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Continuous ambulatory peritoneal dialysis (CAPD) is a well established method of treating end stage renal failure, and is commonly used as an alternative to hemodia]ysis. Several complications have been observed. These include catheter rnalfunction, abdominal and inguinal hernia, and peritonitis. A relatively frequent complication is swetling of externa] geniitalia, due to bowel fluid passing through a patent processus vaginalis. Special diagnostic procedures are necessary to dctermine the nature of the abnormality and to guide the surgical correction. We reported two cases of patent processus vaginalis in patient on CAPD proved by radionuclide peritonea1 scintiscan using Tc-99 m-tin colloid.
Background: Recently there has been evidences that serum Lp(a), an independent risk factor to atherosclerotic cardiovascular diseases, were increased in proteinuric disorders such as nephrotic syndrome and diabetic nephropathy. Methods: We intended to search of altered concentrations of Lp(a) in proteinuric disorder measuring serum Lp(a) concentrations with ELISA in 44 glomerulonephritic patients(25 nephrotic syndrome(N5), 19 non-nephrotic range proteinuric glomerulonephritis(GN), 25 diabetic nephropathy patients(DN), and 31 healthy controls(HC). Also, we compared Lp(a) concentration between glomerulonephritis patients and diabetic nephropathy patients with proteinuria of similar degree. Results: 1) There were significantly increased levels of total cholesterol, triglyceride, and LDL-cholesterol in NS compared to GN, DN, HC. 2) There were significantly increased concentrations of serum Lp(a) in NS compared to HC, but no significant difference in serum Lp(a) among NS, GN, and DN. 3) There was no significant difference in serum Lp(a) concentrations between NS & DN with 24 hour urine protein greater than 3.0g. 4) There was no significant difference in serum Lp(a) concentration between GN with 24 hour urine protein greater than 0.5 g and less than 1.5g and DN with proteinuria of similar degree. 5) In glomerulonephritis patients, there was negative correlation between serum Lp(a) concentration and serum albumin level but correlation with 24 hour urinary protein, total cholesterol, LDL- cholesterol, and HDL-cholesterol was not shown. In diabetic nephropathy, there was no significant correlation among serum Lp(a) concentration and all parameters including serum albumin, 24 hour urinary protein, and other lipid profiles. Conclusion: The present study confirmed that patients with nephrotic syndrome of diverse etiologies have markedly increased plasma level of Lp(a), in conjunction with other lipid abnormalities. However, this study shows no difference in Lp(a) concentrations between diabetic nephropathy and glomerulonephritis with similar degree of proteinuria.
Patients with chronic renal failure may require parathyroidectomy to correct the complications of hyperparathyroidism. Hut severe recalcitrant hypocalcemia and hungrI bone syndrome can complicate the postoperative course of parathyroidectomy, despite of aggressive therapy with oral calcium and vitamin D. Intravenous calcium infusion can be used to treat this condition. But generally prolongs hospitalization and has adverse side effects such as gastrointestinal disturbances and cardiac conduction abnormalities. In patients maintained on peritoneal diahsis. Intraperitoneal administration of calcium is a reasonable altemative. We report severe tertiav hyperparathI-roidism in a patient who has been receiving CAPD after renal transplant failure. He required parathyroidectomy because he demonstrated persistent elevation of the serum calcium level, elevated intact parathIroid homone level. Bone pain, and soft tissue calcification. He developed hungry bone syndrome requiring prolonged calcium therapy including intraperitoneal administration of calcium gluconate after subtotal parathyroidectomy. He has been treated for 6 months by adding OmL of 10.o calcium gluconate solution (calcium concentration 93:23mg Ml) to each bag of diah sate after subtotal parathyroidectomI. Complications such as visible diah sate precipitation. Increased rate of peritonitis. Or abdominal pain were not observed. Mean total calcium uptake was 167.36mg exchange. We conclude that the intraperItoneal calcium therapy is a safe and effective treatment in CAPD patients who require parenteral calcium for more than a few days atter operation.
Hemodialysis requires anticoagulants to prevent fibrin deposition and thrombus formation in the extracorporeal circuit. Unfractionated heparin (UFH) has been used as a conventional anticoagulant for a long time. But recently, many side effects of heparin have been documented: hemorrhage, thrombocyto- penia with or without thrombosis, osteoporosis, skin necrosis, alopecia, and hypersensitivity reactions. In the past decade, low molecular weight heparins (LMWH) have been developed. Compared with UFH, these compounds have a longer plasma half life, less variability in the anticoagulant response to fixed doses, and a more favorable antithrombotic to hem- orrhagic ratio. Thus, rationales for using LMWH as an altemative to UFH would be a reduced risk of bleeding complications and simplified routines for heparinization due to a longer half-life of the anti- coagulant activity. To evaluate the efficacy and safety of LMWH as an anticoagulant in hemo- dialysis treatment, we conducted a prospective cross- over study with paired comparison of two different heparins in 18 end-stage renal disease patients undergoing hemodiatysis. During the first two months of observation, patients received a single bolus of LMWH (Fragmin) 2,552?221 aXa IU/one dialy- sis session, Then patients were switched to UFH dose regimen comprised of a saline prime, no initial bolus and a continuous infusion of 3,174?420 IU/one dialysis session for further two months. All hemodialysis sessions were completed uneventfully. The coagulation values of an anti-factor Xa-specific clotting method (Heptest) from citrated whole blood samples taken 15 minutes after starting hemodialysis were 0.47?0.21 U/ml with LMWH and 0.12?0.03 U/ml with UFH <p<0.05). The values taken 4 hours after starting hemodialysis were 0.24?0.10 U/ml with LMWH and 0,22?0.04 U/ml with UFH (p>0.05). The prolongation of the Heptest clotting times with LMWH and UFH was 2.86 for LMWH and 2.55 for UFH using the whole blood assay. The mean frequency of clot deposition in dialyzer was simil1 vs 0.87) as well as mean venous compression time at the end of dialysis (5.96 vs 6.23 minutes). The hematologic and biochemical parameters such as hemoglobin, platelet count, triglyceride level, total cholesterol and HDL-cholesterol level did not show any differences between the two heparins. We conclude that a single dose of LMWH is effective and safe in repeated use for hemodialysis and prevents clot formation to a similar degree as UFH.