts and cultures should be monitored. Radiologic investigation for abdominal wall or intraabdominal abscesses is indicated if intraperitoneal instillation of urokinase or streptokinase fails to eradicate peritonitis.

Anti-Bacterial Agents↗
PubMed1990

Nephrotic syndrome and rapid renal failure in autosomal dominant polycystic kidney disease.

A 44-year-old man, with autosomal dominant polycystic kidney disease and hypertension under satisfactory control, developed nephrotic syndrome with negative serology. Open renal biopsy revealed focal glomerular sclerosis. Prior to the appearance of heavy proteinuria, serum creatinine was 1.7 mg/dl. After the nephrotic syndrome had been established, renal function deteriorated rapidly and hemodialysis was started within 2.6 years. In patients with autosomal dominant polycystic kidney disease, the appearance of nephrotic range proteinuria along with a rapid decline in renal function indicates the presence of a glomerular lesion, which needs to be investigated by renal biopsy.

Adult↗
PubMed1990

Vascular disease: the critical risk factor for mortality in older patients on CAPD.

Clinical course, complications and outcome were analyzed in 75 patients (14 women, 61 men) who started CAPD at age 55 years or older (55-81). These patients were separated in three groups. Group A patients had high risk for vascular disease (diabetes, hypertension, N = 45), group B patients had a presumed lower risk for vascular disease (primary renal disease, N = 22), and group C patients had miscellaneous conditions (N = 8). Group A was compared to group B. Patient and technique survival was statistically higher for group B than for group A. The rates of peritoneal dialysis related complications (peritonitis, tissue infections, catheter loss, hernias) were comparable between groups A and B. Hernias were seen frequently in all groups and had severe sequellae, including discontinuation of CAPD. Catastrophic vascular events were also seen in all groups, but the frequency of such events, particularly of catastrophic vascular events of the limbs, was statistically higher in group A than in group B. Vascular disease accounted for the majority of deaths in all groups. Four patients died from cardiovascular instability soon after changing from CAPD to hemodialysis. In conclusion, vascular disease is the major factor limiting survival in older CAPD patients. CAPD is superior to hemodialysis for a relatively small fraction of older patients with severe cardiovascular instability.

Aged↗
PubMed1990

Early and late peritoneal dialysate leaks in patients on CAPD.

Dialysate leaks, which occurred in 386 CAPD patients over 11 years, were analyzed retrospectively. 18 patients developed 21 early leaks (within 30 days of catheter insertion) and 18 patients developed 28 late leaks (beyond 30 days of catheter insertion). 8 patients had multiple (2-6) leaks. Both early and late leaks, particularly if they were multiple, were associated with conditions that affect adversely tissue healing and tensile strength. Median surgical insertion was apparently associated with a higher incidence of early leaks. Early leaks were manifested externally, usually through the exit site, and did not require imaging. Late leaks were manifested usually by poor dialysate outflow, localized edema and subcutaneous fluid collections. One third of the late leaks required radiological imaging. Hernias caused 42% of the late leaks. Early leaks were managed by temporary discontinuation of CAPD alone (57%) or surgery. Most late leaks (67%) required surgery. Conservative means (change to IPD, observation) were applied for the management of a few late leaks. Both early and late leaks resulted frequently in replacement of peritoneal catheters, but only late leaks resulted in permanent discontinuation of peritoneal dialysis. Paramedian surgical insertion, waiting period of 10-14 days between catheter insertion and initiation of CAPD, and low starting dialysate volumes have resulted in apparent reduction of the incidence of the early, but not of the late leaks. Dialysate leaks have serious consequences on the performance of CAPD. Early leaks differ from late leaks in some clinical manifestations. Preventive measures have decreased the incidence of early, but not of the late leaks.

Catheters, Indwelling↗
PubMed1989

Intraperitoneal radiocolloid imaging in dialysate leaks.

With the increasing use of continuous ambulatory peritoneal dialysis (CAPD), a number of complications related to the leakage of dialysate from the abdominal cavity have been described (Dubin and Froelich: Clinical Nuclear Medicine 10(3): 173, 174, 1985; Johnson et al.: Archives of Surgery 122(8): 952-954, 1987; Ducassou et al.: Journal of Nuclear Medicine 25(1): 68, 69, 1984; Walker and Fish: Journal of Nuclear Medicine 29(9): 1596-1602, 1988; Eisenberg et al.: Clinical Nuclear Medicine 13(2): 99-101, 1988). The use of intraperitoneal radiolabeled colloid has been previously described to image entities such as hernias, patent processus vaginalis, abdominal wall, and diaphragmatic leakage by other specialities, but has not been described in the general imaging literature. This paper illustrates a simple, noninvasive method of determining the site of dialysate leak and its importance to assist further patient management.

Abdominal Muscles↗
PubMed1989

Soft tissue complications of Tenckhoff catheters.

Soft tissue complications (STC) involving the catheter tract and exit site continue to be a significant source of morbidity (40%) and cause for catheter removal (8%). Inner cuff infections, accompanied by peritonitis and managed with catheter removal, occurred in 6% of catheters. All other STC can be managed without catheter removal. STC presenting without peritonitis have not been associated with an increase in peritonitis related catheter loss.

Catheters, Indwelling↗
PubMed1989

Clinical significance of hemodialysis performed during the course of continuous ambulatory peritoneal dialysis.

We analyzed causes and clinical associations of hemodialysis performed during the course of CAPD in 71 patients (34 diabetic) on CAPD between 1978 and 1988. Thirty seven patients had at least one hemodialysis during CAPD. Causes (multiple for some patients) included poor compliance with CAPD (20 patients), peritoneal catheter loss from infection (16 patients), and miscellaneous other conditions (18 patients). Hemodialysis rates were similar between diabetic and non-diabetic CAPD patients. Compared to non-hemodialyzed patients, CAPD patients hemodialyzed for poor compliance had higher rates of peritonitis (one episode per 8.3 patient months vs one episode per 23.4 patient months, p less than 0.001) and catheter loss (one loss per 27.7 patient months vs one loss per 112.0 patient months, p less than 0.001), and exhibited a trend towards more deaths (annual mortality 30.9% vs 14.3%, p = 0.067). Hemodialysis performed in CAPD patients because of poor compliance is associated with higher rates of peritonitis and catheter loss, and, probably, with increased mortality.

Adult↗
PubMed1988

Renal transplant obstruction by B cell lymphoproliferative disorder: case report and review of the literature.

We report a case of renal transplant ureteral obstruction caused by a cyclosporine-associated B cell lymphoproliferative disorder. The interaction of cyclosporine with Epstein-Barr virus infections and the predisposition towards B cell lymphoproliferative disorders are reviewed. The characterization of these tumors by deoxyribonucleic acid hybridization studies and a review of the clinical experience treating these disorders also are presented.

B-Lymphocytes↗