Septic thrombosis of the basilic, axillary, and subclavian veins caused by a peripherally inserted central venous catheter

The purpose of this study was to determine if ultrasonographic measurement of multiple cross-sectional areas combined with linear dimensions of the bladder could be used as a method of estimating bladder volume in the dog, and, if so, to compare the accuracy of this estimation with that described previously using linear measurements alone. Fifty-two live dogs undergoing investigation for urological disease and 37 fresh canine cadavers were used for bladder volume determination. Maximal length, depth, width, and area were measured from the maximal longitudinal and transverse sonograms in each living animal. In cadavers, the cross-sectional area of the longitudinal section of the bladder was measured at one centimeter intervals, and the measurements were summed. Based on sequential partial regression analysis, the cross-sectional area of the longitudinal section of the bladder and length were the best predictors of actual bladder volume in living animals. However, based on the cadaver experiment, the best predictor of actual bladder volume was summed parasagittal area alone, and, in cadavers, this was a much better predictor of actual bladder volume than the combination of the cross-sectional area of the longitudinal section of the bladder and length. The formula derived in living dogs using the cross-sectional area of the longitudinal section of the bladder and length gave a less accurate estimation of bladder volume than a previously published formula where only linear measurements were used.     

Chylothorax and chylopericardium: a complication of a central venous catheter

Nuclear palisading is a characteristic feature which is typically seen in neural tumours such as neurilemmoma, and also in some other tumours. We report here three patients with basal cell carcinoma who showed histological patterns similar to nuclear palisading. To our knowledge, this is the first such case report in the medical literature; we apply the term 'neuroid-type nuclear palisading' to these cases. In our patients, the spindle-shaped tumour cells were tightly packed and the nuclei were arranged uniformly to form this rare feature.     

Stenosis and thrombosis of the central venous tract as a cause of manifestations of venous hypertension after establishment of an arteriovenous anastomosis for hemodialysis

The authors draw attention to stenoses and occlusions of the central venous tract (subclavicular and brachiocephalic vein) which may be the cause of manifestations of venous hypertension on the upper extremity after establishment of an arteriovenous anastomosis for haemodialysis. In patients where this condition is suspected, careful preoperative examination of the venous circulation is essential. Possible treatment is discussed.     

Use of a chemically defined system for the direct comparison of inner cell mass and trophectoderm distribution in murine, porcine and bovine embryos

The purpose of this study was to evaluate the differences in treatment effects between adult patients who underwent surgically assisted rapid maxillary expansion employing buccal corticotomies and those who had midpalatal splits as well. Responses and sequelae of these treated patients were compared with adults who were expanded orthopedically and adults who were treated orthodontically without expansion. The sample comprised 37 patients who were expanded and 5 controls. Dental study casts were taken prior to treatment, at debanding, and at the posttreatment follow-up. The results indicated that maxillary expansion in adults was predictable and stable, corrected crossbites remained corrected, palatal depth was reduced in SARME, palatal width increased (more dramatically in patients treated with a combined procedure), and tipping was controlled and stable. The long-term buccogingival condition was more acceptable in adults expanded with surgical augmentation than in those expanded orthopedically.     

Heart tamponade: a life-threatening complication of a central venous catheter

A 57-year-old female patient initially admitted with acute pancreatitis became extremely hypotensive, with increased central venous pressure, a few hours after insertion of a central venous catheter into the right subclavian vein. Echocardiography revealed a large amount of pericardial fluid, which was removed by pericardiocentesis. A cardiac tamponade as a result of central venous cannulation is a rare but serious complication with a high mortality rate. The tamponade may be the result of perforation of the V. cava superior, the right atrium or the right ventricle (as in the patient described). Cardiac tamponade should be suspected in any patient with severe hemodynamic problems after insertion of a central venous line.     

The rupture and intravascular migration of the distal fragment of a central venous access catheter

Patients free from occlusal dysfunction rarely have their teeth together. But, when occlusion does occur (i.e., swallowing), the contacts should be simultaneous and in such a manner as to direct the vector of force down the long axis of the tooth or implant. The incline planes should not touch.     

