Catheter Implantation Research Articles

Infections of Port Access Catheters in Children

Background: The most important complication of port access catheters (PAC) compared to peripheral lines is a higher incidence of infections. Objectives: This study investigated the frequency of catheter infection and related factors in Dr. Sheikh Children Hospital (SCH). Methods: This is a retrospective descriptive study at Sheikh children’s hospital, Mashhad, Iran. The data of children with an operation for PAC surgery were gathered from hospital files and completed by calling the parents. The definition of PAC infection was based on clinical signs of catheter infection and any positive blood culture (peripheral or catheter sample) or the resolution of signs of infection after the extraction of the catheter in the absence of positive blood cultures. Results: During six years, 70 children received PAC, all of whom (except five) were followed by telephone calls. Forty percent of them were younger than two years, and 71.4% had malignant disease. Catheter infection occurred in 16 (22.8%) cases. Signs of catheter infection were fever and cellulitis over the port in nine (56%) cases (pocket infection), chills and fever during catheter usage (without port infection) in six (37.5%) cases, and persistent fever in one patient (6.2%). Blood culture was positive in 75% (12 cases) of catheter infections, and the responsible organisms were Gram-negative bacilli (five cases), Coagulase-negative staphylococci (three cases), Candida (three cases), and group B streptococci (GBS). The success rate for “medical therapy per se” was 68% in catheter infections. The catheter was removed in 22 (31.4%) patients, which was due to infection in half of them. The mean time to removal was 15.3 months. Conclusions: The incidence of catheter infection, especially pocket infection, is high in this population, which necessities revision in all procedures of catheter implantation and care.

MO701COMBINED PROCEDURE OF PRE- EXISTING ABDOMINAL WALL HERNIA REPAIR AND PERITONEAL CATHETER INSERTION. LONG TERM FOLLOW- UP IN PERITONEAL DIALYSIS TREATMENT

Abstract Background and Aims Successful peritoneal dialysis (PD) program requires a combination of optimal peritoneal access and low incidence of complications. Between pitfalls of this modality are early mechanical complications such as leak, malfunction, and new abdominal wall hernia formation in the long term of PD treatment. Pre-existing abdominal wall hernia is a relative contraindication for PD. Hernias are also a known and not uncommon complication over the course of PD and one of the causes of technique failure. In our center, a physical examination and an ultrasound for hernias detection are routine procedures before the start of PD. If a hernia is discovered, combined hernia repair and catheter implantation are performed. The aim of this study was to assess to long- term results of this approach. Method The current study presents the retrospective analysis of 10 years' experience of our PD program (1.01.2009 – 31.12. 2018) including all incident PD patients who underwent their first peritoneal catheter placement procedure during the study period. The primary endpoints of the study were the rate of hernia formation in the course of PD treatment, type of hernias, identification risk factors for hernia formation and rate of hernia recurrence after previous repair. The secondary endpoint was the rate of procedure-related complications: infectious, leaks and primary catheter malfunction in patients who underwent surgical catheter insertion compared to percutaneous technique. Patients were followed until the end of PD treatment or until 31.10.2019. Results A total of 211 patients were included in the analysis. Of these, 24.5% underwent surgical procedures and 75.5% percutaneous insertion. Mean follow-up was 23.3 ± 25 months (2 to 96 months). About half (53.1%) of the patients were diabetic, aged 64.2±13 years. In 32 patients (15%) a preventive hernia repair with a simultaneous catheter implantation were performed. Patients who underwent a preventive hernia repair were significantly older than other patients (69.4±11.1 years versus 63.2±13.1 years, P=0.013). During the study period, 203 of 211 patients were treated by PD. Thirty three (16.1%) have developed 38 new hernias. Patients suffering from a new hernia during PD were predominantly male, with longer dialysis vintage than patients without new hernia formation (35.3±22.8 months versus 23±22.9, respectively. P=0.001). Five of 33 patients suffered multiple hernias, including recurrent hernias at the same site. Most common types were inguinal and umbilical (44.7% each other), while only few were incisional or ventral. None of our patients suffered from a pericatheter one. The overall rate of new hernias development was 0.09/patient/years. Neither age, comorbidities, obesity nor polycystic kidney disease did not increase the rate of hernia formation during the course of PD treatment. There was no significant association between type of catheter insertion procedure (surgical/percutaneous) and infections, leakages or catheter function. Leak incidence in diabetic patients was significantly higher in comparison with nondiabetic patients (8% versus 1%, P=0.021). Infectious complications were not different between diabetic and not diabetics patients (5.4% among diabetic patients versus 2% nondiabetic, P=0.29). Conclusion Our findings show that male gender and prolonged peritoneal dialysis duration are the main risk factors for the appearance of hernias in the course of PD therapy. Our data also confirm previous observations that the placement of PD catheter using a paramedian incision approach significantly reduces the incidences of exit site and incision hernias. We suggest that early diagnosis of latent asymptomatic hernias and hernia repair prior to starting PD can improve technique survival.

