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Biomedical subjects

S I Vas

Publications and source records attributed to S I Vas.

At least 19 recordsLinked to original sources
PubMed2001

Chronic peritoneal dialysis in octogenarians.

BACKGROUND: During the past few decades the pattern of end-stage renal failure disease has changed with increasing number of elderly patients admitted for dialysis. In spite of their increasing number, little is known about the optimal mode of therapy of the 'old old' (those >or=80 years) patients. METHODS: In this retrospective study, we analysed the results of treatment of 31 non-institutionalized 'old old' patients at Toronto Western Hospital (17) and Scarborough General Hospital (14) and seven institutionalized patients in chronic care, Riverdale Hospital. The patients were on CAPD with Twin-bag Baxter (28) or Home Choice, Baxter or Fresenius CCPD system (10). Patients were screened at the CAPD clinic when routine blood investigations were done. Patient and technique survival, initial and final laboratory data (last visit or before death) and complications related/unrelated to dialysis method are presented. RESULTS: Multiple comorbid conditions were present at the start of the treatment and new added during treatment; very few were dialysis-related. The majority of non-institutionalized patients required assistance of home-care nurse to perform dialysis. Peritonitis (1/28.6 patient months) and exit-site infection rate (1/75.1 patient months) were low and responded to treatment. Incidence of peritonitis was higher among institutionalized debilitated patients (1/5.3 patient months). Incidence of hospitalization was 1/14.7 patient months and patients spent in hospital 7.5 days/patient year. Forty-seven per cent of patients survived 24 months; 39% survived 30 months. Technique survival was 91.5% at 12 months and 81.4% at 30 months. Poor appetite and malnutrition were frequent among very old patients. Patients and their families were motivated for treatment and discontinuation of dialysis was not higher than described elsewhere in literature. CONCLUSIONS: This study has demonstrated that chronic peritoneal dialysis could be recommended as a safe and suitable modality of treatment of end-stage renal failure in old old patients.

Aged↗
PubMed1999

Outcome of Pseudomonas aeruginosa exit-site and tunnel infections: a single center's experience.

We reviewed the course and outcome of all Pseudomonas aeruginosa (PA) exit-site and tunnel infections (ESI/TI) that occurred at our home peritoneal dialysis (PD) unit over a 3-year period (July 1995 to June 1998). We documented PA ESI/TI in 19 out of a total of 467 patients. Of the 19 patients, 12 having local redness and tenderness but no discharge were treated conservatively with increased frequency of dressing with or without hydrogen peroxide locally. Of the 12 cases receiving local care, 7 resolved without recurrence over 14.4 months follow-up, while the remaining 5 developed persistent ESI/TI with discharge and required treatment with antibiotics. Seven more patients who initially presented with purulent discharge also received systemic antibiotics. Only 1 of the 12 patients with PA ESI/TI treated with antibiotics resolved; the remaining 11 patients developed PA peritonitis over a 1-month to 7-month period after the initial PA ESI/TI. In 2 of these 11 patients, simultaneous PD catheter removal and replacement was attempted for the treatment of PA ESI/TI, but these patients also developed PA peritonitis 1-3 weeks after the procedure. Of the 11 patients with PA peritonitis associated with PA ESI/TI, 1 died, 6 were transferred to permanent hemodialysis, and just 4 continued PD after PD catheter replacement. Though not frequent, PA ESI/TI is still a serious complication of home PD at our unit, resulting in ESI/TI-related PA peritonitis and catheter loss in 58% of cases. Local treatment of mild PA ESI/TI (redness and induration) seems to be effective. On the other hand, patients with purulent discharge are likely to develop peritonitis and technique failure despite antibiotic therapy. Early catheter replacement can be considered in these cases.

Anti-Bacterial Agents↗
PubMed1994

Renaissance of tuberculosis in the 1990s: lessons for the nephrologist.

OBJECTIVE: To call attention to the worldwide increase in tuberculosis and to review the disease in peritoneal dialysis patients. DATA SOURCES: Recent epidemiological publications. DATA EXTRACTION: Epidemiological data summarized in tables and diagnostic and therapeutic recommendations reviewed. CONCLUSIONS: Tuberculosis is on the rise worldwide. Multiple drug-resistant strains are emerging, causing therapeutic problems. The role of atypical mycobacterial infections in continuous ambulatory peritoneal dialysis (CAPD) is reviewed. Early diagnosis of cases and thorough chemotherapy are advocated.

Humans↗
PubMed1993

Single daily dose of aminoglycosides in the treatment of continuous ambulatory peritoneal dialysis peritonitis.

Toxicity of aminoglycosides is a major concern in the treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. The relatively high blood levels and prolonged and repeated usage may all be contributory. The recognition of the so-called postantibiotic effect, together with the increased phagocytosis of antibiotic-treated cells, may introduce a new mode of therapy with once-daily dosage. Intermittent therapy with vancomycin is already generally accepted. The extension of this modality to antibiotic therapy is discussed.

