Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator.
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OBJECTIVES: To determine the incidence of catheter related thrombosis and to test the efficacy of recombinant tissue type plasminogen activator (rt-PA) in preterm infants. STUDY DESIGN: From January 1995 to December 1998, echocardiography was performed in the first few days of life in 76 very low birthweight (< or = 1500 g) infants out of a total of 147 having an umbilical catheter placed. When intracardiac thrombosis was diagnosed, rt-PA infusion was performed. RESULTS: Four infants (5%) developed an intracardiac thrombosis during the first few days of life. In three of them, rt-PA at a dose of 0.4-0.5 mg/kg in a 20-30 minute bolus led to dissolution of the clot. One patient received a three hour infusion after the bolus, at a dose of 0.1 mg/kg/h, with resolution of the thrombus. No systemic effects were observed after rt-PA infusion. CONCLUSIONS: Early thrombosis may occur as a complication of umbilical catheterisation in preterm infants; early echocardiographic detection of this disorder allows complete, safe, and rapid lysis with rt-PA. (+info)
Retroperitoneal abscess and mycotic aortic aneurysm: unusual septic complications of central vascular line placement in premature infants.
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OBJECTIVE: To describe the sonographic appearance of unusual septic complications after central vascular line placement in premature infants. METHODS: Two case reports are presented. RESULTS: The first patient had a retroperitoneal abscess after percutaneous central venous catheter placement. The second patient had a ruptured mycotic aneurysm of the abdominal aorta after umbilical arterial catheter placement. CONCLUSIONS: Retroperitoneal abscess and aortic aneurysm should be considered in patients with histories of long-standing catheters or line sepsis. Both of these complications are readily diagnosed on the basis of sonography. (+info)
Basal muscle amino acid kinetics and protein synthesis in healthy young and older men.
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CONTEXT: Sarcopenia is associated with loss of strength and function, eventually leading to loss of independence. Some studies suggest that basal muscle protein turnover is reduced with aging, but other studies do not confirm this finding. OBJECTIVE: To determine if aging per se affects basal muscle protein turnover in men. DESIGN AND SETTING: Cross-sectional study conducted from June 1997 to July 2000 in a general US community. PARTICIPANTS: Twenty-six young (mean [SE] age, 28 [2] years) and 22 older (mean [SE] age, 70 [1] years) men, who were healthy and independent based on activities of daily living, physical examinations, and screening tests. Subjects were excluded if they had cardiac, pulmonary, liver, or kidney disease; any impairment in activities of daily living; or steroid use. MAIN OUTCOME MEASURES: We measured basal muscle protein and amino acid kinetics, based on stable isotope techniques with femoral arteriovenous catheterization and muscle biopsies. Three models (arteriovenous balance, three-pool, and fractional synthesis rate) were used to estimate the metabolic parameters. RESULTS: Mean (SE) total leg volume was 9.60 (0.32) L in older men vs 10.83 (0.43) L in younger men, which suggests muscle loss in the older men. Net muscle protein balance was similar in both groups (older men, - 19 [2] nmol/min per 100 mL of leg volume vs younger men, - 21 [2] nmol/min per 100 mL of leg volume; P =.51). Small differences were found in mean (SE) muscle protein synthesis in comparisons of older vs younger men: arteriovenous balance, 48 (5) nmol/min per 100 mL of leg volume vs 32 (3) nmol/min per 100 mL of leg volume; P =.004; three-pool, 58 (5) nmol/min per 100 mL of leg volume vs 43 (4) nmol/min per 100 mL of leg volume; P =.04; and fractional synthesis rate, 0.0601 (0.0046) %/h vs 0.0578 (0.0047) %/h; P =.73. Small differences were also found in mean (SE) muscle protein breakdown: arteriovenous balance, 66 (5) nmol/min per 100 mL of leg volume in older vs 53 (4) nmol/min per 100 mL of leg volume in younger men, P =.045; and three-pool, 76 (6) nmol/min per 100 mL of leg volume vs 64 (5) nmol/min per 100 mL of leg volume, P =.14. CONCLUSION: Differences in basal muscle protein turnover between older and younger men do not appear to explain muscle loss that occurs with age. (+info)
Intrapartum epidural catheter migration: a comparative study of three dressing applications.
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We compared three types of catheter fixation application for their ability to minimize the incidence and magnitude of epidural catheter movement during labour. Patients were randomized to have their epidural catheter secured by a Tegaderm dressing (group T; n = 35), a Tegaderm dressing plus filter-shoulder fixation (group F; n = 39), or a Niko Epi-Fix dressing (group N; n = 37). The length of catheter visible at the patient's skin surface was recorded (to the nearest 0.5 cm) after insertion and before removal; the difference was defined as 'catheter movement'. Outward movement of the catheter was greatest when a Niko Epi-Fix was used (P < 0.01). Concerning minimization of displacement of the epidural catheter per se, only a Tegaderm dressing with additional filter-shoulder fixation proved more effective than using a Niko Epi-Fix dressing (P < 0.05). (+info)
Therapeutic efficacy of transcatheter arterial embolization of primary hepatocellular carcinoma: discrepancy in different histopathologic subtypes.
