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Two cases of cerebral involvement in Wegener's granulomatosis (WG) are described. The course of the disease in both patients was characterized by sudden onset and fatal outcome, despite maximum immunosuppressive therapy. Cerebral involvement is a rare complication of WG. Over the past two decades, only a small number of case-reports appeared of patients with WG who showed this complication. Since the era of cyclophosphamide therapy, it is commonly assumed that cerebral involvement in WG has no influence on patient survival. However, the two patients described here both died shortly after the occurrence of central neurological symptoms.

Objective: To determine the complication rate of a totally implantable central venous access device [Port-A-Cath (PAC)] in AIDS patients, used mainly for home infusion therapy., Design: A retrospective study., Setting: The study was performed at the AIDS Unit of the Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands., Patients, Participants: Forty-seven consecutive AIDS patients who had a PAC device implanted to receive either drug maintenance therapy (42 patients) or total parenteral nutrition (TPN; five patients)., Results: Fifty-one devices were implanted between June 1987 and October 1990. Mean puncture frequency was five times per week. The total number of catheter days was 9069. The total complication rate was 0.43 per 100 catheter days. Complications occurred in 17 (36%) patients: three implantation-related bleedings (0.03 per 100 catheter days), three puncture-related bleedings (0.03 per 100), two infections (0.17 per 100), seven occlusions (0.08 per 100), four flow problems (0.04 per 100) and one central vein thrombosis (0.011 per 100). Imminent skin necrosis at puncture site occurred in one case (0.01 per 100) and drug extravasation in two cases (0.02 per 100). Eight devices (17%) had to be removed. Primary septicaemias were resolved using antibiotics in three out of six patients in whom they occurred. Occlusions were almost exclusively caused by TPN., Conclusion: A totally implantable venous access device appears to be safe and convenient in (home) infusion therapy in AIDS patients, without risk of additional infection.