Search

Introduction: Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (KF-HD). We determined both AF incidence and burden in patients with KF-HD using implantable loop recorder (ILR) monitoring. Methods: Patients with KF-HD were enrolled and received an ILR. In 6 monitoring months, the incidence of AF events lasting ≥6 minutes was captured. Demographic, clinical, and dialysis characteristics were collected, and associations with incident AF were estimated using negative binomial regression models and expressed as incidence rate ratios and 95% CIs. Results: We enrolled 66 patients with KF-HD (mean age = 56 years, 70% male); 59 (90%) were without previously diagnosed AF. AF lasting ≥6 minutes was detected in 18 of 59 subjects (31%) without previously diagnosed AF and in 5 of 7 subjects (71%) with a previous AF diagnosis. Among the 23 with detected AF, episodes were present on 16% of patient days. Although 14 of 23 patients (61%) had AF on 2.5 vs. 2.5 mEq/l: incidence rate ratio = 0.62; 95% CI, 0.48–0.80) was associated with lower AF risk whereas higher dialysate bicarbonate concentrations (>35 vs. 35 mEq/l: incidence rate ratio = 3.18; 95% CI, 1.13–8.94) were associated with higher AF risk. Conclusion: New AF was detected in approximately one-third of patients with KF-HD. AF affects a substantial proportion of patient days and may be an underappreciated cause of stroke in KF-HD.

Sudden death is one of the more frequent causes of death for hemodialysis patients, but the underlying mechanisms, contribution of arrhythmia, and associations with serum chemistries or the dialysis procedure are incompletely understood. To study this, implantable loop recorders were utilized for continuous cardiac rhythm monitoring to detect clinically significant arrhythmias including sustained ventricular tachycardia, bradycardia, asystole, or symptomatic arrhythmias in hemodialysis patients over six months. Serum chemistries were tested pre- and post-dialysis at least weekly. Dialysis procedure data were collected at every session. Associations with clinically significant arrhythmias were assessed using negative binomial regression modeling. Sixty-six patients were implanted and 1678 events were recorded in 44 patients. The majority were bradycardias (1461), with 14 episodes of asystole and only one of sustained ventricular tachycardia. Atrial fibrillation, although not defined as clinically significant arrhythmias, was detected in 41% of patients. With thrice-weekly dialysis, the rate was highest during the first dialysis session of the week and was increased during the last 12 hours of each inter-dialytic interval, particularly the long interval. Among serum and dialytic parameters, only higher pre-dialysis serum sodium and dialysate calcium over 2.5 mEq/L were independently associated with clinically significant arrhythmias. Thus, clinically significant arrhythmias are common in hemodialysis patients, and bradycardia and asystole rather than ventricular tachycardia may be key causes of sudden death in hemodialysis patients. Associations with the temporal pattern of dialysis suggest that modification of current dialysis practices could reduce the incidence of sudden death.

40% of DVTs occur in the femoral and iliac veins and have a high risk of pulmonary thromboembolism and Post Thrombotic Syndrome (PTS), which can be avoided by timely interventional management. Catheter Directed Thrombolytic Therapy (CDTT) and Pharmacomechanical Catheter-Directed Thrombolysis (PCDT), (combination of CDTT with percutaneous mechanical thrombectomy) techniques enhance the efficiency and rate of thrombus removal. It also uncovers the May Thurner syndrome in many cases. Massive Pulmonary Embolism (PE) is associated with high morbidity and mortality due to thrombotic occlusion of main pulmonary artery and/or both major pulmonary arteries leading to severe hypoxemia, pulmonary artery hypertension and cardiogenic shock. Till now, open surgical pulmonary endarterectomy was the only option for prompt restoration of flow in major pulmonary arteries but carried a high mortality in hemodynamically unstable patients. Catheter based pulmonary thromboaspiration and intrapulmonary thrombolysis can be used. We present our experience in 45 consecutive patients of massive PE presenting with cardiogenic shock.

Eighty cases of electrical burns admitted over a period of 12 years from 1965 have been analysed with respect to age and sex distribution, incidence, site of burn, mode of electrical contact, management and complications. Mortality in the present review was 3–75 per cent. It is felt that before undertaking massive rural electrification in a developing community, the hazards of electricity should be explained by various means, including the use of audio-visual aids, since the majority of these accidents are avoidable and occur in the younger age groups.

Summary A new operation for the repair of distal penile hypospadias has been described in which the whole of the penile skin is rotated through 180° to provide cover to the shaft of the penis and the reconstructed urethra.

This present study is based on the observations on plasma catecholamines in 35 cases of thermal burns of varying severity. In all the groups, there was an initial rise in plasma catecholamine level followed by a gradual decline except in patients of burn index more than 26 who died and in whom values were persistently high. Results were also compared with that of normal controls and patients with planned and unplanned surgical trauma.