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Background: In hemodialysis patients, tunneled, cuffed, double-lumen catheters are frequently used for long-term venous access. Infections associated with these catheters are one of the major causes of morbidity and resource usage in the hemodialysis population. Objective: The aim of the current study is to investigate the frequency and types of fungal infection in patients on hemodialysis with double lumen catheter in Imamein Kadhimein Teaching Hospital and Al-Karama Teaching Hospital, Iraq. Material and methods: For the purpose of detecting a fungal infection, 19 blood samples from hemodialysis patients with double lumen catheters were subjected to both BacT/ALERT system (Blood Culture) and molecular approaches (Multiplex Real Time PCR). Results: By using traditional techniques, the fungi Candida spp. (2%), and Cryptococcus spp. (1%) were detected. The following fungi were identified using molecular techniques: (2%) R.oryzae. Conclusion: The nephrologist should be aware of the many fungal infections that patients receiving hemodialysis with double lumen catheters may acquire, including R.oryzae, Candida spp., and Cryptococcus spp. The fungi mentioned above may be acquired during hemodialysis or may already be present as underlying illnesses. This study established that hemodialysis patients with renal impairment who use double lumen catheters could have several complications. [ABSTRACT FROM AUTHOR]

Background and Purpose: Diagnosing cervical artery dissection (CAD) is still a challenge based on the current radiographic criteria. This study aimed to assess the value of three-dimensional high-resolution magnetic resonance imaging (3D HRMRI) in the detection of the signs of CAD and its diagnosis. Materials and Methods: Patients with CAD from January 2016 to January 2021 were recruited from our 3D HRMRI database. The signs of dissection (intramural hematomas, intimal flap, double lumen), length and location of the dissection, thickness of the intramural hematoma, intraluminal thrombus, and percentage of dilation of the outer contour of the dissection on 3D HRMRI were assessed. Results: Fourteen patients with 16 CADs, including 12 carotid CADs and 4 vertebral CADs, were finally diagnosed in this study. On 3D HRMRI, intramural hematomas were detected in 13/16 (81.3%) lesions with high sensitivity (100%) and high specificity (100%). Intimal flaps were found in 9/16 (56.3%) lesions with moderate sensitivity (64.3%) and high specificity (88.9%). Double lumen signs were observed in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). In addition, concomitant intraluminal thrombus were detected in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). The mean length of dissection was (25.1 ± 13.7) mm. The mean thickness of the intramural hematoma was (4.3 ± 2.3) mm. The mean percentage of dilation for the outer contour of the dissection was (151.3 ± 28.6)%. Conclusion: The 3D HRMRI enables detection of the dissecting signs, such as intramural hematoma, intimal flap, double lumen, and intraluminal thrombus with high sensitivity and specificity, suggesting a useful, and non-invasive tool for definitively diagnosing CAD. [ABSTRACT FROM AUTHOR]

Abstract Background The ideal fraction of nitrous oxide (N2O) in oxygen (O2) for rapid lung collapse remains unclear. Accordingly, this prospective trial aimed to determine the 50% effective concentration (EC50) and 95% effective concentration (EC95) of N2O in O2 for rapid lung collapse. Methods This study included 38 consecutive patients undergoing video-assisted thoracoscopic surgery (VATS). The lung collapse score (LCS) of each patient during one-lung ventilation was evaluated by the same surgeon. The first patient received 30% N2O in O2, and the subsequent N2O fraction in O2 was determined by the LCS of the previous patient using the Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10, 20, 30, 40%, or 50%). The EC50 and EC95 of N2O in O2 for rapid lung collapse were analyzed using a probit test. Results According to the up-and-down method, the N2O fraction in O2 at which all patients exhibited successful lung collapse was 50%. The EC50 and EC95 of N2O in O2 for rapid lung collapse were 27.7% (95% confidence interval 19.9–35.7%) and 48.7% (95% confidence interval 39.0–96.3%), respectively. Conclusions In patients undergoing VATS, the EC50 and EC95 of N2O in O2 for rapid lung collapse were 27.7 and 48.7%, respectively. Trial registration http://www.chictr.org/cn/ Identifier ChiCTR19 00021474 , registered on 22 February 2019.

