LAM Extra for General Practicioners

[Insertion of percutaneous peritoneal dialysis catheter using Seldinger technic with assistance of image amplifier ]

PETHŐ Ákos Géza1,2, SZABÓ Réka2, SZŰCS Attila3, BALLA József1,2

FEBRUARY 20, 2015

LAM Extra for General Practicioners - 2015;7(01)

[INTRODUCTION - Continuous Ambula­tory Peritoneal Dialysis (CAPD) treatment is widespread used over the years as a result of technical progress. As with any renal replacement therapy, in hemodialysis patients in time made vascular access, also the success of the CAPD depends on the in time inserted catheter for peritoneal dialysis. PATIENTS AND METHOD - Inserting a catheter for chronic peritoneal dialysis in Hungary is currently exclusively surgical procedure. The successfully CAPD treatment is so essential to insert the peritoneal dialysis catheter by dedicated surgeon. The intervention is often not a priority in the surgical tender, and in many places queues delaying the surgery. Proposed as an alternative to the percutaneous technique introduction. If nephrologist are familiar with basic surgical procedures by providing appropriate means, the percutaneous catheter insertion technique can be performed. RESULTS - In the spring of 2014, we introduced in Hungary first this procedure, which reported in the international literature as percutaneous PD-catheter insertion method. The technique was modified to the primary entry point determined by the typical abdominal puncture site. Puncture of the abdomen is performed by physicians as a routine intervention, which is widely accepted. After selecting the appropriate patient population and detailed medical information, patients are prepeared, under x-ray fluoroscopy imaging the implants were made. So far 10 catheter were implanted under this technique, all of them successfully. Thanks to the minimal invasive intervention, the patients healing was significantly faster, after the day of catheter-insertion we were able to start drainage. By the traditional surgical implantation the recovery time is six weeks. CONCLUsiONS - In all cases, when a surgeon not willing to insert the peritoneal dialysis catheter, the percutaneous technique can be safe. All of the catheters made by us are working well. Of course, the surgical procedure is still indispensable, however, and this is the percutaneous technique’s advantage, the CAPD treatment can be started after the intervention. ]

AFFILIATIONS

  1. Debreceni Egyetem, Klinikai Központ, Belgyógyászati Intézet, Nephrológiai Tanszék
  2. FMC Debrecen Extracorporalis Szervpótló Centrum
  3. Debreceni Egyetem, Klinikai Központ, Belgyógyászati Intézet, Intenzív Osztály

COMMENTS

0 comments

Further articles in this publication

LAM Extra for General Practicioners

[Alzheimer’s disease and arrhythmia: cause, effect, complication]

PETŐ Balázs, KOVÁCS Tibor

[Alzheimer’s disease (AD) is a new endemic of the 21st century which becomes the biggest health and social problem of the ageing societies in the next few decades. Vascular factors, such as cardiac arrhythmias, especially atrial fibrillation, play an important role in the pathogenesis of AD. Arrhythmias might develop as a consequence of AD, too, and they might be caused by the cholinergic medications used in the treatment of AD. In addition, AD has a major influence on the treatment of arrhythmias, especially atrial fibrillation. Because of these, AD and arrhythmias might accompany each other in the practice of several medical specialties; these interactions are reviewed in this paper. ]

LAM Extra for General Practicioners

[Treatment of hepatits C virus infected patients with cirrhosis in real-life conditions in Hungary with the two pegylated interferons]

[AIMS - In this trial we have analyzed the data of cirrhotic naiv as well as treatment experienced patients with chronic hepatitis C, treated in the East-Hungarian hepatology centers, between 2004 and 2010, because in the era of triple combinations, we mostly treat cirrhotic patients. PATIENTS AND METHODS - We have found 272 patients and in most of them the cirrhosis was proven by biopsy. These patients were treated with pegylated interferon (pegIFN) alpha plus ribavirin in combination, 172 were naiv and 100 patients were treatment experienced. Data were collected retrospectively and the pretreatment parameters like age, sex, body weight, transaminase level, genotype, initial viral load, comorbidities, and proportion of first and repeated treatments have been analyzed. We have investigated the influence of the initial parameters as well as the type of pegIFN on the complete early virologic response (cEVR) and on the sustained virological response (SVR). RESULTS - The cEVR was 27% (74/272) and the SVR was 21% (58/272) in the whole patient population. With pegIFN a-2a, 32% (45/141) cEVR and 28% (39/141) SVR, whereas with pegIFN a-2b 22% (29/131) cEVR and 15% (19/131) SVR were achieved. Among this patient population the largest subgroup was the naiv patients with high viral load (HVL). In this subgroup the SVR was 21% (28/132). However, with pegIFN a-2a SVR was 29% (21/73), whereas with pegIFN a-2b SVR was only 12% (7/59). The above differences found between the two pegIFNs proved to be statistically significant. Age <40 years, low viral load (LVL) and treatment with pegIFN a-2a proved to be independent positive factors influencing cEVR as well as SVR, by multiple logistic regression analysis. CONCLUSION - According to these results, cirrhotic patients with hepatitis C may benefit if pegIFN a-2a is used as backbone therapy in triple combinations. ]

All articles in the issue

Related contents

Lege Artis Medicinae

[Insertion of percutaneous peritoneal dialysis catheter using Seldinger technic with assistance of image amplifier]

PETHŐ Ákos Géza, SZABÓ Réka, SZŰCS Attila, BALLA József

[INTRODUCTION - Continuous Ambula­tory Peritoneal Dialysis (CAPD) treatment is widespread used over the years as a result of technical progress. As with any renal replacement therapy, in hemodialysis patients in time made vascular access, also the success of the CAPD depends on the in time inserted catheter for peritoneal dialysis. PATIENTS AND METHOD - Inserting a catheter for chronic peritoneal dialysis in Hungary is currently exclusively surgical procedure. The successfully CAPD treatment is so essential to insert the peritoneal dialysis catheter by dedicated surgeon. The intervention is often not a priority in the surgical tender, and in many places queues delaying the surgery. Proposed as an alternative to the percutaneous technique introduction. If nephrologist are familiar with basic surgical procedures by providing appropriate means, the percutaneous catheter insertion technique can be performed. RESULTS - In the spring of 2014, we introduced in Hungary first this procedure, which reported in the international literature as percutaneous PD-catheter insertion method. The technique was modified to the primary entry point determined by the typical abdominal puncture site. Puncture of the abdomen is performed by physicians as a routine intervention, which is widely accepted. After selecting the appropriate patient population and detailed medical information, patients are prepeared, under x-ray fluoroscopy imaging the implants were made. So far 10 catheter were implanted under this technique, all of them successfully. Thanks to the minimal invasive intervention, the patients healing was significantly faster, after the day of catheter-insertion we were able to start drainage. By the traditional surgical implantation the recovery time is six weeks. CONCLUsiONS - In all cases, when a surgeon not willing to insert the peritoneal dialysis catheter, the percutaneous technique can be safe. All of the catheters made by us are working well. Of course, the surgical procedure is still indispensable, however, and this is the percutaneous technique’s advantage, the CAPD treatment can be started after the intervention. ]

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]