Artificial gut for total parenteral nutrition through the peritoneal cavity

Total parenteral nutrition was attempted by using the peritoneal route. In this way it was possible to convey to the patients all elemental nutrients used in hyperalimentation. Three patients were studied while treated for an episode of catabolic stress in the course of acute or chronic uremia. Adequacy of treatment was controlled by measuring urea generation rates, plasma concentrations of 3-methyl-histidine, glucose disappearance from dialysate and kinetics of lipid particles removal from plasma. The data collected demonstrate that peritoneal hyperalimentation is is feasible for adequate for clinical purposes.

The arthropathy of maintenance intermittent peritoneal dialysis

Among 61 patients undergoing maintenance peritoneal dialysis for an average of 20 months, 13 (21%) had a history of attacks of acute arthritis and 19 (31%) were found to have tender and often swollen joints. Deposits of calcium pyrophosphate dihydrate crystals in articular cartilage were identified in four patients and inflammation probably induced by hydroxyapatite crystals was noted in one. Periarticular calcification was observed in 12 patients and subperiosteal resorption of the phalanges in 20. The average calcium X phosphorus product was significantly higher (P < 0.025) in patients with a history of attacks of acute arthritis or with inflamed joints (58 +/- 12) than in those without (50 +/- 12). In the 19 patients whose treatment was changed to continuous ambulatory peritoneal dialysis there was a significant decrease (P < 0.025) in the calcium X phosphorus product but not in the proportion of patients with attacks of acute arthritis or with inflamed joints. The results indicate that articular complications are frequent among patients undergoing maintenance peritoneal dialysis and may be more common than with long-term hemodialysis.

[Peritoneal dialysis and hyperbaric oxygenation in the treatment of disseminated suppurative peritonitis]

Results of the treatment of 120 patients with general diffuse pyoperitonitis are described. In the complex treatment the peritoneal dialysis and forced diuresis with controlled hemodilution were used. Of 86 patients 18 died. In the treatment of 16 patients the peritoneal dialysis was not used. Eleven patients died. The best results were obtained when the complex of medical measures included the peritoneal dialysis combined with forced diuresis and hyperbaric oxygenation.

Treatment of chronic renal failure: situation of CAPD

The authors are using Continuous Ambulatory Peritroneal Dialysis (CAPD) in the treatment of chronic renal failure. Started in May 1978, their experience encompasses 19 patients (9 men, 10 women). The method, developed by Oreopoulos, consists of exchanging 2 liters of dialysate 4 times a day, 7 days a week. They report their clinical and biological results and the complications. The most frequent is peritonitis (1 episode per 9.3 patients months). The simplicity and the efficacy of CAPD permits them to treat 30% of the renal patients who need chronic dialysis.

The status of continuous ambulatory peritoneal dialysis

CAPD continues to show promise as a continuous internal portable dialysis technique. Although unknown long-term problems may develop, it would seem at this time to offer an acceptable form of chronic dialysis for many patients.

Biochemical investigations of CAPD: plasma levels of trace elements and amino acids and impaired glucose tolerance during the course of treatment

Investigations have been initiated into the effect of CAPD on the plasma concentrations of trace elements and amino acids, and in particular the response of patients to an oral glucose tolerance test (OGTT) during the course of treatment. Six months CAPD had no effect on the plasma concentrations of aluminium, fluoride, zinc and copper. Levels of aluminium and fluoride were above the normal range. Loss of amino acids in the dialysate correlated with their plasma concentrations. No changes were observed in the E/NE, Val/Gly or Tyr/Phe ratios during nine months treatment. Five CAPD patients demonstrated an impaired glucose tolerance in response to an OGTT after one month of treatment and a further deterioration occurred in the glucose tolerance of three patients after another six months CAPD. In a preliminary investigation with fructose substituted for glucose in the dialysate of one patient, an improvement in the OGTT and rate of insulin secretion was observed after 3 days dialysis against fructose.

Clinical and metabolic aspects of continuous ambulatory peritoneal dialysis (CAPD)

Experience with CAPD in 14 patients, treated for periods of 2-10 months, is presented. Clinical and biochemical control of uremia appeared adequate in all patients except one. Control of extracellular volume and hypertension was easier with CAPD than with intermittent peritoneal dialysis (IPD). Nine episodes of peritonitis occurred in 5 patients (one peritonitis/8 patients months). Mean protein loss was 9.7 +/- 2.7 g per day. In 6 patients on IPD oral glucose tolerance test resulted in a paradoxical rise of HGH, whereas this was not observed after 4 months of CAPD.

A new technique of continuous ambulatory peritoneal dialysis (CAPD): double-bag system for freedom to the patient and significant reduction of peritonitis

A new technical approach has been described for the treatment of patients on CAPD. The new approach is based on the use of a two-bag system and closed connection by a connector to the Tenckhoff catheter. After each dialyzate exchange the patient discards the entire system and is completely bag-free, unlike the Oreopoulos CAPD technique. Using this new procedure we have markedly reduced the incidence of peritonitis and we have made the patient free from carrying an uncomfortable burden during the interval of solution exchange.