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https://www.readbyqxmd.com/read/28934936/transitional-cell-carcinoma-involving-graft-kidney-in-a-kidney-transplant-recipient-a-case-report
#1
Yu Ah Hong, Hyeon Seok Hwang, Hae Joung Sul, Suk Young Kim, Yoon Kyung Chang
BACKGROUND: Kidney transplantation (KT) is the treatment option for patients with end stage renal disease (ESRD) to prolong survival and improve quality of life. Although the use of potent immunosuppressive agents increases graft survival in kidney transplantation recipients (KTRs), it may lead to the development of malignancy, including transitional cell carcinoma (TCC). TCC developing in the pelvis of graft kidney is very rare in KTRs. CASE PRESENTATION: A 40-year-old male visited hospital with complaints of nausea, vomiting and gross hematuria...
September 21, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28899228/intraoperative-venoplasty-to-facilitate-placement-of-tunneled-catheters-for-hemodialysis
#2
Afsha Aurshina, Anil Hingorani, Natalie Marks, Enrico Ascher
Objective With the implementation of the K-DOQI guidelines, more patients are in need of long-term dialysis catheters until maturation of the arteriovenous fistula. However, on occasion, when placing a tunneled cuffed catheter for hemodialysis, we have encountered difficulty with passing the guidewire in spite of demonstration of a patent cervical portion of the internal jugular vein on duplex. Herein, we review our experience with intraoperative venoplasty for placement of Tesio™ catheters (Medcomp Harleysville, PA)...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28832356/blood-pressure-in-hemodialysis-targets
#3
Panagiotis I Georgianos, Rajiv Agarwal
PURPOSE OF REVIEW: In the absence of 'hard' clinical-trial evidence to define optimal blood pressure (BP) targets and validate different BP measurement techniques, management of hypertension in hemodialysis is based on expert opinions. In this review, we provide a comparative evaluation of out-of-dialysis BP monitoring versus dialysis-unit BP recordings in diagnosing hypertension, guiding its management and prognosticating mortality risk. RECENT FINDINGS: Owing to their high variability and poor reproducibility, predialysis and postdialysis BP recordings provide inaccurate reflection of the actual BP load outside of dialysis...
August 21, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28796425/comparison-of-stroke-volume-measurements-during-hemodialysis-using-bioimpedance-cardiography-and-echocardiography
#4
Michael J Germain, Jyovani Joubert, Daniel O'Grady, Brian H Nathanson, Yossi Chait, Nathan W Levin
BACKGROUND: Fluid management remains a major challenge of hemodialysis (HD) care, with serious implications for morbidity and mortality. Intradialytic fluid management is typically guided by blood pressure, an indirect resultant of hemodynamics status. Direct measurements of hemodynamic parameters may improve cardiovascular outcomes by providing rational bases for intervention. We compare stroke volume (SV) measurements using a noninvasive, regional biompedance cardiography device (NiCaS) with Doppler echocardiography (Echo) in HD setting...
August 10, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28745842/toxic-alcohol-ingestion-prompt-recognition-and-management-in-the-emergency-department-digest
#5
Gillian A Beauchamp, Matthew Valento, Jeremy Kim
Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites...
September 22, 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28731382/external-validation-and-clinical-utility-of-a-prediction-model-for-6-month-mortality-in-patients-undergoing-hemodialysis-for-end-stage-kidney-disease
#6
Brian Forzley, Lee Er, Helen Hl Chiu, Ognjenka Djurdjev, Dan Martinusen, Rachel C Carson, Gaylene Hargrove, Adeera Levin, Mohamud Karim
BACKGROUND: End-stage kidney disease is associated with poor prognosis. Health care professionals must be prepared to address end-of-life issues and identify those at high risk for dying. A 6-month mortality prediction model for patients on dialysis derived in the United States is used but has not been externally validated. AIM: We aimed to assess the external validity and clinical utility in an independent cohort in Canada. DESIGN: We examined the performance of the published 6-month mortality prediction model, using discrimination, calibration, and decision curve analyses...
