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Biomedical subjects

B Page

Publications and source records attributed to B Page.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Positioning of hemodialysis catheters after locating the internal jugular vein by echo-Doppler].

Despite significant progress, vascular access remains a major concern for nephrologists. For the last 6 years we have used as temporary vascular access silastic twin catheters implanted into the internal jugular vein based on Canaud's method. We have developed in 15 patients an ultrasound-guided method using an ultrasonic Doppler to improve access to the internal jugular vein, prior to its catheterization. Ultrasound assistance was provided by a 5MHz mechanical sectorscanning transducer (Toshiba 270A). The internal jugular vein and carotid artery were visualized. The skin overlying the internal jugular vein was marked with indelebile ink. The internal jugular vein was cannulated successfully in 14 patients. The use of ultrasound guidance to cannulate the internal jugular vein improves success, and reduces complications. This method is recommended in patients with distorted cervical or subclavicular anatomic characteristics, or with bleeding tendency.

Catheterization, Central Venous↗
PubMed1994

[Femoral arteriovenous fistulas after vascular puncture for hemodialysis].

From 1978 to 1991 we observed 10 patients who developed femoral arteriovenous fistula after venous puncture for hemodialysis. The fistula most often appeared after several punctures, but 3 developed after a single puncture. Diagnosis was made on the basis of local observation and auscultation of the vessel (bruit + thrill n = 10, hematoma n = 4, pulsatile mass n = 1). Two patients had arteriography and 2 had echo-doppler. Arteriography was not required for diagnosis (since clinical signs were sufficient), or for treatment, since echo-doppler and surgery indicated the location of the fistula. Five patients underwent surgery. In all cases, continuity of the main vessels of the lower member was maintained or reestablished during surgery. Surgery is mandatory for high flow rate. Such fistulas cannot be used and can cause cardiac failure in patient with another fistula for hemodialysis. Surgery should not be undertaken too early because of the possibility of spontaneous clotting (particularity if echo-doppler shows low flow rate), and to allow organization of the lesions and easier dissection. Auscultation of the vessel should be a routine procedure after any femoral vein puncture in order that this complication not be overlooked.

Adult↗
PubMed1994

[Secondary hemomediastinum after positioning a hemodialysis catheter].

We describe a case of late perforation of the superior vena cava by a hemodialysis catheter inserted via the left internal jugular vein. This resulted in extravasation of blood. Malposition of the catheter was confirmed by CT scan. Removal of the catheter resulted in rapid resolution of symptoms. Confirmation of correct placement of central venous catheter must be obtained by chest X-ray contrast study.

Adult↗
PubMed1994

[Tunneled double femoral catheters: emergency vascular access for hemodialysis].

Transient vascular access for hemodialysis is a daily problem in nephrology. Internal jugular twin catheters using Canaud's technique is the method of reference, which we have applied since 1987. In 3 cases where the internal jugular route was impraticable, twin catheters via the femoral route were used. The catheter was placed by percutaneous route, at the bedside, in rigorous aseptic conditions and with local anesthesia. The catheter emerge at mid-thigh. Mean placement time was 45 mn. The ideal site for distal end of the catheters is in the inferior vena cava. No traumatic complication occurred during placement. No infectious episode was observed. All the catheters that were removed were sterile in culture. No thrombosis of femoral, iliac or inferior cava veins were observed by echodoppler after removal of the catheters. In conclusion, twin femoral catheters are a good alternative when jugular access is impossible or contraindicated.

Adult↗
PubMed1993

[Tunnelized double femoral catheters. A technique for vascular access in hemodialysis].

OBJECTIVES: Temporary vascular access for haemodialysis is an everyday problem in a dialysis unit. We used the double catheter method developed for the internal jugular vein to catheterize the femoral vein in patients in which the jugular route could not be used. METHODS: A double catheter was inserted via percutaneous, bedside, punction into the femoral vein in 12 patients under local anaesthesia. The exit point was located near the middle of the thigh. RESULTS: Mean implantation time was 45 minutes. The inferior vena cava was the ideal site for the distal tip of the catheters. Mean duration of utilisation was 41 days (range 6-118) and allowed a mean of 28 haemodialysis sessions (range 4-49). Echo-Doppler examinations after withdrawal did not reveal any thrombosis of the femoral, iliac or vena cava. CONCLUSIONS: When the jugular route is difficult or contraindicated, double femoral catheterism is a useful alternative vascular access for haemodialysis.

