CoagulationBiochemistryHypocalcaemiaHyperkalaemiaAcid–base abnormalitiesHypothermia   Clinical features       Immediate reactionsDelayed reactions       BacterialViralPrion      相似文献   

2.
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   

3.
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   

4.
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   

5.
Anaesthesia for lower limb revascularization     
Tovey  Gail; Thompson  Jonathan P 《CEACCP》2005,5(3):89-92
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 (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   

6.
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   

7.
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   

8.
Dengue haemorrhagic fever after living donor renal transplantation.     
Felicia Li-Sher Tan  Dale L S K Loh  K Prabhakaran  Paul Ananth Tambyah  Hui-Kim Yap 《Nephrology, dialysis, transplantation》2005,20(2):447-448
  The transmission of infection from donor to recipient in solidorgan transplantation can result in loss of the allograft andin severe cases, death of the recipient. The occurrence of denguevirus infection in an immunocompromised renal transplant patientcan have many detrimental effects, the most life-threateningof these is development of dengue shock syndrome. We presenta case of possible transmission of dengue infection from donorto recipient after living donor renal transplantation, resultingin a fulminant course of dengue haemorrhagic fever (DHF).   A 23-year-old male with end-stage renal failure due to lupusnephritis underwent a living  相似文献   

9.
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   

10.
Pseudohypocalcaemia in an elderly patient with advanced renal failure and renovascular disease.     
Patrick B Mark  Emmanouil Mazonakis  David Shapiro  Richard J Spooner  R Stuart C Rodger 《Nephrology, dialysis, transplantation》2005,20(7):1499-1500
  Hypocalcaemia is a common clinical problem in patients withadvanced renal failure, frequently related to abnormal vitaminD metabolism. However, not all causes are due to 1,25-dihydroxycholecalciferoldeficiency and in this case we would like to demonstrate theconfusion which may be caused by iatrogenic pseudohypocalcaemia.   An 84-year-old man with advanced chronic renal failure (glomerularfiltration rate 15 ml/min) was admitted due to rapid deteriorationof his kidney function and was established on haemodialysis.There were  相似文献   

11.
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   

12.
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   

13.
Renal tubular injury associated with anagrelide use.     
Graham E J Rodwell  Megan L Troxell  Richard A Lafayette 《Nephrology, dialysis, transplantation》2005,20(5):988-990
  We describe the first case of biopsy-proven renal tubular injuryassociated with anagrelide.   A 60-year-old man with a 35 year history of Crohn's diseasewas diagnosed with essential thrombocytosis (ET) following aunilateral renal artery thrombosis in May 2003. His plateletcount at the time of diagnosis with ET was 1.3 million cells/mm3. He began taking 0.5 mg oral anagrelide twice daily, increasingthe dose to 1 mg each morning and 0.5 mg each evening over  相似文献   

14.
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   

15.
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   

16.
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   

17.
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   

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.
Pyroglutamic acidosis in a renal transplant patient.     
Carole L Foot  John F Fraser  Daniel V Mullany 《Nephrology, dialysis, transplantation》2005,20(12):2836-2838
  Metabolic acidosis is a common acid–base disorder in criticallyill patients. Elucidation of the cause usually commences withthe calculation of the anion gap. Increased anion gap metabolicacidosis is commonly due to lactic acidosis, renal failure,ketoacidosis as well as a multitude of drugs including toxicalcohols. Pyroglutamic acidosis (5-oxoprolinuria) is a rarecause of increased anion gap acidosis and has not previouslybeen reported in a renal transplant patient.   A 57-year-old married female presented to the hospital witha two day history of lethargy, anorexia and increasing dyspnoea.Her past medical history was extensive. Four years ago she hada renal transplant for medullary sponge kidneys which was failingdespite ongoing immunosuppression. Her baseline creatinine was0.22 mmol/l  相似文献   

20.
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   

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1.
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]
   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    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    Critical limb ischaemia    Preoperative assessment    Preoperative management    Perioperative management    Postoperative management    Acute limb ischaemia    Delirium    Dementia    Postoperative cognitive dysfunction    Anaesthetic technique and postoperative cognitive impairment    Future developments    Introduction    Case    Introduction    Case report    Introduction    Case    Introduction    Case report    Case    Assessing the ECF volume    Introduction    Case 1    Introduction    Case    Definitions    Physiology    Causes of haemorrhage    Management of haemorrhage    Protocols and fire drills    Problems in early pregnancy    Web resources    Introduction    Case    Introduction    Case presentation    Introduction    Case    Introduction    MPGN2    Non-Stx-HUS    Introduction    Narrative    Introduction    Case report
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