Fibrin sheet covering subclavian or femoral dialysis catheters.

The existence of a sheet around a single lumen dialysis catheter tip, which provokes a valve mechanism, is proved by the observation that several times during the replacement procedure of a dialysis catheter, a sheet surrounding the surface of the catheter is removed with the dialysis catheter. This sheet is grey, approximately 1 mm thick and 30 mm long and consists of fibrin and thrombocytes. Bacteriological examinations were always negative. The existence of the sheet in vivo is demonstrated by digitalized angiography during the removal procedure for single lumen dialysis catheters. Rarely, only the sheet is removed with the catheter. It all other instances, the sheet is stripped off and remains in the subcutaneous tunnel or in the vascular bed without causing much clinical discomfort in most patients. Occasionally an episode of cough, dyspnea, hypotension, retrosternal oppression or hemoptae after removing the single lumen dialysis catheter, suggest pulmonary embolism or lung infarction.

Polyunsaturated fatty acids of the n-3 class in chronic dialysis.

N-3 PUFAs are believed to 1) reduce serum lipids, 2) modify the complement activating system, 3) increase red blood cell elasticity, and 4) decrease thrombotic events. These four parameters were investigated in 19 chronic stabilized dialysis patients assessed by 1) the control of the serum lipids, 2) the degree of leukopenia 10 minutes after the start of dialysis, 3) the degree of red cell fragmentation (RCF) during dialysis, and 4) the reusability of the dialyzer. The patients were their own controls during four periods: 1) no PUFAs for longer than 6 months, 2) 4 x 425 mg of PUFAs/day for 6 weeks, 3) 6 x 425 mg PUFAs/day for 6 weeks, and 4) no PUFAs during at least 6 weeks. Previous diets and medications remained unchanged. It was concluded that there was no significant effect on serum lipids in the given dosages, and no effect on the degree of leukopenia, red blood cell elasticity or bleeding, and/or antithrombotic activity. No change was seen in insulinemia, fibrinogenemia, or arterial pressure. No serious side effects were noted other than a "fishy aftertaste."

Limitations of short dialysis are the indications for ultrashort daily auto dialysis.

Dialysis efficiency can be increased while shortening the duration of the treatment by the use of highly permeable dialysis membranes, larger surfaces, and higher blood and dialysate flows. However, vascular repletion of water and solutes, compared with the amount removed by rapid dialysis, is a limitation of short dialysis. This can be overcome by ultrashort daily dialyses, preferably performed by the patient alone. A safe, efficient, and user-friendly apparatus has been developed to permit Ultrashort Daily Auto Dialysis (UDAD).

Successful treatment of aortic rupture presenting as a syncope: the role of echocardiography in diagnosis.

A syncope was the first symptom of aortic rupture in a patient with chronic arterial hypertension. This syncope was the consequence of an acute haemopericardium which resulted in a sudden drop of the cardiac output. Urgent echocardiographic examination in the emergency room made early diagnosis and life-saving pericardiocentesis possible.

Pseudo-Kaposi's sarcoma as a complication of Cimino-Brescia arteriovenous fistulas in hemodialysis patients.

Pseudo-Kaposi's sarcoma is a skin lesion that is associated with chronic venous insufficiency and/or congenital arteriovenous fistulas. Theoretically, this lesion could also be expected in connection with hemodialysis vascular accesses. Nevertheless, this disease has been reported only once in conjunction with a Cimino-Brescia arteriovenous fistula, and no attention has been paid to the potential complications of this disease. In the present paper 3 cases are reported. In 1 patient pseudo-Kaposi's sarcoma was complicated by an infected open wound as a consequence of a trauma. In the 2 other patients, a skin biopsy was followed by local infection and retarded healing of the wound. Evaluation by fistulagraphy and/or Doppler revealed venous outflow stenosis in only 1 case. After reconstruction or ligation of the fistula, correction of the lesions was observed. It is concluded that pseudo-Kaposi's sarcoma can occur as a complication of Cimino-Brescia arteriovenous fistulas, necessitating early correction of the fistula. The performance of a skin biopsy might be associated with infection and delayed wound healing, so that this diagnostic procedure should only be performed in cases where the clinical diagnosis is not obvious.

Postoperative immunological response against contractile proteins after coronary bypass surgery.

The pathogenesis of post-cardiac injury syndrome was studied prospectively in 62 patients who underwent coronary bypass grafting. Preoperative and serial postoperative titres of actin and myosin antibodies were measured by an enzyme linked immunosorbent assay. Perioperative cumulative release of serum aspartate and alanine aminotransferases, lactate dehydrogenase, and creatine kinase was calculated by approximation formulas that are used to estimate infarct size. Complete post-cardiac injury syndrome developed in eight (13%) patients and an incomplete syndrome developed in 16 (26%). There was a significant correlation between frequency and intensity of the syndrome and the ratio of postoperative to preoperative titres of actin and myosin antibodies. Furthermore, there was a significant correlation between the cumulative release of lactate dehydrogenase, serum aspartate aminotransferase, and creatine kinase and the number of coronary vessels that were grafted, but no correlation was found between the incidence of post-cardiac injury syndrome and the number of coronary bypasses grafted or between the cumulative enzyme release and the postoperative immunological response against the major contractile proteins, actin and myosin. The amount of enzymes released during coronary bypass surgery seems to be a good indicator of the extent of myocardial damage during operation but it does not determine either the incidence of post-cardiac injury syndrome or the postoperative immunological response against the main contractile proteins actin and myosin.