Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study.

Background and Objective: Peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) are frequently used for vascular access in neonatal intensive care units (NICUs). While there is a significant need for these devices for critically ill neonates, there are many complications associated with their use. We aimed at investigating the incidence of UVC and PICC complications in very low birth weight (VLBW) infants. Materials and Methods: This is an observational study performed with neonates of the tertiary General Hospital of Piraeus, Greece, during an 18 month-period. Seventy-one neonates were recruited and divided into two groups: 34 neonates with PICC and 37 neonates with UVC. We recorded: Catheter dwell time, the causes of catheter removal, other complications, infections, and catheter tip colonization rates. Results: No significant statistical differences were noticed between the 2 study groups with regards to demographic characteristics, causes for catheter removal, catheter indwelling time or the incidence of nosocomial infection. Eleven UVC tips and no PICC tips were proved colonized (p = 0.001) following catheter removal. Conclusions: The incidence of complications associated with the use of UVCs and PICCs in VLBW infants did not significantly differ in our study. Their use seems to be equally safe. Further studies, with larger samples, are necessary to confirm our results.

Hemoperitoneo masivo por rotura de vena umbilical en paciente cirrótico / Massive hemoperitoneum due to a ruptured umbilical vein in a cirrhotic patient

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Venobiliary fistula related to umbilical venous catheter in a newborn.

We present a case of venobiliary fistula due to umbilical venous catheter (UVC). UVC was inserted the day before surgery in a newborn who was scheduled for type IIIB jejunal atresia surgery. The UVC was superimposed on the liver. It was noted that the gastric drainage became chylous and increased to 790 and then 1977 mL daily. I.v. contrast tomography with 650 mL contrast showed that the opaque substance was dispersed around the catheter and a venobiliary fistula formed, with the administered fluid accumulating in the duodenum. Rapid improvement was seen in the clinical picture after the UVC was removed. Venobiliary fistula may develop in patients with UVC that is not placed appropriately, and can direct the fluid administered from the UVC to the gastrointestinal system through the choledochal duct. The importance of contrast computed tomography in the diagnosis of venobiliary fistula in the newborn is also emphasized.

Umbilical venous catheter-induced hepatic hematoma in neonates.

Umbilical vessel catheterization is common practice for infants in the neonatal intensive care unit (NICU). Umbilical venous catheters (UVC) although very useful as a means of obtaining vascular access, do not come without risks. Here we will describe three separate cases of infants in the NICU who, during their course of treatment, were found to have hepatic masses attributed to UVC misplacement. Two of the cases presented incidentally and one presented acutely. We believe liver hematomas may be a more common complication of malpositioned UVCs than previously believed. An appreciation of the complications of malpositioned UVCs should alert clinicians to screen for potential complications and to ensure ideal line placement.

Derrame pericárdico neonatal: una complicación de los catéteres venosos umbilicales / No disponible

El empleo de catéteres umbilicales es una técnica habitual en las unidades de cuidados intensivos neonatales para obtener muestras de sangre y administrar soluciones y medicamentos. A pesar de considerarse como un procedimiento relativamente seguro, puede tener serias complicaciones y consecuencias fatales, como el derrame pericardio y taponamiento cardiaco. Comunicamos el caso de una recién nacida prematura que ingresó por un distrés respiratorio a la que se le colocó un catéter venoso umbilical, presentando al cabo de tres días esta grave complicación, precisando pericardiocentesis evacuadora con rápida recuperación de la función sistólica. Asimismo, revisamos los principales aspectos clínicos relacionados con estas afecciones (AU)

Central venous catheters are widely used in neonatal units to administer fluids, medication, and for blood sampling. Despite being considered a relatively safe procedure, it may cause to complications with fatal consequences as pericardial effusion and cardiac taponade. We report a case of a premature girl with respiratory distress syndrome who had umbilical venous catheter installed and developed cardiac taponade at third day of life. She was successfully resuscitated by timely pericardiocentesis. This article reviews the principal clinical aspects related with this serious complications (AU)

Sudden intrauterine death associated with furcate insertion of the umbilical cord.

In the case described, a completely uncomplicated pregnancy ended with a fatal outcome. Intrauterine fetal death, which was diagnosed prepartum at 40 weeks of gestation, was caused by hemorrhage of the fetus into the amniotic fluid following rupture of the umbilical vein at the site of furcate insertion of the umbilical cord. This insertion anomaly accompanied by rupture of a vessel occurs only very rarely but represents a placental cause of an abrupt and unpredicted end of a pregnancy. Although this process involved trauma, from a medico-legal point of view, there was no sign of external impact and death could, therefore, be classified as natural.

Role of injured endothelial cells in the recruitment of human pulp cells.

