Fibrin sheath disruption during guidewire exchange for bacteremia: Low recurrence of infection and preservation of vascular access sites

2021 ◽  
pp. 112972982110157
Author(s):  
Adina S Voiculescu ◽  
Dirk M Hentschel
Keyword(s):  
Retrospective Analysis ◽  
Standard Of Care ◽  
Access Site ◽  
Central Venous Stenosis ◽  
Catheter Exchange ◽  
Fibrin Sheath ◽  
Significant Difference ◽  
Gram Negative Bacteremia ◽  
Group 2 ◽  
Lower Death Rate

Background: Catheter-associated bacteremia (CAB) often leads to removal of tunneled dialysis catheters with delayed insertion (RDI). Exchange over a guidewire (ExW) can be considered for access site preservation. Fibrin sheath disruption (FSD) during exchange is not standard practice for infected catheters. Here we present the first analysis of outcomes after such exchanges (ExW-FSD). Methods: Retrospective analysis of catheter exchanges and removals performed by interventional nephrology for bacteremia in 2008–2011 observed for 20.5 months. Charts were reviewed for recurrent or new bacteremia and death at 3 months, and for occurrence of thrombosis or stenosis along the catheter site. Catheter exchange with central venogram and fibrin sheath disruption was our standard of care in all patients presenting for CAB. RDI was performed either for tunnel infection, non-clearing of infection or at the request of referring physicians. Results: Over 4 years, 66 patients were treated for CAB. Forty-two patients underwent ExW-FSD, which was performed even for Staph. aureus, gram negative bacteremia or candidemia. RDI was performed in 24 cases. Bacteremia recurred in 3 (7%) patients after ExW-FSD, and in 7 (30%) cases after RDI ( p = 0.02). There was no significant difference in new infections: 5 (12%) after ExW-FSD and 2 (8%) after RDI. There was no death within 3 months after ExW-FSD and 4 (27%) ( p = 0.005) deaths in the RDI group. There was one new central venous stenosis in the ExW-FSD group (2%) with no loss of access site, and 8 (33%) patients developed thrombosis/stenosis along the prior catheter track after RDI (33%) ( p = 0.006) with loss of access site in (21%). Conclusions: In this retrospective analysis of treatment of CAB, ExW-FSD was associated with lower recurrence of bacteremia, lower death rate and a lower incidence of access site loss compared to RDI. These data support ExW-FSD use in patients with CAB.

scholarly journals Comparing the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter

2018 ◽  
Vol 5 (1) ◽  
pp. 19-22
Author(s):  
Nasser Malekpour Alamdari ◽  
Samad Shams Vahdati ◽  
Barmak Gholizadeh ◽  
Shima Nayebian
Keyword(s):  
Vascular Injury ◽  
Fluoroscopic Guidance ◽  
Hemodialysis Catheter ◽  
Early Function ◽  
Catheter Exchange ◽  
Significant Difference ◽  
Electrolyte Homeostasis ◽  
The Difference ◽  
Group 5 ◽  
Group 2

Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter. Methods: This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury. Results: A total of 101 patients were enrolled in this trial. Early dysfunction (blind group= 5), a need for catheter exchange (blind group= 2), pneumothorax (blind group=2), vascular injury (blind group=1) were recorded but the difference between the two groups was not statistically significant (P>0.05). Conclusion: We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended.

scholarly journals NIMG-10. A RETROSPECTIVE ANALYSIS OF SURVIVAL FOLLOWING TREATMENT WITH BEVACIZUMAB IN GLIOBLASTOMA PATIENTS WITH RADIOGRAPHICALLY-CONFIRMED SUBEPENDYMAL OR LEPTOMENINGEAL SPREAD OF DISEASE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii148-ii149
Author(s):  
Shama Farooq ◽  
Onur Yildirim ◽  
Robert Young ◽  
Jamie Tisnado ◽  
Alexandra Miller
Keyword(s):  
Retrospective Analysis ◽  
Leptomeningeal Disease ◽  
Stage Disease ◽  
Significant Difference ◽  
Mri Scans ◽  
Group 3 ◽  
Group 2 ◽  
Parenchymal Disease ◽  
Disseminated Disease ◽  
Group 1

