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Biomedical subjects

M Dhaene

Publications and source records attributed to M Dhaene.

At least 19 recordsLinked to original sources
PubMed1989

Central venous access for haemodialysis using the Hickman catheter.

One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device.

Catheterization, Central Venous↗
PubMed1989

Adsorption of beta 2-microglobulin on dialysis membranes: comparison of different dialyzers and effects of reuse procedures.

In order to measure beta 2-microglobulin adsorption on dialysis membranes, uremic plasma was passed through different dialyzers in a simulated hemodialysis circuit in which both plasma and dialysate compartments were organized as closed loops, the ultrafiltration pressure being adjusted to minimize water shifts. Under these conditions, comparison of the amounts of beta 2-m in the plasma and dialysate compartments allowed us to calculate the binding of beta 2-m to the membrane at different times of the procedure. Whereas cuprophane membrane (Gambro gf 180m, 1.8m2) did not bind beta 2-m, AN69 (Filtral, 1.1 m2), high flux polysulfone (F60, 1.2m2) and modified polyamide (Polyflux 130, Gambro, 1.3m2) were found to adsorb 49 +/- 8 mg (mean +/- SEM), 17 +/- 5 mg and 38 +/- 4 mg of beta 2-m, respectively. These data were confirmed in trace labeling experiments with 125I-beta 2-m. Adsorption was a saturable phenomenon occurring during the first 90 min of in vitro dialysis. After reuse with peracetic acid, the adsorption capacity of AN69 membrane was lowered to 20 +/- 4 mg of beta 2-m, contrasting with the unchanged adsorption after reuse with sodium hypochlorite. These data indicate that adsorption significantly contributes to beta 2-m removal during hemodialysis with certain dialyzers and that reuse procedures may affect the propensity of dialysis membranes to bind beta 2-m.

Adsorption↗
PubMed1989

Red blood cell destruction in single-needle dialysis.

A high incidence of hemolytic episodes has been documented by increased lacticodeshydrogenase levels after dialysis. When symptomatic, these episodes presented frequently with nausea and abdominal or back pain occurring typically in the last hour of the dialysis session. A prospective study, comparing two different access devices (needle and catheter) and three double-pump systems, demonstrated the critical role of the access device configuration. In addition, the neccessity to monitor the pressures in the arterial and venous lines when working with high blood flow rates is also stressed. By comparison, red blood cell destruction is negligible in conventional double-needle dialysis.

Adult↗
PubMed1988

Osteoarticular amyloidosis associated with haemodialysis: an immunoultrastructural study.

Osteoarticular amyloidosis occurred in a patient receiving long term haemodialysis. Histological examination showed that the amyloid deposit was surrounded by inflammatory cells and macrophages filled with haemosiderin. Electron microscopy showed that the amyloid fibrils were in close contact with cytoplasmic expansions, or located in intracytoplasmic pockets of the infiltrating cells. Immunohistological and immunoultrastructural observations confirmed that beta 2-microglobulin was a major constituent of amyloidosis associated with dialysis. Amyloid P component was also detected within the amyloid deposits. These findings suggest that amyloid P component, iron overload, or macrophage derived factors could have a role in the polymerisation of beta 2-microglobulin into amyloid deposit.

Amyloid↗
PubMed1986

Pneumococcal cellulitis.

A 42-year-old man with pneumonia was admitted for rhabdomyolysis. Streptococcus pneumoniae was isolated from the cellulitis surrounding the muscular necrosis. Subcutaneous localisation of S. pneumoniae in the course of a septicemia has never been described, although rhabdomyolysis may be associated with bacterial infections.

Adult↗
PubMed1986

Complications related to subclavian catheters for hemodialysis. Report and review.

Personal experience with subclavian vein cannulations for hemodialysis are given, and the pertinent literature on the subject is reviewed. Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Immediate complications were two pneumothoraxes and two hemothoraxes due to subclavian artery puncture. Seventeen cases of bacteremia were related to subclavian catheter infections. In 1 case, a complication of sepsis was a vertebral osteomyelitis. Clinical evidences of subclavian vein thrombosis occurred in 5 cases. Life-threatening complications were met in 2 cases: 1 with pericardial tamponade due to right atrium perforation and 1 with mediastinal hematoma and right hemothorax due to superior vena cava perforation. Review of the literature indicates that pneumothoraxes and/or hemothoraxes occurred in 1.7% of the catheter insertions and that sepsis related to subclavian dialysis catheters occurred in 8.9% of the patients. As systematically investigated subclavian vein thrombosis involved at least 50% of the patients. Our 2 personal cases of life-threatening complications and 14 similar cases of the literature were analyzed: left subclavian catheters were associated with superior vena cava perforation with right hemothorax or mediastinal hematoma, while right subclavian catheters gave atrial perforation with pericardial tamponade. Death occurred in 3 of 16 cases, and emergency surgery was required in 5 of 16 cases. Taking into account all these complications, recommendations are made for the use of subclavian dialysis catheters.