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OBJECTIVE: To evaluate preliminarily the therapeutic efficacy of transcatheter arterial embolization (TAE) for different histopathologic subtypes of primary hepatocellular carcinoma (HCC). METHODS: A retrospective study of 226 patients with histopathologically diagnosed primary HCC was performed. The patients were treated with either single TAE, surgical resection of tumor alone, or TAE combined with surgical resection. Follow-up information was achieved in 157 of 226 patients. Comparative analyses of survival data and image findings were performed with correlation to histopathologic classification and different therapeutic methods, respectively. RESULTS: Eight histopathologic subtypes of primary HCC were found in this group, including HCC of trabecular pattern, pseudoglandular pattern, fibrolamellar HCC and sclerosing HCC, as well as HCC of clear cell, of small cell, poorly differentiated or undifferentiated HCC, and hormonally active HCC. The accumulated survival rate for these 157 patients was 74.52% of 1 year, 53.50% of 2 years, 31.85% and 14.01% of 3 and 5 years, respectively. Fibrolamellar HCC and clear cell HCC had relatively higher survival rate (25.00% and 33.22% of 5 years, respectively) than that of other subtypes, and the median survival time of the latter was 71 months. The mean survival time was 25.06 months (SE = 1.87) in single TAE group, 30.38 (SE = 2.05) months in surgical resection, and 72 months (SE = 6.90) in TAE combined with resection. CONCLUSIONS: Discrepancies do exist in therapeutic effect of different subtypes of HCC. In this study, clear cell HCC was more sensitive to TAE than other subtypes, and, in contrast, small cell HCC and poorly differentiated or undifferentiated HCC were of lower sensitivity to TAE. (+info)
Radial osteomyelitis as a complication of venous cannulation.
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Venepuncture of the superficial veins in the forearm is considered a relatively safe procedure. We report two patients who presented with osteomyelitis of the proximal radius following venous cannulation of the median cubital vein, and one patient who developed osteomyelitis of the distal radius after cannulation of the cephalic vein. Osteomyelitis developing in proximity to a venepuncture site should raise the suspicion that a pathogen causing superficial thrombophlebitis has spread through the deep veins of the arm into the adjacent bone, thus causing osteomyelitis. (+info)
Decreased risk of catheter infection in infants and children using subcutaneous tunneling for continuous caudal anesthesia.
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Continuous caudal anesthesia has been commonly used for intra- and post-operative analgesia in infants and children. However, it has a potential risk of bacterial infection, especially in infants in whom the catheter site is easily contaminated with loose stool. To avoid infection, the authors applied a new procedure using subcutaneous tunneling for continuous caudal anesthesia. In the 18 cases studied with subcutaneous tunneling, clinical signs of infection were absent and bacterial colonization was not found on the catheter tip after 3.9 +/- 1.4 days of catheterization. The incidence of catheter colonization after continuous caudal anesthesia without tunneling had been reported. In their reports, the incidence of catheter colonization ranged from 20% to 37%. Therefore, caudal catheterization with subcutaneous tunneling is a simple and safe method, and has proved very effective to reduce the risk of epidural infection. (+info)
Endovascular cooling for moderate hypothermia in patients with acute stroke: first results of a novel approach.
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BACKGROUND AND PURPOSE: We undertook this study to evaluate the feasibility of inducing and maintaining moderate hypothermia with the use of endovascular rather than surface cooling. METHODS: Six patients with severe acute ischemic stroke were treated with moderate hypothermia. This was induced and maintained by circulating temperature-adjusted normal saline in a closed-loop system entailing 3 balloons located near the tip of a central line, which dwelled in the inferior vena cava. RESULTS: The mean+/-SD initial temperature of the patients was 37+/-1 degrees C (range, 35.5 degrees C to 38.4 degrees C). The pace of cooling was 1.4+/-0.6 degrees C/h, and target temperature was reached after 3+/-1 hours (range, 2 to 4.5 hours). During hypothermia, the maximal temperature observed was 33.4 degrees C, and the minimal temperature was 32.2 degrees C. Temperature deviations >0.2 degrees C or >0.3 degrees C were observed during 21% or 10% of the hours under hypothermia, respectively. Singultus was the only device-related complication encountered. Pulmonary infection, arterial hypotension, bradycardia, arrhythmia, and thrombocytopenia were the most common side effects. CONCLUSIONS: Induction and maintenance of hypothermia with an intravenous cooling device are feasible. The safety of this approach remains to be evaluated. (+info)