Peritonitis in peritoneal dialysis patients after renal transplantation.

BACKGROUND: The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed. METHODS: We analyzed, retrospectively, the incidence of peritonitis within 90 days after transplantation, its associated morbidity and mortality, as well as risk factors. From 1980 until March 1995, 238 consecutive kidney transplants in peritoneal dialysis patients were performed. Univariate and multivariated logistic regression analysis were used to identify risk factors for the development of peritonitis. RESULTS: 232 cases (141 men, 91 women) were available for analysis. In 191 patients, the catheter was removed with a mean interval after transplantation of 122 days (range 0-573). Thirty peritonitis episodes with predominantly Staphylococcus aureus (10/30) or gram-negative bacteria (12/30) were observed. Independent risk factors before transplantation were the total number of peritonitis episodes (P<10(-5)), previous peritonitis with S. aureus bacteria (P<10(-5)), and male sex (P<0.004). Risk factors after transplantation were technical surgical problems (P<10(-5)), more than two rejection episodes (P<0.02), permanent graft nonfunction (P<0.026), and urinary leakage (P<0.035). CONCLUSIONS: Transplantation without simultaneous peritoneal catheter removal is feasible. However, this increases the risk of peritonitis after transplantation. Early catheter removal should be considered seriously in those patients at risk. When peritonitis develops, antibiotic treatment should be directed against gram-positive as well as gram-negative bacteria until culture results are available.

Primary renal graft thrombosis.

BACKGROUND: Renal allograft thrombosis is a serious complication of kidney transplantation that ultimately leads to graft loss. Its association with acute and hyperacute rejection is well documented; however, in a large proportion of patients the precise cause remains obscure. The exact incidence and the associated risk factors for those episodes of graft thrombosis lacking evidence of rejection have not yet been clearly established. METHODS: All reported episodes of graft thrombosis in 558 consecutive cadaveric kidney transplants performed in a single centre were examined to identify those without histopathological evidence of rejection, i.e. primary renal graft thrombosis. Univariate and multivariate types of analysis were applied to study the possibly related risk factors and any associated morbid event(s) of those episodes. Recipients without reported episodes of primary renal graft thrombosis (n = 493) represented the control group for the 34 identified cases. RESULTS: The calculated incidence of primary renal graft thrombosis was 6% (1.9% arterial, 3.4% venous and 0.7% both), comprising 45% of early (90 days) and 37% of 1-year graft losses in our centre. The multivariate analysis identified five independent risk factors for primary renal graft thrombosis: donor's right kidney P < 0.007, past history of venous thrombosis (renal or extrarenal) P = 0.000, and diabetic nephropathy P = 0.000 of the recipient, technical surgical problems P = 0.000, and recipient's haemodynamic status peri and early postoperatively P < 0.001. Primary renal graft thrombosis was related to the presentation with delayed graft function (DGF) P < 0.0005 and was significantly associated with extrarenal thromboembolic manifestations P < 0.0005. There was no association between primary renal graft thrombosis and recipient's age, sex, number of previous transplants, type of dialysis, pretransplant treatment with erythropoietin, antiplatelet agents, or oral anticoagulants, donor's age, sex, number or graft vessels, warm and cold ischaemia times, site of transplant (R/L iliac fossa) and type of immunosuppressive agent used for induction whether cyclosporin A (CsA) or OKT3. CONCLUSIONS: Primary renal graft thrombosis is an important cause of graft loss that may be accompanied by thrombosis of extrarenal sites and effective, safe prophylactic regimens are needed, especially for those at high risk.

Effect of surface treatments and storage methods on the shear bond strength between composite/glass-ionomer cement laminate.

The shear bond strengths between a visible light cure posterior composite and different surface treatments of glass-ionomer Cement were estimated in the dry and wet conditions. A total number of 60 specimens were used in the present investigation. The specimens were divided into 6 equal groups (10 specimens each). Each group was divided into two equal subgroups, in order to study the effect of the storage condition on the shear bond strength for each group. It was found that group (V), where saline coupling agent was applied to the non-etched glass-ionomer cement surface, followed by the application of bonding agent, demonstrated the maximum shear bond strength (10.87 mm/m2). On the other hand, group (II) where composite resin was packed directly on the etched glass-ionomer surface displayed the minimum shear bond (1.93 Mn/M2). Moreover, the wet storage of the different groups elicited a varying percentage of reduction in the shear bond strength values.

Tuberculosis in patients undergoing maintenance dialysis.

Tuberculosis was diagnosed in 23 of 205 patients undergoing maintenance dialysis, an incidence of 11%. Seventeen patients (74%) were females. It was characterised clinically by a very insidious onset, the main symptoms being anorexia, loss of weight, and low-grade fever. There were extrapulmonary presentations in 18 of the 23 patients (78%). Tuberculous lymphadenitis predominated in the extrapulmonary form (55%) with peritoneal involvement coming second in frequency (16%). Pulmonary tuberculosis was seen in five patients (21.7%), four of them presenting with pleural effusions. Total white cell and differential count was normal in all patients studied. Most of the patients developed the disease about 1 year from the start of their dialysis treatment. With early therapy all patients survived their tuberculous disease and no recurrence was seen in up to 5 years follow-up. Despite earlier reports of high mortality we suggest that awareness of the increased incidence of tuberculosis in dialysis patients, together with its unusual presentation and consequent early diagnosis, results in a very good prognosis.

Synergistic effect of combined hyperthermia and a nitrosourea in treatment of a murine ependymoblastoma.

The effectiveness of heat therapy in combination with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea on a murine ependymoblastoma was investigated. Based on survival time and the number of survivors, whole-body hyperthermia (40 degrees) increased the therapeutic effectiveness of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea. Heat alone did not modify the course of the tumor. Microscopic evidence of accelerated tumor destruction in hyperthermic mice was apparent within 24 hr of drug administration. A temporary drop in animal weight was observed with hyperthermia at the higher dose levels of drug. Mechanisms which may be involved in this synergism are discussed.