Bilateral central retinal artery occlusions in a patient with activated protein C resistance

We describe the case of a 42-year-old woman who had two episodes of visual loss, first in one and later in the other eye, which caused bilateral reduction of visual acuity to 2/10 with optic atrophy. Detailed clinical and laboratory assessment revealed an activated protein C (APC) resistance and no other obvious cause. APC resistance has not been previously reported as an etiologic factor of central retinal artery occlusion.     

Bloodstream Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae Among Intensive Care Unit Patients After Orthotopic Liver Transplantation: Risk Factors for Infection and Impact of Resistance on Outcomes

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as an important cause of bloodstream infections in intensive care units (ICUs). The aim of this study was to determine risk factors for bloodstream infections caused by CRKP as well as risk factors for CRKP-associated mortality among ICU patients after orthotopic liver transplantation (LT).MethodsThe study cohort of this observational study comprised 17 ICU patients after LT with CRKP bloodstream infections. The data from these patients were matched with 34 ICU patients (1:2) after LT without CRKP infections. The 2 groups were compared to identify risk factors for development of CRKP infection and risk factors for mortality.ResultsSeventeen CRKP bloodstream infections occurred in ICU patients after LT from January 1, 2008, to December 31, 2011. In univariate analysis, primary liver disease and especially hepatitis C virus infection or hepatocellular cancer were significant factors for development of CRKP. Acute Physiology and Chronic Health Evaluation (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score as well as CRKP bloodstream infection were predictors for ICU death (P < .05) in univariate analysis.ConclusionsCRKP bloodstream infections affect immunocompromised post-transplantation patients more. Bloodstream infections with CRKP along with APACHE and SOFA scores were predictors of death in ICU patients after LT.     

Remarkable improvement of relapsing dyshidrotic eczema after treatment of coexistant hyperhidrosis with oxybutynin

Dyshidrotic hand eczema is a common condition, which can be resistant to various treatments. Although a number of etiologic factors are involved in the pathogenesis of dyshidrotic eczema, hyperhidrosis is assumed to play a significant role. Oxybutynin is an alternative treatment for hyperhidrosis. We present the cases of two patients suffering from hyperhidrosis and dyshidrotic eczema, who were treated with oxybutynin with impressive results.     

Causes and Incidence of Renal Replacement Therapy Application in Orthotopic Liver Transplantation Patients: Our Experience

BackgroundRenal dysfunction is commonly found in patients with end-stage liver disease, as well as after liver transplantation, and it often needs renal replacement therapy (RRT) with the application of continuous or intermittent methods. The aim of this study was the recording of the patients who underwent continuous venovenous hemodiafiltration (CVVHDF) in the early postoperative period, as well as the recording of mortality and risk factors.MethodsWe retrospectively examined 71 patients who underwent orthotopic liver transplantation during a 2-year period (2011–2012). We recorded the incidence of acute kidney injury (AKI), according to the Acute Kidney Injury Network criteria, and we distinguished 2 groups of patients. Group A included those who needed RRT during the 1st 7 days after transplantation, and group B included the patients who did not require RRT. The RRT method of choice was CVVHDF.ResultsIn group A, the population of patients who presented AKI reached 52.1%, and 22.5% of the them underwent RRT. The mean Model for End-Stage Liver Disease and Acute Physiology and Chronic Health Evaluation scores were higher in group A, who also presented greater hemodynamic instability and more frequent infections and required more transfusions. The transfusion of >10 units of red blood cells was recognized as a risk factor for RRT (P = .024; odds ratio, 1.15; 95% confidence interval, 1.8–7.53).ConclusionsPatients who required RRT immediately after surgery had a significantly higher rate of mortality and it seemed that the number of transfusions played an important role in this.     

Acute paraplegia after the initiation of anti-tumour necrosis factor-alpha therapy for Crohn's disease

Therapies aimed at inhibiting tumour necrosis factor are currently successfully administered to an increasing number of patients with autoimmune diseases. Infliximab has been approved to induce and maintain remission in Crohn's disease and fistulizing Crohn's disease. We report a case of acute-onset flaccid paraplegia after the initiation of anti-tumour necrosis factor therapy (infliximab) for Crohn's disease. Neuroimaging findings revealed an extensive longitudinal myelopathy. Two months later, no abnormal signal intensity was observed in the spinal cord and after 4 months, the patient presented improvement of motor function. A possible correlation between anti-tumour necrosis factor therapy and acute myelitis is discussed. This case highlights that patients developing new neurological symptoms while on anti-tumour necrosis factor medication should be monitored closely.