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1.
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Introduction
| Polytetrafluoroethylene (PTFE) grafts are widely used to facilitateaccess for haemodialysis. They may present with complicationsincluding infection and thrombosis. However, localised lymphomaassociated with a PTFE graft has not been previously described.Here we present the case of a patient with B-cell lymphoma arisingaround a PTFE graft.
Case
| A 77-year-old Italian woman with end-stage renal failure ofunknown origin had been on haemodialysis since 1995. Her past 相似文献
2.
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Introduction
| Vascular access is the life-line of chronic haemodialysis patients.Its complications play a major role in morbidity and mortality[1]. Vascular access infection remains the leading cause foraccess failure when cuffed silicone catheters are used for long-termaccess and is the second most common cause of graft failurewhen polytetrafluoroethylene (PTFE) grafts are used [2]. Mostreports deal with dual-lumen tunneled cuffed catheter relatedbacteraemia. Arteriovenous (A-V) graft infection with Pseudomonassepticaemia, as reported here, has been rarely discussed.
Case
| A 72-year-old diabetic male had a history of hypertension andcerebral infarction with sequela of right side hemiplegia. AnA-V graft was created on the right forearm on 26 June 2003 fordiabetic nephropathy. He started maintenance haemodialysis onJuly 10 using this A-V graft. He was 相似文献
3.
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Introduction
| Ticlopidine hydrochloride is a platelet aggregation inhibitorthat is used for the prevention of vascular thrombosis. So far,only six cases of ticlopidine-induced lupus have been documentedin the literature [1–3]. We report here a first case ofticlopidine-induced lupus with renal involvement.
Case
| A 相似文献
4.
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Introduction
| Despite being initially developed as short-term vascular accessin haemodialysis patients, cuffed tunnelled haemodialysis cathetersare now often relied on in the medium to long term [1,2]. Thisis either as a consequence of sub-optimal access to vascularsurgical support or technical difficulties in obtaining definitivevascular access. These catheters are associated with an increasedincidence of sepsis [3] and thrombosis [4], 相似文献
5.
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Introduction
| Patients with end-stage renal disease who require chronic dialysisare at high risk of developing malignancy. There are many reportedcases of the development of renal or urothelial cancer in suchpatients [1–8]. We report the first case, to our knowledge,of multifocal, invasive transitional cell carcinoma (TCC) andunilateral renal cell carcinoma (RCC) with acquired cystic disease,occurring simultaneously in a patient on haemodialysis treatedby complete urinary tract exenteration. Our patient was managedsuccessfully with an aggressive treatment.
Case
| A 69-year-old man was referred to our institution 相似文献
6.
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Introduction
| Renal transplant patients remain at risk of graft loss due toacute rejection, calcineurin inhibitor toxicity and chronicallograft nephropathy. Less frequent causes include opportunisticinfections related to immunosuppressive therapy. However, infectionsare a major clinical issue in the field of renal transplantation,impacting on graft and patient survival. Fungal infections accountfor about 5% of infections in renal transplant recipients [1].Candida species are the most common fungal pathogen, and themost common forms of infection are oral and esophageal candidiases,vascular access device-related and urinary tract infections[2]. The incidence of candidiasis of the renal allograft israre and not very well documented.
Case report
| A 50-year-old white female with a prior medical history of hypertension, 相似文献
7.
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Introduction
| It is well known that late referral to a nephrologist is associatedwith many adverse outcomes [1–4], and indeed has beenthe subject of a recent review in this journal [5]. Some ofthe more important negative outcomes include more rapid onsetof end-stage renal disease (ESRD), progression of co-morbidconditions such as anaemia and cardiovascular disease, suboptimalvascular access at initiation of dialysis, increased use ofcentre-based haemodialysis (HD), increased hospital utilization,increased cost and worse survival. The literature has many examplesof suboptimal chronic kidney disease (CKD) care provided byprimary care physicians prior to referral, and also shows clearlythat care provided by nephrologists is better [6,7]. There isa consensus within the renal community that early referral isdesirable [5,8–10].M
Multidisciplinary team-based CKD care
| There is much less consensus 相似文献
8.
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Introduction
| The placement of central venous catheters (CVC) has well-recognizedcomplications many of which tend to be more frequent in chronicdialysis patients. The reasons for this include the large calibreof catheters required and the higher number of catheter placementsneeded [2,3]. In view of the increased risk, various precautionarymeasures are recommended. We report an unusual type of femoral artery injury that wascaused by CVC placement despite adherence to recommended precautions.The case illustrates important learning points.
Case
| A 78-year-old lady of Chinese origin had been maintained ona regular 3 times weekly haemodialysis therapy for 3 years 8months. She had presented with bilaterally small kidneys andend stage 相似文献
9.
