A peripherally inserted central catheter misplacement into lateral thoracic vein: A case report

IntroductionCentral venous catheter applications and complications are closely related to the tip position. Previous studies have reported some rare cases of catheter misplacement. Here, we report a case of misplacement of a peripherally inserted central catheter into the lateral thoracic vein.Case reportA 56-year-old cancer patient underwent placement of a peripherally inserted central catheter through the left basilic vein under ultrasound-guided puncture. The catheterisation procedure was uneventful, so the catheter was believed to be in the superior vena cava. However, the post-anterior chest X-ray image revealed that after the catheter advanced towards the axilla, it turned downwards and outwards in the direction of the left lateral thoracic region, with the projection of the catheter tip giving the appearance of termination in the subcutaneous tissue of the lateral thoracic wall on the two-dimensional image. The catheter was then repositioned in the distal superior vena cava.DiscussionPeripherally inserted central catheters can be potentially misplaced into the lateral thoracic vein because these catheters can pass through the orifice of the lateral thoracic vein which flows into the axillary vein. Some pathological cases and clinical conditions can cause dilatation of the lateral thoracic vein, which increases the probability of catheter misplacement. Three principles were proposed to avoid this rare complication: a comprehensive review of the patients’ medical history, real-time image-guided catheterisation and routine radiographic identification of the tip position.     

微创经皮肾穿刺取石术并发症的防治

目的探讨微创经皮肾穿刺取石术常见并发症的原因及其防治措施。方法回顾性分析我院428例微创经皮肾穿刺取石术产生的并发症及其相关处理的临床资料。结果143例（33.41％）术中／后出现各种并发症,其中严重的并发症37例（8.64％）,包括术中大出血5例（1.17％）,上尿路损伤7例（1.64％）,液气胸4例（O.93％）,茵／毒血症15例（3.50％）,术后继发性大出血6例（1.40）。结论微创经皮肾穿刺取石术有一定的并发症,了解其发生的原理,作好充分术前准备,术中规范操作,可以预防和妥善处理这些并发症。     

CT引导下经皮肾造口术的临床应用和技术探讨

目的 评价CT引导下经皮肾造口瘘术(PCN)的安全性和有效性,探讨相关技术要点和注意事项.方法 回顾性分析341例患者428例次CT引导下PCN的临床和手术资料,包括肾积水原因、穿刺次数、操作时间、成功率、并发症和临床效果.结果 428例次CT引导下PCN操作,单纯CT引导下完成420例次,占98.13%,结合X线透视下完成8例,占1.87%,总体成功率100%.肾盏穿刺次数:1次262例次,2次107例次,3次54例次,4次5例次,平均1.54次.操作时间15～43 min,平均27.43 min.所有患者PCN术后临床均显著好转.15例(4.40%)发生轻微并发症,包括肾周血肿3例、发热7例、导管早期脱出5例,无严重并发症发生.结论 CT引导下经皮肾造瘘术安全有效,注意技术要点、仔细操作能够减少并发症.     

Retrograde nephrostomy and percutaneous resection of fibroepithelial polyps of the renal pelvis

Summary

Benign fibroepithelial polyps of the renal pelvis are extremely rare with only 20 cases reported in the literature. Fibroepithelial polyps of the ureter occur more frequently. We report a case of fibroepithelial polyps in the renal pelvis near the ureteropelvic junction successfully treated by retrograde nephrostomy and percutaneous resection.     

B超和X线片联合引导下微创经皮肾镜治疗肾结石

目的探讨B超和X线片联合引导下应用微通道经皮肾镜技术治疗肾结石的临床意义。方法对462例肾结石患者在B超和X线C臂机联合定位引导下,建立微创工作通道行经皮肾镜取石。结果均准确建立理想的穿刺、工作通道,结石临床清除率为85.71%,462例患者均未出现严重并发症。结论 B超和X线片联合引导下经皮肾镜技术治疗肾结石,既可提高工作通道建立的准确性及安全性,增加手术的成功率,又在一定程度上减少了术中的辐射损伤,临床效果理想。     

超声与透视相结合行经皮肾穿刺造瘘术的临床价值

目的：评价超声与透视相结合在经皮肾穿刺造瘘术中的应用价值。方法：对53例不同原因所致的肾盂积水或积脓患者,采用在超声与透视相结合引导下经皮肾穿刺造瘘术。结果：本组53例患者共穿刺58个肾脏,其中右肾33例,左肾25例,其中同时行双侧穿刺3例。其中一次穿刺成功率为96.6%（56/58）,2例失败而行对侧肾盂穿刺。共留置造瘘引流管56枚,造瘘引流管留置成功率100%（56/56）。术后患者肾脏功能改善明显,全部病例均无严重并发症发生。结论：超声与透视相结合行经皮肾穿刺造瘘快速、安全、微创、有效且并发症少,值得推广应用。     