Composition and formation of the sleeve enveloping a central venous catheter

PURPOSE: After catheterization, 42% to 100% of central venous catheters are surrounded by a "fibrin sleeve." This sleeve has been considered the cause of catheter-related infections, withdrawal occlusion, and pulmonary embolism. The reactions between the vein wall and the catheter were studied. METHODS: A silicone catheter was placed in the anterior caval vein of 123 rats. After in situ fixation at scheduled intervals, the pathologic changes were studied on semi-serial histologic sections by means of light microscopy, transmission electron microscopy, and scanning electron microscopy (SEM). In 36 rats, the catheter was withdrawn immediately; in 72 rats, it was left in situ up to 6 months; and in 15 rats, the study was performed up to 10 months after withdrawal of a catheter that had remained in situ for 6 months. RESULTS: In the group in which the catheter was withdrawn immediately, mural thrombi disappeared by day 7. In the group in which the catheter remained in situ, thrombi remained around the proximal portion of the catheter. This pericatheter thrombosis (PCT) was invaded by migrating and proliferating smooth muscle cells (SMCs), originating from an injured vein wall, and transformed from day 7 into a tissue composed predominantly of SMCs and collagen and covered by endothelial cells. Later, the number of cells decreased, and the relative amount of collagen increased. Up to 10 months after withdrawal of the catheter, the collapsed sleeve was still present within the vein. CONCLUSION: The sleeve around a central venous catheter is not a fibrin sleeve, but a stable cellular-collagen tissue covered by endothelium. It is mainly formed by smooth muscle cells migrating from the injured vein wall into the early pericatheter thrombus.     

The DNA methylation machinery as a target for anticancer therapy

DNA methylation is now recognized as an important mechanism regulating different functions of the genome; gene expression, replication, and cancer. Different factors control the formation and maintenance of DNA methylation patterns. The level of activity of DNA methyltransferase (MeTase) is one factor. Recent data suggest that some oncogenic pathways can induce DNA MeTase expression, that DNA MeTase activity is elevated in cancer, and that inhibition of DNA MeTase can reverse the transformed state. What are the pharmacological consequences of our current understanding of DNA methylation patterns formation? This review will discuss the possibility that DNA MeTase inhibitors can serve as important pharmacological and therapeutic tools in cancer and other genetic diseases.     

Percutaneous central venous catheters in neonates: a descriptive analysis and evaluation of predictors for sepsis

The article describes the experience with percutaneous central venous catheters in 565 neonates with birth weights of 400 to 6810 g. The catheter-related sepsis incidence was 19.1%, or 13.5 infections per 1000 catheter days. By discriminant function analysis, 86% of all neonates studied were correctly classified into the confirmed sepsis and no sepsis groups on the basis of six predictor variables. The model did not accurately predict the neonates who would develop confirmed sepsis. The weight at catheter insertion and length of time for which the catheter was in place were identified as variables that contributed significantly to differentiation between sepsis and no sepsis groups.     

The perils of outperformance: Sensitivity about being the target of a threatening upward comparison.

Outperforming others, although privately satisfying, can be a source of interpersonal strain. This article presents the framework of a major form of outperformance-related distress, which we label sensitivity about being the target of a threatening upward comparison (STTUC). To become STTUC, an individual must believe that another person is making an upward comparison against the self and feels threatened by the contrast in status. The outperformer must also experience concern about some facet of the other's response, and this concern may be focused on the other, the self, or the relationship. In addition to offering new predictions about outperformance-related distress, the STTUC framework unites many previously disconnected findings on topics such as fear of success, envy, self-presentation, and self-evaluation maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interventional therapy for hemangioendothelioma of the liver in a newborn infant using a central venous approach

We report on a newborn (birth weight 3600 g) with high-output cardiac failure due to a large hepatic hemangioendothelioma requiring mechanical ventilation. One day post-partum therapy with steroids, furosemide, and digitalis was initiated. Despite this, the clinical condition deteriorated. Therefore, selective coil-embolization of the arterial vessels supplying the hemangioendothelioma was performed using a venous approach with passage to the arterial side via the ductus arteriosus. After the embolization the patient improved quickly and he was extubated 4 days postinterventionally. Follow-up sonography 4 months postinterventionally showed dramatic regression of the hepatic tumor. We conclude that the coil-occlusion of hepatic hemangioendothelioma should be performed early in symptomatic newborns as arterial puncture and its associated complications can be avoided by using a venous approach with passage to the arterial side via the ductus arteriosus. In addition, in this age group, access to the portal system can be gained through the umbilical vein to occlude portal venous supplies to the hepatic hemangioendothelioma.     

