Spontaneous pneumothorax due to Birt-Hogg-Dube syndrome in a Chinese family

A Chinese woman presented with a spontaneous pneumothorax and a family history suggestive of the autosomal dominant transmission of pneumothorax. The patient also had skin fibrofolliculomas and folliculin gene deletion, compatible with Birt-Hogg-Dube (BHD) syndrome. The importance of BHD syndrome and other familial spontaneous pneumothoraces is discussed.     

Analysis of tip malposition and correction in peripherally inserted central catheters placed at bedside by a dedicated nursing team

PURPOSE: To analyze the patterns of postplacement tip malposition in peripherally inserted central catheters (PICCs) placed at bedside, and to describe results of bedside and imaging-guided correction of tip malposition. MATERIALS AND METHODS: With use of a quality assurance database, all episodes of tip malposition in PICCs placed at bedside were reviewed. Catheter tip location, success or failure of bedside repositioning (in a subset of patients, by using over-the-wire techniques), findings in the interventional radiology (IR) division, and tip correction method used in the IR suite (repositioning vs replacement) were determined with a review of medical records. RESULTS: During the 18-month study period, 2,367 attempts were made to place a PICC at bedside; 1,654 attempts (70%) were initially successful. Of these, 163 tips (10%) were malpositioned. Complete records for 132 malpositioned tips were available for analysis. Malpositioned tips were located in the ipsilateral internal jugular vein in 45 of the 132 cases (36%), axillary vein in 36 cases (27%), ipsilateral subclavian vein in 25 cases (19%), ipsilateral brachiocephalic vein in 15 cases (11%), contralateral subclavian vein in four cases (3%), contralateral brachiocephalic vein in two cases (2%), contralateral internal jugular vein in one case (1%), and subclavian tributary in one case (1%). In three cases (2%), the tip was coiled in the superior vena cava. Malposition was corrected with catheter exchange in 76 of the 132 cases (58%), repositioning in 48 cases (36%), or removal in one case (1%). Spontaneous correction occurred in seven of the 132 malpositioned tips (5%). One hundred nine tips (83%) were repositioned in the IR division with use of imaging guidance, with 100% success. Twenty-five attempts were made to correct malposition at bedside; 16 of those attempts (64%) were successful. CONCLUSION: Tip malposition is relatively frequent with bedside placement of PICCs. Preliminary data suggest that most malpositions can be corrected with bedside techniques. Spontaneous correction may occur but is relatively uncommon.     

Impact of tip culture on the management of infected tunneled hemodialysis catheters

PURPOSE: It is common practice to perform culture of the tip of a catheter when a previously indwelling vascular catheter is removed for presumed infection. This study was conducted to determine the effect of hemodialysis catheter tip cultures (CTCs) on patient management. MATERIALS AND METHODS: Patients whose tunneled hemodialysis catheter (TDC) was removed for infection and who had a CTC between July 2001 and June 2006 were identified. The study sample included 242 patients with 330 catheters (109 men, 133 women). Patients' mean age was 58 years (range, 22-94 y). Catheter tip and blood culture (BC) results obtained during the event leading to catheter removal were recorded. Antimicrobial therapy before and after cultures was recorded. Medical records were reviewed for any indication that the treatment plan was influenced by tip culture results. RESULTS: Of 330 catheters, 134 had positive CTC findings; of these, complete records were available for 52 catheters. The treatment plan for patients with suspected catheter-related bloodstream infection (CRBSI) leading to TDC removal did not change in response to semiquantitative CTC results (51 of 52 patients; 98%). In a single case in which CTC results impacted management, this was because of a delay in processing BCs. Negative CTC findings (n = 108) never changed management (ie, resulted in cessation of antibiotic therapy). Seventy-three percent of patients (n = 38) received empiric antibiotics before any culture results. In these cases, the BC susceptibility profiles confirmed the appropriateness of the initial treatment (n = 10) or led to a change (n = 28). CONCLUSIONS: CTC did not alter management in the treatment of TDC infection. Because CTCs increase costs, their routine use should be abandoned in this population.     

Cancer Prevention through Legislation-Hong Kong Experience

Cancer is the major cause of death worldwide and in the local community. Due to the aging population and changes in lifestyle of the citizens, it is expected that the incidence of cancer will continue to increase. In fact, according to the World Health Organization, about 30% of cancer death can be prevented. The fight against cancer relies on support from the government, together with collaborations with the policymakers, healthcare professionals, and the public. Legislation can act as a tool for cancer prevention. The purpose of this paper is to provide an overview of the global cancer burden and to describe how cancer legislation acts as a tool for cancer prevention in the Hong Kong region.     

Patient satisfaction with out-of-hours primary care in the Netherlands

Background  

In recent years out-of-hours primary care in the Netherlands has changed from practice-based to large-scale cooperatives. The purpose of this study is to determine patient satisfaction with current out-of-hours care organised in general practitioner (GP) cooperatives, and gain insight in factors associated with this satisfaction.     

