Critical limb ischaemia (CLI) is defined as chronic ischaemicrest pain, ulcers or gangrene attributable to objectively provenarterial occlusive disease. Peripheral vascular disease (PVD)is a marker for severe multi-system atherosclerosis and patientswith critical limb ischaemia presenting for lower limb revascularizationpresent a significant challenge to the anaesthetist. They areusually elderly with a high prevalence of hypertension, diabetesmellitus, cerebrovascular and renal vascular disease, and smoking-relatedrespiratory disease. Only 8% of patients with PVD . . . [Full Text of this Article]Treatment strategies       MonitoringGeneral anaesthesiaRegional anaesthesia      相似文献   

2.
Is it rejection? Be on the lookout for 'decoys'.     
Shaun A Summers  Chris Laing  Terence H Cook  Patrick H Maxwell 《Nephrology, dialysis, transplantation》2005,20(9):2002-2004
  We describe the case of a renal transplant recipient, who sufferedfrom acute renal dysfunction, in whom renal biopsy showed findingsconsistent with acute cellular rejection. He was treated withpulsed steroid therapy. After further investigations, a diagnosisother than rejection was made, which highlights an increasinglyimportant clinical problem in the course of renal transplantation.   A 47-year-old man of Pakistani origin underwent live-unrelatedrenal transplantation (1, 2, 1 mismatch) after reaching end-stagerenal failure. His immunosuppression regime consisted of tacrolimus,mycophenolate mofetil (MMF) and prednisolone. Following an uneventful recovery from  相似文献   

3.
Massive haemorrhage in pregnancy     
Banks  Amelia; Norris  Andrew 《CEACCP》2005,5(6):195-198
The first 150 words of the full text of this article appear below. Key points Massive haemorrhage remains a significant causeof maternal mortality and morbidity. Clear and timely communicationbetween surgical, anaesthetic and haematology services is vitalto ensure optimal maternal and fetal outcome. Signs of hypovolaemiaoccur relatively late because of physiological changes in pregnancy. Theextent of intravascular volume deficit is not reflected by visualestimates of vaginal bleeding. The decision to perform a hysterectomyshould be made when other methods of haemostasis have failedand not delayed until control of maternal haemostasis and cardiovascularstability has been lost.   Massive haemorrhage is a major cause of maternal mortality.Life-threatening haemorrhage may occur as frequently as 6.7per 1000 deliveries.1 This equates to 1400 cases yr –1in the UK or 33.5 yr –1 in an obstetric unit with 5000deliveries annually. Pregnancy-related conditions and complicationsaccount for 0.8% of intensive care admissions; 35% of thesearise from massive haemorrhage.1 2 Management of massive . . . [Full Text of this Article]
      Antepartum haemorrhagePostpartum haemorrhageCoagulopathies   GeneralSpecific treatmentsPhysicalPharmacologicalSurgicalRadiologicalBlood and blood productsAnaesthesia for obstetric haemorrhageAutologous transfusion        相似文献   

4.
A rare cause of fever associated with leukopenia in a renal transplant patient.     
Hayet Kaaroud  Soumaya Beji  Amel Jebali  Karima Boubaker  Sami Turki  Ezzeddine Abderrahim  Ta?eb Ben Abdallah  Fatma Ben Moussa  Khaled Ayed  Hédi Ben Maiz 《Nephrology, dialysis, transplantation》2004,19(8):2140-2141
  The occurrence of fever in association with leukopenia in renaltransplanted patients is related to viral infection in the majorityof cases. We report a rare cause of such an association in a renal transplantwoman.   A 24-year-old woman was referred to our unit for end-stage renalfailure secondary to reflux nephropathy. She had mild proteinuria(0.45 g/24 h) without haematuria. Routine immunology tests performedbefore the diagnosis of reflux nephropathy showed  相似文献   

5.
Massive oedema in a Cape Verde sailor.     
Aafke E de Graaff  Jan J Weening  Raymond T Krediet 《Nephrology, dialysis, transplantation》2005,20(11):2545-2547
  Hypoalbuminaemia, fluid retention and interstitial oedema mayseem a straightforward combination in a patient with longstandingpoorly regulated diabetes suspected to have diabetic nephropathy,but can constitute a complex diagnostic problem with an unusualtherapeutic approach and an unexpected outcome. Here we presenta patient with longstanding type II diabetes, mild albuminuria,a biopsy-proven diabetic glomerulopathy and low serum albuminlevels, who developed massive fluid retention and oedema duringa systemic infection complicated by a sudden skin manifestationof non-human immunodeficiency virus (HIV)-related Kaposi sarcoma.His oedema and hypoalbuminaemia only resolved after treatmentof his Kaposi sarcoma.   A 56-year-old man,  相似文献   

6.
Renal allograft failure related to a lower extremity vascular access--a case report.     
Martine C M Willems  L W Ernest van Heurn  Geert W Schurink  Frank M van der Sande  Jan H M Tordoir 《Nephrology, dialysis, transplantation》2006,21(12):3583-3584
  Early renal transplant dysfunction can be caused by acute rejection,acute tubular necrosis (ATN), infection, ciclosporin toxicity,bleeding, urethral obstruction, urinary leak, lymphocele andthrombosis [1]. Prompt treatment of early allograft dysfunctionis essential and therefore accurate diagnosis mandatory. Wedescribe a patient with an unusual cause of allograft dysfunction,which was resolved by a simple surgical intervention.   A 32-year-old man with congenital blindness, hypertension andend-stage renal disease underwent renal transplantation. Hehad been haemodialysis-dependant since the age of 24 years.Dialysis was performed through an  相似文献   

7.
Anaesthesia for cleft lip and palate surgery     
Somerville  Nicola; Fenlon  Stephen 《CEACCP》2005,5(3):76-79
The first 150 words of the full text of this article appear below. Key points A high index of suspicion for conditions associatedwith cleft lip and palate should be maintained. A difficultview at laryngoscopy is a more frequent finding than a difficultairway; the anaesthetist should be prepared for either. Patientsshould be extubated when fully awake with close observationfor signs of airway obstruction. Analgesia is an importantpart of the balanced anaesthetic technique. Children with cleftsshould be managed by a multidisciplinary team of experts.  
  The presence of a cleft lip, cleft palate or both, has a hugeimpact on the life of an individual and their family. Modernmanagement has much to offer these people, revolutionizing appearanceand functional defects to a point where they may be difficultto detect. Surgery aims to correct the anatomically obviouscleft lip, augment normal dento-alveolar development and leadto effective palatal function. Worldwide, cleft lip and palate (CLP) is one of . . . [Full Text of this Article]     GeneralSpecific
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1.
The first 150 words of the full text of this article appear below. Key points Surgery for lower limb revascularization is associatedwith a high risk of cardiac morbidity and mortality. Preoperativecardiac risk assessment is important and risk-reducing measuresshould be started appropriately. Perioperative ß-blockadedecreases perioperative cardiac complications in the highestrisk patients. The quality of anaesthetic practice rather thanspecific technique per se has the most important influence onpatient outcome. Acute limb ischaemia is an emergency thatprecludes prolonged preoperative cardiac evaluation.  
   Critical limb ischaemia    Preoperative assessment    Preoperative management    Perioperative management    Postoperative management    Acute limb ischaemia    Introduction    Case    Definitions    Physiology    Causes of haemorrhage    Management of haemorrhage    Protocols and fire drills    Problems in early pregnancy    Web resources    Introduction    Case    Introduction    Case    Introduction    Case report    Cleft lip and palate    Anaesthetic significance    Preoperative care