Repeated peritoneal dialysis in treatment of heart failure
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A patient with refractory heart failure and anasarca underwent eight peritoneal dialyses during a 21-month period. Clinical response to the dialyses was excellent. To our knowledge, this is the first patient upon whom repeated peritoneal dialysis was used over a prolonged period of time for refractory heart failure.Congestive heart failure is associated with increased levels of several inflammatory mediators, and animal studies have shown that infusion of a number of cytokines can induce heart failure. However, several drugs with proven efficacy in heart failure have failed to affect inflammatory mediators, and anti-inflammatory therapy in heart failure patients has thus far been disappointing. Hence, to what extent heart failure is caused by or responsible for the increased inflammatory burden in the patient is still unclear. Over the past couple of decades, resynchronization therapy with a biventricular pacemaker has emerged as an effective treatment in a subset of heart failure patients, reducing both morbidity and mortality. Such treatment has also been shown to affect the inflammation associated with heart failure. In this study, we review recent data on the association between heart failure and inflammation, and in particular how resynchronization therapy can affect the inflammatory process.
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What is heart failure? what causes heart failure? the public health problem of heart failure pathophysiology of the heart failure syndrome the symptoms and signs of heart failure investigation of the patient with heart failure treatment of heart failure - diuretics treatment for heart failure - ace inhibitors treatment of heart failure - digoxin management of heart failure - non-pharmacological therapy management of concomitant problems in patients with heart failure patients who do not respond to treatment preventions of heart failure.
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PDIBoth patients were fortunate in that they did not develop peritonitis as a result of their PD exit-site or tunnel infection, and they were able to retain the Tenckhoff catheter.no further PD exit-site or tunnel infections with the same organism were observed in either patient after treatment with ofloxacin otic solution, oral antibiotics, and cuff-shaving. DISCUSSIOn AnD COnCLUSIOnSDespite exit-site care, PD patients experience exit-site and tunnel infections (3-5).The standard of care for PD exit-site and tunnel infections is administration of oral antibiotics for 2 -3 weeks (1).Our novel approach using ofloxacin otic solution 0.3% reached the PD exit-site or catheter tunnel and provided therapeutic antibiotic concentrations at the site of infection (6).Ofloxacin otic solution is a sterile aqueous solution normally used to treat otitis externa caused by Escherichia coli, P. aeruginosa, and S. aureus (7).We propose that ofloxacin otic solution be used as adjuvant antibiotic therapy for severe PD exit-site and tunnel infections with P. aeruginosa, MrSA, Klebsiella pneumoniae, or a. xylosoxidans.Prompt treatment of PD exit-site and tunnel infections prevents progression to peritonitis.A lower peritonitis rate allows patients to continue treatment with PD.In summary, ofloxacin otic solution 0.3% may be used as adjuvant antibiotic therapy for PD exit-site and tunnel infections.
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Congestive Heart Failure: Trends in Epidemiology and Therapy Heart Failure and Sudden Cardiac Death Resuscitation Issues in Patients with Severe Congestive Heart Failure Pulmonary Abnormalities in Congestive Heart Failure: A Therapeutic Opportunity? Exercise Gas Exchange in Heart Failure: A Brief Review Exercise Capacity and Prognosis in Congestive Heart Failure Assessment of Physical Activity in the Patient with Heart Failure Pharmacological Enhancement of the Exercise Performance of Patients with Heart Failure Evaluating Quality of Life in Congestive Heart Failure: Issues, Progress and Recommendations Social Support and Congestive Heart Failure Patients Depression in Heart Failure Patients Sexual Functioning in Congestive Heart Failure Patients Clinical Practice Guidelines for Outpatient Management of Patients with Left Ventricular Systolic Dysfunction
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The number of patients with advanced kidney disease requiring dialysis is increasing in all parts of the world. Managing patients as they transition onto dialysis and providing support and guidance as they make important treatment choices are essential components of a nephrologist’s job. Ensuring timely preparation for dialysis, allowing patients the opportunity to explore all options, including conservative care, and managing individual expectations of dialysis are increasingly important. All nephrologists will manage patients treated with dialysis and therefore it is imperative that they have a sound understanding of different dialysis modalities, how to assess the adequacy of dialysis, and the commonly encountered medical problems dialysis patients experience.
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Objective To discuss the clinical effect of heart failure mixture in congestive heart failure.Methods Retrospective analysed clinical data of 30 cases patients with congestive heart failure accepted the treatment of heart failure mixture,and evaluated its efficacy.Results The original Western Medicine following the service on 21 cases of heart failure count not control,plus service with heart failure mixture,all effective;Nine cases with Western,the simple used of heart failure mixture,effective 7 cases,invalid 2 cases.Conclusion Heart failure mixture in congestive heart failure has significant clinical effect,without obvious adverse reaction.
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Orosomucoid
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Peritoneal equilibration test
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Despite advances in the technology of dialysis, mortality in patients who develop acute renal failure remains high. Scoring systems have been developed to improve the ability to define prognosis in seriously ill patients with acute renal failure but predicting outcomes for individual patients is uncertain. Decisions to withhold or withdraw dialysis in seriously ill patients are difficult for patients, families, and health care providers. The clinical practice guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, provides evidence-based recommendations to aid nephrologists in discussions and the process of medical decision-making about starting and stopping dialysis. Estimating prognosis and addressing the issues of advance directives and patient and family preferences through the process of shared decision-making can clarify appropriate strategies for clinical management and interventions. Time-limited trials of dialysis may be an invaluable tool in this process. Increasing nephrologists' awareness of the guideline may facilitate decision-making around the issues of withholding and withdrawing dialysis in part by clarifying patients and situations in which it may be appropriate to withhold or withdraw dialysis.
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