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Restrictive cardiomyopathy is an unusual form of cardiomyopathy accounting only for 2%-5% of all pediatric cardiomyopathies. It is mostly idiopathic. Gaucher disease in association with restrictive cardiomyopathy is extremely rare. We herein report a case of cardiac failure in an 8-year-old male child caused by restrictive cardiomyopathy. Pathogenesis of which was attributed to Gaucher disease. In any case of restrictive cardiomyopathy, Gaucher disease should be included in differential diagnosis and investigated accordingly., Competing Interests: None

Moebius syndrome is a rare congenital neurological disease, nonprogressive in nature, characterized by weakness or palsy of multiple cranial nerves, most often the sixth and seventh cranial nerves. Third and twelfth cranial nerves are also frequently involved. Infants presenting with similar presentation are often misdiagnosed because the facial palsy is commonly attributed to other causes such as birth trauma. Here, we present a 6-week-old infant presenting with poor weight gain and feeding problem, ultimately stamped as Moebius syndrome on the basis of clinical findings suggestive of multiple cranial nerve palsies without any apparent cause., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Pediatric Neurosciences.)

Objective: A subset of military veterans who have experienced both traumatic brain injury and psychological trauma present with chronic neuropsychiatric symptoms and experience persistent obstacles to social reintegration. This project aimed to develop a novel treatment targeting the unmet social rehabilitation needs of these veterans. Initial intervention development, feasibility, and outcome data are explored., Method: Four treatment groups were conducted ( n = 20). A treatment workbook was developed during Groups 1 and 2 ( n = 10) and research data were collected from Groups 3 and 4 ( n = 10)., Results: There was a 0% attrition rate across all groups with unanimous requests for additional sessions. T test effect sizes were analyzed with bias-corrected Hedges' g. Improvements were observed on measures of depression ( p = .026, g = 0.73), empathic perspective taking ( p = .007, g = 0.94), social cognition ( p = .002-.678, g = 0.27-1.30 across multiple measures), social relationships ( p = .007, g = 1.50), traumatic brain injury-related quality of life (social: p = .014, g = 0.68, emotional: p = .009, g = 1.28) and nonsocial executive functioning ( p = .006, g = 0.54)., Conclusions and Implications for Practice: Preliminary evidence from this exploratory study suggests that targeting multiple layers of social competence using a combined psychotherapy and cognitive rehabilitation approach holds promise. Larger, controlled studies are needed to further evaluate the feasibility and efficacy of this intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Central nervous system tuberculoma can have variable presentations depending on the site and number of tuberculomas. We are reporting a rare case of an 11-year-old male child presenting with ptosis and ataxia. Clinical examination revealed bilateral partial 3 rd cranial nerve palsy (ptosis without any upward gaze palsy) associated with dysdiadochokinesia and ataxia on the right side. Magnetic resonance imaging of the brain revealed a single ring-enhancing lesion in the dorsal midbrain with perifocal edema. Magnetic resonance spectroscopy provided the etiological information as tuberculoma., Competing Interests: There are no conflicts of interest.

Background: The clinical pattern and etiology of stroke may vary over time or with geographical location. In Asian countries, specific etiology and outcome of childhood stroke have been rarely reported., Objective: To determine the clinical and etiological pattern of childhood stroke and their outcome in a Tertiary Care Center., Materials and Methods: This study was conducted in a Tertiary Care Hospital of Kolkata over a period of 3 years. All children from 6 months to 12 years, diagnosed as childhood stroke by radio-imaging were included in our study. Children presenting with paraplegia/paraparesis were excluded. Etiologies were determined on the basis of clinical examination, related blood investigations and radio-imaging findings. Data gathered from the stroke patients were entered into a preformed proforma and appropriate statistical analyses were done., Result: Most commonly found clinical presentation was hemiparesis (70.6%). Next in place was a seizure (61.8%) and alteration of consciousness (58.8%). The most common etiology of childhood stroke in our hospital was found to be an intracranial infection (41.2%), followed by vascular etiology. Stroke was ischemic in nature in 91.2% of cases. Among the clinical features, vomiting, alteration of sensorium, and fever were significantly (P < 0.01) more in infectious cases of stroke, but hemiparesis was significantly (P < 0.05) more common in noninfectious etiology. Most of the cases of noninfectious etiology (95%) completely recovered without any persistent neurodeficit or mortality., Conclusion: Intracranial infection is the commonest etiology of stroke in pediatric patients presenting at our hospital. Commonest type is an ischemic stroke. The most of the patients completely recovered from the acute neurological insult after proper and timely management.