Abstract OBJECTIVE We performed a retrospective analysis examining subependymal disease (SED) and leptomeningeal disease (LMD) in bevacizumab treated IDH-wildtype glioblastoma (GBM) patients to assess potential differences in survival. BACKGROUND GBMs are highly infiltrative and often invade the subependymal and leptomeningeal space making them challenging to treat. At recurrence, patients are commonly treated with bevacizumab, which leads to decreased tumor size and swelling. Patients have improved PFS, but there is no benefit in OS. This may reflect infiltrative disease progression--a hallmark of late-stage disease. We hypothesized patients with CSF spread manifested by SED and LMD may have worse outcomes after bevacizumab than patients with non-disseminated disease. METHODS We retrospectively reviewed charts of all IDH-wildtype GBM patients who received bevacizumab in 2016. MRI scans were reviewed by experienced neuro-radiologists to characterize patients into radiographically defined groups (“0” = no LMD/no SED; “1”= no SED/LMD contact; “2”= no SED/LMD dissemination, and “3’= LMD present). Survival from initiation of bevacizumab to death for each group was compared to group “0” (with no SED/LMD). Survival outcomes were analyzed via t-tests. RESULTS We evaluated 87 IDH-WT GBM patients. Radiographically, patients were grouped-- “0”= 16 (18%), “1”= 33 (38%), “2”= 20 (23%), and “3”= 18 (21%). There was no difference between group “0” and any radiographically defined subgroups. Median survival for group “0”= 187 days; group “1”= 219 days; group “2”= 217 days; group “3”= 169 days. CONCLUSION Contrary to our hypothesis, there was no significant difference in survival from the initiation of bevacizumab in patients with SED or LMD. This may be related to the fact that these patients also typically have a high burden of parenchymal disease. Further work is necessary to test this hypothesis in a larger cohort.

scholarly journals Is It Really Safe to Discontinue Anticoagulant/antiplatelet Treatment Before Ptosis Surgery From Serious Bleeding?

2021 ◽  
Author(s):  
Kang Min Lee ◽  
Choul Yong Park ◽  
Minwook Chang
Keyword(s):  
Retrospective Analysis ◽  
Clinical Guidelines ◽  
Surgical Correction ◽  
Treatment Cessation ◽  
Antiplatelet Treatment ◽  
Significant Difference ◽  
Group 2 ◽  
Ptosis Surgery ◽  
Group 1

Abstract PurposeTo evaluate the effects of discontinuing anticoagulants(ACs)/antiplatelets(APs) preoperatively on surgery for blepharoptosisMethodA retrospective analysis included patients with acquired blepharoptosis who underwent surgical correction, and were followed for more than one month. Patients were classified into two groups depending on AC/AP treatment or otherwise. All patients taking AC/AP discontinued with the treatment one week prior to surgery in accordance with our clinical guidelines. Preoperative and postoperative marginal reflex distance 1(MRD1) and ecchymosis grade were evaluated and compared.ResultsGroup 1 (AC/AP treatment cessation) included 47 patients with 93 eyelids, and group 2 (control) included 51 patients with 98 eyelids. The preoperative MRD1 showed no significant difference between groups. Group 1 showed a significantly higher rate of severe ecchymosis (41.8 vs. 22.4%, p = 0.004) at 1 week of surgery as well as 'persistent ecchymosis (58.8 vs. 7.3%, p=0.000) compared with group 2 postoperatively at 1 month. Postoperative MRD1 was significantly lower in group 1 at 1 week (p=0.019). However, the MRD1 and degree of improvement in lid height (postoperative MRD1–preoperative MRD1) was not significantly different between the two groups (p = 0.499, p = 0.058) at 1 month postoperatively.ConclusionPostoperative ecchymosis was more severe in group 1 at one month after ptosis surgery even though the ACs/APs were discontinued. Surgeons should be careful about this before operation.

