Delayed initiation of breast-feeding, deprivation from colostrum and improper weaning are significant risk factors for undernutrition among under-fives. There is need for promotion and protection of optimal infant feeding practices for improving nutritional status of children.

We evaluated the efficacy of the Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) banding procedure in treating dialysis-associated steal syndrome or high-flow access problems. A retrospective analysis was conducted, evaluating banding of 183 patients of which 114 presented with hand ischemia (Steal) and 69 with clinical manifestations of pathologic high access flow such as congestive heart failure. Patients were assessed for technical success and symptomatic improvement, primary and secondary access patency, and primary band patency. Overall, 183 patients underwent a combined 229 bandings with technical success achieved in 225. Complete symptomatic relief (clinical success) was attained in 109 Steal patients and in all high-flow patients. The average follow-up time was 11 months with a 6-month primary band patency of 75 and 85% for Steal and high-flow patients, respectively. At 24 months the secondary access patency was 90% and the thrombotic event rates for upper-arm fistulas, forearm fistulas, and grafts were 0.21, 0.10, and 0.92 per access-year, respectively. Hence, the minimally invasive MILLER procedure appears to be an effective and durable option for treating dialysis access-related steal syndrome and high-flow-associated symptoms.

Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients.Background. Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is associated with higher mortality in these patients. In this study, we have prospectively examined the relationship of bioimpedance indexes to the nutritional status and survival in PD patients.Methods. We enrolled 48 PD patients beginning in November 2000. On enrollment, bioelectrical impedance analysis (BIA) (BIA-101; RJL/Akern, Clinton Township, MI, USA) was performed and monthly blood was analyzed for biochemical markers, including prealbumin. Patients were followed until April 2003.Results. The mean age of PD patients was 51 Ϯ 15 (SD) years. Fifty-eight percent of the patients were female and 23% of the patients were diabetic. Mean body mass index (BMI) was 25.7 Ϯ 5.0 kg/m 2 . Mean resistance, reactance, and phase angle were 521 Ϯ 104 ohms, 57 Ϯ 19 ohms, and 6.16 Ϯ 1.6 degrees, respectively. During the study period, 8 patients (17%) expired. The Kaplan-Meier method was used to compute observed survival. The cumulative observed survival of PD patients with enrollment phase angle greater than or equal to 6 degrees was significantly higher (P ϭ 0.008) than that of patients with phase angle less than 6. Using Cox's multivariate regression analysis, phase angle was an independent predictor (relative risk ϭ 0.39, P ϭ 0.027) of more than two years' survival in PD patients. Serum prealbumin was directly correlated with phase angle (r ϭ 0.54, P Ͻ 0.0001), reactance (r ϭ 0.55, P Ͻ 0.0001), and resistance (r ϭ 0.29, P ϭ 0.06).Conclusion. BIA indexes reflect nutritional status and may be useful in monitoring nutritional status in PD patients. Phase angle is a strong prognostic index in PD patients. It is useful to incorporate prealbumin and BIA parameters in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and overall health status.Bioelectrical impedance analysis (BIA) is a quick, inexpensive, safe, and noninvasive method for estimating body composition and nutritional status in various patient populations [1][2][3][4][5]. The use of BIA to measure body

Dialysis-associated steal syndrome (DASS) is defined as a clinical condition caused by arterial insufficiency distal to the dialysis access owing to diversion of blood into the fistula or graft. The incidence of symptomatic DASS requiring treatment is 1-8%. The etiology is iatrogenic and symptoms are quite debilitating. Banding of the access inflow has largely been abandoned because of the inherent problem with balancing fistula flow with distal flow complicated by a high incidence of subsequent access thrombosis. In this study, we are reporting a modification to the traditional banding procedure, which markedly improves banding outcomes. We are reporting 16 patients who underwent a new standardized minimally invasive banding procedure performed in an outpatient setting with minimal morbidity. This modified banding procedure requires a small (1-2 cm) skin incision for the placement of a ligature and utilizes a 4 or 5 mm diameter endoluminal balloon to achieve and standardize the desired reduction of inflow size. All 16 patients had immediate symptomatic and angiographic improvement after the procedure. Follow-up showed none of the patients had recurrence of symptoms or thrombosis of the access. In our experience, this procedure is an excellent treatment option because of its simplicity and should be considered as a first-line treatment for patients with DASS.

Fistula salvage attempts should not be limited by factors such as a diffusely small diameter or an inaccessibly deep position.