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Sample records for continuous ambulatory peritoneal

  1. Peritonitis during continuous ambulatory peritoneal dialysis.

    PubMed

    Rubin, J; Rogers, W A; Taylor, H M; Everett, E D; Prowant, B F; Fruto, L V; Nolph, K D

    1980-01-01

    We initiated a therapeutic program of continuous ambulatory peritoneal dialysis for patients with chronic renal failure. Our program resulted in many episodes of peritonitis arising from contamination due to the technical aspects of the procedure. Microbiologic evaluation showed that 73% of 97 episodes were culture positive, with gram-positive organisms causing most of the cases, especially early in dialysis. Gram-negative rods tended to occur later. Gram stains of dialysate effluent resulted in a disappointingly low yield of only 9% positivity. Cell counts were a dependable indicator of the presence of peritoneal inflammation and also of therapeutic success. Most patients responded well to intraperitoneal cephalothin, 125 mg/L for 10 to 14 d. The occurrence of peritonitis resulted in 0.93 years of hospitalization during the total of 15.45 patient-years on dialysis, which essentially negated the financial advantages of this method of treatment of chronic renal failure. For this to be a successful mode of therapy, advances in the prevention of peritonitis must be made. PMID:6985785

  2. Campylobacter jejuni peritonitis complicating continuous ambulatory peritoneal dialysis.

    PubMed Central

    Pepersack, F; D'Haene, M; Toussaint, C; Schoutens, E

    1982-01-01

    We report the occurrence of Campylobacter jejuni peritonitis complicating C. jejuni enteritis in a patient treated with continuous ambulatory peritoneal dialysis. Cure followed oral administration of erythromycin and intraperitoneal therapy with gentamicin. PMID:7153322

  3. Mycobacterium fortuitum peritonitis associated with continuous ambulatory peritoneal dialysis.

    PubMed Central

    Woods, G L; Hall, G S; Schreiber, M J

    1986-01-01

    Mycobacterium fortuitum has been isolated from skin and soft tissue lesions with increasing frequency. Rarely, however, has it been a documented cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis. We report here the second such case and discuss both the possibility of M. fortuitum or similar organisms as one cause of "sterile" peritonitis in this patient population and the in vitro antimicrobial susceptibility testing of such isolates. PMID:3700629

  4. Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis.

    PubMed Central

    von Graevenitz, A; Amsterdam, D

    1992-01-01

    The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents. PMID:1735094

  5. Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis.

    PubMed

    Tsai, T C; Hsu, J C; Chou, L H; Lee, M L

    1994-01-01

    We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

  6. Pseudomonas sp. group Ve-2 bacterial peritonitis in a patient on continuous ambulatory peritoneal dialysis.

    PubMed Central

    Amber, I J; Reimer, L G

    1987-01-01

    Pseudomonas sp. group Ve-2 peritonitis occurred in a patient on continuous ambulatory peritoneal dialysis who had recently completed intraperitoneal cephalosporin therapy for culture-negative peritonitis. This is the second reported case of peritonitis in this population of patients due to this unusual organism, which is usually resistant to most cephalosporin antibiotics. PMID:3571484

  7. Raoultella planticola peritonitis in a patient on continuous ambulatory peritoneal dialysis.

    PubMed

    Kim, Sun Woo; Kim, Ji Eun; Hong, Yu Ah; Ko, Gang Jee; Pyo, Heui Jung; Kwon, Young Joo

    2015-12-01

    A 65-year-old man on continuous ambulatory peritoneal dialysis was admitted with peritonitis. Empirical antibiotic therapy was initiated, and Raoultella planticola was identified in the peritoneal fluid culture. We treated the patient with intraperitoneally administered ciprofloxacin and ceftazidime according to the antibiotic susceptibility. His condition improved, and he was well treated with a 2-week antibiotic course.

  8. Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report

    PubMed Central

    Sangwan, Jyoti; Lathwal, Sumit; Kumar, Satish; Juyal, Deepak

    2013-01-01

    Mycobacterium fortuitum, an environmental organism, is capable of producing a variety of clinical infections such as cutaneous infections, abscesses and nosocomial infections. Rarely, it has been a documented as a cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the treatment options which are used for patients with end-stage renal disease (ESRD). Although peritonitis rates have declined in parallel with advances in peritoneal dialysis (PD) technology, peritonitis remains a leading complication of CAPD and it is the major cause for transfer to other methods of dialysis. We are reporting a case of M. fortuitum peritonitis in a patient who was undergoing CAPD, which was successfully treated. This case emphasizes the importance of mycobacterial cultures in patients with CAPD-associated peritonitis, whose routine cultures may yield no organisms. PMID:24551685

  9. Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report.

    PubMed

    Sangwan, Jyoti; Lathwal, Sumit; Kumar, Satish; Juyal, Deepak

    2013-12-01

    Mycobacterium fortuitum, an environmental organism, is capable of producing a variety of clinical infections such as cutaneous infections, abscesses and nosocomial infections. Rarely, it has been a documented as a cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the treatment options which are used for patients with end-stage renal disease (ESRD). Although peritonitis rates have declined in parallel with advances in peritoneal dialysis (PD) technology, peritonitis remains a leading complication of CAPD and it is the major cause for transfer to other methods of dialysis. We are reporting a case of M. fortuitum peritonitis in a patient who was undergoing CAPD, which was successfully treated. This case emphasizes the importance of mycobacterial cultures in patients with CAPD-associated peritonitis, whose routine cultures may yield no organisms.

  10. Group JK corynebacterium peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Pierard, D; Lauwers, S; Mouton, M C; Sennesael, J; Verbeelen, D

    1983-01-01

    We describe a case of peritonitis with isolation of a group JK corynebacterium from the peritoneal effluent in a patient undergoing continuous ambulatory peritoneal dialysis and treated with corticosteroids. Therapy with intraperitoneal vancomycin resulted in a rapid eradication of the organism. However, only 1 month after discontinuation of the 26-day therapy, a second episode of peritonitis with JK corynebacterium occurred. After vancomycin was restarted, the organism disappeared again from the peritoneal fluid, but the patient died a few days later from heart failure apparently unrelated to the infection. Some authors have mentioned the isolation of diphtheroids (without further identification) from peritoneal effluent of continuous ambulatory peritoneal dialysis patients, but to our knowledge, this is the first report of peritonitis associated with JK corynebacterium, an opportunistic organism that must be differentiated from other corynebacteria. PMID:6630457

  11. Peritonitis Due to Roseomonas fauriae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Bibashi, Evangelia; Sofianou, Danai; Kontopoulou, Konstantina; Mitsopoulos, Efstathios; Kokolina, Elisabeth

    2000-01-01

    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis. PMID:10618142

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

    PubMed Central

    Vas, S I; Law, L

    1985-01-01

    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. PMID:3886688

  13. Pharmacokinetics of cefepime in patients undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Barbhaiya, R H; Knupp, C A; Pfeffer, M; Zaccardelli, D; Dukes, G M; Mattern, W; Pittman, K A; Hak, L J

    1992-01-01

    The pharmacokinetics of cefepime were studied in 10 male patients receiving continuous ambulatory peritoneal dialysis therapy. Five patients received a single 1,000-mg dose and the other five received a single 2,000-mg dose; all doses were given as 30-min intravenous infusions. Serial plasma, urine, and peritoneal dialysate samples were collected; and the concentrations of cefepime in these fluids were measured over 72 h by using a high-performance liquid chromatographic assay with UV detection. Pharmacokinetic parameters were calculated by noncompartmental methods. The peak concentrations in plasma and the areas under the plasma concentration-versus-time curve for the 2,000-mg dose group were twice as high as those observed for the 1,000-mg dose group. The elimination half-life of cefepime was about 18 h and was independent of the dose. The steady-state volume of distribution was about 22 liters, and values for the 1,000- and 2,000-mg doses were not significantly different. The values for total body clearance and peritoneal dialysis clearance were about 15 and 4 ml/min, respectively. No dose dependency was observed for the clearance estimates. Over the 72-h sampling period, about 26% of the dose was excreted intact into the peritoneal dialysis fluid. For 48 h postdose, mean concentrations of cefepime in dialysate at the end of each dialysis interval exceeded the reported MICs for 90% of the isolates (MIC90s) for bacteria which commonly cause peritonitis resulting from continuous peritoneal dialysis. A parenteral dose of 1,000 or 2,000 mg of cefepime every 48 h would maintain the antibiotic levels in plasma and peritoneal fluid above the MIC90s for the most susceptible bacteria for the treatment of systemic and intraperitoneal infections [corrected]. PMID:1510432

  14. [Peritonitis in patients treated by continuous ambulatory peritoneal dialysis].

    PubMed

    Georgiev, M; Krivoshiev, S; Kraev, Z

    1989-01-01

    With the present study the authors set themselves the task to compare the number of peritonitis episodes in patients treated with two types of systems: "Sorin-Biomedica" and "Travenol-(UV-XD)", in which disinfection of the connecting devices is achieved accordingly with chemical agents and with ultraviolet irradiation. Eleven patients have been observed from August 1984 through February 1989. The total duration of treatment was 156 months. Twenty one peritonitis episodes were observed--15 with "Sorin-Biomedica" system and 6 with "Travenol-(UV-XD)" system--an average of one episode in 4 1/2 months with the former system and one episode in 14.7 months with the latter. It is pointed out in conclusion that the "Travenol-(UV-XD)" system with ultraviolet disinfection has significantly reduced the incidence of peritonitis at the dialysis center where the authors work.

  15. Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients.

    PubMed

    Shubayra, Amnah

    2015-03-01

    Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  16. Flavimonas oryzihabitans (Pseudomonas oryzihabitans; CDC group Ve-2): an emerging pathogen in peritonitis related to continuous ambulatory peritoneal dialysis?

    PubMed

    Bendig, J W; Mayes, P J; Eyers, D E; Holmes, B; Chin, T T

    1989-01-01

    A case of peritonitis caused by Flavimonas oryzihabitans (Pseudomonas oryzihabitans; CDC group VE-2) in a patient on continuous ambulatory peritoneal dialysis is reported. This is the seventh case of infection caused by this organism reported in the English literature and the third reported case of continuous ambulatory peritoneal dialysis-related peritonitis caused by this organism; it is the first case of infection of any kind caused by this organism in England.

  17. Flavimonas oryzihabitans (Pseudomonas oryzihabitans; CDC group Ve-2): an emerging pathogen in peritonitis related to continuous ambulatory peritoneal dialysis?

    PubMed

    Bendig, J W; Mayes, P J; Eyers, D E; Holmes, B; Chin, T T

    1989-01-01

    A case of peritonitis caused by Flavimonas oryzihabitans (Pseudomonas oryzihabitans; CDC group VE-2) in a patient on continuous ambulatory peritoneal dialysis is reported. This is the seventh case of infection caused by this organism reported in the English literature and the third reported case of continuous ambulatory peritoneal dialysis-related peritonitis caused by this organism; it is the first case of infection of any kind caused by this organism in England. PMID:2913032

  18. Morganella morganii Peritonitis Associated with Continuous Ambulatory Peritoneal Dialysis (CAPD) after Colonoscopy.

    PubMed

    Kimura, Yukihiro; Ito, Ayano; Miyamoto, Kanyu; Suga, Norihiro; Miura, Naoto; Kasagi, Tomomichi; Yamagishi, Yuka; Mikamo, Hiroshige; Imai, Hirokazu

    2016-01-01

    A 79-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and cloudy peritoneal fluid two days after colonoscopy that revealed multiple diverticula. The white blood cell count was 9,000 cells/μL, C-reactive protein level was 6.86 mg/dL, and the white blood cell count of the peritoneal fluid was 7,800 cells/μL, suggesting acute peritonitis. Empiric therapy consisting of cefazolin and ceftazidime slowly improved the patient's symptoms. The initial microbiological examination of the peritoneal fluid demonstrated Morganella morganii. He was changed from CAPD to hemodialysis. It is important to consider M. morganii peritonitis in patients with colonic diverticula.

  19. Evaluation of continuous ambulatory peritoneal dialysis fluid C-reactive protein in patients with peritonitis.

    PubMed

    Ramanathan, Kumaresan; Padmanabhan, Giri; Vijayaraghavan, Bhooma

    2016-05-01

    Severe peritonitis causing death is one of the most devastating complications of peritoneal dialysis (PD). Since the predictive value of C-reactive protein (CRP) in PD fluid has not been assessed, the objective of the present study is to evaluate its predictive value and clinical correlation in patients on PD with peritonitis. One hundred and twenty patients on continuous ambulatory PD (CAPD) were enrolled and their serum and fluid CRP (Fl. CRP) were evaluated at the start of CAPD. All patients who developed peritonitis were further evaluated for serum and fluid CRP. The patients were categorized into four groups, namely: normal patients (control group), patients with peritonitis, patients with peritonitis leading to catheter removal, and death due to peritonitis. Sixty-five patients developed peritonitis of whom, catheter removal was performed in eight patients. Five patients died due to peritonitis-related complications. Fl. CRP showed a significant difference among the three groups, unlike S. CRP. Estimation of CRP in the peritoneal fluid may be a useful marker to monitor the onset of peritonitis. PMID:27215236

  20. Evaluation of continuous ambulatory peritoneal dialysis fluid C-reactive protein in patients with peritonitis.

    PubMed

    Ramanathan, Kumaresan; Padmanabhan, Giri; Vijayaraghavan, Bhooma

    2016-05-01

    Severe peritonitis causing death is one of the most devastating complications of peritoneal dialysis (PD). Since the predictive value of C-reactive protein (CRP) in PD fluid has not been assessed, the objective of the present study is to evaluate its predictive value and clinical correlation in patients on PD with peritonitis. One hundred and twenty patients on continuous ambulatory PD (CAPD) were enrolled and their serum and fluid CRP (Fl. CRP) were evaluated at the start of CAPD. All patients who developed peritonitis were further evaluated for serum and fluid CRP. The patients were categorized into four groups, namely: normal patients (control group), patients with peritonitis, patients with peritonitis leading to catheter removal, and death due to peritonitis. Sixty-five patients developed peritonitis of whom, catheter removal was performed in eight patients. Five patients died due to peritonitis-related complications. Fl. CRP showed a significant difference among the three groups, unlike S. CRP. Estimation of CRP in the peritoneal fluid may be a useful marker to monitor the onset of peritonitis.

  1. Tuberculous peritonitis in a case receiving continuous ambulatory peritoneal dialysis(CAPD) treatment

    PubMed Central

    Sahin, Garip; Kiraz, Nuri; Sahin, Ilknur; Soydan, Mehmet; Akgün, Yurdanur

    2004-01-01

    Background Tuberculosis continues to be an important health problem in the world. Besides pulmonary involvement extrapulmonary involvement becomes an affair in developing countries, even in developed countries. Case presentation A thirty-six year old male patient was admitted with abdominal pain, diarrhea, nausea, vomiting and fever which had started one week before. The patient had been followed up with predialisis Chronic Renal Failure(CRF) diagnosis for 4 years and receiving continuous ambulatory peritoneal dialysis (CAPD) treatment for 4 months. In peritoneal fluid, 1600/mm3 cells were detected and 70% of them were polymorphonuclear leukocytosis. The patient begun nonspesific antibiotherapy but no benefit was obtained after 12 days and peritoneal fluid bacterial cultures remained negative. Peritoneal smear was positive for Asid-fast basilli (AFB), and antituberculosis therapy was started with isoniazid, rifampicine, ethambutol and pyrazinamide. After 15 days his peritoneal fluid cell count was decreased and his symptoms were relieved. Peritoneal fluid tuberculosis culture was found positive. Conclusion Considering this case, we think that in patients with CAPD catheter and peritonitis; when peritoneal fluid leukocytes are high and PMNL are dominant, AFB and tuberculosis culture must be investigated besides bacterial culture routinely. PMID:15461815

  2. [Protozoan infection (Blastocystis hominis) concomitant with Pseudomonas sp. peritonitis in continuous ambulatory peritoneal dialysis (CAPD)].

    PubMed

    Boccardo, G; De Prisco, O; Ettari, G; Donato, G; Maurino, D; Savoia, D

    1996-03-01

    Case-report of protozoal infection (Blastocystis bominis) during Pseudomonas peritonitis in male patient with intestinal diverticulosis on continuous ambulatory peritoneal dialysis (CAPD) treatment for chronic renal failure (CRF). Microscopic morphology and cultural characteristics are summarized from current literature. Photographic images in phase contrast from fresh-observation of faeces and peritoneal fluid are reported. Although other Protozoa (e.g. Acanthamoeba free-living) have already been found in dialysis fluid, this is the first case, referred in literature, of Blastocystis bominis infection in CAPD patients. Some pathogenetic hypothesis are done involving Blastocystis bominis in peritoneal infection, especially in immunodepressed patients like dialysed ones. Although many chemotherapeutics are provided for this protozoiasis during enteritis, in our case no supplement was required except specific antibiotic therapy for Pseudomonas infection. Symbion or pathogen? Is now-a-day the question which troubles parasitologists. Systemic research of Protozoa in dialysed patients is anyhow advisable. PMID:8848771

  3. Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis: a first in Australia.

    PubMed

    Azzam, Omar; Crowe, Amy; Sajiv, Cherian; Pawar, Basant

    2015-01-01

    A 33-year-old Caucasian man with end-stage renal disease secondary to biopsy-proven IgA nephropathy, managed with continuous ambulatory peritoneal dialysis (PD), presented with PD-related peritonitis, the causal organism being a non-branching Gram-positive bacillus, Rhodococcus equi. Initial empirical Gram positive and negative coverage with cefazolin and ceftazidime was unsuccessful, but following isolation of the organism, and conversion to intraperitoneal vancomycin and oral ciprofloxacin, the peritonitis episode resolved. At day 10, vancomycin was switched to azithromycin for a total of 6 weeks of antimicrobial therapy. The PD catheter was preserved, and the patient remained peritonitis-free at 6 months of follow-up.

  4. Blood pressure profile in continuous ambulatory peritoneal dialysis patients

    PubMed Central

    Cader, Rizna Abdul; Gafor, Halim Abdul; Mohd, Rozita; Ibrahim, Suriani; Wan Haslina, W.H.; Bain, Arba'iyah; Kong, Norella CT

    2012-01-01

    Background: Cardiovascular mortality is the leading cause of death in end stage renal disease. Despite being on continuous ambulatory peritoneal dialysis (CAPD), blood pressure (BP) remains poorly controlled. A higher pulse pressure and non dipping are associated with increased cardiovascular mortality. We studied BP control and the prevalence of non dipping in CAPD patients. Methods: All patients undergoing CAPD at our institution who met the inclusion criteria were recruited. We compared BP control and dipping status in diabetic and non diabetic patients on CAPD. We also determined whether BP and peritoneal membrane permeability were associated. Results: Forty six patients with a mean age 45 ± 13 years were enrolled. Diabetic patients were older (mean age 54 ± 13 vs. 40 ± 11 yrs, p <0.001), had a lower mean diastolic BP (80 ± 14 vs. 90 ± 14 mmHg, p = 0.025) and a higher mean pulse pressure (59 ± 17 vs. 49 ± 14 mmHg, p = 0.035). They were also non dippers (n = 15 vs. n = 1, p = 0.007). The low and low average transporters tended to have a higher systolic BP (p = 0.054) and a higher pulse pressure (p = 0.058). On multivariate analysis, age was the main predictor of pulse pressure. Conclusion: Despite being on chronic maintenance PD, BP was not well controlled. Diabetic patients had a higher pulse pressure and were non dippers thereby increasing their cardiovascular risk. We should therefore optimize BP control and aim to restore the nocturnal dip in these patients. PMID:27366136

  5. Telemedicine system for patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Nakamoto, Hidetomo

    2007-06-01

    Over recent decades, rapid progress in information and telecommunications technology has led to the application of these technologies in the medical field. In 1999, we reported on a telemedicine system (version 1.0) that used an automated peritoneal dialysis machine to collect data on patients with end-stage renal disease. After 2002, we focused on using cellular telephones in a new telemedicine system (version 2.0) to monitor patient data at home, including blood pressure (BP), heart rate, body weight, urine volume, and blood glucose. By 2003, we had developed a fully automatic system called I-converter (version 3.0) to collect data from a fully automatic device and send it via cellular telephone. After the fully automatic device measures a patient's BP, I-converter sends the data directly to the main server in our central data center. That server is directly connected to Web site by application service provider (ASP) technology. Recently, to make the system simpler, we developed a new version called D-converter (version 4.0). The telephone used in this new system is a Personal Handy-phone System (PHS). The PHS has several advantages: high-speed data transmission, low power output, little electromagnetic interference with medical devices, and easy locating of patients. The D-converter system uses a small computer and a PHS card called a Dopa card. Our telemedicine systems monitor continuous ambulatory peritoneal dialysis (CAPD) patients at home. For elderly and handicapped patients, these systems are very advantageous because they reduce visits to the outpatient clinic. In addition, data can be monitored at the patient's home in real time. The present paper reports our recent advances in telemedicine systems for CAPD patients.

  6. Disposition kinetics of cefamandole during continuous ambulatory peritoneal dialysis.

    PubMed Central

    Bliss, M; Mayersohn, M; Arnold, T; Logan, J; Michael, U F; Jones, W

    1986-01-01

    Cefamandole disposition kinetics were examined in six male subjects with renal impairment who were undergoing continuous ambulatory peritoneal dialysis. Creatinine clearance values ranged from less than 1 to 11 ml/min. Cefamandole was given as a 1-g intravenous dose infused over 30 min. Cefamandole concentrations were determined in serum, urine, and dialysis fluid by a high-performance liquid chromatographic method. The following average parameter values were obtained (range): half-life, 6.1 h (4.6 to 9.7); systemic clearance, 21.9 ml/min (8.4 to 35.5); renal clearance, 11.5 ml/min (0.03 to 22.3); dialysis clearance, 0.92 ml/min (0.7 to 1.3); nonrenal clearance, 12.2 ml/min (2.9 to 27.0); volume of distribution, 0.18 liter/kg (0.09 to 0.25); steady-state volume of distribution, 0.17 liter/kg (0.09 to 0.24). Approximately 5% of the dose was dialyzed (range, 2.8 to 8.3), indicating that there is no need to supplement a dosing regimen of cefamandole due to loss by dialysis. There was a positive correlation between creatinine clearance and the terminal elimination rate constant of cefamandole (r2 = 0.41) and cefamandole renal clearance (r2 = 0.83). PMID:3707113

  7. Total volume culture technique for the isolation of microorganisms from continuous ambulatory peritoneal dialysis patients with peritonitis.

    PubMed Central

    Dawson, M S; Harford, A M; Garner, B K; Sica, D A; Landwehr, D M; Dalton, H P

    1985-01-01

    A total volume method of culturing dialysis fluid from continuous ambulatory peritoneal dialysis patients during episodes of peritonitis was developed. Concentrated culture media stored in small blood transfer bags were added directly to the drained dialysate exchange bags by the same technique used to carry out the dialysate exchange. The exchange bag with the added culture medium was incubated at 35 degrees C and observed for turbidity. Seventy-eight dialysis exchange bags from patients without clinical peritonitis (negative controls) and forty-eight dialysis exchange bags from patients with clinical peritonitis were cultured. Bacteria were recovered from all cultures of patients with clinical peritonitis (100% sensitivity) and from five cultures of negative control fluids (94% specificity). Of these isolates, 86% were gram positive, and 14% were gram negative. This technique represents an advance over previously described culture techniques in its ability to isolate the causative organism(s) in cases of peritonitis in continuous ambulatory peritoneal dialysis patients. Images PMID:3930561

  8. [Continuous ambulatory peritoneal dialysis in schizophrenia. Experimentation in 3 cases].

    PubMed

    Sichel, J P; Baldauf, A; Horber, M; Wasser, P; Marichal, J F; Faller, B

    1981-01-01

    The authors report their experience in using Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.), in the treatment of chronic schizophrenia. This attempt refers to studies which confirm any role of endorphins in the origin of schizophrenia. Consecutively to american authors who found endorphins (molecular weight 3 300) in the dialysat of hemodialysed schizophrenics, they choose C.A.P.D. This continue technic of dialysis is more efficient than hemodialysis in removal of substances which molecular weight is between 1 500 and 5 000. This technic was used in 3 chronic schizophrenics: the disease has developed since 6 to 17 years and all the previous treatments failed. The duration of C.A.P.D. was 3 to 6 months. The only complication was one episode of inflammation of the peritoneum during 14 months of dialysis. Followed by the same staff with the AMDP 3 scale, the psychiatric evolution includes: --improvement and relapse in 2 patients (but we have to consider the difficulties of socioprofessional rehabilitation of these long term patients); --"clinical recovery" (17 months) in the third patient. The incidence of mothering and institutionalism is not negligible. Dosage of Met-enkephalin and beta-endorphin by radioimmunoassay in the drained dialysat did not show any difference between schizophrenics and the reference chronic renal patient. The results obtained with C.A.P.D. are not very satisfactory so far. But further research especially on the role of endorphins in schizophrenia and on their analysis technics in the body fluids perhaps will allow to treat schizophrenia again by dialysis.

  9. Long-term therapy for heart failure with continuous ambulatory peritoneal dialysis.

    PubMed

    McKinnie, J J; Bourgeois, R J; Husserl, F E

    1985-06-01

    This article reports the treatment with continuous ambulatory peritoneal dialysis of a patient with intractable congestive heart failure secondary to an ischemic cardiomyopathy. Although the use of peritoneal dialysis to treat refractory heart failure is not new, the advent of an effective continuous peritoneal dialysis system has allowed its use over prolonged periods of time. The two-year treatment interval described herein represents the longest reported application of this technique, to the best of our knowledge.

  10. Laboratory diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis.

    PubMed Central

    Ludlam, H A; Price, T N; Berry, A J; Phillips, I

    1988-01-01

    The clinical course and laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis was studied in 32 consecutive episodes. Peritonitis was associated with a failure in aseptic technique in eight episodes and with an exit-site infection in four episodes. Intraperitoneal vancomycin and ceftazidime were safe, effective, and convenient. Most patients administered their antibiotics at home, and symptoms usually resolved by day 4. Culture of the deposit obtained by centrifugation of 50 ml of effluent after leukocyte lysis provided the best rate of recovery (84% culture positive) but was technically demanding. Filtration of the same volume without leukocyte lysis was simple to perform and almost as effective. Enrichment was less satisfactory (65% culture positive) owing to the presence of antibiotic or infection with fastidious microorganisms. Culture of 50 ml of effluent after concentration by a commonly used laboratory technique, centrifugation without leukocyte lysis, performed poorly (59% culture positive at 48 h), as this method caused sequestration and death of microorganisms within the leukocytes. Culture of nearly 1 liter of effluent from 33 asymptomatic patients by the same techniques yielded no microorganisms. PMID:3183023

  11. [Efficacy of continuous ambulatory peritoneal dialysis in treatment of children with end-stage renal insufficiency].

    PubMed

    Sahapozova, E; Ruso, B; Kuzmanovska, D; Tasić, V; Ristoska-Bojkoviska, N

    1998-01-01

    Three children (2 girls and 1 boy) with end-stage renal failure were put in program of continuous ambulatory peritoneal dialysis in the period of 2.5 years (January 1995-September 1997). The age of the children at the treatment onset was 5-12 years. One of three children died due to cardiovascular failure after six-month treatment. Two out of three children had a total of 8 episodes of peritonitis in the period of 37 months during the treatment with peritoneal dialysis. The incidence of peritonitis occurrence in our patients was one episode in 4 patients/months. Most frequent cause for peritonitis occurrence was Staphylococcus aureus in 50% of isolated bacteria. Obtained results in peritoneal equilibration test revealed that the transport and ultrafiltration rate of peritoneal membrane decreased after recurrent peritonitis episodes.

  12. Intraperitoneal pseudocyst formation: Complication of fungal peritonitis in continuous ambulatory peritoneal dialysis

    PubMed Central

    Sahpazova, E; Ruso, B; Kuzmanovska, D

    2007-01-01

    A 14-year-old girl, with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD) the last 4 years, after an episode of Candida albicans was switched to hemodialysis. One month later she came back because of a palpable painful abdominal mass and abdominal distention. Computed tomography (CT) and ultrasound examination demonstrated a demarkated fluid collection in the lower abdomen and pelvis. The cyst was drained percutaneously and the culture disclosed candida albicans which was treated with fluconasole. Two months later, the girl was admitted again with the same symptoms. An investigative laparotomy was undergone and the cyst was drained again. Fluid cultures were negative. CT abdomen examination six months later was negative for cyst relapse. In conclusion, intraperitoneal pseudocyst is a serious complication of CAPD. Surgical intervention may be preferable to percutaneous drainage. PMID:19582199

  13. Intraperitoneal pseudocyst formation: complication of fungal peritonitis in continuous ambulatory peritoneal dialysis.

    PubMed

    Sahpazova, E; Ruso, B; Kuzmanovska, D

    2007-10-01

    A 14-year-old girl, with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD) the last 4 years, after an episode of Candida albicans was switched to hemodialysis. One month later she came back because of a palpable-painful abdominal mass and abdominal distention. Computed tomography (CT) and ultrasound examination demonstrated a demarkated fluid collection in the lower abdomen and pelvis. The cyst was drained percutaneously and the culture disclosed candida albicans which was treated with fluconasole. Two months later, the girl was admitted again with the same symptoms. An investigative laparotomy was undergone and the cyst was drained again. Fluid cultures were negative. CT abdomen examination six months later was negative for cyst relapse. In conclusion, intraperitoneal pseudocyst is a serious complication of CAPD. Surgical intervention may be preferable to percutaneous drainage.

  14. Increased microbial yield from continuous ambulatory peritoneal dialysis peritonitis effluent after chemical or physical disruption of phagocytes.

    PubMed Central

    Taylor, P C; Poole-Warren, L A; Grundy, R E

    1987-01-01

    The laboratory diagnosis of continuous ambulatory peritoneal dialysis-associated peritonitis is often hindered by either the absence of or the recovery of low numbers of viable microorganisms. This may be the result of sequestration of bacteria within phagocytes. Sonication of clinical specimens prior to culturing or culturing on saponin-containing media resulted in the growth of significantly greater numbers of colonies than standard culturing on conventional media. In addition, the demonstration that microorganisms are sequestered in phagocytes helped to establish the pathogenic nature of such isolates and distinguish them from contaminants even when present in low numbers. A variety of physical and chemical techniques can disrupt phagocytes and improve the sensitivity of laboratory methods used to confirm the diagnosis of peritonitis in continuous ambulatory peritoneal dialysis patients. Images PMID:3571464

  15. Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis.

    PubMed Central

    Pignatari, A; Pfaller, M; Hollis, R; Sesso, R; Leme, I; Herwaldt, L

    1990-01-01

    Staphylococcus aureus is the most common cause of peritonitis in patients undergoing peritoneal dialysis in Brazil. Using restriction endonuclease analysis of plasmid DNA, we investigated the importance of chronic carriage of S. aureus in the development of peritonitis in patients on continuous ambulatory peritoneal dialysis at the Division of Nephrology, Escola Paulista de Medicina, Sao Paulo, Brazil. A total of 117 isolates (30 patients) of S. aureus were available for typing, including 51 isolates (22 patients) from the nares, 58 isolates (27 patients) from pericatheter skin, and 8 isolates (6 patients) from peritoneal fluid, from patients with peritonitis. Restriction endonuclease subtyping showed that although most patients harbored more than one subtype of S. aureus, in the majority of patients nasal and/or pericatheter skin isolates with identical restriction endonuclease digest patterns were recovered on more than one occasion. Furthermore, 95% of patients with both nasal and pericatheter colonization were colonized with the same subtypes at both sites. All of the patients with peritonitis were infected with a subtype which colonized the nares, pericatheter skin, or both. These results demonstrate the importance of an endogenous source of S. aureus in the development of continuous ambulatory peritoneal dialysis-associated peritonitis. Images PMID:2172293

  16. Continuous ambulatory peritoneal dialysis: three-year experience at one center.

    PubMed

    Nolph, K D; Sorkin, M; Rubin, J; Arfania, D; Prowant, B; Fruto, L; Kennedy, D

    1980-05-01

    Three years of clinical experience with continuous ambulatory peritoneal dialysis are summarized. Serum urea nitrogen, creatinine, hematocrit, nerve conduction velocity, calcium, inorganic phosphorus, serum proteins, and electrolytes have been maintained in acceptable ranges. Peritonitis, although reduced in incidence because of solutions in plastic bags and a new adapter, is still a problem. Excessive carbohydrate absorption, obesity, and high serum triglyceride concentrations may be long-term problems in some patients. PMID:7387001

  17. Prevalence of peritonitis-associated coagulase-negative staphylococci on the skin of continuous ambulatory peritoneal dialysis patients.

    PubMed Central

    Beard-Pegler, M. A.; Gabelish, C. L.; Stubbs, E.; Harbour, C.; Robson, J.; Falk, M.; Benn, R.; Vickery, A.

    1989-01-01

    The predominance of coagulase-negative staphylococci as normal skin flora is thought to be a factor in their association with episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We investigated the prevalence of peritonitis-associated strains on the skin of 28 patients undergoing peritoneal dialysis. Coagulase-negative staphylococci were the most frequently isolated organisms, comprising 47% of peritoneal dialysis fluid isolates and 59% of body site isolates. A total of 142 coagulase-negative staphylococci were speciated, tested for their antimicrobial sensitivity and slime production, and identified by phage typing and plasmid-profile analysis. Staphylococcus epidermidis was the most commonly identified species from both peritoneal dialysis fluid (73%) and body sites (53%). Multiple antibiotic resistance was common, and the greater proportion of isolates were resistant to methicillin; 63.6% of peritoneal dialysis fluid isolates and 61.7% of body-site isolates. S. haemolyticus isolates were significantly more resistant to methicillin than other species. By phage typing and plasmid-profile analysis it was shown that peritonitis was rarely caused by skin-colonizing strains. In only 3 of 14 patients were peritonitis-associated strains isolated as skin colonizers, and no patients developed peritonitis due to organisms previously isolated as skin colonizers. Images Fig. 1 Fig. 2 Fig. 3 PMID:2737251

  18. Minerals, vitamin D, and parathyroid hormone in continuous ambulatory peritoneal dialysis.

    PubMed

    Delmez, J A; Slatopolsky, E; Martin, K J; Gearing, B N; Harter, H R

    1982-06-01

    The effects of continuous ambulatory peritoneal dialysis on parathyroid hormone (PTH) and mineral metabolism were evaluated in ten patients. Utilizing a PTH radioimmunoassay, which measures both intact hormone and carboxyl-terminal PTH fragments, it was found that the mean clearance of immunoreactive parathyroid hormone was 1.5 +/- 0.73 ml/min (SEM) yielding a daily net removal of 13.6 +/- 3.2% of estimated total extracellular parathyroid hormone. Gel electrophoresis of the dialysate revealed the presence of both intact parathyroid hormone and fragments in a similar pattern to that of peripheral plasma. Normal levels of 25-(OH) vitamin D and vitamin D binding protein were observed prior to the initiation of continuous ambulatory peritoneal dialysis and following 6 months of treatment. Timed dialysate collections (N = 93) demonstrated a daily calcium influx of only 9.9 +/- 9.7 mg. The daily removal of phosphorus was 308.4 +/- 15.5 mg. Despite elevated serum magnesium levels in all patients, the net daily removal was inadequate (31.2 +/- 15.5 mg). It was concluded that: (1) Unlike chronic hemodialysis, continuous ambulatory peritoneal dialysis removes significant amounts of parathyroid hormone. (2) Normal 25-(OH) vitamin D and vitamin D binding protein levels are maintained with continuous ambulatory peritoneal dialysis despite large protein losses. (3) Substantial amounts of phosphorus are removed with continuous ambulatory peritoneal dialysis but not to an extent that precludes use of phosphorus binders. (4) Dialysate containing lower magnesium and possibly higher calcium concentrations should be made available to improve mineral homeostasis. PMID:6897087

  19. In vitro study of bacterial growth in continuous ambulatory peritoneal dialysis fluids.

    PubMed Central

    Sheth, N K; Bartell, C A; Roth, D A

    1986-01-01

    We examined the in vitro survival of bacteria in continuous ambulatory peritoneal dialysis effluents of patients with clinical peritonitis and those without peritonitis. Standard strains of coagulase-negative staphylococci (CNS), Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were inoculated into the fluids, and portions were plated for bacterial counts at 0.5, 4, 24, 48, 72, and 96 h. Unused dialysate fluid was also inoculated simultaneously. Our results show that CNS increased minimally up to 48 h in the noninfected continuous ambulatory peritoneal dialysis effluents and decreased by 96 h, whereas survival was only minimal in the infected effluent. S. aureus showed trends similar to those of CNS, but differences in survival in infected and noninfected effluents were less marked. By contrast, E. coli and P. aeruginosa increased by greater than 1,000-fold in all solutions tested. Based on the above findings, it is likely that a proportionate number of culture-negative cases of peritonitis are due to gram-positive cocci, especially CNS, which are not retrievable by standard culture techniques because of poor survival rate. PMID:3086376

  20. The pharmacokinetics of once-daily oral 400 mg ofloxacin in patients with peritonitis complicating continuous ambulatory peritoneal dialysis.

    PubMed

    McMullin, C M; Brown, N M; Brown, I M; Tomson, C R; White, L O; Reeves, D S; MacGown, A P

    1997-06-01

    Seven patients with end-stage renal disease requiring support by continuous ambulatory peritoneal dialysis received once-daily 400 mg oral ofloxacin for 7 days for the treatment of bacterial peritonitis. Serum and peritoneal dialysis fluid (PDF) were collected for assay throughout the course of the study and for 5 days thereafter. Ofloxacin, desmethyl ofloxacin and ofloxacin-N-oxide accumulated over the course of therapy and could still be detected in serum and PDF 5 days after the end of therapy. The mean elimination half-life of ofloxacin in serum was 32 +/- 7 h, desmethyl ofloxacin 45 +/- 26 h and for ofloxacin-N-oxide 44 +/- 15 h. The total mean recovery of ofloxacin and its metabolites from the PDF was 15.4%. This regimen results in serum and PDF concentrations likely to be effective for the treatment of infection for at least 10 days.

  1. Effects of aerobic exercise on blood glucose in continuous ambulatory peritoneal dialysis patients

    PubMed Central

    Shahgholian, Nahid; KarimiFard, Ozra; Shahidi, Shahrzad

    2015-01-01

    Background: Peritoneal dialysis has a number of complications including increased blood glucose. Although exercise has been suggested to resolve this complication, most patients are not active. The present study aimed at determining the effects of twice-weekly, 40-min sessions of pedaling on a stationary bicycle on mean fasting blood sugar (FBS) and 2-h postprandial blood sugar (PPBS) among continuous ambulatory peritoneal dialysis patients. Materials and Methods: In this clinical trial, convenience sampling was used to select 22 patients [age: 51.4 (12.3) years] undergoing continuous ambulatory peritoneal dialysis [mean duration: 12.5 (8.5) months] from university hospitals in Isfahan, Iran. The subjects were randomly divided into two groups (test and control). The test group participated in an 8-week exercise program in which they pedaled a stationary bicycle with an intensity of four on Borg Scale of Perceived Exertion. FBS and PPBS were measured at baseline and at the end of the 8th and 16th sessions of exercise. Data were analyzed with Student's t-test and repeated measures analysis of variance. Results: After the eighth session, the mean FBS and PPBS levels were lower in the test group than in the control group. However, the differences were not statistically significant. After 16 sessions of exercise, the mean FBS and PPBS levels in the intervention group were significantly less than the in control group. Conclusions: Forty minutes of pedaling on a stationary bicycle for two times a week can significantly reduce mean FBS and PPBS levels in continuous ambulatory peritoneal dialysis patients. PMID:25878690

  2. Risk factors for the occurrence of cardiac arrhythmias in patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Canziani, M E; Saragoça, M A; Draibe, S A; Barbieri, A; Ajzen, H

    1993-01-01

    In order to evaluate the risk factors for the occurrence of ventricular arrhythmias (VA) in continuous ambulatory peritoneal dialysis (CAPD), we studied 47 patients by echocardiography, dipyridamole-thallium tests, and biochemical profile. We observed that the group with VA had a greater cardiac mass index dependent only on an increased left ventricular internal diameter. Septum and posterior wall thickness, as well as biochemical variables, were not associated with the presence of VA in CAPD patients. In addition, altered myocardial perfusion was not associated with VA in these patients. PMID:8399625

  3. Pharmacokinetics of intraperitoneal teicoplanin in patients with chronic renal failure on continuous ambulatory peritoneal dialysis.

    PubMed Central

    Bonati, M; Traina, G L; Gentile, M G; Fellin, G; Rosina, R; Cavenaghi, L; Buniva, G

    1988-01-01

    The pharmacokinetic profile of teicoplanin, a new glycopeptide antibiotic active against Gram-positive aerobic and anaerobic bacteria, is described in five patients with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD). A single 3 mg kg-1 dose was given intraperitoneally in the dialysate during a 6 h dwell time. The drug appeared in the plasma within 15 min at 1.00-0.28 mg l-1 (mean +/- s.d. = 0.70 +/- 0.45) in all five subjects, and peak serum concentrations ranged from 5.53 to 2.80 mg l-1 (4.84 +/- 1.43) at 6 h. Approximately 70% (71 +/- 12) of teicoplanin was absorbed from the peritoneal dialysis fluid during a single 6 h dwell time. The rate constant for peritoneal transfer (lambda d) averaged 0.318 h-1 and the half-life (t1/2 lambda d) was 2.18 h. Further values were serum elimination half-life 114-173 h; total body clearance 263-532 ml h-1; steady-state volume of distribution 68-93 l. This drug profile closely agrees with data reported after intravenous injection in patients on CAPD and suggests that teicoplanin has bidirectional exchange characteristics through the peritoneal membrane, although transfer from the systemic circulation to peritoneal fluid is consistently low. Instillation of teicoplanin in CAPD fluid may be a useful route of administration for treatment of peritonitis and exit site infections in CAPD patients. PMID:2974299

  4. Automated Peritoneal Dialysis Is Associated with Better Survival Rates Compared to Continuous Ambulatory Peritoneal Dialysis: A Propensity Score Matching Analysis

    PubMed Central

    Beduschi, Gabriela de Carvalho; Figueiredo, Ana Elizabeth; Olandoski, Marcia; Pecoits-Filho, Roberto; Barretti, Pasqual; de Moraes, Thyago Proenca

    2015-01-01

    Introduction The impact of peritoneal dialysis modality on patient survival and peritonitis rates is not fully understood, and no large-scale randomized clinical trial (RCT) is available. In the absence of a RCT, the use of an advanced matching procedure to reduce selection bias in large cohort studies may be the best approach. The aim of this study is to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) according to peritonitis risk, technique failure and patient survival in a large nation-wide PD cohort Methods This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZPD study. All patients who were treated exclusively with either APD or CAPD were matched for 15 different covariates using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis. Results After the matching procedure, 2,890 patients were included in the analysis (1,445 in each group). Baseline characteristics were similar for all covariates including: age, diabetes, BMI, Center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous HD, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD. Mortality rate was higher in CAPD patients (SHR1.44 CI95%1.21-1.71) compared to APD, but no difference was observed for technique failure (SHR0.83 CI95%0.69-1.02) nor for time till the first peritonitis episode (SHR0.96 CI95%0.93-1.11). Conclusion In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better

  5. Comparison of Direct Medical Costs Between Automated and Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Cortés-Sanabria, Laura; Rodríguez-Arreola, Brenda E.; Ortiz-Juárez, Victor R.; Soto-Molina, Herman; Pazarín-Villaseñor, Leonardo; Martínez-Ramírez, Héctor R.; Cueto-Manzano, Alfonso M.

    2013-01-01

    ♦ Objective: We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated. ♦ Methods: Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries. ♦ Results: No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component—except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008. ♦ Conclusions: The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were

  6. Solute clearance measurement in the assessment of dialysis adequacy among African continuous ambulatory peritoneal dialysis patients.

    PubMed

    Abdu, Aliyu; Naidoo, Sagren; Malgas, Shirin; Naicker, Jocelyn T; Paget, Graham; Naicker, Saraladevi

    2015-01-01

    Solute clearance measurement is an objective means of quantifying the dose of peritoneal dialysis (PD). Despite continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients, guidelines based on solute clearance values are common in clinical practice. There is limited information on the solute clearance indices and PD adequacy parameters among this predominantly low socioeconomic status PD population. We investigated the solute clearance among continuous ambulatory peritoneal dialysis (CAPD) patients at the Charlotte Maxeke Johannesburg Academic Hospital and its relationship with other parameters of PD adequacy. Seventy patients on CAPD were studied in this cross-sectional study. Solute clearance was assessed using urea clearance (Kt/V). Linear regression analysis was used to determine factors associated with solute clearance, while analysis of variance was used to test the influence of weekly Kt/V on blood pressure (BP), hemoglobin (Hb) and other biochemical parameters. The mean age of the study population was 37.9 ± 12.4 years, 43% were females and 86% were black Africans. The mean duration on CAPD was 19.7 ± 20.8 months. Mean systolic and diastolic BP were 144 ± 28 and 92 ± 17 mm Hg, respectively. The mean Hb was 11.1 ± 2.2 g/dL and the mean weekly Kt/V was 1.7 ± 0.3. Factors like systolic BP, Hb level, serum levels of cholesterol, calcium, phosphate, parathyroid hormone and albumin were not significantly associated with the weekly Kt/V. We conclude that the dose of PD received by the majority of our patients in terms of the weekly Kt/V is within the recommended values and that this finding is significant considering the low socioeconomic background of our patients. There is no significant association between Kt/V and other indices of dialysis adequacy. PMID:26178569

  7. Informal and incidental learning with patients who use continuous ambulatory peritoneal dialysis.

    PubMed

    Keeping, L M; English, L M

    2001-06-01

    Adults learn continuously from the complex interplay of experiences in their day-to-day lives. This article reports on qualitative research conducted with 8 individuals with a diagnosis of end stage renal disease (ESRD) (6 women, 2 men) who were using continuous ambulatory peritoneal dialysis (CAPD). Interviews with each individual in his or her home focussed on how the participants made sense and learned from their experiences. The authors examined the data to determine the informal and incidental learning in the patients' homes, as well as the conditions that supported or limited this learning. Learning themes included understanding of medical and professional language, trusting their own experience, and living on the border of life and death. Barriers to learning included a diminished sense of personhood and the low literacy level of participants. Aspects of informal and incidental learning theory (Watkins & Marsick, 1992) are used to examine the informal learning that occurred. The authors acknowledge the adult learning implications and urge nurses to examine informal learning more closely.

  8. Continuous ambulatory peritoneal dialysis (CAPD) in a patient with glucose-6-phosphatase deficiency.

    PubMed

    Vandepitte, K; Lins, R L; Daelemans, R; Zachée, P; Kuyken, C; De Broe, M E

    1989-01-01

    The metabolic disturbances in glucose-6-phosphatase deficiency (von Gierke's disease) are the consequence of hypoglycemia, occurring mostly during the night. Continuous provision of glucose is the aim of every recently introduced treatment procedure. We studied the influence of continuous ambulatory peritoneal dialysis (CAPD) on the metabolic disturbances in a 42-year-old female patient with von Gierke's disease and end-stage renal disease. During six months of CAPD, there were no dialysis-related complications. The metabolic acidosis didn't worsen: arterial bicarbonate and lactate were not changed. Mean glycemia was 118.6 +/- 14.4 mg%. Total lipemia, cholesterol and triglycerides were not different from those before CAPD, despite the fact that all hypolipidaemic drugs were stopped. Three different exchange procedures were compared during the night: no dialysis, one exchange with a 2 L solution without buffer containing glucose 15 g/L and containing glucose 42.5 g/L. The results show that the 4.25% glucose solution prevents hypoglycaemia, and diminishes the increase in lactate and pyruvate concentration. Intraperitoneal glucose normalizes the plasma free fatty acid concentration. A very important result is the disappearance of hypo-insulinism. We conclude that, from a clinical point of view, CAPD is a well-tolerated treatment in von Gierke's disease. The limited results provide some evidence that the use of a 4.25% glucose solution as an overnight exchange, instead of the usual 1.5% solution, can prevent at least partly the glycogenolysis and consequently the metabolic disturbances of von Gierke's disease. PMID:2488195

  9. Pharmacokinetics of parenteral imipenem/cilastatin in patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Chan, C Y; Lai, K N; Lam, A W; Li, P K; Chung, W W; French, G L

    1991-02-01

    We investigated the pharmacokinetics of two intravenous (iv) dose regimens of imipenem/cilastatin in Chinese patients on chronic ambulatory peritoneal dialysis (CAPD), who had an average creatinine clearance of 3.2 ml/min/1.73 m2. Doses of 0.5 and 1.0 g produced mean peak serum imipenem concentrations of 30 and 70 mg/l respectively, about 60% of cilastatin. Peritoneal dialysis fluid (PDF) imipenem concentrations reached 20-30% of the serum peak 4-5 h after iv injection, and the lowest maximum PDF concentrations were 2 mg/l after the 0.5 g dose and 14 mg/l after 1.0 g. Thus both regimes produced PDF imipenem concentrations above the MICs of susceptible pathogens. The half-life of imipenem was 6.4 h and the plasma clearance 66 ml/min; serum and PDF imipenem were in equilibration after about 5 h. Cilastatin had a prolonged half-life of 19 h and a plasma clearance of 10 ml/min, and accumulated in both serum and PDF. With a 0.5 g dose, the pharmacokinetics of imipenem/cilastatin suggest that the combination may prove an effective treatment for peritonitis associated with CAPD.

  10. Acquired cystic kidney disease in children undergoing continuous ambulatory peritoneal dialysis. Kyushu Pediatric Nephrology Study Group.

    PubMed

    1999-08-01

    Our cross-sectional study aims to elucidate the prevalence of acquired cystic kidney disease (ACKD), time of occurrence of ACKD, relationship between the prevalence of ACKD and duration of dialysis, progression of cysts, and ACKD-related complications in 54 children undergoing continuous ambulatory peritoneal dialysis (CAPD). ACKD was defined as four or more cysts detected in each kidney by ultrasonography, computed tomography (CT), or magnetic resonance imaging. The presence of less than four cysts was diagnosed as solitary cysts (SCs). Noncystic primary disease was present as glomerulonephritis in 23 patients (42.6%); hypoplastic kidney, 7 patients (13.0%); reflux nephropathy, 6 patients (11.1%); and other, 18 patients (33.3%). ACKD was evident in 16 patients (29.6%) during the 57.9 +/- 39.8 months after the start of CAPD. Nine patients (16. 7%) had SCs. SCs and ACKD were detected initially in patients with 1 and 3 years of CAPD, respectively. The mean duration of CAPD for patients with ACKD (96.1 +/- 36.6 months) differed from that of patients with SCs (49.8 +/- 29.9 months) and no cysts (38.3 +/- 25.8 months). The groups were classified according to time after the start of CAPD: 0 to 4 years (n = 33), 5 to 9 years (n = 16), and longer than 10 years (n = 5). The prevalence of ACKD among these three groups was 9.1%, 50%, and 80%, respectively, and this prevalence increased significantly with increasing duration of CAPD. Of 15 patients examined two to four times by ultrasonography or CT, the number and size of cysts increased in 7 patients with ACKD and 2 patients with SC. Two patients with many and large cysts experienced gross hematuria, and one of those patients had intracystic and retroperitoneal bleeding caused by cyst rupture. No solid mass lesion was found by imaging diagnostic modalities in the 54 patients. In conclusion, the prevalence of ACKD in children undergoing CAPD is just as high as that in adults. The prevalence of ACKD and number and size of

  11. Blood pressure monitoring by cellular telephone in patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Nakamoto, Hidetomo; Nishida, Eiichi; Ryuzaki, Munekazu; Sone, Masayoshi; Yoshimoto, Mitsuo; Itagaki, Kaoru

    2004-01-01

    We have developed a new telemedicine system that uses a cellular telephone and Internet Web site to monitor changes of blood pressure (BP) in patients on continuous ambulatory peritoneal dialysis (CAPD). An I-converter data collection system directly transmits all data on BP and heart rate (HR) measured by a fully automatic device (HEM-705IT: Omron Life Science, Tokyo, Japan) to a cellular telephone. The cellular telephone then sends the data directly to the main server at the NTT DoCoMo data center. All data, including BP and HR from each patient, are accumulated in the server. Application service provider technology (ASP) connects that system directly to the Internet. Any time and anywhere, each patient can use a cellular telephone or the Internet Web site to monitor, in graph form, changes in their data. The average data at each collection point are calculated and shown on the Web site. All data collected by cellular telephone are also calculated and sent directly, in real time, to the physician's office. Currently, we are using this telemedicine system for 44 hypertensive patients on CAPD at our center. In the present study, we used the telemedicine system to evaluate changes in 24-hour BP. We followed 20 CAPD patients, monitoring changes in BP for 3 months. At the end of study, we found that the average daytime home BP was 137 +/- 8 mmHg over 80 +/- 4 mmHg and that the average nighttime BP was 128 +/- 7 mmHg over 72 +/- 4 mmHg. The overall average home BP was 132 +/- 7 mmHg over 76 +/- 3 mmHg. The average outpatient clinic BP was 155 +/- 9 mmHg over 86 +/- 5 mmHg. The measured systolic and diastolic BP at the out-patient clinic were significantly higher than those measured at home. As measured at the outpatient clinic, BP indicated that 7 CAPD patients (35%) were hypertensive (> 160/95 mmHg). However, as measured at home, BP indicated that only 4 CAPD patients (20%) were truly hypertensive (> 135/85 mmHg). We were therefore able to determine that 43% of our

  12. Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes? A Ten-year Cohort Study in Taiwan

    PubMed Central

    Tang, Chao-Hsiun; Chen, Tso-Hsiao; Fang, Te-Chao; Huang, Siao-Yuan; Huang, Kuan-Chih; Wu, Yu-Ting; Wang, Chia-Chen; Sue, Yuh-Mou

    2016-01-01

    This paper reports a comprehensive comparison for mortality and technique failure rates between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Taiwan. A propensity-score matched cohort study was conducted by retrieving APD and CAPD patients identified from the Taiwan National Health Insurance Research Database between 2001 and 2010. The main outcomes were the 5-year mortality and technique failure rates. Further analyses were then carried out based upon the first (2001–2004), second (2005–2007), and third (2008–2010) sub-periods. Similar baseline characteristics were identified for APD (n = 2,287) and CAPD (n = 2,287) patients. The proportion on APD therapy increased rapidly in the second sub-period. As compared to CAPD patients of this sub-period, APD patients had a significantly higher risk of mortality (HR, 1.37; 95% CI 1.09–1.72; p < 0.01) and technique failure (HR, 1.43; 95% CI, 1.10–1.86; p < 0.01), particularly in the first year after peritoneal dialysis commencement. However, APD patients had similar mortality and technique failure rates to those of CAPD patients throughout the full sample period and the first and third sub-periods. These findings do not suggest the presence of a clear advantage of CAPD over APD. Differences observed between these two modalities might be attributed to specials circumstances of sub-periods. PMID:27388055

  13. The effect of dwell time on dialysate cancer antigen 125 appearance rates in patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Akman, Sema; van Westrhenen, Roos; De Waart, Dirk R; Hiralall, Johan K; Zweers, Machteld M; Krediet, Raymond T

    2003-01-01

    The dialysate concentration of cancer antigen 125 (CA125) can be considered a reflection of mesothelial cell mass or turnover in stable continuous ambulatory peritoneal dialysis (CAPD) patients. The effect of dwell times exceeding 4 hours on CA125 appearance rate (CA125AR) is not known. Therefore, our objective in the present study was to analyze the effect of dwell time on CA125AR in stable CAPD patients. In 43 stable CAPD patients, we analyzed standard peritoneal permeability analyses (SPAs) performed with a 3.86% glucose dialysate, and night-dwell effluents from the night dwell prior to the SPA. Dialysate CA125 concentration was measured by radioimmunoassay (RIA II: Fujirebio Diagnostics, Malvern, PA, U.S.A.). Night-dwell CA125 correlated with the duration of the dwell (r = 0.32, p = 0.04) and with the CA125 concentration in the 4-hour dwell (r = 0.83, p < 0.001). The mean CA125AR in the SPA effluent was 97.8 +/- 46.3 U/min; in the overnight effluent, it was 108.8 +/- 73.7 U/min (nonsignificant). A good correlation was present between the CA125AR in the 4-hour dwells and in the overnight dwells (r = 0.82, p < 0.001). We conclude that using night dwells to regularly assess dialysate CA125--for instance, at every out-patient visit--is possible in CAPD patients, provided that appearance rate is calculated.

  14. Randomized, double-blind, placebo-controlled trial of spironolactone for hypokalemia in continuous ambulatory peritoneal dialysis patients.

    PubMed

    Yongsiri, Somchai; Thammakumpee, Jiranuch; Prongnamchai, Suriya; Tengpraettanakorn, Pechngam; Chueansuwan, Rachaneeporn; Tangjaturonrasme, Siriporn; Dinchuthai, Pakaphan

    2015-02-01

    The incidence of hypokalemia in continuous ambulatory peritoneal dialysis (CAPD) patients is about 15-60%, leading to significant complications. There is no standard treatment other than potassium supplement in this setting. The aim of this study was to evaluate effect of spironolactone 25 mg/day in CAPD patients who have a history of hypokalemia. This is a randomized, double-blind, placebo-controlled, cross-over study in CAPD patients who had a history of hypokalemia. Study intervention is 4 weeks of oral spironolactone 25 mg/day or placebo, cross-over after a 2-week wash-out period. The primary outcome was the difference of serum potassium before and after 4 weeks of spironolactone treatment. Serum potassium was measured every 2 weeks, serum magnesium, urine and peritoneal fluid potassium measured before and after each treatment period. We enrolled 24 patients, and 20 completed the cross-over study. Ten patients were anuric. The total doses of potassium supplement were the same during the study period. Serum potassium levels before and after study intervention were not significantly different in both groups (4.23 ± 0.64 vs. 3.90 ± 0.59 mEq/L for spironolactone P = 0.077 and 3.84 ± 0.62 vs. 3.91 ± 0.52 for placebo P = 0.551). Total 24-h potassium, magnesium, sodium excretion, urine volume and ultrafiltration volume were not affected by spironolactone or placebo. There was one episode of hyperkalemia (5.6 mEq/L) during the spironolactone treatment period. Spironolactone 25 mg/day does not have a significant effect on serum potassium or urine and peritoneal excretion rate in CAPD patients who have a history of hypokalemia.

  15. Effect of sodium fusidate and ofloxacin on Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Sesso, R; Parisio, K; Dalboni, A; Rabelo, T; Barbosa, D; Cendoroglo, M; Pignatari, A; Draibe, S; Ajzen, H

    1994-06-01

    The effectiveness of sodium fusidate and ofloxacin to eliminate nasal and catheter exit-site Staphylococcus aureus colonization and to prevent infections was compared in 31 patients on continuous ambulatory peritoneal dialysis (CAPD). In a prospective randomized study, 9 patients were treated with topical 2% sodium fusidate ointment applied in the anterior nares and in the pericatheter skin twice daily for 5 days; 9 subjects received oral ofloxacin 200 mg taken every 48 hours for 5 days and 13 subjects were in the control group. Treatment courses were repeated at one-month intervals. Mean duration of follow-up was 7.8 months (242 patients-month). Follow-up samples from the nares and the catheter exit-site were obtained every month from all participants to determine the presence of S. aureus. Development of S. aureus exit-site infection and peritonitis were assessed. During the study, S. aureus was recovered from 45%, 59% and 52% of the samples from the nares and/or exit-site in the sodium fusidate, ofloxacin and control groups, respectively (p = 0.13). S. aureus grew less frequently (p < 0.01) in samples from the exit-site in the sodium fusidate than in the other two groups. Eradication of nasal colonization (two negative cultures within one month) was observed in 43%, 40% and 33% of the cases in the sodium fusidate, ofloxacin and control groups, respectively (p > 0.50). The corresponding figures for exit-site eradication were 43%, 33% and 11%, respectively (p = 0.34). Twenty-four S. aureus-associated infection episodes (12 of exit-site and 12 of peritonitis) were diagnosed in 16 of the 31 patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8076441

  16. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    PubMed

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established.

  17. Effect of Omega-3 fatty acids on blood pressure and serum lipids in continuous ambulatory peritoneal dialysis patients

    PubMed Central

    Naini, Afsoon Emami; Keyvandarian, Nooshin; Mortazavi, Mojgan; Taheri, Shahram; Hosseini, Sayed Mohsen

    2015-01-01

    Objective: Hypertension and hyperlipidemia are two major risk factors for cardiovascular disease in continuous ambulatory peritoneal dialysis (CAPD) patients. This study was designed to investigate the effect of omega-3 fatty acids on blood pressure (BP) and serum lipids in CAPD patients. Methods: This study was a randomized double-blind clinical trial in which 90 CAPD patients were randomly assigned to either the omega-3 or the placebo group. Patients in omega-3 group received 3 g/day omega-3 for 8 weeks, whereas patients in the control group received placebo. At baseline and at the end of 8 weeks, the patients’ BP was controlled, and serum biochemistry was measured. Findings: Mean systolic BP decreased (–22.2 ± 14.2 mmHg) in the omega-3 group at the end of the study while in the placebo group increased (+0.5 ± 30.2 mmHg) (P < 0.0001). Mean diastolic BP of the omega-3 group decreased more (–11.95 ± 11.9 mmHg) comparing with the placebo group (–1.1 ± 17.3 mmHg) (P = 0.001). There were no significant differences between the two groups in mean changes in serum triglyceride, and total, high-density lipoprotein, and low-density lipoprotein cholesterol. Conclusion: The results of this study indicate that omega-3 reduced BP significantly but had no effect on lipid profile in our CAPD patients. PMID:26312252

  18. Coping strategies and health-related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis, and transplant patients.