Tariq O Abbas, 1–4 Mansour Ali, 1, 4 Raphael Moog 5 1Pediatric Surgery Department, Hamad General Hospital, Doha, Qatar; 2College of Medicine, Qatar University, Doha, Qatar; 3Surgery Department, Weill Cornell Medicine - Qatar, Doha, Qatar; 4Department of Surgery, Sidra Medicine, Doha, Qatar; 5University Hospital of Strasbourg, Strasbourg, FranceCorrespondence: Tariq O AbbasDepartment of Pediatric Surgery, Hamad General Hospital, Doha, QatarEmail tariq2c@hotmail.comBackground: Pyeloplasty is a common surgical operation with a high success rate. However, significant challenges are to be optimized in the design of stenting systems in order to improve perioperative monitoring of urine drainage and enhance patient and family comfort through easier post-operative care.Materials and Methods: In a preliminary study in six pigs, handling, mechanical and functional features of this stent system were tested. In our main study, six double-lumen stents (230 mm long each) and 6F/9F external diameter were implanted through the ureteric walls of six domestic pigs to allow postoperative drainage and monitoring following ureteroureterostomy. After a 7-day survival period, monitoring with intravenous antibiotic coverage, and pain control, contrast antegrade pyelogram, under valve control, and renal ultrasonography were conducted and stents explanted and the animals were then euthanized.Results: The double-lumen valve-controlled stent supported the healing of the neo anastomoses and helped to monitor perioperative urine drainage and perianastomotic leakage accurately. It also guided a well-controlled more informative radiological contrast-supported imaging before removal of the stents that confirmed the healing of the neo anastomotic site and no leak formation. The double-lumen system demonstrated high feasibility regarding its insertion, functionality, and removal capacities. The excellent flexibility of the individual stents allowed exact anatomically controlled implantation.Conclusion: The double-lumen valve-controlled stent system was studied in a porcine model, which demonstrated its feasibility. Preclinical experience revealed favorable results concerning stent implantation, operability and functionality, in the perioperative management of pyeloplasty or ureteric surgery.Keywords: pyeloplasty, stent, double lumen, animal model

Abstract Background Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (

Background: The ideal fraction of nitrous oxide (N2O) in oxygen (O2) for rapid lung collapse remains unclear. Accordingly, this prospective trial aimed to determine the 50% effective concentration (EC50) and 95% effective concentration (EC95) of N2O in O2 for rapid lung collapse. Methods: This study included 38 consecutive patients undergoing video-assisted thoracoscopic surgery (VATS). The lung collapse score (LCS) of each patient during one-lung ventilation was evaluated by the same surgeon. The first patient received 30% N2O in O2, and the subsequent N2O fraction in O2 was determined by the LCS of the previous patient using the Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10, 20, 30, 40%, or 50%). The EC50 and EC95 of N2O in O2 for rapid lung collapse were analyzed using a probit test. Results: According to the up-and-down method, the N2O fraction in O2 at which all patients exhibited successful lung collapse was 50%. The EC50 and EC95 of N2O in O2 for rapid lung collapse were 27.7% (95% confidence interval 19.9–35.7%) and 48.7% (95% confidence interval 39.0–96.3%), respectively. Conclusions: In patients undergoing VATS, the EC50 and EC95 of N2O in O2 for rapid lung collapse were 27.7 and 48.7%, respectively. Trial registration: http://www.chictr.org/cn/ Identifier ChiCTR19 00021474, registered on 22 February 2019. [ABSTRACT FROM AUTHOR]

Introduction: Despite all efforts to prevent tunneled-cuffed catheter (TCC) infection, the incidence of this infection has remained considerably high. Objectives: The present study aimed to assess risk determinants affecting TCC infection in hemodialysis patients. Patients and Methods: This case-control study was performed on 165 consecutive patients as known cases of end-stage renal disease on maintenance hemodialysis through double-lumenTCC. The patients were assigned into two groups as the case group with the clinical evidences of TCC infection and the control group with noninfectious condition. Results: In the group with TCC infection, the most common microorganisms cultured in the medium included Staphylococcus aurous and Staphylococcus epidermidis with the overall prevalence of 17.6% and 15.3% in blue lumen and 14.1% and 14.1% in red lumen, respectively. Overall, 75.3% of the lumens were positive for infection, while 52.9% of blood cultures were positive. Multivariable logistic regression modeling showed that female gender, insertion catheter through jugular vein, higher C-reactive protein (CRP) level, lower serum iron level and higher serum ferritin level could predict TCC infection in dialysis patients. According to ROC curve analysis, measuring CRP level, serum iron and serum ferritin could effectively discriminate TCC infection from noninfectious condition. Particularly, serum CRP >16 mg/ dL, ferritin > 200 ng/mL and serum iron

This study aime to assess the double lumen subclavian catheter complications among patients with end stage renal disease and to find out the relationship between the patient double lumen subclavian catheter complications and their demographic characteristics. A descriptive study was carried out through the present study in order to achieve the early stated objectives. The study was begun from February, 1st, 2017 to April, 10th, 2017. The study is conducted in Al-Najaf City in Iraq in dialysis centers of Al-Sadder Medical City and Al-Hakeem General Hospital. A non-probability (Convenience) sample of (29) patients with ESRD who are admitted to the dialysis centers. The data was collected on structured questionnaire designed specifically for this study, and it is consist of two parts: Part 1 Included Socio-demographic characteristics, and Part 2 Include (13) items concerned with the complications of double lumen subclavian catheter. Double lumen subclavian catheter for hemodialysis is preferred by many because catheters can be left in longer than femoral or jugular catheters in mobile patients, but the subclavian vein catheterization is associated with a variety of complications. The researcher can conclude that the infection of the catheter’s orifice is high percentage among double lumen subclavian catheters complications and the result shows that there is no significant relationship between socio-demographic data and complications. The study recommends that the catheter should be performed only by trained personnel and should enhance the methods of sterile techniques in hemodialysis unit to decrease infection by improving the nursing practice through training course. [ABSTRACT FROM AUTHOR]

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The article discusses the techniques and technology for the collection of human oocyte. Topics discussed include the introduction of the transvaginal oocyte retrieval in 1981, the use of follicular aspiration with flushing to maximize the number of the recovered oocytes, and the longer procedure time required by the follicle flushing.

