A randomized, prospective evaluation of the Tesio, Ash split, and Opti-flow hemodialysis catheters.

PURPOSE: A randomized, prospective evaluation of three high-flow hemodialysis catheters. MATERIALS AND METHODS: Ninety-four patients were randomly assigned 113 Tesio, Ash split, and Opti-flow catheters from December 1998 through June 1999. Insertion times, procedural complications, and ease of insertion were recorded. Mean catheter flow rates were recorded at first dialysis, 30 days, and 90 days. Patency, catheter survival, and catheter-related infections were evaluated. RESULTS: Thirty-eight Ash split, 39 Opti-flow, and 36 Tesio catheters were placed. Tesio mean insertion time (41.5 min) was significantly longer than Ash split (29.4 min) or Opti-flow (29.6 min) (P =.004). There were four complications related to Tesio catheters (three cases of pericatheter bleeding, one air embolism), one related to an Opti-flow catheter (pericatheter bleeding), and zero related to Ash split catheters. Opti-flow and Ash split catheters were significantly easier to insert than Tesio catheters (P =.041). Mean flow rates were not significantly different among the catheters initially (P =.112), at 30 days (P =.281), or at 90 days (P =.112). Catheter-related infection rates per 100 catheter days were 0.12 for Ash split, 0.35 for Opti-flow, and 0.14 for TESIO: Median catheter survival was 302 days for Ash split, 176 days for Opti-flow, and 228 days for TESIO: CONCLUSIONS: Opti-Flow and Ash split catheters were faster and easier to place than Tesio catheters. There was no difference in hemodialysis flow rates or catheter survival.

Analysis of cell type and radiographic presentation as predictors of the clinical course of patients with bronchioalveolar cell carcinoma.

STUDY OBJECTIVES: Bronchioloalveolar carcinoma is a primary lung neoplasm of variable histopathologic, radiologic, and clinical expression. There are three cell types described in bronchioloalveolar carcinoma: Clara cells, mucin-producing cells, and alveolar type II epithelial cells. It is unclear whether these three tumor cell types are associated with a specific radiologic presentation and clinical course. In this study, we investigated whether tumor cell type, identified by transmission electron microscopy, correlated with a specific radiologic pattern, and whether tumor cell type or radiologic presentation correlated with the patient's clinical course and outcome. DESIGN: Transmission electron microscopy was used to restudy tissue blocks from the original surgical histopathologic specimens in 54 patients with primary bronchioloalveolar carcinoma diagnosed over a 10-year period (1980 to 1990). The pretreatment radiographs were reviewed in each case, and the first chest radiograph obtained at the time of the discovery of the tumor in each patient was compared with the results of the ultrastructural study. The medical records of each patient were examined to obtain pertinent radiologic, clinical, and patient outcome information. MEASUREMENT AND RESULTS: There were 32 Clara cell tumors, 10 mucin-producing cell tumors, and 1 alveolar type II epithelial cell tumor in this series. Eleven additional tumors had mixtures of two or more cell types. No statistically significant relationship was detected between tumor cell type and radiologic presentation or patient mortality pattern. There was increased mortality among patients who presented radiologically with segmental, lobar, multifocal, or diffuse disease compared with those patients exhibiting a solitary pulmonary nodule at presentation. CONCLUSION: Radiologic presentation, rather than tumor cell type, provides prognostic information that aids in predicting patient outcome.

Carpal tunnel syndrome: are the MR findings a result of population selection bias?

OBJECTIVE: Previous descriptions of MR imaging of carpal tunnel syndrome used limited study populations and volunteers as controls. We reevaluated these descriptions to determine their sensitivity and specificity when applied to a large consecutive clinical series in which the incidence of carpal tunnel syndrome was small. SUBJECTS AND METHODS: In 196 consecutive wrists for which supplemental axial conventional spin-echo T1-weighted and fast spin-echo T2-weighted images were obtained at 1.5 T with a dedicated wrist coil, 165 studies were available for review. Previously described signs of carpal tunnel syndrome such as proximally increased size, flattening of the median nerve, increased median nerve signal intensity, flexor tenosynovitis, retinacular bowing, decreased deep tendon fat, and deep palmar bursitis were retrospectively and independently evaluated by two observers who were unaware of patient diagnosis. RESULTS: None of the previously described signs was sensitive for the diagnosis of carpal tunnel syndrome. However, specificity was high for retinacular bowing (94%), median nerve flattening (97%), and deep palmar bursitis (95%). CONCLUSION: Most previously described MR imaging signs of carpal tunnel syndrome are insensitive and nonspecific. Exceptions include retinacular bowing, median nerve flattening, and deep palmar bursitis, which in our study proved to have specificities greater than or equal to 94%.

Subependymal (grade 1) intracranial hemorrhage in neonates on extracorporeal membrane oxygenation. Frequency and patterns of evolution.

Intracranial hemorrhage (ICH) is a potential contraindication to extracorporeal membrane oxygenation (ECMO) therapy in neonates, since systemic anticoagulation required during ECMO may increase the incidence and progression of ICH. To determine the frequency and the pattern of evolution of subependymal hemorrhage (SEH) (grade 1 ICH) in neonates on ECMO, the daily head ultrasound (HUS) examinations obtained as part of a prospective neurologic evaluation protocol in 212 ECMO patients were reviewed. Forty-three patients (20%) had a total of 65 SEHs. Twenty-two infants had bilateral SEH. Twenty-eight infants developed 38 SEHs during ECMO bypass after pre-ECMO HUS showed no evidence of ICH. An additional 18 neonates had a total of 22 SEHs demonstrated on pre-ECMO HUS. No pre-ECMO HUS was performed in four infants having a total of five SEHs first identified during ECMO bypass. Of the 65 SEHs, 59 (91%) remained stable or resolved during ECMO, while six (9%) evolved during ECMO--three to grade 2, one to grade 3, and two to grade 4 ICH. Our data suggest that SEH should not be considered a contraindication to ECMO bypass and very infrequently will progress significantly during ECMO.