Prevalence and predictors of cigarette smoking among people with HIV in Western Jamaica.

With highly active antiretroviral therapy, HIV infection has become a treatable chronic disease. However, modifiable risk factors such as cigarette smoking continue to impact the morbidity and mortality of people with HIV (PWH). We assessed the prevalence and factors associated with cigarette smoking and motivation to quit among PWH in Western Jamaica. A cross-sectional study was conducted in which 392 adults seeking HIV care at health facilities in Western Jamaica completed an interviewer-administered questionnaire. Current smoking prevalence among participants was 17.4%. Current smoking was significantly associated with being male (OR = 2.99), non-Christian/non-Rastafarian (OR = 2.34), living or working with another smoker (aOR =1.86), being moderate to severely depressed (OR = 3.24), having an alcohol drinking problem (OR = 1.84), and never being asked by a healthcare provider if they smoked (OR = 3.24). Among the PWH who currently smoke, 36.7% are moderately to highly dependent on nicotine. One-third of people who smoke (33.8%) started smoking for the first time after HIV diagnosis, while 66.2% initiated smoking before; 88% were willing to quit smoking. These findings provide baseline information for designing and implementing a comprehensive smoking cessation program that considers the needs of PWH in Jamaica, with the potential of becoming a replicable model for other HIV-specialized healthcare settings in the Caribbean.

Implication of non-coding PAX6 mutations in aniridia.

There is an increasing implication of non-coding regions in pathological processes of genetic origin. This is partly due to the emergence of sophisticated techniques that have transformed research into gene expression by allowing a more global understanding of the genome, both at the genomic, epigenomic and chromatin levels. Here, we implemented the analysis of PAX6, whose coding loss-of-function variants are mainly implied in aniridia, by studying its non-coding regions (untranslated regions, introns and cis-regulatory sequences). In particular, we have taken advantage of the development of high-throughput approaches to screen the upstream and downstream regulatory regions of PAX6 in 47 aniridia patients without identified mutation in the coding sequence. This was made possible through the use of custom targeted resequencing and/or CGH array to analyze the entire PAX6 locus on 11p13. We found candidate variants in 30 of the 47 patients. 9/30 correspond to the well-known described 3' deletions encompassing SIMO and other enhancer elements. In addition, we identified numerous different variants in various non-coding regions, in particular untranslated regions. Among these latter, most of them demonstrated an in vitro functional effect using a minigene strategy, and 12/21 are thus considered as causative mutations or very likely to explain the phenotypes. This new analysis strategy brings molecular diagnosis to more than 90% of our aniridia patients. This study revealed an outstanding mutation pattern in non-coding PAX6 regions confirming that PAX6 remains the major gene for aniridia.

Trimble GX200 and Riegl LMS-Z390i sensor self-calibration.

This paper aims to establish and develop a calibration model for two time-of-flight terrestrial laser scanners (TLS): Trimble GX200 and Riegl LMS-Z390i. In particular, the study focuses on measurement errors and systematic instrumental errors to compile an error model for TLS. An iterative and robust least squares procedure is developed to compute internal calibration parameters together with a TLS data set geo-reference in an external reference system. To this end, a calibration field is designed that performs as an experimental platform that tests the different laser scanner methods. The experimental results show the usefulness and potential of this approach, especially when high-precision measurements are requires.

Toxicidad del hipoclorito de sodio y compuestos de amonio cuaternario en seres humanos. Una revisión sistemática en época de COVID-19 / Toxicity of sodium hypochlorite and quaternary ammonium compounds in humans. A systematic review in the time of COVID-19

