Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.455
Filtrar
1.
Medicine (Baltimore) ; 99(6): e19125, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028438

RESUMO

Pain, the main symptom of osteoarthritis (OA), can lead to functional disability in patients with knee OA. Understanding the association factors related to knee pain is important since preventing OA-induced disabilities can be achieved by modifying these pain-associated issues. Therefore, this study was aimed to investigate the association factors for OA-induced knee pain in Taiwanese patients who received total knee replacements (TKR).In this retrospective study, 357 subjects who had undergone TKR at the Taipei Municipal Wan-Fang Hospital were recruited. The distribution of pain severity among patients with knee OA was evaluated. Demographic data and clinical parameters were analyzed to determine relationships between these variables and the severity of knee OA pain.Of the 357 patients studied, 54% and 33% had moderate and severe knee pain, respectively. Furthermore, a multivariate logistic regression analysis revealed that serum creatinine (>1.5 mg/dL) and an estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m) were significantly associated with severe knee pain in OA patients. A significant correlation between severe knee pain and serum creatinine or eGFR was demonstrated by Pearson correlations.Taken together, the renal insufficiency defined by an elevated serum creatinine or a low eGFR in OA patients who required TKR was associated with severe knee pain. These variables must be considered while treating knee OA pain, especially in those patients with severe pain.


Assuntos
Artralgia/etiologia , Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/complicações , Insuficiência Renal/complicações , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Medição da Dor , Estudos Retrospectivos
2.
Zhonghua Nei Ke Za Zhi ; 59(2): 165-168, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074694

RESUMO

A 47-year-old female patient presented nausea and vomiting for half a year and elevated serum creatinine for 3 days. Proximal renal tubular acidosis (RTA) complicated with anemiawas confirmed after admission. Secondary factors, such as autoimmune disease, drugs, poison, monoclonal gammopathy, were excluded. Renal biopsy revealed acute interstitial nephritis. The patient was administrated with daily prednisone 50 mg, sodium bicarbonate 4 g, 3 times per day, erythropoietin 3 000 U, 2 times per week, combined with potassium, calcium, and calcitriol tablets. Serum creatinine reduced to 90 µmol/L. However nausea and vomiting deteriorated with lactic acidosis. Bone marrow biopsy indicated the diagnosis of non-Hodgkin lymphoma, therefore the patient was treated with chemotherapy. Although metabolic acidosis improved gradually after chemotherapy, severe pneumocystis carinii pneumonia developed two weeks later. The patient refused further treatment and was discharged.


Assuntos
Acidose Láctica/complicações , Acidose Tubular Renal/patologia , Anemia/complicações , Linfoma não Hodgkin/patologia , Pneumonia por Pneumocystis/diagnóstico , Insuficiência Renal/complicações , Acidose Láctica/sangue , Antineoplásicos/administração & dosagem , Biópsia , Creatinina/sangue , Eritropoetina/administração & dosagem , Feminino , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Pessoa de Meia-Idade , Náusea , Pneumonia por Pneumocystis/complicações , Prednisona/administração & dosagem , Bicarbonato de Sódio/administração & dosagem , Recusa do Paciente ao Tratamento , Vômito
3.
Angiology ; 71(2): 183-188, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30987432

RESUMO

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group (P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: -19.996 to -0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.


Assuntos
Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Nicorandil/uso terapêutico , Intervenção Coronária Percutânea , Insuficiência Renal/complicações , Idoso , Meios de Contraste/efeitos adversos , Feminino , Humanos , Masculino , Índice de Gravidade de Doença
4.
Zhonghua Nei Ke Za Zhi ; 59(1): 82-85, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887844

RESUMO

A 43-year-old male presented with elevated serum creatinine for 4 years and developed abdominal pain for 3 days. He started peritoneal dialysis 2 months ago. Dialysis-related peritonitis was ruled out and acute gastroenteritis was diagnosed. The patient was administrated with ertapenem 500 mg/d. An acute mental abnormality developed 3 days later. After excluded organic encephalopathy, ertapenem was discontinued for the suspicion of antibiotic-related encephalopathy. The frequency of peritoneal dialysis was increased to accelerate the clearance of antibiotics. However, the metal abnormality became even more severe. Then a diagnosis of Wernick-Korsakoff syndrome was considered. After the administration of high dose vitamin B(1), the mental disorder dramatically relieved. Vitamin B(1) 30 mg/d is maintained during peritoneal dialysis and the mental disorder does not relapse.


