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September 1978

latrogenic Arteriovenous Fistula-Reply

Arch Intern Med. 1978;138(9):1441. doi:10.1001/archinte.1978.03630340105041

In Reply.—  If the body of the case report of Silverstein and coauthors' article (p 309) is read closely, pericardiocentesis as a modality of therapy was not used until after the patient was treated as suggested by Dr Minuth. That would be a ten-day course of daily hemodialysis with regional heparinization and indomethacin. This patient's course was complicated by a progressive increase in the effusion, and for this reason the pericardiocentesis and instillation of steroids was instituted. This is a very important point that does not become obvious in the article but should be clearly understood: intrapericardial steroid instillation should be reserved for patients who do not respond to the more conservative modalities of therapy and who show a continued increase in the size of the effusion. As we have reported in the past,1 anywhere between 15% to 20% of patients who have undergone hemodialysis for more than two

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