Acute Kidney Injury↗
PubMed1993

[Oropharyngeal origin of septic thrombophlebitis of the internal jugular vein. Apropos of 3 cases].

While before antibiotics cases of septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection were frequent and had a poor prognosis, today they are exceptional and often have a favourable course under antibiotic therapy. The clinical features are often limited to fever and a painful tumefaction of the anterior border of the sterno-cleido-mastoidian muscle, symptoms may be more pronounced in the Lemierre syndrome in which the anaerobic septicaemia is associated with secondary, especially pleuro-pulmonary, localizations. The diagnosis can be confirmed with a cervical CT-scan showing an enlarged, thrombosed vein which does not opacify and has a hyperdense periphery. Treatment is based on parenteral antibiotics adapted to anaerobic germs.

Adult↗
PubMed1993

Late referral to maintenance dialysis: detrimental consequences.

Thirty per cent of patients who started maintenance haemodialysis at our institution between January 1989 and December 1991 had been referred at a very late stage of their renal disease. To assess the causes and consequences of such late referral we retrospectively compared clinical and laboratory features of 65 patients who had been referred less than 1 month prior to first dialysis (late referral, or LR group) and of 153 patients who had been previously followed-up by us for more than 6 months (early referral, or ER group). Age, sex ratio, and socioeconomic status were similar in the two groups. In the LR group, 38 patients had never been referred to a nephrology unit, whereas 27 had discontinued nephrological surveillance. Fluid overload, severe hypertension, and/or pulmonary oedema was present in 57% of LR versus 15% of ER patients (P < 0.001). Mean (+/- 1 SD) systolic and diastolic blood pressure was greater in the LR than the ER group (173 +/- 19/99 +/- 12 versus 147 +/- 15/84 +/- 8 mmHg, P < 0.001). Mean plasma concentration of creatinine, urea and phosphate was significantly greater, whereas bicarbonate, calcium, haematocrit and albumin were less in the LR than the ER group. Most (88%) LR patients started dialysis in emergency conditions through central vein catheterization. Total hospital stay lasted 34.5 +/- 16.3 days in LR versus 5.8 +/- 3.0 days in ER patients (P < 0.0001), resulting in an excess cost of 0.2 million French francs per LR patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Detrimental effects of late referral in patients with chronic renal failure: a case-control study.

Despite broader indications and easier access to renal replacement therapy during the past decades in Western countries, an unduly high number of patients is still referred to maintenance hemodialysis (HD) at a very advanced stage of chronic renal failure (CRF). To assess whether such late referral induces detrimental effects, we retrospectively compared clinical status and laboratory features in 20 patients who had been referred to us less than one month prior to first HD (late referral, or LR group) and in 20 sex- and age-matched controls who had undergone regular follow-up for at least six months prior to HD (early referral, or ER group). Male to female ratio was 12/8 and age averaged 53.5 years in both groups. Mean (+/- 1 SD) systolic and diastolic blood pressure were higher in LR group than in controls (180 +/- 14/102 +/- 10 vs. 153 +/- 15/86 +/- 7 mm Hg, P < 0.001) and fluid overload with pulmonary edema was present in 13/20 versus 3/20 patients (P < 0.001). Plasma concentrations (mmol/liter) of creatinine (1.12 +/- 0.27 vs 0.97 +/- 0.11, P < 0.01) and phosphate (2.58 +/- 0.47 vs. 1.92 +/- 0.31, P < 0.001) were higher, whereas plasma levels of bicarbonate (14.2 +/- 3.9 vs 22.5 +/- 4.2, P < 0.001) and calcium (1.85 +/- 0.24 vs. 2.27 +/- 0.15, P < 0.001) were lower in LR than in ER group, as were hemoglobin (7.1 +/- 1.1 vs. 9.4 +/- 0.9 g/dl, P < 0.001) and serum albumin levels (35.3 +/- 4.8 vs. 39.7 +/- 3.4, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Avascular necrosis of bone and antiphospholipid antibodies in systemic lupus erythematosus.

