Evaluation of Gore-Tex graft patency in hemodialysis access.

AIM: The purpose of this retrospective study was to analyze the patency and complications of Gore-Tex grafts used in hemodialysis (HD) access. METHODS: In the last 16 years, 1649 surgical procedures were performed on 655 patients to ensure and maintain permanent HD access. The study group consisted of 64 HD patients on whom 81 vascular synthetic PTFE Gore-tex grafts were performed. There were 28 males and 36 females, 3 of them were children (4.7%). Mean age was 54.2 years (range 15-77). Two types of Gore-Tex prosthesis were used: Diastat and Stretch. All grafts were implanted in the upper extremities. Kaplan-Meier survival curves were calculated to determine primary and secondary patency. Log-rank analysis was used to determine differences between curves. RESULTS: Primary and secondary patency at 12 months was 52.5% and 67.5%, and at 18 months respectively 41.5% and 58.2%. The Diastat graft had a lower primary and secondary patency compared with the Stretch graft (respectively p = 0.02 and p = 0.008). Factors such as gender, coexisting diabetes and hypertension did not determine graft patency. Thrombosis was one of the most frequent complications. The remaining complications included stenosis, pseudoaneurysms, infection, steal syndrome and seroma. CONCLUSION: On the basis of our experience Stretch grafts appear a better option for creating vascular access for HD than Diastat grafts.

Correlation between plasma carnitine, muscle carnitine and glycogen levels in maintenance hemodialysis patients.

Chronic hemodialysis (HD) may lead to losses of carnitine from plasma and muscle. Plasma carnitine does not reflect the body content of carnitine. The purpose of this study was the evaluation of total and free plasma and muscle carnitine concentrations (TPC, FPC, TMC, FMC), muscle glycogen and the relationship between plasma and tissue carnitine content and the basic indices of lipid metabolism in HD patients. The studies were conducted in two groups: the first one consisted of 37 HD patients (19 F, 18 M), the second one served as the control and was composed of 29 (10 F, 19 M) patients with healthy kidneys. Tissue specimens in HD patients were taken during surgery on arterio-venous fistula from brachioradial muscle. Carnitine and glycogen measurements were performed using enzymatic methods according to Cederblad and Huijng respectively. Total cholesterol (CH), HDL-CH, and triglycerides were assayed by enzymatic commercial test system (Boehringer-Mannheim, Germany). To summarise, we found the following phenomena in our HD patients in comparison with the controls: 1) In plasma: similar TPC but decreased FPC levels and FPC/TPC ratio which may suggest free carnitine deficiency. 2) In muscle: significantly lower TMC and FMC levels but normal FMC/ITMC ratio. 3) Negative correlation between TMC and FMC levels and duration of dialysis treatment. 4) No correlation between plasma and muscle camitine concentration. 5) Significantly higher concentration of muscle glycogen which could be explained by the changes in the structure of muscle fibres in HD patients and/or lower physical activity. 6) A positive correlation between FPC/APC or FPC/TPC ratio and HDL-CH in HD patients which may suggest that an appropriate proportion between free and acylcarnitines may influence HDL-CH levels in that population.

[Thrombotic complications of arterio-venous fistulas in chronically hemodialysed patients]. / Powiklania zakrzepowe przetok tetniczo-zylnych u chorych przewlekle hemodializowanych.

Treatment by means of repeated haemodialysis has been accepted as the basic method of renal substitution treatment in our country. Thrombosis has been found as the most frequent local complication in arterio-venous (A-V) fistulas. The purpose of this study has been to analyse the frequency of thrombosis in relation to the type of A-V fistula and occurrence of early thrombosis (within 24 postoperative hours). Studies have been based in 186 patients (31 children) in whom 545 A-V surgical procedures have been performed to create and maintain permanent vascular access for haemodialysis. The mean age of the patients was 37 years. Thrombosis has been detected in 41.5% of fistulas and has been found as the main cause of 49.4% secondary procedures. Most frequently they have been observed in A-V fistulas using PTFE prosthesis. Rare complications have been found in brachio-basilic and brachio-cephalic fistulas. Early thrombosis has been observed in 4.5% of A-V fistulas. The causes of early thrombosis and within 30 postoperative days have been discussed in detail. In these complications thrombectomy (60.5%) and thrombectomy combined with creating new anastomosis (31.9%) have been performed most frequently. It has concluded that the condition of anastomosed vessels is the most important factor influencing early thrombosis.

[A case of large bowel injury with a safety belt in a pregnant woman]. / Przypadek uszkodzenia jelita grubego pasem bezpieczenstwa u kobiety ciezarnej.

The authors present the case of a 24-year-old pregnant woman (9th week of pregnancy) who, due to a traffic accident, suffered transverse colon rupture through a sudden compression of the intestine with a "traditional" safety belt. The authors analyse the mechanism of injury, method of treatment, and on the basis of literature data discuss various body injuries developing as a result of action of safety belts.