Camphor is a pleasant-smelling cyclic ketone with propensity to cause neurologic side-effect, especially seizures. We report a case of 1½-year-old child who after inadvertent consumption of camphor, experienced an episode of generalized tonic clonic seizure. This case highlights the importance of enquiring any intake of material (medicinal or otherwise) in every patient presenting with seizure and notifying presence of typical smell, if any.

Morphea is a variant of localized scleroderma in which lesions are usually limited to the skin and subcutaneous tissue. Pansclerotic morphea is a rare atrophying and sclerosing type of morphea. It can follow a comparatively benign course with spontaneous resolution of symptoms, or sometimes can lead to a variety of complications resulting in progressive disability. We report a case of Pansclerotic morphea in an 8-year-old male child involving one lower extremity with extension to the lower trunk. It was associated with deformity and hemiatrophy of that limb, leading to restriction of normal day-to-day activity. The case is being reported in view of its rare occurrence in conjunction with other rarer features.

A case of hepatic hemangioendothelioma presenting as congestive cardiac failure in a neonate is being reported which was managed successfully with oral prednisolone, resulting in improvement of symptoms and regression of tumor within 3 months.

Background: Congenital anomalies are a major cause of stillbirths and neonatal mortality. The pattern and prevalence of congenital anomalies may vary over time or with geographical location., Aims and Objectives: The aim of this study is to determine the proportion and types of congenital anomalies in live newborns and to study maternal and perinatal risk factors., Materials and Methods: This cross-sectional descriptive study was carried out in the neonatal care unit of R. G. Kar Medical College and Hospital during the period of September 2011 to August 2012. All the live born babies born in this hospital during this period were included. The newborns were examined for the presence of congenital anomalies and mothers were interviewed for socio-demographic variables., Results: During the study period, 12,896 babies were born, of which 286 had congenital malformations, making the prevalence 2.22%. Most of the women (55.7%) belonged to the age group between 21 and 30 years. Congenital anomalies were seen more commonly (3.3%) in the multiparas in comparison with primiparas (1.8%). The predominant system involved was Musculo-skeletal system (33.2%) followed by gastro-intestinal (GI) system (15%). Talipes (17.1%) was the most common one in musculoskeletal group and likewise cleft lip and cleft palate in GI system. Congenital anomalies were more likely to be associated with low birth weight, prematurity, multiparity, consanguinity and cesarean delivery., Conclusion: Public awareness about preventable risk factors is to be created and early prenatal diagnosis and management of common anomalies is strongly recommended.

Poisonings, stings and bites continue to be important cause of pediatric morbidity and hospitalization. The toxic product involved in the poisoning varies in different geographical areas and in same area over time. A retrospective study was conducted amongst the children of the age group up to 12 years admitted to a tertiary care hospital in Kolkata from January 2005 to December 2008. Total number of admissions was 17019 and that for accidental poisoning was 451 (2.65%). Kerosene constituted the largest group (54.55%). Mosquito coil and refill liquid were the new additions to the list of poisons and their ingestion was cause for admission of 15 (3.33%) children. The number of admissions due to stings and bites was 108 (0.63% of all admissions) during the above period. Of all the cases, 9 (1.83%) cases of accidental poisoning and 4 (3.7%) cases of stings and bites died.

A study was conducted on the 52 serologically positive cases of dengue, admitted to the Dept. of Paediatrics, R.G. Kar Medical College & Hospital, from an outbreak in Kolkata. The most unusual feature observed in this study was that the rash in some cases was urticarial and intensely pruritic. The shock appeared early in the course of the disease and it was less commonly associated with bleeding (22%). One out of three dengue cases was a severe disease. It was not possible to predict a severe disease from the early symptomatology.

Outcomes of patients with diabetes on peritoneal dialysis (PD) are strongly influenced by cardiovascular and other vascular complications, which are directly related to poor glycemic control. These patients are dialyzed with conventional glucose-containing PD solutions, and the glucose that diffuses into the patients' circulation leads to further risk of poor glycemic control, increasing the risk of vascular complications and death. The central objective for managing patients with diabetes undergoing PD treatment is to develop strategies that reduce complications and improve quality of life through proper glycogenic control and reduction of peripheral insulin resistance.

