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.
Ticlopidine-induced lupus with renal involvement.     
Takayasu Ohtake  Shuzo Kobayashi  Koji Okamoto  Machiko Oka  Kyoko Maesato  Takeo Yasu  Hidekazu Moriya 《Nephrology, dialysis, transplantation》2006,21(7):1992-1993
  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.   A  相似文献   

3.
Complications of blood transfusion     
Maxwell  Melanie J; Wilson  Matthew J A 《CEACCP》2006,6(6):225-229
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]
  CoagulationBiochemistryHypocalcaemiaHyperkalaemiaAcid–base abnormalitiesHypothermia   Clinical features       Immediate reactionsDelayed reactions       BacterialViralPrion      相似文献   

4.
Multifocal transitional cell carcinoma associated with renal cell carcinoma in a patient on long-term haemodialysis.     
Kousuke Takehara  Masaharu Nishikido  Shigehiko Koga  Yasuyoshi Miyata  Takashi Harada  Naoe Tamaru  Hiroshi Kanetake 《Nephrology, dialysis, transplantation》2002,17(9):1692-1694
  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.   A 69-year-old man was referred to our institution  相似文献   

5.
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   

6.
Intracapillary proliferative glomerulonephritis due to heavy chain deposition disease.   总被引：1，自引：1，他引：0  
Anouk C Vedder  Jan J Weening  Raymond T Krediet 《Nephrology, dialysis, transplantation》2004,19(5):1302-1304
  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.   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   

7.
Successful endovascular treatment of bilateral renal artery paradoxical embolus by a modified standard technique.     
Yann Goueffic  Roger Carbajal  Marc Burban  Gilles Blancho 《Nephrology, dialysis, transplantation》2006,21(8):2315-2317
  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.   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   

8.
A mouse model of non-Shiga toxin-associated haemolytic uraemic syndrome.     
Jessica Caprioli  Giuseppe Remuzzi 《Nephrology, dialysis, transplantation》2008,23(2):462-465
  Impaired control of the complement system activation due tomutations in complement factor H (CFH) has been described intwo apparently unrelated human diseases, membranoproliferativeglomerulonephitis type II (MPGN2) and non-Shiga toxin-associatedhaemolytic uraemic syndrome (non-Stx-HUS). Mouse models of thesediseases have been developed by Pickering et al., by knocking-outCfh gene (MPGN2) and by subsequently transferring a mutatedCfh gene in the Cfh–/– background (non-Stx-HUS).The data obtained from the two models provided precious informationto clarify the mechanisms that cause the disparate phenotypesunderlying CFH genetic defect.   MPGN2 is a rare cause of chronic nephritis characterized bythe presence of dense deposits within the glomerular basementmembrane (GBM), capillary wall thickening, mesangial cell proliferationand glomerular fibrosis [1,2].   Non-Shiga toxin-associated haemolytic uraemic syndrome (non-Stx-HUS)is a rare disease with manifestations of haemolytic anaemia,thrombocytopenia and renal failure. The clinical outcome isunfavourable,  相似文献   

9.
Atrial fibrillation     
Bajpai  Abhay; Rowland  Edward 《CEACCP》2006,6(6):219-224
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]
            Direct current cardioversionPharmacological restoration of sinus rhythm       Non-pharmacological management   Cardiac surgeryAcute myocardial infarctionPregnancyVentricular pre-excitationHyperthyroidismPulmonary disease  相似文献   

10.
Jaccoud's nephritis.     
Andreas L Birkenfeld  Ute Kettritz  Jan-Hinrich Br?sen  Wolfgang Schneider  Alexander Natusch  Ursula G?bel 《Nephrology, dialysis, transplantation》2005,20(3):654-656
  Jaccoud was a French clinician from the 19th century who reporteda peculiar joint deformity in patients with rheumatic fever[1]. He observed the development of an ulnar deviation thatwas reducible, which indicated that the joint spaces were notdestroyed. We have no evidence that Jaccoud was interested inthe kidney or that he ever saw a patient with nephritis. Perhapsthe patient reported here would have raised his interest inour specialty.   A 69-year-old woman was admitted because of generalized weaknessand decreasing renal function. Two months earlier, her  相似文献   

