Paraquat is a pesticide widely used in agriculture. Numerous cases of paraquat intoxication have been reported either accidentally or intentionally as a suicidal attempt. The most severe cases of paraquat poisoning refer to oral ingestion. Complications include respiratory, hepatic, and renal failure, and are usually fatal. Dermal exposure is less frequent and rarely fatal.This article reports a case of an 81-year-old man with minimal skin burn after accidental paraquat exposure. The patient developed acute renal and respiratory failure and, despite aggressive treatment with hemodialysis, hemoperfusion, and mechanical ventilation, died two days later.
characteristics of the cohort based on the presence or absence of depression has been previously published. 5 Given the lack of correlation between these variables and depression in bivariate models, these variables were not included in the multivariable model. In addition, the number of events ( 52) limited the inclusion of too many covariates at the risk of over-fitting the model. We agree with Brown that perhaps one mediator between depression and poor outcomes could be that those with depression are more non-adherent to dietary and fluid restrictions, which in turn leads to worse outcomes. 6 Future larger studies are warranted to address these important questions.1. Brown CG. Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression.
A 43-year-old woman with end-stage renal disease on hemodialysis for 4 years presented complaining of recurrent edema of her left arm, neck and face during the last 12 months. She dialyzes via a left brachial artery to cephalic vein arteriovenous fistula. Due to difficulties in vascular access, she had three temporary left subclavian catheters placed previously. On examination, the left neck veins were dilated with large collateral veins on the chest wall. A computed tomography (CT) angiogram ( Fig. 1a,b) followed by a fistulogram (Fig. 2) was performed.What does the CT angiogram show (Fig. 1a,b)? What does the fistulogram show ( Fig. 2)? How should the patient be managed?
AnswersThe CT angiogram showed an extensive collateral vein network involving the chest wall and suprascapular veins (Fig. 1a,b). The fistula is evident in the left upper arm on digital reconstruction images (Fig. 1b). A fistulogram was performed and revealed severe stenosis (>95%) of the left branciocephalic vein and a large collateral network of veins (Fig. 2). She underwent balloon angioplasty with successful vein dilatation with 8 and 10 mm balloons. There was no immediate angiographic improvement of collateral veins, but the edema on the face, arm and neck moderately subsided.Swelling of the face and neck in hemodialysis patients should prompt clinicians to consider impaired venous return due to central venous stenosis. The literature suggests that cannulation of central veins with catheters is associated with up to 50% stenosis rates. The number of catheters inserted and the increased duration of catheter days is also associated with the development of central venous stenosis (1). Such a stenosis is more common with subclavian catheters; they should be avoided even temporarily.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.