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1.
BMC Nephrol ; 22(1): 297, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465289

RESUMO

BACKGROUND: Kidney disease and renal failure are associated with hospital deaths in patients with COVID - 19. We aimed to test if contrast enhancement affects short-term renal function in hospitalized COVID - 19 patients. METHODS: Plasma creatinine (P-creatinine) was measured on the day of computed tomography (CT) and 24 h, 48 h, and 4-10 days after CT. Contrast-enhanced (n = 142) and unenhanced (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≤ 60 ml/min/1.73 m2. Contrast-induced acute renal failure (CI-AKI) was defined as ≥27 µmol/L increase or a > 50% rise in P-creatinine from CT or initiation of renal replacement therapy during follow-up. Patients with renal replacement therapy were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine at 48 h and at 4-10 days after contrast-enhanced CT. RESULTS: Median P-creatinine at 24-48 h and days 4-10 post-CT in patients with eGFR> 60 and eGFR≥30-60 in contrast-enhanced and unenhanced groups did not differ from basal values. CI-AKI was observed at 48 h and at 4-10 days post contrast administration in 24 and 36% (n = 5/14) of patients with eGFR≥30-60. Corresponding figures in the eGFR> 60 contrast-enhanced CT group were 5 and 5% respectively, (p < 0.037 and p < 0.001, Pearson χ2 test). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that an eGFR≥30-60 and 30-day mortality were associated with CK-AKI both at 48 h and 4-10 days after contrast-enhanced CT. CONCLUSION: Patients with COVID - 19 and eGFR≥30-60 had a high frequency of CK-AKI at 48 h and at 4-10 days after contrast administration, which was associated with increased 30-day mortality. For patients with eGFR≥30-60, we recommend strict indications are practiced for contrast-enhanced CT. Contrast-enhanced CT had a modest effect in patients with eGFR> 60.


Assuntos
Injúria Renal Aguda/induzido quimicamente , COVID-19/complicações , Meios de Contraste/efeitos adversos , Creatinina/sangue , Iodo/efeitos adversos , Rim/efeitos dos fármacos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Idoso , COVID-19/sangue , COVID-19/mortalidade , COVID-19/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Análise de Regressão , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
3.
Bratisl Lek Listy ; 122(9): 618-620, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34463105

RESUMO

Contrast-induced encephalopathy (CIE) is a rare complication of the intravascular application of a contrast agent. CIE can be manifested by headache, cortical blindness, consciousness disorders, seizures, or focal neurological deficit. Neurological symptoms are typically transient with temporary abnormal findings on a brain scan. Urgent neuroimaging is important to obtain the correct diagnosis, especially in cases that require an acute management and treatment. We present a case of CIE after a digital subtraction angiography of the vertebral arteries in the patient with a symptomatic pre-occlusive stenosis of the posterior cerebral artery (Ref. 36). Text in PDF www.elis.sk Keywords: encephalopathy, iodixanol, contrast agent, cortical blindness, cerebral angiography.


Assuntos
Encefalopatias , Meios de Contraste , Encefalopatias/diagnóstico , Encefalopatias/diagnóstico por imagem , Angiografia Cerebral , Meios de Contraste/efeitos adversos , Humanos , Convulsões
4.
Harefuah ; 160(8): 537-540, 2021 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-34396731

RESUMO

INTRODUCTION: Reviewed are three studies we conducted, assessing the risk of contrast nephropathy in hospitalized patients undergoing computerized tomography. These were retrospective large data analyses at a single tertiary care facility, using meticulous and compound propensity score matching and inverse probability of treatment weighting. These studies indicate that overall, the risk of contrast nephropathy is likely negligible, with the exception of patients with grades 4-5 renal failure at baseline (eGFR<30 ml/min/1.73m2), with an odds ratio of 1.51 to develop AKI, associated with increased mortality as compared with patients undergoing non-enhanced imaging. We also assessed the incidence and magnitude of improved kidney function (acute kidney recovery) around imaging, underscoring its potential to mask subclinical AKI. These studies illustrate the strengths of large data analysis with advanced statistical tools.


