Two hundred eleven patients with acute ischemic stroke, stage III or IV, received daily intravenous infusion of 500-1000 mL low-molecular dextran (dextran 40) over a period of 4 days. In 10 cases (4.7%) acute renal failure, associated with dextran infusion, could be observed; oligoanuria occurred after a mean time of 4 (3-6) days. The incidence of dextran-induced acute renal failure was significantly higher in patients with a preexisting reduction of glomerular filtration rate below 30 mL/min/1.73 m2 (p < 0.005). Five of the patients (50%) with acute renal failure died within 4-12 days after the hemodilution therapy with dextran 40; this high lethality was due to nonrenal complications.

We present a 42 year old woman with autoimmune phenomena following breast augmentation, and remission after explantation.

The Rapid Access Clinic resulted in a substantial improvement of access to rheumatology assessment. More than one-third of the patients presented < 3 months after symptom onset. Suspected diagnoses of inflammatory rheumatic diseases were confirmed in almost 90%. This initiative demonstrates the feasibility of a rapid access service and indicates high diagnostic accuracy in such a setting. In particular, with respect to early access, it compares favorably with similar hospital-based approaches.

In order to evaluate the changes in causes and outcome of acute renal failure (ARF) during the years 1975-1989, 710 patients treated in our dialysis center were analyzed. We compared the etiology, the severity and catabolic state of ARF, the techniques of renal replacement therapy, which were employed and the ages and mortality rates of these patients, who received dialysis therapy during the years 1975-79 (n = 227), 1980-84 (n = 240) and 1985-89 (n = 243). The number of postoperative, posttraumatic and non-traumatic cases of ARF was approximately the same in all three 5-year periods, only the frequency of postrenal failure decreased from 7% in the years 1975-79 to 3% in the years 1985-89. The incidence of sepsis as a major cause of ARF and the most important risk factor was comparably high in the surgical and medical patients during all of the periods, but it increased in the traumatic patients from 7 % in the years 1975-79 to 28 % during the last 5-year period. The prevalence of respiratory failure and jaundice as additional organ failures, the severity of ARF (oligonanuric-nonoliguric) and the metabolic state were not different in the three patient groups. The magnitude of rise in serum creatinine before the start of renal replacement therapy was significant lower in the last 5-year period in comparison to the years 1975-79 (p < 0.05). Hemodialysis was the treatment in choice of 98 and 93 % of the cases during the first two periods, respectively. Since 1980, bicarbonate was employed in the dialysis instead of acetate in the most cases. In the years 1985-89, hemodialysis was only performed in 51 % of the patients, intermittent or continuous hemofiltration was used in 49%. The mortality of all the patients was reduced from 69% in the years 1975-79 to 54 and 48%, respectively, in the last two 5-year periods (p < 0.01), though the mean age of the patients has increased from 44 (9-84) to 57 (10-84) and 58 years (15-90), respectively. This improvement in outcome has been demonstrated in surgical and traumatic as well as nontraumatic and postrenal failure.

Hypercalcemic crisis represents a medical emergency. If conservative treatment is ineffective, low calcium bath or zero calcium bath hemodialysis are good alternatives. We report 4 patients treated with calcium free acetate hemodialysis because of hypercalcemic crisis due to breast cancer, hepatocellular carcinoma, cirrhosis of the liver and immobilisation with hydrochlorothiazids' medication. Following 3 h of hemodialysis, serum calcium concentrations fell from a mean value of 3.96 (range 3.53-4.46) mmol/l to 2.71 (2.28-3.12) mmol/l. In 2 patients rapid clinical improvement was achieved and in one oliguric patient diuresis started spontaneously during hemodialysis. One patient died from gram-negative sepsis. In 3 cases the subsequent conservative treatment was sufficient to maintain serum calcium levels within the normal range. Together with the previously reported cases (5 patients treated by hemodialysis with low dialysate calcium and 3 patients by hemodialysis with calcium free dialysate) our experience indicates that hemodialysis is an effective and safe therapy for hypercalcemic crisis.