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Addressing Mental Health Needs among Physicians.

Addressing Mental Health Needs among Physicians.

South Med J. 2019 Feb;112(2):67-69

Authors: Buck K, Grace A, Runyan T, Brown-Berchtold L

PMID: 30708367 [PubMed - in process]

Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

Veer Vithalani, MD - Wed, 01/30/2019 - 08:39
Related Articles

Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

J Clin Med Res. 2013 Apr;5(2):75-83

Authors: Wang H, Coppola M, Robinson RD, Scribner JT, Vithalani V, de Moor CE, Gandhi RR, Burton M, Delaney KA

Abstract
BACKGROUND: It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered "minor trauma" with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients.
METHODS: Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique.
RESULTS: From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP.
CONCLUSION: Geriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients.

PMID: 23519239 [PubMed]

Clinical Outcomes for Diabetic Foot Ulcers Treated with Clostridial Collagenase Ointment or with a Product Containing Silver.

Travis Motley, DPM - Wed, 01/30/2019 - 08:38
Related Articles

Clinical Outcomes for Diabetic Foot Ulcers Treated with Clostridial Collagenase Ointment or with a Product Containing Silver.

Adv Wound Care (New Rochelle). 2018 Oct 01;7(10):339-348

Authors: Motley TA, Caporusso JM, Lange DL, Eichelkraut RA, Cargill DI, Dickerson JE

Abstract
Objective: To compare outcomes of diabetic foot ulcers (DFUs) treated with clostridial collagenase ointment (CCO) or silver-containing products, both in combination with sharp debridement as needed. Approach: One hundred two subjects with qualifying DFUs were randomized to daily treatment with either CCO or a silver-containing product for 6 weeks followed by a 4 -week follow-up period. The primary outcome was the mean percent reduction in DFU area. A secondary outcome was the incidence of ulcer infections between groups. Results: At the end of treatment, the mean percent reduction in area from baseline of DFUs treated with CCO was 62% (p < 0.0001) and with silver was 40% (p < 0.0001). The difference between groups-22%-was not statistically significant (p = 0.071). Among ulcers closed by the end of treatment, the mean time to closure was 31.1 ± 9.0 days versus 37.1 ± 7.7 days, respectively (not statistically significant). There was a numerically greater incidence of target ulcer infections in the silver group (11, 21.6%) than in the CCO group (5, 9.8%; p = 0.208). No clinically relevant safety signals were identified in either group. Innovation: CCO treatment can progress a wound toward closure. Ulcer infection prophylaxis may not be sacrificed when treating DFU with CCO in lieu of silver-containing products. Conclusion: Both CCO and silver-containing products promote significant reduction in DFU area over 6 weeks of treatment with no clinically relevant safety concerns. Mean percent reduction in lesion area was numerically (22%) but not significantly greater with CCO compared to silver, as was time to ulcer closure, with an incidence of ulcer infection at least as low as for silver-containing products.

PMID: 30374419 [PubMed]

Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure.

Timothy Niacaris, MD - Wed, 01/30/2019 - 08:38
Related Articles

Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure.

J Foot Ankle Surg. 2017 Nov - Dec;56(6):1170-1172

Authors: Carpenter B, Levine L, Niacaris T, Suzuki S

Abstract
Increased patient exposure has been shown to improve residency training as determined by better patient outcomes. The transition of John Peter Smith Hospital from a level II to a level I trauma center in 2009 provided a unique opportunity to investigate the direct effects of increased patient exposure on residency training in a relatively controlled setting. We evaluated the effect of the transition to a level I trauma center on residency training. In 2014, we examined the annual facility reports and separated the data into 2 groups: level II (2001 to 2008) and level I (2010 to 2013). The primary outcome measures were patient volume, surgical volume, patient acuity, and scholarly activity by the residents. The patient volume in all units increased significantly (p < .05 for all) after the transition to a level I center. The surgical volume increased significantly for the general surgery, orthopedics, and podiatry departments (p < .05 for all) but remained unchanged in the gynecology and oral maxillofacial surgery departments. The volume measures were performed on all 98 residents (100%). Patient acuity and scholarly activity increased by 17% and 52%, respectively; however, the differences in these data were not statistically significant. The scholarly activity per resident was measured for the orthopedic and podiatry departments. For those departments, the total number of residents was 30, and scholarly activity was measured for 100% of them. Overall, resident education improved when the hospital transitioned to a level I trauma center, although certain subspecialties benefited more than did others from this transition.

