Biomedical subjects

P Pasadakis

Publications and source records attributed to P Pasadakis.

10 recordsLinked to original sources

PubMed1996

Evaluation of bone mineral density in CAPD patients with dual energy X-ray absorptiometry.

In this study bone mineralization was evaluated using dual energy x-ray absorptiometry (DEXA), which measured regional bone mineral density [BMD (g/cm2)] at two skeletal sites, the lumbar spine and the femur, in 33 patients (15 male, 18 female) undergoing continuous ambulatory peritoneal dialysis (CAPD) with no history of chronic disease or medications affecting bone. The biochemical profile included measurements of plasma levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH). We did not find any statistically significant difference or correlation between BMD and the examined parameters, except for the lower BMD values in the female population. Because of the reported findings of significantly lower PTH levels in CAPD patients with low turnover bone disease (adynamic bone disease) and the higher prevalence in CAPD than in hemodialysis patients, we tried to evaluate any correlation between BMD and iPTH levels in CAPD patients that were separated into two groups: group A (iPTH < 200 pg/mL), 13 patients, and group B (iPTH > 200 pg/mL), 20 patients. Data analysis revealed a negative correlation between PTH levels and BMD values (r = -0.66, p = 0.014) as PTH and serum calcium (r = -0.77, p = 0.002) only in group A. No other statistically significant changes were observed. These findings suggest that there is a favorable influence of CAPD modality on bone mineralization, while no special DEXA findings are representative of the possible appearance of adynamic bone disease.

Absorptiometry, Photon↗

PubMed1995

The identification of bone mineral density in CAPD in comparison with HD patients.

Renal osteodystrophy is a virtually universal complication of chronic renal failure (CRF). Varying degrees of calcium-phosphate metabolism derangement and different types of skeletal damage are observed in CRF for many reasons while the use of dialysis for the management of end-stage renal failure further affects these complications. This study was designed to evaluate the bone mineral density (BMD) that is measured by dual-energy x-ray in three groups of patients: A, 10 patients on continuous ambulatory peritoneal dialysis (CAPD); B, 10 patients on hemodialysis (HD); and C, 10 predialytic patients with advanced CRF. All patients were matched for age, sex, duration of dialysis (> 3 years), and the use of phosphate binders. Biochemical (serum iPTH levels, SAP, Ca, P) and radiological bone studies were compared in the three groups. The majority of predialytic patients had BMD values within the normal range, while the BMD values in PD patients were higher (0.985 g/cm2) in comparison with HD patients (0.949 g/cm2). Some patients, especially in the HD population, showed an increase in BMD with time on dialysis. From all other comparisons, radiological signs of high turnover bone disease and osteopenia were the only variables that were correlated with BMD. All these findings suggest that dialysis affects the bone status and that CAPD patients have better bone mineral metabolism as shown mainly with the use of BMD measurements.

Absorptiometry, Photon↗

PubMed1993

Treatment and prevention of relapses of CAPD Pseudomonas peritonitis.

Pseudomonas peritonitis in continuous ambulatory peritoneal dialysis (CAPD) can be difficult to eradicate, because it is frequently resistant to common antibiotics, inducing the loss of the peritoneal cavity in some cases. A total of 14 episodes of Pseudomonas peritonitis in 12 patients (6 male, 6 female) were treated with intraperitoneal (IP) administration of a combination of ceftazidime and tobramycin. All patients were hospitalized. The loading doses were 1000 mg/2 L of ceftazidime and 1.7 mg/kg of tobramycin, and the maintenance IP doses were 250 mg/2 L of ceftazidime and 16 mg/2 L of tobramycin. The therapy duration was 14 days. In 7 episodes (group A) no other antibiotic regimen was provided, while in the remaining 7 episodes (group B) therapy was continued with 500 mg b.i.d. of oral ciprofloxacin for the next 14 days. Pseudomonas species isolated in group A were P. alcaligenis (1), P. putida (1), P. maltophilia (1), R. cepacia (1), and unidentified (3). In group B the following Pseudomonas species were isolated: P. aeruginosa (4), P. diminuta (1), P. stutszeri (1), and unidentified (1). Recurrence of peritonitis was seen in 4 episodes of group A with 2 catheter removals, while all episodes were cured in group B. These results suggest that IP ceftazidime and tobramycin with the additional use of oral ciprofloxacin is successful in the treatment and prevention of relapses of Pseudomonas peritonitis.

