Laceration of the Iliac Vein in a Patient with a Femoral Catheter for Hemodialysis

Although catheters are an ideal therapeutic treatment for all patients who need hemodialysis, their placement, use may be followed by certain complications. We present a case of iliac vein lacerations in the projection of the tip of a femoral catheter for hemodialysis in a 55-year-old patient

Vascular access failure-cause or complication of central venous catheterization: Case report

© 2020, University of Kragujevac, Faculty of Science. All rights reserved. The quality of life and patient survival rate in terminal chronic renal insufficiency depends on the duration of vascular approaches. Dialysis catheters are used to establish an adequate vascular approach when emergency hemodialysis is indicated and when all approaches are exhausted. Complications of CVC can be classified into three categories: mechanical (hematoma, arterial puncture, pneumothorax, hemothorax, catheter misplacement, and stenosis), infectious (insertion site infection, CVC colonization, and bloodstream infection) and thrombotic (deep vein thrombosis). Despite the increasing prevalence of haemodialysis patients with complex access issues, there remains no consensus on the definition of vascular access failure or end-stage vascular access. The dilema in these cases remains whether the generalized vascular insufficiency is the cause or a complication of exhausted vascular accesses. This case report is one of the examples of combined complications with generalized vascular access insufficiency. During the year and a half of the chronic dialysis program, the patient had several changes of vascular approaches, and each approach became dysfunctional in certain time due to various causes. After six months of successful hemodialysis, the patient was admitted with signs of infection and during hospitalization was again subjected to multiple changes of the vascular approach due to infection, thrombosis, and vascular access failure

Predictive parameters functioning arteriovenous fistula for hemodialysis in the elderly

© 2019, University of Kragujevac, Faculty of Science. All rights reserved. Elderly patients with end stage kidney disease represent a challenge for surgeons to create a vascular access. Determine predictive parameters functionality of the arteriovenous fistulas for hemodialysis in the elderly. The study was organized as a retrospective study at the Center for Dialysis, Clinic for Urology and Nephrology, Clinical Center Kragujevac. The study included patients older than 65 years with arteriovenous fistula thrombosis, in the period of four years, in which there is information on the length of the functioning fistula. The study included 48 patients, mean age 71.3±5.2 years, 29 (60%) men and 19 (40%) women. The data were analyzed according to gender and demographic structure, type of anastomosis, positioning, length of functioning fistulas, and the lumen diameter of the arteries and veins that are used to create a fistula. The median length of functioning arteriovenous fistula, based on Kaplan-Meier model, is 16 months (95% CI 6.9- 25.1). Median functioning for proximaly located fistulas was 24 months (range, 1-259), while median functioning in patient with distally located fistulas was 8 months (range, 1-96). The difference in relation to the positioning of the fistula was statistically significant (p=0.006). In univariate Cox regression model, a statistically significant predictor of the functioning of arteriovenous fistulae is fistula positioning (B=0.700; p=0.022). The predictive parameter of survival of arteriovenous fistulas in elderly is proximally located fistula

Nasal septum extramedullary plasmacytoma

Introduction. Plasmacytomas are malignant tumors characterized by abnormal monoclonal proliferation of plasma cells. They originate in either bone - solitary osseous plasmacytoma, or in soft tissue - extramedullary plasmacytoma (EMP). EMP represents less than 1% of all head and neck malignancies. Case report. We presented a case of EMP of the nasal septum in a 44-year-old male who had progressive difficulty in breathing through the nose and frequent heavy epistaxis on the right side. Nasal endoscopy showed dark red, soft, polypoid tumor in the last third of the right nasal cavity arising from the nasal septum. The biopsy showed that it was plasmacytoma. Bence Jones protein in the urine, serum electrophoresis, bone marrow biopsy, skeletal survey and other screening tests failed to detect multiple myeloma. This confirmed the diagnosis of EMP. The mass was completely removed via an endoscopic approach, and then, 4 week later, radiotherapy was conducted with a radiation dose of 50 Gray. No recurrence was noted in a 3-year follow- up period. Conclusion. EMP of the nasal cavity, being rare and having long natural history, represents a diagnostic and therapeutic challenge for any ear, nose and throat surgeon. Depending on the resectability of the lesion, a combined therapy is the accepted treatment

Automatic identification of variables in epidemiological datasets using logic regression

textabstractBackground: For an individual participant data (IPD) meta-analysis, multiple datasets must be transformed in a consistent format, e.g. using uniform variable names. When large numbers of datasets have to be processed, this can be a time-consuming and error-prone task. Automated or semi-automated identification of variables can help to reduce the workload and improve the data quality. For semi-automation high sensitivity in the recognition of matching variables is particularly important, because it allows creating software which for a target variable presents a choice of source variables, from which a user can choose the matching one, with only low risk of having missed a correct source variable. Methods: For each variable in a set of target variables, a number of simple rules were manually created. With logic regression, an optimal Boolean combination of these rules was searched for every target variable, using a random subset of a large database of epidemiological and clinical cohort data (construction subset). In a second subset of this database (validation subset), this optimal combination rules were validated. Results: In the construction sample, 41 target variables were allocated on average with a positive predictive value (PPV) of 34%, and a negative predictive value (NPV) of 95%. In the validation sample, PPV was 33%, whereas NPV remained at 94%. In the construction sample, PPV was 50% or less in 63% of all variables, in the validation sample in 71% of all variables. Conclusions: We demonstrated that the application of logic regression in a complex data management task in large epidemiological IPD meta-analyses is feasible. However, the performance of the algorithm is poor, which may require backup strategies

Dysfunction of the arteriovenous fistula for hemodialysis as a consequence of venous neointimal hyperplasia and treatment strategies

© 2019, Serbia Medical Society. All rights reserved. One of the main problems related to inadequate planning of vascular access is dysfunction during maturation. Arteriovenous fistula dysfunction is most often a consequence of neointimal hyperplasia. Important causes for initial dysfunction of the fistula include narrow lumens of the arteries and veins used for anastomosis, damage to the vascular endothelium during fistula creation, previous venipunc-ture, postoperative development of venous collaterals, the impact force of friction on the arteriovenous anastomosis, a genetic predisposition for development of vascular stenosis, neointimal hyperplasia and previously persistent venous neointimal hyperplasia. Any damage to the endothelium is a stimulus for neointimal hyperplasia. During surgery for creating the fistula, endothelial cells separate on the intima, edema appears, fibrin is deposited, leukocytes and platelets infiltrate. Spotted edema and necrosis of smooth muscle cells appear in the media. In order to determine an adequate therapeutic strategy, the pathogenesis of intimal hyperplasia has been widely considered from different aspects. It is currently based on preoperative preservation of veins and careful selection of blood vessels, percutaneous transluminal angioplasty or surgical revision. Nevertheless, no current therapeutic strategies provide appropriate recommendations to improve maturation of the arteriovenous fistula. Notwithstanding considerable knowledge about the pathogenesis of venous neointimal hyperplasia, currently no prophylactic treatments would reduce its progression