    PubMed

    Lindqvist, R; Carlsson, M; Sjödén, P O

    2000-06-01

    In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t-test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment. PMID:10849152

  19. Pharmacokinetics of imipenem-cilastatin in patients with renal insufficiency undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Somani, P; Freimer, E H; Gross, M L; Higgins, J T

    1988-01-01

    In six patients with end-stage renal disease, a single bolus of imipenem-cilastatin (500 mg each) was given either intravenously or intraperitoneally in a randomized crossover protocol such that each patient received the drug by both routes at a 2- to 3-week interval. Drug levels in plasma and the peritoneal dialysis fluid were analyzed at frequent intervals, and various pharmacokinetic variables were calculated for a one-compartment open model. Data obtained in the present study suggest that while no significant difference in peak plasma levels or volume of distribution were noted, the following variables were significantly different for imipenem as compared with cilastatin: elimination half-life, total plasma clearance, area under the concentration-time curve, and percent drug excretion in the peritoneal dialysis fluid. The elimination half-life of imipenem (3.28 h) or cilastatin (8.84 h) in our patients was in the same range as observed in patients with minimal renal function undergoing hemodialysis. The dose of imipenem-cilastatin should be reduced appropriately in patients with end-stage renal disease undergoing peritoneal dialysis. PMID:3377464

  20. Improved detection of bacterial growth in continuous ambulatory peritoneal dialysis effluent by use of BacT/Alert FAN bottles.

    PubMed Central

    Alfa, M J; Degagne, P; Olson, N; Harding, G K

    1997-01-01

    Culture-negative peritonitis is a major complication for patients on continuous ambulatory peritoneal dialysis (CAPD) and precludes organism-specific therapy. The aim of the present study was to compare inoculation of 10 ml of CAPD effluent into BacT/Alert blood culture bottles (FAN [fastidious antimicrobic neutralizing], BacTAlert aerobic [BTA], and BacT/Alert anaerobic [BTAn] bottles) to our conventional method of using 50 ml of concentrated CAPD effluent to inoculate peptone broth bottles (BD bottles) and MacConkey agar and blood agar medium (BA-MAC). The FAN, BTA, and BTAn bottles were monitored automatically in the BacT/Alert blood culture instrument. A total of 207 CAPD effluents were studied, and in 97 bacteria were detected by at least one method. Compared to BTA bottles (79 of 97; 81.4%), BTAn bottles (78 of 97; 80.4%), and BD bottles (88 of 97; 90.7%), the single best broth medium for detecting bacterial growth in CAPD effluents was the FAN bottle (90 of 97 effluents; 92.8%). A total of 125 bacterial species were detected by any method, and the majority (91.8%) of CAPD effluents were infected with a single species. A combination of FAN and BTAn bottles detected 111 of 125 (88.8%) of all organisms, whereas a combination of BD bottles and BA-MAC detected 107 of 125 (85.6%) of all organisms. One or more organisms that would have been completely missed by the conventional method with BD bottles and BA-MAC were detected in 18 CAPD effluents. Of these 18 CAPD effluents, 6 showed no growth by the conventional method with BD bottles and BA-MAC. On the basis of our data, the most sensitive and least labor intensive method was direct inoculation of 10 ml of CAPD effluent into a FAN bottle and a BTAn bottle, which could be automatically monitored by the BacT/Alert blood culture instrument. On the basis of case definitions for peritonitis, the sensitivities and specificities of the methods with FAN and BTAn bottles and with BD bottles and BA-MAC were 81.1 and 98

  1. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    PubMed

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established. PMID:25358390

  2. Gordonia Species as Emerging Causes of Continuous-Ambulatory-Peritoneal-Dialysis-Related Peritonitis Identified by 16S rRNA and secA1 Gene Sequencing and Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALDI-TOF MS)

    PubMed Central

    Lam, Jimmy Y. W.; Leung, Wai-Shing; Cheung, Ingrid; Chan, Jasper F. W.; Tse, Cindy W. S.; Lee, Rodney A.; Lau, Susanna K. P.

    2014-01-01

    We report here four cases of continuous ambulatory peritoneal dialysis-related peritonitis caused by three different species of Gordonia. The portal of entry was likely through Tenckhoff catheters. 16S rRNA and secA1 gene sequencing are so far the most reliable methods for the accurate identification of Gordonia species. PMID:25428146

  3. The impact of the earthquake in northwestern Turkey on the continuous ambulatory peritoneal dialysis patients who were living in the earthquake zone.

    PubMed

    Ozener, C; Ozdemir, D; Bihorac, A

    2000-01-01

    In August 1999, an earthquake of magnitude 7.8 on the Richter scale hit northwestern Turkey. The epicenter was in Izmit, an industrial town about 60 km from Istanbul. This paper presents data about the fate of CAPD patients who were living in that region at the time of the earthquake. A total of 42 continuous ambulatory peritoneal dialysis (CAPD) patients (14 females, 28 males; 37 adult patients, 5 pediatric patients) were permanent residents of the earthquake region. They were followed in the CAPD units of Marmara University Hospital (n = 6), Gata Military Hospital (n = 2), and Goztepe SSK Hospital (n = 10, including the 5 pediatric patients) in Istanbul, and in Uludag University Hospital in Bursa (n = 6) and Kocaeli University Hospital in Izmit (n = 18). Two CAPD patients, together with their families, died under the rubble in the city of Golcuk. One CAPD nurse from Kocaeli University Hospital in Izmit also died a victim of the earthquake. One patient who lived in Golcuk was under the rubble for 3 hours; she was rescued with no crush injuries and was able to continue with CAPD 24 hours after her rescue. Eight patients reported that their homes were completely destroyed during the earthquake, while nine patients reported serious damage to their houses. Ten patients had to move to other towns to live with relatives because their homes were no longer suitable for habitation, and twelve patients had to stay permanently in tents provided by the Red Cross. All of the patients were able to continue their CAPD therapy and had no interruption in the supply of their CAPD solutions. Four patients on continuous cycling peritoneal dialysis (CCPD) therapy continued to use their HomeChoice machines (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.) even while living in a tent. CAPD patients from the Kocaeli University Hospital had to be temporarily referred to other CAPD centers in Istanbul and Bursa because the Kocaeli University Hospital was seriously damaged in the

  4. Bacterial growth and killing in chronic ambulatory peritoneal dialysis fluids.

    PubMed Central

    Verbrugh, H A; Keane, W F; Conroy, W E; Peterson, P K

    1984-01-01

    We determined the ability of Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli to survive and grow in peritoneal dialysis fluids from patients undergoing chronic ambulatory peritoneal dialysis. Staphylococci did not survive in commercially available dialysis solutions but grew readily in peritoneal effluents obtained from patients after the dialysis dwell time. The number of CFU doubled 6 and 13 times in 24 h for S. epidermidis and S. aureus, respectively. E. coli grew well in both the pre- and postdialysis peritoneal fluid. Peritoneal macrophages as well as peripheral blood leukocytes inhibited bacterial growth in peritoneal dialysis fluid. However, 10(6) phagocytes per ml were minimally required to obtain a bacteriostatic effect. The addition of serum to peritoneal dialysis fluid increased the antibacterial activity of macrophages and blood leukocytes. The capacity of the aminoglycoside antibiotic tobramycin to reduce bacterial CFU in peritoneal dialysis fluid was only 10% of its bactericidal capacity in standard Mueller-Hinton brush. Peritoneal dialysis fluid had no effect on the antibacterial activity of imipenem. PMID:6386844

  5. Middle molecules in peritoneal equilibration test as a marker of peritoneal stress in children on continuous peritoneal dialysis.

    PubMed

    Laux, C; Weiss, B; Bonzel, K E

    1999-01-01

    At 1 month, 3 months, 6 months, and more than 6 months after healed peritonitis, we evaluated repeated peritoneal equilibration tests (PETs) for small molecules such as urea, and middle molecules such as cystatin C, beta 2-microglobulin, and alpha 1-microglobulin. We analyzed a total of 104 PETs in 21 children aged 1.7-18.6 years (median: 9.9 years). Equilibration quotients (D/P)--that is, substrate concentration in dialysis fluid (D) divided by substrate concentration in plasma (P)--were calculated after a dwell time of 4 hours. The D/P for urea did not change after healed peritonitis. In a cross-sectional study, the D/P for middle molecules showed an increase in peritoneal permeability between 3 months and 6 months after a healed peritonitis. In a consecutive follow-up of 4 patients for more than 6 months, beta 2-microglobulin and, more impressively, alpha 1-microglobulin showed a statistically significant increase in D/P (p < 0.05) 3 months after a healed peritonitis. All differences seen were completely reversible after more than 6 months, showing that peritoneal function is rather stable if peritonitis is healed. It is noteworthy that peritoneal dysfunction lasts for up to 6 months after a completely healed peritonitis. This period might be a vulnerable phase in continuation of peritoneal dialysis. PMID:10682119

  6. First case of CAPD-related peritonitis caused by Morganella morganii.

    PubMed

    Atalay, H; Güney, I; Solak, Y; Almaz, E

    2010-01-01

    Morganella morganii, a gram-negative bacillus, is a rare cause of peritonitis. In this article we report a 55-year-old female patient with peritonitis due to Morganella morganii who was receiving continuous ambulatory peritoneal dialysis (CAPD).

  7. Rapid detection of gram-negative bacterial peritonitis by the Limulus amoebocyte lysate assay.

    PubMed Central

    Smalley, D L; Baddour, L M; Kraus, A P

    1986-01-01

    The chromogenic Limulus amoebocyte lysate test effectively detected 66 (100%) culture-proven gram-negative peritonitis cases among 185 continuous ambulatory peritoneal dialysis patients with clinical evidence of infectious peritonitis. PMID:3771776

  8. Dialysis - peritoneal

    MedlinePlus

    ... The number of exchanges and amount of dwell time depends on the method of PD you use and other factors. Your ... PD: Continuous ambulatory peritoneal dialysis (CAPD) . For this ... routine until it is time to drain the fluid. You are not hooked ...

  9. [Continuous ambulatory chemotherapy with elastomer pump].

    PubMed

    Cabrera Figueroa, J; Arias Hernández, M

    2001-09-01

    Continuous perfusion administration of chemotherapy can be performed by means of various devices known as pumps. There are syringe pumps, elastomeric pumps, peristaltic pumps and pumps which can be implanted. In our hospital environment, the elastomeric pump enjoys a high degree of acceptance since it permits a cancer patient to maintain a large degree of autonomy while he/she carries on his/her activities. PMID:12150128

  10. Advanced glycation end-products in the peritoneal fluid and in the peritoneal membrane of continuous ambulant peritoneal dialysis patients.

    PubMed

    Mahiout, A; Ehlerding, G; Brunkhorst, R

    1996-01-01

    In patients on continuous ambulant peritoneal dialysis (CAPD) treatment, the peritoneal membrane is continuously exposed to the high glucose concentration contained in the dialysate. This may lead to the local generation of advanced glycation end-products (AGEs). To test this hypothesis we evaluated the plasma and dialysate AGE concentrations in five CAPD patients. The dialysate was measured after a 1 h and after a 12 h dwell time. Additionally, in two patients an immunohistochemical investigation of the peritoneal membrane for AGE was performed. For the determination of AGE an ELISA using a polyclonal antibody against AGE bovine serum albumin was used; the immunohistochemical staining was performed using the streptavidin-biotin complex method. We found only low concentrations of AGE in the dialysate after a 1 h dwell time; after 12 h, however, the dialysate AGE was even greater than the plasma concentration. In both peritoneal specimens we found positive staining for AGE in the interstitium of the mesothelial layer. The dialysate AGE contained a high proportion of high-molecular-weight AGE proteins and low-molecular-weight AGE was found to be in the same concentration range as the total serum AGE. We conclude that there is local generation of AGE in the peritoneal membrane and a 'washing out' of AGE from the peritoneal membrane during longer dwell times. We speculate that the accumulation of AGE might lead to some of the functional and morphological alterations observed after long-term CAPD.

  11. Hemodialysis versus continuous ambulatory peritoneal dialysis: effects on the heart.

    PubMed

    Canziani, M E; Cendoroglo Neto, M; Saragoça, M A; Cassiolato, J L; Ramos, O L; Ajzen, H; Draibe, S A

    1995-03-01

    In this study we compared the influence of 2 different modalities of treatment, CAPD and hemodialysis, on the prevalence and severity of left ventricular hypertrophy and cardiac arrhythmias of chronic renal failure patients. We compared 27 patients on the CAPD program with 27 patients on the chronic hemodialysis matched for sex, age, and duration of dialysis treatment. The prevalence of hypertension was significantly lower in CAPD than in hemodialysis patient (41% vs. 81%, p = 0.0023). Blood pressure levels were also lower in CAPD than in hemodialysis patients (systolic pressure 124.9 +/- 4.7 vs. 154.8 +/- 4.6 mm Hg, p < 0.0001; diastolic pressure 77.5 +/- 2.9 vs. 93.3 +/- 2.8 mm Hg, p = 0.0001). Left ventricular hypertrophy (LVH) was present in 52% of CAPD and in 93% of hemodialysis patients (p = 0.0008). Severe cardiac arrhythmias (Lown 3-4) occurred in only 4% of CAPD and in 33% of the hemodialysis group (p = 0.0149). The lower frequency of LVH in CAPD might explain the lower incidence of severe arrhythmias. PMID:7779013

  12. Continuous in situ diffusion of ropivacaine for ambulatory congenital hand disorders surgery in young children.

    PubMed

    Apard, T; Letouze, S; Barbary, S; Becuwe, L; Lammens, S

    2013-09-01

    Pediatric ambulatory surgery presents a specific set of challenges to the anesthesiologist. Similarly to adult ambulatory surgery, we report four ambulatory surgical procedures in two young children with congenital hand disorders. For each surgical procedure pain was controlled with continuous in situ infusion of ropivacaine.

  13. Paecilomyces variotii in peritoneal dialysate.

    PubMed Central

    Marzec, A; Heron, L G; Pritchard, R C; Butcher, R H; Powell, H R; Disney, A P; Tosolini, F A

    1993-01-01

    Four cases of peritonitis caused by the filamentous fungus Paecilomyces variotii in patients on continuous ambulatory peritoneal dialysis are reported. Removal of the Tenckhoff catheter and antifungal chemotherapy led to resolution of symptoms in all cases. Possible contaminating events are discussed, and reported infections with P. variotii are reviewed. PMID:8408561

  14. Peritonitis

    MedlinePlus

    Acute abdomen; Spontaneous bacterial peritonitis; SBP; Cirrhosis - spontaneous peritonitis ... management of adult patients with ascites due to cirrhosis 2012. Hepatology . 2013;57(4):1651-1653. PMID: ...

  15. Stability of antimicrobial agents in peritoneal dialysate.

    PubMed Central

    Sewell, D L; Golper, T A

    1982-01-01

    The stability of cephapirin, gentamicin, penicillin G, nafcillin, ticarcillin, and vancomycin was tested in peritoneal dialysate at 25 degrees C for 24 h. All of the antimicrobial agents were stable except penicillin G, which lost 25% of activity over 24 h (P less than 0.01). The once-daily preparation of drug-dialysate solution is feasible for the treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis. PMID:7103451

  16. Continuous Hyperthermic Peritoneal Perfusion (CHPP) With Cisplatin for Children With Peritoneal Cancer

    ClinicalTrials.gov

    2012-03-29

    Peritoneal Neoplasms; Retroperitoneal Neoplasms; Gastrointestinal Neoplasms; Adenocarcinoma; Neuroblastoma; Ovarian Neoplasms; Sarcoma; Adrenocortical Carcinoma; Wilms Tumor; Rhabdomyosarcoma; Desmoplastic Small Round Cell Tumor

  17. German Ambulatory Care Physicians' Perspectives on Continuing Medical Education--A National Survey

    ERIC Educational Resources Information Center

    Kempkens, Daniela; Dieterle, Wilfried E.; Butzlaff, Martin; Wilson, Andrew; Bocken, Jan; Rieger, Monika A.; Wilm, Stefan; Vollmar, Horst C.

    2009-01-01

    Introduction: This survey aimed to investigate German ambulatory physicians' opinions about mandatory continuing medical education (CME) and CME resources shortly before the introduction of mandatory CME in 2004. Methods: A structured national telephone survey of general practitioners and specialists was conducted. Main outcome measures were…

  18. A Report of Peritonitis from Aeromonas sobria in a Peritoneal Dialysis (PD) Patient with Necrotizing Fasciitis.

    PubMed

    Janma, Jirayut; Linasmita, Patcharasarn; Changsirikulchai, Siribha

    2015-11-01

    A 70-years of age, male patient with underlying type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease had undergone continuous ambulatory peritoneal dialysis (CAPD)for 3 years without any episodes of peritonitis. He was diagnosed with necrotizing fasciitis and later developed peritonitis after receiving a laceration from an aquatic injury suffered during the flood disaster of 2011. The blood culture, necrotic tissue and the clear dialysate collected upon admission had shown Aeromonas sobria. The route of peritonitis may be from the hematogenous spread of A. sobria resulting in necrotizing fasciitis. A. sobria should be considered as the pathogen of peritonitis in PD patients who have history of wounds from contaminated water. We suggest that the PD patients who present with septicemia and did not meet the criteria for peritonitis, the initial dialysate effluent should be sent for culture. The benefit of this is to allow early recognition and treatment of peritonitis.

  19. Continuous quality improvement in the ambulatory endoscopy center.

    PubMed

    Johanson, John F

    2002-04-01

    of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role. PMID:12180166

  20. Continuous quality improvement in the ambulatory endoscopy center.

    PubMed

    Johanson, John F

    2002-04-01

    of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.

  1. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

    ERIC Educational Resources Information Center

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first sections of…

  2. Reducing Peritoneal Dialysis-Related Peritonitis Rate

    PubMed Central

    Shetty, Anupkumar

    2014-01-01

    Background Peritoneal dialysis-related peritonitis is an important negative risk of peritoneal dialysis. Peritonitis results when organisms enter the normally sterile peritoneal space, and the peritoneal immune system is unable to prevent the proliferation of the organisms. Methods The process of reducing the rate of peritonitis includes identification of the need for reducing peritonitis, identification of the cause of the high peritonitis rate through root cause analysis, and intervention. Results Interventions vary depending upon the type of organism causing peritonitis. Nonenterococcal gram-positive peritonitis and Pseudomonas peritonitis are related to contamination and are potentially preventable; enteric peritonitis is difficult to prevent. Conclusion The rate of peritonitis can be reduced through a strong continuous quality improvement team because the majority of peritonitis episodes can be prevented. PMID:25249805

  3. Peritonitis and technique failure caused by Roseomonas mucosa in an adolescent infected with HIV on continuous cycling peritoneal dialysis.

    PubMed

    Boyd, Mary Adetinuke; Laurens, Matthew B; Fiorella, Paul D; Mendley, Susan R

    2012-11-01

    We report the first case of peritonitis caused by Roseomonas mucosa which led to technique failure in an adolescent patient with HIV receiving peritoneal dialysis. Identification of the causative organism by 16S rRNA gene sequencing and phylogenetic analysis is described.

  4. Limited survival in patients with carcinomatosis from foregut malignancies after cytoreduction and continuous hyperthermic peritoneal perfusion.

    PubMed

    Farma, Jeffrey M; Pingpank, James F; Libutti, Steven K; Bartlett, David L; Ohl, Susan; Beresneva, Tatiana; Alexander, H Richard

    2005-12-01

    Peritoneal carcinomatosis is a frequent mode of metastasis in patients with gastric, duodenal, or pancreatic cancer. Survival in this setting is short and therapeutic options are limited. This analysis examines the outcomes of 18 patients treated with operative cytoreduction and continuous hyperthermic peritoneal perfusion. Eighteen patients (6 males and 12 females) with gastric (n = 9), pancreatic (n = 7), or duodenal (n = 2) cancer were treated on protocol. Patients underwent optimal cytoreduction (complete gross resection, 11; minimal residual disease, 7) and a 90-minute perfusion with cisplatin. Clinical parameters and tumor and treatment characteristics were analyzed. Survival curves were estimated using the Kaplan-Meier method. Procedures included gastrectomy (n = 8), pancreaticoduodenectomy (n = 3), and hemicolectomy (n = 2). After cytoreduction, patients had no evidence of residual disease (n = 11), fewer than 100 implants less than 5 mm (n = 1), more than 100 implants between 5-10 mm (n = 3), or multiple implants with greater than 1 cm (n = 3). Five patients received a postoperative intraperitoneal dwell with 5-fluorouracil and paclitaxel. There was one perioperative mortality, and complications occurred in 10 patients. The median progression-free survival was 8 months (mean, 10 months; range, 1-47 months) with a median overall survival of 8 months (mean, 18 months; range, 1-74 months). In this cohort, peritoneal perfusion with cisplatin used to treat foregut malignancies has a high incidence of complications and does not significantly alter the natural history of the disease. Investigation of novel therapeutic approaches should be considered.

  5. Acute Genital Edema during Peritoneal Dialysis: A Review for Surgeons.

    PubMed

    Jorge, Juaquito; Haggerty, Stephen P

    2015-11-01

    Acute genital edema (AGE) is an infrequent but disruptive complication in patients on continuous ambulatory peritoneal dialysis. It is a common manifestation of dialysate leakage caused by inguinal, umbilical, femoral, or incisional hernias; peritoneal tears; leaks around the dialysis catheter; trauma; fluid overload; and malignancy. The evaluation of AGE begins with a history and physical exam. However, the physical exam in these patients is often indeterminate. Several diagnostic measures exist to evaluate and guide management of AGE occurring during continuous ambulatory peritoneal dialysis but little agreement exists on an optimum method. We have conducted a review of the literature on the evaluation and management of AGE and present a summary of the data. CT peritoneography and peritoneal scintigraphy have been used extensively to evaluate AGE although no comparative studies exist. MRI peritoneography has also been described. CT peritoneography offers more anatomical detail but may not be as sensitive as peritoneal scintigraphy in detecting a peritoneal fluid leak as the cause for AGE. CT is also more costly and subjects the patient to more radiation. MRI is a noncontrast study without radiation risk, but has not been studied to the same degree. If testing is equivocal or bilateral hernias are suspected, diagnostic laparoscopy is helpful and can be combined with hernia repair. Whether the etiology is a leak or tear, low-volume peritoneal dialysis (PD) or cessation of PD for two to four weeks will allow closure. However, hernias almost always require operative repair with mesh usually without disrupting PD.

  6. Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

    PubMed Central

    Francis, Maureen D.; Wieland, Mark L.; Drake, Sean; Gwisdalla, Keri Lyn; Julian, Katherine A.; Nabors, Christopher; Pereira, Anne; Rosenblum, Michael; Smith, Amy; Sweet, David; Thomas, Kris; Varney, Andrew; Warm, Eric; Wininger, David; Francis, Mark L.

    2015-01-01

    Background Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear. Methods This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity. Results UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY. Conclusions Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model. PMID:26217420

  7. Clinical outcomes and mortality in elderly peritoneal dialysis patients

    PubMed Central

    Sakacı, Tamer; Ahbap, Elbis; Koc, Yener; Basturk, Taner; Ucar, Zuhal Atan; Sınangıl, Ayse; Sevınc, Mustafa; Kara, Ekrem; Akgol, Cuneyt; Kayalar, Arzu Ozdemır; Caglayan, Feyza Bayraktar; Sahutoglu, Tuncay; Ünsal, Abdulkadir

    2015-01-01

    OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid

  8. Intraperitoneal meropenem for peritoneal dialysis peritonitis with Serratia marcescens immediately on commencing dialysis.

    PubMed

    Bhave, P; Tregaskis, P; Walker, R; Wilson, S

    2016-03-01

    A 67-year-old man developed Serratia marcescens peritonitis within a week of commencing peritoneal dialysis. Dialysate cultures isolated multidrug-resistant S. marcescens, which was treated with intraperitoneal meropenem. This unusual case highlights the problem of multidrug-resistant peritoneal dialysis infections and the potential viability of intraperitoneal meropenem as ambulatory peritonitis therapy.

  9. Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

    PubMed Central

    Francis, Maureen D.; Warm, Eric; Julian, Katherine A.; Rosenblum, Michael; Thomas, Kris; Drake, Sean; Gwisdalla, Keri Lyn; Langan, Michael; Nabors, Christopher; Pereira, Anne; Smith, Amy; Sweet, David; Varney, Andrew; Francis, Mark L.

    2014-01-01

    Background Many internal medicine programs have reorganized their resident continuity clinics to improve the ambulatory care experience for residents. The effect of this redesign on patient satisfaction is largely unknown. Methods Our multi-institutional, cross-sectional study included 569 internal medicine residents from 11 programs participating in the Educational Innovations Project Ambulatory Collaborative. An 11-item patient satisfaction survey from the Consumer Assessment of Healthcare Providers and Systems was used to assess patient satisfaction, comparing patient satisfaction in traditional models of weekly continuity clinic with 2 new clinic models. We then examined the relationship between patient satisfaction and other practice variables. Results Patient satisfaction responses related to resident listening and communication skills, knowledge of medical history, perception of adequate visit time, overall rating, and willingness to refer to family and friends were significantly better in the traditional and block continuity models than the combination model. Higher ambulatory workload was associated with reduced patient perception of respect shown by the physician. The percentage of diabetic patients with glycated hemoglobin < 8% was positively correlated with number of visits, knowledge of medical history, perception of respect, and higher scores for recommending the physician to others. The percentage of diabetic patients with low density lipoprotein < 100 mg/dL was positively correlated with the physician showing respect. Conclusions Patient satisfaction was similar in programs using block design and traditional models for continuity clinic, and both outperformed the combination model programs. There was a delicate balance between workload and patient perception of the physician showing respect. Care outcome measures for diabetic patients were associated with aspects of patient satisfaction. PMID:26279771

  10. [Contribution of ambulatory digestive surgery].

    PubMed

    Sales, J P

    2000-10-01

    In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept.

  11. Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis

    PubMed Central

    2009-01-01

    Background The elevated serum and peritoneal cytokine concentrations responsible for the systemic response syndrome (SIRS) and multiorgan failure in patients with severe acute pancreatitis lead to high morbidity and mortality rates. Prompted by reports underlining the importance of reducing circulating inflammatory mediators in severe acute pancreatitis, we designed this study to evaluate the efficiency of laparotomy followed by continuous perioperative peritoneal lavage combined with postoperative continuous venovenous diahemofiltration (CVVDH) in managing critically ill patients refractory to intensive care therapy. As the major clinical outcome variables we measured morbidity, mortality and changes in the Acute Physiology and Chronic Health Evaluation (APACHE II) score and cytokine concentrations in serum and peritoneal lavage fluid over time. Methods From a consecutive group of 23 patients hospitalized for acute pancreatitis, we studied 6 patients all with Apache II scores ≥19, who underwent emergency surgery for acute complications (5 for an abdominal compartment syndrome and 1 for septic shock) followed by continuous perioperative peritoneal lavage and postoperative CVVDH. CVVDH was started within 12 hours after surgery and maintained for at least 72 hours, until the multiorgan dysfunction syndrome improved. Samples were collected from serum, peritoneal lavage fluid and CVVDH dialysate for cytokine assay. Apache II scores were measured daily and their association with cytokine levels was assessed. Results All six patients tolerated CVVDH well, and the procedure lasted a mean 6 days (range, 3-12). Five patients survived and one died of Acinetobacter infection after surgery (mortality rate 16.6%). The mean APACHE II score was ≥ 19 (range 19-22) before laparotomy and decreased significantly during peritoneal lavage and postoperative CVVDH (P = 0.013 by matched-pairs Students t-test). The decrease in cytokine concentrations in serum and lavage fluid was

  12. Sphingomonas paucimobilis peritonitis: A case report and review of the literature.

    PubMed

    Mohan, Dhanya; Railey, Mohammed

    2015-01-01

    Sphingomonas paucimobilis, a yellow-pigmented, aerobic, glucose non-fermenting, Gram-negative bacillus, is a rare cause of human infection normally associated with immunocompromised hosts. It has been associated with a few cases of continuous ambulatory peritoneal dialysis (PD) and is notorious for its resistance to the commonly used antibiotics. In half of the cases reported so far, the peritonitis was refractory to treatment, necessitating PD catheter removal. We report a case of Sphingomonas paucimobilis peritonitis in a 50-year-old patient who had been on PD for two years. The patient was successfully treated with intraperitoneal and intravenous antibiotics and the PD catheter was salvaged.

  13. Leukotriene release from peripheral and peritoneal leukocytes following exposure to peritoneal dialysis solutions.

    PubMed

    Jörres, A; Jörres, D; Topley, N; Gahl, G M; Mahiout, A

    1991-01-01

    During continuous ambulatory peritoneal dialysis (CAPD), peritoneal host defence mechanisms are repeatedly exposed to dialysis solutions (with unphysiological composition) which may compromise peritoneal immune cell functions. In this context, the current study focused on the capacity of peripheral and peritoneal PMN to release leukotrienes following exposure to conventional CAPD dialysates. PMN were obtained from peripheral blood of healthy volunteers and from the peritoneal effluent of CAPD patients with acute peritonitis. Following isolation, cells were incubated in fresh CAPD dialysates or control buffer, and calcium ionophore A23187-stimulated leukotriene synthesis was measured. Additional experiments included RP-HPLC analysis and radioactivity monitoring of lipoxygenase products in PMN labelled with 14C-arachidonic acid. Leukotriene B4 and leukotrienes C4/D4/E4 were determined by radioimmunoassay. Ionophore-triggered leukotriene release from cells exposed to control buffer was pronounced in inflammatory peritoneal PMN (70.4 +/- 31.3 ng/5 x 10(6) cells LTB4 and 13.4 +/- 19.8 ng/5 x 10(6) cells LTC4/D4/E4, mean +/- SD, n = 14) when compared to healthy peripheral PMN (26.6 +/- 16.9 ng/ml LTB4 and 6.3 +/- 6.6 ng/ml LTC4/D4/E4, n = 12). Incubation in fresh solutions for peritoneal dialysis severely depressed leukotriene release from both cell populations. These results indicate a severe inhibition of cellular responsiveness as a consequence of dialysate exposure which could contribute to the impairment of host defence early in the CAPD cycle.

  14. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial.

    PubMed

    Muxfeldt, Elizabeth S; Margallo, Victor; Costa, Leonardo M S; Guimarães, Gleison; Cavalcante, Aline H; Azevedo, João C M; de Souza, Fabio; Cardoso, Claudia R L; Salles, Gil F

    2015-04-01

    The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129(16)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea-hypopnea index was 41 per hour and 58.5% had severe obstructive sleep apnea. On intention-to-treat analysis, there was no significant difference in any BP change, neither in nocturnal BP fall, between CPAP and control groups. The best effect of CPAP was on night-time systolic blood pressure in per-protocol analysis, with greater reduction of 4.7 mm Hg (95% confidence interval, -11.3 to +3.1 mm Hg; P=0.24) and an increase in nocturnal BP fall of 2.2% (95% confidence interval, -1.6% to +5.8%; P=0.25), in comparison with control group. In conclusion, CPAP treatment had no significant effect on clinic and ambulatory BPs in patients with resistant hypertension and moderate/severe obstructive sleep apnea, although a beneficial effect on night-time systolic blood pressure and on nocturnal BP fall might exist in patients with uncontrolled ambulatory BP levels.

  15. Identification and Characterization of a Rare Fungus, Quambalaria cyanescens, Isolated from the Peritoneal Fluid of a Patient after Nocturnal Intermittent Peritoneal Dialysis

    PubMed Central

    Kuan, Chee Sian; Yew, Su Mei; Toh, Yue Fen; Chan, Chai Ling; Lim, Soo Kun; Lee, Kok Wei; Na, Shiang Ling; Hoh, Chee-Choong; Yee, Wai-Yan; Ng, Kee Peng

    2015-01-01

    Peritonitis is the leading complication of peritoneal dialysis, which is primarily caused by bacteria rather than fungi. Peritonitis is responsible for approximately 18% of the infection-related mortality in peritoneal dialysis patients. In this paper, we report the isolation of a rare fungus, Quambalaria cyanescens, from the peritoneal fluid of a man after he switched from continuous ambulatory peritoneal dialysis to nocturnal intermittent peritoneal dialysis. Based on the morphological examination and multigene phylogeny, the clinical isolate was confirmed as Q. cyanescens. This pathogen exhibited low sensitivity to all tested echinocandins and 5-flucytosine. Interestingly, morphological characterization revealed that Q. cyanescens UM 1095 produced different pigments at low temperatures (25°C and 30°C) on various culture media. It is important to monitor the emergence of this rare fungus as a potential human pathogen in the tropics. This study provides insight into Q. cyanescens UM 1095 phenotype profiles using a Biolog phenotypic microarray (PM). Of the 760 nutrient sources tested, Q. cyanescens UM 1095 utilized 42 compounds, and the fungus can adapt to a broad range of osmotic and acidic environments. To our knowledge, this is the first report of the isolation of Q. cyanescens from peritoneal fluid, revealing this rare fungus as a potential human pathogen that may be misidentified using conventional methods. The detailed morphological, molecular and phenotypic characterization of Q. cyanescens UM 1095 provides the basis for future studies on its biology, lifestyle, and potential pathogenicity. PMID:26716988

  16. Identification and Characterization of a Rare Fungus, Quambalaria cyanescens, Isolated from the Peritoneal Fluid of a Patient after Nocturnal Intermittent Peritoneal Dialysis.

    PubMed

    Kuan, Chee Sian; Yew, Su Mei; Toh, Yue Fen; Chan, Chai Ling; Lim, Soo Kun; Lee, Kok Wei; Na, Shiang Ling; Hoh, Chee-Choong; Yee, Wai-Yan; Ng, Kee Peng

    2015-01-01

    Peritonitis is the leading complication of peritoneal dialysis, which is primarily caused by bacteria rather than fungi. Peritonitis is responsible for approximately 18% of the infection-related mortality in peritoneal dialysis patients. In this paper, we report the isolation of a rare fungus, Quambalaria cyanescens, from the peritoneal fluid of a man after he switched from continuous ambulatory peritoneal dialysis to nocturnal intermittent peritoneal dialysis. Based on the morphological examination and multigene phylogeny, the clinical isolate was confirmed as Q. cyanescens. This pathogen exhibited low sensitivity to all tested echinocandins and 5-flucytosine. Interestingly, morphological characterization revealed that Q. cyanescens UM 1095 produced different pigments at low temperatures (25°C and 30°C) on various culture media. It is important to monitor the emergence of this rare fungus as a potential human pathogen in the tropics. This study provides insight into Q. cyanescens UM 1095 phenotype profiles using a Biolog phenotypic microarray (PM). Of the 760 nutrient sources tested, Q. cyanescens UM 1095 utilized 42 compounds, and the fungus can adapt to a broad range of osmotic and acidic environments. To our knowledge, this is the first report of the isolation of Q. cyanescens from peritoneal fluid, revealing this rare fungus as a potential human pathogen that may be misidentified using conventional methods. The detailed morphological, molecular and phenotypic characterization of Q. cyanescens UM 1095 provides the basis for future studies on its biology, lifestyle, and potential pathogenicity. PMID:26716988

  17. Hospitalizations in patients treated sequentially by chronic hemodialysis and continuous peritoneal dialysis.

    PubMed

    Adeniyi, Muniru; Kassam, Hussein; Agaba, Emmanuel I; Sun, Yijuan; Servilla, Karen S; Raj, Dominic S C; Murata, Glen H; Tzamaloukas, Antonios H

    2009-01-01

    It is not established whether hospitalizations are more frequent or longer in patients on peritoneal dialysis (PD) or chronic in-center hemodialysis (HD). Comorbidity is a major factor affecting the comparison of hospitalizations. To account for comorbidity, we compared hospitalizations between the PD and HD periods in 16 patients, 8 of whom were treated by PD first (group A), and 8, by HD first (group B). In group A, causes of renal failure were diabetes (n = 3), primary renal disease (n = 2), systemic disease (n = 2), and hereditary nephropathy (n = 1). Age at onset of PD was 53 +/- 11 years; duration of PD, 31 +/- 17 months; and duration of HD, 40 +/- 33 months. This group had 52 hospitalizations in the PD period and 80 hospitalizations in the HD period. Hospitalization rate (n/ patient-year) was 2.5 +/- 2.0 during PD and 3.0 +/- 3.0 during HD (nonsignificant), and duration of hospitalization (days/patient-year) was 19.6 +/- 15.5 during PD and 21.9 +/- 17.7 during HD (nonsignificant). The three most common causes of hospitalization were peritonitis (27%), other infections (21%), and cardiovascular disease (14%) in the PD period, and HD access problems (35%), infections (16%), and cardiovascular disease (12%) in the HD period. In group B, causes of renal failure were diabetes (n = 4), primary renal disease (n = 3), and hypertension (n = 1). Age at onset of HD was 56 +/- 10 years; duration of HD, 41 +/- 19 months; and duration of PD, 60 +/- 24 months. This group had 82 hospitalizations in the HD period and 76 hospitalizations in the PD period. Hospitalization rate was 3.0 +/- 2.4 during HD and 1.9 +/- 2.8 during PD (nonsignificant), and duration of hospitalization was 17.3 +/- 25.1 during HD and 12.7 +/- 21.3 during PD (nonsignificant). The three most common causes of hospitalization were HD access problems (40%), cardiovascular disease (19%), and infections (12%) in the HD period, and other infections (36%), cardiovascular disease (19%), and peritonitis (21%) in

  18. Peritoneal Disorders

    MedlinePlus

    ... of the peritoneum are not common. They include Peritonitis - an inflammation of the peritoneum Cancer Complications from ... peritoneal fluid to diagnose the problem. Treatment of peritoneal disorders depends on the cause.

  19. Fungal peritonitis caused by Bipolaris spicifera.

    PubMed

    Bava, A J; Fayad, A; Céspedes, C; Sandoval, M

    2003-12-01

    An episode of fungal peritonitis was produced by Bipolaris spicifera in a 3-year-old girl with chronic renal failure secondary to uremic-hemolytic syndrome and who was under treatment with continuous ambulatory peritoneal dialysis (CAPD). Previously, an episode of purulent peritonitis caused by Pseudomonas spp. had been treated successfully with combined antibacterial therapy for 10 days. Microscopic and macroscopic examinations of the freshly collected purulent dialysate were negative for fungal structures and bacteria. The fungus grew from the dialysate plated on Sabouraud dextrose agar and was also macroscopically recognized as a colony attached to the inner wall of the Tenckhoff catheter. Specific cultures of dialysate for common bacteria and mycobacteria were negative. The patient was successfully treated with early catheter removal and empirical administration of 200 mg/day oral fluconazole for 2 weeks. Subsequently, a new catheter was placed and the patient continued well on CAPD. Post-treatment control cultures of dialysate for fungi, bacteria and mycobacteria were negative and the cell count returned to normal.

  20. Medical Management of Pediatric Malignant Bowel Obstruction in a Patient with Burkitt's Lymphoma and Ataxia Telangiectasia Using Continuous Ambulatory Drug Delivery System.

    PubMed

    Ghoshal, Arunangshu; Salins, Naveen; Damani, Anuja; Deodhar, Jayita; Muckaden, M A

    2016-01-01

    Malignant bowel obstruction (MBO) is commonly seen in patients with advanced abdominal cancers. The incidence of pediatric MBO in a patient with Burkitt's lymphoma and ataxia telangiectasia is rare, with no published case reports till now. Conservative management of inoperable MBO results in relief of symptoms and improves quality of life. An 11-year-old boy with Burkitt's lymphoma and ataxia telangiectasia was referred to pediatric palliative care with MBO. The objective of this report is to demonstrate conservative management of pediatric MBO using continuous ambulatory drug delivery system. The patient was initiated on continuous ambulatory drug delivery (CADD) system for symptom relief. MBO was reversed with conservative management and the child was discharged on self-collapsible portable elastomeric continuous infusion pump under the supervision of a local family physician. The child remained comfortable at home for 4 weeks until his death. His parents were satisfied with the child's symptom control, quality of life, and were able to care for the child at home. In a resource-limited setting, managing patients at home using elastomeric continuous infusion pumps instead of expensive automated CADD is a practical pharmacoeconomic approach. PMID:26862790

  1. Strategies to improve clinical outcomes in peritoneal dialysis patients: delivered dose and membrane transport.

    PubMed

    Churchill, D N

    1998-12-01

    For patients with end-stage renal disease treated with peritoneal dialysis, prospective cohort studies using multivariate statistical analysis have shown an association between greater urea clearance and a decreased relative risk for death. The recommended weekly Kt/V for urea is 2.0, with the corresponding creatinine clearance (CrCl) of 60 L/1.73 m2. This is considered adequate dialysis but fails to define optimum urea and CrCl targets. The assumption that renal and peritoneal clearances are equivalent has been challenged by circumstantial data and is probably untenable. The relative importance of these clearances requires definition. The suggestion that CrCl is a more important indicator of adequacy of dialysis is confounded by association with renal, rather than peritoneal, clearance and perhaps by the early referral and initiation of dialysis. Recent reports have shown an association between increased peritoneal membrane transport and an increased relative risk for technique failure and/or death. Patients with higher peritoneal transport should have greater clearance of urea and creatinine and better clinical outcomes. Possible explanations for this apparent contradiction include the adverse effects of increased glucose absorption, malnutrition, and fluid overload, the latter caused by decreased ultrafiltration. Available data suggest an important role for the failure of ultrafiltration among patients treated with continuous ambulatory peritoneal dialysis (CAPD). Strategies to improve the clearance of urea and creatinine include the preservation of residual renal function and increased peritoneal clearance. Loss of residual renal function may be delayed by the avoidance of nephrotoxic drugs and angiographic dye. Peritoneal clearance can be enhanced by a combination of increased volume and frequency of peritoneal dialysis cycles. Ultrafiltration failure, but not protein loss, can be addressed with shorter cycles with nocturnal peritoneal dialysis. Development of

  2. Comparison of Sirolimus and Colchicine Treatment on the Development of Peritoneal Fibrozis in Rats Having Peritoneal Dialysis

    PubMed Central

    Sağıroğlu, Tamer; Sayhan, Mustafa Burak; Yağcı, Mehmet A.; Yalta, Tülin; Sağıroğlu, Gönül; Çopuroğlu, Elif; Oğuz, Serhat

    2015-01-01

    Background: Continuous ambulatory peritoneal dialysis is a successful treatment modality for patients with end-stage renal disease. Peritoneal fibrosis (PF) is the most critical complication of long-term peritoneal dialysis (PD). Aims: In our study, we aimed to compare the effects of colchicine and sirolimus on PF induced by hypertonic peritoneal dialysis solutions in rats. Study Design: Animal experiment. Methods: Twenty-four rats were randomly divided into three groups. The control group received an intraperitoneal injection (ip) of saline. The sirolimus group received the PD solution, plus 1.0 mg/kg/day Rapamune®. The colchicine group received the PD solution ip plus 1.0 mg/kg/day of colchicine. Blood samples were taken to measure the serum levels of VEGF, TGF-β, and TNF-α. Peritoneal tissue samples were taken for histopathological evaluation. Results: TGF-β and TNF-α values in the sirolimus group were found to be statistically significantly lower than in the control and colchicine groups, but the differences between the control and colchicine groups were not statistically significant. No statistically significant differences were found between the groups regarding the VEGF values. Vascular neogenesis and peritoneal thickness were compared; the values in the sirolimus group were statistically reduced compared to the values in the control group. Mild fibrosis developed in 75% of all animals in the sirolimus group; there was no moderate or severe fibrosis observed. Fibrosis developed to varying degrees in 100% of the animals in the control and colchicine groups. Conclusion: The present study demonstrates that sirolimus might be beneficial for preventing or delaying the progression of PF and neoangiogenesis. These alterations in the peritoneal membrane may be connected with reduced TNF-α and TGF-β levels. PMID:25759780

  3. Ambulatory electrocardiology.

    PubMed

    Romero, Iñaki

    2013-01-01

    About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac monitors have decreased in size to the point of becoming wearable or implantable and are able to monitor heart activity for months or even years. In addition, new telecommunication systems allow clinicians to remotely access cardiac events and to respond within a short period of time. Novel advances in computing and algorithm development are expanding the clinical applications of ambulatory devices with more complex automatic interpretation of the electrocardiographic signal. This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions. PMID:23422020

  4. Peritoneal dialysis: from bench to bedside

    PubMed Central

    Krediet, Raymond T.

    2013-01-01

    Peritoneal dialysis was first employed in patients with acute renal failure in the 1940s and since the 1960s for those with end-stage renal disease. Its popularity increased enormously after the introduction of continuous ambulatory peritoneal dialysis in the end of 1970s. This stimulated both clinical and basic research. In an ideal situation, this should lead to cross-fertilization between the two. The present review describes two examples of interactions: one where it worked out very well and another where basic science missed the link with clinical findings. Those on fluid transport are examples of how old physiological findings on absorption of saline and glucose solutions were adopted in peritoneal dialysis by the use of glucose as an osmotic agent. The mechanism behind this in patients was first solved mathematically by the assumption of ultrasmall intracellular pores allowing water transport only. At the same time, basic science discovered the water channel aquaporin-1 (AQP-1), and a few years later, studies in transgenic mice confirmed that AQP-1 was the ultrasmall pore. In clinical medicine, this led to its assessment in patients and the notion of its impairment. Drugs for treatment have been developed. Research on biocompatibility is not a success story. Basic science has focussed on dialysis solutions with a low pH and lactate, and effects of glucose degradation products, although the first is irrelevant in patients and effects of continuous exposure to high glucose concentrations were largely neglected. Industry believed the bench more than the bedside, resulting in ‘biocompatible’ dialysis solutions. These solutions have some beneficial effects, but are evidently not the final answer. PMID:26120456

  5. Management of secondary peritonitis.

    PubMed Central

    Wittmann, D H; Schein, M; Condon, R E

    1996-01-01

    OBJECTIVE. The authors review current definition, classification, scoring, microbiology, inflammatory response, and goals of management of secondary peritonitis. SUMMARY BACKGROUND DATA. Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, up to one third of patients still die of severe secondary peritonitis. Against the background of current understanding of the local and systemic inflammatory response associated with peritonitis, there is growing controversy concerning the optimal antibiotic and operative therapy, intensified by lack of properly conducted randomized studies. In this overview the authors attempt to outline controversies, suggest a practical clinical approach, and highlight issues necessitating further research. METHODS. The authors review the literature and report their experience. RESULTS. The emerging concepts concerning antibiotic treatment suggest that less-in terms of the number of drugs and the duration of treatment-is better. The classical single operation for peritonitis, which obliterates the source of infection and purges the peritoneal cavity, may be inadequate for severe forms of peritonitis; for the latter, more aggressive surgical techniques are necessary to decompress increased intra-abdominal pressure and prevent or treat persistent and recurrent infection. The widespread acceptance of the more aggressive and demanding surgical methods has been hampered by the lack of randomized trials and reportedly high associated morbidity rates. CONCLUSIONS. Sepsis represents the host's systemic inflammatory response to bacterial peritonitis. To improve results, both the initiator and the biologic consequences of the peritoneal infective-inflammatory process should be addressed. The initiator may be better controlled in severe forms of peritonitis by aggressive surgical methods, whereas the search for methods to abort its systemic consequences is continuing. PMID:8678610

  6. Comparison between continuous ambulatory arterial blood pressure monitoring and standard blood pressure measurements among patients of younger and older age group.

    PubMed

    Babić, Betty Korljan; Bagatin, Jugoslav; Kokić, Slaven; Ostojić, Sanja Barsić; Carević, Vedran; Berović, Nina

    2009-03-01

    The purpose of the study was to evaluate whether there is a difference between blood pressure measured in a physician's office and the average 24 hr continuous blood pressure monitored by hypertensive patients at home. If there is a difference between these two situations then is it possibly the result of a blood pressure response by the patient to the physician which is known as "white coat effect" or "white coat hypertension". We studied 80 hypertensive outpatients which were divided into two groups of 40 patients each--a younger patient group, with a mean age of 22.8 +/- 1.8 years, and an older patient group with a mean age of 50.3 +/- 5.7 years. They were selected because they had been diagnosed as essentially hypertension grade 1, according to 2007 ESH/ESC Guidelines, or the USA Joint National Committee Guidelines (JNC 7) (i.e., arterial blood pressure > 140/90 mm Hg and < 160/100 mmHg) and 35 were not having any antihypertensive treatment. All participants in the study went through a two-week "wash-out" period without medication. At the beginning of the study blood pressure was measured using the Riva-Rocci-Korotkoff method (mercury sphygmomanometer) after 5 minutes of rest and with the patient in the sitting position. The average of the two last measurements by sphygmomanometer was used in the analysis. The subsequent measurement was made by continuous ambulatory blood pressure monitoring (SpaceLabs 90207 device). Continuous ambulatory blood pressure monitoring revealed that 17 patients of the younger age group (42.5%) who were diagnosed hypertonic, according to mercury sphygmomanometeric measurement, were in fact normotonic. In the older age group only 7 (17.5%) of participants were normotonic during 24 hr blood pressure monitoring. The proportion of miss-diagnosed normotonic younger patients was directly related to elevated clinic blood pressure, which could be referred to as office hypertension or isolated clinic hypertension (white coat hypertension

  7. Treatment of Post-mastectomy Pain With Ambulatory Continuous Paravertebral Nerve Blocks: A Randomized, Triple-Masked, Placebo-Controlled Study

    PubMed Central

    Ilfeld, Brian M.; Madison, Sarah J.; Suresh, Preetham J.; Sandhu, NavParkash S.; Kormylo, Nicholas J.; Malhotra, Nisha; Loland, Vanessa J.; Wallace, Mark S.; Proudfoot, James A.; Morgan, Anya C.; Wen, Cindy H.; Wallace, Anne M.

    2013-01-01

    Background We aimed to determine with this randomized, triple-masked, placebo-controlled study if benefits are afforded by adding a multiple-day, ambulatory, continuous ropivacaine paravertebral nerve block to a single-injection ropivacaine paravertebral block following mastectomy. Methods Preoperatively, 60 subjects undergoing unilateral (n = 24) or bilateral (n = 36) mastectomy received either unilateral or bilateral paravertebral perineural catheter(s), respectively, inserted between the third and fourth thoracic transverse process(es). All subjects received an initial bolus of ropivacaine 0.5% (15 mL) via the catheter(s). Subjects were randomized to receive either perineural ropivacaine 0.4% or normal saline using portable infusion pump(s) [5 mL/h basal; 300 mL reservoir(s)]. Subjects remained hospitalized for at least 1 night and were subsequently discharged home where the catheter(s) were removed on postoperative day 3. Subjects were contacted by telephone on postoperative days 1, 4, 8, and 28. The primary end point was average pain (scale: 0–10) queried on postoperative day (POD) 1. Results Average pain queried on POD 1 for subjects receiving perineural ropivacaine (n=30) was a median (interquartile) of 2 (0–3), compared with 4 (1–5) for subjects receiving saline (n = 30; 95% CI difference in medians, −4.0 – −0.3; P = 0.021]. During this same time period, subjects receiving ropivacaine experienced a lower severity of breakthrough pain (5 [3–6] vs 7 [5–8]; P = 0.046) as well. As a result, subjects receiving perineural ropivacaine experienced less pain-induced physical and emotional dysfunction, as measured with the Brief Pain Inventory (lower score = less dysfunction): 14 (4–37) vs 57 (8–67) for subjects receiving perineural saline (P = 0.012). For the subscale that measures the degree of interference of pain on 7 domains, such as general activity and relationships, subjects receiving perineural saline reported a median score 10 times

  8. 77 FR 37680 - Medicare and Medicaid Programs; Application From the Accreditation Association for Ambulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-22

    ... the Accreditation Association for Ambulatory Health Care for Continued Approval of Its Ambulatory... Association for Ambulatory Health Care for continued recognition as a national accrediting organization for... 6 years or as determined by CMS. The Accreditation Association for Ambulatory Health Care...

  9. Ambulatory Assessment

    PubMed Central

    Trull, Timothy J.; Ebner-Priemer, Ulrich

    2014-01-01

    Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients’ everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues. PMID:23157450

  10. Effect of intraperitoneal neostigmine on peritoneal transport characteristics in CAPD.

    PubMed

    Hasbargen, J A; Hasbargen, B J; Fortenbery, E J

    1992-12-01

    Lymphatics have been suggested to play a major role in the absorption of dialysate, which consequently affects the adequacy of peritoneal dialysis. Neostigmine has been found to decrease lymphatic absorption in rats, presumably by causing constriction of the lymphatic stomata. We investigated the effect of neostigmine on seven continuous ambulatory peritoneal dialysis (CAPD) patients in a prospective study. We performed modified peritoneal equilibration tests both with and without intraperitoneal neostigmine in a random order. Radiolabeled albumin (0.8 mg) was added to 2 liters of dialysate +/- 2.0 mg neostigmine. We evaluated ultrafiltration and creatinine, phosphate, and urea clearances. The dialysate bag and the peritoneum were scanned at the initiation and conclusion of the four-hour dwell period. We found no change in ultrafiltration, residual volumes, creatinine, phosphate and urea clearances, or albumin recovered. Of the seven patients exposed to neostigmine, four had diarrhea, abdominal cramps, nausea, and vomiting. In conclusion, we found that 2 mg i.p. neostigmine did cause significant side-effects and did not alter transport characteristics in CAPD patients.

  11. Peritonitis - secondary

    MedlinePlus

    ... blood pressure. Tests may include: Blood culture Blood chemistry, including pancreatic enzymes Complete blood count Liver and kidney function tests X-rays or CT scan Peritoneal fluid culture Urinalysis

  12. Ambulatory blood pressure monitoring: coming of age in nephrology.

    PubMed

    Townsend, R R; Ford, V

    1996-11-01

    The number of patients undergoing ambulatory blood pressure monitoring (ABPM) and the number of publications using this technique to evaluate the risks and effects of high blood pressure on target organs has been increasing, and dramatically so, in the last 5 years. Much of this growth has centered on the role of the blood pressure load (the percentage of systolic or diastolic readings above a preset value during a specific time period) and the changes in blood pressures levels that occur, with sleep. Although many studies are focused on the interaction between blood pressure (as assessed by ABPM) and the heart, interest is growing in the application of ABPM to the practice of nephrology. This paper discusses some of the technical aspects of ABPM, followed by a review of five areas of clinical research using ABPM, and which are relevant to renal medicine: microalbuminuria, renal function, renovascular hypertension, dialysis (hemodialysis and continuous ambulatory peritoneal dialysis), and transplantation. Despite a general lack of reimbursement for performance of the ABPM procedure, the growth in its usage and the willingness of clinicians to withhold or alter therapy on the basis of ABPM readings is testimony to its clinical value in the management of hypertension. PMID:8959618

  13. Mycobacterial Peritonitis in CAPD Patients in Limpopo: A 6-Year Cumulative Report from a Single Center in South Africa.

    PubMed

    Tamayo-Isla, Ramon A; de la Cruz, Mauro Cuba; Okpechi, Ikechi G

    2016-01-01

    South Africa has one of the highest incidences of tuberculosis (TB) worldwide due to the ongoing human immunodeficiency virus (HIV) epidemic. There are, however, no reports on peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to Mycobacterium tuberculosis in South Africa. The aim of this study is to discuss our experience of tuberculous peritonitis in CAPD patients from a rural endemic area of South Africa. This is a retrospective descriptive study of CAPD patients diagnosed with mycobacterium peritonitis infection from January 2008 to August 2014 at the Limpopo Kidney and Dialysis Centre (LKDC) in South Africa. The diagnosis of peritonitis was based on the International Society for Peritoneal Dialysis (ISPD) 2010 recommendations. Peritoneal fluid samples were collected in BACTEC Myco/F Lytic Culture Vials (Becton, Dickinson and Company, Dublin, Ireland). Tenckhoff catheter tips were sent for acid-fast bacilli (AFB) smear and TB culture. Mycobacterium infection was considered in patients with clinical features of peritonitis if 1) AFB smear or TB culture was positive or 2) if the patient was smear- or culture-negative but had suggestive radiological features of TB in the lungs or abdomen or 3) if the patient improved clinically following treatment with anti-tuberculous drugs. Of 170 patients on CAPD for the period reviewed, 12 (7.1%) were diagnosed and treated for mycobacterial peritonitis. There was an equal number of males and females, and all the patients were Black Africans with a mean age of 35.4 years (17-51 years). Eight of the 12 patients (66.7%) had had previous episodes of non-tuberculous peritonitis. Four patients (33.3%) had elevated white blood cell count (WCC) while 9 had higher polymorph count in the PD fluid than lymphocyte count. Mycobacterial organism was confirmed in 9/12 (75%), while the diagnosis was made on clinical and radiological features in the remaining 3 patients. Seven patients (58.3%) died, 10 patients were

  14. Assessment of the feasibility of an ultra-low power, wireless digital patch for the continuous ambulatory monitoring of vital signs

    PubMed Central

    Hernandez-Silveira, Miguel; Ahmed, Kamran; Ang, Su-Shin; Zandari, Fahriya; Mehta, Tinaz; Weir, Rebecca; Burdett, Alison; Toumazou, Chris; Brett, Stephen J

    2015-01-01

    Background and objectives Vital signs are usually recorded at 4–8 h intervals in hospital patients, and deterioration between measurements can have serious consequences. The primary study objective was to assess agreement between a new ultra-low power, wireless and wearable surveillance system for continuous ambulatory monitoring of vital signs and a widely used clinical vital signs monitor. The secondary objective was to examine the system's ability to automatically identify and reject invalid physiological data. Setting Single hospital centre. Participants Heart and respiratory rate were recorded over 2 h in 20 patients undergoing elective surgery and a second group of 41 patients with comorbid conditions, in the general ward. Outcome measures Primary outcome measures were limits of agreement and bias. The secondary outcome measure was proportion of data rejected. Results The digital patch provided reliable heart rate values in the majority of patients (about 80%) with normal sinus rhythm, and in the presence of abnormal ECG recordings (excluding aperiodic arrhythmias such as atrial fibrillation). The mean difference between systems was less than ±1 bpm in all patient groups studied. Although respiratory data were more frequently rejected as invalid because of the high sensitivity of impedance pneumography to motion artefacts, valid rates were reported for 50% of recordings with a mean difference of less than ±1 brpm compared with the bedside monitor. Correlation between systems was statistically significant (p<0.0001) for heart and respiratory rate, apart from respiratory rate in patients with atrial fibrillation (p=0.02). Conclusions Overall agreement between digital patch and clinical monitor was satisfactory, as was the efficacy of the system for automatic rejection of invalid data. Wireless monitoring technologies, such as the one tested, may offer clinical value when implemented as part of wider hospital systems that integrate and support

  15. Chronic peritoneal dialysis in South Asia - challenges and future.

    PubMed

    Abraham, Georgi; Pratap, Balaji; Sankarasubbaiyan, Suresh; Govindan, Priyanka; Nayak, K Shivanand; Sheriff, Rezvi; Naqvi, S A Jaffar

    2008-01-01

    Chronic peritoneal dialysis (PD), especially continuous ambulatory PD (CAPD), is being increasingly utilized in South Asian countries (population of 1.4 billion). There are divergent geopolitical and socioeconomic factors that influence the growth and expansion of CAPD in this region. The majority of the countries in South Asia are lacking in government healthcare system for reimbursing renal replacement therapy. The largest utilization of chronic PD is in India, with nearly 6500 patients on this treatment by the end of 2006. A large majority of patients are doing 2 L exchanges 3 times per day, using glucose-based dialysis solution manufactured in India. Chronic PD is not being utilized in Myanmar, Bhutan, or Seychelles. Affirmative action by the manufacturing industry, medical professionals, government policy makers, and nongovernmental organizations for reducing the cost of chronic PD will enable the growth and utilization of this life-saving therapy. PMID:18178941

  16. Factors affecting Staphylococcus epidermidis growth in peritoneal dialysis solutions.

    PubMed Central

    McDonald, W A; Watts, J; Bowmer, M I

    1986-01-01

    Staphylococcus epidermidis is the most frequent cause of peritonitis complicating continuous ambulatory peritoneal dialysis. We studied factors that might influence the growth of S. epidermidis in commercially available peritoneal dialysis solution (PDS). Test strains were inoculated into PDS and incubated overnight at 37 degrees C. Samples were removed at appropriate intervals, bacterial counts were performed, and growth curves were constructed. We studied the effects of various osmolarities, the neutralization and acidification of fresh and spent PDS, and the effect of intraperitoneal dwell time on the ability PDS to support growth of S. epidermidis. In fresh PDS, numbers of bacteria remained constant after 24 h. No significant differences in growth were observed among PDS with 0.5, 1.5, 2.5, and 4.25% glucose. Neutralizing acidic fresh PDS had no effect on bacterial growth. However, growth did occur in spent PDS. PDS which was recovered after only 2 h in the peritoneal cavity supported growth to the same extent as did PDS recovered after 4 to 6 h. Mean log10 changes after 24 h of incubation were as follows: for fresh PDS, -1.3; after 2 h dwell time, 2.9; after 4 h dwell time, 1.9; and after 6 h dwell time, 1.3. Acidification of spent PDS to less than pH 6.35 produced less rapid growth; mean log10 increases after 24 h of incubation were 1.9 for pH 7.75, 1.6 for pH 6.35, 0.6 for pH 5.75, and 0.7 for pH 4.95. Fresh PDS of all available osmolarities neither supported the growth of S. epidermidis nor was bactericidal. Spent PDS supported bacterial growth, and this growth was partly independent of the neutralization which occurred during the dialysis. PMID:3722356

  17. The Therapeutic Potential of Human Umbilical Mesenchymal Stem Cells From Wharton's Jelly in the Treatment of Rat Peritoneal Dialysis-Induced Fibrosis.

