Where the Kidney is Concerned, How Much Mannitol is Too Much?

1993 ◽  
Vol 27 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Gary M. Rabetoy ◽  
Michael R. Fredericks ◽  
Charles F. Hostettler
Keyword(s):  
Renal Failure ◽  
Cerebral Edema ◽  
Warfarin Therapy ◽  
Case Reports ◽  
Clonic Seizure ◽  
Midline Shift ◽  
Computed Tomography Scan ◽  
Case Summary ◽  
Tomography Scan

OBJECTIVE: To report a case of mannitol-induced acute renal failure (ARF). CASE SUMMARY: A 31-year-old woman who had been on long-term warfarin therapy for atrial fibrillation was admitted to the hospital with hemoptysis. Following reversal of her anticoagulation, she had a tonic-clonic seizure nine days after admission. An emergency computed tomography scan revealed cerebral edema, which was initially treated with hyperventilation and steroids. Two days later, a repeat scan showed progression of the cerebral edema with midline shift. Mannitol 550 g was infused over the next 28 hours, precipitating ARF. Despite prompt hemodialysis to reverse the renal failure, the patient died. This case of apparent mannitol-induced ARF illustrates several pathophysiologic effects of this agent. DISCUSSION: Case reports in the literature discussing mannitol-induced ARF are reviewed and compared. A relationship between dose and ARF and its reversal with hemodialysis is postulated. CONCLUSIONS: It is likely that sufficient doses of mannitol may lead to ARF. Limitation of dose may prevent and treatment with hemodialysis may reverse ARF in these instances.

scholarly journals The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

2020 ◽  
Author(s):  
Nadeem Jimidar ◽  
Patrick Lauwers ◽  
Emmanuela Govaerts ◽  
Marc Claeys
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Case Reports ◽  
Gunshot Wounds ◽  
Computed Tomography Scan ◽  
Imaging Studies ◽  
Left Chest ◽  
Case Summary ◽  
Tomography Scan

Abstract Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.

Levofloxacin and Warfarin Interaction

2002 ◽  
Vol 36 (10) ◽  
pp. 1554-1557 ◽  
Author(s):  
Cade B Jones ◽  
Susan E Fugate
Keyword(s):  
Binding Sites ◽  
Warfarin Therapy ◽  
Case Reports ◽  
Anticoagulation Therapy ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Minor Bleeding ◽  
Protein Binding Sites ◽  
Case Summary

OBJECTIVE: To report 4 cases of hypoprothrombotic response resulting from addition of levofloxacin therapy to chronic warfarin therapy and to review related literature to support or refute a warfarin—levofloxacin interaction. CASE SUMMARY: Four patients, 34–81 years old, were prescribed levofloxacin concomitantly with stable warfarin therapy. Three patients had a target international normalized ratio (INR) range of 2.0–3.0 and experienced an increase in INR to 3.5, 8.12, and 11.5 on days 11, 5, and 4 of a 10-day course of levofloxacin, respectively. The fourth patient experienced minor bleeding, with a slightly elevated INR on the second day of levofloxacin therapy that required up to a 19% warfarin dose reduction during levofloxacin treatment. DISCUSSION: An initial premarketing clinical trial concluded that levofloxacin had no effect on warfarin's pharmacokinetics and pharmacodynamic response. Two case reports have since documented an increase in INR in patients taking long-term warfarin on completion of levofloxacin therapy. Our case reports provide further evidence of a significant increase in INR observed during concomitant levofloxacin therapy. The proposed mechanism of this interaction is displacement of warfarin from protein binding sites, reduction in gut flora producing vitamin K, and decreased warfarin metabolism. CONCLUSIONS: Prolonged prothrombin response in patients undergoing chronic warfarin therapy has been well documented with many antibiotics, including fluoroquinolones. Recognition of newer antibiotics' effects on warfarin therapy is important to guide safe use and monitoring of anticoagulation therapy. Our case studies demonstrate significant elevations in INR values during and up to 1 day after levofloxacin therapy in patients undergoing stable warfarin therapy.

scholarly journals Laparoscopic repair of a right-sided paraduodenal hernia

2019 ◽  
Vol 2019 (12) ◽  
Author(s):  
Stephanie Walkner ◽  
Christian A Nebiker
Keyword(s):  
Case Reports ◽  
Rare Condition ◽  
Paraduodenal Hernia ◽  
Computed Tomography Scan ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Laparoscopic Therapy ◽  
Surgical Options ◽  
Tomography Scan

Abstract With an incidence of less than 1%, paraduodenal hernias are very rare but account for ~0.2–5.8% of mechanical small bowel obstruction and carry a mortality rate of 20–50%. Right-sided paraduodenal hernias are three times less frequent than left-sided paraduodenal hernias. We report the case of a 37-year-old man who suffered from colicky abdominal pain accompanied by vomiting. The computed tomography scan showed a mechanical ileus, caused by a presumed paraduodenal hernia, and we chose an elective laparoscopic surgical approach. The patient recovered quickly and was discharged on the second postoperative day. Paraduodenal hernias are a diagnostic challenge as they are typically characterized by long-term non-specific abdominal symptoms and are only detected in the event of acute intestinal obstruction. Until now, laparoscopic therapy has only been described in eight case reports and we review this rare condition and the surgical options.

