[Impact of omission of axillary dissection on adjuvant therapy in patients with metastatic sentinel lymph nodes according to the ACOSOG Z0011 criteria]. / Impact de l'omission du curage axillaire sur les traitements adjuvants chez les patientes ayant un ganglion sentinelle métastatique et répondant aux critères d'inclusion de l'ACOSOG Z0011.

OBJECTIVES: The results of the ACOSOG Z0011 questioned the usefulness of axillary lymph node dissection (ALND) in case of metastatic sentinel lymph node (SLN). The aim of our study was to assess the impact of the omission of ALND according to the inclusion criteria of the ACOSOG Z0011 study if SLN are metastatic but also the consequences on prescription of the application of a new standard of care for adjuvant treatment. PATIENTS AND METHODS: This retrospective study included, between November 2007 and January 2012, patients with T1-T2N0 breast cancer and metastatic SLN meeting the criteria for omission of completion ALND according to the study of the ACOSOG Z0011. Patients were submitted anonymously and randomly in multidisciplinary meeting (MM) 3 times: with complete information including ALND (MM1), with information from SLN alone (MM2) and with complete information of ALND according to the current protocols in 2013 (MM3). During each presentation, we collected the decision of the different adjuvant treatments proposed: chemotherapy, hormonal therapy, radiotherapy (with radiation fields). Then, we compared therapeutic proposals of the 3 presentations. RESULTS: Fifty-eight patients were eligible for inclusion criteria of the ACOSOG Z0011. Treatments actually proposed during MM1 consisted of 94.8 % of chemotherapy, 77.6 % of breast and lymph nodes radiotherapy and 91.4 % of hormone therapy. During the MM2, there was no significant difference compared to the decision taken during MM1. In fact, during MM2, we decided chemotherapy, radiotherapy and hormonotherapy respectively in 89.7, 79.3 and 91.4 % of the cases. During the MM3, it was shown a significant decrease in the indications of chemotherapy (82.8 %, P=0.03) and lymph nodes irradiation (56.9 %, P=0.02) compared to the therapeutic proposals of the MM1. DISCUSSION AND CONCLUSION: The lack of information of ALND does not seem to significantly alter indications for adjuvant treatment. Otherwise, the evolution of our references causes a decrease in adjuvant therapy.

Human de novo papillary renal-cell carcinomas in a kidney graft: evidence of recipient origin with adenoma-carcinoma sequence.

Papillary renal-cell carcinoma (pRCC) is unusual for its occurrence in kidneys with chronic dysfunction, for its frequent multifocality and for its common association with papillary adenoma, a benign renal lesion morphologically indistinguishable from pRCC. Concomitant development of papillary adenoma and pRCC in five transplanted kidneys, where donor and recipient characteristics are well established, provided a unique opportunity for molecular studies of de novo pRCC carcinogenesis. We aimed to study this tumor type to determine whether or not the different papillary tumors have the same origin, and whether or not papillary adenomas are precursor lesions of pRCC. We performed XY-FISH in sex-mismatched kidney transplants, and polymorphic microsatellite DNA and high-resolution melting of mitochondrial DNA analyzes in all five patients on laser-microdissected tumor cells, then compared these molecular profiles to donor and recipient profiles. This study (i) identified the recipient origin of de novo papillary adenomas and pRCCs in a kidney transplant, (ii) demonstrated an identical origin for precursor cells of papillary adenomas and pRCCs and (iii) showed additional genetic alterations in pRCCs compared to papillary adenomas. This molecular approach of papillary tumors developed in transplanted kidney identified successive steps in carcinogenesis of human de novo papillary renal-cell carcinoma.

Phase I study of BIBF 1120 with docetaxel and prednisone in metastatic chemo-naive hormone-refractory prostate cancer patients.

