Recurrent Episodes Of Peritonitis Research Articles

#1980 Past peritonitis episodes are linked to decreased peritoneal Immune Cell Function and Associated with Chronic Increased Peritoneal Inflammation

Abstract Background and Aims Chronic peritoneal inflammation and infectious complications occur in a significant proportion of PD patients. A relationship between peritoneal IL-6 levels and local immunocompetence is suspected. To analyse local immunocompetence, an ex-vivo stimulation assay of PD effluent was developed. The aim of this study was to analyse peritoneal inflammation and immunocompetence in a PD cohort in relation to clinical outcomes. Method Prospectively, 245 routinely performed 4-hour PETs (143 patients, 2679 patient-months) of patients exclusively receiving 2. generation PD fluids (two-chamber, pH neutral, low amount of glucose degradation products) were analysed. An ex-vivo cell stimulation protocol of the fresh effluents was performed of all PETs. Peritoneal immune cell function was analysed using ex-vivo Toll-like receptor (LPS/Pam3Cys) stimulated IL-6 release as an index of immunocompetence. The molecular effects of effluent components and the addition of alanyl-glutamine to PD fluid were analysed in heterologous cell stimulation experiments and using an effluent proteomics and metabolomics approach. Results IL-6 in the effluent showed no association with various patient characteristics (incl. RRF, underlying disease, peritonitis episodes, time on PD). A significant association of peritoneal IL-6 with solute transport rates and systemic markers of uremic inflammation was found. IL-6 in effluent (HR 2.54) and stimulated 1 h effluent (HR 0.34) was predictive of subsequent peritonitis episodes. An inverse association was observed with ex-vivo stimulated IL-6 release from peritoneal cells (P = .02), most pronounced in patients with a history of peritonitis (P = .008). Patients with above median elevated IL-6 levels showed reduced peritoneal immune cell function. The results were validated in an independent multi-centre PD cohort (n = 48). A proteomics (n = 17) and targeted metabolomics (patients n = 134, 1004 metabolites) analysis of PD effluents show an overrepresentation of apoptosis and neutrophil degranulation pathways in patients with elevated effluent IL-6 levels and reduced response mechanisms to pathogens when compared to effluents from patients with low effluent IL-6 levels. Heterologous donor-PBMC stimulation (4 Healthy donors) with 4h PET PD-effluents of 20 patients showed reduced immunocompetence with elevated IL-6 (P = .038) and improved immunocompetence when 8 mM alanyl-glutamine were added to the PD fluid during the dwell. These results could also be validated in a post-hoc analysis of a RCT testing alanyl-glutamine addition to PD fluid for 8 weeks in PD patients. Conclusion This is the first longitudinal study to show the relationship between peritoneal inflammation and impaired immune function of peritoneal cells, possibly predisposing to infectious complications. The possible underlying mechanistic link may represent the biological correlate (“immune-paralysis”) for PD patients at increased risk for recurrent episodes of peritonitis.

Extended antibiotic therapy for the prevention of relapsing and recurrent peritonitis in peritoneal dialysis patients: a randomized controlled trial

BackgroundRelapsing and recurrent peritonitis episodes are major causes of technique failure in peritoneal dialysis (PD). We examined the efficacy of extended antibiotic therapy for the prevention of relapsing and recurrent peritonitis. MethodsFrom February 2016 to November 2018 we recruited 254 PD patients who fulfilled the diagnostic criteria for PD peritonitis. They were randomized to a standard group, with the duration of intraperitoneal (IP) antibiotic treatment following the International Society for Peritoneal Dialysis (ISPD) guideline according to the causative microorganisms, and an extended group, with 1 extra week of IP antibiotics. The primary endpoint was relapsing, recurrent or repeat peritonitis episodes within 6 months.ResultsThe primary endpoint developed in 36 and 29 patients of the extended and standard groups, respectively (28.3% versus 22.8%; P = 0.34). The rate of complete cure, without relapsing, recurrent or repeat peritonitis within 6 months, was 63.8 and 69.3% for the extended and standard groups, respectively (P = 0.35). Repeat peritonitis episodes were more common in the extended than the standard group (15.0% versus 5.5%; P = 0.013).ConclusionsIn patients with PD-related peritonitis, extending the antibiotic therapy for 1 extra week beyond the ISPD protocol should not be recommended. Extending the treatment does not reduce the risk of relapsing or recurrent peritonitis episodes but rather is associated with a higher risk of repeat peritonitis episodes.

