Effect of vitamin E-bonded dialyzer on eosinophilia in haemodialysis patients.

BACKGROUND: Eosinophilia in haemodialysis patients probably results from allergy to haemodialysis-related materials, including dialyzer membranes. We examined the effects of vitamin E-bonded dialyzers on eosinophil counts in haemodialysis patients. METHODS: We enrolled seven patients who were on regular haemodialysis and had sustained eosinophilia. White blood cell, eosinophil, CD4- and CD8-positive lymphocyte counts, and serum interleukin-5 (IL-5) and IgE levels were determined before, 2 and 4 weeks after switching to vitamin E-bonded dialyzers. RESULTS: Eosinophil and CD4-positive lymphocyte counts and serum IL-5 were significantly (P = 0.003, 0.003 and 0.031, respectively) decreased after switching to vitamin E-bonded dialyzers. CD8-positive lymphocyte counts and serum IgE levels were unaltered. Crossover tests in two cases reproduced the higher eosinophilia within 4 weeks after returning to the original non-vitamin E-bonded dialyzer. Conclusion: Vitamin E-bonded dialyzers may ameliorate eosinophilia through a mechanism mediated by a decrease in IL-5 secretion by CD4-positive lymphocytes.     

Bullous pemphigoid in patients receiving peritoneal dialysis: a case series and a literature survey

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease. Although several cases of BP in end-stage renal disease patients receiving peritoneal dialysis (PD) or hemodialysis have been reported, the incidence of BP in these patients remains unknown. We recently experienced three PD patients diagnosed with BP. The skin injury was likely to be a trigger of BP in all the three PD patients. Nifedipine and icodextrin exposures were possible factors directly or indirectly affecting the onset of BP, because they were common in the three cases. We also report that the incidence of BP in PD patients was 3/478.3 person-years in a single-center 10-year study. This case series with a literature survey describes that the skin and tissue injuries are potential triggers responsible for the onset of BP in dialysis patients and that the incidence of BP in these patients seems to be much higher than that in the general population.     

Phosphate removal in haemodialysis: Effect of two different dialysis membranes

Summary: Phosphate removal with two different dialysis membranes (a standard cellulose acetate membrane and a high performance cellulose diacetate membrane) were studied in ten haemodialysis patients. All patients were dialysed sequentially with two membranes (surface area was 1.5 m²) against bicarbonate buffered dialysis for 4 hours three times a week. With the diacetate membrane, the instantaneous clearances of urea and phosphate after 1 hour of haemodialysis were significantly higher than with the cellulose membrane. Also, the weekly total amount of urea and phosphate removal were significantly increased with the diacetate membrane (a 15% increase in urea and a 16% increase of phosphate). Although there was a significant increase in urea reduction ratio and significantly lower post dialytic plasma urea concentration with the diacetate membrane, these for phosphate did not reach statistical significance. These data suggest that the use of the diacetate membrane potentially offer clinical benefit. However, whether 16% of phosphate removal could improve clinical control of serum phosphate levels will need further investigation.     

Death of 43 Indonesian women with ovarian cancer: A case series

BackgroundOvarian cancer is a gynecological cancer with a higher mortality than other gynecological cancers.Case reportThere were 43 cases of Indonesian women who died of ovarian cancer in 2015–2017. Patients were first diagnosed at the age of 40–59 years (65.11%), of which had normal BMI (62.72%) and mostly in stage III (39.53%). The histology was 88.3% epithelial ovarian cancer with the most subtypes of mucinous carcinoma (25.5%). The majority were referral patients (62.7%), but due to its malignancy, many died before receiving ovarian cancer treatment (40.74%). Of the 43 patients, 17 patients received chemotherapy, and 10 patients received a combination of surgical therapy and chemotherapy. Most of the deaths were caused by primary disease (69.77%). Patients with stages III and IV, as well as patients receiving surgery or chemotherapy alone had shorter survival times.ConclusionMost ovarian cancer patients are first diagnosed at stage III with the mucinous carcinoma subtype. Most deaths are caused by primary ovarian cancer. The therapy that provides the longest survival is a combination of surgery and chemotherapy.     