BACKGROUND: BIBF 1120 is an oral, potent, tyrosine kinase inhibitor that simultaneously targets vascular endothelial growth factor receptors 1-3, platelet-derived growth factor receptors α and ß, and fibroblast growth factor receptors 1-3, as well as FLT3 and Src. Currently, the molecule is in phase III development for second-line non-small cell lung cancer and first-line ovarian cancer patients. METHODS: This phase I dose-escalation study assessed the safety and maximum tolerated dose of continuous daily treatment with BIBF 1120 plus standard-dose docetaxel (75 mg m(-2), every 3 weeks) and prednisone (5 mg BID) in patients with metastatic, chemo-naive, hormone-refractory prostate cancer (HRPC). Secondary objectives were characterisation of BIBF 1120 and docetaxel pharmacokinetics (PK), and preliminary antitumour activity. RESULTS: Patients received BIBF 1120 100 mg BID (n=3), 150 mg BID (n=3), 200 mg BID (n=3), and 250 mg BID (n=12). The most frequent drug-related adverse events were diarrhoea (71.4%), asthenia (61.9%), nausea (28.6%), vomiting (28.6%), and alopecia (23.8%). The maximum tolerated dose was 250 mg BID of BIBF 1120. Overall, reversible grade 3/4 liver enzyme elevations occurred in six of twelve patients at this dose level. Among 19 assessable patients, 13 (68.4%) showed a ≥50% reduction in prostate serum antigen levels from baseline and among 6 evaluable patients with measurable lesions 1 patient experienced a partial response by Response Evaluation Criteria In Solid Tumours criteria. Pharmacokinetic analysis showed no interactions between BIBF 1120 and docetaxel/prednisone. CONCLUSION: Based on the overall safety profile, 200 mg BID was the recommended dose for the combination of BIBF 1120 with the standard dose of 75 mg m(-2) of docetaxel and prednisone that might be further investigated in HRPC patients. This combination was well tolerated, with preliminary signs of efficacy and no indication of PK interaction between BIBF 1120 and docetaxel.

Continuous transition from 3D to 1D confinement observed during the formation of CdSe nanoplatelets.

We study the formation of colloidal CdSe nanoplatelets using both tansmission electron microscopy (TEM) and spectroscopic analysis. We show that the platelets form by continuous lateral extension of small (<2 nm) nanocrystal CdSe seeds. The nanoplatelet thickness is fixed by the seed dimension and remains constant during the platelet formation. The nanoplatelet lateral dimensions can be tuned using additional precursor injection. Absorption and fluorescence analysis of the CdSe nanoplatelets as they continuously extend laterally confirms a continuous transition from 3D to 1D confined nanoparticles. The formation of the CdSe platelets is found to be similar for different platelet thicknesses that we control with a precision of one CdSe monolayer.

Optimization of cisplatin doses in a testicular cancer patient with acute renal failure.

Although testicular cancers are highly curable malignancies, conventional cisplatin based therapy often causes important toxicities, not often easily manageable. Nephrotoxicity occurs in almost all patients, and is potentialized in patients suffering from renal failure. Monitoring of residual levels of unbound platinum was used to define guidelines for cisplatin administration. Monitoring of cisplatin was initiated in a patient treated for metastatic testicular cancer and acute renal failure. Reduced doses of cisplatin were first administered in conjunction with hemodialysis. Unbound and total platinum levels were determined by flameless atomic absorption spectrophotometry. The data found allowed us to adapt and increase sequentially cisplatin doses, accordingly with the renal function. Full regimen doses were eventually administered when useful renal function returned. This simple approach may be useful in monitoring cisplatin administration during acute renal failure.

[Unilateral acneiform rash in facial palsy]. / Éruption acnéiforme unilatérale sur paralysie faciale.

BACKGROUND: Cetuximab is a chimeric monoclonal antibody selective for epidermal growth factor receptor (EGFR). It is increasingly used in epithelial cancer, often in combination with radiotherapy or chemotherapeutic agents, since it induces a broad range of cellular responses that enhance tumour sensitivity to these therapies. However, it can cause numerous adverse effects, the most common being acneiform eruption on the face and trunk, which is generally bilateral and symmetric. PATIENTS AND METHODS: Herein we present the first case of unilateral cetuximab-induced acneiform eruption in facial palsy. DISCUSSION: To our knowledge the medical literature contains no other such cases. Our hypothesis is that lymphoedema associated with facial palsy reduces lymphatic drainage, promoting the deposition of cetuximab on EGFR and persistence of local signs.

Factors affecting the outcome of patients with metastatic leiomyosarcoma treated with doxorubicin-containing chemotherapy.

