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Anemia secondary to end-stage renal disease (ESRD) is an important but complex syndrome which directly contributes to significant morbidity and mortality in this patient population. The interactions between uremia, bone marrow biology and erythropoietin (EPO) responsiveness are of significant interest to improve our basic understanding of anemia management in ESRD. Nocturnal home hemodialysis is an intensive mode of renal replacement therapy, which has been associated with an improvement in EPO responsiveness. The aims of the present review are (1) to update the recent advances in uremia associated perturbations in bone marrow-derived hematopoietic stem cells and (2) to discuss the potential mechanistic explanations by which augmented uremia clearance may directly affect EPO responsiveness.

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Nocturnal home hemodialysis (NHHD) has been associated with several clinical benefits compared to conventional thrice-weekly in-center hemodialysis. However, the prevalence of NHHD remains low. To date, few studies have focused on the importance of training and education of a complex medical procedure such as NHHD. In the present review, we will describe guidelines for implementation of a NHHD program by focusing on 1) patients' selection, assessment and training; 2) challenges of adult education; 3) prescription and 4) barriers to adoption of home hemodialysis. Future challenges in research, the importance of quality assurance and innovations in clinical care delivery in NHHD will also be discussed.

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The diagnosis of occupational asthma can be made by exposing workers to the relevant agent either in a hospital laboratory through specific inhalation challenges (SICs) or in the workplace. As suggested by several authors, workers with negative laboratory SIC can be monitored at the workplace under supervision. The present study aims to assess the frequency of, and identify factors associated with, a positive workplace reaction in workers with negative SIC in the laboratory. The results of workplace challenges were examined in 99 workers who underwent negative SIC between 1994 and 2004. A positive reaction either in the SIC or in the workplace was defined as a sustained fall in forced expiratory volume in one second of > or =20%. In total, 22 (22.2%) workers showed positive responses at the workplace. These subjects more often had increased baseline methacholine responsiveness (90.5 versus 67.6%). They also underwent more days of SIC testing (4.9 versus 3.3 days) and were exposed more often to two or more agents (56 versus 28.4%) and for a longer period of time (363.3 versus 220.4 min) in the laboratory. The present study illustrates the usefulness of workplace monitoring of airway function in the investigation of occupational asthma and identifies factors that are more often associated with a positive reaction.

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Two cases of methylene chloride poisoning treated with hyperbaric oxygen are presented and discussed. Both patients were found unconscious in an occupational setting. Carboxyhemoglobin level determination and neuropsychological evaluation confirmed a diagnosis of carbon monoxide intoxication subsequent to methylene chloride exposure. The serial carboxyhemoglobin levels and Carbon Monoxide Neuropsychological Screening Battery scores obtained from these patients suggest that toxicity from methylene chloride-derived carbon monoxide responds well to treatment with hyperbaric oxygen.

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The incidence of reported cases of toxicity resulting from methylene chloride exposure has increased within the last decade. A vast majority of these reports involve acute episodes, and the prevalence of domestic poisoning is relatively high. Diverse pathologic sequelae attributed to methylene chloride or its metabolites have been reported, although a distinct bias for central nervous system effects is evident. paradoxically, detoxification of methylene chloride via the mixed-function oxidase pathway is an inherently intoxicating event. Although the anomalous conversion of methylene chloride into carbon monoxide has increased the popular awareness of methylene chloride poisoning among medical personnel, lack of experience in diagnosis and treatment of methylene chloride poisoning is widespread. This review of 26 cases spanning 50 years reveals that the industrial and domestic use of methylene chloride is equally widespread. A compendium of the clinical experience with methylene chloride poisoning is presented.

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