Residual Kidney Function and Peritoneal Dialysis-Associated Peritonitis Treatment Outcomes.

Residual kidney function contributes to the clearance of antibiotics excreted by the kidneys, lowering the antibiotic concentration, which may adversely affect the treatment of peritoneal dialysis-associated peritonitis. The objective of our study was to examine the relationship between residual kidneyfunction and peritonitis treatment outcomes. Our study included 181 participants who experienced 339 episodes of Gram-positive, Gram-negative, and culture-negative peritoneal dialysis-associated peritonitis at a single centerfrom 2003 to 2010. Episodes were categorized according to participants' urinary creatinine clearance (0, >0-5, and >5 ml/min). The data were analyzed using generalized estimating equation models to determine the covariate-adjusted association between urinary creatinine clearance and treatment failure (defined as relapse or recurrent peritonitis episodes, peritoneal catheter removal, or death from any cause during peritonitis treatment). Among episodes of peritonitis due to Gram-positive organisms or culture-negative infections, those experienced by participants with urinary creatinine clearance >5 ml/min had significantly higher odds of treatment failure than episodes experienced by anuric participants (27 of 80 versus 20 of 119 episodes resulting in treatment failure for creatinine clearance >5 versus 0 ml/min; odds ratio, 6.80; 95% confidence interval, 2.37 to 19.6). Episodes experienced by participants with creatinine clearance >0-5 ml/min also had significantly higher odds of treatment failure than episodes experienced by anuric participants (14 of 64 episodes resulting in treatment failure for creatinine clearance >0-5 ml/min; odds ratio, 2.87; 95% confidence interval, 1.12 to 7.35). The odds of relapse and recurrent peritonitis among participants with creatinine clearance >5 ml/min was also significantly higher compared with in anuric participants (17 of 80 versus 12 of 119 episodes resulting in relapse and recurrence for creatinine clearance >5 versus 0 ml/min; odds ratio, 6.76; 95% confidence interval, 1.90 to 23.8). Among participants with Gram-negative peritonitis, creatinine clearance was significantly associated with neither treatment failure nor relapse and recurrent peritonitis. Residual kidney function as measured by greater urinary creatinine clearance was associated with treatment failure among participants with Gram-positive and culture-negative peritonitis.

Mechanical complications of continuous ambulatory peritoneal dialysis: A hospital based retrospective study in Kashmir Valley

Objectives: The objective of the study was to assess the mechanical and nonmechanical complications in patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) and to access the contributing factors to improve the patient's survival and reduce morbidity and mortality. Materials and Methods: This observational study was carried out on 121 patients with ESRD undergoing CAPD at the Nephrology Unit of SKIMS, Srinagar, Jammu and Kashmir, India. We retrospectively reviewed the medical records of 121 CAPD patients, in which a double-cuffed straight Tenckhoff catheter was inserted using surgical technique from July 2012 to July 2016. Results: The mean age of the study patients was 45 ± 11.5 years. Males outnumbered female, with a ratio of 1.42:1. The most common etiology for ESRD was diabetes mellitus (38.84%), followed by hypertension (30.57%) and chronic glomerulonephritis (18.18%). About three-fourth of the study patients (77.19%) were on CAPD therapy for more than 6 months showing better acceptability of CAPD therapy. Peritonitis was the most common nonmechanical complication and was seen in 45.45% patients. 14.04% patients had recurrent episodes of peritonitis. Catheter-related complications are early encountered and are mostly due to faulty technique. Conclusion: The complications associated with CAPD are diverse and most of the mechanical complications are catheter related and often result from errors made during catheter implantation. Furthermore, the presence of comorbid factors plays a provital role in exacerbating these complications. Proper evaluation of the patient, care during catheter insertion, and postoperative period can markedly reduce most of these complications and reduce mortality and morbidity associated with CAPD.

