When Arteriovenous Fistulas Are Too Deep: Options in Obese Individuals.

BACKGROUND: Obesity in the hemodialysis population is roughly twice that of the general population. An arteriovenous fistula (AVF) remains the recommended vascular access; however, obesity results in fewer autogenous accesses, more complexity, and higher AVF failure rates. We reviewed our vascular access experience in obese individuals in whom the depth of an AVF prevented reliable cannulation. STUDY DESIGN: We reviewed our database of consecutive vascular access patients, identifying individuals in whom the planned venous outflow cannulation segments were too deep and required additional surgical procedures to establish a functional hemodialysis access. These additional procedures included lipectomy, outflow elevation, cephalic transposition, liposuction, or an implantable cannulation guide. RESULTS: During the study period, 1,874 consecutive new patients had an autogenous vascular access constructed. We identified 120 patients in whom an additional procedure was required due to the depth of the cannulation sites; these comprised this study group. Ninety-nine (83%) were female, 85 (71%) were diabetic, and 53 (45%) had previous access operations. Body mass index was 25.4 to 62.8 kg/m(2) (mean 40.8 kg/m(2)), age range was 27 to 81 years (mean 54 years), and follow-up was 1 to 101 months (mean 25 months). Primary and cumulative patency rates for all patients were 63% and 93% at 1 year and 46% and 91% after 2 years, respectively. The most common additional procedure performed was a lipectomy (n = 78), with 1-year primary and cumulative patency rates of 78% and 97% and 2-year rates of 69% and 91%, respectively. CONCLUSIONS: A variety of surgical options were found to be successful in establishing a functional autogenous vascular access for individuals in whom cannulation sites were simply too deep. Cumulative patency rates for all patients were 93% at 1 year and 91% after 2 years.

Taxa de filtração glomerular pelo EDTA marcado com 51cromo e com 113míndio em equinos / Glomerular filtration rate by 51chromium and 113m indium labeled EDTA in horses

Determinou-se a taxa de filtração glomerular por meio do EDTA, marcado com 51Cr e com 113mIn, pela técnica de injeção única, em nove equinos, seis machos e três fêmeas com idades de dois a 12 anos. A taxa de filtração glomerular foi calculada a partir da curva de desaparecimento no plasma e do volume de distribuição do radiotraçador, 51Cr-EDTA ou 113mIn-EDTA. O resultado (média±desvio-padrão) foi de 148,80±26,42mL.min-1.100kg. Conclui-se que a medida da taxa de filtração glomerular pelo 51Cr-EDTA ou 113mIn-EDTA, pela técnica de injeção única, elimina o cateterismo vesical e, por sua simplicidade, comodidade, precisão e baixa dose de radiação, pode ser empregada em cavalos como método de escolha em rotina clínica.

The glomerular filtration rate was determined in nine healthy horses, six male and three female, aged two to 12-year-old, by means of 51Cr and 113mIn labeled EDTA single injection technique. The glomerular filtration rate was calculated from the plasma disappearance curve and the volume of distribution of the radiotracer, 51Cr-EDTA or 113mIn-EDTA. The result (mean±standard deviation) was 148.80±26.42mL.min-1.100kg. It is concluded that the measurement of glomerular filtration rate by 51Cr-EDTA or 113mIn-EDTA by single injection technique eliminates the bladder catheterization, and for its simplicity, convenience, accuracy, and low dose of radiation, can be used in horses as a method of choice in clinical routine.

Schistosomiasis haematobia in Brazilian patients: clinical and renal functional evaluation with 99mTc-DTPA

The present study was carried out at the Army Central Hospital, Rio de Janeiro, Brazil, from September 2000 to December 2001, employing diethylenetriamine penta-acetic acid labeled with technetium-99m (99mTc-DTPA) to evaluate the renal function of nineteen symptomatic patients infected with S. haematobium during a peace mission in Mozambique. Results evidenced that the most frequent clinical manifestations were hematuria (68.4 percent) and low back pain (68.4 percent) and 73.7 percent patients had altered dynamic renal scintigraphy expressed by an increase in the excretory phase independently of the symptoms duration; furthermore, none of them had mechanical obstructive pattern. Schistosoma haematobium glomerulopathy could be considered a pathological finding without correlation with the disease clinical manifestations.(AU)