超声引导下经皮肾造瘘术对患肾功能改善的评价

目的 探讨超声经皮肾造瘘术治疗肾积水的效果及其用于评价患肾功能的临床价值。 方法 利用超声引导经皮穿刺肾造瘘术对 26 例肾积水患者( 30 例患肾) 进行治疗,超声测量患肾治疗前后肾叶间动脉血流阻力指数及肾实质厚度,术后1周每天记录24小时引流尿量。结果 经皮穿刺肾造瘘术后依据患肾 24 h 引流尿量,分为改善组(22例)及无功能组(8例), 改善组术前肾实质厚度为1.9±0.4cm,无功能组肾实质厚度为1.1±0.2cm,组间具有统计学差异(P<0.01);改善组术前叶间肾动脉血流RI为0.67±0.07,无功能组肾动脉血流RI为0.8±0.02,组间具有统计学差异(P<0.01)。改善组及无功能组患肾术后肾叶间动脉血流阻力指数均较术前显著降低(P<0.01),肾实质厚度均较术前显著增厚(P<0.01)。结论 超声引导下经皮穿刺肾造瘘术操作简便、小创伤、高疗效,成功率及安全性高,能够准确评估和有效地改善患肾功能,为进一步治疗选择提供一定的参考依据,具有较高的临床应用价值。     

Life-threatening intracardiac cement embolisms after percutaneous kyphoplasty: a case report and literature review

BackgroundPercutaneous kyphoplasty is a popular technique in the treatment of osteoporotic vertebral fractures, but intracardiac cement embolism can be a life-threatening complication.Case presentation: The authors present a case involving a patient who developed dyspnea and chest tightness after percutaneous kyphoplasty. Echocardiography and chest computed tomography confirmed several foreign bodies in the right atrium and pulmonary arteries causing cardiac perforation and pericardial tamponade. Conservative treatment was administered, and the patient died of respiratory and heart failure.ConclusionsThe present case highlights that surgical removal may be the first-choice treatment for symptomatic intracardiac cement embolism.     

经皮肾镜超声碎石术术中监测肺功能和中心静脉压的临床意义

目的 在经皮肾镜超声碎石术(PCNL)期间观察中心静脉压和肺功能,预防可出现的灌流液吸收综合征.方法 选择ASAⅠ或Ⅱ级择期上尿路结石经皮肾镜超声碎石术病人60例,采用全凭静脉麻醉.选麻醉前、手术前及术中每30min为记录时间点.纪录中心静脉压(CVP),肺顺应性(Cs)、动态肺顺应性(Cd)、呼吸指数(RI).结果 60例患者中56例顺利完成手术,CVP、RI在T1-5各时段呈递增趋势,Cs,Cd在T1-5各时段呈递减趋势,并在T3-5变化显著,有4例出现灌流液吸收综合征.结论 CVP、RI随手术时间的延长而升高;Cs、Cd随手术时间的延长而减低;当手术时间＞2h,并发症明显增多,应尽快结束手术.     

经皮肾穿刺造瘘术与开放手术治疗肾后性急性肾功能衰竭的疗效对比分析

目的 探讨经皮肾穿刺造瘘术(PCN)治疗肾后性急性肾功能衰竭(PARF)患者的效果及应用价值.方法 回顾性总结分析40例PARF患者在B超引导下行PCN的临床资料,并与20例行常规开放手术患者进行对比.结果 肾穿刺组PCN成功率为100%,引流后2～7 d,患者肾功能均恢复正常;治愈30例;长期留置肾造瘘管10例,其中2例为腹腔继发肿瘤患者,8例为宫颈癌晚期患者;无一例死亡、无造瘘后肾周血肿和胸膜损伤发生,未出现术后感染、多器官功能衰竭等并发症.开放手术组于引流后2～7 d 19例患者肾功能恢复正常,其中术后出现肺部感染3例,经抗感染、对症治疗后好转;多器官功能衰竭死亡1例.结论 PCN具有创伤小、出血少的优点,对挽救PARF患者肾脏功能有重要价值.     