Encapsulating peritoneal sclerosis presenting with haemorrhagic ascites after transfer from peritoneal dialysis to haemodialysis

A patient with end-stage kidney disease due to chronic glomerulonephritis was initiated on continuous ambulatoryperitoneal dialysis. After three years he was transferred to haemodialysis following recurrent episodes of peritonitis. After the commencement of haemodialysis the patient developed progressive abdominal distension; paracentesisrevealed bloody ascites. Radiographic imaging revealed features of small bowel obstruction with bowel loops matted tothe posterior abdominal wall. A diagnosis of encapsulating peritoneal sclerosis was made. Treatment with prednisonewas initiated but the patients condition steadily worsened and he demised a year later due to severe malnutrition andsepsis.

Sclerosing encapsulating peritonitis in HIV-infected patient on dialysis

A 36-year-old man presented to the dialysis unit one week after the onset of drainage of bloody peritoneal dialysate. The patient was HIV-infected and had chronic kidney disease diagnosed ten years before and had been on peritoneal dialysis and HAART. There was a history of recurrent episodes of peritonitis. During the previous three months, the patient had weight loss, anorexia, abdominal pain, and vomiting.

PReS-FINAL-2227: QT and JT dispersion in children with FMF

Familial Mediterranean Fever (FMF) is an autoimmune, autosomal recessive inherited disorder, and characterized by recurrent episodes of peritonitis, ploritis and arthritis. Patients with inflammatory disease are at increased risk of cardiovascular complications due to rhythm disorders. QT and JT dispersions are simple and non-invasive arrhythmogenic markers and can be used to assess the homogeneity of cardiac repolarization.

P01-038 – QT and JT dispersion in children with FMF

Familial Mediterranean Fever (FMF) is an autoimmune, autosomal recessive inherited disorder, and characterized by recurrent episodes of peritonitis, ploritis and arthritis. Patients with inflammatory disease are at increased risk of cardiovascular complications due to rhythm disorders. QT and JT dispersions are simple and non-invasive arrhythmogenic markers and can be used to assess the homogeneity of cardiac repolarization.

Bacteria-Derived DNA Fragment in Peritoneal Dialysis Effluent as a Predictor of Relapsing Peritonitis

Relapsing and recurrent peritonitis episodes are important causes of treatment failure in patients undergoing peritoneal dialysis (PD). This study explored whether the level of bacteria-derived DNA fragment in PD effluent predicts the development of relapsing or recurrent peritonitis. The study included 143 patients with PD peritonitis in a dialysis unit between September 2010 and December 2011. Every 5 days until antibiotic treatment ended, PD effluent was collected to determine bacteria-derived DNA fragment level, which is represented by the number of PCR cycles at which bacterial DNA could be detected. Patients were followed for the development of relapsing or recurrent peritonitis. Thirty-nine patients were excluded because of immediate treatment failure or incorrect diagnosis. Of the other 104 patients, 15 (14.4%) developed relapsing peritonitis, 3 (2.9%) had recurrent peritonitis, and 5 (4.8%) had repeat episodes. Patients with relapsing or recurrent peritonitis episodes had significantly higher levels of bacterial DNA fragment in PD effluent than those without relapsing or recurrence, both 5 days before (31.9 ± 3.4 versus 34.3 ± 3.0 cycles; P=0.002) and on the day of (32.3 ± 2.6 versus 34.1 ± 1.7 cycles; P<0.001) completion of antibiotics. When bacterial DNA fragment detectable by 34 PCR cycles 5 days before the completion of antibiotics is used as the cutoff, it has a sensitivity of 88.9% and specificity of 60.5% for the prediction of relapsing or recurrent peritonitis. Bacterial DNA fragment levels in PD effluent are significantly higher, both 5 days before and on the date of completion of antibiotics, among patients who subsequently develop relapsing or recurrent peritonitis than among those cured by antibiotics. Further studies are needed to validate these results and confirm the clinical utility of dialysate bacterial DNA fragment level.

