[Vascular access for hemodialysis--own experiences]. / Dostep naczyniowy do hemodializ--doswiadczenia wlasne.

AIM OF THE STUDY: We present own experiences in creation and/or reconstruction of vascular access for hemodialysis. MATERIAL AND METHODS: 91 pts (63 men, 28 female) aged 18 to 89 years, with irreversible renal failure qualified for renal replacement therapy, 47% of them with diabetic nephropathy. In years 1996-2006, 167 surgical procedures of creation or reconstruction of vascular access for hemodialysis were performed. In the qualification for surgical procedure we used clinical assessment as well as Doppler ultrasound or computed tomography angiography. RESULTS: In 3 cases from all 167 patients we performed fistula ligation due to transfer to peritoneal dialysis. In the 164 others cases we performed 18 types of different procedures among other thing: 95 first or second degree arteriovenous fistulas creation, 35 procedures of revascularisation and 34 procedures of fistula reconstruction. In our material own modification of Cimino-Brescia arteriovenous anastomosis was introduced with positive hemodynamic effects in all cases. In the discussion we stressed the necessity of selection of creation/reconstruction methods individually for every patient especially in ageing and diabetic population of patients with chronic kidney disease with many cardiovascular complications both in predialysis stage of kidney failure as well as in the course of long term dialysotheraphy. CONCLUSION: The assurance in optimal vascular access for hemodialysis is still big challenge especially in patients of advanced age. Individual approach to every case gives the chance of choice the best surgical procedures for optimal vascular access for hemodialysis.

[Severe nephrotic syndrome requiring bilateral renal arteries embolisation in patient with membranous and diabetic nephropathy]. / Ciezki zespól nerczycowy wymagajacy obustronnej embolizacji tetnic nerkowych u chorego z nefropatia bloniasta nalozona na nefropatie cukrzycowa.

On the case of 62 year old patient with diabetes type 2 complicated by diabetic nephropathy, we present diagnostic and therapeutic problems of severe nephrotic syndrome caused by membranous nephropathy confirmed by renal biopsy superimposed on diabetic nephropathy. Special attention was paid to the difficulties in achievement the remission of nephrotic syndrome with typical pharmacological treatment and necessity of using drastic form of treatment which was bilateral embolisation of renal arteries and subsequent continuous renal replacement therapy.

[Asymptomatic intraperitoneal adhesions disease as the potential cause of unfeasibility of creation dialysis access to peritoneal cavity--case reports]. / Bezobjawowa choroba zrostowa otrzewnej jako potencjalna przyczyna niemozliwosci wytworzenia dostepu dializacyjnego do jamy otrzewnowej--opis przypadków.

Peritoneal dialysis is one of three, complementary methods of renal replacement therapy, including also hemodialysis and kidney transplantation. After qualification for peritoneal dialysis program special attention should be paid for creation proper dialysis access through correct implantation of peritoneal catheter. On the basis of three cases we present difficulties of Tenckhoff peritoneal catheter implantation in patients with massive peritoneal adhesions without previous surgical interventions and other risk factors for peritoneal adhesions.

[Ambulatory or home peritoneal dialysis--time for changes?]. / Ambulatoryjna czy domowa dializa otrzewnowa--czas na zmiany?

Ambulatory peritoneal dialysis need to be adopted to the changing population of patients with irreversible renal failure who require more and more nursing support in normal performance of dialysis procedure. Such possibility might be provided by introduction of supported or assisted by medical personal peritoneal dialysis in patient's home.

[Intradialytic hypotension]. / Hipotonia sróddializacyjna.

Intradialytic hypotension is a frequent complication of hemodialysis. Its etiology is complicated and unclear. Preventive and therapeutic procedures include modification of lifestyle as well as parameters of hemodialysis procedure. Due to multifactorial etiology of this complication we should pay attention to proper prophylactic and in the case of its appearance to adjust the treatment to the individual patient.

[Microalbuminuria and atherosclerosis risk factors in potentially healthy men--preliminary data]. / Mikroalbuminuria u potencjalnie zdrowych meczyzn a obecnosc czynnikw ryzyka miazdzycy--doniesienie wstepne.

