COVID-19 in Seattle-Early lessons learned.

The coronavirus disease 2019 (COVID-19) pandemic has rapidly evolved and now dominates the attention and full efforts of the emergency medicine community, both domestic and abroad. Seattle is the site of the initial diagnosed COVID-19 cases and fatalities in the United States. We provide an overview of the system-level response of 6 Seattle emergency departments and the Washington state chapter of the American College of Emergency Physicians (ACEP) to the COVID-19 pandemic.

Predicting Emergency Department "Bouncebacks": A Retrospective Cohort Analysis.

Introduction: The short-term return visit rate among patients discharged from emergency departments (ED) is a quality metric and target for interventions. The ability to accurately identify which patients are more likely to revisit the ED could allow EDs and health systems to develop more focused interventions, but efforts to reduce revisits have not yet found success. Whether patients with a high number of ED visits are at increased risk of a return visit remains underexplored.

Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses.

Objective: Cephalic arch stenosis (CAS) is a frequent and challenging failure mode of brachiocephalic fistulas. Natural tortuosity of the cephalic arch requires special consideration in selecting a treatment modality. Typical percutaneous angioplasty and bare-metal stent (BMS) treatments provide a short-term treatment solution for CAS without a durable effect.

Challenges and management of high-flow arteriovenous fistulae.

The Kidney Dialysis Outcomes Quality Initiative and Fistula First Initiative have embraced the arteriovenous fistula as the gold standard for hemodialysis accesses. Despite this status, fistulae are fraught with complex issues ranging from a high primary failure rate to high flow resulting in increased cardiovascular morbidity. It is important not to overlook the insidious peril of a hyperfunctioning access that may actively promote cardiac overload, cardiopulmonary recirculation, rapid access growth with aneurysm enlargement, recurrent venous stenosis resulting in access failure, and inflow/outflow mismatch.

Vascular access flow reduction for arteriovenous fistula salvage in symptomatic patients with central venous occlusion.

Purpose: Vascular access patients with central vein (CV) stenosis or occlusion may have significant symptoms. Treatment is generally by balloon angioplasty, with or without stenting. However, CV lesions may not be correctable and when treated, tend to recur.

Sharp needle recanalization for salvaging hemodialysis accesses with chronically occluded peripheral outflow.

Purpose: To assess the effectiveness of sharp needle recanalization (SNR) for treatment of chronically occluded venous outflow in hemodialysis access.

Methods: A retrospective analysis of patient records from January 2006 to March 2010 was conducted. Forty-four hemodialysis patients (31 fistulas, 13 grafts) were referred for arm swelling (18%), excessive bleeding after dialysis (29%), and thrombosis (53%).

Percutaneous salvage of thrombosed immature arteriovenous fistulas.

Thrombosed immature fistulas have historically been considered unsalvageable. However, advances in procedure and balloon catheter technologies have expanded the scope of endovascular treatments. This study investigates the efficacy, functionality, and cost associated with the use of percutaneous techniques for the salvage of thrombosed immature fistulas.

Access flow reduction and recurrent symptomatic cephalic arch stenosis in brachiocephalic hemodialysis arteriovenous fistulas.

Background: Recurrent cephalic arch stenosis (CAS) has been linked to high flow and has a high rate of recurrence following angioplasty. This study investigates the effectiveness of access flow reduction in decreasing rapidly recurrent symptomatic CAS.

Methods: A retrospective study of patient records from February 2005 to April 2009 was conducted.

Long thoracic vein embolization for the treatment of breast edema associated with central venous occlusion and venous hypertension.

Purpose: Breast edema is a rare complication in hemodialysis patients with central venous occlusions. The present study sought to determine whether coil embolization of the long thoracic vein is an effective long-term treatment for this pathology.

Methods: The study patients were 6 female hemodialysis patients whose primary clinical manifestation of central vein occlusion was breast edema.

The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome.

We evaluated the efficacy of the Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) banding procedure in treating dialysis-associated steal syndrome or high-flow access problems. A retrospective analysis was conducted, evaluating banding of 183 patients of which 114 presented with hand ischemia (Steal) and 69 with clinical manifestations of pathologic high access flow such as congestive heart failure. Patients were assessed for technical success and symptomatic improvement, primary and secondary access patency, and primary band patency.

Aggressive approach to salvage non-maturing arteriovenous fistulae: a retrospective study with follow-up.

Purpose: To establish a standardized approach for the maturation of non-maturing arteriovenous fistulae.

Methods: Consecutive patients (n=122) with non-maturing fistulae presented to our outpatient vascular access center for percutaneous interventions to assist in maturation. The techniques used included flow rerouting, competing branch vein elimination, staged balloon angioplasty, and limited controlled extravasation.

Use of CT cholangiography to evaluate the biliary tract after liver transplantation: initial experience.

Evaluation of the biliary tract after liver transplantation, particularly when a Roux-en-Y hepatojejunostomy precludes endoscopic retrograde cholangiography, may be challenging. We present five cases of suspected biliary obstruction after liver transplantation in which multidetector-row computed tomography (CT) cholangiography was used. In conclusion, it was determined that multidetector-row CT cholangiography may be a useful modality for demonstrating patent biliary-enteric anastomoses and excluding flow-limiting biliary anastomotic strictures.

Clients of female sex workers in Lima, Peru: a bridge population for sexually transmitted disease/HIV transmission?

Objectives: The objectives of this study were to determine the prevalence of risk behaviors, gonorrhea, and chlamydia in clients of female sex workers, and to compare them with men selected from the general population.

Study Design: We conducted a cross-sectional study of men recruited from commercial sex venues in Lima, Peru from January to February 2002. Subjects answered a survey and provided a urine sample.