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PubMed2006

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing's syndrome: the importance of thymic vein catheterization.

Thymic hyperplasia has been described after the resolution of hypercortisolism from several etiologies, causing great diagnostic dilemmas. We describe a case where the catheterization of the thymic vein was essential for the differential diagnosis of a thymic enlargement in an adrenalectomized patient with ACTH-dependent Cushing's syndrome. The patient was a 48-year-old female with clinical and laboratorial data suggesting Cushing's disease. She underwent a transsphenoidal surgery with no tumor visualization and no remission of the syndrome. Histopathological studies disclosed a normal pituitary. She underwent a bilateral adrenalectomy and 8 months later a chest CT showed an increase of left thymic lobe, which was previously non-existent. After a negative (111)In-pentetreotide scintigraphy, the patient underwent simultaneous and bilateral catheterism of the petrosus sinuses and catheterization of the thymic and inominate veins and no ACTH gradient was shown among the sites of collection. She did not undergo thoracotomy and a follow-up was established. During the evolution, there was a spontaneous regression of the thymic lesion 38 months after the diagnosis. The ACTH gradient during the catheterization of thymic vein was essential for the differential diagnosis of the thymic enlargement tumor after hypercortisolism resolution in ACTH-dependent Cushing's syndrome, especially in this case, where the ACTH source was occult, thus avoiding an invasive surgical procedure for a benign entity with spontaneous resolution.

Adrenocorticotropic Hormone↗

PubMed2001

Effect of a single-use sterile catheter for each void on the frequency of bacteriuria in children with neurogenic bladder on intermittent catheterization for bladder emptying.

OBJECTIVE: The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters. METHODS: A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded. RESULTS: A total of 158 urine samples were collected during 164 patient-weeks on the new catheter method for each void; 115 (73%) were positive for a pathogen. Of the 161 samples collected during 169 patient-weeks on the standard, reuse method for voiding, 123 (76%) were positive (115 [73%] of 158 vs 123 [76%] of 161). Escherichia coli was the most common pathogen detected during both method periods. CONCLUSION: A new, sterile catheter for each void did not decrease the high frequency of bacteriuria in patients with neurogenic bladder on intermittent catheterization.

Adolescent↗

PubMedDate not supplied

[Complications of arterial catheterization in children].

UNLABELLED: The radial artery catheterization with the purpose of children's monitoring has been more and more used in Pediatric Intensive Care Units, and many times, is use is indispensable, like in cardiac surgery post-operative cases. However, there are only a few articles on the subject among us. PURPOSE: To analyse the complications of radial artery catheterization in the post-operative of cardiac surgery in children. METHODS: We studied the complications of this procedure in 120 children in cardiac surgery post-operative range from 1 month to 2 years. The children were catheterized by percutaneous technique (n = 67) and by cutdown technique (n = 53). The following complications were analysed in relation to the placement time of the catheter and the used technique: local infection, hemorrhagic complication, ischemia, catheter occlusion and accidental catheter displacement. RESULTS: Infection, ischemia and hemorrhage were more frequent and statistically significant in patients submitted to cutdown technique, while the catheter occlusion and accidental displacement were similar in both groups. The placement time of the catheter was an important variable in our study. All of the other infection cases occurred after 72 hours of the catheterization and the frequency of hemorrhage and ischemia was higher in the first 72 hours. CONCLUSION: The main complications of this proceeding are related to the technic utilized, time of utilization of the catheter and to the characteristics of the patients.

Catheterization, Peripheral↗

PubMed1992

Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization.