July 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28729382/recommended-clinical-trial-end-points-for-dialysis-catheters
#7
Michael Allon, Deborah J Brouwer-Maier, Kenneth Abreo, Kevin M Baskin, Kay Bregel, Deepa H Chand, Andrea M Easom, Leonard Mermel, Michele H Mokrzycki, Priti R Patel, Prabir Roy-Chaudhury, Surendra Shenoy, Rudolph P Valentini, Haimanot Wasse
Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration...
July 20, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28709598/simplifying-the-hemodialysis-prescription-in-patients-with-ethylene-glycol-poisoning
#8
Darren M Roberts, Tom N Lea-Henry
The management of ethylene glycol poisoning is multimodal and usually includes hemodialysis. The usual approach for guiding treatment duration is iterative, based on serial measurements of ethylene glycol concentration and routine biochemistry. In this issue, Iliuta et al. present a simplified approach to determining the duration of hemodialysis based on a single ethylene glycol concentration. Although this appears reasonable in many cases, there are circumstances in which further consideration is warranted and it only applies to high-efficiency intermittent hemodialysis...
August 2017: Kidney International
https://www.readbyqxmd.com/read/28700182/-brachial-artery-pseudoaneurysm-a-rare-but-serious-complication-in-hemodialysis-patients-with-arteriovenous-fistula
#9
Andrea Mancini, Giuseppe Castriotta, Pernina Angelini, Michele Bozzi, Vincenzo Giancaspro, Elvira La Raia, Maria Teresa Nisi, Anna Rita Proscia, Giuseppe Tarantino, Ottavia Vitale, Cristoforo Cuzzola
A pseudoaneurysm or false aneurysm of the brachial artery is an uncommon occurrence in patients receiving hemodialysis with arteriovenous fistula (AVF). We describe the case of a 76-year-old woman presenting with a large, tender, pulsatile mass in the right antecubital region 10 cm from the AVF. B-mode ultrasound examination revealed a saccular hematoma. Color doppler showed a recirculation movement of blood, creating a two colors image called "Korean flag". The patient was transferred to the surgical unit where she first underwent ultrasound-guided compression and then surgical repair of the pseudoaneurysm...
June 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28672146/stroke-volume-guided-resuscitation-in-severe-sepsis-and-septic-shock-improves-outcomes
#10
Heath E Latham, Charles D Bengtson, Lewis Satterwhite, Mindy Stites, Dipti P Subramaniam, G John Chen, Steven Q Simpson
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. Net fluid balance for the ICU stay was lower in the SV group (1...
June 28, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28652444/reticulocyte-hemoglobin-content-helps-avoid-iron-overload-in-hemodialysis-patients-a-retrospective-observational-study
#11
Domenico Capone, Mauro Cataldi, Mauro Vinciguerra, Teresa Mosca, Salvatore Barretta, Annalisa Ragosta, Aniello Sorrentino, Alessandra Vecchione, Luca Barretta, Giovanni Tarantino
BACKGROUND/AIM: Anemia in patients suffering from end-stage renal failure is currently treated with Erythropoiesis-Stimulating Agents (ESA). This treatment needs sufficient iron supplementation to avoid an inadequate dosage of ESA. Nowadays modern analytical instruments allow to accurately calculate the content of Hemoglobin (Hb) in reticulocytes (CHr), that can be used as a guide for prescribing patients with the appropriate amount of iron. PATIENTS AND METHODS: Patients, undergoing hemodialysis, were retrospectively selected from the database and were divided in two groups: group A received intravenous (IV) iron and subcutaneously ESA, and their dosages were adjusted on the basis of the following parameters: Hb, Mean corpuscular haemoglobin (MCH), CHr with consequent MCH/CHr ratio and reticulocyte count determined by the ADVIA 120 Hematology System of Siemens; group B patients were administered IV iron and ESA monitoring iron storage, Hb and ferritin...
