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Biomedical subjects

S Izatt

Publications and source records attributed to S Izatt.

At least 19 recordsLinked to original sources
PubMed2003

Structural changes in silicon rubber peritoneal dialysis catheters in patients using mupirocin at the exit site.

Structural damage to polyurethane PD (peritoneal dialysis) catheters in patients using mupirocin ointment is widely appreciated, but damage to silicon rubber PD catheters is less well described. Ten catheters (6.6%) out of 152 were found to have structural alterations such as opacification, ballooning, thinning, and rupture. The duration of PD in these 10 patients ranged from 23 months to 80 months (mean duration 51.1 months). The frequency of mupirocin application varied from daily (2 cases) to 2-3 times per week (7 cases). In eight catheters opacification occurred at the exit site whereas one catheter showed opacification midway between the exit site and the titanium adaptor. One catheter showed opacification, ballooning, and thinning at the exit site ruptured in the form of two slit-like openings. In conclusion, various structural changes such as opacification, ballooning or thinning were seen in 6.6% of silicon rubber PD catheters in patients using mupirocin at the exit site. Although the mechanism remains elusive, mupirocin or the antiseptic solution alone or in combination may be contributory. We believe that this is an under-reported complication and encourage other health care givers to incorporate a search for such changes during clinic visits.

Adult↗
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↗
PubMed1993

Tidal volume peritoneal dialysis versus intermittent peritoneal dialysis.

In a 12-week crossover study we assessed the effect of tidal volume peritoneal dialysis (TVPD) on serum chemistry, patient well-being, appetite and sleep, blood pressure, and body weight period and compared it with the effect of intermittent peritoneal dialysis (IPD) on these same parameters over a similar period. We used similar volumes of dialysis solutions per exchange and session, and the exchanges were of the same duration in each session. There were 12 patients (6 males, 6 females) with a mean age of 76 years (range 61-88 years), and mean duration of peritoneal dialysis 49 months (range 20-148 months). Five patients started with TVPD and switched to IPD after 3 months; the remaining 7 patients started with IPD and switched to TVPD for the next 3 months. No differences were seen between TVPD and IPD in any of the measured parameters: body weight, appetite, sleep, and well-being by self-assessment, number of transfusions, and complications related to peritoneal dialysis. There were two episodes of peritonitis during the TVPD period and none during the IPD period. Our data indicate that TVPD and IPD are equally effective when applied over similar durations and with similar volumes of dialysis solutions in each session. The improved results with TVPD that others have reported probably can be explained by the use of higher volumes of dialysate.

Aged↗
PubMed1992

Is total creatinine clearance a good predictor of clinical outcomes in continuous ambulatory peritoneal dialysis?

The measurement of the adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) is controversial. The use of weekly total creatinine clearance (TCC) has been recommended, but not validated. We analyzed data from our recent urea kinetics in a CAPD study to investigate TCC and its relationship to patient outcomes. TCC was measured over 24 hours by adding residual renal and peritoneal creatinine clearance, correcting for 1.73 m2 surface area and converting to a weekly value. Seventy-six patients had 218 measurements, on starting CAPD and then at 6-month intervals, with mean follow-up of 20 months (range 1-57 months). The mean TCC was 73.62 +/- 32.11 L/week. Due mainly to the loss of residual renal function, the TCC decreased with time (r = -0.40, p < 0.0001), from 88.65 L/week initially to 66.11 at one year, 59.84 at two years, and 50.47 at three years. Dialysate-to-plasma creatinine concentration ratios (D/P Cr) increased with time (r = 0.28, p < 0.0001) from 0.62 initially to 0.66 at one year and 0.73 at two years. The TCC correlated significantly with serum levels of creatinine (r = -0.46, p < 0.0001), urea (r = -0.21, p < 0.001), potassium (r = 0.14, p < 0.05), phosphate (r = 0.25, p < 0.001), and hemoglobin (r = 0.16, p < 0.01), but not with serum albumin or with clinical outcomes including technique failure, hospital days, transfusions, peritonitis rate, nerve conduction velocity, or subjective indices of well-being, except for a weak correlation with the fatigue index (r = 0.19, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Creatinine↗
PubMed1991

Is intraperitoneal tobramycin ototoxic in CAPD patients?

In 40 CAPD patients treated for peritonitis, the authors did a prospective study of ototoxic effects of intraperitoneal tobramycin. They evaluated cochlear function in pure-tone threshold audiograms over a range of frequencies from 250-10,000 Hz, in the speech-reception threshold test and in the speech-discrimination test. These tests were performed within 48 hours of initiation of tobramycin treatment and within 2 or 3 weeks of the drug's discontinuation. With the aminoglycoside doses used in this study, no statistical difference between the mean baseline and mean follow-up hearing levels was seen in these 40 patients. However, according to the standard criteria of ototoxicity, the hearing in 10 of 40 patients (25%) deteriorated after tobramycin, while it improved in seven patients (17.5%). In the remaining 23 (57.5%), hearing remained stable. With respect to the risk factors for ototoxicity such as advanced age, increased duration of treatment, elevated plasma aminoglycoside levels, concomitant treatment with other ototoxic drugs, pre-existing hearing loss, renal dysfunction and hyperthermia, no statistically significant difference was demonstrated between the patients with deteriorated, stable or improved hearing. The results of this study do not confirm that tobramycin given intraperitoneally to CAPD patients produces auditory toxicity. The hearing deterioration observed in 10 patients may be due to synergistic factors. The improvement observed in 7 patients could not be explained.

