Haemodialysis

2018 ◽  
Author(s):  
Victor F. Seabra ◽  
Bertrand L. Jaber
Keyword(s):  
Staff Training ◽  
Visual Loss ◽  
Patient Monitoring ◽  
Pulmonary Complications ◽  
Safe Procedure ◽  
Successful Performance ◽  
Acute Complications ◽  
Life Threatening ◽  
Anaphylactoid Reactions

Since its first successful performance in 1945, haemodialysis has become a widely performed routine and safe procedure. However, despite significant improvements in the dialysis equipment, staff training, and patient monitoring, acute complications can occur during the therapy, ranging from mild to life-threatening. This chapter reviews selected acute complications that are encountered during or are directly related to the haemodialysis procedure, including cardiovascular, neuromuscular, haematological, and pulmonary complications, technical malfunctions, dialysis reactions (including anaphylactic and anaphylactoid reactions), and other complications such as post-dialysis fatigue, pruritus, priapism, and hearing and visual loss.

scholarly journals Vertebral Metastasis Treated by Vertebroplasty, a Cause of Respiratory Failure: Case Report and Literature Review

2021 ◽  
pp. 279-283
Author(s):  
Mathieu Chevallier ◽  
Chloé Chevallier-Lugon ◽  
Alex Friedlaender ◽  
Alfredo Addeo
Keyword(s):  
Spinal Fractures ◽  
Safe Procedure ◽  
Vertebral Metastasis ◽  
Minimally Invasive Surgical Procedure ◽  
Venous Circulation ◽  
Minimally Invasive Surgical ◽  
Life Threatening ◽  
Frequent Site ◽  
The Right ◽  
Substantial Morbidity

Bone is a frequent site of metastases in advanced cancers including lung, breast, prostate, kidney, or myeloma. Lesions are commonly located on the spine. Neoplastic invasion of the vertebral body can result in painful vertebral fractures, leading to disability and substantial morbidity. Percutaneous vertebroplasty is a minimally invasive surgical procedure used to treat spinal fractures due to osteolytic tumors. It could result in pain reduction or resolution in 80–90% of patients with fractures, and it improves stability. Although considered safe, vertebroplasty has been associated over the years with life-threatening complications. We have reported the case of a 55-year-old patient with lung adenocarcinoma, who underwent vertebroplasty for a pathological neoplastic fracture of L2. The procedure was complicated by a leak of cement into the systemic venous circulation, characterized by an 11-cm filament in the right heart chambers and multiple pulmonary emboli. To our knowledge, only one similar case was previously reported, involving an intracardiac cement filament longer than 10 cm. The data are scant, hence the importance of collecting and reporting possible complications about what is perceived as a rather safe procedure. The case highlights the need for a robust postprocedure imaging plan to detect complications, which can impact patients’ morbidity and survival.

Severe pulmonary complications in Japanese patients after bortezomib treatment for refractory multiple myeloma

Blood ◽  
2006 ◽  
Vol 107 (9) ◽  
pp. 3492-3494 ◽  
Author(s):  
Shigesaburo Miyakoshi ◽  
Masahiro Kami ◽  
Koichiro Yuji ◽  
Tomoko Matsumura ◽  
Masaaki Takatoku ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Adverse Effects ◽  
Gastrointestinal Symptoms ◽  
Japanese Patients ◽  
The United States ◽  
Underlying Disease ◽  
Pulmonary Complications ◽  
Bortezomib Treatment ◽  
Toranomon Hospital ◽  
Life Threatening

Bortezomib is a novel proteasome inhibitor with significant antimyeloma activity. Its frequent adverse effects are manageable, including gastrointestinal symptoms, peripheral neuropathy, and thrombocytopenia. Severe lung toxicity has not previously been reported. Between June 2004 and September 2005, 13 Japanese patients with multiple myeloma were treated with bortezomib in Toranomon Hospital, Juntendo University School of Medicine, and Jichi Medical School. Four of them developed severe pulmonary complications, and 2 died of respiratory failure without progression of underlying disease. To our knowledge, this is the first report on life-threatening pulmonary adverse effects after bortezomib therapy. Previous clinical studies on bortezomib, mostly in the United States and Europe, have shown low incidences of pulmonary adverse effects. Our study suggests that bortezomib can cause serious lung injury, and that its incidence might vary among different ethnicities. Clinicians need to be alert to the possibility.

scholarly journals Stapled haemorrhoidopexy: is it time to move on?

