To evaluate our experience with prophylactic balloon occlusion of the internal iliac arteries as a part of a multidisciplinary algorithm for the management of placenta percreta.
Consecutive case series. Setting. Rigshospitalet, Copenhagen University Hospital, Denmark. Sample. Seventeen women with placenta percreta.
Demographic characteristics, intraoperative data and outcomes are summarized and discussed.
Feasibility of local resection, intraoperative blood loss and transfusion requirements.
The multidisciplinary management allowed for local resections in nine of the 11 women who requested preservation of fertility. The mean intraoperative blood loss was 4050 mL (range 450-16 000 mL, median 2500 mL). Adhesions to the bladder or the parietal peritoneum were associated with an intraoperative blood loss >6000 mL.
Prophylactic balloon occlusion of the internal iliac arteries as part of a multidisciplinary algorithm allowed for a safe management of all cases in our consecutive series of 17 women with placenta percreta. However, intraoperative blood loss and transfusion requirements were significant. We have therefore decided to modify our multidisciplinary algorithm to include balloon occlusion of the common iliac arteries rather than the internal iliac arteries.
To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.
Thirty patients with arteriovenous fistulas who underwent 46 interventions had access blood flow measured before and after every procedure. Two methods, catheter-based thermodilution and Doppler ultrasound, were compared to the reference method of ultrasound dilution. Catheter-based thermodilution and Doppler ultrasound were performed during the endovascular procedures while flow by ultrasound dilution was determined within three days of the procedure. The methods were compared using regression analysis and tested for systematic bias.
Failure to position the thermodilutional catheter correctly was observed in 8 out of 46 (17%) pre-intervention measurements. Post-intervention measurements and ultrasound measurements were feasible in all patients. The average level of agreement was good when comparing catheter-based thermodilution to ultrasound dilution. However, blood flow by ultrasound dilution may differ by ±130 mL/min (±22%) at a flow level of 600 mL/min by thermodilution. Results from Doppler ultrasound displayed a moderate level of agreement on average when compared to ultrasound dilution. Blood flow by ultrasound dilution may differ by ±160 mL/min (±27%) at a flow level of 600 mL/min by Doppler ultrasound. No systematic bias was detected by either method.
On average, results from catheter-based thermodilution were more in agreement with results from the ultrasound dilution technique compared to Doppler ultrasound. However, considering the cost and the high technical failure rate of the thermodilutional system, we recommend the use of ultrasound.
In a nationwide survey, all orthopaedic clinics were surveyed via a questionnaire about the use of bone allografts and how they managed their bone banks. Thirty-two clinics (100 per cent) responded to the questionnaire (mid 1991). Seventeen clinics had established bone banks on the basis of femoral heads obtained from donors during primary hip replacement. Only five used bone substitutes. The mean consumption was 30 capita per year (10-132) and ten clinics estimated an increasing demand for allografts. The storage method was by freezing at temperatures varying from minus 20 to minus 80 degrees Celsius. Contraindications to procurement comprised history of infection and malignancy, all clinics tested donors for HIV antibodies and all but one for hepatitis B. Testing for hepatitis C was about to be introduced. All but one clinic developed cultures from the procured bone. Informed consent was employed by nearly all clinics, but very few obtained written consent. Since this survey, revised recommendations have been directed from the Danish National Board of Health, these listing that an HIV-test should be performed with a 90-day interval, and that testing should also be done for hepatitis B and C. International experience and this survey show that the establishment of more specific and general national recommendations would be preferable to present practice.
A collaborative population-based project for bowel cancer prevention provided an ideal opportunity to involve nursing students in applying theory to practice. In this article, described is how the engagement of students and subsequent application of a population health template contributed to a community-based bowel cancer education and screening campaign. The campaign was a valuable teaching-learning experience for students and contributed to the goal of reducing and reporting on the number of bowel cancer deaths in the local area. Project evaluation data provide insight into student learning outcomes and reveal ways to strengthen the population health initiative for future years. Originally, a scholarly pursuit of discovery and application developed in response to growing rates of bowel cancer and advances in effective screening programs, the project has evolved into the domain of teaching and learning. This evolution has benefited students, project organizers and community members.
Captopril, the competitive inhibitor of angiotensin-converting enzyme, has proved efficient in the treatment of arterial hypertension and heart failure. Its use is generally associated with low incidence of adverse reactions and hepatic injury has not been emphasized as an important adverse reaction in Denmark. However worldwide, several cases of hepatic injury have been reported. We report one case of Captopril-induced hepatic injury. Despite discontinuation of Captopril a hepatorenal syndrome developed and the patient died five weeks after admission. This report emphasizes the need to be aware of the possibility of hepatic injury in patients receiving Captopril.
Natural gas has been used in Denmark for 12 years and many installations are old and need an overhaul. A carbon monoxide-poisoning accident caused by a legally installed and maintained natural gas installation is described.
The purpose of this study was to perform bench and clinical testing of a catheter-based intravascular system capable of measuring blood flow in hemodialysis vascular accesses during endovascular procedures.
We tested the Transonic ReoCath Flow Catheter System which uses the thermodilution method. A simulated vascular access model was constructed for the bench test. In total, 1960 measurements were conducted and the results were used to determine the accuracy and precision of the catheters, the effects of external factors (e.g., catheter placement, injection duration), and to test for systematic bias. In the clinical study, two interventional radiologists conducted a total of 250 measurements in 14 patients with arteriovenous fistulas to determine clinical precision and enable testing for bias between measurers.
Accuracy was excellent for both catheters with a high level of agreement between results from the ReoCath Flow Catheter System and the reference flowmeter. Clinical precision, expressed as the mean coefficient of variation, was 5.9% and 4.7% for the antegrade and retrograde catheters, respectively. Flow measurements were significantly affected by the distance between a stenosis and the tip of a retrograde catheter with the effect being proportional to the degree of stenosis. There was no systematic bias between measurers.
The Reocath Flow Catheter System was found to be accurate and precise. Reliable results require careful attention to catheter placement. Blood flow measurements provide unique information on the hemodynamic status of a vascular access and have the potential to optimize results of interventions.