PMID: 28888403 [PubMed - indexed for MEDLINE]

Midcarpal Instability: A Comprehensive Review and Update.

Timothy Niacaris, MD - Wed, 01/30/2019 - 08:38
Related Articles

Midcarpal Instability: A Comprehensive Review and Update.

Hand Clin. 2015 Aug;31(3):487-93

Authors: Niacaris T, Ming BW, Lichtman DM

Abstract
Midcarpal instability has been well described as a clinical entity but the pathokinematics and pathologic anatomy continue to be poorly understood. This article presents a comprehensive review of the existing knowledge and literature-based evidence for the diagnosis and management of the various entities comprising midcarpal instability. It discusses the limitations of the current understanding of midcarpal instability and proposes new directions for furthering knowledge of the causes and treatment of midcarpal instability and wrist pathomechanics in general.

PMID: 26205710 [PubMed - indexed for MEDLINE]

Surgical Techniques for the Management of Midcarpal Instability.

Timothy Niacaris, MD - Wed, 01/30/2019 - 08:38
Related Articles

Surgical Techniques for the Management of Midcarpal Instability.

J Wrist Surg. 2014 Aug;3(3):171-4

Authors: Ming BW, Niacaris T, Lichtman DM

Abstract
Palmar midcarpal instability (PMCI) is an uncommon and poorly understood disorder. Its etiology is believed to be due to traumatic or congenital laxity of the ligaments (volar and dorsal) that stabilize the proximal row. This laxity results in hypermobility of the proximal carpal row and unphysiologic coupling of the midcarpal joint. Clinically, the condition is manifested by a painful clunk with ulnar and radial wrist deviation. The purpose of this article is to chronicle our personal experience with this condition and to review our current treatment recommendations and outcomes.

PMID: 27054049 [PubMed]

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Stefan Buca, MD - Wed, 01/30/2019 - 08:37
Related Articles

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Am J Emerg Med. 2018 Jun 18;:

Authors: Singh N, Robinson RD, Duane TM, Kirby JJ, Lyell C, Buca S, Gandhi R, Mann SM, Zenarosa NR, Wang H

Abstract
OBJECTIVE: Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care.
METHODS: This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016-Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events.
RESULTS: Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10-12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17-2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression.
CONCLUSION: Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care.

PMID: 30139579 [PubMed - as supplied by publisher]

A Derivation and Validation Study of an Early Blood Transfusion Needs Score for Severe Trauma Patients.

Stefan Buca, MD - Wed, 01/30/2019 - 08:37
Related Articles

A Derivation and Validation Study of an Early Blood Transfusion Needs Score for Severe Trauma Patients.

J Clin Med Res. 2016 Aug;8(8):591-7

Authors: Wang H, Umejiego J, Robinson RD, Schrader CD, Leuck J, Barra M, Buca S, Shedd A, Bui A, Zenarosa NR