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Introduction
| A wide spectrum of primary glomerular diseases may occur inpatients with type 1 diabetes mellitus (DM) due to autoimmunemechanisms [1,2]. We here report a patient with type 1 DM andHashimoto's thyroiditis who developed membranoproliferativeglomerulonephritis (MPGN).
Case
| A 35-year-old man with type 1 DM for 18 years and Hashimoto'sthyroiditis for 6 years was referred to 相似文献
10.
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Introduction
| Sezary syndrome is a cutaneous T-cell lymphoma (CTCL), characterizedby erythroderma and infiltration of the epidermis, the dermisand the bone marrow by monoclonal CD4 + T lymphocytes [1]. Renalcomplications of patients with CTCLs have rarely been reported[2–4]. In patients with other haematological malignancies,treated with interferon-
Case
| A 63-year old male, who had been diagnosed with Sezary syndrome 相似文献
11.
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Introduction
| Baclofen is currently used in the treatment of muscle spasticity,especially in patients with multiple sclerosis or in patientswith spinal or cerebral disorders. Baclofen is eliminated predominantlyby the kidneys [1], putting patients with impaired renal functionat particular risk for baclofen accumulation. Several investigatorshave suggested that haemodialyis is effective in the removalof baclofen [2], however the pharmakokinetics of baclofen eliminationduring haemodialysis remains unclear. We herein report a baclofen-associatedencephalopathy, which was resolved by haemodialysis, and pharmacokineticdata is presented. To our knowledge, this is the first reportedcase of baclofen-related encephalopathy with pharmacokineticdata during haemodialysis treatment.
Case
| A 70-year-old woman with end-stage renal disease (ESRD) wastreated by haemodialysis regularly for 14 years. She was 相似文献
12.
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Introduction
| Paradoxical embolism is a rare cause of severe renal arteryocclusion and is frequently under-diagnosed [1]. Rapid endovascular intervention with minimal morbidity may makeclot removal possible and reverse organ function [2,3]. We present here the case of a patient with an acute renal failuredue to a bilateral renal artery paradoxical embolism that wassuccessfully treated by a modified standard technique of anendovascular procedure, with a rapid mechanical and local pharmacologicalthrombolysis. The patient partially recovered her renal functionand was able to stop dialysis.
Case report
| A 70-year-old female with a past medical history of type IIdiabetes, hypertension and dyslipidaemia was admitted for pulmonaryembolism associated with a recurrent deep vein thrombosis ofthe right lower extremity. The anti-coagulation treatment wasinitially well tolerated, but had to 相似文献
13.
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Introduction
| Heavy chain deposition disease (HCDD) is a rare manifestationof plasma cell dyscrasia. Only 11 cases have been describedin the literature [1]. The clinical picture is variable, butin all patients renal biopsy showed a nodular sclerosing glomerulopathy[1–5]. We report a patient with rapidly progressive glomerulonephritisin whom the renal biopsy showed mainly intracapillary proliferativeglomerulonephritis due to HCDD.
Case
| The patient is a 55-year-old musician with an uneventful medicalhistory except ankylosing spondylitis diagnosed at the age of47. Six weeks before admission he noticed foamy urine, at 2weeks he developed generalized swelling, dyspnoea and a severeheadache. Upon admission 相似文献
14.
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Background
| Recently increased attention for chronic renal failure has stimulatednew interest in renal function assessment by direct measurementas well as by algorithms or formulas [1–3]. In the failingrenal graft, a situation in which pharmacological therapy mayinterfere with the complex adaptation mechanisms of renal failure,the assessment of renal function may be particularly difficult[4]. Studies of patients with liver or heart transplantationand advanced kidney disease suggest that creatinine-based indexesmay be poor indicators of residual renal function under calcineurininhibitors [5,6]. The following two cases, displaying a discrepancybetween creatinine and urea 相似文献
15.
The first 150 words of the full text of this article appear below. Key points - Complications of blood transfusion are rare but canbe life-threatening.
- Since 2005, it has been a legal requirementthat all serious adverse reactions attributable to the safetyor quality of blood are reported.
- Most reported complicationsare because of transfusion of mismatched blood products andare avoidable through clinical vigilance.
- Massive blood transfusionsresult in abnormalities of coagulation status, serum biochemistry,acid–base balance and temperature homeostasis.
- Transfusion-relatedacute lung injury is the most common cause of major morbidityand death after transfusion.
The serious hazards of transfusion (SHOT) scheme has collecteddata on significant adverse events resulting from transfusionof blood components from volunteer organizations since 1996.However, after the implementation of the European Union Directiveon Blood Safety and Quality in 2005, it is now a requirementthat all ‘Blood Establishments and Hospital Blood Banksreport to the Secretary of State for Health all serious adversereactions . . . [Full Text of this Article]
Massive transfusion
| CoagulationBiochemistryHypocalcaemiaHyperkalaemiaAcid–base abnormalitiesHypothermia
Transfusion-related acute lung injury
| Clinical features
Pathogenesis
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Incidence
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Haemolytic transfusion reactions
| Immediate reactionsDelayed reactions
Non-haemolytic febrile reactions
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Allergic reactions
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Transfusion-related infections
| BacterialViralPrion
Transfusion-associated graft-vs-host disease
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Immunomodulation
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16.