Audiometry, Pure-Tone↗
PubMed1990

Genital swelling as a surgical complication of continuous ambulatory peritoneal dialysis.

Genital edema was seen as a complication of continuous ambulatory peritoneal dialysis (CAPD) in 18 patients, who accounted for 4 per cent of all patients on CAPD. In the majority of patients, the swelling developed suddenly and painlessly in the scrotum, penis or labia majora. Some of the patients noticed ultrafiltration failure. In the majority of these patients, this was a result of fluid leakage through the patent processus vaginalis. In one female patient, fluid leaked through the implantation site of the catheter. A computed tomographic scan using contrast media is a useful diagnostic tool in identifying the side of the defect in patients with generalized scrotal or penile edema. Surgical repair of the hernia and the hole in the processus vaginalis or hernia sac prevented recurrence. A trial of temporary discontinuation of CAPD or intermittent peritoneal dialysis using small volumes of dialysis fluid prevented recurrence while reinstituting CAPD in patients with normal findings from contrast studies. Intermittent peritoneal dialysis using low volumes of dialysis fluid with stepwise increase prevented recurrence while reinstituting CAPD two to three weeks after surgical repair.

Adult↗
PubMed1989

Changes in peritoneal membrane transport rates in patients on long term CAPD.

Peritoneal equilibration tests (PET's) are a simple means of monitoring peritoneal membrane function in C.A.P.D. patients. Findings on initial testing have been proposed as having prognostic value for a patient's course on peritoneal dialysis. 177 serial P.E.T.'s were performed in 49 patients at six monthly intervals using a 2 litre 4.25% dextrose exchange and a four hour dwell and equilibration ratios were calculated for urea (D/P U), creatinine (D/P C) and glucose (D/Do G). Alterations in equilibration ratios with time were not significant in the group as a whole. However, a subgroup of 12 patients was identified in whom there were significant increases in D/P U (p .02) and in D/P C (p .003) and decreases in D/Do G (p .025) between zero and 18 months. A subgroup of five patients in whom D/P U decreased significantly (p .05) was also identified. These subgroups did not differ significantly in clinical characteristics although peritonitis was more frequent in the group with increasing transport. As results of P.E.T.'s alter with time in many patients prognostication based on initial values only may not be valid.

Adolescent↗
PubMed1978

Influence of exchange volume and dialysate flow rate on solute clearance in peritoneal dialysis.

To find the ideal dialysate flow rate and exchange volume for use in long-term peritoneal dialysis, 10 patients were studied over a period of 1.5 yr. Exchange volumes of 1 or 2 liters and dialysate flow rates of 1, 2, 3, 4, and 6 liters/hr were tested. Dextrose concentration remained constant at 1.5 g/100 ml. Peritoneal clearances for BUN, creatinine, and uric acid were calculated at 2, 5, 10, 15, and 20 hr during dialysis making a total of 120 clearances for each patient. All patients used a reverse osmosis automatic machine. The clearance of all three solutes tended to be higher with exchange volumes of 2 liters than they did with 1 liter; this trend was significant for BUN (P less than 0.025) and uric acid (P less than 0.025) but not for creatinine. There was a significant rise in clearance with increasing flow rates per hour for all solutes as shown in the following table. (Formula: see text), Since patients could not tolerate a flow rate of 6 liters/hr, we conclude that flow rate of 4 liters/hr with a 2-liter exchange will give maximum efficiency.

Blood Glucose↗
PubMed1978

Comparison of intermittent with continuous peritoneal dialysis.

Our experience with 41 patients on CAPD is presented (127 patient months). Thirty-three patients were previously on intermittent peritoneal dialysis. We used 4 exchanges of 2 L each per 24 hours (8, 6, 6 and 4 hours dwell times). There was a dramatic fall in serum creatinine of 27%, BUN fell 22%, total CO2 rose 15%. Haemoglobin rose 10% and serum albumin fell by 5%. The incidence of peritonitis was one episode per 7.1 patient months. All patients noted an increase in well being. There were almost no dietary restrictions and patients gained real body weight. In most instances, their antihypertensive medication could be discontinued. This technique is superior to all the other forms of peritoneal dialysis.

Adult↗
PubMed1975

The permanent Tenckhoff catheter for chronic peritoneal dialysis.

Over a 3 1/2-year period the permanent Tenckhoff catheter was used in 66 patients (32 men and 34 women) maintained on chronic peritoneal dialysis for periods from 2 1/2 to 36 1/2 months; 57 patients had dialysis in hospital for 20 to 24 hours twice a week and the other 9 had dialysis at home for 10 to 12 hours four times a week. While the Tenckhoff catheter was in place 14 patients received a renal transplant; for 13 who required peritoneal dialysis during the post-transplant phase the Tenckhoff catheter was used. In nine patients abdominal surgery did not interfere with the continuation of peritoneal dialysis via the Tenckhoff catheter. From a total of 5067 dialyses 40 positive cultures were reported (0.8%). Peritonitis was clinically evident on only 14 occasions (0.28%). Permanent catheter obstruction developed in 16 patients, in 11 of whom it was related to peritonitis. With the introduction of the permanent Tenckhoff catheter long-term peritoneal dialysis has become a simple, safe and painless procedure, suitable for virtually all patients who require maintenance dialysis.

Abdomen↗