[Tunnelled internal jugular vein catheters with taurolidine lock: an acceptable challenge to arterio-venous fistula in 70 years old haemodialyzed patients: a prospective pilot study]. / Les cathéters jugulaires internes tunnellisés avec verrou antiseptique par taurolidine : une alternative acceptable aux fistules artérioveineuses chez les hémodialysés de plus de 70ans : résultats d'une étude pilote prospective.

Arteriovenous fistula (AVF) is still in 2010 the gold standard of vascular(2) access in haemodialysis (HD) patients. Nevertheless it may be difficult to obtain and/or to use AVF in elderly. With this prospective randomised pilot study, we compare two strategies of vascular access in 70 years old or more new HD patients. AVF were compared to tunnelled jugular vein catheters (TIJC) with taurolidine as bacterial lock solution. Results were as follow: [table: see text] The responses with the visual analogic scale of comfort was 8/10 for TIJC and 5/10 with AVF * P<0.05. In five TIJC patients, heparin was added with success to taurolidine because of partial clotting of catheters. Albuminemia was significantly lower in AVF failure patients compared to AVF success patients (24.8g/L vs 31.1g/L). This pilot study allows to conclude that TIJC is an acceptable challenge to AVF in haemodialysed patients of 70 years or more in a two years long use.

[Sclerosing encapsulating peritonitis: current features]. / La sclérose péritonéale encapsulante: aspects actuels.

We report three original cases of sclerosing encapsulating peritonitis (SEP) which is a rare but severe complication of peritoneal dialysis (PD). In the report of case 1, SEP occurred in a 75-year-old diabetic patient mellitus 18 years after the arrest of PD technique recurrent infectious peritonitis. The switch to hemodialysis was associated with a chronic inflammatory state poorly explained until the discovery of SEP. For case 2, SEP started within seven months after automated PD initiation in a severe septic context leading to leg amputation in a 57-year-old unstable diabetic male. In the last case, 84-year-old woman presented SEP after several peritonitis episodes, including one due to acute pancreatitis. In all cases, SEP was confirmed by open surgery. All patients were treated by visceralysis. The outcome was favorable in two of these three patients. SEP mechanisms, risks factors, prognosis and treatment are discussed with reference to the literature.

Using detachment-promoting agents for the prevention of chronic peritoneal dialysis-associated infections.

Biofilms are known to be responsible for chronic peritoneal dialysis (PD)-related infections. Such infections are still frequent among patients in PD. The aim of this study was to develop a new approach in the prevention of chronic PD-related infection by regular injection of specific formulations containing detachment-promoting agents. A biofilm reactor system reproducing PD-like operating conditions was developed. A first set of experiments allowed the assessment of the anti-biofilm efficacy of various formulations. Then, experiments were performed for a longer duration and selected formulations were tested and compared with taurolidine. Biofilm removal was quantified by calculating the percentage of coverage reduction compared with an untreated control. A regular weekly treatment led to a 97% reduction of the surface coverage although a daily treatment with taurolidine still left 48% of the biomass on the surface. Such treatment is recommended to reduce the frequencies of chronic PD-related infections.