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Biomedical subjects

W C Lye

Publications and source records attributed to W C Lye.

At least 37 records · Page 2Linked to original sources
PubMed1994

Serum tumor markers in patients on dialysis and kidney transplantation.

Tumor markers play an important role in the assessment of patients with some types of malignant tumors. We studied the effects of dialysis and transplantation on the serum levels of five tumor markers; alpha-fetoprotein (AFP), carcino-embryonic antigen (CEA), cancer antigen-125 (CA-125), cancer antigen-19.9 (CA-19.9), and prostate specific antigen (PSA). Serum tumor markers were measured in patients who-had been on dialysis treatment or had a renal transplant for at least one month. Four groups of 30 patients each (hemodialysis, peritoneal dialysis, renal transplant, and normal controls) were studied. Age and sex distribution were comparable between the dialysis and control groups, but the age was significantly younger in the transplant group. Serum AFP and PSA levels were within normal limits in the dialysis and transplant patients. Serum tumor markers, which were raised in the hemodialysis and peritoneal dialysis patients compared to transplant patients and controls, include: CEA (4.5 +/- 2.7 and 5.1 +/- 3.0 vs 1.7 +/- 1.2 and 2.7 +/- 1.2, p < 0.001); CA-125 (41.1 +/- 43.8 and 18.9 +/- 12.7 vs 13.4 +/- 5.7 and 6.1 +/- 4.9, p < 0.001 and p < 0.05); and CA-19.9 (66.0 +/- 60.4 and 66.2 +/- 76.5 vs 20.2 +/- 12.3 and 5.3 +/- 4.5, p < 0.001). Raised CEA, CA-125, and CA-19.9 levels were detected in 37%, 10%, and 53% of peritoneal dialysis patients and 17%, 27%, and 57% of hemodialysis patients. Although the mean serum CEA, CA-125, and CA-19.9 levels were higher in the transplant patients compared to controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers, Tumor↗
PubMed1994

Dermal mast cell density and pruritus in end-stage renal failure.

Skin mast cell density was determined in two age- and sex-matched groups of patients with end-stage renal failure, one with severe uraemic pruritus (n = 9) and the other without (n = 9). In each group, seven patients were on chronic haemodialysis. In uraemic patients without pruritus, skin mast cell density was similar to that in eight healthy controls (40.1 +/- 10.2 mm2 versus 46.5 +/- 20.6 mm2; P = 0.44), a result also obtained when only the patients on haemodialysis were considered (39.3 +/- 14.7 versus 46.5 +/- 20.6; P = 0.46), showing that haemodialysis per se did not cause mast cell proliferation. In contrast, uraemic patients with itch had significantly higher dermal mast cell counts when compared with those without itch (71.8 +/- 36.4 mm2 versus 40.1 +/- 12.9 mm2; P = 0.01). However, there was no difference in serum parathyroid hormone (PTH) and calcium or phosphate concentrations between the two groups. In addition, there was no significant correlation between dermal mast cell density and serum PTH, calcium or phosphate concentrations. These data suggest that uraemic pruritus may be related to mast cell proliferation in the skin.

Adult↗
PubMed1994

Staphylococcus aureus CAPD-related infections are associated with nasal carriage.

Staphylococcus aureus nasal carriage has been shown to be associated with an increased risk of S. aureus exit-site infections, but its association with peritonitis is less well established. We performed a four-year prospective study to determine the relationship between S. aureus continuous ambulatory peritoneal dialysis (CAPD)-related infections and nasal carriage. All patients who had been started on CAPD from 1989 to 1992 had regular nose cultures. S. aureus nasal carriage was defined as two of three positive nose cultures. A total of 41 carriers and 105 noncarriers were studied. The rates of S. aureus exit-site infection (0.23 vs 0.09 episode/patient/year, p < 0.005), peritonitis (0.33 vs 0.10 episode/patient/year, p < 0.005), and catheter loss (0.12 vs 0.05, p < 0.01) were significantly higher among the carriers. Life-table analysis showed a significant risk of S. aureus exit-site infection and peritonitis for carriers (p < 0.01). Logistic regression analysis showed that S. aureus nasal carriage was the most important predictive factor for S. aureus peritonitis. In conclusion, our study showed that S. aureus nasal carriage is related to an increased incidence of S. aureus CAPD-related infections.

