Recently much interest has been focused on the role of immunoregulatory cytokines such as interleukin 1 (IL 1) and interleukin 2 (IL 2) during the pathogenesis of immunological as well as inflammatory diseases. Therefore peripheral blood mononuclear cells (PBMC) of eight patients undergoing hemodialysis (HD) were tested for IL 1 and IL 2 production. Before starting HD, cytokine production by PBMC in culture was not altered in comparison to normal healthy controls, however, a significant increase of IL 1 and IL 2 production was observed within the first HD hour which lasted throughout the end of HD. Moreover direct effects of cellulose membranes on PBMC cytokine production as well as serum IL 1 levels have been investigated. Serum IL 1 levels were already elevated before onset of HD and increased further during HD. The discrepancy between PBMC IL 1 production and serum IL 1 levels may be due to the diminished excretion in patients with end-stage renal disease. Since addition of dialysis membrane particles enhanced monocytes to produce more IL 1 as well as lymphocytes to release more IL 2, a direct stimulatory membrane effect is postulated. The increased release of immunoregulatory cytokines may account for some of the pathologic findings observed during hemodialysis.

The 2 year study results confirm that tacrolimus is a highly efficacious cornerstone immunosuppressant in kidney transplantation. Tacrolimus-based immunosuppression may induce long-term benefits with regard to graft function and graft survival. The overall side-effect profile is considered to be favourable.

To investigate the effect of partial correction of anemia in patients maintained by chronic intermittent hemodialysis on aerobic and anaerobic working capacity, eight patients underwent a bicycle spiro-ergometry before and after treatment with recombinant human erythropoietin (r-HuEPO). the initial mean (+/- SD) hemoglobin value was 5.9 mg/dl +/- 0.61 and increased during treatment to 10.9 +/- 0.59 mg/dl, P less than 0.0001). This partial correction of anemia resulted in a significant increase of both oxygen uptake at the anaerobic threshold and peak peripheral oxygen uptake at subjective exhaustion (P less than 0.01 and P less than 0.0002, respectively). The increase in oxygen uptake corresponded to significant increases in Watts, both at the anaerobic threshold and at maximum workload (P less than 0.02 and P less than 0.0004). These data show that partial correction of renal anemia results in a significant increase of both exercise capacity and maximum work.

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Thrombosis of leg arteries after prolonged travelVenous thrombosis and subsequent pulmonary embolism after prolonged sedentary travel have been reported.'-3 We describe three cases of thrombosis of leg arteries after prolonged travel. Case reportsCase 1-A 68-year-old man presented with pain in his right calf similar to cramp after a flight lasting at least 20 hours from Australia to England. After arriving home his calf became more painful and the foot cold and numb. There was gradual improvement over the next few days, but seven days after arrival in England he sought hospital treatment. He was fit, blood pressure 140/80 mm Hg, in sinus rhythm, with no ankle oedema or calf tenderness. All pulses in the left leg were present and normal. The right common femoral pulse was present, but all pulses below this in the right leg were absent. There was reduced sensation in the right foot, which was cool. He had a block of his right superficial femoral artery. He was given intravenous heparin and subsequently warfarin. A right femoral arteriogram taken six days after admission (see figure) showed a complete block of his right superficial femoral artery, and there were signs of thrombosis. Interestingly there were multiple collateral channels suggesting