A modified DRIL procedure by flow reversal of an aborted distal cephalic vein for critical hand ischaemia

Treatment of dialysis access-related hand ischaemia with preservation of the access remains an issue. We report the case of a patient presenting critical hand ischaemia 2 years after proximalisation of a distal radio-cephalic fistula with preservation of the original access. After valvulotomy, the distal cephalic vein was used as in situ bypass and directly anastomosed to the distal brachial artery, providing a direct flow to the hand. This procedure relieved the hand ischaemia without sacrificing the functioning fistula. Six months later, the fistula and bypass were still patent, showing that flow reversal of a previous fistula can be an efficient strategy to correct dialysis access-related hand ischaemia in selected cases.

Vein measurement by peripherally inserted central catheter nurses using ultrasound: A reliability study

Background Peripherally inserted central catheters (PICCs) are increasingly inserted by trained registered nurses, necessitating the development of specialized skills such as the use of ultrasound. The selection of an adequately sized vein is an important factor in reducing adverse events such as deep vein thrombosis. However, PICC nurses may receive minimal training in the use of ultrasound for vein measurement. Objective We aimed to demonstrate the reliability of a vein measurement protocol using ultrasound by a PICC nurse trained in sonography. Methods The diameter of the basilic, brachial, and cephalic veins in the left arms of healthy participants (n = 12) were measured using ultrasound by a PICC nurse and a sonographer. A PICC nurse performed the measurement twice and the sonographer once; the PICC nurse's results were compared for intra-rater reliability and compared with the sonographer for inter-rater reliability. The results were analyzed using intraclass correlation coefficients (ICCs). Results Inter-rater reliability between the PICC nurse and the sonographer was adequate, the ICC for the brachial vein was 0.60 (95% confidence interval [CI], 0.06-0.87), basilic vein ICC was 0.87 (95% CI, 0.58-0.96) and cephalic vein ICC was 0.77 (95% CI, 0.39-0.93). Intra-rater reliability of the PICC nurse was higher; the ICC for the brachial vein was 0.80 (95% CI, 0.44-0.94), basilic vein ICC was 0.92 (95% CI, 0.67-0.98), and cephalic vein ICC was 0.78 (95% CI, 0.40-0.93). Conclusions Using a suitable protocol, a PICC nurse was able to measure vein diameter reliably when compared with a sonographer and consistently replicate these results.

Vein diameter for peripherally inserted cathether insertion: a scoping review

Background: The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used forperipherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certainvein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veinsavailable to determine the most optimal vessel to introduce a catheter. It is important that clinicians have anunderstanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominanceon vein size to determine whether their clinical practice is appropriate.

Methods: A scoping review of published literature was performed to determine existing knowledge regarding thediameters of veins used for PICC insertion and the influence of patient factors such as hand dominance and laterality(left or right arm) on vein size.

Results: There was limited published research about the diameters of the basilic, brachial, and cephalic veins at themidupper arm, with only 6 studies identified. Three of the 6 selected articles focused on vein diameter measurement toinform arteriovenous fistula development. Only 1 study included participants undergoing PICC insertion. Scant researchexamined the effect of laterality on vein diameter and 1 study was identified that reported the influence of handdominance or vein type on the diameter of veins used for PICC insertion.

Conclusions: This review found that there is a paucity of studies that have examined the veins used for PICC insertion.Nevertheless, it appears that the basilic vein has the largest diameter (with smaller brachial and cephalic veins),although this is not always the case. Laterality and hand dominance does not seem to influence vein diameter. Furtherresearch about the vasculature used for PICC insertion is needed to inform clinical practice.

Anticorpos para Leptospira spp., Toxoplasma gondii e Neospora caninum em cães errantes albergados em canil privado

The serological profile of 300 mongrel dogs of various ages and gender were investigated. Animals were captured in the streets and afterwards directed to a private kennel in Avare city (SP) to search for leptospirosis, toxoplasmosis, and neosporosis. Blood samples were obtained from jugular or cephalic vein for the obtention of sera. The microscopic agglutination test (MAT) was used to leptospirosis. MAT detect the prevalence of 9.3%. The most frequent reactant serovars were Bratislava (35.7%), Cynopteri (17.9%), Autumnalis (14.3%), and Copenhageni (10.7%), besides 7.1% to others serovars: Icterohaemorrhagiae, Canicola, and Hardjo. The modified agglutination test used for the diagnosis of toxoplasmosis showed 26% of positive animals, with titers varying from 16 to 256, with 16 in 3.3%, 64 in 13.7%, and 256 in 9% of the samples. To canine neosporosis, it was used the indirect fluorescent antibody test, and two animals (0.7%) demonstrated antibodies with titers 25 and 100. The results show the participation of the animals in the epidemiological chain of the researched diseases.

