Percutaneous versus laparoscopic placement of peritoneal dialysis catheters: simplicity and favorable outcome.

Implantation of peritoneal dialysis (PD) catheters via the laparoscopic technique is expanding, but none of the studies concerning this technique have compared its outcome with the percutaneous insertion done by the nephrologist. We compared the technical survival and outcome of 52 PD catheters placed in 43 patients with end-stage renal disease (ESRD) in our center from March 2006 to October 2007. Of these, 27 PD catheters were inserted percutaneously by a nephrologist (group 1) and 25 were placed by a surgeon using the conventional laparoscopic technique (group 2). Very obese patients, those with previous abdominal surgery, and those who refused local anesthesia were excluded from the study. All catheters were evaluated for mechanical and infectious complications and the overall technique survival was analyzed. The incidence of complications in PD catheters did not largely differ between the two groups. Early catheter-related infection episodes (within two weeks of catheter placement) occurred in three of 22 (13.6%) patients in group 1, versus three of 21 (14.3%) patients in group 2 (P>0.05). The incidence of exit site leak was higher in group 2 (19.0%) compared to (4.5%) group 1 (P<0.001). Moreover, catheter survival was comparable in both groups (81.8% at 12 months and 77.3% at 18 months in group 1) versus (85.7% at 12 months and 80.9% at 18 months in group 2) (P>0.05). We conclude that in our study, the percutaneous bedside placements of PD catheters done by nephrologists were comparable with the laparoscopic insertions performed by surgeons where the high-risk patients were avoided, and the former provided a safer and more reliable access that allowed a rapid initiation of PD.

Prevention of staphylococcal peritonitis in CAPD patients combining ablution and mupirocin.

Although there has been a dramatic decrease in the incidence of peritonitis in continuous ambulatory peritoneal dialysis (CAPD), rates > 0.5 episodes per patient per year are still common, with a very high rate of relapse. The nasal, pharyngeal, and skin carriage of Staphylococcus aureus (S. aureus) has been reported to be one of the most important of predisposing factors for peritonitis. Mupirocin application has been introduced to combat S. aureus carriage state with some degree of success. To evaluate the benefits of combining ablution for prayer with mupirocin in eliminating the carrier state of S. aureus and thus preventing peritonitis in CAPD patients, we randomized prospectively 65 patients on CAPD into two groups; group (1) used mupirocin intranasal application alone, and group (2) were instructed, in addition to application of mupirocin, to perform the proper ablution technique. The main outcome measures were the state of nasal, skin and pharyngeal S. aureus carriage state, the incidence of peritonitis, and mal-function-free PD catheter survival. After 3 months of CAPD initiation, S. aureus carrier state was detected in 11 (33.3%) patients in group (1), and in 2 (6.25%) patients in group (2) (p aureus carriers (p aureus peritonitis occurred in 19 occasions in 10 patients of group (1) versus 4 occasions in 3 patients of group (2) (p S aureus carriage and hence it decreases the incidence of continuous ambulatory peritoneal dialysis-associated S. aureus peritonitis.

Calciphylaxis of both proximal and distal distribution.

Calciphylaxis is a dreaded complication of chronic renal failure characterized by nodular subcutaneous calcification and pain. Full tissue necrosis often leads to ulceration, secondary infection and high mortality rate. We herewith present a 65-year-old Saudi gentleman who presented with multiple necrotic skin lesions of both proximal and distal distribution. Skin biopsy confirmed the diagnosis of calciphylaxis. Patient was started on sevelamer hydrochloride and low calcium dialysate to which he responded dramatically without the need for parathyroidectomy. To our knowledge, this is the first reported case of calciphylaxis with both proximal and distal distribution.

Xanthgranulomatous pyelonephritis associated with Staphylococcus aureus.

A 44-year old man with xanthogranulomatous pyelonephritis presented with abdominal distention, left lumber pain, fever, loss of appetite, and loss of weight. He had been known to have diabetes mellitus type II for 20 years, and he was diagnosed to have a left renal stone three months prior to this presentation. The patient's urine and the left psous abscess grew staphylococcus aureus.

Successful prevention of tunneled, central catheter infection by antibiotic lock therapy using vancomycin and gentamycin.

Tunneled, cuffed central vein catheters (TCC) are widely used for delivering hemodialysis (HD). Among the complications associated with central vein catheters in HD patients, infection is the principal cause of morbidity and mortality. The optimal strategy for management of TCC infections is unclear. This prospective study was aimed at assessing the efficacy of antibiotic-lock therapy using vancomycin and gentamycin in preventing catheter-related blood stream bacterial infection in patients on HD. A total of 63 HD patients with 81 TCC were enrolled at the time of catheter insertion. Patients were randomized into two groups: Group I (33 patients, 37 insertions) included TCC with antibiotic lock therapy and Group II (30 patients, 44 insertions) with routine TCC management. Infection-free catheter survival of both groups was evaluated and compared at the end of the 12-month study period. A total of 57 TCC infections were encountered with an incidence rate of 8.95 infections per 1000 dialysis sessions (DS). The rate of infection was significantly lower in Group I (4.54 per 1000 DS) as compared to Group II (13.11 per 1000 DS), p 0.05). Our study suggests that antibiotic-lock therapy using a combination of vancomycin and gentamycin is useful in preventing catheter-related blood stream infection in patients on HD.

Tunneled femoral vein catheterization for long term hemodialysis: a single center experience.

Femoral veins have been used for decades to position temporary hemodialysis catheters. Few reports, however, describe its use for permanent vascular access. This study describes the use of tunneled femoral vein catheters as permanent vascular accesses. Fourteen chronic hemodialysis patients (nine males and five females) had tunneled central venous catheters placed in the femoral vein from November 2004 to July 2005. The age of the patients ranged from 21 to 68 years with a mean of 49.8 +/- 5.9 years. Placement of a catheter via the internal jugular veins was impossible in 10 patients whose course was complicated by thrombosis or strictures of the superior vena cava. The remaining four patients had exhausted conventional access sites. The insertion of the femoral catheters involved a subcutaneous tunnel that was created by retrograde passage of the catheter through the cannula to the point of exit at a preselected site in the ipsilateral thigh away from the groin. The life span of the tunneled femoral catheter ranged between 32-240 days; median time in place was 182 days. There were four incidences of tunnel infection with Pseudomonas aeruginosa, E. coli, and Streptococcus epidermidis, which were treated successfully without the need for catheter removal. Other complications such as bleeding, kinking, migration of the catheter, arterial puncture, retroperitoneal or femoral hematomas were not observed. We conclude that tunneled femoral catheters are suitable alternatives for long-term hemodialysis access. Additional studies with a greater sample size are needed to confirm this conclusion.

Co-existence of tuberous sclerosis and the fanconi syndrome in two saudi male siblings: report on two cases.

In this report, we present two cases of familial tuberous sclerosis co-existing with the Fanconi Syndrome. Both cases presented with history of failure to thrive and mental retardation associated with hypokalemic metabolic acidosis. To our knowledge, the association between tuberous sclerosis and the Fanconi Syndrome has not been reported previously.