1/17. Minimally invasive direct coronary artery bypass grafting using the saphenous vein in redo CABG.We describe a patient who underwent minimally invasive direct coronary artery bypass (MIDCAB), who had previously undergone coronary artery bypass grafting (CABG) through a median sternotomy with a left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) and a right gastroepiploic artery (GEA) graft to the posterior descending artery. MIDCAB was less invasive and was an effective alternative procedure for the second operation. Because the patient had no LIMA or GEA available for a graft because of prior use, we used a saphenous vein graft (SVG) for bypassing from the left subclavian artery to the coronary artery by MIDCAB via a left minithoracotomy. The left subclavian artery was selected as the proximal anastomotic site because this artery was less diseased and was easier to reach. The SVG-to-coronary artery anastomosis was facilitated by firm adhesion between the epicardium and the pericardium, which reduced the motion of the epicardium itself. These results suggest that the procedure is safe and promising in selected cases of redo CABG.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/17. Practical considerations in dialysis withdrawal: "to have that option is a blessing".Cessation of life-support treatment is an appropriate option for situations in which the burdens of therapy substantially outweigh the benefits. Decisions to withdraw dialysis now precede 1 in 4 deaths of patients who have end-stage renal disease. Guidelines have been recently published to assist clinicians in making these complex and emotionally charged determinations, and they include: relying on shared decision making by all participants, obtaining informed consent, estimating the prognosis on dialysis, adopting a systematic approach for conflict resolution of disagreements, honoring advance directives, and ensuring the provision of palliative care. These principles are discussed in relation to an elderly man with dementia whose family decided to terminate maintenance hemodialysis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/17. Bilateral and simultaneous rupture of the triceps tendons in chronic renal failure and secondary hyperparathyroidism.BACKGROUND: We report a case of a 27-year-old (male) patient with bilateral and simultaneous rupture of the triceps tendons. He was suffering from chronic renal failure secondary to acute glomerulonephritis and for 4 years he underwent maintenance hemodialysis three times a week. This injury is extremely rare, and only one case has been reported in the international literature. Based on previous cases of tendon ruptures in patients with chronic renal failure, we believe that secondary hyperparathyroidism is the primary causative factor in his case. CASE REPORT: A primary repair was performed using heavy, nonabsorbable sutures passed through holes drilled in the olecranon with the technique described by Levy. The suture line was then protected with a figure-of-eight tension band wire. Our patient obtained full range of motion bilaterally within 3 months.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/17. Home nocturnal hemodialysis in children.OBJECTIVE: To describe the effect of home nocturnal hemodialysis (NHD) in North American children. STUDY DESIGN: Four teenagers underwent NHD for 8 hours, 6 to 7 nights/week, using either central venous lines or fistulae for periods of 6 to 12 months. Blood flow approximated 200 mL/min, and dialysate flow was 300 mL/min; the dialysate contained potassium and phosphate. The procedure was remotely monitored. RESULTS: The children had unrestricted diets and fluid allowance and did not require phosphate binders. Persistent relative hypotension developed in 2 of 4 children. Weekly Kt/V urea values were consistently >10; other biochemical measures varied. quality of life and school attendance improved in 3 of 4 children. The workload and reported emotional burden of NHD was substantial. No significant complications occurred. Dialysate losses of calcium, phosphate and carnitine required supplementation. The annual cost per patient was dollar 64,000 Canadian, which represented a 27% savings compared with thrice weekly in-center hemodialysis. CONCLUSIONS: NHD is feasible in selected children, allows free dietary and fluid intake, and improves patient wellbeing. The burden on the family is substantial, and NHD requires support of a dedicated multidisciplinary team.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/17. Efficacy of biventricular pacing for dialysis-related hypotension due to idiopathic dilated cardiomyopathy.A 45-year-old man who had been undergoing maintenance hemodialysis for end-stage renal failure, caused by chronic glomerulonephritis 4 years before, was admitted to our hospital for biventricular pacemaker implantation (BVP). Ten years ago, he was diagnosed with idiopathic dilated cardiomyopathy, and had been suffering from dialysis-related hypotension (DRH) due to low cardiac function over the past year. An electrocardiogram revealed complete left bundle branch block with a QRS duration of 180 ms, and echocardiography showed moderate hypokinesis of the left ventricular wall and systolic asynchronized motion of the septum and free wall. After BVP, the left ventricular ejection fraction had increased from 29% to 40%, and the transmitral rapid left ventricular filling (E wave) and atrial contraction (A wave) ratio (E/A) had improved from 1.3 to 1.0. Before and after BVP, we measured hemodynamic parameters during hemodialysis by successive echocardiography. Before BVP, systemic vascular resistance had decreased, cardiac output had not changed, and hypotension was noted. In contrast, after BVP, cardiac output had increased and systemic vascular resistance had not changed, which caused an increase in blood pressure. We conclude that BVP improved the cardiac function which resulted in an improvement in dialysis-related hypotension (DRH).- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/17. Increased plasma TGF-beta 1 level in patient with salivary gland carcinoma after renal transplantation.TGF-beta1 maintains homeostasis of rapidly proliferating cells, therefore is a potential tumor suppressor of non-malignant cells. Malignant transformation alters TGF-beta1 signalling pathway, turning it into a stimulator of tumor progression. We describe the case of 54 year old renal transplant patient with highly increased plasma TGF-beta1 level and planoepithelial carcinoma originating from parotid salivary gland. We discuss the role of TGF-beta1 in promotion of carcinogenesis and probable utility in prognosis of malignancy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/17. Description of 12 cases of nephrogenic fibrosing dermopathy and review of the literature.OBJECTIVES: To review the clinical and laboratory features of 12 cases of nephrogenic fibrosing dermopathy (NFD) studied at our institution and of 70 previously described cases in the literature. methods: Clinical evaluation and laboratory studies of 12 patients with NFD associated with chronic hemodialysis or peritoneal dialysis for end-stage renal disease and a review of 23 previous publications describing 70 patients with this disease. RESULTS: Eleven patients undergoing chronic hemodialysis and 1 patient undergoing chronic peritoneal dialysis for end-stage renal failure developed a severe and progressive cutaneous fibrotic process with woody induration of legs, thighs, hands, and forearms, and severe loss of motion and flexion contractures in multiple joints. Several patients displayed systemic involvement including fibrosis of muscles, myocardium, and lungs and marked elevations of the erythrocyte sedimentation rate and/or c-reactive protein. Three patients died within 2 years of symptom onset. A review of previously published reports of this disorder confirmed the presence of systemic involvement and a poor prognosis with a high mortality rate. CONCLUSIONS: NFD is a severe and usually progressive systemic fibrotic disease affecting the dermis, subcutaneous fascia, and striated muscles. It also appears that the disease can cause fibrosis of lungs, myocardium, and other organs.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/17. 'Takotsubo' cardiomyopathy in a maintenance hemodialysis patient.An 84-year-old woman undergoing maintenance hemodialysis presented with chest discomfort lasting several days and electrocardiographic abnormalities. She had stopped smoking 2 weeks earlier and was experiencing irritability. Upon admission, electrocardiography showed ST-segment elevation in leads I, II, aVF, and V2-6 and an abnormal Q wave in leads II, III, and aVF. Ultrasound cardiography showed left ventricular anteroapical akinesia and basal hyperkinesia. The chest discomfort disappeared without specific therapy. During hospital days 1-5, the ST-segment elevation gradually improved. Giant negative T waves then developed. The left ventricular asynergy resolved by day 8. radionuclide imaging with iodine-123-beta-methyl-p-iodophenyl pentadecanoic acid, but not with technetium-99 m-sestamibi, showed an apical defect. Elective coronary angiography showed no stenosis. 'Takotsubo' cardiomyopathy was diagnosed. After discharge, the patient continued regular dialysis without cardiac symptoms. We concluded that endogenously activated sympathetic nerve action in hemodialysis patients, especially those under emotional or physical stress, might be a causative factor for takotsubo cardiomyopathy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/17. Endovascular repair of perirenal and Group IV thoracoabdominal aortic aneurysms: a case study report.BACKGROUND: Endovascular aneurysm repair (EVAR) is an established technique used in infrarenal aneurysms. Fenestrated and branched endografts (FBEGs) are a new option for the treatment of perirenal and Group IV thoracoabdominal aortic aneurysms (TAAAs). With a case study design, the preparation, surgical technique, postoperative nursing care, and medical follow-up involved in Group IV TAAAs treated with an FBEG are discussed. methods: Detailed imaging with state-of-the-art computed tomography scanning is used to create a custom-made endograft in which a combination of fenestrations, scallops, and covered or uncovered stents are used for the visceral arteries. This graft can be introduced in the arterial system through the femoral artery and delivered at the level of the perivisceral abdominal aorta. perioperative nursing care in patients undergoing FBEG draws from protocols of an established EVAR program. With these protocols, preoperative assessment and education are completed to ensure that the patient is both physically and mentally prepared for the surgery. Intraoperatively, the nursing team is instrumental in the functioning of the case: The scrub nurse assists the surgeon while other registered nurses assist with invasive monitoring and emotional support for the conscious patient. Postoperatively, patients are taken directly from the recovery room to a step-down bed where close monitoring occurs. RESULTS: The use of FBEGs to treat Group IV TAAAs reduces the acuity of patient care by avoiding a thoracotomy and major surgical dissection, thus decreasing hospital length of stay. Although long-term follow-up remains limited, durability seems to be promising, and this procedure offers a viable option to high-risk patients. Because EVAR with FBEG is a new procedure in canada, nurses involved with every aspect of care are challenged to maintain high levels of competency by continually educating themselves in this evolving field.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/17. Malfunction of Tenckhoff catheter due to a rare kink.A case of sudden malfunction of Tenckhoff Catheter in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) treatment is reported. Upon laparotomy, the catheter was found to form a knob inside the peritoneal cavity. The report emphasized on the simple but effective diagnostic value of abdominal X-ray and the importance of care of the bowel motion in a patient on CAPD.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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