Limitations in the use of 18F-FDG PET in the pre-operative staging of gastric cancer: A case series

IntroductionPositron emission tomography (PET) is a mainstay in the preoperative evaluation of various cancers. In gastric cancer however, its role in the initial staging remains contentious. Presented is a case series of three gastric patients wherein the use of fluorodeoxyglucose (18F-FDG) PET/CT (computer tomography) as part of the initial staging was inconsequential to treatment, demonstrating its limited role in the staging of primary gastric cancer.MethodsWe analyzed retrospective data from 12/1/2010 to 10/31/2016 of patient with gastric cancer whose initial staging included a PET/CT. Only patients 18 years and older with gastric and gastro-oesophageal junction cancers were included. The data was derived from a single institution. Management of patients involved both an academic institution and a community practice.ResultsOf the three cases reported, an FDG-avid mass with minimal FDG uptake was reported in a single case and no FDG-avid lesion was reported in the other two. Neither of the patients underwent an endoscopic ultrasound for lack of availability.ConclusionWhile various imaging studies such as endoscopic ultrasound have an established role in the initial staging, the role of FDG-PET is yet to be established and its routine use remains contentious. Based on our clinical experience and review of the literature, we believe FDG-PET/CT imaging is of limited clinical and cost effective value in the initial staging workup of gastric cancer.     

Trichobezoar with and without Rapunzel syndrome in paediatric population: A case series from a tertiary care centre of Northern India

IntroductionTrichobezoars are concretions formed by accumulation of hair in stomach. Usually, trichobezoar is confined to the stomach, but rarely it may extend from the stomach to the small intestine and even colon. This is an unusual form called Rapunzel syndrome. Our experience with this rare entity of Rapunzel syndrome and interesting entity of trichobezoar is being presented with review of literature.Presentation of casesWe, at our institute, encountered four cases of trichobezoar in last five years, out of which two were found to be of Rapunzel syndrome. All of these cases were managed successfully by open surgical intervention in view of the very large size of the mass in all the cases.DiscussionThe clinical presentation is highly variable ranging from asymptomatic cases diagnosed incidently to serious gastrointestinal symptoms and complications. Cases of trichobezoar have been reported in literature very infrequently but Rapunzel syndrome is extremely rare and less than 50 cases have been reported in medical literature till date.ConclusionTrichobezoar leading to Rapunzel syndrome is an extremely rare entity. The clinical presentation is usually vague and non-specific. Treatment is mainly surgical because of delayed presentation in majority of the cases. Psychiatric illness is the usual association.     

髌前滑膜血管瘤1例

患者,男,58岁,因右膝关节前侧肿胀7d于2012年4月2日入院。自诉入院前7d于田间长时间蹲位劳作后感觉右膝关节肿痛,未在意,未及时就诊。经休息右膝关节肿胀未见减轻,遂来我院就诊。入院查体:右髌骨前方明显肿胀,可触及一约8cm×6cm×3cm囊性肿物,质软,有波动感,深压痛明显,     

Infective spondylodiscitis in patients on maintenance hemodialysis: a case series

Infective spondylodiscitis is a rare disease. This case review describes the clinical course, risk factors, and outcomes of adult patients on maintenance hemodialysis who presented with infective spondylodiscitis at a single medical center in Taiwan. There were 18 cases (mean age: 64.9?±?10.8 years) over more than 10 years. Analysis of underlying diseases indicated that 50% of patients had diabetes, 55.6% had hypertension, 55.6% had coronary artery disease, 22.2% had congestive heart failure, 22.2% had a cerebral vascular accident, 16.7% had liver cirrhosis, and 11.1% had malignancies. Sixty-one percent of patients had a degenerative spinal disease and the most common symptom was back pain (83.3%). A total of 38.9% of patients had leukocytosis, 99.4% had elevated levels of C-reactive protein, 78.6% had elevated erythrocyte sedimentation rates, and 55.6% had elevated levels of alkaline phosphatase. The average hemodialysis duration was 72.8?±?87.5 months, and 8 patients (44.4%) started hemodialysis within 1 year prior to infective spondylodiscitis. Four patients (22.2%) had vascular access infection-associated spondylodiscitis. The lumbar region was the most common location of infection (77.8%), 44.4% of patients developed abscesses, and Staphylococci were the most common pathogen (38.9%). The mortality rate was 16.7%, all due to sepsis. Thirty-three percent of the survivors had recurrent infective spondylodiscitis within 1 year. Infective spondylodiscitis should be considered in hemodialysis patients who present with prolonged back pain with or without fever. Non-contrast MRI is an appropriate diagnostic tool for this condition. Vascular access infection increases the risk for infective spondylodiscitis in hemodialysis patients.     