Ceftazidime↗

PubMed1992

Evaluation of CNS-function in CAPD patients using magnetoencephalography (MEG): comparison with hemodialysis patients.

In order to evaluate the CNS-function of uremic patients, the magnetic activity emitted from the brain of 20 pts (10 pts on CAPD and 10 on HD) was measured. MEG consisted of taking 32 consecutive records from the 32 equally spaced points chosen on the skull in uremic pts around our reference points T3, T4, P4, F3, F4 of the international 10-20 electrode placement point system. MEG data were converted using an AD-converter with sampling frequency 256 Hz and stored in a P/C. Our results showed significant differences between the two groups. In all HD pts there was abnormal magnetic brain activity with high spectral amplitudes (in the band 2-7 Hz) which was more prominent in pts in hemo for more than 4 years. The magnetic activity was within normal ranges in all CAPD pts. We conclude that: 1) There is high magnetic brain activity in HD pts, which in accordance with the EEG findings are signs of diffuse encephalopathy. 2) CAPD pts show a very low magnetic brain activity which must be interpreted as normal brain function, and 3) MEG can be useful in further measurement of adequacy of dialysis.

Adult↗

PubMed1992

Treatment of CAPD peritonitis with clavulanate potentiated ticarcillin.

A total of 16 episodes of peritonitis in 14 patients (9 males, 5 females), were treated with Clavulanate potentiated ticarcillin (TC), a -lactamase stable parenteral penicillin. All the pts were hospitalized and received initial loading dose of 3.2 gr intraperitoneally (i.p.) in a 6-hour 1 L exchange, which was followed by four 1 L exchanges with 320 mg/LTC. The therapy was continued for ten days. The bacteria isolated were: Staph. epid. (4), Staph. aureus (2), Strept. viridans (1), Enterococcus (1), Klebsiella Pneum. (1), Serratia (1), Enterobacter (1), Pseudomonas species: stutszeri (2), cepacia (1), fluorescens (1), negative cultures (1). Recurrence of peritonitis was seen in three patients with Pseudomonas (stutszeri (2), fluorescens (1)) peritonitis, 10-16 days after cessation of therapy. No clinical or biological side effects were seen in any patient during and/or after the therapy. These results suggest that, i.p. monotherapy of TC is effective in the treatment of CAPD peritonitis, while in cases of Pseudomonas peritonitis more specific regimens should be used.

Anti-Bacterial Agents↗

PubMed1990

Efficacy of vancomycin plus tobramycin as antiperitonitis regimen for patients on CAPD.

From October 1985 to August 1989, 55 episodes of peritonitis were treated with intraperitoneal (i.p.) use of Vancomycin (V) and Tobramycin (T), in 35 patients (18 males, 17 females). After three rapid IL peritoneal exchanges, the pts received i.p. loading dose of V500 mg/L and an intramuscular dose of T 1.7 mg/Kg, followed by four IL exchanges, with addition of V15 mg/L and T8 mg/L. The length of treatment was 10 days for all pts. The continued administration of V or T as the simple antibiotic regimen was based on the antibiogram, while the combination of both antibiotics was used in negative cultures. Recurrence of peritonitis was seen in 3 episodes (5.4%). No side effects were seen during the therapy. These results indicate that the i.p. use of Vancomycin plus Tobramycin are an appropriate antiperitonitis regimen in the treatment of CAPD peritonitis.

Drug Therapy, Combination↗

PubMed1989

Effect of a calcium antagonist (verapamil) on the permeability of the peritoneal membrane in patients on continuous ambulatory peritoneal dialysis.

Peritoneal clearances of small solutes, mass transfer, ultrafiltration, and the mass transfer area coefficient were measured in order to evaluate the effect of calcium antagonists on the permeability of the peritoneal membrane in patients on continuous ambulatory peritoneal dialysis. We studied 10 patients before and after the instillation of 10 mg (5 mg/l) of verapamil into the peritoneal cavity. Our results showed a significant increase of urea, creatinine, and uric acid clearances. A significant increase in ultrafiltration and mass transfer coefficient area was also observed (p less than 0.05), while the mass transfer of K+, Na+, and Ca2+ was essentially unchanged. These findings indicate that the intraperitoneal use of verapamil may induce an increase in the peritoneal permeability in patients on continuous ambulatory peritoneal dialysis.

Adult↗

PubMed1989

Vancomycin therapy for gram-positive peritonitis in patients on CAPD.

