[Congenital aneurysmal dilatation of the left auricle].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M Manes
Publications and source records attributed to M Manes.
Peritoneal dialysis compared with hemodialysis in the treatment of end-stage renal disease.
Whether to use peritoneal dialysis (PD) or hemodialysis (HD) is a major decision in terms of clinical outcome and management implications; the final choice is difficult because of the conflicting results of comparisons reported in the literature. A review of studies comparing survival shows either superiority of HD, or superiority of PD, or equivalence of the two techniques, but an analysis of the comparisons as a whole brings to light two clear phases in the survival curves. In the first, residual renal function (RRF) gives PD an advantage, or at least puts it on the same level as HD. In the second phase, the reduction in Kt/V as RRF declines gives PD a potential risk. After a few years of PD treatment a sharp watch is therefore necessary to detect signs of under-dialysis promptly and to shift the patient to HD. In patients without RRF it is more difficult to control hypertension with PD and they are more prone to hyperhydration. Despite a widespread belief in the Eighties that PD was the treatment modality of election for diabetics, HD is in fact preferable in these patients, except younger ones. High-turnover and low-turnover bone lesions are more frequent respectively in HD and PD patients. Anemia is better controlled with PD. Blood lipids and nutritional indices are less well controlled with PD. Despite poor technical survival, the "pool" of patients treated with PD frequently reaches 20-30% because it is indicated as first treatment in a large proportion. PD preserves renal function better than HD and is useful while awaiting renal transplantation, with faster postoperative restoration of diuresis. The quality of life with PD as home treatment is usually better than with HD. In conclusion, dialytic centers should establish an integrated PD/HD programme as the two methods are not competitive but are different tools for the treatment and rehabilitation of uremic patients.
Australia↗
[Dialysis in the elderly].
Assuming >/= 75 years old as the age limit to define dialysis in the elderly, the incidence in this group of patients is progressively increasing in most dialysis units, with an annual growth of 8 to 16%, and represents 20 to 33% of the overall population being affected. The prevalence of the elderly dialysis group is also high, 14 to 20%, in the main literature casistics. Vascular nephropathies, 13 to 50%, represent the major cause of end-stage renal disease, followed by diabetes, 11 to 37%. First year survival rate is an acceptable 52 to 82%, whereas the fifth year value is on average 20 %, also due to the high baseline mortality in these patients. The death causes are mainly cardiac related and represent 45% of the overall mortality. The main prognostic factors are frequency and severity of comorbid factors, in addition to nutritional indexes that are particularly important in this age group. Dialysis dose and treatment time are not related to mortality. Haemodialysis and peritoneal dialysis complement each other to allow the best results. The survival rate, however, is usually better with haemodialysis, especially in old diabetic patients and after some years of treatment. Vascular access, intradialytic hypotension, cardiopathy, intestinal bleeding and amyloidotic arthropathy represent the more critical aspects of dialysis in the elderly, while the quality of life is sometimes unexpectedly good.
Age Factors↗
[Hemodialysis access recirculation].
Vascular access recirculation (R) allows the evaluation of the adequacy of the extracorporeal blood circuit in dialysis patients. The test verifies the correct needle position in patients with arterovenous fistulae (AVF) and the effective function of central venous catheters. In clinically uncomplicated native fistulae, a normal R test could avoid more complex procedures like blood flow measure or angiography. The AVF recirculation has two components, vascular access recirculation (AR) and cardiopulmonary recirculation (CPR). While the first phenomenon is well known, the second remained undetected for many years resulting in wrong R calculations with false positives. Using the correct formula, the great majority of AVF resulted in zero recirculation. The presence of R reduces the dialysis efficiency to critical levels, mainly in unsuspected cases. Among the numerous available R tests, the urea test is the oldest and historically the most commonly used method, but unfortunately it is labor intensive, with low sensitivity and specificity and with delayed results. The "ultrasound dilution"method is considered the gold standard, easy to perform, with good repeatability, but it is expensive requiring a specific device. Finally, the glucose infusion test (GIT) is a new low-cost test with immediate results and a very low detection limit, with good repeatability and high specificity and sensitivity.
Humans↗