Epidemiology and antimicrobial resistance of Streptococcus pneumoniae in France in 2007: data from the pneumococcus surveillance network.

Antimicrobial resistance of Streptococcus pneumoniae in France is closely monitored by the pneumococcus surveillance network, founded in 1995, which collects data from regional observatories (Observatoire Régionaux du Pneumocoque [ORP]). In 2007, 23 ORPs analyzed the antibiotic susceptibility of 5,302 isolates of S. pneumoniae recovered in France from cerebrospinal fluid, blood, middle ear fluid, and pleural fluid, as well as from adult respiratory samples.

Association between scleroderma, renal cell carcinoma and membranous nephropathy.

We report a patient with scleroderma, renal cell carcinoma (RCC) and membranous nephropathy (MN). Certain clinical and laboratory features suggested that RCC caused or enhanced the other two conditions. A 55-year-old man developed scleroderma which progressed rapidly during its first 2 years with development of hypertension and acute renal failure, peak serum creatinine (SCr) 327 micromol/l (3.

Management of extreme azotemia from urinary tract obstruction without dialysis. Clinical correlates and kinetic modeling of the recovery of renal function.

The recovery of renal function following release of urinary tract obstruction with advanced azotemia determines both the need for emergency dialysis in the early post-obstructive period and the long-term planning for chronic kidney disease management. A man with prostatic cancer who presented with 16 days of anuria and a serum creatinine (Scr) of 42.7 mg/dl but had evidence suggesting residual renal function was managed conservatively and reached a steady-state Scr of 1.

Pyocystis in patients on chronic dialysis. A potentially misdiagnosed syndrome.

Pyocystis is an important complication of non-functioning urinary bladder, which often poses diagnostic difficulties. We present a case of pyocystis in a patient on chronic hemodialysis who was anuric for one year. The patient was initially diagnosed with diverticulitis.

Percutaneous removal of spilled gallstones in a subhepatic abscess.

Abscess formation from spilled gallstones after laparoscopic cholecystectomy is infrequent. However, if an abscess does form and contains the spilled stones simple percutaneous drainage will not resolve the dilemma of a recurrent abscess. Open drainage has previously been recommended to remove the retained stones and decrease recurrent abscess formation.

Symptomatic ascites after discontinuation of continuous peritoneal dialysis.

Objective: To analyze pathogenetic associations, clinical features, management, and outcome of ascites following discontinuation of continuous peritoneal dialysis (CPD).

Design: Retrospective analysis of symptomatic ascites, defined as ascites requiring at least one therapeutic paracentesis, developing in patients who discontinued CPD.

Setting: Dialysis unit of one tertiary care center.

Magnetic resonance microscopy of water diffusion and edema during hypothermic preservation of rat kidneys.

Kidney degradation during hypothermic storage was studied on rat kidneys, using magnetic resonance microscopy. Poor storage, modeled by storage with lactated Ringer's solution, resulted in rapid kidney swelling, together with increased signal intensity and water diffusion coefficient in the cortical and medullary regions. Storage of kidneys in Euro-Collins solution resulted in slower swelling and no significant change in signal intensity and in the water diffusion coefficient.

Peritonitis associated with intra-abdominal pathology in continuous ambulatory peritoneal dialysis patients.

Features helpful in diagnosis and associated with death were evaluated in 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) in continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, increasing free air in the abdominal cavity) were infrequently found.

Persistence of positive dialysate cultures after apparent cure of CAPD peritonitis.

Clinical features, diagnosis and outcomes of persistently positive dialysate culture (PPDC) after apparent cure of continuous ambulatory peritoneal dialysis (CAPD) peritonitis were investigated in 16 PPDC episodes observed in 16 elderly (age 62 +/- 8 years) men who had been on CAPD for 14 +/- 9 months. Seven patients (46.7%) were diabetic.

Intraperitoneal thrombolytic agents in relapsing or persistent peritonitis of patients on continuous ambulatory peritoneal dialysis.

Urokinase or streptokinase was instilled intraperitoneally as an adjunct to the antibiotic therapy in 16 episodes of relapsing or persistent peritonitis in CAPD patients. In eight patients the combination of antibiotics and intraperitoneal thrombolytic agents resulted in clearing of the infection with no recurrences. The treatment failed in eight other patients, who had their peritoneal catheters removed.

Renal scintigraphy in the diagnosis and surgical management of a patient with caliceal colic: a case report.

A patient with persistent renal colic and a caliceal stone is presented. Furosemide renography, commonly used to differentiate functional stasis from mechanical obstruction of an entire kidney or duplicated collecting system, can make this determination at the caliceal level. As in this case such determination can affect clinical management of the patient.

Nephrotic syndrome and rapid renal failure in autosomal dominant polycystic kidney disease.

A 44-year-old man, with autosomal dominant polycystic kidney disease and hypertension under satisfactory control, developed nephrotic syndrome with negative serology. Open renal biopsy revealed focal glomerular sclerosis. Prior to the appearance of heavy proteinuria, serum creatinine was 1.

Early and late peritoneal dialysate leaks in patients on CAPD.

Dialysate leaks, which occurred in 386 CAPD patients over 11 years, were analyzed retrospectively. 18 patients developed 21 early leaks (within 30 days of catheter insertion) and 18 patients developed 28 late leaks (beyond 30 days of catheter insertion). 8 patients had multiple (2-6) leaks.

Vascular disease: the critical risk factor for mortality in older patients on CAPD.

Clinical course, complications and outcome were analyzed in 75 patients (14 women, 61 men) who started CAPD at age 55 years or older (55-81). These patients were separated in three groups. Group A patients had high risk for vascular disease (diabetes, hypertension, N = 45), group B patients had a presumed lower risk for vascular disease (primary renal disease, N = 22), and group C patients had miscellaneous conditions (N = 8).

Clinical significance of hemodialysis performed during the course of continuous ambulatory peritoneal dialysis.

We analyzed causes and clinical associations of hemodialysis performed during the course of CAPD in 71 patients (34 diabetic) on CAPD between 1978 and 1988. Thirty seven patients had at least one hemodialysis during CAPD. Causes (multiple for some patients) included poor compliance with CAPD (20 patients), peritoneal catheter loss from infection (16 patients), and miscellaneous other conditions (18 patients).

Soft tissue complications of Tenckhoff catheters.

Soft tissue complications (STC) involving the catheter tract and exit site continue to be a significant source of morbidity (40%) and cause for catheter removal (8%). Inner cuff infections, accompanied by peritonitis and managed with catheter removal, occurred in 6% of catheters. All other STC can be managed without catheter removal.