UNLABELLED: The aim of the study was the assessment of occurrence of microalbuminuria (MI) and selected biochemical atherosclerosis risk factors in the group of potentially healthy men. MATERIAL AND METHODS: In the studied group were 200 men in mean age 28.7 +/- 8.1 years. In the first part of the study all participants filled environmental inquiry concerning the cardiovascular risk factors. On the basis of qualitatively and then quantitatively MI measurement the whole studied group was divided in two subgroups: A (18 men with MI) and B (182 men without MI). In the second part of the study, in both groups we investigated occurrence of abnormal levels of atherosclerosis risk factors such as: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, uric acid, glucose, homocysteine (HCYS), C reactive protein (CRP). In the whole group we measured blood pressure, BMI and WHR. RESULTS: In the group with MI we found mean HCYS levels 14.75 micromol/ml. This value was higher then in the group without MI (p < 0.0007). Mean level of CRP in group with MI was 0.24 mg/dl and was higher than in the group without MI (p < 0.04). Levels of HDL and ApoA in the group with MI were 49.05 mg/ml and 1.46 mg/ dl and were lower than in the group B (p < 0.03 and p < 0.036 respectively). The most important factors preceeding MI were age and level of LDL cholesterol. CONCLUSIONS: Our preliminary data suggest that MI might be important atherosclerosis risk factor in potentially healthy men.

[Pseudoaneurysms after femoral arteries cannulations in hemodialysed patients--preliminary data]. / Tetniaki rzekome po kaniulacji tetnicy udowej u chorych hemodializowanych--doniesienie wstepne.

UNLABELLED: Patients undergoing chronic haemodialysis (HD) therapy have higher risk of arterial injury during cannulation for diagnostic and therapeutic procedures. Aim of our study was to evaluate frequency of femoral pseudoaneurysms (FPA) occurring after femoral artery (FA) cannulation (FAC) as well as presentation of ultrasound guided compression (USGC) of FPA. MATERIAL AND METHODS: From the group of 340 HD patients in our Centre in years 1996-2003 37 consecutive HD patients (23M, 14F, aged 55, 5 +/- 8, 2years, on HD 24, 2 +/- 22,6 months) after FAC, indicated from cardiological point of view, underwent regular femoral colour duplex USG. RESULTS: In 21 pts we found no local complications. In 16 of 37 pts 7 hematomas (HM) and 9 femoral pseudoaneurysms (FPA) were found. All HM were treated conservatively. From 9 FPA cases, 2 thrombosed spontaneously and the remaining 7 pts were treated firstly with USG guided controlled compression (UGCC). UGCC resulted in successful thrombosis of FPA in 3 pts with mean volume of FPA 40 +/- 12 ml but failed in 4 other pts with mean volume of FPA 39 +/- 17 ml. CONCLUSION: Our preliminary results show, for the first time in the literature, that occurrence of FA damage might occur rather often in HD pts qualified for this procedure from cardiological point of view. Pseudoaneurysms of FA, being in our material the most frequent pathology, should be promptly diagnosed with colour duplex USG and subsequently treated non surgically with USG guided controlled compression.

[New diagnostic and therapeutic methods in pseudoaneurysm of arterio-venous fistula for hemodialysis--case report]. / Nowe mozliwosci diagnostyczno-terapeutyczne tetniaka rzekomego przetoki tetniczo-zylnej do hemodializ--opis przypadku.

On the basis of case of 78 years old female patient being on chronic hemodialysis we present the usefulness of spiral computed tomography in the diagnosis of pseudoaneurysm complicating arterio-venous fistula for hemodialysis as well as usefulness of endovascular stent for closing such pseudoaneurysm.

[Mediastinal cyst in a patient on continuous ambulatory peritoneal dialysis successfully treated with video-assisted thoracic surgery (VATS)]. / Torbiel sródpiersia leczona skutecznie torakowideoskopia u chorej leczonej ciaglq ambulatoryjna dializq otrzewnowa.

Renal transplantation is the most effective form of renal replacement therapy of irreversible renal insufficiency. Due to posttransplant long term immunosuppressive treatment careful evaluation of the recipient is essential, especially detection and elimination of all potential sources of malignancy. In this paper, we describe successful video assisted thoracoscopic surgery of mediastinal cyst in peritoneal dialysis patient prepared for renal transplantation.