Role of color Doppler assessment in predicting outcomes of wrist Brescia-Cimino arteriovenous fistula creation: A single-center prospective study.

Introduction: The most common reason for constructing an arteriovenous fistula (AVF) is chronic kidney disease. Various factors are associated with nonmaturation or failure of AVF, which can be evaluated using color Doppler/duplex ultrasound (DUS). We carried out this study to evaluate the role of pre- and postoperative DUS for the prediction of outcomes of wrist radiocephalic (RC) AVF. Methods: In our prospective observational study, dialysis-dependent patients between 20 and 70 years of age undergoing primary RC-AVF from May 2019 to July 2020 were included. All patients underwent pre- and postoperative DUS examination after obtaining consent. Results: Among 104 participants, 87 (83.7%) were male and 17 (16.3%) were female. Successful maturation was seen in 68 (65.4%) participants, whereas 90 (86.53%) had functional maturation. Radial artery diameter (RAD) ≥1.6 mm, cephalic vein diameter (CVD) ≥2.0 mm, vein distensibility (VD) ≥0.5 mm, and peak systolic velocity (PSV) RAD ≥30 cm/s were associated with higher successful maturation of AVF with statistically significant results (P < 0.05). RAD ≥1.6 mm, CVD ≥2.0 mm, VD ≥0.5 mm, and PSV RAD ≥30 cm/s were related to a greater probability of RC-AVF maturation. Among them, VD and PSV-RA were the most influencing factors predicting RC-AVF successful maturation. Conclusions: If we consider the rule of six for AVF maturation, then the results will be much less than the actual fistulas which are dialyzable with adequate blood flow as per functional maturation criteria. Thus, more randomized studies are needed to define maturation criteria for the Indian population and to identify the effect of papaverine on successful AVF maturation.

Development of phimosis as an adverse drug reaction to capecitabine with irinotecan.

We present a case of a 32-year-old male who developed capecitabine-induced phimosis which resolved spontaneously without the need for circumcision within a few days of discontinuation of chemotherapy. The patient was on capecitabine with irinotecan chemotherapy for peritoneal metastasis from adenocarcinoma of the lower esophagus. A detailed literature review showed a few case reports with penile and scrotal erythema, ulceration, and swelling along with hand-foot syndrome, but none reported the occurrence of phimosis with spontaneous resolution.

Modified Inguinal Lymph Node Dissection in Groin-Negative Patients of Penile Cancer: Our Experience.

Cancer of the penis is an important health problem in India, causing significant morbidity. Involvement of locoregional lymph nodes is the most significant prognostic factor for patients with penile cancer. In this study, we reviewed clinical data of all patients who underwent modified inguinal lymph node dissection as a means to diagnose micro-metastasis in inguinal lymph nodes, and analysed the outcomes. We retrospectively reviewed the hospital clinical charts of patients treated for carcinoma of the penis. Inguinal and distant metastases were assessed by physical examination, ultrasound imaging of the inguinal region, computed tomography of the abdomen and pelvis and a chest radiograph. Patients with clinically negative inguinal lymph nodes underwent modified lymph node dissection (mILND) both to diagnose and stage the disease. Complications occurring during a 30-day period after surgery were defined as early and thereafter as late complications. A total of 40 patients with a mean age of 52.27±13.10 (range 25-73) years underwent mILND. Wedge biopsy from the primary lesion had revealed intermediate-risk disease in 22 (55%) patients and high-risk disease in 18 (45%) patients. Histopathological examination of the primary penile lesion revealed a pT1 lesion in 32 patients and a pT2 lesion in the remaining 8 patients. Fourteen (35%) of the 40 patients showed micro-metastases in the inguinal lymph nodes on frozen sections. The mean follow-up in these patients was 56.6±18.09 months. There were no instances of local or systemic recurrences seen in 38 (95%) patients within 5 years. Superficial lymph node dissection and where facilities are available DSLNB remain the standard of care in the management of patients with clinically groin-negative (cN0) intermediate- and high-risk groups. Modified inguinal lymph node dissection would be a safe and appropriate alternative to this in all centres that do not have access to newer modalities like DSLNB, video-endoscopic (VEIL) or robotic-assisted techniques.

A prospective study on red blood cell transfusion related hyperkalemia in critically ill patients.

BACKGROUND: Transfusion-associated hyperkalemic cardiac arrest is a serious complication in patients receiving packed red blood cell (PRBC) transfusions. Mortality from hyperkalemia increases with large volumes of PRBC transfusion, increased rate of transfusion, and the use of stored PRBCs. Theoretically, hyperkalemia may be complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. In this study, we focus on transfusion-related hyperkalemia involving only medical intensive care unit (MICU) patients. METHOD: This prospective observational study focuses on PRBC transfusions among MICU patients greater than 18 years of age. Factors considered during each transfusion included patient's diagnosis, indication for transfusion, medical co-morbidities, acid-base disorders, K(+) levels before and after each PRBC transfusion, age of stored blood, volume and rate of transfusion, and other adverse events. We used Pearson correlation and multivariate analysis for each factor listed above and performed a logistic regression analysis. RESULTS: Between June 2011 and December 2011, 125 patients received a total of 160 units of PRBCs. Median age was 63 years (22 - 92 years). Seventy-one (57%) were females. Sixty-three patients (50%) had metabolic acidosis, 75 (60%) had acute renal failure (ARF), and 12 (10%) had end-stage renal disease (ESRD). Indications for transfusion included septic shock (n = 65, 52%), acute blood loss (n = 25, 20%), non-ST elevation myocardial infarction (NSTEMI) (n = 25, 20%) and preparation for procedures (n = 14, 11%). Baseline K(+) value was 3.9 ± 1.1 mEq/L compared to 4.3 ± 1.2 mEq/L post-transfusion respectively (P = 0.9). During this study period, 4% of patients developed hyperkalemia (K(+) 5.5 mEq/L or above). The mean change of serum potassium in patients receiving transfusion ≥ 12 days old blood was 4.1 ± 0.4 mEq/L compared to 4.8 ± 0.3 mEq/L (mean ± SD) in patients receiving blood 12 days or less old. Sixty-two patients (77.5%) that were transfused stored blood (for more than 12 days) had increased serum K(+); eight (17.7%) patients received blood that was stored for less than 12 days. In both univariate (P = 0.02) and multivariate (P = 0.04) analysis, findings showed that among all factors, transfusion of stored blood was the only factor that affected serum potassium levels (95% CI: 0.32 - 0.91). No difference was found between central and peripheral intravenous access (P = 0.12), acidosis (P = 0.12), ARF (P = 0.6), ESRD (P = 0.5), and multiple transfusions (P = 0.09). One subject developed a sustained cardiac arrest after developing severe hyperkalemia (K(+) = 9.0) following transfusion of seven units of PRBCs. Multivariate logistic regression showed linear correlation between duration of stored blood and serum K(+) (R(2) = 0.889). CONCLUSION: This study assesses factors that affect K(+) in patients admitted to MICU. Results from the study show that rise in serum K(+) level is more pronounced in patients who receive stored blood (> 12 days). Future studies should focus on the use of altered storage solution, inclusion of potassium absorption filters during transfusion and cautious use of blood warmer in patients requiring massive blood transfusions.