Catheters, Indwelling↗
PubMed1994

Isolation of organisms in CAPD peritonitis: a comparison of two techniques.

The identification of organisms is important in the treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. We compared two techniques for isolating organisms in CAPD peritonitis. Clinical and microbiologic data on all episodes of peritonitis from 1991-1993 were prospectively recorded. The isolation of organisms from 77 episodes of peritonitis was done using the conventional centrifugation culture method from 1991-1992; the isolation of organisms from 121 episodes of peritonitis was done using the BACTEC method from 1992-1993. The total culture-positive rates were 75% for the BACTEC technique and 58% for the conventional technique (p = 0.05), with a higher isolation rate for gram-negative organisms (36% vs 18%, p < 0.05). In the isolation of organisms from new episodes of peritonitis, the culture-positive rates were significantly higher for the BACTEC than for the conventional technique (82% vs 55%, p < 0.01). The recovery rates of organisms for both techniques were similar for relapse peritonitis. The treatment outcomes of CAPD peritonitis for the two technique groups, and for the culture-positive and culture-negative groups were not significantly different. In conclusion, the BACTEC method yielded a higher rate of positive cultures for CAPD peritonitis, but did not affect treatment outcome of the infections.

Bacteriological Techniques↗
PubMed1993

Methicillin-resistant Staphylococcus aureus nasal carriage and infections in CAPD.

In view of the increasing concern about methicillin-resistant Staphylococcus aureus (MRSA) infections, we studied the characteristics and outcome of MRSA nasal carriage and infections in our CAPD program. All patients entering into the CAPD program from January 1989 to December 1991 were enrolled into the study. The patients' anterior nares were cultured before the implantation of the catheters. Peritoneal dialysis-related infections were diagnosed based on standard criteria. Data on MRSA nasal carriage, exit-site and tunnel infections and peritonitis were prospectively collected. A total number of 167 patients with 225.9 patient dialysis years were studied with a mean follow-up duration of 16.2 +/- 9.5 months. There were 28 patients with MRSA nasal carriage. The carrier state was unrelated to age, sex and presence of diabetes mellitus. MRSA nasal carriage was associated with a significant increase in the rate of peritonitis (P < 0.01) and exit-site infections (P < 0.01), the number of catheter losses, and CAPD patient dropout (P < 0.001). A total of 30 patients had MRSA infections. In this group, 15 patients had 24 episodes of peritonitis; 20 had 22 episodes of exit-site infections; and 1 had tunnel infection. Fourteen patients had a combination and/or multiple episodes of infections. Treatment of MRSA infections with intraperitoneal vancomycin was unsuccessful in 12 patients (40.0%) resulting in catheter loss. Nine patients (30.0%) dropped out of CAPD after treatment failure for MRSA peritonitis. The patient dropout rate per infection for MRSA infections was comparable to Pseudomonas and fungal infections, but was significantly higher than MSSA infections (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Renal cholesterol embolic disease. Case report and review of the literature.

Renal cholesterol embolization is a rare disease occurring usually in elderly men who had undergone an angiographic procedure or vascular surgery. We report a man who developed systemic cholesterol embolic disease and acute renal failure after coronary angiography. A review of the English literature for renal cholesterol embolic disease revealed a high incidence of eosinophilia (71%). Livedo reticularis and digital infarcts occurred in more than 30% of patients. Forty percent of patients required dialysis for acute renal failure of whom only one fifth recovered sufficient renal function to stop dialysis. The overall mortality was high at 64%. Skin, muscle and kidney biopsies remain the main tools for diagnosis.

Acute Kidney Injury↗
PubMed1993

A prospective study of peritoneal dialysis-related infections in CAPD patients with diabetes mellitus.

Data comparing peritoneal dialysis (PD)-related infection rates between diabetic and nondiabetic patients on chronic peritoneal dialysis are conflicting. We carried out a prospective study comparing PD-related infection rates between diabetic and nondiabetic patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our center. All patients commencing CAPD between January 1989 and June 1992 were enrolled into the study. Patients were followed up until death, CAPD dropout, or until December 1992. Data on diabetes mellitus status, Staphylococcus aureus nasal carriage, and PD-related infections were gathered. Infection rates were analyzed using life tables and the negative binomial test. One hundred and seven diabetic patients and 72 nondiabetic patients were studied. Patients with diabetes mellitus were not at increased risk of being S. aureus nasal carriers. The peritonitis rate was significantly higher in the diabetic group (1.2 vs 0.8 episodes/patient/year, p < 0.05). The exit-site and tunnel infection, catheter loss, and patient dropout rates were not significantly different between the two groups. Life-table analysis did not show a significant difference in the time to first episode of peritonitis and catheter-related infection.

