Sonographer’s Role in the Screening, Diagnosis, and Treatment of Dialysis Fistula Pseudoaneurysms

2020 ◽  
Vol 36 (4) ◽  
pp. 357-363
Author(s):  
Ashley Gaspard
Keyword(s):  
Diagnosis And Treatment ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Access Site ◽  
Spectral Doppler ◽  
Life Threatening ◽  
Dialysis Fistula ◽  
Dependent Patient

Pseudoaneurysm (PSA) formation, in an arteriovenous fistula (AVF) undergoing hemodialysis, can occur as a result of frequent venipunctures and can lead to a weakened vessel wall. Since many dialysis patients’ lives depend on their weekly hemodialysis sessions, complications that result from dialysis require treatment. A PSA can be a life-threatening complication, especially for these patients. Sonography has been demonstrated to be a useful modality of choice in the screening, diagnosis, and treatment of a PSA. The sonographic appearance of a PSA using gray-scale, color, and spectral Doppler can play a significant role in ruling out other diagnoses. A case study is presented of a dialysis-dependent patient who developed a PSA in his dialysis access site. Sonography played a key role in the diagnosis and follow-up for this specific case. Due to the risks involved with these patients, there is an essential need for sonographers to be competent in performing these examinations. Evaluation of the AVF to check for patency and a thorough assessment of the PSA are required.

scholarly journals Swallow-induced syncope in 5 patients

2017 ◽  
Vol 7 (4) ◽  
pp. 316-323 ◽  
Author(s):  
Ibrahim Aydogdu ◽  
Can Hasdemir ◽  
Ahmet Acarer ◽  
Sezin Alpaydin ◽  
Cumhur Ertekin
Keyword(s):  
Standing Position ◽  
Permanent Pacemaker ◽  
Diagnosis And Treatment ◽  
Afferent Pathways ◽  
Electrocardiographic Monitoring ◽  
Threatening Condition ◽  
Pacemaker Placement ◽  
Life Threatening

AbstractBackground:We sought to characterize a cohort of participants with swallow-induced syncope (SIS) with clinical and electrophysiologic evaluations.Methods:Using electrocardiographic monitoring and neurophysiologic methods of swallowing, we evaluated a cohort of 5 patients with SIS, 4 of whom had longitudinal follow-up.Results:We determined electrophysiologically that the duration between the onset of swallow and a bradyarrhythmia or asystole is extremely short (2–3 seconds) in SIS. Most participants with SIS do not have a neurologic or esophageal disorder. SIS can occur with different food types, in sitting or standing position, and has varying frequency in different participants. Permanent pacemaker placement is a curative measure in SIS.Conclusions:Our findings suggest that SIS is elicited by reflex afferent pathways originating in the oropharynx, rather than an esophageal origin, as previously proposed. Our longitudinally followed cohort with detailed clinical and electrophysiologic characterization should aid the clinician in the diagnosis and treatment of this potentially life-threatening condition.

Transient Myeloproliferative Disorder Associated with Trisomy 21

2007 ◽  
Vol 26 (1) ◽  
pp. 7-19 ◽  
Author(s):  
Branda Kruger
Keyword(s):  
Trisomy 21 ◽  
Case Reports ◽  
Myeloproliferative Disorder ◽  
Neonatal Nurses ◽  
Transient Myeloproliferative Disorder ◽  
Congenital Leukemia ◽  
Life Threatening ◽  
Dermatologic Manifestations

Transient myeloproliferative disorder (TMD) is a spontaneously resolving condition affecting infants born with trisomy 21 syndrome. Although TMD is rather rare among infants with trisomy 21, its ramifications can become severe enough that neonatal nurses should be aware of the condition, its manifestations, and its management. The spectrum of TMD presentation ranges from subtle blastemia in an otherwise healthy infant to severe, life-threatening expression of the disease. TMD may be a precursor to congenital leukemia—thus, the importance of nurses’ becoming aware of this condition. This article addresses the pathology of TMD, case reports in the literature, potential complications of the disorder, and nursing implications. A case study of an infant with dermatologic manifestations of TMD is presented, including history, differential diagnoses, treatment, and follow-up.

