Two Afro-Trinidadian siblings with end-stage renal disease

The case histories of two Afro-Trinidadian brothers aged 8 and 11 years who developed end-stage renal disease (ESRD) are presented. Neither had had cause in the past to seek medical attention for any renal-related illness. At presentation both had anaemia, growth failure and other clinical and laboratory evidence of ESRD. Kidney histology in one child was consistent with familial juvenile nephronophthisis (NPH). This is common cause of ESRD in children in other countries but it has not been recognized previously in Trinidadian and other West Indian children, and should be considered as a possible aetiology in West Indian children presenting with renal failure.(AU)

Non-operative management of stab wounds to the abdomen with omental evisceration

A consecutive series of 12 patients with anterior abdominal stab wounds and omental evisceration treated at the Kingston Public Hospital Jamaica over a 3-year period is presented. During this period 223 patients with abdominal stab wounds were seen of which 66 had omental evisceration. Conservative surgical management was the approach followed in 14 patients who presented without signs of peritonitis. There were no late complications or missed visceral injuries necessitating laparotomy. Serial physical examination was the method used to select patients for conservative surgical management with the exclusion of patients with deteriorating clinical signs or peritonitis. Omental evisceration through an abdominal stab wound in a patient with stable clinical signs and without evidence of peritonitis is not an absolute indication for exploratory laparotomy. (AU)

Continuous ambulatory peritoneal dialysis (CAPD) in patients with diabetes mellitus and chronic renal failure. Use of erythropoietin for treatment of anaemia of chronic renal failure - abstract

The renal replacement options in ERSD are (1) Haemodialysis (HD) in hospital or at home; (2) Peritoneal Dialysis: intermittent (IPD), continuous ambulatory (CAPD), continuous cyclic (machine) (CCPD); (3) Renal transplantation: living donor kidney and cadaver donor kidney and (4) Haemofiltration. Since 1979, there has been a phenomenal growth in the number of patients on chronic peritoneal dialysis, increasing from 2,000 patients worldwide to over 75,000 in 1992. This accounts for 14 per cent of patients on dialysis worldwide. The percentage of patients on CAPD is 6 percent in Japan, 51 percent in the United Kingdom and 93 percent in Mexico. CAPD is the cheapest form of dialysis in Europe and Canada and as cheap as home haemodialysis in the USA. In the USA, 1 in 3 new patients commenced on CAPD is diabetic. Data from the United States Renal Data System (USRDS) show that for primary renal disease in the non-diabetic, survival on CAPD is as good as haemodialysis. In the diabetics younger than 50 years, survival on CAPD is better than HD, but, over 50 years, there is no difference in survival. This applies for both Blacks and Whites. There are advantages for CAPD for diabetic patients when compared to HD. There is rapid establishment as with home therapy, training usually taking about three weeks; a partner is not essential; there are fewer hypotensive episodes and there is minimal stress on the cardiovascular system. One of the main disadvantages is peritonitis. Other less common problems are obstruction of the peritoneal catheter, tunnel infections and peritoneal thickening, leading to loss of peritoneal membrane surface. The main symptoms and signs of peritonitis are cloudly dialysate fluid, fever, abdominal pain and tenderness. Major improvements in the type of catheter, the type of giving sets and aseptic techniques have led to reduced incidence of peritonitis and patient mortality. The use of Erythropoietin in Patients with Chronic Renal Failure - Erythropoietin is normally produced in the peritubular interstitial cells of the kidneys. About 10 percent is produced in the liver, and there are no pre-formed stores of erythropoietin. Hypoxia increases de novo production of erythropoietin. It recruits and maintains the survival of the erythroid progenitor cells and promotes their maturation. The main condition in which erythropoietin is deficient is chronic renal failure, but it has also been found deficient in patients with cancer, chronic inflammations and chronic infections. Erythropoietin has been produced by genetic engineering, and its major indication is for the treatment of anaemia of chronic renal failure patients on haemodialysis, CAPD and also for predialysis patients (AU)

Peritonitis in acute peritoneal dialysis at the University Hospital of the West Indies: a five-year review

The records of patients receiving acute peritoneal dialysis during the 1983 - 1987 were retrospectively evaluated. Of a total of 59 patients receiving dialysis, 10 developed peritonitis. Staphylococcus aureus was the single most frequently isolated organism. However, gram-negative bacilli as a group were more common. We recommend the use of cloxacillin orally and gentamicin intra-peritoneally as empiric antibiotic coverage until results of culture reports are available (AU)

An unusual mixed bezoar in a child

A case report is presented of a mixed bezoar, composed of hair and carpet, occurring in a Negro toddler. The tail of the bezoar had progressed into the small bowel, giving rise to necrosis, perforation and peritonitis before removal of the mass and bowel resection led to a favourable outcome. The unusual features of the case are stressed (AU)

Successful treatment of a case of pyonephrosis of a solitary kidney with intraperitoneal rupture

A case is recorded of spontaneous intraperitoneal rupture of pyonephrsis in a solitary kidney in a 34-year-old woman. This appears to be the first report of such a case in the English literature. The patient was treated conservatively with antibiotics and intraperitoneal drainage. She survived, despite a number of life-threatening complications (AU)