MO718ROLE OF CT-PERITONEOGRAPHY IN THE PATIENT WITH GENITAL EDEMA AND PERITONEAL DIALYSIS

Abstract Background and Aims Genital edema is a frequent complication in those patients who are on peritoneal dialysis, generally secondary to the increase in intra-abdominal pressure that it entails. It occurs late after the implantation of the peritoneal catheter (after 30 days of implantation). The typical clinical manifestation of this condition is basically subcutaneous edema in the genital area, accompanied by pain and UF failure. The diagnosis must be made by using an imaging test, mainly CT-peritoneography. Method A series of clinical cases of PD patients who consulted for genital edema is reviewed, analyzing the role of peritoneography Results CASE 1 A 76-year-old male, 15 days after the start of the technique, consulted for right scrotal edema. It was decided to suspend CAPD and start hospital intermittent IPD with low volumes. A CT-peritoneography was requested, which revealed a right peritoneal-vaginal duct and a left inguino-scrotal leak. Surgical correction of the anatomical defect was performed without incident, with subsequent return of the patient to CAPD. CASE 2 A 78-year-old man, 15 days after the start of the technique, consulted for bilateral scrotal edema. A CT-peritoneography was performed, which showed that the leak of peritoneal fluid to the scrotum was due to bilateral inguinal hernia. Subsequently, inguinal hernioplasty of the surgical defect was performed without complications. Conclusion Genital edema, as a complication of patients with CAPD, appears in approximately 4-10% of them. CT-peritoneography is the diagnostic technique of choice. To do this, 150 ml of nonionic iodinated contrast, with a concentration of 300 mg/ml, are diluted in approximately 2 liters of dialysis solution, which are introduced into the peritoneal cavity of the patient 2 h before performing the CT. Subsequently, a CT scan of the abdomen and pelvis including the perineum is performed, in the supine position and craniocaudal direction.

Subcutaneous implantable pleural port catheter in the management of malignant pleural effusions in young patients with solid tumors: A new option in the armamentarium of symptomatic treatment.

The contribution of subcutaneous implantable pleural port catheter (SIPP) for malignant pleural effusions (MPE) management in young patients with cancer, in a palliative care setting is not well explored. This monocentric series analyzed 38 patients, median age 18years (range 3-25) with significant pleural effusion. SIPP were considered efficient for eight of 12 evaluable patients (67%) and allowed MPE outpatient management in five cases. SIPPs are safe and efficient device to manage MPE patients with solid tumors, in the palliative care setting. This original tool could help health care providers for thoracic symptom management in alternative to iterative pleural punctures.

