Results: Dialysate concentrations of NaT were not different during selleck inhibitor PETs using Lac and Lac/Bic. Dialysate concentrations of NaI in fresh PD
solutions were different (133.3 +/- 1.7 vs 128.2 +/- 3.9 mmol, p < 0.0001); however, these differences disappeared just after the end of the infusion of the fresh solutions. Peritoneal UF rate was not significantly different during PETs using Lac versus Lac/Bic (609 +/- 301 mL vs 542 +/- 362 mL). The dialysate-to-plasma ratios of sodium concentrations at 60 minutes of the PETs (which are expressions of free water transport) were not different using Lac versus Lac/Bic (0.89 +/- 0.04 vs 0.89 +/- 0.04 respectively, p = 0.96). All the other classical parameters of the PET were not different between
Lac and Lac/Bic.
Conclusions: The higher dialysate concentrations of NaI due to lower dialysate pH and consequently the higher effective osmolality of the fresh Lac PD solutions did not influence peritoneal UF rate, probably because of the fast reduction of NaI concentrations due to rapid correction of dialysate pH at the end of the infusion of Lac solutions into the peritoneal cavity.”
“Acute pancreatitis remains an unpredictable, potentially lethal disease with significant morbidity and mortality rates. New insights in the pathophysiology of acute pancreatitis have changed management concepts. In the first phase, characterized by a systemic inflammatory response syndrome, organ failure, not related to infection but rather to severe inflammation, dominates the focus of treatment. In the second selleck products phase, secondary infectious complications largely determine the clinical outcome. As infection is associated with increased mortality in acute pancreatitis, numerous prophylactic
strategies have been explored selleck chemicals in the past two decades.
This review describes the strategies that have been developed to lower the infection rate, in an attempt to lower mortality. Antibiotic prophylaxis has been the subject of many RCT’s without showing convincing evidence of their efficacy. Probiotics, although theoretically capable of lowering the rate of infection, also had no effect on infectious complications, and consequently, no effective strategy to lower the rate of infectious complications is currently available. In the second part of this review, new approaches for necrosectomy that have been designed by different centers around the world are discussed. All the interventional techniques have in common their aim to lower the invasive character, hypothesizing that lowering the surgical trauma will improve survival and lower complication rates. Recent advances include postponing intervention as a strategy to facilitate necrosectomy and improve prognosis and the “”step-up approach”" in case of infected necrosis.