Los desinfectantes son productos que se utilizan de manera cotidiana, su uso se ha incrementado debido a los cambios en los hábitos de bioseguridad que incorporó la población desde el inicio de la pandemia por la COVID-19; en similar medida, han aumentado las intoxicaciones por la exposición a estas sustancias. Conocer los mecanismos a través de los cuales los productos de desinfección pueden causar una intoxicación es importante para desarrollar estrategias de prevención y manejo oportuno. Con este fin, se revisó la información de artículos científicos y reportes de caso, mediante la búsqueda sistemática en línea en PubMed, Medline, Google Scholar y EBSCO, relacionada a intoxicaciones con compuestos de amonio cuaternario e hipoclorito de sodio. El procedimiento utilizado implicó la búsqueda de palabras claves alusivas al tema mediante el uso de Descriptores en Ciencias en Salud y Medical Subject Headings, posteriormente se utilizó metodología “Preferred Reporting Items for Systematic reviews and Meta-Analyses”. Los resultados del estudio evidenciaron que el hipoclorito de sodio afecta a las células y tejidos, mediante sus propiedades oxidativas, provocando alteración de la membrana citoplasmática, desnaturalización y formación de agregados en las proteínas, daño al ADN e inflamación asociada a la lisis celular. Por otro lado, los compuestos de amonio cuaternario afectan principalmente a la membrana celular, ocasionando daño inflamatorio, fibrosis y alteraciones reproductivas. Los dos compuestos afectan la integridad de la célula de manera directa. Sin embargo, sus efectos se ven exacerbados por los cambios que ocurren en el entorno celular. (AU)

Disinfectants are products that are used on a daily basis, their use has increased due to changes in biosafety habits that the population has adopted since the beginning of COVID19. To a similar extent, poisoning from exposure to these substances has increased. Consequently, knowing the mechanisms through which disinfection products can cause poisoning is important to develop prevention strategies and timely management. To this end, the information related to poisoning with quaternary ammonium compounds and sodium hypochlorite was reviewed in scientific articles and study cases by a systematic online search in PubMed, Medline, Google Scholar and EBSCO. The procedure used involved the search for keywords alluding to the topic by using Descriptors in Health Sciences and Medical Subject Headings. Later the «Preferred Reporting Items for Systematic reviews and Meta-Analyses» methodology was used. The results of the study showed that sodium hypochlorite affects cells and tissues through its oxidative properties, causing alteration of the cytoplasmic membrane, denaturation and formation of protein aggregates, DNA damage and inflammation associated with cell lysis. On the other hand, quaternary ammonium compounds mainly affect the cell membrane, causing inflammatory damage, fibrosis and reproductive disorders. Both compounds directly affect the integrity of the cell. However, its effects are exacerbated by changes that occur in the cellular environment. (AU)

[Results of polyurethane implant for persistent knee pain after partial meniscectomy with a minimum of two years follow-up]. / Resultados de un implante de poliuretano para el tratamiento del dolor persistente de rodilla tras meniscectomía parcial con un mínimo de dos años de seguimiento.

PURPOSE: To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy. METHODS: Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al. RESULTS: Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p=.001), one year (83.3 points) (p<.001) and final follow-up (84.4 points) (p<.001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p=.001), one year (81.39 points) (p<.001) and final follow-up (83.34 points) (p<.001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p<.001), 1.9 points at one year (p<.001), and 1.9 points at final follow-up (p<.001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus. CONCLUSION: A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus. The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy.

213 elderly uremic patients over 75 years of age treated with long-term peritoneal dialysis: a French multicenter study.

UNLABELLED: We report our experience in 213 elderly patients over 75 years treated by peritoneal dialysis (PD) as first and exclusive dialysis therapy. The mean age at start of PD was 79.4 +/- 3.6 years, and the cumulative time on PD was 4551 months (mean time: 21.4 +/- 19.8 months). Twenty-six patients lived in institutions and 187 lived at home. Thirty patients had an effective autonomy with the ability to carry on normal activities. One hundred and two patients were cared for by a private nurse at home, and 46 patients were cared for in a family environment. Most cases were treated by three exchanges per day (152 cases) and used a nondisconnect system (175 cases) on account of absence of autonomy. The rate of peritonitis per patient-month was one episode per 16.8 patient-months. Patient survival (Kaplan-Meier curves) was 74%, 59%, 45%, and 19% at one, two, three, and five years, respectively. The causes of death were various with a higher frequency of cardiovascular causes (48.3% of the 116 deaths). Thirty-three patients died in less than six months including 18 patients in less than three months. IN CONCLUSION: elderly uremic patients can be treated with long-term PD with relatively good results. Mortality is high but essentially due to age and poor general status-the dedication of private home nursing is very important in treating elderly PD patients. This fact often is a necessary condition in maintaining these elderly patients at home.