Cu/Zn-superoxide dismutase, paraoxonase and arylesterase activities and malondialdehyde levels in patients with familial mediterranean fever

In this study, alterations in antioxidant enzyme activities and malondialdehyde (MDA) levels in the serum samples of patients with familial Mediterranean fever (FMF), an autosomal recessive disease characterized by recurrent episodes of peritonitis, pleuritis, arthritis and fever, were investigated and compared with those of age- and sex-matched healthy controls. Twenty-five patients with FMF undergoing colchicine therapy at doses of 1-1.5 mg and 25 age- and sex-matched healthy controls were included in the study. In the patients with FMF and control subjects, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were measured. Cu/Zn-superoxide dismutase (Cu/Zn-SOD), paraoxonase-1 (PON-1) and arylesterase (ARE) enzyme activities and MDA levels as a production of lipid peroxidation were evaluated using the appropriate methods. No statistically significant differences in the serum levels of ESR, CRP, Cu/Zn-SOD, MDA and PON-1 between the groups were observed (p>0.05). Serum ARE activity was significantly decreased in the patients with FMF compared with the control subjects (p<0.01). In conclusion, some abnormalities in the antioxidant defense system and lipid peroxidation may be observed in FMF patients during attack-free periods. However, further long-term studies on the subject are needed to explore altered lipid peroxidation and antioxidant defense mechanisms in patients with FMF (Tab. 1, Fig. 1, Ref. 35).

Recurrent Peritonitis Episodes in a Continuous Ambulatory Peritoneal Dialysis Patient after Gynecologic Procedures

Recurrent Peritonitis Episodes in a Continuous Ambulatory Peritoneal Dialysis Patient after Gynecologic Procedures

Growing a peritoneal dialysis program: A single‐center experience

Growing a peritoneal dialysis program: A single‐center experience

Gastric Changes Following Colchicine Therapy in Patients with FMF

Familial Mediterranean fever (FMF) is also called recurrent polyserositis. The salient features of this disease include brief recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. Colchicine is highly effective in the treatment of FMF and in preventing the development of recurrent attacks and amyloidosis, and it is essential to make the correct diagnosis and institute daily therapy with colchicine (0.5-0.6 mg bid). Colchicine is used to treat a variety of conditions but it is known to have gastrointestinal (GI) side effects. In this study, effects of colchicines on the gastrointestinal tract were evaluated in patients with FMF treated with colchicine.Biopsies were reviewed from 43 patients attending Ain Shams University Hospital (Egypt) who were diagnosed with FMF and treated with colchicine. One-hundred and twelve GI biopsies, obtained over a 14-year period, were reviewed. This included biopsies from stomach body (38), stomach antrum (50), and colon (24). In addition, gastric biopsies were reviewed from 17 control patients who did not have FMF and were not on colchicine.Three patients known to have FMF and on colchicine therapy showed typical histological features of colchicine (metaphase mitoses, epithelial pseudoproliferation, mucin depletion, and frequent apoptosis). These features were seen only in gastric antral biopsies and not in colonic biopsies. None of the control group showed the characteristic morphological features of colchicine toxicity.This is the first report of histological changes seen in the stomach following colchicine therapy. In contrast with previous reports, we did not find any definitive change in the large intestine. Our data show that gastric changes can be encountered in symptomatic patients who have recently had colchicine. If these finding are seen histologically, they merit correlation with the clinical impression and should not be interpreted as toxicity in isolation.

A single-dose vancomycin application after standard protocol in peritoneal dialysis patients with recurrent peritonitis.

