Ash Split Cath in geriatric dialyzed patients.

Vascular access is the essential step in performing hemodialysis in uremic patients. In the absence of a permanent and utilizable native arterio-venous fistula, the use of a tunnelled catheter makes dialysis therapy possible. The Ash Split Cath, a recently introduced chronic hemodialysis catheter, was inserted in five patients (7.1% of our prevalent dialysis population) because of repeated venous thrombosis in three patients and a poor venous tree in two. The mean age of patients was 78 years +/- 7. The average blood flow rate was 250+/-50 ml/minute and the mean venous pressure 140mm Hg +/- 35. Recirculation determined by low flux technique was less than 2%. KT/V calculated 3 months after the catheter placement was 1.2+/-0.02. During the follow-up we did not document any infection of the exit site or related to the catheter. This device is simple to place, gives adequate dialysis treatment and is useful in geriatric dialyzed patients in whom the arterio-venous fistula can no longer be used.

[Fulminant liver failure caused by antitubercular drugs. Report of a clinical case]. / Insufficienza epatica fulminante da farmaci antitubercolari. Descrizione di un caso clinico.

The incidence of tuberculosis has grown seriously in the last ten years and so have the risks due to drug toxicity of Ethambutol, Isoniazid, Pyrazinamide, Rifampicin. One of the questions is whether a careful monitoring of liver function during anti-tubercular chemotherapy could be useful, given that once severe organ toxicity initiates the survival rate remains under 10% if organ transplant is not available. International literature shows a clear prevalence of this event in Asiatic populations which are now well represented in Italy owing to incoming migrations. A case of fulminant hepatitis in a young Chinese man under treatment for TBC arrived at our ICU with a drug-induced acute hepatitis is reported.

[Acute distension followed by gastric rupture after an episode of bulimia. Apropos of a case]. / Distension aiguë suivie de rupture gastrique après un accès de boulimie. A propos d'un cas.

The authors report a case of spontaneous gastric rupture due to acute distension following an episode of bulimia. A two stage surgical procedure was performed with a favorable outcome. The difficulty in the choice of therapy was confirmed in a review of the literature. A minor surgical intervention involving a lesser degree of trauma may be chosen, and after appropriate resuscitation, definitive surgery can be planned.