Assuntos
Dor Abdominal/etiologia , Síndrome de Korsakoff/tratamento farmacológico , Diálise Peritoneal , Insuficiência Renal/terapia , Tiamina/administração & dosagem , Encefalopatia de Wernicke/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Ertapenem/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Síndrome de Korsakoff/diagnóstico , Masculino , Transtornos Mentais , Peritonite , Insuficiência Renal/complicações , Resultado do Tratamento , Encefalopatia de Wernicke/diagnóstico
7.
Medicine (Baltimore) ; 98(48): e18205, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770278

RESUMO

BACKGROUND AND OBJECTIVES: This meta-analysis was to investigate the efficacy and safety of new oral anticoagulant (NOAC) in atrial fibrillation (AF) patients with renal function insufficiency, and to explore whether renal decline occurs in AF patients with NOAC and its impact on outcomes. METHODS AND RESULTS: In AF patients with mild renal insufficiency, the NOAC was associated with significantly lower rates of stroke (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67-0.91; P < .05). Lower rates of bleeding were significantly observed in NOAC group (OR, 0.85; 95% CI, 0.75-0.97; P < .05). In AF patients with moderate renal impairment, similar results were revealed (OR for stroke or systemic embolism, 0.80; 95% CI, 0.67-0.95, P < .05; OR for major bleeding, 0.78; 95% CI, 0.59-1.03; P = .07). During the follow-up, pooled data revealed that NOAC showed a less renal toxicity, but the difference did not reach statistical significance (creatinine clearance decline: -0.12 mL/min [-0.84, 0.61 mL/min]). We have revealed that the NOACs were associated with significantly lower rates of stroke or systemic embolism (hazard ratio [HR], 0.66; 95% CI, 0.42-0.89; P < .05) and lower rates of bleeding (HR, 0.93; 95% CI, 0.70-1.16; P = .153) in AF patients with worsening renal function. CONCLUSIONS: NOAC may have the potentiality to be at least as effective as warfarin and may equal safety outcomes in AF patients with renal impairment. Renal decline during therapeutics may be less likely happened in NOAC than warfarin dose. NOAC may reveal good efficacy and safety outcomes in these scenarios. Further detailed research is needed to gain more clear profile on this new anticoagulant.


Assuntos
Anticoagulantes , Fibrilação Atrial , Insuficiência Renal/complicações , Anticoagulantes/classificação , Anticoagulantes/farmacologia , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Humanos , Farmacovigilância , Resultado do Tratamento
8.
Rev Med Suisse ; 15(673): 2210-2212, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778052

RESUMO

Since 2017 the world suffers from a piperacillin/tazobactam shortage. Cefepime is then proposed as a broad spectrum antibiotic alternative. Up to 15 % of the patients under treatment develop neurotoxicity, mostly in kidney failure settings. Cefepime serum concentration and electroencephalogram guide diagnosis. Treatment consists in withholding or reducing the dose. Most of the patients recover without neurologic sequelae.


Assuntos
Encefalopatias/induzido quimicamente , Cefepima/efeitos adversos , Antibacterianos/efeitos adversos , Antibacterianos/provisão & distribução , Antibacterianos/uso terapêutico , Encefalopatias/sangue , Encefalopatias/diagnóstico , Cefepima/administração & dosagem , Cefepima/sangue , Cefepima/uso terapêutico , Humanos , Insuficiência Renal/sangue , Insuficiência Renal/complicações , Insuficiência Renal/tratamento farmacológico
9.
J Cardiothorac Surg ; 14(1): 191, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699143

RESUMO

BACKGROUND: Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. METHODS: After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60-89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09-2.90, p = 0.035; 95%CI 1.14-2.49, p = 0.027). CONCLUSIONS: Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Período Pré-Operatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
10.
Dtsch Med Wochenschr ; 144(22): 1576-1584, 2019 11.
Artigo em Alemão | MEDLINE | ID: mdl-31658482

RESUMO

Hyperkalemia increases morbidity and mortalilty risk in both in- and outpatients. Common causes are decreased renal excretion, excess intake or potassium shifting from the intra- to the extracellular space in combination with reduced renal excretion or impairment of regulation. Hyperkalemia may alter the cellular transmembrane potential and cause life-threatening arrhythmias. Heart failure patients with comorbid renal insufficiency and/or diabetes mellitus are at increased risk of developing hyperkalemia, which thus constitutes a common reason for insufficient up-titration, down-titration or discontinuation of prognostically relevant heart failure medications predisposing to hyperkalemia (e. g. angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers and mineralocorticoid receptor antagonists). New oral potassium binders may enhance treatment opportunities in this respect.


