Acute scrotal oedema complicating peritoneal dialysis

A case of extraperitoneal leakage of dialysate producing massive acute scrotal oedema complicating peritoneal dialysis is presented. Important diagnostic features including select clinical images, the role of imaging modalities and appropriate management are discussed.     

Acute peritoneal dialysis in neonates: comparison of two types of peritoneal access

 A total of 23 sessions of peritoneal dialysis (PD) were given to 20 neonates with acute renal failure. Intravenous cannula (Biovalve 14G Vygon) was used for PD access in 13 procedures and guide wire-inserted femoral vein catheter (Medcomp-pediatric) in 10 procedures. Intraperitoneal bleed was seen in 1 procedure each in both groups. Dialysate leak and catheter blockade were more common with intravenous cannula [3 (23.1%), 8 (61.5%)] than guide wire-inserted femoral vein catheter [1 (10%), 4 (40%), P-NS]. Due to repeated catheter blockade, 5 (38.4%) PD sessions could not be completed with intravenous cannula and had to be prematurely closed; this complication was not seen with guide wire-inserted femoral vein catheter (P<0.05). Percentage reduction of serum creatinine per PD session was significantly higher in neonates being dialyzed with guide wire-inserted femoral vein catheter (51.7%±8.5%) than those dialyzed with intravenous cannula (38.3%±5.2%). Incidence of peritonitis was not significantly different [2 (15.4%) vs. 1 (10%)]. To conclude, for an effective PD in neonates, guide wire-inserted femoral vein catheter is safe and is associated with fewer access-related problems. Received: 23 February 1998 / Revised: 1 July 1998 / Accepted: 14 August 1998     

Acute hydrothorax in peritoneal dialysis patients: diagnosis and treatment options

Sir, Following the recent clinical report by Tang et al. [1], wewould like to comment on the diagnostic methods and the treatmentindications and limitations mentioned for this rare and seriousperitoneal dialysis complication. Hydrothorax in this situation is rightfully called ‘sweethydrothorax’ [2] as hypertonic glucose peritoneal solutionfills the pleura [3]. Efforts to treat what is frequently wrongly     

A laparoscopic method for optimal peritoneal dialysis access

Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better (P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3-2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.     

A novel method of laparoscopy-assisted peritoneal dialysis catheter placement

Peritoneal dialysis (PD) is a widely used renal replacement therapy for end-stage renal disease patients. We compared our novel laparoscopic-assisted method with conventional procedures in the catheter survival and complications. Seventy-three patients who underwent PD catheter placement were enrolled in this study. Our laparoscopic methods were characterized with smaller incision and additional fixation in the lower abdomen. Catheter migration developed in 4 patients in the conventional group compared with none in the laparoscopic group. The catheter dysfunction-free survival was significantly longer among the patients in the laparoscopic group than that in the conventional group (P=0.001). There were no significant differences between the 2 groups in peritonitis, exit-site hematoma, or exit-site infection. Laparoscopy-assisted PD catheter insertion with an intraperitoneal loop fixation is safe and provides good maintenance of catheter function (See the video, Supplemental Digital Content 1, http://links.lww.com/SLE/A28).     

Low-dose erythropoietin is effective and safe in children on continuous ambulatory peritoneal dialysis

Hypertension is one of the most important complications of erythropoietin (rHuEPO) therapy in dialysis patients. In this study, the effect of two different dosage regiments of subcutaneous rHuEPO on blood pressure [BP] was evaluated in 20 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Patients were randomized to receive rHuEPO 50 U/kg, either once a week (group 1, 50 U/kg per week) or three times a week (group 2, 150 U/kg per week). At the beginning of the study, 8 patients in group 1 and 8 patients in group 2 were on antihypertensive therapy. In group 1, the hematocrit increased gradually and significantly from 18.98%±1.79% to 30.1%±1.62% after 6 months, while in group 2 it rapidly increased from 19.53%±1.86% to 32.4%±1.11% after 3 months. A significant increase in the mean arterial BP was observed in group 2. Antihypertensive therapy had to be increased in all of the 8 previously hypertensive patients and had to be initiated in 1 of the 2 originally normotensive patients in the same group. None of the patients in group 1 required a change in antihypertensive medication. We conclude that during treatment with rHuEPO pre-existing hypertension and the dose of rHuEPO are the most important risk factors for the development or worsening of hypertension in children on CAPD, and gradual elevation of hematocrit by low-dose rHuEPO avoids the development of severe hypertension. Received December 11, 1995; received in revised form September 16, 1996; accepted September 19, 1996     

Multivisceral robotic liver surgery: feasible and safe

The application of robotic technology allows for the performance of multi-organ liver resections by multidisciplinary teams in a minimally invasive manner.     

Acute renal failure in a burn patient: the advantages of continuous peritoneal dialysis

An 8-year-old girl sustained 65–70 per cent body surface area burns when her clothes caught fire. Two weeks later, she developed acute renal failure (ARF) and needed dialysis therapy. The extensive, infected burn area prevented the establishment of a safe vascular access for haemodialysis. Continuous peritoneal dialysis proved to be a valid alternative form of treatment and even had advantages over haemodialysis. Large amounts of fluids, calories and electrolytes could be administered via the peritoneal route. This facilitated the treatment of the catabolic state of the uraemic burn patient and served to correct the electrolyte losses via the skin. Peritoneal dialysis is a valuable adjunct to the treatment of acute renal failure in burn patients who need renal replacement therapy.     

腹膜透析套管针穿刺置管术和传统开腹置管术的回顾性病例对照研究

目的 回顾性分析腹膜透析套管针穿刺置管术和传统开腹置管术的临床应用效果.方法 采用单中心回顾性病例对照研究.纳入2016年1月至2018年5月在成都医学院第一附属医院行腹膜透析置管手术并术后规律随访的125例维持性腹膜透析患者作为研究对象,根据不同手术方式分为两组,接受套管针穿刺置管术的患者64例(A组),接受传统开腹...