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Native arteriovenous fistulae (AVF) are the best options for chronic hemodialysis (HD) access. In elderly, diabetics or patients with late initiation of HD we need to adapt surgical procedures, taking advantage of any opportunity to overcame shortcomings and create a native dialysis access. The case that we present has the particularity of a deep cephalic vein that required superficialization of the acquired brachiocephalic AVF in a normal weight patient (body mass index = 18.6 kg/m2). At the intervention for fistula formation, the poor nutritional status (moderate malnutrition - albuminemia = 2.9 g/dL) and the thin walls of the vein obliged us to perform the two-step procedure: first the creation, then the transposition of the fistula. The presence of two collateral veins imposed a classical intervention that allowed the ligature of these tributary vessels for a better fistula maturation. There were no injuries of the vessels or inflammatory / infectious complications, no impediment for cannulation due to overlapping scar after superficialization. In the dialysis vascular access planning algorithm we must consider all the conditions of the patient, anatomical particularities and the best way to ensure the longevity of the AVF. All the techniques available must be considered as options. [ABSTRACT FROM AUTHOR]

Our study aims to present the principal and the advantage of using the Liquid Based Cytology method by Cytoscreen system, as an alternative to the conventional Babes-Papanicolaou test, by reducing the false negative results frequency due to the poor quality of the smears and the epithelial cell screening by the blood elements, mucus or inflammatory exudates. A set of 1 054 female patients was available to be investigated during 2002-2004 both in the Clinical Gynaecology of The Clinical Hospital Filantropia and the Clinic of Oncology of the Clinical County Emergency Hospital of Craiova; the patients were from the rural and urban places as well; they underwent cytologic screening by Cytoscreen method. We simultaneously performed the cytologic exam by using both the Cytoscreen and the conventional Papanicolaou methods in 220 patients; the rest of them, namely 834 patients, were examined just by Cytoscreen method. The samples were processed in the Laboratory of Pathology and Cytology of the Clinical County Emergency Hospital of Craiova. The smears were fixed in the absolute ethanol for minimum five minutes than was performed the Papanicolaou stain. The diagnosis was according to Bethesda System 2001. Most of the patients (85.87%) were 21-50 aged. For the group of those tested by Cytoscreen, the rate of the "satisfactory smears" was significant increase (82.27% compared to 65.45% of the patients examined by using only the conventional method). The positive results were 5.44% compared to 2.27%. More accurate diagnosis of high degrees squamous intraepithelial lesions (1.36% compared to one case --0.45%), of low degree lesions (4 cases--1.81% compared to 2 cases--0.91%) and the atypical squamous cells with undetermined significance (1.36%Cytoscreen tested compared with 0.91%). Cytologic diagnosis was enforced by biopsy with histopathologic exam for 4 of 10 cases; the rest of the patients did not present for biopsy to be performed. In one case, HSIL diagnosis was false negative as the biopsy result was well-differentiated invasive squamous carcinoma. Both the diagnosis sensitivity and the smears feasibility were significantly improved by using Cytoscreen method.

Microalbuminuria after physical exercise is characteristic for the preclinical stage of diabetic nephropathy, permitting an early diagnosis of this severe complication of diabetes mellitus. In 24 patients with type I diabetes, 11 women and 13 men free of clinical and biological signs of renal damage, the presence of microalbuminuria has been investigated by radial immunodiffusion in the urines collected between 3 and 7 hrs in the morning, as well as after a 20-min rest following a moderate exercise of 75 watts during 20 min at the ergometric bicycle. The patients were distributed into four groups, according to the age of disease, and microalbuminuria was expressed in micrograms/min. Compared with the mean values recorded in normal subjects by the same method (6.8 micrograms/min), the level of microalbuminuria has been significantly higher in the cases evaluating since more than two years, in keeping with the time elapsed after onset, and particularly following exercise. No relationship could be established between the quality of metabolic control of diabetes and the levels of microalbuminuria after exercise.