values (347 and 536 U/i). We do not believe it is scientifically ethical to eliminate observations merely because they do not fall into line with our preconceived ideas. However, if one does exclude the values for the large infarct the correlation is still valid, with P < 0.05 and r = 0.52. Likewise, if all three "malfits" are excluded, P becomes < 0.01 and r = 0.74. The point we are attempting to make is that there is a correlation between the scintigraphic area of SSmTc..PYP myocardial uptake and the peak serum CPK value. This suggests that the size of the infarct correlates with the extent of tracer localization. We mentioned the need for more detailed comparison between the enzymatic and the scintigraphic estimation of infarct size. We agree with Dr. Maxwell that problems arise in assessing small infarcts by this method. The serum CPK concentration is not zero even in healthy individuals. Scanning equipment lacks an infinitely small spatial resolution; thus, a small infarct (with only slight elevation of CPK concentrations) may appear disproportionately large when the area is visualized scmtigraphically. We believe that we have shown a meaningful correlation between the scintigraphic area of myocardial uptake of ssmTcPYP and the peak serum CPK value. As mentioned in our paper, verification is required with the enzymatic method of estimating infarct size. Finally, Dr. Maxwell's final quote from our paper is taken out of context - he omitted the important twoletter word "If". WJ. KosruK, MD, FRCP[C] P.Ko, MD D. DEATRICH, RT (NM) Cardiac investigation unit University Hospital London, Ont.
References 1. SHELL WE, KJEK5HUS 3K, SOBEL BE: Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest 50: 2614, 1971 2. SOBEL BE, BRESNAHAN GF, SHELL NE, et al:
Estimation of infarct size in man and its relation to prognosis. Circulation 46: 640, 1972
3. ROBERTS R, HENRY PD, SOBEL BE: An improved basis for enzymatic estimation of
infarct size. Circulation 52: 743, 1975
Home peritoneal dialysis Ta the editor: We read with great interest the article entitled "Home pentoneal dialysis: 3 years' experience in Toronto", by Dr. S. Karanicolas and colleagues (Can Med Assoc J 116: 266, 1977) and we are aware of other series of patients undergoing long-term pen-
toneal dialysis.14 In light of these reports it is increasingly apparent that peritoneal dialysis is a modality of treatment comparable to hemodialysis in terms of clinical results. Peritoneal dialysis is a safe and simple procedure that can be carried out easily at home. Dialysis methods such as the manual system and the use of the automatic peritoneal cycler, with which 108 1 of dialysate is used per week for 36 to 44 hours in three divided sessions, were adequately explained by Karanicolas and associates. At West Saint John Community Hospital, Saint John, NB, over the past 5½ years 29 patients (15 males and 14 females) have been managed by peritoneal dialysis. This group constitutes 22.5% of all patients in New Brunswick with end-stage renal disease who received dialysis during that period. The average age of these patients was 47.7 years (range, 17 to 72 years) and peritoneal dialysis was given for an average of 5.5 months (range, 2 to 18 months). The underlying diseases were as follows: glomerulonephritis and interstitial nephritis, six patients each; polycystic kidneys, five patients; and pyelonephritis, hypertension and diabetes, three patients each. All patients had creatinine clearance values of less than 5 ml/min before they were treated with dialysis. The present status of the patients is given in Table I. During the first 3 years 15 patients underwent peritoneal dialysis while awaiting a renal transplant or before entering a dialysis program. However, in August 1974 peritoneal dialysis was started as treatment of choice. Since then 14 patients have been thus treated, 12 of whom were trained for home peritoneal dialysis. The duration of Table I-Present status of patients who underwent peritoneal dialysis No. of patients (and average duration of peritoneal dialysis [mol) 6 (4.0) 1 (2.0) 5* (4.6)
Status Received transplant Undergoing hemodlalysis At home In hospital Undergoing peritoneal dialysis At home St (6.6) In hospital 2 (5.0) *Three other patients underwent hemodialysis in hospital: one received a renal transplant, one died in an accident and two died of infection. trour other patients underwent peritoneal dialysis at home: two died of myocardial infarction, one was transferred to hospital peritonea I dialysis after 2 months of home dialysis, and one was transferred to hemodialysis.