11.
Membranoproliferative glomerulonephritis associated with type 1 diabetes mellitus and Hashimoto's thyroiditis.     
Omer Dizdar  Serkan Kahraman  Gültekin Gen?toy  Dilek Ertoy  Mustafa Arici  Bülent Altun  Unal Yasavul  Cetin Turgan 《Nephrology, dialysis, transplantation》2004,19(4):988-989
  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).   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   

12.
Optimal peritoneal dialysis: choice of volume and solution.     
Cornelis H Schr?der 《Nephrology, dialysis, transplantation》2004,19(4):782-784
  Traditionally, peritoneal dialysis is performed using a volumeof 2 l of fluid, containing glucose as an osmotic agent andlactate as a buffer. Currently, both the volume to be appliedand the composition of the dialysis solution are subject todiscussion. An interesting contribution with respect to thevalue of pH-neutral dialysis solutions is reported in this issueof Nephrology Dialysis Transplantation [1].   Historically, 2 l of dialysis fluid are administered for thedwell during peritoneal dialysis in adult patients. This willvary from 1.5 l in the very small adult to 2.5  相似文献   

13.
Pre-hospital trauma care: systems and delivery     
Lockey  David; Deakin  Charles D 《CEACCP》2005,5(6):191-194
The first 150 words of the full text of this article appear below. Key points Victims of trauma often spend a significant periodof time in the pre-hospital phase. There is wide variationin the practice of pre-hospital care internationally. The term‘paramedic’ covers a wide range of skills and abilities. Incountries other than the UK, physician-led pre-hospital careis well established. Where pre-hospital anaesthesia is performed,in-hospital standards should apply.   When the literature on pre-hospital trauma care is examined,it becomes apparent that a significant period of time is oftenspent between the time of accident and arrival in the emergencydepartment. Although the ‘Golden Hour’ is an arbitraryconcept, it is often applied to trauma care and emphasizes theimportance of life-saving interventions soon after injury. Inthe UK and elsewhere, the majority of the first hour has passedbefore the hospital-based physician has contact with the patient.Time at the scene can be much longer if the patient is . . . [Full Text of this Article]
  Ambulance ServicesDoctors in UK pre-hospital careMobile medical teams   Aeromedical services in the UKMainland European and US models of service          相似文献   

14.
Kidney biopsies taken before and after oral sodium phosphate bowel cleansing.     
Willy Aaseb?  Helge Scott  Rüdiger Ganss 《Nephrology, dialysis, transplantation》2007,22(3):920-922
  Acute renal failure due to phosphate nephropathy following bowelcleansing with an oral sodium phosphate solution is a rare,but well-known, complication [1]. Several authors have reporteddiffuse tubular injury and tubular deposition of calcium phosphatein biopsies taken from such patients [1–4]. In these patients,the term acute phosphate nephropathy more aptly describes thisentity than the previously used term acute nephrocalcinosis[1]. It has been a matter of debate whether these changes aredirectly induced by the phosphate load or whether they werebeing present before the procedure [3]. We, therefore, reporta patient with acute phosphate nephropathy who had kidney biopsiestaken before and after bowel cleansing with sodium phosphate.   In 2002, a 69-year-old woman was  相似文献   

15.
A rare case of acute renal failure due to massive renal allograft infiltration with Candida glabrata.     
Nadia Wasi  Venkata Reddivari  Luis Salinas-Madrigal  Paul Garvin  Bahar Bastani 《Nephrology, dialysis, transplantation》2008,23(1):374-376
  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.   A 50-year-old white female with a prior medical history of hypertension,  相似文献   

16.
Iatrogenic fistula between prosthetic haemodialysis access graft and autogenous vein: unusual cause of graft thrombosis.     
Seung Kee Min  Yeon Ho Park  Hyun Hee Lee  Joon Seung Lee  Woo Kyung Chung  Jong Ho Lee  Young Hwan Koh  Tae-Seok Seo 《Nephrology, dialysis, transplantation》2004,19(10):2647-2649
  Haemodialysis access graft is so important as to be called alifeline for the patient on maintenance haemodialysis. The vascularaccess problem is the leading cause of admission in patientswith end-stage renal disease. Many complications of the prostheticvascular access graft are reported, such as graft thrombosis,infection, aneurysm or pseudoaneurysm, and arterial steal syndrome[1]. We recently experienced two cases of graft thrombosis relatedto the iatrogenic fistula between haemodialysis access graftand autogenous vein at the needling site during haemodialysis.We report our cases with their clinical manifestation and thetreatment outcome and possible methods of prevention [2].   A 76-year-old female on long-term haemodialysis  相似文献   

