Acid-base state disorders and their correction in acute mesenteric vascular obstruction]

The results of the investigation of main indices of acid-base equilibrium in 28 patients with acute obstruction of the mesenteric vessels are set forth. 12 patients out of 28 developed subcompensated or decompensated metabolic acidosis. The authors believe that the correction of acid-base equilibrium disorders is an efficacious factor of intense therapy and recommend to use it at all the stages of the treatment.     

Peritoneal infection in acute intermittent peritoneal dialysis

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.     

Comparison of vascular calcification scoring systems using plain radiographs to predict vascular stiffness in peritoneal dialysis patients

Aim: Vascular stiffness is associated with cardiovascular mortality in dialysis patients and related with vascular calcification and microvascular inflammation. The objective of this study is to compare predictability of two different vascular calcification scoring systems using plain radiographs in peritoneal dialysis (PD) patients. Methods: Vascular stiffness was represented by heart‐to‐femoral pulse wave velocity (hfPWV) in our 79 PD patients. Peripheral vascular calcification score (PVCS) and abdominal aortic calcification score (AACS) were measured from plain radiographs. Microvascular inflammation was represented by peritoneal protein clearance (PPC). Regression analysis and the receiver operating characteristic (ROC) curve analysis were used for analysis. Results: The hfPWV revealed correlation with PVCS and AACS independently. In the ROC curve analysis, area under the curve (AUC) of PVC score was 0.7119 (P = 0.006), and AUC of AACS were 0.6960 (P = 0.011). After multiple linear regression analysis, PVCS remained as a predictor of vascular stiffness (R² = 0.579, β = 0.210, P = 0.038). The combination of PVCS and PPC exhibited a trend toward better predictability for vascular stiffness (AUC 0.7738, P = 0.001) than any of the two parameters alone. Conclusion: It is assumed that the PVCS system is more predictable for vascular stiffness in our study. Moreover, the combination of PVCS and PPC might be more useful as a screening test for vascular stiffness.     

Experimental model for peritoneal dialysis in small laboratory animals.

A simple method of performing peritoneal dialysis in rats and guinea-pigs for 48 hours is described. The method appears to be suitable for the experimental investigation of clinical problems although the long term problem of protein loss should not be forgotten when assessing the results of these short term experiments.     

Experimental study of selective mesentericography in acute intestinal obstruction]

Experimentally on 76 animals (dogs) the authors have studied some diagnostic opportunities of angiography in various forms of acute intestinal obstruction: strangulation, obturation and paralytic (in peritonitis) types. Angiographic symptoms of an organic origin proved to be mainly typical for strangulation obstruction. Symptoms of a functional character reflecting disorders in mesenteric hemocirculation were found to be equally pronounced in all kinds of intestinal obstruction, these consisted in a retarded linear rate of arterial and venous blood flow, in particular.     

Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis.

BACKGROUND: Acute, massive, unilateral hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. Its clinical course and treatment outcome after a recently advocated technique of video-assisted thoracoscopic (VATS) talc pleurodesis remains unclear. METHODS AND RESULTS: Between July 1998 and March 2002, among 475 CAPD patients in two regional hospitals in Hong Kong, nine patients (three men, six women, mean age 53+/-12 years) developed acute hydrothorax due to pleuroperitoneal communication (R=8, L=1) within 5.8+/-4.2 months (median, 5.2 m; range, 2 days to 11.6 months) of commencing peritoneal dialysis. Analysis of simultaneously obtained peritoneal and pleural fluid in all subjects only showed concordance in protein content (consistently<4 g/l), while fluid glucose and lactate dehydrogenase levels were not comparable. The methylene blue test was negative (n=4). Radionuclide scan (n=6) and contrast CT peritoneography (CTP, n=3) detected pleuroperitoneal communication in half and one-third of the patients, respectively. All patients underwent pleurodesis achieved by talc insufflation into the pleural cavity under VATS guidance. All patients were successfully returned to peritoneal dialysis. After a mean follow-up of 18.8+/-12.5 months, hydrothorax recurred in one patient (at 7 months after pleurodesis), who was successfully treated by repeating the procedure. CONCLUSIONS: Hydrothorax complicating CAPD is more commonly right-sided, and tends to occur within the first year of starting peritoneal dialysis. Isotope scan and CTP are insensitive in diagnosing pleuroperitoneal communication. A low pleural fluid protein content is the most consistent biochemical finding. VATS talc pleurodesis is a safe and reliable treatment of choice that allows sustained continuation of CAPD with low recurrence rate.     

Surgical treatment of an acute destructive pancreatitis using laparoscopy and peritoneal dialysis

Laparoscopic intervention was performed in early stages of acute destructive pancreatitis in 34 patients. In 23 patients after draining of the abdominal cavity the laparoscopic intermitting peritoneal dialysis with application of the "Gambro" firm solutions during 2-4 days was done. Efficacy of the proposed method of detoxication in complex treatment of patients was established.     

重症急性胰腺炎腹膜透析的护理

目的探讨腹膜透析治疗重症急性胰腺炎的治疗方法和护理措施。方法总结20例重症急性胰腺炎腹膜透析的护理经验。结果本组20例治愈17例,治愈率为85％。其中2例并发胰腺囊肿瘤,1例发生腹透管堵塞。3例患者因多器官功能功能障碍综合征而死亡。。结论早期腹膜透析治疗可改善急性重症胰腺炎的预后。在治疗过程中,同时配合精心护理可提高治愈率、减少并发症和降低死亡率。     

胃穿孔引发腹膜透析患者急性腹膜炎

患者,男,80岁,腹膜透析4年.1周前患者无诱因腹痛,腹透引流液浑浊,腹透液常规白细胞总数1500/mm3,多核细胞0.85,诊断为腹膜炎,予头孢唑啉及头孢他啶各1 g/d入腹透液治疗.     

Tactics for treating acute intestinal obstruction]

Performance of infusion-transfusion therapy before the operation, suboperative intravenous administration of antibiotics, metrogil, sanitation of the abdominal cavity with the use of antiseptics, performance of transnasal intraoperative intubation of the small intestine, Hartmann operation in patients with cancer of the left colon complicated by acute ileus (AI), liquidation of ileus at operation permitted considerable improvement of treatment of the patients with AI. The incidence of postoperative complications reduced from 9.7 to 4.1%, lethality--from 12.6 to 5%.