Of a total of 800 patients with systemic lupus erythematosus, 37 were found to have developed avascular necrosis of bone (4.6%). Routine radiological screening of all joints was not performed and these 37 represented symptomatic patients only. Twenty-seven of these were positive for antiphospholipid antibodies (aPL) (73%). Both aPL positive and aPL negative patients had received large doses of oral steroids. The frequency of vasculitis and livedo reticularis, as well as arterial thrombosis was higher in the aPL positive group, but this did not reach statistical significance, perhaps because of the small numbers of patients involved. Although the difference in the frequency of thrombocytopenia was more marked in the aPL positive group (p < 0.08), once again, this was not statistically significant at the 5% level. Since the prevalence of aPL positivity in the general lupus population is about 30-40%, the presence of the aPL may be associated with an increased tendency to develop avascular necrosis. This is supported by recent reports of avascular necrosis occurring in patients with primary antiphospholipid syndrome in the absence of previous steroid administration.

Adolescent↗
PubMed1992

Correction of severe secondary hyperparathyroidism in two dialysis patients: surgical removal versus percutaneous ethanol injection.

Two chronic hemodialysis patients had recurrent, severe secondary hyperparathyroidism. The first had no sonographically visible parathyroid gland in the neck. Computed tomography (CT) scan indicated the existence of a parathyroid mass in the upper mediastinum, which was removed surgically. The second patient had two intracervical, hyperplastic parathyroid glands visible on ultrasound examination. He volunteered for nonsurgical removal via sonographically guided percutaneous injection of ethanol. In both patients, serum total calcium concentration decreased dramatically to values near 1.5 mmol/L 24 hours after treatment. In patient 1, serum immunoreactive parathyroid hormone (iPTH) (1-84) decreased from 1,582 pg/mL before surgery to 34 pg/mL after 24 hours (normal range, 10 to 65 pg/mL). In contrast, serum iPTH (1-84) decreased only progressively in patient 2, from 1,680 pg/mL before ethanol injection to 865 pg/mL after 24 hours and to 378 pg/mL after 72 hours to reach 30 pg/mL after 14 days. Thus, patient 2 had a striking decrease of plasma calcium immediately after parathyroid gland destruction, even though circulating iPTH was still very high. The reason for such a discrepancy remains unexplained at present, and further study will be necessary to solve this issue.

Adult↗
PubMed1992

Decrease of tumor-like calcification in uremia despite aggravation of secondary hyperparathyroidism: a case report.

Extraskeletal pseudotumoral calcifications generally develop in uremic patients with a high calcium x phosphorus (Ca x P) product and severe secondary hyperparathyroidism. In the present case report we describe a chronic hemodialysis patient presenting with a massive calcification of the left shoulder region, severe aluminum (Al) intoxication and moderate hyperparathyroidism. Her initial serum Ca x P product was only slightly elevated: 5.01 mmol2/l2. Under deferoxamine treatment during the subsequent 4 months, Al overload decreased. On the other hand, parathyroid overfunction worsened, as reflected by an increase of the serum immunoreactive parathyroid hormone [1-84] level from initially 690 to 1052 pg/ml (normal, 15-60 pg/ml) and an increase of alkaline phosphatase activity, and plasma calcitriol increased from undetectable to a low-normal value. Predialysis serum total Ca levels decreased rapidly from 2.9 to 2.5 mM but serum P concentrations remained elevated: 1.6-2.5 mM. Unexpectedly, the extent of the periarticular calcification diminished considerably during the same time period. The present observation shows that in a subset of uremic patients with Al overload, pseudotumoral calcifications may regress during Al chelation therapy despite progression of hyperparathyroidism. Since Al may predispose collagen to develop dystrophic or metastatic calcification, it is suggested that this process is reversible by correcting Al intoxication.

Aluminum↗