2015 ◽  
Vol 97 (7) ◽  
pp. 490-493 ◽  
Author(s):  
EH Aly
Keyword(s):  
Operative Time ◽  
Wound Care ◽  
Dentate Line ◽  
Safe Procedure ◽  
Stapled Haemorrhoidopexy ◽  
Short Operative Time ◽  
Stapled Haemorrhoidectomy ◽  
Life Threatening ◽  
Number Of Publications ◽  
Randomised Controlled

Stapled haemorrhoidectomy was proposed as an ‘ideal’ solution for symptomatic haemorrhoids, with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time. Some randomised controlled trials and reviews confirmed these findings, claiming that stapled haemorrhoidopexy is the most effective and safe procedure for haemorrhoids. However, there are increasing number of publications highlighting that the technique is associated with serious and life threatening complications. Maybe it is now the time to accept that stapled haemorrhoidopexy has done its role in directing our attention to the fact that modern surgical treatment of haemorrhoids should avoid excision of anorectal skin but should instead aim at treatment intervention above the dentate line.

scholarly journals Gluteal artery injuries including pseudoaneurysm associated with powered bone marrow biopsies

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Aditi P. Singh ◽  
Gopichand Pendurti ◽  
Shashi Singh ◽  
Alexander Shestopalov ◽  
Thomas Pacello ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Minimal Risk ◽  
Safe Procedure ◽  
Bone Marrow Biopsies ◽  
Fundamental Component ◽  
Current Review ◽  
Life Threatening ◽  
Therapeutic Measures ◽  
Life Threatening Complication ◽  
The U.S

The bone marrow procedure (BMP) is a frequently performed procedure, with over 700,000 recorded in the U.S. annually. It is a fundamental component in the evaluation and management of both malignant and benign hematologic conditions. Adult patients are generally assured that the BMP is a safe procedure with minimal risk, albeit briefly painful. Traditionally performed using a manual Jamshidi needle, the procedure is increasingly being performed using powered bone marrow kits, which have shown consistently good results. In the current review we describe three cases of gluteal artery injuries following the powered driver procedure, one of which resulted in the formation of a pseudoaneurysm requiring radiology-guided intervention. We highlight the need for both hematologists and patients to be aware of this potentially life threatening complication as well as how to recognize it clinically and institute timely diagnostic and therapeutic measures.

Mechanism of Anaphylactoid Reactions: Improper Preparation of High-Dose Intravenous Cyclosporine Leads to Bolus Infusion of Cremophor El and Cyclosporine

1997 ◽  
Vol 31 (11) ◽  
pp. 1287-1291 ◽  
Author(s):  
Merry Liau-Chu ◽  
Jochen GW Theis ◽  
Gideon Koren
Keyword(s):  
High Dose ◽  
Cremophor El ◽  
Bolus Infusion ◽  
Cyclosporine Therapy ◽  
High Incidence ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Mixing Techniques ◽  
Initial Bolus ◽  
Therapy Protocol

