Vascular access unit: Six-years experience report in France.

BACKGROUND: The role of nurses in peripherally inserted central catheters (PICC) placement has been limited in France. Having a fully trained nurse-led PICC team can positively impact nursing profession and make better use of valuable human and economic healthcare resources. It can also improve the standards of patient's care, procedural experience, and safety. AIM: The aim of this article is to report the successful outcomes of nurse-led PICC team performed over a 6-year period from a single central hospital in France. METHODS: The authors reviewed all PICCs insertions performed by their trained nurse led team between 2014 and 2019. All quantitative and qualitative variables were considered: the patients admitted, the type of PICC inserted, overall procedural time, the mentor's help, the insert failures, the number of punctures required, the procedural pain utilizing Visual Analog Scale (VAS), any procedural complications, chest X-rays needed, the follow up to the eighth day (D8). RESULTS: From 2014 to 2019, 12,687 PICC were inserted with 128 failed procedures (1%). In 2019, 73% of procedural insertion time was less than 10 min. The request of support rapidly decreased to 2 calls/month. More than 90% of procedures were associated with mild pain (VAS ⩽ 3). After the first month of training, 81% of all procedures were performed with a single insertion puncture. Accidental artery puncture during procedure was 0.5%. The authors found room for improvement, progressing from 97% in the first year to 99% in 2019. Furthermore, the authors found that only 1.85% of all catheters developed local infection within D8, and only 0.83% evolved in vein thrombosis. Total bloodstream infection was at 0.1%. CONCLUSION: The authors report successful outcomes from data collected during the 6-year period demonstrating clear benefits of a nurse-led vascular access team with regard to system wide efficiencies and patient satisfaction.

Endoluminal metastasis of colon cancer to the urinary bladder via the ureter: report of a case.

A 67-year-old woman was admitted for intermittent gross hematuria. Her medical history included a right colectomy for cancer of the ascending colon and removal of metastatic nodes adjacent to the right internal iliac vessels, respectively at 63 and 65 years of age. Cystoscopy detected a semi-pedunculated, nonpapillary (3.5-4 cm diameter) tumor situated above the right ureteral orifice. The histological evaluation of the resected specimen revealed metastatic colonic adenocarcinoma. The history and pathological findings were consistent with a mechanism of endoluminal implantation of adenocarcinoma of the large bowel to the bladder via the right ureter.

Screening of Helicobacter pylori infection after gastrectomy for cancer or peptic ulcer: results of a cohort study.

BACKGROUND: Gastric cancer commonly follows a long-standing inflammation, mainly due to Helicobacter pylori (HP) infection. After resection, the stump develops precancerous alterations. DESIGN: Prospective study of patients undergoing endoscopy from April 1, 2000, through March 31, 2006. SETTING: University departments of Surgery and Experimental Medicine and Pathology. PATIENTS: One hundred eighty-seven patients receiving upper gastrointestinal tract endoscopy many years after surgery for duodenal ulcer or gastric cancer. Ten to 12 postoperative endoscopic biopsy samples were taken from the remnant stomach. MAIN OUTCOME MEASURE: The risk of gastric cancer precursor lesions associated with HP infection. RESULTS: The gastric cancer precursor lesions were more common in the entire HP-positive population (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.25-4.49; P = .007). However, HP-positive patients undergoing resection for cancer had a higher risk of the precursor lesions compared with HP-negative patients in the same diagnostic group (OR, 4.20; 95% CI, 1.10-15.96) and all patients undergoing resection for duodenal ulcer (OR, 1.59; 95% CI, 0.44-5.73). CONCLUSION: The results of this investigation support the role of HP in gastric carcinogenesis and suggest that the HP eradication therapy might prevent the development of metachronous gastric cancer after gastric resection.

Silent colon carcinoma presenting as a hepatic abscess.

Penetration and abscess formation in an adjacent parenchymal organ as presentation of a colon cancer is very uncommon. We report a rare case of pyogenic liver abscess as the first manifestation of an infiltrative and penetrating hepatic flexure colon carcinoma without liver metastases. A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. Eight months after a right colectomy and liver resection there was no evidence of disease. The occurrence of a pyogenic liver abscess should raise the suspicion of a silent colon cancer.