Radionuclide evaluation of hepatic hydrothorax

La cirrosis es una común enfermedad del higado con una gran morbosidad y mortalidad. Tiene varias causas siendo la mas frecuente el alcoholismo y las hepatitis viral C. El hydrothorax Hepático es una manifestación de hipertensión portal entre los pacientes con cirrosis de higado mas avanzadas, cuyo manejo es extremadamente desafiante, aunque frecuentemente ingrato, con resultado malo en la mayoría de los casos. Por consiguiente, un diagnóstico exitoso y eficaz, y un enfoque terapeutico es de vital importancia. El diagnóstico de hydrothorax hepático puede establecerse a través de la administración del intraperitoneal de un radiotracer, que es un simple, fisiológico, y menos invasivo metodo para evaluar a los pacientes con hydrothorax hepático. La migración en la cavidad del pleural confirma la presencia de una comunicación entre el peritoneal y espacios del pleural. Quince pacientes (8 mujeres y 7 hombres) de 32 a 69 años fueron examinadas y trece fueron positivos, mostrando comunicación entre las cavidades predominantemente del lado derecho; dos fueron negativos. Conclusión: Nuestros resultados están de acuerdo con varios autores. Mientras el Scintigrafia es un método simple y fisiológico, menos invasivo con buena sensibilidad y especificidad y da baja radiación al paciente, parece que podría ser recomendado como un chequeo en sospecha clínica de efusión del pleural de origen hepático.

Esophageal reconstruction surgery in oncologic patients: determination of gastric emptying time.

All parts of the gastrointestinal tract are accessible for study using nuclear medicine techniques. We have studied the effect of esophageal reconstruction surgery, in different periods of time, after surgical procedure. Oncologic patients (19) were evaluated after esophageal reconstruction surgery with gastric (group II - 14 patients) or colonic tube (group III - 5 patients) and they were compared with 15 healthy volunteers (group I). Gastric emptying was performed in the same subjects using solid food (egg sandwich) labeled with 99mTc-phytate. In emptying gastric studies, the mean (T1/2) of the patients was much faster than those of the control (p<0.05) when 1/3 distal tube was considered as stomach. However, there was no difference between the T1/2 of group II and group III. We concluded that this nuclear medicine method could be useful in the monitoring the surgical reconstruction of the esophagus.

Trânsito esofagiano em pacientes com diabetes mellitus; contribuiçäo ao seu estudo com radionuclídeo / Esophageal transit in patients bearing diabetes mellitus; contribution to its study radionuclidium

Nas complicaçöes da diabetes mellitus pode estar incluido o comprometimento da inervaçäo esofagiana, levando a distúrbios motores do esôfago, mesmo em fases näo sintomáticas. Tendo em vista a simplicidade e a sensibilidade do método cintilográfico no estudo da motilidade esofagiana, os autores propuseram a comparar o tempo de trânsito esofagiano com radionuclídeo em pacientes portadores de diabetes mellitus e em individuos normais. Foram estudados 33 pacientes diabéticos e 26 controles, sendo divididos em grupo A (dependente de insulina) e B (näo dependentes). O estudo mostrou que as alteraçöes no tempo de trânsito esofagiano predominam nos grupos diabéticos näo dependentes de insulina, näo havendo relaçäo com o tempo de duraçäo da doença. No grupo dependente, as anormalidades encontradas tiveram relaçäo com o tempo de doença

Evaluation of portal circulation with radioisotopes in dogs.

The objective of the present study was to contribute to the development of a noninvasive method for the evaluation of portal circulation using rectally administered radiotracers in dogs. 99mTc absorption was previously checked in rabbits and the present study reports similar results in dogs. Circulation time between the terminal large bowel and the liver (RL-t) and heart (RH-t) was determined by external counting at the hepatic and cardiac level with a large-field computerized gamma camera. In 16 animals studied, average RL-t was 5.2 s and RH-t 8.6 s. In 3 animals with partial binding of the portal vein, RL-t increased to 32, 44 and 34 s. Being noninvasive and harmless, this method could be used to study portal circulation in several physiopathological conditions of the human liver.