Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Renal transplantation has significantly improved survival of patients with end-stage renal disease (ESRD). Transplantation is the best treatment in this population of patients. Despite the introduction of various preventive measures, viral hepatitis, i.e. hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, are still a major problem because they are common in patients on renal replacement therapy as well as in allograft recipients. ⋯ The use of nucleid acid testing (NAT) could be useful because it involves amplification of viral gene products and thus is not dependent on antibody formation. Therefore, by using this method the period between the infection and detectability, which is known as the window period, could be reduced. However, this method is expensive and time consuming.
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The usage of temporary and permanent dialysis catheters for hemodialysis vascular access has been on continual increase. The reason for this increase is aging population on hemodialysis with blood vessels inappropriate for arteriovenous fistula creation. ⋯ Monitoring of dialysis catheter function, choice of the site of catheter insertion and methods of salvaging catheters from thrombosis and treating catheter-related local and systemic infections are described in this paper. Constant evaluation, proper care and hygiene of dialysis catheters are highly recommended.
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Randomized Controlled Trial Comparative Study
A comparative study on the sedative effect of oral midazolam and oral chloral hydrate medication in lumbar puncture.
Lumbar puncture (LP) is usually associated with anxiety and apprehension in children and their parents. This study was performed for controlling children's anxiety before and during LP and increasing the success of LP due to relaxation of the child following the use of sedative drugs and to compare the efficacy and side effects of oral midazolam and oral chloral hydrate. ⋯ Based on the level of sedation, side effects, time to onset of sedation and recovery time from sedation, oral chloral hydrate is a better sedative medication than oral midazolam.
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Observational Study
[Stroke volume and pulse pressure variation are good predictors of fluid responsiveness in sepsis patients].
Stroke volume variation (SVV) and pulse pressure variation (PPV) are dynamic preload indicators. Specific interactions of the cardiovascular system and lungs under mechanical ventilation cause cyclic variations of SVV and PPV. Real time measurement of SVV and PPV by arterial pulse contour analysis is useful to predict volume responsiveness in septic patients. Results of a prospective, 2-year observational study conducted at Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, are presented. Volume responders and non-responders were defined. Correlation between SW, PPV, stroke volume index (SVI) and other hemodynamic data in septic patients was analyzed. The study was conducted from September 2009 to December 2011. Sepsis group included 46 patients (22 male, age 46 +/- 6, APACHE II score 26 +/- 5, and 24 female, age 41 +/- 6, APACHE II score 24 +/- 4) undergoing major abdominal surgery with clinically and laboratory confirmed sepsis, defined according to the international criteria. ⋯ patients with LVEF < 45%, atrial fibrillation, aortic insufficiency, pulmonary edema, children, pregnant women, patients on lithium therapy, and patients who did not sign informed consent. Septic patients were divided into volume responders (VR) and volume non-responders (VNR). Responders were defined as patients with an increase in SVI of > or = 15% after fluid loading. SVV, PPV and SVI were assessed by arterial pulse contour analysis using the LiDCOTM plus system continuously for 8 hours. Simultaneously, cardiac index (CI), mean arterial pressure (MAP), heart rate (HR), oxygen delivery (DO2), oxygen consumption (VO2) and central venous oxygen saturation (ScvO2) were assessed. Hemodynamic data were recorded before and after fluid administration of 500 mL of 6% hydroxyethyl starch over 30 min. All patients were sedated with midazolam (0.05-0.15 mg/kg/h). Analgesia was maintained with sufentanil (0.2-0.6 microg/kg). All patients were intubated and mechanically ventilated (IPPV; FiO2 0.4; TV 7 mL/kg; PEEP 5 cm H2O) in sinus cardiac rhythm. Circulatory unstable patients had vasoactive support and SOFA scores calculated. Ventilator settings and dosage of vasoactive drugs were all kept constant during the study. Data were compared using Student's t-test. Correlation was estimated using Pearson's coefficient. The level of statistical significance was set at P < 0.05. Positive response to fluid loading was present in 26 (57.4%) patients. Baseline SVV correlated with baseline PPV (r = 0.92, P < 0.001). SVV and PPV were significantly higher in responders than in nonresponders. SVV: 14.4 +/- 3.3 vs. 7.1 +/- 3.1; P < 0.001. PPV: 15.2 +/- 4.1 vs. 7.4 +/- 4.5; P < 0.001. Other hemodynamic parameters measured were statistically different between the two groups. Only DO2 values showed no statistical significance between the responders and non-responders. There was no difference between the area under receiver operating characteristic curves of SVV (0.96; 95% confidence interval 0.859-0.996) and PPV (1.000; 95% confidence interval 0.93-1.000). Optimal threshold value for discrimination between VR and VNR was 10% for SVV (sensitivity 96.15%, specificity 100%) and 12% for PPV (sensitivity 100%, specificity 100%). In conclusion, SVV and PPV measured by LiDCO plus system are reliable predictors of fluid responsiveness in mechanically ventilated septic patients in sinus cardiac rhythm.
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Foot injuries caused by firearms and high pressure washing machines are not common, but due to high energy can be very destructive and contaminated with microorganisms. Due to the anatomical specificity of the foot, injures of the specific structure such as blood vessels, nerves and tendon-ligament apparatus are frequent. ⋯ Functional and aesthetic recovery of the foot is a challenge for the surgeon. Direct and indirect effect of the negative pressure therapy helps in wound healing and provides good preparation for definitive surgical management of wounds.