Long-Term Tunneled Hemodialysis Catheters: Achieving Efficiency Through Tip Position Optimization

BACKGROUND

This retrospective study assesses the influence of tunneled hemodialysis catheter tip location and lateralization on catheter-related complications, including dysfunction and catheter-related bloodstream infection.

METHODS

Using data from 162 patients who underwent catheter placement between January 2017 and December 2020, postoperative chest X-rays and clinical records were reviewed. Outcomes were assessed based on catheter removal duration and complication incidence.

RESULTS

Out of 177 catheter placements, 56 (32%) patients experienced complications during an average 530-day follow-up. Catheters placed in the superior vena cava (SVC) exhibited more severe complications with shorter dwell times compared with those in the pericavoatrial junction (pCAJ) or right atrium (RA). Moreover, complication rates were significantly higher (P < 0.01) in the SVC (1.91 per 1000 catheter days) compared with the pCAJ (0.54) or RA (0.47). Lateralization (right or left internal jugular vein) did not significantly affect the complication rates (0.60 vs. 0.58; P = 0.90). However, in subgroup analysis, a significantly higher complication rate was observed for catheters with tips inserted from the left side into the SVC than for those inserted from the right side (6.6 vs. 1.5; P < 0.01).

CONCLUSIONS

Catheters with tips in the SVC exhibited more severe complications than those in the pCAJ or RA, with left-side insertion of SVC-tipped catheters resulting in significantly higher complication rates compared with right-side insertion. These findings highlight the importance of optimal catheter tip positioning in long-term hemodialysis care to minimize complications and enhance patient outcomes.

The Role of Pre-Operative MRI for Prediction of High-Grade Intracranial Meningioma: A Retrospective Study

OBJECTIVE

High histological grade (WHO grade 2 and 3) intracranial meningiomas have been linked to a greater risk for tumor recurrence and worse clinical outcomes compared to low-grade (WHO grade 1) tumors. Preoperative magnetic resonance imaging (MRI) plays a crucial role in tumor evaluation and allows a better understanding of tumor grading, which could potentially alter clinical outcomes. The present study sought to determine whether preoperative MRI features of intracranial meningiomas can serve as predictors of high-grade tumors.

METHODS

This retrospective study reviewed 327 consecutive confirmed cases of intracranial meningiomas, among whom 210 (64.2%) had available preoperative MRI studies. Thereafter, imaging features such as intratumoral signal heterogeneity, venous sinus invasion, necrosis or hemorrhage, mass effect, cystic component, bone invasion, hyperostosis, spiculation, heterogeneous tumor enhancement, capsular enhancement, restricted diffusion, brain edema, and unclear tumor-brain interface were obtained and data were analyzed using univariate and multivariate analyses.

RESULTS

249 (76.1%) patients had low-grade (grade I), and 78 (23.9%) had high-grade (grades 2 and 3) intracranial meningioma. The majority of cases were females (274 cases, 83.3%) and most patients were below 60 years of age (mean age, 52.50 ± 11.51 years). The multivariate analysis with Multiple Logistic regression analysis using factors determined to be significant during univariate analysis via a backward stepwise selection method with statistical significance set at 0.05 identified three MRI features including necrosis or hemorrhage (adjusted OR = 2.94, 95% CI: 1.15-7.48, p = 0.024), hyperostosis (adjusted OR = 0.31, 95% CI: 0.12-0.79, p = 0.014), and brain edema (adjusted OR = 2.33, 95% CI: 1.13-4.81, p = 0.022) as significant independent predictors of high-grade meningioma after adjusting for confounders.

CONCLUSIONS

Our study suggested that certain preoperative MRI features of intracranial meningiomas including necrosis or hemorrhage and brain edema could potentially predict high-grade tumors while hyperostosis is a predictor for low-grade tumors.

Atypical Neurological Manifestation in Childhood Microscopic Polyangiitis: A Case Report and Review of Literature

Microscopic polyangiitis (MPA), a systemic necrotizing vasculitis of small vessels, is primarily associated with necrotizing and crescentic glomerulonephritis and pulmonary capillaritis. Neurological involvement, particularly of the central nervous system (CNS) is scarcely observed. The diversity of CNS symptoms could puzzle the diagnosis causing delays in treatment and potentially having a considerable effect on patient's quality of life or even death. The aim of this case report is to highlight the unusual manifestation of MPA in order to raise awareness of this orphaned disease among pediatricians or even pediatric rheumatologists and neurologists.

CASE REPORT

Herein we report the case of a 13-year-old Thai girl diagnosed with MPA presented with rapidly progressive glomerulonephritis (RPGN). Renal biopsy was performed demonstrated crescentic glomerulonephritis with negative immunofluorescence and positive titer of myeloperoxidase (MPO) antibody. Pulse methylprednisolone (MP) and cyclophosphamide (CYC) as well as plasmapheresis were initiated. Despite treatment with prednisolone (45 mg/day) and monthly CYC for two doses, she experienced a brief generalized tonic-clonic seizure during the follow-up period. The potential differential diagnosis of new-onset neurological manifestation contains infection owing to the immunocompromised status of the patient and CNS vasculitis as a result of the disease itself. Lumbar puncture was performed, and cerebrospinal fluid analysis demonstrated pleocytosis with negative infectious panel. Contrast magnetic resonance imaging studies of the brain showed multifocal patchy T2/FLAIR-hyperintense lesions in the cerebral as well as cerebellum regions, and irregular narrowing along the V4 segment of the right vertebral artery was demonstrated in magnetic resonance angiography. In the presence of CNS vasculitis, pulse MP and CYC were provided. The symptom of nervous system has progressively improved.

CONCLUSION

In our case, MPA revealed RPGN with neurological manifestation. Despite the fact that it is scarcely reported, CNS vasculitis is one of the organ-threatening symptoms. To improve patient morbidity and mortality, multidisciplinary care teams with prompt diagnosis and treatment are highly recommended.

Normal Measurement of Diameters of the Common Bile Ducts in Different Aged Groups

BACKGROUND

Computed tomography (CT) is widely used in diagnosis of biliary disorders in adults yet there is no data on the normal common bile duct (CBD) size of the average Thai adult. This study attempts to establish a reference normal measurement for CBD diameter for the Thai population.

MATERIAL AND METHOD

In this retrospective study, CBD measurements were performed on axial oblique images, perpendicular to the long axis of the distal CBD. The mean diameter of the normal CBD was measured in 277 patients. The patients were divided into 7 groups according to their age. Analysis of variance (ANOVA) was used to compare data obtained from the seven age groups.

RESULTS

Mean diameter of CBD ranged from 2.3 to 9.5 mm. The mean of the mean diameter of 277 subjects was 4.65±1.39 mm. The diameter of the CBD significantly increased with age (p<0.05), and are not significantly related to gender.

CONCLUSION

Diameter of CBD shows a considerable increase with age. The largest diameter of the CBD is up to 6.4 mm in patients who less than 60 years. An upper limit of 8 mm appears reasonable after the age of 60.