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Key Clinical Message: Proper diagnosis and treatment of vascular stenosis which is a possible complication of renal transplant is important in improving patients' quality of life and prognosis. Abstract: One known consequence among recipients of renal transplants is graft renal artery stenosis. Early identification and therapy are crucial to avoid graft malfunction and the serious consequences that might arise due to elevated hypertension in several organs. We report a rare case of transplant renal artery stenosis in a mid-aged woman who presented with edema, hypertension, and increased creatinine 2 months after kidney transplant. The patient had normal renal arterial resistive index (RI) and perfusion index (PI), and there was only a modest decrease in perfusion on duplex ultrasound. Following the patient's renal stenting treatment, angiographic resolution was observed. After 14 days of regulated blood pressure following renal artery stenting, she was discharged from the hospital with her edema resolved. Considering complications in patients with clinical manifestations such as hypertension resistant to treatment and graft dysfunction, vascular stenosis is a notable issue to consider even in the context of normal renal arterial RI, PI, and duplex ultrasound. Proper diagnosis and treatment are of importance to improve patients' quality of life and prognosis.
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BACKGROUND: Mendelian susceptibility to mycobacterial disease (MSMD) is an uncommon disorder with increased susceptibility to less virulent mycobacteria including bacillus Calmette-Guérin (BCG). Fibrosing mediastinitis (FM) is also a rare condition defined by excessive fibrotic reactions in the mediastinum. So far, some infectious organisms and autoimmune diseases have been introduced as possible etiologies of FM. However, no study has ever discussed the possible association of BCG infection and FM. CASE PRESENTATION: In this study, we report a 3-year-old female presenting with persistent fever, weakness, and bloody diarrhea in addition to mediastinal lymphadenopathy, hepatosplenomegaly, and pleural and pericardial effusion. Further examinations established a diagnosis of MSMD based on her clinical condition, immunologic data, positive tests for mycobacterial species, positive family history, and genetic study (IL12RB1 gene, c.G1193C, p.W398S). A year and a half later, she was referred with submandibular lymphadenitis and underwent immunologic work-up which revealed high inflammatory indices, a slight reduction in numbers of CD3 + and CD4 + cells as well as elevated CD16/56 + cell count and hyperimmunoglobulinemia. Purified protein derivative (PPD), QuantiFERON, and gastric washing test were all negative. Her chest computed tomography (CT) scan revealed suspicious para-aortic soft tissue and her echocardiography was indicative of strictures in superior vena cava and pulmonary veins. She further underwent chest CT angiography which confirmed FM development. Meanwhile, she has been treated with anti-mycobacterial agents and subcutaneous IFN-γ. CONCLUSION: In summary, we described a novel case of MSMD in a child presenting with granulomatous FM possibly following BCG infection. This is the first report introducing aberrant BCG infection as the underlying cause of FM. This result could assist physicians in identifying early-onset FM in suspicious cases with MSMD. However, more studies are required to support this matter.
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Background: Gastric residual volume (GRV) is considered an important parameter for gastric emptying and nutrition tolerance. This volume is measured before any nutrition and has a direct effect on the volume and timing of the next nutrition. The present study aimed to examine the GRV via ultrasound after receiving intravenous ondansetron, metoclopramide, and neostigmine. Materials and Methods: In the present study, 40 patients were included in the study, 10 patients were excluded from the study due to death during treatment, and 30 patients were divided into three groups of 10(10 patients in each group).The first, second, and third groups received 2.5, 10, and 8 mg neostigmine, metoclopramide, and ondansetron every 8 h, respectively. The drugs were infused as a micro set in 100 ml normal saline into patients within 30 min. The patients underwent ultrasound imaging and GRV measurement by an intensive care unit (ICU) subspecialty fellow, who was not aware of the drugs received by the patients, in the 1st h of hospitalization, 6 h after drug injection, and once daily for 4 days. Results: A total of 40 patients entered the study based on inclusion and exclusion criteria. The effect of neostigmine on reducing GRV (Gastric residual volume) in ICU patients was better than those of the other two drugs, which was significant. Conclusion: The results of this study showed that neostigmine has a better and significant effect on reducing GRV in ICU patients, compared to those of ondansetron and metoclopramide.
