[Difficulties in diagnosis of dislocated permanent dialysis catheter followed by perforation of right internal jugular and massive hemothorax]. / Trudnosti diagnostiki dislotsirovannogo permanentnogo dializnogo katetera, privedshei k massivnomu gemotoraksu pri perforatsii pravoi vnutrennei iaremnoi veny.

Great vein perforation followed by massive hemothorax occurred after implantation of permanent dialysis catheter. Diagnostic difficulties in this case were caused by placement of catheter's shadow in the projection of right atrium on the frontal X-ray scan. Injury of initial segment of superior vena cava was diagnosed during emergency surgery for ongoing bleeding.

[Endovascular embolization of arteriovenous fistula in a patient with hand ischemia]. / Éndovaskuliarnoe razobshchenie arteriovenoznoi fistuly u bol'noi s ishemiei ruki.

We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.

[Integrated hemodynamic response to hemofiltration and peritoneal dialysis in patients with acute renal failure]. / Integrirovannyi gemodinamicheskii otvet na gemofil'tratsiiu i peritoneal'nyi dializ u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.