Baseline and time-averaged fluid removal affect technique survival in peritoneal dialysis in a non-linear fashion

AIM: The longevity of peritoneal dialysis (PD) is limited by technique failure and patient mortality. The authors assessed the influence of baseline and time-averaged fluid removal on patient, technique and death-censored technique survival. METHODS: Peritoneal and total fluid removal was measured 1 month after commencing PD, then 6 monthly, in 225 incident patients (mean age 55.3+/-15.8 years, 52% male). A Cox proportional hazards model regression analysis was performed to identify variables independently predictive of technique and patient survival. RESULTS: Seventy (31.9%) patients were transferred to haemodialysis and 39 (17.63%) died. Technique survival was greatest in the middle tertile of baseline total fluid removal (mean survival time 3.5 vs 2.5 and 2.2 years for the lower and upper tertiles, respectively, log rank 6.5, P=0.039). The middle tertile of both baseline and time-averaged total fluid removal were significant predictors of PD survival (adjusted hazard ratio (HR) 0.476, 95% CI 0.286-0.795, P=0.005 relative to the upper tertile and HR 0.573, 95% CI 0.350-0.939, P=0.027 for baseline and time-averaged, respectively). Other significant variables on multivariate analysis were body mass index (HR 1.044 per kg/m2, 95% CI 1.005-1.084, P=0.028), creatinine (HR 0.999 per micromol, 95% CI 0.998-1.000, P=0.048) and residual Kt/V (HR 0.418, 95% CI 0.233-0.747, P=0.003). Patient survival was not affected by fluid removal. CONCLUSION: Patients with moderate total fluid removal both at baseline and throughout their PD career have improved technique survival. Attention should be paid to optimizing total fluid removal.     

The incidence, indications and outcome for the non-operative management of breast cancer

BACKGROUND AND OBJECTIVES: This study aimed to identify the proportion of patients with breast cancer who do not undergo primary operative treatment, to identify the reasons surgery is not performed, and to determine the outcome for this group of patients. METHODS: Data was obtained from the Bedford Breast Cancer Registry for all non-metastatic patients presenting between January 1990 and December 2004 who were initially treated non-operatively. Robust diagnostic, therapeutic, and follow-up data on all patients was collected prospectively during this period. RESULTS: One hundred and eighty-five out of 2110 episodes of breast cancer were treated non-operatively during this period. Sixty-eight percent of patients were unfit for surgery, 15% had inoperable tumours, and 17% refused surgical intervention. Median survival and 5-year survival rate for all non-operative patients were 3.7 years and 41.2%. Median survival for inoperable patients was 3.7 years, compared with 3.5 years for those unfit for surgery and 4.2 years for those who refused surgery. The 5-year survival rate for patients refusing surgery was 43%, compared with 61% for a matched group of patients undergoing standard surgical therapy. CONCLUSIONS: This study provides useful data on the reasons for, and outcome of, the non-operative management of breast cancer.     

Combined cryptogenic fibrosing alveolitis and emphysema: the value of high resolution computed tomography in assessment

Simple tests of lung function may be misleading in the assessment of patients with interstitial lung disease. Eight patients are described with cryptogenic fibrosing alveolitis (histologically proven in four) with severe breathlessness and low gas transfer (median DLCO 32.4%, range 9.2 to 35.3%, % predicted) in whom lung volumes were preserved [median VC 98.7, range 67.5-131.1%; median TLC 92.5, range 88.1 to 121.2, (% predicted)], and in whom there was no evidence of airflow obstruction [median FEV1/FVC 84.6, range 68-116 (% predicted)]. All were current or ex-heavy smokers. Thoracic high resolution computed tomography revealed upper zone emphysema, the extent of which was not appreciated using conventional chest radiography. The atypical physiological and radiological features can be explained by coincidental cryptogenic fibrosing alveolitis and emphysema and high resolution computed tomography was valuable in the assessment of these patients.     

Oligohydramnios in each sac of a triplet gestation caused by Motrin--fulfilling Kock's postulates

A triplet gestation was treated with Motrin for oral tocolysis. A significant reduction of amniotic fluid was observed, but this was corrected by stopping the drug. A cause-and-effect relationship was established by restarting the Motrin and observing the same development of oligohydramnios, which again returned to normal with discontinuation of the drug.     

Concentric coil arrays for parallel MRI.

A new type of coil array is proposed that consists of concentrically placed coil elements, each of which is characterized by symmetrically arranged lobes that have alternating current directions. Symmetries in the coil elements' conductor paths allow for the minimization of mutual inductance and noise correlations. In addition, the concentric arrangement of the coil elements provides spatial encoding capabilities in multiple directions, which is valuable when arrays are used with parallel MRI. Simulations are presented that describe the signal-to-noise ratio (SNR) properties of individual concentric array elements, and a four-element prototype concentric array is constructed. This prototype array is compared experimentally with three alternative four-element array designs. The overall SNR of the concentric array is comparable to the SNR of the competing arrays. Reconstruction of twofold undersampled data using the concentric array yields an average g-factor of less than 1.3 in all directions parallel to the plane of the array. There is some degradation in performance when threefold undersampled data are reconstructed, but the array still shows substantial directional invariance compared to alternative designs. Both fully-sampled and undersampled cardiac images acquired using the concentric array are shown. These results suggest that concentric structures can be useful tools for designing specialized coil arrays for parallel MRI.     

Drinking at a southern university: its description and correlates

A sample of 100 undergraduate students at a southern college campus were employed to answer computer-administered questions once a week for 20 weeks. This facility was used to collect both intensive and comprehensive data to describe respondents' drinking and its correlates. Although women were somewhat less likely to be abstainers than were men, women were disproportionately represented among moderate-only drinkers and men were overrepresented among heavy drinkers. The data indicate that the change in respondents' reported drinking was quite volatile in the transition from high school to college. Heavy-drinking college students reported that they drank in bars accompanied by friends. Different types of drinkers (e.g., moderate, infrequent, heavy) attributed different motives to drinking as well as to sometimes abstaining, but they held similar antialcohol beliefs. The drinking-related variables of friends explained more of the variance in respondents' drinking than did those of their parents. However, the variance explained by the parents' drinking-related variables was increased when statistical interactions involving family cohesion and control were included. The variance explained by the friends' drinking-related variables was also greater when interactions with respondents' spending money were included. There was a small positive correlation between socioeconomic status and drinking. The only variables to decrease this relationship when statistically controlled were the drinking-related variables of significant others.