The purposes of this study were to determine the prevalence of angiographically significant renal artery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant renal artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterization were enrolled in the study. Of the 1,302 abdominal aortograms performed, 1,235 (95%) were deemed of adequate quality for the evaluation of renal artery anatomy. Renal artery disease was identified in 30% of the patients. Insignificant renal artery stenosis was found in 187 (15%) and significant (greater than or equal to 50% diameter narrowing) stenosis was found in 188 (15%). Significant unilateral disease was present in 11%, and bilateral disease was present in 4%. By univariable and multivariable logistic regression analysis, the association of both clinically and catheterization-derived variables with renal artery disease was assessed. Multivariable predictors included age, severity of coronary artery disease, congestive heart failure, female gender, and peripheral vascular disease. Hypertension was not an associated variable. These data reveal the previously undetected high prevalence of renal artery disease in patients undergoing cardiac catheterization and provide clinical and angiographic features that assist in predicting its presence.

Aged↗

PubMed1982

Percutaneous transhepatic portal catheterization-modification of Chiba method and portal vein pressure in liver diseases.

Percutaneous transhepatic portal catheterization was performed in 68 cases of liver diseases in the 2 year period from 1978 to 1980. The Chiba University method was modified. Portal vein catheterization was successful in 61 cases (90%). Selective splenic vein catheterization was successful in 55 of the 61 cases (90%) and selective superior mesenteric vein catheterization in 59 cases (97%). The liver was punctured an average of 4.6 times in order to successfully insert the catheter into the main portal vein, and the number of punctures was less than 10 in 57 of the 61 cases (93%). The portal vein pressure was 310+/-67 mm H2O in idiopathic portal hypertension (8 cases), 290+/-83 in liver cirrhosis (33 cases), 193+/-71 in chronic hepatitis (7 cases) and 166+/-50 in fatty liver (4 cases). Portal vein pressure rose from 205+/-75 to 380+/-55 mm H2O in 11 cases after forced Valsalva maneuver. No major complications were encountered.

Catheterization↗

PubMed2005

Evaluation of a method of intracoelomic catheterization in koi.

OBJECTIVE: To develop an easy and safe method for catheterization and determine the pharmacokinetics of a single dose of enrofloxacin after intracoelomic administration in koi. DESIGN: Prospective study. ANIMALS: 20 healthy koi. PROCEDURE: 6 koi were anesthetized with tricaine methanesulfonate, and a 23-gauge, three-fourths-inch butterfly catheter was inserted into the coelomic cavity and secured. Catheters were flushed daily for 6 days with 0.4 mL of sterile saline (0.9% NaCl) solution containing heparin (100 units of heparin in 250 mL of saline solution) without removing koi from the aquarium. At the end of the sixth day (144 hours), each of the 6 catheterized koi and 6 uncatheterized (control) koi was anesthetized individually. Enrofloxacin (10 mg/kg [4.5 mg/lb]) was administered to catheterized koi via the injection port and to control koi via a 23-gauge needle in the same site as the catheter placement. A pharmacokinetics study was performed on multiple plasma samples to validate the efficiency of the catheter. Reliability of the catheterization method was determined in 8 koi. RESULTS: All 6 catheters remained patent and effective for the 6 days prior to the start of the pharmacokinetics study. Results for the 2 routes of administration were comparable, and all koi survived the study without any detectable clinical problems. CONCLUSIONS AND CLINICAL RELEVANCE: An intracoelomic catheter was effective and safe when maintained in koi for at least 6 days. This would be highly beneficial for veterinarians, clients, and fish, especially when intracoelomic administration of a drug would require daily or more frequent dosing.

Animals↗

PubMedDate not supplied

Percutaneous serial catheterization in swine: a practical approach.

In a model designed for experimental cryoablation of the His bundle in swine, a study that required multiple and follow-up cardiac catheterizations, femoral percutaneous cannulations were successfully performed in 14 of 15 swine: 6/6 Yucatan miniature, 5/6 Hanford miniature, and 3/3 Yorkshire farm pigs, weight range 15-50 kg. A follow-up cardiac catheterization was performed in 10 of these animals: 5 Hanford and 5 Yucatan. Femoral percutaneous cannulation was successful in 6. A cutdown approach was successful in the remaining 4 after failed attempts at percutaneous vascular access. The results show that percutaneous femoral cardiac catheterization is a feasible and practical technique for cardiovascular studies in swine, especially those that require multiple and serial catheterizations.