scholarly journals Decreasing procedure times with a standardized approach to ELVO cases

2016 ◽  
Vol 9 (1) ◽  
pp. 2-5 ◽  
Author(s):  
Ryan A McTaggart ◽  
Shadi Yaghi ◽  
Grayson Baird ◽  
Richard A Haas ◽  
Mahesh V Jayaraman
Keyword(s):  
Standard Of Care ◽  
Stent Retriever ◽  
Single Institution ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Phase Group ◽  
Standardization Process ◽  
Group 2 ◽  
The Impact ◽  
Group 1

BackgroundEmbolectomy is the standard of care for emergent large vessel occlusion (ELVO), and needs to be done as quickly as possible for the best possible outcomes. Optimization of workflow and process is certainly paramount. One aspect of this is process improvement to standardize as much as possible the procedure in order to decrease variability among operators, which breeds familiarity for the entire team.ObjectiveTo evaluate the impact of a standardized approach to ELVO cases in decreasing times from groin puncture to first deployment of a stent-retriever and final recanalization.MethodsA retrospective review of 83 consecutive patients consisting of a pre-standardization phase (group 1) and those after standardization (group 2). The standardization process involved all three neurointerventional radiologists agreeing on a standard approach to the cases and to the equipment to be used. Times from groin puncture to first deployment of the stent-retriever and from puncture to final reperfusion were evaluated. Angiographic outcomes were scored using the Modified Thrombolysis in Cerebral Ischemia (mTICI) score. Complications from intracranial catheter manipulation (such as wire perforation) were also recorded. Clinical outcomes were assessed based on admission and discharge National Institute of Health Stroke Scale score.ResultsThere were 22 patients in group 1 and 61 patients in group 2. Mean times from groin puncture to first deployment were 39.8 min in group 1 and 20 min in group 2, a difference which was statistically significant (p<0.0001). Overall times from puncture to final recanalization were reduced from 68.2 to 37 min, also a statistically significant difference (p<0.001). There were no cases of intraprocedural complications such as wire perforation or subarachnoid hemorrhage.ConclusionsA standardized approach to the equipment used and process for ELVO cases at a single institution can dramatically reduce procedure times.

ANATOMICAL TOPOGRAPHIC FEATURES OF THE FACIAL NERVE ON CONE-BEAM CT

2019 ◽  
Vol 25 (3) ◽  
pp. 46-52
Author(s):  
A.A. Zubareva ◽  
◽  
Zh.Y. Beiseyeva ◽  
Keyword(s):  
Facial Nerve ◽  
Retrospective Analysis ◽  
Temporal Bone ◽  
Middle Ear ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Horizontal Semicircular Canal ◽  
Significant Difference ◽  
Group 2 ◽  
Temporal Bones

Introduction. Cone-beam computer tomography (CBCT) was introduced into the ENT practice more than 10 years ago. In recent years, it is actively used to visualize temporal bones in acute and chronic diseases of the middle ear (especially in visualizing implants of the middle and inner ear, shunts), but there is no precise description of anatomical features of the temporal bone’s structure. Materials and methods. A retrospective analysis of tomogram, made on a Sirona tomograph, Galaxis / Galileos software for the period from 08/04/2016 to 23/06/2017, in overall, there was analyzed 82 images, from which 71 images of temporal bones were selected from 41 people. Group 1 - CT of the temporal bone in patients with signs of acute inflammation of the middle ear, group 2 - CT of the temporal bone in patients with signs of chronic inflammation of the middle ear, group 3 - CT of the temporal bone in patients without signs of inflammation. Results. An algorithm for assessing the temporal bone according to the above parameters is(was) proposed. When three groups were compared, the length of the mastoid and drum part of the facial nerve, the canal of the facial nerve near the aditus ad antrum and the horizontal semicircular canal were revealed, and the distance between them, regardless to the progress of the disease, corresponds to the parameters of the norm. Conclusion. Thus, taking into account the data of the retrospective analysis, it should be noted that there was no significant difference between the quantitative indices of the facial nerve’s canal structure without inflammation and in the acute and chronic pathology of the middle ear