scholarly journals Dialysis access as a source of infective endocarditis in dialysis patients

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Hee D. Jeon ◽  
Kevin B. Lo ◽  
Eduardo E. Quintero ◽  
Byeori Lee ◽  
Asma Gulab ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Vascular Access ◽  
Medical Center ◽  
Bacterial Invasion ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Access Site ◽  
Source Of Infection ◽  
Duke Criteria ◽  
Increased Risk

The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center. All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.

scholarly journals Sodium Thiosulfate: An Emerging Treatment for Calciphylaxis in Dialysis Patients

2015 ◽  
Vol 5 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Zanzhe Yu ◽  
Leyi Gu ◽  
Huihua Pang ◽  
Yan Fang ◽  
Hao Yan ◽  
...  
Keyword(s):  
Sodium Thiosulfate ◽  
Chelating Agent ◽  
Slight Reduction ◽  
Total Parathyroidectomy ◽  
Dialysis Patients ◽  
Skin Ulcers ◽  
High Calcium ◽  
Calcium Phosphorus ◽  
Life Threatening

Calciphylaxis is a rare but life-threatening complication seen in dialysis patients. We report a case with calciphylaxis and severe secondary hyperparathyroidism. Sodium thiosulfate (STS) was used for treatment in this case. The painful skin ulcers improved significantly soon after treatment, with a slight reduction in the calcium-phosphorus product. Total parathyroidectomy was carried out 6 months after the STS therapy, which successfully solved hyperparathyroidism and the high calcium-phosphorus profiles. Until now, no recurrence of calciphylaxis has been observed during the more than 7 years of follow-up. STS, as a chelating agent for calcium and iron, is an emerging treatment option for calciphylaxis; however, the mechanisms of STS in treating calciphylaxis are not clear. Our case demonstrates that STS treatment did not work through normalizing calcium-phosphorus profiles, although to optimize hyperparathyroidism and to control calcium and phosphorus levels is clearly part of the general treatment of calciphylaxis. The literature on STS treatment for calciphylaxis in dialysis patients was also reviewed.

scholarly journals Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis

2019 ◽  
Vol 13 (2) ◽  
pp. 166-171
Author(s):  
Delin Wang ◽  
Nathan Calabro-Kailukaitis ◽  
Mahmoud Mowafy ◽  
Eric S Kerns ◽  
Khetisuda Suvarnasuddhi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Cohort ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Central Venous ◽  
The Usa ◽  
The Mean

Abstract Background Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). Methods We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. Results Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average &gt;1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P &lt; 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. Conclusions Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.

scholarly journals TOXIC EPIDERMAL NECROLYSIS INDUCED BY CARBAMAZEPINE: A CASE STUDY

2017 ◽  
Vol 10 (7) ◽  
pp. 78 ◽  
Author(s):  
Jahirul Islam Laskar ◽  
Pinaki Chakravarty ◽  
Babul Dewan
Keyword(s):  
Case Report ◽  
Toxic Epidermal Necrolysis ◽  
Causality Assessment ◽  
Treatment Guidelines ◽  
Drug Reactions ◽  
Medical College ◽  
Life Threatening ◽  
Ward Rounds

 Objectives: The objective of this case study is to evaluate the importance of detection, assessment, and reporting of an adverse drug reaction and to improve the medication perseverance. Methods: This is an observational type of case report which was observed and analyzed in Silchar Medical College and Hospital on regular ward rounds. Results: A case report of toxic epidermal necrolysis due to carbamazepine (CBZ) administration by a 47-year-old male patient who presented as a follow-up case of ischemic stroke. Causality assessment of the event done with Naranjo’ causality assessment scale suggests to be “Probable.” Conclusion: Daily, CBZ is being increasingly prescribed for control of pain in neuralgias and diabetic neuropathy, apart from control of seizures. Awareness about the drugs implicated in life-threatening drug reactions will help physicians in preventing them by cautious use of the drugs. Moreover, proper counseling to the patient regarding the use of medications is of utmost importance, in such life-threatening conditions where treatment guidelines remain indistinct. 

