The global atmospheric environment for the next generation

Air quality, ecosystem exposure to nitrogen deposition, and climate change are intimately coupled problems: we assess changes in the global atmospheric environment between 2000 and 2030 using 26 state-of-the-art global atmospheric chemistry models and three different emissions scenarios. The first (CLE) scenario reflects implementation of current air quality legislation around the world, while the second (MFR) represents a more optimistic case in which all currently feasible technologies are applied to achieve maximum emission reductions. We contrast these scenarios with the more pessimistic IPCC SRES A2 scenario. Ensemble simulations for the year 2000 are consistent among models and show a reasonable agreement with surface ozone, wet deposition, and NO2 satellite observations. Large parts of the world are currently exposed to high ozone concentrations and high deposition of nitrogen to ecosystems. By 2030, global surface ozone is calculated to increase globally by 1.5 +/- 1.2 ppb (CLE) and 4.3 +/- 2.2 ppb (A2), using the ensemble mean model results and associated +/-1 sigma standard deviations. Only the progressive MFR scenario will reduce ozone, by -2.3 +/- 1.1 ppb. Climate change is expected to modify surface ozone by -0.8 +/- 0.6 ppb, with larger decreases over sea than over land. Radiative forcing by ozone increases by 63 +/- 15 and 155 +/- 37 mW m(-2) for CLE and A2, respectively, and decreases by -45 +/- 15 mW m(-2) for MFR. We compute that at present 10.1% of the global natural terrestrial ecosystems are exposed to nitrogen deposition above a critical load of 1 g N m(-2) yr(-1). These percentages increase by 2030 to 15.8% (CLE), 10.5% (MFR), and 25% (A2). This study shows the importance of enforcing current worldwide air quality legislation and the major benefits of going further. Nonattainment of these air quality policy objectives, such as expressed by the SRES-A2 scenario, would further degrade the global atmospheric environment.

Growing bone cysts in long-term hemodialysis

All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven.

Balloon angioplasty of venous structures

Percutaneous transluminal angioplasty was attempted in 20 patients with stenoses of venous structures. It concerned one stenosis in a native subclavian vein, 12 stenoses in venous bypass grafts and 7 stenoses in hemodialysis-access fistulas. Primary results were excellent for the procedures in the native vein and the venous bypass grafts with success in all patients (13/13). In the arteriovenous fistulas for hemodialysis, dilatation of the venous stenoses was only possible in 5 out of 7 patients. The subclavian vein stenosis did not recur within a follow-up period of 3 years. Of the stenoses in the venous bypass grafts, two lesions reoccluded within one week and 6 lesions recurred within one year. Two of these lesions were successfully redilated so that 6 lesions remain patent with a follow-up of more than one year. Of the 5 successful dilatations in hemodialysis-access fistulas, two lesions recurred within 2 months. Only 3 veins are still accessible for hemodialysis. It is concluded that attempts at balloon dilatation of stenoses in venous bypass grafts or hemodialysis-access fistulas are meaningful in order to prolong the life of these surgical procedures. Recurrence of stenoses is however likely to occur within one or two years.

Haemostatic effects of recombinant human erythropoietin in chronic haemodialysis patients

Recombinant human erythropoietin was administered for up to 40 weeks to nine patients on chronic haemodialysis. From the third week of administration onwards, not only haemoglobin and haematocrit but also the platelet count rose, the latter, however, transiently. Subnormal platelet aggregation before therapy also improved transiently and in parallel with the erythropoietin dosage. The bleeding time normalized in almost all patients. There were no major side-effects. We conclude that recombinant erythropoietin improves haemostasis in chronic haemodialysis patients by increasing the haematocrit and in addition transiently enhances platelet number and function.

Renal cadaveric transplantation in diabetics using total lymphoid irradiation or cyclosporin A. A controlled randomized study. Leuven Collaborative Transplantation Group

A total of 20 renal transplant patients with end-stage diabetic nephropathy entered a randomized controlled trial comparing preoperative, fractionated total lymphoid irradiation (TLI) (radiation dose, 20-30 Gy) with postoperative cyclosporin A (CsA). Both groups received postoperative low-dose methylprednisolone maintenance therapy. The 3-year patient and graft survival was similar for both groups (100% and 71% in the TLI and 75% and 75% in the CsA group, respectively). Rejection crises occurred significantly more frequently (P less than 0.01) in the TLI-treated recipients. The incidence of infectious or diabetic complications was not significantly different in both groups. It is concluded that TLI and CsA are both effective treatment modalities for cadaveric renal transplantation in diabetics; CsA, however, is superior in preventing rejection crises.

Candida parapsilosis in a patient receiving chronic hemodialysis

A case of Candida parapsilosis involving the left wrist in an immunocompromised host is described. The arthritis followed an indolent course, present for about 1 year before specific treatment was started. There was no response to 2-month ketoconazole therapy, and an open drainage had to be performed. In addition to crystal arthropathies and the more common infectious arthritides, one should be aware of arthritides with opportunistic microorganisms in immune compromised hemodialysis patients.

Infections caused by Kingella kingae: report of four cases and review

Kingella kingae, formerly known as Moraxella kingae, is a fastidious, non-motile, coccobacillary, fermentative Gram-negative rod that has been chiefly associated with two types of infections in man: bone and joint infections, and endocarditis. We describe four patients with K. kingae infections, one with septicaemia, two with endocarditis, and one with osteoarthritis. The current literature on infections with K. kingae is reviewed.

Protein-losing enteropathy in systemic lupus erythematosus

A 33-year-old woman presented a recurrent steroid-sensitive protein-losing enteropathy as the major manifestation of systemic lupus erythematosus. An increased capillary permeability for proteins is considered to be the most likely explanation.

Sclerosing peritonitis with mural bowel fibrosis in a patient on long-term CAPD

A 66 year old white woman developed an incomplete small-bowel obstruction after 3 years of CAPD with lactate containing solutions. There were six episodes of peritonitis. The bowel obstruction was not due to a "sclerosing obstructive" (encapsulating) peritonitis but to a diffuse sclerosis of the serosal membranes extending into the muscle layers of the small and large bowels ("mural fibrosis"). This picture may be just one other expression of a spectrum of structural changes resulting from long-term chronic irritation of the abdominal cavity.

Recurrent hemolytic uremic syndrome during oral contraception

A 23-year-old multiparous normotensive woman developed a hemolytic uremic syndrome (HUS) five months postpartum, and four months after starting estro-progestogen contraception. Eight years later a recurrence appeared, five years after a successful cadaver kidney transplantation and ten months after resumption of the estro-progestogen intake. In the interval a pure progestogen contraceptive was prescribed without problems. This observation is consistent with the hypothesis that HUS can be triggered by oral estrogen intake in predisposed individuals.

Silicon nephropathy: a possible occupational hazard

A 37-year-old white male, working in a tile factory, presented proteinuria with no obvious tubular dysfunctional. Renal biopsy disclosed a mild focal segmental proliferative glomerulonephritis. Distinct alterations were found by electron microscopy, especially in the proximal tubular cells. Because of a history of heavy dust exposure the silicon content was determined in the kidney biopsy tissue. The finding of 150 mg/kg silicon on tissue dry weight supports the diagnosis of silicon nephropathy.

Glomerulonephritis in late-onset cystinosis. Report of two cases and review of the literature

This paper describes the clinical history of two male nontwin siblings with late-onset cystinosis, a variant of cystine storage disease. The diagnosis was established clinically and confirmed by measurement of cystine concentrations in leucocytes and skin-fibroblasts. Both patients presented with an incomplete nephrotic syndrome and renal biopsy showed, in addition to lesions of polykaryocytosis, a picture of focal and segmental glomerular hyalinosis. Renal function was stable in one patient over a follow-up period of two years; the other patient progressed toward terminal renal failure and was successfully transplanted.