Imbalance between intraperitoneal coagulation and fibrinolysis during peritonitis of CAPD patients: the role of mesothelial cells

We compared peritoneal dialysis effluents from 18 CAPD patientswho had not suffered from peritonitis during the last 6 months(group 1) with the effluents from five patients with acute peritonitis(group 2), measuring activation markers of coagulation and fibrinolysis.These markers included prothrombin fragment F1+2 (F1+2), thrombin-antithrombinIII complex (TAT), fibrin monomer (FM), and fibrin degradationproducts (FbDP). In the dialysate of group 1 we found remarkablyhigh levels of F1+2, TAT and FM concomitant with a high concentrationof FbDP, indicating a high rate of intraperitoneal fibrin turnover.The balance between peritoneal generation and degradation offibrin was disturbed in untreated patients of group 2, who hadsignificantly higher levels of coagulation markers and a higherratio between FM and FbDP. Seven days after treatment with intraperitonealadministration of antibiotics and heparin, F1+2, TAT, FM andFbDP decreased significantly. To evaluate the role of mesothelial cells (MC) in the high peritonealfibrin turnover we investigated the expression of tissue-typeplasminogen activator (t-PA), urokinase-type plasminogen activator(u-PA), plasminogen activator inhibitor type-1 (PAI-1), andtissue factor in cultured human peritoneal MC under basal conditionsand after exposure to tumour necrosis factor (TNF) interleukin-1(IL-1), or bacterial lipopolysaccharide (LPS). The exposureof MC to TNF or to a lesser extent IL-1 or LPS reduced theirfibrinolytic activity by decreasing t-PA production and increasingPAI-1 synthesis. Furthermore the addition of TNF resulted inactivation of the coagulation cascade by the expression of tissuefactor. These in-vitro findings explain the imbalance betweenintraperitoneal coagulation and fibrinolysis during peritonitisof CAPD patients.     

血清唾液酸含量诊断胃疾病探讨

测定慢性浅表性胃炎１５例,萎缩性胃炎５例,胃溃疡１５例,胃癌９例患者血唾液酸（ＳＡ）的含量。结果表明在４组胃疾病中,胃癌、胃溃疡ＳＡ比慢性浅表性胃炎高。经统计学处理（方差分析）差别有高度显著性（Ｆ＝９１７,Ｐ＜００１）。结论：定期测定ＳＡ含量,对胃部疾患的随访和病情变化有着重要意义。     

Penicillium peritonitis in an adolescent receiving chronic peritoneal dialysis

A 19-year-old female on chronic peritoneal dialysis developed acute peritonitis; multiple peritoneal fluid and catheter tip cultures yielded Penicillium species. She promptly responded to catheter removal and intravenous amphotericin B, followed by oral fluconazole, without further recurrences 1 year later. This is the first reported case of Penicillium peritonitis in the pediatric population. We review the microbiology and clinical spectrum of this disease, as well as the few previous reported cases in adults. Received: 2 November 1998 / Revised: 1 February 1999 / Accepted: 4 February 1999     

不同生物相容性的透析膜对红细胞免疫功能的影响

目的：了解血液透析病人透析过程中红细胞免疫功能指标的动态改变及不同生物相容性的透析膜对其变化的影响。方法：分别采用铜仿膜（Ｃｕ膜）、聚砜膜（ＰＳ膜）、聚甲基丙烯酸甲酯膜（ＰＭＭＡ膜）,观察了透析过程中不同时相的红细胞免疫功能指标ＲＢＣ－Ｃ３ｂ和ＲＢＣ－ＩＣ的变化。结果：尿毒症病人的 ＲＢＣ－Ｃ３ｂ显著下降, ＲＢＣ－ＩＣ显著增高。透析开始后,早期 ＲＢＣ－Ｃ３ｂ进一步下降,其后逐渐上升;而 ＲＢＣ－ＩＣ早期逐渐增加,其后逐渐稳定。结论：Ｃｕ膜能明显地影响红细胞的免疫功能; Ｐｓ膜次之; ＰＭＭＡ膜对其影响最小。     

国产宁红欣配合腹膜透析治疗肾性贫血的疗效观察

采用国产的ＥＰＯ（宁红欣）配合腹膜透析治疗肾性贫血。将３０ 例尿毒症患者随机分为治疗组和对照组,结果显示：２月后治疗组血红蛋白（Ｈｂ）和红细胞压积（ＨＣＴ）显著增高（Ｐ分别小于０．０１,０．０５）,而对照组治疗结果无显著差异（Ｐ＞ ０．０５）。提示：国产ＥＰＯ对肾性贫血治疗有效。     

Weak effects of local and systemic administration of the GABA uptake inhibitor,SK&F 89976, on extracellular GABA in the rat striatum