The first 150 words of the full text of this article appear below. Key points - Atrial fibrillation (AF) is the commonest cardiacarrhythmia; its incidence increases with age.
- Diabetes mellitus,hypertension and ventricular hypertrophy are commonly associatedwith non-valvular atrial fibrillation.
- Primary aims of managementof AF are conversion to sinus rhythm, maintenance of sinus rhythmand prevention of thromboembolic complications.
- In elderlypatients who are asymptomatic, adequate rate control of AF appearsto offer the same benefits as rhythm control.
- Chronic AF carriesa high risk of ischaemic stroke from thromboembolism; all patientsat risk must receive adequate anticoagulation.
- Anticoagulationshould be continued in patients with risk factors despite successfulconversion to sinus rhythm.
Atrial fibrillation (AF) is the commonest cardiac arrhythmia.The incidence increases with age and affects 5% of UK populationabove the age of 65 yr and 10% above 75 yr. 1 2 In the UnitedStates, AF accounts for more than 35% of all admissions forcardiac arrhythmias. 3 Men are . . . [Full Text of this Article]
Definition and electrocardiographic patterns
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Classification
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Pathophysiology and mechanisms
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Causes and risk factors
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Principles of management
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Restoration of sinus rhythm
| Direct current cardioversionPharmacological restoration of sinus rhythm
Maintenance of sinus rhythm
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Rate control of atrial fibrillation
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Prevention of thromboembolism
| Non-pharmacological management
Management in special situations
| Cardiac surgeryAcute myocardial infarctionPregnancyVentricular pre-excitationHyperthyroidismPulmonary disease 相似文献
17.
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Introduction
| Tenofovir is an antiviral nucleotide with activity against humanimmunodeficiency virus type I (HIV-1). Tenofovir is extensivelyand rapidly excreted in the urine by the kidneys [1]. Thereare no available data on tenofovir pharmacokinetics in patientswith renal failure. We report here on the clinical effects andthe pharmacokinetics of tenofovir in one patient with end-stagerenal disease (ESRD) undergoing haemodialysis.
Case
| The patient was a 46-year-old Caucasian man co-infected withHIV-1 and hepatitis B virus (HBV) who was undergoing haemodialysistwice a week for end-stage renal failure (ESRD) secondary toautosomal polycystic kidney disease. At the time of the study,his creatinine clearance was 10 ml/min with a urinary outputof 相似文献
18.
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Introduction
| Diffuse alveolar haemorrhage (DAH) often mimics, clinicallyand radiologically, severe pneumonia or ARDS [1]. The causesof DAH include a variety of non-infectious diseases, e.g. collagenvascular disease. In DAH associated with SLE, a regimen of corticosteroidscombined with cyclophosphamide and plasma exchange is generallyrecommended [2]. We describe here a ventilated SLE patient withDAH refractory to standard therapies. To our knowledge, thisrepresents the first successful application of rituximab inDAH.
Case report
| A 29-year-old North African female presented to our institution 相似文献
19.
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Introduction
| Thrombotic microangiopathy (TMA) is a well-recognized complicationof solid organ transplantation. Both calcineurin inhibitorscyclosporine [1] and tacrolimus [2] have been associated withTMA. Treatment strategies for TMA have included plasmapheresis[1,2], calcineurin inhibitor dose reduction [1,2], calcineurininhibitor withdrawal [1,2], and conversion from one calcineurininhibitor to the other [3]. However, calcineurin inhibitor dosereduction or discontinuation increases the risk of acute allograftrejection and recurrent TMA has been described in patients thatwere converted from cyclosporine to tacrolimus [4,5]. We presenttwo cases of biopsy-proven transplant-associated TMA that weresuccessfully treated by discontinuation of tacrolimus followedby the use of sirolimus, mycophenolate mofetil (MMF) and prednisonefor the prevention of allograft rejection.
Case 1
| A 42-year-old white male with end-stage 相似文献
20.
The first 150 words of the full text of this article appear below. Key points Perioperative delirium and longer term cognitivedisturbance are common and disabling consequences of anaesthesiaand surgery in the elderly. Evidence is emerging that the riskof postoperative delirium can be predicted by preoperative screeningof otherwise asymptomatic patients. The risk of prolonged postoperativecognitive dysfunction (POCD) is
Delirium
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Dementia
| Anaesthetic assessment
Postoperative cognitive dysfunction
| Possible causes of POCDEmboliPerioperative physiological disturbancesPre-existing cognitive impairmentOther factors
Anaesthetic technique and postoperative cognitive impairment
| PremedicationConduct of anaesthesia
Future developments
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