[Prevalence and significance of the C virus antibody in chronic hepatopathy not related to B virus in alcoholics]. / Prevalencia y significado del anticuerpo al virus C en hepatopatía crónica de alcohólicos no relacionada al virus B.

The presence of antibody to the hepatitis C virus was determined in 254 alcoholic patients with non-B chronic hepatitis and a titre of antinuclear antibodies of 1/40 or lower. Alcoholic hepatitis was present in 12 patients, steatohepatitis in 20, active chronic hepatitis in 22, cirrhosis in 181, and hepatocarcinoma in 19. Twenty patients had previously received blood transfusion alone or during surgery, 49 had undergone previous surgery without transfusion, a clinical episode of hepatitis could be traced in 14, 4 patients were drug addicts, 41 had received blood transfusion after the diagnosis was made, and 128 presented with alcoholism alone. Anti-hepatitis C antibody was found in 20 out of 2,000 blood donors (1%) in our hospital. Anti-hepatitis C antibody was found in 87 patients (34.2%) in our series, a figure unaltered by past medical history. Patients with anti-HC antibody had higher levels of AST, ALT, total proteins, gamma-globulin, and IgG. The incidence of active chronic hepatitis was higher among patients with anti-HC antibody, whereas the incidence of steatohepatitis was higher among patients without anti-HC. Regarding findings on liver biopsy, the incidence of anti-HC was significantly higher (p less than 0.001) among patients with active chronic hepatitis (72.7%) than in any other group; no significant differences were found between patients with cirrhosis (33.3%), hepatocarcinoma (31.5%), steatohepatitis (15%), or alcoholic hepatitis (16.7%). Among HBsAg-negative patients, the incidence of anti-HC was similar between those with (39.7%) and without other serum markers of HB (32.9%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Determining wall shear stress in artificial blood pumps of heart assist devices]. / Bestimmung der Wandschubspannung in künstlichen Blutpumpen von Herzunterstützungssystemen.

The walls in blood pumps are made of artificial material and thus are thrombogenic to a lesser or larger degree. Also the flow plays a role: a blood flow with no flow separations and stagnation zones is required to avoid the generation of thrombi. A precondition for solving this problem is the assessment of the wall shear rate. However this parameter is difficult to assess because of the deformability of the walls and the pulsation of the flow. Two methods are proposed to estimate the wall shear stress in bloodpumps. The paint erosion method allows a characterisation of the flow near the wall. The second method is a special development of standard Particle Image Velocimetry (PIV). A vector field of the flow close to the wall results. Both methods should permit the assessment of the wall shear stress in bloodpumps.

[Flow through an improved ball valve for the heart assist device]. / Strömung durch eine neu entwickelte Kugelklappe für ein Herzunterstützungssystem.

Objective of the present study is the hemodynamic investigation of the fluidmechanics a ball valve developed for ventricular assist devices with improved parameters. The flow was investigated using Digital Particle Image Velocimetry with an enlarged model of the valve (2.8:1). The flow was recorded using a high speed video camera with 250 fps and analyzed by a cross-correlation method implemented in the software DaVis by LaVision. The results confirmed the improvement of the ball valve performed by a numerical study. The flow separations on the ball valve housing observed in the first design version was eliminated in the final design of the novel valve. Hence a valve of this design applied in ventricular assist devices can be expected to have a lower rate of thromboembolic complications.

[Municipal population and size: reflections on the 1991 census]. / Poblacion y tamano municipal: reflexiones a partir del censo de 1991.

