Peritoneal dialysis underscores its merits in portal hypertensionrelated and nephrogenic ascites.

In the Western world, peritoneal dialysis (PD) is less frequently applied as substitute therapy in end-stage renal disease (ESRD). In the Netherlands the use of PD has decreased from 30.3 to 13.5% due to several factors, but not due to lower PD-related outcome. The lower penetrance of PD diminishes experience with and exposure of young professionals to this treatment modality. This does not enhance a free and motivated choice among renal replacement therapies for patients who cannot be transplanted pre-emptively. To rejuvenate interest in PD and to underscore its merits, we would like to share the use of PD on two extraordinary occasions, where PD was the only way out. Ascites due to portal hypertension with profound gastrointestinal haemorrhage and nephrogenic ascites poses major management challenges in ESRD patients. In conclusion, PD came to the rescue and tremendously increased quality of life in the patients presented. To be readily available, a certain penetrance of and expertise in PD as renal replacement therapy is warranted.

Aortic aneurysm and orchitis due to Wegener's granulomatosis.

We present a patient with Wegener's granulomatosis (WG) with involvement of the abdominal aorta, testis, peripheral nerve system, and skin. A 51-year-old man presented at our outpatient clinic with lower back pain. He had a history of smoking, hypertension, and an embryonal carcinoma of the left testis, treated 13 years ago with orchidectomy and chemotherapy. One month earlier, he underwent a partial orchidectomy of the right testis due to testicular swelling. Abdominal computed tomography showed a 3.8 cm wide aneurysm of the distal part of the aorta with inflammation. One week later he was admitted to the hospital with numbness of his hands and feet. Physical examination showed signs of peripheral microemboli. Serological laboratory tests revealed elevated antineutrophil cytoplasmic antibody titers with positive reactions against proteinase-3, indicating Wegener's disease. The chest X-ray was normal. Pathological examination of the right testis showed necrotizing vasculitis of a small artery. He was treated with cyclophosphamide and prednisolone. WG with extrapulmonary involvement occurs infrequently, and reports of manifestations of WG in aorta, testis, the peripheral nerve system, and skin are even more uncommon. Small- and medium-vessel vasculitis can precede large-vessel vasculitis or occur in the absence of small-vessel involvement. Therefore, WG should be included in the work-up of large-vessel vasculitis, which can give rise to periaortic inflammation.

Concentrations of testosterone and androsterone in peripheral and umbilical venous plasma of fetal rats.

Mean +/- s.d. testosterone concentrations in the peripheral plasma of 21- and 22-day-old male fetuses (1.32 +/- 0.43 ng/ml) were significantly (P less than 0.05) higher than those in the umbilical venous plasma (0.37 +/- 0.08 ng/ml). Testosterone concentrations in umbilical venous plasma of male and female (0.29 +/- 0.06 ng/ml) fetuses and in peripheral plasma of female fetuses (0.36 +/- 0.10 ng/ml) were not significantly different. Androsterone levels measured in umbilical venous plasma of male (11.5 +/- 2.5 ng/ml) and female (12.3 +/- 2.1 ng/ml) fetuses were nearly as high as those in peripheral plasma (males, 12.9 +/- 3.1; females, 13.3 +/- 3.5 ng/ml). There were high concentrations of androsterone in the placentas of male (33 +/- 4 ng/g) and female (33 +/- 5 ng/ml) fetuses, suggesting that this organ is the major source of fetal androsterone. We also conclude that a major part of the testosterone present in female fetuses is secreted by the placentas.