A Flexible Implantable Polyimide Catheter Device for Targeted Treatment of Cardiovascular Diseases by Aggregating Magnetic Nanoparticles

This article presents a flexible implantable device fabricated on a polyimide (PI) catheter for targeted treatment of cardiovascular diseases. The copper (Cu) microcoil was fabricated on a PI catheter surface using the rotated UV lithography system and surrounding electroplating technology. The simulation on the magnetic fields generated from the Cu microcoil with 0.2 A current and the driving force analysis on magnetic nanoparticles (MNPs) were conducted. The results demonstrated the precise control of MNPs motions within the magnetic fields generated from the Cu microcoil fabricated on the PI surface. The maximum temperature that increased from the magnetized Cu microcoil was 2 °C at room temperature, suggesting no induced hyperthermia. Moreover, the electrical performance of Cu microcoil was excellently stable in a variety of environments, such as wet, dry, and mechanical fatigue conditions. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">In vivo</i> tests displayed great biocompatibility of the fabricated device within the carotid artery of a rat model. The directional assembly of MNPs can be achieved by a Cu microcoil fabricated on the surface of a PI catheter. The fabricated device shows notable advantages in promoting the targeted therapeutic strategy of cardiovascular diseases.

Quality of life and Comprehensive Geriatric Assessment (CGA) in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of Multi-Catheter Interstitial High-Dose Rate Brachytherapy (MIB). The SiFEBI phase I/II trial

ObjectivesThe SiFEBI trial demonstrated that a post-operative Multicatheter Interstitial Brachytherapy (MIB) appears feasible and with acceptable toxicity in older adults aged 70 years and older presenting with low-risk breast cancer. The aim of the present ancillary study was to analyze the quality of life and Comprehensive Geriatric Assessment (CGA) domains within 6 months in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of MIB. Materials and MethodsFrom 11/2012 to 09/2014, 37 patients were included and 26 were evaluable. Patients (pts) aged 70 years and older with a Balducci score of 1 or 2 and presenting with low-risk breast cancer were prospectively enrolled in this phase I/II trial (NCT01727011). After lumpectomy, intra-operative catheter implantation was performed for post-operative APBI after pathological findings. Quality of life (QoL) evaluation and CGA were scheduled at baseline and 1, 3, and 6 months after APBI. Autonomy decline was defined as a 1-point decrease in Activities of Daily Living (ADL). ResultsMean age was 77 years. Within the first 6 months of follow-up, no autonomy decline was observed in ADL, 3 patients had an autonomy decline in Instrumental Activities of Daily Living (IADL) and 2 patients had a slower gait speed but no changes in cognitive function, nutritional status, and depression screening. Global QoL was quite similar at baseline compared to 1, 3, and 6 months. No differences were observed for functional items. ConclusionAPBI based on a single fraction of MIB in older adults with low-risk breast cancer appears to be feasible with a minimal loss of autonomy regarding IADL, no loss of autonomy in ADL, an acceptable decrease in other CGA domains, and with no impact on global quality of life.

Utility of a Suture-Mediated Closure System for Large Bore Arterial Access During Challenging Liver Intra-Arterial Catheters Implantation

To describe and study the utility of vascular suture-mediated closure systems for large bore arterial access during challenging implantation of liver intra-arterial catheters taking as a reference the conventional procedure involving patients without challenging anatomy. Between January 2017 and January 2019, 61 consecutive patients underwent 65 intra-arterial catheter IAC implantations for colorectal cancer. Twenty-three procedures (35%) considered by the operators with challenging coeliac trunk angulations were treated using a vascular suture technique where a 6-F introducer was used, the other patients were treated with a conventional 4F access technique. Clinical and radiological characteristics of patients, technical success (implantation of catheters allowing safe infusion of chemotherapy) and complications (Common Terminology Criteria for Adverse Events, CTCAE 5.0) were recorded. Mean coeliac trunk angulations were 36.3° (± 14.3) for the vascular closure group and 49.6° (± 17.1) for the conventional group. Technical success of the procedures was 100% for the vascular closure group and 80% in the conventional group (p < .05). Four patients with technical failure in the conventional group had a successful IAC implantation on the second attempt using the vascular closure technique. The use of a suture-mediated closure system for large bore arterial access allowed more frequent positioning of the distal tip into the gastro duodenal artery (GDA) (p = .01). No major complication occurred. The use of a large bore arterial access combined with a suture-mediated closure system may be useful for challenging IAC implantation without major complications.

