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Primary Sjögren's syndrome is a connective tissue disorder affecting primarily the lacrimal and salivary glands, resulting in xerophtalmia and xerostomia. Extraglandular manifestations are frequent and may include renal involvement.

(1) In the case of leiomyomas of the esophagus having a prevalent inward development correct diagnosis is generally feasible on the basis of clinical, endoscopic and radiological datas. (2) Great difficulty may arise in the diagnostic evaluation of leiomyomas of the esophagus having a prevalent mediastinal growth: it follows that in these cases preoperative diagnosis is often incorrect. (3) In the cases in which probative diagnostic elements should be missing, the clinical appraisal of such eventuality will be of the greatest importance in the surgical management of this disease, for the surgeon will be induced to search for them at the operating table and will be prepared to perform the more conservative procedure.

A case-control study was undertaken to evaluate the role of hematocrit (Hct) level in the pathogenesis of stroke. Hct was determined in 110 subjects with acute ischemic stroke and compared with the values obtained in 110 subjects, matched for age and sex, admitted to our Division of General Medicine because of other diseases. Statistical analysis of the results by means of the McNemar test for pairs did not confirm the hypothesis that Hct values in stroke patients differ significantly from the control values.

Aluminium (Al) overload has been recognised as a frequent complication in uraemic patients on regular dialysis treatment. We report how acute visual disorders occurred after performing a desferrioxamine (DFO) test in patients on regular dialysis treatment suspected of having aluminium overload. Fifteen patients on regular dialysis treatment for 132±73 (range 17–250) months, aged 61±10 (range 47–79) years were given DFO as a test at standard dosage. In the 13 patients who complained of visual disorders, we performed ophthalmologic examinations soon after DFO administration, and again 5 months later in 11 of them. A decrease in visual acuity and/or dyschromatopsia, transient or permanent, were present in ten patients. Four had permanent maculopathy and three also had a permanent alteration of VEP (visual evoked potential). Visual fields were normal in all patients except one who presented a permanent central scotoma. The EOG (electro-oculogram) was permanently impaired in five patients and some of them had fluoroangiographic alterations due to damage of the pigmented epithelium. Six to eight months after the DFO test four patients still complained of visual acuity reduction. We conclude that there is a high rate of visual disorders after giving DFO at the standard doses; therefore we stress the need to modify the doses commonly used and/or the mode of infusion

To clarify the role of chronic anaemia in the pathogenesis of the left ventricular hypertrophy (LVH) of chronic uraemia, nine normotensive dialysed patients were studied before and 3 and 6 months after start of intravenous treatment with recombinant human erythropoietin (rHuEpo). M-Mode echocardiographic estimations of left ventricular mass indices (LVMi) and plasma noradrenaline determinations were made at 3 and 6 months, and total blood volume (TBV) only at 6 months. Resting haemoglobin values were 5.9±1.3 (SD) g/dl, increased within 3 months to 10.2±1.2 (P<0.001), then remained unchanged. Baseline LVMi was 115±18 g/m2 body surface area (b.s.a.) and decreased significantly (P<0.0025) over the entire period to a final value of 78±13 g, which did not differ from the average value for 19 healthy controls. Resting plasma noradrenaline was 1.45±0.44 pmol/ml and did not change significantly, although values were reduced at the 3rd month, when decreased heart rates and slightly and non-significantly increased blood pressures were recorded. TBV did not vary because the increased erythrocyte mass was compensated for by parallel decreases in plasma volume. These data demonstrate the existence of a cause-effect relationship between uraemic anaemia and LVH, although the precise mechanism remains unknown. Amelioration of anaemia with rHuEpo, by allowing recovery from the attendant LVH, might improve longterm cardiovascular prognosis in some dialysed uraemic patients.

On 578 unselected new patients followed from 1981 through 1993, 51% on CAPD and 49% on HD, long-term patient and method survivals, cause of death, and drop-out in the two methods were compared. Survival, adjusted for patient selection biases, was not different on CAPD and HD up to 10 years. 50% of the patients were still in their first treatment after 3.5 years on CAPD and after 7 years on HD, and 5 and 28% respectively, after 10 years. Patient survival on CAPD was not falsely improved by drop-outs. Drop-out is increasing for CAPD, mainly due to patient/partner burn-out, which should be relieved by a more liberal application of automated PD. Malnutrition is more frequent on CAPD than on HD but not for the elderly. In a 3 year prospective study on 60 CAPD and 34 HD patients serum albumin, nPCR and nutritional status, as assessed by SGA did not influence survival in each modality. Survival was similar with K(p,r)t/V≥1.7/week on CAPD and Kt/V≥1/treatment on HD, and worse below these values. On CAPD, a Kp,rt/V≥1.96 gave better survivals.