The Moncrief-Popovich catheter. A new peritoneal access technique for patients on peritoneal dialysis.

Existing catheter implantation techniques violate a fundamental premise of wound healing. The immediate presence of the catheter in the post operative surgical wound forms a passage for permanent colonization of the catheter tunnel and cuff(s). This is manifested by the almost universal presence of the biologic products of bacterial growth (biofilm) on the external and internal surfaces of these catheters. The Moncrief-Popovich catheter and implantation technique are designed to address this problem. The Moncrief-Popovich catheter is implanted in the standard fashion, except that the external segment of the catheter is buried subcutaneously at the time of implantation. After allowing 3-5 weeks for tissue in-growth in a sterile environment, a small incision is made in the skin through which the external segment of the catheter is exteriorized and attached to an adapter. A 2 year trial was conducted in 59 patients, comprising 530 patient-months of experience; the incidence of peritonitis was one episode for every 29.4 patient months. All but three of the patients used the standard spike exchange technique. In a recently initiated study using disconnect procedures in 63 of the 74 patients studied, the peritonitis rate was one episode for every 28.7 patient-months; patient-months have totalled 201.2 to date. There was a rate of one exit site infection every 12.57 patients-months. It was concluded that the Moncrief-Popovich catheter and implantation technique result in a substantial decrease in the incidence of peritonitis for patients using the standard spike exchange system.

Observer variation in assessment of liver biopsies including analysis by kappa statistics.

In an observer variation study, six histopathologists independently coded 27 features and final diagnoses on the same 60 liver biopsies without knowledge of clinical data. Many features were shown by kappa statistics to have significantly high agreement, and differences were shown to be due in part to differences in definitions of particular features. Intraobserver variation was much lower than interobserver variation. Full agreement with respect to the final histopathologic diagnosis between the six observers occurred in only nine instances--all of these were cases of alcoholic liver disease. Some of the biopsies of acute hepatitis were confused with chronic active hepatitis, while others were mistaken for cholestasis, usually believed to have been related to drugs. Biopsies from patients with extrahepatic biliary obstruction were most commonly misdiagnosed as drug cholestasis. However, agreement was higher when the results were calculated in terms of observer pairs by comparing the final diagnosis of each observed with that obtained from each of the other five observers. The most striking finding here was the very high agreement rate (80%) between the two specialist pathologists compared with that obtained from the remaining fourteen pairs of observers who averaged an (43%) agreement rate.