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1.
W. B. Thomson A. A. Buchanan P. B. Doak W. S. Peart 《BMJ (Clinical research ed.)》1964,1(5388):922-923
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Three patients with chronic uremia and one patient with glutethimide intoxication were treated by peritoneal dialysis at the Prince Edward Island Hospital, Charlottetown. The procedure was discovered to be technically simple and was carried on in one instance for five days and in another for six days without undue difficulty. The dialysis was initiated by the authors on each occasion, but was carried on by graduate nurses under supervision. It is concluded that this procedure is practical and of value for use in relatively small non-teaching hospitals, provided one or more members of the medical staff become familiar with the indications, technical details and complications of the procedure. 相似文献
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A total of 18 peritoneal dialyses were performed on 14 patients at the Hamilton Civic Hospital over a period of 11 months. Nine of these patients were in uremia, four had non-nephrotoxic intoxication, and one had hepatic coma. Patients with chronic uremia may present with acute renal failure which may be treated by peritoneal dialysis with resultant significant prolongation of life. A decreased mortality rate might be expected in acute renal failure if dialysis is implemented before the classical picture of uremia develops. Many non-nephrotoxic intoxicating substances are readily dialysable. Considerable benefit to the patient and decreased time in hospital may result from the use of this procedure in cases of intoxication with such substances. Peritoneal dialysis may be of value in treatment of intractable congestive heart failure. This procedure may eventually provide another means of treating hepatic coma. 相似文献
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David N. Edelbaum Albert Sokol Sanford Gaynor Milton E. Rubini 《The Western journal of medicine》1968,108(2):85-89
The long-term results of intermittent peritoneal dialysis in long-term treatment of renal disease have yet to equal those of intermittent hemodialysis. However, further exploration and refinement of this technique is justified.Performed in acute stages of disease, both peritoneal dialysis and hemodialysis relieve the symptoms of uremia and specifically “buy time” for the patient so that proper medical or surgical therapy may be instituted. In acute situations, peritoneal dialysis is the procedure of choice, and is an important adjunct to more conventional treatment for chronic renal disease. It may be useful sometimes even in chronically hemodialyzed patients—for example, when the hemodialysis cannula for one reason or another is inaccessible because of clots, replacement, or infection. It is especially valuable when the hemorrhagic complications of uremia contraindicate hemodialysis treatment.Its use in chronic uremia remains sharply limited in time, but for brief periods chronic peritoneal dialysis appears to be a reasonably satisfactory means of prolonging life while awaiting homotransplant or decision for maintenance hemodialysis therapy. 相似文献
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Clinical experience with peritoneal dialysis in eight cases of acute and four cases of chronic renal failure is presented. Seven of the acute cases survived but in some of these hemodialysis was also employed. The relatively simple technique of peritoneal dialysis was found to be effective, although slower than hemodialysis. In three of the cases it was selected in preference to hemodialysis. Its main advantages are that it does not require elaborate arrangements, or the use of blood or anticoagulants. The authors conclude that when the peritoneum is intact the method can be employed whenever the use of a temporary kidney substitute is indicated. 相似文献
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在我国,终末期肾脏病的发病率逐年增加,相应地,腹膜透析病人的数量也在不断增长。明确腹膜透析病人预后的影响因素是临床医师亟待解决的重要课题。尿毒症毒素的积蓄可对腹膜透析病人的心血管系统产生不良作用,影响病人的生活质量。腹膜透析充分性的相关指标对于预测病人的生存率也有一定的指导意义。此外,腹膜炎的发生可使超滤量明显下降,增加病人的死亡率。合并症可能通过加重病人的营养不良状态、促进炎症水平,影响病人的预后。因此,重视病人的尿毒症毒素水平、透析充分性指标与合并症情况,积极防治腹膜炎,将有助于改善腹膜透析病人的预后。 相似文献
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Jesús Loureiro Pilar Sandoval Gloria del Peso Guadalupe Gónzalez-Mateo Vanessa Fernández-Millara Beatríz Santamaria Maria Auxiliadora Bajo José Antonio Sánchez-Tomero Gonzalo Guerra-Azcona Rafael Selgas Manuel López-Cabrera Abelardo I. Aguilera 《PloS one》2013,8(4)
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. 相似文献
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Hsin-Hsu Wu I-Jung Li Cheng-Hao Weng Cheng-Chia Lee Yung-Chang Chen Ming-Yang Chang Ji-Tseng Fang Cheng-Chieh Hung Chih-Wei Yang Ya-Chung Tian 《PloS one》2013,8(8)
Introduction
Continuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients.Patients and methods
We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012.Results
Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p = 0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005). Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05). Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05). No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05). Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p = 0.10).Conclusion
Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures. 相似文献12.