Incarcerated paraesophageal hernia complicated by pancreatic damage and unusual comorbidity: Two retrospective case series

Introduction: About 1% of paraesophageal hernias (PEH) require emergency surgery due to obstruction or gangrene. We present two complicated cases of incarcerated PEH.Presentation of cases: A patient aged 18 with trisomy 21 was admitted after four days of vomiting and epigastric pain. CT scan revealed a large PEH. The stomach was massively dilated with compression of adjacent viscera and the celiac trunk. The stomach was repositioned laparoscopically and deflated by endoscopy in an attempt to avoid resection. During second look laparoscopy a gastrectomy was necessary. The patient was reoperated for intestinal obstruction, and treated for dehiscence of the esophagojejunostomy and a pancreatic fistula. A patient aged 65 with hereditary spastic paresis had two days history of emesis and epigastric pain. Upon arrival he was hemodynamically unstable and a CT scan revealed perforation of the herniated stomach. A subtotal gastrectomy without reconstruction was performed with vacuum closure of the abdomen. Later a gastrectomy was completed with a Roux-en-Y reconstruction. Except from reoperation for wound dehiscence after 14 days, the recovery was uneventful.Discussion: Trisomy 21 and hereditary spastic paresis may increase the risk of developing PEH. Challenges in regard to symptom evaluation may delay diagnosis. The pressure of the dilated stomach can give rise to ischemic and mechanical damage from compression of major blood vessels and organs. Urgent diagnosis and gastric deflation is required.Conclusions: In patients with known PEH or with comorbidity that may increase the risk of PEH, this diagnosis should be considered early on.     

Peritoneal dialysis in pregnancy: a case series

SUMMARY:   Patients with significant renal impairment have difficulties maintaining a viable pregnancy due to maternal and fetal complications. Both peritoneal dialysis and hemodialysis support throughout pregnancy has been reported to assist in these pregnancies. We report our experience with the use of peritoneal dialysis in five cases leading to successful deliveries with minimal complications.     

Hyperbaric oxygen in the treatment of calciphylaxis: a case series.

BACKGROUND: Calciphylaxis, also referred to as calcific uraemic arteriolopathy, is a syndrome associated with end-stage renal disease (ESRD), and causes necrotic skin ulcers, often leading to a fatal outcome. Hyperbaric oxygen (HBO(2)) therapy has been used to enhance wound healing, but its role in the treatment of calciphylaxis is unclear. METHODS: We undertook a retrospective study of patients on renal replacement therapy with biopsy-proven calciphylaxis who were treated with HBO(2) between March 1997 and February 2000. RESULTS: Five patients were treated with HBO(2): three patients were on continuous ambulatory peritoneal dialysis (CAPD) and two were on chronic haemodialysis therapy. None of the patients had uncontrolled hyperparathyroidism and none underwent parathyroidectomy. The patients each received 25-35 treatments of HBO(2) at 2.5 atmospheres for 90 min per treatment. Two of these patients had complete resolution of extensive necrotic skin ulcers, with no adverse effects of HBO(2) therapy. Both had improvement in wound area transcutaneous oxygen pressure (P(tc)O(2)) with administration of 100% oxygen when measurements were taken at normobaric and hyperbaric pressures. In the other three patients receiving HBO(2), the skin lesions did not resolve. P(tc)O(2) was measured in two of these patients, neither of whom showed improvement with 100% oxygen administered at normobaric pressure. CONCLUSIONS: The data support a role for HBO(2) in the treatment of some patients with calciphylaxis, particularly as in the absence of uncontrolled secondary hyperparathyroidism there are few therapeutic options.     