Estradiol‐Specific Neural Regulation of Social Stress Susceptibility in Female Rats

Repeated exposure to social stress is a common risk factor for development of anxiety disorders. Women are twice as likely as men to suffer from anxiety. However, this increased susceptibility in females is confined between the onset of puberty and the end of menopause. This suggests that ovarian hormones may contribute to the disproportionate development of stress-related anxiety disorders among women. We have previously shown that witness stress (WS), a model of social stress in which a female rat is subjected to witnessing an aggressive social defeat encounter between a male intruder and a novel male resident, produces anxiety-like behaviors selectively in intact, cycling female rats. Ovariectomized (OVX) females are largely resistant to witness stress. Moreover, intact females exposed to WS exhibit a distinct increase in corticotropin releasing factor (CRF) expression in the CeA. The current study seeks to understand specific 17-β estradiol-induced neural regulation that may contribute to the heightened susceptibility to social stress among females. Following recovery from implantation of an intravenous catheter and OVX or sham surgery, female rats were treated with either 17-β estradiol (17-βE, 10μg/rat, s.c.) or vehicle (veh, 0μg/rat, s.c.). One hour after injection, female rats were exposed to WS or control handling and video-recorded for 15 minutes. Witness stress-evoked burying, freezing, and rearing behaviors were subsequently quantified to assess stress-induced anxiety-like responses. To quantify CRF expression, frozen brains were sliced coronally, immunohistochemistry was conducted, and brains were double labeled for CRF and cfos in various stress-sensitive regions. Behavioral responses showed WS rats spent significantly more time burying compared to control rats. Veh-treated OVX rats were less behaviorally reactive to WS as evidenced by decreased WS-evoked burying durations compared with intact veh-treated witnesses. However, OVX rats treated with 17-βE exhibited WS-induced anxiety-like responses similar to those of intact females as demonstrated by similar stress-evoked burying durations during stress. There was no effect of stress or treatment on freezing or rearing behaviors. Furthermore, cfos positive CRF expression in the CeA was increased for intact WS rats. Analysis of stress sensitive brain regions such as the hippocampus and locus coeruleus are ongoing. Taken together, these finding suggest that 17-βE plays a paramount role in facilitating the anxiety-like behaviors to witness stress and points towards specific neural regulation of these responses. These studies will lay the foundation for identifying pharmacological targets to increase stress resilience.

Cateterização venosa central de longa permanência em adolescentes com doenças onco-hematológicas

Objetivo: analisar o uso dos cateteres venosos centrais, de longa permanência, em adolescentes com doenças onco-hematológicas, atendidos no período compreendido entre 2008 e 2018, em uma enfermaria especializada de atenção integral a saúde do adolescente. Método: Estudo descritivo transversal, retrospectivo, de análise documental, com abordagem quantitativa, desenvolvido em um Hospital Universitário do Estado do Rio de Janeiro, Brasil. Resultados: Amostra composta por 49 impressos sobre as condições clínicas de adolescentes com doenças onco-hematológicas submetidos à implantação dos cateteres venosos centrais. 65% (n=32) eram do sexo masculino com a idade mínima e máxima de 12 e 19 anos, sendo 22,45% (n=11) com a idade de 15 anos. Quanto às doenças onco-hematológicas, observou-se predomínio das leucemias destacando-se a Leucemia linfoide aguda, representada por 43% (n=21) dos casos, seguida dos linfomas em 35% (n=17). Dentre os tipos de dispositivos, houve predomínio do Cateter Central de Inserção Periférica em 71,43% (n=35), e dentre os motivos de retirada dos cateteres prevaleceu a ausência de registros em 51,02% (n=25), seguida da obstrução e da infecção, ambas com 12,24% (n=6). Em relação ao tempo de permanência, notou-se que dos 49 cateteres implantados, 55,10% (n=27) apresentou ausência dos registros e 36,74% (n=18) permaneceram em um tempo menor que um ano. Conclusão: Os dados evidenciados reforçam a necessidade dos registros de enfermagem e da aplicação de boas práticas de manutenção e manuseio destes cateteres. Ressalte-se a importância da capacitação da equipe de enfermagem, a fim de promover a segurança do paciente por meio de uma assistência qualificada de enfermagem.

