Peritoneal-mediastinal leakage complication of peritoneal dialysis

Peritoneal-mediastinal communication complication in peritoneal dialysis

Peritoneal-mediastinal communication is a rare complication of peritoneal dialysis (PD). We report the first case of peritoneal-mediastinal communication complication in a 36-year-old Caucasian man on continuous cycler peritoneal dialysis (CCPD) after undergoing cardiac surgery. He developed end-stage kidney disease (ESKD) due to calcineurin inhibitor nephrotoxicity and BK virus nephropathy in the setting of prior heart transplantation. He was initially started on intermittent hemodialysis (iHD) and was switched to CCPD 1 year later. He presented with increased drainage from his sternal incision site and reduced ultrafiltration. A contrast-enhanced chest computed tomography scan revealed an anterior chest wall subcutaneous fluid collection. He was found to have a peritoneal-mediastinal communication intraoperatively. He was successfully managed with "low-volume" PD by using reduced fill volumes for all his exchanges and did not require transition to iHD. He also had no vascular access options because of multiple prior thromboses, which would have made transitioning to iHD not feasible. This case further highlights the complex management of an ESKD patient who cannot do iHD and only do low-volume PD because of a surgical complication and the need for a multidisciplinary approach to ensure appropriate patient care.

Functional characterization of the BnNCED3 gene in Brassica napus

Abscisic acid (ABA) has been implicated in plant adaptation to various environmental stresses and the regulation of seed dormancy, leaf senescence and organ abscission progression. The cleavage of cis-epoxycarotenoids by 9-cis-epoxycarotenoid dioxygenase (NCED) family proteins is a critical step in the regulation of abscisic acid (ABA) synthesis in plants. In the present study, the NCED family gene BnNCED3 was isolated from Brassica napus. BnNCED3 encodes a 592-amino acid protein with high amino acid sequence similarity to the Arabidopsis AtNCED3 protein. Expression pattern assays revealed that BnNCED3 is ubiquitously expressed at different levels in all the examined organs. Furthermore, the overexpression of BnNCED3 contributed to ABA accumulation and NO and ROS generation in transgenic Arabidopsis plants, thereby enhancing abiotic stress tolerance. These experiments also indicated the involvement of BnNCED3 in the control of plant development in transgenic Arabidopsis, such as the inhibition of seed germination, lateral root initiation, early phase changes and the enhancement of ABA-associated leaf senescence. Together, these results indicated that BnNCED3 is at least partly involved in both stress adaptation and plant development through the regulation of ABA biosynthesis.

Low pleural fluid-to-serum glucose gradient indicates pleuroperitoneal communication in peritoneal dialysis patients: presentation of two cases and a review of the literature

BACKGROUND

Transudative pleural effusions due to pleuroperitoneal communication occur in 1.6-10% of patients receiving peritoneal dialysis (PD) and usually have overtly elevated glucose concentrations.

METHODS

We report two cases of verified pleuroperitoneal communication with minimally elevated pleural fluid glucose levels. We reviewed the literature of all PD patients with pleuroperitoneal communication that reported pleural glucose levels to assess their clinical and laboratory features and pleural fluid-to-serum glucose gradients.

RESULTS

We evaluated a total of 47 reported patients on PD with diagnosed pleuroperitoneal communication. Onset of the transudative pleural effusion after initiating PD was <3 months in only 48%. Shortness of breath was reported in 96%. Pleural effusions were right sided in 87%. Pleural fluid-to-serum glucose gradients varied from 2 to 1885 mg/dL, with 20% ≤50 mg/dL, 13% being 51-100 and 67% >100 mg/dL. All pleural fluid-to-serum glucose ratios were >1.

CONCLUSIONS

With a transudative pleural effusion in patients receiving PD, a pleural fluid-to-serum glucose ratio >1 is consistent with a pleuroperitoneal communication. In questionable cases, independent verification is necessary.

Hydrothorax: pleural effusion associated with peritoneal dialysis

Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.

Peritoneal dialysis and cough: ACCP evidence-based clinical practice guidelines

OBJECTIVE

To review the clinical associations between peritoneal dialysis (PD) and cough.

METHODOLOGY

A literature review was performed on PubMed for articles published between 1983 and 2004 using the search terms "dialysis" and "cough."

RESULTS/CONCLUSIONS

Patients receiving PD are more likely to develop a cough than other patients with end-stage renal disease who are receiving hemodialysis. Although both groups of patients frequently receive medications, such as angiotensin-converting enzyme inhibitors and beta-adrenergic blocking agents, that can trigger cough and both may be at increased risk for fluid overload and pulmonary edema, the increased risk associated with PD appears to relate to gastroesophageal reflux, likely from the peritoneal dialysate.

Transdiaphragmatic peritoneal hernia complicating peritoneal dialysis: demonstration with spiral computed tomography peritoneography and peritoneal scintigraphy

The authors describe a rare case of peritoneal transdiaphragmatic hernia discovered immediately after a car accident in a young male patient on peritoneal dialysis. The potential role of CT peritoneography and peritoneal scintigraphy to demonstrate and understand thoracic complications of ambulatory peritoneal dialysis is discussed.