目的:探讨腹腔镜下腹膜透析置管术与手术切开腹膜透析置管术的临床对比与应用价值.方法:选择2007年3月1日至2012年3月1日在新疆维吾尔自治区人民医院肾病科收治的慢性肾功能衰竭且自愿行腹膜透析的患者96例,其中45例在局麻下行常规手术切开置管术(A组),51例行腹腔镜置管术(B组),术后均使用百特双联系统装置进行腹膜透析.并对术后导管相关性并发症、住院天数、手术费用等方面进行回顾性分析和对比.结果:A组中:导管移位3例(6.7%),网膜包裹2例(4.4%),胸膜瘘1例(2.2%),腹膜炎1例(2.2%),短期透析引流时疼痛2例(4.4%),总体导管相关并发症发生率(19.9%),手术时间为25-40 min,人均手术费用1000元,住院时间7-15天.B组中:无一例发生漂管,阴囊水肿2例(3.9%%),透析管周围渗液2例(3.9%),胸膜瘘1例(2.0%),腹壁疝2例(3.9%),腹膜炎1例(2.0%),总体导管相关并发症发生率(15.7%),手术时间为15-25min,人均费用5500元,住院时间12-25天.结论:腹腔镜置管术与手术切开置管术各有利弊,选择哪种方法要根据患者经济、身体状况、患者意愿来选择. 相似文献
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Fuquan Wu Ying Xu Min Xia Guanghui Ying Zhangfei Shou 《The Korean journal of parasitology》2016,54(3):315-317
Hookworm infections as well as other intestinal nematodiases are endemic in China. In this case, a 70-year-old male showed symptoms of chest tightness, shortness of breath, and both lower extremities edema. The diagnostic result was chronic renal insufficiency, chronic kidney disease (5th stage), and renal anemia at first. Then, he received treatment with traditional drugs. However, this treatment did not help to alleviate the symptoms of the patient significantly. The results of gastroendoscopy showed hookworms in the duodenum, also confirmed by pathology examination. Anemia was markedly ameliorated after eliminating the parasites. The results mentioned above suggested that ancylostomiasis was the leading causes of anemia in this patient, and the etiology of anemia in uremic patients should be systematically considered. Especially when anemia could not be cured by regular treatments, rare diseases should be investigated. 相似文献
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Hyung Woo Kim Geun Woo Ryu Cheol Ho Park Ea Wha Kang Jung Tak Park Seung Hyeok Han Tae-Hyun Yoo Sug Kyun Shin Shin-Wook Kang Kyu Hun Choi Dae Suk Han Tae Ik Chang 《PloS one》2015,10(6)
Background and Aim
Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients on peritoneal dialysis (PD). Hyponatremia was recently shown to be a modifiable factor that is strongly associated with increased mortality in PD patients. However, the clinical impact of hyponatremia on CV outcomes in these patients is unclear.Methods
To determine whether a low serum sodium level predicts the development of CV disease, we carried out a prospective observational study of 441 incident patients who started PD between January 2000 and December 2005. Time-averaged serum sodium (TA-Na) levels were determined to investigate the ability of hyponatremia to predict newly developed CV events in these patients.Results
During a mean follow-up of 43.2 months, 106 (24.0%) patients developed new CV events. The cumulative incidence of new-onset CV events after the initiation of PD was significantly higher in patients with TA-Na levels ≤ 138 mEq/L than in those with a TA-Na > 138 mEq/L. After adjustment for multiple potentially confounding covariates, an increase in TA-Na level was found to be associated with a significantly lower risk of CV events (subdistribution hazard ratio per 1 mEq/L increase, 0.90; 95% confidence interval, 0.83–0.96; p = 0.003). Patients with a TA-Na ≤ 138 mEq/L had a 2.31-fold higher risk of suffering a CV event.Conclusions
These results provide evidence of a clear association between low serum sodium and new-onset CV events after dialysis initiation in PD patients. Whether the correction of hyponatremia for this indication provides additional protection for the development of CV disease in these patients remains to be addressed in interventional studies. 相似文献15.