Long-Term Results of a Standard Algorithm for Intravenous Port Implantation.

Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.

Risk factors and change in the nutritional status in patients who develop catheter‐related bloodstream infection following implantation of a totally implantable central venous catheter port

Risk factors and change in the nutritional status in patients who develop catheter‐related bloodstream infection following implantation of a totally implantable central venous catheter port

Comparison of single-injection ultrasound-guided thoracic paravertebral block with transversus abdominis plane block in peritoneal dialysis catheter implantation: a randomized controlled trial

BackgroundPrevious study indicated that transversus abdominis plane (TAP) block could be the principal anesthetic technique for peritoneal dialysis catheter (PDC) implantations. However, a TAP block could not provide an optimal anesthetic effect on catheter exit site during PDC implantation. We hypothesized that single-injection ultrasound-guided thoracic paravertebral block (US-TPVB) could be the principal anesthetic technique with better pain relief at catheter exit site during PDC implantation, compared to a TAP block. And anesthesia quality of a single-injection US-TPVB was compared with that of a TAP block and local anesthetic infiltration (LAI).MethodsPatients undergoing PDC implantations were randomized into groups TPVB or TAP or LAI. In group TPVB, single-injection US-TPVB at T10-T11 level was performed with 20 ml of 0.25% ropivacaine. In group TAP, oblique subcostal TAP block was performed with 20 ml of 0.25% ropivacaine. In group LAI, 40 ml of 0.25% ropivacaine was used. Anesthesia quality was compared among the three groups, including general anesthesia conversion rate, cumulative rescuing sufentanil consumption, and satisfaction rate by nephrologists and patients.ResultsEighty-eight eligible patients were enrolled. Visual analogue scale (VAS) at most time points (except for the catheter exit site) were lower in group TAP, compared with group TPVB. VAS at parietal peritoneum manipulation was 6 (5, 7), 3 (0, 6), and 7 (4.75, 9) in groups TPVB, TAP, and LAI, respectively (P < 0.001). VAS at catheter exit site was 4 (3, 4), 5.5 (4, 8), and 5 (3, 7.25) in groups TPVB, TAP, and LAI, respectively (P = 0.005). Lower general anesthesia conversion rate, less cumulative rescuing sufentanil consumption, and higher satisfaction rates by nephrologists and patients were recorded in group TAP, compared with groups TPVB and LAI.ConclusionsSingle-injection US-TPVB provided a better pain relief at catheter exit site. The quality and reliability of anesthesia after a single-injection US-TPVB was comparable to that of LAI, but not better than that of an oblique subcostal TAP block for PDC implantation.Trial registrationTCTR20160911002. Registered on 8 September 2016.

Hypersensitivity Induced by Intrathecal Bradykinin Administration Is Enhanced by N-oleoyldopamine (OLDA) and Prevented by TRPV1 Antagonist.

Transient receptor potential vanilloid 1 (TRPV1) channels contribute to the development of several chronic pain states and represent a possible therapeutic target in many painful disease treatment. Proinflammatory mediator bradykinin (BK) sensitizes TRPV1, whereas noxious peripheral stimulation increases BK level in the spinal cord. Here, we investigated the involvement of spinal TRPV1 in thermal and mechanical hypersensitivity, evoked by intrathecal (i.t.) administration of BK and an endogenous agonist of TRPV1, N-oleoyldopamine (OLDA), using behavioral tests and i.t. catheter implantation, and administration of BK-induced transient thermal and mechanical hyperalgesia and mechanical allodynia. All these hypersensitive states were enhanced by co-administration of a low dose of OLDA (0.42 µg i.t.), which was ineffective only under the control conditions. Intrathecal pretreatment with TRPV1 selective antagonist SB366791 prevented hypersensitivity induced by i.t. co-administration of BK and OLDA. Our results demonstrate that both thermal and mechanical hypersensitivity evoked by co-administration of BK and OLDA is mediated by the activation of spinal TRPV1 channels.

