Improving Dialysis Access: Regional Anesthesia Improves Arteriovenous Fistula Prevalence

An autologous arteriovenous (AV) fistula is the preferred form of angioaccess for chronic hemodialysis. A prospective study was carried out to evaluate the potential of regional anesthesia to improve AV fistula prevalence. One hundred ninety-three patients underwent preoperative duplex ultrasound evaluation over a 14-month period. The qualification of each patient to receive either an autologous AV fistula or a prosthetic graft was based on specific sonographic criteria. Patients scheduled for placement of a graft received an ultrasound-directed supraclavicular brachial plexus block, which produces dense sympathetic blockade. After the regional block, those patients who met criteria for primary fistula construction on repeat ultrasound received a fistula instead of a graft. Of 62 patients scheduled to receive an AV graft, 23 or 37 per cent were recruited to receive a fistula instead. The outcome of the recruited fistulas was compared with the 121 planned fistulas. There was no statistically significant difference in primary failure rate (4.3 vs 5.8%). The recruited fistulas had a shorter average maturation time, 83 ± 48 versus 132 ± 82 days ( P = 0.023). Within the study population, functioning fistula prevalence was increased from 61.7 to 79.8 per cent. Regional anesthesia and immediate preoperative ultrasound is a useful strategy for increasing fistula prevalence.

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A Prospective Study of Strut versus Miniplate for Fractures of Mandibular Angle

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0033-1349213 ◽

2013 ◽

Vol 6 (3) ◽

pp. 191-196 ◽

Cited By ~ 13

Author(s):

Amy S. Xue ◽

John C. Koshy ◽

Erik M. Wolfswinkel ◽

William M. Weathers ◽

Kristina P. Marsack ◽

...

Keyword(s):

Mandibular Angle ◽

Patient Demographics ◽

Mandibular Angle Fracture ◽

Plate Group ◽

Angle Fracture ◽

Significant Difference ◽

Comminuted Fractures ◽

Angle Fractures ◽

A Prospective Study ◽

To Receive

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients were randomly assigned to receive the strut plate or Champy miniplate for angle fracture fixation. Patient demographics, fracture characteristics, operative and postoperative outcomes were collected prospectively. Statistical analysis was performed to evaluate the significance of the outcome. A total of 18 patients were included in this study and randomly assigned to receive either the strut plate or Champy miniplate. Out of which five patients were excluded postoperatively due to complex fracture resulting in postoperative maxillomandibular fixation. The final enrollment was 13 patients, N = 6 (strut) and N = 7 (Champy). There was no statistically significant difference in the pretreatment variables. Nine of these patients had other associated facial fractures, including parasymphyseal and subcondylar fractures. Most of the (11) patients had sufficient follow-up after surgery. Both groups exhibited successful clinical unions of the mandibular angle fractures. The complications associated with the mandibular angle were 20% in the strut plate group and 16.7% in the Champy group. One patient in the strut plate group had a parasymphyseal infection, requiring hardware removal. The strut plate demonstrated comparable surgical outcome as the Champy miniplate. It is a safe and effective alternative for management of mandibular angle fracture.

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Fifty years of hemodialysis access literature: The fifty most cited publications in the medical literature

Vascular ◽

10.1177/1708538117721001 ◽

2017 ◽

Vol 26 (1) ◽

pp. 75-79

Author(s):

Edvard Skripochnik ◽

David J O’Connor ◽

Eric B Trestman ◽

Evan C Lipsitz ◽

Larry A Scher

Keyword(s):

Medical Literature ◽

Chronic Hemodialysis ◽

Dialysis Access ◽

Hemodialysis Access ◽

Av Fistula ◽

Hemodialysis Catheter ◽

Number Of Patients ◽

Number Of Publications ◽

Modern Era ◽

Access Surgery

Objectives The modern era of hemodialysis access surgery began with the publication in 1966 by Brescia et al. describing the use of a surgically created arteriovenous fistula. Since then, the number of patients on chronic hemodialysis and the number of publications dealing with hemodialysis access have steadily increased. We have chronicled the increase in publications in the medical literature dealing with hemodialysis access by evaluating the characteristics of the 50 most cited articles. Methods We queried the Science Citation Index from the years 1960–2014. Articles were selected based on a subject search and were ranked according to the number of times they were cited in the medical literature. Results The 50 most frequently cited articles were selected for further analysis and the number of annual publications was tracked. The landmark publication by Dr Brescia et al. was unequivocally the most cited article dealing with hemodialysis access (1109 citations). The subject matter of the papers included AV fistula and graft (9), hemodialysis catheter (9), complications and outcomes (24), and other topics (8). Most articles were published in nephrology journals (33), with fewer in surgery (7), medicine (7), and radiology (3) journals. Of the 17 journals represented, Kidney International was the clear leader, publishing 18 articles. There has been an exponential rise in the frequency of publications regarding dialysis access with 42 of 50 analyzed papers being authored after 1990. Conclusion As the number of patients on hemodialysis has increased dramatically over the past five decades, there has been a commensurate increase in the overall number of publications related to hemodialysis access

