Post-transplantation swelling of the lower eyelid.

Case An 11-year-old boy with end-stage renal disease due to diarrhoea-associatedhaemolytic uraemic syndrome was seen by a paediatrician forswelling of the lower eyelid. He had a history of treatmentwith peritoneal dialysis for 11 months, followed by cadaverickidney transplantation 4 months earlier. Immunosuppression consistedof cyclosporin A (blood trough levels: 120–200 ng/ml),mycophenolate mofetil (1.2 g/m²/day) and prednisolone (4 mg/m²/day).Prophylactic oral ganciclovir was given for 40 days post-transplantationin view of a high-risk status for CMV (CMV antibody-positivedonor and -negative recipient). Two months earlier, a severeCMV disease with enterocolitis had been successfully treatedwith intravenous ganciclovir. At this time, EBV seroconversionwas noted (EBV DNA, EBV-IgM-antibody positive).     

Ultrasonographic fata morgana.

Case A 35-year-old female with end-stage renal disease due to chronicglomerulonephritis received a cadaveric renal transplantationinto the right fossa iliaca. Her body mass index was 23 kg/m².The clinical course after transplantation was uneventful andgraft function was stable during follow-up. Ultrasonographicmonitoring of the renal transplant was performed regularly withB-scan, colour Duplex and Doppler ultrasonography using a 3.75MHz curved array transducer and sector transducer (SonolayerSSA 270A; Toshiba, Tokyo,     

Posterior nutcracker phenomenon.

Case A 26-year-old woman was referred to us because of her hypertensionand microscopic haematuria. Her past medical and family historieswere unremarkable and the physical examination was not contributory.The urinary analysis revealed numerous red blood cells withoutdysmorphic changes. The laboratory tests revealed haemoglobin13.6 g/dl, haematocrit 39%, white blood cell count 4300/mm³,blood urea nitrogen 16     

Massive haemorrhage in pregnancy

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]

Nephroquiz: a woman with renal failure, ureteric obstruction and vasculitic rash.

Case A 57-year-old housewife presented to the emergency departmentwith seizures. She was drowsy and disorientated, febrile, tachypnoeic,tachycardic and tender in the left loin. There were a few brownmacules on her ankles. Recent history revealed low back pain,ankle swelling, a purpuric rash and haematuria. Two years earlier,a nodular lesion on her left leg was diagnosed and treated aspyoderma gangrenosum. Laboratory studies on admission showed: white cell count 23.8x 10⁹/l, haemoglobin 7.2 g/dl, potassium 7.4 mmol/l, urea     

Anaesthesia and adrenocortical disease

The first 150 words of the full text of this article appear below. Key points Adrenocortical disease results in disturbances ofbody water volume and electrolyte concentrations; intra-cellularelectrolyte defects may be severe. Preoperative assessmentis of crucial importance in identifying the endocrine diseaseprocess and the severity of its effects. Preoperative preparationinvolves correction of volume deficit and electrolyte disturbances,and replacement of deficient hormones. Cardiovascular disturbanceand instability are particularly common and invasive cardiovascularmonitoring should be considered. Postoperative mineralocorticoidand glucocorticoid supplementation should be considered in Addison'sdisease and in steroid-induced hypoadrenalism.  

Carbon dioxide transport

The first 150 words of the full text of this article appear below. Key points Carbon dioxide is transported in the blood in threeways: (i) dissolved in solution; (ii) buffered with water ascarbonic acid; (iii) bound to proteins, particularly haemoglobin. Ata haemoglobin concentration of 15 g dl^–1, mixed venous

Orange-like skin lesion and hypertension--what is the link?

Case A 12-year-old girl was hospitalized in July 2000 for an episodeof abdominal pain, vomiting and collapse. Anaemia secondaryto acute upper gastrointestinal haemorrhage was diagnosed; however,the reason for the haemorrhage could not be identified. Physicalexamination revealed normal growth, and hypertension of 180/110mmHg. Thickened yellowish skin (peau d’orange) was noticedin the axilar and inguinal regions and on the abdominal wall(Figure 1). Femoral pulse was palpable. Laboratory tests revealed:haemoglobin 8.1 g/dl, haematocrit 0.20, white blood cell count11.2 x 10⁹, platelets 230 x 10⁹, erythrocyte     

STUDIES ON CONTINUOUS POSITIVE AIRWAY PRESSURE BREATHING SYSTEMS

A study was undertaken to compare CPAP/IMV systems shown tobe in common use in the U.K. The most frequently used system(Servo 900B) has characteristics which are likely to increasethe work of breathing. Recommendations are made regarding thetheoretically most acceptable systems Footnotes ^*Present address: Department of Anaesthetics, Oxford RegionalHealth Authority, Oxford     

Alcohol and anaesthesia

The first 150 words of the full text of this article appear below. Key points

Consumption of alcohol is widespread in British societyand a common co-factor in emergency hospital admissions.

Morbidityassociated with chronic alcohol abuse appears to be increasingand affecting younger patients.

Anaesthetists must considerthe acute and chronic effects of alcohol at all stages of thepatient pathway.

Alcohol withdrawal is a potentially life-threateningcomplication that must be diagnosed and actively managed.

Anaesthetistsare as susceptible to alcohol-related disease as others in thesame socio-economic group.

  Two-thirds of adults in England drink alcohol on a weekly basis,and 30% drink more than the recommended daily level.¹ Amongchildren, 46% of 15 yr olds and 3% of 11 yr olds admit to drinkingperiodically.² Alcohol misuse is estimated to cost the NHS £3 billionper year. Alcohol-related disease was the primary or secondarydiagnosis for over 180 000 NHS hospital admissions in 2004/2005.³This includes a doubling in the number . . . [Full Text of this Article]