Left thorascopic sympathectomy for refractory long QT syndrome in children

2011 ◽  
Vol 8 (5) ◽  
pp. 455-459 ◽  
Author(s):  
Steven W. Hwang ◽  
Jonathan G. Thomas ◽  
William E. Whitehead ◽  
Daniel J. Curry ◽  
Robert C. Dauser ◽  
...  
Keyword(s):  
Long Qt Syndrome ◽  
Pediatric Patients ◽  
Relevant Literature ◽  
Long Qt ◽  
Thoracic Sympathectomy ◽  
Life Threatening ◽  
Qt Syndrome ◽  
Congenital Long Qt Syndrome

Congenital long QT syndrome (LQTS) is a rare genetic ion transmembrane disorder that has been associated with multiple various genetic mutations including life-threatening cardiac arrhythmias and sudden death. Left thorascopic sympathectomy is an effective treatment for patients who are refractory to medical therapy or who need frequent epicardial internal cardiodefibrillator intervention. Although there is substantial literature about this therapy in adults, few reports detail the outcomes in children who undergo left thorascopic sympathectomies to treat LQTS. The authors report the successful use of a left thoracic sympathectomy for the treatment of an 11-year-old girl who had persistently symptomatic LQTS, even after implantation of an automatic cardioverter-defibrillator. The patient remained clinically stable without arrhythmias through 6 months' of follow-up. The authors also reviewed the relevant literature and found that it suggests that 77% of patients will have immediate resolution of their symptoms/arrhythmias after the procedure. When the outcome definition was broadened to include patients who had only 1 or 2 cardiac episodes in the follow-up period, 88% of cases were considered successful. The results of this case study and literature review suggest that left thorascopic sympathectomy is a safe and effective approach for treating pediatric patients with LQTS.

Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

2011 ◽  
Vol 21 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Farzan Irani ◽  
Rodney Gabel
Keyword(s):  
Case Report ◽  
Therapeutic Intervention ◽  
Intensive Therapy ◽  
Positive Outcome ◽  
Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

Efektivitas Layanan Darurat Jakarta Siaga 112 dalam Penanganan Kebakaran oleh UPT. Pusat Data & Informasi Kebencanaan BPBD Provinsi DKI Jakarta

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Musa Musa
Keyword(s):  
Emergency Service ◽  
Fire Management ◽  
Emergency Services ◽  
The Public ◽  
Information Center ◽  
Disaster Data ◽  
In Fire ◽  
Document Review

This research was conducted to determine the Effectiveness of Jakarta Siaga 112 Emergency Services in Fire Management by UPT. Disaster Data & Information Center of BPBD DKI Jakarta Province by paying attention to aspects contained in the Effectiveness of the Jakarta Siaga Emergency Service Program 112. The research method was carried out with a case study method with data collection techniques using interview methods and document review. Interviews were conducted on 10 (ten) key informants, document review focused on documents related to the Jakarta Emergency Alert Service 112 Effectiveness research in Fire Management. The results showed that the Effectiveness of Jakarta Siaga 112 Emergency Services in Fire Management by UPT. The Center for Disaster Data & Information BPBD DKI Jakarta Province Its effectiveness is still low, due to the Implementation of Emergency Services Jakarta Standby 112 in Fire Management implemented by UPT. Disaster Data & Information Center of BPBD DKI Jakarta Province in terms of the Target Group Understanding of the Program, the Achievement of the Program Objectives aspects, and the Program Follow-up aspects. It is recommended to continue to disseminate this Emergency Service to the public, it is necessary to increase the firm commitment of the Head of 8 SKPD related to fire management so that all units play a role in accordance with the Standard Operating Procedures (SOPs) for Fire Management and the evaluation and follow-up of program services that are held periodically 3 once a month.Keywords: Effectiveness, Emergency Services, Fire Handling

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