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Duplex Ultrasound Evaluation for Dialysis access Selection and Maintenance: A Practical Guide

The Journal of Vascular Access ◽

10.1177/112972980800900101 ◽

2008 ◽

Vol 9 (1) ◽

pp. 1-9 ◽

Cited By ~ 35

Author(s):

I. Davidson ◽

D. Chan ◽

B. Dolmatch ◽

M. Hasan ◽

D. Nichols ◽

...

Keyword(s):

Duplex Ultrasound ◽

Dialysis Access ◽

Access Selection ◽

Practical Guide ◽

Ultrasound Evaluation

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Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1385 ◽

2015 ◽

Vol 18 (4) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Mehmet Taşar ◽

Mehmet Kalender ◽

Okay Güven Karaca ◽

Ata Niyazi Ecevit ◽

Salih Salihi ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Carotid Artery Disease ◽

Risk Groups ◽

Cardiac Risk ◽

Cervical Plexus ◽

Cardiac Risk Factors ◽

Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

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SMILE and Wavefront-Guided LASIK Out-Compete Other Refractive Surgeries in Ameliorating the Induction of High-Order Aberrations in Anterior Corneal Surface

Journal of Ophthalmology ◽

10.1155/2016/8702162 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Min-jie Ye ◽

Cai-yuan Liu ◽

Rong-feng Liao ◽

Zheng-yu Gu ◽

Bing-ying Zhao ◽

...

Keyword(s):

Spherical Aberration ◽

Laser In Situ Keratomileusis ◽

Small Incision Lenticule Extraction ◽

Corneal Surface ◽

Small Incision ◽

Significant Difference ◽

Lenticule Extraction ◽

A Prospective Study ◽

High Order Aberrations

Purpose. To compare the change of anterior corneal higher-order aberrations (HOAs) after laser in situ keratomileusis (LASIK), wavefront-guided LASIK with iris registration (WF-LASIK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), and small incision lenticule extraction (SMILE).Methods. In a prospective study, 82 eyes underwent LASIK, 119 eyes underwent WF-LASIK, 88 eyes underwent FS-LASIK, and 170 eyes underwent SMILE surgery. HOAs were measured with Pentacam device preoperatively and 6 months after surgery. The aberrations were described as Zernike polynomials, and analysis focused on total HOAs, spherical aberration (SA), horizontal coma, and vertical coma over 6 mm diameter central corneal zone.Results. Six months postoperatively, all procedures result in increase of anterior corneal total HOAs and SA. There were no significant differences in the induced HOAs between LASIK and FS-LASIK, while SMILE induced fewer total HOAs and SA compared with LASIK and FS-LASIK. Similarly, WF-LASIK also induced less total HOAs than LASIK and FS-LASIK, but only fewer SA than FS-LASIK (P<0.05). No significant difference could be detected in the induced total HOAs and SA between SMILE and WF-LASIK, whereas SMILE induced more horizontal coma and vertical coma compared with WF-LASIK (P<0.05).Conclusion. FS-LASIK and LASIK induced comparable anterior corneal HOAs. Compared to LASIK and FS-LASIK, both SMILE and WF-LASIK showed advantages in inducing less total HOAs. In addition, SMILE also possesses better ability to reduce the induction of SA in comparison with LASIK and FS-LASIK. However, SMILE induced more horizontal coma and vertical coma compared with WF-LASIK, indicating that the centration of SMILE procedure is probably less precise than WF-LASIK.

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Alternative chemoradiotherapy in anal carcinoma patients with mutations in thymidylate synthase and dihydropyrimidine dehydrogenase genes

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211024464 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110244

Author(s):

Muhammad Wasif M. Saif ◽

Ruchi Hamal ◽

Nauman Siddiqui ◽

Antonia Maloney ◽

Melissa Smith

Keyword(s):