    PubMed

    Fan, Yu-Pei; Hsia, Ching-Chih; Tseng, Kuang-Wen; Liao, Chih-Kai; Fu, Tz-Win; Ko, Tsui-Ling; Chiu, Mei-Miao; Shih, Yang-Hsin; Huang, Pei-Yu; Chiang, Yi-Chia; Yang, Chih-Ching; Fu, Yu-Show

    2016-02-01

    A major complication in continuous, ambulatory peritoneal dialysis in patients with end-stage renal disease who are undergoing long-term peritoneal dialysis (PD) is peritoneal fibrosis, which can result in peritoneal structural changes and functional ultrafiltration failure. Human umbilical mesenchymal stem cells (HUMSCs) in Wharton's jelly possess stem cell properties and are easily obtained and processed. This study focuses on the effects of HUMSCs on peritoneal fibrosis in in vitro and in vivo experiments. After 24-hour treatment with mixture of Dulbecco's modified Eagle's medium and PD solution at a 1:3 ratio, primary human peritoneal mesothelial cells became susceptible to PD-induced cell death. Such cytotoxic effects were prevented by coculturing with primary HUMSCs. In a rat model, intraperitoneal injections of 20 mM methylglyoxal (MGO) in PD solution for 3 weeks (the PD/MGO 3W group) markedly induced abdominal cocoon formation, peritoneal thickening, and collagen accumulation. Immunohistochemical analyses indicated neoangiogenesis and significant increase in the numbers of ED-1- and α-smooth muscle actin (α-SMA)-positive cells in the thickened peritoneum in the PD/MGO 3W group, suggesting that PD/MGO induced an inflammatory response. Furthermore, PD/MGO treatment for 3 weeks caused functional impairments in the peritoneal membrane. However, in comparison with the PD/MGO group, intraperitoneal administration of HUMSCs into the rats significantly ameliorated the PD/MGO-induced abdominal cocoon formation, peritoneal fibrosis, inflammation, neoangiogenesis, and ultrafiltration failure. After 3 weeks of transplantation, surviving HUMSCs were found in the peritoneum in the HUMSC-grafted rats. Thus, xenografts of HUMSCs might provide a potential therapeutic strategy in the prevention of peritoneal fibrosis. Significance: This study demonstrated that direct intraperitoneal transplantation of human umbilical mesenchymal stem cells into the rat effectively

  18. Tuberculous peritonitis

    PubMed Central

    Srivastava, Udayan; Almusa, Omar; Tung, Ka-wah; Heller, Matthew T.

    2015-01-01

    Tuberculous peritonitis is a serious condition with rising prevalence in recent years. It is especially common in those patients with risk factors such as an immunocompromised state, chronic kidney disease, or cirrhosis/liver disease. Spread is typically hematogenous from pulmonary foci. We report on a 34-year-old man who presented with initial complaints of cough, low-grade fevers, abdominal pain, and nausea/vomiting. Chest x-ray showed a cluster of nodular opacities on the right upper lobe, and a CT scan showed diffuse thickening and nodularity of the omentum with prominent mesenteric lymph nodes, consistent with tuberculous peritonitis. PMID:27186257

  19. Chryseobacterium indologenes peritonitis in peritoneal dialysis

    PubMed Central

    Afshar, Mehdi; Nobakht, Ehsan; Lew, Susie Q

    2013-01-01

    Peritoneal dialysis-related peritonitis remains a major complication of peritoneal dialysis in patients with end-stage renal disease. Chryseobacterium indologenes is a rare organism that has been reported to cause infections mostly in hospitalised patients with severe underlying diseases. We report the first case of C indologenes peritonitis in a patient on peritoneal dialysis outside of Asia. Our patient with end-stage renal disease on peritoneal dialysis grew C indologenes from peritoneal fluid when he presented with abdominal pain and cloudy effluent. The patient responded well to intraperitoneal antibiotic therapy. Tenckhoff catheter did not require removal. This case demonstrates the importance of considering rare causes of peritonitis, such as C indologenes, in patients on peritoneal dialysis. Given the resistance of such organisms to commonly used broad-spectrum antibiotics, antimicrobial susceptibility testing must be assessed as early as possible to assure appropriate antibiotic coverage to avoid untreated peritonitis leading to peritoneal dialysis failure. PMID:23709544

  20. Chryseobacterium indologenes peritonitis in peritoneal dialysis.

    PubMed

    Afshar, Mehdi; Nobakht, Ehsan; Lew, Susie Q

    2013-05-24

    Peritoneal dialysis-related peritonitis remains a major complication of peritoneal dialysis in patients with end-stage renal disease. Chryseobacterium indologenes is a rare organism that has been reported to cause infections mostly in hospitalised patients with severe underlying diseases. We report the first case of C indologenes peritonitis in a patient on peritoneal dialysis outside of Asia. Our patient with end-stage renal disease on peritoneal dialysis grew C indologenes from peritoneal fluid when he presented with abdominal pain and cloudy effluent. The patient responded well to intraperitoneal antibiotic therapy. Tenckhoff catheter did not require removal. This case demonstrates the importance of considering rare causes of peritonitis, such as C indologenes, in patients on peritoneal dialysis. Given the resistance of such organisms to commonly used broad-spectrum antibiotics, antimicrobial susceptibility testing must be assessed as early as possible to assure appropriate antibiotic coverage to avoid untreated peritonitis leading to peritoneal dialysis failure.

  1. Peritoneal tuberculosis.

    PubMed

    Guirat, A; Koubaa, M; Mzali, R; Abid, B; Ellouz, S; Affes, N; Ben Jemaa, M; Frikha, F; Ben Amar, M; Beyrouti, M I

    2011-01-01

    The peritoneum is one of the locations outside the most common pulmonary tuberculosis. Peritoneal tuberculosis poses a public health problem in endemic regions of the world. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease in regions where it was previously controlled. The aim of this review is to expose the clinical, biologic end radiologic futures of the peritoneal tuberculosis and to present the methods of diagnosis and treatment. The diagnosis of this disease is difficult and still remains a challenge because of its insidious nature, the variability of presentation and limitations of available diagnostic tests. The disease usually presents a picture of lymphocytic exudative ascites. There are many complementary tests with variable sensitivities and specificities to confirm the diagnosis of peritoneal tuberculosis. Isolation of mycobacteria by culture of ascitic fluid or histological examination of peritoneal biopsy ideally performed by laparoscopy remains the investigation of choice. The role of PCR, ascitic adenosine deaminase, interferon gamma and the radiometric BACTEC system can improve the diagnostic yield. An antituberculous treatment with group 1 of the WHO for 6 months is sufficient in most cases.

  2. Status of renal replacement therapy and peritoneal dialysis in Mexico.

    PubMed

    Cueto-Manzano, Alfonso M; Rojas-Campos, Enrique

    2007-01-01

    Mexico is struggling to gain a place among developed countries; however, there are many socioeconomic and health problems still waiting for resolution. While Mexico has the twelfth largest economy in the world, a large portion of its population is impoverished. Treatment for end-stage renal disease (377 patients per million population) is determined by the individual's access to resources such as private medical care (approximately 3%) and public sources (Social Security System: approximately 40%; Health Secretariat: approximately 57%). With only 6% of the gross national product spent on healthcare and most treatment providers being public health institutions that are often under economic restrictions, it is not surprising that many Mexican patients do not receive renal replacement therapy. Mexico is still the country with the largest utilization of peritoneal dialysis (PD) in the world, with 18% on automated PD, 56% on continuous ambulatory PD (CAPD), and 26% on hemodialysis. Results of PD (patient morbi-mortality, peritonitis rate, and technique survival) in Mexico are comparable to other countries. However, malnutrition and diabetes mellitus are highly prevalent in Mexican patients on CAPD programs, and these conditions are among the most important risk factors for a poor outcome in our setting.

  3. A comparative study of the effect of icodextrin based peritoneal dialysis and hemodialysis on lipid metabolism.

    PubMed

    Kadiroğlu, A K; Ustündag, S; Kayabaşi, H; Yilmaz, Z; Yildirım, Y; Sen, S; Yilmaz, M E

    2013-09-01

    Dyslipidemia is frequent in patients with end stage renal disease. Excessive peritoneal glucose absorption from high glucose-containing peritoneal dialysis solutions may enhance disturbances on the lipid metabolism of patients on peritoneal dialysis. We compared the effect of icodextrin-based peritoneal dialysis therapy with hemodialysis (HD) therapy on lipid metabolism. A total of 157 non-diabetic patients on dialysis at least for 3 months; 78 patients on Icodextrin-based continuous ambulatory peritoneal dialysis (CAPD) (44 M, 34 F) and 79 patients in HD group (47M, 32F) were included into the study. After 12 h of fasting and before the dialysis session, serum urea, creatinin, glucose, Sodium, potasium, and albumin, total cholesterol (TC), triglycerides (TG), very low density lipoprotein (VLDL), low density lipoprotein (LDL)-C, high-density lipoprotein (HDL)-C, apolipoprotein A (Apo A), apolipoprotein B, and lipoprotein a were measured. TG (P = 0018) and VLDL (P = 0.022) were lower in CAPD group than HD group, HDL-C (P < 0.001) and Apo A (P = 0.001) were higher in CAPD group than in HD group. A total of 24.4% in CAPD group and 11.4% in HD group (P < 0.034) had normal serum levels of TG, LDL-C, and HDL-C. More patients in CAPD group (47.4%) had high serum Apo A levels than in HD group (21.5%) (P = 0.001). We suggest that patients receiving icodextrin-based CAPD may have better TG, HDL-C, and Apo A levels than patients on HD.

  4. [Effectiveness of and tolerance to human recombinant erythropoietin in the treatment of kidney failure anemia in children undergoing continuous peritoneal dialysis. Multicenter study].

    PubMed

    Parchoux, B; Broyer, M; Cochat, P; Burguet, A; Menget, A; Benoît, D; Nivet, H; Fischbach, M; Geisert, J; Dabout, D

    1993-01-01

    Eight young children with renal failure, undergoing continuous peritoneal dialysis (CDP) and presenting an anemia (hemoglobin level [Hb] 57 to 89 g/l) were treated by subcutaneous recombinant human erythropoietin (rHu EPO) twice weekly. The initial dose of 75 U/kg was adjusted to induce progressive increase of Hb with a target level of 100-120 g/l. Treatment duration was 24 weeks in five of these children and 10 to 13 weeks in the three others. In seven cases out of eight, anemia was corrected. The target Hb level was reached in 3 to 21 weeks with rHu EPO doses of 150 to 300 U/kg/w (mean: 200 U/kg/w) for four children without recent transfusion; then the median maintenance dose was 135 U/kg/w (range: 50-300 U/kg/w). In only one patient, Hb never reached a level higher than 77 g/l despite weekly dose of 350 U/kg, a reticulocytosis of 5.6%, rHu EPO treatment lasting up to 24 weeks and the absence of iron deficiency. In any case, no transfusion was necessary after the first day of rHu EPO treatment. In three patients, the increase of a preexisting hypertension required the adaptation of antihypertensive treatments. One patient presented a marked thrombocytosis. In conclusion, twice-a-week subcutaneous injections of 75 to 150 U/kg of rHu EPO appear to be well tolerated and effective in the treatment of anemia of CPD children.

  5. The cost barrier to peritoneal dialysis in the developing world--an Asian perspective.

    PubMed

    Li, P K; Chow, K M

    2001-01-01

    Countries in Asia vary significantly in culture and socioeconomic status. Dialysis costs and reimbursement structures are significant factors in decisions about the rates and modalities of renal replacement therapy. From our survey of Asian nephrologists conducted in 2001, a number of observations can be made. In many developing countries, the annual cost of continuous ambulatory peritoneal dialysis (CAPD) is greater than the per-capita gross national income (GNI). The median cost of a 2-L bag of peritoneal dialysis (PD) fluid is around US$5. The absolute cost of PD fluid among countries with significant differences in per-capita GNI actually varies very little. Thus, most renal failure patients can be expected to have problems accessing PD therapy in developing countries in Asia. In countries with unequal reimbursement policies for PD versus hemodialysis, a lack of incentive to prescribe PD also exists. Automated PD is nearly non existent in many developing countries in Asia. Some possible ways to reduce the cost barriers to PD in those countries include individual governments providing more public funding for treating dialysis patients; dialysate-producing companies reducing the cost of their products; physicians using appropriately smaller exchange volumes (3 x 2 L) in some Asian patients with smaller body sizes and with residual renal function; and reducing the complication rate for PD (for example, peritonitis) thereby reducing the costs required for treatment and hospitalization. PMID:11887842

  6. Leukotriene B4 and tumor necrosis factor release from leukocytes: effect of peritoneal dialysate.

    PubMed

    Jörres, A; Jörres, D; Gahl, G M; Kessel, M; Müller, C; Köttgen, E; Serke, S; Schulz, E; Mahiout, A

    1991-01-01

    The effect of peritoneal dialysate on the capacity of peripheral blood polymorphonuclear (PMNL) and mononuclear leukocytes (MNC) to release leukotriene B4 (LTB4) and tumor necrosis factor alpha (TNF alpha) was investigated in vitro. Following density gradient separation, aliquots of 5 x 10(6) PMNL or MNC were incubated in peritoneal dialysis fluid containing 1.5% glucose or Hanks' buffer (= control) for 1-2 h at 37 degrees C. TNF alpha and LTB4 production was stimulated with Escherichia coli lipopolysaccharide (LPS) and calcium ionophore A23187, respectively. MNC incubated in buffer and LPS produced (mean +/- SD) 1,006 +/- 522 pg TNF alpha/5 x 10(6) cells; no significant amounts of TNF alpha were detectable in the presence of dialysate. An inhibition of TNF alpha release was also observed in MNC exposed to bicarbonate-buffered dialysates (pH 7.40) and 4.25% and 1.5% glucose solution with physiologic osmolality. Incubation of PMNL in Hanks' buffer followed by A23187 stimulation led to production of 29.1 +/- 19.2 ng LTB4/5 x 10(6) cells, whereas glucose-incubated cells were refractory to ionophore stimulation (less than 0.1 ng LTB4/5 x 10(6) cells). The failure of dialysate-exposed leukocytes to release inflammatory mediators in response to adequate stimuli may contribute to the impairment of cellular host defense in the setting of continuous ambulatory peritoneal dialysis.

  7. Peripheral nerve blocks for ambulatory surgery.

    PubMed

    Salinas, Francis V; Joseph, Raymond S

    2014-06-01

    Peripheral nerve blocks (PNBs) provide significant improvement in postoperative analgesia and quality of recovery for ambulatory surgery. Use of continuous PNB techniques extend these benefits beyond the limited duration of single-injection PNBs. The use of ultrasound guidance has significantly improved the overall success, efficiency, and has contributed to the increased use of PNBs in the ambulatory setting. More recently, the use of ultrasound guidance has been demonstrated to decrease the risk of local anesthetic systemic toxicity. This article provides a broad overview of the indications and clinically useful aspects of the most commonly used upper and lower extremity PNBs in the ambulatory setting. Emphasis is placed on approaches that can be used for single-injection PNBs and continuous PNB techniques.

  8. Feline infectious peritonitis.

    PubMed

    Goodson, Teresa; Randell, Susan; Moore, Lisa

    2009-10-01

    Feline infectious peritonitis (FIP) frequently results in death in cats. It is caused by a mutated, highly contagious coronavirus, and it is more common in indoor cats in multicat households. A complex interaction between the coronavirus and the feline immune system causes disseminated vasculitis, which is the hallmark of FIP. New tests are being developed, but the antemortem diagnosis of FIP continues to be difficult and frustrating. Current treatments are crude and involve supportive care and immunosuppression. Minimizing exposure is the best method of preventing infection.

  9. Simple models for fluid transport during peritoneal dialysis.

    PubMed

    Waniewski, J; Heimbürger, O; Werynski, A; Lindholm, B

    1996-08-01

    Peritoneal fluid transport can be predicted using different simplified formulas. To evaluate three such models, fluid transport was studied in 38 single six hour dwell studies using standard glucose 1.36% (n = 9), 2.27% (n = 9) and 3.86% (n = 20) dialysis fluids as well as amino acid 2.70% fluid (n = 8) in 33 patients on continuous ambulatory peritoneal dialysis (CAPD). Dialysate volume and the peritoneal absorption rate were measured using radioiodinated serum albumin (RISA) as a marker. The dialysate volume over dwell time curves were examined using three mathematical models of fluid transport for solutions with a crystalloid osmotic agent: Model P based on phenomenologically derived exponential function of time (Pyle, 1981), Model OS based on linear relationship between the rate of net volume change, Qv, to the difference of osmolality in dialysate and blood, and Model G based on linear relationship between Qv and the difference of glucose concentration in dialysate and blood. All these models provided a good description of the measured dialysate volume over time curves, however the descriptions with Models OS and G for glucose 3.86% fluid were slightly but significantly less precise. The coefficients of Model OS were stable in time, but the coefficients of Model G and P dependend in general on the time period used for their estimation, especially for glucose 3.86% dialysis fluid. The evaluation of dwell studies with solutions containing amino acid 2.70% (instead of glucose) as osmotic agent, using Model OS and P, showed that the transport coefficients were stable in time and both models provided equally precise descriptions. These results suggested that all three models can be used but models P and OS can be preferred for practical applications such as predictions of fluid transport with alternative cristalloid osmotic agents. Furthermore, we found that the peritoneal barrier for fluid transport may change transiently during exchanges with the standard glucose

  10. Peritoneal fluid culture

    MedlinePlus

    Culture - peritoneal fluid ... sent to the laboratory for Gram stain and culture. The sample is checked to see if bacteria ... based on more than just the peritoneal fluid culture (which may be negative even if you have ...

  11. Peritoneal Fluid Analysis

    MedlinePlus

    ... limited. Home Visit Global Sites Search Help? Peritoneal Fluid Analysis Share this page: Was this page helpful? Formal name: Peritoneal Fluid Analysis Related tests: Pleural Fluid Analysis , Pericardial Fluid ...

  12. Molecular Mechanisms Underlying Peritoneal EMT and Fibrosis

    PubMed Central

    Strippoli, Raffaele; Moreno-Vicente, Roberto; Battistelli, Cecilia; Cicchini, Carla; Noce, Valeria; Amicone, Laura; Marchetti, Alessandra; del Pozo, Miguel Angel; Tripodi, Marco

    2016-01-01

    Peritoneal dialysis is a form of renal replacement alternative to the hemodialysis. During this treatment, the peritoneal membrane acts as a permeable barrier for exchange of solutes and water. Continual exposure to dialysis solutions, as well as episodes of peritonitis and hemoperitoneum, can cause acute/chronic inflammation and injury to the peritoneal membrane, which undergoes progressive fibrosis, angiogenesis, and vasculopathy, eventually leading to discontinuation of the peritoneal dialysis. Among the different events controlling this pathological process, epithelial to mesenchymal transition of mesothelial cells plays a main role in the induction of fibrosis and in subsequent functional deterioration of the peritoneal membrane. Here, the main extracellular inducers and cellular players are described. Moreover, signaling pathways acting during this process are elucidated, with emphasis on signals delivered by TGF-β family members and by Toll-like/IL-1β receptors. The understanding of molecular mechanisms underlying fibrosis of the peritoneal membrane has both a basic and a translational relevance, since it may be useful for setup of therapies aimed at counteracting the deterioration as well as restoring the homeostasis of the peritoneal membrane. PMID:26941801

  13. [Ambulatory alcohol withdrawal].

    PubMed

    Grehl, Oliver

    2014-10-01

    Alcohol addiction is a common problem in daily life as well as in medicine. Apart from inpatient therapy programs, ambulatory withdrawal is a relatively new option, which may be done safely, efficient and cost-effective close to the domicile an without stigmatisation of the patient.

  14. Clinical reminders in ambulatory care.

    PubMed

    Banks, N J; Palmer, R H

    1990-01-01

    Computerized reminders are a tool to improve patient care, increase compliance, and reduce medical liability in ambulatory health care. Continuity of care is often hard to achieve given large patient loads, cost containment pressures, and regulatory requirements. Recall reminders prompt patients to make or keep appointments for health maintenance or screening exams. Physician reminders are issued to clinicians at or between visits when their patients have specific screening or diagnostic needs. Reminder systems based on clinical protocols have the added advantage of providing explicit instructions for workup or treatment of abnormal conditions. These reminder systems are especially useful to standardize care in offices with many providers. Implementation of reminder systems is aided by careful staff preparation and resource allocation. Ultimately, reminder systems enhance quality of care, increase patient satisfaction, and reduce costs through improved continuity of care and early detection of serious illness.

  15. [Peritoneal biofilms: microscopic features].

    PubMed

    Maloman, E; Lepadatu, C; Ciornâi, A; Sainsus, Natalia; Balica, I; Gladun, N

    2007-01-01

    Antibiotherapy remains one of the basic clinical tools, which can influence the evolution of severe peritonitis. Peritoneal biofilm formation may minimize the antibiotic effects due to dramatic growth of Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentrations (MBC) for matrix-enclosed bacteria. In this paper we demonstrate the presence and evolution of bacterial biofilms on the peritoneal surface during the course of severe secondary peritonitis using an experimental model and clinical material. Cecal Ligation Puncture was performed in 20 mice Swiss Webster. Peritoneal samples were studied at optic and electronic microscope at 10, 24, 48 and 72 hours postoperative. Clinical samples were taken from 10 patients with diffuse peritonitis. At 24 hours after the onset of the peritonitis bacterial colonies were detected on the peritoneal surface. The formation of mature multilayer polymicrobial biofilms with deep penetration in abdominal wall by 48-72 hours was documented. The bacterial biofilms appear in first 24 hours in the course of experimental generalized peritonitis. Our experimental and clinical data demonstrate formation of the mature polymicrobial biofilm in 48-72 hours after the onset of peritonitis. The possibility of resistant biofilm formation in secondary diffuse peritonitis should be taken into consideration in elaboration of treatment schemes.

  16. Fungal peritonitis caused by Lecythophora mutabilis.

    PubMed Central

    Ahmad, S; Johnson, R J; Hillier, S; Shelton, W R; Rinaldi, M G

    1985-01-01

    Fungal peritonitis caused by Lecythophora mutabilis, a mold rarely isolated from humans, is described. A patient on continuous peritoneal dialysis developed clinical, microbiological, and serological evidence for peritonitis due to this fungus. In vitro susceptibility testing of the fungus revealed marked differences in the activities of various antifungal agents. Although initially responding to treatment with oral ketoconazole, intraperitoneal miconazole, and catheter replacement, the patient had a documented relapse. The patient was eventually cured following the removal of a second catheter in association with prolonged imidazole treatment. Images PMID:4031032

  17. Peritoneal dialysis as salvage renal replacement therapy after complete failure of hemodialysis access in an elderly patient with multiple comorbidities.

    PubMed

    Onime, Aideloje; Tzamaloukas, Antonios H; Servilla, Karen S; Hartshorne, Michael F

    2007-01-01

    Although peritoneal dialysis (PD) has been advocated as a suitable substitution therapy in patients with failure of hemodialysis (HD) blood access, documentation of the performance of PD in such patients is limited. Here, we present an elderly patient with total failure of HD blood access who has had a remarkably successful course on PD. A 78-year-old man with several comorbidities started continuous ambulatory PD after a 3.5-year course of HD complicated by repeated vascular access infections and clotting episodes. These access complications resulted in 8 hospitalizations and led to inability to ambulate following a right femoral shaft fracture sustained in a fall secondary to confusion during an episode of access sepsis, and to superior vena cava (SVC) syndrome following SVC thrombosis after internal jugular catheter insertion. Over approximately 3 years, PD has been very successful in this patient, with 2 early routine episodes of peritonitis and 1 early episode of exit-site infection, control of hematologic and biochemical values, no hospitalizations in the 2.5 years before the time of writing, and good quality of life. A dedicated spouse performing the PD tasks has been a major factor in the success of PD in this patient. Peritoneal dialysis can be successful as a renal replacement procedure in incapacitated elderly patients with failure of HD blood access. In these cases, the success of PD is enhanced by dedicated family members taking on PD tasks that the patient cannot perform.

  18. Automated peritoneal dialysis as the modality of choice: a single-center, 3-year experience with 458 children in Mexico.

    PubMed

    Fabian Velasco, Rosaura; Lagunas Muñoz, Jesus; Sanchez Saavedra, Veronica; Mena Brito Trejo, Jorge E; Qureshi, Abdul Rashid; García-López, Elvia; Divino Filho, Jose C

    2008-03-01

    Automated peritoneal dialysis (APD) has been considered as the ideal dialysis modality for pediatric patients. This study reports the 3-year APD experience with 458 end-stage renal disease (ESRD) children who started APD in a single pediatric center in Mexico City between June 2003 and June 2006. By June 2003, there were 310 patients being treated with continuous ambulatory peritoneal dialysis (CAPD). At that time, these patients were gradually switched to APD, with priority being given to those prescribed more than four exchanges per day, younger than 6 years of age, or presenting complications [hernias or decreased ultrafiltration (UF)]. An improvement of daily UF was observed when the patients were switched from CAPD (590 +/- 340 ml/day) to APD (846 +/- 335 ml/day). The presence of edema decreased (from 67% to 8%) as well as the percentage of patients requiring antihypertensive drugs (from 83% to 38%), the peritonitis rate improved from one episode every 35 patient/month to one episode every 47 patient/month, the total number of hospitalizations decreased (from 384 to 51), and 85% of children attended school. While waiting for renal transplant, APD is the dialysis modality of choice for ESRD children at the La Raza Medical Center in Mexico City.

  19. Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis: Findings from the International Pediatric Peritoneal Dialysis Network (IPPN) Registry

    PubMed Central

    Borzych, Dagmara; Soo Ha, Il; Serdaroglu, Erkin; Büscher, Rainer; Salas, Paulina; Patel, Hiren; Drozdz, Dorota; Vondrak, Karel; Watanabe, Andreia; Villagra, Jorge; Yavascan, Onder; Valenzuela, Maria; Gipson, Deborah; Ng, K.H.; Warady, Bradley A.; Schaefer, Franz

    2011-01-01

    Summary Background and objectives Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow-up in dialyzed children. Design, setting, participants, & measurements Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95th percentile of LV mass index relative to height age was used to define LVH. Results The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia. Conclusions Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH. PMID:21737855

  20. Ambulatory extracorporeal shockwave lithotripsy.

    PubMed

    Nisonson, I; Witus, W S; Madorsky, M L; Weems, W S

    1986-11-01

    The Kidney Stone Center in Fort Lauderdale, Florida, is an ambulatory ESWL facility where 226 patients have been treated since July, 1985. A total of 258 kidneys were treated over a period of five months with a success rate of 99 per cent. The post-treatment admission rate, both immediate and delayed, was 14.2 per cent. Outpatient ESWL treatment of both renal and ureteral calculi is feasible, medically safe, and cost-effective.

  1. Peritoneal Metastases: Prevention and Treatment.

    PubMed

    Sugarbaker, Paul H

    2016-06-01

    Colorectal cancer is a surgicaly curable disease. It requires multimodality of treatment in Localy advanced and metastatic disease. Molecular markers like RAS mutation has brought in change in the mangement of metastatic disease. Nearly 15 to 20 % presents with peritonieal surface metastasis. The debate continues with systomic vs Cyutoreductive surgery with are without HIPEC. This article highlights management of peritoneal metastasis with special reference to prevention and treatment. PMID:27065703

  2. Peritonitis caused by Rothia mucilaginosa in a peritoneal dialysis patient.

    PubMed

    Gosmanova, Elvira O; Garrett, Tiffani R; Wall, Barry M

    2013-12-01

    Peritonitis is an important cause of morbidity in patients undergoing peritoneal dialysis. Rothia mucilaginosa has been reported as an unusual cause of peritoneal dialysis associated peritonitis. Difficulty in the management of this microorganism lies in the absence of uniform recommendations for anti-microbial therapy directed against this pathogen. The current report describes the clinical course of an episode of peritoneal dialysis associated peritonitis caused by Rothia mucilaginosa. Treatment options for this organism are summarized. PMID:24263080

  3. Ambulatory Care Nurse-Sensitive Indicators Series: Reaching for the Tipping Point in Measuring Nurse-Sensitive Quality in the Ambulatory Surgical and Procedure Environments.

    PubMed

    Brown, Diane Storer; Aronow, Harriet Udin

    2016-01-01

    The value of the ambulatory care nurse remains undocumented from a quality and patient safety measurement perspective and the practice is at risk of being highly variable and of unknown quality. The American Academy of Ambulatory Care Nursing and the Collaborative Alliance for Nursing Outcomes propose nurse leaders create a tipping point to measure the value of nursing across the continuum of nursing care, moving from inpatient to ambulatory care. As care continues to shift into the ambulatory care environment, the quality imperative must also shift to assure highly reliable, safe, and effective health care. PMID:27439252

  4. Vitamin K status in peritoneally dialyzed patients with chronic kidney disease.

    PubMed

    Stankowiak-Kulpa, Hanna; Krzyżanowska, Patrycja; Kozioł, Lidia; Grzymisławski, Marian; Wanic-Kossowska, Maria; Moczko, Jerzy; Walkowiak, Jarosław

    2011-01-01

    Abnormal vitamin K status was documented in patients with chronic kidney diseases (CKD), especially those undergoing hemodialysis. The data related to patients undergoing peritoneal dialysis (PD) are contradictory. Therefore, in the present study we aimed to evaluate vitamin K status in patients with CKD who are treated with continuous ambulatory PD. Twenty-eight patients entered into the study. Dialysis vintage ranged from 3 to 89 months. Vitamin K status was assessed in all subjects using undercarboxylated prothrombin measurement (PIVKA-II). In addition, total protein and albumin levels, total cholesterol, LDL cholesterol, triglyceride, calcium, urea and creatinine concentrations were determined. PIVKA-II concentrations were abnormal in 13 (46.4 %) subjects. BMI values, both total and LDL cholesterol concentrations were significantly higher in patients with than those without vitamin K deficiency. Moreover, PIVKA II levels correlated with BMI values (r = 0.441, p < 0.019), LDL cholesterol (r = 0.434, p < 0.021) and creatinine (r = 0.406, p< 0.032) concentrations. However, through the use of logistic regression analysis and multiple regression analysis, no clinical factor was documented to be the independent risk factor of vitamin K deficiency. In conclusion, vitamin K deficiency is a frequent condition in peritoneally dialyzed patients. Assessment of vitamin K status should become a standard procedure in this group of patients.

  5. Bromocriptine induces regression of left ventricular hypertrophy in peritoneal dialysis patients.

    PubMed

    Mejía-Rodríguez, Oliva; Alvarez-Aguilar, Cleto; Vega-Gómez, Helios Eduardo; Belio-Caro, Francisco; Vargas-Espinosa, Juan M; Paniagua-Sierra, José Ramón

    2005-01-01

    Left ventricular hypertrophy (LVH) prevalence is very high in end stage renal disease (ESRD). It's a predictor of cardiac death in peritoneal dialysis patients. Noradrenalin, Angiotensin II and aldosterone are involved incardiac hypertrophy. Dopamine, acting at DA2 receptors inhibits norephinephrin release, antagonizes aldosterone and down-regulates AT1 receptor numbers, suggesting that DA2 agonists, like bromocriptine (BEC) could regress LVH. The objective of this study was to evaluate the changes in left ventricular mass in patients with ESRD in continuous ambulatory peritoneal dialysis (CAPD), by adding BEC to the treatment. An open clinical trial was conducted. Twenty patients were enrolled. Five formed the control group. Fifteen patients in the experimental group received BEC 2.5 mg three times daily over three months. M mode echocardiography and prolactin plasma levels were measured at the beginning and at the end of the study. The statistical analysis was performed using Student t test. The echocardiography reports showed a 24.4% decreased in left ventricular mass index (LVMI); the interventricular septum decreased 11.3%, the ejection fraction was not modified. The control group showed no difference. BEC-mediated decreases in left-ventricular mass in LVH patients on dialysis suggest that Dopaminergic agonists could be useful in caring for patients with ESRD and LVH. PMID:16416676

  6. Palisade dorsoventral lavage for neglected peritonitis.

    PubMed

    Losanoff, J; Kjossev, K

    1997-02-01

    A modification of the procedure of laparostomy with palisade dorsoventral lavage for treating neglected peritonitis is described. It consists of adding a polyethylene foil to cover the intestines and thus avoiding the direct contact between them from one side, and the suction drains and the palisade laparostomy screen from the other. Between 1988 and 1995, 19 patients with neglected peritonitis (APACHE II scores from 12 to 42; mean 22.3) were managed using this modified technique. A total of 81 reexplorations were done (average, 4.3 reexplorations per patient). The technique proved effective (21% mortality, n = 4). No intestinal perforations, fistulas, or residual pus collections occurred among survivors or among those who died. Primary fascial closure was achieved in all survivors and during an 18-months followup, no incisional hernia occurred. Based on these results, we believe this technique is extremely useful when both laparostomy and continuous peritoneal irrigations are considered in patients with neglected peritonitis.

  7. Peritoneal dialysis in Asia.

    PubMed

    Cheng, I K

    1996-01-01

    three years from the straight-line systems with or without germicidal connection devices to the disconnect systems. In China and India, where PD has been introduced only recently, the disconnect systems are used almost exclusively. The disconnect systems are also the most popular systems in use in Japan and Taiwan. As data concerning the cost-effectiveness of different PD systems becomes available, it is likely that trend towards a more liberal use of disconnect systems will continue in the future. The usage of low calcium peritoneal dialysate and the average number of daily CAPD exchanges also vary among the Asian countries. Low calcium peritoneal dialysate has been introduced only in Japan, Hong Kong, and Singapore, with the highest utilization rate (90%) recorded in Singapore. The Philippines had the lowest average number of daily peritoneal exchanges (6L) among the countries surveyed, followed by Hong Kong (6.4L), China and Indonesia (7L), and the rest (8L). The use of a lower number of exchanges was introduced in some countries, initially, mainly as a cost-saving measure based on the assumption that Asians are of small body build. The justification for the continued use of a lower number of exchanges among Asian patients is debatable, but is supported by the acceptable, long-term clinical outcome of patients given this form of dialysis prescription. It is suggested that long-term prospective studies on dialysis adequacy and clinical outcome should be done in different ethnic groups in Asia to see if the similar guidelines with regard to dialysis adequacy can be applied uniformly to Orientals and Caucasians.

  8. The subperitoneal space and peritoneal cavity: basic concepts.

    PubMed

    Pannu, Harpreet K; Oliphant, Michael

    2015-10-01

    The subperitoneal space and peritoneal cavity are two mutually exclusive spaces that are separated by the peritoneum. Each is a single continuous space with interconnected regions. Disease can spread either within the subperitoneal space or within the peritoneal cavity to distant sites in the abdomen and pelvis via these interconnecting pathways. Disease can also cross the peritoneum to spread from the subperitoneal space to the peritoneal cavity or vice versa.

  9. Shewanella algae Peritonitis in Patients on Peritoneal Dialysis.

    PubMed

    Shanmuganathan, Malini; Goh, Bak Leong; Lim, Christopher; NorFadhlina, Zakaria; Fairol, Ibrahim

    Patients with peritonitis present with abdominal pain, diarrhea, fever, and turbid peritoneal dialysis (PD) fluid. Shewanella algae peritonitis has not yet been reported in PD patients in the literature. We present the first 2 cases of Shewanella algae peritonitis in PD patients. Mupirocin cream is applied on the exit site as prophylactic antibiotic therapy. PMID:27659933

  10. Chronic peritoneal dialysis catheters: challenges and design solutions.

    PubMed

    Ash, S R

    2006-01-01

    Although highly successful as transcutaneous access devices, today's peritoneal dialysis catheters still have imperfect hydraulic function, biocompatibility and resistance to infection. Success of Tenckhoff catheters is greatly improved by the proper positioning of deep and subcutaneous cuffs and intraperitoneal segment. Newer peritoneal catheter designs are intended to improve hydraulic function, avoid outflow failure, and diminish exit site infection. These catheter designs serve as excellent alternatives for patients with various types of failure of Tenckhoff catheters. Catheters have been designed for Continuous Flow Peritoneal Dialysis, and have generally been successful in providing high peritoneal dialysis flow rate, but not always successful in optimally distributing flow of peritoneal fluid. Improvements in catheter design may expand the use of peritoneal dialysis as a successful home dialysis therapy. PMID:16485243

  11. The evolution of ambulatory ECG monitoring.

    PubMed

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health. PMID:24215744

  12. Serum level of vascular endothelial growth factor is influenced by erythropoietin treatment in peritoneal dialysis patients. (Grupo de Estudios Peritoneales de Madrid).

    PubMed

    del Peso, G; Selgas, R; Bajo, M A; Fernández de Castro, M; Aguilera, A; Cirugeda, A; Jiménez, C

    2000-01-01

    Some patients on long-term peritoneal dialysis (PD) develop a hyperpermeability state, owing to peritoneal neoangiogenesis. Vascular endothelial growth factor (VEGF), a potent mitogen for endothelial cells, has been implicated in most diseases characterized by microvascular neoformation. Erythropoietin (EPO) is able to induce endothelial proliferation in vitro. Our aim was to elucidate whether VEGF serum levels are influenced by EPO treatment, and whether VEGF serum level maintains a relationship with peritoneal transport data. We analyzed serum levels of VEGF in 35 PD patients (18 males, 17 females). Mean age was 58 years, with a mean time on PD of 98 +/- 75 months. Of the 35 patients, 19 were on automated peritoneal dialysis, and 16 were on continuous ambulatory peritoneal dialysis. Seven patients had diabetes. Peritoneal transport parameters were: urea mass transfer coefficient (MTC), 19.5 +/- 6.6 mL/min; creatinine MTC, 9.9 +/- 4.7 mL/min; net ultrafiltration, 491 +/- 166 mL per 4-hour dwell. Twenty seven patients were under therapy with recombinant human erythropoietin (rHuEPO). Mean serum VEGF levels were 347 +/- 203 pg/mL (range 66-857 pg/mL), with most patients in the normal range (60-700 pg/mL). VEGF levels did not correlate with age, sex, primary renal disease, diabetes, type of PD, time on PD, peritonitis, and cumulative glucose load. We found no correlation with urea MTC, creatinine MTC, ultrafiltration rate, or protein effluent levels. However, a significant negative correlation with residual renal function was seen (r = -0.39, p < 0.05). Patients treated with rHuEPO showed significantly higher serum levels of VEGF than non treated patients (375 +/- 220 pg/mL vs 251 +/- 75 pg/mL, p < 0.05), although they had similar residual renal function. We conclude that increased serum VEGF levels are associated with EPO treatment. Consequently, VEGF might have a role in the EPO effects found in PD patients. Whether both agents are related to peritoneal

  13. [Assisted peritoneal dialysis].

    PubMed

    Klarić, Dragan; Prkačin, Ingrid

    2014-04-01

    According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.

  14. Survey of the attitude of physicians towards establishing and maintaining a peritoneal dialysis program.

    PubMed

    Souqiyyeh, Muhammad Ziad; Shaheen, Faissal A M

    2006-09-01

    In an attempt to evaluate the attitude of physicians towards establishing and maintaining a peritoneal dialysis (PD) program in the Kingdom of Saudi Arabia (KSA), we sent a questionnaire to 160 physicians; the heads of the 148 active dialysis centers in the KSA and 12 other consultants working in these centers. This covered decision makers in 109 centers (73.6%) in the Ministry of Health (MOH), 18 (12.2%) in Governmental-non-MOH centers, and 21 (14.2%) in private hospitals that, together, care for a population of more than 7300 patients on chronic hemodialysis (HD) and 559 on PD. The study was performed between September and December 2005. A total of 145 of the 160 physicians (90.6%) from 141 dialysis centers (95.2%) answered the questionnaire. There were 81 respondents (56.3%) who believed that follow-up of the PD patients should be available in all the dialysis centers, 80 (55.2%) would like to have a PD clinic at their centers, and only 20 (13.8%) had PD clinics in their centers. However, 93 (66.4%) respondents did not request from the administration of their hospitals to open a PD clinic and 62 (44.6%) admitted to having no expertise in managing the patients on PD, while 53 (38.1%) claimed that they did not have enough space in their dialysis centers to start a PD program. Regarding training and expertise, 57 (40.7%), 58 (43.3%), 48 (35.6%) and 72 (52.9%) physicians had training in continuous ambulatory PD (CAPD), intermittent peritoneal dialysis (IPD), automated peritoneal dialysis (APD) or continuous cyclic peritoneal dialysis (CCPD), and acute PD, respectively. The comparisons between the health sectors in the KSA showed that MOH had significantly less active PD programs, and this reflected tremendously on the knowledge of the staff. Our survey indicates that the current practices concerning the PD programs in the KSA are modest, and that a new strategy is required to spread this modality of therapy horizontally in all the dialysis centers, and vertically by

  15. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

    PubMed

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed. PMID:27382329

  16. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    PubMed Central

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed. PMID:27382329

  17. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

    PubMed

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

  18. Treatment Methods for Kidney Failure: Peritoneal Dialysis

    MedlinePlus

    ... 3.70 MB) MedlinePlus Alternate Language URL Peritoneal Dialysis Page Content On this page: What is peritoneal ... Points to Remember Clinical Trials What is peritoneal dialysis and how does it work? Peritoneal dialysis is ...

  19. Training patients for automated peritoneal dialysis: A survey of practices in six successful centers in the United States.

    PubMed

    Firanek, Catherine A; Sloand, James A; Todd, Lucy B

    2013-01-01

    In the United States, the majority of patients on peritoneal dialysis (PD) use a cycler or automated peritoneal dialysis (APD). The aim of this study was the identification of common features in nurse-led APD training programs that were likely to contribute to successful home dialysis. This study collected data on nurse-led APD training programs in six high-performing PD centers. A 13-point survey, which focused on training tools, topics covered methods used, and level of support at home, was administered during group face-to-face interviews with the PD training nurses. Data were reviewed for trends between centers. Training programs in all six centers focused on essential information and skill sets to begin home dialysis using APD, with simple instructions and a hands-on approach. Every center initially trained patients on continuous ambulatory PD before APD. The clinics provided ongoing education, reinforcement, and retraining of concepts and skills through discussion, quizzes, and topic-specific monthly training sessions. All clinics provided 24-hour support for patients. Adopting the best practices identified in this study has the potential to improve APD training.

  20. Partial peritoneal alimentation in an infant.

    PubMed

    Merritt, R J; Atkinson, J B; Whalen, T V; Thomas, D W; Sinatra, F R; Roloson, G J

    1988-01-01

    We provided partial peritoneal alimentation to a 1.69-kg 11-month-old premature infant who had no available central venous access, depleted peripheral venous access, and gastrointestinal dysfunction. A cuffed silastic catheter was surgically inserted into the suprahepatic space. An alimentation solution was continuously infused into the peritoneum for 28 days to supplement peripheral venous and nasogastric alimentation and contributed 42 +/- 15% of total calories daily. Weight gain was achieved, but complications included hypoglycemia, hypophosphatemia, intravascular dehydration, catheter site leakage, ascites, and hydrocele. At autopsy 11 months later, lipid accumulation was present in the upper peritoneum and the hilar regions of the lungs secondary to preexisting lymphatic obstruction. Partial peritoneal alimentation may be feasible when other access routes are inadequate, but lymphatic obstruction is a contraindication to the peritoneal administration of lipid emulsions.

  1. VAP-1 in peritoneally dialyzed patients.

    PubMed

    Koc-Zorawska, Ewa; Malyszko, Jolanta; Zbroch, Edyta; Malyszko, Jacek; Mysliwiec, Michal

    2013-01-01

    VAP-1 (vascular adhesion protein-1) possesses semicarbazide-sensitive amine oxidase (SSAO) activity. It has also been found that serum VAP-1 was elevated in acute and chronic hyperglycemia and in patients with diabetes as well as in chronic kidney disease. Renalase, with possible monoamine oxidase activity, which breaks down catecholamines such as SSAO, is expressed in the endothelium as well as in the kidney. The aim of the study was to assess serum VAP-1 levels in peritoneally dialyzed (PD) patients and factors explaining its variability. This pilot study was performed on 25 peritoneally dialyzed patients, including 4 patients with type 2 diabetes. We found that the mean VAP-1 was significantly higher in chronic ambulatory peritoneal dialysis (CAPD) patients when compared to the control group (p<0.05). Dopamine was significantly lower in PD patients when compared to the healthy volunteers (p<0.05), whereas noradrenaline was significantly higher in PD patients relative to the healthy volunteers (p<0.01). There was a significant difference in the VAP-1 concentration in the group with and without residual renal function (p<0.05) as well as between 10 patients with hyperglycemia when compared to patients with normoglycemia (p<0.05). There was no effect of gender on the serum VAP-1 levels. In PD patients VAP-1 correlated with systolic blood pressure (r=-0.4, p<005), residual renal function (r=-0.62, p<0.05), and glucose (=0.54, p<0.05). We concluded that VAP-1, elevated in patients on PD, was predominantly dependent on residual kidney function and glucose level, factors both linked to endothelial damage and cardiovascular complications.

  2. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery.

    PubMed

    Joshi, Girish P; Ankichetty, Saravanan P; Gan, Tong J; Chung, Frances

    2012-11-01

    The suitability of ambulatory surgery for a patient with obstructive sleep apnea (OSA) remains controversial because of concerns of increased perioperative complications including postdischarge death. Therefore, a Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for ambulatory surgery. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Although the studies evaluating perioperative outcome in OSA patients undergoing ambulatory surgery are sparse and of limited quality, they do provide useful information that can guide clinical practice. Patients with a known diagnosis of OSA and optimized comorbid medical conditions can be considered for ambulatory surgery, if they are able to use a continuous positive airway pressure device in the postoperative period. Patients with a presumed diagnosis of OSA, based on screening tools such as the STOP-Bang questionnaire, and with optimized comorbid conditions, can be considered for ambulatory surgery, if postoperative pain can be managed predominantly with nonopioid analgesic techniques. On the other hand, OSA patients with nonoptimized comorbid medical conditions may not be good candidates for ambulatory surgery. What other guidelines are available on this topic? The American Society of Anesthesiologists (ASA) practice guidelines for management of surgical patients with OSA published in 2006. Why was this guideline developed? The ASA guidelines are outdated because several recent studies provide new information such as validated screening tools for clinical diagnosis of OSA and safety of ambulatory laparoscopic bariatric surgery in OSA patients. Therefore, an update on the selection of patients with OSA undergoing ambulatory surgery is warranted. How does this guideline differ from existing guidelines? Unlike the ASA guidelines, this

  3. Aseptic peritonitis in patients on maintenance peritoneal dialysis.

    PubMed

    Gandhi, V C; Kamadana, M R; Ing, T S; Daugirdas, J T; Viol, G W; Robinson, J A; Geis, W P; Hano, J E

    1979-01-01

    An 'epidemic' of aseptic peritonitis occurred in our peritoneal dialysis unit, affecting 5 of 20 patients. Acute and convalescent viral titers were normal in all 5. The peritoneal fluid of the affected patients was not tested for endotoxin, but endotoxin was found in subsequent dialysis fluids from two machines in the unit. This endotoxin might have been the causative agent of this outbreak. Rapid recovery ensued in all patients following peritoneal lavage. PMID:503270

  4. Peritoneal fibrosis intervention.

    PubMed

    Kaneko, Kayo; Hamada, Chieko; Tomino, Yasuhiko

    2007-06-01

    Peritoneal fibrosis (PF) is invariably observed in patients undergoing long-term peritoneal dialysis (PD). The condition is thought to occur in response to a variety of insults, including bioincompatible dialysates (acidic solution, high glucose, glucose degradation products, or a combination), peritonitis, uremia, and chronic inflammation. Recently, the pathophysiologic mechanisms that contribute to the fibrosing process have been intensively studied. Transforming growth factor-beta has been shown to be a key mediator of PF. Loss of the mesothelial cell layer has been identified in several studies and shown to correlate with submesothelial thickening and vasculopathy. An association has also been identified between increased submesothelial thickness in the peritoneal membrane and increased solute transport, suggesting a relationship between PF and loss of ultrafiltration capacity. Thus, to maintain long-term PD and improve quality of life for patients, it is important to develop interventions for prevention and treatment of PF. Several strategies for peritoneal fibrosis intervention have been reported, including developing biocompatible dialysate, targeting mediators responsible for inflammation and fibrosis, and reconstituting the peritoneum using mesothelial or bone marrow-derived cells. Recent experimental trials in animal models and clinical studies are presented in this review.

  5. Hamster bite peritonitis: Pasteurella pneumotropica peritonitis in a dialysis patient.

    PubMed

    Campos, A; Taylor, J H; Campbell, M

    2000-11-01

    We report the first case of Pasteurella pneumotropica peritonitis in a peritoneal dialysis patient. This rare infection was the result of contamination of the dialysis tubing by a pet hamster. We stress the importance of household pets as a source of infection in the peritoneal dialysis population. PMID:11095007

  6. Transitioning the RN to Ambulatory Care: An Investment in Orientation.

    PubMed

    Allen, Juliet Walshe

    2016-01-01

    Registered nurses (RNs) struggle when transitioning from the inpatient setting to the outpatient clinical environment because it results in a diverse skill-set shift. The RN, considered an outpatient revenue source, experiences a decrease in peer-to-peer relationships, changes in leadership responsibilities, and changes in workgroup dynamics (supervision of unlicensed clinical personnel who function under the direction of the physician, not the RN). Ambulatory organizations find themselves implementing clinical orientation programs that may not delineate the attributes of the RN. This diminishes their value while emphasizing the unlicensed technical skill set. Creating a core RN orientation program template is paramount for the transition of the RN to the ambulatory setting. The literature reveals several areas where improving the value of the RN will ultimately enhance recruitment and retention, patient care outcomes, and leverage the RN role within any organization. Eleven 30-minute in-depth telephone interviews were conducted in addition to 4 nurse observations to explore the lived experience of the RN in ambulatory care. The findings disclosed an overarching theme of nurse isolation and offered insightful underpinnings for the nurse leader as ambulatory growth continues and nurse leaders further endorse the RN presence in the ambulatory setting. PMID:26938183

  7. Peritoneal infection in acute intermittent peritoneal dialysis.

    PubMed

    Sharma, Raj Kumar; Kumar, Jitendra; Gupta, Amit; Gulati, Sanjeev

    2003-11-01

    A prospective study was done to evaluate the incidence and microbiological trend of peritoneal infection in patients undergoing acute intermittent peritoneal dialysis (PD). Complete sterile procedure was ensured and at the completion of the procedure PD fluid was sent for bacteriological culture, sensitivity, and total and differential cell count. During the period September 2000 to February 2001 a total of 100 patients were evaluated. Male female ratio was 72:28. Mean age was 43.17 +/- 17.2 years. In 26 patients cyclers were used. Bacterial culture was positive in total of 30 cases (30%). Gram positive, Gram negative and mixed infection was found in 10%, 15%, and 5% respectively. Number of exchanges (31.61 +/- 7.7 vs. 31.3 +/- 6, p = 0.8) were similar and number of repositioning was significantly more in the infected group (23.3% vs. 11.4%, p < 0.01). Total cell count was significantly higher in infected group (274.3 +/- 502 vs. 31.25 +/- 79.34, p < 0.01). Among Gram +ve organisms Staphylococcus was found in 7, Enterococcus faecalis in 4 and Coryne bacterium sps. in 2 cases. Among Gram -ve organisms, E. coli was found in 4, Enterobacter in 3, Klebsiella 1, Pseudomonas 1, Acinetobacter arinatus 5, Acinetobacter baumani 3, and Citrobacter freundii 3. Mixed flora comprised of Enterococcus faecalis 3, Enterobacter 1, Staphlococcus 1, E. coli 3, Citrobacter 1, Acinobacter baumani 1. Although with the cyclers using collapsible bags, staphylococcus was not isolated, the total incidence of infection (11/26 cases) was not decreased with the use of cyclers. We conclude that in acute intermittent peritoneal dialysis the incidence of bacterial infection is 30% with preponderance of Gram -ve over Gram +ve organisms and organism of fecal origin being commoner than those of skin origin. Use of cycler-assisted over manual PD do not improve the incidence of infection. Repositioning of the stiff catheter significantly increases the incidence of infection.

  8. Peritoneal Dialysis Dose and Adequacy

    MedlinePlus

    ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Peritoneal Dialysis Dose and Adequacy Page Content On this page: ... from the abdominal cavity. [ Top ] Types of Peritoneal Dialysis The two types of peritoneal dialysis differ mainly ...

  9. Biomedical Wireless Ambulatory Crew Monitor

    NASA Technical Reports Server (NTRS)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

    A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

  10. [Adjuvant therapy of peritonitis with taurolidine. Modulation of mediator liberation].

    PubMed

    Staubach, K H

    1997-01-01

    Despite aggressive surgical treatment, prompt antibiotic therapy, and modern intensive care, up to one half of patients still die of diffuse peritonitis. There must be a distinction between infection as a microbiological phenomenon and sepsis as a complex, deleterious, inflammatory host response. Physiologic and metabolic changes during the latter process by taxonomically different organisms or different sources of infection are often clinically indistinguishable. Taurolidine, an amino acid derivate, seems to cover a variety of effects in peritonitis. As secondary peritonitis is associated with a significant cytokine release that is compartementalized in the peritoneal cavity, taurolidine is bactericidal, antiendotoxic, and antiadherent locally and, on the other hand, may modulate the systemic cytokine-mediated inflammatory response after being adsorbed systemically by the peritoneum. Current management of peritonitis can clear the peritoneal cavity of microorganisms and their products but patients continue to die of uncontrolled cytokine-induced systemic inflammation. In patients that undergo daily staged, planned relaparotomies they should not only be treated locally by taurolidine but also systemically by intravenous administration. The latter should, as a sort of sequential therapy, be continued, especially when the peritoneal cavity has been closed after a series of relaparotomies.

  11. [Feline infectious peritonitis].

    PubMed

    Lutz, H; Hauser, B; Horzinek, M C

    1985-11-15

    This paper gives a summary of our present-day knowledge concerning etiology, clinical aspects, diagnosis, pathology and pathogenesis of feline infectious peritonitis. Special emphasis is given to the participation of the immune system in the development of lesions. A therapy protocol is proposed and an extensive list of original literature for further study is given.

  12. Peritoneal fluid analysis

    MedlinePlus

    ... the fluid to measure: Albumin Protein Red and white blood cell counts Tests will also check for bacteria and other ... be a sign of tumor or injury. High white blood cell counts may be a sign of peritonitis . Milk-colored ...

  13. French National Registry of Rare Peritoneal Surface Malignancies

    ClinicalTrials.gov

    2016-07-12

    Rare Peritoneal Surface Malignancies; Pseudomyxoma Peritonei; Peritoneal Mesothelioma; Desmoplastic Small Round Cell Tumor; Psammocarcinoma; Primary Peritoneal Serous Carcinoma; Diffuse Peritoneal Leiomyomatosis; Appendiceal Mucinous Neoplasms

  14. IMAGING DIAGNOSIS-SCLEROSING ENCAPSULATING PERITONITIS IN A DOG.

    PubMed

    Veiga-Parga, Tamara; Hecht, Silke; Craig, Linden

    2015-01-01

    An approximately 5-month-old American Staffordshire terrier was presented with a history of recurrent peritoneal effusion. Abdominal radiographs and ultrasound showed a loculated effusion in the ventral abdomen with dorsal displacement of abdominal organs, hepatomegaly and rounding of liver and splenic margins. Computed tomography demonstrated centrally located gastrointestinal segments surrounded by a thin soft tissue band and a thickened peritoneal lining. At necropsy a fibrous membrane continuous with liver and splenic capsules encapsulated all abdominal organs. Microscopically the abdominal wall and fibrous capsule consisted of an irregular thick layer of hypocellular connective tissue. The final diagnosis was sclerosing encapsulating peritonitis. PMID:26095283

  15. Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum.

    PubMed

    Lemoine, Lieselotte; Sugarbaker, Paul; Van der Speeten, Kurt

    2016-09-14

    Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death worldwide. Besides the lymphatic and haematogenous routes of dissemination, CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity, which ultimately leads to peritoneal carcinomatosis (PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However, this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements, involving several well-defined steps, together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor, gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum, subsequently invade the subperitoneal space, where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript, we review current data regarding the molecular mechanisms underlying the development of colorectal PC, with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread. PMID:27678351

  16. Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum

    PubMed Central

    Lemoine, Lieselotte; Sugarbaker, Paul; Van der Speeten, Kurt

    2016-01-01

    Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death worldwide. Besides the lymphatic and haematogenous routes of dissemination, CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity, which ultimately leads to peritoneal carcinomatosis (PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However, this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements, involving several well-defined steps, together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor, gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum, subsequently invade the subperitoneal space, where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript, we review current data regarding the molecular mechanisms underlying the development of colorectal PC, with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread. PMID:27678351

  17. Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum

    PubMed Central

    Lemoine, Lieselotte; Sugarbaker, Paul; Van der Speeten, Kurt

    2016-01-01

    Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death worldwide. Besides the lymphatic and haematogenous routes of dissemination, CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity, which ultimately leads to peritoneal carcinomatosis (PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However, this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements, involving several well-defined steps, together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor, gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum, subsequently invade the subperitoneal space, where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript, we review current data regarding the molecular mechanisms underlying the development of colorectal PC, with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread.

  18. [Quality in ambulatory medicine].

    PubMed

    Raetzo, M A

    2001-11-01

    The perspectives of the insurance companies, medical associations and practitioners about quality in outpatient care are different. After a brief discussion of each of these views, a proposal for quality improvement through continuous medical education is presented. It applies to the doctor-patient relationship, the diagnostic and therapeutic strategies and the handling of uncertainty. Practically, simulations can help the physicians to understand the theory behind continuous quality improvement and apply it to the process of outpatient care.

  19. Peritoneal tuberculosis: diagnostic options.

    PubMed Central

    Lal, N; Soto-Wright, V

    1999-01-01

    BACKGROUND: Extrapulmonary tuberculosis has vague symptoms and few signs. It is essential to recognize and diagnose this curable disease prior to performing definitive surgery. Newer tests such as DNA or RNA amplification allow for early diagnosis but have limitations. CASE: We report a case of peritoneal tuberculosis in an immigrant woman. She had vague symptoms of low-grade fever, mild abdominal pain, obstipation, and bloating. Diagnostic laparoscopy was performed to establish the diagnosis. Tuberculosis was confirmed by DNA extraction from the frozen section specimen with subsequent analysis using polymerase chain reaction. CONCLUSION: Peritoneal tuberculosis is a disease that often simulates malignancies. With the increasing prevalence of human immunodeficiency virus in developed countries, tuberculosis is also on the rise and should be considered in the differential diagnosis of a patient with an abdominal/pelvic mass and ascites. PMID:10524670

  20. Peritoneal dialysis in Mexico.

    PubMed

    Cueto-Manzano, Alfonso M

    2003-02-01

    While Mexico has the thirteenth largest economy, a large portion of the population is impoverished. About 90% of the population is Mestizo, the result of the admixture of Mexican Indians and Spaniards, with the Indigenous peoples concentrated in the southeastern region. Treatment for end-stage renal disease (estimated 268 patients per million population) is largely determined by the limited healthcare system and the individual's access to resources such as private insurance ( approximately 15%) and governmental sources ( approximately 85%). With only 5% of the gross national product spent on healthcare and most treatment providers being public health institutions that are often under severe economic restrictions, it is not surprising that many Mexican patients do not receive renal replacement therapy. Mexico uses proportionately more peritoneal dialysis than other countries; 1% of the patients are on automated peritoneal dialysis, 19% on hemodialysis and 80% on CAPD. Malnutrition and diabetes, important risk factors for poor outcome, are prevalent among the patients in CAPD programs.

  1. Intraperitoneal Meropenem for Polymicrobial Peritoneal Dialysis-Related Peritonitis.

    PubMed

    de Fijter, Caroline W H; Jakulj, Lily; Amiri, Fariba; Zandvliet, Anthe; Franssen, Eric

    With the current rise in multiresistant gram-negative bacteria, carbapenems are more frequently used. Surprisingly, limited data exist on the pharmacokinetics of meropenem in peritoneal dialysis (PD)-related peritonitis. We report on the pharmacokinetics of repeated intraperitoneal (IP) meropenem during 21 days as treatment for polymicrobial multiresistent PD-related peritonitis.Our current report supports daily doses of 125 mg/L intraperitoneal meropenem in all bags as an effective and safe modality in the treatment of PD-associated peritonitis with multiresistant microorganisms. No signs of over- or underdosing were found based on serial drug concentration measurements at fixed time points up to 21 days. PMID:27659932

  2. Personal abilities in patients undergoing peritoneal dialysis and hemodialysis. A pilot study using the existence scale.

    PubMed

    Schwaiger, Johannes P; Kopriva-Altfahrt, Gertrude; Söllner, Wolfgang; König, Paul

    2007-01-01

    Personality psychology is increasingly used in various clinical medicine settings to help in decision-making in difficult situations, especially in chronic disease. Patients with chronic renal disease are very dependent on modern medicine, and psychological aspects could help give answers in certain circumstances. Logotherapy and Existence analysis, after Viktor Frankl (Third Viennese School of Psychotherapy), is the theory of the possibilities and conditions for a fulfilled existence and evaluates a different aspect of personality psychology, namely meaning (in life). We used the existence scale questionnaire in this pilot study to investigate the personal abilities self-distancing, self-transcendence, freedom and responsibility in dialysis patients and compared a group of hemodialysis (HD) patients with patients treated with continuous ambulatory peritoneal dialysis (CAPD). We studied a mixed dialysis cohort (24 HD, 24 CAPD) at two Austrian centers (Innsbruck Medical University Hospital and Wilhelminenspital of the City of Vienna). Overall, results for dialysis patients (n = 48) were very close to those reported for healthy persons; however, CAPD patients scored significantly better than HD patients (p = 0.017) on the subscale self-distancing. This significant difference was also seen in the overall scores (p = 0.045). Our results might indicate that contented CAPD patients have personal abilities that predestine them for this type of treatment. The existence scale might help decide between CAPD and HD treatment alternatives.

  3. Sclerosing Encapsulating Peritonitis

    PubMed Central

    Machado, Norman O.

