scholarly journals Peritoneal access – a pressing problem

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
Patrícia Valério ◽  
◽  
Maria Carvalho ◽  
Olívia Santos ◽  
António Cabrita ◽  
...  
Keyword(s):  
Catheter Placement ◽  
Dialysis Access ◽  
Early Group ◽  
Access Management ◽  
Peritoneal Catheter ◽  
Patient Journey ◽  
Management Protocol ◽  
Lower Egfr ◽  
First 90 Days ◽  
Late Group

In Portugal, as well as in Europe, peritoneal dialysis (PD) use remains low. Reorganization of PD units including a well -structured peritoneal access management protocol are fundamental to improve the take -up of this therapy. We analyzed the procedure and outcomes in a PD unit, addressing two key quality questions: at which level of estimated glomerular filtration rate (eGFR) were patients referred to peritoneal catheter placement and whether if it was timely placed. We retrospectively evaluated all patients submitted to catheter placement between 2017 and June 2020. We analyzed the patient journey from Kidney Replacement Therapies (KRT) Option Appointment, until PD start, as well as demographic and clinical variables, including eGFR at four time points (KRT Options Appointment, PD unit evaluation, catheter placement, and PD start). To explore the adequacy of catheter placement schedule, we compared the characteristics of the patients who started PD within 90 days of catheter placement (Early group), and of those who started after the first 90 days (Late group). We analyzed 48 patients in the Early and 27 in the Late group. The Early group presented a lower eGFR on KRT Options Appointment, with timely intervention: eGFR at catheter placement averaged 8.0 ± 2.1 mL/min/1,72m2. PD start occurred at 7.0 ± 1.9 and 8.0 ± 2.4 mL/min/1.72m2, in the Early and Late group, respectively. None of the patients suffered an urgent transition to HD by CVC. Four patients started PD less than 15 days after catheter placement, all of them without complications. PD patients’ admission involves specific tasks. Administrative tools or indicators to evaluate those processes are lacking. A peritoneal access clinic would allow the formalization of this circuit, allowing a quality and equitable approach to dialysis access. We suggest a structured pathway for peritoneal access management.

Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden

2021 ◽  
Vol 12 (1) ◽  
pp. 27-34
Author(s):  
Stina Manhem ◽  
Katarina Hanséus ◽  
Håkan Berggren ◽  
Britt-Marie Ekman-Joelsson
Keyword(s):  
Pulmonary Atresia ◽  
Early Time ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Early Group ◽  
Time Period ◽  
Medical Reports ◽  
One Year ◽  
Survival Risk ◽  
Late Group

Background: Patients born with pulmonary atresia and intact ventricular septum represent a challenge to pediatric cardiologists. Our objective was to study changes in survival with respect to morphology in all children born with pulmonary atresia and intact ventricular septum in Sweden during 36 years. Methods: A retrospective, descriptive study based on medical reports and echocardiographic examinations consisting of those born between 1980 and 1998 (early group) and those born between 1999 and 2016 (late group). Results: The cohort consists of 171 patients (early group, n = 86 and late group, n = 85) yielding an incidence of 4.35 and 4.46 per 100,000 live births, respectively. One-year survival in the early group was 76% compared to 92% in the late group ( P = .0004). For patients with membranous atresia, one-year survival increased from 78% to 98%, and for muscular pulmonary atresia, from 68% to 85%. In patients with muscular pulmonary atresia and ventriculocoronary arterial communications, there was no significant increase in survival. Risk factors for death were being born in the early time period hazard ratio (HR), 6; 95% CI (2.33-14.28) P = .0002, low birth weight HR, 1.26; 95% CI (1.14-1.4) P < .0001 and having muscular pulmonary atresia HR, 3.74; 95% CI (1.71-8.19) P = .0010. Conclusion: The incidence of pulmonary atresia and intact ventricular septum remained unchanged during the study period. Survival has improved, especially for patients with membranous pulmonary atresia, while being born with muscular pulmonary atresia is still a risk factor for death. To further improve survival, greater focus on patients with muscular pulmonary atresia and ventriculocoronary arterial communications is required.

Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

1992 ◽  
Vol 3 (1) ◽  
pp. 103-107
Author(s):  
N S Nahman ◽  
D F Middendorf ◽  
W H Bay ◽  
R McElligott ◽  
S Powell ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Seldinger Technique ◽  
First Episode ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Percutaneous Approach ◽  
Tunnel Infection

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

scholarly journals Benefits of early intervention with catheter ablation in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Early Intervention ◽  
Catheter Ablation ◽  
Success Rate ◽  
Therapeutic Option ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Early Group ◽  
Late Group

Abstract Background Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF. Purpose We evaluated the ablation success in AF patients intervened early versus late in the disease course. Methods Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: &gt;12 months. All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring. Results A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p&lt;0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B). Conclusion In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Omentectomy with Peritoneal Catheter Placement in Acute Renal Failure

Nephron ◽  
1994 ◽  
Vol 68 (3) ◽  
pp. 327-328 ◽  
Author(s):  
N. Pumford ◽  
J. Cassey ◽  
W.S. Uttley
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Catheter Placement ◽  
Peritoneal Catheter

Delaying an Appendectomy: Is it Safe?