The first report of Hepatozoon sp (Apicomplexa : Hepatozoidae) in neotropical felids from Brazil

In order to investigate the occurrence of Hepatozoon infection in Neotropical felids from Brazil, blood from the jugular or cephalic vein was taken from 29 non-domestic felids including ocelot (Leopardus pardalis), little spotted cat (Leopardus tigrinus), margay (Leopardus wiedii), and jaguarondi (Puma yagouaroundi) from the Northeast region of Brazil. Hepatozoon infection was confirmed by light microscopy and molecular techniques. The results showed five naturally infected felids. Partial sequences of the 18S rRNA gene of the Hepatozoon sp. from these felids were further analyzed. Sequences revealed that the isolates found are closely related to Hepatozoon sp. from domestic cats in Spain. Hepatozoon species from Neotropical felids were identified molecularly and characterized for the first time. This is also the first report of Hepatozoon infection in a little spotted cat. (C) 2007 Elsevier B.V. All rights reserved.

Molecular and parasitological survey of Hepatozoon canis (Apicomplexa : Hepatozoidae) in dogs from rural area of São Paulo state, Brazil

Hepatozoon canis is a protozoan that infects dogs and is transmitted by the ingestion of the brown dog tick, Rhipicephalus sanguineus. Two distinct species of Hepatozoon genus can infect dogs, H. canis and H. americanum. Routine tests to detect the disease are based on direct examination of gametocytes on Giemsa-stained blood smears. The objectives of this study were the investigation of infection prevalence in rural area dogs, the comparison of diagnostics by blood smear examination and polymerase chain reaction (PCR), and the association of infection with tick infestation. Blood smears, collected by puncture of the cephalic vein and ear margin capillary bed from 150 dogs, were examined. This technique detected 17 positive animals (11.3%), with 14 (9.3%) in peripheral blood and seven (4.7%) in cephalic vein blood. PCR tests detected 80 (53.3%) positive animals. R. sanguineus and Amblyomma spp. were found in 36 of the dogs (24%), in equal proportions. The identified species for Amblyomma genus were A. cajennense and A. ovale. Data analysis showed that PCR was much more sensitive when compared to blood smear examination. Hepatozoon species was previously identified as closely related to H. canis.

Determinação de cetamina em plasma por HPLC: Aplicação em um estudo de farmacocinética de associação medicamentosa em cães

A S(+) cetamina é um fármaco amplamente utilizado na medicina para induzir anestesia e a associação com midazolam é empregada para minimizar seus efeitos adversos. Associações medicamentosas podem resultar em interações farmacocinéticas e a disponibilidade de métodos bioanalíticos para a determinação da cetamina em plasma constitui ferramenta útil para a avaliação do perfil cinético do fármaco administrado isoladamente ou em associação. O presente estudo teve como objetivo o desenvolvimento e validação de um método analítico para determinação da cetamina em plasma por cromatografia líquida de alta eficiência (HPLC) e a investigação do perfil farmacocinético da cetamina em quatro cães hígidos da raça Beagle. A S(+) cetamina (10mg/kg) foi administrada pela veia cefálica em dose única isoladamente (protocolo I) ou associada ao midazolam (0.2mg/kg) (protocolo II) em estudo cruzado com intervalo de uma semana para washout. Amostras seriadas de sangue foram coletadas no intervalo de oito horas e analisadas por HPLC para a avaliação do perfil farmacocinético utilizando modelo bicompartimental. O método bioanalítico apresentou limites de confiança aceitáveis para sua aplicação em estudos de farmacocinética e os parâmetros área sob a curva (ASC0-8), volume de distribuição (Vd), clearance total (Clt), meia vida de eliminação (t/12 ß), constante de eliminação (ß), meia vida de distribuição (t1/2α) e constante de distribuição (α) não mostraram diferenças estatísticas significativas entre os grupos (p < 0.05, Wilcoxon). Os resultados obtidos sugerem que a redução dos efeitos colaterais da cetamina decorrente do uso da associação cetamina-midazolam não está relacionada a alterações no perfil farmacocinético da cetamina.