Encrustations of the urinary catheter and prevention strategies: a literature review

Patients with an indwelling urinary catheter are at risk of developing urinary tract infection: for each day of the catheter remaining in situ, there is an increasing risk from 3% to 7% for infection to appear. One of the main complications of catheterization is the onset of encrustations, frequently resulting in obstruction of the catheter. Aim of this study is to describe the problem of indwelling urinary catheter encrustation and prevention strategies. A narrative review of the literature was conducted. Indwelling urinary catheter encrustations originate more easily when urine contains high concentrations of poorly soluble constituents and when the state of the urinary tract enables their precipitation as an alkaline urinary pH, often associated with the presence of bacteria urease‐producers, for instance Proteus mirabilis. Urease can generate crystals and this process keeps going until the accumulation of crystalline deposits block the urine flow within the catheter lumen. The literature suggests that there are manifold pharmacological and non‐pharmacological strategies to prevent encrustations. The literature analysis suggests that the permanence of the catheter could potentially be one of the most relevant causes of encrustation. The catheterization duration is the most important risk factor for bacteriuria, essential for the process of encrustation to start off. There are many prevention strategies, among which promotion of nucleation pH (pHn) supplementation in the daily diet with liquids containing citrate; this is the most simple and suitable for all patients being inexpensive and effective.     

Near-infrared ray catheter and indocyanine green via nephrostomy in delayed robotic reconstruction of injured ureter: A case report

Delayed surgical reconstruction of iatrogenic ureteral injuries is often a challenging procedure because spreading scar tissue impedes accurate identification and dissection of the injured ureter. We report a novel real-time navigation system using a ureteral near-infrared ray catheter (NIRC) and indocyanine green (ICG) via nephrostomy in delayed robot-assisted ureteral reconstruction. A female patient presented with complete obstruction of the right upper ureter after gynecological surgery with extensive lymphadenectomy. A nephrostomy tube was urgently placed, and surgical repair was performed. A straight NIRC was placed in the right ureter up to the obstruction point. ICG was administered via nephrostomy. Near-infrared light could clearly visualize the ureter and renal pelvis encased in scar tissue. The ureter and renal pelvis were dissected and successfully anastomosed. We found that near-infrared navigation using ureteral NIRC and ICG via nephrostomy was valuable for delayed laparoscopic reconstruction of the injured ureter.     

静脉内上皮样血管内皮瘤─附病例报告及文献复习

报告１例经免疫组化及电镜证实的下肢静脉内上皮样血管内皮瘤。患者女性，６８岁，同时患有对侧小腿浮肿，双下肢静脉炎。我们结合文献复习对该肿瘤的临床和病理特征、预后以及与梭形细胞血管内皮瘤的相关性等问题进行了讨论。     

1例完全植入式手臂输液港导管与注射座脱离的报道并文献复习

摘要：完全植入式输液港（totally implantable access port, TIAP）在临床静脉输液治疗中主要用于恶性肿瘤患者化疗或胃肠外营养支持治疗等领域[1]极大的改善了恶性肿瘤患者的生活质量。上臂植入式输液港选择从左上肢或右上肢静脉穿刺并植入。与锁骨下静脉或颈内静脉植入相比,经上臂植入输液港植入有穿刺成功率高,无发生气胸、血胸的优势。上臂式输液港在临床使用中的并发症有：感染、血栓、堵塞、移位、导管断裂或者滑脱等[2-4],其中,导管断裂或者滑脱是非常严重的并发症,在临床实践中需要及时发现并迅速处理。本文通过上臂式输液港导管滑脱至心脏及肺动脉的处理过程,系统地回顾该类并发症的发生概率、处理措施。以期通过合理的预防措施来降低此类并发症的发生概率,同时提供处理此类并发症的有效方法。     

Pregnancy and delivery after augmentation cystoplasty: A case report and review of literature

BACKGROUNDAugmentation cystoplasty, first described by Mikulicz in 1899 involves segments of bowel, stomach or mega-ureter to increase bladder capacity in those with inadequate bladder function or lack of detrusor compliance. The most widely used bowel segment is a detubularised patch of ileum. When ileum is not suitable for augmentation, sigmoid colon is the alternative. However, only eight pregnancies after sigmoidocystoplasty have been reported without detail and clinicians may be uncertain about the effects of sigmoidocystoplasty on reproductive health and pregnancy. CASE SUMMARYWe followed the patient from gestational week 32+3 until 6 wk after delivery. During pregnancy, our patient suffered urinary tract infection twice and had to undergo percutaneous nephrostomy drainage due to progressive hydronephrosis. Despite a dense adhesion between the uterus and neobladder, we were able to deliver a healthy baby by cesarian section in the presence of the attending urologist.CONCLUSIONAugmentation cystoplasty-afflicted women can have a healthy reproductive life. Certain perioperative measures may be advisable to avoid serious surgical complications.     

