Biochemical Factors Affecting Thrombosis Development in Permanent Tunneled Hemodialysis Catheter.

BACKGROUND: It is critical to clarify the biochemical factors associated with thrombosis development following tunneled dialysis catheter (TDC) insertion. METHODS: The study involved retrospective analysis of charts of patients hospitalized for permanent TDC placement between 2013 and 2020 in a tertiary academic center. Patients undergoing a hemodialysis schedule with permanent TDC for more than three months were included in the study. To determine predictive factors associated with thrombosis development in permanent TDC, patients were assigned to one of two groups, according to the extent of thrombosis. The groups were compared in terms of demographic characteristics, blood test values, complication and length of follow-up period. RESULTS: A total of 350 patients (204 female, 146 male) were enrolled into the study. In patients with thrombosis the mean BMI was found significantly higher (p = 0.001) and presence of diabetes mellitus was significantly common (p = 0.014). Patients with thrombosis had significantly higher D-dimer (6.5 vs. 2.4 µg/mL, p = 0.001) and procalcitonin levels (4.1 vs. 1.4 ng/mL, p = 0.001). Additionally, patients with thrombosis had a significantly higher rate of infective complications (p = 0.014). Logistic regression analysis revealed that BMI > 30 kg/m2 and infective complications increased thrombosis risk 3.842 and 3.104 times (p = 0.004 and p = 0.038, respectively). Additionally, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were significantly associated with the development of thrombosis (p = 0.001 and p = 0.007). CONCLUSIONS: The present study demonstrated that the presence of infection, higher BMI > 30 kg/m2, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were found to increase the incidence of thrombosis.

Relaxant effect of the prostacyclin analogue iloprost on isolated human radial artery: An approach for the reversal of graft spasm.

Radial artery graft spasm in the perioperative or postoperative period of coronary bypass surgery necessitates urgent treatment due to risk of graft failure and mortality. Herein, we evaluated the effect of iloprost, a prostacyclin (PGI2) analogue, against the contractions produced by noradrenaline and potassium chloride on isolated human radial artery. Following the determination of endothelial and vascular relaxing capacities of the arteries, iloprost (10-9M-10-6M) was cumulatively applied on rings precontracted submaximally with the spasmogens. In some rings, the response to iloprost was assessed following pretreatment with nitric oxide (NO) synthase inhibitor, l-NAME (3×10-4M,30min). Iloprost produced complete relaxations on radial artery rings precontracted with noradrenaline whereas, only moderate relaxations against the contractions induced by potassium chloride. Notably, the relaxation to iloprost was remarkably blunted in radial arteries with impaired endothelial function. Moreover, the relaxation to iloprost was unchanged in rings pretreated with l-NAME. Our results demonstrated that iloprost could be a potent relaxant agent in reversing radial artery spasm, particularly initiated by noradrenaline, possibly acting via an endothelium-mediated mechanism unrelated to NO.

Ablation of the great saphenous vein with nontumescent n-butyl cyanoacrylate versus endovenous laser therapy.

