Persistent Left Superior Vena Cava: Rare Location of Hemodialysis Catheter.

When the left cardinal vein fails to involute during fetal life, a persistent left superior vena cava (PLSVC) develops. PLSVC is a rare vascular anomaly, and the reported incidence is 0.3-0.5% in healthy individuals. It is usually asymptomatic and does not cause hemodynamic disturbances unless associated with cardiac malformations. If the PLSVC drains adequately into the right atrium and there are no cardiac abnormalities, catheterization of this vessel, including temporary and cuffed HD catheter insertion, is deemed safe. We present the case of a 70-year-old woman with acute kidney injury (AKI), in which the necessity to place an HD central venous catheter (CVC) through the left internal jugular vein led to the discovery of a PLSVC. Once it was shown that the vessel was adequately draining into the right atrium, this catheter was changed to a cuffed tunneled HD catheter, which was successfully utilized for HD sessions for three months and removed after the recuperation of renal function without complications.

A Rare and Severe Cause of Abdominal Pain in a Hemodialysis Patient.

Pneumatosis intestinalis (PI) and aeroportia have been rarely described in hemodialysis patients. We present a case of a 64-year-old woman on regular hemodialysis who presented with abdominal pain, vomiting, and diarrhea. Abdominal CT showed pneumatosis intestinalis and aeroportia suggestive of ischemic abnormalities. In this case, given the absence of transmural necrosis or bowel perforation, aeroportia seemed to be caused by nonocclusive mesenteric ischemia (NOMI), an increasingly recognized complication in hemodialysis patients. The patient was proposed for emergent exploratory laparotomy; however, she had a fatal outcome. Hemodialysis-dependent patients should be considered at risk of the "low-flow syndrome" of mesenteric arterial circulation. Prevention is crucial, and early detection of these entities is important for prompt diagnosis and management of mesenteric ischemia.

A intervenção do enfermeiro especialista em saúde mental na prevenção do bullying em contexto escolar / The intervention of the nurse specialist in mental health in the prevention of bullying in school context

As perturbações do foro mental na população infantojuvenil estão descritas como causadoras de grande impacto na vida em idade adulta e com impacto não só humano, mas também para a sociedade em geral. O bullying surge como um fenómeno merecedor de intervenção em contexto escolar por parte do Enfermeiro Especialista em Enfermagem de Saúde Mental e Psiquiátrica, pelas suas repercussões nos envolvidos, devendo a intervenção incidir na prevenção como estratégia promotora da saúde mental e controlo do fenómeno. Indo ao encontro do preconizado pelo Plano Nacional da Saúde Mental, com extensão a 2020, que pretende aumentar o número de ações no âmbito dos programas de promoção da saúde mental e de prevenção das doenças mentais, surge o presente relatório que objetiva o planeamento duma proposta de programa de intervenção na prevenção do bullying, no âmbito das competências do EEESMP, baseado na Metodologia de Projeto e com recurso à Revisão Integrativa da Literatura. Será ainda evidenciado o percurso, reflexivo, para a aquisição de competências comuns e específicas do EEESMP e de Mestre em Enfermagem.

Mental disorders in children and adolescents are described as having a major impact on adult life, not only human but also on society in general. Bullying emerges as a phenomenon worthy of intervention in the school context by the Specialist Nurse in Mental Health and Psychiatric Nursing, due to its repercussions on those involved. This intervention should focus on prevention as a strategy that promotes mental health and control of the phenomenon. The present report appears in line with the recommendations of the National Mental Health Plan extended to 2020, which intends to increase the number of actions under the programs for the promotion of mental health and the prevention of mental illnesses. Our aim is to develop an intervention program proposal in the prevention of bullying, within the scope of the skills of the SNMHPN, based on the Project Methodology and using the Integrative Literature Review. It will also be evidenced the reflexive path for the acquisition of common and specific competences of the SNMHPN and Master in Nursing.

Haemolytic uraemic syndrome associated with H1N1 influenza.

Haemolytic uraemic syndrome (HUS) is one of the two forms of thrombotic microangiopathies and is characterized by the triad of microangiopathic haemolytic anaemia, thrombocytopaenia, and acute renal failure. It has been associated with bacterial and viral infections as well as non-infective causes. We report a subject who presented with HUS associated with an influenza-like syndrome which was confirmed as an influenza A (H1N1) infection. There are reports of HUS associated with seasonal influenza, but there have been no reported cases of HUS after novel influenza A (H1N1) in the literature so far.