Abstract
BACKGROUND: There is no existing adequate blood transfusion needs determination tool that Emergency Medical Services (EMS) personnel can use for prehospital blood transfusion initiation. In this study, a simple and pragmatic prehospital blood transfusion needs scoring system was derived and validated.
METHODS: Local trauma registry data were reviewed retrospectively from 2004 through 2013. Patients were randomly assigned to derivation and validation cohorts. Multivariate logistic regression was used to identify the independent approachable risks associated with early blood transfusion needs in the derivation cohort in which a scoring system was derived. Sensitivity, specificity, and area under the receiver operational characteristic (AUC) were calculated and compared using both the derivation and validation data.
RESULTS: A total of 24,303 patients were included with 12,151 patients in the derivation and 12,152 patients in the validation cohorts. Age, penetrating injury, heart rate, systolic blood pressure, and Glasgow coma scale (GCS) were risks predictive of early blood transfusion needs. An early blood transfusion needs score was derived. A score > 5 indicated risk of early blood transfusion need with a sensitivity of 83% and a specificity of 80%. A sensitivity of 82% and a specificity of 80% were also found in the validation study and their AUC showed no statistically significant difference (AUC of the derivation = 0.87 versus AUC of the validation = 0.86, P > 0.05).
CONCLUSIONS: An early blood transfusion scoring system was derived and internally validated to predict severe trauma patients requiring blood transfusion during prehospital or initial emergency department resuscitation.

PMID: 27429680 [PubMed]

Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.

Stefan Buca, MD - Wed, 01/30/2019 - 08:37
Related Articles

Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.

Injury. 2015 Nov;46(11):2113-7

Authors: Wang H, Phillips JL, Robinson RD, Duane TM, Buca S, Campbell-Furtick MB, Jennings A, Miller T, Zenarosa NR, Delaney KA

Abstract
OBJECTIVES: Pelvic fractures are associated with increased risk of death among trauma patients. Studies show independent risks predicting mortality among patients with pelvic fractures vary across different geographic regions. This study analyses national data to determine predictors of mortality in initially stable adult pelvic trauma patients in the US.
METHODS: This study is a retrospective analysis of the US National Trauma Data Bank from January 2003 to December 2010 among trauma patients ≥18 years of age with pelvic fractures (including acetabulum). Over 150 variables were reviewed and analysed. The primary outcome was all-cause in-hospital mortality. Logistic regression analysis was used to determine independent risk factors predictive of in-hospital mortality in stable pelvic fracture patients.
RESULTS: 30,800 patients were included in the final analysis. Overall in-hospital mortality rate was 2.7%. Mortality increased twofold in middle aged patients (age 55-70), and increased nearly fourfold in patients with advanced age ≥70. We found patients with advanced age, higher severity of injury, Glasgow Coma Scale (GCS) <8, GCS between 9 and 12, prolonged mechanical ventilation, and/or in-hospital blood product administration experienced higher mortality. Patients transported to level 1 or level 2 trauma centres experienced lower mortality while concomitantly experiencing higher associated internal injuries.
CONCLUSIONS: Geriatric and middle aged pelvic fracture patients experience higher mortality. Predictors of mortality in initially stable pelvic fracture patients are advanced age, injury severity, mental status, prolonged mechanical ventilation, and/or in-hospital blood product administration. These patients might benefit from transport to local level 1 or level 2 trauma centres.

PMID: 26377773 [PubMed - indexed for MEDLINE]

A twisting of points: recognize the signs of Torsades de Pointes.

Stefan Buca, MD - Wed, 01/30/2019 - 08:37
Related Articles

A twisting of points: recognize the signs of Torsades de Pointes.

JEMS. 2011 Jul;36(7):40, 44

Authors: Buca S, McKinney J, Brywczynski J, Slovis C

PMID: 21807276 [PubMed - indexed for MEDLINE]

Chest pain · shortness of breath · fever and nausea · Dx?

Smita Subramaniam, MD - Wed, 01/30/2019 - 08:37
Related Articles

Chest pain · shortness of breath · fever and nausea · Dx?

J Fam Pract. 2015 May;64(5):282-4

Authors: Manov A, Gopalakrishnan PP, Subramaniam S, Wardi M, White J

PMID: 26009736 [PubMed - indexed for MEDLINE]

Lack of energy, petechiae, elevated PSA level--Dx?

