Nephrogenic systemic fibrosis (NSF) has been observed with increased frequency in recent years. Progressive hardening of the skin advancing to severe woody induration and the development of thickened hyperpigmented plaques on the extremities and the trunk are the main clinical features. Further progression of the disease results in flexion contractures of the upper and lower extremities, resulting in immobilization and severe morbidity. In this study, we reviewed our experience with seven end-stage renal disease patients who were referred to our center between January 2004 and June 2005 for kidney transplant evaluation or for diagnosis and treatment of their deteriorating condition. Diagnosis in all patients was confirmed by skin and muscle biopsy. Three of these patients underwent renal transplantations, and softening of the skin and improved mobility of the joints was noted after kidney transplantation. Three of the four patients who remained on dialysis showed further deterioration of their NSF despite a trial of immunosuppressive therapy. Improvement after transplantation could be secondary to immunosuppression, increased renal clearance and/or more effective fluid management.

Tunneled dialysis catheters (TDCs) are associated with the highest rate of complications, morbidity, and mortality when compared to arteriovenous fistulas or grafts, and this relates to higher costs in their management. Over time, catheters are prone to higher rates of infection, thrombosis, and central venous stenosis, and, thereby, catheter dysfunction. Lower blood flow rates are a consequence of the dysfuncion. Despite efforts to reduce incident and prevalent rates of catheter use for dialysis by the National Kidney Foundation and Fistula First Initiative, they remain a common modality of hemodialysis. The management of common TDC-related complications is discussed, in addition to ways to reduce and prevent morbidity associated with their use.

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Substantial empirical evidence supports low resting heart rate (HR) as the best replicated psychophysiological correlate of aggression [Ortiz and Raine, 2004]; however, researchers continue to debate the explanatory mechanisms of the phenomenon. Sensation seeking has been proposed as a possible outcome of low resting HR that may lead to aggressive tendencies but findings have been inconsistent in terms of showing a relationship between sensation seeking and aggression. A meta‐analysis was conducted on 43 independent effect sizes, from studies with a total of 32,217 participants, to test the hypothesis that sensation seeking would be positively related to aggression across studies. A significant overall effect size was found (d = .1935, P<.001), supporting the hypothesis. Moderator analyses revealed that the relationship differed based on participant and methodological characteristics, such as participant age and the nature of the aggression measurement; however, these conclusions are limited by the uneven number of studies in many of the moderator classes. Overall, the findings provide support for higher levels of aggression in high sensation seekers and have theoretical implications for arousal theory. Further research on the links between arousal, sensation seeking and aggression can inform clinicians about potential interventions. Aggr. Behav. 37:81–90, 2011. © 2010 Wiley‐Liss, Inc.