BACKGROUND: To determine whether pulmonary metastasectomy or the addition of ifosfamide/dacarbazine to a doxorubicin-containing regimen offers a survival benefit to adult patients with metastatic leiomyosarcoma. PATIENTS AND METHODS: We retrospectively collected data from 147 patients treated with a doxorubicin-containing regimen from 1998 to 2008. RESULTS: Progression-free survival (PFS) was 6.5 months (range 1-141 months). We did not identify an independent prognostic factor for PFS. Planned dose of doxorubicin was the sole parameter improving PFS [hazard ratio (HR) = 0.13, P = 0.023]. Overall survival (OS) was 17 months (range 1-115 months). The sole identified prognostic factor for OS was the interval between initial diagnosis and metastatic relapse. After adjustment to this prognostic factor, metastasectomy improved OS (HR = 0.52, P = 0.012) and the addition of ifosfamide seemed to worsen OS (HR = 1.42, P = 0.028). CONCLUSION: In our analysis, combined regimens did not improve the outcome. Maintenance of the doxorubicin dose was associated with improved PFS. Metastasectomy favorably influenced OS.

[PET/CT in breast cancer: an update]. / Différents rôles de la TEP-TDM en sénologie : mise au point.

The authors discuss the various roles of 18F-FDG PET/CT in the management of breast cancer. Roles of new tracers such as F-18 fluoro-L-thymidine (a marker of cell proliferation), 18-fluoro-17-B-estradiol (marker of estrogen receptor) and sodium fluoride (marker of bone matrix) are also mentioned. There is little justification for the use of FDG-PET/CT in patient with clinically T1 (< or = 2 cm) N0 tumours. Notably, it cannot be used as a substitute to SLNB "sentinel lymph node biopsy" for axillary staging due to limited sensitivity for the detection of small metastases. The case is different in higher risk patients, and especially so in patients with locally advanced disease. FDG-PET/CT in these patients might depict lymph node involvement in the level III of Berg or in supraclavicular or internal mammary basins. It might also uncover occult distant metastases, notably, early osteomedullary infiltration. Thus, for these tumors, initial PET/CT can enable better intramodality treatment planning or a change in treatment. PET/CT as a whole-body examination is also very efficient in case of suspicion of recurrence. On the other hand, many studies show that this functional imaging could be used to assess early response to neoadjuvant chemotherapy or to chemotherapy of metastatic disease. 18FDG-PET/CT could thus become an unavoidable modality to answer various clinical situations.

[Survival of cementless dual mobility sockets: ten-year follow-up]. / Survie a dix ans d'une cupule double mobilité non cimentée.

PURPOSE OF THE STUDY: We report a retrospective series of 106 total hip prosthesis with ten years follow-up. The purpose of this study was to analyze survival of cementless dual mobility sockets. MATERIAL AND METHODS: The series included 90 consecutive patients with 106 first-intention total hip prosthesis, all with cementless dual mobility sockets. All prosthesis (Novae-1 socket and Profil-1 stem, Serf) were implanted within a 6-month period. The stainless steal socket was coated with alumina and had two short anchorage studs and a superior mooring screw and a polyethylene retentive liner. The stem had a 22.2 mm chromium cobalt head. The main indication for arthroplasty was degenerative joint disease. Mean age at implantation was 56 years (range 23-87). All patients were seen for physical examination and x-rays every two or three years. We noted cup survival at ten years (actuarial method), defining surgical revision for cup replacement due to an aseptic cause as the endpoint. RESULTS: Twelve patients died during the 10-year follow-up and one was lost to follow-up. The Postel-Merle d'Aubligné score improved from 7.1 preoperatively to 15.8 at ten years. There were two isolated acetabular loosenings, two intra-prosthetic dislocations due to advanced wear of the polyethylene insert. The overall survival rate of the socket was 94.6% at ten years. There were no episodes of prosthetic instability in this series. DISCUSSION: This study demonstrates the good ten-year survival of the dual mobility socket, comparable to that of conventional prostheses. The absence of any case of prosthetic instability in this series confirms the good short-term and long-term stability of the dual mobility socket. Intraprosthetic dislocation, due to loss of the polyethylene retaining ring is the main limitation of this method. The incidence was however low (2% at ten years) and treatment was not a problem. We recommend using the dual-mobility socket as the first-intention implant for patients with a high risk of post-operative instability, but also recommend it for all patients aged over 70 years since instability is the leading cause of surgical revision after this age.

[The consequences of passive smoking in adults]. / Conséquences du tabagisme passif chez l'adulte.

