Search for Primary Focus of Staphylococcus aureus Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients / 대한내과학회지

OBJECTIVES: Peritonitis is the most important complication of CAPD, often leading to failure of the technique and recourse to hemodialysis. Staphylococci is the most common organism in bacterial peritonitis associated with CAPD. The importance of the skin as a source of peritonitis causing isolate is suggested. We investigated the importance of anterior nares, hands and catheter exit-site skin as a source of peritonitis in CAPD patients by comparing the plasmid analysis with the bacterial protein analysis. METHODS: Thirty patients were suffered by peritonitis which was caused by S. aureus were studied. At presentation with an episode of S. aureus peritonitis, peritoneal dialysates, anterior nares, hands and catheter exit-site skin cultures were obtained. Antibiotics-sensitivity tests was performed and antibiogram of S. aureus which was cultured from peritoneal dialysates was compared with that from the skin. The similar antibiogram was identified in sixteen patients. The isolates were typed by rapid plasmid screen analysis and by means of visual comparison of autoradiographs of 35S-methionine staphylococcal protein analysis. RESULTS: The same plasmid analysis pattern of S. aureus isolated from the skin as that from the peritoneal dialysate was observed in 7patients and bacterial protein analysis pattern in 3patients. In seven patients who had the same plasmid analysis patients, three patients had the same plasmid analysis pattern of S. aureus from peritoneal dialysate as that from anterior nares and four patients had the same plasmid analysis pattern as that from the isolates of the exit-site skin. CONCLUSION: This study confirms the epidemiological link between carriage of S. aureus and peritonitis in CAPD patients and clinical usefulness of plasmid analysis for the delineation of focus of infection.

Estimating the Volume of Pericardial Effusion by M-Mode and 2-D Echocardiographic Method

BACKGROUND: This study was undertaken to test the validity of M-mode and a new cross sectional cehocardiographic quantification of pericardial effusion. METHODS: This study was performed in 12 patients with large pericardial effusion of whom hed M-mode and 2-D echocardiography just before therpeutic drainage of the effusion. The volume of Pericardial fluid removed by pericardiocentesis was compared with te echo-free space estimated by M-mode echocardiography and the volume estimated by new 2-D echocardiographic method. The pericardial sac volume and the cardiac volume were calculated by applying the formula for the volume of a prolate ellipse. RESULTS: 1) There was a good correlation between 2-D echocardiographic estimate and the actual volume removed by pericardiocentesis(r=0.72, p<0.05). 2) The correlation between the echo-free space estimated by M-mode echocardiography at the level of mitral valve and the actual volume was also good(r=0.81,p<0.001). CONCLUSION: The M-mode and 2-D echocardiographic method is successful in helping to estimate large pericardial effusion.