[Advantages of insulin Lispro (short-acting) in terminal kidney failure]. / Vorteile von Insulin Lispro bei terminaler Niereninsuffizienz.

Diabetic management of dialysis patients with end-stage renal failure is often problematic. Renal failure interferes with the metabolism of glucose and insulin. Many of these diabetics have wide fluctuations in their daily blood glucose profile. The kinetics of regular insulin may be appreciably prolonged in consequence of the failure of renal insulin degradation, making the dose-effect profile of the insulin difficult to control, and hypoglycemia more likely. Intensified conventional insulin treatment (ICT) using the short-acting insulin, Lispro, facilitates the calculation of insulin requirements and helps to avoid large fluctuations in blood glucose levels. The present case report illustrates these difficulties in a patient on dialysis, and shows how ICT with Lispro can improve the quality of life of diabetics with renal failure.

Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: silver ring prophylaxis at the catheter exit study.

Catheter-related infections remain a significant cause of method failure in chronic peritoneal dialysis (PD) therapy. Given the increasing antibiotic resistance, such nonpharmacological strategies as local silver devices attract more interest. To establish whether a silver ring device (designed by Grosse-Siestrup in 1992) mounted onto the PD catheter and placed at the exit site at skin level is effective in preventing exit-site and other catheter-related infections, a prospective 12-month, multicenter, controlled study stratified by diabetes status was conducted. The study subjects were assessed by an extensive structured inventory, including a broad spectrum of control variables, such as age, body mass index (BMI), Staphylococcus aureus carrier status, catheter features, mode and quality of PD therapy, comorbidity, and psychosocial rehabilitation. Ten experienced German outpatient dialysis centers (seven adult, three pediatric) participated in the trial. All eligible patients (n=195) from the study area without catheter-related infections during the ascertainment period were included (incidental subjects undergoing PD therapy for at least 3 months). The main outcome measures were the occurrence of first exit-site infections (primary study end point), sinus tract/tunnel infection, and peritonitis. Ninety-seven patients were assigned to the silver ring and 98 patients to the control group. Baseline characteristics of age, sex, proportion of pediatric and incidental patients, S aureus carrier status, and other variables were similar in both groups. The incidence of infections in the silver ring group versus the control group was as follows: 23 of 97 versus 16 of 98 patients had exit-site infections, 12 of 97 versus 12 of 98 patients had sinus tract/tunnel infections, 16 of 97 versus 18 of 98 patients had peritonitis, respectively. Kaplan-Meier analysis for the probability of an infection-free interval showed no statistical difference (log-rank test) between the two groups. Displacement of the silver ring contributed to study termination in 6% of the study group patients, including two patients with catheter loss. Univariate analysis and multiple logistic regression identified younger age (<50 years), low serum albumin level (<35 g/L), number of previously placed PD catheters, short cuff-exit distance (<2 cm), and S aureus nasal carriage as risk factors for the development of exit-site infections. In conclusion, our study does not show any benefit of the silver ring in preventing catheter-related infections in PD patients. Thus, prevention of infection-related method failure in PD still has to rely on conventional antibiotic treatment strategies and less so on alternative methods.

Improvement of uremic neuropathy and hypogeusia by dialysate zinc supplementation: a double-blind study.

A reduction in the plasma zinc concentration is a well-recognized complication of hemodialysis. A positive clinical response to zinc therapy under controlled conditions is the most reliable criterion of zinc deficiency. Zinc therapy using a nonproprietary zinc dialysate was evaluated in 12 dialysis patients with proven hypogeusia and polyneuropathy, in a randomized double-blind crossover comparison (preliminary phase, 4 weeks; placebo phase, 12 weeks; initial phase, 12 weeks; final phase, 6 weeks; post phase, 4 weeks). The dosage was related to the zinc plasma and erythrocyte levels, measured weekly. Nerve conduction velocity (NCV) and taste-testing were used to evaluate the effect of treatment at the end of the placebo and therapy phases. There was significant reduction in the recognition and determination threshold level for each of the four qualities of taste. The NCV improved significantly. The plasma zinc level could be elevated in all patients to the desired concentration, using individualized supplementation of dialysate with zinc. The erythrocyte zinc level remained constant, at double the normal value. The plasma zinc concentration fell back to the initial level 6 weeks after conclusion of therapy. We conclude that (1) zinc substitution may provide a specific therapy for uremic polyneuropathy, (2) the observed hypogeusia results from zinc deficiency, (3) long-term therapy is necessary to obtain a constant normal plasma zinc concentration, (4) zinc substitution by dialysate is a suitable and nonstressful method of administration.

[Malabsorption caused by HBsAg-positive panareteritis nodosa]. / Malabsorption bei HBsAg-positiver panarteritis nodosa

A 36 year old man with panarteriitis nodosa (PAN) presented over a certain period of time meinly with gastrointestinal symptoms. He was HBsAg positive and a "reactive" hepatitis with histologically demonstrated. Arterial microaneurysms and stenoses were detected by angiography in the liver, kidney and small intestine. These findings were confirmed by autopsy. Vascular occlusions had caused infarctions of the small intestine as well as necroses and ulcerations of the large bowel. Chronic ischemia is considered as cause of the patient's malabsorption-syndrome. It is suggested, that cachexia of PAN may be partly due to malabsorption.

Catecholamine content of serum and adrenals in protracted anaphylactic shock of guinea pigs.

In ovalbumin-sensitized guinea pigs, the serum catecholamines were significantly increased 20 or 120 min after antigen injection. The highest serum cathecholamine values were obtained in animals which were selected during a severe state of protracted shock, and in those which died in protracted shock. Antihistamine pretreatment reduced the serum noradrenaline, but not the adrenaline values in anaphylaxis. In urethane anesthesia, the anaphylactic serum catecholamine levels (especially noradrenaline) were lower than in nonanesthetized animals. The adrenaline and noradrenaline content of the adrenals in protracted and in acute anaphylactic shock did not differ from control values.