The self-locating catheter: clinical experience and follow-up.

BACKGROUND: The self-locating catheter invented by Nicola Di Paolo has been used increasingly in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted into the tip of the conventional Tenckhoff catheter during extrusion does not significantly change its form, but suffices to keep the tip firmly in the Douglas cavity. OBJECTIVE: The aim of the present study was to confirm our preliminary results in a large population of peritoneal dialysis patients. SETTING: 16 Italian nephrology departments. RESULTS: In addition to confirming the validity of the new catheter, the present results show that patients with the new catheter have fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction, and leakage. CONCLUSION: The present multicenter control study confirms preliminary results and demonstrates that complications of peritoneal dialysis, such as cuff extrusion, infection, peritonitis, early leakage, and obstruction, are statistically less frequent in patients with self-locating catheters than in patients with classic Tenckhoff catheters.     

Meconium ileus equivalent and Kawasaki syndrome. Case report.

Kawasaki syndrome appeared after operation for meconium ileus equivalent in a 4-year-old child with cystic fibrosis. The course and management are described.     

Vertical ocular motor apraxia

We report a case of vertical ocular motor apraxia in a 4-year old boy whom we have followed for 2 years. The patient had no upward and downward voluntary movements of the eyes since birth, but horizontal movements were normal. He achieved gaze changes in the vertical plane by combined blinks and head movements. Magnetic resonance imaging demonstrated bilateral lesions at the mesencephalic-diencephalic junction.     

Xanthogranulomatous cholecystitis associated with gallbladder adenocarcinoma. A clinicopathological study of 5 cases.

The simultaneous presence of xanthogranulomatous cholecystitis and adenocarcinoma of the gallbladder has rarely been reported. A review of 53 cases of gallbladder adenocarcinoma in a 15-year period revealed 5 cases in which a concomitant diffuse xanthogranulomatous disease was observed. Clinical and pathologic features of these cases are commented and the diagnostic importance stressed. Both inflammatory and neoplastic components were closely mixed in 3 cases, thus making a prompt diagnosis difficult. Etiologic factors implicated in the development of both entities are considered.     

Cellular immunodeficiency in Paget's disease of bone: Changes induced by treatment with elcatonin

Summary We have found a cellular immune defect (low CD4 T lymphocyte count, high CD8 T lymphocyte count and a low CD4/CD8 ratio) in 39 PDB patients. This finding is not correlated with the bone metabolic activity of the disease. There was an improvement in the cellular immune defect in fifteen patients after treatment with elcatonin. These changes could be related to the improvement in the metabolic derangement or else could be the consequence of an effect on altered immunity.     

Hypertension in the elderly: conventional wisdom revisited.

Elevated systolic and/or diastolic blood pressure in the elderly is a problem the extent of which may be somewhat overstated. In those elderly with definite hypertension, pathophysiology may differ from that of younger counterparts. The contribution of elevated plasma renin activity to hypertension and to the choice of therapy also appears to be exaggerated. The risks of ignoring hypertension in the elderly are similar to those in younger patients, and therefore excessively elevated blood pressure should no longer be considered a normal consequence of aging. Notably, elevated systolic pressure is a better predictor of future adverse occurrences than is elevated diastolic pressure. Unfortunately, there is no well defined therapeutic regimen to manage isolated systolic hypertension. Conservative reduction of elevated systolic and diastolic pressures may nevertheless be accomplished safely and effectively. Individualization of therapy is recommended based primarily on concomitant disease(s). Thus no single agent or combination of agents is preferable in all elderly hypertensive patients. Aggressive use of non-pharmacologic therapy preferably precedes judicious of antihypertensive medication. Aggressive blood pressure reduction with potent drugs is not recommended.     

Contribution to the pharmacodynamic study of a ketosulphoxide derivative (omega-methylsulphinyl alpha-acetothiophene). Activity on the CNS

In order to establish the pharmacological profile of a series of ketosulphoxide derivatives which have been synthesized in the pharmaceutic and organic chemistry department of the Sevilla Pharmacy Faculty, a study of omega-methylsulphinyl alpha-acetothiophene has been initiated. Experiments were carried out on male Swiss mice, using a dosage of 100 and 200 mg/kg. High toxicity tests have been undertaken, followed by an investigation of activity at CNS levels. The results obtained show that the composite mentioned has a marked depressant activity lacking in any significant toxic effects.     

Migraine-related stroke: brain infarction in superior cerebellar artery territory demonstrated by nuclear magnetic resonance

We report 4 cases of migraine-related stroke in young females. Two patients were taking oral contraceptives and one was pregnant. The results of the computerized tomography of the brain were negative in 3 patients and partially positive in one, while NMR showed ischemic lesions in the posterior fossa in each case. We would like to highlight the value of NMR in the assessment of migraine associated with prolonged focal neurologic deficiencies when the clinical examination revealed brain stem or cerebellar signs and the peculiar localization of the ischemic lesion that corresponded in all 4 cases to the area irrigated by the superior cerebellar artery. An hormonal factor is suspected as the precipitating event of this complication in 3 of these patients.