ABSTRACT
Arteriovenous fistulae traditionally have been placed in the upper extremity. Experience with groin hemodialysis access has been discouraging because of high infection rates and associated limb amputation. The aim of this study was to determine infection rates, patency rates, and possible predictive factors for prosthetic thigh angioaccess outcomes in our hemodialysis patient population. A prospective study was performed for 53 patients who underwent placement of thigh vascular access graft at Sina Hospital, Tehran University of Medical Sciences, between Jan 2000 and July 2005. Demographics, complications, and subsequent treatment were recorded. Survival distributions were plotted using the Kaplan-Meier method for graft survival [primary patency]. Log rank tests were used to evaluate for statistical differences in survival distribution between different groups. The primary patency rates were, 78.4%, 61.2%, 56.2%, and 50% at 3, 6, 9 and 12 months, respectively. There were 15 [28.3%] access failures, related to infection in 2 cases [3.7%], thrombosis in 10 cases [18.9%] and bleeding in 3 case [5.7%].There was no limb ischemia.No significant differences in infection rate or graft patency rates were found by patients' age and gender. A PTFE vascular access in the thigh is not associated with higher morbidity compared with the upper extremity, and should be considered as a promising alternative when upper extremity arteriovenous fistulas cannot be constructed .The incidence of infection and thrombosis in our series is comparable with rates reported in the literature for lower extremity polytetrafluoroethylene angioaccess grafts
Subject(s)
Humans , Male , Female , Catheters, Indwelling , Treatment Outcome , Prospective StudiesABSTRACT
The Fontan operation is the definitive operation for palliation of complex congenital heart disease with single -ventricle physiology. The use of the extra cardiac conduit has recently been gaining popularity. The purpose of this study was to compare the outcomes of extra cardiac conduit Fontan procedure [off-pump technique] and that of traditional technique [lateral tunnel technique] in which cardiopulmonary bypass is routinely used. Forty one patients in different age groups underwent extra cardiac conduit Fontan procedure between April 2001 and December 2004. Data were collected from ICU sheets, files and during follow up visits. Under general anesthesia and through median sternotomy, using two temporary decompressing shunts, superior vena cava implanted on right pulmonary artery and a conduit interposed between transected inferior vena cava and main pulmonary artery. Fenestration was done in almost all patients and previous shunts were closed if there were any. Of our patients, 13 were female and 28 were male. Mean age of the patients was 11.1 years [SD=7.8].In 24.4% of cases Fontan procedure was done as the first palliative surgery and in 75.6% of them there was previous history of palliative procedures. In 6 patients [14.6%] we were constrained to use cardiopulmonary bypass which was predictable or necessary in 50% of cases. There was no reoperation due to post operative bleeding. Two cases suffered from prolonged plural effusion. Our in-hospital mortality was 9.8%. During 2-24 months follow up, we found two cases who were in NYHA functional class II and one case in functional class I. Extra cardiac conduit Fontan procedure could be used in a safe way. The results of this study were comparable and even in some cases better than that of the traditional technique
Subject(s)
Female , Humans , Male , Cardiac Surgical Procedures , Heart Bypass, Right , Heart Defects, Congenital/surgeryABSTRACT
Systemic lupus erythematosus [SLE] is a disease with life-threatening complications. Since evidence indicates that measurement of triglyceride [TG] and HDL levels and tumor necrosis alpha factor [TNF- alpha] and its types I and II soluble receptors plays a major role in evaluation of lupus activity, this study was conducted to investigate the relationship between the above mentioned factors and lupus activity in Tehran in 2005. In this cross-sectional study fasting blood samples were obtained from 86 SLE patients who had been entered into the study through convenient sampling and the disease activity was calculated using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]. Scores >/= 6 were considered as active lupus and <6 as dormant lupus. Serum levels of TNF- alpha, sTNFR[1] and sTNFR[2] were measured through ELISA [Bender Medsystem] and blood TG and HDL through routine biochemical tests within 12 hours overnight fasting. The results were analysed by t-test, Mann-Whitney and Pearson correlation tests. 46 people [53.5%] suffered from dormant disease and 40 people [46.5%] from active disease. TG level had significant relationship with disease activity, sTNFR[2] [P=0.001] and TNF-alpha [P=0/01], while HDL level had inverse significant relationship with SLEDAI [P=0.007], TNF [P=0.01], STNFR1 [P=0.001]. There was no significant relation between TG and HDL with STNFR2. Multiple linear analysis of regression showed that three variables [TG, sTNFR[1] and sTNFR[2]] are maintained in the model for prognosis of the disease while TNF-alpha and HDL are omitted. Dislipoproteinemia [elevated TG and reduced HDL] correlates with SLE activity following an increase in TNF-alpha and its soluble receptors. Thus, serum levels of TG, HDL and TNF-alpha and its soluble receptors are connected with lupus activity and are valuable markers for the disease activity