RESUMEN
BACKGROUNDS: The peritoneal catheter is the continuous ambu1atary peritoneal dialysis (CAPD) patients lifeline. Over the years, Obstruction or displacement of the chronic dialysis catheter have been a common complication of peritoneal dialysis (PD), Laparoscopic surgery or guide wire directed manipulation under fluoroscopy have been developed to manage outflow obstruction. We describes our retrospective experience with laparoscopic surgery or fluoro-scopically controlled guide wire manipulation, including catheter outcome to determine the ultimate benefit of these procedures. MATERIALS AND METHODS: During the period from June 1996 to May 1999, 182 Tenckhoff double-cuff peritoneal catheter were inserted. Approximately 86Yo of the catheters were inserted by nephrologist using the Y-TEC system and 14% by laparoscopic implantation. 21 (11.5%) were manipulated. 11 (52%) were initially performed with guide wire under fluoroscopic control. The remaining 10 manipulations were performed by laparoscopic surgery. A successful outcome was defined as normal peritoneal catheter function at thirty days. RESULTS: Among the catheters manipulated, 16 (76%) were inserted by nephrologist and 5 (24%) inserted by surgeons. The time elapsed between catheter insertion and manipulation varied between one day and thirty-two days with a mean of nine days. The primary etiology of dysfunction was catheter displacement in fourteen, and omental wrapping with adhesions in the remaining 7 cases. Thirty-day catheter function was achieved in 52% of initially catheter manipulations with guide wire under fluoroscapic control (40%) or laparoscopic surgery (60%) and 100% of subsequently laparoscopic manipulations following initially guide wire under fluoroscopy, with an overall success rate of 15 of 21 (71.4%). There were no significant complications. CONCLUSION: Malfunctioning CAPD catheters can successfully be restored to a usable state by the combination laparoscopic surgery and fluoroscopically guide wire manipulations.
Asunto(s)
Humanos , Catéteres , Diálisis , Fluoroscopía , Laparoscopía , Diálisis Peritoneal , Diálisis Peritoneal Ambulatoria Continua , Estudios RetrospectivosRESUMEN
Carbamylated hemoglobin (CarHb) is formed by the reaction of hemoglobin with cyanate derived from the spontaneous dissociation of in vivo urea. Previous studies have shown that formation of CarHb depends upon both the severity and the duration of renal failure. To study the clinical significances of CarHb in Korean patients with chronic renal failure, we measured CarHb levels by high-performance liquid chromatography in 159 CRF patients and 46 normal controls. Patients with CRF had a higher CarHb concentration than normal controls (107.9+/-58.8 vs 35.1+/-14.2 microgramVH/gHb; P<0.001). In patients with CRF, nondialysis group had a higher value than dialysis group (129.8+/-77.9 vs 98.7+/-46.1 microgramVH/gHb; P<0.05). There were no siginificant difference in CarHb levels between hemodialysis (92.0+/-35.8microgramVH/gHb) and peritoneal dialysis (106.7+/-55.3microgramVH/gHb) groups. CarHb levels were not different between diabetic and nondiabetic patients in predialysis and hemodialysis groups. Although there was a significant difference in peritoneal dialysis group, the BUN levels were also lower in diabetic patients than nondiabetic patients. There were no correlation between CarHb and HbA1c percentage in patients with diabetes. CarHb levels were positively correlated with BUN (r=0.489; P<0.001) and creatinine (r=0.458; P<0.01) concentrations. There were negative correlations between CarHb and both Kt/V (r=-0.358; P<0.05) and URR (r=-0.415; P<0.05) in hemodialysis patients. In conclusion, CarHb may be a useful index of uremic control in patients with chronic renal failure, and are independent of the mode of dialysis and the presence of diabetes.