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Percutaneous cannulation of the internal jugular vein (IJV) is widely used for patients suffering with end stage renal disease. As with all invasive procedures, it is associated with a number of recognized complications. Cardiac tamponade is one such complication. Cardiac tamponade is thought to arise from the guide-wire, the dilator and venous cannulation perforating the right atrium, the right ventricle and on rare occasion the superior vena cava. We report here on a case of cardiac tamponade that was caused by perforating the inferior vena cava (IVC) via the guide-wire while attempting IJV catheterization under echographic guidance. Case Report: A 62-year-old woman with end stage renal disease secondary to diabetic nephropathy presented with anorexia and dyspnea. Because the patient had severe uremic symptoms, we planned to start emergency hemodialysis. Her arteriovenous fistula for hemodialysis was not adequately created; therefore, IJV catherization was needed. With the patient in the Trendelenberg position, we inserted a soft j-tipped guide-wire into the right jugular vein under echographic guidance. No resistance was encountered when inserting the guide-wires, dilators or catheters. Over the next few minutes, the patient's systolic blood pressure gradually decreased to 70 mmHg. The jugular venous pressure was not elevated, and her heart sounds were normal. Yet an emergency echocardiogram and chest CT scan were done because it was necessary to rule out occult vascular injury associated with the procedure. A large pericardial effusion was identified on the emergency echocardiogram and chest CT scan. An exploratory median sternotomy was immediately performed. The pericardial sac was tense and it contained a large amount of blood with grossly visible clots. In the IVC adjacent to the RA, a scratch and a 1mm sized hole was found and then primary closure was done. These lesions were thought to be due to penetration of the IVC wall by a guide-wire because of the distance from the access site to the perforation site. The vital signs of the patient were stabilized after the operation. The postoperative course was uneventful, and the patient was discharged 22 days later.

Bosonic superweakly interacting massive particles (super-WIMPs) are a candidate for warm dark matter. With the absorption of such a boson by a xenon atom these dark matter candidates would deposit an energy equivalent to their rest mass in the detector. This is the first direct detection experiment exploring the vector super-WIMPs in the mass range between 40 and 120 keV. Using 165.9 days of data no significant excess above background was observed in the fiducial mass of 41 kg.The present limit for the vector super-WIMPs excludes the possibility that such particles constitute all of dark matter. The absence of a signal also provides the most stringent direct constraint on the coupling constant of pseudoscalar super-WIMPs to electrons. The unprecedented sensitivity was achieved exploiting the low background at a level 10 −4 kg −1 keV −1 ee day −1 in the detector.

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