Radiofrequency guidewire-facilitated recanalization of chronic thoracic central venous occlusions in hemodialysis patients

PURPOSE

To assess the outcome and safety of radiofrequency (RF) wire recanalization in patients with end-stage renal disease (ESRD) and chronic central venous occlusions (CVO).

MATERIALS AND METHODS

A retrospective review of ESRD patients who underwent RF-wire recanalization of symptomatic chronic thoracic CVO from January 2017 to August 2022 yielded 20 patients who underwent 21 procedures. All patients had undergone at least one prior unsuccessful attempt at central venous recanalization using conventional catheter-based techniques. Technical success was defined by the ability to cross the CVO using RF-wire recanalization enabling endovascular treatment. Access circuit patency was evaluated based on follow-up imaging and symptomatic improvement.

RESULTS

Radiofrequency wire recanalization was successful in 17/21 procedures (81%) with all patients (100%) reporting resolution of arm ± facial swelling. Three major complications occurred (14%): two hemothoraces and one hemopericardium. Medial stent diameter was 13 mm (range, 9-14 mm). Mean duration of hospital stay was 2 days ± 3 days. Mean procedure time was 158 ± 46 min with a mean fluoroscopy time of 31.7 ± 16.3 min. Primary unassisted patency at 6 and 12 months was 94 ± 6% and 85 ± 10%, respectively. Additional interventions resulted in significantly increased stent graft patency (P = 0.006).

CONCLUSION

Radiofrequency wire-enabled recanalization of CVO in symptomatic dialysis patients has a high rate of technical success with resolution of arm and facial swelling and resumed use of the ipsilateral dialysis access. Although a superior safety profile was seen than with needle-based techniques such as sharp recanalization, major complications were not infrequent indicating that this RF-wire procedure should be performed in centers equipped to manage central venous perforations.

A Framework for Developing a Comprehensive Venous Practice

Chronic venous disease (CVD) of the lower extremities is a complex process encompassing abnormalities related to venous drainage secondary to thrombotic and non-thrombotic pathologies. CVD can have an untold economic impact due to lost productivity and the costs of treating its sequela and underlying aetiologies. Building a comprehensive venous service for the treatment of CVD requires a multifaceted approach with longitudinal care, similar to those that have been developed for peripheral arterial disease and oncology.

Gata4 and Gata5 cooperatively regulate cardiac myocyte proliferation in mice

GATA5 is a member of the zinc finger transcription factor GATA family (GATA1-6) that plays a wide variety of roles in embryonic and adult development. Experiments in multiple model systems have emphasized the importance of the GATA family members 4-6 in the development of the endoderm and mesoderm. Yet despite overlapping expression patterns, there is little evidence of an important role for GATA5 in mammalian cardiac development. We have generated a new Gata5 mutant allele lacking exons 2 and 3 that encodes both zinc finger domains (Gata5(tm)(2)(Eem)), and we show that although Gata5(-/-) mice are viable, Gata4(+/-)5(-/-) mutants die at mid-gestation and exhibit profound cardiovascular defects, including abnormalities of cardiomyocyte proliferation and cardiac chamber maturation. These results demonstrate functional redundancy between Gata4 and Gata5 during cardiac development and implicate Gata5 as a candidate modifier gene for congenital heart disease.

Field trials of a formulation containing moxidectin and 6 in 1 vaccines for sheep

OBJECTIVE

To assess the efficacy and safety of a formulation containing moxidectin and 6 in 1 vaccine in sheep under field conditions.

DESIGN

Efficacy and safety study.

ANIMALS

Two hundred and five crossbred Merino lambs and two hundred and eight Merino ewes were used in the studies.

PROCEDURE

A formulation was made for the simultaneous treatment of sheep with moxidectin and immunisation against clostridial diseases and caseous lymphadenitis. The efficacy against nematodes, vaccine response and safety were assessed.

RESULTS

Effective control of nematodes and responses to antigens were achieved following subcutaneous administration. The formulation was safe to administer; occasional minor tissue reactions were evident, but no other adverse effects of treatment were observed in either pregnant ewes or lambs, using either the recommended dose, or an overdose of the formulation.

CONCLUSION

Administration of a formulation containing moxidectin, five clostridial antigens and caseous lymphadenitis antigen proved safe and efficacious under field conditions.

Duration of the persistent activity of moxidectin against Haemonchus contortus in sheep

Weaned lambs were infected with Haemonchus contortus 35, 28, 21, 14 and 7 days after treatment with moxidectin at 0.2 mg/kg and 35 and 14 days after treatment with ivermectin at the same dose rate. Worm counts 14 days after infection showed that moxidectin prevented the establishment of over 99% of infective larvae for 28 days and reduced the establishment rate at 35 days by 96%, relative to ivermectin. There was no difference in the protective efficacy of ivermectin at 14 or 35 days. The persistence of moxidectin is likely to provide advantages in nematode control, particularly when used as a strategic early summer treatment or as a pre-lambing treatment to ewes. Implications of the persistent activity of moxidectin for the development of resistance during the decay phase are discussed.

An evaluation of an oral formulation of moxidectin against selected anthelmintic-resistant and -susceptible strains of nematodes in lambs

The efficacy of an oral formulation of the newly developed parasiticide, moxidectin, was tested against benzimidazole-resistant Haemonchus contortus, Trichostrongylus colubriformis, and Nematodirus spathiger, levamisole-resistant Ostertagia circumcincta, and susceptible Cooperia curticei infections in weaned lambs. Thirty-two lambs were experimentally infected with mixed doses of the above strains of nematodes. They were allocated into four treatment groups by stratified randomisation using liveweights and faecal egg counts 28 days later. One group received moxidectin at 0.2 mg/kg liveweight, one group oxfendazole at 4.5 mg/kg liveweight, one group levamisole at 7.5 mg/kg liveweight and the last group remained untreated as the control. Worm burdens in the lambs at slaughter 10 days after oral treatment confirmed the resistance status of the nematode strains used, and showed that moxidectin had a greater than 99.9% efficacy (p<0.01) against all of them. No adverse effects due to treatment with moxidectin were observed in any of the animals.

Proximal femoral osteotomy: a trigonometric analysis of effect on leg length

A trigonometric analysis of the effect of a proximal femoral osteotomy, either dome or cuneiform, on leg length was done to aid the preoperative planning for this surgery. Change in leg length may be determined for a dome osteotomy by multiplying the length of the head-neck segment by the difference between the cosines of the preoperative and postoperative neck-shaft angles as measured from the vertical. A series of determinations are tabulated for a variety of head-neck lengths and angulation changes. When a cuneiform osteotomy is being done, the effect of the wedge can be determined and should be considered. Also to be considered are a tendency for spontaneous correction and growth stimulation from the osteotomy.