Minimally invasive surgical therapies for catheter-dependent men with benign prostatic hyperplasia: expanding the treatment paradigm.
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Benign prostatic hyperplasia (BPH)↗
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Intermittent catheterization to obtain catheter-free bladder function in spinal cord injury.
The intermittent bladder catheterization technique has been proposed as an effective way of eliminating the need for an inlying. Foley catheter in patients with neurovesical dysfunction following spinal cord injury. In the study reported here, a group of 41 male patients with spinal cord injuries achieved a catheter-free state with this method. Of these 41 patients, 19 have been followed for 1 year. Data obtained from the 19 patients are presented here for comparison with data from other recent studies. In the present study, the patients' fluid intake was restricted to 2,000 cc daily. A detrusor reflex was triggered by lower abdominal percussion followed by a Credé maneuver. A 6-hour catheterization schedule was used unless autonomic dysreflexia required more frequent catheterizations. Ascorbic acid, methenamine mandelate and nitrofurantoin were routinely administered, and specific antibiotics were also given following trial off-catheter, depending on the results of urine cultures and sensitivity studies. All patients achieved a catheter-free state in an average time of 17.1 days; no late failures have occurred. Two patients developed vesicoureteral reflux, but no evidence of hydronephrosis was observed. At 1 year only 16% of the patients were found to have infected urine, as compared to 100% at initiation of the trial off-catheter.
Ascorbic Acid↗
[Prevention of tracheal lesions by rhythmic insufflation of the intubation catheter ballone].
The prevention of tracheal lesions due to the ballons of the intubation catheters depends on the correction of several factors concerning: -the material used (polyvinyl is better tolerated than rubber); -the shape (the sleeve-shape balloons are less traumatic); -the pressure of use, which should remain moderate; -the permanence of the compression (one should use intermittent filling of the ballon). A device designed by the authors and which is described here, permits intermittent insufflation of the ballons of the endotracheal catheters, by adaptation of certain apparatus of artificial ventilation, type LOGIC and SF4, has given excellent results.
Humans↗
In vivo calibration of flow-dependent blood gas catheters.
In vivo calibration of blood gas catheters is complicated by the fact that their signals are flow dependent. A calibration method is described here, which permits continuous in vivo calibration. The principle is to compensate for flow dependence through simultaneous measurement on an inspired, inert reference gas of known partial pressure. The method is demonstrated by experiments on three anesthetized dogs, in which the arterial oxygen partial pressure was measured in situ with a flow-dependent blood gas catheter. The compensated signal was in good agreement with the partial pressure of oxygen measured with conventional techniques.
Animals↗
Risk of systemic infections associated with umbilical vessel catheterization.
The purpose of the present study is to determine the risk of infections associated with umbilical vessel catheterization. During a period of recent four years, 97 catheters were inserted into the umbilical vessels of 94 newborn infants in a newborn nursery. Thirty percent of the catheter tips were colonized upon removal with pathogens (11%) and contaminants. The rate of catheter colonization was not dependent on sex, gestational age, birth weight and duration of catheterization. Bacteria were isolated from blood specimen drawn via the catheter upon removal in one patient, but blood sample from peripheral artery and catheter tip yielded no organisms in this patient. One patient (1%) was found to be septicemic while the catheter was in place. Culture of the catheter tip and blood drawn via the catheter proved unreliable in the diagnosis of subsequent systemic infection. Judicious surveillance for systemic infection by peripheral blood culture is necessary.
Bacterial Infections↗
[Experience with a guidable catheter for angiography and bronchography (author's transl)].
Despite certain disadvantages, depending partly on the design of the catheter and partly on other problems, a guidable catheter is, in many cases, the only means for achieving a successful angiographic examination. The guidable catheter is therefore a valuable addition to the equipment used for angiography.
Angiography↗
Cerebral ischemia. I. Current angiographic techniques, complications, and safety.
The angiographic evaluation of the transient ischemic attack has been technically difficult, time consuming, and complication prone because of underlying arteriosclerosis and other medical diseases. The examination described depends upon small soft catheters, dynamic fluoroscopy for positioning, and selective magnified views of the arteries needed for surgical planning. Five basic views are exposed. On the side of clinical interest, a lateral view of the head and neck, a frontal view of the head, and a fluoroscopically positioned view of the carotid bifurcation are obtained; on the other side the frontal view is omitted. A total of 662 consecutive studies were performed on 603 patients without death or permanent strokes. The only permanent complication was a partial radial nerve palsy.
Cerebral Angiography↗
Antinociceptive effects of intrathecally administered human beta-endorphin in the rat and cat.