Animals↗

PubMedDate not supplied

Hepatic vein catheterization: a new technique in rats.

Blood samples taken directly from the hepatic veins are often required for evaluation of liver function or ischemia/reperfusion injury and for direct determination of metabolic products of the liver. In the rat, blood samples are usually obtained by direct puncture of the hepatic veins. Successful catheterization of these small vessels is only possible under direct vision because great dexterity is needed to persuade the catheter to enter the hepatic vein. In this report a procedure for hepatic vein catheterization under direct vision is described in the rat. After performing a median laparotomy, a flexible catheter (Buchbinder, 3.0 F/1 mm, as used in cardiology) with a bent end is inserted into the infrahepatic vena cava. Under direct vision through the thin walls of the inferior vena cava the bent end of the catheter is slowly pushed up until the tip slides into a hepatic vein, which opens into the inferior vena cava at a right angle. Selective catheterization of the desired hepatic vein is possible by rotating the catheter and changing the position of its tip. This is a reliable new technique of hepatic vein catheterization in rats, by which blood samples can be collected directly from the hepatic veins.

Animals↗

PubMed2001

Massive thrombosis after central venous catheterization in a patient with previously undiagnosed Behcet's disease.

Thrombosis is an important complication of central venous catheterization. Among the many intrinsic and extrinsic factors, the patient's medical disease can play a role in thrombogenesis. Behcet's disease (BD), classified as a vasculitis, is a multisystem disease involving the small blood vessels. It is often difficult to recognize and diagnose the disease. A 24-yr-old female patient showed massive central venous thrombosis which caused superior vena cava syndrome after subclavian vein catheterization. Twenty days after catheterization, the patient exhibited swelling of the face, neck, and both upper extremities. Despite thrombectomy and continuous anticoagulation therapy, her facial and upper extremity swelling reappeared and follow-up chest computed tomography (CT) showed the recurrent thrombosis in the same central veins previously affected. A diagnosis of BD was then made. Following steroid therapy, neither clinical symptoms nor CT findings suggestive of central venous thrombosis were observed during the subsequent 6-months of follow-up period. This case emphasizes that central venous catheterization in a patient with BD should be performed with great caution.

Adult↗

PubMed1991

[Urethral indwelling catheter, intermittent self-catheterization and urinary infection].

Once a catheter has been passed into the bladder without contamination, there are several possible routes of subsequent infection during drainage period, such as: 1. Entry of bacteria alongside the catheter in the urethra. 2. Introduced bacteria adhered easily to the indwelling catheter and drainage system and colonized. 3. The catheter tip is covered rapidly by various nutrient materials which becomes a good culture medium of stuck bacteria, which is a supply source of bacteria into the bladder urine. 4. Although the motile bacilli ascend very slowly through the stagnant tube and no bacteria ascend against a slowly moving column, rapid transport of organisms occurs in the swirling fluid caused by the passage of rising air bubbles. 5. Continuous urethral catheter drainage permits an average residual urine volume of 7.3 ml. 6. The catheter destroys the antibacterial defense mechanisms of the urinary bladder. The reasons why in many cases of intermittent self-catheterization (CID) urine becomes sterile despite non-sterile procedure, are as follows. In addition to that CIC has none of the disadvantages of the indwelling catheter, it improves the vesical defense mechanisms deteriorated by high pressure voiding. The number of bacteria reintroduced during catheterization is relatively small and they can be eradicated by usual scheduled catheterization within 4-5 hours without residual urine. CIC must be started before trabeculation or diverticuli are formed, in which bacteria remain. Actual determination of residual urine volume after catheterization will help to prescribe a rational program of CIC.

Bacteria↗

PubMed2001

[Development of new hydrophilic catheter kit for self-catheterization: study in pediatric cases].