    2016-01-01

    Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition of the peritoneum with an unknown aetiology. Also known as abdominal cocoon, the condition occurs when loops of the bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Due to its rarity and non-specific clinical features, it is often misdiagnosed. The condition presents with recurrent episodes of small bowel obstruction and can be idiopathic or secondary; the latter is associated with predisposing factors such as peritoneal dialysis or abdominal tuberculosis. In the early stages, patients can be managed conservatively; however, surgical intervention is necessary for those with advanced stage intestinal obstruction. A literature review revealed 118 cases of SEP; the mean age of these patients was 39 years and 68.0% were male. The predominant presentation was abdominal pain (72.0%), distension (44.9%) or a mass (30.5%). Almost all of the patients underwent surgical excision (99.2%) without postoperative complications (88.1%). PMID:27226904

  4. Ambulatory care practice variation within a Medicaid program.

    PubMed Central

    Weiner, J P; Starfield, B H; Powe, N R; Stuart, M E; Steinwachs, D M

    1996-01-01

    STUDY QUESTIONS: What is the extent of variation in patterns of ambulatory care practice across one state's Medicaid program once case mix is controlled for? How much of this variation in resource consumption is explained by factors linked to the provider, patient, and geographic subarea? DATA SOURCES/STUDY SETTING: Practices of all providers delivering care to persons who were continuously enrolled in the Maryland Medicaid program during FY 1988 were studied. A computerized summary of all services received during this year for 134,725 persons was developed using claims data. We also obtained data from the state's beneficiary and provider files and the American Medical Association's masterfile. Each patient was assigned a "usual source of care" (primary provider) based on the actual patterns of service. The Ambulatory Care Group (ACG) measure was used to help control for case mix. STUDY DESIGN: This was a cross-sectional study based on the universe of continuously enrolled Medicaid enrollees in one state. PRINCIPAL FINDINGS: After controlling for case mix, the variation in patient resource use by type of primary provider was 19 percent for ambulatory visits, 46 percent for ancillary testing, 61 percent for prescriptions, and 81 percent for hospitalizations. Across Maryland counties, comparing the low- to high-use jurisdiction, there was 41 percent variation in case mix-adjusted visit rates, 72 percent variation in pharmacy use, and 325 percent variation in hospital days. At the individual practice level, physician characteristics explain up to 17 percent of ambulatory resource use and geographic area explains only a few percent, while patient characteristics explain up to 60 percent of variation. CONCLUSIONS: Since a large proportion of variation was explained by patient case mix, it is evident that risk adjustment is essential for these types of analyses. However, even after adjustment, resource use varies considerably across types of ambulatory care provider and

  5. Microbiological Surveillance of Peritoneal Dialysis Associated Peritonitis: Antimicrobial Susceptibility Profiles of a Referral Center in GERMANY over 32 Years

    PubMed Central

    Kitterer, Daniel; Latus, Joerg; Pöhlmann, Christoph; Alscher, M. Dominik; Kimmel, Martin

    2015-01-01

    Objectives Peritonitis is one of the most important causes of treatment failure in peritoneal dialysis (PD) patients. This study describes changes in characteristics of causative organisms in PD-related peritonitis and antimicrobial susceptibility. Methods In this single center study we analyzed retrospective 487 susceptibility profiles of the peritoneal fluid cultures of 351 adult patients with peritonitis from 1979 to 2014 (divided into three time periods, P1-P3). Results Staphylococcus aureus decreased from P1 compared to P2 and P3 (P<0.05 and P<0.01, respectively). Methicillin-resistant S. aureus (MRSA) occurred only in P3. Methicillin-resistant Staphylococcus epidermidis (MRSE) increased in P3 over P1 and P2 (P <0.0001, respectively). In P2 and P3, vancomycin resistant enterococci were detected. The percentage of gram-negative organisms remained unchanged. Third generation cephalosporin resistant gram-negative rods (3GCR-GN) were found exclusively in P3. Cefazolin-susceptible gram-positive organisms decreased over the three decades (93% in P1, 75% in P2 and 58% in P3, P<0.01, P<0.05 and P<0.0001, respectively). Vancomycin susceptibility decreased and gentamicin susceptibility in gram-negatives was 94% in P1, 82% in P2 and 90% in P3. Ceftazidim susceptibility was 84% in P2 and 93% in P3. Conclusions Peritonitis caused by MSSA decreased, but peritonitis caused by MRSE increased. MRSA peritonitis is still rare. Peritonitis caused by 3GCR-GN is increasing. An initial antibiotic treatment protocol should be adopted for PD patients to provide continuous surveillance. PMID:26405797

  6. [Ambulatory treatment of deep venous thrombosis].

    PubMed

    Metz, D; Hezard, N; Brasselet, C

    2001-11-01

    Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation. PMID:11794978

  7. Spectrum of perforation peritonitis in delhi: 77 cases experience.

    PubMed

    Yadav, Dinesh; Garg, Puneet K

    2013-04-01

    Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8 months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4 %) and ileal typhoid perforation (26.4 %), each followed by small bowel tuberculosis (10.3 %) and stomach perforation (9.2 %), perforation due to acute appendicitis (5 %). The highest number of perforations was seen in ileum (39.1 %), duodenum (26.4 %), stomach (11.5 %), appendix (3.5 %), jejunum (4.6 %), and colon (3.5 %). Overall mortality was 13 %. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup.

  8. Ambulatory blood pressure monitoring: methodologic issues.

    PubMed

    Prisant, L M; Bottini, P B; Carr, A A

    1996-01-01

    Blood pressure, like heart rate, is a changing physiologic variable. Like ambulatory electrocardiography, ambulatory blood pressure can be recorded intermittently throughout the day. Ambulatory blood pressure is a dynamic variable influenced by multiple factors, and it correlates more strongly with target organ damage than do static office blood pressure measurements. Office (but not ambulatory) measurements are subject to the placebo and physician pressor effect. There is a great patient variability of blood pressure measurements in the office compared with ambulatory methods. Ambulatory blood pressure devices are portable rather than 'ambulatory'. The auscultatory (listens for Korotkoff sounds) and oscillometric (detects maximal arterial vibrations and calculates diastolic blood pressure) methods are used to detect blood pressure. Equipment is generally safe, although mild sleep derangements have been reported. The 24-h blood pressure and diurnal change are usually assessed. A 24-h ambulatory blood pressure mean of 140/90 mm Hg or above is clearly abnormal, though recent data suggest that the 95th centile is 134/84 mm Hg. Correlation of individual blood pressure readings with diary entries may be instructive. New American and British validation criteria have been published to assess the performance of each new device that becomes available. It should not be assumed that newer ambulatory devices have been tested (particularly by a third party) or are better. Test/retest 24-h ambulatory blood pressure shows less variability than office measurements; however, the percentage of patients with a mean difference greater than +/- 5 mm Hg on repeat 24-h blood pressure measurement after 1 week is still surprisingly high (49.3%, systolic; 52.1%, diastolic). European trials are in progress to assess the prognosis of hypertension assessed by ambulatory compared with office blood pressure. Ambulatory blood pressure monitoring has been restricted for use in several clinical

  9. Feline infectious peritonitis.

    PubMed

    Hartmann, Katrin

    2005-01-01

    The article discusses feline infectious peritonitis (FIP), an important disease frequently seen in veterinary practice. FIP causes many problems to the veterinarian as it can be difficult to definitively diagnose the disease, as there is no effective treatment, and as prophylactic interventions are not very successful. Although intense research has created a lot of new knowledge about this disease in the last years, there are still many unanswered questions. The objective of this article is to review recent knowledge and to increase understanding of the complex pathogenesis of FIP.

  10. Feline infectious peritonitis.

    PubMed

    Andrew, S E

    2000-09-01

    Feline infectious peritonitis is a noncurable viral disease affecting cats worldwide. Recent evidence suggests that the FIPV has evolved as a deletion mutation of FECV. Immune complex deposition and vasculitis with pyogranulomatous lesions are the hallmark of FIP. The only definitive antemortem diagnostic test for FIP is histopathologic examination of tissue. Ocular manifestations occur commonly with noneffusive FIP. The most common clinical sign is a bilateral granulomatous anterior uveitis often accompanied by chorioretinitis. Treatment of ocular FIP is symptomatic, and the mainstay of palliative therapy is topical or systemic corticosteroids or both.

  11. Disseminated Peritoneal Leiomyomatosis

    PubMed Central

    Momtahan, Mozhdeh; Nemati, Maryam; Safaei, Akbar

    2011-01-01

    Leiomyomatosis peritonealis disseminata is a very rare condition characterized by the development of multiple smooth muscle-like nodules in the peritoneal cavity. It is associated with increased serum levels of gonadal steroids. The present report describes a 29-year-old patient underwent transabdominal hysterectomy and Bilateral Salpingo oophorectomy six years ago because of leiomyomatosis peritonealis disseminata. After six years she referred to us again because of retroperitoneal fibroma, another rare entity, during hormone replacement therapy inspite of lack of uterus and previous castration. PMID:23365481

  12. Big Data and Ambulatory Care

    PubMed Central

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2015-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care. PMID:25401945

  13. An ambulatory trial of guanfacine

    PubMed Central

    Mann, Stewart; Craig, Michael W. Millar; Melville, Donald I.; Cashman, Peter M. M.; Raftery, E. B.

    1980-01-01

    1 The effects of acute and long-term treatment with guanfacine on ambulatory BP were studied. 2 The first day of therapy with guanfacine 1 mg produced a small reduction in BP whereas chronic therapy with doses up to 6gm given once daily produced a substantial smooth reduction throughout the whole 24 hours. 3 There were no noticeable symptoms or rebound effects on withdrawal of the drug; side-effects, were, however, prominent during therapy. 4 The drug reduced BP during dynamic exercise but did little during isometric exercise; no postural hypotension was noted during tilting. PMID:6994762

  14. Teaching Dance to Children with Ambulatory Disabilities.

    ERIC Educational Resources Information Center

    Stran, Margaret; Hardin, Brent

    2002-01-01

    Presents various instructional techniques and examples of dances teachers can use to accommodate and integrate students with ambulatory disabilities, reviewing basic inclusion principles as they relate to dance and providing a suggested progression for teaching dance when including children with ambulatory disabilities. The article illustrates…

  15. 42 CFR 494.70 - Condition: Patients' rights.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., transplantation, home dialysis modalities (home hemodialysis, intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis),and in-facility hemodialysis. The... Patient Care § 494.70 Condition: Patients' rights. The dialysis facility must inform patients (or...

  16. Lung cancer and peritoneal carcinomatosis

    PubMed Central

    SERENO, MARÍA; RODRÍGUEZ-ESTEBAN, ISABEL; GÓMEZ-RAPOSO, CÉSAR; MERINO, MARÍA; LÓPEZ-GÓMEZ, MIRIAM; ZAMBRANA, FRANCISCO; CASADO, ENRIQUE

    2013-01-01

    Lung cancer is currently one of the most common malignancies in the world and peritoneal involvement is rare in these types of tumors. Clinical manifestations of these metastases are also uncommon and include intestinal perforation and obstruction. The present study reviewed certain aspects of the complication of peritoneal involvement and illustrated it with four cases of patients that were diagnosed with primary lung carcinoma and secondary peritoneal carcinomatosis (PC). The outcome of these patients is poor and they rarely respond to chemotherapy. Surgery is successful in the majority of cases. PMID:24137394

  17. Peritonitis due to Rhizobium radiobacter.

    PubMed

    Marta, Raquel; Dâmaso, Catarina; Silva, José Esteves da; Almeida, Margarida

    2011-09-01

    Rhizobium radiobacter (Agrobacterium radiobacter) is an aerobic Gram-negative rod belonging to Agrobacterium genus, a group of phytopathogenic bacteria present in the soil that has been implicated in human opportunistic infections. We report a clinical case of bacterial peritonitis in a 5-year-old child with chronic renal disease in peritoneal dialysis, who had a history of direct soil contact identified. The infection was treated with ceftazidime and piperaciline+tazobactam without relapses or the need to remove the peritoneal dialysis catheter.

  18. Peritoneal dialysis in microencephaly.

    PubMed

    Peters, April

    2008-01-01

    J.T. was able to remain home in her familiar environment and receive safe and adequate treatment for her renal disease. J.T. had no infectious episodes or hospitalizations while under this unit's care for 35 months. She was also able to participate in her regular activities of daily living, interact with her family members, and travel on occasion, thus maintaining a good quality of life. Therefore, unit goals for her care were met. J.T.'s experience demonstrates that with proper teaching, preparation, and support from the dialysis care team working with a dedicated family, peritoneal dialysis can be an ideal modality for the treatment of ESRD in people with mental disabilities. PMID:19260611

  19. Presternal peritoneal catheter.

    PubMed

    Twardowski, Zbylut J

    2002-04-01

    The swan neck presternal catheter is composed of 2 flexible (silicon rubber) tubes joined by a titanium connector at the time of implantation. The exit site is located in the parasternal area. The catheter located on the chest was designed to reduce the incidence of exit site infections compared to peritoneal dialysis catheters with abdominal exits. From August 1991 to September 30, 2001, 974 swan neck presternal catheters were implanted worldwide. At the university of Missouri, 150 of these catheters were implanted and followed for over 130 patient years. Presternal catheters tended to perform better than swan neck abdominal catheters regarding exit and tunnel infections, even though they were implanted in several patients in whom regular catheters with the exit on the abdomen would be difficult or impossible to implant. Two-year survival probability of presternal catheters was 0.95. Recurrent/refractory peritonitis was the only reason for catheter failure. The catheter is particularly useful in obese patients (body mass index >35), patients with ostomies, children with diapers and fecal incontinence, and patients who want to take baths without the risk of exit contamination. Many patients prefer presternal catheter because of better body image. Disadvantages of the presternal catheter are minimal. Compared with abdominal catheters, dialysis-solution flow is slightly slower because of the increased catheter length; however, slower flow is insignificant clinically. There is a possibility of catheter disconnection in the tunnel, but this complication is extremely rare in adults and easily corrected. Finally, the implantation technique is more challenging compared with that of single-piece, abdominal catheters. PMID:12085389

  20. Evolution of management in peritoneal surface malignancies

    PubMed Central

    Canbay, Emel; Torun, Bahar Canbay; Torun, Ege Sinan; Yonemura, Yutaka

    2016-01-01

    Management of peritoneal surface malignancies has gradually evolved by the introduction of cytoreductive surgery in combination with intraperitoneal chemotherapy applications. Recently, peritoneal metastases of intraabdominal solid organ tumors and primary peritoneal malignancies such as peritoneal mesothelioma are being treated with this new approach. Selection criteria are important to reduce morbidity and mortality rates of patients who will experience minimal or no benefit from these combined treatment modalities. Management of peritoneal surface malignancies with this current trend is presented in this review. PMID:27528813

  1. Evolution of management in peritoneal surface malignancies.

    PubMed

    Canbay, Emel; Torun, Bahar Canbay; Torun, Ege Sinan; Yonemura, Yutaka

    2016-01-01

    Management of peritoneal surface malignancies has gradually evolved by the introduction of cytoreductive surgery in combination with intraperitoneal chemotherapy applications. Recently, peritoneal metastases of intraabdominal solid organ tumors and primary peritoneal malignancies such as peritoneal mesothelioma are being treated with this new approach. Selection criteria are important to reduce morbidity and mortality rates of patients who will experience minimal or no benefit from these combined treatment modalities. Management of peritoneal surface malignancies with this current trend is presented in this review. PMID:27528813

  2. Protective Effects of Paricalcitol on Peritoneal Remodeling during Peritoneal Dialysis

    PubMed Central

    Stavenuiter, Andrea W. D.; Farhat, Karima; Vila Cuenca, Marc; Schilte, Margot N.; Keuning, Eelco D.; Paauw, Nanne J.; ter Wee, Pieter M.; Beelen, Robert H. J.; Vervloet, Marc G.

    2015-01-01

    Peritoneal dialysis (PD) is associated with structural and functional alterations of the peritoneal membrane, consisting of fibrosis, angiogenesis, and loss of ultrafiltration capacity. Vitamin D receptor activation (VDRA) plays an important role in mineral metabolism and inflammation, but also antiangiogenic and antifibrotic properties have been reported. Therefore, the effects of active vitamin D treatment on peritoneal function and remodeling were investigated. Rats were either kept naïve to PDF exposure or daily exposed to 10 mL PDF and were treated for five or seven weeks with oral paricalcitol or vehicle control. Non-PDF-exposed rats showed no peritoneal changes upon paricalcitol treatment. Paricalcitol reduced endogenous calcitriol but did not affect mineral homeostasis. However, upon PDF exposure, loss of ultrafiltration capacity ensued which was fully rescued by paricalcitol treatment. Furthermore, PD-induced ECM thickening was significantly reduced and omental PD-induced angiogenesis was less pronounced upon paricalcitol treatment. No effect of paricalcitol treatment on total amount of peritoneal cells, peritoneal leukocyte composition, and epithelial to mesenchymal transition (EMT) was observed. Our data indicates that oral VDRA reduces tissue remodeling during chronic experimental PD and prevents loss of ultrafiltration capacity. Therefore, VDRA is potentially relevant in the prevention of treatment technique failure in PD patients. PMID:26605330

  3. [Ambulatory care nursing sites in Italy: results of a pilot study].

    PubMed

    Alvaro, Rosaria; Venturini, Giulia; Tartaglini, Daniela; Vellone, Ercole; De Marinis, Maria Grazia

    2009-01-01

    The aim of this study was to map existing ambulatory care nursing sites in Italy, compare operational and organizational methodologies used, and evaluate visibility of the sites in health institutions and the community. Nurses' level of satisfaction with this work experience was also evaluated. The American Academy of Ambulatory Care Nursing and American Nurses Association definition of ambulatory care nursing (1997) was used to select sites for the study. Two hundred fifty ambulatory care sites meeting this definition were listed, most of which provide clinical and educational services to oncology and cardiology patients. Surgical sites provide treatment of surgical wounds and stomas. Results of the study show that ambulatory care nursing sites are not uniformly distributed across Italy and a greater concentration of sites can be found in northern Italy with respect to central and southern Italy. Nurses report having greater professional autonomy and an excellent level of satisfaction. All interviewed nurses attend specific training and continuing education courses. Ambulatory care sites are managed by nurses; medical consultations are requested when necessary and home assistance is assured through coordination with general practitioners. PMID:19629150

  4. New Developments in Peritoneal Fibroblast Biology: Implications for Inflammation and Fibrosis in Peritoneal Dialysis

    PubMed Central

    Witowski, Janusz; Kawka, Edyta; Rudolf, Andras; Jörres, Achim

    2015-01-01

    Uraemia and long-term peritoneal dialysis (PD) can lead to fibrotic thickening of the peritoneal membrane, which may limit its dialytic function. Peritoneal fibrosis is associated with the appearance of myofibroblasts and expansion of extracellular matrix. The extent of contribution of resident peritoneal fibroblasts to these changes is a matter of debate. Recent studies point to a significant heterogeneity and complexity of the peritoneal fibroblast population. Here, we review recent developments in peritoneal fibroblast biology and summarize the current knowledge on the involvement of peritoneal fibroblasts in peritoneal inflammation and fibrosis. PMID:26495280

  5. A vision for ambulatory care in the 21st century.

    PubMed

    Zuckerman, A M

    1998-01-01

    The 1990's have been a remarkable decade for ambulatory care providers. Ambulatory care services have flourished in an era of rapidly increasing demands and seemingly limitless potential. Will the first decade of the next millennium continue this trend or is something new on the horizon? Ambulatory care's future prospects need to be evaluated within the context of the overall health care delivery environment of the future. At this time, three alternative "futures" seem plausible for the next decade. Managed care dominates. This scenario appears most likely at present with managed care poised to make significant inroads into Medicaid and Medicare populations. National health insurance is instituted. Some believe that this is a logical reaction to the excesses of the current competitive marketplace and is possible following the presidential election of 2004. Slow evolution of current system. This scenario may be viewed as the status quo alternative and is likely in the absence of a crisis or a better, generally agreed upon way in which to improve health care delivery.

  6. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneal dialysis system and accessories. 876.5630 Section 876.5630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices §...

  7. Postoperative Peritoneal Adhesions

    PubMed Central

    Ryan, Graeme B.; Grobéty, Jocelyne; Majno, Guido

    1971-01-01

    This paper describes an experimental model of peritoneal adhesions, in the rat, based on two relatively minor accidents that may occur during abdominal surgery in man: drying of the serosa, and bleeding. Drying alone had little effect; drying plus bleeding consistently produced adhesions to the dried area. Fresh blood alone produced adhesions between the three membranous structures [omentum and pelvic fat bodies (PFBs)]. The formation of persistent adhesions required whole blood. Preformed clots above a critical size induced adhesions even without previous serosal injury; they were usually captured by the omentum and PFBs. If all three membranous structures were excised, the clots caused visceral adhesions. The protective role of the omentum, its structure, and the mechanism of omental adhesions, are discussed. These findings are relevant to the pathogenesis of post-operative adhesions in man. ImagesFig 3Fig 4Fig 5Fig 6Fig 7Fig 12Fig 13Fig 1Fig 2Fig 14Fig 15Fig 8Fig 9Fig 10Fig 11 PMID:5315369

  8. [Current developments in the treatment of acute generalised peritonitis].

    PubMed

    Mitaritonno, M; Perrucci, S; Pellegrini, D; De Tullio, D

    2001-10-01

    Generalised acute peritonitis is a relatively frequently pathology which has always been extremely difficult to treat owing to the large number of complications. Considerable progress has been made over the past few years in the surgical treatment of these pathologies following the introduction of new materials accompanied by new techniques: continuous peritoneal lavage (CPL) and laparostomy are the best known. These techniques must be used in carefully selected patients. They allow a marked improvement in results: fewer cases of redo surgery; fewer local and general complications; shorter hospitalisation stay; fewer deaths. These results are possible because these techniques ensure a better cleansing of the peritoneal cavity, with easier removal of necrotic and purulent materials, the main cause of local and general complications.

  9. Setting up of ambulatory hysteroscopy service.

    PubMed

    Kolhe, Shilpa

    2015-10-01

    There is an obvious trend towards developing ambulatory procedures in gynaecology with ambulatory hysteroscopy as its mainstay. In the recent years, the fast pace of modern technological advances in gynaecologic endoscopy, and particularly in the field of hysteroscopy, have been both thrilling and spectacular. Despite this, the uptake of operative hysteroscopy in ambulatory settings has been relatively slow. There is some apprehension amongst gynaecologists to embark on therapeutic outpatient hysteroscopy, and an organisational change is required to alter the mindset. Although there are best practice guidelines for outpatient hysteroscopy, there are unresolved issues around adequate training and accreditation of future hysteroscopists. Virtual-reality simulation training for operative hysteroscopy has shown promising preliminary results, and it is being aggressively evaluated and validated. This review article is an attempt to provide a useful practical guide to all those who wish to implement ambulatory hysteroscopy services in their outpatient departments. PMID:25979350

  10. Ambulatory spine surgery: a survey study.

    PubMed

    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value < 0.25 were entered into a multiple logistic regression model. All statistical analyses were performed using the SAS System software Version 9.2 (SAS Institute, Inc., Cary, North Carolina, United States). Results Overall, 84.2% of respondents performed some manner of ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety. PMID:25083356

  11. Ambulatory spine surgery: a survey study.

    PubMed

    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value < 0.25 were entered into a multiple logistic regression model. All statistical analyses were performed using the SAS System software Version 9.2 (SAS Institute, Inc., Cary, North Carolina, United States). Results Overall, 84.2% of respondents performed some manner of ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety.

  12. Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

    PubMed Central

    Chuengsaman, Piyatida

    2016-01-01

    Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value < 0.001 for all comparisons). Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

  13. Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis.

    PubMed

    Tantiyavarong, Pichaya; Traitanon, Opas; Chuengsaman, Piyatida; Patumanond, Jayanton; Tasanarong, Adis

    2016-01-01

    Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value < 0.001 for all comparisons). Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter. PMID:27656294

  14. Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

    PubMed Central

    Chuengsaman, Piyatida

    2016-01-01

    Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value < 0.001 for all comparisons). Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter. PMID:27656294

  15. Water channels in peritoneal dialysis.

    PubMed

    Devuyst, Olivier

    2010-01-01

    Peritoneal dialysis involves diffusive and convective transports and osmosis through the highly vascularized peritoneal membrane. Several lines of evidence have demonstrated that the water channel aquaporin-1 (AQP1) corresponds to the ultrasmall pore predicted by the modelization of peritoneal transport. Proof-of-principle studies have shown that up-regulation of the expression of AQP1 in peritoneal capillaries is reflected by increased water permeability and ultrafiltration, without affecting the osmotic gradient and the permeability for small solutes. Inversely, studies in Aqp1 mice have shown that haploinsufficiency in AQP1 is reflected by significant attenuation of water transport. Recent studies have identified lead compounds that could act as agonists of aquaporins, as well as putative binding sites and potential mechanisms of gating the water channel. By modulating water transport, these pharmacological agents could have clinically relevant effects in targeting specific tissues or disease states. These studies on the peritoneal membrane also provide an experimental framework to investigate the role of water channels in the endothelium and various cell types.

  16. Laparoscopic surgery complications: Postoperative peritonitis

    PubMed Central

    Drăghici, L; Drăghici, I; Ungureanu, A; Copăescu, C; Popescu, M; Dragomirescu, C

    2012-01-01

    Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery. PMID:23049630

  17. Trends and initiatives in hospital ambulatory care.

    PubMed

    Burns, L A

    1982-05-01

    Changes in the financing and delivery of hospital ambulatory care are discussed. Ambulatory care encompasses a wide spectrum of clinical services provided to patients who are not confined overnight to an institutional bed as inpatients. There are a large and growing number of ways hospitals and physicians cooperate to provide ambulatory-care services. Technological advancements, which have spurred changes in other sectors of medicine, have also changed patterns of medical practice in ambulatory care. Some of the reasons why hospitals develop and expand ambulatory-care programs relate to the changing demand for health services, the shifting preferences of third-party payers and regulators, competitive influences, diversification of risk, and use of such programs as feeders for inpatient services and as teaching and research settings. Although outpatient revenues are a small portion of total hospital revenues, they are growing more rapidly than inpatient revenues. Changes in the health industry that offer opportunities to hospitals are described, such as the increasing physician supply and the formation of group practices, the climate of cost consciousness and price competition, and the trend toward new corporate structures for hospitals. These changes portend changes for hospital pharmacists and give them the opportunity to increase their clinical roles in providing ambulatory care. PMID:7081250

  18. Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis.

    PubMed

    Beladi Mousavi, Seyed Seifollah; Hayati, Fatemeh; Valavi, Ehsan; Rekabi, Fazlollah; Mousavi, Marzieh Beladi

    2015-03-01

    Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar.

  19. The liver in tuberculous peritonitis.

    PubMed

    Sanai, Faisal M

    2006-01-01

    Tuberculous peritonitis is a common form of abdominal tuberculosis and is frequently associated with liver disease. Diagnosis of this disease presents a diagnostic dilemma and the presence of liver cirrhosis further confounds the clinical picture. Moreover, the co-existence of these two diseases casts doubt on the validity of various diagnostic tests available. The interpretation of tests of ascitic fluid analysis becomes questionable despite the fact that peritoneal tuberculosis and liver disease cause ascites to develop through separate mechanisms. In addition, the treatment of tuberculosis mandates a better understanding of the co-existent disease in view of the potential hepatotoxicity of anti-tuberculous medication. This review aims to address the prevalence of coexistent liver disease in patients with tuberculous peritonitis, the diagnostic difficulties posed by such and the various treatment approaches to be adopted.

  20. Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns

    PubMed Central

    Esch, Lindsay M.; Bird, Amber-Nicole; Oyler, Julie L.; Lee, Wei Wei; Shah, Sachin D.; Pincavage, Amber T.

    2015-01-01

    Introduction Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns’ ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. Methods During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. Results Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (p<0.001). All interns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. Conclusions The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered. PMID:26609962

  1. [Analysis of mortality in acute diffuse peritonitis].

    PubMed

    Bondarev, V I; Tatarenko, L D; Golovnia, P F; Sviridov, N V

    1990-01-01

    The causes were studied and the analysis was performed of the lethality in 329 patients with acute diffuse peritonitis (ADP). The incidence of lethal outcome of ADP directly depended on the time of hospitalization, age of the patients, source of peritonitis, and as well on the technique of operative intervention. Progressive peritonitis caused death in 71 (92.2%) of 77 patients.

  2. Humicola sp. as a Cause of Peritoneal Dialysis-Associated Peritonitis.

    PubMed

    Burns, Nathan; Arthur, Ian; Leung, Michael; Ketharanathan, Selva; Sandoval-Denis, Marcelo; Gené, Josepa; Guarro, Josep; Chakera, Aron

    2015-09-01

    Peritoneal dialysis is the renal replacement modality used by ∼20% of patients with end-stage kidney disease (S. McDonald, P. Clayton, and K. Hurst, p. 6.2-6.27, in ANZDATA 2012 Annual Report, 35th ed., 2012). A major complication of peritoneal dialysis is the development of peritonitis. We describe a case of Humicola sp. causing peritoneal dialysis (PD)-associated peritonitis, successfully treated with a prolonged course of antifungal therapy.

  3. Comparative Analysis of the Equivital EQ02 Lifemonitor with Holter Ambulatory ECG Device for Continuous Measurement of ECG, Heart Rate, and Heart Rate Variability: A Validation Study for Precision and Accuracy

    PubMed Central

    Akintola, Abimbola A.; van de Pol, Vera; Bimmel, Daniel; Maan, Arie C.; van Heemst, Diana

    2016-01-01

    Background: The Equivital (EQ02) is a multi-parameter telemetric device offering both real-time and/or retrospective, synchronized monitoring of ECG, HR, and HRV, respiration, activity, and temperature. Unlike the Holter, which is the gold standard for continuous ECG measurement, EQO2 continuously monitors ECG via electrodes interwoven in the textile of a wearable belt. Objective: To compare EQ02 with the Holter for continuous home measurement of ECG, heart rate (HR), and heart rate variability (HRV). Methods: Eighteen healthy participants wore, simultaneously for 24 h, the Holter and EQ02 monitors. Per participant, averaged HR, and HRV per 5 min from the two devices were compared using Pearson correlation, paired T-test, and Bland-Altman analyses. Accuracy and precision metrics included mean absolute relative difference (MARD). Results: Artifact content of EQ02 data varied widely between (range 1.93–56.45%) and within (range 0.75–9.61%) participants. Comparing the EQ02 to the Holter, the Pearson correlations were respectively 0.724, 0.955, and 0.997 for datasets containing all data and data with < 50 or < 20% artifacts respectively. For datasets containing respectively all data, data with < 50, or < 20% artifacts, bias estimated by Bland-Altman analysis was −2.8, −1.0, and −0.8 beats per minute and 24 h MARD was 7.08, 3.01, and 1.5. After selecting a 3-h stretch of data containing 1.15% artifacts, Pearson correlation was 0.786 for HRV measured as standard deviation of NN intervals (SDNN). Conclusions: Although the EQ02 can accurately measure ECG and HRV, its accuracy and precision is highly dependent on artifact content. This is a limitation for clinical use in individual patients. However, the advantages of the EQ02 (ability to simultaneously monitor several physiologic parameters) may outweigh its disadvantages (higher artifact load) for research purposes and/ or for home monitoring in larger groups of study participants. Further studies can be aimed

  4. Ambulatory measurement of arm orientation.

    PubMed

    Luinge, H J; Veltink, P H; Baten, C T M

    2007-01-01

    In order to evaluate the impact of neuromuscular disorders affecting the upper extremities, the functional use of the arm need to be evaluated during daily activities. A system suitable for measuring arm kinematics should be ambulatory and not interfere with activities of daily living. A measurement system based on miniature accelerometers and gyroscopes is adequate because the sensors are small and do not suffer from line of sight problems. A disadvantage of such sensors is the cumulative drift around the vertical and the problems with aligning the sensor with the segment. A method that uses constraints in the elbow to measure the orientation of the lower arm with respect to the upper arm is described. This requires a calibration method to determine the exact orientation of each of the sensors with respect to the segment. Some preliminary measurements were analyzed and they indicated a strong reduction in orientation error around the vertical. It seemed that the accuracy of the method is limited by the accuracy of the sensor to segment calibration. PMID:16455089

  5. Evaluation of the Del Mar Avionics automatic ambulatory blood pressure-recording device.

    PubMed

    Sheps, S G; Elveback, L R; Close, E L; Kleven, M K; Bissen, C

    1981-12-01

    We have the opportunity to evaluate a portable ambulatory device for the recording of sequential indirect arterial blood pressure and continuous electrocardiogram (Del Mar Avionics automatic ambulatory blood pressure recording device). With careful attention to technique, only 11% of systolic and 5% of diastolic blood pressure readings differed by more than 10 mm Hg as compared with a trained technician's observations simultaneously in the same arm. The device has been useful in the evaluation of borderline (labile) hypertension, hypertensive drug therapy programs, and various episodic cardiovascular phenomena--for example, vasodepressor syncope and pheochromocytoma crises.

  6. 77 FR 70783 - Medicare and Medicaid Programs; Approval of the Accreditation Association for Ambulatory Health...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-27

    ... Association for Ambulatory Health Care (AAAHC) for continued recognition as a national accrediting... Notice On June 22, 2012, we published a proposed notice in the Federal Register (77 FR 37678) entitled...), AAAHC revised its standards to ensure patients have the right to ``voice grievances regarding...

  7. 78 FR 43533 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-19

    ...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2014 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine......

  8. Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients: NT-ProBNP, Cardiac TnT, or hsCRP?

    PubMed Central

    Oh, Hyung Jung; Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2015-01-01

    Abstract Although numerous previous studies have explored various biomarkers for their ability to predict mortality in end-stage renal disease (ESRD) patients, these studies have been limited by retrospective analyses, mostly prevalent dialysis patients, and the measurement of only 1 or 2 biomarkers. This prospective study was aimed to evaluate the association between 3 biomarkers and mortality in incident 335 ESRD patients starting continuous ambulatory peritoneal dialysis (CAPD) in Korea. According to the baseline NT-proBNP, cTnT, and hsCRP levels, the patients were stratified into tertiles, and cardiovascular (CV) and all-cause mortalities were compared. Additionally, time-dependent ROC curves were constructed, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) of the models with various biomarkers were calculated. We found the upper tertile of NT-proBNP was significantly associated with increased risk of both CV and all-cause mortalities. However, the upper tertile of hsCRP was significantly related only to the high risk of all-cause mortality even after adjustment for age, sex, and white blood cell counts. Moreover, NT-proBNP had the highest predictive power for CV mortality, whereas hsCRP was the best prognostic marker for all-cause mortality among these biomarkers. In conclusions, NT-proBNP is a more significant prognostic factor for CV mortality than cTnT and hsCRP, whereas hsCRP is a more significant predictor than NT-proBNP and cTnT for all-cause mortality in incident peritoneal dialysis patients. PMID:26554763

  9. Redesigning the Regulatory Framework for Ambulatory Care Services in New York

    PubMed Central

    Chokshi, Dave A; Rugge, John; Shah, Nirav R

    2014-01-01

    Context While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public's interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state's ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves. Methods We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review. Findings The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory care services. From the state government's perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers’ understanding of rights and responsibilities. Finally, the regulatory mechanisms employed—from mandatory reporting to licensure to regional planning to the certificate of need—should remain flexible and match the degree of consensus regarding the appropriate regulatory path. Conclusions Few other

  10. Plan and operation of the National Survey of Ambulatory Surgery.

    PubMed

    McLemore, T; Lawrence, L

    1997-10-01

    The National Survey of Ambulatory Surgery (NSAS), a national probability sample survey of ambulatory surgery visits in hospitals and freestanding ambulatory surgery centers, began operation in 1994. This report traces the development of the survey instruments and procedures, and presents the survey methodology for the NSAS.

  11. Diagnostic Errors in Ambulatory Care: Dimensions and Preventive Strategies

    ERIC Educational Resources Information Center

    Singh, Hardeep; Weingart, Saul N.

    2009-01-01

    Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may…

  12. Peritonitis with multiple rare environmental bacteria in a patient receiving long-term peritoneal dialysis.

    PubMed

    Levitski-Heikkila, Teresa V; Ullian, Michael E

    2005-12-01

    We describe a patient receiving long-term peritoneal dialysis who experienced 2 episodes of peritonitis in successive months caused by unusual bacteria of environmental origin: Agrobacterium radiobacter, Pseudomonas oryzihabitans, and Corynebacterium aquaticum. A radiobacter and P oryzihabitans occurred simultaneously in the first episode of peritonitis, and C aquaticum, in the second episode. The patient's vocation necessitated exposure to moist soiled conditions. Both episodes responded promptly to antibiotics commonly used to treat peritonitis. Although these organisms rarely lead to loss of life and commonly are considered to be contaminants, they can cause symptomatic peritonitis and peritoneal dialysis catheter loss. A review of previous case reports is included.

  13. Peritonitis with multiple rare environmental bacteria in a patient receiving long-term peritoneal dialysis.

    PubMed

    Levitski-Heikkila, Teresa V; Ullian, Michael E

    2005-12-01

    We describe a patient receiving long-term peritoneal dialysis who experienced 2 episodes of peritonitis in successive months caused by unusual bacteria of environmental origin: Agrobacterium radiobacter, Pseudomonas oryzihabitans, and Corynebacterium aquaticum. A radiobacter and P oryzihabitans occurred simultaneously in the first episode of peritonitis, and C aquaticum, in the second episode. The patient's vocation necessitated exposure to moist soiled conditions. Both episodes responded promptly to antibiotics commonly used to treat peritonitis. Although these organisms rarely lead to loss of life and commonly are considered to be contaminants, they can cause symptomatic peritonitis and peritoneal dialysis catheter loss. A review of previous case reports is included. PMID:16310563

  14. Peritoneal malignant mesothelioma in a patient with recurrent peritonitis

    SciTech Connect

    Riddell, R.H.; Goodman, M.J.; Moossa, A.R.

    1981-07-01

    A patient is presented who developed a peritoneal malignant mesothelioma in association with severe persistent and recurrent diverticulitis. The case is unusual in that a spectrum of mesothelial proliferation was documented beginning initially as benign foci of mesothelial proliferation and passing through a stage of atypical proliferation before terminating as a malignant process. The possible role of the diverticular disease in the pathogenesis of the tumor is discussed.

  15. Comparison of experimental and bioelectrical impedance analysis methods in calculation of dry weight in peritoneal dialysis patients

    PubMed Central

    Naini, A Emami; Savoj, J; Atapoor, A; Mortazavi, M; Taheri, Sh

    2012-01-01

    Background: To optimize dialysis prescription and fluid balance of the peritoneal dialysis (PD) patients, it is important to assess their dry weight accurately. The experimental evaluation is the method which is widely used in PD centers which needs continuous and controlled reduction of the postdialysis weight down to the point where patient does not show any signs of hypotension and volume overload. This study intends to indicate that the bioelectrical impedance analysis (BIA) method can be used as an alternative method to evaluate the dry weight. Materials and Methods: The demographic data of 101 continuous ambulatory peritoneal dialysis (CAPD) patients of Alzahra and Noor hospitals of Isfahan University (50 males and 51 females) who had been referred for periodical examinations from April 2009 to April 2010 were extracted from their files. The normal body volume was selected as the inclusion criteria and identified by an examiner group (a nephrologist, a general practitioner and a PD nurse). The patients’ dry weights were calculated based on both methods. The bioelectrical impedance analysis method was done by the Maltron Bioscan ver916 and data were analyzed by SPSS program ver18. Results: There were 49.5% males and 50.5% females with the mean age of 54.6±17 years. The mean dry weight in the experimental method was 63.4±13.3 kg in comparison to the other (61.5± 13.7 kg). There was a significant difference between the results (P value <0.001) depended on the gender t-test, but there was a 98% correlation between the results by two methods. No correlation observed between the patient's age, body mass index, blood pressure, previous hemodialysis history, PD duration time, and underlying disease. Conclusion: The study showed that there is significant difference between the two methods. However, there was 98% direct correlation between them. It is concluded that bioelectrical impedance analysis could be a better alternative for accurate evaluation of dry

  16. Peritoneal dialysis and peritonitis rate: Kuwait, four years' experience.

    PubMed

    Alyousef, Anas M; Abdou, Salah M; Mansour, Yasser S; Radi, Ahmad D

    2016-01-01

    Peritoneal dialysis (PD) program was established in Farwaniya Hospital Kidney Center, Kuwait, in February 2011. Patient recruitment for this modality of treatment was growing steadily. One of the major complications of PD is peritonitis. There is a belief that PD therapy is inferior and carries more complications than hemodialysis, we aimed to show that PD is a good and a non-inferior option for dialysis therapy with comparable outcome in both patient and technique survival. This was a retrospective analysis of all patients who were on PD from February 2011 to December 2014. Peritonitis rate, exit site infection rate, and all-cause mortality rate were all assessed for this period. Peritonitis rate during the 1 st year, 2011, was 0.92 incidents/year. This number had progressively declined in the following years; in 2012, it was 0.65 incidents/year; in 2013, it was 0.58 incidents/year; and in 2014, it was 0.38 incidents/year. This improvement in the rate of peritonitis incidence could be explained by better education of patients and meticulous supervision of the nursing staff. Farwaniya Hospital Kidney Center had an all-cause mortality rate of 9.3% among patients on renal replacement therapy in 2011. In 2012, all-cause mortality rate increased to 17.1%. The following year, 2013, it decreased to 14.3%, and in 2014, all-cause mortality rate dropped further to 7.6%. All-cause mortality rate among PD patients was zero in 2011. In 2012, the all-cause mortality rate in PD was 11.54%, and in 2013, it decreased to 10.52%. Then, again in 2014, the all-cause mortality rate among PD patients was zero. This improvement in all-cause mortality rate could be explained by the better medical care offered to the end-stage renal disease patients, in particular PD patients, in Farwaniya Hospital Kidney Center. PMID:27424695

  17. Comparison of the Effects of Dialysis Methods (Haemodialysis vs Peritoneal Dialysis) on Diastolic Left Ventricular Function Dialysis Methods and Diastolic Function

    PubMed Central

    Ellouali, Fedoua; Berkchi, Fatimazahra; Bayahia, Rabia; Benamar, Loubna; Cherti, Mohammed

    2016-01-01

    Introduction: In patients undergoing chronic dialysis, several factors appear to influence the occurrence of cardiac abnormalities. The aim of our study was to evaluate the effects of two different methods of renal replacement therapy (chronic haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)) on left ventricular (LV) diastolic function. Patients and Methods: We enrolled 63 patients: 21 patients on CAPD, and 42 age- and gender-matched patients on HD; 35 patients were men (55.6%). Median of age was 46.4 (35-57) years. The median duration of renal replacement therapy was 3(2-5) years. Results: The two groups (HD vs PD) were similar concerning body mass index, dialysis duration and cardiovascular risk factors. The comparison of echocardiographic parameters showed statistically significant differences between two groups, regarding the presence of calcification, cardiac effusion, severely abnormal left ventricular hypertrophy(LVH) and the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e’) >13 (p= 0.001, p= 0.003, p= 0.02, p= 0.004, respectively). In multivariate analysis, an E/e’>13 was higher in PD group ( OR= 5.8, CI [1.3-25.5], p=0.002). Conclusion: The method of dialysis seems to influence LV diastolic function. We observed a higher prevalence of diastolic LV dysfunction in the PD group. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients. PMID:27583042

  18. A Case of Encapsulating Peritoneal Sclerosis Complicated by Malignant Peritoneal Mesothelioma.

    PubMed

    Kanai, Genta; Kakuta, Takatoshi; Hirukawa, Takashi; Okamatsu, Chizuko; Fukagawa, Masafumi

    2016-01-01

    We report a case of peritoneal mesothelioma discovered in a patient during peritoneal dialysis. The patient was a 55-year-old woman who had no history of asbestos exposure. Owing to end-stage kidney failure, she had been undergoing peritoneal dialysis for over 8 years, and she had been diagnosed with encapsulating peritoneal sclerosis. She was admitted to the hospital for intestinal obstruction. Three months later, she noticed an enlarging mass in the epigastric region. Computed tomography showed a 10-cm mass originating in the abdominal wall that had invaded the liver. It was diagnosed as malignant mesothelioma via biopsy. Cases of sarcoma-like mass-forming peritoneal mesothelioma are rare, and there are no prior reports of encapsulating peritoneal sclerosis complicated by malignant peritoneal mesothelioma. Thus, this unique case of peritoneal mesothelioma can provide us with important knowledge about this rare entity. PMID:27628605

  19. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home1

    PubMed Central

    Abud, Ana Cristina Freire; Kusumota, Luciana; dos Santos, Manoel Antônio; Rodrigues, Flávia Fernanda Luchetti; Damasceno, Marta Maria Coelho; Zanetti, Maria Lúcia

    2015-01-01

    Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance. Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015). Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment. PMID:26487141

  20. Peritoneal ultrafiltration in end-stage chronic heart failure

    PubMed Central

    Fröhlich, Hanna; Katus, Hugo A.; Täger, Tobias; Lossnitzer, Nicole; Grossekettler, Leonie; Kihm, Lars; Zeier, Martin; Remppis, Andrew; Frankenstein, Lutz; Schwenger, Vedat

    2015-01-01

    Background Cardiorenal syndrome type 2 (CRS-2) is common in end-stage chronic heart failure (CHF). Peritoneal ultrafiltration (pUF) may entail clinical functional improvement and a reduction in hospitalizations. Methods Thirty-nine consecutive end-stage CHF patients with stable CRS-2 were initiated on ambulatory pUF after interdisciplinary cardiological/nephrological evaluation and prospectively followed for 1 year. All-cause hospitalization was the primary end point. Secondary end points included mortality, treatment alteration and change in weight, NYHA functional class or quality of life (QoL). Outcomes were compared both within the pUF cohort (365 prior to initiation) and with 39 matched CHF patients receiving standard medical treatment. Results Compared with pretreatment, there was a trend to a reduction in 1-year hospitalization days in the pUF group (P = 0.07). One-year mortality was 33% in the pUF group and 23% in the matched control cohort. pUF was stopped in eight patients (18%) due to recurrent peritonitis (n = 3), insufficient ultrafiltration (n = 3) or cardiac recompensation (n = 1). Compared with standard medical treatment, pUF significantly improved volume overload (P < 0.05), NYHA functional class (P < 0.001) and mental health (P < 0.05). Moreover, hospitalization days for all causes as well as cardiovascular hospitalization days were significantly reduced during the interim periods in the pUF group (P < 0.05 and P < 0.001, respectively). Conclusions pUF is effective in improving the clinical condition of end-stage CHF patients suffering from CRS-2. Randomized controlled trials are needed to clarify the effects of pUF on hospitalization and mortality in these patients. PMID:25815181

  1. Clinical Assessment Applications of Ambulatory Biosensors

    ERIC Educational Resources Information Center

    Haynes, Stephen N.; Yoshioka, Dawn T.

    2007-01-01

    Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals…

  2. Faculty Development for Ambulatory Care Education.

    ERIC Educational Resources Information Center

    Anderson, William A.; Carline, Jan D.; Ambrozy, Donna M.; Irby, David M.

    1997-01-01

    A study documented the practices of 14 peer-nominated medical educators who conduct faculty development programs in ambulatory care settings. Results indicate the programs were delivered almost exclusively in workshop format, with great similarities in topics and strategies. Evaluation was generally limited to satisfaction ratings. Makes…

  3. Memo to: Ambulatory Health Care Planners.

    ERIC Educational Resources Information Center

    Educational Facilities Labs., Inc., New York, NY.

    Planning for changing types of health professions and a changing clientele necessitates designing flexible facilities. Findings from a recently completed analysis of ambulatory care facilities are directed to planners in the form of 16 memos. Approaches to planning and design considerations are made that attempt to humanize these facilities.…

  4. Planning an ambulatory care joint venture.

    PubMed

    Harpster, L M

    1988-01-01

    This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.

  5. Spontaneous biliary peritonitis in children.

    PubMed

    Kohli, Supreethi; Singhal, Anu; Arora, Anita; Singhal, Sanjeev

    2013-01-01

    Pediatric Spontaneous Bile duct perforation is a rare clinical condition with only around 150 cases reported worldwide. Early management gives excellent prognosis but the condition often presents a diagnostic dilemma. Hepato-biliary Technetium-99m-iminodiacetic acid scintiscan is the diagnostic investigation of choice but its availability in third world countries is limited. We present two cases of spontaneous biliary peritonitis in children, which were diagnosed without scintiscanning. The first case was a one-and -a half-year-old child, who was diagnosed with biliary peritonitis without pneumoperitoneum by a combination of Ultrasound (USG), Contrast enhanced computed tomography (CECT), and Magnetic Resonance Imaging (MRI). The child underwent USG-guided drainage and subsequent cholecystectomy with hepatico-jejunostomy. The second child also had biliary peritonitis without pneumoperitoneum, which was initially suspected on USG. CECT revealed dilated gall bladder and fluid collection in sub-hepatic space and pelvis. Abdominal paracentesis revealed presence of bile. The child responded to conservative therapy. Both are doing well on two-year follow-up. In a patient with jaundice, biliary tract abnormalities and/or free fluid, either generalized or localized to peri-cholecystic/sub-hepatic space on USG/CT/MRI, in the absence of pneumoperitoneum, suggest a diagnosis of biliary perforation even in the absence of scintiscanning.

  6. Spontaneous Biliary Peritonitis in Children

    PubMed Central

    Kohli, Supreethi; Singhal, Anu; Arora, Anita; Singhal, Sanjeev

    2013-01-01

    Pediatric Spontaneous Bile duct perforation is a rare clinical condition with only around 150 cases reported worldwide. Early management gives excellent prognosis but the condition often presents a diagnostic dilemma. Hepato-biliary Technetium-99m-iminodiacetic acid scintiscan is the diagnostic investigation of choice but its availability in third world countries is limited. We present two cases of spontaneous biliary peritonitis in children, which were diagnosed without scintiscanning. The first case was a one-and -a half-year-old child, who was diagnosed with biliary peritonitis without pneumoperitoneum by a combination of Ultrasound (USG), Contrast enhanced computed tomography (CECT), and Magnetic Resonance Imaging (MRI). The child underwent USG-guided drainage and subsequent cholecystectomy with hepatico-jejunostomy. The second child also had biliary peritonitis without pneumoperitoneum, which was initially suspected on USG. CECT revealed dilated gall bladder and fluid collection in sub-hepatic space and pelvis. Abdominal paracentesis revealed presence of bile. The child responded to conservative therapy. Both are doing well on two-year follow-up. In a patient with jaundice, biliary tract abnormalities and/or free fluid, either generalized or localized to peri-cholecystic/sub-hepatic space on USG/CT/MRI, in the absence of pneumoperitoneum, suggest a diagnosis of biliary perforation even in the absence of scintiscanning. PMID:24083062

  7. [Focusing on peritoneal dialysis adequacy].

    PubMed

    Issad, Belkacem; Durand, Pierre-Yves; Siohan, Pascale; Goffin, Eric; Cridlig, Joëlle; Jean, Guillaume; Ryckelynck, Jean-Philippe; Arkouche, W; Bourdenx, J-P; Cridlig, J; Dallaporta, B; Fessy, H; Fischbach, M; Giaime, P; Goffin, E; Issad, B; Jean, G; Joly, D; Mercadal, L; Poux, J-M; Ryckelynck, J-P; Siohan, P; Souid, M; Toledano, D; Verger, C; Vigeral, P; Uzan, M

    2013-11-01

    The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane. PMID:23850000

  8. Intra-abdominal benign multicystic peritoneal mesothelioma.

    PubMed

    Jouvin, I; Dohan, A; Gergi, P; Pocard, M

    2014-04-01

    Benign multicystic peritoneal mesotheliomas are rare: pre-operative diagnosis relies on proper imaging. The differential diagnosis includes pseudomyxoma peritonei and other peritoneal cysts. Absence of previous surgical resection offers the best chance of success when complete resection is performed in a specialized center. We report the case of a 43 year-old man with benign multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. PMID:24433857

  9. Peritoneal dialysis in hypernatraemic, ketoacidotic diabetic coma.

    PubMed

    Køolendorf, K; Møoller, B B

    1976-01-01

    Hypertonic dehydration in a 13-year-old boy with ketoacidotic diabetic coma has been treated successfully with peritoneal dialysis and isotonic fluids. Modes of treatment with either hypotonic or isotonic fluids are discussed, as is the feasibility of peritoneal dialysis. We recommend isotonic solutions composed of equal parts of 5.5% glucose and 0.9% sodium chloride combined with peritoneal dialysis in order to secure a relatively slow correction of the hypertonic state.

  10. Laboratory diagnostics of spontaneous bacterial peritonitis.

    PubMed

    Lippi, Giuseppe; Danese, Elisa; Cervellin, Gianfranco; Montagnana, Martina

    2014-03-20

    The term peritonitis indicates an inflammatory process involving the peritoneum that is most frequently infectious in nature. Primary or spontaneous bacterial peritonitis (SBP) typically occurs when a bacterial infection spreads to the peritoneum across the gut wall or mesenteric lymphatics or, less frequently, from hematogenous transmission in combination with impaired immune system and in absence of an identified intra-abdominal source of infection or malignancy. The clinical presentation of SBP is variable. The condition may manifest as a relatively insidious colonization, without signs and symptoms, or may suddenly occur as a septic syndrome. Laboratory diagnostics play a pivotal role for timely and appropriate management of patients with bacterial peritonitis. It is now clearly established that polymorphonuclear leukocyte (PMN) in peritoneal fluid is the mainstay for the diagnosis, whereas the role of additional biochemical tests is rather controversial. Recent evidence also suggests that automatic cell counting in peritoneal fluid may be a reliable approach for early screening of patients. According to available clinical and laboratory data, we have developed a tentative algorithm for efficient diagnosis of SBP, which is based on a reasonable integration between optimization of human/economical resources and gradually increasing use of invasive and expensive testing. The proposed strategy entails, in sequential steps, serum procalcitonin testing, automated cell count in peritoneal fluid, manual cell count in peritoneal fluid, peritoneal fluid culture and bacterial DNA testing in peritoneal fluid. PMID:24508989

  11. Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

    MedlinePlus

    ... Professionals Questions to Ask about Your Treatment Research Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal ... primary peritoneal cancer that are not listed here. Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal ...

  12. Periodic Peritoneal Dialysis in End Stage Renal Disease: Is it Still Relevant? A Single Center Study from India

    PubMed Central

    Gandhi, K; Prasad, D; Malhotra, V; Agrawal, D; Beniwal, P; Mathur, M

    2015-01-01

    Background: High cost of maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD) in India has made renal replacement therapy out of reach of many patients with end stage renal disease (ESRD). Repeated puncture PD although inferior to HD biochemically, is easily and freely available across Rajasthan, India, and is simple to perform, and does not require sophisticated machines, thus making it an attractive option for dialysis for ESRD. Aim: To analyze the outcomes of periodic PD in patients with ESRD requiring dialysis support. Subjects and Methods: A prospective study analyzing the data of patients who underwent PD between August 2010 and January 2013 in Sawai Man Singh Hospital, Jaipur, India was conducted. Patients were divided into three groups based on the time period between first and second session of PD. Detailed demographic and clinical data during the study period were collected along with PD related complications. The main outcome studied was technique survival 1 year post initiation of PD. Results: 234 patients received an initial session of PD, of which 174 had a good response and were included in the study. 19 patients received the second PD within 7 days of first (Group 1), 45 patients within 8–14 days (Group 2) and 110 patients within 15–21 days (Group 3). The overall 1 year technique survival was 68.4% (91/133), with a rate of 50% (5/10), 56.8% (21/37), and 75.6% (65/86) for Group 1, Group 2, and Group 3, respectively. The time duration between first and second PD proved to be reliable indicator of the subsequent response, with a technique survival rate significantly lower in Group 1 patients compared to Groups 2 and 3 (P = 0.04). Median dialysis free days were 11, 16 and 21 days in Group 1, Group 2, and Group 3, respectively. Peritonitis rate observed was 2.1% (49/2261) during the study period. Conclusion: Periodic PD is a simple, safe and cheap procedure, which can be considered as used as a palliative measure in

  13. Pro-inflammatory cytokines: a possible relationship with dialytic adequacy and serum albumin in peritoneal dialysis patients

    PubMed Central

    Milan Manani, Sabrina; Virzì, Grazia Maria; Clementi, Anna; Brocca, Alessandra; de Cal, Massimo; Tantillo, Ilaria; Ferrando, Lorena; Crepaldi, Carlo; Ronco, Claudio

    2016-01-01

    Background Inflammation and serum albumin concentration are both important predictors of survival in patients treated with peritoneal dialysis (PD). Furthermore, systemic and local inflammatory mediators may induce structural and functional alterations in the peritoneal membrane, thus interfering with dialysis adequacy. PD adequacy is monitored primarily by indices of small solute clearance, such as Kt/V urea and weekly creatinine clearance (wCc). The aim of this study was to investigate the possible relationship between pro-inflammatory cytokines, such as interleukin-6 (IL-6) and interleukin-1β (IL-1β), and serum albumin and C-reactive protein (CRP). Moreover, the relationship between IL-6 and IL-1β and PD adequacy has been analysed. Methods We enrolled 46 stable PD patients undergoing maintenance PD for a minimum of 3 months. Plasma levels of serum albumin, high-sensitivity (hs)-CRP, IL-6 and IL-1β were measured in all patients. We used weekly Kt/V urea and wCc to monitor PD adequacy. Daily urine volume was measured in all patients. Results The median values of serum albumin, hs-CRP, IL-6 and IL-1β showed no significant differences between continuous ambulatory PD and automated PD patients. IL-6 levels showed a positive correlation with hs-CRP levels (P < 0.001) and a negative correlation with serum albumin concentration (P = 0.01). There was no statistically significant relationship between IL-1β and hs-CRP or serum albumin concentrations. Subsequently, PD patients were divided into two groups based on Kt/V urea value. PD patients with Kt/V ≤1.7 had significantly higher IL-6 levels compared with PD patients with Kt/V >1.7 (P = 0.015). No statistically significant relationship between IL-6 and wCc was observed. There was no significant difference in IL-1β levels between PD patients with Kt/V ≤1.7 and with Kt/V >1.7 [median (interquartile range) 0.82 (0.88–5.2) versus 1.82 (0.95–2.7)]. There was no significant difference in IL-6 and IL-1β levels in

  14. Equine wellness care in ambulatory practice.

    PubMed

    Sandoval, Claudia; True, Claudia

    2012-04-01

    Clients want dependable veterinary care and to understand how the services will benefit and meet their horse’s needs. Wellness visits provide ambulatory practitioners with great opportunities to strengthen the doctor-client-patient bond; effective communication with clients during wellness visits, where new literature or facts can be presented, can offer opportunities for demonstrating the value of having the veterinarian maintain a primary role in disease control. The criteria for selecting vaccines, interpreting FECs, and diagnosing dental pathology require the continued need for veterinary involvement. When providing wellness services, veterinarians should discuss those services, the reasons for them, as well as the possibility of adverse reactions. In so doing, the veterinarian is able to clearly distinguish himself or herself from a technician who is merely giving a "shot." Although some of these services can be performed by clients and lay professionals, the knowledge and training that veterinarians bring to these tasks add benefits to the horse beyond the services provided. For example, by targeting treatment and conveying the goals and limitations of FECs and deworming to clients, the speed at which anthelmintic resistance occurs will be diminished, and veterinarians will regain control over equine parasite management. Additional client education, such as demonstrating dental pathology to clients and how veterinary treatment benefits their horse, will not only improve the health of the horse further but also solidify the veterinarian’s role in preventative medicine. While all components of a wellness program were not detailed here, services such as nutritional consultation, blood work, and lameness evaluation should be offered based on the practice’s equine population. With the increasing population of geriatric horses, dentistry, nutrition, blood work, and lameness should be assessed annually or biannually. Each practice has its own set of criteria

  15. Perioperative management of peritoneal dialysis patients: review of abdominal surgery.

    PubMed

    Kleinpeter, Myra A; Krane, N Kevin

    2006-01-01

    On abdominal computed tomography scan for evaluation of hematuria, the index patient, a 23-year-old male, was found to have multiple renal cysts bilaterally. He had been on peritoneal dialysis for 6 years, complicated by intermittent episodes of exit-site infection and peritonitis. Over time, he developed recurrent urinary tract infection and nephrolithiasis with intermittent hematuria. His maintenance dose of recombinant erythropoietin was discontinued, and he maintained a normal hemoglobin level. Annual surveillance of the bilateral renal cysts with magnetic resonance imaging revealed development of a complex cystic mass that warranted further investigation. Following a urology consultation, laparoscopic nephrectomy was performed without complications and with minimal interruption of PD. Pathology evaluation revealed renal cell carcinoma within the renal parenchyma and multiple cystic structures consistent with acquired cystic kidney disease. No clear recommendations exist in the literature regarding continuation or interruption of PD in the perioperative period for planned nephrectomy, tumor resection, or other uncomplicated abdominal or retroperitoneal procedures. A perioperative management strategy for PD patients requiring abdominal or retroperitoneal surgery is outlined here. If these recommendations are followed, patients may continue PD with minimal interruption, preservation of the peritoneal membrane, and few complications.

  16. Asymptomatic peritoneal carcinomatosis originating from benign cystic peritoneal mesothelioma

    PubMed Central

    Iacoponi, S; Calleja, J; Hernandez, G; de la Cuesta, R Sainz

    2015-01-01

    Benign multicystic mesothelioma is a rare tumour that originates from the abdominal peritoneum with a predisposition to the pelvic peritoneum. It typically affects women of reproductive age. There have been less than 200 cases of this rare neoplasia reported to date. We present the case of a 35-year-old woman who was referred to our centre because of the detection of a peritoneal carcinomatosis during a gynaecological exam. A diagnostic laparoscopy was performed. The findings included multiple cysts appearing as ‘a bunch of grapes’ occupying the omentum. Biopsies were taken during the surgery and the results showed benign multicystic peritoneal mesothelioma. Benign multicystic mesothelioma can simulate other conditions, such as malignant ovarian tumours or cystic lymphangioma. It is often diagnosed accidentally during surgery performed for another reason. The diagnosis is interoperative, observing multicystic structures grouped as a ‘bunch of grapes’ containing clear fluid with thin walls made of connective tissue. Immunohistochemistry confirmed mesothelial origin. Surgery is considered the treatment of choice and is based on the removal of the cysts from the abdominal cavity. Hyperthermic intraperitoneal chemotherapy can be considered as a primary treatment in patients with recurrences or even as a part of primary treatment associated with surgery. Survival at 5 years is 100% and invasive or malignant progression is extraordinary. The treatment approach should be multidisciplinary, and the patient should be referred to a referral centre. PMID:26715942

  17. Peritoneal dialysis prescription during the third trimester of pregnancy.

    PubMed

    Batarse, Rodolfo R; Steiger, Ralph M; Guest, Steven

    2015-01-01

    Management of the pregnant patient on peritoneal dialysis (PD) is potentially challenging because uterine enlargement may negatively affect catheter function and prescribed dwell volumes. Additional reports of the management of these patients are needed. Here, we describe a near-full-term delivery in a 27-year-old woman who had been on dialysis for 7 years. Peritoneal dialysis was continued during the entire pregnancy. In the third trimester, a higher delivered automated PD volume allowed for adequate clearance and control of volume status. A decision to hospitalize the patient to limit activity and facilitate the delivery of increased dialysate is believed to have contributed to the successful outcome for mother and infant. Our report discusses the management of this patient and reviews published dialysis prescriptions used during the third trimester of pregnancy in patients treated with PD. PMID:24711639

  18. [The social environment of patients on peritoneal dialysis].