Sir, Peritonitis remains the major cause of catheter removal in peritoneal dialysis (PD) patients suffering from recurrent attacks, despite appropriate antibiotic therapy. Bacteria such as coagulase-negative staphylococci (CNS) from the exit site of the catheter and contaminated dialysis fluids can grow into microcolonies in biofilms on the surface of the catheter [1,2]. In the preliminary study, we evaluated the outcome of administration of a single-dose intracatheterial vancomycin just after primary response to the treatment of the last peritonitis attack with cefazolin in continuous ambulatory PD patients with recurrent peritonitis. Among 166 patients who underwent routine PD, six cases with recurrent peritonitis attacks were treated with initial empiric antibiotic therapy consisting of intraperitoneal cefazolin given in each exchange for gram-positive organisms. The characteristics and data regarding peritonitis attacks are given in Table ​Table1.1. Six patients had three to five peritonitis attacks with intervals of ∼1–7 weeks following the completion of a standard 2- or 3-week course of antimicrobial therapy. Four cases out of six had no history of peritonitis, tunnel or exit-site infection before. One patient (fourth case in the table) had exit-site infection. For S. aureus positive culture, the patient received mupirocin pomade and Sodium Fusidate (1 g/day per oral for 7 days). After therapy, exit-site infection completely resolved, and the two cultures taken afterwards were negative. Then, she also had a peritonitis attack with S. aureus on 21 February 2006. The other patient (third case in the table) had a culture-negative peritonitis attack on 1 May 2006. They were treated with cefazolin. The wives of the two male patients (one having diabetic retinopathy) helped during the dialysis exchanges, and the remaining patients were on their own. Six patients and the two assistants (wives) were negative for nasal carriage state. However, prophylactic mupirocin was given to all patients, but the peritonitis attacks recurred. None of the patients had tunnel infection. After complete resolution of peritonitis by cefazolin alone in the last attack, 50 cc peritoneal dialysate was mixed with 2 g vancomycin after drainage of the entire peritoneal fluid and left in the catheter lumen for 8 h. Then, without drainage, a normal dialysis session was carried out. During the mean follow-up of 25 ± 0.8 months, none of the six patients had recurrence peritonitis. Table 1 Characteristics of peritoneal dialysis patients with recurrent gram-positive peritonitis Many episodes of peritonitis appear to be unrelated to obvious causes. Bacterial biofilm formation on the dialysis catheter represents a concern for PD patients in terms of our ability to eradicate the infection [2]. However, there is sometimes no clear relationship between biofilms and clinical peritonitis. Indeed, one exception may occur in patients with multiple episodes of peritonitis who were likely to have stable biofilms, positive biofilm cultures and a high incidence of catheter loss. Recently, examination by electron microscopy of catheters of patients who experienced PD peritonitis revealed biofilm formation; however, no biofilm formation was found in PD catheters removed from patients without infection [3]. The risk associated with administering cefazolin continuously (in every PD bag) is that the organisms survive and continue dividing in biofilms. Our current antimicrobial protocols may not permit adequate dosing to penetrate the biofilm and be a reason for recurrent episodes of peritonitis. To evaluate the differences in the antibiotic sensitivity patterns of CNS, minimum inhibitory concentrations (MIC) and minimum biofilm eradication concentration (MBEC) assays were compared in CNS isolates from patients with PD-associated peritonitis in a study [4]. In the PD effluent sample from patients with repeat infection, the rate of first-generation cephalosporin (FGC) or gentamicin or both resistances was higher. MBEC results were higher than those with standard MIC assays. Although no vancomycin resistance was observed with MIC assays, a small number of cases were identified with MBEC assays. There was no resistance when a vancomycin/rifampin 1:1 combination was used. All patients with repeat infections had high degrees of FGC resistance, and infection cycles were terminated when their treatment protocol included vancomycin. In conclusion, we assume that adequate antibiotic levels will be achieved within the catheter-contained biofilm with a single dose of vancomycin of 2 g at the end of the treatment course that will prevent recurrent peritonitis and catheter loss. These results are difficult to compare because patient numbers are small. In our opinion, this observation should be confirmed by other investigators. Conflict of interest statement. None declared.