CT引导下经皮穿刺置管引流在胰腺术后腹腔感染患者中的应用疗效

目的 探讨CT引导下经皮穿刺置管引流应用于胰腺术后腹腔感染的可行性、安全性及疗效。方法 回顾性纳入胰腺术后腹腔积液合并感染并接受CT引导下经皮穿刺置管引流的患者,分析穿刺置管对患者腹腔积液感染的治疗效果。结果 纳入8例胰腺术后患者,术后均出现腹腔积液合并腹腔感染。共完成10次CT引导下穿刺置管引流,置管13根,穿刺成功率100%。穿刺管引流液淀粉酶含量较高者达92.3%(12/13),细菌培养阳性率达100%,联合应用抗生素治疗后均治愈。结论 CT引导下经皮穿刺置管引流是胰腺术后腹腔积液感染治疗的重要手段,安全有效、创伤小。     

Palliative percutaneous nephrostomy in recurrent cervical cancer: a retrospective analysis of 50 consecutive cases

Cervical cancer is a public health problem in Brazil, with annual incidence rates of 20–40 cases/100,000 women. Most patients with recurrent disease have symptoms from locoregional disease and may develop renal failure. This study aims to evaluate the outcome of patients with recurrent cervical cancer who underwent percutaneous nephrostomy (PN). We reviewed the medical records of 50 such patients who were referred to the Palliative Care Unit of the Brazilian National Cancer Institute from January 2002 to October 2006. Median age was 44 years (range, 26–67 years). Half the patients had improvement in pain or uremic symptoms, and seven (14%) had improved performance status (PS) after the procedure. Thirty patients (60%) had improvement of renal function; median creatinine levels before and after PN were 6.4 and 3.7 mg/dL, respectively (P < 0.05). Median overall survival after PN was 8.9 weeks (95% confidence interval [CI]: 7.4–10.3). Median survival was 9.9 weeks (95% CI: 8.7–11.0) in 40 patients with baseline PS 1–3 and one week (95% CI: 0.1–1.9) in 10 patients with PS 4 (log rank, P < 0.0001). Median survival in patients with and without improvement of renal function after PN was 10.0 weeks (95% CI: 8.6–11.3) and 2.6 weeks (95% CI: 0–11.3), respectively (log rank, P = 0.01). Twenty-nine patients (58%) died from renal failure. Complications were mainly urinary tract infection (n = 10), catheter loss (n = 9), and bleeding (n = 1). These data suggest that PN can be of clinical benefit for carefully selected patients with recurrent cervical cancer.     

Management of inferior vena cava injury and secondary thrombosis after percutaneous nephrolithotomy: a case report

Percutaneous nephrolithotomy (PCNL) remains an important method for treating upper urinary calculi. However, bleeding and peripheral vascular injury are serious complications of PCNL. Injury of the inferior vena cava accompanied by secondary thrombosis has rarely been reported clinically. We treated a patient who experienced bleeding during PCNL to establish a channel. A catheter was used to make a renal fistula, and the inferior vena cava was implanted. The wound was fixed and compressed by balloon injection, and secondary thrombosis and repeated infection occurred after the operation. A filter was then placed, the water balloon was released, and the fistula was removed. The anti-bacterial and anticoagulant filter was removed. This major complication was successfully managed. In our patient, during PCNL, the renal fistula entered the inferior vena cava by mistake. If this issue cannot be treated in time, it can easily lead to the formation of secondary thrombosis. A fistula can be extracted through an inferior vena cava filter, and anticoagulant treatment and other conservative treatment regimens can be used to treat patients in this situation. These treatments avoid the possibility of further damage from open surgery.     

Hypopharyngeal perforation following minor trauma: a case report and literature review

Hypopharyngeal perforation is mainly reported in association with high velocity road traffic accidents, or with low velocity direct blows to the neck. We report a case of hypopharyngeal perforation following a low velocity motorcycle accident where neither of these mechanisms of injury was apparent. A 52 year old man was referred from the emergency department (ED) with a sore throat and dysphagia, following a low speed side impact accident. A gastrograffin swallow demonstrated a posterior pharyngeal wall tear. After 11 days of conservative hospital treatment, he recovered and was discharged. The presumed mechanism of injury in this case was cervical spine hyperextension without cervical compression.