    PubMed

    Ruiz de Gauna, R; Minguela Pesquera, I; Ocharán-Corcuera, J; Gimeno Martín, I; Chena Alejandro, A

    2008-01-01

    Patients suffering chronic illnesses, such as those on replacement therapy, condition and are conditioned by their family, work, and social environment. A continuous psychophysical impairment occurs and alters the hormonal stress mediators from the central nervous system and the hypothalamic-pituitary-adrenal axis. Such stress situation causes a pathological effect additional to the factors inherent to the disease. Psychological disorders (depression, anxiety, and others) are associated to an increased morbidity, directly acting upon treatment course, subsequent treatment failure, and personal perception of one's own state of health. Individual factors (sex, lifestyles, health and dietary habits, spirituality, financial and family situation, personal skills for coping with disease, cultural level, and social status) condition morbidity in these patients, and the course and complications of peritoneal dialysis. Interactions between healthcare staff and patients on peritoneal dialysis cause these patients to have a more active attitude and a greater involvement in their treatment, which has an impact on the course of disease and clinical status.

  19. The sub-peritoneal arterial plexus of Sir William Turner.

    PubMed

    Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marious; Shokouhi, Ghaffar; Ghabili, Kamyar; Agutter, Paul S

    2010-08-20

    Sir William Turner (1832-1916) was Professor of Anatomy at the University of Edinburgh. His classic paper of 1863 on the anastomoses between the parietal and visceral branches of the abdominal aorta, later known as the sub-peritoneal arterial plexus of Turner, has mostly been forgotten. Located in the retroperitoneum and surrounding the kidneys and other adjacent structures, this plexus is an important route of collateral circulation. In the current paper, we discuss the sub-peritoneal arterial plexus as described by Turner in 1863 and review the literature concerning its potential clinical significance in the kidney, emphasizing its probable role in the metastatic spread of various tumors of abdominal organs and in the continuing viability of the kidney after renal artery occlusion. A biographical sketch of Sir William Turner is also presented.

  20. Chronic peritoneal dialysis in children

    PubMed Central

    Fraser, Nia; Hussain, Farida K; Connell, Roy; Shenoy, Manoj U

    2015-01-01

    The incidence of end-stage renal disease in children is increasing. Peritoneal dialysis (PD) is the modality of choice in many European countries and is increasingly applied worldwide. PD enables children of all ages to be successfully treated while awaiting the ultimate goal of renal transplantation. The advantages of PD over other forms of renal replacement therapy are numerous, in particular the potential for the child to lead a relatively normal life. Indications for commencing PD, the rationale, preparation of family, technical aspects, and management of complications are discussed. PMID:26504404

  1. [The past and present of peritoneal dialysis].

    PubMed

    Polner, Kálmán

    2008-01-01

    The author reviews briefly the history of peritoneal dialysis, and highlights the significance of the work of two Hungarian nephrologists, Stephen I. Vas and István Taraba . By now, peritoneal dialysis has been considered as equal renal replacement modality compared to haemodialysis. It is even more advantageous in the protection of the patients' residual renal function, morbidity-mortality indices, and quality of life peritoneal dialysis in the first two years. From economical point of view peritoneal dialysis is less expensive than hemodialysis, therefore in the future its greater role can be expected in the treatment of more and more renal patients. The recently achieved technical development, and also the more widespread use of the automated peritoneal dialysis machines contribute to quality improvement. The peritoneal dialysis therapy, by the patients' self-treatment, establishes a new kind of relationship between the patients and the medical personnel; there is a growing requirement for patient education, the patients' self-esteem and cooperation increase, which altogether provides better results in rehabilitation and higher quality of life. Our national peritoneal dialysis utilization falls behind the European achievements, but has been growing dynamically, and we can expect an increase of the number of renal patients on peritoneal dialysis. PMID:18089476

  2. Peritoneal hydatidosis in a young girl.

    PubMed

    Wani, I; Lone, A M; Hussain, I; Malik, A; Thoker, M; Wani, K A

    2010-12-01

    We report a case of peritoneal hydatidosis that occurred post laparotomy. Patient was diagnosed nine months after she had laparotomy for suspected acute appendicitis. The whole peritoneal cavity was studded with cysts. In view of diffuse involvement, patient was managed conservatively and showed response to medical therapy. PMID:21416052

  3. Advances in ambulatory monitoring: regulatory considerations.

    PubMed

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device.

  4. Advances in ambulatory monitoring: regulatory considerations.

    PubMed

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device. PMID:15534803

  5. Cochlear implant in an ambulatory surgery center.

    PubMed

    Joseph, Aimee M; Lassen, L Frederick

    2013-02-01

    Presbycusis, or sensorineural hearing loss in the elderly population, affects approximately 40% to 50% of people over the age of 75. A variety of devices are available to those with hearing loss. Cochlear implants, for example, are especially useful for those with severe-to-profound hearing loss. The population is aging, so the demand for cochlear implantation in ambulatory surgery centers will likely increase. Ambulatory surgery centers (ASC) can provide a more convenient and less expensive location for cochlear implant surgery than hospital-based operating facilities. Patient selection using standard ASC criteria, coupled with an understanding of the unique surgical and anesthetic needs of cochlear implant patients, are key to bringing this once exotic inpatient procedure into the ASC.

  6. Asbestos-induced peritoneal mesothelioma in a construction worker.

    PubMed Central

    Fonte, Rodolfo; Gambettino, Salvatore; Melazzini, Mario; Scelsi, Mario; Zanon, Claudio; Candura, Stefano M

    2004-01-01

    Occupational and environmental asbestos exposure continues to represent a public health problem, despite increasingly restrictive laws adopted by most industrialized countries. Peritoneal mesothelioma is a rare and aggressive asbestos-related malignancy. We present the case of a 65-year-old man who developed recurrent ascites after having been exposed to asbestos in the building industry for > 40 years. Liver function and histology were normal. Abdominal computed tomography initially excluded the presence of expansive processes, and no abnormal cells were found in the ascitic fluid. Laparoscopy showed diffuse neoplastic infiltration of the peritoneum. Histopathology of bioptic samples revealed epithelioid neoplastic proliferation with a tubulopapillary pattern, falsely suggesting metastatic adenocarcinomatosis. In consideration of the occupational history, and after further diagnostic procedures had failed to identify the hypothetical primitive tumor, immunostaining of the neoplastic tissue was performed. Results were negative for carcinoembrionary antigen and the epithelial glycoprotein Ber-EP4, whereas results were positive for the mesothelial markers cytokeratins, calretinin, epithelial membrane antigen, and HBME-1, thus leading to the correct diagnosis of peritoneal epithelial mesothelioma. The Italian Workers' Compensation Authority recognized the occupational origin of the disease. Cytoreductive surgery associated with continuous hyperthermic peritoneal perfusion (cisplatin at 42 degrees C, for 1 hr) was performed. The disease relapsed after 4 months and was later complicated by a bowel obstruction requiring palliative ileostomy. The patient died 23 months after diagnosis. This case illustrates the insidious diagnostic problems posed by peritoneal mesothelioma, a tumor which often simulates other malignancies (e.g., metastatic carcinomas) at routine histopathological examination. Occupational history and immunohistochemistry are helpful for the correct

  7. Asbestos-induced peritoneal mesothelioma in a construction worker.

    PubMed

    Fonte, Rodolfo; Gambettino, Salvatore; Melazzini, Mario; Scelsi, Mario; Zanon, Claudio; Candura, Stefano M

    2004-04-01

    Occupational and environmental asbestos exposure continues to represent a public health problem, despite increasingly restrictive laws adopted by most industrialized countries. Peritoneal mesothelioma is a rare and aggressive asbestos-related malignancy. We present the case of a 65-year-old man who developed recurrent ascites after having been exposed to asbestos in the building industry for > 40 years. Liver function and histology were normal. Abdominal computed tomography initially excluded the presence of expansive processes, and no abnormal cells were found in the ascitic fluid. Laparoscopy showed diffuse neoplastic infiltration of the peritoneum. Histopathology of bioptic samples revealed epithelioid neoplastic proliferation with a tubulopapillary pattern, falsely suggesting metastatic adenocarcinomatosis. In consideration of the occupational history, and after further diagnostic procedures had failed to identify the hypothetical primitive tumor, immunostaining of the neoplastic tissue was performed. Results were negative for carcinoembrionary antigen and the epithelial glycoprotein Ber-EP4, whereas results were positive for the mesothelial markers cytokeratins, calretinin, epithelial membrane antigen, and HBME-1, thus leading to the correct diagnosis of peritoneal epithelial mesothelioma. The Italian Workers' Compensation Authority recognized the occupational origin of the disease. Cytoreductive surgery associated with continuous hyperthermic peritoneal perfusion (cisplatin at 42 degrees C, for 1 hr) was performed. The disease relapsed after 4 months and was later complicated by a bowel obstruction requiring palliative ileostomy. The patient died 23 months after diagnosis. This case illustrates the insidious diagnostic problems posed by peritoneal mesothelioma, a tumor which often simulates other malignancies (e.g., metastatic carcinomas) at routine histopathological examination. Occupational history and immunohistochemistry are helpful for the correct

  8. Staff selection for an ambulatory surgery unit.

    PubMed

    Martin, B J

    1992-07-01

    Major changes in the care delivery system affect the selection of the professional nursing staff for an ambulatory surgery unit. The skills required are diverse and dynamic. Selecting the right applicant requires not only knowledge of the interview process, but also acute observation and communication skills. The use of a matrix system helps to organize the process as well as to quantify and qualify the information gained.

  9. Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis

    PubMed Central

    Gorkem, Umit; Gungor, Tayfun; Bas, Yılmaz; Togrul, Cihan

    2015-01-01

    Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies. PMID:26558122

  10. Postnatal Treatment in Antenatally Diagnosed Meconium Peritonitis.

    PubMed

    Ionescu, S; Andrei, B; Oancea, M; Licsandru, E; Ivanov, M; Marcu, V; Popa-Stanila, R; Mocanu, M

    2015-01-01

    Meconium peritonitis is a rare prenatal disease with an increased rate of morbidity and mortality in the neonatal period. Distinctive features revealed by prenatal and postnatal ultrasoundmay be present: abdominal calcifications, ascites, polyhydramnios, meconium pseudocyst, echogenic mass and dilated bowel or intestinal obstruction. Establishing clear postnatal treatment and prognosis is difficult because of the heterogeneity of the results obtained by ultrasound. The aim of the study is to determine how prenatal diagnosis of meconium peritonitis is associated with perinatal management and further evolution. Clinical results are different depending on the presence of antenatal diagnosis of meconium peritonitis and its form, which can be mild or severe. Surgical treatment and management of meconium peritonitis depend on the clinical presentation of the newborn. Meconium peritonitis diagnosed prenatally differs from that of the newborn, not only concerning the mortality rates but also through reduced morbidity and overall better prognosis.

  11. Accelerometer recorder and display system for ambulatory patients

    NASA Astrophysics Data System (ADS)

    Berka, Martin; Żyliński, Marek; Niewiadomski, Wiktor; Cybulski, Gerard

    2015-09-01

    This paper presents the design of a compact, wearable, rechargeable acceleration recorder to support long-term monitoring of ambulatory patients with motor disorders, and of software to display and analyze its output. The device consists of a microcontroller, operational amplifier, accelerometer, SD card, indicator LED, rechargeable battery, and associated minor components. It can operate for over a day without charging and can continuously collect data for three weeks without downloading to an outside system, as currently configured. With slight modifications, this period could be extended to several months. The accompanying software provides flexible visualization of the acceleration data over long periods, basic file operations and compression for easier archiving, annotation of segments of interest, and functions for calculation of various parameters and detection of immobility and vibration frequencies. Applications in analysis of gait and other movements are discussed.

  12. Attenuation of methylglyoxal-induced peritoneal fibrosis: immunomodulation by interleukin-10.

    PubMed

    Onishi, Akira; Akimoto, Tetsu; Urabe, Masashi; Hirahara, Ichiro; Muto, Shigeaki; Ozawa, Keiya; Nagata, Daisuke; Kusano, Eiji

    2015-12-01

    Peritoneal fibrosis (PF), a serious pathophysiology of peritoneal dialysis (PD), is implicated in various types of chronic inflammation. In the present study, we examined the benefits of interleukin (IL)-10, which exerts anti-inflammatory effects, in an experimental rat model of methylglyoxal (MGO)-induced PF. We injected an adeno-associated virus (AAV) vector encoding rat IL-10 or enhanced green fluorescent protein (GFP) into male Sprague-Dawley rats at 6 weeks of age. Four weeks later, the rats received continuous peritoneal injections of conventional PD fluid (PDF) with MGO for 3 weeks. Then, the peritoneal histology and the expression levels of fibrogenic mediators and proinflammatory cytokines were analyzed. The rats demonstrating persistent IL-10 expression showed significantly reduced fibrous peritoneal thickening compared with those with GFP expression. The infiltration of macrophages, the expression of tumor necrosis factor-α, IL-1β, IL-6, transforming growth factor-β1, Snail, and matrix metalloproteinase 2 genes as well as the proliferation of mesenchymal-like mesothelial cells augmented by MGO were all significantly suppressed by IL-10 expression. IL-10 also abrogated the extent of MGO-induced bowel adhesions mimicking a cocoon-like mass. Our findings provide valuable insight into the potential benefit of immunomodulation with IL-10 as one potentially effective therapeutic strategy for preventing the onset of peritoneal injury resulting in PF.

  13. Inflammation and the Peritoneal Membrane: Causes and Impact on Structure and Function during Peritoneal Dialysis

    PubMed Central

    Baroni, Gilberto; Schuinski, Adriana; de Moraes, Thyago P.; Meyer, Fernando; Pecoits-Filho, Roberto

    2012-01-01

    Peritoneal dialysis therapy has increased in popularity since the end of the 1970s. This method provides a patient survival rate equivalent to hemodialysis and better preservation of residual renal function. However, technique failure by peritonitis, and ultrafiltration failure, which is a multifactorial complication that can affect up to 40% of patients after 3 years of therapy. Encapsulant peritoneal sclerosis is an extreme and potentially fatal manifestation. Causes of inflammation in peritoneal dialysis range from traditional factors to those related to chronic kidney disease per se, as well as from the peritoneal dialysis treatment, including the peritoneal dialysis catheter, dialysis solution, and infectious peritonitis. Peritoneal inflammation generated causes significant structural alterations including: thickening and cubic transformation of mesothelial cells, fibrin deposition, fibrous capsule formation, perivascular bleeding, and interstitial fibrosis. Structural alterations of the peritoneal membrane described above result in clinical and functional changes. One of these clinical manifestations is ultrafiltration failure and can occur in up to 30% of patients on PD after five years of treatment. An understanding of the mechanisms involved in peritoneal inflammation is fundamental to improve patient survival and provide a better quality of life. PMID:22547910

  14. Laboratory indices of clinical peritonitis: total leukocyte count, microscopy, and microbiologic culture of peritoneal dialysis effluent.

    PubMed Central

    Males, B M; Walshe, J J; Amsterdam, D

    1987-01-01

    Total leukocyte count, microscopy, and conventional bacteriologic culture (10-ml sediment) of dialysis effluent were assessed for their ability to detect peritonitis in patients on peritoneal dialysis. A total of 73 patients were surveyed over a 17-month period. Laboratory findings included an examination of 1,774 dialysate samples and culture results from blood, wounds, indwelling catheters, and other specimens. Of 90 peritonitis events, 72 were culture positive. Gram-stained films were positive in no more than 14% of the dialysates collected during periods of clinical peritonitis. Factors which adversely affected the microscopic or cultural detection of microorganisms in effluent included the concentration of organisms in dialysate, antibiotic therapy, and growth medium used. Seeding of the peritoneum with organisms originating from other sites of infection or colonization was documented, although infrequent, yet bacteremia secondary to peritonitis was not seen. Because of the frequent isolation of microorganisms from dialysates in the absence of clinical peritonitis, culture-positive findings were a poor predictor of peritonitis without other evidence of infection. Detection of peritonitis by total leukocyte count (without a differential count) of dialysate specimens was adversely affected by the overlap in cell counts between dialysates collected either during or in the absence of peritonitis. This was attributed in part to nonspecific increases in dialysate cell count in the absence of peritonitis and was associated with intermittent dialysis and extraperitoneal infection. PMID:3429626

  15. 76 FR 66929 - Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-28

    ... Association for Accreditation of Ambulatory Surgery Facilities for Approval of Deeming Authority for Rural... American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a... of Ambulatory Surgery Facilities (AAAASF's) request for deeming authority for RHCs. This notice...

  16. Psychosocial aspects of ambulatory pediatrics.

    PubMed

    Jellinek, M S; Slovik, L; Murphy, J M; Herzog, D; Beresin, E

    1990-10-01

    The ability to interview is an essential skill that continues to develop throughout a pediatrician's professional life. Interviewing is a complex procedure that requires in-depth understanding of medical illness, child development, individual and family dynamics, cultural variations, and self-awareness--your personal values and response to crisis, serious illness, and stress. Interviewing is learned by thoughtful reflection of each interview as well as more formally through the use of videotape and attending observation. Each interview is an opportunity to develop a relationship and add a bit of experience that is unique to the patient or parent and potentially useful in understanding more in the future. Although this procedure receives little formal attention, the interview is often the primary vehicle for making the diagnosis, relating to the child and family, and easing emotional suffering and can be a source of satisfaction for the many hours of hard work. PMID:2245654

  17. [Quality assurance in ambulatory surgery].

    PubMed

    Hansis, M L

    2004-02-01

    Surgery in outpatients and surgery under hospital conditions should provide the patient with the same high level of quality and the same low risk level. The one-person surgery practice is able to offer the patient a classic "one client-one customer" relation. Thus, the continuity of treatment is optimal. On the other hand, intervening systemic complications are more easily managed by the multidisciplinary staff of a hospital with its equipment. The weaknesses of both principles can be counteracted by employing special precautions in organization. The future of surgery is to be seen in combined forms, for example, in-sourcing of a surgeon from private practice into a hospital. PMID:14991173

  18. Health-related quality of life in patients on hemodialysis and peritoneal dialysis.

    PubMed

    Okpechi, Ikechi G; Nthite, Tebogo; Swanepoel, Charles R

    2013-05-01

    Chronic kidney disease (CKD) is a worldwide public health problem, and its treatment imposes a considerable burden on patients and their families. Limitations in everyday activity may worsen the situation and affect the health-related quality of life (HRQOL) of patients with CKD. There are no studies on the HRQOL of dialysis patients in South Africa. We assessed the HRQOL of patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD) attending the Groote Schuur Hospital renal unit by using the Kidney Disease Quality of Life-Short Form version 1.3 questionnaire. Baseline demographic and clinical details of the participants were recorded. Analysis was performed (unpaired t test and univariate analysis) to compare the HRQOL between HD and PD patients and to identify factors influencing HRQOL. The HRQOL was low but not significantly different between HD and PD patients. In PD patients, the use of erythropoiesis-stimulating agents (ESA) significantly contributed to the emotional well-being (r 2 = 0.267; P = 0.01) and alleviation of pain (r 2 = 0.073; P = 0.049); in HD patients also, ESA use was associated with emotional well-being (r 2 = 0.258; P <0.0001) as well as improvement in energy/fatigue (r 2 = 0.390; P <0.0001). Systolic and diastolic blood pressures significantly influenced cognitive function in PD patients (P <0.05). Parathyroid hormone level significantly influenced the physical functioning and energy/fatigue domains in HD patients (P <0.0001). Serum ferritin (r 2 = 0.441; P = 0.002) and level of hemoglobin concentration (r 2 = 0.180; P = 0.006) were significantly associated with the domain role emotional in PD and HD patients, respectively. Although HRQOL is low in dialysis patients in Cape Town, the factors that have been identified to be associated with these scores (such as anemia and hyperparathyroidism) if aggressively managed and corrected may assist in improving patients' HRQOL.

  19. Resting energy expenditure and subsequent mortality risk in peritoneal dialysis patients.

    PubMed

    Wang, Angela Yee-Moon; Sea, Mandy Man-Mei; Tang, Nelson; Sanderson, John E; Lui, Siu-Fai; Li, Philip Kam-Tao; Woo, Jean

    2004-12-01

    Cardiovascular disease is the leading cause of death in ESRD patients and is strongly associated with malnutrition. The mechanism of malnutrition is not clear, but hypermetabolism is suggested to contribute to cardiac cachexia. This study examined resting energy expenditure (REE) in relation to the clinical outcomes of ESRD patients who receive continuous ambulatory peritoneal dialysis (CAPD) treatment. A prospective observational cohort study was performed in 251 CAPD patients. REE was measured at study baseline using indirect calorimetry together with other clinical, nutritional, and dialysis parameters. Patients were followed up for a mean +/- SD duration of 28.7 +/- 14.3 mo. REE was 39.1 +/- 9.6 and 40.1 +/- 9.0 kcal/kg fat-free edema-free body mass per day for men and women, respectively (P = 0.391). Using multiple regression analysis, fat-free edema-free body mass-adjusted REE was negatively associated with residual GFR (P < 0.001) and serum albumin (P = 0.046) and positively associated with diabetes (P = 0.002), cardiovascular disease (P = 0.009), and C-reactive protein (P = 0.009). At 2 yr, the overall survival was 63.3, 73.6, and 95.9% (P < 0.0001), and cardiovascular event-free survival was 72.3, 84.6, and 97.2% (P = 0.0003), respectively, for patients in the upper, middle, and lower tertiles of REE. Adjusting for age, gender, diabetes, and cardiovascular disease, patients in the upper and middle tertiles showed a 4.19-fold (95% confidence interval, 2.15 to 8.16; P < 0.001) and a 2.90-fold (95% confidence interval, 1.49, 5.63; P = 0.002) respective increase in the risk of all-cause mortality compared with those in the lower tertile. However, the significance of REE in predicting mortality was gradually reduced when additional adjustment was made for C-reactive protein, serum albumin, and residual GFR in a stepwise manner. In conclusion, a higher REE is associated with increased mortality and cardiovascular death in CAPD patients and is partly related to

  20. The Role of Peritoneal Lavage in Severe Acute Pancreatitis

    PubMed Central

    Ranson, John H. C.; Spencer, Frank C.

    1978-01-01

    Encouraged by reports of the therapeutic efficacy of peritoneal lavage in small series of five or six patients with acute pancreatitis, we have evaluated this treatment in 24 patients with “severe” pancreatitis. One hundred and three patients with “severe” pancreatitis (28% mortality) were separated from 347 with “mild” pancreatitis (0.9% mortality) by previously described early objective signs. Early treatment (Day 0-7) of “severe” pancreatitis included peritoneal lavage through catheters placed nonoperatively in 18 (Group A) and by catheters placed at laparotomy in six (Group C). Early treatment of nonlavaged patients with “severe” pancreatitis was by standard nonoperative measures in 61 (Group B) and included early operation in 18 (Group D). Lavage was continued for 48-96 hours, usually using 36-48 L/24 hours of balanced isotonic dialysate fluid, and was uncomplicated. Lavage led to striking immediate clinical improvement and no lavaged patient (Groups A and C) died during the first 10 days of treatment of pancreatitis. By contrast, 45% of deaths in nonlavaged patients (Group B and D) occurred during this early period, usually from cardiovascular or respiratory failure. Although lavage reduced mortality in subgroups of patients, ultimate overall survival was no affected (Group A, 83%; B, 84%; C, 33%; D,33%). Late peripancreatic abscesses caused most deaths in lavaged patients. These data show that peritoneal complications of severe acute pancreatitis and dramatically reduces early mortality. Lavage does not prevent the late local sequelae of peripancreatic necrosis. PMID:646497

  1. Molecular and cellular profiles of the resolution phase in a damage-associated molecular pattern (DAMP)-mediated peritonitis model and revelation of leukocyte persistence in peritoneal tissues.

    PubMed

    Lastrucci, Claire; Baillif, Vincent; Behar, Annie; Al Saati, Talal; Dubourdeau, Marc; Maridonneau-Parini, Isabelle; Cougoule, Céline

    2015-05-01

    Models of microbe-elicited peritonitis have been invaluable to identify mechanisms underlying inflammation resolution, but whether resolution mechanisms differ from an inflammatory agent to another has not been determined. Thus, we analyzed the cellular and molecular components of the resolution phase of non-microbe-induced inflammation. In thioglycollate (TG)-induced peritonitis, resolution started at 12 h (Tmax) and displayed a 22 h resolution interval (Ri). During resolution, lipoxin A4, resolvin (Rv) D1 and RvD2, protectin D1 (PD1), and maresin 1 (MaR1) were transiently produced while RvD5 was continually generated. In addition, docosahexaenoic acid (DHA)-derived mediators were produced to a higher extent than in microbial peritonitis. We also investigated leukocyte infiltration and clearance in peritoneal tissues surrounding the inflammatory site. In the omentum, resolution parameters, neutrophil apoptosis, and efferocytosis were similar to those of the peritoneal cavity. However, we noticed long-term persistence of M2-polarized macrophages and B-lymphocytes in the omentum after TG administration, whereas zymosan injection caused M1/M2-macrophage and T-lymphocyte persistence regardless of the magnitude of the inflammatory response. Our study indicates that some aspects of resolution are shaped in a stimulus-specific manner, and it ultimately argues that the tissues surrounding the inflammatory site must also be considered to address the inflammatory response globally.

  2. Peritoneal interleukin-8 in acute appendicitis.

    PubMed

    Zeillemaker, A M; Hoynck van Papendrecht, A A; Hart, M H; Roos, D; Verbrugh, H A; Leguit, P

    1996-05-01

    Interleukin-8 (IL-8) is a chemoattractant that is highly selective for neutrophils. This study was designed to investigate the presence of IL-8 in peritoneal fluid of patients with acute appendicitis. The clinical circumstances underlying the secretion of IL-8 by mesothelium and its mechanism of activation have not been defined. In an in vitro model for bacterial peritonitis the role of bacteria in activating human mesothelial cells to secrete IL-8 was studied. Cultured human mesothelium was incubated with various species of pathogenic bacteria, isolated from peritoneal exudate fluids of patients with appendicitis. The amount of IL-8 secreted by the cultured mesothelial cells was determined in an IL-8 ELISA, as IL-8 was present in the original peritoneal fluid of these patients. Peritoneal fluids from patients with a perforated appendix were found to contain a significantly higher concentration of IL-8 compared to peritoneal fluids from patients with nonperforating appendicitis (121.6 (57.8) ng/ml versus 0.2 (0.07) ng/ml, respectively; mean (SEM), P < or = 0.01). Species of Bacteroïdes and Fusobacterium necrophorum induced IL-8 secretion from cultured mesothelial monolayers to levels comparable to those found in peritoneal fluids in vivo. Heat-killed bacteria and bacterial supernatant were also able to stimulate mesothelium to secrete IL-8. The results suggest that in the early phase of bacterial peritonitis the influx of PMN is regulated by bacteria-induced IL-8 secretion by the mesothelium lining the peritoneal cavity.

  3. Peritoneal tuberculosis in pregnancy: a case report

    PubMed Central

    Alaoui, Fatima Zohra Fdili; Rachad, Myriem; Chaara, Hikmat; Bouguern, Hakima; Melhouf, Moulay Abdilah

    2012-01-01

    Peritoneal tuberculosis in pregnancy is one of the least common forms of extrapulmonory tuberculosis in pregnancy. Early diagnosis is important to prevent obstetrical and neonatal morbidity. We report the case of a 37-year-old pregnant woman who presented with abdominal volume increase, night-sweat, anorexia, loss of weight and abdominal pain at 23 weeks. A peritoneal laparoscopic biopsy was performed and confirmed the diagnosis of tuberculous peritonitis. The patient received antituberculosis chemotherapy. The recovery was good as gave birth to a healthy infant of 3200Kg at 37th week's gestation by vaginal delivery. PMID:23024824

  4. Peritoneal tuberculosis in pregnancy: a case report.

    PubMed

    Alaoui, Fatima Zohra Fdili; Rachad, Myriem; Chaara, Hikmat; Bouguern, Hakima; Melhouf, Moulay Abdilah

    2012-01-01

    Peritoneal tuberculosis in pregnancy is one of the least common forms of extrapulmonory tuberculosis in pregnancy. Early diagnosis is important to prevent obstetrical and neonatal morbidity. We report the case of a 37-year-old pregnant woman who presented with abdominal volume increase, night-sweat, anorexia, loss of weight and abdominal pain at 23 weeks. A peritoneal laparoscopic biopsy was performed and confirmed the diagnosis of tuberculous peritonitis. The patient received antituberculosis chemotherapy. The recovery was good as gave birth to a healthy infant of 3200Kg at 37th week's gestation by vaginal delivery. PMID:23024824

  5. A case of tuberculous peritonitis in childhood.

    PubMed

    Avcu, Gulhadiye; Sensoy, Gulnar; Karli, Arzu; Caltepe, Gonul; Sullu, Yurdanur; Belet, Nursen; Bilgici, Meltem C

    2015-01-01

    Currently, tuberculosis remains a major public health problem worldwide. Peritoneal tuberculosis occurs in approximately 1% of all of tuberculosis cases and is rarely observed in children. Diagnosis and treatment delays caused by mimicking many other intra-abdominal diseases can lead to increases in morbidity and mortality. Here, we present a case of a four-year-old child with tuberculosis peritonitis who was diagnosed by laparoscopic biopsy and histopathological examination and recovered with antituberculosis therapy. Peritoneal tuberculosis should be considered in younger patients and adults with fever, abdominal pain and weight loss in endemic areas. PMID:25868903

  6. [The specific nutritionnal care in peritoneal dialysis].

    PubMed

    Castrale, Cindy; Azar, Raymond; Piquet, Marie-Astrid; Lobbedez, Thierry

    2016-07-01

    Protein energy wasting is a major complication in peritoneal dialysis. It is leading to a poor quality of life and increasing mortality. Diagnosis must be early, according to criteria defined by the International society of renal nutrition and metabolism. It is necessary to appropriate the diagnostic tools with dialysis method. The nutritional care is difficult in peritoneal dialysis. Indeed, studies are limited and practical nutrition is complex. In this point of view, we propose to treat guidelines for protein energy wasting, in peritoneal dialysis patients. PMID:27320370

  7. Ambulatory Pediatric Oncology CLABSIs: Epidemiology and Risk Factors

    PubMed Central

    Rinke, Michael L.; Milstone, Aaron M.; Chen, Allen R.; Mirski, Kara; Bundy, David G.; Colantuoni, Elizabeth; Pehar, Miriana; Herpst, Cynthia; Miller, Marlene R.

    2015-01-01

    Background To compare the burden of central line-associated bloodstream infections (CLABSIs) in ambulatory versus inpatient pediatric oncology patients, and identify the epidemiology of and risk factors associated with ambulatory CLABSIs. Procedure We prospectively identified infections and retrospectively identified central line days and characteristics associated with CLABSIs from January 2009 to October 2010. A nested case–control design was used to identify characteristics associated with ambulatory CLABSIs. Results We identified 319 patients with central lines. There were 55 ambulatory CLABSIs during 84,705 ambulatory central line days (0.65 CLABSIs per 1,000 central line days (95% CI 0.49, 0.85)), and 19 inpatient CLABSIs during 8,682 inpatient central line days (2.2 CLABSIs per 1,000 central lines days (95% CI 1.3, 3.4)). In patients with ambulatory CLABSIs, 13% were admitted to an intensive care unit and 44% had their central lines removed due to the CLABSI. A secondary analysis with a sub-cohort, suggested children with tunneled, externalized catheters had a greater risk of ambulatory CLABSI than those with totally implantable devices (IRR 20.6, P < 0.001). Other characteristics independently associated with ambulatory CLABSIs included bone marrow transplantation within 100 days (OR 16, 95% CI 1.1, 264), previous bacteremia in any central line (OR 10, 95% CI 2.5, 43) and less than 1 month from central line insertion (OR 4.2, 95% CI 1.0, 17). Conclusions In pediatric oncology patients, three times more CLABSIs occur in the ambulatory than inpatient setting. Ambulatory CLABSIs carry appreciable morbidity and have identifiable, associated factors that should be addressed in future ambulatory CLABSI prevention efforts. Pediatr Blood Cancer 2013;60:1882–1889. PMID:23881643

  8. Myths and reality concerning hypertension in peritoneal dialysis patients: results of a multicenter study.

    PubMed

    Lucatello; Cocchi; Degli Esposti E; Fabbri; Sturani; Quarello; Boero; Dadone; Bruno; Favazza; Scanziani; Tommasi; Giangrande

    1998-04-01

    OBJECTIVES: To evaluate the prevalence of hypertension, the average blood pressure level, the 24 h blood pressure profile, and the efficacy of antihypertensive therapy for a large population of peritoneal dialysis patients.DESIGN: A cross-sectional, observational multicenter study. METHODS: From 504 peritoneal dialysis patients (18% of the Italian peritoneal dialysis population) involved in a multicenter observational study, we selected 414 who had undergone successful ambulatory blood pressure monitoring (i.e. no hours with data absent, >/= 75% successful readings and monitoring duration >/= 24 h). Office blood pressure measurements and ambulatory blood pressure monitoring were performed for each patient on the same day with a standard mercury sphygmomanometer and a SpaceLabs 90207 device, respectively.RESULTS: According to World Health Organization/International Society of Hypertension criteria, 44 peritoneal dialysis patients (10.6%) were normotensive and 370 patients (89.4%) were hypertensive, 304 (82.1%) of whom were being administered antihypertensive therapy. Daytime systolic and diastolic blood pressures were both significantly lower than office systolic and diastolic blood pressures (140.7 +/- 19.7/72.1 +/-11.1 versus 148.3 +/- 23.6/85.6 +/- 12 mmHg; P < 0.001). The difference between office blood pressure and daytime blood pressure was significantly correlated to office blood pressure (P < 0.001 for systolic and P < 0.001 for diastolic). The diurnal blood pressure rhythm evaluated by visual inspection of hourly mean plots was not influenced by sex, age, antihypertensive treatment, and peritoneal dialysis modality. Systolic and diastolic blood pressures exhibited a day-night mean decreases of 8.6 +/- 11.7 and 7.7 +/- 6.9 mmHg, respectively, and daytime blood pressure values were significantly higher than night-time ones (P < 0.001). Two hundred and twenty patients (53.1%) were nondippers according to O'Brien's criteria, 247 patients (59.7%) were nondippers

  9. microRNA Regulation of Peritoneal Cavity Homeostasis in Peritoneal Dialysis

    PubMed Central

    Lopez-Anton, Melisa; Bowen, Timothy; Jenkins, Robert H.

    2015-01-01

    Preservation of peritoneal cavity homeostasis and peritoneal membrane function is critical for long-term peritoneal dialysis (PD) treatment. Several microRNAs (miRNAs) have been implicated in the regulation of key molecular pathways driving peritoneal membrane alterations leading to PD failure. miRNAs regulate the expression of the majority of protein coding genes in the human genome, thereby affecting most biochemical pathways implicated in cellular homeostasis. In this review, we report published findings on miRNAs and PD therapy, with emphasis on evidence for changes in peritoneal miRNA expression during long-term PD treatment. Recent work indicates that PD effluent- (PDE-) derived cells change their miRNA expression throughout the course of PD therapy, contributing to the loss of peritoneal cavity homeostasis and peritoneal membrane function. Changes in miRNA expression profiles will alter regulation of key molecular pathways, with the potential to cause profound effects on peritoneal cavity homeostasis during PD treatment. However, research to date has mainly adopted a literature-based miRNA-candidate methodology drawing conclusions from modest numbers of patient-derived samples. Therefore, the study of miRNA expression during PD therapy remains a promising field of research to understand the mechanisms involved in basic peritoneal cell homeostasis and PD failure. PMID:26495316

  10. Campylobacter jejuni: A rare agent in a child with peritoneal dialysis-related peritonitis.

    PubMed

    Tural Kara, Tugce; Yilmaz, Songul; Ozdemir, Halil; Birsin Ozcakar, Zeynep; Derya Aysev, Ahmet; Ciftci, Ergin; Ince, Erdal

    2016-10-01

    La peritonitis es un problema grave en los niños que reciben diálisis peritoneal. La bacteria Campylobacter jejuni es una causa infrecuente de peritonitis. Un niño de 10 años de edad con insuficiencia renal terminal causada por síndrome urémico hemolítico atípico ingresó a nuestro hospital con dolor abdominal y fiebre. El líquido de la diálisis peritoneal era turbio; en el examen microscópico se observaron leucocitos abundantes. Se inició tratamiento con cefepime intraperitoneal. En el cultivo del líquido peritoneal se aisló Campylobacter jejuni, por lo que se agregó claritromicina oral al tratamiento. Al finalizar el tratamiento, el resultado del cultivo del líquido peritoneal era negativo. Hasta donde sabemos, no se había informado previamente peritonitis por C. jejuni en niños. Conclusión. Si bien la peritonitis por C. jejuni es rara en los niños, debe considerarse como factor etiológico de la peritonitis.

  11. Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes.

    PubMed

    Bakkaloglu, Sevcan A; Warady, Bradley A

    2015-09-01

    Despite technological improvements in dialysis connectology and dialysis technique, peritonitis remains the most common and most significant complication of peritoneal dialysis (PD) in children. Most children undergoing chronic PD experience none or only one peritonitis episode, while others have multiple episodes or episodes secondary to unusual organisms. Knowledge of potential risk factors and likely patient outcome is imperative if treatment is to be optimized. In this review we will, in turn, describe episodes of peritonitis that are characterized as either relapsing, recurrent, repeat or zoonosis-related to highlight the clinical issues that are commonly encountered by clinicians treating these infections.

  12. Patient Perceptions of Mistakes in Ambulatory Care

    PubMed Central

    Kistler, Christine E.; Walter, Louise C.; Mitchell, C. Madeline; Sloane, Philip D.

    2011-01-01

    CONTEXT Little information exists about current patient perceptions of medical mistakes in ambulatory care within a diverse population. OBJECTIVES To learn about adults’ perceptions of mistakes in ambulatory care, what factors were associated with perceived mistakes, and whether or not the respondents changed physicians because of these perceived mistakes DESIGN Cross-sectional survey conducted in 2008 SETTING Seven primary care medical practices in North Carolina PARTICIPANTS One thousand six hundred ninety-seven English or Spanish speaking adults, aged 18 and older, who presented to a medical provider during the data collection period. MAIN OUTCOME MEASURES 1) Has a doctor in a doctor’s office ever made a mistake in your care? 2) In the past 10 years, has a doctor in a doctor’s office made a wrong diagnosis or misdiagnosed you? (If yes, how much harm did this cause you?) 3) In the last 10 years, has a doctor in a doctor’s office given you the wrong medical treatment or delayed treatment? (If yes, how much harm did this cause you?) 4) Have you ever changed doctors because of either a wrong diagnosis or a wrong treatment of a medical condition? RESULTS Two hundred sixty-five participants (15.6%) responded that a doctor had ever made a mistake, 13.4% reported a wrong diagnosis, 12.4% reported a wrong treatment, and 14.1% reported having changed doctors because of a mistake. Participants perceived mistakes and harm in both diagnostic care and medical treatment. Patients with chronic low back pain, higher levels of education, and poor physical health were at increased odds of perceiving harm, whereas African-Americans were less likely to perceive mistakes. CONCLUSIONS Patients perceived mistakes in their diagnostic and treatment care in the ambulatory setting. These perceptions had a concrete impact on the patient-physician relationship, often leading patients to seek another health care provider. PMID:20837835

  13. Catumaxomab for Treatment of Peritoneal Carcinomatosis in Patients With Gastric Adenocarcinomas

    ClinicalTrials.gov

    2016-10-13

    Gastric Adenocarcinoma With Peritoneal Carcinomatosis; Siewert Type II Adenocarcinoma of Esophagogastric Junction With Peritoneal Carcinomatosis; Siewert Type III Adenocarcinoma of Esophagogastric Junction With Peritoneal Carcinomatosis

  14. Degree of Ambulatory Disability: Effects on Rural Siblings' Social Development.

    ERIC Educational Resources Information Center

    Chamberlain, Theresa Nowak; Ross-Reynolds, Jane

    1993-01-01

    Interviews with 22 mothers of children with ambulatory disability and 33 nondisabled siblings showed no differences in sibling's child care responsibilities, general home responsibilities, or independence related to severity of the ambulatory disability. A difference in the amount of social activity, reported by mothers, was not confirmed by…

  15. An Agenda for Residency Training in Ambulatory Care.

    ERIC Educational Resources Information Center

    Link, Kurt; Buchsbaum, David

    1984-01-01

    Some of the differences between in-hospital and ambulatory medicine and their implications for the teaching and practice of ambulatory care are explored. The availability of time, the role of patient cooperation, and the decision-making process differ in the two settings. (MLW)

  16. An Ambulatory Program for Surgical Residents and Medical Students.

    ERIC Educational Resources Information Center

    Levy, Margaret

    1988-01-01

    A pilot program based in a freestanding ambulatory surgery center at the Chicago Medical School Department of Surgery is described, its curriculum outlined, and the daily activities of the residents and medical students are detailed. A brief history of ambulatory surgery is given. (Author/MLW)

  17. Nutrition in Older Adults on Peritoneal Dialysis.

    PubMed

    Johansson, Lina

    2015-11-01

    Nutrition in older adults on peritoneal dialysis is an important aspect of a patient's clinical management as well as being influenced by their overall well-being, both mental and physical. This is especially pertinent as individuals age, since the potential impact of life changes and physical changes contribute to the development of protein-energy wasting and potentially exacerbating sarcopenia and wasting. This article provides an outline of the nutritional issues to consider in older adults on peritoneal dialysis (PD).

  18. The Evolution of Ambulatory Medical Record Systems in the U.S

    PubMed Central

    Kuhn, Ingeborg M.; Wiederhold, Gio

    1981-01-01

    This paper is an overview of the developments in Automated Ambulatory Medical Record Systems (AAMRS) from 1975 to the present. A summary of findings from a 1975 state-of-the-art review is presented with the current findings of a follow-up study of the AAMRS. The studies revealed that effective automated medical record systems have been developed for ambulatory care settings and that they are now in the process of being transfered to other sites or users, either privately or as a commercial product. Since 1975 there have been no significant advances in system design. However, progress has been substantial in terms of achieving production goals. Even though a variety of system are commercially available, there is a continuing need for research and development to improve the effectiveness of the systems in use today.

  19. Effect of Curcumin in Experimental Peritonitis.

    PubMed

    D, Savitha; Mani, Indu; Ravikumar, Gayatri; Avadhany, Sandhya T

    2015-12-01

    Despite medical advancements, the inflammatory cascade and oxidative stress worsen the prognosis in most cases of peritonitis. Curcumin has emerged as a potential antioxidant and anti-inflammatory agent in few of the acute inflammatory and infective conditions. We examined the effect of intraperitoneal injection of curcumin in endotoxin-induced peritonitis in rats. The blood and peritoneal fluid samples were collected at 3 and 24 h following the induction of peritonitis. Animals were sacrificed at 24 h and the organs preserved. The histopathological report of lung, liver, and intestines in the curcumin-treated rats showed maintenance of tissue architecture to a large extent compared to the control group which showed massive congestion, hemorrhage, and necrosis. The blood and peritoneal fluid total count and differential neutrophil counts were significantly higher at 24 h of induction of peritonitis. Serum amyloid assay and lipid peroxidation were significantly lower, and myeloperoxidase assay was higher in the curcumin-treated group at the end of 24 h; thus, curcumin probably demonstrated a neutrophil-mediated immunopotentiation and anti-inflammatory action thereby protecting the animal from endotoxemia-induced multi-organ damage. PMID:26884658

  20. The importance of ultrasonographic measurement of peritoneal wall thickness in pediatric chronic peritoneal dialysis patients.

    PubMed

    Yavaşcan, Önder; Aksu, Nejat; Alparslan, Caner; Sarıtaş, Serdar; Elmas, Cengiz Han; Eraslan, Ali Nihat; Duman, Soner; Mir, Sevgi

    2015-04-01

    Loss of peritoneal function due to peritoneal fibrosing syndrome (PFS) is a major factor leading to treatment failure in chronic peritoneal dialysis (PD) patients. Although the precise biologic mechanisms responsible for these changes have not been defined, the general assumption is that alterations in peritoneal function are related to structural changes in the peritoneal membrane. Studies of the peritoneal membrane by non-invasive ultrasonography (US) in chronic PD patients are limited. The aim of the present study is to assess the relationship between functional parameters of peritoneum and peritoneal thickness measured by US in children treated by chronic PD. We recruited two groups of patients: 23 subjects (13 females, 10 males) on chronic PD (patient group) and 26 (7 females, 19 males) on predialysis out-patient follow-up (creatinine clearance: 20-60 mL/min/1.73 m(2)) (control group). Age, sex, weight, height, body mass index (BMI), chronic PD duration, episodes of peritonitis and the results of peritoneal equilibration test (PET) were recorded. Hemoglobin (Hb), blood pressure (BP), left ventricular mass index (LVMI) and renal osteodystrophy (ROD) parameters were also obtained. The thickness of the parietal peritoneum was measured by trans-abdominal US in all children. Statistical analyses were performed by using Student's t and Pearson's correlation tests. Mean peritoneal thickness in chronic PD patients (1028.26 ± 157.26 μm) was significantly higher than control patients (786.52 ± 132.33). Mean peritoneal thickness was significantly correlated with mean body height (R(2) = 0.93, p < 0.05), BMI (R(2) = 0.25, p < 0.05), chronic PD duration (R(2) = 0.64, p < 0.05), episodes of peritonitis (R(2) = 0.93, p < 0.05), D/Pcreatinine (R(2) = 0.76, p < 0.05) and D4/D0glucose (R(2) = 0.81, p < 0.05). No correlation was found between peritoneal thickness and Hb, BP, LVMI and ROD parameters. In conclusion

  1. The importance of ultrasonographic measurement of peritoneal wall thickness in pediatric chronic peritoneal dialysis patients.

    PubMed

    Yavaşcan, Önder; Aksu, Nejat; Alparslan, Caner; Sarıtaş, Serdar; Elmas, Cengiz Han; Eraslan, Ali Nihat; Duman, Soner; Mir, Sevgi

    2015-04-01

    Loss of peritoneal function due to peritoneal fibrosing syndrome (PFS) is a major factor leading to treatment failure in chronic peritoneal dialysis (PD) patients. Although the precise biologic mechanisms responsible for these changes have not been defined, the general assumption is that alterations in peritoneal function are related to structural changes in the peritoneal membrane. Studies of the peritoneal membrane by non-invasive ultrasonography (US) in chronic PD patients are limited. The aim of the present study is to assess the relationship between functional parameters of peritoneum and peritoneal thickness measured by US in children treated by chronic PD. We recruited two groups of patients: 23 subjects (13 females, 10 males) on chronic PD (patient group) and 26 (7 females, 19 males) on predialysis out-patient follow-up (creatinine clearance: 20-60 mL/min/1.73 m(2)) (control group). Age, sex, weight, height, body mass index (BMI), chronic PD duration, episodes of peritonitis and the results of peritoneal equilibration test (PET) were recorded. Hemoglobin (Hb), blood pressure (BP), left ventricular mass index (LVMI) and renal osteodystrophy (ROD) parameters were also obtained. The thickness of the parietal peritoneum was measured by trans-abdominal US in all children. Statistical analyses were performed by using Student's t and Pearson's correlation tests. Mean peritoneal thickness in chronic PD patients (1028.26 ± 157.26 μm) was significantly higher than control patients (786.52 ± 132.33). Mean peritoneal thickness was significantly correlated with mean body height (R(2) = 0.93, p < 0.05), BMI (R(2) = 0.25, p < 0.05), chronic PD duration (R(2) = 0.64, p < 0.05), episodes of peritonitis (R(2) = 0.93, p < 0.05), D/Pcreatinine (R(2) = 0.76, p < 0.05) and D4/D0glucose (R(2) = 0.81, p < 0.05). No correlation was found between peritoneal thickness and Hb, BP, LVMI and ROD parameters. In conclusion

  2. 76 FR 6572 - Non-Ambulatory Disabled Veal Calves and Other Non-Ambulatory Disabled Livestock at Slaughter...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-07

    ... Slaughter'' (72 FR 38700)). The Agency had prohibited the slaughter of non-ambulatory disabled cattle for...-Ambulatory Disabled Following Ante-Mortem Inspection'' (74 FR 11464)). In that rulemaking the Agency also... provision that permits veal calves that are tired or cold to be set aside and treated (74 FR...

  3. Enterococcus gallinarum Spontaneous Bacterial Peritonitis in an HCV Cirrhotic.

    PubMed

    Abidali, Hussein; Sheikh, Maheen; Abidali, Moustapha; Abidali, Ali; Farraji, Hamoudi S; Berry, Andrew C

    2015-01-01

    We present the case of a 60-year-old Caucasian male with history of hepatitis C viral cirrhosis with portosystemic encephalopathy and ascites with evidence of spontaneous bacterial peritonitis (SBP) with absolute neutrophil count (ANC) of 944 cells/µL blood. Despite adequate treatment, the abdominal pain and elevated creatinine continued to persist. Initial ascites fluid cultures returned back positive for growth of Enterococcus gallinarum. Empiric antibiotics were then substituted with ampicillin/sulbactam. Our case of Enterococcus gallinarum causing SBP is only the seventh case reported in the literature to date. PMID:26064715

  4. Managing hypertension with ambulatory blood pressure monitoring.

    PubMed

    White, William B; Gulati, Vinay

    2015-02-01

    There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.

  5. Intelligent artifact classification for ambulatory physiological signals.

    PubMed

    Sweeney, Kevin T; Leamy, Darren J; Ward, Tomas E; McLoone, Sean

    2010-01-01

    Connected health represents an increasingly important model for health-care delivery. The concept is heavily reliant on technology and in particular remote physiological monitoring. One of the principal challenges is the maintenance of high quality data streams which must be collected with minimally intrusive, inexpensive sensor systems operating in difficult conditions. Ambulatory monitoring represents one of the most challenging signal acquisition challenges of all in that data is collected as the patient engages in normal activities of everyday living. Data thus collected suffers from considerable corruption as a result of artifact, much of it induced by motion and this has a bearing on its utility for diagnostic purposes. We propose a model for ambulatory signal recording in which the data collected is accompanied by labeling indicating the quality of the collected signal. As motion is such an important source of artifact we demonstrate the concept in this case with a quality of signal measure derived from motion sensing technology viz. accelerometers. We further demonstrate how different types of artifact might be tagged to inform artifact reduction signal processing elements during subsequent signal analysis. This is demonstrated through the use of multiple accelerometers which allow the algorithm to distinguish between disturbance of the sensor relative to the underlying tissue and movement of this tissue. A brain monitoring experiment utilizing EEG and fNIRS is used to illustrate the concept.

  6. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis

    PubMed Central

    Harris, Chelsea; Wallack, Elizabeth M.; Drodge, Olivia; Beaulieu, Serge; Mayo, Nancy

    2015-01-01

    Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified ‘a priori’ variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24–2.91]); low disability (OR 1.50, 95% CI [1.34–1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08–1.26] for each additional point on the scale of 0–14), less fatigue (OR 2.01, 95% CI [1.32–3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11–2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02–2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non-ambulatory

  7. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis.

    PubMed

    Ploughman, Michelle; Harris, Chelsea; Wallack, Elizabeth M; Drodge, Olivia; Beaulieu, Serge; Mayo, Nancy

    2015-01-01

    Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified 'a priori' variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24-2.91]); low disability (OR 1.50, 95% CI [1.34-1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08-1.26] for each additional point on the scale of 0-14), less fatigue (OR 2.01, 95% CI [1.32-3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11-2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02-2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non-ambulatory groups suggesting

  8. Effluent Tenascin-C Levels Reflect Peritoneal Deterioration in Peritoneal Dialysis: MAJOR IN PD Study

    PubMed Central

    Hirahara, Ichiro; Kusano, Eiji; Imai, Toshimi; Morishita, Yoshiyuki; Inoue, Makoto; Akimoto, Tetsu; Saito, Osamu; Muto, Shigeaki; Nagata, Daisuke

    2015-01-01

    Peritoneal deterioration causing structural changes and functional decline is a major complication of peritoneal dialysis (PD). The aim of this study was to explore effluent biomarkers reflecting peritoneal deterioration. In an animal study, rats were intraperitoneally administered with PD fluids adding 20 mM methylglyoxal (MGO) or 20 mM formaldehyde (FA) every day for 21 days. In the MGO-treated rats, tenascin-C (TN-C) levels in the peritoneal effluents were remarkably high and a cluster of TN-C-positive mesothelial cells with epithelial-to-mesenchymal transition- (EMT-) like change excessively proliferated at the peritoneal surface, but not in the FA-treated rats. Effluent matrix metalloproteinase-2 (MMP-2) levels increased in both the MGO- and FA-treated rats. In a clinical study at 18 centers between 2006 and 2013, effluent TN-C and MMP-2 levels were quantified in 182 PD patients with end-stage renal disease. Peritoneal function was estimated using the peritoneal equilibration test (PET). From the PET results, the D/P Cr ratio was correlated with effluent levels of TN-C (ρ = 0.57, p < 0.001) and MMP-2 (ρ = 0.73, p < 0.001). We suggest that TN-C in the effluents may be a diagnostic marker for peritoneal deterioration with EMT-like change in mesothelial cells in PD. PMID:26770971

  9. Effluent Tenascin-C Levels Reflect Peritoneal Deterioration in Peritoneal Dialysis: MAJOR IN PD Study.

    PubMed

    Hirahara, Ichiro; Kusano, Eiji; Imai, Toshimi; Morishita, Yoshiyuki; Inoue, Makoto; Akimoto, Tetsu; Saito, Osamu; Muto, Shigeaki; Nagata, Daisuke

    2015-01-01

    Peritoneal deterioration causing structural changes and functional decline is a major complication of peritoneal dialysis (PD). The aim of this study was to explore effluent biomarkers reflecting peritoneal deterioration. In an animal study, rats were intraperitoneally administered with PD fluids adding 20 mM methylglyoxal (MGO) or 20 mM formaldehyde (FA) every day for 21 days. In the MGO-treated rats, tenascin-C (TN-C) levels in the peritoneal effluents were remarkably high and a cluster of TN-C-positive mesothelial cells with epithelial-to-mesenchymal transition- (EMT-) like change excessively proliferated at the peritoneal surface, but not in the FA-treated rats. Effluent matrix metalloproteinase-2 (MMP-2) levels increased in both the MGO- and FA-treated rats. In a clinical study at 18 centers between 2006 and 2013, effluent TN-C and MMP-2 levels were quantified in 182 PD patients with end-stage renal disease. Peritoneal function was estimated using the peritoneal equilibration test (PET). From the PET results, the D/P Cr ratio was correlated with effluent levels of TN-C (ρ = 0.57, p < 0.001) and MMP-2 (ρ = 0.73, p < 0.001). We suggest that TN-C in the effluents may be a diagnostic marker for peritoneal deterioration with EMT-like change in mesothelial cells in PD. PMID:26770971

  10. Successful Treatment of Peritoneal Dialysis Catheter-Related Polymicrobial Peritonitis Involving Clostridium difficile

    PubMed Central

    Malhotra, Prashant; Juretschko, Stefan

    2015-01-01

    Clostridium difficile is one of the most common nosocomial pathogens and the cause of pseudomembranous colitis in cases of prior antimicrobial exposure. Extraintestinal manifestations of C. difficile are uncommon and rarely reported. We report the first successfully treated case of catheter-related C. difficile peritonitis in a patient undergoing peritoneal dialysis. PMID:26378285

  11. Aging of silastic peritoneal catheters.

    PubMed

    Poisetti, P; Bergonzi, G; Ballocchi, S; Fontana, F; Scarpioni, L

    1991-12-01

    Increasing the survival of patients on CAPD is related to the long-term reliability of the peritoneal access. Six silicone Tenckhoff catheters (with strip or diffuse barium sulphate inclusion) removed after 39-69 months because of the appearance of external segment fissures, were analysed by scanning electron microscopy (SEM) and infra-red spectroscopy with attenuated total refractance (ATR). The extracorporeal portion of the catheters showed (by ATR) a more prominent oxidation peak on the external than the internal surface; SEM showed marks and cracks on the external surface and exfoliation and flattening of the silastic reticle on the intraluminal surface. No evidence of oxidation was found in the intra-abdominal portion of the catheters but biofilm was found. We suggest that barium sulphate may render the silastic brittle and physiological and environmental long-term factors (such as uv-rays, temperature, sweat and disinfectants) could cause oxidation and loss of physico-chemical properties, with critical aging of the silastic and loss of catheter resistance to mechanical injury. PMID:1783450

  12. Tissue response to peritoneal implants

    NASA Technical Reports Server (NTRS)

    Picha, G. J.

    1980-01-01

    Peritoneal implants were fabricated from poly 2-OH, ethyl methacrylate (HEMA), polyetherurethane (polytetramethylene glycol 1000 MW, 1,4 methylene disocynate, and ethyl diamine), and untreated and sputter treated polytetrafluoroethylene (PTFE). The sputter treated PTFE implants were produced by an 8 cm diameter argon ion source. The treated samples consisted of ion beam sputter polished samples, sputter etched samples (to produce a microscopic surface cone texture) and surface pitted samples (produced by ion beam sputtering to result in 50 microns wide by 100 microns deep square pits). These materials were implanted in rats for periods ranging from 30 minutes to 14 days. The results were evaluated with regard to cell type and attachment kinetics onto the different materials. Scanning electron microscopy and histological sections were also evaluated. In general the smooth hydrophobic surfaces attracted less cells than the ion etched PTFE or the HEMA samples. The ion etching was observed to enhance cell attachment, multinucleated giant cell (MNGC) formation, cell to cell contact, and fibrous capsule formation. The cell responsed in the case of ion etched PTFE to an altered surface morphology. However, equally interesting was the similar attachment kinetics of HEMA verses the ion etched PTFE. However, HEMA resulted in a markedly different response with no MNGC's formation, minimal to no capsule formation, and sample coverage by a uniform cell layer.

  13. A case of peritoneal dialysis-associated peritonitis caused by Sphingomonas paucimobilis.

    PubMed

    Lee, Jae Un; Kim, Joong Keun; Yun, So Hee; Park, Moon Sik; Lee, Na Eun; Sun, In O; Lee, Kwang Young

    2013-06-01

    Sphingomonas paucimobilis is an aerobic Gram-negative bacillus found in soil and water. Knowledge regarding the role of this infectious agent is limited because it is rarely isolated from human material. Furthermore, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. The clinical courses and outcomes of peritonitis caused by S. paucimobilis are variable. Whereas some patients were cured with appropriate antibiotic therapy, others required catheter removal. Cases of PD-associated peritonitis caused by S. paucimobilis have been reported worldwide, and there was a case report of coinfection with S. paucimobilis and Chryseobacterium indologenes in Korea. However, there has been no case caused by S. paucimobilis as a single pathogen. We report a case of PD-associated peritonitis due to S. paucimobilis in which the patient recovered after catheter removal.

  14. Tamoxifen Ameliorates Peritoneal Membrane Damage by Blocking Mesothelial to Mesenchymal Transition in Peritoneal Dialysis

    PubMed Central

    del Peso, Gloria; Gónzalez-Mateo, Guadalupe; Fernández-Millara, Vanessa; Santamaria, Beatríz; Bajo, Maria Auxiliadora; Sánchez-Tomero, José Antonio; Guerra-Azcona, Gonzalo; Selgas, Rafael; López-Cabrera, Manuel; Aguilera, Abelardo I.

    2013-01-01

    Mesothelial-to-mesenchymal transition (MMT) is an auto-regulated physiological process of tissue repair that in uncontrolled conditions such as peritoneal dialysis (PD) can lead to peritoneal fibrosis. The maximum expression of peritoneal fibrosis induced by PD fluids and other peritoneal processes is the encapsulating peritoneal sclerosis (EPS) for which no specific treatment exists. Tamoxifen, a synthetic estrogen, has successfully been used to treat retroperitoneal fibrosis and EPS associated with PD. Hence, we used in vitro and animal model approaches to evaluate the efficacy of Tamoxifen to inhibit the MMT as a trigger of peritoneal fibrosis. In vitro studies were carried out using omentum-derived mesothelial cells (MCs) and effluent-derived MCs. Tamoxifen blocked the MMT induced by transforming growth factor (TGF)-β1, as it preserved the expression of E-cadherin and reduced the expression of mesenchymal-associated molecules such as snail, fibronectin, collagen-I, α-smooth muscle actin, and matrix metalloproteinse-2. Tamoxifen-treatment preserved the fibrinolytic capacity of MCs treated with TGF-β1 and decreased their migration capacity. Tamoxifen did not reverse the MMT of non-epitheliod MCs from effluents, but it reduced the expression of some mesenchymal molecules. In mice PD model, we demonstrated that MMT progressed in parallel with peritoneal membrane thickness. In addition, we observed that Tamoxifen significantly reduced peritoneal thickness, angiogenesis, invasion of the compact zone by mesenchymal MCs and improved peritoneal function. Tamoxifen also reduced the effluent levels of vascular endothelial growth factor and leptin. These results demonstrate that Tamoxifen is a therapeutic option to treat peritoneal fibrosis, and that its protective effect is mediated via modulation of the MMT process. PMID:23637793

  15. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring.