Effect of Dialysis Type on Serum Lipids,Apolipoproteins, and Lipoproteins

Aim. Dyslipidemia is common among patients with end-stage renal disease, whether treated by hemodialysis (HD) or peritoneal dialysis (PD). However, there are not enough data about the effect of dialysis type on serum lipoprotein (a) [Lp(a)], apolipoprotein (a) [Apo(a)], apolipoprotein (b) [Apo(b)], and lipid levels. The aim of this study was to determine the effect of dialysis type on serum lipid levels. Materials and Methods. This study enrolled 40 HD patients (20 men and 20 women, aged 48.1?±?17.6 years) and 69 PD patients (35 men and 34 women, aged 45.2?±?16.3 years). Serum lipid profile including total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), triglyceride (TG), Apo(a), Apo(b), and Lp(a) were determined in HD and PD patients. Patients who have used statins within the last six months were not included in the study. Results. No significant differences in TC, LDL-C, HDL-C, TG, Apo(a), Apo(b), or Lp(a) serum levels were found between HD and PD patients. Serum TC, LDL-C, HDL-C, TG, Apo(a), Apo(b), and Lp(a) in HD and PD patients were 172.2?±?42.7 (mg/dL) vs. 181.0?±?53.0 (mg/dL), 97.2?±?36.2 (mg/dL) vs. 101.4?±?33.6 (mg/dL), 45.3?±?11.9 (mg/dL) vs. 41.4?±?11.1 (mg/dL), 144.7?±?71.8 (mg/dL) vs. 173.0?±?76.8 (mg/dL), 1.2?±?0.5 (g/L) vs. 1.0?±?0.2 (g/L), 0.9?±?0.3 (g/L) vs. 1.2?±?0.3 (g/L), and 43.1?±?40.6 (mg/dL) vs. 46.0?±?42.7 (mg/dL), respectively. Conclusion. The results of this study show that the maintenance CAPD treatment is associated with more pronounced alterations of the lipoproteins and lipid metabolism than those observed during HD treatment.     

Angiolymphoid hyperplasia with eosinophilia involving the common digital artery of the hand: A case report and classification of upper limb lesions

IntroductionAngiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign reactive inflammatory lesion. The usual presentation is a single or multiple skin nodules of the head and neck. Involvement of the hand is very rare and there have been no comprehensive reviews on ALHE of the upper limb. In this paper, we report on a case involving the common digital artery of the hand. We also review the literature and offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either single or multiple lesions.Presentation of caseA 32-year old female presented with a slowly growing subcutaneous mass at the second web space of the left hand. The mass was neither tender or mobile. An MRI showed a tri-lobed soft tissue lesion. At the time of surgery, the lesion was found to be within the common digital artery of the second web space. Complete excision was done. Histopathology confirmed the diagnosis of ALHE There has been no recurrence or cold tolerance at final follow-up 1 year later.DiscussionWe offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either a single or multiple lesions.ConclusionA rare case of ALHE of the hand is presented. The literature is reviewed and two classification systems for upper limb lesions are offered and their implications are discussed.     

Natural orifice specimen extraction in laparoscopic colorectal cancer surgery: A case series study

IntroductionIn recent years, natural orifice specimen extraction (NOSE) has been attracting attention as a further minimally invasive operation for colorectal cancer, and not only improvement of appearance, but also reduction of pain and wound-related complications due to abdominal wall destruction has been reported. However, NOSE is technically complicated and difficult, and it has not yet been widely used. The aim of this study was to confirm the feasibility, safety, and short-term outcomes of total laparoscopic colon cancer surgery with NOSE.Case presentationFrom May 2018 to October 2019, eight patients with stage 0 or I colon cancer underwent NOSE surgery in our hospital. Transanal specimen extraction was performed in six cases, and transvaginal specimen extraction was performed in two cases. All operations were successfully accomplished without conversion to open surgery. The anastomosis method was double stapling technique in three cases and overlap method in five cases. The median operative time was 224 min. The median blood loss was 10 mL. The median time to first flatus was 1 day, and the median time to first stool was 2 days. The median postoperative observation period was 18 months, but there was no recurrence. There were no postoperative complications in these cases.ConclusionTotal laparoscopic colon cancer surgery with NOSE appears to be feasible, safe, and show promising efficacy for selected patients.     