Retrospective analysis of glioblastoma multiforme (GBM) patients treated initially with BCNU compared to temozolomide (TMZ) with concomitant radiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2071-2071
Author(s):  
M. Vinjamuri ◽  
R. Adumala ◽  
R. Altaha ◽  
J. Hobbs ◽  
E. Crowell
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Retrospective Analysis ◽  
Performance Status ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Survival Curves ◽  
Ecog Performance Status ◽  
Free Survival ◽  
Significant Difference

2071 Background: TMZ and radiation as initial treatment has become the standard of care for GBM. There are no randomized studies comparing TMZ to BCNU in GBM. Methods: We did a retrospective analysis of all 100 GBM patients (pts) diagnosed by our pathology department in the last 10 years. 20 pts were excluded, in 12 pts no chemotherapy was given and there was no data available for 8 pts. BCNU treatment was given in earlier years than TMZ generally. Overall survival (OS), progression free survival (PFS) and four prognostic factors were compared between BCNU and TMZ treated groups. Results: Results show that there is no significant difference in OS and PFS between the two groups. Survival curves were superimposable. This is despite the fact that tumor size and ECOG performance status were worse, though not significantly so in the BCNU group. Age was the only variable that correlated with survival. After correcting for age there was still no difference in PFS and OS between the BCNU and TMZ group. Conclusions: Our study fails to shows superiority of TMZ over BCNU despite the fact that the BCNU group had worse prognostic factors. A randomized comparison of these two agents seems justifiable. [Table: see text] No significant financial relationships to disclose.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Clinical-Reported Outcomes Of Deferoxamine Versus Deferasirox In The Treatment Of Homozygous BetaThalassemia

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Zeina A Munim Al-Thanoon ◽  
Zeina A Munim Al-Thanoon ◽  
Mustafa Basil ◽  
Nasih A Al-Kazzaz
Keyword(s):  
Serum Ferritin ◽  
Iron Chelation ◽  
Iron Chelator ◽  
Beta Thalassemia ◽  
Control Group ◽  
Current Standard ◽  
Cross Sectional ◽  
Significant Difference ◽  
Multiple Blood ◽  
Group 2

Iron chelation therapy with deferoxamine (DFO),the current standard for the treatment of iron overload in patients with betathalassemia,requires regular subcutaneous or intravenous infusions. This can lead to reduced quality of life and poor adherence,resulting in increased morbidity and mortality in iron-overloaded patients with beta-thalassemia. Deferasirox (DFX) is an orally administered iron chelator that has been approved for use in many countries. The requirement of an effective,well tolerated iron chelator with a less demanding mode of administration has led to the development of deferasirox. The present study was aimed to compare the satisfaction and compliance with deferoxamine versus deferasirox (Exjade®),a novel oral iron chelator in patients with transfusion - dependent beta- thalassemia. A cross-sectional,single-center investigation study was carried out in the Thalassemia Center of Ibn-Atheer Teaching Hospital in Nineveh province,Iraq. One hundred and eight thalassemic patients aged between 2- 20 years old having received multiple blood transfusions and a serum ferritin greater than 1500 ng/ml. Patients were randomised into two groups. Group 1 received deferoxamine at a dose of 20-50mg/kg/day and group 2 received deferasirox at the dose of 10-30 mg/kg/day. Another 56 apparently healthy volunteers were used as a control group. The assessment of chelation was done during the period between November 2013 and February 2014 by measurement of serum ferritin. Satisfaction and compliance was assessed by using a special questionnaire prepared by the researcher. Out of the 108 thalassemic patients enrolled there was no discontinuation in treatment with the two drugs under study. The serum ferritin did not change significantly in any of the chelation groups. In comparison with the patients who were treated with DFO,those receiving DFX reported a significantly higher rate of compliance and satisfaction (P < 0.05). However,no significant difference was observed between the two groups regarding their satisfaction (P > 0.05).Compliance with deferasirox (50 %) was more than that with deferoxamine (20 %). Satisfaction with deferoxamine was significantly lower than deferasirox (p= 0.00).

