6 research outputs found
Complete Catheter Disconnection and Migration of an Implantable Venous Access Device: The Disconnected Cap Sign
No full textThe use of totally implantable venous access device has provided a solution to difficult venous access. Early reports have, however, recognized several complications with their use. Catheter disruption is a rare but important complication of these devices; it may be asymptomatic but can be fatal in some cases. We present a case of a patient who had a rare and serious complication secondary to catheter disconnection from its chamber. © 2010 Annals of Vascular Surgery Inc.AITKEN DR, 1984, AM J SURG, V148, P633, DOI 10.1016-0002-9610(84)90340-4; ANDRIS DA, 1994, JPEN-PARENTER ENTER, V18, P531, DOI 10.1177-0148607194018006531; Ballarini C, 1999, ONCOLOGY-BASEL, V56, P97, DOI 10.1159-000011947; BARRIOS CH, 1992, ONCOLOGY, V49, P474; Behrend M, 2002, SURG TODAY, V32, P724; Biffi R, 1998, ANN ONCOL, V9, P767, DOI 10.1023-A:1008392423469; Biffi R, 1997, EUR J CANCER, V33, P1190, DOI 10.1016-S0959-8049(97)00039-7; Bodner LJ, 2000, CARDIOVASC INTER RAD, V23, P187, DOI 10.1007-s002700010041; Di Carlo I, 2000, J SURG ONCOL, V73, P172, DOI 10.1002-(SICI)1096-9098(200003)73:3172::AID-JSO113.0.CO;2-Z; Filippou Dimitrios K, 2004, World J Surg Oncol, V2, P36, DOI 10.1186-1477-7819-2-36; Gowda MR, 2004, ANGIOLOGY, V55, P557, DOI 10.1177-000331970405500512; GREENE FL, 1988, SOUTHERN MED J, V81, P580; HINKE DH, 1990, RADIOLOGY, V177, P353; Iannelli A, 2001, Minerva Chir, V56, P303; Karam AR, 2009, CLIN IMAG, V33, P140, DOI 10.1016-j.clinimag.2008.10.001; Kock HJ, 1998, WORLD J SURG, V22, P12; Koller M, 1998, J SURG ONCOL, V68, P166, DOI 10.1002-(SICI)1096-9098(199807)68:3166::AID-JSO63.0.CO;2-3; KOONINGS PP, 1994, J AM COLL SURGEONS, V178, P164; Lam AWC, 1999, JPN J CLIN ONCOL, V29, P643, DOI 10.1093-jjco-29.12.643; Liu JC, 2004, CLIN IMAG, V28, P223, DOI 10.1016-S0899-7071(03)00119-0; LOKICH JJ, 1985, J CLIN ONCOL, V3, P710; Maisey NR, 2003, BREAST, V12, P287, DOI 10.1016-S0960-9776(03)00060-2; Ouaknine-Orlando B, 1999, ANN FR ANESTH, V18, P949, DOI 10.1016-S0750-7658(00)87944-7; ROGGLA G, 1993, INT J SPORTS MED, V14, P345, DOI 10.1055-s-2007-1021190; Sattari Maryam, 2003, Interact Cardiovasc Thorac Surg, V2, P532, DOI 10.1016-S1569-9293(03)00137-3; SUAREZPENARANDA JM, 1995, AM J FOREN MED PATH, V16, P124; Surov A, 2008, ANGIOLOGY, V59, P90, DOI 10.1177-000331970730388312
Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: The ASSENT-3 randomised trial in acute myocardial infarction
No full textBackground: Current fibrinolytic therapies fail to achieve optimum reperfusion in many patients. Low-molecular-weight heparins and platelet glycoprotein IIb/IIIa inhibitors have shown the potential to improve pharmacological reperfusion therapy. We did a randomised, open-label trial to compare the efficacy and safety of tenecteplase plus enoxaparin or abciximab, with that of tenecteplase plus weight-adjusted unfractionated heparin in patients with acute myocardial infarction. Methods: 6095 patients with acute myocardial infarction of less than 6 h were randomly assigned one of three regimens: full-dose tenecteplase and enoxaparin for a maximum of 7 days (enoxaparin group; n=2040), half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-h infusion of abciximab (abciximab group; n=2017), or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 h (unfractionated heparin group; n=2038). The primary endpoints were the composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischaemia (efficacy endpoint), and the above endpoint plus in-hospital intracranial haemorrhage or in-hospital major bleeding complications (efficacy plus safety endpoint). Analysis was by intention to treat. Findings: There were significantly fewer efficacy endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group: 233/2037 (11.4%) versus 315/2038 (15.4%; relative risk 0.74 [95% CI 0.63-0.87], p=0.0002) for enoxaparin, and 223/2017 (11.1%) versus 315/2038 (15.4%; 0.72 [0.61-0.84], p<0.0001) for abciximab. The same was true for the efficacy plus safety endpoint: 280/2037 (13.7%) versus 347/2036 (17.0%; 0.81 [0.70-0.93], p=0.0037) for enoxaparin, and 287/2016 (14.2%) versus 347/2036 (17.0%; 0.84 [0.72-0.96], p=0.01416) for abciximab. Interpretation: The tenecteplase plus enoxaparin or abciximab regimens studied here reduce the frequency of ischaemic complications of an acute myocardial infarction. In light of its ease of administration, tenecteplase plus enoxaparin seems to be an attractive alternative reperfusion regimen that warrants further study