BACKGROUND: During a Phase I/II trial of high-dose intravenous cyclosporine, a high incidence of anaphylactoid reactions was observed. Epidemiologic investigations revealed that the occurrence of anaphylactoid reactions was significantly associated with improper mixing during preparation of the infusions. It was hypothesized that improper mixing during the preparation of the infusion may have caused initial bolus infusions of the vehicle, Cremophor EL. These inadvertent bolus infusions may have caused the anaphylactoid reactions. OBJECTIVE: To investigate the effect of different mixing techniques on the distribution of the components of cyclosporine concentrate for infusion: cyclosporine, Cremophor EL, and ethanol in the infusions administered to the patients. METHODS: Infusions were prepared in a similar fashion as those administered to study patients enrolled in a high-dose cyclosporine therapy protocol. Samples were collected at defined time points of the infusions. Concentrations of cyclosporine and Cremophor EL were spectrophotometrically determined; ethanol concentrations were measured enzymatically. RESULTS: Cyclosporine and Cremophor EL concentrations were up to ninefold higher than intended during the first 10 minutes of the infusions that were not appropriately mixed. In contrast, the concentrations of cyclosporine and Cremophor EL were similar to the intended concentrations in all of the well-mixed infusions. CONCLUSIONS: Inappropriate mixing of high-dose cyclosporine infusions can lead to initial bolus infusion of cyclosporine and Cremophor EL. Bolus infusions of Cremophor EL have been associated with anaphylactoid reactions. Thus, thorough mixing of high-dose cyclosporine infusions may be important to reduce the possibility of life-threatening anaphylactoid reactions.

An unusual case of concurrent Kounis syndrome and prolonged QT in a young patient

2021 ◽  
pp. 1-3
Author(s):  
Emrah Erdogan ◽  
Murat Cap ◽  
Gorkem Kus ◽  
Cem Gokhan ◽  
Yakup Kilic
Keyword(s):  
Acute Coronary Syndrome ◽  
Young Patient ◽  
Unusual Case ◽  
Allergic Reactions ◽  
Kounis Syndrome ◽  
Unique Case ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Prolonged Qt

Abstract Allergic reactions related to drug use is a common entity presenting often from minor urticaria to life-threatening anaphylactoid reactions. A common but easily overlooked diagnosis, Kounis syndrome, is an established hypersensitivity coronary disorder induced by drugs, foods, environmental factors, and coronary stents that can present in the same way as non-allergy-induced acute coronary syndrome. Here within, we present a unique case of dual presentation of Kounis syndrome and prolonged QTc in a young patient after a single dose of Domperidone and Lansoprazole.

scholarly journals Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview

2019 ◽  
Vol 8 (1) ◽  
pp. 101 ◽  
Author(s):  
Sara Torretta ◽  
Claudio Guastella ◽  
Paola Marchisio ◽  
Tal Marom ◽  
Samantha Bosis ◽  
...  
Keyword(s):  
Visual Loss ◽  
Care Setting ◽  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Urgent Care ◽  
Pediatric Diseases ◽  
Life Threatening ◽  
Infectious Disease Specialists ◽  
Urgent Care Setting ◽  
Practical Recommendations

Sinonasal-related orbital infections (SROIs) are typically pediatric diseases that occur in 3–4% of children with acute rhinosinusitis. They are characterised by various clinical manifestations, such as peri-orbital and orbital cellulitis or orbital and sub-periosteal abscesses that may develop anteriorly or posteriorly to the orbital septum. Posterior septal complications are particularly dangerous, as they may lead to visual loss and life-threatening events, such as an intracranial abscess and cavernous sinus thrombosis. Given the possible risk of permanent visual loss due to optic neuritis or orbital nerve ischemia, SROIs are considered ophthalmic emergencies that need to be promptly recognised and treated in an urgent-care setting. The key to obtaining better clinical outcomes in children with SROIs is a multi-disciplinary assessment by pediatricians, otolaryngologists, ophthalmologists, radiologists, and in selected cases, neurosurgeons, neurologists, and infectious disease specialists. The aim of this paper is to provide an overview of the pathogenesis, clinical manifestations, diagnosis, and treatment of pediatric SROIs, and to make some practical recommendations for attending clinicians.

scholarly journals Botulinum toxin A for trismus in cephalic tetanus

1994 ◽  
Vol 52 (3) ◽  
pp. 410-413 ◽  
Author(s):  
Luiz Augusto F. Andrade ◽  
Sonia Maria D. Brucki
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Pulmonary Complications ◽  
Toxin A ◽  
Clostridium Tetani ◽  
Considerable Difficulty ◽  
Respiratory Problems ◽  
Life Threatening ◽  
The Difference ◽  
Cephalic Tetanus

