Septic pulmonary embolism in an intravenous drug user.

A recent case of septic pulmonary embolism in an intravenous drug user, complicated by issues of recurrent self discharge and delays in diagnosis yields opportunity to increase awareness of this uncommon yet life-threatening disorder. The literature is reviewed and includes suggested aids to raise clinical suspicion and improve subsequent management.

Abnormalities of body composition in peritoneal dialysis patients.

Objectives: Body composition changes occur in peritoneal dialysis (PD) due to abnormalities in nutrition and hydration. We investigated abnormalities of nutrition and hydration in PD patients compared with healthy controls by measurement of total body potassium (TBK) and body water compartments.

Design: Cross-sectional comparison study.

Polydipsia: a feature of peritoneal dialysis.

Background: Some dialysis patients fail to comply with their fluid restriction causing problems due to volume overload. These patients sometimes blame excessive thirst. There has been little work in this area and no work documenting polydipsia among peritoneal dialysis (PD) patients.

Disturbed appetite patterns and nutrient intake in peritoneal dialysis patients.

Objective: Malnutrition is common among peritoneal dialysis (PD) patients. Reduced nutrient intake contributes to this. It has long been assumed that this reflects disturbed appetite.

Cholecystokinin and leptin: their influence upon the eating behaviour and nutrient intake of dialysis patients.

Background: We have used serial visual analogue scores to demonstrate disturbances of the appetite profile in dialysis patients. This is potentially important as dialysis patients are prone to malnutrition yet have a lower nutrient intake than controls. Appetite disturbance may be influenced by accumulation of appetite inhibitors such as leptin and cholecystokinin (CCK) in dialysis patients.

The case of stainless statins.

Two cases of hypercholesterolaemic patients are presented in whom raised plasma creatine kinase was noted during treatment with statins. The plasma creatine kinase failed to fall following cessation of therapy. Further investigation revealed the aetiology of the raised plasma creatine kinase to be due to previously undiagnosed glycogen storage diseases (McArdle's and Pompe's diseases).

Zinc supplementation at conventional doses does not improve the disturbance of taste perception in hemodialysis patients.

Objective: To determine the effect of zinc supplementation on taste perception in a group of hemodialysis patients.

Design And Setting: Double-blind randomized placebo-controlled study in a teaching hospital dialysis unit.

Patients: Fifteen stable hemodialysis patients randomized to placebo (6 male, 2 female; median age, 67; range, 30 to 72 years) or treatment (5 male, 2 female; median age, 60; range, 31 to 76 years).

Comparison of anthropometric equations for estimation of total body water in peritoneal dialysis patients.

Background: Several formulae exist for estimating total body water (TBW). We aimed to assess their validity in peritoneal dialysis patients by comparison with TBW estimated by deuterium oxide dilution (TBW(D)).

Methods: We compared the equations of Chertow (TBW(Cher)), Chumlea (TBW(Chum)), Hume and Weyers (TBW(HW)), Johansson (TBW(J)), Lee (TBW(L)), Watson (TBW(W)) and TBW as 58% of body weight (TBW(0.

The measurement of total body potassium in patients on peritoneal dialysis.

Objectives: To assess the validity of measuring total body potassium (TBK) to estimate fat-free mass (FFM) and body cell mass (BCM) in patients on peritoneal dialysis (PD).

Methods: We studied 29 patients on PD (14 men, 15 women) and 30 controls (15 men, 15 women). We calculated TBK by using a whole-body counter to measure 1.

A novel technique to demonstrate disturbed appetite profiles in haemodialysis patients.

Background: Malnutrition is common among dialysis patients and is associated with an adverse outcome. One cause of this is a persistent reduction in nutrient intake, suggesting an abnormality of appetite regulation.

Methods: We used a novel technique to describe the appetite profile in 46 haemodialysis (HD) patients and 40 healthy controls.

Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis.

Background: Glucose absorption from glucose-based dialysis fluids limits ultrafiltration from the daytime dwell in automated peritoneal dialysis (APD). Icodextrin may allow greater ultrafiltration during the daytime period in APD, enhancing fluid control.

Methods: A 7.

Effect of peritoneal fluid on whole body and segmental multiple frequency bioelectrical impedance in patients on peritoneal dialysis.

Objective: We investigated the ability of whole body and segmental multiple frequency bioelectrical impedance (MFBIA) to detect peritoneal fluid in peritoneal dialysis patients.

Design: Prospective study.

Setting: Teaching hospital renal unit.

Low thrombogenicity of polyethylene glycol-grafted cellulose membranes does not influence heparin requirements in hemodialysis.

Heparin is the most commonly used anticoagulant for hemodialysis despite potentially serious side effects. Polyethylene glycol-grafted cellulose (PGC) membranes produce less activation of the coagulation cascade than cuprophane membranes. Anecdotally, we found some patients required a surprisingly low level of anticoagulation using these membranes.

Comparison of icodextrin and glucose solutions for the daytime dwell in automated peritoneal dialysis.

Background: The sustained ultrafiltration achieved by icodextrin is more suited for the daytime dwell in automated peritoneal dialysis (APD) than glucose solutions.

Methods: Seventeen patients receiving APD underwent assessment using three different solutions for the daytime dwell: 2.27% glucose, 3.

Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism.

Background: Tertiary hyperparathyroidism continues to cause significant morbidity in patients with chronic renal failure. This is frequently resistant to medical management and may ultimately require a surgical parathyroidectomy. Recent studies have reported upon the technique of percutaneous ethanol ablation for both primary and tertiary hyperparathyroidism.

Effective utilization of erythropoietin with intravenous iron therapy.

Introduction: Iron replacement therapy reduces the demand for erythropoietin (EPO) in some dialysis patients. It has been postulated that iron supply to the bone marrow is a rate-limiting step in the process of erythropoiesis under erythropoietin stimulation.

Methods: We evaluated the economic benefit of intravenous iron therapy for this purpose in a prospective, non-blinded study of 22 haemodialysis patients, 16 male, six female, mean age 62 years (range 24-80 years).

Association of anticardiolipin antibodies with intraglomerular thrombi and renal dysfunction in lupus nephritis.

We studied positivity for anti-cardiolipin antibody, intraglomerular capillary thrombi on renal biopsy, and the progression of renal disease in 51 patients (10 male and 41 female), mean age 37 years (range 17-65 years), with a diagnosis of systemic lupus erythematosis and clinically evident nephritis confirmed by renal biopsy. Serum creatinine, serum indicators of disease activity and biopsies were analysed in subgroups according to thrombi and anticardiolipin status. End-points were death or chronic dialysis requirement and survival.