Assuntos
Hiperpotassemia , Comorbidade , Insuficiência Cardíaca/complicações , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Hiperpotassemia/fisiopatologia , Hiperpotassemia/terapia , Potássio/sangue , Potássio/metabolismo , Insuficiência Renal/complicações
11.
Orthopade ; 48(11): 927-935, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31531703

RESUMO

BACKGROUND: Reduced renal function is not rare in patients with inflammatory rheumatic diseases and is associated with an increased risk of treatment-induced and perioperative adverse events. METHOD: A literature search was carried out for the medical treatment and perioperative management of rheumatic disease in the presence of renal insufficiency. RESULTS: Patients with rheumatic disease and renal insufficiency have a higher risk of cardiovascular disease, bone loss and immunodeficiency than those without kidney disease. The perioperative rate of cardiovascular and infectious complications and the risk of acute kidney failure are elevated in these patients. The pharmacokinetics of many drugs used in rheumatology is influenced by the kidney function. Especially methotrexate is contraindicated in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. Nonsteroidal anti-inflammatory drugs (NSAIDS) and cyclooxygenase (COX)-2 inhibitors should not be used with renal insufficiency or only for a short term with the lowest effective dose. The treatment of osteoporosis with antiresorptive drugs may lead to adynamic bone disease in advanced kidney disease, and, therefore, the use of these drugs is controversial. CONCLUSION: Medication should be modified in patients with rheumatic disease and kidney involvement according the grade of renal insufficiency. There is also a need for special perioperative management in these patients, with interdisciplinary cooperation of rheumatologists, nephrologists and orthopedic doctors.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Inibidores de Ciclo-Oxigenase/efeitos adversos , Rim/efeitos dos fármacos , Insuficiência Renal/complicações , Doenças Reumáticas/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Humanos , Osteoporose , Insuficiência Renal/terapia , Doenças Reumáticas/complicações
12.
Int J Colorectal Dis ; 34(10): 1781-1790, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31512020

RESUMO

PURPOSE: Acute mesenteric ischemia (AMI) is still associated with very high morbidity and mortality while the rareness and heterogeneity hamper the establishment of evidence-based guidelines. We sought to help standardize contemporary treatment by a cohort study at our tertiary center in the rising endovascular age. METHODS: A retrospective cohort study was conducted from 2005 to 2015. Patients with occlusive (OMI), non-occlusive (NOMI), and venous mesenteric ischemia (VMI) were compared with respect to clinical and treatment parameters as well as outcome. RESULTS: The study cohort consisted of 48 patients composed of 27 males and 21 females with an average age of 63 years and an average BMI of 25.1 kg/m2. In 48% of patients (N=23), an acute arterial OMI had occurred while NOMI was present in 31% (N=15) and VMI in 21% (N=10). Interventional and intraoperative recanalizations were significantly more often required in OMI patients compared with other entities (p=0.003). Patients with venous mesenteric ischemia had a significant better overall survival than patients with OMI or NOMI in the univariate analysis (p=0.027). Patients with renal failure had a 14.7-fold higher relative risk (Cox p=0.013) and patients without bowel resection during primary surgery had a 17.8-fold higher relative risk (Cox p=0.047) to die of AMI in the postoperative course. CONCLUSIONS: AMI remains a rare but oftentimes fatal disease. Our study provides evidence that outcome may depend on the AMI subtype, presence of renal insufficiency, and early bowel resection. Further research should help individualize treatment for optimized outcomes.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Isquemia Mesentérica/complicações , Insuficiência Renal/complicações , Doença Aguda , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Equipe de Assistência ao Paciente , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
13.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527213

RESUMO

Inhibitors of BRAF, a gene coding a protein called B-raf, with or without inhibitors of MEK (MAPK/extracellular signal-regulated kinase) are often used as palliative treatment in BRAF-mutated metastatic melanoma. Recent data show improved progression-free survival with encorafenib with binimetinib, a newer BRAF/MEK inhibitor combination, compared with older agents, but there have been no reports of this treatment in the setting of renal and liver failure. We report a patient with disease-induced transaminitis and renal failure requiring dialysis who was successfully treated with encorafenib and binimetinib. His transaminitis improved and he was able to stop dialysis without any significant adverse effects during treatment, suggesting encorafenib with binimetinib may be used safely and effectively even in patients with end organ damage.