INTRODUCTION: Passive smoking is the involuntary inhalation by a non-smoker of smoke generated in his neighbourhood by one or more smokers. BACKGROUND: The effect of this exposure is already generally recognised in children. In adults the induction of chronic obstructive lung disease has not been demonstrated. This is no longer the case for ischaemic heart disease and lung cancer where the effect of passive exposure of non-smokers to cigarette smoke is recognised. The biological plausibility together with the concordance of results obtained over successive years, as well as the large numbers of patients included in the studies, lead to a confident conclusion that the risks in adult non-smokers are increased by the order of 25%. CONCLUSIONS: There is no evidence that bias affects the conclusions reached and the World Health Organisation has recently classified passive smoking as being carcinogenic in man. As a result of these data prevention of passive exposure to cigarette smoke should be part of a larger framework of smoking prevention, especially among the young.

Results with a cementless alumina-coated cup with dual mobility. A twelve-year follow-up study.

Between April 1980 and December 1981, 135 alumina-coated hemispherical cups were inserted without cement in patients with degenerative lesions. The cups were anchored by press fit and secured with a tripod attachment. The follow up was for over ten years. A bipolar polyethylene insert was used. Only one patient was lost to follow up in less than 2 years. Forty-four implants worked perfectly up to the time of death of the patients. Four cups were replaced, two after the patients sustained violent trauma, and there was an isolated instance of replacement of the insert only. The cumulative survival rate was 95.4% at 10 and 12 years follow up. The 78 surviving patients (85 cups) were examined, and radiographs were taken in 62 of them. Three patients showed clinical signs of deterioration and radiological signs of loosening, 2 others showed radiological signs of cup displacement without clinical symptoms. There was no evidence of osteolysis at the bone-cup interface in well functioning implants. These results confirm that cementless hemispherical cups survive well and demonstrate the value of a cup without holes for screws which can allow migration of polyethylene particles which might induce osteolysis of the adjacent ilum.

New connection method for isolating and disinfecting intraluminal path during peritoneal dialysis solution-exchange procedures.

Microbiological data have been collected on the performance of a new method of isolating and disinfecting the intraluminal path at the connect/disconnect site of a peritoneal dialysis (PD)-exchange pathway. High-temperature moist-heat (HTMH) disinfection is accomplished by a new device that uses microwave energy to heat the solution contained in the pressure-tight inner lumen of PD connector pairs between the transfer-set connector-clamp and the bag-connector break-away seal. An 85 degrees C (S.D. = 2.4 degrees C, n = 10) rise in solution temperature is seen in 12 seconds, thus yielding temperatures under pressure well over 100 degrees C with starting temperatures of 25 degrees C. Connector pairs were prepared by inoculation of a solution suspension containing at least 10(6) colony-forming units (CFU) of a test micro-organism. Approximately 0.4 mL of solution was contained within the mated connector pair. Using standard D-value determination methods, data were obtained for surviving organisms versus five exposure times and a positive control to obtain a population reduction curve. Four micro-organisms (S. epidermidis, P. aeruginosa, C. albicans, and A. niger) recognized to be among the most prevalent or problematic in causing peritonitis were tested. After microwave heating, the treated solution was aseptically withdrawn from the connector pair using a needle and syringe, plated in growth media, and incubated. Population counts of CFUs after incubation were used to establish survival curves. Results showed a tenfold population reduction in less than 3 seconds for all organisms tested. A 30-second cycle time safely achieves a > 10(8) population-reduction for bacteria and yeast organisms, and a > 10(7) population reduction for fungi. One potential benefit of using this new intraluminal disinfection method is that it may help reduce peritonitis resulting from the even more problematic pathogens such as the gram-negative bacteria and fungal organisms.

[Surgical treatment of ruptures of the Achilles tendon. Apropos of 42 cases treated by Bosworth's technique]. / Traitement chirurgical des ruptures du tendon d'Achille. A propos de 42 cas traités selon la technique de Bosworth.