17.
Acute renal failure in SARS patients: more than rhabdomyolysis.     
Vin-Cent Wu  Po-Ren Hsueh  Wei-Chou Lin  Jenq-Wen Huang  Hung-Bin Tsai  Yung-Ming Chen  Kwan-Dun Wu 《Nephrology, dialysis, transplantation》2004,19(12):3180-3182
  Severe acute respiratory syndrome (SARS)-associated coronavirus(SARS-CoV) has been identified as the causal agent of SARS.Although not common, acute renal failure (ARF) in SARS patientsusually has a catastrophic outcome, with a mortality rate of77% [1]. The causes of ARF in association with SARS are unknown.An increase in creatine kinase (CK) may play a role [2]. Wepresent two patients who met the definition of probable SARS.   A 78-year-old man  相似文献   

18.
Estimation of trisodium citrate (Citra-Lock) remaining in central venous catheters after the interdialytic interval.     
Cornelius J Doorenbos  Marjo Van den Elsen-Hutten  Margret J M Heuven  Jan Hessels 《Nephrology, dialysis, transplantation》2006,21(2):543-545
  Infection of central venous catheters used for haemodialysisremains an important cause of morbidity and mortality [1]. Patencyof the catheters can be maintained between dialyses by a heparinlock, but this has no antibacterial activity. Sodium citrate,especially at higher concentrations, is an anticoagulant withintrinsic antibacterial activity [2]. However, citrate inadvertentlyentering the circulation of the patient will chelate calciumions and depress the ionized calcium level. This may prolongthe QT interval [3], which may lead to ventricular dysrhythmiasand torsade de pointes. We investigated the amount of citrateremaining in dialysis catheters after the interdialytic intervalin order to assess the risk of this amount entering the circulation.   Eight incidental patients with a central venous dialysis catheterwere examined. They had  相似文献   

19.
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   

20.
Spontaneous renal pelvic haematoma mimicking cancer in IgA nephropathy.     
Young-Woong Won  Sang-Woong Han  Ho-Jung Kim  Young-Ha Oh  Moon-Hyang Park 《Nephrology, dialysis, transplantation》2007,22(1):254-256
  Common causes of gross haematuria include stones, neoplasms,tuberculosis, trauma and prostatitis. However, macroscopic haematuriacan occur in patients with IgA nephropathy. IgA nephropathyusually occurs in patients under 40 years of age, and loin painoften accompanies the haematuria [1]. Furthermore, macroscopichaematuria in IgA nephropathy often causes acute renal failurebecause of tubular obstruction by red blood cells [2–4].Obstruction or haematoma of the renal pelvis and lower urinarytract by gross haematuria in IgA nephropathy or any other diseasescausing haematuria has not been reported. Here, we report thecase of a patient with pelvic haematoma in IgA nephropathy,that was erroneously suspected for pelvic malignancy leadingto its radical resection.   A  相似文献   

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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    Massive transfusion    Transfusion-related acute lung injury    Pathogenesis    Incidence    Haemolytic transfusion reactions    Non-haemolytic febrile reactions    Allergic reactions    Transfusion-related infections    Transfusion-associated graft-vs-host disease    Immunomodulation    Introduction    Case    Introduction    Case report    Introduction    Case    Introduction    Case report    Introduction    MPGN2    Non-Stx-HUS    Definition and electrocardiographic patterns    Classification    Pathophysiology and mechanisms    Causes and risk factors    Principles of management    Restoration of sinus rhythm    Maintenance of sinus rhythm    Rate control of atrial fibrillation    Prevention of thromboembolism    Management in special situations    Introduction    Case    Introduction    Case    Introduction    Volume    UK pre-hospital care    Transfer medicine    Evidence-base    Doctors at major incidents    Pre-hospital airway management    Conclusion    Introduction    Case report    Introduction    Case report    Introduction    Case 1    Introduction    Case 1    Introduction    Patients and methods    Definitions    Physiology    Causes of haemorrhage    Management of haemorrhage    Protocols and fire drills    Problems in early pregnancy    Web resources    Introduction    Case
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