Browsing by Author "Perić, Vladan (9741677100)"

Backgraund/Aim. Hemodialysis catheter, as an integral part of hemodialysis, is a catheter placed into the jugular, subclavian and femoral vein. The most common catheter-related complications are infections and thrombosis. The aim of the study was to analyze the prevalence of complications associated with differently inserted central-vein catheters for hemodialysis. Methods. The study was organized as a prospective examination during the period from December 2003 to November 2006, and included all patients who needed an active depuration by hemodialysis, hospitalized at the Clinical Center Kragujevac. The subject of the study were 464 central-vein catheters inserted during the mentioned period and there were recorded all complications related to the placement and usage of catheters. Results. The largest percent of inserted catheters was into the femoral vein - 403 (86.8%), significantly less into the jugular vein - 42 (9.2%), while into the subclavian vein there were placed only 19 catheters (4%). The average of femoral catheter functioning was 17 catheter days, in jugular catheters it was 17.3 days while the subclavian catheters had an average rate of functioning of 25.9 catheter days; there was found a statistically significant difference regarding the duration of functioning (p = 0.03). By microbe colonization of smear culture of the skin at the catheter insertion site, in clinically present suspicion of catheter infection, there was obtained a positive finding in 5.5% of catheters placed into the femoral vein and 7.1% of catheters instilled into the jugular vein, of which Staphylococcus aureus was the most important bacterial type, without statistically significant difference (p = 0.51). Haemoculture, done when there was a suspicion of bacteriemia, was positive in 3.7% of the patients with femoral and 4.8% with jugular catheters; Staphylococcus aureus was the most common bacteria type, but there was no statistically significant difference (p = 0.65). Colonizing the smears of the cut catheter tops, there was found a positive finding in 8.9% of femoral and 4.7% of jugular catheters in which the mentioned type of staphylococcal bacteria was prevalent, without statistically significant difference (p = 0.82). In 77% of femoral, 71.4% of jugular and 68.4% of subclavian catheters, there were no complications associated with insertion and manipulation of catheters for hemodialysis and the difference was at the limits of statistical significance (p = 0.06). Conclusion. Unconvincing rate of infections and a smaller percent of serious complications associated with the placement and use of central vein catheters instilled into the femoral vein, indicate that personal experience is sufficient recommendation to convince us that femoral vein does not represent a region with an increased risk for insertion of hemodialysis catheters.

Background/Aim: Interatrial conduction time is early marker of disturbed impulse propagation in adult with elevated blood pressure. The aim of our study was to evaluate significance of noninvasive echocardiographic marker of slow sinus impulse propagation (atrial conduction time) for the identification of persons with slightly elevated blood pressure and hypertension in adults. Methods: One hundred and forty nine adults with normal and elevated blood pressure were studied: 46 normotensive adults (group 1), 28 adults with elevated blood pressure and hypertension stage 1 (group 2) and 75 adults with hypertension stage 2 (group 3), based on the Joint National Committee 8 (JNC-8) hypertension guidelines. We studied P wave dispersion, reservoir function of the left atrium (LA), total emptying volume of the LA and total emptying fraction of the LA (LATEF). The atrial conduction time (ACT) was evaluated by the pulsed tissue Doppler, and expressed as interatrial and intraatrial conduction time. Results: The LATEF decreased progressively from the group 3 (64.8 ± 4.4%) to the group 2 (59.8 ± 5.2%) and the group 1 (55.6 ± 7.3%) (p < 0.001). The P wave dispersion (55.1 ± 9.8 ms vs. 46.8 ± 3.1 ms vs. 43.1 ± 2.6 ms; p < 0.01) and intra ACT were significantly prolonged only in the group 3 compared to the other groups (22.7 ± 11.0 ms vs. 8.4 ± 4.7ms vs. 5.6 ± 2.4 ms, respectively; p < 0.001). Inter ACT significantly increased from the group 1 to the group 2 and the group 3 (15.6 ± 3.9 ms vs. 24.6 ± 5.7 ms vs. 50.4 ± 20 ms, respectively; p < 0.05). Using a cut-off level of 19.5 ms, inter ACT could separate adults in the group 2 from the group 1 with a sensitivity of 85%, and specificity of 89% [area under receiver operating characteristic (ROC) curve 0.911]. Conclusion: Prolonged ACT estimated with the tissue Doppler may be useful for identification persons with slighty elevated blood pressure, and hypertension stage 1. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. The field of lung ultrasonography (US) is a fast-developing one, and it provides the medical community with numerous new diagnostic opportunities. The aim of this study was to examine the etiology of dyspnea on admission and assess the stage of heart failure (HF) according to the US examination of the heart and lungs. Methods. The cross-sectional study included a total of 110 patients treated for the symptoms of dyspnea. The study included all patients treated for any heart or pulmonary condition, as well as patients who reported the first episode of dyspnea without any previous illness. The most important diagnostic sign in the US of the lungs in patients with HF was the appearance of B-lines or “comets” (ultrasound artifacts reminiscent of comet tails), which indicate the accumulation of fluid in the interstitium of the lungs. Results. The mean number of registered “comets” in the total number of patients was 14.2 ± 7.4 (minimum 2, maximum 30). The mean number of “comets” among patients with HF was 18.8 ± 5.9. The mean number of “comets” among patients without HF was 8.0 ± 3.7 (p ≺ 0.001). Multivariate linear regression analyses showed the association between the number of “comets” and HF (p ≺ 0.001). Conclusion. As the assessment of present “comets” in pulmonary US examination is safe and non-invasive, it can easily be integrated into the daily clinical practice because it has been shown that the number of pulmonary “comets” is significantly higher in patients with HF compared to those with dyspnea of other etiologies. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.