home dialysis, excluding the training period, has now averaged 6.6 months (range, 0.5 to 17 months). Dialysis has been conducted either by the manual method or by use of the automatic cycler with an indwelling Tenckhoff peritoneal catheter. In only one patient was a Goldberg catheter used. Nineteen catheter insertions were required for the 14 patients. Malfunction of the catheter was attributed to dislodgement due to incisional hernia on two occasions in one patient, multiple adhesions secondary to abdominal surgery in a second patient, and breaking of the catheter near the exit from the skin in a third patient. In only one patient did peritonitis develop; it was managed conservatively but a new catheter was subsequently inserted. Pericarditis occurred in two patients; frequent dialysis improved their condition. One patient was transferred to a peritoneal dialysis centre because of social reasons and the fact that leftsided hemiplegia had developed. Another patient presented with severe hypertension and had to be treated by hemodialysis; she subsequently died of refractory heart failure. Two patients died of myocardial infarction. Eight patients are currently undergoing home peritoneal dialysis and, as at other centres,4 their biochemical abnormalities have been satisfactorily controlled. In one patient hyperphosphatemia, anemia and hypoproteinemia required aggressive use of aluminum hydroxide, iron supplements with or without intermittent blood transfusion, and occasional intravenous albumin infusion, respectively. All patients undergoing home peritoneal dialysis have achieved reasonable activity. The seven women have been able to do housework, and the eighth patient, a man aged 72, is enjoying a healthy retired life. Our limited experience in Saint John supports the conclusions presented by the Toronto group in the field of home peritoneal dialysis. S. PAUL HANDA, MD, FRCP(C] West Saint John Community .Ios.ita1
H. TEWARI, MD, FRcs[cJ Department of urology West Saint John Community Hospital and Saint John General Hospital Saint John, NB
References 1. PALMER RA, QUINTON WE, GRAY JE: Pro-
longed peritoneal dialysis for chronic renal failure. Lancet 1: 700, 1964 2. TENCKHOFF H, CURTIS FK: Experience with maintenance peritoneal dialysis in the home. Trans Am Soc Anti Intern Organs 16: 90, 1970 3. BoaN ST: Overview and history of peritoneal dialysis. Dial Transplant 6: 12, 1977 4. HARTITZSCH By, MEDLOCK TR: Chronic pentoneal dialysis - a regime comparable to
conventional hemodialysis. Trans Am Soc Anti Intern Organs 22: 595, 1976
CMA JOURNAL/MAY 21, 1977/VOL. 116 1123
References 1. SHELL WE, KJEK5HUS 3K, SOBEL BE: Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest 50: 2614, 1971 2. SOBEL BE, BRESNAHAN GF, SHELL NE, et al:
Estimation of infarct size in man and its relation to prognosis. Circulation 46: 640, 1972
3. ROBERTS R, HENRY PD, SOBEL BE: An improved basis for enzymatic estimation of
infarct size. Circulation 52: 743, 1975
Home peritoneal dialysis Ta the editor: We read with great interest the article entitled "Home pentoneal dialysis: 3 years' experience in Toronto", by Dr. S. Karanicolas and colleagues (Can Med Assoc J 116: 266, 1977) and we are aware of other series of patients undergoing long-term pen-
toneal dialysis.14 In light of these reports it is increasingly apparent that peritoneal dialysis is a modality of treatment comparable to hemodialysis in terms of clinical results. Peritoneal dialysis is a safe and simple procedure that can be carried out easily at home. Dialysis methods such as the manual system and the use of the automatic peritoneal cycler, with which 108 1 of dialysate is used per week for 36 to 44 hours in three divided sessions, were adequately explained by Karanicolas and associates. At West Saint John Community Hospital, Saint John, NB, over the past 5½ years 29 patients (15 males and 14 females) have been managed by peritoneal dialysis. This group constitutes 22.5% of all patients in New Brunswick with end-stage renal disease who received dialysis during that period. The average age of these patients