    PubMed

    Li, Yan; Wang, Ji-Guang; Dolan, Eamon; Gao, Ping-Jin; Guo, Hui-Feng; Nawrot, Tim; Stanton, Alice V; Zhu, Ding-Liang; O'Brien, Eoin; Staessen, Jan A

    2006-03-01

    We hypothesized that 1 minus the slope of diastolic on systolic pressure during 24-hour ambulatory monitoring (ambulatory arterial stiffness index [AASI]) might reflect arterial stiffness. We compared AASI with established measures of arterial stiffness and studied its distribution in Chinese and European populations. We used 90207 SpaceLabs monitors and the SphygmoCor device to measure AASI, central and peripheral pulse pressures, the central (CAIx) and peripheral (PAIx) systolic augmentation indexes, and aortic pulse wave velocity. In 166 volunteers, the correlation coefficient between AASI and pulse wave velocity was 0.51 (P<0.0001). In 348 randomly recruited Chinese subjects, AASI correlated (P<0.0001) with CAIx (r=0.48), PAIx (r=0.50), and central pulse pressure (r=0.50). AASI increased with age and mean arterial pressure but decreased with body height. Both before and after adjustment for arterial wave reflections by considering height and heart rate as covariates, AASI correlated more (P<0.0001) closely with CAIx and PAIx than 24-hour pulse pressure. Among normotensive subjects, the 95th percentile of AASI was 0.55 in Chinese and 0.57 in 1617 Europeans enrolled in the International Database on Ambulatory Blood Pressure Monitoring. The upper boundary of the 95% prediction interval of AASI in relation to age ranged from 0.53 at 20 years to 0.72 at 80 years. In conclusion, AASI is a new index of arterial stiffness that can be easily measured under ambulatory conditions. Pending additional validation in outcome studies, normal values of AASI are probably <0.50 and 0.70 in young and older subjects, respectively. PMID:16432048

  16. Cost sharing and hospitalizations for ambulatory care sensitive conditions.

    PubMed

    Arrieta, Alejandro; García-Prado, Ariadna

    2015-01-01

    During the last decade, Chile's private health sector has experienced a dramatic increase in hospitalization rates, growing at four times the rate of ambulatory visits. Such evolution has raised concern among policy-makers. We studied the effect of ambulatory and hospital co-insurance rates on hospitalizations for ambulatory care sensitive conditions (ACSC) among individuals with private insurance in Chile. We used a large administrative dataset of private insurance claims for the period 2007-8 and a final sample of 2,792,662 individuals to estimate a structural model of two equations. The first equation was for ambulatory visits and the second for future hospitalizations for ACSC. We estimated the system by Two Stage Least Squares (2SLS) corrected by heteroskedasticity via Generalized Method of Moments (GMM) estimation. Results show that increased ambulatory visits reduced the probability of future hospitalizations, and increased ambulatory co-insurance decreased ambulatory visits for the adult population (19-65 years-old). Both findings indicate the need to reduce ambulatory co-insurance as a way to reduce hospitalizations for ACSC. Results also showed that increasing hospital co-insurance does have a statistically significant reduction on hospitalizations for the adult group, while it does not seem to have a significant effect on hospitalizations for the children (1-18 years-old) group. This paper's contribution is twofold: first, it shows how the level of co-insurance can be a determinant in avoiding unnecessary hospitalizations for certain conditions; second, it highlights the relevance for policy-making of using data on ACSC to improve the efficiency of health systems by promoting ambulatory care as well as population health.

  17. Emotion and ambulatory EHR in the ARRA era.

    PubMed

    Berlin, Amy

    2010-01-01

    There is a growing focus in change management literature on the role of emotion in managing change. Barriers to adoption and effective implementation of ambulatory EHR-ranging from technical to financial to logistical-are well-described in the health-care IT literature. In the ARRA era, ambulatory practices are under increasing pressure to overcome these barriers. This article explores the emotional barriers to EHR adoption and implementation in ambulatory settings, synthesizing ideas drawn from business and psychology literature on emotion in organizational change. Key strategies for assessing and addressing these barriers are outlined.

  18. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    NASA Technical Reports Server (NTRS)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  19. Microprocessor-Based Ambulatory ECG Monitoring System

    PubMed Central

    Le-Huy, P.; L'Huillier, J.P.; Oumerzouk, Y.; Yvroud, E.

    1983-01-01

    Ambulatory monitoring of electrocardiograms (ECGs) was facilitated by the introduction of Holter method in the early '60s. Since this time, many researchs have been undertaken in order to improve the overall performances of the recorder and analyser, two unseparated parts of this method. The principal drawbacks of Holter method are well-known: • Recording of ECG is based on the assumption that the arrhythmia of interest will be occurred in monitoring period. • Analysis and arrhythmia detection could be processed only after the monitoring period. This is a time-consuming and tedious job, and subjected to human error. • Process “Recording-Play-back - Analysis - Diagnosis” takes usually many days. In this paper, the design of a microprocessor - based portable recorder will be described. The analysis and classification of arrhythmia are processed immediately upon their occurrence according to a look-up table, which could be programmed to suit a particular need.

  20. Antibiotic stewardship: a focus on ambulatory care.

    PubMed

    Gangat, M Azhar; Hsu, Jennifer L

    2015-01-01

    Antibiotic resistance is one of the major health threats facing modern medicine. While there are many tactics to address this issue, antibiotic stewardship has been shown effective in reducing antimicrobial resistance, adverse drug effects, mortality and health care cost. Most antibiotic stewardship programs have evolved within acute care settings where the bulk of resistant infections are identified. Unfortunately, hospitals are just the tip of the iceberg in terms of overall antibiotic use. The vast majority of the antibiotic prescriptions are dispensed in ambulatory care settings, making this a critical target for stewardship programs. This article discusses the global need for antibiotic stewardship, highlights the importance of outpatient stewardship, and discusses strategies and challenges for implementation of stewardship in community settings.

  1. Computer database of ambulatory EEG signals.

    PubMed

    Jayakar, P B; Brusse, E; Patrick, J P; Shwedyk, E; Seshia, S S

    1987-01-01

    The paper describes an ambulatory EEG database. The database contains segments of AEEGs done on 45 subjects. Each epoch (1/8th second or more) of AEEG data has been annotated into 1 of 40 classes. The classes represent background activity, paroxysmal patterns and artifacts. The majority of classes have over 200 discrete epochs. The structure is flexible enough to allow additional epochs to be readily added. The database is stored on transportable media such as digital magnetic tape or hard disk and is thus available to other researchers in the field. The database can be used to design, evaluate and compare EEG signal processing algorithms and pattern recognition systems. It can also serve as an educational medium in EEG laboratories.

  2. Acute chylous peritonitis due to acute pancreatitis.

    PubMed

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

  3. Idiopathic encapsulating peritonitis: report of two cases.

    PubMed

    Da Luz, Magda Maria Profeta; Barral, Sumara Marques; Barral, Carlyle Marques; Bechara, Cristiane De Souza; Lacerda-Filho, Antônio

    2011-12-01

    This report presents two cases of young males who developed the rare idiopathic form of sclerosing encapsulating peritonitis (SEP) presented as partial bowel obstruction, both diagnosed during surgical treatment, with satisfactory outcomes. Sclerosing encapsulating peritonitis is a rare and enigmatic condition, characterized by intraperitoneal fibrosclerosis, which causes intestinal obstruction. It is a chronic entity with a poorly elucidated pathophysiology, leading to the constitution of a thick white nacreous fibrosis membrane that wraps the bowel in a concertina-like fashion with some adhesions configuring an intra-abdominal cocoon. Sclerosing encapsulating peritonitis is reported in a wide variety of patients, including those who have undergone peritoneal dialysis, young adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients treated with β-blockers. Nevertheless, the etiology of SEP remains obscure. This entity presents many difficulties in preoperative diagnosis because of its peculiar characteristics. Recognition of the SEP results in proper management and prevents unnecessary bowel resection. Regardless of cause, the treatment of the obstruction is surgical, with dissection of the encasing membrane from the intestine and separation of adherent loops of small bowel until they are laid free and returned to their normal configuration. The prognosis after appropriate surgical therapy is good, but depends on coexisting diseases. PMID:21969199

  4. Acute chylous peritonitis due to acute pancreatitis

    PubMed Central

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of “chyle” occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide. PMID:22563182

  5. Pyruvate anions neutralize peritoneal dialysate cytotoxicity.

    PubMed

    Mahiout, A; Brunkhorst, R

    1995-01-01

    A new peritoneal dialysate containing pyruvate anions was developed in order to avoid cytotoxic effect of conventional lactate-based dialysate. The dialysate has a final pH of 5.4 to 5.6 and is composed of 1.36-3.86% glucose-monohydrate; 132 mmol/l sodium; 1.75 mmol/l calcium; 0.75 mmol/l magnesium; 102 mmol/l chloride and 35 mmol/l pyruvate. For cytotoxicity testing peritoneal macrophages, and mesothelial cells (MC) were exposed to conventional lactate dialysate, and pyruvate dialysate. We investigated the O2- generation and cytokine synthesis after endotoxin stimulation in peritoneal macrophages and the proliferation of mesothelial cells of cultured human MC. After exposure to lactate dialysate O2- generation and cytokine synthesis in peritoneal macrophages and proliferation of mesothelial cells were inhibited when compared to solution containing pyruvate and the control solution. After preincubation with 3.86% glucose containing solutions, all negative effects became even more pronounced in the lactate group whereas after pre-exposure to pyruvate containing solution the toxic effects were absent. These results suggest that the acute toxic effects of commercially available peritoneal dialysates can be avoided by the use of sodium pyruvate instead of sodium lactate.

  6. [Ambulatory ureteral lithotripsy with "Modulith SL-20"].

    PubMed

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R

    1993-03-01

    Analysis of our experience in 'in situ' ambulatory shockwave extracorporeal lithofragmentation of ureteral stones in 104 patients seen in the Lithotrity Unit, Urology Service, Fundación "Jiménez Díaz". Using Modulith SL 20, a third generation lithotripter, 'in situ' disintegration was achieved in 82.69% of cases, 51.92% of which were fragmented in a single lithotrity session. As a first choice, no ureteral handling was used in any of the patients prior to lithotrity. In 9.62% of patients it was necessary to place a 'double J' by-pass catheter, due to the disease presenting with a septic picture. The patient's position was either dorsal or ventral decubitus depending on the lithiatic site, while location and focusing of the stones was done radiologically. All patients were treated ambulatory without hospitalization. Only 18% was given oral or i.v. anaesthesia. Fursemide 40 mg was administered to all patients shortly before starting the session. Each patient received an average of 3,200 shockwaves per session (14-18 Kv, average 16 Kv). Haematuria was the single and modest side effect that happened during the 24 hours following lithofragmentation in 30% of patients, while 20% reported slight discomfort at the time of eliminating the gritted stones. We conclude stating that 'in situ' shockwave extracorporeal lithotrity of ureteral stones with Modulith SL 20 allows for elective disintegration of ureteral stones in whatever location they are found, due to the patient's easy positioning. The simple location and focusing of ureteral stones has allowed us to treat and solve some cases of ureteral lithiasis at the precise moment of the nephritic colic painful emergency, thus speeding up and facilitating the resolution of the condition. Our results and our strategy imply a new change of direction in the management of these lithiasis, as opposed to the well established and historical doctrines in existence regarding stones with ureteral location.

  7. Development and application of a population-oriented measure of ambulatory care case-mix.

    PubMed

    Weiner, J P; Starfield, B H; Steinwachs, D M; Mumford, L M

    1991-05-01

    This article describes a new case-mix methodology applicable primarily to the ambulatory care sector. The Ambulatory Care Group (ACG) system provides a conceptually simple, statistically valid, and clinically relevant measure useful in predicting the utilization of ambulatory health services within a particular population group. ACGs are based on a person's demographic characteristics and their pattern of disease over an extended period of time, such as a year. Specifically, the ACG system is driven by a person's age, sex, and ICD-9-CM diagnoses assigned during patient-provider encounters; it does not require any special data beyond those collected routinely by insurance claims systems or encounter forms. The categorization scheme does not depend on the presence of specific diagnoses that may change over time; rather it is based on broad clusters of diagnoses and conditions. The presence or absence of each disease cluster, along with age and sex, are used to classify a person into one of 51 ACG categories. The ACG system has been developed and tested using computerized encounter and claims data from more than 160,000 continuous enrollees at four large HMOs and a state's Medicaid program. The ACG system can explain more than 50% of the variance in ambulatory resource use if used retrospectively and more than 20% if applied prospectively. This compares with 6% when age and sex alone are used. In addition to describing ACG development and validation, this article also explores some potential applications of the system for provider payment, quality assurance, utilization review, and health services research, particularly as it relates to capitated settings. PMID:1902278

  8. Peritoneal dialysis in developing countries.

    PubMed

    Nayak, K S; Prabhu, M V; Sinoj, K A; Subhramanyam, S V; Sridhar, G

    2009-01-01

    Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 billion and the two fastest growing economies worldwide. A holistic approach to tackle the issues in the developing countries, which may vary from region to region, is critical in popularizing PD and establishing PD as the first-choice RRT for ESRD. At our center, we have been pursuing a 'PD first' policy and promoting PD as the therapy of choice for various situations in the management of renal failure. We use certain novel strategies, which we hope can help PD centers in other developing countries working under similar constraints. The success of a PD program depends on a multitude of factors that are interlinked and inseparable. Each program needs to identify its strengths, special circumstances, and deficiencies, and then to strategize accordingly. Ultimately, teamwork is the 'mantra' for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program.

  9. Peritoneal dialysis in developing countries.

    PubMed

    Nayak, K S; Prabhu, M V; Sinoj, K A; Subhramanyam, S V; Sridhar, G

    2009-01-01

    Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 billion and the two fastest growing economies worldwide. A holistic approach to tackle the issues in the developing countries, which may vary from region to region, is critical in popularizing PD and establishing PD as the first-choice RRT for ESRD. At our center, we have been pursuing a 'PD first' policy and promoting PD as the therapy of choice for various situations in the management of renal failure. We use certain novel strategies, which we hope can help PD centers in other developing countries working under similar constraints. The success of a PD program depends on a multitude of factors that are interlinked and inseparable. Each program needs to identify its strengths, special circumstances, and deficiencies, and then to strategize accordingly. Ultimately, teamwork is the 'mantra' for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program. PMID:19494625

  10. Peritoneal ultrafiltration in patients with advanced decompensated heart failure.

    PubMed

    Iadarola, Gian Maria; Lusardi, Paola; La Milia, Vincenzo; Amici, Gianpaolo; Santarelli, Stefano; Virga, Giovambattista; Basile, Carlo; Bertoli, Silvio; Bonofiglio, Renzo; Del Rosso, Goffredo; Feriani, Mariano; Galli, Emilio; Gallieni, Maurizio; Gambaro, Giovanni; Sandrini, Massimo; Sisca, Sergio; Cancarini, Giovanni

    2013-01-01

    The aim of the Best Practice guidelines on peritoneal ultrafiltration (UF) in patients with treatment-resistant advanced decompensated heart failure (TR-AHDF) is to achieve a common approach to the management of decompensated heart failure in those situations in which all conventional treatment options have been unsuccessful, and to stimulate a closer cooperation between nephrologists and cardiologists. The standardization of the case series of different centers would allow a better definition of the results published in the literature, without which they are nothing more than anecdotes. TR-AHDF is characterized by the persistence of severe symptoms even when all possible pharmacological and surgical options have been exhausted. These patients are often treated with methods that allow extracorporeal UF - slow continuous ultrafiltration (SCUF) and continuous renal replacement therapy (CRRT) - which have to be performed in hospital facilities. Peritoneal ultrafiltration (PUF) can be considered a treatment option in patients with TR-AHDF when, despite the fact that all treatment options have been used, patients meet the following criteria: • stage D decompensated heart failure (ACC/AHA classification); • INTERMACS level 4 decompensated heart failure; • INTERMACS frequent flyer profile; • chronic renal failure (estimated glomerular filtration rate <50 ml/min per 1.73 m2: KDOQI classification stage 3 chronic kidney disease); • no obvious contraindications to peritoneal UF. PUF treatment modes are derived from the treatment regimens proposed by various authors to obtain systemic UF in patients with severe decompensated heart failure, using manual and automated incremental peritoneal dialysis involving various glucose concentrations in addition to the single icodextrin exchange. These guidelines also identify a minimum set of tests and procedures for the follow-up phase, to be supplemented, according to the center's resources and policy, with other tests that

  11. Newer antibiotics for the treatment of peritoneal dialysis-related peritonitis.

    PubMed

    Ma, Terry King-Wing; Leung, Chi Bon; Chow, Kai Ming; Kwan, Bonnie Ching-Ha; Li, Philip Kam-Tao; Szeto, Cheuk Chun

    2016-08-01

    Peritonitis is a debilitating infectious complication of peritoneal dialysis (PD). Drug-resistant bacterial peritonitis typically has a lower response rate to antibiotics. In the past 15 years, newer antibiotics with activities against drug-resistant Gram-positive bacteria have been developed. In most circumstances, peritonitis due to methicillin-resistant staphylococci responds to vancomycin. If vancomycin cannot be used due to allergy and/or non-susceptibility, there is increasing evidence that linezolid and daptomycin are the drugs of choice. It is reasonable to start linezolid orally or intravenously, but subsequent dose reduction may be necessary in case of myelosuppression. Daptomycin can be given intravenously or intraperitoneally and has excellent anti-biofilm activity. Other treatment options for drug-resistant Gram-positive bacterial peritonitis include teicoplanin, tigecycline and quinupristin/dalfopristin. Teicoplanin is not available in some countries (e.g. the USA). Tigecycline can only be given intravenously. Quinupristin/dalfopristin is ineffective against Enterococcus faecalis and there is only low-quality evidence to support its efficacy in the treatment of peritonitis. Effective newer antibiotics against drug-resistant Gram-negative bacteria are lacking. Polymyxins can be considered, but evidence on its efficacy is limited. In this review, we will discuss the potential use of newer antibiotics in the treatment of drug-resistant bacterial peritonitis in PD patients. PMID:27478608

  12. Newer antibiotics for the treatment of peritoneal dialysis-related peritonitis

    PubMed Central

    Ma, Terry King-Wing; Leung, Chi Bon; Chow, Kai Ming; Kwan, Bonnie Ching-Ha; Li, Philip Kam-Tao; Szeto, Cheuk Chun

    2016-01-01

    Peritonitis is a debilitating infectious complication of peritoneal dialysis (PD). Drug-resistant bacterial peritonitis typically has a lower response rate to antibiotics. In the past 15 years, newer antibiotics with activities against drug-resistant Gram-positive bacteria have been developed. In most circumstances, peritonitis due to methicillin-resistant staphylococci responds to vancomycin. If vancomycin cannot be used due to allergy and/or non-susceptibility, there is increasing evidence that linezolid and daptomycin are the drugs of choice. It is reasonable to start linezolid orally or intravenously, but subsequent dose reduction may be necessary in case of myelosuppression. Daptomycin can be given intravenously or intraperitoneally and has excellent anti-biofilm activity. Other treatment options for drug-resistant Gram-positive bacterial peritonitis include teicoplanin, tigecycline and quinupristin/dalfopristin. Teicoplanin is not available in some countries (e.g. the USA). Tigecycline can only be given intravenously. Quinupristin/dalfopristin is ineffective against Enterococcus faecalis and there is only low-quality evidence to support its efficacy in the treatment of peritonitis. Effective newer antibiotics against drug-resistant Gram-negative bacteria are lacking. Polymyxins can be considered, but evidence on its efficacy is limited. In this review, we will discuss the potential use of newer antibiotics in the treatment of drug-resistant bacterial peritonitis in PD patients. PMID:27478608

  13. Clinical effects of icodextrin in peritoneal dialysis.

    PubMed

    Cnossen, Trijntje T; Konings, Constantijn J; van der Sande, Frank M; Leunissen, Karel M; Kooman, Jeroen P

    2008-10-01

    Objective. This study reviews the relevant publications on the clinical effects of icodextrin in peritoneal dialysis (PD). Design. The study provides a systematic review of the literature (MEDLINE search with icodextrin as the keyword). Results. Icodextrin induces sustained transcapillary ultrafiltration during long dwell periods. It also stimulates increased removal of sodium by the peritoneal membrane, reduction of extracellular water (ECW) and total body water (TBW). Effects of icodextrin on blood pressure control and residual renal function are discrepant. Icodextrin induces a reduction in the formation of advanced glycation end-products, while the longitudinal changes in the peritoneal membrane transport are less prominent. Conclusions. Use of icodextrin in PD improves the sodium and fluid balance. Icodextrin is potentially more biocompatible, when compared with the conventional glucose solutions. The side effects are rare.

  14. Intestinal obstruction associated with chronic peritonitis caused by Sphingomonas paucimobilis.

    PubMed

    Di Leo, Alberto; Busetti, Rosanna; Pusiol, Teresa; Piscioli, Francesco; Franceschetti, Ilaria; Ricci, Francesco

    2009-06-01

    We describe a very rare case of chronic peritonitis with secondary adhesive intestinal obstruction caused by Sphingomonas paucimobilis in a healthy 28-year-old Chinese man. This bacillus has not been described as a cause of spontaneous peritonitis in healthy people. It was an asymptomatic, generalized, and slow-growing peritonitis causing peritoneal adherens and at the end intestinal occlusion that needed surgical adhesiolysis.

  15. Comprehensive ambulatory medicine training for categorical internal medicine residents.

    PubMed

    Bharel, Monica; Jain, Sharad; Hollander, Harry

    2003-04-01

    It is challenging to create an educational and satisfying experience in the outpatient setting. We developed a 3-year ambulatory curriculum that addresses the special needs of our categorical medicine residents with distinct learning objectives for each year of training and clinical experiences and didactic sessions to meet these goals. All PGY1 residents spend 1 month on a general medicine ambulatory care rotation. PGY2 residents spend 3 months on an ambulatory block focusing on 8 core medicine subspecialties. Third-year residents spend 2 months on an advanced ambulatory rotation. The curriculum was started in July 2000 and has been highly regarded by the house staff, with statistically significant improvements in the PGY2 and PGY3 evaluation scores. By enhancing outpatient clinical teaching and didactics with an emphasis on the specific needs of our residents, we have been able to reframe the thinking and attitudes of a group of inpatient-oriented residents. PMID:12709096

  16. Ambulatory blood pressure monitoring during exercise and physical activity.

    PubMed

    White, W B

    1991-12-01

    Ambulatory blood pressure recorders have two potential advantages over standard casual blood pressure measurements; they are able to take multiple recordings automatically throughout the day and night and also during the activities of normal daily living. At present, the general recommendations for validation of blood pressure recorders do not include assessment during motion. In order to obtain accurate information on an ambulatory blood pressure recorder's capabilities during exercise or physical activity, the blood pressure standard must use direct (intra-arterial) measurements. Data from some of the existing ambulatory blood pressure recorders suggest that many are accurate during resting measurements but lose their precision when the subjects are walking or during exercise. If ambulatory recorders are to be used in ambulant conditions with a moving arm, the device should be validated for accuracy and reliability during motion, using simultaneous direct measurements for comparison. PMID:1795196

  17. [Ambulatory procedures to replace inpatient care. Background and applications].

    PubMed

    Hensen, P; Bunzemeier, H; Fürstenberg, T; Luger, T A; Rochell, B; Roeder, N

    2004-07-01

    Since January 2004, German hospitals and specialists in private practice have equal rights to provide and to charge for ambulatory surgeries according to paragraph 115b, 5th Code of Social Law. The current agreement between the German self-governing bodies replaces the existing contracts from 1993. In contrast to the previous version, the revised catalogue contains additional non-operative procedures. Some procedures may be provided either in an ambulatory or inpatient setting. However, for the hospitals it is of particular importance that some specified procedures should be performed on an ambulatory basis. If these particular services are delivered in an inpatient setting at least one stipulated criteria of exception has to be fulfilled. From the perspective of dermatology, not only opportunities but also obligations for ambulatory care arise from the new conditions. The critical facts and aspects with special relevance to dermatology are reviewed in detail. PMID:15168028

  18. Secondary Peritonitis Caused by Streptomyces viridis

    PubMed Central

    Arora, Shilpa; Jain, Ruby; Chander, Jagdish; van de Sande, Wendy

    2012-01-01

    Streptomyces organisms are soil inhabitants rarely causing nonmycetomic infections. We describe a case of secondary peritonitis caused by Streptomyces viridis in a chronic alcoholic patient who presented with fever, abdominal distension, and pain in the abdomen. The most likely source of infection was by inoculation through multiple paracenteses, done for treatment of ascites, before the patient came to our health care center. This is the second case report of Streptomyces peritonitis and the first case caused by Streptomyces viridis, which is usually found in the soil in our geographic region. PMID:22337982

  19. Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

    PubMed Central

    Ul-Haq, Anwar; Al-Otaibi, Faisal; Alshanafey, Saud; Sabbagh, Mohamed Diya; Al Shail, Essam

    2013-01-01

    The ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. The peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identified a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted after the infection was healed. This type of complication occurs rarely, so there are a limited number of case reports in the literature. This report is complemented by a literature review. PMID:24109528

  20. Pros and cons of the ambulatory surgery center joint venture.

    PubMed

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  1. Low level of self-reported physical activity in ambulatory patients new to dialysis.

    PubMed

    Johansen, Kirsten L; Chertow, Glenn M; Kutner, Nancy G; Dalrymple, Lorien S; Grimes, Barbara A; Kaysen, George A

    2010-12-01

    Physical inactivity contributes to the frailty and the decline in function that develops over time among patients with end-stage renal disease. We assessed physical activity among 1547 ambulatory patients new to dialysis in the United States Renal Data System Comprehensive Dialysis Study. We used a self-reporting Human Activity Profile that included Maximal and Adjusted Activity Scores and compared results to established norms by age and gender. Physical activity was found to be extremely low with scores for all age and gender categories below the 5th percentile of healthy individuals and 95% of patients had scores consonant with low fitness. Older age, female gender, diabetes, atherosclerotic disease, and a low level of education were associated with lower activity scores assessed by univariate and multivariable linear regression analysis. Higher serum albumin, creatinine, and lower body mass index, but not hemoglobin levels, were associated with greater physical activity. By multivariable analysis, patients on hemodialysis using a catheter reported lower levels of physical activity compared to those on peritoneal dialysis, hemodialysis using an arteriovenous fistula, or with a graft. Lower Maximal and Adjusted Activity Scores were associated with poor physical function and mental health. Hence, physical activity is distressingly low among patients new to dialysis. Thus, strategies to enhance activity in these patients should be explored.

  2. Ambulatory respiratory rate detection using ECG and a triaxial accelerometer.

    PubMed

    Chan, Alexander M; Ferdosi, Nima; Narasimhan, Ravi

    2013-01-01

    Continuous monitoring of respiratory rate in ambulatory conditions has widespread applications for screening of respiratory diseases and remote patient monitoring. Unfortunately, minimally obtrusive techniques often suffer from low accuracy. In this paper, we describe an algorithm with low computational complexity for combining multiple respiratory measurements to estimate breathing rate from an unobtrusive chest patch sensor. Respiratory rates derived from the respiratory sinus arrhythmia (RSA) and modulation of the QRS amplitude of electrocardiography (ECG) are combined with a respiratory rate derived from tri-axial accelerometer data. The three respiration rates are combined by a weighted average using weights based on quality metrics for each signal. The algorithm was evaluated on 15 elderly subjects who performed spontaneous and metronome breathing as well as a variety of activities of daily living (ADLs). When compared to a reference device, the mean absolute error was 1.02 breaths per minute (BrPM) during metronome breathing, 1.67 BrPM during spontaneous breathing, and 2.03 BrPM during ADLs.

  3. Asaia bogorensis peritonitis identified by 16S ribosomal RNA sequence analysis in a patient receiving peritoneal dialysis.

    PubMed

    Snyder, Richard W; Ruhe, Jorg; Kobrin, Sidney; Wasserstein, Alan; Doline, Christa; Nachamkin, Irving; Lipschutz, Joshua H

    2004-08-01

    Here the authors report a case of refractory peritonitis leading to multiple hospitalizations and the loss of peritoneal dialysis access in a patient on automated peritoneal dialysis, caused by Asaia bogorensis, a bacterium not previously described as a human pathogen. This organism was identified by sequence analysis of the 16S ribosomal RNA gene. Unusual microbial agents may cause peritonitis, and molecular microbiological techniques are important tools for identifying these agents.

  4. Evaporation versus iced peritoneal lavage treatment of heatstroke: comparative efficacy in a canine model.

    PubMed

    White, J D; Kamath, R; Nucci, R; Johnson, C; Shepherd, S

    1993-01-01

    The authors compared the speed of cooling and treatment efficacy for evaporative cooling versus iced peritoneal lavage in a canine heatstroke model. Nine random-source, mongrel dogs were anesthetized, shaved, and internally heated until the core temperature reached 43.0 degrees C. The animals were then randomly assigned to be cooled to 37 degrees C either by sterile normal saline (6 degrees C) continuous peritoneal lavage at 250 mL/min (n = 4), or by spraying with tap water (15 degrees C, 12 L/min) before a large fan blowing room temperature air (23 degrees C) across the dog at 0.5 m/sec from a height of 50 cm (n = 5). Temperatures were monitored by thermocouples in both tympanic membranes. Electrocardiogram, blood pressure, and pulse were continuously monitored. Evaporative cooling was as rapid as iced peritoneal lavage (0.18 +/- .03 versus 0.17 +/- .07 degrees C/min/m2, P = NS). All animals survived, although one animal in each treatment group demonstrated a moderate neurologic deficit when measured 48 hours following resuscitation. A simple noninvasive evaporative cooling technique, readily available in the emergency department, appears to be as rapid readily available in the emergency department, appears to be as rapid and effective as aggressive peritoneal lavage for cooling and treating heatstroke in the dog. PMID:8447861

  5. Infection as a cause of peritoneal catheter dysfunction in ventriculo-peritoneal shunting in children.

    PubMed

    Frykberg, T; Olden, L

    1983-12-01

    Peritoneal catheter dysfunction is a significant complication of VP shunting in children. Improvement in technique and material should reduce complications such as detachment and breakage. Shunt infection, even if subclinical, should be suspected as the cause of early peritoneal catheter obstruction, especially if recurrent, as well as in cases of organ perforation. Cultures, prolonged if necessary, should be taken and infection should be treated prior to shunt revision. We have had no recurrence of infection or peritoneal catheter dysfunction after treatment with exteriorization of the infected shunt, antibiotic therapy and insertion of a new shunt on the contralateral side. In infected cases antibiotic therapy, both pre- and intra-operatively, should be a matter of course. With these precautions a better result with the ventriculo-peritoneal shunt should be achieved.

  6. A Case of Unsuspected Peritoneal Mesothelioma Occurring with Colonic Adenocarcinoma Masquerading as Peritoneal Metastases

    PubMed Central

    Green, Linda K.; Patel, Rishi A.; Lai, Syeling

    2014-01-01

    We report a case of synchronous primary colonic adenocarcinoma and malignant mesothelioma. A 61-year-old male presented with a six-month history of fatigue and weight loss. An abdominal computed tomography (CT) scan showed a 5.8 cm partially obstructing mass in the cecum with ascites and peritoneal thickening. A biopsy of the large mass showed an adenocarcinoma. Because the patient was clinically thought to be a T4 colon carcinoma with peritoneal metastatic lesions (M1), prior to initiating chemotherapy, a debulking right hemicolectomy was performed. Resection of the colon and ileum revealed a T3N0 colonic mucinous adenocarcinoma and concurrent diffuse malignant peritoneal mesothelioma. Presenting synchronous colonic and peritoneal mesothelial primary malignancies are exceedingly rare but must be considered to prevent incorrect clinical staging. PMID:24963429

  7. A case of peritoneal dialysis-associated peritonitis by Rothia mucilaginosa.

    PubMed

    Kim, Byeong Gwan; Cho, A Young; Kim, Sang Sun; Lee, Seong Hee; Shin, Hong Shik; Yoon, Hyun Ju; Kim, Jeong Gwan; Sun, In O; Lee, Kwang Young

    2015-09-01

    Rothia muciliaginosa (R. mucilaginosa) is a facultative, Gram-positive coccus that is considered to be part of the normal flora of the mouth and respiratory tract. There are sporadic reports of the organism causing endocarditis in patients with heart valve abnormalities, as well as meningitis, septicemia, and pneumonia associated with intravenous drug abuse. However, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. Although R. mucilaginosa is generally susceptible to penicillin, ampicillin, cefotaxime, imipenem, rifampicin, and glycopeptides, there are no guidelines for the treatment of PD-associated peritonitis. Herein, we report a case of PD-associated peritonitis due to R. mucilaginosa that was resolved with intraperitoneal antibiotic treatment. PMID:26484045

  8. Asbestos and peritoneal mesothelioma among college-educated men.

    PubMed

    Welch, Laura S; Acherman, Yair I Z; Haile, Elizabeth; Sokas, Rosemary K; Sugarbaker, Paul H

    2005-01-01

    The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.

  9. Comamonas testosteroni-associated peritonitis in a pediatric peritoneal dialysis patient.

    PubMed

    Parolin, Mattia; Baraldi, Maura; Valentini, Elena; Murer, Luisa; Vidal, Enrico

    2016-03-01

    Comamonas testosteroni (C. testosteroni) has been rarely observed as an infectious agent in clinical practice. Few reports described its potential pathogenicity in bloodstream and abdominal infections. Here, we report our experience in the treatment of a C. testosteroni-associated peritonitis in a four-year-old girl receiving chronic peritoneal dialysis (PD). The organism was shown to be highly susceptible to appropriate antibiotic therapy. Infection responded promptly and the patient was managed conservatively without withdrawal from PD.

  10. Looking up: Recent advances in understanding and treating peritoneal carcinomatosis.

    PubMed

    Lambert, Laura A

    2015-01-01

    Until recently, a diagnosis of peritoneal carcinomatosis was uniformly accompanied by a grim prognosis that was typically measured in weeks to months. Consequently, the management of carcinomatosis revolves largely around palliation of symptoms such as bowel obstruction, nausea, pain, fatigue, and cachexia. A prior lack of effective treatment options created the nihilistic view that currently exists and persists despite improvements in the efficacy of systemic therapy and the evolution of multimodality approaches including surgery and intraperitoneal chemotherapy. This article reviews the evolution and current state of treatment options for patients with peritoneal carcinomatosis. In addition, it highlights recent advances in understanding the molecular biology of carcinomatosis and the focus of current and future clinical trials. Finally, this article provides practical management options for the palliation of common complications of carcinomatosis. It is hoped that the reader will recognize that carcinomatosis is no longer an imminent death sentence and that through continued research and therapeutic innovation, clinicians can make an even greater impact on this form of metastatic cancer.

  11. Removal of phosphorus by peritoneal dialysis.

    PubMed

    Delmez, J A

    1993-01-01

    Substantial evidence exists that peritoneal dialysis, as currently practiced, cannot alone remove adequate amounts of phosphorus in well-nourished patients. Current efforts should address the possibility of developing improved nontoxic oral phosphorus binders and/or different compositions of dialysate fluid. PMID:8399639

  12. Pasteurella species peritoneal dialysis-associated peritonitis: Household pets as a risk factor

    PubMed Central

    Poliquin, Philippe Guillaume; Lagacé-Wiens, Philippe; Verrelli, Mauro; Allen, David W; Embil, John M

    2015-01-01

    BACKGROUND: Pasteurella species are Gram-negative coccobacilli that are a part of the normal oropharyngeal flora of numerous domestic animals. They have been recognized as a rare but significant cause of peritonitis in patients undergoing peritoneal dialysis (PD). A consensus about management strategies for PD-associated peritonitis caused by Pasteurella species currently does not exist. METHODS: The microbiological database serving the Manitoba Renal Program was searched from 1997 to 2013 for cases of Pasteurella species PD-associated peritonitis, and charts were reviewed. PubMed was searched for case reports and data were abstracted. RESULTS: Seven new local cases and 30 previously reported cases were analyzed. This infection is clinically similar to other forms of PD peritonitis, with household pet exposure appearing to be the strongest risk factor. Cats are the most commonly implicated pet. Direct contact between the pet and the equipment was commonly reported (25 of 37 patients) but was not necessary for infection to develop. The mean duration of treatment was 15 days. Complication rates were low, with only 11% of patients requiring PD catheter removal. There was no mortality reported. CONCLUSION: Pasteurella species are a rare cause of PD-associated peritonitis that can be successfully treated with a two-week course of intraperitoneal antibiotics with a high likelihood of catheter salvage. PMID:25798157

  13. Peritoneal adhesions after laparoscopic gastrointestinal surgery

    PubMed Central

    Mais, Valerio

    2014-01-01

    Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than

  14. Cognitive Impairment in Peritoneal Dialysis Patients

    PubMed Central

    Kalirao, Paramjit; Pederson, Sarah; Foley, Robert N.; Kolste, Ali; Tupper, David; Zaun, David; Buot, Vanessa; Murray, Anne M.

    2011-01-01

    Background Prevalence of moderate to severe cognitive impairment among hemodialysis patients is more than double the prevalence in the general population. This study describes cognitive impairment occurrence in a peritoneal dialysis cohort compared with a cohort without chronic kidney disease (CKD). Study Design Cross-sectional study. Setting and Participants 51 English-speaking peritoneal dialysis patients from two urban dialysis units, compared with 338 hemodialysis patients from 16 urban dialysis units and 101voluntary controls without CKD from urban general medicine clinics. Predictor A 45-minute battery of nine validated neuropsychological tests (cognitive domains memory, executive function, language). Outcomes Mild, moderate, or severe cognitive impairment, classified according to a previously designed algorithm. Results Of the peritoneal dialysis cohort, 33.3% had no or mild, 35.3% moderate, and 31.4% severe cognitive impairment; corresponding values were 60.4%, 26.7%, and 12.9% of the non-CKD cohort, and 26.6%, 36.4%, and 37.0% of the hemodialysis cohort. A logistic regression model including age, sex, race, education, hemoglobin, diabetes, and stroke showed that only non-white race (P = 0.002) and education (P = 0.002) were associated with moderate to severe cognitive impairment in the peritoneal dialysis cohort. Compared with hemodialysis patients, more peritoneal dialysis patients had moderate to severe memory impairment (60% vs. 52%), but fewer had impaired executive function (one-third vs. one-half). Peritoneal dialysis was associated with a more than 2.5-fold increased risk of moderate to severe cognitive impairment compared with no CKD (OR, 2.58; 95% confidence interval 1.02-6.53), as was hemodialysis (OR, 3.16; 95% CI, 1.91-5.24), in an adjusted logistic regression model. Limitations Small sample size, participation rate somewhat low. Conclusions Similar to hemodialysis patients, two-thirds of peritoneal dialysis patients had moderate to severe

  15. Syndromic Surveillance Using Ambulatory Electronic Health Records

    PubMed Central

    Hripcsak, George; Soulakis, Nicholas D.; Li, Li; Morrison, Frances P.; Lai, Albert M.; Friedman, Carol; Calman, Neil S.; Mostashari, Farzad

    2009-01-01

    Objective To assess the performance of electronic health record data for syndromic surveillance and to assess the feasibility of broadly distributed surveillance. Design Two systems were developed to identify influenza-like illness and gastrointestinal infectious disease in ambulatory electronic health record data from a network of community health centers. The first system used queries on structured data and was designed for this specific electronic health record. The second used natural language processing of narrative data, but its queries were developed independently from this health record. Both were compared to influenza isolates and to a verified emergency department chief complaint surveillance system. Measurements Lagged cross-correlation and graphs of the three time series. Results For influenza-like illness, both the structured and narrative data correlated well with the influenza isolates and with the emergency department data, achieving cross-correlations of 0.89 (structured) and 0.84 (narrative) for isolates and 0.93 and 0.89 for emergency department data, and having similar peaks during influenza season. For gastrointestinal infectious disease, the structured data correlated fairly well with the emergency department data (0.81) with a similar peak, but the narrative data correlated less well (0.47). Conclusions It is feasible to use electronic health records for syndromic surveillance. The structured data performed best but required knowledge engineering to match the health record data to the queries. The narrative data illustrated the potential performance of a broadly disseminated system and achieved mixed results. PMID:19261941

  16. Hospital-based, acute care following ambulatory surgery center discharge

    PubMed Central

    Fox, Justin P.; Vashi, Anita A.; Ross, Joseph S.; Gross, Cary P.

    2014-01-01

    Background As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. However, this may underestimate patient’s acute care needs after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Methods Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or surgical procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. Results We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1/1,000 discharges (95% CI, 1.1–1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8/1,000 discharges (95% CI, 31.6–32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median=1.0/1,000 discharges [25th–75th percentile=1.0–2.0]), while substantial variation existed in adjusted hospital-based, acute care rates (28.0/1,000 [21.0–39.0]). Conclusions Among adult patients undergoing ambulatory surgery center care, hospital transfer at discharge is a rare event. In contrast, the hospital-based, acute care rate is nearly 30-fold higher, varies across centers, and may be a more meaningful measure for discriminating quality. PMID:24787100

  17. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

    PubMed

    Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

    2016-08-01

    OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (P<.0001), and respiratory (P=.01) surgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

  18. The effect of ambulatory oncology nursing practice models on health resource utilization. Part 2, Different practice models--different use of health resources?

    PubMed

    Porter, H B

    1995-02-01

    The continuous rise in healthcare expenditures concerns providers, recipients, and payers alike, all of whom seek to explain, justify, or contain these costs. Although nurses are major healthcare providers in ambulatory oncology settings, the efficiency or productivity of nursing, expressed as frequency and cost of services (resource utilization), has not been addressed. Part 1 presented findings from a retrospective comparative study that delineated two different models of oncology nursing practice, the Nurse Complement Model and the Nurse Substitute Model of practice. Part 2 discusses these differences in the economic effectiveness of ambulatory oncology nursing in terms of health resource utilization. PMID:7844628

  19. Disaster planning for peritoneal dialysis programs.

    PubMed

    Kleinpeter, Myra A; Norman, Lisa D; Krane, N Kevin

    2006-01-01

    Because of increased intensity of hurricanes in the Gulf Coast region of the United States, peritoneal dialysis (PD) programs have been disrupted and patients relocated temporarily following these catastrophic events. We describe the disaster planning, implementation, and follow-up that occurred in one such PD program in New Orleans following Hurricane Katrina. Each year at the beginning of the North American hurricane season, the PD program's disaster plan is reviewed by clinic staff and copies are distributed to patients. Patients are instructed to assemble a disaster kit and are provided with contact numbers for dialysis suppliers and for a PD program in their planned evacuation city. In July 2005, this disaster plan was tested when an early tropical storm and hurricane entered the Gulf and several patients briefly relocated or evacuated because of power loss and then returned without incident. However, when Hurricane Katrina, a category 5 storm, was predicted to strike the metropolitan area, patients were notified by telephone to evacuate, and contact information, including their evacuation city and telephone and cellular phone numbers, was obtained. Patients were also reminded to take all medications, bottled water, antibacterial soap, hand sanitizer, and 4-5 days of PD supplies. Following the storm, telephone and cellular phone services were severely disrupted. However, text messaging was available to contact patients to confirm safety and to provide further instructions. Arrangements with the major dialysis suppliers to ship emergency supplies to new locations were made by the PD nurse and the patients. Only 2 of 22 patients required hospitalization because of complications resulting from evacuation failure, contamination, and inability to perform dialysis for a prolonged period of time. Both of these patients were quickly released and have continued PD. Following the event, all patients remained on PD, and most have planned to return to their home PD

  20. Disaster planning for peritoneal dialysis programs.

    PubMed

    Kleinpeter, Myra A; Norman, Lisa D; Krane, N Kevin

    2006-01-01

    Because of increased intensity of hurricanes in the Gulf Coast region of the United States, peritoneal dialysis (PD) programs have been disrupted and patients relocated temporarily following these catastrophic events. We describe the disaster planning, implementation, and follow-up that occurred in one such PD program in New Orleans following Hurricane Katrina. Each year at the beginning of the North American hurricane season, the PD program's disaster plan is reviewed by clinic staff and copies are distributed to patients. Patients are instructed to assemble a disaster kit and are provided with contact numbers for dialysis suppliers and for a PD program in their planned evacuation city. In July 2005, this disaster plan was tested when an early tropical storm and hurricane entered the Gulf and several patients briefly relocated or evacuated because of power loss and then returned without incident. However, when Hurricane Katrina, a category 5 storm, was predicted to strike the metropolitan area, patients were notified by telephone to evacuate, and contact information, including their evacuation city and telephone and cellular phone numbers, was obtained. Patients were also reminded to take all medications, bottled water, antibacterial soap, hand sanitizer, and 4-5 days of PD supplies. Following the storm, telephone and cellular phone services were severely disrupted. However, text messaging was available to contact patients to confirm safety and to provide further instructions. Arrangements with the major dialysis suppliers to ship emergency supplies to new locations were made by the PD nurse and the patients. Only 2 of 22 patients required hospitalization because of complications resulting from evacuation failure, contamination, and inability to perform dialysis for a prolonged period of time. Both of these patients were quickly released and have continued PD. Following the event, all patients remained on PD, and most have planned to return to their home PD

  1. Draining Fluids through a Peritoneal Catheter in Newborns after Cardiac Surgery Helps to Control Fluid Balance.

    PubMed

    Ruano Cea, Elisa; Jouvet, Philippe; Vobecky, Suzanne; Merouani, Aicha

    2010-01-01

    Dialysis can be used in severe cases, but may not be well tolerated. In such patients, peritoneal drainage could be an alternative option for fluid removal. We report the case of a newborn with a truncus arteriosus who developed postoperatively a complicated clinical course with right ventricular dysfunction, prerenal condition as well as fluid overload despite diuretic therapy. Dialysis was indicated for fluid removal. Peritoneal dialysis was started using a surgically placed Tenckhoff catheter and stopped due to inefficacy and leaks and no other modalities of dialysis were used. However, the catheter was left in place over a period of two months for fluid drainage and removed because of unexplained fever. In order to determine the effect of peritoneal drainage, we selected a period of one week before and one week after the removal of the drain to compare daily clinical data, urine electrolytes and renal function and found a positive effect on fluid balance control. We conclude that the fluid removal by continuous peritoneal drainage is a simple and safe alternative that can be used to control fluid balance in infants after cardiac surgery. PMID:20379389

  2. Peritoneal absorption of pancreatic enzymes in bile-induced acute pancreatitis in dogs.

    PubMed

    Sugimoto, Y; Hayakawa, T; Kondo, T; Shibata, T; Kishimoto, W

    1990-01-01

    To clarify the contribution of peritoneal absorption of enzyme-rich exudate to the persistent elevation of serum amylase in bile-induced pancreatitis in dogs, serum amylase, lipase and immunoreactive trypsin (IRT) levels were measured during 24 h after induction of pancreatitis with and without peritoneal lavage. The basal level of serum amylase activity (m +/- s.e. = 1291 +/- 111 U/L) reached a plateau at 30 min (2688 +/- 185) after induction of pancreatitis and continued to rise until 24 h (7201 +/- 424). This persistent amylase elevation could be reduced significantly by peritoneal lavage. Serum IRT rose to a peak (378 +/- 103 ng/mL) at 30 min from the basal (20 +/- 5), then decreased until 3 h (211 +/- 34) and maintained a consistent level thereafter. Serum lipase elevation took an intermediate course between the levels of serum amylase and IRT. Intraperitoneal injection of 5 mL pancreatic juice could reproduce similar elevations to those of the respective enzymes, except lipase, seen in pancreatitis. These results suggest that transperitoneal absorption of pancreatic enzymes contributes to the elevation in serum enzymes levels and that rates of peritoneal absorption and serum disappearance differ from enzyme to enzyme.

  3. Practical guidelines for automated peritoneal dialysis.

    PubMed

    Sritippayawan, Suchai; Nilwarangkur, Sukij; Aiyasanon, Nipa; Jattanawanich, Parnthip; Vasuvattakul, Somkiat

    2011-09-01

    The development of APD technologies enables physician to customize PD treatment for optimal dialysis. Dialysis dose can be increased with APD alone or in conjunction with daytime dwells. Although there is no strong evidence of the advantage over CAPD, APD is generally recommended for patients having a high peritoneal transport, outflow problems or high intraperitoneal pressure (IPP) and those who depend on caregivers for their dialysis. The benefits of APD over CAPD depends on the problems and treatment results among dialysis centers. Before starting the APD, medical, psychosocial and financial aspects, catheter function, residual renal function (RRF), body surface area and peritoneal transport characteristic must be evaluated. The recommended starting prescription for APD is the dwell volume of 1,500 ml/m2, 2 hours/cycle, and 5 cycles/session, which will provides 10-15 L of total volume and 10 hours per session. The IPP should be monitored and kept below 18 cmH2O. NIPD is accepted for patients with significant RRF. Anuric patients usually require 15-20 L of total fill volume and may need 1-2 day-dwells of 2L icodextrin or hypertonic glucose solutions. Small solute clearances and ultrafiltration depend on the peritoneal catheter function and dialysis schedule. The clinical outcomes and small solute clearances must be monitored and adjusted accordingly to meet the weekly total Kt/V urea > or = 1.7 and in low peritoneal transporters, the weekly total CCr should be > or = 45 L/1.73 m2. The volume status must be normal. To diagnose the peritonitis in NIPD patients, 1 L of PDF should be infused and permitted to dwell for 2 hours before sending for analysis. The differential of white cell count may be more useful than the total cell counts. In Siriraj Hospital, APD patients had 1.5-3 times less peritonitis than CAPD patients and most of our anuric patients can achieve the weekly total Kt/V urea target with 10 L of NIPD.

  4. Understanding the Diffusion of Ambulatory Surgery Centers

    PubMed Central

    Suskind, Anne M.; Zhang, Yun; Dunn, Rodney L.; Hollingsworth, John M.; Strope, Seth A.; Hollenbeck, Brent K.

    2015-01-01

    Background Outpatient surgery is increasingly delivered at freestanding ambulatory surgery centers (ASCs), which are thought to deliver quality care at lower costs per episode. The objective of this study was to understand potential facilitators and/or barriers to the introduction of freestanding ASCs in the United States. Methods This is an observational study conducted from 2008–2010 using a 20% sample of Medicare claims. Potential determinants of ASC dissemination, including population, system, and legal factors, were compared between markets that always had ASCs, never had ASCs, and those that had new ASCs open during the study. Multivariable logistic regression was used to determine characteristics of markets associated with the opening of a new facility in a previously naïve market. Results New ASCs opened in 67 previously naïve markets between 2008 and 2010. ASCs were more likely to open in HSAs that were urban (adjusted OR 4.10; 95% CI 1.51–10.96), had higher per capita income (adjusted OR 3.83; 95% CI 1.43–10.45), and had less competition for outpatient surgery (adjusted OR 2.13; 95% CI 1.02–4.45). Legal considerations and latent need, as measured by case volumes of hospital-based outpatient surgery in 2007, were not associated with the opening of a new ASC. Conclusions Freestanding ASCs opened in advantageous socioeconomic environments with the least amount of competition. Because of their associated efficiency advantages, policymakers might consider strategies to promote ASC diffusion in disadvantaged markets to potentially improve access and reduce costs. PMID:25143440

  5. Prognostic Relevance of the Peritoneal Surface Disease Severity Score Compared to the Peritoneal Cancer Index for Colorectal Peritoneal Carcinomatosis

    PubMed Central

    Ng, Jia Lin; Ong, Whee Sze; Chia, Claramae Shulyn; Tan, Grace Hwei Ching; Soo, Khee-Chee; Teo, Melissa Ching Ching

    2016-01-01

    Background. Peritoneal Carcinomatosis Index (PCI) is a widely established scoring system that describes disease burden in isolated colorectal peritoneal carcinomatosis (CPC). Its significance may be diminished with complete cytoreduction. We explore the utility of the recently described Peritoneal Surface Disease Severity Score (PSDSS) and compare its prognostic value against PCI. Methods. The endpoints were overall survival (OS), progression-free survival (PFS), and survival less than 18 months (18 MS). Results. Fifty patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for CPC from 2003 to 2014, with 98% achieving complete cytoreduction. Median OS was 28.8 months (95% CI, 18.0–39.1); median PFS was 9.4 months (95% CI, 7.7–13.9). Univariate analysis showed that higher PCI was significantly associated with poorer OS (HR 1.11; 95% CI, 1.03–1.20) and PFS (HR 1.09; 95% CI, 1.03–1.14). Conversely, PSDSS was not associated with either endpoint. Multivariate analysis showed that PCI, but not PSDSS, was predictive of OS and PFS. PCI was also able to discriminate survival outcomes better than PSDSS for both OS and PFS. There was no association between 18 MS and either score. Conclusion. PCI is superior to PSDSS in predicting OS and PFS and remains the prognostic score of choice in CPC patients undergoing CRS/HIPEC. PMID:27006828

  6. Cisplatin and Flavopiridol in Treating Patients With Advanced Ovarian Epithelial Cancer or Primary Peritoneal Cancer

    ClinicalTrials.gov

    2014-05-06

    Recurrent Ovarian Epithelial Cancer; Recurrent Primary Peritoneal Cavity Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Primary Peritoneal Cavity Cancer

  7. Fungal Peritonitis: Underestimated Disease in Critically Ill Patients with Liver Cirrhosis and Spontaneous Peritonitis

    PubMed Central

    Lahmer, Tobias; Brandl, Andreas; Rasch, Sebastian; Schmid, Roland M.; Huber, Wolfgang

    2016-01-01

    Introduction Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. Methods Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. Results Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP). APACHE II and SOFA score were significantly higher in patients with SFP (26; 22–28; p<0.004 and 16; 14–18; p<0.002), SBP (26; 22–28; p<0.004 and 16; 14–18; p<0.002) and SP (24; 18–30; p<0.045 and 14; 10–18; p<0.044) as compared to NP (22; 16–24 and 12; 10–14). CHILD Pugh classification was mainly CHILD C and MELD Score was in patients with SFP (34; 18–40; p<0.001), SBP (32;12–40 p<0.002) and SP (29; 14–40 p<0.003) significantly higher as compared to NP (25;8–40). Nosocomial peritonitis could be significantly more often found in patients with SFP (65%; p<0.023) and SBP (62%, p<0.030) as compared to SP (51 p = 0.243) and NP (45%). Antibiotic pretreatment last 3 month prior peritonitis was significantly more often in patients with SFP (85%; p<0.002), SBP (71%, p<0.033), and SP (56; p<0.040) as compared to NP (33%). Candida albicans (60%; 12/20) was the most common isolated fungus, followed by Candida glabrata (13%) and Candida krusei (13%). Mortality rate was significantly higher in patients with SFP (90%, p<0.001), followed by SBP (75%; p<0.001) and SP (69%; p<0.001) as compared to NP (45%). Conclusion SFP is not a rare complication in end stage liver disease which is associated with increased mortality. Physicians should be aware of SFP in patients with CHILD C liver cirrhosis, elevated MELD score, antibiotic pretreatment and

  8. [Peritoneal dialysis adequacy in pediatrics. From the peritoneal equilibration test to the aquaporins].

    PubMed

    Bolte, Lillian; Cano, Francisco

    2015-01-01

    An evaluation of the characteristics of peritoneal solute and water transport is essential to assess the suitability of prescribing dialysis in patients suffering from chronic renal disease. There are currently a series of models to perform this evaluation. The peritoneal equilibration test (PET) evaluates the peritoneal transport capacity, classifying the patients into four transport categories: high, high-average, low-average, and low. The short PET enables the same evaluation to be made in only 2hours, and has been validated in paediatric patients. On the other hand, the MiniPET provides additional information by evaluating the free water transport capacity by the ultra-small pores, and the Accelerated Peritoneal Examination Time (APEX) evaluates the time when the glucose and urea equilibration curves cross, and has been proposed as the optimum dwell time to achieve adequate ultrafiltration. An analysis is presented on the current information on these diagnostic methods as regards free water transport via aquaporins, which could be an important tool in optimising solute and water transport in patients on chronic peritoneal dialysis, particularly as regards the cardiovascular prognosis.

  9. [Peritoneal dialysis adequacy in pediatrics. From the peritoneal equilibration test to the aquaporins].

    PubMed

    Bolte, Lillian; Cano, Francisco

    2015-01-01

    An evaluation of the characteristics of peritoneal solute and water transport is essential to assess the suitability of prescribing dialysis in patients suffering from chronic renal disease. There are currently a series of models to perform this evaluation. The peritoneal equilibration test (PET) evaluates the peritoneal transport capacity, classifying the patients into four transport categories: high, high-average, low-average, and low. The short PET enables the same evaluation to be made in only 2hours, and has been validated in paediatric patients. On the other hand, the MiniPET provides additional information by evaluating the free water transport capacity by the ultra-small pores, and the Accelerated Peritoneal Examination Time (APEX) evaluates the time when the glucose and urea equilibration curves cross, and has been proposed as the optimum dwell time to achieve adequate ultrafiltration. An analysis is presented on the current information on these diagnostic methods as regards free water transport via aquaporins, which could be an important tool in optimising solute and water transport in patients on chronic peritoneal dialysis, particularly as regards the cardiovascular prognosis. PMID:26455699

  10. Ambulatory Monitoring in the Genetics of Psychosomatic Medicine

    PubMed Central

    Finan, Patrick H.; Tennen, Howard; Thoemmes, Felix; Zautra, Alex J.; Davis, Mary C.

    2015-01-01

    Psychosomatic disorders are comprised of an array of psychological, biological, and environmental features. The existing evidence points to a role for genetic factors in explaining individual differences in the development and maintenance of a variety of disorders, but studies to date have not shown consistent and replicable effects. As such, the attempt to uncover individual differences in the expression of psychosomatic disorders as a function of genetic architecture requires careful attention to their phenotypic architecture, or the various intermediate phenotypes that make up a heterogeneous disorder. Ambulatory monitoring offers a novel approach to measuring time-variant and situation-dependent intermediate phenotypes. Recent examples of the use of ambulatory monitoring in genetic studies of stress reactivity, chronic pain, alcohol use disorders, and psychosocial resilience are reviewed in an effort to highlight the benefits of ambulatory monitoring for genetic study designs. PMID:22582332

  11. A Twelve-Year Experience in Ambulatory Surgery within Urology

    PubMed Central

    Navalón, Pedro; Pallás, Yoni; Navalón, Victor; Ordoño, Felipe; Monllor, Elisa

    2012-01-01

    Purpose. The aim of this study is to show you the results we obtained through the integration of the Urology Department into the Ambulatory Surgery Unit for the very first twelve years. Scope. We will explain both the criteria we followed for patients to join in and the surgical and anesthetic procedures we used with those 1544 patients who were ambulatory subjected to urological diseases. After those patients were treated, they reached up to 95% of reasonable results. Conclusions. Most of urological patients liable to have surgical treatment are bound to be included in an ambulatory surgery program, which implies neither a worse healthcare service standard nor a worse satisfaction in patients. PMID:22530152

  12. Characteristics of effective clinical teachers of ambulatory care medicine.

    PubMed

    Irby, D M; Ramsey, P G; Gillmore, G M; Schaad, D

    1991-01-01

    This study identified characteristics of clinical teachers in ambulatory care settings that influenced ratings of overall teaching effectiveness and examined the impacts of selected variables of the clinic environment on teaching effectiveness ratings. A survey instrument derived from prior research and observations of ambulatory care teaching was sent to 165 senior medical students and 60 medicine residents at the University of Washington School of Medicine in 1988. A total of 122 (74%) of the seniors and 60 (71%) of the residents responded. Results indicate that the most important characteristics of the ambulatory care teachers were that they actively involved the learners, promoted learner autonomy, and demonstrated patient care skills. Environmental variables did not have a substantial influence on these ratings.

  13. Developing ambulatory care clinics: nurse practitioners as primary providers.

    PubMed

    Lamper-Linden, C; Goetz-Kulas, J; Lake, R

    1983-12-01

    While hospitals evaluate ambulatory clinics as a revenue-generating service alternative, nursing executives develop new areas for nursing practice in nurse-managed clinics. The authors describe the five-year growth of a nurse-managed ambulatory clinic providing primary health care to those aged 55 and older. The discussion explains nurse practitioner leadership and practice, and accountability between professions. The concept and structure of services and marketing strategies are elated to the people served. Financial feasibility, cost containment, and other factors demonstrate the clinic's contribution to its sponsoring hospital.

  14. A Comprehensive Computer Package for Ambulatory Surgical Facilities

    PubMed Central

    Kessler, Robert R.

    1980-01-01

    Ambulatory surgical centers are a cost effective alternative to hospital surgery. Their increasing popularity has contributed to heavy case loads, an accumulation of vast amounts of medical and financial data and economic pressures to maintain a tight control over “cash flow”. Computerization is now a necessity to aid ambulatory surgical centers to maintain their competitive edge. An on-line system is especially necessary as it allows interactive scheduling of surgical cases, immediate access to financial data and rapid gathering of medical and statistical information. This paper describes the significant features of the computer package in use at the Salt Lake Surgical Center, which processes 500 cases per month.

  15. Hemoperitoneum in a peritoneal dialysis patient from a retroperitoneal source.

    PubMed

    Balsera, Cristina; Guest, Steven

    2013-01-01

    Hemoperitoneum in peritoneal dialysis patients is a known but infrequent complication. Hemoperitoneum is more frequent in women because of its association with a variety of gynecologic presentations such as reflux menstruation, ovulation, endometrial tissue implants within the peritoneal cavity (endometriosis), and bleeding follicular cysts. Other intraperitoneal causes of hemoperitoneum include minor catheter or abdominal trauma, vascular anomalies, or hepatic or splenic cysts. Less frequently encountered is a presentation of hemoperitoneum from a retroperitoneal source. These presentations result either from peritoneal inflammation and subsequent peritoneal bleeding or retroperitoneal cavity pathology rupturing into the peritoneal cavity. Here, we present the case of a peritoneal dialysis patient presenting with hemoperitoneum several days after undergoing cardiac catheterization. The catheterization was complicated by a large retroperitoneal hematoma. Details of the case are reported, and other retroperitoneal causes of hemoperitoneum are reviewed.

  16. Flow cytometric quantification of radiation responses of murine peritoneal cells

    SciTech Connect

    Tokita, N.; Raju, M.R.

    1982-01-01

    Methods have been developed to distinguish subpopulations of murine peritoneal cells, and these were applied to the measurement of early changes in peritoneal cells after irradiation. The ratio of the two major subpopulations in the peritoneal fluid, lymphocytes and macrophages, was measured rapidly by means of cell volume distribution analysis as well as by hypotonic propidium iodide (PI) staining. After irradiation, dose and time dependent changes were noted in the cell volume distributions: a rapid loss of peritoneal lymphocytes, and an increase in the mean cell volume of macrophages. The hypotonic PI staining characteristics of the peritoneal cells showed two or three distinctive G/sub 1/ peaks. The ratio of the areas of these peaks was also found to be dependent of the radiation dose and the time after irradiation. These results demonstrate that these two parameters may be used to monitor changes induced by irradiation (biological dosimetry), and to sort different peritoneal subpopulations.