Респираторная терапия у больных с острым повреждением легких и сопутствующим пневмотораксом
No full textObjective. To comparatively study the efficiency of respiratory support using biphasic positive airway pressure (BIPAP), spontaneous intermittent mandatory ventilation (SIMV), and intermittent positive pressure ventilation (IPPV) in patients with acute lung injury (ALI) and concomitant pneumothorax. Subjects and materials. Sixty-eight patients were examined. The severity of disease was 18 to 24 APACHE II scores. After elimination of pneumothorax, lung opening maneuver was made by the routine procedure 1—2 times daily on different types of respiratory support. Results. The study has indicated that in patients with ALI and concomitant pneumothorax, BIPAP reduces the time of pleural cavity drainage, which allows the lung opening maneuver to be earlier used. Conclusion. BIPAP leads to a better adaptation of a patient to respiratory support, to the limited use of sedatives, and to better gas exchange in the lung and accelerates transfer from total respiratory support to spontaneous breathing. Key words: acute lung injury, pneumothorax, BIPAP, lung opening maneuver.Цель — сравнить исследование эффективности респираторной поддержки с использованием BIPAP (вентиляция легких с двухфазным положительным давлением в дыхательных путях), SIMV (синхронизированная перемежающаяся принудительная вентиляция легких) и IPPV (вентиляция легких с положительным давлением в дыхательных путях) у больных с острым повреждением легких (ОПЛ) и сопутствующим пневмотораксом. Материалы и методы. Обследовано 68 больных. Тяжесть состояния по шкале APACНЕ II составила 18—24 баллов. После ликвидации пневмоторакса проводили «маневр открытия легких» на различных видах респираторной поддержки 1—2 раза в сутки, по общепринятой методике. Результаты. В результате исследования показано, что использование BIPAP у больных с ОПЛ и сопутствующим пневмотораксом снижает время дренирования плевральной полости, что позволяет раньше использовать маневр открытия легких. Заключение. Применение BIPAP приводит к лучшей адаптации больного к респиратору, ограничению применения седатив-ных средств, улучшению газообмена в легких и ускоряет переход от тотальной респираторной поддержки к самостоятельному дыханию. Ключевые слова: острое повреждение легких, пневмоторакс, BIPAP, маневр открытия легких
Clinical characteristics and risk factors of acute kidney injure in inpatients with dengue at Hospital Infantil Napoleón Franco pareja in Cartagena - Colombia.
No full textRevista Ciencias Biomédicas Vol.7, Núm.2 (2016) Pag. 223 - 233Introducción: la lesión renal aguda (LRA) es una complicación frecuente de la infección por el virus del dengue que ha sido poco estudiada, especialmente en pacientes pediátricos. Se ha descrito que está asociada a mayor mortalidad y estancia hospitalaria, sin embargo, los estudios que evalúan su incidencia, factores de riesgo y desenlaces son escasos. Objetivos: determinar las características, los factores de riesgo y los desenlaces de los pacientes pediátricos con LRA hospitalizados por dengue con signos de alarma o dengue grave. Materiales y métodos: se realizó un estudio observacional de cohorte prospectivo en el cual se analizaron y compararon las características clínicas de los pacientes hospitalizados por dengue grave o con signos de alarma en un hospital infantil del Caribe colombiano. Se evaluaron potenciales factores de riesgo asociados a LRA. Resultados: se recopiló información de 122 pacientes, de los cuales 16.3% presentaron insuficiencia renal aguda. El análisis comparativo mostró que los pacientes con LRA presentaron con mayor frecuencia resequedad de mucosas, aspecto anormal de la piel, presencia de derrame pleural o ascitis. Los niveles séricos de nitrógeno ureico, transaminasa glutámica, transaminasa pirúvica, así como el recuento leucocitario total, tiempo de protrombina y de tromboplastina también fueron mayores. El análisis de regresión logística univariante y multivariante permitió confirmar la oliguria como el único factor de riesgo independiente para el desarrollo de insuficiencia renal aguda, y tendencia a la asociación con la presencia de ascitis o derrame pleural.
Conclusión: en el presente estudio la incidencia de LRA fue alta, en comparación con estudios previos. Se asoció con mayor estancia hospitalaria y necesidad de manejo en cuidados intensivos. El único factor de riesgo identificable fue la oliguria
