There is growing concern about the development of antibacterial resistance with the use of antibiotics in catheter lock solutions. The use of an antibiotic that is not usually used to treat other serious infections may be an alternative that may reduce the clinical impact should resistance develop. We conducted a randomized controlled trial to compare a solution of minocycline and EDTA with the conventional unfractionated heparin for the prevention of catheter-related bacteremia in hemodialysis patients during a period of 90 d. The study included 204 incident catheters (27.8% tunneled); 14 catheters were excluded because of early dysfunction and 3 because of protocol violations. We observed catheter-related bacteremia in 19 patients in the heparin group (4.3 per 1000 catheter-days) and in 5 patients in the minocycline-EDTA group (1.1 per 1000 catheter-days; P ϭ 0.005). We did not detect a significant difference in the rate of catheter removal for dysfunction. Catheter-related bacteremia-free survival was significantly higher in the minocycline-EDTA group than in the heparin group (P ϭ 0.005). In conclusion, a minocycline-EDTA catheter lock solution is effective in the prevention of catheter-related bacteremia in hemodialysis patients. 22: 193922: -194522: , 201122: . doi: 10.1681 Despite all efforts to reduce the use of catheters in hemodialysis units because of related complications, the frequency of catheter use continues to rise, probably in consequence of the tendency to place native arteriovenous fistula at all cost. 1,2 The main complications related to catheter use are dysfunction (inadequate blood flow) and infection. The type of infections comprise exit-site infection, tunnel infection, and bacteremia. Despite the fact that exit-site and tunnel infections are the most common complications, 3,4 catheter-related bacteremia (CRB) is the most serious one, representing a barrier to long-term catheter use and emerging as a significant cause of morbidity and mortality. 5 Some studies have demonstrated that in patients using a hemodialysis catheter, the risk of death is 1.5-to threefold higher when compared with patients with a primary arteriovenous fistula. [5][6][7] Moreover, in a large cohort, the occurrence of septicemia was associated subsequently with higher cardiovascular morbidity and mortality. 8 A recent clinical trial addressing the prevention of CRB demonstrated that 12% of bacteremia-episodes resulted in death. 9 For these reasons, the prevention of CRB has become one of the major challenges in the routine care of hemodialysis patients. J Am Soc NephrolIn recent years several studies have employed specific locking solutions instead of the usual hep-

Both physical examination (PE) and intra-access pressure (IAP) measurements have been used in the identification of stenosis in an arteriovenous access. The aim of this study was to evaluate the accuracy of PE and IAP in the diagnosis of arteriovenous fistula (AVF) stenosis. A total of 84 patients were enrolled in the study (54% men, mean age of 50.7 +/- 12.7 years and mean AVF patency of 24.9 +/- 7.8 months, 52% radiocephalic). Abnormalities of pulse and thrill were used as the diagnostic tools for the detection of stenosis using the physical examination. For IAP, stenosis was suspected when the ratio between IAP at the arterial puncture site and the mean blood pressure was <0.13 or >0.43. The diagnosis of stenosis was confirmed by Doppler ultrasound (DU). Sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (PNV), and accuracy were calculated for the two early detection tests. According to DU, 50 (59%) AVF were considered positive for the presence of stenosis. Fifty-six (66%) AVF were considered positive for the presence of stenosis by PE and 34 (40%) by IAP. S, SP, PPV, and NPV for PE and IAP were 96%, 76%, 86%, and 93% and 60%, 88%, 88%, and 60%, respectively. The accuracy for PE and IAP was 88% and 71%, respectively. PE proved to be an accurate method for the diagnosis of stenosis and should be part of all surveillance protocols of stenosis detection in AVF.

Percutaneous peritoneal catheter insertion can be performed by trained nephrologists. The objective of this study was to compare the outcome of peritoneal dialysis (PD) catheters percutaneous inserted with the traditional surgical technique. One hundred twenty-one PD catheters were placed in 121 stage-5 Chronic kidney disease patients using three techniques: percutaneous insertion (Group P, n = 53), percutaneous insertion guided by radioscopy (Group R, n = 26), and surgical insertion (Group S, n = 42). The mean age of the whole cohort was 57 ± 16 years and 54% were male. Patients and catheter outcomes were followed up prospectively for 19 months. Gender, age, body mass index, previous abdominal surgeries, and the prevalence of diabetes mellitus were not significantly different among the groups as well as the incidence of bleeding and the presence of catheter dysfunction. In addition, the incidence of exit-site infections and peritonitis was not significantly different among the groups. Finally, the survival catheter rate was not significantly different by the end of the follow-up of 19 months (70% in P group, 85% in R, and 70% in S group (log rank = 0.88, p = 0.95). The outcome of percutaneous implanted catheters, which were inserted by a trained nephrologist, did not demonstrate to be inferior as compared with the traditional surgical approach.

BACKGROUND AND PURPOSE: Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis. MATERIALS AND METHODS:We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease. RESULTS:Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with .2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The "dual rim sign" on SWI occurred in 100% of our patients with lesions of .2 cm. CONCLUSIONS:The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.ABBREVIATIONS: PCM ¼ paracoccidioidomycosis; CT ¼ computed tomography; MRI ¼ magnetic resonance imaging; CNS ¼ central nervous system; DSC ¼ dynamic susceptibility contrast; DCE ¼ dynamic contrast enhanced; rCBV ¼ relative cerebral blood volume; Gd ¼ gadolinium P aracoccidioidomycosis (PCM) is a fungal infection, which is endemic in Latin America and is mainly caused by the thermodimorphic fungus Paracoccidioides spp, which primarily attacks the lungs and has a potential to disseminate to other organs. 1 Recently described are 4 other species of the genus Paracoccidioides apart from P brasiliensis: P lutzii, P restrepiensis, P venezuelensis, and P Americana. 2,3 Paracoccidioides spp inhabits primarily the soil and causes autochthonous infection from southern Mexico to northern Argentina. 4-6 Most reported cases (approximately 80%) are from Brazil, and the rest are mainly from Venezuela, Colombia, and Argentina. [6][7][8][9][10][11][12][13][14] The criterion standard for the diagnosis of PCM consists of demonstrating the presence of the fungus as multiple budding cells in clinical or tissue specimens. Nevertheless, serologic tests and imaging examinations such as CT, MR imaging, and x-rays also play an important role in the diagnosis and evaluation of the disease. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] CNS involvement is more common than it was once believed, and the disease can affect the CNS, ranging from 1% to 27.27% of cases. [18][19][20][21][22][23][24][25] Although the brain form of PCM is usually an outcome of hematogenous or lymphatic dissemination of a primary focus, it is not necessarily followed by disseminated PCM; in a few cases, it is the only location of the fungus in the body. 26 Our purpose was to describe the clinical and radiologic data (CT ...