RESUMEN
An easy venous access improves the quality of life of patients who need prolonged intravenous therapy. In the case of vena cava superior syndrome the classic access in the jugular or subclavian vein can be difficult or even impossible. We report on seven implantations of Port-a-Cath in the inferior vena cava for patients presenting contra-indications to classic venous access to the vena cava superior (five cases of vena cava superior compression syndrome, one tracheostomy and one extended tumor of thoracic wall). We describe the operative technique and we analyze the indications, the results and the complications of this rarely used technique.
Asunto(s)
Cateterismo Periférico/instrumentación , Catéteres de Permanencia , Vena Safena/cirugía , Síndrome de la Vena Cava Superior/terapia , Adulto , Anciano , Cateterismo Venoso Central , Contraindicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Vena Safena/diagnóstico por imagen , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Incisión VenosaRESUMEN
To assess the relationship between glucose and advanced glycation end products (AGE) and the relationship between AGE and retinal changes in vivo, we studied the time course of retinopathy over 12 months in trypsin digest preparations and measured glycaemia and retinal AGE in spontaneous diabetic hamsters of mild (MD) and severe (SD) phenotypes. Blood glucose levels were elevated in MD (9.44+/-0.76 mmol/l) and in SD (3 months: 24.3+/-1.4 mmol/l; 12 months: 31.7+/-0.8 mmol/l) over non-diabetic controls (NC: 7.15+/-0.25 mmol/l; p < 0.05 or less vs MD; p < 0.001 vs SD). Similar relations were found for HbA1. Retinal AGE in mild diabetes was 405+/-11.3 arbitrary units (AU) (NC 245+/-7.7; p < 0.01) after 3 months and remained unchanged. A non-linear increase of AGE over time was found in severe hyperglycaemic hamsters (466+/-21 AU after 3 months and 758+/-21 AU after 12 months; p < 0.001 vs MD). Pericyte loss in mild diabetes progressed from -26% after 3 months to 41% after 12 months (p < 0.001 vs NC). Whereas the initial pericyte loss in severely diabetic hamsters was identical to the mildly diabetic group, a higher degree of pericyte loss occurred after 12 months (-57%; p < 0.05 vs MD). Endothelial cell numbers remained unaffected by mild hyperglycaemia, but significantly increased over time in severe diabetes reaching 31.7% above controls after 12 months (p < 0.001 vs NC and MD). Microaneurysms were absent in all retinae examined. Acellular capillary segments were increased in mild diabetes (3.83+/-0.31 per mm2 of retinal area) and severe diabetes (7.83+/-0.73) over controls (1.0+/-0.23). These data suggest that a threshold of glycaemia might exist above which AGE removal systems become saturated. Pericyte loss and acellular capillary formation are associated with mild increases in blood glucose and AGE levels while endothelial cell proliferation requires higher glucose and AGE levels.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus/patología , Retinopatía Diabética/patología , Productos Finales de Glicación Avanzada/metabolismo , Retina/patología , Animales , Cricetinae , Cricetulus , Complicaciones de la Diabetes , Diabetes Mellitus/sangre , Diabetes Mellitus/metabolismo , Retinopatía Diabética/etiología , Retinopatía Diabética/metabolismo , Retina/metabolismo , Vasos Retinianos/patología , Factores de TiempoRESUMEN
The story of the total knee arthroplasty begins in the last century. But in 1971, Gunston shows the way of the modern knee arthroplasty and creates the concept of unconstrained arthroplasty. The indication of the total knee arthroplasty should be precise and rigorous. It's not possible to describe all the situations, where a total knee arthroplasty is indicated or not, but the clinical signs could be summarized in pain, stiffness, deformation with or without instability. We observed 10% of postoperative complications; most of them are secondary, but the infections and loosening remain the principal problem in 2% and in 5% of cases, respectively. If the results are now quite the same to those of total hip arthroscopy by survivorship analysis, the indication and the choice of the total knee prosthesis should be passed on a reflection, where the clinical and functional evaluation are the most important.