Femoral vein tunneled catheters as a last resort to vascular access: report of five cases and review of literature.

Vascular access (VA) remains a thorny problem in at least some patients requiring hemodialysis (HD). When options like arterio-venous fistulae, grafts, and thoracic tunneled central catheters are exhausted, the patient survival becomes endangered. The choices left are limited to transplantation, peritoneal dialysis, and translumbar and femoral catheter insertion. The latter may, in many instances, be the only possibility. We report our experience in six patients, in whom all the vascular accesses were exhausted and transplantation or peritoneal dialysis could not be performed. Hence, we opted for femoral tunneled catheters (FTC) as a permanent and sole VA. The mean follow up period was 16 months (8-22 months). The mean age of the patients was 53.1 (35-72) years, the mean time on HD was 3.125 years (2-4.5), and the mean number of vascular accesses was 4.7 (4-7). In five patients, a Permcath (Quinton, Kendall) was inserted, and in one patient, a twin Tessio catheter (MPS, Germany) was inserted. All patients were administered aspirin or clopidogrel to prevent catheter thrombosis. Aseptic nursing procedures and personal hygiene were emphasized. All catheters were functional at 2.5 months. The mean blood flow was 220 mL/min (200-240 mL/min). One patient died at 18 months, with a functional catheter, due massive gastro-intestinal bleed not directly related to the FTC. In one patient, the site of the catheter was changed at 6.5 months due to accidental pulling of the catheter by the patient. One catheter flow became inadequate after nine months, which could be reversed with streptokinase or tissue plasminogen activator. One patient presented excessive bleeding at the time of insertion that was controlled after 25 minutes of compression against the pelvic bone. One patient presented deep vein thrombosis with catheter thrombosis that required reinsertion of the catheter three months later. In one patient, the catheter functioned for 19.5 months after insertion. It is noteworthy that no patient developed catheter-related septicemia. None of the patients developed late hemorrhage. We conclude that tunneled femoral catheter is a viable option in patients with exhausted VA. Strict aseptic nursing technique and personal hygiene are essential. A multi-center study would give a better insight into this type of VA.

The influence of seasonal temperatures on meat quality characteristics of hot-boned, m. psoas major and minor, from goats and sheep.

Samples of psoas major and minor muscles were randomly collected weekly from 203 (99 hot and 104 cool seasons) Omani goats, 215 (106 hot and 109 cool seasons) Omani sheep, 212 (104 hot and 108 cool seasons) Somali goats, 242 (127 hot and 115 cool seasons) Somali sheep and 211 (110 hot and 101 cool seasons) Australian Merino sheep slaughtered at the Central Slaughterhouse in Oman to investigate the effect of season on meat quality. The collection period was during November 2004-October 2005 and divided into two seasons according to ambient temperatures and relative humidity. These were termed: cool season (average temperature of 21°C and 59% relative humidity and hot season (average temperature of 35°C and 47% relative humidity). Muscles collected during the hot season had significantly (P<0.05) higher ultimate pH values (5.78) than those collected during the cool season (5.65). Myofibrillar fragmentation index was significantly (P<0.05) higher for hot season samples (86.88%) than for cool season samples (85.59%). Expressed juice was significantly (P<0.05) higher for cool season samples (36.84) than for hot season samples (35.74). Goat meat from the hot seasonal group was significantly (P<0.05) darker than the cold season group based on L∗ (37.6 vs. 39.6), a∗ (20.0 vs. 23.3) and b∗ (3.6 vs. 4.2) colour measurements. These results indicated that high ambient temperatures had caused an increase in muscle ultimate pH leading to significant effects on meat quality.

Risk assessment of chromium and arsenic in date palm leaves used as livestock feed.

Appreciable levels of total chromium (Cr) and arsenic (As) were found (by emission spectroscopy) in date palm leaves, which form a significant ingredient in livestock feed. The levels in the fruit were considered safe for human consumption. Our work involved evaluation of the distribution of these elements in the leaves during the developmental stages of the fruiting season. Thirty-six leaf specimens of the Fard cultivar were collected 9, 15 and 20 weeks, respectively, after pollination and subjected to a standard digestion procedure. Sample masses of typically 1 g (dry weight) were prepared in 25 ml dilute acid solution and investigated for trace levels of Cr and As by ICP-AES. Eleven soil samples collected at random during the growth stages were subjected to a similar digestion procedure and analysis. According to the literature, the permissible mean levels of Cr and As in plants are 200 and 80 ng/g (dry weight), respectively. We used these values as our guideline to assess the "risk" levels in our samples of interest. In the case of Cr, about 45% of the specimens possessed levels between 250 and 700 ng/g, while a significant number produced levels between 1000 and 5000 ng/g. With regard to As, about 70% of the samples were above the documented permissible mean value. As a result of the unusually high Cr concentrations in some cases, the feasibility of Cr "accumulation" in the leaves was examined. Insects and other organisms subsist on the leaves and an added concern was the accumulation of these elements in the food chain. The study formed an interesting contribution to environmental research, and the impact of our assessment on the environment is discussed.