Assuntos
Benzimidazóis/uso terapêutico , Carbamatos/uso terapêutico , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Sulfonamidas/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas B-raf/genética , Insuficiência Renal/complicações
14.
Nutrients ; 11(9)2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31480674

RESUMO

Dyslipidemia, anemia, and inflammation are associated with declined kidney function. This study investigated the association of inflammatory dietary pattern with dyslipidemia, anemia, and kidney function biomarkers among middle-aged and older Taiwanese adults with declined kidney function. Biochemical data and food frequency questionnaire were obtained from 41,128 participants with estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 and positive urinary protein. Inflammatory dietary pattern was identified by reduced rank regression with C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (N/L) as response variables. Males had higher prevalence of dyslipidemia and higher inflammatory markers, but lower prevalence of anemia and lower eGFR levels compared to females. Inflammatory dietary pattern characterized with low intakes of seafood, grains, vegetables, and fruits but high intakes of meat, eggs, preserved/processed foods, and sugary drinks was associated with an increased risk of dyslipidemia by 21% in males and an increased risk of anemia by 28-47% in both genders. Furthermore, high consumption of inflammatory dietary pattern was associated with reduced eGFR (males ß = -0.85, 95% CI -1.26 to -0.43, females ß = -0.53, 95% CI -0.98 to -0.08) and increased N/L and/or CRP in both genders. In conclusion, inflammatory dietary pattern is positively associated with dyslipidemia, anemia, and decreased kidney function in middle-aged and older adults with declined kidney function.


Assuntos
Anemia/etiologia , Dieta/efeitos adversos , Dislipidemias/etiologia , Inflamação/induzido quimicamente , Insuficiência Renal/complicações , Idoso , Anemia/epidemiologia , Grupo com Ancestrais do Continente Asiático , Biomarcadores/sangue , Estudos Transversais , Dislipidemias/epidemiologia , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Taiwan
15.
BMC Surg ; 19(1): 114, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429742

RESUMO

BACKGROUND: In gastrectomy, postoperative elevation of C-reactive protein (CRP) is thought to be useful for predicting complications. Laparoscopic gastrectomy (LG) is less invasive than laparotomy and the elevation of CRP is also mild. Postoperative complications such as anastomotic leakage not only increase the severity of the condition, but also carry a poor prognosis when treatment is delayed. Early treatment is therefore necessary. METHOD: This retrospective study examined the relationship between occurrence of complications and the ratio of CRP levels on postoperative days 1 and 3 (CRP ratio) for 449 gastric cancer patients who underwent LG in the Department of Gastrointestinal Surgery at Osaka City University Hospital between 2006 and 2016. RESULTS: We observed that factors associated with postoperative complications were preoperative renal failure and CRP ratio. No significant associations with surgical procedure, operation time, bleeding volume, age, obesity, measured CRP concentration, or white blood cell count were evident. The optimal cut-off for CRP ratio to predict postoperative complications from the receiver operating characteristic curve was 2.13. CONCLUSION: Our results suggested that the risk of severe postoperative complications after LG could be predicted using the CRP ratio.


Assuntos
Proteína C-Reativa/metabolismo , Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Curva ROC , Insuficiência Renal/complicações , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/complicações
16.
BMJ Case Rep ; 12(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31266760

RESUMO

We reported a case of a young female patient presented with sepsis and diagnosed with melioidosis and systemic lupus erythematosus (SLE) within the same admission. She presented with 1-week history of productive cough, progressive dyspnoea together with prolonged fever, arthralgia, rashes and oral ulcers. She had septicemic shock, respiratory failure requiring intubation and ventilation in intensive care unit and subsequently developed acute renal failure requiring haemodialysis. Antibiotics and immunosuppressive treatment including low-dose intravenous cyclophosphamide were commenced. She had a remarkable recovery and was discharged after 6 weeks. There was no evidence of active SLE or relapse of melioidosis during clinic follow-ups.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Melioidose/complicações , Melioidose/diagnóstico , Sepse/complicações , Sepse/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Melioidose/tratamento farmacológico , Diálise Renal , Insuficiência Renal/complicações , Insuficiência Renal/terapia , Sepse/tratamento farmacológico
17.
Intern Med ; 58(21): 3107-3111, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292373

