Continuous Ambulatory Peritoneal Dialysis Complicated by Fournier's Syndrome

Two patients developed Fournier's syndrome while on continuous ambulatory peritoneal dialysis. In both cases, massive scrotal edema appears to have been the precipitating cause of the polymicrobial genital infection. Early recognition and prompt treatment of this syndrome is essential if one is to avoid the high morbidity and mortality associated with this disease. Fournier's syndrome, first described in 1883, is a fulminant necrotising subcutaneous infection of the male external genitalia (I). Although initially thought to be idiopathic, recent evidence suggests that an underlying condition can usually be identified as the precipitating cause of this rare but serious infection (2, 3). Herein, we describe two patients who developed massive scrotal edema while on continuous ambulatory peritoneal dialysis (CAPO). Subsequently, both patients suffered polymicrobial infections of the scrotum with necrosis. We discuss the possible role of CAPO and scrotal edema in leading to the development of Fournier's syndrome.

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Recognition and management of neonatal sepsis

British Journal of Nursing ◽

10.12968/bjon.2021.30.7.410 ◽

2021 ◽

Vol 30 (7) ◽

pp. 410-415

Author(s):

Luke William Crocker ◽

Ayesha White ◽

Paul Anthony Heaton ◽

Débora Pascoal Horta ◽

Siba Prosad Paul

Keyword(s):

Neonatal Sepsis ◽

Early Recognition ◽

Signs And Symptoms ◽

Evidence Based ◽

Suspected Sepsis ◽

Serious Illness ◽

Prompt Treatment ◽

Serious Infection ◽

Common Causes ◽

Red Flag

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

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The Role of Sonic Hedgehog-Gli2 Pathway in the Masculinization of External Genitalia

Endocrinology ◽

10.1210/en.2011-0263 ◽

2011 ◽

Vol 152 (7) ◽

pp. 2894-2903 ◽

Cited By ~ 42

Author(s):

Shinichi Miyagawa ◽

Daisuke Matsumaru ◽

Aki Murashima ◽

Akiko Omori ◽

Yoshihiko Satoh ◽

...

Keyword(s):

Signaling Pathway ◽

Sonic Hedgehog ◽

Hedgehog Signaling ◽

External Genitalia ◽

Sexually Dimorphic ◽

Hedgehog Signaling Pathway ◽

Initial Development ◽

Urethral Plate ◽

Male External Genitalia

During embryogenesis, sexually dimorphic organogenesis is achieved by hormones produced in the gonad. The external genitalia develop from a single primordium, the genital tubercle, and their masculinization processes depend on the androgen signaling. In addition to such hormonal signaling, the involvement of nongonadal and locally produced masculinization factors has been unclear. To elucidate the mechanisms of the sexually dimorphic development of the external genitalia, series of conditional mutant mouse analyses were performed using several mutant alleles, particularly focusing on the role of hedgehog signaling pathway in this manuscript. We demonstrate that hedgehog pathway is indispensable for the establishment of male external genitalia characteristics. Sonic hedgehog is expressed in the urethral plate epithelium, and its signal is mediated through glioblastoma 2 (Gli2) in the mesenchyme. The expression level of the sexually dimorphic genes is decreased in the glioblastoma 2 mutant embryos, suggesting that hedgehog signal is likely to facilitate the masculinization processes by affecting the androgen responsiveness. In addition, a conditional mutation of Sonic hedgehog at the sexual differentiation stage leads to abnormal male external genitalia development. The current study identified hedgehog signaling pathway as a key factor not only for initial development but also for sexually dimorphic development of the external genitalia in coordination with androgen signaling.

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Magnesium Homeostasis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Role of the Dialysate Magnesium Concentration

Artificial Organs ◽

10.1046/j.1525-1594.2003.07193.x ◽

2003 ◽

Vol 27 (9) ◽

pp. 853-857 ◽

Cited By ~ 14

Author(s):

Kostas P. Katopodis ◽

Elli L. Koliousi ◽

Emilios K. Andrikos ◽

Michael V. Pappas ◽

Moses S. Elisaf ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Magnesium Concentration ◽

Magnesium Homeostasis

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Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0095 ◽

2019 ◽

Vol 41 (3) ◽

pp. 427-432 ◽

Cited By ~ 2

Author(s):

Arbey Aristizabal-Alzate ◽

John Fredy Nieto-Rios ◽

Catalina Ocampo-Kohn ◽

Lina Maria Serna-Higuita ◽

Diana Carolina Bello-Marquez ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Therapeutic Option ◽

Supportive Therapy ◽

Hematological Toxicity ◽

High Morbidity ◽

Multiple Exchange ◽

Severe Pancytopenia ◽

Stage Renal Disease ◽

End Stage

Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.

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Continuous ambulatory peritoneal dialysis-associated Histoplasma capsulatum peritonitis: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-020-05441-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Thanat Ounsinman ◽

Piriyaporn Chongtrakool ◽

Nasikarn Angkasekwinai

Keyword(s):

Peritoneal Dialysis ◽

Amphotericin B ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Histoplasma Capsulatum ◽

Rare Complication ◽

Clinical Specimen ◽

Rare Condition ◽

High Morbidity ◽

High Grade Fever ◽

Fungal Peritonitis

Abstract Background Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Case presentation An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. Conclusion H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.

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Phosphatidylcholine Administration in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients with Reduced Ultrafiltration

Peritoneal Dialysis International ◽

10.1177/089686088900900312 ◽

1989 ◽

Vol 9 (3) ◽

pp. 207-210 ◽

Cited By ~ 21

Author(s):

Amedeo De Vecchi ◽

Claudia Castelnovo ◽

Luisella Guerra ◽

Antonio Scalamogna

Keyword(s):

Peritoneal Dialysis ◽

Side Effects ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Clinical Relevance ◽

Ultrafiltration Rate ◽

Sodium Potassium

To evaluate the possible role of oral phosphatidylcholine administration in improving peritoneal ultrafiltration sixteen continuous ambulatory peritoneal dialysis (CAPD) patients with a reduced ultrafiltration rate (less than 500 mL/4 h after a standard 3.86% glucose exchange) were studied. Three patients spontaneously stopped phosphatidylcholine due to gastric side effects. Three out of the remaining 13 patients showed a mild increase of standard ultrafiltration, which was not followed by any increase in daily dialysate output. No differences in glucose, sodium, potassium, urea and creatinine equilibration curves were seen. In conclusion, in our series oral phosphatidylcholine is not free of side effects, and its efficacy in improving ultrafiltration is scanty, with no clinical relevance in increasing daily ultrafiltration.

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