PURPOSE: To increase the management of self-catheterization in children of school age, a catheter kit consisting of hydrophilic catheter and a packet containing sterilized water was developed. We evaluated the lubricating characteristic and clinical efficacy of this new catheter kit. MATERIALS AND METHODS: The catheter kit used in the study was a pocket-size plastic container in which a polyurethane catheter coated with hydrophilic polymer and a packet containing sterilized water were packed in combination. The lubricating characteristic of catheter was assessed by the measurement of friction value. For clinical assessment, male children aged over 6 years old who were doing self-catheterization at 17 medical institutions nationwide were selected as the subjects. The 32 children who had given informed consent (mean age: 11.6 years old) were asked to use the catheter kit continuously for 1 week. The results were investigated by a questionnaire survey in which the assessment before and after the use was expressed in scores. At the same time, urinalysis and urine culture were examined. RESULTS: The friction value of hydrophilic catheter was equivalent to or less than that observed by applying a lubricant to the conventional catheter. The comparison of conventional catheter with the kit indicated significantly higher scores (assessment in 5 grades expressed in scores) for the portability and operability of the kit. Though there was no significant difference in the ease of insertion between the two catheters, there were several comments that the kit got stuck in the urethra when it was withdrawn. The global assessment gave a significantly higher score to the kit and 30 (94%) of the 32 children wanted to use the kit continuously. No increase in hematuria which caused a clinical problem or no new apparent urinary tract infection occurred after the use of the kit. CONCLUSIONS: Compared with the conventional catheter, the hydrophilic catheter kit highly satisfied a large number of children at the time of self-catheterization. Depending on the condition of children, the kit is considered useful for continued self-catheterization for a long term.

Child↗

PubMed2002

Sex differences in access to coronary revascularization after cardiac catheterization: importance of detailed clinical data.

BACKGROUND: Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care. OBJECTIVE: To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization. DESIGN: Cohort study with prospective data collection. SETTING: Alberta, Canada. PATIENTS: Persons undergoing cardiac catheterization between 1 January 1995 and 31 December 1998 (n = 21 816). MEASUREMENTS: The occurrence of revascularization procedures (PCI or CABG) in the year after cardiac catheterization was measured. Unadjusted revascularization rates, partially adjusted rates (adjusted for clinical variables available in most databases, including administrative databases), and fully adjusted rates (additionally adjusted for extent of coronary artery disease and ejection fraction) were also evaluated. RESULTS: The unadjusted relative risk was 0.67 (95% CI, 0.65 to 0.71) for the end point of any revascularization in women relative to men. The relative risk increased to 0.69 (CI, 0.66 to 0.72) with partial adjustment and to 0.98 (CI, 0.94 to 1.03) with full adjustment, indicating equivalent access to revascularization for men and women. For PCI, the corresponding relative risks were 0.77 (CI, 0.73 to 0.82), 0.84 (CI, 0.80 to 0.89), and 1.02 (CI, 0.96 to 1.08). For CABG surgery, the relative risks were 0.54 (CI, 0.51 to 0.58), 0.51 (CI, 0.48 to 0.55), and 0.93 (CI, 0.87 to 1.01). CONCLUSIONS: In Alberta, Canada, clinical variables fully explain sex differences in rates of revascularization after cardiac catheterization, and misleading conclusions would arise without full adjustment for clinical differences between men and women. Extreme caution is needed in interpreting reports on access to care that use sparsely detailed clinical data sources.

Alberta↗

PubMed1999

[Temporary retrograde and anterograde ureteral catheterization].

This article examines the technical modalities or ureteral catheterization. The authors also discuss unconventional modalities which, if used without prejudice, can sometimes constitute brilliant and economic solutions to complex problems which are often impossible to resolve otherwise. After a summary of the history of ureteral catheterization, the authors present the main indications for temporary ureteral catheterization: radiographic and fluoroscopic examination of the ureter; separate cytological harvesting; separate bacteriological harvesting; confirmation of the side of unilateral haematuria; preliminary temporary dilatation of the ureter to prepare it for ureteroscopy; temporary drainage of the excretory tract after endourological investigation. The authors also present particular situations may be observed temporary catheterization, or even permanent stenting, for example in the case of procedures in children, pregnant women and renal transplant recipients.