关节镜治疗膝关节滑膜血管瘤1例

<正>患儿,6岁,女,因右膝关节间断肿胀、疼痛3年余入院。自诉3年前开始出现右膝关节肿胀并伴有内侧压痛。无明显外伤史。关节腔穿刺显示为血性液体。一直行保守治疗。同年在吉林大学中日联谊医院行同侧大腿中段内侧血管瘤切除术。入院查体:右膝关节明显肿胀,局部皮肤可见血管影(见图1a),皮温不高,局部压痛明显,右膝关节活动度为0°～120°,末稍血运及感觉正常。X线检查示右膝关节骨质及     

Effect of the subcutaneous route for iliac screw insertion in lumbopelvic fixation for vertical unstable sacral fractures on the infection rate: A retrospective case series

ObjectiveTo report the perioperative results and surgical outcomes of patients with vertical unstable sacral fractures who underwent lumbopelvic fixation through a modified subcutaneous route for iliac screw fixation.Summary of background dataTreating vertical unstable sacral fractures is still challenging for orthopedic surgeons. Among various methods for treating these fractures, lumbopelvic fixation provides a high reduction quality and promising stability for early weight-bearing ambulation. However, wound healing disturbance and surgical site infection (SSI) are the drawbacks of this extensive technique, especially after inserting iliac screws.MethodsHere, we provide an alternative subcutaneous route for iliac screw insertion during lumbopelvic fixation surgery to lessen soft tissue retraction and injury, and thus decrease soft tissue complications.ResultsUsing this modified technique, 28 patients with vertical unstable sacral fractures were treated between 2012 and 2014. One patient had an SSI (infection rate: 3.5%). All fractures were united with a mean sacral kyphosis correction angle of 10.5°. The mean Majeed score of the 17 patients during the 12-month follow-up was 84.5.ConclusionsThe subcutaneous route for iliac screw insertion is a simple, safe, and effective technique when performing lumbopelvic fixation for vertical unstable sacral fractures.     

Effect of acetate-free biofiltration on the anaemia of haemodialysis patients: a prospective cross-over study.

BACKGROUND: The discussion about the pathogenesis of renal anaemia, whether it is primarily due to relative erythropoietin (Epo) deficiency or to uraemic inhibition of erythropoiesis, is still open. Although it has so far not been possible to identify or isolate a substance retained in uraemia with a suppressive action directed specifically against red-cell production, dialysis therapy can improve the effect of both residual endogenous Epo and exogenous rHuEpo. To what extent the mode and/or the dose of dialysis influence Epo efficacy is as yet poorly understood. METHODS: This study was performed as a single-centre trial. The protocol included a run-in period of 4 months followed by a prospective cross-over study including 6 months each of acetate-free biofiltration (AFB) with a high-flux biocompatible membrane and standard bicarbonate dialysis (BD) with a low-flux cellulosic membrane in a random sequence. AFB is a haemodiafiltration technique based on a continuous post-dilution infusion of a sterile isotonic bicarbonate solution. At the start of the run-in period (and for the entire length of the study), rHuEpo administration was withdrawn; patients whose haemoglobin (Hb) levels dropped at a level <8.0 g/dl at one single monthly check, had to be withdrawn from the study. A blood sample was collected every month for the blood gas analysis and for the determination of blood urea nitrogen, serum creatinine, sodium, potassium, calcium, phosphorus, Hb, erythrocyte, reticulocyte, leukocyte and thrombocyte cell counts, mean globular volume and haematocrit. An equilibrated single pool Kt/V(urea)>1.2 was mandatory in both treatment modalities. Serum iron, total iron-binding capacity, and ferritin were checked every 3 months. RESULTS: Twenty-three of 137 haemodialysis patients were considered eligible for the trial on the basis of the entry criteria. Of these, 15 volunteered and only 10 completed the study. No significant differences in the haematological indices, in the biochemical parameters assessing body iron stores, or in i.v. iron dosage was observed when comparing AFB with BD treatments. The equilibrated single pool Kt/V(urea) was always >1.2 and in no case was a significant difference observed when comparing AFB with BD treatments. Treatment time was significantly different between the two treatments (262+/-2 min in BD and 249+/-1 in AFB, P<0.0001). Neither pre- nor post-dialysis systolic and diastolic blood pressures, pre-dialysis serum bicarbonate and pH, pre-dialysis serum sodium, potassium, calcium, or phosphorus were significantly different when comparing the two treatment modalities. All 10 patients completed the 1-year follow-up without any major side-effects. CONCLUSIONS: Our study did not show any improvement of anaemia when treating a highly selected patient group, in the absence of any Epo therapy, with AFB compared with standard BD. Even though these conclusions cannot be extended in toto to the entire dialysis population, in which there is a large proportion of Epo-treated patients with Hb levels around 11 g/dl, we may nevertheless conclude that when patients are well selected, adequately dialysed, and not iron- and/or vitamin-depleted, the effect of a haemodiafiltration technique with a high-flux biocompatible membrane is less than might be expected from the results of uncontrolled studies.     

