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A dialysis unit's introduction of automated recycling of dialysers is described. The responses of the staff and the patients are outlined, along with the pertinent ethical issues. Suggestions regarding the educational processes necessary with any innovation in long-term medical care are discussed.

Investigation was undertaken to produce a radioactive material with affinity for amyloid tissue. Studies of a number of major dyes using paraffin histological sections of an amyloid spleen as test material showed that the only compounds with marked affinity for amyloid were watersoluble disazo dyes of the type E<--D-->E, where D is usually benzidine, o-tolidine or o-dianisidine, and E is a naphthol or aminonaphthol sulfonic acid. Substitution of an amino or a hydroxyl group in position 1 of the naphthalene nucleus caused loss of staining affinity. It was found that trypan blue could be radioiodinated at position 8 using the Sandmeyer reaction, and the labelled dye showed excellent staining and radioautographs of the test amyloid section. Metabolism of the tagged dye using 10-200 mug./kg. in animals showed minimal organ uptake, except for the liver which accumulated 30-40% of the injected dose by the end of four days. Use of this material in the diagnosis of human amyloid disease is being explored.

Experience with chronic hemodialysis as a definitive form of therapy is described for six children aged 11 to 15 years at the onset. Duration on dialysis in the home has been between one and 4(1/2) years. All patients are alive and rehabilitated without serious complications. It is concluded that although transplantation is the most desirable form of treatment for children, long-term hemodialysis is an alternative acceptable second choice.

Three cases of pericarditis with effusion associated with infection and occurring in patients under good biochemical control on hemodialysis are reported. Continuation of hemodialysis, even with regional heparinization, allowed further accumulation of fluid. Peritoneal dialysis was instituted, with subsequent improvement in all three patients. This treatment is recommended in the belief that it hastens the resolution of the condition and may obviate the necessity of establishing permanent or semi-permanent artificial pericardial drainage.

Ten terminal uremic patients seen over the period of one and one-half years have been kept alive by repeated hemodialysis using a modification of the Seattle system, carried out for the most part by nurses and technicians. All the patients had creatinine clearance values below 5 ml./min., and blood urea nitrogen values which ranged between 156 and 453 mg. % before beginning the first dialysis.Selection was based on their ability to co-operate with and to tolerate the regimen. Nine patients were fully rehabilitated.The major complications were those related to shunt-site infections, including septicemia, bacterial endocarditis, septic arthritis, septic pulmonary embolism and mycotic aneurysm.Nevertheless, all patients except one were rehabilitated and resumed their full-time occupations and have continued to lead happy and useful lives.

Twenty hours after ingesting 15-25 g. of ethchlorvynol, a 37-year-old woman was admitted comatose and in shock. The blood level of ethchlorvynol was 21.6 mg. % (method of Wallace). Supportive measures were instituted and hemodialysis, carried out for 10 hours, removed 5.49 g. of the drug. The post-dialysis blood level was 9.05 mg. % and the rate of dialysance was 50.5 ml./min. Only 0.6 g. of the substance was recovered from the urine over the same period.Although dialysis removed significant amounts of the drug and sustained life, the patient remained comatose for five days before withdrawal symptoms and seizures developed.