The emergence of S. aureus with intermediate resistance to glycopeptides emphasizes the importance of the prudent use of antibiotics, the laboratory capacity to identify resistant strains, and the use of infection-control precautions to prevent transmission.

A retrospective study of 109 patients who underwent renal biopsy was designed to correlate the sonographic appearance of the kidney with the histologic changes and clinical and laboratory findings in various renal parenchymal diseases. The clinical, pathologic, and sonographic data were analyzed blindly and independently by a team from each corresponding discipline. There was no correlation between the specific sonographic appearance and the type of renal disease. There was a significant correlation between renal length and the prevalence of global sclerosis, focal tubular atrophy, and the number of hyaline casts per glomerulus. A significant positive correlation was also found between cortical echogenicity and the severity of global sclerosis, focal tubular atrophy, the number of hyaline casts per glomerulus, and focal leukocytic infiltration. While there was overall significant correlation between the degree of cortical echogenicity and blood urea nitrogen and creatinine concentrations in each group, a wide range of variance was present. It is not currently feasible to distinguish different types of renal medical disorders using diagnostic ultrasound.

With a renewed interest in continuous flow peritoneal dialysis (CFPD), our standard practice of implanting a second catheter in those patients facing access failure provided us the opportunity to perform acute studies on CFPD in these patients, since it temporarily provided us with two catheters. Four patients were studied, with a total of five studies performed. A standard protocol was followed utilizing 1.5% dextrose solution, a 2 L fill, an inflow rate of 200 ml/min with a proportionate outflow for a 4-hour session. A full drain was performed at the end of the study. Our results provided us with a mean effective peritoneal clearance for urea (KpeU) and creatinine (KpeCr) of 40 ml/min and 28 ml/min, respectively, and a mean ultrafiltration rate (Qf) of 13.4 ml/min. Our average mass transfer coefficient (MTC) for urea was 40 ml/min, consistent with kinetic modeling and historical data. The Kpe, MTC, and Qf achieved are significantly higher than other investigators, which could possibly be explained by those obtained by two separate catheters resulting in adequate mixing of the dialysate. These clinical results provide a solid foundation for the future development of this PD modality.

No abstract

Continuous flow peritoneal dialysis (CFPD) is a therapy originally utilized in the sixties. It was then abandoned because of technical reasons, but, today, a new interest in this technique is emerging, because of new technical solutions and new hardware capabilities. CFPD is a peritoneal dialysis technique in which a certain amount of fluid is maintained in the peritoneal cavity, while a continuous inflow and outflow is provided via twin catheters or through a double lumen catheter. In this paper a new double lumen catheter is presented. The catheter is characterized by the presence of a diffuser in the inflow lumen, while a standard coiled shape characterizes the outflow lumen. The diffuser allows the use of high dialysate flows without peritoneal damage and with an excellent distribution of the fluid. The other feature of the catheter is the removable hub which allows for an easy subcutaneous tunneling of the catheter with a subsequent connection to the y segment. The special shape also guarantees a minimum recirculation during treatment. Data obtained in the first implanted catheter showed a progressive increase in small solute clearances in relation to an increase of the flow and the tidal volume in the peritoneal cavity. In particular, urea clearances up to 48 ml/min and creatinine clearances up to 39 ml/min were obtained. No major complications were observed after one year of use of the catheter.