The osmotic effectiveness of a large molecular weight glucose polymer fraction (Icodextrin) as a novel "colloid" osmotic agent in peritoneal dialysis was established, but the long-term safety remained undetermined. A randomized, controlled multicenter investigation of Icodextrin in ambulatory peritoneal dialysis (MIDAS) was undertaken to evaluate the long-term safety and efficacy by comparing daily overnight (8 to 12 hr dwell) use of isosmolar Icodextrin (282 mOsm/kg) with conventional 1.36% (346 mOsm/kg) and 3.86% (484 mOsm/kg) glucose exchanges over six months. Two hundred and nine patients were randomized from 11 centers, with 106 allocated to receive Icodextrin (D) and 103 to remain on glucose (control group; C); 138 patients completed the six month study (71 C, 67 D). All patients were divided into weak (1.36%) or strong (3.86%) subgroups based on their use of glucose solutions overnight during the pretreatment baseline period. The mean (+/- SEM) overnight ultrafiltration (UF) with D was 3.5 times greater than 1.36% glucose at eight hours [527 +/- 36 vs. 150 +/- 47 ml; 95% confidence interval (CI) for the difference +257 to +497 ml; P < 0.0001] and 5.5 times greater at 12 hours (561 +/- 44 vs. 101 +/- 48 ml, 95% CI for the difference +329 to +590; P < 0.0001) and no different from that of 3.86% glucose at eight hours (510 +/- 48 vs. 448 +/- 60 ml, 95% CI for the difference -102 to +226 ml; P = 0.44) and at 12 hours (552 +/- 44 vs. 414 +/- 78 ml, 95% CI for the difference -47 to +325 ml; P = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

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SYNOPSIS A modified nitroblue tetrazolium test (NBT) is described which is suitable for routine application in the haematology or bacteriology laboratory and which provides a rapid aid to the diagnosis of bacterial infection.Hitherto published methods have recommended the use of heparinized whole blood samples for the performance ofthe NBT test. However, we have demonstrated that the use ofthe sucrose polymer Ficoll permits the test to be carried out on buffy coats prepared from venous blood anticoagulated in sequestrene (EDTA).The mean percentage of NBT-positive neutrophils in 60 healthy control subjects was 6-1. The mean percentage of NBT-positive neutrophils in 56 patients with confirmed or presumed bacterial infection was 34-2. Scores within the normal range were observed in 13 patients in this group.

Objective To use the experience of an international group of gynaecological laparoscopists to evaluate the prevalence, causes, sites, management and outcomes of bowel injury occurring during or as a result of laparoscopy. Design A questionnaire was sent to members of the International Society for Gynecologic Endoscopy (ISGE) requesting details of all laparoscopies complicated by bowel trauma and performed by them over a 2‐year period. One year was retrospective and one prospective. Results A total of 135 members (24%) replied and reported 45 bowel injuries. The estimated prevalence was 1 in 1652 level 1 laparoscopies and 1 in 280 levels 2 and 3 laparoscopies combined. Injuries were caused by the Veress needle, primary trocar, forceps, scissors and by electro‐ and laser surgery. Adhesions from previous surgery or endometriosis were present in 78% of cases. Bowel trauma was statistically significantly related to the experience of the surgeon, defined by a cut‐off at 100 procedures per year. In experienced hands trauma occurred as frequently during access as during the surgical procedure. The diagnosis was made during the laparoscopy in 38 cases. Expectant treatment was carried out in four cases after Veress needle injury without consequences, laparoscopic suturing in eight cases and conversion to laparotomy in 26 cases. The diagnosis was delayed in seven patients (15%) of whom two (28%) died 7 days after surgery without any further intervention. Conclusions Bowel injury during gynaecological laparoscopy is significantly related to the experience of the surgeon. With the experienced group, bowel trauma occurs as frequently during access as during the surgical procedure. The occurrence of two deaths in our study suggests that the mortality due to bowel trauma may be underestimated in reports from highly privileged societies.

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