Recurrent Pseudomonas luteola (CDC group Ve-1) peritonitis occurred in a patient undergoing continuous ambulatory peritoneal dialysis. Catheter removal was required for cure despite therapy based on antibiotic susceptibilities. This is the third report in the English literature of severe P. luteola infection and the first report of peritonitis caused by this organism.

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Localized genital edema occurred in 8 of 81 patients (10 per cent) undergoing continuous ambulatory peritoneal dialysis. Underlying causes included defects in the inguinal canal and noninguinal peritoneal leaks that were localized with clinical, radiographic and scintigraphic techniques. Management included temporary cessation of continuous ambulatory peritoneal dialysis exchanges in half of the patients, particularly those with recently inserted catheters. Surgical repair was recommended in all cases when inguinal defects were identified. Edema resolved permanently in 6 patients and all patients were able to remain on continuous ambulatory peritoneal dialysis.

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SUMMARY Captopril facilitates detection of unilateral renovascular hypertension by selectively reducing glomerular filtration rate in affected kidneys. To determine if volume depletion augments this response, we compared the effects of captopril, furosemide, and combined furosemide plus captopril on individual kidney computer-derived clearances of 99ra Tc-diethylenetriamine pentaacetic acid (DTPA) and [l3l I]o-iodohippurate in two-kidney, one clip Goldblatt hypertensive rats and normal controls. In clipped kidneys, captopril reduced DTPA clearance significantly from baseline (from 0.31 ±0.02 to 0.19 ±0.04 ml/min/100 g; p<0.02) whereas furosemide alone had no effect (0.28 ± 0.03 ml/min/100 g). Combined furosemide plus captopril further reduced clipped kidney DTPA clearance to a level significantly less than captopril alone (0.10 ± 0.02 ml/min/100 g; p<0.02). Clipped kidney o-iodohippurate clearance was not changed from baseline by any treatment. In contralateral undipped and normal kidneys, DTPA clearance did not decline from baseline following either captopril or furosemide plus captopril treatment. Since the dose of captopril used (3 mg/kg by intraperitoneal injection) did not reduce systolic blood pressure of hypertensive rats significantly, these changes probably reflect intrarenal rather than systemic hemodynamic effects of converting enzyme inhibition and are consistent with the hypothesis that captopril interferes with glomerular nitration in stenotic kidneys by reducing efferent arteriolar vascular resistance. Prior volume depletion accentuates the effect of captopril on stenotic kidney glomerular filtration rate, providing improved functional discrimination of stenotic kidneys from contralateral undipped and normal kidneys. These results indicate that furosemide-induced volume depletion may increase the diagnostic sensitivity of captopril-enhanced 1 Maintenance of glomerular filtration in the stenotic kidney depends in part on angiotensin II-mediated efferent arteriolar vasoconstriction.2 ' 3 By interfering with angiotensin II production and further lowering pressure distal to the fixed obstruction, converting enzyme inhibition can reduce the glomerular filtration rate in the stenotic kidney while renal plasma flow remains stable. The contralateral normal kidney,