ABSTRACT
A patient, who had recently undergone a laparoscopic ovarian cyst operation, receiving nightly automated peritoneal dialysis treatment, was discovered to have peritonitis due to Pseudomonas putida. She was successfully treated with a 21-day course of intraperitoneal ceftazidime and gentamicin, without needing to remove the dialysis catheter. No recurrence was observed over 3 months of follow-up.
Subject(s)
Peritoneal Dialysis , Peritonitis/microbiology , Pseudomonas Infections/microbiology , Pseudomonas putida/isolation & purification , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Automation , Ceftazidime/pharmacology , Ceftazidime/therapeutic use , Female , Humans , Kidney Failure, Chronic/therapy , Peritonitis/drug therapy , Pseudomonas Infections/drug therapy , Pseudomonas putida/drug effects , Treatment OutcomeABSTRACT
Hyponatremia and its rapid correction may cause osmotic demyelination syndrome (ODS) with damage to the pontine and extrapontine areas of the brain. The damage may become persistent or may regress and disappear during follow-up. We describe the case of a 35-year-old woman with chronic renal failure who was admitted to the emergency department with profound hyponatremia which was corrected rapidly after hemodialysis treatment. During follow-up, she developed quadriparesis and dysartria. Magnetic resonance imaging (MRI) demonstrated abnormalities characteristic of ODS in the pons as well as the basal ganglia with increased signal intensity on T2 and diffusion-weighted (DW) MRI and low apparent diffusion coefficient (ADC) values. After the sixth day, her clinical status improved progressively. Control MRI revealed rapid normalization of the ADC values during the first week and month parallel to the clinical improvement. However, the hyperintensities on T2-weighted images persisted. Four months later the MRI findings were completely normal. The close relationship between the ADC abnormality and the clinical status suggests that DW-MRI may be useful in predicting the prognosis of ODS.
Subject(s)
Diffusion Magnetic Resonance Imaging , Myelinolysis, Central Pontine/diagnosis , Adult , Female , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Myelinolysis, Central Pontine/etiology , PrognosisABSTRACT
Even though prominent technical improvements in continuous ambulatory peritoneal dialysis (CAPD) treatments during the last decade, peritonitis keeps its place as an important cause of morbidity and mortality in these patients. Among them fungal peritonitis is happened to be the most difficult one to deal with and comes out serious clinical presentation. It is presented here a case of CAPD related fungal peritonitis caused by Penicillium spp. This case experienced recently relapsing bacterial episodes of peritonitis and received long term antibiotics intraperitoneally and systemically. Eventually, Penicillium spp. was detected in several cultures of peritoneal effluent and also tip of Tenckhoff catheter, therefore it was considered as a causative agent. Then, the catheter was removed and amphotericin B therapy was performed. But the general condition of the patient did not improve till surgically drainage of peritoneal collection which was determined by MR (Magnetic Resonance) examination of abdomen after antifungal treatment was completed and Penicillium spp. in the drainage samples was not determined anymore.
Subject(s)
Mycoses/etiology , Penicillium/isolation & purification , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/microbiology , Aged , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Catheterization , Drainage , Equipment Contamination , Humans , Male , Peritonitis/therapyABSTRACT
Patients with chronic renal failure, particularly those undergoing regular dialysis treatment (RDT) are candidates for free radical damage. It is difficult to quantitate free radicals because of their short half-lives and reactive nature. Therefore, indirect methods measuring products of lipid peroxidation and protein oxidation are preferred. The present study displays a profile of lipid peroxidation and protein oxidation parameters, which are more sensitive and specific than the widely used method measuring thiobarbituric acid reactive substances (TBARS), adapted to the plasma and erythrocyte samples of RDT patients. We have observed increased levels of plasma and erythrocyte lipid peroxidation and also demonstrated increased protein oxidation in erythrocyte membranes of RDT patients.