Bacteria↗
PubMed1993

Breaking-in after the insertion of Tenckhoff catheters: a comparison of two techniques.

Breaking-in after catheter implantation may be an important factor in the development of early catheter-related infections in continuous ambulatory peritoneal dialysis (CAPD) patients. We carried out a prospective study comparing two break-in techniques after catheter implantation. All patients entering the CAPD program from March 1991 to December 1992 were enrolled into the study. Data on diabetes mellitus status, Staphylococcus aureus nasal carriage, and peritoneal dialysis-related infections were gathered. After catheter implantation, the patients were assigned to either have their catheter rested until the fourteenth postoperative day (group 1) or immediate use of the catheter for intermittent peritoneal dialysis (group 2). Exit-site care was identical for both groups. A total of 32 patients in group 1 and 74 in group 2 were studied. Age, sex, and S. aureus nasal carriage were not significantly different between the two groups. There were more patients with diabetes mellitus in group 2. Four patients in group 2 dropped out of the CAPD program because of refractory peritonitis. There was no significant difference in the number of exit-site infections between groups 1 and 2. There were more patients who had pericatheter leakage and catheter migration in group 2 compared to group 1, although the difference was not statistically significant.

Catheters, Indwelling↗
PubMed1993

Nosocomial urinary tract infection: a microbiological study.

Nosocomial urinary tract infection (UTI) is an important cause of increased morbidity and mortality in hospitalised patients. The increasing use of broad spectrum antibiotics will result in changes in the microbiological and antibiotic sensitivity pattern of pathogens isolated from nosocomial UTI. We have endeavoured to study the bacteriological pattern of nosocomial UTI and the antibiotic sensitivity patterns of the pathogens concerned. Over a period of one year, a total of 541 patients with 656 episodes of nosocomial UTI were studied. A total of 748 organisms were isolated. The two main complicating factors in nosocomial UTI were urogenital instrumentation (70.4%) and diabetes mellitus (24.2%). Klebsiella species (spp) was the predominant organism isolated (25.0%) and was significantly associated with age and diabetes mellitus. Klebsiella spp in nosocomial UTI showed an overall increase in resistance to antibiotics and multiple antibiotic resistant strains were not uncommon. Escherichia coli was isolated in 17.7% of cases. Streptococcus faecalis was isolated in 10.6% of cases and was significantly associated with instrumentation. Pseudomonas spp was isolated in 8.6% of cases and was generally sensitive to ceftazidime and amikacin. It was associated with systemic malignancies and the use of immunosuppressants.

Adolescent↗
PubMed1993

Intraperitoneal vancomycin/oral pefloxacin versus intraperitoneal vancomycin/gentamicin in the treatment of continuous ambulatory peritoneal dialysis peritonitis.

Sixty patients were enrolled in a prospective, randomized study to evaluate the efficacy of two different regimens for the empirical treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. At presentation, Group I received intraperitoneal vancomycin (1 g) and oral pefloxacin (400 mg b.i.d.), and Group II intraperitoneal vancomycin (1 g) and gentamicin (80 mg loading dose, followed by 15 mg/2 L). Treatment duration was 14 days. Despite randomization, Group I had significantly more patients with primary Candida peritonitis. When fungal peritonitis was excluded from analysis, there were no significant differences in the treatment success rate (Group I, 73.3% vs Group II, 80.0%, p = NS), number of relapses (Group I, 0 vs Group II, 1), and Tenckhoff catheter removal rates (Group I, 26.6% vs Group II, 16.6%, p = NS) between the two groups. The patients treated with pefloxacin had an increased incidence of nausea and vomiting. In selected situations oral pefloxacin may be a suitable substitute for intraperitoneal gentamicin as out-patient therapy for CAPD peritonitis.

Administration, Oral↗