Adult↗

PubMedDate not supplied

Clean technique for intermittent self-catheterization.

Seven patients with neurogenic bladder dysfunction who ranged in age from 16 to 54 years, and who had been on sterile intermittent self-catheterization, were changed to clean intermittent self-catheterization. Urine was monitored for one year after changing to clean technique. Urine specimens obtained while on clean technique were bacteriologically equivalent to urine specimens examined while patients were on sterile technique; the only exception to equivalent urine results were in patients who did not catheterize themselves at frequent intervals. Renal function tests on all patients were also normal. The clean, intermittent self-catheterization technique was effective, since infection did not seem to be caused by introducing bacteria into the bladder via the urethra.

Adolescent↗

PubMed1999

Achieving femoral artery hemostasis after cardiac catheterization: a comparison of methods.

BACKGROUND: Cardiac catheterization is a common procedure that involves the introduction of a small sheath (5F-8F) into the femoral artery for insertion of other diagnostic catheters. After cardiac catheterization, local compression of the femoral artery is required to prevent bleeding and to achieve hemostasis. Traditional methods of achieving hemostasis require significant time and close supervision by medical personnel and can contribute to patients' discomfort. VasoSeal is a recently developed device that delivers absorbable collagen into the supra-arterial space to promote hemostasis. OBJECTIVES: To compare outcomes between patients receiving a collagen plug and patients in whom a traditional method of achieving hemostasis was used after diagnostic cardiac catheterization. METHODS: An outcomes tracking tool was used to analyze the medical records of 95 patients in whom a traditional method was used (traditional group) and 81 patients in whom VasoSeal was used (device group) to achieve hemostasis. Complications at the femoral access site, patients' satisfaction, and times to hemostasis, ambulation, and discharge were compared. RESULTS: Hematomas of 6-cm diameter occurred in 5.3% of the traditional group; no complications occurred in the device group. The device group also achieved hemostasis faster and had earlier ambulation (P < .001). Patients in the device group were discharged a mean of 5 hours sooner than patients in the traditional group (P < .05). No significant differences were found in patients' satisfaction. CONCLUSIONS: VasoSeal is a safe and effective method of achieving hemostasis after cardiac catheterization that can hasten time to hemostasis, ambulation, and discharge.

Adult↗

PubMed2000

Complications from cardiac catheterization: analysis of a military database.

BACKGROUND: Cardiac catheterization is a common procedure in the United States. Our purpose was to assess possible risk factors for complications from cardiac catheterization. METHODS: The Civilian External Peer Review Program database, which contains data on 3,494 cardiac catheterizations performed at 28 military facilities from 1987 to 1989, provided the patient population for this study. Of 360 abstracted clinical elements, 27 were selected by a panel of internists and cardiologists for evaluation as potential risk factors and were analyzed using logistic regression. Complications were analyzed within three categories: major (myocardial infarction, cerebral vascular accident, or death within 24 hours of catheterization); minor (hemorrhage requiring transfusion, pseudoaneurysm, fistula, or femoral thrombosis); and any. RESULTS: The mean age of the 3,494 patients was 56 years, and 75% of them were male; 85% were white, 10% were African-American, and 5% were other races. Complication rates were as follows: death (N = 13), 3.7/1,000; cerebral vascular accident (N = 16), 4.1/1,000; myocardial infarction (N = 22), 5.6/1,000; hemorrhage (N = 20), 5.1/1,000; fistula (N = 7), 0.3/1,000; and thrombosis (N = 15), 3.8/1,000. These were categorized as 59 major, 71 minor, or 122 any complications. Complications were more likely in patients with hypertension (odds ratio, 1.8; 95% confidence interval, 1.05-3.18), peripheral vascular disease (odds ratio, 2.9; 95% confidence interval, 1.1-8.7), age greater than 60 years (odds ratio, 2.1; 95% confidence interval, 1.2-3.8), and those undergoing angioplasty (odds ratio, 6.0; 95% confidence interval, 2.9-12.2). CONCLUSIONS: Hypertension, age greater than 60 years, peripheral vascular disease, and procedures either nonelective or involving angioplasty all independently increased the risk of complications. There was a "dose-response" relationship between risk and number of risk factors. The risk of a complication may be greater than 10% in patients with more than three risk factors.