Dihydropyrimidine Dehydrogenase ◽

Anal Carcinoma ◽

Complete Response ◽

Genetic Mutations ◽

Molecular Testing ◽

Severe Toxicity ◽

Metabolizing Enzymes ◽

Radiological Response ◽

A Prospective Study ◽

To Receive

Background: 5-fluorouracil (5-FU) and mitomycin-C (MMC) with radiotherapy (RT) remain an established treatment for patients with anal cancer (AC). Genetic mutations in two major metabolizing enzymes for 5-FU; dihydropyrimidine dehydrogenase ( DPYD and thymidylate synthetase ( TYMS), have been associated with clinical response and toxicity. However, their place in the treatment of AC remains undetermined. Methods: We retrospectively reviewed 21 patients with AC, including T2-4, N0-1, M0 or T1-4, N2-3, and M0 treated between 2012 and 2018. All patients were treated with 5-FU 1,000 mg/m2/day via continuous intravenous (IV) infusion 1–4 and 29–32, MMC 10 mg/m2 IV bolus days 1 and 29 plus RT. Patients who developed ⩾3 grade toxicities were tested for the DPYD and TYMS genes. Treatment was either modified with reduced doses or changed to MMC 10 mg/m2 day 1 and 29 with cisplatin 25 mg/m2/week plus RT. Toxicities and responses were collected. Results: Six out of 21 patients who developed ⩾3 grade toxicities including pancytopenia, neutropenia, thrombocytopenia, mucositis, nausea, rash, and nephritis were found to have genetic mutations: TYMS 2RG/3RC ( n = 2), 3RG/3RC ( n = 1), 2R/2R ( n = 2), T YMS 3′UTR del/Ins ( n = 2), and DPYD c.2864A > T heterozygous ( n = 1). Two patients received 5-FU at a 50% reduced dose on days 29–32; one patient refused to receive 5-FU (continued with MMC and RT); one patient received only radiation therapy due to persistent pancytopenia despite the use of growth factors; two patients received an alternative regimen consisting of MMC 10 mg/m2 on day 29 with cisplatin (CDDP) 25 mg/m2/week plus RT; and two patients received cisplatin/MMC with RT from the beginning as they were prospectively detected to have TYMS abnormalities prior to dosing the chemotherapy. These patients tolerated treatment very well with only grade 2 toxicities. All the patients (4/4) on cisplatin/MMC achieved clinical complete response (cCR), while four patients (4/15) on 5-FU/MMC reached cCR at the first assessment. Radiological response showed complete response at the end of 24 weeks assessment. Conclusions: Molecular testing for DPYD and TYMS genes can allow us to identify patients who are most likely to respond or face severe toxicity to 5-FU in a potentially curable cancer. Combining radiation with CDDP with MMC in patients with AC is feasible. A prospective study based on pharmacogenetic testing comparing MMC/cisplatin with MMC/5-FU is indicated in patients with AC.

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Impact of Treatment on Vestibular Schwannoma–Associated Symptoms: A Prospective Study Comparing Treatment Modalities

Otolaryngology ◽

10.1177/0194599820986564 ◽

2021 ◽

pp. 019459982098656

Author(s):

Jason H. Barnes ◽

Neil S. Patel ◽

Christine M. Lohse ◽

Nicole M. Tombers ◽

Michael J. Link ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Median Number ◽

Treatment Modalities ◽

Baseline Survey ◽

Limited Attention ◽

Subjective Symptoms ◽

Prospective Survey ◽

Significant Difference ◽

Associated Symptoms ◽

A Prospective Study

Objective The degree to which various treatment modalities modify vestibular schwannoma (VS)–associated symptoms has received limited attention. The purpose of this study was to determine how different treatment modalities affect subjective symptoms in those presenting with VS. Study Design Prospective survey. Setting Tertiary neurotology referral center. Methods Patients with sporadic VS who received treatment at our institution were prospectively surveyed with a VS symptom questionnaire. Those who completed a baseline survey prior to treatment and at least 1 posttreatment survey were included. The prospective survey evaluated the severity of self-reported symptoms (Likert scale, 1-10), including tinnitus, dizziness or imbalance, headaches, and hearing loss. Results A total of 244 patients were included (mean age, 57 years). The mean duration of follow-up was 2.1 years, and the median number of surveys completed was 2 (interquartile range, 1-3). Seventy-eight (32%) cases were managed with observation, 118 (48%) with microsurgery, and 48 (20%) with radiosurgery. Multivariable analyses revealed no statistically significant difference in the change in tinnitus ( P = .15), dizziness or imbalance ( P = 0.66), or headaches ( P = .24) among treatment groups. Evaluation of clinically important differences demonstrated that microsurgery leads to significant bidirectional changes in headaches. Conclusions Limited prospective data exist regarding the progression or resolution of subjective symptoms in those presenting with VS. This study suggests that tinnitus, dizziness or imbalance, and headaches are unlikely to be significantly modified by treatment modality and generally should not be used to direct treatment choice.

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Physical activity in Sahara Moroccan hemodialysis patients

BMC Research Notes ◽

10.1186/s13104-021-05460-8 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

A. Bahadi ◽

H. Lagtarna ◽

S. Benbria ◽

Y. Zajjari ◽

D. Elkabbaj ◽

...

