RESUMO
PURPOSE: To evaluate the safety and efficacy of modern interventional radiology techniques and imaging guidance for placement of jugular vein twin Tesio hemodialysis catheters. MATERIALS AND METHODS: Eighty-two sets (75 patients) of twin Tesio catheters were percutaneously placed in the right (n = 70) and left (n = 12) internal jugular veins with use of ultrasound (US) and fluoroscopic guidance. Immediate procedural and late complications were recorded. The efficacy of the Tesio system was also evaluated. RESULTS: With US and fluoroscopic guidance, the technical success for access and catheter placement was 100%. Measured dialysis blood flow rate of greater than 375 mL/min was obtained in 95% of the patients and recirculation averaged 4.6% +/- 5%. An inadvertent common carotid artery puncture occurred in one (0.6%) patient and prolonged exit site bleeding occurred in another five patients (3%). Each of these was successfully controlled with compression. More chronically, catheter thrombosis and exit site infection occurred each at the rate of 0.16 episodes per 100 catheter days. All thrombosis and exit site infections responded to local thrombolysis and antibiotic therapy, respectively. Bacteremia occurred in 20 patients and required catheter removal in five patients. There was no clinical evidence of upper extremity or superior central vein thrombosis. CONCLUSION: Placement of internal jugular, twin Tesio catheters with use of imaging and interventional techniques provides a safe and efficacious means of either short or long-term hemodialysis.
Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Veias Jugulares , Diálise Renal/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Infecções Bacterianas/tratamento farmacológico , Velocidade do Fluxo Sanguíneo , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/patologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres de Demora/efeitos adversos , Cateteres de Demora/classificação , Feminino , Fluoroscopia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções/efeitos adversos , Radiografia Intervencionista , Estudos Retrospectivos , Segurança , Terapia Trombolítica , Trombose/tratamento farmacológico , Trombose/etiologia , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
Pneumonia due to Pneumocystis carinii may present atypical radiographic and pathologic findings. We report the case of a 32-year-old man with acquired immune deficiency syndrome (AIDS) whose chest roentgenogram showed a bilateral diffuse nodular pattern suggestive of miliary tuberculosis. Diagnosis ultimately required open lung biopsy, which showed evidence of an atypical granulomatous reaction with Pneumocystis carinii in the absence of other organisms. P carinii pneumonia must be considered in the differential diagnosis of patients with AIDS with nodular pulmonary densities and evidence of an atypical granulomatous reaction on pathologic specimens.