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2.
Anatol J Cardiol ; 25(1): 24-29, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33382052

RESUMEN

OBJECTIVE: This study aimed to analyze the role of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with persistent chest symptoms after acute PE. METHODS: Patients aged between 18 and 80 years who were followed up for acute PE were screened for chest symptoms which persisted after the anticoagulation treatment. Patients suffering other types of pulmonary hypertension (PH) or metastatic malignancies were excluded in this study. Demographic and functional data of patients included this study were collected. The patients underwent transthoracic echocardiography and ventilation/perfusion (VQ) scans. Also, invasive hemodynamic studies were done to patients with intermediate/high probability of VQ scans. RESULTS: Of the 140 patients screen for this study, 29 patients (Female/Male=16/13) with mean age of 56.1±11.2 years and follow-up time of 35.1±17.7 months met the inclusion criteria. The mean systolic pulmonary artery blood pressure (sPAP) on transthoracic echocardiography was 28.9±4.9 mm Hg (range=20-40 mm Hg). Furthermore, intermediate or high probability of VQ scans was detected in 2 patients, who were subsequently diagnosed with CTEPH (6.9%) via right heart catheterization. CONCLUSION: CTEPH was diagnosed at a low rate in patients with persistent chest symptoms after the anticoagulation treatment for PE. CTEPH is still an elusive entity, which requires a multidisciplinary and invasive approach.


Asunto(s)
Hipertensión Pulmonar , Embolia Pulmonar , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Ecocardiografía , Femenino , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagen , Adulto Joven
3.
Ther Apher Dial ; 23(4): 328-335, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30447048

RESUMEN

Weak evidence is present for choosing amongst different temporary hemodialysis catheter (THC) designs with regards to the risk of venous thrombosis, therefore two THC designs for the right internal jugular vein (RIJV) were compared. Patients aged ≥18 years who needed THC insertion into the RIJV for acute hemodialysis due to either acute or chronic renal failure were included. The type of THC (precurved/straight) was dependent on the date of hospital admission. Clinical and ultrasonographic surveillance was conducted prospectively. Thrombosis of the RIJV was the primary objective. Precurved and straight catheters were inserted into 32 and 23 patients (mean age 63 ± 15 years, females 28), respectively. The baseline characteristics and catheter dwell-times were similar in both groups. Partial and total thrombosis of the RIJV during catheter dwell-time developed at a higher rate in the straight group (52% vs. 9.3%, P = 0.000; 47.8% vs. 9.3%, P = 0.001, respectively). At least 2 weeks after catheter removal, total thrombosis was found in 43.4% vs. 9.6% (P = 0.004) of patients with straight and precurved THCs, respectively. The hazard ratios for total thrombosis was 0.161 (P = 0.006) during catheter dwell-time and 0.190 (P = 0.012) after catheter removal. Catheter dysfunction did not occur and only one catheter-related bloodstream infection (CRBI) was seen. Thrombosis rates of the RIJV were higher with straight vs. precurved THCs, both during catheter dwell-time and after catheter removal. Catheter dysfunction was not noted in any group and the rate of CRBI was extremely low.


Asunto(s)
Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Venas Yugulares , Diálisis Renal/instrumentación , Insuficiencia Renal/terapia , Trombosis , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/métodos , Investigación sobre la Eficacia Comparativa , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Factores de Riesgo , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/prevención & control , Turquía , Dispositivos de Acceso Vascular/efectos adversos , Dispositivos de Acceso Vascular/normas
5.
Int J Artif Organs ; 41(8): 431-436, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29976124

RESUMEN

BACKGROUND/AIMS: Severe metabolic acidosis during cardiopulmonary resuscitation is an important and yet unresolved issue. The potential use of hemodialysis for severe metabolic acidosis during cardiopulmonary resuscitation was investigated. METHODS: Acute hemodialyses between January 2012 and April 2017 were reviewed for patients with concomitant hemodialysis and cardiopulmonary resuscitation. In addition, MEDLINE was searched for similar reports. Data were extracted from hospital records. RESULTS: Two patients (36M, 70F) were found to study, without similar reports in MEDLINE. Cardiac arrests (in-hospital) occurred due to severe metabolic acidosis in both patients (due to ethylene glycol and metformin intoxications, respectively). Return of spontaneous circulation could not be obtained within the first 28 and 30 min of cardiopulmonary resuscitation only, whereas both patients had return of spontaneous circulation following at least 45 min of concomitant hemodialysis and cardiopulmonary resuscitation. One patient (70F) was discharged with good neurological outcome, but the other died. CONCLUSION: The addition of high-efficiency hemodialysis during cardiopulmonary resuscitation may contribute to the return of spontaneous circulation in patients with severe metabolic acidosis due to intoxication.


Asunto(s)
Acidosis/terapia , Reanimación Cardiopulmonar , Paro Cardíaco/terapia , Diálisis Renal , Acidosis/complicaciones , Adulto , Anciano , Terapia Combinada , Femenino , Paro Cardíaco/complicaciones , Humanos , Masculino , Resultado del Tratamiento
6.
Hemodial Int ; 21(1): 29-34, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27457403

RESUMEN

INTRODUCTION: Air embolism (AE) is a rare, but serious complication that can occur in the practice of hemodialysis. In contrast to careful techniques and meticulous care during insertions and manipulations of the central catheters, awareness of the risk of AE following catheter removal is less. We aimed to analyze the clinical characteristics of the all case reports with AE after catheter removal and summarize the mechanisms, clinical consequences, treatment and prevention of AE. METHODS: In addition to our case, MEDLINE database was searched for all case reports with AE following catheter removal, and the clinical, diagnostic and outcome data were analyzed. FINDINGS: A total of 10 patients (including our case) (M/F 6/4; median age 50.5 years) were found for the analysis. Procedures for prevention of AE were reported in a few patients (Trendelenburg position 2, airtight dressing 1). The time that elapsed between catheter removals and onset of AEs was ranged from seconds to 6 hours. The most common findings were dyspnea (90%), hypoxemia (70%), and cerebral dysfunction (70%). The most common sites where air could be detected were the left ventricle (40%), pulmonary artery (30%) and right ventricle (30%). Mortality was reported in 4 (40%) cases and the remaining 6 patients had complete recovery. Blocking of air portal was not reported in any of the fatal cases. DISCUSSION: AE following catheter removal carries a major risk of mortality. Great awareness and attention to preventive procedures and appropriate care after development of AE seem mandatory.


Asunto(s)
Cateterismo Venoso Central/efectos adversos , Embolia Aérea/etiología , Diálisis Renal/efectos adversos , Adulto , Humanos , Masculino , Persona de Mediana Edad
7.
Hemodial Int ; 20(3): 369-77, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-26843030

RESUMEN

Thoracic venous anomalies without congenital heart anomalies are present in minority of the population, but they are frequent enough to be encountered while placing hemodialysis catheters through the jugular or subclavian veins. Persistent left superior vena cava is the most commonly seen anomaly and it is rarely noticed before the observation of an unusual course of hemodialysis catheter or guidewire on chest X-ray. We present two patients with previously unspotted persistent left superior vena cava and uncomplicated hemodialysis catheter insertions through the internal jugular veins with good catheter functions. Review of the relevant literature from a nephrologists' perspective with technical aspects is provided.


Asunto(s)
Nefrólogos , Vena Cava Superior/anomalías , Adulto , Anciano de 80 o más Años , Cateterismo , Humanos , Masculino , Diálisis Renal/instrumentación
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