Endovascular treatment of immature, dysfunctional and thrombosed forearm autogenous ulnar-basilic and radial-basilic fistulas for haemodialysis.

BACKGROUND: Forearm basilic fistulas are rarely used as vascular accesses for haemodialysis but they represent a valuable option when autogenous radial-cephalic fistulas cannot be performed. There is no information in the literature to date about the outcome of direct ulnar-basilic or transposed radial-basilic forearm autogenous fistulas after endovascular treatment of stenosis or thrombosis. METHODS: This retrospective study included 78 consecutive patients from eight dialysis units who were referred to a single interventional radiology centre for endovascular treatment of delayed maturation (n = 30), dysfunction (n = 35) or thrombosis (n = 13) of their autogenous forearm ulnar-basilic (n = 62) or radial-basilic fistulas (n = 16). The male/female ratio was 54/24, mean age was 64.7 years, 26% had diabetes, 83% were treated for hypertension and the mean body mass index was 24 kg/m(2). Immature and dysfunctional fistulas were treated by dilation and thrombosed fistulas by aspiration thrombectomy. Clinical success was defined as the perception of a continuous palpable thrill and the ability to perform dialysis. Fistula patency rates were calculated with the Kaplan-Meier method. RESULTS: Overall primary patency rates were 51% and 44% at 1 and 2 years, respectively. These rates were lower for immature and thrombosed fistulas compared to dysfunctional mature fistulas. Secondary patency rates were 96% and 91% at 1 and 4 years, respectively. Immediate overall clinical success was 97%. The two failures occurred with an immature and a thrombosed fistula. Immediate complications included two transient dilation-induced ruptures treated by prolonged balloon inflation. One case of subsequent hand ischaemia was successfully treated by distal artery ligation. CONCLUSIONS: Endovascular treatment plays a major role in the maturation process, maintenance and salvage of radial and ulnar-basilic fistulas. The preservation of upper arm veins for the future, with low risk of hand ischaemia or hyperflow, might encourage nephrologists and surgeons to consider forearm basilic fistulas systematically in their strategy of vascular access creation.

Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis.

BACKGROUND: The depth of veins can discourage surgeons from creating radial-cephalic arteriovenous accesses for hemodialysis in obese patients. Elevation and tunneled transposition are the two techniques that have been described to superficialize these veins and make them accessible for cannulation. Unfortunately, such manipulation of veins has potential drawbacks. We report lipectomy, a new technique that removes subcutaneous fat and does not mobilize the vein. METHODS: This single-center prospective study included 49 consecutive patients (17 men, 32 women) who underwent second-stage lipectomy after creation of a radial-cephalic fistula. Mean patient age was 54 years, 36% had diabetes, and the mean body mass index was 31 +/- 5.6 kg/m(2). Subcutaneous fatty tissues were removed after two transverse skin incisions under regional anesthesia and preventive hemostasis. Cannulation was first allowed 1 month later, after clinical and color duplex ultrasound evaluation. Technical success was defined as the ability to remove the fat and to palpate the patent vein immediately under the skin at the end of the operation. Clinical success was defined as the ability to perform at least three consecutive dialysis sessions with two needles. All patients were checked systematically every 6 months by the surgeon. RESULTS: Technical and clinical success rates were 96% (47 of 49) and 94% (46 of 49), respectively. Mean vein depth decreased from 8 +/- 2 to 3 +/- 1 mm according to duplex ultrasound imaging. The mean vein diameter increased from 6 +/- 1 to 8 +/- 2 mm. In one patient, vein tortuosity that was overlooked required conventional repeat tunneling. One extensive hematoma resulted in loss of the fistula. One patient died before the fistula could be used. Primary patency rates were 71% +/- 7% and 63% +/- 8% at 1 and 3 years, respectively, and secondary patency rates were 98% +/- 2% and 88% +/- 7%. Delayed complications were treated by surgery (n = 7) or by endovascular procedures (n = 10). CONCLUSION: Lipectomy is a safe, effective, and durable approach to make deep arterialized forearm veins accessible for routine cannulation for hemodialysis in obese patients. It might even be hypothesized that incident obese dialysis patients will eventually have the highest proportion of radial-cephalic fistulas because they often have distal veins that have been preserved by their fat from previous attempts at cannulation for blood sampling or infusion.