#19: Challenges and Opportunities for the Improvement of Care and Prevention of Infections in Institutions Serving Cancer Patients in Bolivia

Abstract Background Children with cancer in low-income countries are at risk of dying 10 times more than children with similar disease in countries with more resources; and more than half of the deaths are due to infectious complications. Risks of infectious mortality could be reduced by systematically implementing care and infection prevention, for which the collaboration and commitment of health personnel are required. We describe the structure, execution, and results of the first symposium and workshop on basic aspects of care and prevention of infections in children with cancer for health personnel in three pediatric oncology units in Bolivia. Methods We conducted a quality improvement study of training, where a symposium and workshop was convened to the health personnel in charge of the care of children with cancer of the main pediatric cancer centers in Bolivia. A survey was conducted regarding the current state of care for children with cancer in their respective institutions, as well as the situational perception regarding the care and prevention of infections. At the same time, a symposium was held with presentations by experts regarding hand hygiene, blood cultures, isolation precautions, and safe vascular access; After that, a participatory workshop was developed that included: simulation exercises, feedback on basic points of the four topics, decisions and choices of improvements to be implemented and finally a commitment was made by the attendees to apply these improvements in their institutions. Results Fifty-nine health workers from the only three pediatric cancer centers in Bolivia attended the workshop. Currently, these healthcare professionals see a total of 345 children with cancer. There are 61 new cases annually, approximately 6 patients per month, and with a percentage of abandonment of 20%. In these three centers, peripheral catheters, implantable catheters, and nontunneled catheters are used in 90%, 27%, and 36% of cases, respectively. In relation to patient care, only 26% receive antibiotics in the first hour after hospital admission, 73% have an infection control program, 63% have infection policies and procedures and 76% do not know the infection rates associated with their institution. Through interactive discussion in the workshop, health staff involvement and training emerged as the main priority. The improvements selected by the participants were: training of intravenous therapy teams and increasing health personnel (vascular access); reminders for medical and nonmedical professionals (hand hygiene), ongoing training, monitoring of practices, education, and training in sampling (blood culture); and training of leaders for services (isolation precautions). The written commitment was made by all the participants and an agenda was made to monitor the progress of the selected improvements. Conclusions The group strategy of theoretical-practical training with a motivational and participatory background is a tool that can help health personnel to commit to improving the care of children with cancer in Bolivia. Follow-up is being conducted for the next 6 months to determine the long-term impact of this strategy.

Rectus abdominis muscle thickness as a predictor of peritoneal catheter dysfunction in emergency-start peritoneal dialysis patients.

Percutaneous insertion of a peritoneal dialysis catheter (PDc) is an alternative to open surgical techniques, and the anatomical characteristics of the abdominal wall may predict PDc dysfunction. We evaluated the role of rectus abdominis muscle (RAM) thickness as a predictor of PDc dysfunction. A prospective cohort of emergency-start PD patients (EmPD) who had their first percutaneous PDc insertion were included. PDc failure was defined as the removal of a PDc due to mechanical failure within the first 30 PD fluid exchanges. Clinical variables were recorded. The skin to parietal peritoneum depth and RAM thickness were determined by abdominal ultrasound. Univariate and multivariate logistic regression models were developed to test associations between clinical parameters and PDc dysfunction. Over 6 months, 119 patients underwent PDc insertion; 73 (61.3%) were males, with a mean age of 46.0±17.8 years. The mean skin-to-peritoneum depth was 2.5±1.0 cm, the RAM thickness was 0.91±0.3 cm, and catheter implantation was successful in 116 (97.4%) patients. Insertion failed in 3 (2.5%) cases, and 30 (25.8%) patients presented with catheter dysfunction. Univariate analysis indicated that RAM thickness ≥1.0cm, skin-to-peritoneum depth >2.88cm, abdominal waist >92.5cm, and skin-to-RAM fascia distance >2.3cm were associated with PDc dysfunction; in multivariate logistic regression analysis, only greater RAM thickness remained a significant predictor (OR 1.6, 95% CI 1.38 - 1.88, p<0.001). In EmPD patients, RAM thickness is associated with PDc dysfunction and could aid in identifying patients at risk for PDc dysfunction in emergency settings. Additional adequately powered studies are needed to confirm our findings.