Cardiac Catheterization↗

PubMed1975

Bacteriuria in the catheterized patient. Cystitis or pyelonephritis?

Seventy-two patients with indwelling urethral catheters had urine specimens cultured to detect bacteriuria. Bacterial sediments were examined to find the source of the bacteria, with use of an antibody immunofluorescence (IF) technique. Antibody coating demonstrated by fluorescence was considered evidence for pyelonephritis. In cystitis, the bacteria did not fluoresce. Repeat culture and immunofluorescence studies were done 3 to 18 week later. One third of the patients had a urinary infection. Two (13%) of the patients catheterized for one day and 17 (55%) catheterized four or more days had appreciable bacteriuria. One patient catheterized less than three days had positive IF, while 5 patients (16%) catheterized four or more days had positive IF. Only two of the ten patients observed, with an initial infection, had sterile urine on follow-up culture. On follow-up study, of the four patients with bacteriuria of renal origin, one showed a sterile urine, two had cystitis, and one still had pyelonephritis.

Adult↗

PubMed2001

[Complications in administration of contrast media in the catheterization laboratory: a 5-year retrospective study].

UNLABELLED: Iodine contrast substances (CS) are used since the twenties of the 20th century. From the chemical aspect benzoic acid derivatives are involved which are classified according to their osmolality (high-low- and isoosmolar) tendency of ionization (ionic and non-ionic) and according to the molecular structure monomers and dimers). Side-effects are due to their osmotic, ionic and chemical action on tissues. They include a number of systemic and organ symptoms (cardiovascular, immunological, haemocoagulation, neurological and renal), from the clinical aspect divided into mild, medium severe and severe. The relatively high incidence of undesirable reactions when ionic high-molecular CS are used led to the-development of non-ionic preparations with a lower osmolality, the more extensive use of which is limited by economic factors. Moreover so far convincing clinical data are lacking that the higher incidence of undesirable reactions after the use of CS has a clinical impact. OBJECTIVE: To summarize experience with administration of CS in the catheterization laboratory of the Cardiocentre of the General Faculty Hospital during diagnostic and intervention procedures within 5 years with regard to the occurrence of undesirable effects when comparing ionic and non-ionic CS. METHOD: Retrospective analysis of a group of patients examined in the catheterization laboratory to whom a CS was administered during the period between Jan. 1 1995 and Dec. 31 1999. RESULTS: In 1995-1999 (5 years) in the catheterization laboratory a total of 10,149 procedures where implemented where ionic (ioxitalam-Telebrix 350) and non-ionic (iopromide Ultravist 370, ioversol--Optiray 370 and iomeprol-Iomeron 350) contrast substances were administered. Ionic CS were administered in 4,668 (46%) and non-ionic CS in 5,481 (54%) instances. Undesirable effects were recorded in a total of 107 (1.1%) patients, incl. ventricular fibrillation in 76 (0.75%), cardiac arrest in 12 (0.12%) and in 19 (0.19%) there were other undesirable effects (weakness, nausea, hypotension, flush, urtica etc.). Ionic and non-ionic CS participated equally in complications: ionic CS in 53 (49.5%) cases and non-ionic CS in 54 (50.5%), whereby no difference was observed in the type of complications. No death in conjucntion with administration of CS was observed. CONCLUSION: The use of contemporary contrast substances in the catheterization laboratory for diagnostic and intervention procedures on the heart is relatively safe with a minimal risk of development of serious complications. No difference was observed between the use of ionic and non-ionic CS.

Cardiac Catheterization↗