Assuntos
Injúria Renal Aguda , Análise de Dados , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Taxa de Filtração Glomerular , Humanos , Estudos Retrospectivos , Fatores de Risco
5.
Bratisl Lek Listy ; 122(9): 643-646, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34463110

RESUMO

METHODS: Forty-two COVID-19 patients who underwent emergency PCI due to the diagnosis of acute coronary syndrome were included in the study. Mean age was 63±14.76 and males accounted for 81 % (34/42). Contrast-induced acute kidney injury (CI-AKI) was defined as absolute increase in serum creatinine level by 0.3 mg/dL above baseline within 48 hours of contrast exposure. Patients were divided into two groups according to CI-AKI development following coronary angiography. RESULTS: CI-AKI developed in 33.3 % (14/42) of the patients. Pre-procedure e-GFR (p=0.028), serum albumin levels (p=0.021), and ejection fraction (p=0.039) were lower in the CI-AKI group. Whereas the platelet/lymphocyte ratio was significantly lower in the non-CI-AKI group (p=0.010). CONCLUSIONS: Our study results demonstrated that patients suffering from COVID-19 had a high risk of CI-AKI development following coronary angiography (Tab. 1, Ref. 36).


Assuntos
Injúria Renal Aguda , COVID-19 , Meios de Contraste , Intervenção Coronária Percutânea , Injúria Renal Aguda/induzido quimicamente , COVID-19/complicações , Meios de Contraste/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
6.
J Int Med Res ; 49(8): 3000605211033177, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34382462

RESUMO

Contrast-induced nephropathy (CIN) is the impairment of kidney function defined as a serum creatinine increase of 25% or 44 µmol/L compared with baseline, usually occurring 24 to 48 hours after the use of intravenous contrast. Important risk factors for CIN include female sex, advanced age (>65 years), type 2 diabetes (T2D), kidney disease, advanced heart failure, and intravascular volume depletion. We herein present a male patient with T2D, moderately reduced renal function, no albuminuria, and a positive echocardiography stress test. He underwent percutaneous coronary intervention (PCI), and two drug-eluting stents (in the left anterior descending coronary artery) and three bare-metal stents (in the right coronary artery) were implanted. Despite adequate rehydration (0.9% intravenous NaCl with 8.4% sodium bicarbonate) before and after the procedures, he developed irreversible kidney injury after coronary angiography and PCI. This case report demonstrates the unpredictable clinical course of CIN. Patients with T2D are at high risk for the occurrence of CIN, so careful clinical assessment is recommended with global renal functional reserve evaluation.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Nefropatias , Intervenção Coronária Percutânea , Idoso , Meios de Contraste/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Creatinina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
8.
Medicine (Baltimore) ; 100(28): e24004, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260518

RESUMO

ABSTRACT: We aim to investigate the association between plasma endothelial microparticles (EMPs) and contrast-induced nephropathy of patients underwent coronary angiography.The patients were divided into normal renal function group and renal dysfunction group based on the estimated glomerular filtration rate (eGFR). Among the 180 cases, 117 received determination of EMP and serum creatinine after percutaneous coronary intervention (PCI) and/or coronary angiography. The patients were divided into contrast-induced-nephropathy (CIN) group and non-CIN group. EMPs collection and determination were performed, together with biochemical analysis and digital subtraction angiography (DSA) analysis.Spearman correlation showed that the expression of EMP was negatively correlated with eGFR (r = -0.201, P < .01). The serum hypersensitive C-reactive protein (hs-CRP), cystatin C (Cys-C), uric acid (UA) were significantly higher in CIN group than that in the non CIN group. Spearman correlation showed that the expression of EMP was positively correlated with serum interleukin-6 (IL-6, r = 0.393, P < .01). The expression of EMP was positively correlated with serum hs-CRP (r = 0.360, P < .01). Logistic regression analysis showed that the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), eGFR, UA, and Cys-C were correlated with the incidence of contrast induced nephropathy.In patients with contrast-induced-nephropathy, the plasma EMPs were significantly increased after coronary angiography. The expression of plasma EMPs may play a role in the occurrence of contrast-induced-nephropathy.


Assuntos
Micropartículas Derivadas de Células/metabolismo , Meios de Contraste/efeitos adversos , Endotélio Vascular/metabolismo , Nefropatias/sangue , Nefropatias/induzido quimicamente , Idoso , Proteína C-Reativa/análise , Angiografia Coronária/efeitos adversos , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade
9.
Pan Afr Med J ; 38: 311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285734