Gluteus maximus transfer and mass graft (Capsulorraphy) in recurrent hip dislocation with the history of total hip replacement: A case series

IntroductionPost THR dislocation has been a significant complication that interferes with the patient’s life. Detection of risk factors, careful planning, proper operative procedures, and patient education is essential to prevent the incidence of dislocation. Several operative measures have been studied to achieve this, including the use of mesh for soft tissue procedures and capsulorraphy.Case PresentationA total of four patients is included in this case series. Two had a history of trauma that contributes to the necessity of the procedure while the other two had degenerative joint issues. All were operated by soft tissue procedure of gluteus maximus transfer as an abductor replacement and along with capsule augmentation using synthetic mesh as a synthetic capsule to strengthen and provide more stability.DiscussionThe abductor strength from this gluteus maximus procedure is sufficient to stabilize the pelvis and prevent pelvic sag. The primary material of the mesh should produce inflammatory reaction so that a fibro capsular structure is formed surrounding the hip joint to add stability.ConclusionThe use of mesh in soft tissue procedures, such as capsulorraphy, with the addition gluteus maximus transfer may assist to prevent (re)dislocations of the hip. However, further study should be conducted to validate the routine use of mesh and gluteus maximus transfer to prevent dislocation after the procedure.     

Ultrastructure of basement membranes of peritoneal capillaries in a chronic peritoneal infusion model in the rat.

BACKGROUND: Long-term peritoneal dialysis with glucose- based dialysis solutions has been associated with diabetiform alterations of peritoneal tissue. A peritoneal infusion model in the rat was developed to study the effect of chronic infusion of a glucose-based dialysis solution and an isotonic non-glucose solution on the ultrastructure of the basement membranes of peritoneal capillaries. The effect of ageing was also studied in an untreated control group. METHODS: A vascular access port (Rat-o-Port) with attached peritoneal catheter was implanted subcutaneously in the neck of nine male Wistar rats. The rats were divided randomly into three groups: the glucose group (n = 3) was infused daily for 20 weeks with 60 ml/kg body weight 3.86% glucose solution. A control group (n = 2) was infused daily for 20 weeks with 60 ml/kg body weight Ringer's lactate. The untreated control group (n = 4) was studied at the onset of the experiment and after 20 weeks. Omental tissue was obtained from each rat at the end of the experimental period for ultrastructural examination. RESULTS: Extensive lamination of basement membranes of omental capillaries was found in the glucose group. This was in contrast to the untreated control group where clear, single basement membranes were seen at the onset of the experiment and after 20 weeks. These latter findings were similar to those in the Ringer's lactate group. CONCLUSIONS: The chronic infusion model in the rat is suitable for the investigation of the effects on the ultrastructure of peritoneal capillaries of chronic exposure to dialysis fluids. The duplications of basement membranes of omental capillaries found in the glucose group show a striking resemblance to those found in long-term peritoneal dialysis patients. This suggests a role for glucose in the development of peritoneal ultrastructural alterations found in long-term peritoneal dialysis.