A case of severe bleeding and deep inferior epigastric pseudoaneurysm after peritoneal dialysis catheter removal.

We present an unusual but severe complication of peritoneal dialysis (PD) catheter removal resulting in significant haemorrhage and hospitalisation. A patient presented for PD catheter removal under local anaesthesia in the interventional radiology suite and was noted to have a heavily calcified deep Dacron cuff. This cuff was intimately associated with a deep inferior epigastric perforating (DIEP) vessel. Removal of the catheter resulted in shearing of DIEP vessel and pseudoaneurysm formation. Despite attempted surgical management with ligation haemorrhage continued, requiring urgent angiographic embolisation to stop the bleeding. Intimate relationship between DIEP vessel and Dacron cuff due to calcification was the cause of this complication. This case report represents a rare but important complication associated with PD catheter removal, highlighting that when calcification is seen at the deep cuff, caution should be exercised and there should be access to angiography suite in case of complication.

An Interprofessional Approach in Caring for a Patient on Maintenance Hemodialysis with COVID-19 in Toronto, Canada: An Educational Case Report.

RATIONALE: Hemodialysis patients are at significant risk from COVID-19 due to their frequent interaction with the health care system and medical comorbidities. We followed up the trajectory of the first COVID-19-positive maintenance hemodialysis patient at Sunnybrook Health Sciences Centre in Toronto. We present the lessons learned and changes in practices that occurred to prevent an outbreak in our center. PRESENTING CONCERNS OF THE PATIENT: The patient, a 66-year-old woman on in-center hemodialysis, initially presented with a 2-day history of a productive cough. She subsequently developed a fever, was placed on contact and droplet isolation, and admitted to hospital. DIAGNOSES: On March 13, 2020, the patient tested positive for COVID-19. Within the next 48 hours, she developed hypoxia and acute respiratory distress syndrome as a complication of her illness requiring an extended critical care stay. This extended critical care stay resulted in critical illness-associated secondary sclerosing cholangitis. INTERVENTIONS: An interprofessional team was established, performing rapid Plan-Do-Study-Act quality improvement cycles to improve screening practices and promote the safety of patients and staff in the hemodialysis unit. OUTCOMES: We present here the lessons learned, the changes to our screening protocols, and the clinical course of our first in-center hemodialysis patient with SARS-CoV-2. TEACHING POINTS: Regular review of the infection screening processes is paramount in preventing outbreaks of COVID-19, particularly in hemodialysis units. Hospital admission should be arranged if a patient exhibits any clinical signs of hemodynamic compromise or hypoxia. Early education for health care practitioners caring for patients with COVID-19 and refresher information regarding personal protective equipment helped promote the safety of staff and prevent health care-associated outbreaks.

Oxygen as a regulator of cellular phenotypes in pregnancy and cancer.

Cellular phenotype is determined by genetic and microenvironmental factors. There is evidence that tissue oxygenation status is one of the microenvironmental factors regulating cellular behaviour. Both normal and pathological processes such as blastocyst implantation in the uterus, placentation, and rapidly growing tumours occur under conditions characterized by relatively low oxygen levels. In this review, we address the effects of low oxygen concentrations on the phenotype of trophoblast and cancer cells. We provide evidence that oxygenation levels play an important role in the regulation of normal and pathological cellular invasiveness as it occurs during trophoblast invasion of the uterus and in tumour progression and metastasis, drug resistance in cancer, and antitumour activity of natural killer cells of the immune system.