Cephalic tetanus is a localized form of tetanus. As in generalized forms , trismus is a prominent feature of the disease, leading to considerable difficulty in feeding, swallowing of the saliva and mouth hygiene. These difficulties often precede respiratory problems and aspiration bronchopneumonia is a frequent life-threatening complication. Muscle relaxants other than curare drugs may show a limited benefit for relieving trismus. Tetanospasmin, the tetanic neurotoxin, and botulinum toxin share many similarities, having a closely related chemical structure, an origin from related microorganisms (Clostridium tetani and Clostridium botulinum, respectively), and presumably, the same mechanisms of action in the neuron. The difference between the two lies in their peculiar neurospecificity, acting in different neurons. Injection of minute doses of botulinum toxin in the muscles involved in focal dystonias or other localized spastic disorders have proved to be very effective in these conditions. We describe the use of botulinum toxin A in the successful treatment of trismus in a patient suffering from cephalic tetanus. We believe that this form of treatment may be of value in lowering the risk of pulmonary complications in tetanic patients.

Cough – A Curious Case

2017 ◽  
Vol 5 (2) ◽  
pp. 139-140
Author(s):  
Sanjith Saseedharan ◽  
Edwin Pathrose ◽  
AM Argikar
Keyword(s):  
Hemodynamic Monitoring ◽  
Rectus Sheath ◽  
Pulmonary Complications ◽  
Elderly Female ◽  
Life Threatening ◽  
Extra Pulmonary

Cough, as a symptom by default gets the focus of a physician towards the chest ruling out the causes could be of the same. However an incessant cough causing life threatening extra pulmonary complications is a rarity. We present a case of an elderly female who presented with a cough with expectoration but ended up requiring strict hemodynamic monitoring due to a rectus sheath hematoma.Bangladesh Crit Care J September 2017; 5(2): 139-140

Cetuximab use without chronic antihistamine premedication

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13521-13521 ◽  
Author(s):  
J. Timoney ◽  
K. Y. Chung ◽  
V. Park ◽  
R. Trocola ◽  
C. Peake ◽  
...  
Keyword(s):  
Side Effects ◽  
Cancer Center ◽  
First Year ◽  
Institutional Practice ◽  
Chemotherapy Administration ◽  
Time Period ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Grade 3 ◽  
Severe Grade

13521 Background: Cetuximab is a human-murine chimeric monoclonal antibody against EGFR with approximately a 3% reported incidence of severe (≥ grade 3) anaphylactoid reactions. The overwhelming majority of such reactions have been reported with the initial dose of cetuximab. Diphenhydramine (Benedryl)or a related antihistamine is often given as a premedication for cetuximab, however this may cause fatigue or other side effects. Most early clinical trials of cetuximab permitted investigator discretion in use of premedication beyond the initial cetuximab dose. Methods: We obtained an IRB waiver of authorization to review the records of patients treated with cetuximab at Memorial Sloan Kettering Cancer Center for the first year of commercial availability of cetuximb (Feb, 2004 through Feb, 2005). Computerized pharmacy records were reviewed to identify all patients who were treated with cetuximab (outside of a clinical trial) and use of premedication was then evaluated. Records of institutional adverse event reports regarding chemotherapy administration were reviewed, and, any moderate or severe/life-threatening reactions were evaluated for presence or absence of concurrent premedication. Results: As per our institutional guidelines, all patients received 50 mg of diphenhydramine prior to the initial loading dose of cetuximab, and 25 mg of diphenhydramine prior to the second dose. While there was inconsistency in terms of cessation of diphenhydramine, overall a total of 115 patients received one or more doses of cetuximab without premedication. A total of 746 doses of cetuxmab without diphenhydramine premedication were given over this time period. No severe/life-threatening reactions to cetuximab occurred during these doses given without premedication. Conclusions: Omission of diphenhydramine premedication after the initial two doses of cetuximab is our current institutional practice, and appears not to alter the safety profile of cetuximab. Considering the side effects of diphenhydramine, routine long tern use of antihistamine premedication with cetuximab administration does not appear to be warranted. [Table: see text]

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