Smita Subramaniam, MD - Wed, 01/30/2019 - 08:37
Related Articles

Lack of energy, petechiae, elevated PSA level--Dx?

J Fam Pract. 2014 Oct;63(10):565-7

Authors: Subramaniam S, Choufani E, Manov A

PMID: 25343154 [PubMed - indexed for MEDLINE]

The link between sleep disturbance and depression among Mexican Americans: a Project FRONTIER study.

Sherif Al-Farra, MD - Wed, 01/30/2019 - 08:36
Related Articles

The link between sleep disturbance and depression among Mexican Americans: a Project FRONTIER study.

J Clin Sleep Med. 2014 Apr 15;10(4):427-31

Authors: Roane BM, Johnson L, Edwards M, Hall J, Al-Farra S, O'Bryant SE

Abstract
OBJECTIVE: To examine the link between disturbed sleep and depression scores in Mexican Americans and non-Hispanic Whites.
METHODS: Data were analyzed for 566 participants (45% Mexican Americans) who were part of a rural healthcare study, Project FRONTIER. Mean age was 55.5 years for Mexican Americans (70% female) and 65.6 years for non-Hispanic Whites (69% female). Self-reported sleep disturbance was entered as the predictor, GDS-30 total and factor scores as the outcome variables, and age, sex, education, BMI, and medical diagnoses (hyperlipidemia, diabetes mellitus, and hypertension) entered as covariates.
RESULTS: Mexican Americans reported higher rates of sleep disturbances (25%) than non-Hispanic whites (17%). Sleep disturbances were significantly associated with GDS-30 total scores and the factors Dysphoria and Cognitive Impairment in both Mexican Americans and non-Hispanic whites.
CONCLUSIONS: In this study, Mexican Americans reported higher rates of sleep disturbances than non-Hispanic whites. Disturbed sleep was positively associated with depression and the factor scores for Dysphoria and Cognitive Impairment in both groups. Given the paucity of research on sleep disorders in Mexican Americans, identifying what sleep disorders are present and the impact treating these sleep disorders have on depression warrant further investigation.

PMID: 24733989 [PubMed - indexed for MEDLINE]

Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas.

J Vasc Access. 2017 Jul 14;18(4):319-324

Authors: Balamuthusamy S, Reddi AL, Madhrira MH, Sankarapandian B, Nguyen P, Vallurupalli A, Gabbard W, Jalandhara N, Yurvati A

Abstract
INTRODUCTION: Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis.
METHODS: Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software.
RESULTS: The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis.
CONCLUSIONS: Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.

PMID: 28665461 [PubMed - indexed for MEDLINE]

Self-centering split-tip catheter versus conventional split-tip catheter in prevalent hemodialysis patients.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Self-centering split-tip catheter versus conventional split-tip catheter in prevalent hemodialysis patients.

J Vasc Access. 2016 May 07;17(3):233-8

Authors: Balamuthusamy S, Nguyen P, Bireddy S, Vallurapalli A, Jalandhara N, Afolabi D

Abstract
PURPOSE: This study compared the patency of a split-tip self-centering catheter with a predesigned curve (CentrosFLO; Merit, Salt Lake City, Utah) and a standard split-tip catheter with straight distal limbs (Medcomp, Harleysville, Pennsylvania) catheter in patients requiring exchange of a dysfunctional tunneled dialysis catheter (TDC).
MATERIALS AND METHODS: A single-center retrospective chart review was performed between January 2013 and July 2014. Patients had an existing dysfunctional TDC that was exchanged over a wire using the same access site for either a split-tip self-centering catheter with a predesigned curve or a standard split-tip catheter with straight distal limbs catheter. The primary endpoint was catheter patency analyzed at 1, 3, and 6 months after initial exchange.
RESULTS: A total of 73 patients met inclusion criteria (46 in the self-centering catheter group and 27 in the standard split-tipped group). Mean durations of the exchanged catheters were similar between groups. The mean 1-, 3-, and 6-month patency rates for the self-centering and split-tip catheters were 89%, 67.4%, and 23.9% and 81.5%, 40.7%, and 14.8%, respectively. Mean blood flow rates (BFRs) were similar between groups at 1 and 3 months; however, at 6 months, mean rates were 388 mL/min versus 352 mL/min for the self-centering group and split-tipped group, respectively (p&lt;0.01).
CONCLUSIONS: These results demonstrate improved patency with the CentrosFLO self-centering catheter versus the split-tip catheter. This may be due to the unique design of the self-centering catheter, allowing for preserved BFRs and patency. These results should be further explored in prospective, randomized multicenter studies.