Tuberculosis of the meninges and central nervous system. Experience of clinical diagnostics in St. Petersburg for 50 years

MedAlliance ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 14-24
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Medical Errors ◽  
Clinical Diagnostics ◽  
Lethal Outcome ◽  
Significant Difference ◽  
Group 2 ◽  
Allergic Vasculitis ◽  
Tuberculosis Meningitis ◽  
Group 1

The clinic and diagnostics of tuberculosis meningitis (TM) in 926 patients treated in St. Petersburg hospitals in 1965–1994 (group 1) and in 1995–2018 (group 2) is presented. The TM clinic is demonstrated to be determined by the form of tuberculosis and its characteristic generalization nature in the presence of repeated waves of bacteremia and allergic vasculitis of greater or lesser severity. There is clinical peculiarity of TM in primary pulmonary tuberculosis and its early large-focal and late miliar generalization, as well as in hematogenous tuberculosis. In patients of the 1st and 2nd groups the TM clinic shows in some respects a noticeable similarity, in others — a significant difference. Despite the typical symptoms, early diagnosis of TM took place in less than 20% of patients. Clinical examples illustrating the unusual development of TM, contrasting with its usual course, are given. A number of objective and subjective factors contributing to the adverse evolution of TM and its lethal outcome are discussed. These include the peculiarity of modern tuberculosis, especially when associated with HIV infection, as well as medical errors associated with ignorance of the pathogenesis of tuberculosis and failure to comply with the minimum examination for tuberculosis.

Two Adhesive Systems-effect on Adhesion to Tooth Structure

2019 ◽  
Vol 70 (7) ◽  
pp. 2608-2613
Author(s):  
Larisa Simona Deac ◽  
Kamel Earar ◽  
Adela Loredana Colceriu Burtea ◽  
Alexandra Stefania Berghe ◽  
Aurora Antoniac ◽  
...  
Keyword(s):  
Adhesive Systems ◽  
Hybrid Layer ◽  
Tooth Structure ◽  
Selective Etch ◽  
Etch And Rinse ◽  
Significant Difference ◽  
Wisdom Teeth ◽  
Group 2 ◽  
Self Etch ◽  
Group 1

This study evaluates and compares by dye penetration method and SEM photomicrographs the sealing obtained using two different classes of adhesive systems (etch-and-rinse and self-etch with selective etching) with SDR (Dentsply) bulk fill composite. 84 class V cavities were prepared on oral and vestibular face of 42 intact, freshly extracted wisdom teeth. The cavities were randomly divided in two groups and restored: Group 1 with prime &bond one select (Dentsply) and SDR (Dentsply) and Group 2 with prime&bond one Etch&Rinse (Dentsply) and SDR (Dentsply). Prime&bond one Select (Dentsply) is a single component adhesive and can be used in self etch mode, in selective enamel etch mode, or in etch-and-rinse mode. We chosen for this study the selective etch of the enamel mode. Prime&bond one Etch Rinse (Dentsply) is a universal etch-and-rinse one-bottle dental adhesive, designed to be used in two steps. The bulk fill composites are commonly used in modern dentistry due to their properties of low polymerization shrinkage and curing in layer of 4 mm depth, offering the practitioner a fast clinical procedure with good results. The results showed a good sealing at enamel and dentin margins with no statistically significant difference between adhesives, even though the mean of enamel infiltration was smaller for Group1. Furthermore the results show that there were differences between the two groups, for the infiltrations at the enamel, the values of microleakage being arithmetically higher for Group 1, but with no statistically difference between the two groups.SEM images showed for both groups a good adhesion surface with the tooth, but the hybrid layer of the total-etch adhesives is different from the hybrid layer formed by self etch adhesives, in terms of thickness, uniformity. In conclusion both adhesive systems have equivalent sealing qualities and can be successfully used with SDR.

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