We compared the effects of dialysate composition on changes in intermediary metabolites, acid-base balance, and potassium removal during hemodialysis. Patients were dialyzed against dialysates containing acetate or bicarbonate, each with or without glucose, in a four-way cross-over study. Dialysates containing acetate were associated with significant perturbations in intermediary metabolism, including increases in blood citrate, acetoacetate and beta-hydroxybutyrate and a decrease in pyruvate. In contrast, bicarbonate-containing dialysates caused minimal perturbations in intermediary metabolism. Addition of glucose to the dialysate decreased the changes in intermediary metabolites; however, the magnitude of this effect was less than that observed for the change from acetate to bicarbonate. Use of acetate also resulted in lower post-dialysis blood-concentrations of base equivalents than obtained with bicarbonate; this difference was unaffected by the presence or absence of glucose. Although pre- and post-dialysis potassium concentrations were unaffected by the dialysate formulation, total potassium removal was significantly greater when glucose was omitted from the dialysate. Our results suggest that both bicarbonate and glucose should be included in the dialysate, particularly for those patients whose capacity for metabolism may be limited because of highly efficient dialysis, intercurrent illness, or starvation. However, addition of glucose to the dialysate may require a reduction in dialysate potassium to maintain proper potassium homeostasis.

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A patient with basal-cell epithelioma occurring in a sm all pox vaccination site is reported. The association is pro b ably not a chance occurrence. M a l i g n a n t TUMORS arising in smallpox vaccination sites are relatively rare occurrences'. Basal-cell epitheliomas and squamous-cell carcinomas2 have predominated in in cidence; melanomas have occurred; and one instance of a dermatofibrosarcoma protuberans and another of a mesen chymoma at the site of an injection of insulin has been reported3. Vaccination with BCG has been followed by the development of a malignant melanoma4.The case reported here is the 51st of malignancy de veloping in a scar of smallpox vaccination. nation had been asymptomatic until a nodule began to de velop one year ago.On examination, a 9 x 10 mm nodular and erythematous lesion was found on the left deltoid region within the borders of a depressed scar (Fig. 1). ___ M . 1 ■ w ËiÊÊÈÊÈÊBÊÈ if m m m m F IG U R E 1. Nodule in a vaccination scar on the left deltoid region.

In this chapter, the author identifies key challenges facingStudent services professionals are committed to student learning and development and to creating campus environments that support all students, regardless of their educational goals. These professionals are involved in teaching and learning, much of which occurs outside the formal classroom, and they form collaborative programs both inside and outside the college to address the diverse needs of students and to foster student success. Typically, student services functions include such areas as "admissions and registration, advising and course placement, assessment and testing, athletics, counseling, discipline, financial aid, orientation, job placement, retention, student activities and campus life, and services for special need students" (Culp, 1995, p. 35).To perform their various functions effectively, student services staff in community colleges face numerous challenges, most of which cluster around three broad themes: challenges arising from the increasing diversity of students, the call for a renewed focus on student learning and success, and the need to demonstrate more clearly the benefits of the work of student services units for students and the institution.

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