Administration, Oral↗
PubMed1991

Primary and secondary role of viruses in chronic renal failure.

Viruses may be the cause of renal disease. This effect may be direct, affecting the renal parenchyma, or may be indirect, usually through immune complex damage. The classification and potential role of viruses involved in renal damage is discussed.

Animals↗
PubMed1990

Successful treatment of systemic blastomycosis with high-dose ketoconazole in a renal transplant recipient.

A case of disseminated blastomycosis in a male renal transplant recipient is presented. Discontinuation of immunosuppressive therapy and treatment with high-dose ketoconazole was successful in treating the patient's cutaneous and pulmonary disease initially. Ketoconazole was discontinued after 12 months of chronic therapy, but 2 weeks after discontinuation, blastomycosis recurred. High-dose ketoconazole was again effective; the patient remains asymptomatic presently on chronic suppressive therapy with ketoconazole.

Aged↗
PubMed1989

Subcapsular steatonecrosis in response to peritoneal insulin delivery: a clue to the pathogenesis of steatonecrosis in obesity.

Hepatic steatosis and steatonecrosis occur in nonalcoholic individuals, usually in a setting of obesity, type II diabetes mellitus, and after jejunoileal bypass. We propose an hypothesis for the pathogenesis of these hepatic lesions based on an observation in peritoneal dialysis patients. Hepatic histology was examined at autopsy in 11 patients with type I diabetes mellitus and renal failure who had received i.p. insulin in conjunction with continuous ambulatory peritoneal dialysis (CAPD). Steatosis in a unique subcapsular distribution occurred in 10 of 11 patients treated with i.p. insulin and in 0 of 9 controls receiving CAPD without insulin. Three of the 11 had steatonecrosis, 2 of whom had Mallory bodies. We suggest that insulin has an important role in the pathogenesis of steatosis and steatonecrosis. In CAPD patients the lesions occurred only under the capsule where concentrations of insulin are high secondary to its i.p. administration. In obese patients the lesions occur throughout the liver where insulin concentrations are high because of elevated levels in the portal vein. Free fatty acids (FFA) are oxidized in the liver by a pathway that is blocked by insulin. In the presence of insulin, FFA are preferentially esterified into triglycerides which accumulate in large quantities leading to steatosis; small amounts of FFA escaping local control may lead to membrane injury and steatonecrosis. Steatosis and/or steatonecrosis will occur when there is insulin secretion sufficient to block FFA oxidation but not sufficient to block FFA mobilization from adipose tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Infections of continuous ambulatory peritoneal dialysis catheters.

In the last several years we have reached a certain plateau in the frequency of peritonitis seen in patients. Consequently, a peritonitis rate of one every two patient years may be acceptable. Further reduction of this peritonitis rate will require large efforts on all fronts. One will have to consider what the acceptable cost/risk of peritonitis is in peritoneal dialysis patients. New developments in catheter technology, improved connections, better understanding of patient selection and training programs, improved diagnostic and therapeutic methods in the management of peritonitis, and an understanding of the infectious and immune processes are eagerly awaited.

Humans↗
PubMed1988

Slow continuous hemodialysis for the management of complicated acute renal failure in an intensive care unit.

This paper describes a simple system for the performance of slow continuous hemodialysis (SCHD) as a means of treating difficult and complicated cases of oliguric acute renal failure. The method, which employs access to the circulation via a double-lumen central venous catheter and a BSM 22 blood systems module, can be performed safely in the intensive care unit of a general hospital if closely supervised by a trained nephrologist. The results of treating 16 consecutive cases of complicated acute renal failure in a large general hospital without a hemodialysis unit are described. The method, whose simplicity makes it suitable for intensive care unit nurses without previous hemodialysis training, was not associated with any serious accidents or complications, and was tolerated well by even the most critically ill and hemodynamically unstable patients. The advantages of this approach over more traditional continuous arteriovenous hemofiltration (CAVH) are discussed.

Acute Kidney Injury↗
PubMed1986

In vitro cytotoxicity and antibiotic activity of polymyxin B nonapeptide.

Polymyxin B nonapeptide, prepared by enzymic removal of the fatty acyl diaminobutyric acid side chain from polymyxin B, was about 100-fold less toxic to K562 cells than polymyxin B. MICs of polymyxin B nonapeptide against a test panel of bacteria were 2- to 64-fold lower than those of polymyxin B.

Bacteria↗
PubMed1985

Microbiological diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis.

The fast and accurate etiological diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis is essential. The concentration of larger volumes of peritoneal fluids may yield more isolates than conventional methods. The removal of antibiotics present in the fluids as a consequence of therapy by washing or using antibiotic-removing resins increases the yield considerably. The use of anaerobic culture media is justified if fecal organisms are suspected as the cause of the infection.

Bacteriological Techniques↗