We describe the use of vancomycin in the therapy of gram-positive peritonitis in patients on CAPD. Two ways of administration were in comparison: a) the intraperitoneal (IP) route, with the intraperitoneal administration of 30 mg/l vancomycin for 10 days and b) the intravenous (IV) route with 2 infusions of 1 gram of vancomycin, the first one on the day of the diagnosis of gram-positive peritonitis and the second 7 days later. Each one of these therapeutic schedules was applied at random for 20 episodes of peritonitis out of 40 episodes with gram-positive organisms (28 Staph. albus, 10 Staph aureus and 2 Streptococcus). Remission of clinical symptoms occurred in 49-72 hours in both groups, while macroscopic clearing of dialysate effluent and sterilization of cultures were observed in 4-7 days. Recurrence of peritonitis was seen in 4 patients of the IV group 2 weeks after the administration of the second dose of vancomycin. We conclude that the use of vancomycin with either of the two ways of administration is of great value in the treatment of gram-positive peritonitis. The IV infusion was less successful but it seems to be useful for the out-patient treatment of gram-positive peritonitis.

Drug Administration Schedule↗

PubMed1989

The effect of calcium antagonists on the peritoneal membrane in patients on CAPD.

In order to evaluate the effect of Calcium Antagonists on the permeability of the peritoneal membrane in patients on CAPD, the peritoneal clearances, the mass transfer, the ultrafiltration and the mass transfer area coefficient (MTAC) were measured. We studied 10 patients before and after the instillation of 10 mg (5 mg/L) of Verapamil into the peritoneal cavity. Our results showed a significant (p less than 0.05) increase of urea, creatinine and uric acid clearances. A significant increase (p less than 0.05) in the ultrafiltration and MTAC was also observed, while the mass transfer of electrolytes K+, Na+ and Ca++ was unchanged. These findings indicate that the intraperitoneal use of verapamil may induce an increase in the peritoneal permeability in patients on CAPD.

Adult↗

PubMedDate not supplied

Decrease in Staphylococcus aureus exit-site infections and peritonitis in CAPD patients by local application of mupirocin ointment at the catheter exit site.

OBJECTIVE: To evaluate the potential effectiveness of the application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis caused by Staphylococcus aureus (SA). DESIGN: This prospective, historically controlled study was done on 181 peritoneal dialysis patients treated between 1 November 1996 and 1 November 1997. They were instructed to apply mupirocin at the catheter exit site daily or three times per week at the conclusion of their exit-site care (Study 1). The patients were not screened to determine whether they were SA carriers. The group's historical control was the infection data from the previous year among these patients. A second group of 70 patients, who started using mupirocin within a month after catheter implantation (1996-1997), was compared with a historical group of 118 patients (controls) who were on continuous ambulatory peritoneal dialysis (CAPD) for 1 year after in-patient implantation without mupirocin, (1990-1995) (Study 2). RESULTS: In the group of 181 patients (Study 1), application of mupirocin at the exit site led to a significant reduction in SA exit-site infections--21 versus 3 episodes (0.11 vs 0.01 episodes/patient/year)--and a significant reduction of SA peritonitis--35 episodes in the year preceding mupirocin versus 11 episodes during the year of mupirocin treatment (0.19 vs 0.06 ep/pt/yr). The same results were observed in Study 2: the incidence of SA exit-site infection was significantly lower in the mupirocin-treated group--17 episodes among the 118 nontreated patients versus 4 episodes among 70 patients using mupirocin (0.14 ep/pt/yr vs 0.06 ep/pt/yr, respectively). Similarly there were 20 episodes of SA peritonitis among 118 patients during their first year of CAPD versus 4 episodes in 70 mupirocin-treated patients (0.16 ep/pt/yr vs 0.06 ep/pt/yr, respectively). No adverse effects were observed among the patients treated with mupirocin. Overall peritonitis rates decreased from 0.87 to 0.48 ep/pt/yr (p < 0.01) in Study 1 and from 0.56 to 0.41 ep/pt/yr (p = NS) in Study 2. We observed no differences in the incidence of exit-site infection and peritonitis rates among patients applying mupirocin ointment at the exit site daily, compared to three times per week. CONCLUSIONS: Mupirocin application at the exit site significantly lowers the incidence of SA exit-site infections and peritonitis due to SA infections. Since SA infections are accompanied by significant morbidity and occasional mortality, this treatment may improve long-term survival of patients on CAPD.

Administration, Topical↗