James F. Winchester

Ten Years’ Experience With Continuous Ambulatory Peritoneal Dialysis

Up to January 1989, 171 patients were trained at our center on continuous ambulatory peritoneal dialysis (CAPD), and 17 on continuous cyclic peritoneal dialysis (CCPD). Over 10 years, we have gained 5,068 patient-months experience. Patient survival was 60% and 31% at 5 and 10 years, respectively. In contrast, diabetics had a survival of 32% at 5 years. Major complications included 499 new episodes of peritonitis, 304 exit-site infections, 22 hernias, five bowel perforations, one hydrothorax, and three episodes of sclerosing encapsulating peritonitis. Our technique survival has been 62% and 40% at 5 and 10 years, respectively. We believe that CAPD is a viable dialysis technique for long-term treatment of chronic renal failure and it should be offered as an option to intermittent hemodialysis.

Therapeutic uses of aspirin in renal diseases

Inhibition, by aspirin, of platelet aggregation, prostaglandin synthesis, smooth muscle cell proliferation, and thromboxane genesis has potential therapeutic uses in renal diseases. Clinically, some benefit from aspirin has been shown in some forms of glomerulonephritis but not in others, such as renovascular hypertension, pregnancy-induced hypertension, and diabetic nephropathy. Experimentally, aspirin aided in amelioration of cyclosporine toxicity and in preservation of explanted kidneys being prepared for transplantation.

Bilateral nephrectomy and dialysis as an option for patients with bilateral renal cancer.

Six patients who underwent bilateral nephrectomy for renal carcinoma were placed on maintenance dialysis; of these, 1 patient had a renal transplant. A 5-year 44% survival of these patients was observed. We feel that radical nephrectomy followed by chronic dialysis is a reasonable alternative and offers a fair prognosis to patients with bilateral renal cancer in which partial nephrectomy is not possible.

Clinical Aspects of Bowel Perforation in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Since the advent of the Tenckhoff catheter (1968) and the introduction of continuous ambulatory peritoneal dialysis (CAPD) by Popovich et al. in 1976, peritoneal dialysis (PD) has gaine:d popularity for the treatment of end-stage renal failure. By the end of 1990 there were 16,484 patients on chronic peritoneal dialysis in the United States (13.5% of all dialysis patients) (1). However, as lwith any mode of therapy, it is not free of complicati,ons. Major complications of PD include peritonitis, exit-site infection, bowel perforation, hydrothorax, and sclerosing encapsulating peritonitis (SEP) (2). In this paper, we review the clinical aspects of bowel perforation in patients on continuous peritoneal dialysis.

Extracorporeal Blood Purification Techniques: Plasmapheresis and Hemoperfusion

This chapter will focus on techniques other than dialysis for removal of chemical toxins (endogenous or exogenous), immune toxins, or other naturally occurring biochemical substances considered to produce disease. Plasmapheresis is the process of removal of plasma (by mechanical, immunoprecipitation, cryoprecipitation, or filtration techniques) which contains the substance in question. Hemoperfusion is the passage of blood over sorbent agents for removal of harmful products

Peritoneal dialysis in older individuals

Peritoneal dialysis is a viable alternative to hemodialysis for management of elderly patients requiring renal replacement therapy. Peritoneal dialysis confers several advantages over hemodialysis for the elderly--namely independence, home treatment and perhaps preservation of residual renal function. Although there are a few contraindications, these are minimal and can largely be overcome with attention to special training and the use of healthcare partners to perform the technique of peritoneal dialysis exchanges.

Telemedicine: Future Promise for Dialysis Management

James F. Winchester, Betty Levine, Jeff Collmann, Kevin A. Schulman, Jeanine W. Turner, Saif Rathore, Nasib Khanafer, Adil Alaoui, Neela Pania, Arwa Al-Awaa, Lance Hoffman, Marisa Hofilena, and Seong K. Mun Department of Medicine (JFW, MH), Department of Radiology, Imaging Science and Information Systems Center (JWT, BL, SKM, JC, AA), Clinical Economics Research Unit (SR, NP, KAS), Georgetown University Medical Center, Washington, D.C., and School of Engineering and Applied Science, Institute on Computer and Telecommunications Systems Policy (AAA, LH, NK), George Washington University, Washington, D.C.

A multimedia medical database component for a dialysis telemedicine application

With the aim of increasing the efficiency of distributed multimedia medical databases in terms of the clinical consulting process, we propose a multimedia medical database component for a dialysis telemedicine application to manage external data access using distributed middleware standardizations. External data access to distributed multimedia medical databases consists of a collection of software components that interact with each other using a common set of system-level interfaces defined by DCOM and CORBA. External data access interfaces consist of individual DCOM and CORBA interfaces, a DCOM-CORBA connection interface, and DCOM/CORBA interfaces to legacy data. With our current focus on the seamless integration of component and non-component programs in medical databases, we support a telemedicine system which allows the distribution of multimedia medical data.

Organ and Metabolic Complications: Bleeding Disorders in Renal Failure

Coagulation abnormalities associated with renal diseases, are seen in chronic and acute renal failure, but also in nephrotic syndrome, glomerulonephritis, urogenital neoplasms, and renal transplantation. In this chapter we will discuss, specifically, uremia and acute renal failure, including disseminated intravascular coagulation, since the latter two conditions are often inextricably linked. For causes of, and manifestations of, bleeding/thrombosis in nephrotic syndrome, nephritis, genito-unnary cancer and transplantation the reader is referred to a recent review (1). Normal hemostasis is outlined in Figure I

Low BUN: A Negative Prognostic Indicator Early in CAPD

A low mean value for predialysis BUN has been associated with decreased survival and decreased parameters of well-being in hemodialysis patients. We sought to extend our investigations into our CAPD population. Early in CAPD a population exists with a low mean BUN who will fail to thrive. Postulates as to mechanisms of disease are discussed.