Keyword(s):

Physical Activity ◽

Hemodialysis Patients ◽

Education Level ◽

Chronic Hemodialysis ◽

Biological Data ◽

New Approach ◽

Male Predominance ◽

Low Education ◽

Reduced Physical Activity ◽

A Prospective Study

Abstract Objective The evaluation of physical activity for chronic hemodialysis patients is a new approach for patient global care. The objective of this work is to evaluate the physical activity in chronic hemodialysis patients and identify the risk factors associated with reduced physical activity. This is a prospective study for 6 months including 150 chronic hemodialysis patients in the Guelmim-Oued Noun Regionin Moroccan Sahara. We use Baecke's survey, translated and validated in Arabic local language. The socio-demographic, clinical, and biological data were completed during the interrogation and from the medical records of the patients. Results The mean age of our patients was 54.6 ± 16.4 years, with male predominance (59%). Most patients have a low education level and 60% were illiterate. Hypertension was found in 54% of our patients, diabetes in 39%, and cardiovascular disease in 10% of patients. Low Physical activity was associated with gender (OR = 4.05), age (OR = 1.03) and high education level (OR = 0.2). Our work has met the various pre-established objectives, however other more specific studies must be conducted to better characterize the profile of physical activity in chronic hemodialysis patients.

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PREDICTIVE VALUE OF LOW AT III LEVELS FOR THE OCCURRENCE OF IVH, IRDS AND DEATH IN PREMATURE NEONATES

10.1055/s-0038-1644268 ◽

1987 ◽

Author(s):

W van den Berg ◽

M Peters ◽

C Breederveld ◽

J W ten Cate ◽

J G Koppe

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Distress Syndrome ◽

Peripheral Vein ◽

Premature Neonates ◽

Significant Difference ◽

At Iii ◽

Diffuse Intravascular Coagulation ◽

Idiopathic Respiratory Distress Syndrome ◽

A Prospective Study

The observation of AT III deficiency in premature neonates with Idiopathic Respiratory Distress Syndrome (IRDS), suggests a positive predictive value for a poor outcome. The underlying diffuse intravascular coagulation could generate serious hemorrhagic complications like Peri/Intraventricular Hemorrhage (IVH).A prospective study was performed in consecutively born neonates to assess the predictive value of low AT III for theoccurrence of IVH, (gr. III/IV), IRDS, and death. Eighty-one neonates were included in the study during a period of 5 months. AT III levels were determined immediately after birth by a chromogenic substrate assay. Values in umbilical cord blood were identical with values in capillary or peripheral vein blood samples taken within 6 hours after birth. There was no correlation between AT III values and gestational age (r: 0.18). Twenty-four neonates with IRDS showed a mean AT III value of 0.23 U/ml (S. D. ± 0.07 U/ml) which was significantly lower than a mean AT III value of 0.35 U/ml (S. D. ± 0.1 U/ml) for neonates without IRDS (p ≺0.00005). When IVH gr. III/IV was diagnosed in neonates having IRDS (8/24) no significant difference in mean AT IIIact was observed with respect to jnean AT III levels of remaining neonates without this complication. No death occurred in neonates without IRDS. Mean AT IIIact (0.21 U/ml) in neonates with IRDS who died (9/24) was low compared with mean AT III levels of neonates with IRDS who survived (0.25 U/ml), but did not reach significance (p≻0.1). Assuming a critical value of AT III of 20% a positive predictive value of 89% for IRDS, 44% for IVH, and 56% for death was calculated. It is concluded that low AT Illact levels have a high predictive value for IRDS.

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Strategy for the Maximal Use of Native Arteriovenous Fistulae for Hemodialysis

The Scientific World JOURNAL ◽

10.1100/tsw.2006.171 ◽

2006 ◽

Vol 6 ◽

pp. 808-815 ◽

Cited By ~ 8

Author(s):

Marko Malovrh

Keyword(s):

Clinical Practice ◽

Vascular Access ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Significant Proportion ◽

Chronic Hemodialysis ◽

Diabetic Patients ◽

Term Survival ◽

Av Fistula ◽

Native Fistula

The long-term survival and quality of life of patients on hemodialysis is dependant on the adequacy of dialysis via an appropriately placed vascular access. The native arteriovenous fistula (AV fistula) at the wrist is generally accepted as the vascular access of choice in hemodialysis patients due to its low complication and high patency rates. It has been shown beyond doubt that an optimally functioning AV fistula is a good prognostic factor of patient morbidity and mortality in the dialysis phase. Recent clinical practice guidelines recommend the creation of a vascular access (native fistula or synthetic graft) before the start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. A multidisciplinary approach, including nephrologists, surgeons, interventional radiologists, and nurses should improve the hemodialysis outcome by promoting the use of native AV fistulae. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. This approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate, and a high maturation, even in risk groups such as elderly and diabetic patients. Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results also support clinical practice guidelines that recommend the preferential placement of a native fistula.

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