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INTRAPERITONEAL REINFUSION OF ASCITIC FLUID AFTER EXTRACORPOREAL CONCENTRATION AS A TREATMENT FOR OLIGURIC PATIENTS WITH REFRACTORY ASCITES
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Stomach phytobezoars in two uremic anorexic patients
No full textConglomerates of food and mucus or phytobezoars composed of vegetable
matter are sometimes found in the stomach in the general population.
Reports of phytobezoars in uremic patients are, however, scarce. Here we
describe 2 uremic patients in which esophagogastroduodenoscopy was
performed due to dyspepsia associated with weight loss and in which stomach
phytobezoars were discovered. Theoretically, uremic patients should be at
risk for producing bezoars. In fact, these patients frequently present
predisposing conditions such as autonomic neuropathy, diabetes mellitus and
delayed gastric emptying. Gastric bezoars cause anorexia. Anorexia is a
frequent symptom in dialysis patients and is associated with malnutrition.
In these patients, malnutrition is strongly associated with mortality and
is quite difficult to reverse. Similarly, phytobezoars cause chronic
anorexia. We suggest that clinicians working in dialysis units should
consider the possibility of a gastric bezoar when evaluating anorexic
uremic patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
MULTICENTRIC STUDY ON PAIRED FILTRATION DIALYSIS AS A SHORT HIGHLY EFFICIENT DIALYSIS TECHNIQUE
No full textThe PFD is a hemodiafiltration technique where ultrafiltration and dialysis are carried out in two separate chambers, thereby avoiding the negative interference which exists when convection and diffusion are carried out together. High efficiency purification is achieved using this technique and this allows the dialysis time to be shortened. We studied a population of 35 patients from different centres treated with PFD over one year and evaluated the efficiency, clinical tolerance and possible complications of the technique. The patients were divided into two groups according to their body weight, interdialytic weight gain and quality of the vascular access. Group A (n = 18) had 3 weekly sessions lasting 180 mins; in group B (n = 18) the sessions lasted 150 mins. The following were used in both groups: an SG-3 (Sorin) filter, 0.5 sqm polisulphone filter for convection and 1.4 sqm filter of hemophan as dialyser. The volume of UF was 12% of the body weight plus the interdialytic body weight gain. The composition of the reinfusion solution varied accordingly. The Kt/V was = 1.0 and the PCR > 1.1 g/kg/day in all patients. All the analytic parameters measured, including the B-2-M, remained stable. The tolerance to treatment was good and even improved over time in both groups. There were no changes in the cardiovascular parameters measured by echocardiography. The nerve conduction velocity improved in both groups, particularly in group B (p > 0.05). There were no clinical or technical complications. Therefore, we conclude that PFD is an efficient form of dialysis treatment, which allows the dialysis time to be shortened and present excellent clinical tolerance
Thoracic lymphadenopathy due to vascular transformation of lymph node sinuses associated with upper limb edema in a chronic hemodialysis patient with congestive heart failure
No full textBACKGROUND: Vascular transformation of lymph node sinuses (VTLS) is a rare
disorder characterized by transformation of lymph node sinuses into
endothelium-lined capillary-like channels. This phenomenon was originally
discovered by accident whilst examining regional lymph nodes draining
cancer. However, it has been found in association with other conditions
associated with lympho venous congestion and distension, such as congestive
heart failure (CHF) or even lymphoadenopathy alone. CASE REPORT: We
describe the clinical case of a male dialysis patient with CHF (secondary
to ischemic-hypertensive cardiac failure) who developed gross edema of the
upper left limb on the arteriovenous fistula (AVF) side. Edema appeared
within a month after carotid endoarteriectomy following approximately
twenty years of chronic hemodialysis. Doppler ultrasound with other
investigations showed that subclavian and upper cava veins were patent, but
revealed many enlarged lymph nodes in the upper left thorax and in the left
axilla. Suspicion of lymphoproliferative disease or metastatic involvement
was raised and a lymph node biopsy was performed, revealing VTLS. Bone
marrow biopsy and abdominal tomographies showed no mass or a proliferative
disorder. Based on a hypothesis of an association between upper limb edema
and ipsilateral AVF, the AVF was tied. The upper limb edema decreased
dramatically within weeks, whilst RRT was continued by means of a central
venous catheter. However, a few months later the patient's condition
worsened; he developed relapsing pleural effusions and eventually died.
Post-mortem examination revealed severe ischemic-calcific cardiopathy and
showed that major thoracic and brachial vessels were patent whilst most
thoracic and hilar lymph nodes showed VTLS and fibrosis. CONCLUSIONS: We
believe that in our patient CHF was the primary cause of thoracic
adenomegaly and that CHF, together with venous hypertension at the left
fistula's arm, caused ipsilateral limb edema. Thus, adenomegaly due to VTLS
could represent an accompanying feature even in upper limb edema in chronic
hemodialysis patients. To our knowledge, this is the first report of such
an association. In our patient months were "lost" because we thought that
limb edema was secondary to the adenomegaly. It is important that
clinicians working in dialysis units are aware that when upper limb edema
is present, adenomegaly might just be an accompanying symptom, especially
in case of concomitant diagnosis of CHF
ADEQUACY OF CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS - COMPARISON WITH OTHER DIALYSIS TECHNIQUES
No full textVariations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Ash split cath® in geriatric dialyzed patients
No full textVascular access is the essential step in performing hemodialysis in uremic
patients. In the absence of a permanent and utilizable native
arterio-venous fistula, the use of a tunnelled catheter makes dialysis
therapy possible. The Ash Split Cath, a recently introduced chronic
hemodialysis catheter, was inserted in five patients (7.1 % of our
prevalent dialysis population) because of repeated venous thrombosis in
three patients and a poor venous tree in two. The mean age of patients was
78 years (plus or minus) 7. The average blood flow rate was 250 (plus or
minus) 50 ml/minute and the mean venous pressure 140mm Hg (plus or minus)
35. Recirculation determined by low flux technique was less than 2 %. KT/V
calculated 3 months after the catheter placement was 1.2 (plus or minus)
0.02. During the follow-up we did not document any infection of the exit
site or related to the catheter. This device is simple to place, gives
adequate dialysis treatment and is useful in geriatric dialyzed patients in
whom the arterio-venous fistula can no longer be used
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