Accuracy of Template Versus Ultrasound Identification of the Reservoir Access Port of Intrathecal Drug Delivery System.

INTRODUCTION: Precise localization of the center of the reservoir access port (RAP) of intrathecal pump is a crucial step to ensure a safe refill procedure. In difficult refill cases, ultrasound guidance has been reported useful. Being more expensive and time-consuming, the purpose of the study was therefore to identify situations in which sonographic localization is more accurate than the template method, in order to restrict its use to these defined conditions. MATERIALS AND METHODS: The RAP was localized using the template provided by the manufacturer and by ultrasound guidance. The distance between the two points was measured. A distance superior to 3.5 mm, corresponding to the radius of the silicone septum of the RAP, was considered a clinically significant deviation. RESULTS: During the study period, 22 patients underwent a total of 81 refill procedures. No significant correlation was found between the distance between the two points and age, height, weight, body mass index (BMI) or abdominal perimeter. The correlation was significant between distance and pump's depth. According to the ROC curve, the sensitivity of ultrasound identification of the RAP was 69.2% and the specificity 83.3% when the pump was implanted at a depth of 10 mm. DISCUSSION: Our results are comparable to these published in the literature, pointing the usefulness of ultrasound for refill of deeply implanted pumps. Our study provides an additional element by specifying the depth from which the ultrasound seems to be superior to template. CONCLUSION: Poor accuracy in RAP identification of intrathecal pump can lead to life-threatening complications. The results of our study suggest that the localization of recessed-RAP can be improved by ultrasound in cases of pump implanted deeper than 10 mm. For more superficially implanted devices, the template method seems to be as accurate as ultrasound.

Hypercalcaemia and acute renal failure after major burns: An under-diagnosed condition.

BACKGROUND: Hypercalcaemia has been shown to occur in about 20% of patients with major burns requiring prolonged intensive care unit (ICU) treatment, and it may be associated with renal failure. Having observed the early onset of hypercalcaemia, the study aimed to determine the frequency and timing of this condition in a European patient cohort. METHODS: A retrospective cohort study on a prospectively collected, computerised database of the 225 burn-injury ICU admissions between 2001 and 2007 was undertaken. The inclusion criteria included: burns >20% of the body surface area (BSA) or in-hospital stay >20 days. Hypercalcaemia was defined as an ionised plasma calcium (Ca(2+)) concentration >1.32 mmol l(-1) (or total corrected calcium=[Ca]c>2.55 mmol l(-1)). Four emblematic cases are reported in this article. RESULTS: A total of 73 patients met the inclusion criteria (age: 13-88 years, burns: 12-85% BSA): of these, 22 (30%) developed hypercalcaemia. The median time to the first hypercalcaemia value was 21 days. Only 11 patients had both high Ca(2+) and elevated [Ca]c (which remained normal in others). The risk factors of the disorder were burned surface (p=0.017) and immobilisation (fluidised bed use: p<0.05, duration: p=0.02) followed by burned BSA. Acute renal failure tended to be more frequent in hypercalcaemic patients (five (23%) vs. three (6%): p=0.11), while mortality was not increased. The disorder resolved with hydration and mobilisation in most cases: pamidronate was successful in three cases that were most severe. CONCLUSION: Hypercalcaemia and associated acute renal failure occur more frequently and earlier than previously reported. Determining the ionised Ca rather than the total Ca with albumin correction enables earlier detection of hypercalcaemia. Bisphosphonates are an effective treatment option in controlling severe hypercalcaemia and preventing bone loss.