RESUMO
Gadolinium (Gd)-based contrast media were introduced as alternatives to iodinated media for magnetic resonance imaging (MRI). Although originally thought to be non-nephrotoxic, Gd-based contrast media have recently been reported to be associated with acute kidney injury. The underlying mechanism of Gd-induced renal injury is not completely understood. We report an 80-year-old patient with buccal mucosa cancer for whom MRI with Gd-based contrast agent was conducted 3 times within 3 weeks. The patient developed rapid deterioration of preexisting renal insufficiency, and developed uremic symptoms and pulmonary edema. The patient was hemodialyzed 3 times. This resulted in improvement of renal function and clinical symptoms. This case emphasizes the potential nephrotoxicity of Gd-based contrast media and suggests that renal insufficiency, diabetes mellitus, old age and high dose of Gd-based contrast medium are risk factors for acute kidney injury.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Gadolínio DTPA/efeitos adversos , Imageamento por Ressonância Magnética , Neoplasias Bucais/patologia , Insuficiência Renal/complicações , Injúria Renal Aguda/terapia , Idoso de 80 Anos ou mais , Humanos , Masculino , Neoplasias Bucais/complicações , Edema Pulmonar/induzido quimicamente , Diálise Renal , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Uremia/induzido quimicamenteRESUMO
INTRODUCTION: This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach. STUDY DESIGN: Cadaveric study. RESULTS: The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach. However, the anterior endoscopic approach provides a smaller channel to the jugular foramen than the preauricular approach. CONCLUSIONS: The anterior endoscopic approach to the anterolateral part of the jugular foramen is a useful alternative to the lateral microsurgical preauricular approach in carefully selected cases. The vaginal process of the tympanic part of the temporal bone provides a valuable landmark to aid in accessing the jugular foramen in both procedures and can be drilled to open the foramen in the preauricular approach.