  17. [Influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with arterial hypertension].

    PubMed

    Bregvadze, T R; Tseluĭko, V I; Mishchuk, N E

    2013-12-01

    Hypertension is the most common disease of the cardiovascular system. Active treatment of hypertension with adequate control of blood pressure (BP) can prevent complications, improve life quality and increase life expectancy. One of the interesting new antihypertensive agents, from the group of angiotensin receptor blockers is olmesartan. The obvious advantages of ambulatory blood pressure monitoring to traditional one-time measurements of BP make this method perspective for quality control of anti-hypertensive therapy. The aim of this study was to evaluate the influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with hypertension. 38 out-patients with hypertension at the age of 25-84 years (mean 55,3±10,6) were studied. Patients received olmesartan 20 mg daily as monotherapy (20 patients (52,6%)) or in combination with other antihypertensive agents (18 patients (47,4%)). Treatment continued for 6 months. The complex examination included: measurement of office brachial BP, electrocardiography, echocardiography and ambulatory blood pressure monitoring (ABPM). As a result of treatment, office BP and diurnal BP, according to ABPM, significantly decreased; the favorable circadian BP profile dynamics were found: significantly less frequently observed lack of reduction in BP during night (daily index - non-dipper) - 18% vs. 64% (p <0,001), while the number of individuals with normal daily index (dipper) increased significantly - 76% vs. 28% (p <0,001). Also there was determined the significant reduction in daytime and nighttime systolic BP variability - by 1.5 mmHg and 2.1 mmHg, respectively, with the normalization of these parameters at the end of the observation period. The presented results allow conclude, that treatment of hypertensive patients with olmesartan provides significant decline not only in office BP, but also in diurnal BP, normalizes BP of active and passive periods, also - daily index and reduces BP

  18. [Influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with arterial hypertension].

    PubMed

    Bregvadze, T R; Tseluĭko, V I; Mishchuk, N E

    2013-12-01

    Hypertension is the most common disease of the cardiovascular system. Active treatment of hypertension with adequate control of blood pressure (BP) can prevent complications, improve life quality and increase life expectancy. One of the interesting new antihypertensive agents, from the group of angiotensin receptor blockers is olmesartan. The obvious advantages of ambulatory blood pressure monitoring to traditional one-time measurements of BP make this method perspective for quality control of anti-hypertensive therapy. The aim of this study was to evaluate the influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with hypertension. 38 out-patients with hypertension at the age of 25-84 years (mean 55,3±10,6) were studied. Patients received olmesartan 20 mg daily as monotherapy (20 patients (52,6%)) or in combination with other antihypertensive agents (18 patients (47,4%)). Treatment continued for 6 months. The complex examination included: measurement of office brachial BP, electrocardiography, echocardiography and ambulatory blood pressure monitoring (ABPM). As a result of treatment, office BP and diurnal BP, according to ABPM, significantly decreased; the favorable circadian BP profile dynamics were found: significantly less frequently observed lack of reduction in BP during night (daily index - non-dipper) - 18% vs. 64% (p <0,001), while the number of individuals with normal daily index (dipper) increased significantly - 76% vs. 28% (p <0,001). Also there was determined the significant reduction in daytime and nighttime systolic BP variability - by 1.5 mmHg and 2.1 mmHg, respectively, with the normalization of these parameters at the end of the observation period. The presented results allow conclude, that treatment of hypertensive patients with olmesartan provides significant decline not only in office BP, but also in diurnal BP, normalizes BP of active and passive periods, also - daily index and reduces BP

  19. Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery.

    PubMed

    Joshi, Girish P; Chung, Frances; Vann, Mary Ann; Ahmad, Shireen; Gan, Tong J; Goulson, Daniel T; Merrill, Douglas G; Twersky, Rebecca

    2010-12-01

    Optimal evidence-based perioperative blood glucose control in patients undergoing ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing ambulatory surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for providing suggestions. It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.

  20. Outcome of percutaneous endoscopic gastrostomy feeding in patients on peritoneal dialysis.

    PubMed

    Fein, P A; Madane, S J; Jorden, A; Babu, K; Mushnick, R; Avram, M M; Grosman, I

    2001-01-01

    Protein malnutrition is now well established as an important contributory factor to the high mortality in peritoneal dialysis (PD) patients. Low dietary protein calorie intake is one of the factors leading to protein malnutrition. If PD patients develop difficulty eating, percutaneous endoscopic gastrostomy (PEG) feeding may prove beneficial in providing adequate nutrition. Studies on the effectiveness of PEG feeding in PD patients are limited to pediatric patients. The objective of the present study was to assess the outcome of PEG feeding in adult patients with end-stage renal disease (ESRD) on PD. We retrospectively reviewed charts from May 1992 to February 2000 of 10 consecutive patients in our center who had had feeding tubes inserted. The patients' ages ranged from 37 to 81 years, with mean age of 65. Of the 10 patients, 7 were male, 5 were diabetic, and 1 was infected with the human immunodeficiency virus. Two patients had cerebrovascular accident (CVA) with dysphagia, 3 had multi-infarct dementia, 2 had anoxic encephalopathy, 2 had dementia, and 1 had calciphylaxis with anorexia. Of the 10 patients, 9 failed to eat because of neurologic disorders. Two patients who had functioning PEG feedings before starting PD had no complications. Only 2 of 8 patients already on PD continued with long-term PD after a PEG was inserted. Both patients whose PD was not interrupted at the time of PEG placement immediately developed peritonitis. Of the 6 patients who were maintained on hemodialysis (HD), 2 developed peritonitis within one week of starting PEG feedings. The other 4 had no complications from PEG feedings while being maintained on HD, but 1 developed peritonitis when PD was resumed. Of the 5 patients who developed peritonitis, 3 experienced fungal peritonitis. In PD patients, PEG feeding is associated with frequent complications. However, PEG placement prior to PD initiation appears to be safe. Maintaining patients on HD for at least 6 weeks appears to decrease

  1. Case Report of a Patient Undergoing Peritoneal Dialysis with Encapsulating Peritoneal Sclerosis Superimposed With Calciphylaxis

    PubMed Central

    Li Tsai, Jun; Ju Wu, Ming; Hsu Chen, Cheng; Feng Tsai, Shang

    2016-01-01

    Introduction Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis (PD). Tamoxifen has been generally well-tolerated, even without randomized controlled trials. Case Presentation Herein, we report a case of a patient undergoing 12 years of PD who developed EPS and calciphylaxis simultaneously. We also provide a comprehensive discussion about the association between EPS and calciphylaxis. Moreover, although tamoxifen is used in EPS due to its inhibition of fibroblast-transforming growth factor beta (TGFβ) production, it may worsen the calciphylaxis due to a hypercoagulable state. Conclusions We suggest avoiding the use of tamoxifen for EPS in patients with superimposed calciphylaxis.

  2. Ovarian, Fallopian Tube, and Primary Peritoneal Cancer—Patient Version

    Cancer.gov

    Information about ovarian, fallopian tube, and primary peritoneal cancer treatment, prevention, genetics, causes, screening, clinical trials, research and statistics from the National Cancer Institute.

  3. Gastric Cancer with Peritoneal Tuberculosis: Challenges in Diagnosis and Treatment

    PubMed Central

    Alshahrani, Amer Saeed

    2016-01-01

    Herein, we report a 39-year-old female patient presenting with gastric cancer and tuberculous peritonitis. The differential diagnosis between advanced gastric cancer with peritoneal carcinomatosis and early gastric cancer with peritoneal tuberculosis (TB), and the treatment of these two diseases, were challenging in this case. Physicians should have a high index of suspicion for peritoneal TB if the patient has a history of this disease, especially in areas with a high incidence of TB, such as South Korea. An early diagnosis is critical for patient management and prognosis. A surgical approach including tissue biopsy or laparoscopic exploration is recommended to confirm the diagnosis. PMID:27433397

  4. A new internet tool to report peritoneal malignancy extent. PeRitOneal MalIgnancy Stage Evaluation (PROMISE) application.

    PubMed

    Villeneuve, L; Thivolet, A; Bakrin, N; Mohamed, F; Isaac, S; Valette, P-J; Glehen, O; Rousset, P

    2016-06-01

    Based on the importance of assessing the true extent of peritoneal disease, PeRitOneal MalIgnancy Stage Evaluation (PROMISE) internet application (www.e-promise.org) has been developed to facilitate tabulation and automatically calculate surgically validated peritoneal cancer index (PCI), and other surgically validated scores as Gilly score, simplified peritoneal cancer index (SPCI), Fagotti and Fagotti-modified scores. This application offers computer-assistance to produce simple, quick but precise and standardized pre, intra and postoperative reports of the extent of peritoneal metastases and may help specialized and non-specialized institutions in their current practice but also facilitate research and multicentre studies on peritoneal surface malignancies. PMID:27067193

  5. American Society of Regional Anesthesia and Pain Medicine 2010 Gaston Labat Lecture: Perineural catheter analgesia as a routine method after ambulatory surgery--effective but unrealistic.

    PubMed

    Rawal, Narinder

    2012-01-01

    Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery and remains a challenge. The problem of pain at home may be increasing because previously inpatient surgical procedures are becoming ambulatory and it is expected that the number and complexity of ambulatory surgical procedures will continue to increase. In 1998, we described the use of surgical-site and perineural catheter techniques that allowed patients to self-administer local anesthetics through disposable, elastomeric pumps for pain management at home. In recent years, availability of improved elastometric and other lightweight pump devices, the general trend of avoiding strong opioids and the preference for non-opioid analgesic techniques has led to increasing use of this technique after a variety of ambulatory surgical procedures. The two most common techniques are perineural and wound catheter infusions (WCI). Current evidence suggests that both are effective, although comparative studies are lacking. Perineural techniques are highly effective but are technically challenging and require labor-intensive and expensive home care that can be provided only in specialized centers. Disappointing past experience with implementation of perineural catheter techniques in inpatients suggests that it is unrealistic to expect their routine use in most ambulatory centers. Surgical-site catheter technique is a simpler, safer, and less expensive alternative and therefore more likely to gain widespread use. Only controlled comparisons can show whether the current belief about the superiority of ambulatory perineural techniques over WCI is justified. Such studies should address technical failures, side effects, home care of the medically unsupervised or undersupervised patient, and cost-effectiveness to demonstrate which of the 2 techniques is most appropriate for a particular procedure. PMID:22157738

  6. Ambulatory care centers: structure, services, and marketing techniques.

    PubMed

    Phillips, J H; Reeder, C E

    1987-12-01

    A generic definition for an ambulatory care center (ACC) is not apparent. ACCs differ in ownership, primary function, and services offered. ACCs are attempting to expand their patient base by providing nonemergency care, contracting with provider organizations (e.g., HMOs and PPOs), and using aggressive marketing techniques.

  7. A new system for ambulatory pulmonary artery pressure recording

    PubMed Central

    Simon, J; Gibbs, R; MacLachlan, Donald; Fox, Kim M

    1992-01-01

    Objective—To develop a complete system for the measurement, recording, and analysis of ambulatory pulmonary artery pressure. Design—The new system consists of a pulmonary artery catheter, an ambulatory recorder, and a desktop computer. Pulmonary artery pressure is measured by a micromanometer tipped catheter with an in vivo calibration system to allow correction for zero drift. This catheter is plugged into a small battery powered recorder. The recorder has two input channels, one for pressure and one for an event marker. The pressure wave is sampled 32 times/s, processed by an in built computer, compressed, and stored in semiconductor memory. On completion of a recording, data is transferred from the ambulatory recorder through a serial data link to an Acorn Archimedes desktop computer on which further data processing, statistical analysis, graphics, and printouts can be obtained. Results—The system has been used in 18 patients, with technically successful recording in 14, less than 15 minutes of data loss in three, and 12 hours of data loss in one. Conclusions—A new system for ambulatory pulmonary artery monitoring has been developed and used clinically with success. It may provide new perspectives on the pathophysiology of disease as it applies to everyday life. PMID:1389746

  8. [Interprofessional pill box management in an ambulatory care setting].

    PubMed

    Abrecht, Loïc; Anchisi, Annick; Widmer, Daniel; Bugnon, Olivier; Du Pasquier, Sophie; Jotterand, Sébastien; Karlen, Martine; Herzig, Lilli

    2014-11-26

    Complex multimorbid patients are now more common in ambulatory care and the management of their medication more frequently needs interprofessional collaboration. This qualitative study explored health professional's main challenges when introducing, preparing and sharing the use of a pill box for a patient. Another objective of this study was to explore options for improving care in these situations.

  9. Teaching Interdisciplinary Geriatrics Ambulatory Care: A Case Study

    ERIC Educational Resources Information Center

    Williams, Brent C.; Remington, Tami L.; Foulk, Mariko A.; Whall, Ann L.

    2006-01-01

    Interdisciplinary health care training is advocated by numerous government and philanthropic organizations. Educators in the health professions are increasingly offering training in interdisciplinary health care in a variety of contexts, including ambulatory settings. This paper describes a three-year program to teach skills in interdisciplinary…

  10. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

    PubMed Central

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387

  11. Utilizing ambulatory blood pressure recordings to evaluate antihypertensive drug therapy.

    PubMed

    White, W B

    1992-04-30

    Until recently, the efficacy and pharmacodynamics of antihypertensive agents were assessed by resting blood pressure measurements in the doctor's office or a research clinic. The limitations of the office or clinic blood pressure measurement include the lack of representation (from recording only 1 point of time in the dosing schedule), the effects of the doctor's office on the patient's blood pressure, and, perhaps more relevant, observer bias. Ambulatory monitoring of the blood pressure has gained worldwide acceptance as an alternative method to assess antihypertensive drug efficacy and the time-effect relation of a drug. The ambulatory monitoring devices have been refined and are smaller, more precise, and more reliable than earlier recording models. Although there are no reference standards for analysis of ambulatory blood pressure data, international consensus groups are presently addressing this problem. Key roles for ambulatory blood pressure recordings in clinical trials of antihypertensive agents now include determination of the entry criteria for patients, improving the assessment of peak/trough pharmacodynamics in the patient's own environment (including nocturnal/sleep readings), and evaluating efficacy through calculation of the hypertensive burden, or blood pressure load. PMID:1575177

  12. Computerized ambulatory monitoring in mood disorders: feasibility, compliance, and reactivity.

    PubMed

    Husky, Mathilde M; Gindre, Claire; Mazure, Carolyn M; Brebant, Catherine; Nolen-Hoeksema, Susan; Sanacora, Gerard; Swendsen, Joel

    2010-07-30

    Patients with depression (n=20) or bipolar disorder (n=21) completed computerized ambulatory monitoring for three consecutive days. Results indicate satisfactory rates of acceptance and compliance, with no salient fatigue effects. However, some evidence for reactive effects was found. The findings provide support for this approach in the study of mood disorders.

  13. Heart Rate Variability in Porcine Progressive Peritonitis-Induced Sepsis

    PubMed Central

    Jarkovska, Dagmar; Valesova, Lenka; Chvojka, Jiri; Benes, Jan; Sviglerova, Jitka; Florova, Blanka; Nalos, Lukas; Matejovic, Martin; Stengl, Milan

    2016-01-01

    Accumulating evidence suggests that heart rate variability (HRV) alterations could serve as an indicator of sepsis progression and outcome, however, the relationships of HRV and major pathophysiological processes of sepsis remain unclear. Therefore, in this experimental study HRV was investigated in a clinically relevant long-term porcine model of severe sepsis/septic shock. HRV was analyzed by several methods and the parameters were correlated with pathophysiological processes of sepsis. In 16 anesthetized, mechanically ventilated, and instrumented domestic pigs of either gender, sepsis was induced by fecal peritonitis. Experimental subjects were screened up to the refractory shock development or death. ECG was continuously recorded throughout the experiment, afterwards RR intervals were detected and HRV parameters computed automatically using custom made measurement and analysis MATLAB routines. In all septic animals, progressive hyperdynamic septic shock developed. The statistical measures of HRV, geometrical measures of HRV and Poincaré plot analysis revealed a pronounced reduction of HRV that developed quickly upon the onset of sepsis and was maintained throughout the experiment. The frequency domain analysis demonstrated a decrease in the high frequency component and increase in the low frequency component together with an increase of the low/high frequency component ratio. The reduction of HRV parameters preceded sepsis-associated hemodynamic changes including heart rate increase or shock progression. In a clinically relevant porcine model of peritonitis-induced progressive septic shock, reduction of HRV parameters heralded sepsis development. HRV reduction was associated with a pronounced parasympathetic inhibition and a shift of sympathovagal balance. Early reduction of HRV may serve as a non-invasive and sensitive marker of systemic inflammatory syndrome, thereby widening the therapeutic window for early interventions. PMID:26779039

  14. [Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme].

    PubMed

    Saurina, A; Pou, M; Fulquet, M; Ramírez de Arellano, M; Chiné, M; Esteba, M D; de las Cuevas, X

    2006-01-01

    The presence of peritoneal implants detected by computered axial tomography (CT) is usually related to mesothelial primary neoformative processes or, more frequently to peritoneal metastasis or peritoneal carcinomatosis. Although the higher prevalence of neoplastic processes in the chronic renal failure population, the association of peritoneal implants and constitutional syndrome is not always correlated to peritoneal carcinomatosis. We present the case of two patients with chronic renal failure in hemodialysis programme, with abdominal insidious clinical, constitutional syndrome and similar peritoneal implants seen by CAT: the histologic analysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosis and peritoneal tuberculosis respectively.

  15. Peritoneal dialysis. An adjunct to pediatric postcardiotomy fluid management.

    PubMed Central

    Stromberg, D; Fraser, C D; Sorof, J M; Drescher, K; Feltes, T F

    1997-01-01

    Patients requiring cardiopulmonary bypass for congenital heart surgery commonly exhibit impaired renal function and extravascular fluid retention. These conditions contribute to early postoperative fluid overload, which may result in significant morbidity and mortality. We examined the safety and efficacy of peritoneal dialysis in removing extravascular fluid from critically ill postcardiotomy patients. A retrospective case review from July of 1995 through April of 1996 was conducted. All patients undergoing peritoneal dialysis achieved a net negative fluid balance. Average urine output increased from 2.1 cc/kg/hr to 3.9 cc/kg/hr (P < 0.01) during the pre-peritoneal dialysis to post-peritoneal dialysis period, and the mean number of inotropic agents decreased from 2.2 to 1.7 (P < 0.05). Controlled comparison revealed that the peritoneal dialysis cohort more rapidly achieved a negative weight-adjusted fluid balance throughout the early postoperative course. The peritoneal dialysis group's illness severity decreased more rapidly within the 24-hour period after initiation of peritoneal dialysis than did that of the control cohort over the same period of time. No difference in postoperative morbidity or mortality existed between the study groups. Complications from the catheter placement were minimal, and no patient experienced peritonitis or metabolic or hemodynamic instability during peritoneal dialysis catheter placement, usage, or removal. Peritoneal dialysis is a safe and effective form of renal replacement therapy, even among critically ill pediatric postcardiotomy patients. Early postsurgical institution of peritoneal dialysis may hasten early postoperative recovery. We speculate that intraoperative catheter placement reduces the complication rate associated with this treatment modality. PMID:9456479

  16. Pro: Ambulatory blood pressure should be used in all patients on hemodialysis

    PubMed Central

    Agarwal, Rajiv

    2015-01-01

    In the adult population in general and among people with chronic kidney disease in particular, it is now well established that hypertension is a major driver of renal disease progression and cardiovascular morbidity and mortality [1–4]. Although the contribution of hypertension to cardiovascular morbidity and mortality among patients on long-term dialysis continues to be debated [5–8], a major barrier to detect hypertension as a risk factor for cardiovascular events in these patients has been the inability to diagnose hypertension [9]. Largely to blame has been the easy availability of pre-dialysis and post-dialysis blood pressure recordings in stark contrast to ambulatory blood pressure measurements in dialysis patients to accurately diagnose the presence or control of hypertension [10]. It is increasingly becoming clear that out-of-office blood pressure recordings are superior to clinic recordings in making a diagnosis, assessing target organ damage, evaluating prognosis and managing patients with hypertension [11–15]. In this debate, I have been asked to defend the position that ambulatory blood pressure recordings should be systematically applied to all patients on hemodialysis. PMID:26022728

  17. Ambulatory pressure monitoring in the assessment of antihypertensive therapy.

    PubMed

    Coats, A J; Conway, J; Somers, V K; Isea, J E; Sleight, P

    1989-06-01

    A low-cost, ambulatory blood-pressure monitor has been calibrated and validated against a random zero sphygmomanometer. The repeatability of ambulatory pressure recordings after a placebo month in 44 mild to moderate untreated hypertensives was assessed. Systolic blood pressure showed a mean difference over 1 month of 2.0 mmHg, with a standard deviation of differences of 9.3 mmHg. The diastolic blood pressure mean difference was 0.1 mmHg (SD = 6.3 mmHg). This variability was much less than for clinic readings (SD = 17.3 mmHg) or for single home pressure readings (SD = 19.7 mmHg). Using ambulatory monitoring to detect a drop in pressure of 8/5 mmHg with a power of 0.9, the number of subjects needed in a parallel group trial is reduced from 360 to 68, and in a crossover study from 88 to 16 subjects. The usefulness of ambulatory pressure monitoring is demonstrated in a placebo-controlled comparison of atenolol, nifedipine retard, or their combination in random order. Eleven subjects, 21-60 years, with initial average blood pressures of 166.5/104.7 mmHg, showed a reduction in pressure with atenolol 50 mg a day of 15.1/10.0 mmHg, with nifedipine retard 20 mg b.i.d. of 21.0/11.6 mmHg, and with atenolol 50 mg and nifedipine retard 20 mg once a day of 26.2/16.8 mmHg. Ambulatory monitoring of pressure improved the accuracy of the trial and demonstrated a reduction in the alerting response with atenolol. PMID:2487802

  18. Ambulatory blood pressure and physical activity in heart failure.

    PubMed

    Tai, Mei-Kuei; Meininger, Janet C; Frazier, Lorraine Q; Chan, Wenyaw

    2010-01-01

    This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF). The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in HF. Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 + or - 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings. Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I HF had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction. In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients. These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with HF. PMID:19617234

  19. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery

    PubMed Central

    Ishman, Stacey L.; Tawfik, Kareem O.; Smith, David F.; Cheung, Kristin; Pringle, Lauren M.; Stephen, Matthew J.; Everett, Tiffany L.; Stierer, Tracey L.

    2015-01-01

    Purpose: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. Methods: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. Results: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p < 0.001), known OSA (p = 0.006), and a scheduled adenotonsillectomy (p = 0.02). Conclusion: OSA was not routinely screened for by anesthesia providers prior to ambulatory pediatric surgery. When screening did occur, “snoring” was the most commonly recorded symptom. Paradoxically, patients with undiagnosed OSA who would benefit the most from screening were the least likely to be screened. Commentary: A commentary on this article appears in this issue on page 697. Citation: Ishman SL, Tawfik KO, Smith DF, Cheung K, Pringle LM, Stephen MJ, Everett TL, Stierer TL. Screening for pediatric obstructive sleep apnea before ambulatory surgery. J Clin Sleep Med 2015;11(7):751–755. PMID:25902820

  20. Increasing sodium removal on peritoneal dialysis: applying dialysis mechanics to the peritoneal dialysis prescription.

    PubMed

    Fischbach, Michel; Schmitt, Claus Peter; Shroff, Rukshana; Zaloszyc, Ariane; Warady, Bradley A

    2016-04-01

    Optimal fluid removal on peritoneal dialysis (PD) requires removal of water coupled with sodium, which is predominantly achieved via the small pores in the peritoneal membrane. On the other hand, free-water transport takes place through aquaporin-1 channels, but leads to sodium retention and over hydration. PD prescription can be adapted to promote small pore transport to achieve improved sodium and fluid management. Both adequate dwell volume and dwell time are required for small pore transport. The dwell volume determines the amount of "wetted" peritoneal membrane being increased in the supine position and optimized at dwell volumes of approximately 1400 ml/m(2). Diffusion across the recruited small pores is time-dependent, favored by a long dwell time, and driven by the transmembrane solute gradient. According to the 3-pore model of conventional PD, sodium removal primarily occurs via convection. The clinical application of these principles is essential for optimal performance of PD and has resulted in a new approach to the automated PD prescription: adapted automated PD. In adapted automated PD, sequential short- and longer-dwell exchanges, with small and large dwell volumes, respectively, are used. A crossover trial in adults and a pilot study in children suggests that sodium and fluid removal are increased by adapted automated PD, leading to improved blood pressure control when compared with conventional PD. These findings are not explained by the current 3-pore model of peritoneal permeability and require further prospective crossover studies in adults and children for validation.

  1. Increasing sodium removal on peritoneal dialysis: applying dialysis mechanics to the peritoneal dialysis prescription.

    PubMed

    Fischbach, Michel; Schmitt, Claus Peter; Shroff, Rukshana; Zaloszyc, Ariane; Warady, Bradley A

    2016-04-01

    Optimal fluid removal on peritoneal dialysis (PD) requires removal of water coupled with sodium, which is predominantly achieved via the small pores in the peritoneal membrane. On the other hand, free-water transport takes place through aquaporin-1 channels, but leads to sodium retention and over hydration. PD prescription can be adapted to promote small pore transport to achieve improved sodium and fluid management. Both adequate dwell volume and dwell time are required for small pore transport. The dwell volume determines the amount of "wetted" peritoneal membrane being increased in the supine position and optimized at dwell volumes of approximately 1400 ml/m(2). Diffusion across the recruited small pores is time-dependent, favored by a long dwell time, and driven by the transmembrane solute gradient. According to the 3-pore model of conventional PD, sodium removal primarily occurs via convection. The clinical application of these principles is essential for optimal performance of PD and has resulted in a new approach to the automated PD prescription: adapted automated PD. In adapted automated PD, sequential short- and longer-dwell exchanges, with small and large dwell volumes, respectively, are used. A crossover trial in adults and a pilot study in children suggests that sodium and fluid removal are increased by adapted automated PD, leading to improved blood pressure control when compared with conventional PD. These findings are not explained by the current 3-pore model of peritoneal permeability and require further prospective crossover studies in adults and children for validation. PMID:26924063

  2. Bladder perforation in a peritoneal dialysis patient.

    PubMed

    Ounissi, M; Sfaxi, M; Fayala, H; Abderrahim, E; Ben Abdallah, T; Chebil, M; Ben Maiz, H; Kheder, A

    2012-05-01

    The dysfunction of the catheter in peritoneal dialysis (PD) is a frequent complication. However, perforation of organs are rare, particularly that of the urinary bladder. This requires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur. PMID:22569443

  3. Shortage of Peritoneal Dialysis Solution and the Food and Drug Administration’s Response

    PubMed Central

    Throckmorton, Douglas C.

    2015-01-01

    Although the number of new drug shortages has been lower in recent years than in the past, severe shortages have occurred that have affected large numbers of patients. A new law entitled the Food and Drug Administration Safety and Innovation Act was enacted in July of 2012, which requires companies to notify the Food and Drug Administration of anticipated shortages. This notification requirement has allowed the Food and Drug Administration to work closely with manufacturers earlier to mitigate and, often, prevent shortages. However, not all shortages are able to be prevented, and the shortage of peritoneal dialysis solution is one that has had a significant effect on patients. The Food and Drug Administration continues to use all available tools to address this shortage with manufacturers, including temporary availability of imported peritoneal dialysis solution from Ireland. Mitigating shortages is a top priority for the Food and Drug Administration, and communication with all stakeholders is essential. PMID:25896999

  4. Shortage of Peritoneal Dialysis Solution and the Food and Drug Administration's Response.

    PubMed

    Jensen, Valerie; Throckmorton, Douglas C

    2015-08-01

    Although the number of new drug shortages has been lower in recent years than in the past, severe shortages have occurred that have affected large numbers of patients. A new law entitled the Food and Drug Administration Safety and Innovation Act was enacted in July of 2012, which requires companies to notify the Food and Drug Administration of anticipated shortages. This notification requirement has allowed the Food and Drug Administration to work closely with manufacturers earlier to mitigate and, often, prevent shortages. However, not all shortages are able to be prevented, and the shortage of peritoneal dialysis solution is one that has had a significant effect on patients. The Food and Drug Administration continues to use all available tools to address this shortage with manufacturers, including temporary availability of imported peritoneal dialysis solution from Ireland. Mitigating shortages is a top priority for the Food and Drug Administration, and communication with all stakeholders is essential. PMID:25896999

  5. Shortage of Peritoneal Dialysis Solution and the Food and Drug Administration's Response.

    PubMed

    Jensen, Valerie; Throckmorton, Douglas C

    2015-08-01

    Although the number of new drug shortages has been lower in recent years than in the past, severe shortages have occurred that have affected large numbers of patients. A new law entitled the Food and Drug Administration Safety and Innovation Act was enacted in July of 2012, which requires companies to notify the Food and Drug Administration of anticipated shortages. This notification requirement has allowed the Food and Drug Administration to work closely with manufacturers earlier to mitigate and, often, prevent shortages. However, not all shortages are able to be prevented, and the shortage of peritoneal dialysis solution is one that has had a significant effect on patients. The Food and Drug Administration continues to use all available tools to address this shortage with manufacturers, including temporary availability of imported peritoneal dialysis solution from Ireland. Mitigating shortages is a top priority for the Food and Drug Administration, and communication with all stakeholders is essential.

  6. Peritoneal mesothelioma in a jaguar (Panthera onca).

    PubMed

    Souza, Francisco de Assis Leite; de Carvalho, Ciro José Sousa; de Almeida, Hatawa M; Pires, Lidiany Viana; Silva, Lucilene dos Santos; Costa, Francisco Assis Lima; Silva, Silvana M Medeiros de Sousa

    2013-09-01

    A 21-yr-old female jaguar (Panthera onca) died in a zoo in Teresina, Piaui, Brazil, following a history of abdominal distension, ascites, anorexia, and dyspnea. At necropsy, a dark red, watery, blood-tinged serous fluid was present in the abdominal cavity. The peritoneum was thick with firm, yellow, villous projections. Histologically, the tumors were composed of a biphasic population of cells, which reacted to anti-cytokeratin and anti-vimentin antibodies, consistent with a biphasic benign mesothelioma of peritoneal origin. This is the first reported case of mesothelioma in a captive jaguar.

  7. Peritoneal mesothelioma in a jaguar (Panthera onca).

    PubMed

    Souza, Francisco de Assis Leite; de Carvalho, Ciro José Sousa; de Almeida, Hatawa M; Pires, Lidiany Viana; Silva, Lucilene dos Santos; Costa, Francisco Assis Lima; Silva, Silvana M Medeiros de Sousa

    2013-09-01

    A 21-yr-old female jaguar (Panthera onca) died in a zoo in Teresina, Piaui, Brazil, following a history of abdominal distension, ascites, anorexia, and dyspnea. At necropsy, a dark red, watery, blood-tinged serous fluid was present in the abdominal cavity. The peritoneum was thick with firm, yellow, villous projections. Histologically, the tumors were composed of a biphasic population of cells, which reacted to anti-cytokeratin and anti-vimentin antibodies, consistent with a biphasic benign mesothelioma of peritoneal origin. This is the first reported case of mesothelioma in a captive jaguar. PMID:24063103

  8. Berardinelli-Seip syndrome in peritoneal dialysis.

    PubMed

    Bande-Fernández, José Joaquín; García-Castro, Raúl; Sánchez-Alvarez, José Emilio; Rodríguez-Suárez, Carmen; Coronel-Aguilar, Diego; Hidalgo, Carlos; Istanbuli, Beatriz; Merino-Bueno, Carmen; Del Rio-García, Laura

    2015-01-01

    A case of Berardinelli-Seip syndrome, a congenital generalised lipodystrophy, is reported. Symptoms first appeared when the patient was 20 years old. She showed severe insulin resistance as well as micro- and macro-angiopathic complications, including chronic kidney disease, which required renal replacement therapy with peritoneal dialysis. The patient's clinical course was reviewed since paediatric age (when initial signs of the disease being already evident) to present time. Berardinelli-Seip syndrome is very uncommon, and the present case is particularly rare because it is the only case (at least as reported in the literature) in a patient receiving dialysis.

  9. [A new view on pathochemical mechanisms of prolonged peritoneal dialysis].

    PubMed

    Petrovich, Iu A; Iarema, I V; Terekhina, N A; Kichenko, S M

    2010-01-01

    New data on etiology, pathogenesis, clinics, quantity estimation, treatment and complications of peritoneal dialysis are observed. The role of aquaporine, nitric oxide, NO-synthase, inflammation and sepsis markers (procalcitonine, C-reactive protein) in pathochemical mechanism of peritoneal dialysis is discussed. PMID:20734476

  10. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... peritoneal dialysis, a source of dialysate, and, in some cases, a water purification mechanism. After the... together with the time course of each cycle of filling, dwell time, and draining of the peritoneal cavity...”) or dialysate prepared from dialysate concentrate and sterile purified water (for automatic...

  11. Vitamin K Status of Canadian Peritoneal Dialysis Patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vitamin K –dependent proteins have been implicated in the regulation of vascular calcification, a condition that is prevalent among peritoneal dialysis patients. Vitamin K status in this patient population is unknown. In a cross-sectional study of 22 peritoneal dialysis patients selected from a Can...

  12. Are the Mesothelial-to-Mesenchymal Transition, Sclerotic Peritonitis Syndromes, and Encapsulating Peritoneal Sclerosis Part of the Same Process?

    PubMed Central

    Loureiro, Jesús; Gónzalez-Mateo, Guadalupe; Jimenez-Heffernan, José; Selgas, Rafael; López-Cabrera, Manuel; Aguilera Peralta, Abelardo

    2013-01-01

    Mesothelial-to-mesenchymal transition (MMT) is an autoregulated physiological process of tissue repair that in uncontrolled conditions, such as peritoneal dialysis (PD), can lead to peritoneal fibrosis. The maximum expression of sclerotic peritoneal syndromes (SPS) is the encapsulating peritoneal sclerosis (EPS) for which no specific treatment exists. The SPS includes a wide range of peritoneal fibrosis that appears progressively and is considered as a reversible process, while EPS does not. EPS is a serious complication of PD characterized by a progressive intra-abdominal inflammatory process that results in bridles and severe fibrous tissue formation which cover and constrict the viscera. Recent studies show that transdifferentiated mesothelial cells isolated from the PD effluent correlate very well with the clinical events such as the number of hemoperitoneum and peritonitis, as well as with PD function (lower ultrafiltration and high Cr-MTC). In addition, in peritoneal biopsies from PD patients, the MMT correlates very well with anatomical changes (fibrosis and angiogenesis). However, the pathway to reach EPS from SPS has not been fully and completely established. Herein, we present important evidence pointing to the MMT that is present in the initial peritoneal fibrosis stages and it is perpetual over time, with at least theoretical possibility that MMT initiated the fibrosing process to reach EPS. PMID:23476771

  13. Complicated Candida parapsilosis peritonitis on peritoneal dialysis in a neonate with renal failure because of bilateral adrenal abscesses.

    PubMed

    Cheng, I; Chen, Yi-Lin; Lin, Cheng-Hui; Jow, Guey-Mei; Mu, Shu-Chi

    2011-10-01

    We present a full-term female infant with a difficult delivery course complicated with Escherichia coli sepsis and bilateral adrenal abscesses. She developed renal failure and received peritoneal dialysis. Peritonitis of Candida parapsilosis developed later. The infant was successfully treated with hemofiltration and a combination of antifungal agents.

  14. Type of peritoneal dialysis catheter and outcomes.

    PubMed

    Gallieni, Maurizio; Giordano, Antonino; Pinerolo, Cristina; Cariati, Maurizio

    2015-01-01

    In peritoneal dialysis (PD), a well-functioning catheter is of great importance, because a dysfunctional catheter may be associated with incidence of peritonitis, efficiency of dialysis, and to the overall quality of treatment, representing one of the main barriers to optimal use of PD. When considering the relationship between PD catheter type and outcomes, we should keep in mind the different types of available PD catheters, those that are most commonly used in clinical practice, and the available head-to-head comparisons in the literature. The main differences in PD catheter design include the number of cuffs, the shape of subcutaneous tract (straight vs. swan neck), and the shape of intraperitoneal tract (straight vs. coiled). The availability of the best catheter design and materials, along with a skillful management of PD access, may have the greatest impact on long-term patient outcome on PD. It is now established that the use of straight catheters may improve outcomes and technique survival, but further advances in PD catheter technology can potentially improve technique survival. The self-locating PD catheter is a well established device that has not been fully studied and it may represent, based on the available observational evidence and on the clinical experience, an already existing technological advance deserving further studies. PMID:25751555

  15. Possible development of idiopathic sclerosing encapsulating peritonitis.

    PubMed

    Yanagi, H; Kusunoki, M; Yamamura, T

    1999-01-01

    We report a rare case of idiopathic sclerosing encapsulating peritonitis (SEP). During a laparotomy before undergoing a distal gastrectomy with Billroth II reconstruction for early gastric cancer, the patient was found to have a membranous encapsulation wrapping each small bowel loop, unlike peritoneal encapsulation or typical SEP. He had complained of persistent heartburn, distension and diarrhea for 2 months in the post-operative course. The second laparotomy, which was performed to improve prolonged transit, revealed typical SEP with a thick and fibrotic membrane that encased the small bowel entirely. Stripping of the sclerosing encasing membrane, separation of the adherent loops of the proximal small bowel, and Braun's anastomosis were performed. The patient complained of epigastric fullness and diarrhea after he was relieved from the complete bowel obstruction for 45 days post-operatively. Trimebutine maleate was administrated 5 months after the second operation and this markedly improved his symptoms. This case might reflect the developmental process of idiopathic SEP. In addition, the use of a motility regulator may improve symptoms related to the abnormal intestinal motility by this disease. PMID:10228820

  16. Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease

    PubMed Central

    Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A.; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

    2012-01-01

    To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm—chronobiology—that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological “loads” related to stress and stress relief and the undesirable effects of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologically interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such

  17. Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease.

    PubMed

    Halberg, Franz; Mult, Hc; Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

    2012-05-01

    To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact actually be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm-chronobiology-that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological "loads" related to stress and stress relief and the undesirable effcts of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologi cally interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such

  18. Nutritional status in peritoneal dialysis: studies in body composition, lipoprotein metabolism and peritoneal function.

    PubMed

    Johansson, Ann-Cathrine

    2002-01-01

    This thesis is based on clinical studies including virtually all patients treated with peritoneal dialysis in Gothenburg during the 1990s. The patients had a fundamentally altered body composition compared to healthy subjects, characterised by a reduction in body cell mass and body fat already at start of dialysis. During PD treatment. a further decrease in body cell mass was observed. Energy stores tended to normalise during the first years of treatment and remained constant thereafter, or declined subsequently. Extracellular water, calculated from the four-compartment model, was increased when patients started PD treatment and increased further, in parallel to the reduction in body cell mass. These alterations were seen in combination with a normal. or slightly reduced, body weight. Standard methods of assessing nutritional status may therefore not be valid in the dialysis population. Prediction equations to estimate total body water, used in measurements of dialysis adequacy, give erroneous results in PD patients, as shown in a study on our PD population. This may have important clinical consequences, especially in wasted patients. Reduced muscle mass is a marker of protein-energy malnutrition, and therefore simple and reliable methods to measure muscle mass are warranted. When lean body mass was calculated from creatinine generation rate and compared to lean body mass estimated from measurements of total body potassium. the agreement between the two methods was low. Furthermore, when repeated measurements of creatinine generation rate were performed, the variation coefficient was unacceptably high. Thus. creatinine generation rate cannot be recommended as a method to evaluate somatic protein status in PD patients. The lipoprotein metabolic derangements are pronounced in PD patients. in which a further increase in cholesterol and cholesterol-rich apoB-containing lipoproteins are added to the already pre-existing renal dyslipidemia. characterised by increased

  19. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    PubMed

    Powers, Sharon; Bacon, Cynthia Thornton

    2016-01-01

    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges. PMID:27259130

  20. [New methods for the ambulatory evaluation of female infertility].

    PubMed

    Török, Péter; Major, Tamás

    2013-08-18

    Incidence of infertility increased in the past years and it affects 15% of couples. Female and male factors are responsible in 40% and 40% of the cases, respectively, while factors present in both females and males can be found in 20% of cases. Female factors can be further divided into organic and functional ones. Function of the female organs can be evaluated in an outpatient setting by well-developed laboratory techniques but evaluation of the uterine cavity and inspection of the tubal patency have been traditionally carried out in one-day surgery. However, the latter can be performed under ambulatory setting with the use of office hysteroscopy, so that the use of operating theatre and staff costs can be saved. Using selective pertubation for the evaluation of tubal patency via office hysteroscopy can reduce cost further. The new methods in infertility workup which can be performed in ambulatory setting have several advantages for the patients.

  1. Septic peritonitis and uroperitoneum secondary to subclinical omphalitis and concurrent necrotizing cystitis in a colt

    PubMed Central

    Lores, Marcos; Lofstedt, Jeanne; Martinson, Shannon; Riley, Christopher B.

    2011-01-01

    A 15-day-old American Quarter horse colt was presented for depression and pyrexia. Peritonitis was diagnosed following peritoneal fluid analysis. Exploratory laparotomy revealed an area of focal necrosis over the dorsal wall of the urinary bladder leading to peritonitis and uroperitoneum. The affected area of the urinary bladder was resected and the peritonitis resolved with medical treatment. PMID:22294797

  2. Hospitalization of older adults due to ambulatory care sensitive conditions

    PubMed Central

    Marques, Aline Pinto; Montilla, Dalia Elena Romero; de Almeida, Wanessa da Silva; de Andrade, Carla Lourenço Tavares

    2014-01-01

    OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life. PMID:25372173

  3. Differences in Treatment of Chlamydia trachomatis by Ambulatory Care Setting.

    PubMed

    Pearson, William S; Gift, Thomas L; Leichliter, Jami S; Jenkins, Wiley D

    2015-12-01

    Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection (STI) in the US and timely, correct treatment can reduce CT transmission and sequelae. Emergency departments (ED) are an important location for diagnosing STIs. This study compared recommended treatment of CT in EDs to treatment in physician offices. Five years of data (2006-2010) were analyzed from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Surveys (NHAMCS), including the Outpatient survey (NHAMCS-OPD) and Emergency Department survey (NHAMCS-ED). All visits with a CT diagnosis and those with a diagnosis of unspecified venereal disease were selected for analysis. Differences in receipt of recommended treatments were compared between visits to physician offices and emergency departments using Chi square tests and logistic regression models. During the 5 year period, approximately 3.2 million ambulatory care visits had diagnosed CT or an unspecified venereal disease. A greater proportion of visits to EDs received the recommended treatment for CT compared to visits to physician offices (66.1 vs. 44.9 %, p < .01). When controlling for patients' age, sex and race/ethnicity, those presenting to the ED with CT were more likely to receive the recommended antibiotic treatment than patients presenting to a physician's office (OR 2.16; 95 % CI 1.04-4.48). This effect was attenuated when further controlling for patients' expected source of payment. These analyses demonstrate differences in the treatment of CT by ambulatory care setting as well as opportunities for increasing use of recommended treatments for diagnosed cases of this important STI. PMID:25940936

  4. [The ambulatory polyclinic institutions in closed administrative territorial municipality].

    PubMed

    Fomin, E P

    2014-01-01

    The article presents the results characterizing functioning of ambulatory polyclinic institutions included into medical sanitary unit of closed administrative territorial municipality of lesser towns. The study established the resource support of staff and full-time positions of physician and paramedical personnel, dynamics of indicators from 2005 to 2013, coverage of population of able-bodied age with preventive and target medical examinations for syphilis and tuberculosis. The progression of contingents under dispensary registration was determined.

  5. Redesigning ambulatory care business processes supporting clinical care delivery.

    PubMed

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care. PMID:10181605

  6. Embracing the Insulin Revolution in the Ambulatory Care Setting.

    PubMed

    Bzowyckyj, Andrew S

    2016-08-01

    IN BRIEF Recent additions of various new formulations of insulin to the U.S. marketplace have increased the number of treatment options available to people living with diabetes. However, it is important to take into consideration the implications of these new insulins in terms of patient safety and medication errors, integration with electronic medical records, and financial considerations. This review outlines several considerations for practitioners regarding the implications of these new insulin products for ambulatory care practice. PMID:27574367

  7. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    PubMed

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  8. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

    PubMed

    Phillips, J H

    1989-01-01

    Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice.

  9. Artificial gravity training improves orthostatic tolerance in ambulatory men and women

    NASA Astrophysics Data System (ADS)

    Stenger, Michael B.; Evans, Joyce M.; Patwardhan, Abhijit R.; Moore, Fritz B.; Hinghofer-Szalkay, Helmut; Rössler, Andreas; Ziegler, Michael G.; Knapp, Charles F.

    2007-02-01

    Orthostatic intolerance (OI) continues to be a problem experienced by astronauts upon return from spaceflight. Artificial gravity (AG) training via short radius centrifugation has been suggested as a countermeasure to this OI. The purpose of our research was to determine effects of three weeks of intermittent (+1 to +2.5 Gz for 35 min/day) AG exposure on normal, ambulatory men and women. The results of this study indicate that 3 weeks of AG training improved orthostatic tolerance in a group of 14 men and 12 women by an average of 13.6%. This improvement was associated with a decrease in arterial pressure and vascular resistance, and increases in stroke volume and low frequency (0.04-0.15 Hz) arterial pressure and heart rate spectral power. These results suggest that improvement may be attributable to increased venous return possibly as a function of increased stress-induced sympathetic activity and/or vascular sympathetic responsiveness.

  10. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    PubMed

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient. PMID:27439249

  11. Evaluation of a career ladder program in an ambulatory care environment.

    PubMed

    Nelson, Joan M; Cook, Paul F

    2008-01-01

    Clinical ladders, or career advancement systems, were designed to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing practice, and improve job satisfaction among nurses. Most of the literature on RN clinical ladder programs is related to the acute care setting, where these programs originated; not much is known about their effectiveness in the ambulatory care environment. The RN Career Ladder at Kaiser Permanente of Colorado was begun by a Labor Management Partnership Committee in 2003, and awards financial incentives to RNs who demonstrate a commitment to continuing education, leadership activities, and program development on a local and regional level. In this study significantly more involvement in leadership, interdisciplinary, and quality improvement activities were found among career ladder nurses than non-career ladder nurses, regardless of their job role. It is not clear whether nursing leaders gravitate toward a career ladder or whether career ladder participation encourages increased participation in leadership activities. PMID:19330969

  12. Positive peritoneal fluid fungal cultures in postoperative peritonitis after bariatric surgery.

    PubMed

    Zappella, N; Desmard, M; Chochillon, C; Ribeiro-Parenti, L; Houze, S; Marmuse, J-P; Montravers, P

    2015-09-01

    Postoperative peritonitis (POP) is a common surgical complication after bariatric surgery (BS). We assessed the importance of positive fungal cultures in these cases of POP admitted to the intensive care unit. Clinical features and outcome were compared in 25 (41%) Candida-positive patients (6 (22%) fluconazole-resistant Candida glabrata) and 36 patients without Candida infection. Candida infections were more commonly isolated in late-onset peritonitis and were often associated with multidrug-resistant bacteria. Risk factors for intensive care unit mortality (19.6%) were diabetes and superobesity. Candida infections, including fluconazole-resistant strains, are common in POP after BS. These data encourage the empirical use of a broad-spectrum antifungal agent.

  13. Molecular mechanisms of peritoneal dissemination in gastric cancer

    PubMed Central

    Kanda, Mitsuro; Kodera, Yasuhiro

    2016-01-01

    Peritoneal dissemination represents a devastating form of gastric cancer (GC) progression with a dismal prognosis. There is no effective therapy for this condition. The 5-year survival rate of patients with peritoneal dissemination is 2%, even including patients with only microscopic free cancer cells without macroscopic peritoneal nodules. The mechanism of peritoneal dissemination of GC involves several steps: detachment of cancer cells from the primary tumor, survival in the free abdominal cavity, attachment to the distant peritoneum, invasion into the subperitoneal space and proliferation with angiogenesis. These steps are not mutually exclusive, and combinations of different molecular mechanisms can occur in each process of peritoneal dissemination. A comprehensive understanding of the molecular events involved in peritoneal dissemination is important and should be systematically pursued. It is crucial to identify novel strategies for the prevention of this condition and for identification of markers of prognosis and the development of molecular-targeted therapies. In this review, we provide an overview of recently published articles addressing the molecular mechanisms of peritoneal dissemination of GC to provide an update on what is currently known in this field and to propose novel promising candidates for use in diagnosis and as therapeutic targets. PMID:27570420

  14. Nodular smooth muscle metaplasia in multiple peritoneal endometriosis.

    PubMed

    Kim, Hyun-Soo; Yoon, Gun; Ha, Sang Yun; Song, Sang Yong

    2015-01-01

    We report here an unusual presentation of peritoneal endometriosis with smooth muscle metaplasia as multiple protruding masses on the lateral pelvic wall. Smooth muscle metaplasia is a common finding in rectovaginal endometriosis, whereas in peritoneal endometriosis, smooth muscle metaplasia is uncommon and its nodular presentation on the pelvic wall is even rarer. To the best of our knowledge, this is the first case of nodular smooth muscle metaplasia occurring in peritoneal endometriosis. As observed in this case, when performing laparoscopic surgery in order to excise malignant tumors of intra-abdominal or pelvic organs, it can be difficult for surgeons to distinguish the metastatic tumors from benign nodular pelvic wall lesions, including endometriosis, based on the gross findings only. Therefore, an intraoperative frozen section biopsy of the pelvic wall nodules should be performed to evaluate the peritoneal involvement by malignant tumors. Moreover, this report implies that peritoneal endometriosis, as well as rectovaginal endometriosis, can clinically present as nodular lesions if obvious smooth muscle metaplasia is present. The pathological investigation of smooth muscle cells in peritoneal lesions can contribute not only to the precise diagnosis but also to the structure and function of smooth muscle cells and related cells involved in the histogenesis of peritoneal endometriosis.

  15. Molecular mechanisms of peritoneal dissemination in gastric cancer.

    PubMed

    Kanda, Mitsuro; Kodera, Yasuhiro

    2016-08-14

    Peritoneal dissemination represents a devastating form of gastric cancer (GC) progression with a dismal prognosis. There is no effective therapy for this condition. The 5-year survival rate of patients with peritoneal dissemination is 2%, even including patients with only microscopic free cancer cells without macroscopic peritoneal nodules. The mechanism of peritoneal dissemination of GC involves several steps: detachment of cancer cells from the primary tumor, survival in the free abdominal cavity, attachment to the distant peritoneum, invasion into the subperitoneal space and proliferation with angiogenesis. These steps are not mutually exclusive, and combinations of different molecular mechanisms can occur in each process of peritoneal dissemination. A comprehensive understanding of the molecular events involved in peritoneal dissemination is important and should be systematically pursued. It is crucial to identify novel strategies for the prevention of this condition and for identification of markers of prognosis and the development of molecular-targeted therapies. In this review, we provide an overview of recently published articles addressing the molecular mechanisms of peritoneal dissemination of GC to provide an update on what is currently known in this field and to propose novel promising candidates for use in diagnosis and as therapeutic targets. PMID:27570420

  16. A Rare Case of Ascites due to Peritoneal Amyloidosis

    PubMed Central

    Stofer, Fernanda; Barretto, Maria Fernanda; Gouvea, Ana Luisa; Ribeiro, Mario; Neves, Marcio; Gismondi, Ronaldo Altenburg; Mocarzel, Luís Otavio

    2016-01-01

    Patient: Male, 65 Final Diagnosis: Peritoneal amyloidosis Symptoms: Anasarca • Dyspnea • Orthopnea Medication: — Clinical Procedure: Paracentesis and peritoneal biopsy Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: The clinical manifestations of amyloidosis depend on the type of insoluble protein as well as the location of amyloid deposits in tissues or organs. In the gastrointestinal tract, the small intestine is the most common site of amyloid deposits, whereas peritoneal involvement and ascites are rare. Case Report: We report on a case of ascites due to peritoneal amyloidosis. A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators. Despite improvement in pulmonary congestion and peripheral edema, his ascites was not reduced. Echocardiogram revealed restrictive cardiomyopathy and a speckle-tracking pattern suggestive of cardiac amyloidosis. Subcutaneous and peritoneal biopsies revealed amyloidosis. Conclusions: Amyloidosis is rare in the peritoneum and is usually asymptomatic. Ascites occurs in only 20% of patients with peritoneal amyloidosis. We searched PubMed using “ascites” and “amyloidosis” and identified only eight case reports of amyloidosis with ascites. Physicians should be particularly careful in heart failure and anasarca cases when ascites is disproportional or not responsive to diuretic treatment. To date, there is no specific treatment for peritoneal amyloidosis. PMID:27353538

  17. Predictors of static balance in ambulatory persons with multiple sclerosis.

    PubMed

    Fry, Donna K; Huang, Min H; Rodda, Becky J

    2016-03-01

    People with multiple sclerosis (MS) experience a high rate of falls and have decreased static and dynamic balance. The purpose of this study was to determine best predictors of static standing balance, as measured by a single limb stance (SLS) timed test, in ambulatory persons with MS (PwMS) from among commonly used medical and rehabilitation clinical tests. Ambulatory PwMS participated in a single test session. Medical exam data gathered included the Function System (FS) neurologic exam and Expanded Disability Status Score (EDSS). A variety of commonly administered rehabilitation clinical tests addressing static balance, dynamic balance, gait endurance, functional lower extremity strength, abdominal and respiratory muscle strength were completed. Descriptive statistics, Pearson product moment correlations, and forward step-wise linear regressions were calculated. Twenty-eight ambulatory PwMS completed this study. Mean age was 54.74 years. Mean SLS score was 14.6 s. Pyramidal, sensory, bowel/bladder, and visual FS scores and the EDSS were significantly correlated with SLS. Maximal step length scores were significantly correlated with SLS at P less than 0.05 and the Functional Stair Test (FST) and 6-min walk test were correlated with SLS at P less than 0.10. Medical exam data EDSS and FS sensory explain 72.1% of the variance in SLS scores. Rehabilitation exam data FS sensory and FST explain 68.8% of the variance. The FS sensory, EDSS, and FST together explain 73.3% of the variance. PMID:26579696

  18. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children. PMID:26794338

  19. Economic disparities in treatment costs among ambulatory Medicaid cancer patients.

    PubMed Central

    Mullins, C. Daniel; Snyder, Stephen E.; Wang, Junling; Cooke, Jesse L.; Baquet, Claudia

    2004-01-01

    BACKGROUND: Cancer is the second leading cause of death in the United States and a major contributor to healthcare expenditure. There are few studies examining disparities in treatment costs. Studies that do exist are dominated by the cost of hospital care. METHODS: Utilizing Maryland Medicaid administrative claims data, a retrospective cohort, design was employed to examine disparities in ambulatory treatment costs of breast, colorectal and prostate cancer treatment by region, race and gender. We report mean and median results by each demographic category and test for the statistical significance of each. Lorenz curves are plotted and Gini coefficients calculated for each type of cancer. RESULTS: We do not find a consistent trend in ambulatory costs across the three cancers by traditional demographic variables. Lorenz curves indicate highly unequal distributions of costs. Gini coefficients are 0.687 for breast cancer, 0.757 for colorectal cancer and 0.774 for prostate cancer. CONCLUSION: Significant variation in nonhospital-based expenditures exists for breast, colorectal and prostate cancers in a population of homogeneous socioeconomic status and uniform insurance entitlement. Observed individual-level disparities are not consistent across cancers by region, race or gender, but the majority of this low-income population receives very little ambulatory care. Images Figure 2 PMID:15622686

  20. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children.

  1. Assessment of ambulatory blood pressure recorders: accuracy and clinical performance.

    PubMed

    White, W B

    1991-06-01

    There are now more than ten different manufacturers of non-invasive, portable blood pressure monitors in North America, Europe, and Japan. These ambulatory blood pressure recorders measure blood pressure by either auscultatory or oscillometric methodology. Technologic advances in the recorders have resulted in reduction in monitor size, reduction in or absence of motor noise during cuff inflation, ability to program the recorder without an external computer system, and enhanced precision. Recently, there has been concern that more structured validation protocols have not been implemented prior to the widespread marking of ambulatory blood pressure recorders. There is a need for proper assessment of recorders prior to use in clinical research or practice. Data on several existing recorders suggest that while most are reasonably accurate during resting measurements, many lose this accuracy during motion, and clinical performance may vary among the monitors. Validation studies of ambulatory recorders should include comparison with mercury column and intra-arterial determinations, resting and motion measurements, and assessment of clinical performance in hypertensive patients. PMID:1893652

  2. Ambulatory impedance cardiography in hypertension: a validation study.

    PubMed

    McFetridge-Durdle, Judith A; Routledge, Faye S; Parry, Monica J E; Dean, C R T; Tucker, B

    2008-09-01

    The management of hypertension is improved by knowledge of the hemodynamics underlying blood pressure. Impedance Cardiography (ICG) provides data on a range of hemodynamic variables that affect blood pressure. However, ICG captures only fixed descriptions of hemodynamic characteristics. Improvements in ambulatory technology have led to the development of the Ambulatory Impedance Monitor (AIM) which records hemodynamic data during the activities of daily living. The purpose of this study was to evaluate the sensitivity of the AIM to detect hemodynamic changes associated with postural shift in persons with hypertension. Using a repeated measures cross-over design, sitting and standing hemodynamic measures were taken in seventeen persons with hypertension while wearing the AIM-BpTRU system designed for standard office use and the AIM-Spacelabs system designed for ambulatory monitoring. Both AIM-blood pressure monitoring systems detected significant changes from sitting to standing posture in heart rate (p=0.03), stroke volume (p=0.002), left ventricular ejection time (p<0.001), systemic vascular resistance (p=0.03) and diastolic blood pressure (p<0.001). Additionally, both systems generated measures of cardiac function that were positively correlated (p<0.001) and not significantly different (p>0.05). Our findings support previous work and demonstrate that the AIM provides valid and reliable estimates of cardiac function in persons with hypertension. PMID:18234557

  3. Linagliptin Ameliorates Methylglyoxal-Induced Peritoneal Fibrosis in Mice.

    PubMed

    Nagai, Takuo; Doi, Shigehiro; Nakashima, Ayumu; Irifuku, Taisuke; Sasaki, Kensuke; Ueno, Toshinori; Masaki, Takao

    2016-01-01

    Recent studies have reported increases of methylglyoxal (MGO) in peritoneal dialysis patients, and that MGO-mediated inflammation plays an important role in the development of peritoneal fibrosis through production of transforming growth factor-β1 (TGF-β1). Linagliptin, a dipeptidyl peptidase-4 inhibitor, exerts anti-inflammatory effects independent of blood glucose levels. In this study, we examined whether linagliptin suppresses MGO-induced peritoneal fibrosis in mice. Male C57/BL6 mice were divided into three groups: control, MGO injection plus saline, and MGO injection plus linagliptin (n = 6 per group). Peritoneal fibrosis was induced by daily intraperitoneal injection of saline containing 40 mmol/L MGO for 21 days. Saline was administered intraperitoneally to the control group. Linagliptin (10 mg/kg) or saline were administrated by once-daily oral gavage from 3 weeks before starting MGO injections. Immunohistochemical staining revealed that linagliptin suppressed expression of α-smooth muscle actin and fibroblast-specific protein-1, deposition of type I and III collagen, and macrophage (F4/80) infiltration. Peritoneal equilibration testing showed improved peritoneal functions in mice treated with linagliptin. Peritoneal injection of MGO increased plasma levels of glucagon-like peptide-1 (GLP-1) in mice, and a further increase was observed in linagliptin-treated mice. Although MGO increased plasma glucose levels, linagliptin did not decrease plasma glucose levels. Moreover, linagliptin reduced the TGF-β1 concentration in the peritoneal fluid of MGO-treated mice. GLP-1 receptor (GLP-1R) was expressed in monocytes/macrophages and linagliptin suppressed GLP-1R expression in MGO-injected mice. These results suggest that oral administration of linagliptin ameliorates MGO-induced peritoneal fibrosis. PMID:27513960

  4. Linagliptin Ameliorates Methylglyoxal-Induced Peritoneal Fibrosis in Mice

    PubMed Central

    Nagai, Takuo; Doi, Shigehiro; Nakashima, Ayumu; Irifuku, Taisuke; Sasaki, Kensuke; Ueno, Toshinori; Masaki, Takao

    2016-01-01

    Recent studies have reported increases of methylglyoxal (MGO) in peritoneal dialysis patients, and that MGO-mediated inflammation plays an important role in the development of peritoneal fibrosis through production of transforming growth factor-β1 (TGF-β1). Linagliptin, a dipeptidyl peptidase-4 inhibitor, exerts anti-inflammatory effects independent of blood glucose levels. In this study, we examined whether linagliptin suppresses MGO-induced peritoneal fibrosis in mice. Male C57/BL6 mice were divided into three groups: control, MGO injection plus saline, and MGO injection plus linagliptin (n = 6 per group). Peritoneal fibrosis was induced by daily intraperitoneal injection of saline containing 40 mmol/L MGO for 21 days. Saline was administered intraperitoneally to the control group. Linagliptin (10 mg/kg) or saline were administrated by once-daily oral gavage from 3 weeks before starting MGO injections. Immunohistochemical staining revealed that linagliptin suppressed expression of α-smooth muscle actin and fibroblast-specific protein-1, deposition of type I and III collagen, and macrophage (F4/80) infiltration. Peritoneal equilibration testing showed improved peritoneal functions in mice treated with linagliptin. Peritoneal injection of MGO increased plasma levels of glucagon-like peptide-1 (GLP-1) in mice, and a further increase was observed in linagliptin-treated mice. Although MGO increased plasma glucose levels, linagliptin did not decrease plasma glucose levels. Moreover, linagliptin reduced the TGF-β1 concentration in the peritoneal fluid of MGO-treated mice. GLP-1 receptor (GLP-1R) was expressed in monocytes/macrophages and linagliptin suppressed GLP-1R expression in MGO-injected mice. These results suggest that oral administration of linagliptin ameliorates MGO-induced peritoneal fibrosis. PMID:27513960

  5. Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

    PubMed Central

    Morelle, Johann; Sow, Amadou; Hautem, Nicolas; Bouzin, Caroline; Crott, Ralph

    2015-01-01

    Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis (PD) characterized by extensive fibrosis of the peritoneum. Changes in peritoneal water transport may precede EPS, but the mechanisms and potential predictive value of that transport defect are unknown. Among 234 patients with ESRD who initiated PD at our institution over a 20-year period, 7 subsequently developed EPS. We evaluated changes in peritoneal transport over time on PD in these 7 patients and in 28 matched controls using 3.86% glucose peritoneal equilibration tests. Compared with long-term PD controls, patients with EPS showed early loss of ultrafiltration capacity and sodium sieving before the onset of overt EPS. Multivariate analysis revealed that loss of sodium sieving was the most powerful predictor of EPS. Compared with long-term PD control and uremic peritoneum, EPS peritoneum showed thicker submesothelial fibrosis, with increased collagen density and a greater amount of thick collagen fibers. Reduced osmotic conductance strongly correlated with the degree of peritoneal fibrosis, but not with vasculopathy. Peritoneal fibrosis was paralleled by an excessive upregulation of vascular endothelial growth factor and endothelial nitric oxide synthase, but the expression of endothelial aquaporin-1 water channels was unaltered. Our findings suggest that an early and disproportionate reduction in osmotic conductance during the course of PD is an independent predictor of EPS. This functional change is linked to specific alterations of the collagen matrix in the peritoneal membrane of patients with EPS, thereby validating the serial three-pore membrane/fiber matrix and distributed models of peritoneal transport. PMID:25636412

  6. Recent advances in peritoneal morphology: the milky spots in peritoneal dialysis.

    PubMed

    Garosi, G; Di Paolo, N

    2001-01-01

    Milky spots are submesothelial lymphoid structures, essential for the maturation of resident peritoneal macrophages, for peritoneal defense, and for all peritoneal inflammatory and immune processes. We evaluated the number and size of milky spots in omentum of rats subjected to dialysis for 15, 30, and 60 days and in omentum of non dialyzed control rats (5 rats per group). After 15 days of dialysis, the number (4.2 +/- 1.5/cm2) and mean size (0.13 +/- 0.04 mm2) of milky spots were significantly lower than in the control group (7.6 +/- 2.3/cm2, p < 0.03; 0.25 +/- 0.04 mm2, p < 0.01). After 30 days of dialysis, values returned to a level similar to that in controls (6.8 +/- 1.9/cm2 and 0.20 +/- 0.04 mm2). After 60 days of dialysis, values were significantly greater than in all other groups (11.8 +/- 2.2/cm2 and 0.41 +/- 0.07 mm2, p < 0.03). The early decrease in milky spots seems to be due to washing of the peritoneum and replacement of resident white cells at the expense of the white cell population in the milky spots. At 30 days, a process of adaptation seems to establish functional equilibrium. The increase in milky spots after 60 days of dialysis may be due to the chronic inflammatory stimulus of dialysis solutions with poor biocompatibility.