A drug-vs-food “choice” self-administration procedure in rats to investigate pharmacological and environmental mechanisms of substance use disorders

BackgroundPreclinical drug self-administration procedures are commonly used to investigate expression, mechanisms, and treatment of substance use disorders. New methodThe aims were to back-translate an intravenous drug-vs-food choice procedure primarily utilized in monkeys to male and female rats and to develop a surgical method for sustained intravenous catheter patency suitable for long-term drug-choice studies. ResultsThe surgical protocol resulted in a median intravenous jugular catheter patency in male and female rats of 126 days (range: 25–365 days). Drug-vs-food choice was established with opioids (fentanyl and heroin), psychostimulants (cocaine, methamphetamine, and amphetamine), and an opioid/psychostimulant mixture (fentanyl + methamphetamine). The average time from catheter implantation to stable choice behavior across all drugs was 27 sessions (range: 16–44 sessions). Choice behavior stabilized more quickly for cocaine and fentanyl than for other drugs. Manipulations of both environmental variables (e.g., response requirement or food reinforcer magnitude) and pharmacological variables (e.g., extended access drug self-administration or continuous buprenorphine treatment via osmotic pump) significantly shifted opioid-vs-food choice consistent with previous monkey studies. Comparison with existing methodsDuration of intravenous catheter patency in rats was suitable for long-term, within-subject drug choice studies. Effects of environmental and pharmacological manipulations in rats confirmed and extended previous results from monkeys. ConclusionsThe concordance of behavioral results between rats and monkeys using the present drug-vs-food choice procedure supports its utility to improve our basic understanding of the expression and mechanisms of substance use disorders towards to development of more effective therapeutics.

Stereotactic cysto-ventricular catheters in craniopharyngiomas: an effective minimally invasive method to improve visual impairment and achieve long-term cyst volume reduction

Craniopharyngiomas are typically located in the sellar region and frequently contain space-occupying cysts. They usually cause visual impairment and endocrine disorders. Due to the high potential morbidity associated with radical resection, several less invasive surgical approaches have been developed. This study investigated stereotactic-guided implantation of cysto-ventricular catheters (CVC) as a new method to reduce and control cystic components. Twelve patients with cystic craniopharyngiomas were treated with CVC in our hospital between 04/2013 and 05/2017. The clinical and radiological data were retrospectively analysed to evaluate safety aspects as well as ophthalmological and endocrine symptoms. The long-term development of tumour and cyst volumes was assessed by volumetry. The median age of our patients was 69.0 years and the median follow-up period was 41.0 months. Volumetric analyses demonstrated a mean reduction of cyst volume of 64.2% after CVC implantation. At last follow-up assessment, there was a mean reduction of cyst volume of 92.0% and total tumour volume of 85.8% after completion of radiotherapy. Visual acuity improved in 90% of affected patients, and visual field defects improved in 70% of affected patients. No patient showed ophthalmological deterioration after surgery, and endocrine disorders remained stable. Stereotactic implantation of CVC proved to be a safe minimally invasive method for the long-term reduction of cystic components with improved ophthalmological symptoms. The consequential decrease of total tumour volumes optimised conditions for adjuvant radiotherapy. Given the low surgical morbidity and the effective drainage of tumour cysts, this technique should be considered for the treatment of selected cystic craniopharyngiomas.

Percutaneous Implantation of a Microcatheter-Port System for Hepatic Arterial Infusion Chemotherapy of Unresectable Liver Tumors: Technical Feasibility, Functionality, and Complications.

