Pegylated interferon alfa-2a (40 kD) and ribavirin in haemodialysis patients with chronic hepatitis C.

Background: Chronic hepatitis C virus (HCV) infection is associated with liver dysfunction and hepatocellular carcinoma. In patients with normal kidney function, treatment with pegylated interferon (PEG-IFN) and ribavirin (RBV) frequently leads to eradication of HCV. Treatment in dialysis patients has long been controversial and until recently, the use of RBV was considered to be contra-indicated.

[Three patients with weight loss as a result of sarcoidosis presenting as liver disease].

Sarcoidosis presenting as a liver disease is uncommon. Hepatic sarcoidosis was diagnosed in three male patients aged 80, 64 and 69 years. They all presented with aspecific symptoms such as weight loss.

Atorvastatin and simvastatin in patients on hemodialysis: effects on lipoproteins, C-reactive protein and in vivo oxidized LDL.

Background: Cardiovascular disease as a result of accelerated atherogenesis is common in patients with end-stage renal disease (ESRD). Dyslipidemia may be a major contributor in this process and can be influenced by lipid-lowering drugs (statins). Moreover, statins may exhibit additional inhibitory effects on the atherogenesis, such as a modulation of the immune system as triggered by oxidatively modified LDL and a reduction of the inflammatory marker C-reactive protein (CRP).

Saquinavir soft-gel capsules (Fortovase) give lower exposure than expected, even after a high-fat breakfast.

Background: The soft-gel capsule (sgc) of saquinavir has been developed in order to improve the poor oral bioavailability of the original hard-gel capsules. However, in a Dutch study population using saquinavir-sgc plasma levels were lower than expected. We hypothesised that this was caused by differences in the amount of fat in the meals of the study populations.

Assessment of adherence to HIV protease inhibitors: comparison and combination of various methods, including MEMS (electronic monitoring), patient and nurse report, and therapeutic drug monitoring.

Background: Adherence to protease inhibitor-containing antiretroviral therapy is crucial, but difficult to measure.

Objective: To compare and combine various methods of measuring adherence to the strict protease inhibitor-containing regimens.

Methods: The following methods were used: medication event monitoring system (MEMS) caps (electronic monitoring), therapeutic drug monitoring, pill count, pharmacy refill data, questionnaires, diaries (for registration of food patterns and special events related to the use of MEMS), adherence assessment by the physician and clinical nurse specialist, and in-depth interviews.

Culture negative endocarditis combined with glomerulonephritis caused by Bartonella species in two immunocompetent adults.

Two cases of culture negative endocarditis are presented. In both, Bartonella species could be identified as the causative agent and in one of them Bartonella henselae was very likely. Both cases were accompanied by glomerulonephritis, in one case proven by a kidney biopsy.

Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism.

Objective: To examine whether a reduced daily glucose load by overnight application of the less-absorbed glucose polymer icodextrin would have favorable effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients.

Study Design: Randomized crossover study with two subsequent periods of 6 weeks.

Setting: Home PD unit of a secondary-care hospital.

Hepatic steatosis and lactic acidosis caused by stavudine in an HIV-infected patient.

Lactic acidosis and hepatic steatosis caused by mitochondrial toxicity of nucleoside reverse transcriptase inhibitors (NRTI) is a rare cause of liver disease with a high mortality rate. This report describes a male, HIV-positive patient with a 4-week history of nausea, vomiting and abdominal pain. His medication consisted of prednisone 5 mg od (because of auto-immune thrombocytopenia), didanosine (for 2 years) and stavudine (for 3 months).

[Acute renal insufficiency due to vomiting or diarrhea: the Achilles heel of medical support for heart failure].

Morbidity and mortality of heartfailure are decreasing because of improved medical treatment. The recompensation balance can however be very fragile, which is illustrated by three patients. A woman aged 73 and a man aged 62, both known with heart failure, became seriously ill after diarrhoea; examination revealed uraemia, hyperpotassaemia and raised digitalis levels.

[Open lung biopsy in severely ill patients with unrecognized pulmonary infiltrates].

In three patients, a man aged 34 with aids, a woman aged 67 with recurrent major dyspnoea and a woman aged 73 with chronic lymphatic leukaemia, examination revealed progressive dyspnoea while the chest X-rays showed infiltrative lesions in both lungs. In view of the inadequate response to the treatment administered, an open lung biopsy was performed, following which the diagnosis could be made. Adequate treatment was then started and followed by clinical recovery.

[Chronic hepatitis C in hemodialysis patients].

Hepatitis C virus (HCV) is an important cause of chronic hepatitis in dialysis patients. With regard to epidemiology, the time on haemodialysis, the (previous) use of intravenous drugs as well as the number of blood transfusions received are important risk factors. There are strong indications suggesting nosocomial transmission of HCV.

Cytokine profiles in bronchoalveolar lavage fluid and blood in HIV-seropositive patients with Pneumocystis carinii pneumonia.