PURPOSE OF THE STUDY: There is no consensus on the treatment of acute ruptures of the Achilles tendon. We have chosen surgical technique with early muscle stimulation. This study analyses possibilities of functional recovery and complications in Athletes. MATERIALS AND METHODS: Between 1983 and 1994, we treated surgically 42 Athletes who had Achilles tendon ruptures with early musculo-tendinous stimulation. The 39 male and 4 female patients had a mean age of 41 years (range, 15 to 70). We have always used Bosworth's technique with gastrocnemius flap procedure. Immediately after surgery, weightbearing with below-the-knee cast was initiated for 6 weeks followed by rehabilitation. RESULTS: There was no local major complication, deep vein thrombosis or pulmonary embolism. Only one patient suffered from a traumatic rerupture one month after surgery. Mean value of the calf atrophy was less than 1 cm. 93 per cent of patients returned to previous activity levels and 78.5 per cent of patients returned to their usual sport activity. DISCUSSION: Like this study recent results confirm the low complication and recurrence rate of the surgical treatment. Percutaneous technique and conservative treatments seem to be worse for rerupture and sportive functional recovery. Early muscle stimulation decrease morbidity and calf atrophy. Our protocol with weightbearing in ankle neutral position reduces calf atrophy. CONCLUSION: A rigid and stable reconstruction, allowing early weightbearing without equinus position seems to be a rational treatment for Achilles tendon rupture in athletes.

[Long-term results of active-passive ligament repair of the external lateral ligament of the ankle]. / Résultats à long terme de la ligamentoplastie activo-passive du ligament latéral externe de la cheville.

We reviewed 95 ankles at an average of 9 years after an "activo-passive" operation performed for chronic lateral instability. All the patients had suffered recurrent ankle sprain or instability, with pain in 67 patients. Ten ankles showed a subtalar injury at operation. Degenerative changes were noted in 11 ankle joints. On review, 81 ankles (85%) were stable. The 14 cases with persistent instability had developed the problem one to five years after operation. Two cases presented with limitation in mobility. Osteoarthritis, found in 15 ankles, was severe in only two, and had been present on preoperative films. We found no correlation between functional results (talar tilt, anterior-drawer test) and radiological evaluation. The "activo-passive" operation provides long-term stabilization with preservation of the ankle and of subtalar mobility without severe osteoarthritis.

[Wear characteristics of different metal-polyethylene beating surfaces. An experimental study of a new model of knee prosthesis]. / Caractéristiques d'usure de différents couples de frottement métal-polyéthylène. Etude expérimentale sur un nouveau modèle de prothèse de genou.

PURPOSE OF THE STUDY: Wear of artificial components joint is the most important factor in long term durability. Only few studies have analysed in laboratory experimentation the quality of different alloys on the same type of prosthesis. MATERIAL: During the development of a new knee prosthesis, we studied the friction mechanisms of the metal/polyethylene (UHMWPE) couple and particularly the value of titanium alloy (Ti-6AI-4V) treatment using an ionic nitrogen implantation process (IMPLATEC). Two friction surfaces were studied in vitro: one in flexion-extension between femoral component and tibial plateau, the other in rotation between tibial plateau and "metal-back". METHODS: The implanted Ti-6AI-4V was compared with 316L stainless steel, cobalt chromium molybdenium alloy and with Ti-6AI-4V using a prosthesis of each configuration. The samples were tested on a TRIBOCUP friction machine during 3 x 10(6) cycles in Ringer 's solution. The friction couples were controlled every 200,000 cycles and the loss of polyethylene mass every 500,000 cycles. We have also evaluated the roughness and the rubbing surface macroscopically. RESULTS: The results analysis shows that friction couples such as Cobalt Chromium and implanted Ti-6AI-4V are weakest but implanted Ti-6AI-4V over time, tends to match the strength of Ti-6AI-4V without treatment. With implanted Ti-6AI-4V and with Cobalt Chromium alloy, the loss of polyethylene is slight comparatively to the stainless steel and non implanted Ti-6AI-4V. Surface analysis showed good protection of titanium alloy by ionic implantation especially in the femoral component where roughness is close (0.04 micron) to that of Cobalt Chromium alloy (0.07 micron). DISCUSSION: Our study confirms the results with pin-on-disk and cup-on-ball with results for the Ti-6AI-4V implanted and Cobalt Chromium alloys with protection of the metal surface and decrease of polyethylene wear comparatively to stainless steel and non implanted Ti-6AI-4V. CONCLUSION: Our conclusion is for this type of experimental device that the surface condition is satisfactory for such friction couples as implanted Ti-6AI-4V/polyethylene and Cobalt-chromium/polyethylene, with very similar results. However, the long-term durability of the nitrogen implanted on Titanium Alloy remains unknown.