was 47.7 years (range, 17 to 72 years) and peritoneal dialysis was given for an average of 5.5 months (range, 2 to 18 months). The underlying diseases were as follows: glomerulonephritis and interstitial nephritis, six patients each; polycystic kidneys, five patients; and pyelonephritis, hypertension and diabetes, three patients each. All patients had creatinine clearance values of less than 5 ml/min before they were treated with dialysis. The present status of the patients is given in Table I. During the first 3 years 15 patients underwent peritoneal dialysis while awaiting a renal transplant or before entering a dialysis program. However, in August 1974 peritoneal dialysis was started as treatment of choice. Since then 14 patients have been thus treated, 12 of whom were trained for home peritoneal dialysis. The duration of Table I-Present status of patients who underwent peritoneal dialysis No. of patients (and average duration of peritoneal dialysis [mol) 6 (4.0) 1 (2.0) 5* (4.6)
Status Received transplant Undergoing hemodlalysis At home In hospital Undergoing peritoneal dialysis At home St (6.6) In hospital 2 (5.0) *Three other patients underwent hemodialysis in hospital: one received a renal transplant, one died in an accident and two died of infection. trour other patients underwent peritoneal dialysis at home: two died of myocardial infarction, one was transferred to hospital peritonea I dialysis after 2 months of home dialysis, and one was transferred to hemodialysis.
home dialysis, excluding the training period, has now averaged 6.6 months (range, 0.5 to 17 months). Dialysis has been conducted either by the manual method or by use of the automatic cycler with an indwelling Tenckhoff peritoneal catheter. In only one patient was a Goldberg catheter used. Nineteen catheter insertions were required for the 14 patients. Malfunction of the catheter was attributed to dislodgement due to incisional hernia on two occasions in one patient, multiple adhesions secondary to abdominal surgery in a second patient, and breaking of the catheter near the exit from the skin in a third patient. In only one patient did peritonitis develop; it was managed conservatively but a new catheter was subsequently inserted. Pericarditis occurred in two patients; frequent dialysis improved their condition. One patient was transferred to a peritoneal dialysis centre because of social reasons and the fact that leftsided hemiplegia had developed. Another patient presented with severe hypertension and had to be treated by hemodialysis; she subsequently died of refractory heart failure. Two patients died of myocardial infarction. Eight patients are currently undergoing home peritoneal dialysis and, as at other centres,4 their biochemical abnormalities have been satisfactorily controlled. In one patient hyperphosphatemia, anemia and hypoproteinemia required aggressive use of aluminum hydroxide, iron supplements with or without intermittent blood transfusion, and occasional intravenous albumin infusion, respectively. All patients undergoing home peritoneal dialysis have achieved reasonable activity. The seven women have been able to do housework, and the eighth patient, a man aged 72, is enjoying a healthy retired life. Our limited experience in Saint John supports the conclusions presented by the Toronto group in the field of home peritoneal dialysis. S. PAUL HANDA, MD, FRCP(C] West Saint John Community .Ios.ita1
H. TEWARI, MD, FRcs[cJ Department of urology West Saint John Community Hospital and Saint John General Hospital Saint John, NB
References 1. PALMER RA, QUINTON WE, GRAY JE: Pro-
longed peritoneal dialysis for chronic renal failure. Lancet 1: 700, 1964 2. TENCKHOFF H, CURTIS FK: Experience with maintenance peritoneal dialysis in the home. Trans Am Soc Anti Intern Organs 16: 90, 1970 3. BoaN ST: Overview and history of peritoneal dialysis. Dial Transplant 6: 12, 1977 4. HARTITZSCH By, MEDLOCK TR: Chronic pentoneal dialysis - a regime comparable to
conventional hemodialysis. Trans Am Soc Anti Intern Organs 22: 595, 1976
CMA JOURNAL/MAY 21, 1977/VOL. 116 1123
