RESUMO
BACKGROUND: Endothelial cells are known to grow on the luminal surface of arteriovenous grafts (AVGs) used in hemodialysis. Although endothelial cells are important for preventing infection, a detailed growth of endothelial cells in AVGs is unknown. This study sought to create a simpler animal model of AVGs and to investigate how endothelial cells form on the luminal surface. METHODS: Polyethylene grafts were placed between the cervical artery and vein of Wistar rats. The grafts were removed at 6 h, 24 h, 3 days, or 7 days after placement. The luminal surface was observed under optical and polarizing microscopy and stained with endothelial cell markers (LEL, CD31), the progenitor cell marker CD34, and the macrophage marker ED-1. RESULTS: Microscopy demonstrated many diffuse vascular endothelial cells on the luminal surface of AVGs after placement. While there was no difference in the number of LEL-positive cells between the arterial side (AS) and venous side (VS) at 6 h or 7 days, there were significantly more of these cells on the VS at both 24 h and 3 days (p < 0.05). Analysis at 24 h showed some CD31-positive cells and few CD34-positive cells. CONCLUSIONS: This was the first study to use a simple rat model of AVG placement. Endothelial cell formation was initially more active on the VS than on the AS, but these cells subsequently increased in number across the luminal surface. Future clinical studies might contribute clinically by confirming whether AS versus VS puncture results in different infection rates.
Assuntos
Derivação Arteriovenosa Cirúrgica , Animais , Ratos , Células Endoteliais , Ratos Wistar , Túnica Íntima , Veias , Diálise RenalRESUMO
BACKGROUND: Although percutaneous transluminal angioplasty has been established as a first-line therapy for access failure in dialysis, there are few reports on primary patency after percutaneous transluminal angioplasty. We investigated factors associated with primary patency following the first percutaneous transluminal angioplasty performed after vascular access construction in patients with arteriovenous fistula, including blood flow volume before and after percutaneous transluminal angioplasty and previously reported factors. METHODS: We used medical records at six dialysis centers to retrospectively identify and analyze prognostic factors for primary patency after percutaneous transluminal angioplasty in 159 patients with arteriovenous fistula who underwent initial percutaneous transluminal angioplasty after vascular access construction. RESULTS: Multivariate analysis with the Cox proportional hazard model showed that primary patency after percutaneous transluminal angioplasty in patients with arteriovenous fistula was significantly associated with lesion length (hazard ratio, 1.76; 95% confidence interval, 1.01-3.07; P = 0.045), and blood flow volume after percutaneous transluminal angioplasty (hazard ratio, 0.71; 95% confidence interval, 0.60-0.84; P < 0.001). When blood flow volume after percutaneous transluminal angioplasty was classified into three categories, risks of outcome events defining the end of primary patency after percutaneous transluminal angioplasty were significantly lower for 400-630 mL/min (hazard ratio, 0.38; 95% confidence interval, 0.21-0.68; P = 0.001) and >630 mL/min (hazard ratio, 0.16; 95% confidence interval, 0.06-0.40; P < 0.001) compared with <400 mL/min. CONCLUSION: Our study showed that blood flow volume after percutaneous transluminal angioplasty is an important prognostic factor for primary patency after percutaneous transluminal angioplasty in patients with arteriovenous fistula.
Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
INTRODUCTION: We report a case in which we performed an anastomotic part septal formation surgery (anastoplasty) and artificial blood vessel replacement surgery. CASE DESCRIPTION: When forearm arteriovenous fistula occlusion of a dialysis patient was observed, there was a thrombus in the vein of the whole forearm from the anastomotic part. We performed a septum formation surgery to suppress the blood flow in the vein near the anastomotic site, and artificial blood vessel replacement was performed on the high stenosis of the cephalic vein of the elbow. Postoperative blood flow was stable and hemodialysis was possible. Although there are various blood flow suppression methods for suppressing excessive blood flow, we report a case in which an anastomotic part septal formation surgery and artificial blood vessel replacement to secure an outflow passage were performed at the same time. CONCLUSION: Anastoplasty for excessive blood flow is considered to be an effective means in this case.
Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular , Antebraço/irrigação sanguínea , Oclusão de Enxerto Vascular/cirurgia , Trombose/cirurgia , Idoso , Velocidade do Fluxo Sanguíneo , Angiografia por Tomografia Computadorizada , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Flebografia/métodos , Diálise Renal , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
We herein report two cases of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA)-related nephritis in infectious endocarditis. In both cases, the patients were middle-aged men with proteinuria and hematuria, hypoalbuminemia, decreased kidney function, anemia, elevated C-reactive protein (CRP) levels, and PR3-ANCA positivity. Each had bacteremia, due to Enterococcus faecium in one and Streptococcus bovis in the other. One patient received aortic valve replacement therapy for aortic regurgitation with vegetation, and the other underwent tricuspid valve replacement therapy and closure of a ventricular septic defect to treat tricuspid regurgitation with vegetation. These patients' urinary abnormalities and PR3-ANCA titers improved at 6 months after surgery following antibiotic treatment without steroid therapy.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Endocardite Bacteriana Subaguda/complicações , Mieloblastina/imunologia , Nefrite/imunologia , Adulto , Endocardite Bacteriana Subaguda/imunologia , Humanos , Masculino , Nefrite/etiologiaRESUMO
A 79-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and cloudy peritoneal fluid two days after colonoscopy that revealed multiple diverticula. The white blood cell count was 9,000 cells/µL, C-reactive protein level was 6.86 mg/dL, and the white blood cell count of the peritoneal fluid was 7,800 cells/µL, suggesting acute peritonitis. Empiric therapy consisting of cefazolin and ceftazidime slowly improved the patient's symptoms. The initial microbiological examination of the peritoneal fluid demonstrated Morganella morganii. He was changed from CAPD to hemodialysis. It is important to consider M. morganii peritonitis in patients with colonic diverticula.
Assuntos
Divertículo do Colo/complicações , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/complicações , Peritonite/etiologia , Idoso , Antibacterianos/uso terapêutico , Líquido Ascítico/microbiologia , Proteína C-Reativa , Colonoscopia , Infecções por Enterobacteriaceae/tratamento farmacológico , Humanos , Contagem de Leucócitos , Masculino , Morganella morganii , Peritonite/tratamento farmacológico , Peritonite/microbiologiaRESUMO
A 55-year-old man showed a serum creatinine level of 1.51 mg/dL, CRP of 0.79 mg/dL, and proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) of 43.9 EU (normal range: below 10). The serum levels and ratios of IgG1, IgG2, IgG3, and IgG4 to total IgG were 1,570 mg/dL (49%), 1,190 mg/dL (37%), 82 mg/dL (3%), and 351 mg/dL (11%), respectively. Positron emission tomography and CT with (18)F-fluorodeoxyglucose (PET-CT) demonstrated retroperitoneal fibrosis. After a diagnosis of IgG4-related retroperitoneal fibrosis with PR3-ANCA was made, oral prednisolone improved serum creatinine and the titer of PR3-ANCA to normal levels, with no abnormal findings on PET-CT.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Imunoglobulina G/sangue , Mieloblastina/imunologia , Fibrose Retroperitoneal/diagnóstico por imagem , Fibrose Retroperitoneal/imunologia , Creatinina/sangue , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Prednisolona/uso terapêutico , Compostos Radiofarmacêuticos , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
We report an 82-year-old man who developed ventricular tachycardia and Torsades de Pointes (TdP) after oral administration of garenoxacin, a novel quinolone antibiotic agent that differs from the third-generation quinolones, for pneumonia. He had hypokalemia (K 2.3 mmol/L) induced by licorice and also had received disopyramide for arrhythmia, bicalutamide for prostate cancer, and silodosin for prostate hypertrophy. After taking him off all drugs and administering spironolactone supplemented with potassium, his low serum potassium level was ameliorated. Therefore, although garenoxacin reportedly causes fewer adverse reactions for cardiac rhythms than third-generation quinolone antibiotics, one must be cautious of the interference of other drugs during hypokalemia in order to prevent TdP.