Tumor involvement in hepatic veins: comparison of MR imaging and US for preoperative assessment

PURPOSE: To compare use of magnetic resonance (MR) imaging and ultrasonography (US) for diagnosis of vascular involvement by tumor at the hepatic vein confluence. MATERIALS AND METHODS: Thirty-seven consecutive patients with tumors at the hepatic vein confluence were prospectively evaluated with spin-echo and gradient-echo MR imaging and gray-scale and Doppler US. Encasement, thrombosis, occlusion, and nonvisualization were considered to be evidence of vascular involvement. Imaging results were compared with surgical and pathologic examination findings in 27 patients who underwent resection. RESULTS: Sixteen hepatic veins (nine right, four middle, three left) were seen to be involved at surgery. Twelve of 16 involved veins were identified at MR imaging (75% sensitivity, 98% specificity, 92% positive predictive value, 94% negative predictive value). Thirteen of 16 involved veins were detected at US (81% sensitivity, 97% specificity, and 87% positive and 95% negative predictive values). There was one false-positive diagnosis of inferior vena cava involvement at both MR imaging and US. Ten patients had unresectable disease. One patient had motion artifact on MR images; in the remaining nine patients, MR imaging and US yielded identical findings at 26 of 27 hepatic vein sites. CONCLUSION: MR imaging and US provide comparable results for assessment of hepatic vein involvement by tumor.     

Peripheral morphine analgesia: synergy with central sites and a target of morphine tolerance

Morphine injected s.c. in the tail is a potent analgesic in the tail-flick assay when the radiant heat source is focused directly over the injection site (ED50, 4.5 micrograms), but not if the radiant heat source is moved 1 cm proximally or distally to the injection site. Naloxone given systemically reverses this peripheral analgesia. Antisense oligodeoxynucleotides directed against exons 1 and 4 of MOR-1, a cloned mu opioid receptor, administered intrathecally (i.t.) block the local analgesic effect of morphine in the tail, indicating that the local response is mediated through mu receptors located on the terminals of sensory neurons from the dorsal root ganglia. Combinations of morphine given locally in the tail and spinally (i.t.) are synergistic. Spinal morphine also synergizes with systemic morphine in analgesia assays. Supraspinal morphine enhances systemic morphine analgesia, but less dramatically. We also examined tolerance on these analgesic systems by using a daily morphine injection paradigm which shifts the dose-response curve for systemic morphine approximately 2-fold after 5 days. In this paradigm, morphine's analgesic potency after either supraspinal or spinal administration alone does not change. However, the dose-response curve for local morphine in the tail is shifted by over 19-fold. The analgesic activity of the combination of supraspinal and systemic morphine is lowered approximately 2-fold and the combination of i.t. and systemic morphine by 12-fold. These studies confirm the presence of a peripheral mechanism for morphine analgesia mediated by mu receptors located on sensory neurons from the dorsal root ganglia, which is extremely sensitive to chronic morphine dosing.     

Dysrhythmia update: The effect of intermittent heart block on the central venous pressure trace

A prospective study of 71 patients with hyponatraemia was undertaken over an 18-month period in one surgical unit at King Edward VIII Hospital, Durban, to study the incidence and pattern of hyponatraemia. Electrolytes and urea values were measured serially in all patients. Hyponatraemia was defined as a serum sodium level of < 130 mmol/l. The incidence of hyponatraemia was 2.2%, the most common type being normovolaemic hypotonic hyponatraemia. Hyponatraemia was either mild (sodium level 120-130 mmol/l) or moderate (111-120 mmol/l). No patient had severe hyponatraemia (< 110 mmol/l). Hyponatraemia was corrected within 1-6 days using normal saline; in 73% of patients it was corrected within 24 hours. No patient developed neurological symptoms. A mortality rate of 28% was attributed to underlying illness, and hyponatraemia per se was asymptomatic in this study. Aggressive sodium correction was therefore not indicated.     

Use of jugular venous blood, compared with mixed venous blood, for measurement of venous oxygenation indices in a porcine model of endotoxic shock

OBJECTIVE: To evaluate the reliability of oxygen saturation and oxygen content values measured from jugular venous blood in estimating values measured from mixed venous blood during endotoxic shock. ANIMALS: 14 random-bred 10- to 15-kg Yorkshire pigs. PROCEDURE: 60 pairs of heparinized blood samples were simultaneously collected from the pulmonary artery and right jugular vein during an independent study, using a porcine model of endotoxic shock. Endotoxic shock was induced by infusion of Escherichia coli endotoxin. Eighteen of the sample pairs were obtained from pigs prior to infusion of endotoxin or from control pigs. Oxygen saturation and venous oxygen content were measured by direct oximetry. Analysis of bias and precision was used to compare jugular venous blood values with values obtained from mixed venous blood. Samples from endotoxemic pigs were subclassified on the basis of abnormal states of global oxygen imbalance associated with septic shock. RESULTS: Indices of venous oxygenation measured from jugular venous blood were an imprecise method of estimating values measured from mixed venous blood. There was no significant difference in bias between nonendotoxemic and endotoxemic pigs, regardless of abnormal hemodynamic states. CONCLUSION: Jugular venous blood oxygen saturation and oxygen content values should not be used to assess global oxygen transport during endotoxic shock.