PIP: "This paper is an update on the grouping of the Spanish population by municipal demographic size. This intermediate scale analysis, although traditionally important, is not included in the publications of the results from the 1991 Population Census. These results go from the provincial to the municipal scales, skipping any intermediate states." (EXCERPT)^ieng

[Does the medial-lateral stability of total knee replacements have an effect on short-term clinical outcomes? One-year results of a multicentre study with computer assisted surgery]. / Influye la estabilidad mediolateral de las artroplastias totales de rodilla en la evolución clínica a corto plazo? Estudio multicéntrico a un año con cirugía asistida por ordenador.

OBJECTIVE: To evaluate the influence of the medial-lateral stability of the joint on the short-term clinical outcomes after performing navigation in total knee replacement. MATERIAL AND METHODS: A multicentre prospective study was conducted on 111 consecutive total knee replacements performed with computer assisted surgery. The study included the evaluation of KSS, WOMAC, and SF-12 preoperatively, and at 3 and 12 months of follow-up, and correlation with stability data obtained during surgery, in extension and at 20° and 90° of flexion. RESULTS: No differences were found in WOMAC, KSS and SF-12 relative to coronal stability during surgery. CONCLUSIONS: Variations in coronal stability were shown to have no influence on the short-term clinical results of navigated total knee replacement.

Treatment of high-grade glioma in children and adolescents.

Pediatric high-grade gliomas (HGGs)--including glioblastoma multiforme, anaplastic astrocytoma, and diffuse intrinsic pontine glioma--are difficult to treat and are associated with an extremely poor prognosis. There are no effective chemotherapeutic regimens for the treatment of pediatric HGG, but many new treatment options are in active investigation. There are crucial molecular differences between adult and pediatric HGG such that results from adult clinical trials cannot simply be extrapolated to children. Molecular markers overexpressed in pediatric HGG include PDGFRα and P53. Amplification of EGFR is observed, but to a lesser degree than in adult HGG. Potential molecular targets and new therapies in development for pediatric HGG are described in this review. Research into bevacizumab in pediatric HGG indicates that its activity is less than that observed in adult HGG. Similarly, tipifarnib was found to have minimal activity in pediatric HGG, whereas gefitinib has shown greater effects. After promising phase I findings in children with primary CNS tumors, the integrin inhibitor cilengitide is being investigated in a phase II trial in pediatric HGG. Studies are also ongoing in pediatric HGG with 2 EGFR inhibitors: cetuximab and nimotuzumab. Other novel treatment modalities under investigation include dendritic cell-based vaccinations, boron neutron capture therapy, and telomerase inhibition. While the results of these trials are keenly awaited, the current belief is that multimodal therapy holds the greatest promise. Research efforts should be directed toward building multitherapeutic regimens that are well tolerated and that offer the greatest antitumor activity in the setting of pediatric HGG.

Resultados de un implante de poliuretano para el tratamiento del dolor persistente de rodilla tras meniscectomía parcial con un mínimo de dos años de seguimiento / Results of polyurethane implant for persistent knee pain after partial meniscectomy with a minimum of two years follow-up

Objetivo. Evaluar los resultados de un implante de poliuretano en 10 pacientes con dolor persistente tras meniscectomía parcial. Material y métodos. Estudio prospectivo descriptivo de 10 pacientes que fueron intervenidos para colocación artroscópica de un implante meniscal de poliuretano. Se realizó evaluación funcional, de resonancia magnética y radiología simple antes de la intervención, a los 6 meses, un año, y en el seguimiento final con un mínimo de dos años. La evaluación clínica incluyó las escalas de Lysholm, KOOS y EVA. En resonancia magnética (RM) se evaluó la morfología y la intensidad de la señal del implante según los criterios de Genovese et al. Resultados. Se encontraron diferencias significativas entre la media de puntuación de Lysholm antes de la cirugía (63,5 puntos), a los 6 meses (76,8 puntos) (p = 0,001), al año (83,3 puntos) (p < 0,001) y al final del seguimiento (84,4 puntos) (p < 0,001). En la puntuación del KOOS se hallaron diferencias significativas entre las medias en el preoperatorio (64,23 puntos) y 6 meses (73,66 puntos) (p = 0,001), un año (81,39 puntos) (p < 0,001) y el seguimiento final (83,34 puntos) (p < 0,001). Los valores promedio de la EVA fueron de 5,7 puntos en el preoperatorio, 3,6 puntos a los 6 meses (p < 0,001), 1,9 puntos al año (p < 0,001) y 1,9 puntos al final del seguimiento (p < 0,001). La radiología mostró cambios degenerativos en un caso. En la RM, el tamaño del implante y la intensidad de la señal de RM disminuyeron progresivamente, no llegando a alcanzar nunca los de un menisco normal. Conclusiones. Veinticuatro meses después de la cirugía se ha encontrado una mejora significativa en todos los parámetros clínicos, salvo en un paciente que precisó reintervención. El tamaño del implante se redujo y en ningún caso se alcanzó una imagen de RM similar a la de un menisco normal. El procedimiento demostró ser seguro y útil para el tratamiento del dolor persistente tras meniscectomía (AU)

