Abstract. The thyroid function of 13 patients with proteinuria and normal serum creatinine level (Group 1) and 15 patients with proteinuria and increased creatinine level (Group 2) was investigated. The daily urinary T41-and T3 excretion was much higher in Group 1 patients than in Group 2 patients (37.1 ± 25.9 nmol T4 vs 17.5 ± 8.7 nmol T4, 3.3 ± 1.6 nmol T3 vs 1.1 ± 0.8 nmol T3, respectively) and correlated in both groups with the protein loss. None of the patients suffered from hypothyroidism as a consequence of this hormone loss. Although the mean serum T4-, T3-, FT4-, FT3-, TBG-and TBPA concentrations in both groups of patients were within the normal range, the urinary hormone loss appeared to influence these values considerably. It was striking that the rT3 concentration in the patients with the highest hormone loss was frequently less than 0.08 nmol/l, the lower limit of detectability. The basal TSH levels in serum of the nephrotic patients were similar to those of normal individuals. The thyroid function of patients with proteinuria accompanied by retention of creatinine due to renal failure was more difficult to assess because different pathological mechanisms may exert their influence on the thyroidal hormone secretion as well as on the peripheral hormone metabolism.
We measured total serum creatine kinase (CK) and serum creatine kinase MB fraction (CK-MB) in 53 patients on continuous ambulatory peritoneal dialysis (CAPD) and 52 patients on maintenance hemodialysis (HD), using Scalva UV methodology for CK and electrophoresis for CK-MB. Seven of the 53 CAPD patients (13%) had an elevated total CK, and only one of these 7 patients had an elevated CK-MB greater than 5%. In contrast 22 HD patients (42%) had increased total CK values, and 6 of these 22 HD patients (27%) showed elevated CK-MB isoenzyme greater than 5%. For each sex, blacks had higher mean CK values than whites. Twenty-one out of the 43 HD patients who received intramuscular injections had elevated total CK values and 6 of these 21 patients had elevated CK-MB isoenzyme independent of the timing of injection. The increased frequency of higher total CK values in HD patients appears to be related to race and androgen administration. The modest elevations in CK-MB fraction (5 to 8%) in these patients require careful interpretation.
The Rapunzel syndrome is a rare manifestation of a gastric trichobezoar with a "tail" extending throughout the small intestine and sometimes even to the colon. We report on the surgical removal of such a bezoar in a 4-year-old patient by gastrotomy--the third published case in the German literature. The syndrome is mainly seen in young girls with trichophagia psychodynamically associated with early childhood deprivation and a high comorbidity of serious pediatric psychiatric disorders. The symptoms are nonspecific and may mimic those of other pathologic gastrointestinal conditions. Clinical characteristics are a movable mass in the epigastrium and alopecia. The therapy of choice is surgery of the trichobezoar together with the whole intestinal "tail," as in most cases endoscopic removal fails due to the large extension. Early diagnosis and treatment of the Rapunzel syndrome is of eminent importance in order to avoid later fatal complications such as gastric perforation and intestinal necroses. Intensive psychiatric follow-up is mandatory for preventing relapses.
Pharmacokinetics of ofloxacin in plasma and peritoneal fluid were studied in 11 patients on continuous ambulatory peritoneal dialysis (CAPD). Seven patients without peritonitis received 20 mg ofloxacin added to 2L dialysate i.p. every 6 h for one day only, while 4 patients with acute peritonitis were treated with this same dosage every 4 h for 3 days, then every 6 h for the next 7 days. Ofloxacin concentrations in plasma and dialysate were determined by HPLC. After i.p. drug application there was a rapid elimination of ofloxacin from dialysate, this being significantly faster in patients with peritonitis as compared to those without. Likewise, the total amount lost from the first bag after a 3 h dwell was higher in the peritonitis group (84.7±1.5%; mean±SEM) than in the non-peritonitis group (75.6±2.1 %). Twenty-four h after start of ofloxacin treatment, the mean peritoneal fluid concentrations at the end of each exchange studied were all above 3 mg/L. In patients with peritonitis, plasma concentrations of ofloxacin rose to 0.94±0.05 mg/L after 24 h reaching a Cmax of 1.8±0.2 mg/L after a tmax of 84±23 h.lntraperitoneal administration of ofloxacin was well tolerated, and no local or systemic adverse events were observed. Peritonitis episodes that were caused by Staphylococcus epidermidis (3) and by E. coli (1) were cured in all patients.
A sustained ultrafiltration during long-dwell peritoneal dialysis exchanges cannot be achieved with rapidly absorbable small molecular weight substances such as commonly used glucose. Uncharged polymeric substances are absorbed slower, but yield insufficient osmotic driving force because osmolality is inversely proportional to the molecular weight.Charged polymers induce colloid osmotic pressure not only because of the molecules themselves, but also by ions kept in the peritoneal cavity by opposite charges of polymers. In an in vitro model of peritoneal dialysis, a sustained ultrafiltration has been achieved with several synthetic polymers including polyacrylate, dextran sulfate and polyethylenimine. However, these polymers were locally toxic to the peritoneal membrane when tested in rats and rabbits.Chemically modified gelatin derivatives, such as polygelin, exypolygelatin, and succinylated gelatin are widely used in Europe as plasma substitutes. They are metabolized and have proven to be systemically non-toxic. These gelatin derivative solutions were tested in rat models of peritoneal dialysis. Up to 10% solutions achieved sustained ultrafiltration at the rate proportional to the concentration and no untoward systemic or local effects on the peritoneum were observed. Absorption of gelatin molecules ranged from 40–60% of the infused amounts. The results of the studies indicate that gelatin derivitives have potential for clinical use as osmotic agents in long-dwell peritoneal dialysis exchanges if the absorption rates in humans are markedly lower than in rats.
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