PMID: 26980629 [PubMed - indexed for MEDLINE]

Flow reduction in high-flow arteriovenous fistulas improve cardiovascular parameters and decreases need for hospitalization.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Flow reduction in high-flow arteriovenous fistulas improve cardiovascular parameters and decreases need for hospitalization.

Hemodial Int. 2016 07;20(3):362-8

Authors: Balamuthusamy S, Jalandhara N, Subramanian A, Mohanaselvan A

Abstract
High output heart failure (HF) and pulmonary hypertension have been demonstrated in patients with prevalent arteriovenous (AV) fistulas. Fistulas with flow >2000 mL/minutes are more likely to induce changes in cardiac geometry and pulmonary artery pressure. The effects of reducing flow in AV access and its implications on HF decompensation and hospitalizations have not been studied. Retrospective analysis of 12 patients who needed hospitalization for acute Congestive Heart Failure (CHF) decompensation with AV access flow of 2 L/minutes (as defined by Kidney Disease Outcomes Quality Initiative (KDOQI)) or more were included in the study. All the patients underwent banding of their inflow at the anastomosis with perioperative access flow measurement. Follow-up period was 6 months. 2D echo was done at 6 months postbanding in addition to access flow and clinical evaluation. Complete data was available for all the 12 patients. Study data was collected on all the 12 patients. Mean age was 64.7 years. The mean access flow pre and postbanding were 3784 mL/minutes and 1178 mL/minutes, respectively (P < 0.001). Eighty percent of the patients had diabetes and 41% had coronary artery disease. There was a statistically significant decrease in cardiac output (pre = 7.06 L/minutes, post = 6.47 L/minutes P = 0.03), pulmonary systolic pressure (pre = 54 mmHg, post = 44 mmHg P = 0.02), left ventricular mass index (LVMI) (pre = 130 g/m(2) , post = 125 g/m(2) P = 0.006) and need for rehospitalization for CHF decompensation. The New York Heart Association (NYHA) staging improved by 1 stage postbanding (P = 0.002). The hospitalization rate was 3.75 ± 1.2 in the 6 months before banding and was decreased to 1.08 ± 1.2 (P = 0.002) postbanding. The hemoglobin level, predialysis systolic blood pressure, calcium phosphorous product and the use of Renin Angiotensin Aldosterone System (RAAS) blockade agents and calcium channel blockers were comparable before and after inflow banding. Flow reduction in high flow fistulas are associated with decreased LVMI and pulmonary artery pressures. There is also a significant reduction in the risk for hospitalization due to acute HF and an improvement in NYHA heart failure stage.

PMID: 26663664 [PubMed - indexed for MEDLINE]

Percutaneous Peritoneal Dialysis Catheter Placement in Patients with Complex Abdomen.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Percutaneous Peritoneal Dialysis Catheter Placement in Patients with Complex Abdomen.

