[Treatment of pseudoaneurysms with injection of thrombin]. / Liecba pseudoaneuryziem injekciou trombínu.

OBJECTIVES: To introduce and assess the efficacy and risks associated with a new treatment method of post-catheterization pseudoaneurysms. METHODS: Thrombin injection was indicated in patients with failure of compression therapy during 24 hours. Patients with a cavity volume < 1 cm3, with a pseudoaneurysm causing compression or haemorrhagic shock were excluded. A needle is introduced under local anaesthesia with ultrasound guidance, its tip is placed thoroughly in the centre of the cavity. Subsequently, under colour-flow mapping, thrombin solution with concentration of 1000 IU/ml is cautiously injected, which results in instantaneous thrombosis of the pseudoaneurysm cavity. RESULTS: Thrombin injection was used in 17 patients during a period of 12 months. 12 of them were women, 6 patients with valvular disease, 2 after intervention and 5 anticoagulated. The method was successful in 16 patients. In 5 of them, a small residual cavity persisted, which was not suitable for re-injection, and was closed completely after a few minutes of compression by a ultrasound transducer. There were no thrombotic complications. CONCLUSION: Although compression remains the method of choice, thrombin injection is a highly effective, quick and, with necessary precautions, safe alternative to surgical treatment of pseudoaneurysms, mainly in anticoagulated patients.

Nephrotoxicity of aminoglycosides, polypeptides and cephalosporins in cancer patients.

The nephrotoxicity of various combinations of antibiotics--aminoglycosides, cephalosporins, vancomycin, amphotericin B--in 171 oncologic patients is described. The most nephrotoxic combination seems to be cefotaxime plus gentamicin, ceftriaxone plus amikacin and amphotericin B with cephalosporin, vancomycin or aminoglycoside. Less toxic was netilmicin with penicillin or cephalosporin, and vancomycin.