Purpose. To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy. Methods. Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al. Results. Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p = .001), one year (83.3 points) (p < .001) and final follow-up (84.4 points) (p < .001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p = .001), one year (81.39 points) (p < .001) and final follow-up (83.34 points) (p < .001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p < .001), 1.9 points at one year (p < .001), and 1.9 points at final follow-up (p < .001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus. Conclusion. A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus (AU)

The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy (AU)

[Territorial differences in mortality in Andalusia at the end of the nineteenth century]. / Las diferencias territoriales de la mortalidad en Andalucia a fines del siglo XIX.

PIP: "This paper concerns the territorial differences between the mortality rates in Andalusia [Spain] during the last decades of the nineteenth century....[It analyzes] interprovincial differences...and the inequalities between urban areas and rural areas. The comparative study of the mortality conditions shows the contrasts between the oriental and the occidental provinces and the high mortality [in] the cities. The analysis of the age and sex structure of...mortality reveals...infant and child mortality as determining elements [in] this Mediterranean region." (EXCERPT)^ieng

[Management of malnutrition in peritoneal dialysis]. / Prise en charge de la dénutrition en dialyse péritonéale.

Peritoneal dialysis is associated with nutritional abnormalities due to peritoneal glucose absorption and protein or amino acid losses into the dialysate. Nutritional assessment, every four months, is essential, based on body composition, anthropometric measurements, clinical characteristics, biochemical parameters and dietary survey. Thus 1.2 g to 1.3 protein/kg/day and 30 to 35 kcal/kg/day energy intake may be required. Oral, parenteral or intraperitoneal amino acids supplementation can improve the nutritional status in peritoneal dialysis patients.

The prognosis of renal vein thrombosis: a re-evaluation of 27 cases.

Twenty-seven patients with renal vein thrombosis were retrospectively studied to evaluate their long-term prognosis and relevant prognostic factors. Twenty-four patients presented with a nephrotic syndrome, and 15 had renal impairment (8 acute; 7 moderate). Ten patients had a previous history of proteinuria, and 14 of nephrotic syndrome. Renal biopsy performed in 20 patients, of whom 19 were nephrotic, showed membranous glomerulonephritis in 14, focal segmental glomerulosclerosis in three, minimal change glomerulonephritis in two, and periarteritis nodosa in one. Renal vein thrombosis was angiographically proven in all patients and was bilateral in 18, localised to the left renal vein in seven, and to the right in two. Thrombosis of the inferior vena cava was associated in seven patients. Ten patients were treated by anticoagulants alone, nine by surgical thrombectomy, seven by thrombolysis, and two did not receive any specific treatment. One patient underwent successively thrombectomy and then thrombolysis. Eleven patients died within the first 6 months, mainly from haemorrhagic complications (n = 5) or severe sepsis (n = 2). Survivors were followed up from 6 months to 19 years. Nephrotic syndrome improved or even disappeared in 12 patients, and renal function did not worsen throughout the follow-up in any patients. The main prognostic factors were initial renal function and type of nephropathy: patients with membranous glomerulonephritis had a significantly better renal function and a lower mortality rate than patients with other nephropathies. Initial renal insufficiency was significantly associated with a poor prognosis. There was no advantage, in terms of survival, kidney function and nephrotic syndrome, of either thrombectomy or thrombolysis over anticoagulants alone, despite two complete venous recanalisations after thrombolysis. Accordingly, patients with renal vein thrombosis from membranous glomerulonephritis should be treated by anticoagulants alone, since the long-term prognosis of this disease seems unaffected by intercurrent renal vein thrombosis. With respects to the risk-to-benefit ratio, thrombectomy should be avoided and thrombolysis considered only in patients with initial acute renal failure from acute renal vein thrombosis.

