Distribution of indications and procedures within the framework of centers participating in the WAA apheresis registry

The WAA apheresis registry was established in 2003 and an increasing number of centers have since then included their experience and data of their procedures. The registry now contains data of more than 74,000 apheresis procedures in more than 10,000 patients. This report shows that the indications for apheresis procedures are changing towards more oncological diagnoses and stem cell collections from patients and donors and less therapeutic apheresis procedures. In centers that continue to register, the total extent of apheresis procedures and patients treated have expanded during the latest years.     

Thrombotic microangiopathy

Thrombotic microangiopathy (TMA) is a histopathological feature of various diseases including thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). There are many secondary causes of TMA, many of them could mimic TTP or HUS. This article presents a short overview on TMA. In conclusion TMA is the result of various etiology reasons and pathologic reactions with various clinical entities. It is important to focus on a thorough history including family history when deciding on a diagnosis. Analysis of ADAMTS 13 and ADAMTS 13-antibodies may help to decide continued therapy.     

Measuring stroke in the population: quality of routine statistics in comparison with a population-based stroke registry.

The validity of routine stroke data (official mortality statistics and hospital discharge registries) and a population-based MONICA stroke registry was assessed in a population of 309,806 25- to 74-year-old people in Sweden. The 'true' number of strokes in the population was estimated by screening for non-stroke diagnoses in death certificates and hospital discharge records and by a period of intensified search for otherwise unrecognized non-hospitalized stroke cases. Applying strict stroke criteria, the proportion of false-positive diagnoses was 10% and false-negative 17% in official mortality statistics. Among patients discharged alive from hospital, there were 32% false-positive and 6% false-negative stroke diagnoses. In the MONICA registry, the proportion of false-negative cases was 6% in fatal cases and 4% in non-fatal cases. Diagnostic information for subtyping stroke improved over time in non-fatal cases but remained essentially unchanged in fatal cases. We conclude that official mortality statistics give a reasonably good estimate of fatal stroke cases in Sweden, whereas hospital discharge records reflect poorly the incidence of stroke in the population. The overall quality of the population-based MONICA registry is good, although 4% of all strokes are missed. The proportion of unspecified stroke is substantial and changes over time; this makes longitudinal studies of stroke subtype difficult.     

Lateral Catheter Insertion Together with Three Purse-String Sutures Reduces the Risk for Leakage During Peritoneal Dialysis

Abstract: Insertion of a catheter is needed to perform peritoneal dialysis. Techniques for insertion vary and have different drawbacks with regard to risk for leakage, secondary peritonitis, and catheter dysfunction. This study includes 85 consecutive patients who underwent a total of 114 insertions; peritoneal dialysis catheters (Tenckhoff, double-cuffed) were inserted under local anesthesia and using a lateral technique—through the rectus muscle—plus 3 purse-string sutures. Dialysis in all patients was started in the direct course of insertion of the catheter. One early but no late leakage occurred; leakage occurred in a patient in whom the second purse-string suture failed. The lateral insertion technique enables immediate start of dialysis and considerably reduces the risk for leakage from peritoneal dialysis fluid.     

Cadmium concentration in human kidney biopsies

This study reports the cadmium concentration and histopathology of kidney tissue from 29 patients with clinical findings that motivated a diagnostic percutaneous kidney biopsy and/or a history of possible exposure to cadmium. Cadmium was found in all specimens examined including those from controls. In the patients, the mean cadmium concentration was 12.9 (0.6-45.0) micrograms cadmium per g wet kidney tissue. The highest concentrations (30-45 micrograms/g) were found in three patients with morphological and clinical findings of tubulo-interstitial damage. Patients with signs of tubulo-interstitial disease had higher mean cadmium concentrations than those with glomerular changes, and patients with normal blood pressure had higher concentrations than those with diastolic hypertension. In a control group of 22 autopsies, the mean cadmium concentration was 8.7 (2.9-22.4) micrograms/g. The mean difference between the right and the left kidney was 2.3 (0.9-9.6) micrograms/g. Laboratory findings in patients with cadmium nephropathy were nonspecific. Thus, in patients with interstitial nephritis and cadmium exposure, a biopsy for the analysis of kidney cadmium concentration may be motivated. The combination of morphological and clinical findings of interstitial nephritis and a high concentration of cadmium in biopsied kidney tissue indicates cadmium nephropathy.     

The European artificial organ scene: present status

This article summarizes the current evolutions regarding artificial organs in Europe. The review emanates from the activities by four of the work groups of the European Society for Artificial Organs (ESAO) and is essentially based on the reports by these work groups at the latest ESAO meeting in Warsaw, Poland (2004). The topics are: apheresis, heart support, liver support, uremic toxins.     

Elderly patients on haemodialysis have 50% less functional capacity than gender- and age-matched healthy subjects

OBJECTIVE: Patients on haemodialysis (HD) are by necessity inactive for 3-6 h three times a week. The aim of this prospective controlled study was to investigate the level of functional capacity of elderly HD patients using simple measures. MATERIAL AND METHODS: A total of 11 consecutive HD patients aged > 60 years (median age 75 years) were included in the study. They were compared with 22 gender- and age-matched healthy subjects using a prospective 1:2 case:healthy subject study design. As tests of functional capacity and maximal exercise capacity we used a "sit-to-stand" test (number of cycles within 10 s) and a staircase test (the number of cycles completed per second was used as the effect variable), respectively. RESULTS: The patients managed significantly fewer cycles than the healthy subjects in the staircase test (median 2 vs 10; p<0.003) and performed approximately 50% fewer cycles in the sit-to-stand test (p<0.014). The work performed in a given time in the staircase test was 54% less for the patients (p<0.017). CONCLUSIONS: The HD patients in the study had a considerably lower functional capacity than the healthy subjects, which may have interfered with their daily living activities. The tests used are easy to apply and need no specialized equipment. The importance of investigating functional capacity and instituting rehabilitation programmes is emphasized.     

Systemic antibodies to the leukotoxin of the oral pathogen Actinobacillus actinomycetemcomitans correlate negatively with stroke in women

BACKGROUND: Chronic infections and associated inflammatory markers are suggested risk factors for cardiovascular diseases (CVD) and stroke. The proinflammatory cytokine interleukin (IL)-1beta is suggested to play a role in the regulation of local inflammatory responses in both CVD and periodontitis. The leukotoxin from the periodontal pathogen Actinobacillus actinomycetemcomitans has recently been shown to cause abundant secretion of IL-1beta from macrophages. The aim of the present study was to compare the prevalence of systemic antibodies to A. actinomycetemcomitans leukotoxin in stroke cases (n = 273) and matched controls (n = 546) in an incident case-control study nested within the Northern Sweden MONICA and Vasterbotten Intervention cohorts. METHODS: Antibodies to A. actinomycetemcomitans leukotoxin were analyzed in a bioassay with HL-60 cells (leukocytes), purified A. actinomycetemcomitans leukotoxin, and plasma. Plasma samples which inhibited lactate dehydrogenase release from leukotoxin-lysed cells by > or =50% were classified as antibody positive. RESULTS: Antibodies to A. actinomycetemcomitans leukotoxin were detected in 18.8% of the women and 15.2% of the men. Women with those antibodies had a significantly decreased risk for stroke (OR = 0.28, 95% CI: 0.13-0.59), but not men (OR = 0.88, 95% CI: 0.52-1.51). CONCLUSION: The immunoreactivity to A. actinomycetemcomitans leukotoxin correlates negatively with a future stroke in woman, but not in men. Further studies are needed to explain the underlying mechanisms, as well as the biological relevance of this finding.