July 2017: In Vivo
https://www.readbyqxmd.com/read/28652048/the-efficacy-of-low-intensity-vibration-to-improve-bone-health-in-patients-with-end-stage-renal-disease-is-highly-dependent-on-compliance-and-muscle-response
#12
Chamith S Rajapakse, Mary B Leonard, Elizabeth A Kobe, Michelle A Slinger, Kelly A Borges, Erica Billig, Clinton T Rubin, Felix W Wehrli
RATIONAL AND OBJECTIVES: Low intensity vibration (LIV) may represent a nondrug strategy to mitigate bone deficits in patients with end-stage renal disease. MATERIALS AND METHODS: Thirty end-stage renal patients on maintenance hemodialysis were randomized to stand for 20 minutes each day on either an active or placebo LIV device. Analysis at baseline and completion of 6-month intervention included magnetic resonance imaging (tibia and fibula stiffness; trabecular thickness, number, separation, bone volume fraction, plate-to-rod ratio; and cortical bone porosity), dual-energy X-ray absorptiometry (hip and spine bone mineral density [BMD]), and peripheral quantitative computed tomography (tibia trabecular and cortical BMD; calf muscle cross-sectional area)...
June 23, 2017: Academic Radiology
https://www.readbyqxmd.com/read/28639917/concomitant-staple-aneurysmorrhaphy-and-flow-calibrated-arteriovenous-fistula-banding-over-a-coronary-dilator-to-treat-hand-steal-syndrome
#13
Jennifer Baker, Rafael D Malgor
BACKGROUND: True venous aneurysm formation can occur in patients with arteriovenous fistulas (AVFs) for hemodialysis but association with steal syndrome is uncommon. METHODS: To describe a case of a patient on chronic hemodialysis through a right brachiocephalic fistula, who presents with associated steal syndrome and true arteriovenous access aneurysm. RESULTS: A 34-year-old female with true AVF aneurysm presented with hand steal syndrome confirmed by noninvasive studies...
July 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28577269/catheterization-via-direct-cannulation-of-superior-vena-cava-for-a-hemodialysis-patient-with-an-original-dysfunctional-catheter-on-the-left-internal-jugular-vein
#14
Li Zhou, Lin Chen, Yang Yu, Tianlei Cui, Xiao Li, Ping Fu
Establishing a long-term vascular access in patients exhibiting vascular access exhaustion is challenging. In this study, we reported a case of a direct catheterization in the superior vena cava of a hemodialysis patient with vascular access exhaustion and original dysfunctional catheter inserted via the left internal jugular vein. The direct catheterization was performed with cuffed tunnel catheter (CUFF) and guided by digital subtraction angiography (DSA) and multidetector computed tomography venography (MDCTV)...
September 2017: Frontiers of Medicine
https://www.readbyqxmd.com/read/28558866/potential-clinical-utility-and-feasibility-of-combined-left-atrial-appendage-closure-and-positioning-of-miniaturized-pacemaker-through-a-single-right-femoral-vein-access
#15
François Regoli, Marco Araco, Tiziano Moccetti, Maria Luce Caputo, Giulio Conte, Angelo Auricchio, Marco Moccetti
This study assessed the clinical utility and feasibility of concomitant of combined left atrial appendage (LAA) closure and positioning of miniaturized pacemaker (Micra TPS). All consecutive patients who underwent VVI-PM implant from November 2015 to October 2016 were considered. VVI-PM implant was conducted either using transvenous approach or by positioning Micra TPS. In selected patients with concomitant contraindication to OAC, Micra TPS was combined with LAA occlusion ("combined approach"), performed in general anesthesia and guided by multimodality imaging; procedural and follow-up data of these specific patients were registered...