2012 ◽  
Vol 78 (8) ◽  
pp. 897-900 ◽  
Author(s):  
Kamal Nagpal ◽  
Navalkishor Udgiri ◽  
Niraj Sharma ◽  
Ernesto Curras ◽  
John Morgan Cosgrove ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Early Group ◽  
Perforation Rate ◽  
Exclusion Criteria ◽  
Open Conversion ◽  
Urgent Operation ◽  
The Mean ◽  
The Relationship ◽  
Late Group

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group ( P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant ( P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

scholarly journals SP523OUR EXPERIENCE IN MODIFIED LAPAROSCOPIC PERITONEAL CATHETER PLACEMENT WITH INTRAABDOMINAL FIXATION

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i524-i524
Author(s):  
Regina Gershkovich ◽  
Nana Peleg ◽  
Yakov Slobodkin ◽  
Noa Berar-Yanay
Keyword(s):  
Catheter Placement ◽  
Peritoneal Catheter

Inhibition of liver protein synthesis during laparoscopic surgery

1999 ◽  
Vol 277 (4) ◽  
pp. E591-E596 ◽  
Author(s):  
Hans Barle ◽  
Björn Nyberg ◽  
Stig Ramel ◽  
Pia Essén ◽  
Margaret A. McNurlan ◽  
...  
Keyword(s):  
Protein Synthesis ◽  
Laparoscopic Surgery ◽  
Synthesis Rate ◽  
Protein Synthesis Rate ◽  
Liver Protein ◽  
Early Group ◽  
Total Liver ◽  
Elective Laparoscopic Cholecystectomy ◽  
Absolute Synthesis ◽  
Late Group

Previous studies have indicated that laparoscopic surgery is associated with a decline in liver protein synthesis. In this study, the fractional synthesis rate (FSR) of total liver protein and albumin was measured in patients undergoing elective laparoscopic cholecystectomy at different times after commencing the procedure ( n = 8 + 8). Liver biopsy specimens were taken after 15 min of surgery in an “early” group and after 49 min of surgery in a “late” group. The liver FSR was higher in the early group (24.1 ± 4.7%/day) compared with the late group (19.0 ± 2.8%/day, P < 0.02). The fractional and absolute synthesis rates of albumin were similar in the two groups, 6.4 ± 1.5 vs. 6.5 ± 1.0%/day and 97 ± 19 vs. 96 ± 18 mg ⋅ kg−1⋅ day−1for the early and late groups, respectively. It is concluded that laparoscopic surgery was accompanied by a decrease in total liver protein synthesis rate, which developed rapidly during surgery. In contrast, no change in the synthesis rate of albumin was apparent during the course of surgery.

Grazing behaviour and weight change of cattle turned out to pasture in spring

2003 ◽  
Vol 83 (4) ◽  
pp. 801-808 ◽  
Author(s):  
E. Charmley ◽  
R. W. Jannasch ◽  
J. Boyd
Keyword(s):  
Weight Loss ◽  
Weight Change ◽  
Dry Matter ◽  
The Other ◽  
Early Group ◽  
Initial Weight ◽  
Sward Height ◽  
Behavioural Patterns ◽  
Late Group ◽  
Grazing Behaviour

In the first of two trials, 20 Hereford steers were allocated to two adjacent 1.6-ha pastures on 29 May 1996. Steers in one pasture were given no supplement, while those in the other received supplemental silage each day. All steers on each treatment grazed their allocated paddock continuously for 28 d. Steers on pasture were weighed and their behaviour was monitored periodically throughout the 4 wk of grazing. The dry matter (DM) availability at turnout (651 kg hd-1) was considered in excess to requirement, since neither availability nor sward height declined over 28 d. In spite of this, steers lost 15 kg after turnout and took 12 d to regain their initial weight. There were no treatment effects. Nutrient composition of the sward changed in accordance with advancing maturity. Percent of time observed grazing (51%) did not change over the 28-d period; however, rumination time increased from around 10 to 30%. Grazing behaviour was similar for steers on both treatments. Silage intake averaged only 1.3 kg DM hd-1d-1. In 1997, 28 yearling steers were used in a 2 × 2 factorial design to study the effect of turnout date to pasture [21 May (E) vs. 4 June (L)] and supplemental silage feeding on weight change, grazing behaviour, pasture productivity and forage quality over 28 d. The DM availability at turnout was 391 kg hd-1. Available DM and sward height declined in both early and late treatments after turnout. The early group had to be removed from the trial after 16 d when sward height dropped below 4 cm. Sward quali ty after turnout declined only for the late group. Loss of body weight (BW) and days to regain initial BW after turnout were greater for early versus late steers. Steers ate only 0.5 kg silage DM hd-1d-1, but this reduced weight loss in late steers. Cattle turned out later spent less time grazing (P < 0.001 at 5 and 14 d) but no less time ruminating. Transient weight loss associated with turnout to pasture cannot be wholly explained by behavioural patterns. Other factors, such as altered ruminal conditions, must also play an important role. Key words: Pasture, steer performance, grazing behaviour, weight change

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