Purpose: Thoracic central venous obstruction is a common clinical complication in dialysis patients utilizing hemodialysis catheters. Thoracic central venous obstruction can lead to inability to utilize affected veins for catheter placement and sequential use of less preferred alternative venous access sites. The latter can affect the ability to create and/or mature permanent arteriovenous access and contribute to the future loss of thoracic veins for venous access. While alternative procedures exist for gaining venous access in patients who have exhausted routine venous access options, these procedures are complex, time-consuming, and associated with high patient risk. The Surfacer System provides a new approach in patients with right-sided thoracic central venous obstruction, enabling the ability to establish repeated access from the right side of the neck to the right atrium. Methods: We describe the use of the Surfacer System to facilitate placement of hemodialysis catheters in a series of nine patients with thoracic central venous obstruction involving one or more central veins. Patient characteristics and procedure-related outcomes were recorded for all patients. Results: Central venous access was successfully achieved in eight of nine patients using the Surfacer System. Significant venous tortuosity resulted in the inability to achieve venous access in one patient and prolonged procedural time to achieve access in another patient. The mean time required for Surfacer-related procedural steps and associated fluoroscopy time in the remaining seven patients was 13.3 and 3.7 min, respectively. Conclusion: The Surfacer System provides an efficient low-complexity alternative for gaining repeated right-sided central venous access in hemodialysis patients with obstructed thoracic veins.
RESUMENObjetivo: El propósito de la presente investigación fue dilucidar factores etiológicos y determinar la comorbilidad en enfermos con trastornos temporomandibulares (TTM) y dolor orofacial (DOF), con el objetivo de definir orientaciones terapéuticas. Materiales y métodos: Se realizó un estudio clínico-anamnésico entre abril de 2004 y abril de 2008, en pacientes que concurrieron en forma espontánea a la clínica universitaria de la especialidad. Resultados: Se examinaron 263 pacientes, de los cuales 80,22% fueron mujeres. El motivo de consulta más prevalente fue dolor cráneo-cérvicofacial (84%). El 49,43% de los pacientes no reconoció la causa de inicio del problema, siendo "estrés/depresión" (24,71%) la más referida. Los TTM representaron una condición eminentemente crónica: el 34,55% de los pacientes relataron un tiempo de evolución entre 1-5 años, solo un 17,58% tuvo una evolución menor de 6 meses. La frecuencia relativa de diagnósticos, no excluyentes, fue: dolor muscular local, 81,37%; capsulitis/sinovitis, 74,52%; y desórdenes psicosociales, 61,98%. Se observó alta comorbilidad con cefaleas, 55,89%; alteraciones psicosociales, 52,47%; disturbios del sueño, 39,54%, y alteraciones cervicales, 28,9% Discusión: Las características sociodemográficas y clínicas de los pacientes evaluados, se corresponden con los reportes de la literatura actual. Se encontraron asociaciones significativas entre: bruxismo y dolor muscular local (p=0,014); bruxismo y capsulitis/sinovitis (p=0,025), y depresión severa/moderada con dolor muscular local (p=0,006). Se concluye que para el tratamiento de pacientes con TTM es necesaria la autorregulación física, el control de parafunciones y la colaboración interdisciplinaria.Palabras clave: Trastornos temporomandibulares, dolor orofacial, dolor crónico, comorbilidad, trastornos psicosociales. SUMMARYPurpose: The aim of this study was to elucidate the etiologic factors and assess comorbidity in patients with temporomandibular disorders (TMD) and orofacial pain (OFP), to define therapeutic guidelines. Results: 263 patients were examined, of whom 80.22% were women. The most common complaint was cranio facial pain (84%). A 49.43% of the patients did not recognize the cause of onset of the problem. "Stress / depression" (24.71%) was the most mentioned. TMD eminently represented a chronic condition: the 34.55% of patients reported a duration time between 1-5 years, only 17.58% had the pathology less than 6 months. The relative frequency of diagnoses, non exclusive, was local muscle pain, 81.37%; capsulitis / synovitis, 74.52%, and psychosocial disorders, 61.98%. High comorbidity of TMD was observed with headache, 55.89%; psychosocial disorders, 52.47%; sleep disturbances, 39.54%; and cervical abnormalities, 28.9%. Discussion: The sociodemographic and clinical features of patients that were evaluated match reports of the current literature. We found significant associations between bruxism and local muscle pain (p=0,014); bruxism and capsulitis / synovitis (p=0,025), and depression / modera...
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