Two groups of patients are compared with respect to capsular contracture after insertion of silicone breast prostheses. Six hundred seventy four women received single-lumen gel prostheses and 700 received double-lumen prostheses with cortisone. The addition of 12.5 mg of prednisolone to double-lumen prostheses diminished capsular contracture (Baker II to IV) dramatically; in patients with simple augmentation from 19% to 4.9%, in patients with subcutaneous mastectomy from 54% to 14.9%, and in patients with breast reconstruction from 64% to 24.4%. The use of double-lumen implants has three distinct advantages: (l) There is no bleeding and therefore no contact of the body with the silicone gel. (2) There is no danger of ruptured implants, even if the outer shell shows leakage. (3) if prednisolone is administered, capsular contracture is prevented to a significant degree. [ABSTRACT FROM AUTHOR]

The role of various airway adjuncts in the management of difficult airway has been described in the literature. Bonfils rigid fiberscope is one of the airway assist devices widely used for endotracheal intubation in the individuals with cervical instability warranting limited neck movements. With our experience in the utilization of Bonfils for single lumen endotracheal tube placement, we are increasingly using for double lumen endobronchial (DLT) intubation as well. We would like to describe our experience in the use of Bonfils for DLT placement and outline the merits and limitations of the other suitable airway assist devices in this report. The double lumen tube has to be modified by decreasing the length of DLT to accommodate the Bonfils fiberscope and this is applicable only in certain type of double lumen tubes for e.g. Bronchocath. [ABSTRACT FROM AUTHOR]

Background: Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube., Methods: We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography., Result: Patients with a left main bronchus length of less than 40mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105)., Conclusions: We identified that patients with a left main bronchus length of less than 40mm have a great chance of desaturation, especially if other desaturation risk factors are present., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: The use of previously described catheter technique was expanded to complex supra- and abdominal- aortic catheterizations., Methods: A new (Qureshi 5) catheter with curved shape at the distal end that has two lumens was used. One of lumens can accommodate a 0.035-inch guide wire and the second lumen can accommodate a 0.018-inch guide wire and terminates at the beginning of the distal curve of the first lumen. The manipulation and engagement of the curved distal end catheter was facilitated by rotation and movement of the J-shaped 0.018-inch guide wire extended coaxial and beyond the distal end of catheter. Subsequently, either contrast was injected or a 0.035-inch guide wire advanced into the target artery., Results: The catheters were used in one patient to perform diagnostic cerebral and abdominal angiography through a 6F introducer sheath placed in the right common femoral artery. The catheterization was complex because of severe tortuosity of arch and descending aorta secondary to kyphosis. The left and right internal carotid arteries and left and right vertebral arteries, left renal artery, and superior mesenteric artery were catheterized in patient (fluoroscopy time 19:46 min). No complications were observed in the patient., Conclusions: The Qureshi-5 catheter was successful in complex supra- and abdominal-aortic catheterizations.

Background: A catheter technique was developed to overcome current challenges in the stabilization and manipulation of catheter in tortuous arteries such as right subclavian artery and left common carotid artery., Methods: The new catheter has the following two lumens: first lumen can accommodate a 0.035-inch guide wire (lumen A) and a curved shape at the distal end; the second lumen can accommodate a 0.018-inch guide wire and terminates at the beginning of the distal curve of the first lumen (lumen B). The catheter is withdrawn or advanced over the 0.018-inch guide wire and the curved free end of catheter manipulated until the end engages the origin of the target artery. Subsequently, either contrast can be injected or a 0.035-inch guide wire advanced into the target artery., Results: The catheters were used in two patients to perform diagnostic cerebral angiography through a 6F introducer sheath placed in the right common femoral artery. The left and right common carotid arteries and left and right vertebral arteries were catheterized in first patient (contrast used 50 ml; fluoroscopy time 20:09 min). The left and right internal carotid arteries, left and right subclavian arteries, and left external carotid artery were catheterized in second patient (contrast used 40 ml; fluoroscopy time 13:56 min). No complications were observed in either of the two patients., Conclusions: The performance of the new catheter for catheterization of multiple arteries in two patients was considered adequate with high-quality angiographic image acquisitions.

EasyTube is an esophageal-tracheal double lumen airway device that combines the features of an endotracheal tube with a supraglottic airway device, enabling ventilation with either tracheal or esophageal insertion. EasyTube can be inserted blindly or by using a laryngoscope. Its main indication is for airway emergencies both in pre-and in-hospital areas. In this article we review the current knowledge on the use of the EasyTube., Competing Interests: Conflict of interest Nothing to declare