In restorative dentistry, deep cavity preparation may lead to partial destruction of the odontoblastic layer. However, newly formed odontoblast-like cells can replace the necrotic odontoblasts and secrete a reparative dentine matrix. While growth factors such as transforming growth factor beta1 (TGFbeta1) and bone morphogenetic proteins (BMP-2 and BMP-4) seem to be involved in the proliferation and differentiation of pulp cells, little is known about the migration of the newly proliferating stem cells to the injury site. Our hypothesis was that endothelial cell injury may be involved in directing these cells towards the injury site. For this study, human pulp fibroblasts and L929 cells were fluorescence-labeled by transduction with the Enhanced Green Fluorescent Protein (EGFP). Similarly, human umbilical vein endothelial cells (HUVEC) were labeled with the Discosoma Red Fluorescent Protein-2 (DsRed2). Cell migration was then studied in an insert cell culture system. The HUVEC cells were cultured in the lower compartment while the human pulp fibroblasts or L929 were in the upper compartment. After artificial injury to the HUVEC cells, only human pulp fibroblasts migrated to the lower compartment. At early time periods (4 days), migrating cells were randomly localized on the HUVEC layer. However, after 14 and 20 days, they were perfectly aligned along the injury site. In the absence of injury, no migration was observed. These results suggest that, the endothelial injury is involved in the recruitment of odontoblast-like cells at the injury site.

Mechanisms of shock wave induced endothelial cell injury.

BACKGROUND AND OBJECTIVES: Medical procedures, for example, laser angioplasty and extracorporeal lithotripsy as well as high-energy trauma expose human tissues to shock waves (SWs) that may cause tissue injury. The mechanisms for this injury, often affecting blood vessel walls, are poorly understood. Here we sought to assess the role of two suggested factors, viz., cavitation or reactive oxygen species (ROS). STUDY DESIGN/MATERIALS AND METHODS: A laser driven flyer-plate model was used to expose human umbilical cord vein endothelial cell (HUVEC) monolayers to SWs or to SWs plus cavitation (SWC). Cell injury was quantified with morphometry, trypan blue staining, and release of (51)Cr from labeled HUVECs. RESULTS: HUVECs, exposed to SWs only, could not be distinguished from controls in morphological appearance or ability to exclude trypan blue. Yet, release of (51)Cr, indicated a significant cell injury (P < 0.05). HUVEC cultures exposed to SWC, exhibited cell detachment and cell membrane damage detectable with trypan blue. Release of (51)Cr was fourfold compared to SW samples (P < 0.01). Signs of cell injury were evident at 15 minutes and did not change over the next 4 hours. No protective effects of ROS scavengers were demonstrated. CONCLUSIONS: Independent of ROS, SWC generated an immediate cell injury, which can explain, for example, vessel wall perturbation described in relation to SW treatments and trauma.

Caracterización y biocompatibilidad de las prótesis vasculares de poliuretano estabilizado con polidimetilsiloxano / Characterization and biocompatibility of vascular prostheses made of polyurethane stabilized with polydimethylsiloxane

Introducción. El desarrollo de nuevos biomateriales ha desembocado en la aparición de nuevas prótesis vasculares que mejoren el comportamiento de injertos protésicos de pequeño calibre. Objetivo. El objetivo del presente trabajo es el estudio del comportamiento biológico de prótesis vasculares de poliuretano. Material y métodos. Prótesis: poliuretano-polidimetilsiloxano (PU-PDMS). Caracterización: fragmentos de PU-PDMS se procesaron para su estudio en microscopia óptica y electrónica de barrido. Se determinó la carga eléctrica de la superficie interna mediante análisis espectral. Biocompatibilidad: fragmentos (1 cm2) de PU-PDMS se implantaron en el músculo dorsal de conejos Nueva Zelanda (n= 18) durante 3 y 8 meses. Realizamos estudios morfológicos, inmunohistoquímicos (antiactina) y de reacción de cuerpo extraño (RAM11). Siembra: fragmentos de 1 cm2 se sembraron con células endoteliales de vena umbilical humana. Tiempos de estudio: 24, 48, 72 horas y 7 días. Resultados. La composición es fibrilar, con presencia de numerosos poros. Existencia de cargas negativas en la superficie interna del biomaterial. A los tres meses, la prótesis se embebe en tejido neoformado muy vascularizado y rico en células blancas y células de reacción a cuerpo extraño. A los 8 meses se puede observar la total integración del biomaterial, que aparece rodeado de colágeno y muy vascularizado. A las 24 horas de la siembra observamos una superficie endotelizada, que deja al descubierto grandes poros que se tapizan en los estadios posteriores. Conclusiones. Las prótesis PUPDMS presentan características adecuadas para utilizarse como sustitutos vasculares, gracias a su estructura, ausencia de rechazo y buena integración a corto y medio plazo. (AU)

Plasma complement C5 protects endothelial cells from polymorphonuclear neutrophil-derived, H2O2-mediated cytotoxicity.

BACKGROUND: In vitro studies suggest that polymorphonuclear neutrophils (PMN) can damage endothelial cells (EC) by releasing hydrogen peroxide. In vivo this can lead to anasarca secondary to capillary leakage of fluid, protein, and electrolytes. The result is multiple organ dysfunction syndrome, which is associated with high mortality. In vivo, circulating PMN-EC interactions take place in the presence of plasma, and we have shown previously that plasma affords protection to EC from PMN-mediated damage. METHODS: Human umbilical vein endothelial cells were primed with cytokines, cultured to a confluent monolayer, and coincubated with normal human PMNs. Cytotoxicity was assayed by gamma scintigraphy, plasma C5 was determined by sepharose column elution, and H(2)O(2) was assayed by R-Phycoerythrin fluorescence. RESULTS: Addition of C5, but not C3, to RPMI resulted in EC cytoprotection equivalent to adding whole serum. Removal of C5 from serum using F(ab')(2) rabbit IgG anti-human C5 coupled to CNBr-activated 4 sepharose beads resulted in significant loss of EC cytoprotection against H(2)O(2)-mediated damage, whereas adding back C5 restored the cytoprotection. C5 also reduced H(2)O(2)-mediated destruction of R-Phycoerythrin. CONCLUSIONS: The data suggest that the protection of EC against hydrogen peroxide-mediated damage is partly mediated through complement component C5.

Protective effect of defibrotide on perfusion induced endothelial damage.

In the present study, in vitro effects of Defibrotide (D) on perfusion-induced changes in the morphology of endothelium were investigated by scanning (SEM) and transmission (TEM) electron microscope. Human umbilical cord veins were incubated or perfused with platelet-rich plasma alone (PRP) or platelet-rich plasma with Defibrotide (PRP+D) at 3ml/min or 14ml/min and the changes observed were compared. SEM examination of luminal surfaces demonstrated that perfusion with high flow rates may damage endothelial cells and lead to morphological changes which may be prevented by the presence of Defibrotide in the perfusate. Also, the marked reduction in the number of adhered platelets on luminal surface of veins incubated or perfused with Defibrotide compared to veins treated with platelet-rich plasma only revealed that Defibrotide has anti-thrombotic effects. TEM examination of ruthenium red (RR) stained thin sections of veins demonstrated that perfusion disrupts the glycosaminoglcan (GAG) coat on endothelial cells. But the presence of D in the perfusate preserves the integrity of GAG, indicating further cytoprotective effects of the drug on endothelium.

Spontaneous haematoma of the umbilical cord with a single umbilical artery.

A rare example of the partial rupture of the umbilical vein resulting in a cord haematoma is reported. CTG alterations made possible to anticipate the deterioration of the foetal condition and a healthy infant was delivered by emergency caesarean section. Cross sections of the umbilical cord revealed the lack of one of the umbilical arteries and the haematoma having interfered with the foetal circulation.

Shock wave induced endothelial damage--in situ analysis by confocal laser scanning microscopy.

For more than a decade, extracorporal shock wave lithotripsy has been a standard clinical method for the treatment of urinary stones. However, side effects that are likely to be correlated to vessel damage can often be observed using noninvasive diagnostic techniques, e.g., magnetic resonance imaging. To avoid side effects it is useful to understand the interaction between shock waves and the vascular system. In particular, this is important in view of new applications like gallstone lithothripsy. In the present study, we exposed human umbilical vessels to electromagnetically generated ultrasound shock waves to analyze subsequent alterations of their endothelial layer. Following en face preparation and fluorescent staining, the endothelium was examined in a confocal laser scanning microscope. Endothelial cells of the shock wave exposed vessels revealed permeabilization of plasma membranes and mitochondrial alterations as potentially lethal damage. An increase in the number of stress fibres may indicate functional changes possibly influencing vessel wall permeability.

Pathologic aspects of the umbilical cord after percutaneous umbilical blood sampling.

Percutaneous umbilical blood sampling (cordocentesis) appears to be a valuable new procedure for prenatal diagnosis. In order to evaluate whether focal injury of the umbilical vessels caused by the needle puncture is potentially harmful, we completely examined 50 umbilical cords collected between 1 hour and 20 weeks after cordocentesis. Macroscopic evidence of the needle entry was found in 37 cases, including one giant hematoma of the cord. Within 48 hours after the procedure, microscopic examination of transverse sections taken at the puncture site revealed distinct perforation of the vessel wall, associated in four cases with a small hematoma encircling the vessel. One week after cordocentesis, the vessel wall was partially reformed. There were no histologic differences between needle entry in a vein or in an artery. No thromboses of the umbilical vessels were found.

Intrapartum rupture of the falciform ligament and umbilical vein. A rare cause of hemoperitoneum in the newborn.

Intra-abdominal hemorrhage in the newborn is uncommon, but it must be considered in the first 48 hours of life in the infant with pallor, anemia, abdominal distension, and shock. The injured liver is the most common source of bleeding, with the spleen and kidney less often involved. In the case presented, the hallmarks of intra-abdominal hemorrhage were evident. Exploratory laparotomy revealed intraperitoneal bleeding emanating from the disruption of the umbilical vein and its enveloping falciform ligament. There was no other site of intra-abdominal bleeding and there were no intrinsic abnormalities of the umbilical cord or the placenta. Disruption of the intra-abdominal umbilical vein represented the sole source of intra-abdominal bleeding in this patient. The case is reported to document disruption of the intra-abdominal umbilical vein as a rare cause of neonatal hemoperitoneum.