[Superior vena cava syndrome in a patient with large intravascular mediastinal sarcoma]. / Syndrome de veine cave supérieure dans un contexte de volumineux sarcome médiastinal Intravasculaire.

The superior vena cava (SVC) syndrome associates a series of signs and symptoms caused by an obstruction of the superior vena cava. The etiologies are multiple, but the most common cause is external compression of this vein by a tumor process. The present report concerns a young female with SVC syndrome. The etiology has been shown to be extra-skeletal Ewing's sarcoma extending from the right atrium to the left brachiocephalic trunk and right humeral vein. This diagnosis of tumor was delayed in the present clinical case and the patient developed serious iatrogenic complications during the early hospital management.

Le syndrome de veine cave supérieure (SVCS) associe une série de manifestations liées à une obstruction de la veine cave supérieure. Les étiologies en sont multiples, mais la cause la plus fréquente de ce syndrome est une compression externe de la veine par un processus tumoral. Le cas rapporté est celui d'une jeune patiente présentant un SVCS pour lequel l'étiologie se révélera être un sarcome d'Ewing extra-squelettique s'étendant de l'oreillette droite au tronc brachio-céphalique gauche et à la veine humérale droite. Ce diagnostic de masse néoplasique ne sera toutefois posé que tardivement et la patiente développera diverses complications iatrogènes graves durant sa prise en charge hospitalière initiale.

Salvage of immature forearm fistulas for haemodialysis by interventional radiology.

BACKGROUND: The goal of this article is to assess the value of endovascular techniques for the salvage of fistulas that fail to mature. METHODS: Over a 6-year period, 52 dysfunctional and 17 thrombosed immature forearm fistulas (mean age 10 weeks) were treated by interventional radiology. Angiography was performed by puncture of the brachial artery but dilation of underlying stenoses was performed after cannulation of the fistula itself, whenever possible, with a balloon never smaller than 5 mm. Embolization or ligation of any type of vein was never indicated and never performed. For thrombosed fistulas, significant clots were removed by manual catheter-directed aspiration. A covered stent (Passager) was used in cases of dilation-induced rupture not controlled by balloon tamponade. RESULTS: An underlying stenosis was diagnosed in 100% of cases. Half of them were located in the anastomotic area. The initial success rate of interventional radiology was 97%. Dilation-induced rupture occurred in nine cases (13%) but stents were necessary in only two cases. The rate of significant clinical complications was 2.8% (bacteraemia, pseudoaneurysm). Primary and secondary patency rates at 1 year were 39 and 79%, respectively. CONCLUSIONS: Delayed maturation of native fistulas should lead systematically to imaging as an underlying stenosis is diagnosed in all cases. Interventional radiology can treat the majority of cases and achieve a 97% success rate but early recurrence of stenoses can occur. Multidisciplinary re-evaluation of the patient must, therefore, be performed after radiological salvage of the fistula.

Bacteriological validation of a new apparatus for disinfection of hospital waste at the point of disposal.

OBJECTIVES: To evaluate the ability of a new apparatus (Dipsys 25, Société SGN, Bagnols sur Cèze, France) to disinfect biomedical waste, including both potentially infectious agents and the normal saprophytic flora of the waste. METHODS: Disinfection was assessed using standard methods (reference strains were fixed on reference carriers according to the French AFNOR methods) and nonstandard assays. Assays in conditions of hospital use, evaluations of bacterial survival during storage, sporicidal effect, and spore survival during storage were performed in parallel. Finally, bactericidal effect in extreme conditions (association of high contamination and high bacterial protection conditions) was tested with normal fecal flora. Bacterial counts were performed after treatment by the apparatus and without treatment (controls). All tests were carried out in triplicate. RESULTS: In all treated carriers, a bacterial population decrease of at least 5 log10 was obtained. Assays performed in hospital-use conditions did not show any bacterial growth. Concerning the evaluation of sporicidal effect and spore revival during conservation, a minimum reduction of 5 log10 was observed in all assays performed, without survival. Finally, concerning assays in extreme conditions, the decrease of bacterial population was between 5 log10 and 10 log10 for vegetative anaerobes of normal fecal flora. CONCLUSION: Under our study conditions, the study apparatus reduced the tested microbial populations by a minimal factor of 5 log10. The main advantage of the apparatus is the opportunity to treat contaminated waste inside hospital wards, at the point of initial collection, without pulverization, by nonspecialized staff.

Manual thromboaspiration and dilation of thrombosed dialysis access: mid-term results of a simple concept.

PURPOSE: To report the feasibility, safety, and effectiveness of manual thromboaspiration as a single means of declotting dialysis access. MATERIALS AND METHODS: Between April 1994 and December 1996, 59 consecutive conduits (43 polytetrafluoroethylene [PTFE] grafts, 16 native fistulas) were declotted with 8-F or 7-F angulated catheters. Unmasked stenoses were dilated. Clinical and paraclinical nephrologic surveillance (poor flow, palpation, difficulties with cannulation, increased compression times, increasing venous pressures) led to redilations and stent placements. Rethromboses were treated with further declotting by aspiration. The results are presented according to the life-table method. RESULTS: The initial success of 43 of 43 PTFE grafts (mean procedure time, 119 min +/- 29 [standard deviation]) led to a primary patency rate of 85% +/- 5% (SE) at 1 month, 33% +/- 8% at 6 months, and 24% +/- 12% at 1 year. A graft was ligated 6 days after declotting for acute bleeding in one patient given high-dose warfarin. The secondary patency rates were 86% +/- 7% at 6 months and 86% +/- 9% at 1 year, with a mean duration of patency of 5.7 months between two radiologic interventions performed to maintain or to restore patency, and 19 stents were placed at a mean follow-up of 3 months. The success rate was 81% for native fistulas, with primary patency rates of 81% +/- 10% at 1 month, 74% +/- 14% at 6 months, and 60% +/- 27% at 1 year; secondary patency rates of 81% +/- 12% at 6 months and 81% +/- 18% at 1 year. CONCLUSION: Thromboaspiration is a safe and effective method for declotting dialysis access, yielding a low rethrombosis rate during the first month. Overall radiologic management with reintervention on average every 6 months results in high secondary patency rates at 1 year (81%-86%).

[Revascularization of occluded renal arteries. A case]. / Utilité de la revascularisation des artères rénales occluses. Une observation.

After recent treatment with an angiotensin converting enzyme inhibitor, a 62-year old woman with diabetes, hyperlipidemia and hypertension was admitted for oliguric acute renal failure due to bilateral renal artery lesions (right stenosis and left thrombosis). Hemodialysis was instituted. Percutaneous transluminal angioplasty (PTA) of the right renal artery did not improve the patient's condition, whereas left renal PTA, three weeks after admission, restored diuresis and renal function, allowing hemodialysis to be discontinued. This case underlines the capacity of functional recovery after late recanalization of a totally occluded renal artery. The best outcome predictor is the development of a collateral circulation and the visualization of distal renal arteries at arteriography. The kidney can be recanalized by surgery or PTA.