ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;The objective of this study was to determine the efficacy of two‐dimensional and contrast echocardiograms to identify venous cannula position. Sequential sampling of 20 infants was evaluated by contrast echocardiography after meeting institutional criteria for extracorporeal life support. Each infant was placed on venovenous extracorporeal life support using a double‐lumen cannula. After surgical placement was thought to be satisfactory, optimal two‐dimensional images of the cannula were obtained via a subxiphoid or apical view and 2 ml agitated normal saline were injected rapidly into the nearest infusion port. Patient demographics and mixed venous saturations were noted. Distance of the venovenous cannula to tricuspid valve and distance of the venovenous cannula from the intra‐atrial septum was recorded. Echo‐cardiograms were available for review on 18 of the 20 patients. Position of the venovenous cannula in relationship to the tricuspid valve was as follows: <5 mm (8); 5‐10 mm (5); >10 mm(5). Mixed venous saturations decreased, which indicated less recirculation when the orientation of the tip of the cannula was toward the lateral wall in those who required repositioning. The authors conclude that two‐dimensional and contrast echocardiography aid in the positioning of the venovenous cannula. Satisfactory position is approximately 5 mm from the tricuspid valve, with orientation toward the lateral wall of the right atrium.ASAIO Journal1996;42:142‐145.

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;Neither the sociodemographic correlates nor the biochemical/clinical consequences of missed dialysis treatments have been well defined. During a 10 week period, the authors enumerated missed dialysis treatments among 430 patients randomly selected from a pool of 1,395 hemodialysis patients. A forward logistic regression model was used to determine whether a relationship existed between missed dialysis treatments and the following independent variables: age, gender, race, renal diagnosis, length of time on maintenance hemodialysis, co‐morbidity index, modified Karnofsky score, employment status, household residents, and laboratory indices. Forty‐three (10%) of 430 patients missed a total of 96 treatments. Despite equivalent treatment with erythropoietin, patients who missed dialysis treatment(s) had a lower mean hematocrit (27 ± 4.3%) at the end of the study than those patients who underwent all treatments (29 ± 4.5%) (p= 0.0287). Mean serum albumin and creatinine levels were equivalent in compliant and noncompliant patients. Recent starts (p= 0.0048), and younger patients (p= 0.0424) were most likely to miss dialysis treatment(s). One of the major consequences of missed dialysis treatment(s) is exacerbation of anemia, and younger patients and freshly started patients are more likely to miss scheduled dialysis treatments than their respective counterparts.ASAIO Journal1996;42:146‐149.

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;Left ventricular assist devices effectively improve hemodynamic function and reverse renal and hepatic dysfunction; however, their effects upon the gastrointestinal (GI) system have not been addressed. We evaluated GI function in 27 left ventricular assist device recipients using interviews, GI contrast studies, endoscopy, and99mTc sulfur colloid studies of esophageal transit and gastric emptying. While on left ventricular assist device support (mean duration of 84 days), 19 patients reported early satiety and/or nausea, and 1 was unable to tolerate oral intake. Esophageal transit time (normal, <10 sec) was borderline slow at 14 ± 4 (mean ± standard error of the mean) and gastric emptying (normal <90 min) was prolonged (range of 106‐506 min, mean = 283 ± 69 min). In a 1‐38 month follow‐up, gastric function subjectively improved in all. Six patients had intraperitoneal device placement. One died of aspiration pneumonia secondary to small bowel obstruction, and one had prolonged inability to tolerate oral intake, which required feeding jejunostomy tube placement. The 21 patients with pre peritoneal placement of the device did not require GI operative interventions and had no catastrophic GI events; they had mild to no GI complaints. Pre peritoneal placement may mitigate early satiety and obviate serious GI complications.ASAIO Journal1996;42:150‐153.

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;This study assessed the accuracy of using a two‐dimensional principal stress analysis compared to a three‐dimensional analysis in estimating peak turbulent stresses in complex three‐dimensional flows associated with cardiac prostheses. Three‐component, coincident laser Doppler anemometer measurements were obtained in steady flow downstream of three prosthetic valves: a St. Jude bileaflet, Bjork‐Shiley monostrut tilting disc, and Starr‐Edwards ball and cage. Two‐dimensional and three‐dimensional principal stress analyses were performed to identify local peak stresses. Valves with locally two‐dimensional flows exhibited a 10‐15% underestimation of the largest measured normal stresses compared to the three‐dimensional principal stresses. In nearly all flows, measured shear stresses underestimated peak principal shear stresses by 10‐100%. Differences between the two‐dimensional and three‐dimensional principal stress analysis were less than 10% in locally two‐dimensional flows. In three‐dimensional flows, the two‐dimensional principal stresses typically underestimated three‐dimensional values by nearly 20%. However, the agreement of the two‐dimensional principal stress with the three‐dimensional principal stresses was dependent upon the two velocity‐components used in the two‐dimensional analysis, and was observed to vary across the valve flow field because of flow structure variation. The use of a two‐dimensional principal stress analysis with two‐component velocity data obtained from measurements misaligned with the plane of maximum mean flow shear can underpredict maximum shear stresses by as much as 100%.ASAIO Journal1996;42:154‐163.

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;By using a computerized database, we have catalogued the presence of 29 co‐morbid risk factors in 683 patients with end‐stage renal disease who started dialysis from 1970 through 1989, with follow‐up through 1992. The authors hypothesized that current end‐stage renal disease patients have more serious co‐morbid risk factors impacting upon their mortality rate. Quantitation of dialysis patient co‐morbidity, as a measure of patient illness, is lacking in the general nephrology literature. Seven co‐morbid risk factors have been reserved for new dialysis patients: hypertension, low albumin, cerebral vascular disease, peripheral vascular disease, pre‐existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure. Except for low serum albumin, the proportion of patients with the six other co‐morbid risk factors has increased significantly over this 20‐year period (p< 0.0001, chi‐square test for hypertension, peripheral vascular disease, pre‐existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure, andp< 0.006 for cerebral vascular disease). In addition, the co‐morbid risk factors of hypertension, low serum albumin, and pre‐existing cardiac disease at the start of dialysis were strongly prognostic of survival. The Cox proportional hazards regression model identified these three risks, among other factors, that were significantly associated with a decreased survival, with risk ratios ranging from 1.40‐1.66. These results support the authors' hypothesis that incoming end‐stage renal disease patients, who recently start dialysis, are sicker than in the earlier years of the authors' program. If the authors' patients reflect the national end‐stage renal disease population, the presence of co‐morbid risk factors may, in part, explain the continuing high mortality of dialysis patients.ASAIO Journal1996;42:164‐169.

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;The present study was performed to evaluate the clinical usefulness of an anatomical snuff box arteriovenous fistula with special reference to its short‐term and long‐term patency in 139 hemodialysis patients. A snuff box fistula was established in 139 patients, including 39 with diabetic nephropathy (DN group) and 100 with non diabetic nephropathy (non DN Group). Fistula blood flow was measured by Doppler ultrasound in 18 patients. Early and late obstruction was observed in 24 (17%) of the 139 patients. The long‐term patency rate of the snuff box fistula in the non DN group was 87% at 57 months, whereas the patency rate at 57 months in the DN group (72%) was significantly (p< 0.05) lower than that in the non DN group. The increase in arterialized vein blood flow in DN patients was less marked than that in the non DN patients. These results suggest that the high prevalence of late obstruction in DN patients may partly be reflected by an insufficient increase of arterialized vein blood flow at the snuff box site.ASAIO Journal1996;42:177‐180.

ISSN:1058-2916    

出版商:OVID    

年代:1996

数据来源: OVID