RESUMO

During the malignant phase of hypertension in patients with primary aldosteronism complicated with severe renal failure, the plasma renin activity may markedly increase with a false negative screening result for primary aldosteronism, thus potentially leading to a missed diagnosis of primary aldosteronism. We herein report the case of 37-year-old man who presented with accelerated-malignant hypertension complicated with severe renal insufficiency. The plasma renin activity was markedly increased in the malignant phase of hypertension, which were atypical results for primary aldosteronism. However, a plain abdominal computed tomography scan revealed a left adrenal nodule, which was diagnosed as aldosterone-producing adenoma by adrenal venous sampling.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Hiperaldosteronismo/diagnóstico , Hipertensão Maligna/etiologia , Insuficiência Renal/complicações , Renina/sangue , Adenoma/complicações , Adenoma/patologia , Neoplasias do Córtex Suprarrenal/complicações , Neoplasias do Córtex Suprarrenal/patologia , Adulto , Aldosterona/sangue , Humanos , Hiperaldosteronismo/complicações , Masculino , Tomografia Computadorizada por Raios X
18.
J Surg Res ; 243: 380-383, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31277015

RESUMO

BACKGROUND: Parathyroidectomy for patients with secondary hyperparathyroidism (sHPT) generally requires a four-gland exploration. Some groups have strongly recommended routine preoperative Tc-99m-sestamibi scans; others practice scanning for only selected patients. To determine the utility of sestamibi scans in this patient population, we reviewed our experience. METHODS: We performed a retrospective review of patients who underwent parathyroidectomy for sHPT by one surgeon between 2000 and 2018. Data reviewed included patient demographics, laboratory results, pathology and radiology reports, and clinical and operative notes. RESULTS: Of the 72 patients in the cohort, mean age was 47.2 ± 15.6, and 50% were female. The preoperative mean calcium and parathyroid hormone levels were 9.6 ± 1.1 mg/dL and 1192.1 ± 914.1 pg/mL, respectively. Sestamibi scans were performed in 21 patients (29%). Of these, 17 were reoperative cases. Of all sHPT patients, 27.8% had ectopic glands. In the sestamibi cohort, only four patients had ectopic glands identified on the scan. Among the 51 patients without preoperative imaging, 16 had ectopic glands (26.2% of nonimaged patients). All these 16 ectopic glands were found by the surgeon at the time of operation without the need for preoperative imaging. All patients in the series were cured with a minimum follow-up of 6 mo. CONCLUSIONS: Ectopic parathyroid glands are commonly seen in patients undergoing parathyroidectomy for sHPT. The majority of ectopic glands were successfully identified during the operation without preoperative sestamibi scan. Therefore, routine preoperative Tc-99m-sestamibi scans are not needed for successful parathyroidectomy for sHPT.


Assuntos
Hiperparatireoidismo Secundário/diagnóstico por imagem , Paratireoidectomia , Cintilografia , Insuficiência Renal/complicações , Tecnécio Tc 99m Sestamibi , Adolescente , Adulto , Idoso , Coristoma/diagnóstico por imagem , Feminino , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Desnecessários , Adulto Jovem
20.
J Artif Organs ; 22(4): 286-293, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31342287

RESUMO

Lung opacification on chest radiography (CXR) is common during extracorporeal life support (ECLS), often resulting from pulmonary edema or inflammation. Concurrent use of continuous renal replacement therapy (CRRT) during ECLS is associated with improved fluid balance and cytokine filtration; through modification of these pathologic states, CRRT may modulate lung opacification observed on CXRs. We hypothesize that early CRRT use during infant ECLS decreases lung opacification on CXR. We conducted a retrospective cohort study comparing CXRs from infants receiving ECLS and early CRRT (n = 7) to matched infants who received ECLS alone (n = 7). The CXR obtained prior to ECLS, all CXRs obtained within the first 72 h of ECLS, and daily CXRs for the remainder of the ECLS course were analyzed. The outcome measure was the degree of opacification, determined by independent assessment of two, blinded pediatric radiologists using a modified Edwards et al.'s lung opacification scoring system (from Score 0: no opacification to Score 5: complete opacification). 220 CXRs were assessed (cases: 93, controls: 127). Inter-rater reliability was established (Cohen's weighted к = 0.74; p < 0.0001, good agreement). At baseline, the mean opacification score difference between cases and controls was 1 point (cases: 1.8, controls 2.8; p = 0.049). Using mixed modeling analysis for repeated measures accounting for differences at baseline, the average overall opacification score was 1.2 points lower in cases than controls (cases: 2.1, controls: 3.3; p < 0.0001). The overall distribution of scores was lower in cases than controls. Early CRRT utilization during infant ECLS was associated with decreased lung opacification on CXR.


Assuntos
Simulação por Computador , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/fisiologia , Modelos Teóricos , Insuficiência Renal/terapia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Insuficiência Renal/complicações , Insuficiência Renal/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA