phenylephrine-hydrochloride and Cutaneous-Fistula

Catheter-related infections remain a significant cause of method failure in chronic peritoneal dialysis (PD) therapy. Given the increasing antibiotic resistance, such nonpharmacological strategies as local silver devices attract more interest. To establish whether a silver ring device (designed by Grosse-Siestrup in 1992) mounted onto the PD catheter and placed at the exit site at skin level is effective in preventing exit-site and other catheter-related infections, a prospective 12-month, multicenter, controlled study stratified by diabetes status was conducted. The study subjects were assessed by an extensive structured inventory, including a broad spectrum of control variables, such as age, body mass index (BMI), Staphylococcus aureus carrier status, catheter features, mode and quality of PD therapy, comorbidity, and psychosocial rehabilitation. Ten experienced German outpatient dialysis centers (seven adult, three pediatric) participated in the trial. All eligible patients (n=195) from the study area without catheter-related infections during the ascertainment period were included (incidental subjects undergoing PD therapy for at least 3 months). The main outcome measures were the occurrence of first exit-site infections (primary study end point), sinus tract/tunnel infection, and peritonitis. Ninety-seven patients were assigned to the silver ring and 98 patients to the control group. Baseline characteristics of age, sex, proportion of pediatric and incidental patients, S aureus carrier status, and other variables were similar in both groups. The incidence of infections in the silver ring group versus the control group was as follows: 23 of 97 versus 16 of 98 patients had exit-site infections, 12 of 97 versus 12 of 98 patients had sinus tract/tunnel infections, 16 of 97 versus 18 of 98 patients had peritonitis, respectively. Kaplan-Meier analysis for the probability of an infection-free interval showed no statistical difference (log-rank test) between the two groups. Displacement of the silver ring contributed to study termination in 6% of the study group patients, including two patients with catheter loss. Univariate analysis and multiple logistic regression identified younger age (<50 years), low serum albumin level (<35 g/L), number of previously placed PD catheters, short cuff-exit distance (<2 cm), and S aureus nasal carriage as risk factors for the development of exit-site infections. In conclusion, our study does not show any benefit of the sil

Topics: Adult; Age Factors; Analysis of Variance; Anti-Bacterial Agents; Bacterial Infections; Body Mass Index; Catheters, Indwelling; Child; Cutaneous Fistula; Diabetic Nephropathies; Equipment Design; Female; Humans; Incidence; Logistic Models; Male; Middle Aged; Nose; Peritoneal Dialysis; Peritonitis; Prospective Studies; Risk Factors; Serum Albumin; Silver; Staphylococcus aureus; Treatment Outcome

Topics: Cutaneous Fistula; Humans; Nose

Topics: Adult; Cutaneous Fistula; Dental Fistula; Female; Humans; Lip; Nose; Periapical Abscess; Root Canal Therapy

Midline upper lip sinuses alone are rare entitities, with less than 25 cases reported previously. Midline upper lip sinuses with associated cleft lip are even more rare. A patient report of median cleft lip with associated upper lip sinuses in a 16-year-old boy is presented. Controversy exists as to whether these abnormalities are related. This report demonstrates the plausibility of a cause-and-effect relationship between midline clefts and sinuses.

Topics: Adolescent; Cleft Lip; Cutaneous Fistula; Fistula; Humans; Lip; Lip Diseases; Male; Nose; Nose Diseases

Topics: Adult; Child; Cutaneous Fistula; Family; Forehead; Humans; Male; Nose; Photography

Topics: Cutaneous Fistula; Humans; Nasal Surgical Procedures; Nose; Paranasal Sinuses