Prospective study of balloon inflation pressures and other technical aspects of hemodialysis access angioplasty

PURPOSE: Balloon angioplasty is a mainstay in the treatment of failing or thrombosed hemodialysis access grafts and fistulas. A sizable body of outcomes data exists concerning percutaneous transluminal angioplasty (PTA) in hemodialysis access, yet there is a relative paucity of technical information available, especially regarding dilation pressures. The aim of the present study was to compile such information, which can be critical to the choice of devices for PTA and to the design of future clinical trials seeking to improve outcomes in this area. MATERIALS AND METHODS: Technical data were collected prospectively for 102 PTA procedures (66 prophylactic PTA procedures and 36 PTA procedures performed during access thrombectomy). Demographic data concerning the access were collected. Technical data were collected individually for each lesion treated, including lesion location; degree of stenosis (in quartiles); lesion length; PTA balloon brand, size, and length; pressure at which the waist of the balloon was effaced; residual stenosis; and reason for additional balloons or inflations if used. Outcomes data other than residual stenosis were not collected, but the endpoint for all interventions was a thrill in the access. RESULTS: A total of 230 lesions were treated. Two (1%) could not be successfully treated with PTA despite the use of "ultra high" pressure (approximately 40 atm); one was treated successfully with parallel wire technique and the other was revised surgically after the use of a cutting balloon also failed. Overall, 55% of lesions required pressures greater than 15 atm to efface the waist. Excluding initial failures, 20% of lesions in native fistulas and 9% in grafts required very high pressure (>20 atm) to efface the waist (P = .02). High pressure was needed less frequently in PTA procedures performed in the setting of thrombectomy procedures than in prophylactic PTA procedures (P = .0001). Residual stenosis was positively correlated with severity of initial stenosis and negatively correlated with duration of inflation. CONCLUSIONS: Conventional angioplasty balloons are inadequate for the treatment of most hemodialysis access stenoses. High pressures (>15 atm) are commonly needed for PTA in hemodialysis access. Very high pressures (>20 atm) are more frequently needed in native fistulas.     

Comparison of sequential versus simultaneous methods of adrenal venous sampling

PURPOSE: To compare two methods of adrenal venous sampling (AVS) in preoperative localization of adrenal lesions in primary hyperaldosteronism. MATERIALS AND METHODS: Twenty-one patients (13 men, eight women) underwent selective adrenal venous sampling between July 2001 and May 2003. One of the 21 patients underwent repeat AVS, for a total of 22 procedures. In half the procedures (n = 11), simultaneous bilateral adrenal venous catheterization and sampling was performed before and after intraprocedural adrenocorticotropic hormone (ACTH) administration; in the remaining half (n = 11), sequential catheterization of the left and right adrenal veins was performed during continuous ACTH infusion 1 hour before and throughout AVS. Chart review provided procedural data, including sampling intervals and aldosterone/cortisol ratios. Patient records provided clinical data, including blood pressure, serum aldosterone levels, and computed tomography and magnetic resonance imaging findings. Surgical pathology reports confirmed unilateral disease but were not applicable to bilateral disease. RESULTS: Selective AVS was completed successfully in 21 of 22 procedures (95%); the unsuccessful sampling was repeated successfully. Disease lateralized in 13 of 22 cases. Simultaneous bilateral AVS localized unilateral disease in seven of eight cases (88%) and was nondiagnostic in one case (13%), with cases confirmed by surgical pathology reports. Sequential bilateral AVS localized unilateral disease in four of four cases (100%) confirmed by surgical pathology reports, with one lost to follow-up. Bilateral disease was diagnosed in six of 22 cases: two of 11 by simultaneous AVS and four of 11 by sequential AVS. Three of 22 cases demonstrated borderline hormone levels that failed to meet the diagnostic threshold for recommended adrenalectomy. Mean elapsed time between acquisition of right and left samples did not differ between simultaneous and sequential AVS (P = .09). Baseline (prestimulation) sampling did not contribute unique diagnostic information in any case and provided contradictory or confounding information in three of 11 simultaneous AVS procedures (27%). CONCLUSIONS: Sequential bilateral catheterization does not compromise the reliability of time-sensitive AVS. Both simultaneous and sequential AVS are adequate studies; however, obtaining baseline prestimulation samples during simultaneous AVS is unnecessary and increases the cost of the procedure.     

Use of balloon-expandable stents in transjugular intrahepatic portosystemic shunts in cases of Wallstent endoprosthesis technical failure and revision of shunt stenosis

Thirteen patients underwent placement of a balloon-expandable stent either at initial transjugular intrahepatic portosystemic shunt (TIPS) creation (n = 3) because of immediate technical failure of the Wallstent or at shunt revision because of failure of the Wallstent to reduce the portosystemic gradient 相似文献   

黄芩汤及其肠道菌群的代谢产物对D-半乳糖胺诱导的肝损伤的保护作用的比较研究

目的 :对黄芩汤及其经肠道菌群作用后的代谢产物的体内保肝作用进行比较研究。方法 :使用普通和伪无菌小鼠 ,用D-半乳糖胺造成肝脏损伤模型 ,分别给予黄芩汤和黄芩汤的代谢产物 ,测定给药 3d后血清中丙氨酸氨基转换酶 (ALT)和天门冬氨酸氨基转换酶 (AST)的活性。结果 :普通小鼠口服黄芩汤后 ,高、中剂量组小鼠血清中ALT水平明显下降 ,与模型组产生显著差异 ;伪无菌小鼠口服黄芩汤代谢产物之后 ,高、中剂量组血清中ALT水平显著下降 ,但黄芩汤 3个剂量组对其无相似的药理作用。结论 :黄芩汤经过肠道菌群作用后的代谢产物是体内产生保肝降酶作用的物质基础。