Ultrasound-guided Placement of Permanent Hemodialysis Catheters Compared to the Traditional Blind Method

Background: Central venous hemodialysis catheters are one of the most common vascular accesses for patients suffering from end-stage kidney disease. The application of ultrasound-guided placement of permanent hemodialysis catheters is highly recommended by the new guidelines because of its advantages over the traditional blind methods.Methods: In this prospective study, the samples comprised patients (N=80) referred to a vascular surgery clinic by their nephrologist or elective vascular surgery consultations and asking for the placement of permanent hemodialysis catheters in Imam Hossain Hospital (A referral hospital complex center in, Tehran, Iran) during 2014 to 2015. The patients were randomly divided into two groups (n=40); one of the groups underwent the placement of catheters with the guidance of Doppler ultrasound and the other with the traditional blind method. Then, the data were analyzed by SPSS V. 21 software.Results: There was statistically significant fewer attempts for successful placement (Z= -2.725, P=0.006), less insertion failure (Chi-Square=9.600, P=0.002), fewer failures with the first attempt (Chi-square=9.600, P=0.002), and less total placement time (t=1.379, df=69.549, P=0.172) in the sonography-guided group compared to the blind method. Furthermore, there was no significant difference in venous cannulation time and complications such as pneumothorax, neck hematoma, and carotid puncture between the two groups. Moreover, the patients had significantly greater satisfaction with the sonography-guided method (Z=-4.306, P=0.0001).Conclusion: According to this study, it might be beneficial to use ultrasound as the first method of permanent hemodialysis catheters insertion and patients would be more satisfied with this approach as well. In addition, learning the blind method is recommended to the practitioners because of the possibility of lacking ultrasound in an emergency.

Biphasic Epithelial Predominant Synovial Sarcoma Presenting as Painful Thigh Mass

Synovial sarcomas are soft tissue neoplasms mostly located in the lower extremities of young adults. A case of synovial sarcoma of the thigh in a 35-year-old male with the predominant epithelial component is reported. Microscopically the tumor showed variable-sized well-differentiated glands lined by the cuboidal cells with small foci of spindle cell component between glandular structures. Immunohistochemically glandular components showed positivity for the pan CK and EMA while CD99 and TLE1 were positive in both glandular and spindle cell components. This type of synovial sarcoma could be indistinguishable from metastatic adenocarcinoma and malignant adnexal tumor, thus, immunohistochemistry and molecular studies play an essential role in the exact diagnosis of this type of tumor.