Prolonged treatment of chronic Pseudomonas aeruginosa osteomyelitis with a combination of two effective antibiotics.

Emergence of Pseudomonas aeruginosa resistant to antibiotic monotherapy is one of the causes of therapeutic failure in chronic P. aeruginosa osteomyelitis. We report 15 cases of chronic (> 3 months of evolution) biopsy culture proven P. aeruginosa osteomyelitis included in an open prospective study evaluating the efficacy of prolonged treatment (> 4 months) with two effective antibiotics in combination. Mean post-treatment follow-up was 38 months. A regimen of cefsulodin in combination with oral ofloxacin was used for six patients, cefsulodin-pefloxacin for three patients, cefsulodin-ciprofloxacin for one patient, piperacillin-pefloxacin for one patient, cefsulodin-fosfomycin for one patient, imipenem-ciprofloxacin for two patients and amoxicillin-ciprofloxacin-fosfomycin for one patient as home therapy. The clinical cure rate of 73% and bacteriological cure rate of 93% are far superior to those previously described in the literature. We did not observe adverse drug reactions. We think that a prolonged use of two effective antibiotics in combination is a safe and improved therapeutic schedule for chronic P. aeruginosa osteomyelitis.

Effectiveness of microwave moist-heat intraluminal disinfection of CAPD connectology.

Studies were performed to quantify the microbial population reduction achieved with the Peritoneal Dialysis Moist Heat Device (PDM-1). This microwave method is used to disinfect the inner lumen of connectors used in the exchange process for continuous ambulatory peritoneal dialysis (CAPD). The microwave heating technique was evaluated on different connector systems containing a suspension of 10(6) microorganisms. The most prevalent and most problematic peritonitis-causative microorganisms were tested. After heating, the degree of disinfection was measured by enumerating bacterial colonies of the treated suspension. D-value determinations were then performed. The D-value for spores of A. niger was found to be 7.1 seconds for one type of connector system. Two other connector systems containing different intraluminal solution volumes were also tested using spores of A. niger and D-values were determined to be 7.6 seconds and 9.5 seconds, respectively. Other organisms tested were determined to have D-value times shorter than that for A. niger. Rapid heating of the solution contained within the CAPD connectors is a key characteristic of the microwave technique since temperatures rise high enough for destruction of microorganisms while leaving the plastic safe to touch. Thus, this technique is a safe and effective method for providing intraluminal disinfection.

Congestive heart failure: a review of nonpharmacologic therapies.

Although pharmacologic therapy is the mainstay of treatment for patients with congestive heart failure (CHF), several nonpharmacologic interventions are useful adjuncts in the overall management of this clinical syndrome. Comprehensive treatment plans include sodium and fluid restriction, as well as a balance of rest and physical activity. Hemofiltration and peritoneal dialysis may be effective in patients who have become resistant to diuretic therapy. Mechanical support from intraaortic balloon counterpulsation and ventricular assist devices has improved survival in certain high-risk patients. For patients refractory to conventional therapies, cardiac transplantation offers new hope. These interventions and the nursing care of patients with CHF are discussed in this article.

Moist heat intraluminal disinfection of CAPD connectors.

A moist heat technique for disinfecting the inner lumen of commercially available connectology used in the exchange process for Continuous Ambulatory Peritoneal Dialysis (CAPD) was evaluated. Moist heat was generated by a device (PDM-1) that directed microwave energy to heat a sample solution containing a concentration of 10(6) microorganisms inside a pair of mated plastic CAPD connectors. Microorganisms tested included those most prevalent and most problematic in causing peritonitis. Testing, performed according to F.D.A. approved standards, involved heating a sample solution and then placing the sample solution into vials which were then sealed and incubated. Absolute determination of growth versus no growth was measured by macroscopic observation. Positive control samples were performed in the same manner but were not exposed to heat. Negative controls were performed in the same manner in the absence of test organisms. At temperatures of approximately 100 degrees C a D-value of 6.6 seconds was determined using the organism found the most thermoresistant. A cycle time of 54 seconds appeared sufficient to achieve a 10(6) population reduction of all microorganisms tested. The moist heat technique offers a safe, effective method for disinfection of the inner lumen of CAPD connectors.