Hyunsuk Kim Jung Nam An Dong Ki Kim Myoung-Hee Kim Ho Kim Yong-Lim Kim Ki Soo Park Yun Kyu Oh Chun Soo Lim Yon Su Kim Jung Pyo Lee CRC for ESRD Investigators 《PloS one》2015,10(6)
The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. 相似文献
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Naya Huang Jiehui Chen Li Fan Qian Zhou Qingdong Xu Ricong Xu Liping Xiong Xueqing Yu Haiping Mao 《PloS one》2014,9(10)
Background
Continuous ambulatory peritoneal dialysis (CAPD) patients with diabetes are at increased risk of mortality and high peritoneal transporters appear to contribute to poor survival. However, little is known about the combined impacts of high peritoneal transporters and diabetes on mortality.Methods
This was a prospective observational cohort study. 776 incident CAPD patients were enrolled. Unadjusted and adjusted Cox proportional regression models were used to evaluate the association and interaction of peritoneal transport and diabetic status with mortalityResults
In the entire cohort, high peritoneal transport status was associated with an increased risk of all-cause mortality in unadjusted model [hazard ratio (HR) 2.35, 95% confidence interval (CI) 1.30 to 4.25, P = 0.01], but this association was not significant in multivariable model. There was an interaction between peritoneal membrane transport status and diabetes (P = 0.028). Subgroup analyses showed that compared to low and low average transporters, high transporters was associated with a higher risk of all-cause mortality (adjusted HR 1.78, 95% CI 1.07 to 4.70, P = 0.04) in CAPD patients without diabetes, but not in those with diabetes (adjusted HR 0.79, 95%CI 0.33 to 1.89, P = 0.59). Results were similar when transport status was assessed as a continuous variable.Conclusions
The association between high peritoneal transport and all-cause mortality was likely to vary with diabetes status. High peritoneal transport was associated with an elevated risk of death among CAPD patients without diabetes, but not in those with diabetes. 相似文献17.
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The influence of human plasma on the antibacterial effect of solutions for peritoneal dialysis was studied. The solutions contained 43 mEq per litre of either acetate or lactate as the source of base. Enough pooled human plasma was added to half of each solution to give a total concentration of a gramme of protein per litre. The numbers of viable organisms from 15 clinical isolates each of Staphylococcus aureus, Escherichia coli, and Pseudomonas species were counted before and after incubation in the four solutions. Numbers of viable Staph. aureus and E. coli diminished consistently after incubation in all four solutions, but the greatest decreases occurred in the acetate solution which contained no plasma. Plasma abolished the greater antibacterial effect of acetate on these organisms. Differences between numbers of viable Pseudomonas sp. after incubation in the four solutions were not significant. The diffusion of substances from plasma into dialysis fluids during peritoneal dialysis, therefore, may abolish the greater antibacterial effect of solutions made with acetate rather than lactate. 相似文献
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Tae Ik Chang Yung Ly Kim Hyungwoo Kim Geun Woo Ryu Ea Wha Kang Jung Tak Park Tae-Hyun Yoo Sug Kyun Shin Shin-Wook Kang Kyu Hun Choi Dae Suk Han Seung Hyeok Han 《PloS one》2014,9(10)
Background and Aim
Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients.Methods
This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients.Results
Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = −0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73–0.86; p<0.001) and infection-related (HR per 1 mEq/L increase, 0.77; 95% CI, 0.70–0.85; p<0.001) deaths.Conclusions
This study showed that hyponatremia is an independent predictor of mortality in PD patients. Nevertheless, whether correcting hyponatremia improves patient survival is unknown. Future interventional studies should address this question more appropriately. 相似文献20.