Summary The effects of local and systemic administration of the potent GABA uptake inhibitor, SK&F 89976, on GABA overflow from the striatum of conscious rats were investigated in brain dialysis experiments. Administration of the compound via the dialysis probe at concentrations of 25 or 100 gmol/l significantly increased basal GABA overflow about 2-fold. Overflow evoked by 104 mmol/l K⁺ remained unaltered at the lower and was almost doubled at the higher concentration; this increase did, however, not reach statistical significance.Given systemically at 50 mg/kg i.p., a dose which is severalfold higher than those which exhibit anticonvulsant effects, SK&F 89976 caused a significant enhancement of K⁺-stimulated GABA overflow by about a factor of 2; the lower dose of 20 mg/kg i.p. was not effective. Basal GABA overflow was not significantly increased by either dose. These results suggest that the marked effects of nipecotic acid on basal GABA overflow reported by several authors seem to be related to GABA displacement rather than uptake inhibition, and that uptake inhibition does not improve the interpretability of measurements of GABA release by brain dialysis. They neither support the idea that the relative insensitivity of extracellular GABA to low Ca²⁺ and tetrodotoxin is indirectly due to very efficient removal of GABA by neuronal and/or glial uptake, leaving only residual amounts to be measured. Send offprint requests to P. Waldmeier at the above address     

绝育术后盆腔痛患者血浆、腹腔液中甾体激素与前列腺素相关性研究

本文测定绝育术后盆腔痛患者44例、输卵管绝育术后行输卵管复通术11例和正常妇女15例血浆与腹腔液中的甾体激素及前列腺素水平。结果发现:血中E_2与PGF_(2α)呈明显正相关,与TXB_2呈负相关,而P则与PGF_(2α)呈明显负相关;腹腔液中E_2与PGF_(2α)、TXB_2呈负相关。盆腔痛患者,包括异位症、无明显病变盆腔痛和盆腔静脉瘀血症3组的某种PG水平高于其他组。结果表明:血与腹腔液中PGs受甾体激素的影响,绝育术后慢性盆腔痛与PGs有关。     

Intravenous glycerol therapy should not be used in patients with unrecognized fructose-1,6-bisphosphatase deficiency

BACKGROUND: In Asian countries, glycerol solution that contains fructose (5%) is often used for management of brain edema. However, glycerol and fructose may cause severe hypoglycemia and metabolic acidosis in patients with fructose-1,6-bisphosphatase (FBPase) deficiency, even under stable conditions. The aim of the present study was to determine whether glycerol solution was used for brain edema during acute metabolic decompensation of hypoglycemia and metabolic acidosis in patients with unrecognized FBPase deficiency in Japan and to examine a long-term prognosis of the patients who had this kind of severe metabolic decompensation with or without glycerol therapy. METHODS: A retrospective study of 20 children with FBPase deficiency was conducted, based on their medical records. RESULTS: Six of the 20 children were given glycerol solution for the presence or possibility of brain edema during acute metabolic decompensation of hypoglycemia and metabolic acidosis; two of the six patients administered with glycerol were given dialysis. In four patients treated with glycerol alone without dialysis, two had no brain edema before glycerol administration but it developed later after the administration. These four patients treated with glycerol alone died or developed severe neurological complications. Fourteen patients who were not treated with glycerol solution had no brain edema and showed good prognosis. CONCLUSIONS: Glycerol solution, which contains fructose in Asian countries including Japan, should not be used as an osmotic agent for treatment of brain edema in patients who have hypoglycemia and retention-type metabolic acidosis, until FBPase deficiency is ruled out by measuring blood concentration of lactate.     

Hemodialysis in elderly patients

International Urology and Nephrology -     

Natural changes in peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients: a retrospective, seven year cohort survey

We conducted a retrospective, 7 year cohort survey to examine the natural changes in peritoneal equilibration test (PET) results in patients with long-term uneventful continuous ambulatory peritoneal dialysis (CAPD). Thirty-two (17 males, 15 females) patients on CAPD with two or more standard PETs performed more than 6 months apart, in the absence of peritoneal insult, were included. Changes and pattern of PET results were evaluated by the dialysate to plasma ratio of creatinine (D:P-cre), the fourth h dialysate to instilled glucose ratio (D4:Do) and ultrafiltration volume (UF, ml). The subgroups included high (H), high-average (HA), low-average (LA), or low (L) transporters with the dividing ratios (D:P-cre) of >0.81, >0. 65 to 0.81, >0.5 to 0.65, and <0.5, respectively. The median D:P-cre significantly decreased (p = 0.04), but neither the D4:Do nor the final median UF significantly decreased. The change in D:P-cre was strongly and inversely correlated with the initial D:P-cre value (r = -0.68; p < 0.05). A similar relationship was found between the change in the final D4:Do and the initial D4:Do (r = -0.752; p < 0. 01) and between the change in the final UF and the initial UF (r = -0.875; p < 0.01). No correlation was found between the change in D:P-cre and the age of the patient, the time interval between PETs, monthly dialysate glucose exposure, or underlying diabetes/non-diabetes. The final peritoneal transport pattern was altered with 5 (15.6%) patients remaining in the extreme subgroups (H or L) and, by contrast, 84.4% (27/32) of the patients now in the averaged (HA or LA) groups (p < 0.01, chi2 test). We demonstrated a natural "centralization" migration of PET results after long-term uneventful CAPD, which may help to explain why patients with extreme PET characteristics, that is, H or L, continued to do well on CAPD.