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We reviewed 44 consecutive patients treated for Legg-Calvé-Perthes disease who underwent serial technetium 99m diphosphonate bone scintigraphy. The average follow-up was 4.4 years. The bone-scintigraphy classification characterizes the A pathway by early lateral column formation not seen in the B pathway. Pathway A had 20 hips. The average age at presentation was 6.1 years. At last follow-up, this group had an average Mose classification of 1.2 and Catterall score of 2.4, without any patient having "head-at-risk" signs or requiring operative treatment. Pathway B had 20 hips. The average age at presentation was 5.8 years. At last follow-up, this group had an average Mose classification of 5.2, a Catterall score of 3.5, and 18 patients had head-at-risk signs, with 11 requiring operative treatment. Our bone-scintigraphy classification preceded the radiographic head-at-risk signs by an average of 3 months, allowing earlier treatment and correlated with subsequent femoral head involvement.

The objective of this study was to compare, using in vitro quantitative microbiology, the ability of two commercially available peritoneal dialysis solution delivery systems to prevent and remove, via convective fluid flow, intralumenal fluid path bacterial contamination. The two systems (A and B) differed in both the configuration of their flow control, or Y-junction and the method of fluid flow control and also in the design of their Luer tubing connectors. System A had a tubing type Y-junction that requires clamps to control fluid flow and uses a connector with a male Luer that is deeply recessed within a shroud. System B has a dial-type rigid Y-junction with in-line flow control and a connector with a male Luer that is shrouded but not recessed. System A connectors allowed significantly (p < 0.0001) fewer bacteria to be transferred into the fluid path than System B after simulated touch contamination. Also, when an equivalent number of bacteria were deliberately placed into the fluid paths of both systems, System A was more effective in removal of the bacterial contamination by convective fluid flow than System B (p < 0.0001), resulting in fewer organisms infused into the simulated peritoneum. Specific design features of System A, such as a recessed male Luer, and a Y-junction fluid flow path with low turbulence were likely explanations for its superior results. This study emphasizes the importance of connector and fluid path flow design in the aseptic performance of peritoneal dialysis delivery systems.

The goal of this study was to quantitatively compare in vitro the ability of four commercially available peritoneal dialysis solution system designs to prevent the infusion of the most common accidental touch and airborne bacterial contaminant, Staphylococcus epidermidis, into the peritoneum using a total system evaluation approach. This approach took into consideration the number of system openings to the environment during an exchange combined with each system’s convective flushing characteristics. A Y set and a Twinbag system utilizing either an antimicrobial cap or a snap disconnect design for disconnection at the end of the solution exchange procedure were selected for study. The lowest peritoneal bacterial recovery count was seen with the antimicrobial cap system Twinbag, being significantly lower than any of the other systems tested (p < 0.0001). The highest bacterial recovery count occurred in the snap disconnect Y system, being significantly higher than any of the other products tested (p < 0.0001). Both the antimicrobial cap systems permitted infusion of fewer bacteria than the snap disconnect systems, despite being inoculated with larger numbers of bacteria to account for a potential additional opening of the system, during the disconnect procedure. This evaluation emphasizes the importance of fluid path flow design in the overall safety performance of peritoneal dialysis systems.

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