Failure of the pancreatic beta cells to produce insulin or development of defective molecular signaling of insulin to the peripheral tissue cells (insulin resistance) induces persistent hyperglycemia and accumulation of fatty acids in the blood of patients with diabetes. Over time, those changes lead to microvascular and macrovascular damage in various target organs. In patients on peritoneal dialysis (PD), complications may accelerate with treatment using conventional glucose-containing solutions. Strategies for proper glycemic control in diabetic PD patients are therefore essential to prevent complications and to maintain a good quality of life. Dietary restrictions and weight control remain the foundation of the management approach for glycemic control. Further therapeutic actions include the stepwise addition of oral hypoglycemic agents and insulin, based on individual assessment of PD patients. Other strategies of immediate importance in reducing hyperglycemia are to use PD exchanges with new non glucose PD solutions (such as those with icodextrin or amino acids) in combination with fewer daily exchanges of low-glucose solutions. Combined, these approaches will sufficiently control hyperglycemia in diabetic PD patients. Research is in progress to develop therapeutic agents aimed at correcting various molecular defects of insulin signaling or at reducing protein kinase C activation induced by oxidative stresses in various tissue cells. Clinical experience with the use of such agents in diabetic PD patients is limited at present.

Bacteria from the exit site of the peritoneal dialysis (PD) catheter and from contaminated dialysis fluids can grow into microcolonies in biofilm. Those bacteria are implicated in recurrent peritonitis in patients undergoing treatment with PD. The present article highlights new strategies that are designed to alter the major factors regulating biofilm formation and that thereby reduce biofilm-related infections in PD patients.

Biofilm bacterial infections are implicated in most human bacterial infections and are also common in patients undergoing treatment with hemodialysis and peritoneal dialysis. Skin bacteria, which grow into microcolonies with biofilm formation in dialysis environments, are implicated in most of these infections. Dissemination of bacterial biofilms in hemodialysis patients induces bacteremia and endotoxemia. In peritoneal dialysis patients, biofilm causes peritonitis and catheter-related infections with consequent loss of catheters and technique failure. Effective strategies for the diagnosis, intervention, and prevention of biofilm-related infections in dialysis patients are described in this review.

Despite the decrease in peritonitis rate from touch contamination caused by the use of disconnect systems, technique failure in peritoneal dialysis (PD) from pericatheter and exit-site infections in PD remains unchanged. This indicates a failure of current PD catheters to prevent bacterial transfer from exit site to the peritoneal cavity. In 1991, Moncrief and Popovich introduced a new catheter design and implantation technique to address this problem. The catheter is made of silastic, has a coiled tip with 2 cuffs, and an arcuate bend between the cuffs. This would prevent catheter malfunction and leakage of PD fluid. The implantation technique involves embedding of the external segment of the catheter in the subcutaneous tunnel at insertion. The catheter segment is kept embedded for 4 to 6 weeks before externalization. This procedure will allow time for tissue ingrowth on into the external cuff and catheter surfaces between the 2 cuffs, preventing bacterial colonization of the catheter surfaces from the exit wound and thereby reducing pericatheter infections. Thus, the new technique will establish a more effective bacteriologic barrier between the exit wound and the peritoneal cavity than the conventional catheters. Ten years after validation of the catheter design and implantation technique by Moncrief and Popovich, various clinical studies confirm that this new technique of catheter implantation increases catheter life expectancy and reduces pericatheter infections in PD. Like the arteriovenous fistula of haemodialysis, this new catheter remains embedded in subcutaneous tunnel, is exteriorized electively when patient needs to be started on dialysis, and reduces pericatheter and exit-site infections in PD. The new technique, therefore, is widely accepted as a simple, safe, and cost-effective procedure for quality care of PD patients around the world., (Copyright 2002 by the National Kidney Foundation, Inc.)

Microbial adhesions and biofilm bacterial growth have been implicated in serious infections associated with the use of bioprosthetic medical devices and indwelling catheters in humans. Biofilm bacterial growth also commonly occurs on peritoneal dialysis (PD) catheters from skin bacteria. Mature biofilms develop high antibiotic resistance and cause recurrent peritonitis and catheter loss in a subgroup of PD patients. That subgroup of patients can be identified by comparing the antibiotic sensitivities [minimum inhibitory concentrations (MICs)] of a biofilm culture and a routine microbiologic (planktonic) culture of the same PD effluent.

