Serum levels of ICAM-1, VCAM-1, and MCP-1 are increased in HD patients and probably result from either inadequate clearance or enhanced synthesis and release. HD session resulted in a significant increase of the above molecule levels but the exact mechanism(s) responsible for these alterations are yet to be fully elucidated. Increased levels of adhesion molecules are associated with inflammation, dyslipidaemia, and cardiovascular events. However, the potential link between these processes and its clinical significance warrants further investigation.

Toxic epidermal necrolysis (TEN) or Lyell's syndrome is a rare fulminating skin disease notorious for its rapidly progressive course and high mortality rate. TEN is characterized by the sudden onset of epithelial necrosis of skin with frequently associated involvement of the gastrointestinal, genitourinary tract and bronchopulmonary linings. We describe the clinical course of five patients with severe drug-induced TEN, treated with PE. The suspected drugs were carbamazepine in one patient, paracetamol in one, a combination of paracetamol and mefenamic acid in one, allopurinol in one and ciprofloxacin in one. Three had a skin involvement affecting almost the entire surface of the body. In addition to the skin lesions, mouth, esophagus and lungs were also involved. Steroids proved ineffective. PE was carried out because of the rapid deterioration of the clinical picture. The mean number of PE sessions was 3.22 (range 1-5). Complete remission of the syndrome was achieved in four patients. One patient died due to septic shock. As so far there is no treatment of proven value for this condition, controlled trials should be set up in order to assess the value of PE in TEN.

Objective The aim of this study was to find out whether prosthetic mesh repair of recurrent and large abdominal hernias in continuous ambulatory peritoneal dialysis (CAPD) patients is effective in maintaining them on CAPD. Design Retrospective analysis of case notes over a period of 5 years. Setting Single renal unit of a university hospital. Patients Forty-six of 217 CAPD patients (16%) had their hernias repaired. Among them, 5 women in whom hemodialysis was not possible had multiple or large hernias repaired with polypropylene (PP) mesh. Results Radical repair was achieved by a modified operation consisting of a conventional hernioplasty complemented by a supporting prosthetic overlay mesh, without discontinuation of CAPD. The patients continued CAPD for a mean period of 17.6 months without hernia recurrence. Two patients died in the twelfth and fifteenth postoperative month due to cardiac arrest and hepatic failure, respectively, and the remaining 3 are alive and have been doing well on CAPD for 13, 14, and 21 months. Conclusions Prosthetic mesh repair of large recurrent hernias in CAPD patients with vascular access problems seems to be a valuable method to maintain them on this renal replacement therapy.

The clinical characteristics of 118 patients (60 male) with acute renal failure (ARF) admitted between 1980 and 1991, were retrospectively analyzed and compared with our earlier series of the 1960s. The mean age was 53 years (16-82 years). There was a marked decline in the hypotension-related cases (43% vs. 17%, p < 0.01) and a concomitant increase in the nephrotoxic cases (5% vs. 17%, p < 0.005) in recent years. The number of ARF cases significantly decreased after 1986 (31%) compared to the pre-1986 era (69%, p < 0.001). A complete (35%) or partial recovery (55%) was the rule in the majority of the patients. The overall mortality was 27%, virtually unchanged in comparison to the 1960s (30%). However, a tendency toward lower mortality was seen after 1986 (17%) in comparison to before (32%, p < 0.05). Sepsis and cardiovascular complications were the leading causes of death. Fewer deaths were observed among younger patients (< 30 years, 12.5%) compared to middle-aged patients (30-59 years, 34%, p < 0.05) and to these older than 60s (53.5%, p < 0.002). Also, deaths were rare in patients with only renal involvement (6%), increasing to 30% when 2 vital organ systems were affected (p < 0.005) and to 67% in cases with multiple organ failure (p < 0.001). Early institution of dialysis and the nonoliguric forms of the syndrome seem to be associated with better prognosis. In conclusion, the incidence of ARF has declined in recent years, with a concomitant tendency towards lower mortality. Death rate is mainly determined by the age and the number of organ involvement. Early dialysis seems to contribute to the lower mortality seen in recent cases.