RESUMO

Introduction: contrast media are increasingly used in diagnostic and interventional procedures but are also known causes of acute kidney injury - a condition known as contrast induced nephropathy (CIN). We aimed to determine the magnitude and associated factors of CIN among patients undergoing coronary angiography and percutaneous coronary intervention at a cardiac referral hospital in Tanzania. Methods: all adult patients undergoing elective coronary angiography and percutaneous coronary intervention at Jakaya Kikwete Cardiac Institute were consecutively enrolled between August 2017 and January 2018, if they fulfilled the inclusion criteria. Pre-procedure, 24- and 72-hours' post procedure serum creatinine was measured. CIN was defined as increase of ≥25% or absolute increase of ≥44µmol/L of serum creatinine within 72 hours following exposure to contrast media. Data analysis were done using SPSS Version 20. P-value of <0.05 was considered statistically significant. Results: in total, 210 (94.6%) out of 222 patients seen during the study period fulfilled the inclusion criteria and were enrolled. Their mean (SD) age was 61.3 (10.9) years and 64.3% were men. Hypertension, diabetes, smoking and alcohol consumption was present in 86.7%, 37.7%, 12.4% and 37.6% respectively. The incidence of CIN was 19% within 72 hours post procedure. On multivariate logistic regression analysis, independent factors for developing CIN were history of heart failure (aOR=7.34), central obesity (aOR=3.12), triple vessel disease (aOR=10.14) and post procedure stay of ≥3 days (aOR=4.1), all p<0.05. Conclusion: the incidence of CIN found in this population is high (19%) and is associated with heart failure, obesity, multi-vessel disease and longer post-procedure hospital stay.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Angiografia Coronária/métodos , Injúria Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Fatores de Risco , Tanzânia
10.
West J Emerg Med ; 22(3): 614-622, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-34125036

RESUMO

INTRODUCTION: Acute kidney injury (AKI) after intravenous contrast administration for computed tomography (CT) occurs infrequently, but certain patients may be susceptible. This study evaluated AKI incidence among emergency department (ED) patients with pre-existing chronic kidney disease (CKD) undergoing CT exams. METHODS: This retrospective cohort study in an integrated healthcare system included ED patients previously diagnosed with CKD stages 3-5 (estimated glomerular filtration rate <60 milliliters per minute per 1.73 meters squared over at least three months), undergoing CT exams with or without intravenous contrast, from January 1, 2013-December 31, 2017. We excluded patients with CT prior to (30 days) or following (14 days) index CT and missing serum creatinine (sCr) measurements. We applied propensity score matching, and then multivariable regression adjustment for post-CT ED disposition and ED diagnosis, to calculate adjusted risk of AKI. Secondary patient-centered outcomes included 30-day mortality, end-stage renal disease (ESRD) diagnosis, and dialysis initiation. RESULTS: Among 103,573 eligible ED patients undergoing CT, propensity score matching yielded 5,589 pairs. Adjusted risk ratio (ARR) for AKI was higher overall for contrast-enhanced CT (1.60; 95% confidence interval [CI], 1.43-1.79). However, secondary outcomes were infrequent: 19/5,589 non-contrast vs 40/5,589 contrast patients with new dialysis initiation at 30 days (adjusted risk 0.3% vs 0.7%; adjusted risk reduction 0.4%; 95% CI, 0.1%-0.7%). CONCLUSION: In ED patients with chronic kidney disease undergoing CT, intravenous contrast was associated with higher overall adjusted risk of AKI, but patient-centered secondary outcomes were rare. The clinical significance of transient kidney injury after CT is unclear, although patients with advanced chronic kidney disease appear to have elevated risk.


Assuntos
Meios de Contraste/efeitos adversos , Insuficiência Renal Crônica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/efeitos adversos , Injúria Renal Aguda/epidemiologia , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Meios de Contraste/administração & dosagem , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
12.
Ann Palliat Med ; 10(6): 7126-7131, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34154335

RESUMO

A 70-year-old man was admitted to our hospital due to "liver cirrhosis; grade 3 hypertension; pulmonary infection". On May 27, 2019, during upper abdomen plain and enhanced magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP), the patient experienced anaphylactic shock, manifested as sudden unconsciousness and lack of response, after intravenous administration of gadobenate dimeglumine (Multihance®). Gadobenate dimeglumine is a paramagnetic contrast used during diagnostic MRI. It has hepatobiliary specificity with very good imaging performance. A small amount is absorbed by normal liver cells after intravenous injection and excreted via the bile ducts while maintaining the chemical structure of gadobenate dimeglumine. It allows the visualization of local angiogenesis and perfusion, which reflect the hepatic blood supply and recent liver function, thereby providing a reference for clinical diagnosis. Gadobenate dimeglumine intravenous injection may cause adverse reactions such as nausea, dizziness, and anaphylactic shock. Anaphylactic shock is a known serious adverse reaction of gadobenate dimeglumine injection. In this paper, we report a case of gadobenate dimeglumine-induced anaphylactic shock based on the temporal relationship between the onset of symptoms and the injection. The patient received chest compressions and balloon-assisted ventilation in addition to rehydration and volume expansion and vasoactive drugs to maintain blood pressure, etc. The patient died despite treatments. In the clinical, physicians, nurses, and clinical pharmacists should closely monitor patients and promptly discontinue drug administration and provide symptomatic care in case of adverse reactions.


