Peritonitis Problems Research Articles

Survey of Continuous Ambulatory Peritoneal Dialysis in the United Kingdom, 1982

Forty -one adult renal units undertaking continuous ambulatory peritoneal dialysis (CAPD) in the United Kingdom answered a questionnaire about available facilities and their own practices. The responses suggest that many units are struggling with unsatisfactory environmental facilities and inadequate staff. Working methods, diagnostic facilities and therapeutic policies varied considerably from unit to unit. We need more information about the influence of such variables on the results of CAPD and its complications, particularly peritonitis. The use of CAPO for the management of end-stage renal failure in the United Kingdom has increased dramatically since its introduction in 1978 (I, 2). Although statistics from the European Dialysis and Transplant Association (EDT A) revealed a high technique failure rate and considerable morbidity from catheter and peritonitis problems (2, 3), individual units have reported better results (4, 5, 6). Discussion with nephrologists in the United Kingdom suggested that there were marked differences between renal units in the techniques used and the facilities available for the practice of CAPD, and that these might be reflected in the results of treatment. Therefore, we circulated a questionnaire to the 59 dialysis units in the United Kingdom requesting information concerning their facilities, practices, and the ways in which they diagnosed and managed CAPD-related infection in 1982. Replies were received from 52 units; of these six were not using CAPD and five others were pediatric centres. The questionnaires from the remaining 41 adult renal units were analysed for this report.

Update on continuous ambulatory peritoneal dialysis.

By now many patients have been successfully maintained on CAPD for five years or more, thus demonstrating that CAPD is a viable long-term treatment for end-stage renal disease. Peritonitis--the main concern of the earlier years--is now a less frightening complication. We know better how to treat peritonitis and its incidence has decreased from one episode every 8 months initially to one episode every 18 months now. In addition, several innovations, which have been or soon will be introduced, promise to decrease the frequency of peritonitis to an even lower rate. The problem of peritonitis is now being replaced by the chronic complications of CAPD, predominantly malnutrition and decrease in peritoneal ultrafiltration. CAPD has become an important adjunct in the treatment of children with ESRD, especially the very young. Even though not normal, their growth on CAPD is better than that of children on hemodialysis and as good as that after a successful transplant. CAPD has become a promising treatment for the diabetic with ESRD. This experience has stimulated interest and research in the role of intraperitoneal administration of insulin for blood glucose control. With the present worldwide experience of CAPD, this treatment has ceased to be experimental. A percentage of patients requiring dialysis will be better off on CAPD than on hemodialysis. Even though this percentage will vary among various countries, the nephrologist who wants to provide the best treatment for each patient must be well experienced in and have all treatments at his disposal including CAPD.

Initial experiences with continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) has been initiated on 51 patients: 27 females (mean age -- 43.9 years) and 24 males (mean age -- 46.4 years). This group has been observed for a total of 1420 patient weeks of treatment (27.3 patient years). Thirty-six episodes of peritonitis have been noted among 19 patients. The overall incidence was one episode per 39.4 patient weeks. Recurrent episodes of peritonitis resulted in discontinuation of CAPD in five (9.8%) of the patients. Three (5.9%) of the patients were unable to continue with CAPD because of its inability to control extracellular fluid balance. In the patients who transferred from intermittent peritoneal dialysis to CAPD, there was a 4.5 mg/dl drop in serum creatinine and a 34 mg/dl drop in mean BUN values. There was a rise of approximately 2 gm in the hemoglobin levels of this group of patients. If the problem of peritonitis can be solved, CAPD will become the dialytic treatment of choice for the majority of patients with end-stage renal disease.

INTRAPERITONEAL INJECTION OF VACCINE IN PREVENTION OF POSTOPERATIVE PERITONITIS

The problem of peritonitis has long been puzzling and vexatious for the abdominal surgeon and the clinician as well. Some peritonitis probably occurs postoperatively in every case in which an abdominal operation is performed. Usually the degree of this peritonitis is slight, and the origin is chemical or traumatic. In intestinal operations, particularly on the large bowel, there is in most instances some bacterial peritonitis. Fortunately, if certain accepted principles are followed, in most cases the postoperative peritonitis is mild and nonfatal. However, when one is operating on malignant lesions of the large bowel, perforation of the growth and formation of abscess are often encountered. Occasionally, too, the anatomic situation of the malignant lesion places insuperable difficulties in the path of the surgeon. It has been our hope that we might increase the resistance of each patient against fatal peritonitis and thereby reduce the number of postoperative deaths. We realized