[Prognosis of renal vein thrombosis in the adult: influence of treatment]. / Pronostic des thromboses des veines rénales de l'adulte: influence du traitement.

The medical histories of 27 patients with renal vein thrombosis were evaluated retrospectively. Short and long term evolution as well as prognostic factors were analysed. 24 of the patients were suffering from a nephrotic syndrome, 15 from renal failure. In the 20 biopsies performed we observed: 14 cases of extramembranous glomerulonephritis, 2 cases of minimal glomerular lesions, 3 cases of segmental focal glomerulosclerosis and 1 periarteritis nodosa. The renal vein thrombosis was bilateral (18), left (7) or right (2). In 7 patients this was associated with thrombosis of the inferior vena cava. 9 patients were treated with anticoagulants alone, 9 underwent thrombectomy, 7 were treated by thrombolysis and 2 received no treatment. Within the first six months 11 patients died as a result of complications due to hemorrhaging (5), septic infection (2) or embolism (1) and 3 patients died of undetermined causes. The progression of the remaining patients was followed up over a period of 6 months to 19 years. In 12 patients, the nephrotic syndrome regressed and renal function did not deteriorate in any of the cases. The main causes for poor prognosis are the existence of initial renal failure and glomerulonephritis which is not extramembranous. Since the evolution of the glomerulopathy does not appear to be affected by extramembranous glomerulonephritis, renal vein thrombosis associated with this complication should be treated with anticoagulants alone. The risk-benefit ratio of thrombectomy leads us to conclude that this technique should be abandoned. Thrombolysis could be considered in cases where renal vein thrombosis is associated with acute renal failure.

[Serum and bronchial concentrations of netilmicin during its continuous intratracheal administration]. / Etude des concentrations sériques et bronchiques au cours de l'administration continue de nétilmicine intratrachéale.

Respiratory tract infections in intensive care units have a high fatality rate, perhaps as a result of the poor diffusion into bronchial secretions of aminoglucosides given by a systemic route. Endotracheal administration of aminoglycosides has been advocated but the optimal dosage remains to be determined. To investigate this problem we studied 13 patients free of renal failure and 6 patients with renal failure. Netilmicin was given by continuous endotracheal infusion in a daily dosage of 3 to 30 mg/kg. A good correlation was found between infused doses and serum concentrations; very high bronchial secretion concentrations were consistently found. There is a significant risk of accumulation in patients with renal failure. The characteristics of the respiratory tract secretions had no influence on the passage of netilmicin into the bloodstream. The dosages we advocate on the basis of our results are 8 mg/kg/day in patients free of renal failure and 4 mg/kg/day in patients with renal failure; serum netilmicin concentrations should not exceed 1 microgram/ml.

Endoscopic retrograde cholangiopancreatography in Echinococcus (hydatid) cysts of the liver.

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out on 19 patients with hydatid cyst of the liver, either before or after operation. Cholangiographic findings included biliary tract obstruction in 8 cases, intrinsic compression in 4 cases, laminated membranes or daughter cysts in the biliary tree in 3 cases, perforation into the biliary tract in 2 cases, stricture in the biliary ductal system in 1 case, and biliary fistula in the remaining case. Biliary tract obstruction was secondary to chemical cholangitis by formalin in 2 patients. ERCP is a useful procedure in patients with suspected intrabiliary rupture or when symptoms occur after surgical removal of the cyst.