Systemic sclerosis and scleroderma renal crisis in association with carcinoma of the breast.

During recent years it has been shown conclusively that the incidence of malignancy in systemic sclerosis (SSc) is significantly increased and that rapidly progressive skin thickening, among other factors, is a strong predictor of scleroderma renal crisis (SRC). We present a case of carcinoma of the breast presenting concurrently with SSc that subsequently progressed to dialysis-dependent renal failure in just 1 month. We discuss the possible relationship between SSc and malignancy at a cellular level. In conclusion, we recommend that patients with rapidly progressive SSc and SRC at an early stage be screened for malignancy. In those patients developing malignancy in SSc, a careful vigil for accelerated renal, cardiac, and pulmonary complications should also be undertaken.

Interventional radiology placement of twin Tesio catheters for dialysis access: review of 75 patients.

PURPOSE: To evaluate the safety and efficacy of modern interventional radiology techniques and imaging guidance for placement of jugular vein twin Tesio hemodialysis catheters. MATERIALS AND METHODS: Eighty-two sets (75 patients) of twin Tesio catheters were percutaneously placed in the right (n = 70) and left (n = 12) internal jugular veins with use of ultrasound (US) and fluoroscopic guidance. Immediate procedural and late complications were recorded. The efficacy of the Tesio system was also evaluated. RESULTS: With US and fluoroscopic guidance, the technical success for access and catheter placement was 100%. Measured dialysis blood flow rate of greater than 375 mL/min was obtained in 95% of the patients and recirculation averaged 4.6% +/- 5%. An inadvertent common carotid artery puncture occurred in one (0.6%) patient and prolonged exit site bleeding occurred in another five patients (3%). Each of these was successfully controlled with compression. More chronically, catheter thrombosis and exit site infection occurred each at the rate of 0.16 episodes per 100 catheter days. All thrombosis and exit site infections responded to local thrombolysis and antibiotic therapy, respectively. Bacteremia occurred in 20 patients and required catheter removal in five patients. There was no clinical evidence of upper extremity or superior central vein thrombosis. CONCLUSION: Placement of internal jugular, twin Tesio catheters with use of imaging and interventional techniques provides a safe and efficacious means of either short or long-term hemodialysis.

Long-term performance and complications of the Tesio twin catheter system for hemodialysis access.

The Tesio twin catheter system (Medcomp, Harleysville, PA) was developed to overcome the problems with the existing central venous catheters in providing high-efficiency dialysis, such as inadequate blood flows, high recirculation rates, and need for surgical insertion. The relatively large internal lumens and multiple side holes in a spiral pattern allow for high blood flow rates and lower tendency to thrombosis. In this series, 82 catheter pairs were placed in 75 patients and monitored for a period encompassing 231 patient-months. We achieved mean nominal blood pump flow rates of 400 +/- 6 mL/min and an average recirculation of 4.6% +/- 0.5%. In 20 sets of catheters, a nominal blood flow rate of 388 +/- 6 mL/min was measured ultrasonically at 352 +/- 8 mL/min, representing an error of 36 +/- 5 mL/min. Thrombosis of the catheter occurred at a rate of one episode per 21 patient-months, and on all occasions responded to local instillation of urokinase. Despite having two exit sites, the infection rates were comparable to other catheters: exit site infections occurred at a rate of one per 21 patient-months and bacteremic episodes occurred at one per 11.5 patient-months, necessitating catheter removal once per 46 patient-months. Based on these data, we believe that the Tesio twin catheter system is an excellent long- and short-term vascular access for providing high-efficiency dialysis.