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AIM: The aim of the present study was to compare different disinfection techniques for the peritoneal dialysis bag medication port (MP). METHODS: An experimental study was conducted testing different cleaning agents (70% alcohol vs 2% chlorhexidine) and time periods (5, 10 and 60 s) for disinfection of the MP. Five microorganisms (S. aureus, E. coli, A. baumannii and C. parapsilosis, CNS) were prepared for use as contaminants of the MP. MP were incubated in Tryptic soy broth at 36°C for 24 h, after which, they were seeded on a Biomérieux blood agar plate and incubated for 24 h at 36°C. RESULTS: Three hundred peritoneal dialysis bags were analyzed regarding the time expose to the disinfectant showed a statistically significant difference in the number of culture positive (7/100) P = 0.001; Gram positive (6/100) P = 0.006 for 5 s, one positive culture and turbid bag with 10 s, while friction for 60 s showed all negative results. The comparison between disinfectant, alcohol or chlorhexidine, 150 bag in each group, showed that the ones disinfected with alcohol had five turbid bags, eight positive cultures and seven germs identified, while all bags disinfected with chlorhexidine were negative for all parameters, with a difference statistically significant (P = 0.004). CONCLUSION: Our results suggest that the MP should be scrubbed with 2% chlorhexidine for at least 5 s; if alcohol 70% is used the length of friction should not be inferior to 10 s.

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During long-term exposure to continuous ambulatory peritoneal dialysis (PD), the characteristics of the peritoneal membrane may be altered. The substrate for nitric oxide synthesis is L-arginine, which may enter cells via the y+ and y+L transport systems. Peritoneal membrane characteristics may depend on vascular function and the L-arginine-NO pathway. Maximal capacity for L-arginine transport is higher in patients with a lower dialysis adequacy index. Our aim was to evaluate erythrocyte L-arginine uptake in PD patients at the start and end of a 3-year interval. Our longitudinal study evaluated 8 stable patients on PD who were not using NO donors and who had been free of peritonitis for at least 1 month. Uptake of L-arginine was measured in 2003 and again in 2006. Maximal transport capacity (Vmax, in micromoles per liter-cells per hour) and half-saturation constant (km, in micromoles per liter) were measured in erythrocytes using 14C as a marker and N-ethylmaleimide as inhibitor of the y+ system. For the years 2003 and 2006 respectively, mean +/- standard deviation for total L-arginine uptake Vmax was 749 +/- 182 micromol/L-cells/h and 1146 +/- 365 micromol/L-cells/h (p = 0.016, paired t-test),for y+L Vmax was 180 +/- 58 micromol/L-cells/h and 515 +/- 142 micromol/L-cells/h (p = 0. 002), and for y+ Vmax was 556 +/- 177 micromol/L-cells/h and 662 +/- 267 micromol/ L-cells/h (nonsignificant). The total y+L and y+km were not significantly different. The L-arginine maximal uptake capacity in erythrocytes increased after 3 years of PD treatment. These findings agree with the suggestion of an association between y+L activity and dialysis adequacy or uremia toxicity. Peritoneal membrane characteristics may depend on vascular function and the L-arginine-NO pathway.

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Epidermolysis bullosa acquisita (EBA) is a subepidermal autoimmune blistering disease that is rarely reported in childhood. We describe a nine-month-old mulatto boy presenting with multiple, annular, widespread, tense blisters and oral lesions. The diagnosis of EBA was confirmed by histopathology, immunofluorescence, and immunoblotting analysis. The patient was successfully treated with systemic steroids (prednisone) and dapsone. After 20 months of initial treatment, clinical remission was observed, and dapsone remains as the current treatment. This case report emphasizes the rarity of EBA in childhood and the difficulties in reaching the final diagnosis.

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The present study evaluates the influence of the preceding exchange on peritoneal equilibration test (PET) results in patients on automated peritoneal dialysis (APD). A standard PET was performed following a 24-hour CAPD period with a preceding long overnight dwell of 8-10 hours (PETST), and following the usual APD regimen with short overnight dwell (PETAPD). We evaluated 9 patients of mean age 59 +/- 18 years. Mean time on peritoneal dialysis was 31 +/- 17 months, and mean APD duration was 15 +/- 11 months. Mean D/P creatinine at 4 hours was 0.77 +/- 0.12 (PETST) and 0.77 +/- 0.13 (PETAPD, p = 0.901). Mean D/D0 glucose was 0.33 +/- 0.07 (PETST) and 0.36 +/- 0.09 (PETAPD, p = 0.347). A significant correlation was seen between the D/P creatinine ratios (r = 0.946, p < 0.001) for the two PET methods and the D/D0 glucose ratios (r = 0.554, p = 0.017) for the two PET methods. Transport classification did not change in any patient. The current data support the use of the PET for peritoneal membrane evaluation immediately after cycler therapy in APD patients. We suggest that there is no need to change the dialysis regimen to a long dwell for the preceding exchange to evaluate peritoneal membrane characteristics when D/P creatinine and D/D0 glucose ratios are measured.

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O xantoranuloma necrobiótico é forma rara de histiocitose não Langerhans caracterizada por placas enduradas e nódulos de cor eritêmato-amarelada, com distribuição preferencial nas regiões palpebrais, no tronco e nos membros. Habitualmente associa-se à paraproteinemia e pode cursar com acometimento sistêmico. Descreve-se o caso de um doente do sexo feminino, de 64 anos, com quadro clínico exclusivamente cutâneo até o momento e boa resposta terapêutica ao clorambucil

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