Cases reported "Kidney Failure, Chronic"

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1/10. Transverse cervical artery pseudoaneurysm: a rare complication of internal jugular vein cannulation.

    Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. Internal jugular vein catheterization is associated with a high rate of successful catheter placement. However, significant complications such as internal carotid artery (ICA) puncture, pneumothorax, vessel erosion, thrombosis, airway obstruction and infection can occur. The most common complication is ICA puncture. More recently a few cases of thyrocervical trunk pseudoaneurysm and fistula following internal jugular vein and subclavian vein catheterization attempts have been reported. patients with renal failure who are on hemodialysis may have to undergo multiple catheter placements and vascular access interventions. This, along with their comorbid conditions, increases the risk of such complications. Here we report a patient on hemodialysis who developed transverse cervical artery pseudoaneurysm following an attempted right internal jugular vein catheterization. We report this case because of its rarity, to raise awareness of such a complication and to discuss different treatment options, in particular endovascular coil occlusion. A review of relevant literature is also presented.
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2/10. Percutaneous thrombin injection of carotid artery pseudoaneurysm.

    PURPOSE: To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection. CASE REPORT: A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications. CONCLUSIONS: Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.
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3/10. Neurotoxicity of acyclovir in patients with end-stage renal failure treated with continuous ambulatory peritoneal dialysis.

    We report two cases of herpes-zoster in which the administration of acyclovir to patients with end-stage renal failure treated by continuous ambulatory peritoneal dialysis (CAPD) resulted in acyclovir neurotoxicity, even though the doses administered were within those recommended by the manufacturer's data sheet for patients with renal failure. acyclovir removal was negligible with peritoneal dialysis and one patient died. The other patient was successfully treated with hemodialysis, which effectively reduced plasma concentrations, resulting in an improvement in conscious state. acyclovir neurotoxicity should be considered in patients with renal failure who have been treated for viral infections, in whom the conscious state has deteriorated despite normal brain computed tomography (CT) scan and lumbar puncture investigations. Hemodialysis is the preferred treatment for the rapid removal of acyclovir.
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4/10. Translumbar high inferior vena cava access placement in patients with thrombosed inferior vena cava filters.

    Venous access is a dire necessity in some patients such as those with end-stage renal disease or short gut syndrome. The right internal jugular vein is the preferred entry site for tunneled central venous catheters. Alternatively, the left internal jugular is considered next, with the external jugular and subclavian veins being considered later. Catheter-related venous stenosis approaches 40% in certain sites, resulting in loss of access sites. As sites are lost, insertion of functional long-term central venous catheters becomes challenging. Translumbar inferior vena cava (IVC) access created in two patients with limited venous access sites who had thrombosed IVCs containing IVC filters is described. Because of the higher IVC punctures in these cases, procedural planning with cross-sectional imaging is crucial to avoid puncturing the right renal artery as it passes posterior to the IVC.
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5/10. Benign intracranial hypertension and chronic renal failure.

    Benign intracranial hypertension (also called pseudotumor cerebri, otitic hydrocephalus, or meningeal hydrops) is a syndrome of markedly elevated intracranial pressure in the absence of intracranial mass, inflammation, or obstruction. Numerous disease processes and medications have been associated with it. However, renal failure has not been documented as an associated condition. In this report, the case of a 27-year-old Native American man with chronic renal failure of unknown etiology is described, with new-onset headache, papilledema, and elevated intracranial pressure. After normal cerebrospinal fluid, computed tomography, and magnetic resonance imaging studies, a diagnosis of benign intracranial hypertension was made. Despite repeated lumbar punctures with cerebrospinal fluid removal, the patient's headaches persisted, and intracranial pressures remained in the 200 to 400 mm H2O range. After initiation of hemodialysis due to progressive deterioration of renal function, the patient's headaches became less severe and eventually disappeared. This case represents a unique association of chronic renal failure with benign intracranial hypertension.
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6/10. Infective tricuspid valve endocarditis due to abscess of an endogenous arteriovenous fistula in a chronic hemodialysis patient.

    patients on chronic hemodialysis are at high risk for endocarditis due to prosthetic access devices. Right-sided endocarditis without any predisposing factors is rare in dialysis patients. A 76-year-old female, who had chronic renal failure had been treated by hemodialysis and had a permanent pacemaker implanted, was admitted to our hospital with a high fever and lumbago after abscess formation at an autogenous arteriovenous fistula for hemodialysis. methicillin Resistant staphylococcus aureus was identified by blood culture examination. echocardiography revealed vegetation attached to the tricuspid valve. Chest X-ray and perfusion lung scintigraphy showed pulmonary infarction, perhaps due to vegetation-derived emboli. Computed tomography also showed pyogenic spondylitis in L4 and L5. Repeated vascular punctures even of autogenous grafts expose dialysis patients to bacteremia and imply a higher risk of infectious endocarditis.
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7/10. mitral valve repair in patients on chronic hemodialysis.

    Two cases of successful mitral valve repair in patients on chronic hemodialysis are presented. We stress that valve repair is preferable to valve replacement whenever feasible because of improved left ventricular function, reduced complication rate, and freedom from anticoagulation. This especially applies to patients on chronic hemodialysis as they have impaired immunological function, are subjected to repeated fistula punctures with possible bacteremia, and are more susceptible to early calcification and degeneration of tissue valves.
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8/10. Grey-Turner's sign in sclerosing peritonitis.

    A 41-year-old CAPD patient developed Grey-Turner's sign during the course of bacterial peritonitis due to pseudomonas aeruginosa. At the same time a diagnosis of sclerosing peritonitis was made by CT-scanning of the abdomen. We think that Grey-Turner's flank staining could either have been caused by synthesis of proteases by the Pseudomonas bacteria or by reduced mesenteric flexibility and increased vascularization of the peritoneum due to the sclerosing peritonitis. This could have led to spontaneous mesenteric bleeding with leakage to the retroperitoneal tissues. A possible relationship with an ascites puncture is less likely.
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9/10. pasteurella multocida peritonitis in patients undergoing peritoneal dialysis.

    A 12-year-old girl on peritoneal dialysis developed sub-clinical peritonitis due to pasteurella multocida, following puncture of her dialysis tubing by a domestic cat. Only four other similar cases of P. multocida peritonitis have been reported in adults. This unusual form of peritonitis could be easily prevented by not allowing domestic animals to come into contact with dialysis tubings in patients undergoing peritoneal dialysis.
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10/10. Use of a puncture needle for recanalization of an occluded right subclavian vein.

    We report a patient in whom we used a puncture needle to initiate percutaneous recanalization of a chronic occlusion of the junction between the right subclavian vein and the right brachiocephalic vein. Under fluoroscopic guidance, an 18-gauge needle was used to puncture the right subclavian vein. When contrast material injected through the needle confirmed intravascular location, the needle was advanced until it deflected and perforated an occlusion balloon target positioned within the right brachiocephalic vein. This technique may be useful in patients with central venous occlusions that are refractory to traversal using traditional catheter and guidewire techniques.
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