Adult↗
PubMed1986

Infections associated with subclavian dialysis catheters: the key role of nurse training.

Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Catheterization time ranged from 1 to 79 days with an average of 14.0 +/- 1.0 days per catheter and 18.9 +/- 1.0 days per patient. Twenty nine catheters were infected, 17 of which were the source of bacteremias due to Staphylococcus epidermidis in 13 cases and to Staphylococcus aureus in 4 cases. The incidence of sepsis was not significantly greater in diabetic patients, in patients with corticotherapy or in patients presenting an underlying systemic disease. On the contrary, the incidence was greater in hospitalized patients (15 bacteremias during 1,948 catheter days) than in ambulatory patients (2 bacteremias during 850 catheters-days) as well as during a period corresponding to a greater number of untrained nurses enrolled in the dialysis team. During this period, 6 sepsies occurred in 19 catheters (other periods: 7 sepsies/116 catheters, p less than 0.01). 6 of 28 nurses had less than 3 months of professional experience (other periods: 1 of 25, p less than 0.01). These data underline the key role of nurse training in the prevention of catheter-related infections.

Catheters, Indwelling↗
PubMed1986

Effect of chronic oral testosterone undecanoate administration on the pituitary-testicular axes of hemodialyzed male patients.

Testosterone undecanoate (TU) or placebo was administered orally (for 12 weeks) in a double blind study, to 19 patients with chronic renal insufficiency on hemodialysis in a daily dose of 240 mg. Effect on plasma testosterone (T), dihydrotestosterone (DHT), androstenedione (A), 110H androstenedione (110A), FSH, LH and PRL concentration and the pituitary responsiveness to LH-RH/TRH stimulation was studied. These hormone levels were determined before the study and after 6 and 12 weeks of treatment. There was a rise in plasma androgen concentration in all treated patients. Mean plasma DHT, A and 110A increased at 12 weeks from 0.3, 0.85 and 1.13 ng/ml to 1.13 (p less than 0.05), 1.4 (p less than 0.05) and 1.44 (p less than 0.05) respectively. There was no change in plasma T or free testosterone. However, basal LH, FSH fell progressively from 5.51 and 5.51 ng/ml to 2.13 and 1.84 ng/ml (p less than 0.05). The level of significance of these changes was confirmed when the response to LH-RH was considered. Basal plasma PRL also decreased from 376 microU/nl to 306 (p less than 0.05), but PRL response to TRH remained unchanged. In contrast, none of these modifications were observed in placebo-treated patients. We conclude that oral TU restored to normal the pituitary-testicular axis. This form of treatment should be preferentially chosen instead of intramuscular injections in these frequently heparinized patients on hemodialysis.

Administration, Oral↗
PubMed1985

Usefulness of 99mTc pyrophosphate bone scintigraphy in the survey of dialysis osteodystrophy.

Fogelman's score (FS) was used to determine the usefulness of 99mTc pyrophosphate (Tc-PP) bone scintigraphy in the evaluation of dialysis osteodystrophy. FS correlated well with bone 47Ca accretion rate. It remained stable after six months in patients treated with 1 alpha (OH)D3 and increased significantly in a randomised group of untreated patients. It decreased after two years of 1 alpha (OH)D3 therapy while serum calcium increased and iPTH and alkaline phosphatases decreased. Patients with low FS, treated by 1 alpha (OH)D3, rapidly developed hypercalcaemia. In cases of spontaneous hypercalcaemia, parathyroidectomy did not normalise serum calcium in patients with low FS despite a significant decrease in serum iPTH. Lower FS were associated with a higher increase in serum aluminium after desferrioxamine (DFO) administration and in two cases of proven aluminium osteomalacia, DFO therapy was followed by a dramatic increase in FS.

Bone and Bones↗
PubMed1981

Predictive value of 99mTc pyrophosphate bone scintigraphy for vitamin D trials in uraemia.

The usefulness of 99mTc-Pyrophosphate (99mTc-PPi) bone scintigraphy was evaluated in the follow up of 21 haemodialysed patients without clinical or radiological evidence of osteodystrophy. 99mTc-PPi bone scintigraphy was semi-quantitatively analysed using Fogelman's score. Patients were randomised to receive vitamin D analogues (1 alpha hydroxyvitamin D3 or dihydrotachysterol, n = 12) or to serve as controls (n = 9), both groups being given oral calcium supplements. Bone scintigraphy deteriorated in patients only on calcium therapy but not in patients treated by vitamin D-analogues. Vitamin D therapy reduced secondary hyperparathyroidism in all cases but induced rapid intoxication with normal doses in 4 of the 12 treated patients. Since intoxicated patients had significantly lower Fogelman's score than the patients who tolerated the treatment well, 99mTc-PPi bone scintigraphy is proposed as a screening test before vitamin D-analogues trials.

Bone and Bones↗