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.
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   

3.
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   

4.
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   

5.
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   

6.
B-cell lymphoma arising around a PTFE graft.     
Sally M A Hamour  Patrick F K Yong  Peter Amlot  Aine Burns 《Nephrology, dialysis, transplantation》2003,18(11):2428-2430
  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.   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   

7.
Anaesthesia and cognitive disturbance in the elderly     
Fines  Daniel P; Severn  Andrew M 《CEACCP》2006,6(1):37-40
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
    Anaesthetic assessment   Possible causes of POCDEmboliPerioperative physiological disturbancesPre-existing cognitive impairmentOther factors   PremedicationConduct of anaesthesia    相似文献   

8.
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   

9.
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   

10.
Nephrotic syndrome: cause of an abnormal response to the rapid ACTH stimulation test.     
Aoife Brennan  Kieran A O'Connor  William D Plant  Domhnaill J O'Halloran 《Nephrology, dialysis, transplantation》2004,19(2):477-478
  The intravenous rapid ACTH (250 mcg) stimulation test [shortsynacten® test (SST)] is the investigation of choice insuspected hypoadrenalism. We describe a patient with nephroticsyndrome in whom the initial SST was abnormal due to low cortisolbinding globulin (CBG). Repeat testing, after the patient haddeveloped end-stage renal failure, revealed a normal response.   A 53-year-old woman presented with peripheral oedema. Nephroticsyndrome was diagnosed on the basis of hypoalbuminaemia, proteinuriaand dyslipidaemia. She had  相似文献   

11.
A case of successful double sequential bone marrow and kidney transplantations in a patient with multiple myeloma.     
Rami Khoriaty  Zaher K Otrock  Walid A Medawar  Raja B Khauli  Ali Bazarbachi 《Nephrology, dialysis, transplantation》2006,21(12):3585-3588
  Multiple myeloma (MM) is a plasma-cell malignancy that, in theUnited States, constitutes 1.1% of all malignancies, 13.8% ofhaematological malignancies and   In May 1998, a 48-year-old man was found to have a Se Cr of176.8 µmol/l  相似文献   

12.
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   

13.
Diffuse alveolar haemorrhage in a systemic lupus erythematosus patient successfully treated with rituximab: a case report.     
Cordula M Nellessen  Uwe P?ge  Karl A Brensing  Tilman Sauerbruch  Hans-Ulrich Klehr  Christian Rabe 《Nephrology, dialysis, transplantation》2008,23(1):385-386
  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.   A 29-year-old North African female presented to our institution  相似文献   

14.
Dialysis independence following radiotherapy of renal extramedullary haemopoeisis.     
David Semple  Edward Kingdon  Steve Holt 《Nephrology, dialysis, transplantation》2004,19(5):1310-1312
  Myelofibrosis is a clonal haemopoietic stem cell disorder thatresults in chronic myeloproliferation and atypical megakaryocytichyperplasia. The abnormal production of growth factors by thesemegakaryocytes leads to the non-clonal proliferation and hyperactivityof fibroblasts, and subsequent bone marrow fibrosis. Additionalcharacteristic features of myelofibrosis include splenomegaly,extramedullary haemopoiesis (EMH) and severe constitutionalsymptoms. Although EMH has been observed in many organs, it usually occursin the liver and spleen. However, there are cases of EMH occurringwithin the renal parenchyma. We describe only the third caseof acute renal failure secondary to EMH in myelofibrosis, andthe first to be treated successfully with radiotherapy alone.   This patient, a 77-year-old man with a past history of ischaemicheart disease, was treated at a local hospital with  相似文献   

15.
Influenza vaccine-induced rhabdomyolysis leading to acute renal transplant dysfunction.     
K S Raman  T Chandrasekar  R S Reeve  M E Roberts  P A Kalra 《Nephrology, dialysis, transplantation》2006,21(2):530-531
  Rhabdomyolysis is a well-known cause of renal failure and iscommonly associated with drugs, toxins and infections. Therehas been one reported case of rhabdomyolysis attributed to influenzavaccine causing renal failure in native kidneys.   A 57-year-old Caucasian man was diagnosed to have focal segmentalglomerlosclerosis (FSGS) in 1995. He eventually underwent acadaveric renal transplantation in February 2002 and becausethis was complicated by delayed graft function, his creatinineplateaued at a  相似文献   

16.
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   

17.
Assessing the degree of extracellular fluid volume contraction in a patient with a severe degree of hyperglycaemia.     
Olga Napolova  Stacey Urbach  Mogamat Razeen Davids  Mitchell L Halperin 《Nephrology, dialysis, transplantation》2003,18(12):2674-2677
  A 7-year-old, 20 kg female had a 2 week history of polydipsia,polyuria and a weight loss of   It is difficult to quantitate the degree of ECF volume  相似文献   

18.
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   

19.
Pharmacokinetics of tenofovir in haemodialysis.     
Hassane Izzedine  Vincent Launay-Vacher  Vincent Jullien  Guy Aymard  Claudine Duvivier  Gilbert Deray 《Nephrology, dialysis, transplantation》2003,18(9):1931-1933
  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.   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   

20.
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   

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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    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    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    Delirium    Dementia    Postoperative cognitive dysfunction    Anaesthetic technique and postoperative cognitive impairment    Future developments    Introduction    Case    Introduction    Case 1    Introduction    Case    Introduction    Case presentation    Introduction    Case    Introduction    Case report    Introduction    Case    Introduction    Case Report    UK pre-hospital care    Transfer medicine    Evidence-base    Doctors at major incidents    Pre-hospital airway management    Conclusion    Case    Assessing the ECF volume    Introduction    MPGN2    Non-Stx-HUS    Introduction    Case    Introduction    Case
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