Assuntos
Anafilaxia , Compostos Organometálicos , Idoso , Anafilaxia/induzido quimicamente , Meios de Contraste/efeitos adversos , Humanos , Imageamento por Ressonância Magnética , Masculino , Meglumina/efeitos adversos , Meglumina/análogos & derivados , Compostos Organometálicos/efeitos adversos
13.
Eur J Vasc Endovasc Surg ; 62(2): 193-201, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34140226

RESUMO

OBJECTIVE: Use of colour duplex ultrasound (CDUS) and computed tomography angiography (CTA) for infrarenal endovascular aortic aneurysm repair (EVAR) surveillance differs in internationally published guidelines. This study aimed firstly to compare CDUS detection of significant sac abnormalities with CTA. Secondly, a sensitivity analysis was conducted to compare financial estimates of the, predominantly CDUS based, local and Society of Vascular Surgery (SVS) protocols, the risk stratified European Society of Vascular Surgery (ESVS) protocol, and the CTA based National Institute of Health and Care Excellence (NICE) protocol. METHODS: Agreement between CDUS and CTA was assessed for detection of significant sac abnormalities. Surveillance protocols were extrapolated from published guidelines and applied to infrarenal EVAR patients active on local surveillance at a large, single centre. Surveillance intensity was dependent on presence of endoleak and subsequent risk of treatment failure in accordance with surveillance recommendations. Estimates for each surveillance protocol were inclusive of a range of published incidences of endoleak, contrast associated acute kidney injury (AKI), and excess hospital bed days, and estimated for a hypothetical five year surveillance period. RESULTS: The kappa coefficient between CDUS and CTA for detecting sac abnormalities was 0.68. Maximum five year surveillance cost estimates for the 289 active EVAR patients were £272 359 for SVS, £230 708 for ESVS, £643 802 for NICE, and £266 777 for local protocols, or £1 270, £1 076, £3 003, and £1 244 per patient. Differences in endoleak incidence accounted for a 1.1 to 1.4 fold increase in costs. AKI incidence accounted for a 3.3 to 6.2 fold increase in costs. CONCLUSION: A combined CTA and CDUS EVAR surveillance protocol, with CTA reserved for early seal assessment and confirmatory purposes, provides an economical approach without compromising detection of sac abnormalities. AKI, as opposed to direct imaging costs, accounted for the largest differences in surveillance cost estimates.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Angiografia por Tomografia Computadorizada/economia , Endoleak/diagnóstico por imagem , Vigilância da População/métodos , Ultrassonografia Doppler em Cores/economia , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/economia , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/efeitos adversos , Endoleak/economia , Endoleak/etiologia , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Fidelidade a Diretrizes/economia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Guias de Prática Clínica como Assunto , Reoperação , Estudos Retrospectivos
15.
J Am Vet Med Assoc ; 259(1): 77-83, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34125610

RESUMO

OBJECTIVE: To identify potential risk factors for death following IV or intraosseous (IO) administration of contrast medium in birds undergoing CT scans. ANIMALS: 120 birds that underwent 134 contrast-enhanced CT scans. PROCEDURES: Medical records of birds of any species that underwent a CT scan which included administration of nonionic iodinated contrast medium from June 2013 to February 2020 were included. Information on birds and use of contrast medium was extracted from the medical records as well as information on deaths following IV or IO administration of contrast medium. RESULTS: 6 birds died shortly following administration of contrast medium. Necropsies were performed in 3 birds (2 cockatiels and 1 macaw), and all had lesions associated with the respiratory tract. When body weight was used as a binary variable to compare odds of death between small birds (≤ 150 g [0.33 lb]) and large birds (> 150 g), small birds had a 97-fold increased odds (OR, 97.5; 95% CI, 9.8 to 966.0) of dying following contrast medium administration. Following 131 CT scans with contrast medium administration (3 scans were excluded because of perivascular or subcutaneous leakage of contract medium), small birds had a mortality rate of 45.4% (5/11), compared with a mortality rate of 0.8% (1/120) for large (> 150 g) birds. Other variables (ie, sex, age, anesthesia or sedation, sedation protocol, and type of contrast medium) were not significantly associated with death after contrast medium administration. CONCLUSIONS AND CLINICAL RELEVANCE: Although the administration of contrast medium cannot be conclusively confirmed as the cause of death in these birds, the high mortality rate for small birds coupled with the temporality of the event following contrast medium administration justifies the cautious use of contrast medium in small sick psittacine birds.