Rats chronically implanted with intrathecal catheters displayed a dose-dependent increase in the hot-plate and tail-flick response latencies following the injection of human beta-endorphin into the lumbar spinal subarachnoid space through the indwelling catheter. beta-Endorphin was approximately 25 times more potent than morphine on a molar basis. Matching morphine and beta-endorphin doses such that approximately equal submaximal submaximal effects occurred, it was observed that the antinociception produced by beta-endorphin lasted approximately three times longer than that produced by morphine. Experiments with intrathecal injection of beta-endorphin into the spinal subarachnoid space of cats fitted with intrathecal catheters also revealed a potent antinociceptive effect which was completely antagonized by naloxone. In the rats, naloxone administered systemically in doses of 10--100 microgram/kg produced a parallel shift in the dose-response curves of both nociceptive measures suggesting a competitive antagonism. Using a dose ratio analysis, an in vivo pA2 of 7.1 for naloxone was obtained. These data and those derived from previous work based on the pA2 suggest that the interaction of morphine, certain pentapeptides, and beta-endorphin is the same with regard to the spinal opiate receptor population mediating behaviorally defined analgesia.
Analgesics↗
A comparative study of peripherally inserted silicone catheters for parenteral nutrition.
One hundred patients receiving parenteral nutrition with lipids and hypertonic amino acids and glucose were divided into five groups of 20, depending on the type of intravenous catheter used for the infusion. Least satisfactory were the short Butterfly needles (average 3.3 days in place) and the long peripherally inserted polyvinyl central venous catheters (average 6.2 days in place). Subclavian catheters of polyvinyl (average 15.3 days) or silicone elastomer (average 17.5 days) were equally efficacious. A new long silicone elastomer catheter inserted peripherally was most satisfactory (average 29.5 days). Problems common with polyvinyl catheters (phlebitis, thrombosis, and sepsis) rarely occurred with either the long or short silicone elastomer catheter.
Catheterization↗
Relationship of central and peripheral airway resistance to lung volume in dogs.
We could not reconcile reported relationships between lung resistance measurements and lung volume with bronchographic and anatomic studies showing that airway diameters change monotonically with lung volume and that small airways change diameter proportionately at least as much as large ones. Accordingly we measured central and peripheral airways resistances with a new technique. The relevant pressures were measured with a tracheal cannula, a wedged retrograde catheter, and two parenchymal needles in seven open-chested dogs while pleural pressure was oscillated at 1 Hz. In contrast to previous studies, the volume dependency of peripheral resistance was at least as great as that of central resistance with vagi intact, the volume dependencies of central and peripheral resistances were not abolished by vagotomy, and neither resistance increased systematically at high volumes. Volume dependency of central resistance resembled predictions for isotropic expansion of airways with vagi cut but increased with bronchomotor tone. These results fit generally with bronchographic data. Previous studies may have been affected by volume dependency due to "tissue resistance" and catheter phase lags.
Airway Resistance↗
[Central vein catheters. Four unusual accidents (author's transl)].
Malpositioning of the tip of a central vein catheter is an accident whose frequency depends in part upon the puncture site. Certain dispositions are especially rare; the authors thus describe. Knotting in the left innominate vein after left internal jugular vein puncture. Catheterisation of the left internal mammary vein from the left subclavian vein. Intertion of a catheter in a pulmonary vein from the femoral route through a septal defect. And finally a thoracic aorta catheterisation by an unnoticed puncture of the left subclavian artery. The diagnostic steps and the conditions necessary to avoid the complications inherent to these malpositions are thereafter discussed.
Adolescent↗
Exerience with the Broviac catheter for prolonged parenteral alimentation.
Home hyperalimentation is now recognized as a technique which allows patients with severe short bowel syndrome or inflammatory bowel disease to return to a near normal life style. The success of this program is dependent on the longterm use of a catheter through which intravenous fluids are infused. In the past 20 months, we have inserted 32 catheters into 22 patients for purposes of home parenteral nutrition. In a 1 to 20-month follow-up, the average duration of catheter insertion was 6 months, the longest has been 19 months in 2 patients. One patient with superior vena cava thrombosis has had a catheter inserted via a femoral vein which has been functioning well for 5 months. Thirteen catheters have been removed: 3 for obstruction, 2 for sepsis, 1 due to breakage of the catheter, 4 for slippage (3 were pulled out by the patient, and 1 was removed because of inability to psychologically accept the presence of the catheter). The removal of 6 of these 13 catheters was necessitated by breaks in the proper techniques of catheter care, which include daily dressing changes and heparinization of the catheter at least once daily. Techniques of catheter insertion and catheter care will be presented
Arm↗
The catheterized urinary tract selects for MRR1-mediated efflux and fluconazole resistance in Candida albicans biofilms.
Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection in developed countries, and Candida species are among the most frequently isolated organisms. Despite this, little is known about the biology, host-pathogen interactions, or outcomes of these infections, and this has led to uncertain guidelines for clinical management of Candida CAUTIs. Here, we develop the first physiologically relevant artificial urine medium (AUM) that supports fungal growth in a manner similar to, but more consistent than, human urine samples. We demonstrate that human catheter-associated (CA) clinical isolates of C. albicans exhibit environment-dependent fluconazole resistance: many isolates determined to be susceptible by standard CLSI testing in RPMI (MIC ≤ 2 µg/mL) were fully resistant (MIC ≥ 128 µg/mL) when grown in pooled human urine or AUM, complicating clinical management, which is based on catheter exchange and fluconazole treatment. Transcriptomic profiling of biofilms formed in AUM revealed a remarkably convergent upregulation of efflux and detoxification processes across clinical isolates with diverse biofilm phenotypes. Whole-genome sequencing of the CA isolates identified variant alleles of transcriptional regulators of drug efflux, including MRR1, that have been previously associated with antifungal resistance. A competition assay confirmed that Mrr1 provides a fitness advantage in urine and AUM in a urea-dependent manner. Thus, we show that the urinary environment promotes a unique biofilm differentiation program and selects for adaptations that increase drug resistance and would be predicted to render standard treatment regimens ineffective.IMPORTANCECatheter-associated urinary tract infections are the most common nosocomial infection in the United States, and Candida albicans is one of the most frequently isolated organisms from these infections. Despite this high prevalence, few molecular studies have examined C. albicans biology in the urinary environment, and recommendations for clinical management lack robust evidence. Here, we show that clinical catheter-associated isolates of C. albicans identified as susceptible to fluconazole by standard clinical microbiology testing were resistant when grown in human or artificial urine. We identified transcriptional responses intrinsic to the urinary environment that produce this environment-specific resistance phenotype. Biofilm growth in the urinary environment induces cellular processes for efflux and detoxification. These findings suggest that standard susceptibility testing may not predict fluconazole efficacy in the urinary tract and underscore the need for niche-informed approaches to antifungal management of these common infections.
Candida albicans↗
Loss of indicator in the thermodilution technique.
The use of a second thermistor for detecting the injectate temperature in the extravascular segment of a standard right heart thermodilution catheter is described. Experiments with chilled (0 degrees C) indicator show that the temperature of the injectate as it enters the catheter is always greater than zero and that it depends on time and the gradient between indicator and surroundings; that serial injections made 30 to 60 seconds apart are successively cooler and do not plateau until the third injection. These variables amount to an overestimation in the cardiac output of 3 to 12%.
Cardiac Catheterization↗
Central venous cannulation and pressure monitoring.
Central venous pressure (CVP) varies directly with circulating blood volume and vascular tone and inversely with right heart competency. Indications for central cannulation include cardiorespiratory arrest. The two general approaches to cannulation of central veins are peripheral and central. The physician's skill, patient's body habitus, clinical circumstances, age and thoracic deformity all influence the choice of technique. Three of the possible complications discussed are pneumothorax, arterial puncture and air embolus. Accurate measurement of CVP depends on the patient being supine, a patent and accurately located catheter and the establishment of a baseline external zero point.
Carotid Artery Injuries↗
[Diagnosis of yeast contamination in urine especially of patients with indwelling catheters (authors transl)].
Mycologic investigations of female patients with permanent catheters have shown that the yeast contamination detected in the urine depends on the time of catheterizing. Yeast from the genital and anal regions are the main sources of infection. Prophylactic therapy with antimycotic agents is recommended.
Humans↗
Assessment of myocardial function in the horse. 1. Theoretical and technical considerations.
The paper discusses the various parameters which are currently used in attempts to assess the contractile efficiency of the myocardium in various species. These procedures depend upon accurate recording of intracavity pressure. The response of a catheter-mounted microtransducer compared with a fluid-filled catheter manometer system is illustrated to show the advantage of the former in providing a true representation of pressure changes.
Animals↗
Plasma insulin and C-peptide levels during continuous subcutaneous insulin infusion.
A study was performed to estimate the absorption kinetics of insulin infused subcutaneously. Four insulin-dependent diabetic subjects had their insulin pumped through a subcutaneously implanted fine polyethylene catheter at a constant rate of 5.0 +/- 0.3 ml/h but at two different insulin concentrations: 218 mU/ml between meals, and 2400 mU/ml at the start of breakfast, lunch, and dinner (lasting 20, 30, and 30 min, respectively). The amount (40 U/day) and distribution of insulin delivered was identical in the four patients in order to facilitate comparison between the subjects. No attempt was made to normalize their blood glucose during the study period. A study of the kinetics of insulin absorption was made by assaying plasma insulin levels; lack of plasma anti-insulin antibodies was verified; plasma C-peptide levels were measured and were far below values observed in the fed state in nondiabetic patients. The mean maximum insulin level reached after switching from low to high concentration insulin was observed 87 +/- 2 min after breakfast, 117 +/- 22 min after lunch, and 125 +/- 20 min after dinner. Differences observed are not significant. These values are similar to those observed after subcutaneous injection of 40 U/ml Regular insulin as a single bolus. After switching from high to low concentration, plasma insulin levels did not return to their basal values before the third or fourth hour. Subcutaneous insulin infusion could be a safe and easy way of insulin administration in an open-loop system; however, this method does not seem to be suitable for a closed-loop system.
Blood Glucose↗