Recent evidence suggested that noncompliance (NC) with continuous ambulatory peritoneal dialysis (CAPD) exchanges may be more common in US than in Canadian dialysis centers. This issue was investigated using a questionnaire-based method in 656 CAPD patients at 14 centers in the United States and Canada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of their individual results. Mean patient age was 56 +/- 16 years, 52% were women, and 39% had diabetes. The overall admitted rate of NC was 13%, with a rate of 18% in the United States and 7% in Canada (P < 0.001). NC was more common in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and Hispanic than in Asian and white patients (P < 0.001). NC was more common in patients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than four exchanges per day, black race, being employed, younger age, and not having diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors.

We evaluated peritoneal membrane transport status (high, high-average, low-average, and low) of 35 patients on persistent peritoneal dialysis (PD) for 5-16 years. We noted that most of these patients (n = 21) had low-average transport by dialysate-to-plasma creatinine (D/PCr) ratio.

Inadequate dialysis dose is associated with poor patient-survival in peritoneal dialysis (PD). Most patients would require more than four exchanges a day after losing residual renal function. The use of automated peritoneal dialysis (APD) seems to be a practical way to provide extra dialysis for these patients. In our Dialysis Centre in Northern Alberta, we started to use APD for our adult patients only from 1993. When we evaluated our practice recently, we found that we are progressively increasing the use of APD (including cyclers and night exchange devices) from 3% to 21% for our total adult PD patients in the last 3 years. This increase in the use of APD is mostly to accommodate PD prescription changes and not changes in lifestyle. Increase in the use of APD was associated with decrease in the rate of our PD dropout to hemodialysis. We conclude that to maintain adequate dialysis, rapid growth of APD will become common in North American PD centers in the future and will reduce transfer to hemodialysis.

Recent studies demonstrate that 14-membered macrolides increase permeability and destruction of Pseudomonas biofilms. The effect of a macrolide antibiotic, erythromycin, on methicillin-resistant Staphylococcus aureus (MRSA) biofilm on Silastic catheter materials in comparison with two different quinolone antibiotics, sparfloxacin (SPFX) and a new quinolone, SYN 1193, was examined. Two different MRSA strains were grown in biofilm, using Mueller-Hinton broth with and without the addition of 10% pooled normal human serum (PNHS), in a modified Robbins device, at 37 degrees C for 24, 48, and 72 hours. Two different clinical MRSA strains were used and minimum bactericidal concentration (MBC) were determined at the time intervals mentioned. Three different dosages of each antibiotic were tested: 5.0, 20.0, and 50.0 micrograms/mL. In addition, a constant dosage of SPFX and SYN 1193, in combination with varying dosages of erythromycin, was tested under similar experimental conditions. SYN 1193 demonstrated the highest MBC in comparison to SPFX; addition of PNHS did not alter the effect of SYN 1193. However, erythromycin alone and in combination with SPFX and SYN 1193 had no effect on MBC. We conclude that (1) macrolide antibiotic erythromycin has poor MRSA biofilm permeability and killing in comparison to SPFX and SYN 1193, and (2) SYN 1193 had the highest MBC to MRSA biofilm.

Interferon-gamma, a cytokine, is produced by lymphocytes when they are stimulated by cytokines from activated macrophages, and is essential for macrophage-mediated bactericidal operations. To investigate whether a strain of bacteria can activate macrophages and lymphocytes, the interferon-gamma levels may thus be measured. Current literature maintains that peritoneal dialysis patients with recurrent peritonitis have "unhealthy" macrophages and lymphocytes unable to produce interferon-gamma, but that the administration of interferon improves the rates of peritonitis. In an in vitro experiment, Staphylococcus epidermidis, in both its planktonic and biofilm forms, was added to a suspension of peritoneal dialysis effluents, macrophages, and healthy peripheral blood lymphocytes, which were incubated at 37 degrees C for 18 h and then centrifuged. Subsequent levels of interferon-gamma were measured in the supernatants. Three such experiments were done with peritoneal macrophages and dialysis effluents collected from each of the three different patients involved in the study. It was found that little or no interferon-gamma (0.42 +/- 0.17 U/mL) was produced when biofilm bacteria were tested, but significant amounts of interferon-gamma (9.25 +/- 4.63 U/mL) resulted in conjunction with the planktonic form of the same bacteria. To eliminate experimental errors, all conditions were left identical, appropriate control groups were added, and each of the three experiments was duplicated. These in vitro data therefore provide new insight in the role of biofilm in the pathogenesis of recurrent peritonitis in peritoneal dialysis patients. Further clinical studies are required.