Concentrations and ex vivo production of interleukin 1 beta (IL-1), tumour necrosis alpha (TNF), interleukin 6 (IL-6), interleukin-1 receptor antagonist (IL-1RA) and TNF soluble receptors (sTNF-receptors, P55 and P75) were measured in bronchoalveolar lavage (BAL) fluid and blood in 23 HIV-seropositive (HIV+) patients with Pneumocystis carinii pneumonia (PCP) and compared with values found in healthy HIV-seronegative (HIV-) controls and asymptomatic HIV+ subjects. Concentrations of the proinflammatory cytokine IL-1 beta were increased in BAL fluid of HIV+ patients with PCP (184 +/- 47 pg mL-1) compared with undetectable levels in healthy control subjects (P = 0.0001).

Treatment of poor prognosis epidemic Kaposi's sarcoma with doxorubicin, bleomycin, vindesine and recombinant human granulocyte-monocyte colony stimulating factor (rh GM-CSF).

The efficacy and toxicity of doxorubicin, bleomycin and vindesine in epidemic Kaposi's sarcoma, and the role of rh GM-CSF in chemotherapy-induced neutropenia were evaluated in this Phase II study. Patients with progressive Kaposi's sarcoma were eligible, and were staged according to ACTG criteria. Treatment consisted of 20 mg/m2 doxorubicin, and a fixed dose of 15 mg bleomycin and 4 mg vindesine every 2 weeks.

Successful renal autotransplantation for renal failure with prolonged oliguria in a Jehovah's Witness with fibromuscular dysplasia of the renal arteries.

A young female presented with hypertension and oliguric renal insufficiency caused by fibromuscular dysplasia of the renal arteries. There was a left kidney remnant and a normal-sized right kidney with a retrograde blood supply through capsular arteries. Reconstruction of the occluded right renal artery with autotransplantation of the kidney after 60 days of oliguric renal insufficiency was followed by complete functional repair.

Vascular access in continuous arteriovenous hemodiafiltration.

We describe experiences with the use of silicone catheters for continuous arteriovenous hemodiafiltration (CAVHD) in 43 patients in the Intensive Care Unit from July 1991 through March 1993. There were no serious complications with regard to the use of these widebore catheters at introduction, during therapy, or at removal. All patients who needed renal replacement therapy could be treated with CAVHD.

The incidence of subclavian vein stenosis using silicone catheters for hemodialysis.

Complications related to the use of silicone subclavian catheters for hemodialysis were prospectively studied in 21 consecutive patients with acute and chronic renal failure. Between July 1991 and December 1992, 34 double-lumen silicone catheters (Medcomp; 12 French; 20 or 24 cm) were inserted in 21 patients. The mean duration of catheterization was 20 days (range, 2-58 days).

Identification of the component part in an epoetin alfa preparation that causes pain after subcutaneous injection.

The subcutaneous administration of epoetin alfa preparations may cause pain at the injection site. To identify the pain-causing substance in these formulations we performed two double-blind, placebo-controlled, randomized order, cross-over studies. Differences in pain experienced after subcutaneous injection of an epoetin alfa solution and its vehicle were assessed in 36 patients.

[Surgical complications in treatment with continent ambulatory peritoneal dialysis; 9-year experience].

Objective: To determine the number of surgical complications in patients treated with continuous ambulatory peritoneal dialysis (CAPD).

Design: Retrospective (1980-1989), partially prospective (1987-1989).

Setting: Rijnstate Hospital, Arnhem, the Netherlands.

[9-year experience with continuous ambulatory peritoneal dialysis in one center].

The experience gained with CAPD in a group of 101 patients with terminal renal failure and a subgroup of 19 patients with diabetes mellitus was analysed. The actuarial patient survival was 81% after two years and 50% after five years. The combined patient-technique survival after two years was 48.

[Experience with continuous arteriovenous hemodiafiltration for acute kidney insufficiency in intensive care patients].

Acute renal failure is a frequent complication at the Intensive Care Department. For this complication dialysis is often necessary. In our Intensive Care Department we have opted for continuous arteriovenous hemodiafiltration (CAVHD) as the treatment of first choice for patients with acute renal failure.

Continuous ambulatory peritoneal dialysis (CAPD) in patients with diabetic nephropathy.

A 3-centre study was done to analyse the results of 70 patients with end-stage renal disease caused by diabetic nephropathy and treated with CAPD. Fifty patients had insulin-dependent diabetes (mean age 42, mean duration of diabetes 24 yr); 20 had non-insulin-dependent diabetes (mean age 61, mean duration 15 yr). Total treatment time was 1563 months and ranged from one to 83 months (median 18).

Urine cytology as a screening method for transitional-cell carcinoma in dialysis patients with analgesic nephropathy.

The abuse of analgesic-containing drugs leads to chronic nephropathy with an increased risk of developing a transitional-cell carcinoma of the urinary tract. In our experience follow-up is often stopped or has never been started when patients present for dialysis. We use urine cytology as the screening method.