Recurrent and Relapsing Peritonitis: Causative Organisms and Response to Treatment

The clinical behavior and optimal treatment of relapsing and recurrent peritonitis episodes in patients undergoing long-term peritoneal dialysis are poorly understood. Retrospective study over 14 years. University dialysis unit; 157 relapsing episodes (same organism or culture-negative episode occurring within 4 weeks of completion of therapy for a prior episode), 125 recurrent episodes (different organism, occurs within 4 weeks of completion of therapy for a prior episode), and 764 control episodes (first peritonitis episode without relapse or recurrence). Exit-site infection, empirical antibiotics. Primary response (resolution of abdominal pain, clearing of dialysate, and peritoneal dialysis effluent neutrophil count < 100 cells/mL after 10 days of antibiotic therapy), complete cure (resolution by using antibiotics without relapse/recurrence), catheter removal (for any cause while on antibiotic therapy), and mortality. Compared with the control group, more relapsing episodes were caused by Pseudomonas species (16.6% versus 9.4%) and were culture negative (29.9% versus 16.4%); recurrent infections commonly were caused by Enterococcus species (3.2% versus 1.2%) or other Gram-negative organisms (27.2% versus 11.1%) or had mixed bacterial growth (17.6% versus 12.7%). There were significant differences in primary response, complete cure, and mortality rates among groups (P < 0.001 for all comparisons). Compared with the control and relapsing groups, post hoc analysis showed that the recurrent group had a significantly lower primary response rate (86.4%, 88.5%, and 71.2%, respectively), lower complete cure rate (72.3%, 62.4%, and 42.4%, respectively), and higher mortality rate (7.7%, 7.0%, and 20.8%, respectively). Retrospective analysis. Relapsing and recurrent peritonitis episodes are caused by different spectra of bacteria and probably represent 2 distinct clinical entities. Recurrent peritonitis episodes had a worse prognosis than relapsing ones.

Bone mineral density in patients with familial Mediterranean fever

This study was carried out to determine lumbar and femoral bone mineral density (BMD) in patients with familial Mediterranean fever (FMF), an autosomal-recessive disease characterized by recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. In patients with FMF and control subjects, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. BMD was determined at the lumbar spine (L1-4) and the femoral regions (neck and total) using dual energy X-ray absorptiometry. Twenty-eight FMF patients and 30 control subjects without a history of inflammatory disease participated in our study. The demographic variables, such as age, sex and body mass index were similar between patients and controls (P > 0.05). We found statistically significant difference in ESR and CRP between FMF patients and controls (P < 0.01, P < 0.05 respectively). There was statistically significant difference in lumbar spine, femoral neck, and total femur BMD between FMF patients and control groups (P < 0.001, P < 0.01, P < 0.01 respectively).Our study indicates that lumbar spine and femoral neck and total femur BMD in patients with FMF may be lower than in healthy subjects.

Frequency of Abdominal Surgery in Patients with Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is characterized by recurrent episodes of peritonitis. Abdominal FMF attacks can be indistinguishable from those of an acute abdominal emergency, and patients may undergo one or more laparotomies before the true nature of their disease is documented. The objectives of this study were to investigate the frequency and reasons for abdominal surgeries performed on patients with FMF. We retrospectively reviewed the files of 254 patients with FMF (127 males, 127 females, mean age 27.2+/-6.3 years). We also included 182 healthy individuals for this study (89 males, 93 females, mean age 27.6+/-5 years; range 11-43) to make a comparison between FMF and healthy controls (HC) with respect to frequency of abdominal operations. The number of patients with abdominal surgery in FMF group was 74 (29.1%). The number of surgeries performed in 74 patients with FMF was 92. The first abdominal surgery before the diagnosis of FMF was appendectomy in 68 patients (26.6%). In HC group, the number of abdominal operations was found to be 16 (8.7%). Of these abdominal operations, 9 (4.9%) were due to appendectomy. The rate of total abdominal operations and appendectomy were significantly higher in FMF group than in HC group (p=0.0001). Abdominal attacks of FMF patients may cause an unnecessary laparotomy prior to the diagnosis of FMF. FMF patients can present with abdominal emergency while they are receiving colchicine. Therefore, each abdominal pain should be carefully determined according to clinical findings. The purpose of this study was to emphasize the misdiagnosis of appendicitis.