As peritoneal macrophages require Interferon-gamma (IFN-gamma) for bacterial lysis, IFN-gamma levels were measured in peritoneal dialysis effluents. (PDE) by a specific radioimmunoassay. High IFN-gamma levels were found in patients with peritonitis compared to low levels in patients without peritonitis (mean 9.73 +/- 2.63 SE U/ml, N = 39 vs. 0.25 +/- 0.04, N = 32). IFN-gamma levels varied among different bacteria: Staph. aureus (highest: 23.4 +/- 5.7, N = 14), Staph. epidermidis (lower: 3.2 +/- 0.8, N = 13), other gram-positive (1.06 +/- 0.32, N = 6), gram-negative bacteria (lowest: 0.57 +/- 0.30, N = 6). After treatment of peritonitis levels decreased. In corresponding blood and PDE samples, by comparing IFN-gamma levels in 10 peritoneal dialysis patients (5 with peritonitis, 5 without), levels were raised only in PDE of patients with peritonitis, implying local IFN-gamma production. Total lymphocytes, T, B and monocyte subsets in patients' plasma and PDE did not differ, except for a higher number of mononuclear cells in PDE of patients with peritonitis (P < 0.05). Further investigation of in vitro IFN-gamma production in PDE with peritoneal monocytes, syngeneic host lymphocytes, and bacteria showed that Staph. aureus induced the highest levels of IFN-gamma and E. coli the lowest, in experiments with T cell enriched host lymphocytic fractions. We conclude that Staph. aureus peritonitis induces high levels of IFN-gamma in PDE, possibly by a T cell dependent superantigen response.

A modified Robbins' device was used to monitor the growth of bacteria associated with clinical peritonitis in peritoneal dialysis fluid. To simulate bacterial colonization and biofilm formation on peritoneal catheters, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli were allowed to adhere to silastic disks and were then grown in fresh or used dialysis fluid. Adherent bacteria formed microcolonies and biofilms on silastics within 4 to 24 hours. Our data showed that colonization of the silastic disks was related to the quantity of bacteria and there were significant differences between the growth of adherent bacteria in fresh and used dialysis fluid. Adherent S epidermidis and P aeruginosa grew better in dialysis fluids than adherent E coli. These results suggest that S epidermidis and P aeruginosa are more likely to colonize silastic catheters and to cause catheter-related peritonitis in peritoneal dialysis patients than E coli.

Bacterial colonization potentials by Staphylococcus aureus (Staph. aureus) were determined in silver peritoneal dialysis (PD) catheter materials and were compared to colonization of the same bacteria in silastic catheter materials. The bacteria were colonized in two different experimental systems: In Vitro: In an in vitro biofilm bacterial culture system with a modified Robbins' device (MRD), seven different clinical strains of Staph. aureus were grown in PD effluents on silver or silastic catheter discs, each 0.5 cm in diameter. In identical experimental conditions, reduced bacterial growth was detected in silver catheter discs compared to growth on silastic discs, but the results were not statistically different (p = 0.12). In Vivo: In a rabbit model of PD the, in vivo colonization potential of Staph. aureus was examined in two groups of rabbits using silver (n = 3) and silastic (n = 3) PD catheters. The exit sites of the PD catheters were inoculated with a single strain of Staph. aureus for six days, followed by PD for six days. The rabbits were then sacrificed. After sacrifice, comparison between the bacterial counts of identical segments of silver and silastic catheters showed that there had been a reduction in the growth of Staph. aureus in vivo on silver PD catheters, contrary to the increased growth on the silastic catheters (p < 0.05). Reduced bacterial growth on the silver PD catheters in vivo indicates that the release of silver in tissues over time cause antibacterial effects in vivo. Further in vivo experiments are needed before future clinical use of silver catheters in PD patients.

