Articles: cations.
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Anion gap (AG) is a calculated value commonly used in clinical practice. It approximates the difference between the concentration of unmeasured anions (UA) and unmeasured cations (UC) in serum. At present, the reference range of anion gap has been lowered from 8-16 to 3-11 mmol/l because of the changes in technique for measuring electrolyte. ⋯ If one finds high incidence of increased anion gap (>24 mmol/l) or decreased anion gap (<2 mmol/l), one should check the quality control of electrolyte and whether the patients were hypoalbuminemia or hyperglobulinemia. An anion gap exceeding 24 mmol/l will suggest the presence of metabolic acidosis. It is very rare to find anion gap with the negative sign.
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Skull Base Interd Ap · May 2001
Infrasellar craniopharyngiomas: case report and review of the literature.
Although craniopharyngiomas account for a large percentage of pediatric intracranial tumors, there is a bimodal age distribution. Most of these neoplasms are suprasellar or sellar in location. In this report we describe an unusual case of an infrasellar craniopharyngioma in a child. ⋯ This case illustrates a rare and unusual location for a craniopharyngioma. Craniopharyngiomas should be considered in the differential diagnosis of infrasellar neoplasms. Infrasellar craniopharyngiomas compromise part of the spectrum of tumors originating from enamel-forming neural crest cells.
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Internal jugular vein cannulation has become a routine and clinically important aspect of medical care in hemodialysis patients. Mismanagement in the location of a central venous catheter may occur in up to 20% of cases. The aim of the study was to evaluate the utility of endocavitary electrocardiography in right internal jugu-lar vein placement of central venous catheters. ⋯ In 6 catheterizations, no atrial trace was obtained due to atrial fibrillation in 4 cases, and in 2 cases technical error and guide-wire looping into a right jugular vein. Complications as a direct result of guide-wire or catheter placement were not observed. In our opinion this method can be used safely and makes radiological control usually unnecessary. (The Journal of Vascular Access 2001; 2: 45-50).
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The NKF-DOQI guidelines recommend performing chest-X-ray(CXR) after subclavian and internal jugular vein insertion prior to catheter use. This is to exclude complications such as a pneumothorax before starting hemodialysis. Indication of a central venous dialysis catheter was based on the historic use of the subclavian vein for placement of these catheters and upon the reported incidence of pneumothorax after this approach of between 1% to 12.4%. ⋯ In the first hundred cases, all patients underwent CXR. Subsequently, because of total absence of complications and catheter tip malpositioning, the CXR control was carried out only in selected cases (repeated cannulation of the jugular vein or absence of P wave). We believe that only in selected cases should a pCXR be performed before starting hemodialysis sessions, and that our method using the right IJV, ultrasound-guided puncture of the vessel, and catheter placement by EC-ECG is a safe and simple technique that avoids the need for CXR control.