Assuntos
Anestesia , Meios de Contraste , Anestesia/veterinária , Animais , Aves , Meios de Contraste/efeitos adversos , Infusões Intravenosas/veterinária , Tomografia Computadorizada por Raios X/veterinária
16.
Medicine (Baltimore) ; 100(22): e26213, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087898

RESUMO

ABSTRACT: Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia.Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE.Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement.CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/efeitos adversos , Pulmão/irrigação sanguínea , Embolia Pulmonar/diagnóstico , Exposição à Radiação/efeitos adversos , Administração Intravenosa , Adulto , Idoso , Angiografia por Tomografia Computadorizada/normas , Meios de Contraste/administração & dosagem , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Exposição à Radiação/prevenção & controle , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária
17.
Medicine (Baltimore) ; 100(22): e26242, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087911

RESUMO

RATIONALE: A special case of transient oculomotor nerve palsy after cerebral angiography. PATIENT CONCERNS: A 55-year-old man developed oculomotor nerve dysfunction after right radial artery puncture angiography. DIAGNOSES: Cerebral angiography-induced oculomotor nerve palsy. INTERVENTIONS: According to the patient's disease state, intravenous drip of dexamethasone 10 mg/d. OUTCOMES: Magnetic resonance imaging (MRI) showed no abnormalities, and the patient recovered completely after 48 hours of hormone therapy. LESSONS: Transient eye palsy caused by contrast agent encephalopathy is a clinically rare neurological dysfunction caused by adverse effects of contrast agents. Early prevention and correct treatment are critical.


Assuntos
Angiografia Cerebral/efeitos adversos , Doenças do Nervo Oculomotor/etiologia , Oftalmoplegia/etiologia , Administração Intravenosa , Assistência ao Convalescente , Meios de Contraste/efeitos adversos , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Encefalite/induzido quimicamente , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/fisiopatologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/tratamento farmacológico , Artéria Radial/cirurgia , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 30(9): 105930, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34176719

RESUMO

Chronic Kidney Disease is a common medical condition that frequently overlaps with neurologic disease. Neuroimaging can be a useful tool to aid in the diagnoses of neurologic illness, including those that result from renal impairment. Some neuroimaging studies also have the potential to lead to adverse effects on the kidneys necessitating a thoughtful approach to selection of imaging modalities. In particular, multimodal imaging is becoming increasingly common in patients presenting with symptoms of acute stroke, a population that may be at higher risk for renal complications. This article will summarize the neuroimaging manifestations of conditions with shared renal and neurologic involvement and highlight considerations regarding the use of contrast media, nephrogenic systemic fibrosis, and metformin-associated lactic acidosis.


Assuntos
Encefalopatias/diagnóstico por imagem , Neuroimagem , Insuficiência Renal Crônica/epidemiologia , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologia , Encefalopatias/epidemiologia , Encefalopatias/fisiopatologia , Comorbidade , Meios de Contraste/efeitos adversos , Humanos , Neuroimagem/efeitos adversos , Valor Preditivo dos Testes , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Fatores de Risco
20.
BMJ Open ; 11(4): e043436, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33945499

RESUMO

OBJECTIVES: To summarise current evidence on the use of pentoxifylline (PTX) to prevent contrast-induced nephropathy (CIN). METHODS: The PubMed, Embase and CENTRAL databases were searched for randomised controlled trials including patients with and without PTX undergoing contrast media exposure. We analysed the incidence of CIN and serum creatinine changes before and after contrast media exposure. All statistical analyses were conducted with Review Manager V.5.3. RESULTS: We finally enrolled in seven randomised controlled trials with a total of 1484 patients in this analysis. All of seven included studies were performed in patients undergoing angioplasty or stenting. The overall rates of CIN were 8.8% and 10.4% in the PTX groups and control groups, respectively. However, no significant reduction in the CIN rate was observed in the patients treated with PTX compared with the control groups (OR 0.81, 95% CI 0.57 to 1.13, I2=0, p=0.21). All studies reported no hospital mortality and the new requirement for dialysis during the trials. CONCLUSION: Perioperative administration of PTX to patients undergoing angioplasty did not significantly reduce the development of CIN but showed some weak tendency of lower serum creatinine increase. Based on the available trials, the evidence does not support the administration of PTX for the prevention of CIN. More trials with larger sample sizes are needed to evaluate the role of PTX in CIN prevention.


Assuntos
Nefropatias , Pentoxifilina , Meios de Contraste/efeitos adversos , Angiografia Coronária , Creatinina , Humanos , Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Pentoxifilina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal
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