July 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28529812/diabetic-muscle-infarction-masquerading-as-necrotizing-fasciitis
#16
Kalyana C Janga, Ankur Sinha, Perry Wengrofsky, Phone Oo, Sheldon Greenberg, Regina Tarkovsky, Kavita Sharma
A 43-year-old male patient with past medical history of diabetes mellitus (DM), end stage renal disease (ESRD) on hemodialysis (HD), congestive heart failure (CHF), obstructive sleep apnea (OSA), and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT) of the thigh revealed evidence of edema with no evidence of a focal collection or gas formation noted. The patient's clinical symptoms persisted and he underwent magnetic resonance imaging (MRI) of his thigh which was reported to show small areas of muscle necrosis with fluid collection...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28507910/penile-calciphylaxis-the-use-of-radiological-investigations-in-the-management-of-a-rare-and-challenging-condition
#17
Rebecca A Campbell, Laith M Alzweri, Nikolai A Sopko, Katarzyna J Macura, Arthur L Burnett
Penile calciphylaxis is a rare phenomenon of penile necrosis observed in patients with hemodialysis-dependent end-stage renal failure. Multiple treatments have been proposed including conservative management, surgical debridement and penectomy; yet, the prognosis remains extremely poor. Here, we describe a patient with protracted resolution of dry gangrene of the glans, which failed conservative management of wound care and pain management. Radiological studies revealed extensive calcification of abdominal aorta and branching vessels including the penile arteries...
July 2017: Urology Case Reports
https://www.readbyqxmd.com/read/28486776/ultrasound-guided-cannulation-of-the-hemodialysis-arteriovenous-access
#18
Frank Ward, Rose Faratro, Rory F McQuillan
Successful cannulation of the arteriovenous access for patients with end-stage kidney failure to allow catheter-free hemodialysis is associated with superior patient outcomes. With an increasing rate of arteriovenous access creation, coupled with increasing dialysis patient age, the "difficult-to-cannulate" access is becoming more commonplace. Ultrasound-guided cannulation aims to improve first-time successful cannulations and minimize cannulation-associated complications such as infiltration and hematoma formation, minimizing delays in access use and reducing catheter dependency...
July 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28466757/applicability-of-an-entry-flow-model-of-the-brachial-artery-for-flow-models-of-the-hemodialysis-fistula
#19
Sulav Bastola, William D Paulson, Steven A Jones
The native arteriovenous fistula creates a shunt that provides the high blood flow that is needed for dialysis. Lumped parameter hemodynamic models of the arteriovenous fistula can be used to predict shear stresses and pressure losses and can be applied to help understand unsolved problems such as the high rate of arteriovenous fistula maturation failure. These models combine together flow components, such as arteries, stenosis, anastomoses, arterial compliance, and blood inertia, and each component must be modeled with an appropriate pressure-flow relationship...
May 1, 2017: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
https://www.readbyqxmd.com/read/28444336/intradialytic-hypotension-blood-pressure-changes-and-mortality-risk-in-incident-hemodialysis-patients
#20
Jason A Chou, Elani Streja, Danh V Nguyen, Connie M Rhee, Yoshitsugu Obi, Jula K Inrig, Alpesh Amin, Csaba P Kovesdy, John J Sim, Kamyar Kalantar-Zadeh
Background.: Intradialytic hypotension (IDH) occurs frequently in maintenance hemodialysis (HD) patients and may be associated with higher mortality. We hypothesize that nadir intradialytic systolic blood pressure (niSBP) is inversely related to death risk while iSBP change (Δ) and IDH frequency are incrementally associated with all-cause mortality. Methods.: In a US-based cohort of 112 013 incident HD patients over a 5-year period (2007-11), using niSBP, ΔiSBP (pre-HD SBP minus niSBP) and IDH frequency (proportion of HD treatments with niSBP <90 mmHg) within the first 91 days of HD, we examined mortality-predictability at 1, 2 and 5 years using Cox models and restricted cubic splines adjusted for case-mix, comorbidities and laboratory covariates...
April 21, 2017: Nephrology, Dialysis, Transplantation
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