  7. [Appendiceal peritonitis in childhood, antibiotic treatment with cefoxitin].

    PubMed

    Aristegui, J; de la Fuente, E; Pérez Legorburu, A; de Gárate, J

    1982-11-01

    Twenty one cases of appendiceal peritonitis in children are reviewed. An antibiotic (sodium cefoxitine) has been used during the post-operative course to decrease the risk of suppurative complications. Cultures obtained from peritoneal exudate yielded "E. coli" and "Bacteroides" sp. as the most commonly isolated bacteria. External drainage was placed as a rutine and the percentage of suppurative complications was 14%. No patient showed evidence of adverse reactions to the antibiotic and the mortality of the serie was zero. Obtained results allow to state that cefoxitine is effective in the management of appendiceal peritonitis in children.

  8. Oral Tori in Chronic Peritoneal Dialysis Patients

    PubMed Central

    Hsu, Chia-Lin; Hsu, Ching-Wei; Chang, Pei-Ching; Huang, Wen-Hung; Weng, Cheng-Hao; Yang, Huang-Yu; Liu, Shou-Hsuan; Chen, Kuan-Hsing; Weng, Shu-Man; Chang, Chih-Chun; Wang, I-Kuan

    2016-01-01

    Background The pathogenesis of oral tori has long been debated and is thought to be the product of both genetic and environmental factors, including occlusal forces. Another proposed mechanism for oral tori is the combination of biomechanical forces, particularly in the oral cavity, combined with cortical bone loss and trabecular expansion, as one might see in the early stages of primary hyperparathyroidism. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in peritoneal dialysis patients, and analyzed the influences of hyperparathyroidism on the formation of oral tori. Method In total, 134 peritoneal dialysis patients were recruited between July 1 and December 31, 2015 for dental examinations for this study. Patients were categorized into two subgroups based on the presence or absence of oral tori. Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis. Results The prevalence of oral tori in our sample group was high at 42.5% (57 of 134), and most patients with oral tori were female (61.4%). The most common location of tori was TP (80.7%), followed by TP and TM (14.0%), then TM (5.3%). All 54 TP cases were at the midline, and most were <2 cm (59.3%), flat (53.7%), and located in the premolar region (40.7%). Of the 11 TM cases, all were bilateral and symmetric, mostly <2 cm (81.9%), lobular (45.4%), and located at premolar region (63.6%). Interestingly, patients with oral tori had slightly lower serum levels of intact parathyroid hormones than those without oral tori, but the difference was not statistically significant (317.3±292.0 versus 430.1±492.6 pg/mL, P = 0.126). In addition, patients with oral tori did not differ from patients without tori in inflammatory variables such as serum high sensitivity C-reactive protein levels (6.6±8.2 versus 10.3±20.2 mg/L, P = 0.147) or nutritional variables such as serum albumin levels (3.79±0.38 versus 3.77±0.45 g/dL, P = 0

  9. [The peritoneal environment: physiopathogenesis of endometriosis].

    PubMed

    Corchado Gómez, A; Hinojosa Cruz, J C

    1997-04-01

    In this report an hypothetical model of the pathophysiology of endometriosis is reviewed based on recent literature, focusing a variety of factors within the specific environment confined by peritoneum, whose alteration has repercussion among endometriotic and immune response cells relationships. At this point vasoactive substances, cytokines (interleukines and growth factors), and menstrual cycle hormones may act as soluble mediators that are able to induce several effects over cellular proliferation, growth and differentiation; and expression of new antigenic epitopes and cell adhesion molecules. This interactions are evident through inflammatory and immune responses, wound repair, fibrosis and pelvic adhesion formation, producing an adequate peritoneal environment for the initiation, maintenance, and progression of endometriotic implants. These finally leads to endometriosis-associated symptoms as pelvic pain, dysmenorrhea, dyspareunia and infertility.

  10. Chlamydia Peritonitis and Ascites Mimicking Ovarian Cancer

    PubMed Central

    Macer, Matthew; Azodi, Masoud

    2016-01-01

    Background. Pelvic inflammatory disease (PID) rarely results in diffuse ascites. Severe adhesive disease secondary to PID may lead to the formation of inclusion cysts and even pelvic peritoneal nodularity due to postinflammatory scarring and cause an elevation of serum CA-125 levels. The constellation of these findings may mimic an ovarian neoplasm. Case. We report a case of a 22-year-old female who presented with multiple pelvic cysts and diffuse ascites due to Chlamydia trachomatis infection. The initial gynecologic exam did not reveal obvious evidence of PID; however, a positive Chlamydia trachomatis test, pathologic findings, and the exclusion of other etiologies facilitated the diagnosis. Conclusion. Chlamydia trachomatis and other infectious agents should be considered in the differential diagnosis of a young sexually active female with abdominal pain, ascites, and pelvic cystic masses. Thorough workup in such a population may reduce the number of more invasive procedures as well as unnecessary repeat surgical procedures. PMID:27747116

  11. [Spontaneous bacterial peritonitis in patients with cirrhosis].

    PubMed

    Nousbaum, Jean-Baptiste

    2015-12-01

    Spontaneous bacterial peritonitis (SBP) is a severe complication occurring in patients with cirrhosis, and is associated with high mortality. Liver transplantation should be considered after a first episode of SBP. Gram-negative bacilli are the major cause of SBP, however there is an increasing trend of Gram-positive cocci related SBP. Management includes empirical antibiotic treatment and albumin infusion. The choice of antibiotics depends on the site of acquisition (community-acquired vs nosocomial or health-care associated infection) and local resistance profile, due to the emergence of drug-resistant bacteria. Secondary prophylaxis is recommended after resolution of SBP and reduces recurrence and mortality. Primary prophylaxis in patients with low protein ascites (<15 g/L) should be restricted to patients with severe cirrhosis awaiting for liver transplantation.

  12. Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

    PubMed Central

    Martin, Luis C.; Caramori, Jacqueline C.T.; Fernandes, Natalia; Divino-Filho, Jose C.; Pecoits-Filho, Roberto

    2011-01-01

    Summary Background and objectives Peritonitis remains as the most frequent cause of peritoneal dialysis (PD) failure, impairing patient's outcome. No large multicenter study has addressed socioeconomic, educational, and geographic issues as peritonitis risk factors in countries with a large geographic area and diverse socioeconomic conditions, such as Brazil. Design, setting, participants, & measurements Incident PD patients recruited from 114 dialysis centers and reporting to BRAZPD, a multicenter observational study, from December 2004 through October 2007 were included. Clinical, dialysis-related, demographic, and socioeconomic variables were analyzed. Patients were followed up until their first peritonitis. Cox proportional model was used to determine independent factors associated with peritonitis. Results In a cumulative follow-up of 2032 patients during 22.026 patient-months, 474 (23.3%) presented a first peritonitis episode. In contrast to earlier findings, PD modality, previous hemodialysis, diabetes, gender, age, and family income were not risk predictors. Factors independently associated with increased hazard risk were lower educational level, non-white race, region where patients live, shorter distance from dialysis center, and lower number of patients per center. Conclusions Educational level and geographic factors as well as race and center size are associated with risk for the first peritonitis, independent of socioeconomic status, PD modality, and comorbidities. PMID:21737854

  13. Left Ventricular Diastolic Dysfunction in Peritoneal Dialysis

    PubMed Central

    Wu, Cho-Kai; Lee, Jen-Kuang; Wu, Yi-Fan; Tsai, Chia-Ti; Chiang, Fu-Tien; Hwang, Juey-Jen; Lin, Jiunn-Lee; Hung, Kuan-Yu; Huang, Jenq-Wen; Lin, Jou-Wei

    2015-01-01

    Abstract Left ventricular diastolic dysfunction (LVDD) is common among patients undergoing peritoneal dialysis (PD). We examined the relationship between LVDD, major adverse cardiovascular events (MACE), and mortality in PD patients. A total of 149 patients undergoing PD with preserved left ventricular systolic function were included and followed for 3.5 years. LVDD was diagnosed (according to the European Society of Cardiology guidelines) by conventional and tissue Doppler echocardiography. Serum high-sensitivity C-reactive protein (hsCRP) was measured. The location and volume of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra. Subjects with LVDD had higher levels of hsCRP, and more visceral and peritoneal fat than controls. The relationship between adjusted visceral adipose tissue and LVDD became nonsignificant when hsCRP and baseline demographic data were introduced into the logistic regression model (odds ratio = 1.52, P = 0.07). Subsequent hierarchical multivariate Cox regression analysis showed that LVDD was one of the most powerful determinants of MACE and mortality after adjusting for all confounding factors (hazard ratio [HR]: 1.71, 95% confidence interval [CI]: 1.43–3.51, P = 0.02 and HR: 2.25, 95% CI: 1.45–2.91, P = 0.04, respectively). Systemic inflammation (hsCRP) was also significantly associated with MACE and mortality (HR: 2.03, P = 0.03 and HR: 2.16, P = 0.04, respectively). LVDD is associated with systemic inflammation and increased visceral fat in patients undergoing PD. LVDD is also a sensitive, independent indicator of future MACE and mortality in PD patients. PMID:25997054

  14. Immunologic Effects Of Peritoneal Photodynamic Treatment

    NASA Astrophysics Data System (ADS)

    Lynch, David H.; Haddad, Sandra; Jolles, Christopher J.; King, Vernon J.; Ott, Mark J.; Robertson, Bekkie; Straight, Richard C.

    1989-06-01

    One of the side effects of peritoneal photodynamic treatment (PDT) of mice is a systemic suppression of contact hypersensitivity (CH) responses. Treatment with either laser alone or the photosensitizer, Photofrin II (PFII), alone does not cause suppression of CH responses. Immunosuppression of CH responses is an active process that is adoptively transferable using viable cells, but not serum, from PDT-treated mice. The induction of adoptively transferable suppressor cells in PDT-treated mice requires exposure to an antigenic stimulus, yet the suppressor cells are antigen non-specific in their function. T cell function in PDT-treated mice, as measured by the ability of splenic lymphoid cells to generate allogeneic cytotoxic T lymphocyte responses, is comparable to that detected in normal mice. However, the ability of spleen cells from PDT-treated mice to act as stimulators in a mixed lymhocyte reaction is dramatically impaired, suggesting that the major cell type affected by peritoneal PDT is of the macrophage lineage. Support for this concept is provided by experiments in which spleen cells from PDT-treated mice were chromatographically separated into populations of T cells, B cells and macrophages prior to adoptive transfer into naive recipients. The results indicate that the cell type mediating adoptively transferable suppression of CH responsiveness is of the macrophage lineage. Analysis of hematologic parameters revealed that induction of suppression by PDT-treatment was associated with a marked neutrophilia and lymphocytosis, and was also accompanied by a 5-fold increase in concentration of the acute phase protein, Serum Amyloid P. Finally, attempts to ameliorate PDT-induced immunosuppression by pharmacologic intervention have proved successful using implants of pellets that release indomethacin at a rate of 1.25µg/day. Thus, the data suggest that PDT-treatment induces macrophages to produce factors (e.g., prostaglandins) that are known to be potently

  15. Sunitinib Malate in Treating Patients With Recurrent Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cancer

    ClinicalTrials.gov

    2015-01-15

    Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Primary Peritoneal Cavity Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Primary Peritoneal Cavity Cancer

  16. 75 FR 73088 - Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) for Deeming Authority for... Surgery Facilities (AAAASF) for recognition as a national accrediting organization for providers...

  17. Rapamycin Protects from Type-I Peritoneal Membrane Failure Inhibiting the Angiogenesis, Lymphangiogenesis, and Endo-MT.

    PubMed

    González-Mateo, Guadalupe Tirma; Aguirre, Anna Rita; Loureiro, Jesús; Abensur, Hugo; Sandoval, Pilar; Sánchez-Tomero, José Antonio; del Peso, Gloria; Jiménez-Heffernan, José Antonio; Ruiz-Carpio, Vicente; Selgas, Rafael; López-Cabrera, Manuel; Aguilera, Abelardo; Liappas, Georgios

    2015-01-01

    Preservation of peritoneal membrane (PM) is essential for long-term survival in peritoneal dialysis (PD). Continuous presence of PD fluids (PDF) in the peritoneal cavity generates chronic inflammation and promotes changes of the PM, such as fibrosis, angiogenesis, and lymphangiogenesis. Mesothelial-to-mesenchymal transition (MMT) and endothelial-to-mesenchymal transition (Endo-MT) seem to play a central role in this pathogenesis. We speculated that Rapamycin, a potent immunosuppressor, could be beneficial by regulating blood and lymphatic vessels proliferation. We demonstrate that mice undergoing a combined PD and Rapamycin treatment (PDF + Rapa group) presented a reduced PM thickness and lower number of submesothelial blood and lymphatic vessels, as well as decreased MMT and Endo-MT, comparing with their counterparts exposed to PD alone (PDF group). Peritoneal water transport in the PDF + Rapa group remained at control level, whereas PD effluent levels of VEGF, TGF-β, and TNF-α were lower than in the PDF group. Moreover, the treatment of mesothelial cells with Rapamycin in vitro significantly decreased VEGF synthesis and selectively inhibited the VEGF-C and VEGF-D release when compared with control cells. Thus, Rapamycin has a protective effect on PM in PD through an antifibrotic and antiproliferative effect on blood and lymphatic vessels. Moreover, it inhibits Endo-MT and, at least partially, MMT. PMID:26688823

  18. Sustained release of antibiotic complexed by multivalent ion: in vitro and in vivo study for the treatment of peritonitis.

    PubMed

    Na, Seung Yeon; Oh, Se Heang; Kim, Tae Ho; Yoon, Jin A; Lee, In Soo; Lee, Jin Ho

    2014-12-10

    The main aims of this study are (i) the development of an antibiotic complexed with multivalent ion, which can allow sustained release of the antibiotic without any additional matrix or difficult process and (ii) the feasibility study of the ion-complexed antibiotic as a therapeutic technique for peritonitis treatment. An ion-complexed antibiotic is prepared by simple mixing of two aqueous solutions containing an ionized (water-soluble) drug (tetracycline) and a multivalent counter ionic compound. The ion-complexed antibiotic shows a continuous release of the antibiotic up to 21 days, and thus prolonged anti-bacterial effect by gradual ionic exchange between the multivalent ions in the complex and same-charged monovalent ions in surrounding medium. From the in vivo animal study using a cecum perforated peritonitis mouse model, the ion-complexed antibiotic group shows sufficient anti-bacterial effect and thus effectively treat the peritonitis because of the extermination of the contaminated enteric bacteria in the peritoneum during wound healing of injury cecum (by the sustained release of antibiotic from the ion complex). These results suggest that the ion-complexed antibiotic system may be promising for the effective treatment of the peritonitis caused by frequent gastrointestinal defect in clinical fields.

  19. Rapamycin Protects from Type-I Peritoneal Membrane Failure Inhibiting the Angiogenesis, Lymphangiogenesis, and Endo-MT

    PubMed Central

    Aguirre, Anna Rita; Loureiro, Jesús; Abensur, Hugo; Sandoval, Pilar; Sánchez-Tomero, José Antonio; del Peso, Gloria; Jiménez-Heffernan, José Antonio; Ruiz-Carpio, Vicente; Selgas, Rafael; López-Cabrera, Manuel; Aguilera, Abelardo; Liappas, Georgios

    2015-01-01

    Preservation of peritoneal membrane (PM) is essential for long-term survival in peritoneal dialysis (PD). Continuous presence of PD fluids (PDF) in the peritoneal cavity generates chronic inflammation and promotes changes of the PM, such as fibrosis, angiogenesis, and lymphangiogenesis. Mesothelial-to-mesenchymal transition (MMT) and endothelial-to-mesenchymal transition (Endo-MT) seem to play a central role in this pathogenesis. We speculated that Rapamycin, a potent immunosuppressor, could be beneficial by regulating blood and lymphatic vessels proliferation. We demonstrate that mice undergoing a combined PD and Rapamycin treatment (PDF + Rapa group) presented a reduced PM thickness and lower number of submesothelial blood and lymphatic vessels, as well as decreased MMT and Endo-MT, comparing with their counterparts exposed to PD alone (PDF group). Peritoneal water transport in the PDF + Rapa group remained at control level, whereas PD effluent levels of VEGF, TGF-β, and TNF-α were lower than in the PDF group. Moreover, the treatment of mesothelial cells with Rapamycin in vitro significantly decreased VEGF synthesis and selectively inhibited the VEGF-C and VEGF-D release when compared with control cells. Thus, Rapamycin has a protective effect on PM in PD through an antifibrotic and antiproliferative effect on blood and lymphatic vessels. Moreover, it inhibits Endo-MT and, at least partially, MMT. PMID:26688823

  20. General Information About Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

    MedlinePlus

    ... condition or to keep cancer from starting. General Information About Ovarian, Fallopian Tube, and Primary Peritoneal Cancer ... PDQ Screening and Prevention Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

  1. Benign Multicystic Peritoneal Mesothelioma: A Rare Tumour of the Abdomen

    PubMed Central

    Somasundaram, Soundappan; Khajanchi, Monty; Vaja, Tejas; Jajoo, Bhushan; Dey, Amit Kumar

    2015-01-01

    Benign multicystic peritoneal mesothelioma: a rare tumor of the abdomen, is a diagnostic dilemma. This report emphasizes the importance of diagnostic laparoscopy in the diagnosis of the tumour. PMID:25866695

  2. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic conditions, and that consists of a peritoneal access device, an administration set...

  3. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic conditions, and that consists of a peritoneal access device, an administration set...

  4. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic conditions, and that consists of a peritoneal access device, an administration set...

  5. Anal extrusion of a ventriculo peritoneal shunt tube: Endoscopic removal.

    PubMed

    Vuyyuru, Sreedhar; Ravuri, Sreenivas R; Tandra, Vamsidhar R; Panigrahi, Manas K

    2009-07-01

    We describe the extrusion of a ventriculo peritoneal shunt tube from the anus into a 6-year-old boy following the placement of a ventriculo peritoneal shunt for postoperative periventricular tumor-induced hydrocephalus. He was admitted with a complaint of extrusion of a tube through anus on and off during bowel evacuation. He was evaluated with an X-ray of the abdomen which was showing a coiled tube in descending and sigmoid colon, confirmed by sigmoidoscopy. The proximal end was exposed for external ventricular drainage and distal end was removed endoscopically. The patient was watched for peritonitis and managed conservatively. The proximal end of the tube was removed after 5 days of external ventricular drainage and after ruling out ventriculitis and meningitis. Bowel perforation by a ventriculo peritoneal tube is a rare complication. Diagnosis is often difficult and delayed. Most of the bowel perforation is seen in young patients. PMID:21887196

  6. Regulation of Synthesis and Roles of Hyaluronan in Peritoneal Dialysis

    PubMed Central

    Bowen, Timothy; Meran, Soma; Williams, Aled P.; Newbury, Lucy J.; Sauter, Matthias; Sitter, Thomas

    2015-01-01

    Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS) enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis. PMID:26550568

  7. (1→3)-β-D-glucan and galactomannan testing for the diagnosis of fungal peritonitis in peritoneal dialysis patients, a pilot study.

    PubMed

    Worasilchai, Navaporn; Leelahavanichkul, Asada; Kanjanabuch, Talerngsak; Thongbor, Nisa; Lorvinitnun, Pichet; Sukhontasing, Kanya; Finkelman, Malcolm; Chindamporn, Ariya

    2015-05-01

    Fungal peritonitis is an uncommon but serious complication of peritoneal dialysis (PD) due to the fact that routine culture to recovered the etiologic agents are time consuming and KOH staining has very low sensitivity. Peritoneal (1→3)-β-D-glucan (BG) or galactomannan (GM), both fungal cell wall components, are candidate biomarkers of fungal peritonitis. Hence, a comparative cross-sectional analysis of peritoneal dialysis fluid (PDF) BG (Fungitell, Cape Cod, MA, USA) and GM (Platelia Aspergillus Ag kits, Bio-rad, France) from all PD patients with and without fungal peritonitis (13 cases, identified by culture), over a 1 year period, was performed. PDF of the fungal peritonitis group showed very high BG (494 ± 19 pg/ml) and high GM (3.41 ± 1.24) similar results were noted in specimens from cases of peritonitis with other causes, especially gram negative bacterial peritonitis. A BG cut-off value at 240 pg/ml and GM at 0.5 showed sensitivity/ specificity at 100%/ 83% and 77%/ 58%, respectively. A concomitantly positive GM reduced the false positive rate of BG from nonfungal peritonitis. In conclusion, BG and GM in peritoneal fluid with provisional cut-off values were applicable as surrogate biomarkers for the diagnosis of fungal peritonitis in PD patients.

  8. The physiological impact of the nonlinearity of arterial elasticity in the ambulatory arterial stiffness index.

    PubMed

    Craiem, Damian; Graf, Sebastian; Salvucci, Fernando; Chironi, Gilles; Megnien, Jean-Louis; Simon, Alain; Armentano, Ricardo L

    2010-07-01

    The ambulatory arterial stiffness index (AASI) is claimed to be a new estimator for arterial rigidity. It was recently defined as one minus the slope of the linear regression of systolic to diastolic ambulatory pressure during 24 h. Although several reports testify its clinical relevance, the explanation of how this new index is conceptually associated with arterial stiffness remains controversial. In this work we hypothesize that nonlinear arterial elasticity is behind AASI physiological principles. To that end, random number generators were used to emulate arterial cross-sectional area (CSA) during 24 h. Pressure values were calculated using linear and nonlinear elasticity models for rigid and compliant arteries. The AASI was calculated from simulated pressures and also analytically predicted for each model. Additionally, invasive aortic pressure and CSA were continuously measured in a conscious sheep during 24 h to test the nonlinear model. We found that analytical solutions agreed with simulation outcomes; for the nonlinear model, the AASI was higher in rigid arteries with respect to compliant arteries (0.51 versus 0.38) and the linear model systematically predicted AASI = 0. For in vivo pressure measurements, AASI was 0.31. Using the measured pulsatile CSA and an estimation of the elastic constant for the nonlinear model, the AASI was accurately predicted with errors below 5%. We conclude that the AASI is higher in stiffer arteries due to the nonlinear behavior of the arterial wall. With a nonlinear arterial function, the slope of the linear regression of diastolic to systolic pressures during 24 h depends on the product of an elastic constant by the pulsatile CSA. As the elastic constant dominates the product, the reported associations between the AASI and arterial stiffness indices now have a consistent explanation.

  9. Field Trips as a Novel Means of Experiential Learning in Ambulatory Pediatrics

    PubMed Central

    Friedland, Allen R.; Rintel-Queller, Hayley C.; Unnikrishnan, Devi; Paul, David A.

    2012-01-01

    Background Parents and caregivers look to pediatric health care providers for guidance on feeding, safety issues, and child-care products for children, but trainees have infrequent first-hand exposure to child products marketed to parents. Objective To conduct a pilot study to assess an experiential field trip as a novel method of enhancing medical knowledge in ambulatory pediatric feeding and safety. Methods Resident physicians and medical students visited a local children's store, where they took part in an interactive store tour, product discussions, and product demonstrations led by a physician educator. Participants also completed a 20-question pretest and a 20-question posttest related to common ambulatory pediatric feeding and safety issues, based on recent American Academy of Pediatrics (AAP) policy statements and practice guidelines. Results Sixty-seven medical students and resident physicians participated in the study. Overall, participants' short-term knowledge significantly increased from 9.9 ± 2.6 to 15.4 ± 2.2 questions correct (P  =  .001), with statistically significant gains (P < .001) on both the feeding and safety sections of the test. There were no differences in improvement based on participant's student or resident status, residency program type, program year, sex, or parental status. Ninety-five percent of the participants believed that their knowledge was enhanced by this approach, and participants uniformly agreed that this field trip was valuable to their pediatric training and that such field trip sessions should continue. Conclusions The inclusion of experiential learning through an interactive field trip in the curriculum of medical training was acceptable and feasible and showed short-term improvements in knowledge of AAP safety and feeding concepts. PMID:23730450

  10. Ambulatory Treatment of Type 2 Diabetes in the U.S., 1997–2012

    PubMed Central

    Turner, Lydia W.; Nartey, David; Stafford, Randall S.; Singh, Sonal; Alexander, G. Caleb

    2014-01-01

    OBJECTIVE Type 2 diabetes is increasingly common and associated with substantial morbidity and mortality. This study examines trends in the patterns and costs of drug treatment of type 2 diabetes from 1997 to 2012. RESEARCH DESIGN AND METHODS We conducted descriptive analyses of cross-sectional data using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory physician practices in the U.S. We focused on visits for diabetes among patients 35 years of age or older. We used the IMS Health National Prescription Audit of pharmacy dispensing to derive information about drug expenditures. RESULTS Ambulatory diabetes visits increased from 23 million treatment visits in 1997 (95% CI 21–25) to 35 million (32–37) in 2007 and declined to 31 million visits by 2012 (27–31). Between 1997 and 2012 biguanide use increased, from 23% (20–26) to 53% (50–56) of treatment visits. Glitazone use grew from 6% (4–8) in 1997 (41% [39–43] of all visits in 2005), but declined to 16% (14–18) by 2012. Since 2005, dipeptidyl peptidase-4 (DPP-4) inhibitor use increased steadily, representing 21% (18–23) of treatment visits by 2012. Glucagon-like peptide 1 (GLP-1) agonists accounted for 4% of treatment visits in 2012. Visits where two or more drug compounds were used increased nearly 40% from 1997 to 2012. Between 2008 and 2012, drug expenditures increased 61%, driven primarily by use of insulin glargine and DPP-4 inhibitors. CONCLUSIONS Declining sulfonylurea and glitazone use has been offset by increases in DPP-4 inhibitor use and, to a lesser degree, use of GLP-1 agonists. Treatment of diabetes has grown in complexity while older treatments continue to be replaced or supplemented by newer therapies. PMID:24198301

  11. Automated ambulatory assessment of cognitive performance, environmental conditions, and motor activity during military operations

    NASA Astrophysics Data System (ADS)

    Lieberman, Harris R.; Kramer, F. Matthew; Montain, Scott J.; Niro, Philip; Young, Andrew J.

    2005-05-01

    Until recently scientists had limited opportunities to study human cognitive performance in non-laboratory, fully ambulatory situations. Recently, advances in technology have made it possible to extend behavioral assessment to the field environment. One of the first devices to measure human behavior in the field was the wrist-worn actigraph. This device, now widely employed, can acquire minute-by-minute information on an individual"s level of motor activity. Actigraphs can, with reasonable accuracy, distinguish sleep from waking, the most critical and basic aspect of human behavior. However, rapid technologic advances have provided the opportunity to collect much more information from fully ambulatory humans. Our laboratory has developed a series of wrist-worn devices, which are not much larger then a watch, which can assess simple and choice reaction time, vigilance and memory. In addition, the devices can concurrently assess motor activity with much greater temporal resolution then the standard actigraph. Furthermore, they continuously monitor multiple environmental variables including temperature, humidity, sound and light. We have employed these monitors during training and simulated military operations to collect information that would typically be unavailable under such circumstances. In this paper we will describe various versions of the vigilance monitor and how each successive version extended the capabilities of the device. Samples of data from several studies are presented, included studies conducted in harsh field environments during simulated infantry assaults, a Marine Corps Officer training course and mechanized infantry (Stryker) operations. The monitors have been useful for documenting environmental conditions experienced by wearers, studying patterns of sleep and activity and examining the effects of nutritional manipulations on warfighter performance.

  12. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD).

    PubMed

    Gorrin, Maite Rivera; Teruel-Briones, José Luis; Vion, Victor Burguera; Rexach, Lourdes; Quereda, Carlos

    2015-01-01

    Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a shortterm life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis.

  13. The Moncrief-Popovich catheter. A new peritoneal access technique for patients on peritoneal dialysis.

    PubMed

    Moncrief, J W; Popovich, R P; Broadrick, L J; He, Z Z; Simmons, E E; Tate, R A

    1993-01-01

    Existing catheter implantation techniques violate a fundamental premise of wound healing. The immediate presence of the catheter in the post operative surgical wound forms a passage for permanent colonization of the catheter tunnel and cuff(s). This is manifested by the almost universal presence of the biologic products of bacterial growth (biofilm) on the external and internal surfaces of these catheters. The Moncrief-Popovich catheter and implantation technique are designed to address this problem. The Moncrief-Popovich catheter is implanted in the standard fashion, except that the external segment of the catheter is buried subcutaneously at the time of implantation. After allowing 3-5 weeks for tissue in-growth in a sterile environment, a small incision is made in the skin through which the external segment of the catheter is exteriorized and attached to an adapter. A 2 year trial was conducted in 59 patients, comprising 530 patient-months of experience; the incidence of peritonitis was one episode for every 29.4 patient months. All but three of the patients used the standard spike exchange technique. In a recently initiated study using disconnect procedures in 63 of the 74 patients studied, the peritonitis rate was one episode for every 28.7 patient-months; patient-months have totalled 201.2 to date. There was a rate of one exit site infection every 12.57 patients-months. It was concluded that the Moncrief-Popovich catheter and implantation technique result in a substantial decrease in the incidence of peritonitis for patients using the standard spike exchange system.

  14. Educating Asthmatic Children in European Ambulatory Pediatrics: Facts and Insights

    PubMed Central

    Robberecht, Marie Noëlle; Beghin, Laurent; Deschildre, Antoine; Hue, Valérie; Reali, Laura; Plevnik-Vodušek, Vesna; Moretto, Marilena; Agustsson, Sigurlaug; Tockert, Emile; Jäger-Roman, Elke; Deplanque, Dominique; Najaf-Zadeh, Abolfazl; Martinot, Alain

    2015-01-01

    The aim of this study was to assess the role of European ambulatory pediatricians in caring for asthmatic children, especially in terms of their therapeutic education. We developed a survey that was observational, declarative, retrospective and anonymous in nature. 436 ambulatory pediatricians in Belgium, France, Germany, Italy, Luxembourg and Slovenia were asked to participate in the survey providing information on three children over 6 years old suffering from persistent asthma, who had been followed for at least 6 months. We considered the pediatricians’ profile, and their role in the therapeutic education of children. 277 pediatricians (64%) responded: 81% were primary care pediatricians; 46% participated in networks; 4% had specific training in Therapeutic Patient Education; 69% followed more than 5 asthmatic children per month, and over long periods (7 ± 4 years). The profiles of 684 children were assessed. Answers diverged concerning the provision of a Personalized Action Plan (60–88%), training the child to measure and interpret his Peak Expiratory Flow (31–99%), and the prescription of pulmonary function tests during the follow-up programme of consultations (62–97%). Answers converged on pediatricians’ perception of their role in teaching children about their condition and its treatment (99%), about inhalation techniques (96%), and in improving the children’s ability to take preventive measures when faced with risk situations (97%). This study highlights the role of European pediatricians in caring for asthmatic children, and their lack of training in Therapeutic Patient Education. Programmes and tools are required in order to train ambulatory pediatricians in Therapeutic Patient Education, and such resources should be integrated into primary health care, and harmonized at the European level. PMID:26061153

  15. Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

    PubMed Central

    Bundy, David G.; Chen, Allen R.; Milstone, Aaron M.; Colantuoni, Elizabeth; Pehar, Miriana; Herpst, Cynthia; Fratino, Lisa; Miller, Marlene R.

    2013-01-01

    OBJECTIVE: Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line–associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients. METHODS: We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, in-service training, and bulletin boards. CLABSI and bacteremia person-time incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model. RESULTS: The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P < .001). CONCLUSIONS: Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations. PMID:24101764

  16. Improving outpatient access and patient experiences in academic ambulatory care.

    PubMed

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume. PMID:22193182

  17. [Candida peritonitis and sepsis due to Acinetobacter baumannii in peritoneal dialysis: an association with prognosis not always unfavourable].

    PubMed

    Rapisarda, Francesco; Aliotta, Roberta; Pocorobba, Barbara; Portale, Grazia; Ferrario, Silvia; Zanoli, Luca; Fatuzzo, Pasquale

    2015-01-01

    Fungal infections have a high incidence in patients receiving peritoneal dialysis. (1)
Peritoneal dialysis is often complicated by peritonitis which has only minimally mycotic etiology, but nonetheless it is associated with 15-45% mortality (8).
 The opportunistic pathogens such as Candida can cause infection in immunocompromised conditions. Even the Acinetobacter tends to infect immunocompromised individuals and it has the same risk factors for infection as Candida: immunosuppression, malignancy, HIV positivity and all the other conditions of immunosuppression, central venous catheterization, mechanical ventilation and prolonged antibiotic therapy. The sepsis by Acinetobacter predicts a negative prognosis with the mortality rate between 20 to 60% (12), especially in cases of isolation of multi-resistant germs.
 We present a case report of a CKD patient undergoing peritoneal dialysis therapy who was hospitalized for acute pancreatitis, later complicated by the development of pancreatic pseudocysts, C. albicans peritonitis with hematologic spread of the fungus, superimposed Acinetobacter baumannii sepsis and pneumonia. She has been subjected to percutaneous drainage of pseudocysts, to switch from peritoneal dialysis to hemodialysis, to various evacuative thoracentesis, and to polymicrobial therapy (meropenem, teicoplanina, tigeciclina, linezolid, colimicina, fluconazolo, etc.) that allowed the resolution of sepsis. The peculiarity of this case is represented by the numerous morbidity that the patient developed simultaneously, with the genesis of a complex clinical picture, by the combination of infections due to Candida albicans and Acinetobacter baumannii. Successful treatment strategies allowed to fight and cure a medical condition associated with a high mortality rate.

  18. Transperitoneal administration of dissolved hydrogen for peritoneal dialysis patients: a novel approach to suppress oxidative stress in the peritoneal cavity

    PubMed Central

    2013-01-01

    Background Oxidative stress (OS) related to glucose degradation products such as methylglyoxal is reportedly associated with peritoneal deterioration in patients treated with peritoneal dialysis (PD). However, the use of general antioxidant agents is limited due to their harmful effects. This study aimed to clarify the influence of the novel antioxidant molecular hydrogen (H2) on peritoneal OS using albumin redox state as a marker. Methods Effluent and blood samples of 6 regular PD patients were obtained during the peritoneal equilibrium test using standard dialysate and hydrogen-enriched dialysate. The redox state of albumin in effluent and blood was determined using high-performance liquid chromatography. Results Mean proportion of reduced albumin (ƒ(HMA)) in effluent was significantly higher in H2-enriched dialysate (62.31 ± 11.10%) than in standard dialysate (54.70 ± 13.08%). Likewise, serum ƒ(HMA) after administration of hydrogen-enriched dialysate (65.75 ± 7.52%) was significantly higher than that after standard dialysate (62.44 ± 7.66%). Conclusions Trans-peritoneal administration of H2 reduces peritoneal and systemic OS. PMID:23816239

  19. Flexible Capacitive Electrodes for Minimizing Motion Artifacts in Ambulatory Electrocardiograms

    PubMed Central

    Lee, Jeong Su; Heo, Jeong; Lee, Won Kyu; Lim, Yong Gyu; Kim, Youn Ho; Park, Kwang Suk

    2014-01-01

    This study proposes the use of flexible capacitive electrodes for reducing motion artifacts in a wearable electrocardiogram (ECG) device. The capacitive electrodes have conductive foam on their surface, a shield, an optimal input bias resistor, and guarding feedback. The electrodes are integrated in a chest belt, and the acquired signals are transmitted wirelessly for ambulatory heart rate monitoring. We experimentally validated the electrode performance with subjects standing and walking on a treadmill at speeds of up to 7 km/h. The results confirmed the highly accurate heart rate detection capacity of the developed system and its feasibility for daily-life ECG monitoring. PMID:25120162

  20. Cardiac emergency simulation: drilling for success in the ambulatory setting.

    PubMed

    Kusler-Jensen, Jane A

    2014-03-01

    The "see one, do one, teach one" method of clinical teaching is no longer practical for preparing perioperative personnel to respond to emergency situations. Teaching with simulation trains team members to respond to unexpected events and enables them to provide care when an emergency situation arises. Simulation drills resemble clinical practice and allow personnel to apply and integrate skills, teamwork, and critical thinking. This article provides information and tools for performing cardiac simulation drills in the ambulatory setting. Tools included are a 10-step guide to simulation drills, a scenario, roles and duties to assign during a drill, and a drill evaluation form. PMID:24581645

  1. Twenty-five years of ambulatory laparoscopic cholecystectomy.

    PubMed

    Bueno Lledó, José; Granero Castro, Pablo; Gomez I Gavara, Inmaculada; Ibañez Cirión, Jose L; López Andújar, Rafael; García Granero, Eduardo

    2016-10-01

    It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

  2. International accreditation of ambulatory surgical centers and medical tourism.

    PubMed

    McGuire, Michael F

    2013-07-01

    The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States. PMID:23830758

  3. International accreditation of ambulatory surgical centers and medical tourism.

    PubMed

    McGuire, Michael F

    2013-07-01

    The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States.

  4. Scheduling of procedures and staff in an ambulatory surgery center.

    PubMed

    Pash, Joel; Kadry, Bassam; Bugrara, Suhabe; Macario, Alex

    2014-06-01

    For ambulatory surgical centers (ASC) to succeed financially, it is critical for ASC managers to schedule surgical procedures in a manner that optimizes operating room (OR) efficiency. OR efficiency is maximized by using historical data to accurately predict future OR workload, thereby enabling OR time to be properly allocated to surgeons. Other strategies to maintain a well-functioning ASC include recruiting and retaining the right staff and ensuring patients and surgeons are satisfied with their experience. This article reviews different types of procedure scheduling systems. Characteristics of well-functioning ASCs are also discussed.

  5. Association between obesity and the severity of ambulatory hypertension in children and adolescents.

    PubMed

    Babinska, Katarina; Kovacs, Laszlo; Janko, Viktor; Dallos, Tomas; Feber, Janusz

    2012-01-01

    The goal of our study was to analyze the association between obesity and the severity of ambulatory hypertension in obese children. A total of 109 patients with primary obesity ages 7 to 18 years (mean ± SD age 14.1 ± 3.1) were enrolled. Patients were divided into three groups according to body mass index (BMI) Z-scores: group 1 (n = 27): BMI >1.65 and < 3.28 standard deviation scores (SDS); group 2 (n = 55): BMI >3.29 and <4.91 SDS; group 3 (n = 27): BMI >4.92 SDS. Definition and staging of ambulatory hypertension was based on blood pressure (BP) levels and BP load, obtained from ambulatory BP monitoring (ABPM). Only 24% had ambulatory normotension, 25% had ambulatory prehypertension, 3% had hypertension, and 48% had severe ambulatory hypertension. The severity of hypertension increased significantly with the degree of obesity (P = .0027). Daytime systolic, diastolic, and mean arterial BPs increased significantly with increased BMI, whereas the nighttime pressure remained elevated regardless of the degree of obesity. Isolated nighttime hypertension was observed in 25% of patients and 38% were classified as nondippers. Almost 50% of children with obesity and hypertension detected on ABPM suffer from severe ambulatory hypertension. BMI is associated with the severity of ambulatory hypertension and the increase of daytime BP.

  6. Tackling feline infectious peritonitis via reverse genetics.

    PubMed

    Thiel, Volker; Thiel, Heinz-Jürgen; Tekes, Gergely

    2014-01-01

    Feline infectious peritonitis (FIP) is caused by feline coronaviruses (FCoVs) and represents one of the most important lethal infectious diseases of cats. To date, there is no efficacious prevention and treatment, and our limited knowledge on FIP pathogenesis is mainly based on analysis of experiments with field isolates. In a recent study, we reported a promising approach to study FIP pathogenesis using reverse genetics. We generated a set of recombinant FCoVs and investigated their pathogenicity in vivo. The set included the type I FCoV strain Black, a type I FCoV strain Black with restored accessory gene 7b, two chimeric type I/type II FCoVs and the highly pathogenic type II FCoV strain 79-1146. All recombinant FCoVs and the reference strain isolates were found to establish productive infections in cats. While none of the type I FCoVs and chimeric FCoVs induced FIP, the recombinant type II FCoV strain 79-1146 was as pathogenic as the parental isolate. Interestingly, an intact ORF 3c was confirmed to be restored in all viruses (re)isolated from FIP-diseased animals.

  7. Genotyping coronaviruses associated with feline infectious peritonitis

    PubMed Central

    Lewis, Catherine S.; Porter, Emily; Matthews, David; Kipar, Anja; Tasker, Séverine; Helps, Christopher R.

    2015-01-01

    Feline coronavirus (FCoV) infections are endemic among cats worldwide. The majority of infections are asymptomatic or result in only mild enteric disease. However, approximately 5 % of cases develop feline infectious peritonitis (FIP), a systemic disease that is a frequent cause of death in young cats. In this study, we report the complete coding genome sequences of six FCoVs: three from faecal samples from healthy cats and three from tissue lesion samples from cats with confirmed FIP. The six samples were obtained over a period of 8 weeks at a single-site cat rescue and rehoming centre in the UK. We found amino acid differences located at 44 positions across an alignment of the six virus translatomes and, at 21 of these positions, the differences fully or partially discriminated between the genomes derived from the faecal samples and the genomes derived from the tissue lesion samples. In this study, two amino acid differences fully discriminated the two classes of genomes: these were both located in the S2 domain of the virus surface glycoprotein gene. We also identified deletions in the 3c protein ORF of genomes from two of the FIP samples. Our results support previous studies that implicate S protein mutations in the pathogenesis of FIP. PMID:25667330

  8. Treatment of cats with feline infectious peritonitis.

    PubMed

    Hartmann, Katrin; Ritz, Susanne

    2008-05-15

    Feline infectious peritonitis (FIP) infection resulting in clinical signs is invariably fatal despite clinical intervention. As FIP is an immune-mediated disease, treatment is mainly aimed at controlling the immune response triggered by the infection with the feline coronavirus (FCoV). Immune suppressive drugs such as prednisone or cyclophosphamide may slow disease progression but do not produce a cure. In nearly every published case report of attempted therapy for clinical FIP, glucocorticoids have been used; there are, however, no controlled studies that evaluate the effect of glucocorticoids as a therapy for FIP. Some veterinarians prescribe immune modulators to treat cats with FIP with no documented controlled evidence of efficacy. It has been suggested that these agents may benefit infected animals by restoring compromised immune function, thereby allowing the patient to control viral burden and recover from clinical signs. However, a non-specific stimulation of the immune system may be contraindicated as clinical signs develop and progress as a result of an immune-mediated response to the mutated FCoV.

  9. Tackling feline infectious peritonitis via reverse genetics

    PubMed Central

    Thiel, Volker; Thiel, Heinz-Jürgen; Tekes, Gergely

    2014-01-01

    Feline infectious peritonitis (FIP) is caused by feline coronaviruses (FCoVs) and represents one of the most important lethal infectious diseases of cats. To date, there is no efficacious prevention and treatment, and our limited knowledge on FIP pathogenesis is mainly based on analysis of experiments with field isolates. In a recent study, we reported a promising approach to study FIP pathogenesis using reverse genetics. We generated a set of recombinant FCoVs and investigated their pathogenicity in vivo. The set included the type I FCoV strain Black, a type I FCoV strain Black with restored accessory gene 7b, two chimeric type I/type II FCoVs and the highly pathogenic type II FCoV strain 79–1146. All recombinant FCoVs and the reference strain isolates were found to establish productive infections in cats. While none of the type I FCoVs and chimeric FCoVs induced FIP, the recombinant type II FCoV strain 79–1146 was as pathogenic as the parental isolate. Interestingly, an intact ORF 3c was confirmed to be restored in all viruses (re)isolated from FIP-diseased animals. PMID:25482087

  10. Recommendations for bowel obstruction with peritoneal carcinomatosis.

    PubMed

    Laval, Guillemette; Marcelin-Benazech, Blandine; Guirimand, Frédéric; Chauvenet, Laure; Copel, Laure; Durand, Aurélie; Francois, Eric; Gabolde, Martine; Mariani, Pascale; Rebischung, Christine; Servois, Vincent; Terrebonne, Eric; Arvieux, Catherine

    2014-07-01

    This article reports on the clinical practice guidelines developed by a multidisciplinary group working on the indications and uses of the various available treatment options for relieving intestinal obstruction or its symptoms in patients with peritoneal carcinomatosis. These guidelines are based on a literature review and expert opinion. The recommended strategy involves a clinical and radiological evaluation, of which CT of the abdomen is a crucial component. The results, together with an analysis of the prognostic criteria, are used to determine whether surgery or stenting is the best option. In most patients, however, neither option is feasible, and the main emphasis, therefore, is on the role and administration of various symptomatic medications such as glucocorticoids, antiemetic agents, analgesics, and antisecretory agents (anticholinergic drugs, somatostatin analogues, and proton-pump inhibitors). Nasogastric tube feeding is no longer used routinely and should instead be discussed on a case-by-case basis. Recent studies have confirmed the efficacy of somatostatin analogues in relieving obstruction-related symptoms such as nausea, vomiting, and pain. However, the absence of a marketing license and the high cost of these drugs limit their use as the first-line treatment, except in highly selected patients (early recurrence). When these medications fail to alleviate the symptoms of obstruction, venting gastrostomy should be considered promptly. Rehydration is needed for virtually every patient. Parenteral nutrition and pain management should be adjusted according to the patient needs and guidelines. PMID:24798105

  11. Feline infectious peritonitis: still an enigma?

    PubMed

    Kipar, A; Meli, M L

    2014-03-01

    Feline infectious peritonitis (FIP) is one of the most important fatal infectious diseases of cats, the pathogenesis of which has not yet been fully revealed. The present review focuses on the biology of feline coronavirus (FCoV) infection and the pathogenesis and pathological features of FIP. Recent studies have revealed functions of many viral proteins, differing receptor specificity for type I and type II FCoV, and genomic differences between feline enteric coronaviruses (FECVs) and FIP viruses (FIPVs). FECV and FIP also exhibit functional differences, since FECVs replicate mainly in intestinal epithelium and are shed in feces, and FIPVs replicate efficiently in monocytes and induce systemic disease. Thus, key events in the pathogenesis of FIP are systemic infection with FIPV, effective and sustainable viral replication in monocytes, and activation of infected monocytes. The host's genetics and immune system also play important roles. It is the activation of monocytes and macrophages that directly leads to the pathologic features of FIP, including vasculitis, body cavity effusions, and fibrinous and granulomatous inflammatory lesions. Advances have been made in the clinical diagnosis of FIP, based on the clinical pathologic findings, serologic testing, and detection of virus using molecular (polymerase chain reaction) or antibody-based methods. Nevertheless, the clinical diagnosis remains challenging in particular in the dry form of FIP, which is partly due to the incomplete understanding of infection biology and pathogenesis in FIP. So, while much progress has been made, many aspects of FIP pathogenesis still remain an enigma.

  12. Long-term EEG in adults: sleep-deprived EEG (SDE), ambulatory EEG (Amb-EEG) and long-term video-EEG recording (LTVER).

    PubMed

    Michel, V; Mazzola, L; Lemesle, M; Vercueil, L

    2015-03-01

    Long-term EEG in adults includes three modalities: sleep deprived-EEG lasting 1 to 3 hours, 24 hours ambulatory-EEG and continuous prolonged video-EEG lasting from several hours to several days. The main indications of long-term EEG are: syndromic classification of epilepsy; search for interictal discharges when epilepsy is suspected or for the purpose of therapeutic evaluation; positive diagnosis of paroxysmal clinical events; and pre-surgical evaluation of drug-resistant epilepsy. Sleep deprived-EEG and ambulatory-EEG are indicated to detect interictal discharges in order to validate a syndromic classification of epilepsy when standard EEG is negative. These exams can help in evaluating treatment efficacy, especially when clinical evaluation is difficult. Long-term video EEG is indicated for drug-resistant epilepsy, to analyze electro-clinical correlations in a pre-surgical evaluation context, and to refine a positive diagnosis when paroxysmal clinical events are frequent.

  13. Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre

    PubMed Central

    2010-01-01

    Background Against the background of a decreasing number of general practitioners (GPs) in rural regions in Germany, the AGnES-concept (AGnES = GP-supporting, community-based, e-health-assisted, systemic intervention) supports the delegation of regular GP-home visits to qualified practice assistants. The concept was implemented and evaluated in different model projects in Germany. To explore the economic effects of this concept, the development of the number of home visits in an ambulatory healthcare centre was analysed and compared with the number of home visits in the surrounding county. Methods Information about GP-home visits was derived from reimbursement data of the ambulatory healthcare centre and a statutory health insurance. Information about home visits conducted by AGnES-practice assistants was collected from the project documentation over a time period of 12 consecutive quarter years, four quarter years before the beginning of the project and 8 quarter years while the project was implemented, considering background temporal trends on the population level in the study region. Results Within the ambulatory healthcare centre, the home visits by the GPs significantly decreased, especially the number of medically urgent home visits. However, the overall rate of home visits (conducted by the GPs and the AGnES-practice assistants together) did not change significantly after implementation of the AGnES-concept. In the surrounding county, the home visit rates of the GPs were continuous; the temporal patterns were approximately equal for both usual and urgent home visits. Conclusion The results of the analyses show that the support by AGnES-practice assistants led to a decrease of GP-home visits rather than an induction of additional home visits by the AGnES-practice assistants. The most extended effect is related to the medically urgent home visits rather than to the usual home visits. PMID:20529307

  14. Prediction of Ambulatory Status After Hip Fracture Surgery in Patients Over 60 Years Old

    PubMed Central

    2016-01-01

    Objective To predict ambulatory capacity, 1 month after physical therapy following hip fracture surgery. Methods A retrospective chart review was carried out. Patients more than 60 years old, who underwent hip fracture surgery and received physical therapies, were selected (n=548). Age, gender, presence of cognitive dysfunction, combined medical diseases, combined fractures, previous history of hip surgery, prefracture ambulatory capacity, days from the fracture to surgery, type of fracture, type of surgery, presence of postoperative complications, days from the surgery to physical therapy, and total admission period, were collected. Prefracture ambulatory capacity and postoperative ambulatory capacity were classified into non-ambulatory status (NA), ambulation with assistive device (AA), and independent-ambulation without any assistive device (IA). Multiple-logistic regression analysis was performed for the prediction of postoperative ambulatory capacity. Results Age (odds ratio [OR]=0.94 for IA and 0.96 for IA or AA), gender (OR=1.64 for IA and 0.98 for IA or AA), prefracture ambulatory capacity (OR of IA=19.17 for IA; OR of IA=16.72 for IA or AA; OR of AA=1.26 for IA, OR of AA=9.46 for IA or AA), and combined medical disease (OR=2.02) were found to be the factors related to postoperative ambulatory capacity and the prediction model was set up using these four factors. Conclusion Using this model, we can predict the ambulatory capacity following hip fracture surgery. Further prospective studies should be constructed to improve postoperative ambulatory capacity.

  15. Prediction of Ambulatory Status After Hip Fracture Surgery in Patients Over 60 Years Old

    PubMed Central

    2016-01-01

    Objective To predict ambulatory capacity, 1 month after physical therapy following hip fracture surgery. Methods A retrospective chart review was carried out. Patients more than 60 years old, who underwent hip fracture surgery and received physical therapies, were selected (n=548). Age, gender, presence of cognitive dysfunction, combined medical diseases, combined fractures, previous history of hip surgery, prefracture ambulatory capacity, days from the fracture to surgery, type of fracture, type of surgery, presence of postoperative complications, days from the surgery to physical therapy, and total admission period, were collected. Prefracture ambulatory capacity and postoperative ambulatory capacity were classified into non-ambulatory status (NA), ambulation with assistive device (AA), and independent-ambulation without any assistive device (IA). Multiple-logistic regression analysis was performed for the prediction of postoperative ambulatory capacity. Results Age (odds ratio [OR]=0.94 for IA and 0.96 for IA or AA), gender (OR=1.64 for IA and 0.98 for IA or AA), prefracture ambulatory capacity (OR of IA=19.17 for IA; OR of IA=16.72 for IA or AA; OR of AA=1.26 for IA, OR of AA=9.46 for IA or AA), and combined medical disease (OR=2.02) were found to be the factors related to postoperative ambulatory capacity and the prediction model was set up using these four factors. Conclusion Using this model, we can predict the ambulatory capacity following hip fracture surgery. Further prospective studies should be constructed to improve postoperative ambulatory capacity. PMID:27606273

  16. The quality of ambulatory care in Medicare health maintenance organizations.

    PubMed

    Retchin, S M; Brown, B

    1990-04-01

    The quality of ambulatory care received by Medicare recipients who enrolled in health maintenance organizations (HMOs) was compared to the care received by fee-for-service (FFS) Medicare recipients, in a quasi-experimental, non-randomized design. Both samples were drawn from the four major geographic areas in the country, and included two types of HMO practices: staff/group models, and independent practice associations (IPAs). A panel of expert physicians developed criteria for evaluating ambulatory care, and medical record abstractions using these criteria were performed on 1,590 outpatient records: 777 FFS and 813 HMO (441 staff/group, 372 IPA). While individual items of medical histories and physical examinations were performed most often for staff/group HMO patients and least often in FFS patients, odds ratios (OR) for performance in staff/group HMO patients were particularly large for health maintenance items: tonometry (OR = 8.4), mammography (OR = 2.7), pelvic examination (OR = 5.3), rectal examination (OR = 2.9), fecal occult blood test (OR = 3.3). The results suggest that recommended elements of routine and preventive care are more likely to be performed for Medicare enrollees in staff/group HMOs than in FFS settings.

  17. Wearable and superhydrophobic hardware for ambulatory biopotential acquisition.

    PubMed

    Martinez-Tabares, F J; Delgado-Trejos, E; Castellanos-Dominguez, G

    2013-01-01

    Wearable monitoring devices are a promising trend for ambulatory and real time biosignal processing, because they improve access and coverage by means of comfortable sensors, with real-time communication via mobile networks. In this paper, we present a garment for ambulatory electrocardiogram monitoring, a smart t-shirt with a textile electrode that conducts electricity and has a coating designed to preserve the user's hygiene, allowing long-term mobile measurements. Silicon dioxide nanoparticles were applied on the surface of the textile electrodes to preserve conductivity and impart superhydrophobic properties. A model to explain these results is proposed. The best result of this study is obtained when the contact angles between the fluid and the fabric exceeded 150°, while the electrical resistivity remained below 5 Ω·cm, allowing an acquisition of high quality electrocardiograms in moving patients. Thus, this tool represents an interesting alternative for medium and long-term measurements, preserving the textile feeling of clothing and working under motion conditions. PMID:24110070

  18. Pain Management in Ambulatory Surgery—A Review

    PubMed Central

    Jakobsson, Jan G.

    2014-01-01

    Day surgery, coming to and leaving the hospital on the same day as surgery as well as ambulatory surgery, leaving hospital within twenty-three hours is increasingly being adopted. There are several potential benefits associated with the avoidance of in-hospital care. Early discharge demands a rapid recovery and low incidence and intensity of surgery and anaesthesia related side-effects; such as pain, nausea and fatigue. Patients must be fit enough and symptom intensity so low that self-care is feasible in order to secure quality of care. Preventive multi-modal analgesia has become the gold standard. Administering paracetamol, NSIADs prior to start of surgery and decreasing the noxious influx by the use of local anaesthetics by peripheral block or infiltration in surgical field prior to incision and at wound closure in combination with intra-operative fast acting opioid analgesics, e.g., remifentanil, have become standard of care. Single preoperative 0.1 mg/kg dose dexamethasone has a combined action, anti-emetic and provides enhanced analgesia. Additional α-2-agonists and/or gabapentin or pregabalin may be used in addition to facilitate the pain management if patients are at risk for more pronounced pain. Paracetamol, NSAIDs and rescue oral opioid is the basic concept for self-care during the first 3–5 days after common day/ambulatory surgical procedures. PMID:25061796

  19. The expression profiling and ontology analysis of noncoding RNAs in peritoneal fibrosis induced by peritoneal dialysis fluid.

    PubMed

    Liu, Yanli; Guo, Runsheng; Hao, Guojun; Xiao, Jun; Bao, Yi; Zhou, Jing; Chen, Qinkai; Wei, Xin

    2015-06-15

    Increasing amounts of evidence have indicated that noncoding RNAs (ncRNAs) have important regulatory potential in various biological processes. However, the contributions of ncRNAs, especially long noncoding RNAs (lncRNAs), to peritoneal fibrosis remain largely unknown. The aim of this study was to investigate miRNA, lncRNA and mRNA expression profiles and their potential roles in the process of peritoneal fibrosis. Microarray expression profiles of the miRNAs, lncRNAs and mRNAs were determined in normal control peritoneum and in a mouse model of peritoneal dialysis fluid (PDF)-induced fibrotic peritoneum. Differential expression, pathway and gene network analyses were developed to identify possible functional RNA molecules in peritoneal fibrosis. Compared to the normal control, 232 lncRNAs (127 up-regulated and 105 down-regulated), 154 mRNAs (87 up-regulated and 67 down-regulated) and 15 miRNAs (14 miRNAs up-regulated and 1 down-regulated) were differentially expressed in the fibrotic peritoneum. Among the differentially expressed ncRNAs, 9 lncRNAs and 5 miRNAs were validated by real-time RT-PCR. Pathway analysis showed that the Jak-STAT, TGF-beta and MAPK signaling pathways had a close relationship with peritoneal fibrosis. Gene co-expression network analysis identified many genes, including JunB, HSP72, and Nedd9. It also identified lncRNAs AK089579, AK080622, and ENSMUST00000053838 and miRNAs miR-182 and miR-488. All of these species potentially play a key role in peritoneal fibrosis. Our results provide a foundation and an expansive view of the roles and mechanisms of ncRNAs in PDF-induced peritoneal fibrosis. PMID:25827714

  20. Quantitation of Intra-peritoneal Ovarian Cancer Metastasis.

    PubMed

    Lewellen, Kyle A; Metzinger, Matthew N; Liu, Yueying; Stack, M Sharon

    2016-01-01

    Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancy in the United States. Mortality is due to diagnosis of 75% of women with late stage disease, when metastasis is already present. EOC is characterized by diffuse and widely disseminated intra-peritoneal metastasis. Cells shed from the primary tumor anchor in the mesothelium that lines the peritoneal cavity as well as in the omentum, resulting in multi-focal metastasis, often in the presence of peritoneal ascites. Efforts in our laboratory are directed at a more detailed understanding of factors that regulate EOC metastatic success. However, quantifying metastatic tumor burden represents a significant technical challenge due to the large number, small size and broad distribution of lesions throughout the peritoneum. Herein we describe a method for analysis of EOC metastasis using cells labeled with red fluorescent protein (RFP) coupled with in vivo multispectral imaging. Following intra-peritoneal injection of RFP-labelled tumor cells, mice are imaged weekly until time of sacrifice. At this time, the peritoneal cavity is surgically exposed and organs are imaged in situ. Dissected organs are then placed on a labeled transparent template and imaged ex vivo. Removal of tissue auto-fluorescence during image processing using multispectral unmixing enables accurate quantitation of relative tumor burden. This method has utility in a variety of applications including therapeutic studies to evaluate compounds that may inhibit metastasis and thereby improve overall survival. PMID:27500635