ABSTRACT
Continuous peritoneal dialysis (CPD) was performed in 13 children with acute renal failure (ARF) in our intensive care units (ICU). The median age was 6 months (range 3 days to 77 months). Sixty-nine percent of the patients (9/13) were below the age of 12 months. CPD was performed for a median duration of 5 days (range 1-35 days). In 62% of the patients (8/13), the cause of ARF was acute tubular necrosis (ATN) due to cardiac surgery. The outcome of CPD regarding total survival was 54% (7/13). A high mortality was registered (83% of the deaths [5/6]) within the first year of life, which suggests a worse prognosis if ARF occurs at this age. Half of the total deaths (3/6) were among the cardiac surgery patients. Peritoneal equilibration tests (PET) were performed utilizing measurement of urea and glucose transport through the peritoneal membrane at short intervals during a period of 45-60 min from the start of treatment. Short dwell times of 5-20 min were found to be sufficient for adequate uremic control until a satisfactory daily urine production was noted. CPD is a useful and simple treatment modality for ARF in critically ill ICU children. Equilibration tests are useful and should be considered for optimization of CPD treatment in critically ill children with ARF in order to achieve the goal of controlling uremia and fluid overload, and giving nutritional support.
Subject(s)
Acute Kidney Injury/therapy , Peritoneal Dialysis , Acute Kidney Injury/metabolism , Biological Transport , Child , Child, Preschool , Dialysis Solutions/chemistry , Female , Humans , Infant , Infant, Newborn , Male , Peritoneal Dialysis/methods , Peritoneum/metabolismABSTRACT
Cytocentrifuged preparations of mononuclear cells in blood and pleural fluid were stained for acid alpha-naphthyl acetate esterase (ANAE) in order to characterize the lymphocytes of pleural effusions histochemically. The cellular samples were obtained from 42 patients with pleural effusions caused by tuberculosis, pneumonia, cancer, malignant lymphoma, sarcoidosis, congestive heart failure, hepatic cirrhosis or nonspecific causes. The mean percentage of ANAE-positive lymphocytes from patients with tuberculous pleural effusion was significantly greater (P less than 0.001) in pleural fluid (85.6%) than in peripheral blood (70.0%). Tuberculous pleural fluid also contained a higher mean percentage of ANAE-positive lymphocytes than did pleural fluid from patients with cancer (75.0%), malignant lymphoma (50.0%), pneumonia, nonspecific disease (74.9%) or transudates (59.3%). The findings show that ANAE staining is useful for demonstrating T lymphocytes in pleural effusions. The pathogenetic role of these T lymphocytes and the diagnostic significance of demonstrating ANAE-positive cells in pleural effusions are discussed.