The suitability of using catheterized, partially nephrectomized (uremic) pigs to study catheter-associated infection in peritoneal dialysis was investigated. In some pigs, an inoculum of 10(9) cfu of Staphylococcus epidermidis ATCC 35984 was deposited around the catheter exit site and the organism was allowed to colonize over 21 days. The strain was recoverable from tissues and catheter samples at various locations along the catheter tract from inoculated pigs at postmortem examination. Uninoculated control catheters were colonized to a significantly lesser degree and by various other staphylococcal species. Immune response by inoculated pigs toward catheter-associated bacteria was indicated by a significant increase in serum antistaphylococcal IgG concentration and an increased percentage of peripheral polymorphonuclear leukocytes. Uremia had no significant effect on serologic response. Immunoblotting against S. epidermidis lysostaphin-extracted proteins showed that although incubation with inoculated group antisera produced more intense banding and reacted to a wider range of protein than did antisera from uninoculated controls, common antigenic proteins among the groups were found.

Staphylococcus epidermidis RP62A (ATCC 35984) was grown in tryptic soy broth (TSB), iron-depleted TSB (TSB-Fe), iron-reconstituted TSB-Fe (TSB+Fe), a chemically defined medium, and fetal calf serum (FCS) and on silastic disks in chambers that were sutured to the pig peritoneal wall. Bacterial cell wall proteins were extracted by digestion with recombinant lysostaphin, separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and detected by silver staining. Cell wall proteins from TSB-, chemically defined medium-, or FCS-grown cells had a complex profile of greater than 25 protein bands spanning the full molecular mass range. By contrast, a digest obtained from in vivo-grown cells had only five major proteins of 40 kDa or greater. Proteins of 130 and 106 kDa were present in the cell envelopes of TSB-Fe- and in vivo-grown cells but not in those grown in TSB or TSB+Fe. A 43-kDa protein expressed by in vitro-grown cells and 52- and 96-kDa proteins expressed by in vivo-grown cells reacted with antisera from pigs with the chamber implants and from catheterized, paracatheter-inoculated pigs but not with hyperimmune sera from pigs immunized with TSB-grown cells. The data indicate that S. epidermidis, growing under in vivo conditions, expresses antigens distinct from those that are grown in vitro.

In a regional CAPD program in Northern Alberta, Canada, the peritonitis rates among patients undergoing CAPD treatment were quite high: 1/8.3 and 1/7.4 per patient month from a population of 75 and 76 patients in 1989 and 1990 respectively. Our patient population is comprised of different ethnic groups, separated widely from the dialysis centre; over half of them are above the age of 60 years. As it is not possible to change the patient characteristics in our centre, we switched to the Twin-bag disconnect system in 83 out of a total of 103 patients in 1991. With this change our overall peritonitis rate has significantly improved to 1/14 per patient months and 1/17 per patient months in patients using the Twin-bag system. This improvement in the peritonitis rate has occurred without any change in our patient characteristics. We find the improvement in our peritonitis rate is due to the use of the new Twin-bag system, which provides total disconnection with no spikes and thereby reduces peritonitis due to touch contamination.

To study the significance of biofilm bacteria in CAPD peritonitis, in a preliminary study, we compared the growth of planktonic and biofilm bacteria by parallel cultures of the same PD effluent in 14 patients with CAPD-associated peritonitis. Planktonic bacteria were isolated by routine microbiologic culture techniques and biofilm bacteria by the use of a modified Robbins' device (MRD). Antibiotic sensitivity or MIC's of bacterial strains isolated by the two techniques were compared. This comparison of the IC identified a subgroup of patients who developed recurrent antibiotic resistant biofilm-induced peritonitis and their peritoneal catheters were subsequently removed.

In patients undergoing CAPD treatment, removal of peritoneal catheters has become a standard practice after two or more episodes of recurrent peritonitis which are refractory to antibiotic treatment. Immediate replacement of peritoneal catheters is not always safe in the presence of active peritonitis. Temporary institution of hemodialysis treatment in some of these patients may also be impossible because of unstable hemodynamic states or loss of vascular access sites. Successful continuation of CAPD treatment in some of these patients has been reported by using intraperitoneal (IP) administration of fibrinolytic agents such as streptokinase or urokinase as an adjunctive therapy to antibiotic treatment and as an outpatient procedure. Although numbers of cases reported are few in the literature and controlled studies in large numbers of patients are lacking, these reports emphasize the safety of IP use of these agents without any major systemic adverse effects. The reports are reviewed here to provide some practical guidelines for safe use of these agents in selected patients with recurrent CAPD-associated peritonitis.

