Problèmes dus aux fistules d'hémodialyse: un réseau régional de prise en charge [Problems related to haemodialysis vascular accesses: a regional network of care]

The number of patients treated by haemodialysis (HD) is continuously increasing. The complications associated with vascular accesses represent the first cause of hospitalisation in these patients. Since 2001 nephrologists, surgeons, angiologists and radiologists at the CHUV are working to develop a multidisciplinary model that includes planning and monitoring of HD accesses. In this setting the echo-Doppler represents an important tool of investigation. Every patient is discussed and decisions are taken during a weekly multidisciplinary meeting. A network has been created with nephrologists of peripheral centres and other specialists. This model allows to centralize investigational information and coordinate patient care while keeping and even developing some investigational activities and treatment in peripheral centres.

Assessment of the role of LASER-Doppler in the treatment of port-wine stains in infants.

BACKGROUND: Port-wine stains (PWS) are malformations of capillaries in 0.3% of newborn children. The treatment of choice is by pulsed dye LASER (PDL), and requires several sessions. The efficacy of this treatment is at present evaluated on the basis of clinical inspection and of digital photographs taken throughout the treatment. LASER-Doppler imaging (LDI) is a noninvasive method of imaging the perfusion of the tissues by the microcirculatory system (capillaries). The aim of this paper is to demonstrate that LDI allows a quantitative, numerical evaluation of the efficacy of the PDL treatment of PWS. METHOD: The PDL sessions were organized according to the usual scheme, every other month, from September 1, 2012, to September 30, 2013. LDI imaging was performed at the start and at the conclusion of the PDL treatment, and simultaneously on healthy skin in order to obtain reference values. The results evidenced by LDI were analyzed according to the "Wilcoxon signed-rank" test before and after each session, and in the intervals between the three PDL treatment sessions. RESULTS: Our prospective study is based on 20 new children. On average, the vascularization of the PWS was reduced by 56% after three laser sessions. Compared with healthy skin, initial vascularization of PWS was 62% higher than that of healthy skin at the start of treatment, and 6% higher after three sessions. During the 2 months between two sessions, vascularization of the capillary network increased by 27%. CONCLUSION: This study shows that LDI can demonstrate and measure the efficacy of PDL treatment of PWS in children. The figures obtained when measuring the results by LDI corroborate the clinical assessments and may allow us to refine, and perhaps even modify, our present use of PDL and thus improve the efficacy of the treatment.