Semin Dial. 2015 Nov-Dec;28(6):680-6

Authors: Jalandhara N, Balamuthusamy S, Shah B, Souraty P

Abstract
Peritoneal dialysis (PD) is an effective treatment for end-stage renal disease. There are several techniques of percutaneous PD catheter placement including trocar or Seldinger techniques. Placement can be performed with fluoroscopy and/or sonography or as a blind percutaneous procedure. Historically, percutaneous PD catheters have been placed in patients even if they had prior abdominal surgeries. The outcomes of percutaneous PD catheter placement in patients with complex abdomen (patients with two or more abdominal surgeries or known adhesions) are unknown. This study was carried out to determine the outcomes of percutaneous PD catheter placements using Seldinger technique with sonography and fluoroscopy in patients with complex abdomen. Preprocedure sonography was also used to identify site of adhesions and blood vessels. The goal was to see if ultrasound and fluoroscopy would support placement of PD catheters in patients with complex abdomens. There were total of 10 catheter placements in 10 patients with complex abdomen. The initial success rate was 100%. The patients had an average of 2.8 abdominal surgeries. The mean BMI was 28.4. There were no incidences of perforation or failed placements. One catheter was replaced due to outflow failure and one patient discontinued PD due to peri-catheter leak. One year catheter survival was 80%. Our study demonstrates benefits of using ultrasonography and fluoroscopy during percutaneous PD catheter placement by the Seldinger technique in patients with complex abdomen.

PMID: 26138688 [PubMed - indexed for MEDLINE]

Persistent Median Artery As A Cause Of Nonmaturing AV Fistula.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Persistent Median Artery As A Cause Of Nonmaturing AV Fistula.

Semin Dial. 2015 Sep-Oct;28(5):552-7

Authors: Jalandhara N, Balamuthusamy S, Skaria S, Jalandhara P, Hansen J, Waiganjo N

Abstract
A 68-year-old right handed male with End-Stage Renal Disease with a left radiocephalic fistula created 8 months ago was referred for the evaluation of a nonmaturing access. Patient had an arterial anastomosis lesion that underwent successful angioplasty. Diagnostic arteriogram of the AV access extremity revealed the presence of a short radial artery and dominant common interosseous artery manifesting as a persistent median artery in the distal forearm and was anastomosed to the fistula and then continues as the median-ulnar superficial arch in the palm. Balloon angioplasty of the common interosseous artery led to a complication when the distal 30 cm of the 0.018 guide wire fractured and had to be retrieved using a snare device. In addition to anticipating and treating the common complications of vascular access procedures, it is also important to be aware of the anomalies of the distal forearm arterial anatomy and perform a detailed arterial evaluation prior to creating the arterio-venous anastomosis.

PMID: 25787139 [PubMed - indexed for MEDLINE]

Renal sympathetic nervous system and the effects of denervation on renal arteries.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Renal sympathetic nervous system and the effects of denervation on renal arteries.

World J Cardiol. 2014 Aug 26;6(8):814-23

Authors: Kannan A, Medina RI, Nagajothi N, Balamuthusamy S

Abstract
Resistant hypertension is associated with chronic activation of the sympathetic nervous system resulting in various comorbidities. The prevalence of resistant hypertension is often under estimated due to various reasons. Activation of sympathetic nervous system at the renal- as well as systemic- level contributes to the increased level of catecholamines and resulting increase in the blood pressure. This increased activity was demonstrated by increased muscle sympathetic nerve activity and renal and total body noradrenaline spillover. Apart from the hypertension, it is hypothesized to be associated with insulin resistance, congestive heart failure and obstructive sleep apnea. Renal denervation is a novel procedure where the sympathetic afferent and efferent activity is reduced by various techniques and has been used successfully to treat drug-resistant hypertension improvement of various metabolic derangements. Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Renal denervation can be done by various techniques including radiofrequency ablation, ultrasound guided ablation and chemical ablation. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios. Appropriate patient selection might be the key in determining the effectiveness of the procedure.

PMID: 25228960 [PubMed]

Effect of spironolactone in CV mortality in hemodialysis patients.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Effect of spironolactone in CV mortality in hemodialysis patients.

J Am Coll Cardiol. 2014 Aug 05;64(5):528-9

Authors: Kannan A, Poongkunran C, Balamuthusamy S

PMID: 25082591 [PubMed - indexed for MEDLINE]

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