The use of ultrasound during and after central venous catheter insertion versus conventional chest X-ray after insertion of a central venous catheter.

BACKGROUND: After insertion of a central venous catheter (CVC) a conventional chest X-ray (CXR) is usually taken to check for complications and correct position. Ultrasound might be equally effective as CXR and is less time consuming. We studied the use of ultrasound versus CXR after insertion of a CVC in general ward patients. METHODS: General ward patients in need of a CVC were included. CVCs were inserted under direct ultrasound guidance. After insertion, ultrasound was performed and compared with CXR to check for complications and position. The waiting time for CXR was noted. RESULTS: In total, 53 patients were included. In 52/53 patients ultrasound was feasible. The results of ultrasound and CXR only differed in 3 of 53 patients. The sensitivity of ultrasound in detecting the correct CVC position was 98% (89.4-100%). No complications were detected (ultrasound or CXR). The median waiting time for CXR was 24.5 minutes. CONCLUSIONS: Our study shows that an integral use of ultrasound during and after CVC insertion is effective in establishing that the CVC is correctly positioned and for identifying post-procedural complications in patients from the general ward when compared with CXR.

Culture negative endocarditis combined with glomerulonephritis caused by Bartonella species in two immunocompetent adults.

Two cases of culture negative endocarditis are presented. In both, Bartonella species could be identified as the causative agent and in one of them Bartonella henselae was very likely. Both cases were accompanied by glomerulonephritis, in one case proven by a kidney biopsy. A nephrotic syndrome may be the first presentation of an endocarditis caused by Bartonella species.

[Open lung biopsy in severely ill patients with unrecognized pulmonary infiltrates]. / Open longbiopsie bij ernstig zieke patiënten met onbegrepen longinfiltraten.

In three patients, a man aged 34 with aids, a woman aged 67 with recurrent major dyspnoea and a woman aged 73 with chronic lymphatic leukaemia, examination revealed progressive dyspnoea while the chest X-rays showed infiltrative lesions in both lungs. In view of the inadequate response to the treatment administered, an open lung biopsy was performed, following which the diagnosis could be made. Adequate treatment was then started and followed by clinical recovery. It is not clear if open lung biopsy carries higher risks of mortality and morbidity than biopsy by means of flexible bronchoscopy. Open lung biopsy more often leads to a classifying diagnosis. For collection of endobronchial or transbronchial biopsy samples in ununderstood diffuse interstitial lung diseases, flexible bronchoscopy is the method of first choice. Open lung biopsy is a justified supplementary examination, at any rate in severely ill, immunocompromised patients who require adequate therapy without delay.

Determinants of red blood cell deformability in relation to cell age.

Red blood cell (RBC) deformability was determined with an ektacytometer in fractions separated on the basis of differences in cell volume or density. Deformability was measured with ektacytometry (rpm-scan and osmo-scan). We studied three groups of RBC fractions:1. By counterflow centrifugation we obtained fractions of different cell age which showed a slight decrease in mean corpuscular haemoglobin concentration (MCHC) and an increase in surface-to-volume (S/V) ratio in fractions with older cells. 2. By Percoll fractionation fractions were obtained which showed a pronounced increase in (MCHC) but no change in S/V ratio. 3. By a combination of both fractionation techniques, fractions were obtained which showed an increased MCHC and an increase in S/V ratio. Deformability in group 1,2 and 3 showed respectively no change, a moderate decrease and a pronounced decrease in fractions of older cells. A decline in deformability occurs during the aging process of the red blood cell. This decline in deformability in old red cells is greater than originally thought. This decline is the result of an increase in haemoglobin concentration and a second factor, probably a decrease in membrane elasticity.

[Successful electroconvulsive therapy in a pregnant woman with neuroleptic malignant syndrome]. / Succesvolle elektroconvulsietherapie bij een zwangere vrouw met het maligne neuroleptica-syndroom.

Neuroleptic malignant syndrome was diagnosed in a 27-year-old pregnant female with a psychiatric disorder, after treatment with haloperidol. The syndrome did not respond to treatment with dantrolene. Serious vegetative instability weighed against the use of electroconvulsive treatment. After 29 3/7 weeks of amenorrhoea electroconvulsive treatment was started, and the clinical picture gradually improved. Mother and child were discharged in good clinical condition.

Urine cytology as a screening method for transitional-cell carcinoma in dialysis patients with analgesic nephropathy.

The abuse of analgesic-containing drugs leads to chronic nephropathy with an increased risk of developing a transitional-cell carcinoma of the urinary tract. In our experience follow-up is often stopped or has never been started when patients present for dialysis. We use urine cytology as the screening method. Nine of the 138 patients entering dialysis between 1980 and 1990 had analgesic nephropathy. In three patients urine cytology led to a suspicion of malignancy. Cystoscopy and/or retrograde pyelography showed a carcinoma of the renal pelvis in two patients and a carcinoma of the bladder in one patient. The patients with carcinoma of the renal pelvis died of cardiovascular complications within 2 years of nephroureterectomy. An autopsy was performed in one of these patients and there were no residual tumours or metastases. In the other patient autopsy was not performed, but urine cytology again suggested malignancy. The patient with a carcinoma of the bladder is still alive. She was treated with transurethral resection of the tumour and etoglucide instillations. We conclude that urine cytology is a good screening method for the early detection of transitional-cell carcinomas in dialysis patients with analgesic nephropathy.