RESUMEN
OBJECTIVE: To determine the number of surgical complications in patients treated with continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Retrospective (1980-1989), partially prospective (1987-1989). SETTING: Rijnstate Hospital, Arnhem, the Netherlands. METHOD: In 1978 CAPD was introduced in the Netherlands. Since 1980 we have used this technique in our clinic. Over the period 1980-1989 we studied the number of surgical complications of CAPD and the loss of catheter caused by these complications. With these numbers the probability of having a functioning Tenckhoff double cuff catheter was calculated with the Kaplan-Meier method. RESULTS: 101 patients (54 men (mean age 52.5 years), 47 women (mean age 49.6 years)) with terminal renal insufficiency were treated during the study period. 123 catheters were implanted of which 33 had to be removed afterwards. The probability of having a functioning catheter after one year was 85%, after two years 64% and after three years 53%. Peritonitis was the main cause of temporary or final loss of the catheter. The number of observed cases of peritonitis was 187. CONCLUSION: Methods to improve the survival of the catheter are prevention of peritonitis by using an appropriate system for the fluid exchanges, screening patients for the existence of diverticulosis before starting CAPD, and prevention of exit site and tunnel infections.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infecciones/etiología , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/instrumentación , Diálisis Peritoneal Ambulatoria Continua/métodos , Peritonitis/etiología , Estudios Prospectivos , Estudios Retrospectivos , Factores de TiempoRESUMEN
The experience gained with CAPD in a group of 101 patients with terminal renal failure and a subgroup of 19 patients with diabetes mellitus was analysed. The actuarial patient survival was 81% after two years and 50% after five years. The combined patient-technique survival after two years was 48.8%. The most important reasons for drop-out were transplantation (25%) and death (24%). Death was method-related in 4 patients and caused by peritonitis in 2 of them. More often peritonitis was the cause of morbidity and temporary interruption (10 x) or of permanent abandoning of the method (11 x ). The peritonitis frequency during the whole period of nine years was 1 : 11.3 months. Use of the Y-connector Twinbag system and a U.V.-light system reduced the incidence substantially. However, faecal peritonitis remains a dangerous situation which cannot be prevented in this way. The mortality in patients with diabetes mellitus is high but not method-related. The incidence of peritonitis is not significantly different from that among patients without diabetes mellitus.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua , Análisis Actuarial , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/mortalidad , Peritonitis/etiología , Peritonitis/microbiología , Análisis de SupervivenciaRESUMEN
Hypospadias occurs in one out of 300 boys and is the most common congenital deformity of the male urethra. A modified Ombrédanne operation of urethral reconstruction, the so-called Groningen method, was employed in 21 patients. A good functional result with a virtually normal aspect of the external genitalia could be obtained in 17 patients. The Groningen method for correction of hypospadias is a relatively simple operation which can be used for the peripheral types of hypospadias (about 85% of cases). Referral and treatment at a young age is important for their psychologic development.