To evaluate the feasibility and safety of percutaneously implanted arterial port catheter systems for hepatic arterial infusion of chemotherapy (HAI) in patients with unresectable liver malignancies. From October 2010 to August 2018, arterial port catheters for HAI were percutaneously implanted in 43 patients with unresectable liver malignancies. Three different catheter placement techniques were compared: a conventional end-hole catheter placed in the common hepatic artery (technique 1, n = 16), a side-hole catheter with the tip fixed in the gastroduodenal artery (technique 2, n = 18), and a long-tapered side-hole catheter with the tip inserted distally in a segmental hepatic artery (technique 3, n = 6). Catheter implantation was successful in 40 (93%) of the 43 patients. Complications related to catheter placement were observed in 10 (23%) patients; 5 (83%) of the 6 major complications were resolved, as well as all 4 minor complications. Catheter migration and occlusion occurred in 9 (22.5%) patients. Catheter migration was more frequent with technique 1 (n = 6) than with technique 2 (n = 1), although the difference was not significant (p = 0.066). Percutaneous arterial port catheter implantation for HAI is highly feasible and carries a low risk of complications.

Infected thoracoabdominal aortic aneurysm related to an implanted long-term arterial catheter for chemotherapy: a case report

BackgroundAn infected aortic aneurysm is a rare and life-threatening vascular condition with a high incidence of arterial rupture and recurrence even after treatment. One of the most common causes of an infected aortic aneurysm is catheter-related bloodstream infection. Although infection due to indwelling catheters is possible, the incidence of this is rare, especially for long-term implanted arterial catheters.Case presentationA 78-year-old Japanese man with a past medical history of rectal cancer with metastasis to the liver presented to our hospital as a result of low back pain. Remission had been achieved following surgery and adjuvant chemotherapy via an implanted catheter for arterial infusion. However, the original catheter that was inserted from the femoral artery to the hepatic artery via the celiac artery was still present more than 10 years after diagnosis, without being replaced, in case of a recurrence. On the day of admission, computed tomography scan of the chest and abdomen with contrast revealed an irregularly shaped aortic aneurysm at the origin of the celiac artery and a partially expanded common hepatic artery with disproportionate fat stranding along the implanted arterial catheter without extravasation. Although the initial impression was an impending rupture of the acute thoracoabdominal aortic aneurysm, a catheter-related infection was considered as a differential diagnosis. Surgery was performed, which revealed a catheter-related infected aortic aneurysm based on images along the catheter, pus cultures, and tissue pathology examination results.ConclusionsThis is an extremely rare case of an infectious aneurysm caused by prolonged implantation of an arterial catheter for chemotherapy. It should be noted that an indwelling arterial catheter not only causes bloodstream infections but can also cause an infection of a thoracoabdominal aortic aneurysm.

On the bacteriostatic activity of hyaluronic acid composite films

Biofilm-related infections and contamination of biomaterials are major problems in the clinic. These contaminations are frequently caused by Staphylococcus aureus and are a pressing issue for implantable devices, catheters, contact lenses, prostheses, and wound dressings. Strategies to decrease contamination and biofilm related infections are vital for the success of implantable biomaterials. In this context, hyaluronic acid (HA), a naturally derived carbohydrate polymer, known to be biocompatible, degradable, and immunomodulatory, has shown some antimicrobial activity effects. Due to its poor structural stability, crosslinking strategies, and the incorporation of reinforcing fibres in HA gels is required to produce tailored gels for varying applications. Whilst carbon-based reinforcing materials, such as carbon nanofibers (CNF), present some intrinsic antimicrobial activity related to their high surface area, herein, a crosslinking strategy to enhance the mechanical properties and regulate the rate of degradation of HA is presented. We utilise bis-(β-isocyanatoethyl) disulphide (BIED) as the crosslinker with the gel reinforced using 0.25 wt% CNF. The effects of CNF and BIED on the structural, mechanical, thermal, and swelling behaviour are examined. These new HA derivatives exhibit excellent mechanical properties and are capable of withstanding physiological stresses in vivo. Antimicrobial activity of the HA derivatives were tested against Staphylococcus aureus and the results reveal antibacterial effect. These carbohydrate based materials have potential application on surfaces within clinical settings where staphylococcal contamination is currently an issue.