Effect of remifentanil hydrochloride administered via constant rate infusion on the minimum alveolar concentration of isoflurane in cats

Objective - To evaluate the effects of increasing doses of remifentanil hydrochloride administered via constant rate infusion (CRI) on the minimum alveolar concentration (MAC) of isoflurane in cats. Animals - 6 healthy adult cats. Procedures - For each cat, 2 experiments were performed (2-week interval). On each study day, anesthesia was induced and maintained with isoflurane; a catheter was placed in a cephalic vein for the administration of lactated Ringer's solution or remifentanil CRIs, and a catheter was placed in the jugular vein for collection of blood samples for blood gas analyses. On the first study day, individual basal MAC (MAC Basal) was determined for each cat. On the second study day, 3 remifentanil CRIs (0.25, 0.5, and 1.0 μg/kg/min) were administered (in ascending order); for each infusion, at least 30 minutes elapsed before determination of MAC (designated as MAC R0.25, MAC R0.5, and MAC R1.0, respectively). A 15-minute washout period was allowed between CRIs. A control MAC (MAC Control) was determined after the last remifentanil infusion. Results - Mean ± SD MAC Basal and MAC Control values at sea level did not differ significantly (1.66 ± 0.08% and 1.52 ± 0.21%, respectively). The MAC values determined for each remifentanil CRI did not differ significantly. However, MAC R0.25, MAC R0.5, and MAC R1.0, were significantly decreased, compared with MAC Basal, by 23.4 ± 79%, 29.8 ± 8.3%, and 26.0 ± 9.4%, respectively. Conclusions and Clinical Relevance - The 3 doses of remifentanil administered via CRI resulted in a similar degree of isoflurane MAC reduction in adult cats, indicating that a ceiling effect was achieved following administration of the lowest dose.

Avaliação do efeito trombogênico da perfusão regional intravenosa com gentamicina em equinos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos do cloridrato de remifentanil, administrado em infusão contínua, na concentração alveolar mínima(CAM) de isofluorano em felinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aspectos epidemiológicos da infecção por Hepatozoon spp.(Apicomplexa: hepatozoidae) em cães de áreas rurais do Estado de São Paulo, Brasil e caracterização molecular de isolados

Pós-graduação em Medicina Veterinária - FMVZ

Validação da técnica de angiotomografia helicoidal cerebral em cães hígidos

Pós-graduação em Medicina Veterinária - FMVZ

Anestesia local por tumescência com lidocaína em cadelas submetidas a mastectomia

The present study investigated the benefits of tumescent anesthesia with lidocaine in dogs undergoing mastectomy, seeking the patients' comfort and their postoperative recovery. Seven animals, with different weight and breed, who had cancer in the region of mammary chain underwent mastectomy surgery. All animals received the same anesthetic protocol being used as the association between acepromazine and morphine doses of 0.04mg.kg-1 and 0.4mg.kg-1 (IM), respectively. After 15 minutes a catheter was placed in the cephalic vein and induction with propofol 4mg.kg-1 and 0.2mg.kg-1 followed by maintenance with isoflurane anesthesia was done. After instrumentation, we proceeded to the tumescent anesthesia technique with ice-cold solution consisting of Ringer's lactate, lidocaine 2% without epinephrine and adrenaline in a total volume of 15mL.kg-1. The average duration of the procedure was 74±18 minutes. The plasmatic peak of lidocaine was between 30 and 60 minutes after infiltration. The rescue analgesic was performed after approximately seven hours of infiltration. It can be concluded that the tumescent anesthesia with lidocaine should be considered as a constituent of anesthetic and analgesic protocol in dogs undergoing mastectomy surgery providing parameter stability, safety and good quality postoperative recovery.

Avaliação do efeito trombogênico da perfusão regional intravenosa com gentamicina em equinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Farmacocinética da gentamicina asministrada pela via intravensa regional em equinos com a utilização de modelos de torniques

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)