RETRACTED ARTICLE: Gastric Changes Following Colchicine Therapy in Patients with FMF

Background Familial Mediterranean fever (FMF) is also called recurrent polyserositis. The salient features of this disease include brief recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. Colchicine is highly effective in the treatment of FMF and in preventing the development of recurrent attacks and amyloidosis, and it is essential to make the correct diagnosis and institute daily therapy with colchicine (0.5–0.6 mg bid). Colchicine is used to treat a variety of conditions but it is known to have gastrointestinal (GI) side effects. In this study, effects of colchicines on the gastrointestinal tract were evaluated in patients with FMF treated with colchicine. Methods Biopsies were reviewed from 43 patients attending Ain Shams University Hospital (Egypt) who were diagnosed with FMF and treated with colchicine. One-hundred and twelve GI biopsies, obtained over a 14-year period, were reviewed. This included biopsies from stomach body (38), stomach antrum (50), and colon (24). In addition, gastric biopsies were reviewed from 17 control patients who did not have FMF and were not on colchicine. Results Three patients known to have FMF and on colchicine therapy showed typical histological features of colchicine (metaphase mitoses, epithelial pseudoproliferation, mucin depletion, and frequent apoptosis). These features were seen only in gastric antral biopsies and not in colonic biopsies. None of the control group showed the characteristic morphological features of colchicine toxicity. Conclusion This is the first report of histological changes seen in the stomach following colchicine therapy. In contrast with previous reports, we did not find any definitive change in the large intestine. Our data show that gastric changes can be encountered in symptomatic patients who have recently had colchicine. If these finding are seen histologically, they merit correlation with the clinical impression and should not be interpreted as toxicity in isolation.

Peritoneal Adhesions and Intestinal Obstructions in Patients with Familial Mediterranean Fever—Are They More Frequent?

Familial Mediterranean fever (FMF) is characterized by recurrent episodes of peritonitis. A controversy exists as to whether intestinal obstruction due to peritoneal adhesions is more common among FMF patients compared with healthy controls. The aim of the study was to estimate the rate of spontaneous or postsurgical small-bowel obstruction (SBO) in FMF patients. We reviewed the charts of 560 FMF patients followed in our clinic for the occurrence of spontaneous SBO. We also assessed the occurrence of postappendectomy intestinal obstruction among 89 FMF patients compared with 417 individuals without FMF who underwent an appendectomy without other abdominal surgery in the same medical center. Ten of 471 FMF patients (2.1%) developed spontaneous SBO, 8 of whom required laparotomy and adhesiolysis. Six of 89 FMF patients (6.7%) who underwent appendectomy developed SBO. None of the non-FMF patients developed SBO. Our retrospective study showed that FMF patients are at a higher risk than healthy individuals for developing SBO either spontaneously or as a postsurgical complication. Physicians should be alert to this possible complication when FMF patients arrive at the emergency room.

The natural course of peritoneal membrane biology during peritoneal dialysis

There is accumulating evidence to indicate that during the early years of renal replacement therapy, peritoneal dialysis (PD) provides an equivalent, if not superior, mode of dialysis to hemodialysis (HD) for a substantial number of patients [1, 2]. The benefit of PD, however, appears to be limited to the first three or four years, and the majority of patients switch therapy to HD because of technique failure. The causes of this treatment failure are multifactorial and include recurrent episodes of peritonitis, loss of residual renal function, and loss of peritoneal function [3]. The most common change in peritoneal function is a loss of ultrafiltration capacity, although a reduction in solute clearance is not an infrequent occurrence [4–6]. The causes of such functional changes are poorly understood but there is increasing evidence that they are related to changes in the structure of the membrane which correlates in most patients with the longevity of dialysis [7–10], although other factors clearly are influential. Structural changes include the loss of mesothelial cells, an increase in the thickness of the submesothelial compact zone, and a plethora of vascular changes, which range from classical small vessel atherosclerosis to venular changes. The etiology of these structural changes, however, remains speculative and includes the uremic process itself, recurrent infections, and the continuous exposure of the membrane to bioincompatible dialysis fluids [11]. Dialysis fluid has long been recognized as “bioincompatible” with the homeostasis of the peritoneal cavity [12–16]. A low pH, hyperosmolar fluid containing lactate as a buffering agent, and glucose degradation products (GDP) as a byproduct of production will inevitably have long-term negative pathophysiologic consequences [17, 18, 19]. By definition however, the fluid cannot be phys-