OBJECTIVE: The endovenous application of n-butyl cyanoacrylate (NBCA) is a new nontumescent ablation technique for the treatment of venous insufficiency. The aim of this study was to retrospectively compare an NBCA-based ablation method with endovenous laser ablation (EVLA) for the management of incompetent great saphenous veins. METHODS: Between May 2013 and August 2014, there were 339 patients with incompetent varicose veins who were treated with either the endovenous application of NBCA (VariClose Vein Sealing System [VVSS]; Biolas, Ankara, Turkey) or EVLA. The preprocedural, intraprocedural, postprocedural, and follow-up data of the patients were collected and retrospectively compared. RESULTS: The mean age was 45.09 ± 12 years in the VVSS group and 47.08 ± 11 years in the EVLA group (P = .113). The average ablated vein length was 31.97 ± 6.83 cm in the VVSS group and 31.65 ± 6.25 cm in the EVLA group (P = .97). The average tumescent anesthesia use was 300 mL (range, 60-600 mL) in the EVLA group. The average procedure time was 7 minutes (range, 4-11 minutes) in the VVSS group and 18 minutes (range, 14-25 minutes) in the EVLA group (P < .01). On the basis of ultrasound examinations performed at the end of the procedure, all procedures in both groups were successful, and the target vein segments were fully occluded. The 12-month total occlusion rates in the VVSS and EVLA groups were 98.6% and 97.3%, respectively (P = .65). In both the VVSS and EVLA groups, the Venous Clinical Severity Score declined significantly with no difference between groups. There were fewer adverse events after VVSS treatment compared with EVLA treatment (pigmentation, P ≤ .002; phlebitis, P ≤ .015). There was no need for tumescent anesthesia in the VVSS group. CONCLUSIONS: The NBCA-based vein sealing system is a fast and effective treatment option for the management of incompetent saphenous veins that does not involve tumescent anesthesia, compression stockings, paresthesia, burn marks, or pigmentation. Further large-scale studies with long-term outcomes are required to identify the optimal treatment modalities for patients with saphenous vein insufficiency.

Efficacy of tigecycline and vancomycin in experimental catheter-related Staphylococcus epidermidis infection: microbiological and electron microscopic analysis of biofilm.

Central venous catheters are frequently used. The commonest cause of catheter-related bloodstream infections (CRBSI) is coagulase-negative staphylococci (CoNS) associated with adherent biofilm. Tigecycline, a derivative of tetracycline, acts against strains producing biofilm. In this study, we aimed to determine the effect of tigecycline in a CRBSI model. A single dose of 10(8) colony-forming units (CFU)/mL of slime-producing Staphylococcus epidermidis was given through polyethylene catheters inserted into 24 rabbits. After 72 h, groups of eight rabbits were treated with heparin, vancomycin/heparin or tigecycline/heparin. Blood obtained from peripheral veins and the catheter lumen as well as catheter tips were cultured, and three catheters from each group were studied using electron microscopy. Surfaces were randomly subdivided and areas with ≥50 bacteria were compared. Blood cultures were positive from all heparin-treated rabbits but were negative from those receiving either antibiotic (P<0.001). Catheter tip cultures revealed growth from six, two and one rabbit(s) given heparin, vancomycin and tigecycline, respectively. Electron microscopy showed that catheters from heparin-treated rabbits were most heavily colonised (more areas with ≥50 CFU) compared with catheters from animals treated with vancomycin or tigecycline (P<0.003 and P<0.001, respectively). In conclusion, this study shows that tigecycline and vancomycin are both effective for treating CRBSI due to CoNS. Electron microscopy of catheters themselves suggests that tigecycline is superior to vancomycin (P<0.001). Tigecycline may be useful for the treatment of CRBSI.

Large cardiac hydatid cyst in the interventricular septum.

Cystic hydatid disease results from infection with the larval or adult form of the Echinococcus granulosus tapeworm. Cardiac involvement is seen in 0.5% to 2% of patients with hydatid disease, and involvement of the interventricular septum is even rarer. Herein, we report our surgical treatment of a large cardiac hydatid cyst in the interventricular septum. A 39-year-old woman presented with dyspnea. Transthoracic echocardiography revealed a large cyst in the apical part of the interventricular septum. Thoracic computed tomography showed a cystic lesion in that site, and magnetic resonance imaging confirmed the presence of a 50 × 55-mm mass. The patient was placed on cardiopulmonary bypass. Hypertonic saline solution-soaked sponges were distributed within the pericardial cavity to prevent local invasion of the parasite intraoperatively. Through an incision parallel to the left anterior descending coronary artery, and without opening adjacent cardiac chambers, we aspirated the entire contents of the cyst, removed its germinative membrane, and washed the cavity with 20% hypertonic saline solution. The patient recovered uneventfully. She had begun taking albendazole 5 days preoperatively, and this therapy was continued for 12 weeks postoperatively. In cases of an interventricular cardiac hydatid cyst, the combination of surgical resection, washout of the remaining cavity with hypertonic saline solution, and albendazole therapy typically yields excellent results.