A reproducible rat model of chronic bacterial prostatitis was developed using a defined bacterial pathogen (Escherichia coli) to study the pathogenesis and persistence of chronic bacterial prostatitis. The progression of inflammation and its consequences from acute to chronic prostatitis were documented with microbiological, histological, ultrastructural and immunological data. Chronic bacterial prostatitis in this model was associated with sparse glycocalix-enclosed protected bacterial microcolonies within the prostatic acini and ducts which appeared to stimulate a persistent local and systemic immunological reaction resulting in chronic inflammation of the gland. This model has many striking similarities to the natural history of human chronic bacterial prostatitis.

We simulated touch contamination of peritoneal dialysis fluids perfused through an in vitro system with a modified Robbins' device (MRD) and Y-connecting tubings, to study the pathogenesis of bacterial biofilm (BB) growth on Tenckhoff catheter (TC) discs. The spike ends of Y-connecting sets were dipped in a suspension of freshly cultured cells of Staphylococcus epidermidis (3 X 10(8) cfu/ml), and connected to 2 litres of 0.5% dianeal solution which was perfused through the MRD with plugs containing TC discs. Four simulated clinical exchanges were performed with or without prior flushing and/or bleach treatment of the Y sets. Control experiments were done with fresh Dianeal solution with no contamination, flushing, or bleach treatment. BB growth on the TC discs was examined by scanning electron microscopy (SEM) and transmission electron microscopy and quantitated by routine culture of scrapings from the discs. We noted that touch contamination of dialysis fluids via the spike ends of the connecting sets can generate dense BB growth on TC discs in this experimental system (62 +/- 8% by SEM and 10.2 +/- 8.3 X 10(3) cfu/ml by culture). This growth of BB was significantly reduced by flushing the Y set with sterile Dianeal solution (24.3 +/- 3% by SEM and 5.7 +/- 3.5 X 10(1) cfu/ml by culture) and was absent by bleach treatment. We conclude that although bleach treatment of Y sets can prevent BB growth, the 'flushing' procedure alone can significantly reduce BB growth on TC from touch contamination of dialysate fluid.

A composite method using polyethylene glycol (PEG) and different markers for detecting circulating immune complexes (CIC) is described. The markers used are bovine conglutinin (RK-BA), C1q (C1q-BA) and IgG, IgM quantitation of PEG precipitate (RID-Ig). A composite scoring system is used in interpreting results from individual assays. The sensitivity of multiple PEG methods (MPM) was determined in 418 serum samples and compared with Raji cell assay in 204. Correlations between individual assays, viz., RK-BA-C1q-BA, RID-Ig and Raji cell test in several disease conditions including rheumatoid arthritis, glomerulonephritis, post-renal transplantation, maintenance haemodialysis, multiple sclerosis and normal pregnancies were computed. The relative discriminatory ability of a single PEG technique to differentiate normal from pathological sera in these disease states was observed in comparison with the composite PEG index. This index gives an improved assessment of abnormal sera, is simple and sensitive and has some advantages over biological techniques such as the Raji cell assay.U

Two hundred fifty-four MS patients were studied for circulating immune complexes (CIC) by three different assays: Raji-RIA, Clq-PEG, and Conglutinin-BA. Thirty-five percent of the sera were positive by one or more of these tests; Raji-RIA had the highest sensitivity (29.4%). Incidence of CIC in acute relapse, progressive, remission, and stable state of MS was 33.3%, 30.2%, 26.1%, and 23.1%, respectively, by Raji-RIA, compared with 7.75% and 8.82% among normal and neurologic controls. The incidence of CIC in neurologic controls differed significantly from both acute relapse and progressive disease, and almost significantly from patients in remission. There was no significant difference between patients with stable MS and neurologic controls, and there was no association of CIC with HLA-B7.

It has been suggested that antibodies to native DNA occur with some frequency in patients treated by hemodialysis. This has been attributed to the use of the technique. We have investigated 48 patients on maintenance dialysis for the presence of antibodies to single stranded DNA (ss-DNA) and native DNA (n-DNA) compared to a control group of 25 nondialyzed patients with renal disease. In neither group of patients were antibodies to ss-DNA detected frequently. Antibodies to n-DNA were present in three of the dialyzed patients and in none of the control group. The frequency of antibodies in dialysis patients was insignificant in comparison to the same control group of non-dialyzed renal patients. There was no correlation between duration of dialysis and development of antibodies. A drug-induced lupus state is possible, but not established for two of the three patients on dialysis.