scholarly journals Long-term Outcome in Chest Trauma

2008 ◽  
Vol 109 (5) ◽  
pp. 864-871 ◽  
Author(s):  
Marc Leone ◽  
Fabienne Brégeon ◽  
François Antonini ◽  
Kathia Chaumoître ◽  
Aude Charvet ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Chest Trauma ◽  
Computed Tomography Scan ◽  
Walk Distance ◽  
Chest Computed Tomography ◽  
Tomography Scan

Background Currently, there are limited data available describing the long-term outcomes of chest trauma survivors. Here, the authors sought to describe chest trauma survivor outcomes 6 months and 1 yr after discharge from the intensive care unit, paying special attention to pulmonary outcomes. Methods A cohort of 105 multiple trauma patients with blunt chest trauma admitted to the intensive care unit was longitudinally evaluated. After 6 months, a chest computed tomography scan, pulmonary function testing (PFT), and quality of life were collected in 55 of these patients. A subgroup of 38 patients was followed up for 1 yr. Results At least one abnormal PFT result was found in 39 patients (71%). Compared with normalized data of the age- and sex-matched population, physical function was decreased in 38 patients (70%). The 6-min walk distance was reduced for 29 patients (72%). Although pathologic images were observed on the chest computed tomography scan from 33 patients (60%), no relation was found between PFT and computed tomography. A ratio of arterial oxygen pressure to inspired oxygen fraction less than 200 at admission to the intensive care unit predicted an abnormal PFT result at 6 months. One year after discharge from the intensive care unit, paired comparisons showed a significant increase in forced vital capacity (P = 0.02) and Karnofsky Performance Status (P < 0.001). Conclusions Survivors of multiple traumas including chest trauma demonstrate a persistent decrease in the 6-min walk distance, impairment on PFT, and reduced pulmonary-specific quality of life.

scholarly journals Clinical, socio-demographic profile and outcome of neurocysticercosis in children: a hospital based study

2017 ◽  
Vol 5 (6) ◽  
pp. 2394
Author(s):  
Kumar Saurabh ◽  
Shilpi Ranjan ◽  
Neelam Verma
Keyword(s):  
Parasitic Infection ◽  
Clonic Seizure ◽  
Common Type ◽  
Tonic Clonic Seizure ◽  
Age Group ◽  
Computed Tomography Scan ◽  
Demographic Profile ◽  
Lower Socioeconomic ◽  
Tomography Scan ◽  
Human Nervous System

Background: Neurocysticercosis (NCC) is perhaps the most common parasitic infection of human nervous system. The objective of this study was to study the spectrum of clinical, socio-demographic profile and treatment outcome of 60 paediatric neurocysticercosis cases over a mean duration of two years from September 2006-August 2008.Methods: Diagnosis was made mainly on the basis of clinical features, ring enhancing lesions on Computed Tomography scan of brain and exclusion of other causes. Patients were treated with Albendazole for 28 days, Prednisolone and anticonvulsant.Results: 10-14 years was the most affected age group with no sex predilection. Seizure was the most common initial presentation (86.66%) followed by headache and vomiting. Generalized tonic clonic seizure was the most common type of seizure. Four patients returned with relapse.Conclusions: Neurocysticercosis is a disease of lower socioeconomic group with poor sanitation and poor hand hygiene. Generalized tonic clonic seizure is the main presentation. Anticysticercal therapy has a good outcome.

scholarly journals Pancreatic Resections in Renal Failure Patients: Is It Worth the Risk?

HPB Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
K. S. Norman ◽  
S. R. Domingo ◽  
L. L. Wong
Keyword(s):  
Renal Failure ◽  
Pancreatic Surgery ◽  
Case Reports ◽  
Case Series ◽  
Cardiovascular Complications ◽  
Improvement Program ◽  
Term Survival ◽  
Pancreatic Resections ◽  
American College Of Surgeons

Background. Chronic kidney disease affects 20 million US patients, with nearly 600,000 on dialysis. Long-term survival is limited and the risk of complex pancreatic surgery in this group is questionable. Previous studies are limited to case reports and small case series and a large database may help determine the true risk of pancreatic surgery in this population. Methods. The American College of Surgeons National Surgical Quality Improvement Program database was queried (2005–2011) for patients who underwent pancreatic resection. Renal failure was defined as the clinical condition associated with rapid, steadily increasing azotemia (rise in BUN) and increasing creatinine above 3 mg/dL. Operative trends and short-term outcomes were reviewed for those with and without renal failure (RF). Results. In 18,533 patients, 28 had RF. There was no difference in wound infections, neurologic or cardiovascular complications. Compared to non-RF patients, those with RF had more unplanned intubation (OR 4.89, 95% CI 1.85–12.89), bleeding requiring transfusion (OR 3.12, 95% CI 1.37–14.21), septic shock (OR 8.86, 95% CI 3.75–20.91), higher 30-day mortality (21.4% versus 2.3%, P<0.001) and longer hospital stay (23 versus 12 days, P<0.001). Conclusions. RF patients have much higher morbidity and mortality after pancreatic resections and surgeons should consider this before proceeding.

Hepatitis following Treatments with Famotidine and Then CimetIDINE

1994 ◽  
Vol 28 (1) ◽  
pp. 37-39 ◽  
Author(s):  
Fred Hashimoto ◽  
Robin L. Davis ◽  
Douglas Egli
Keyword(s):  
Computed Tomography ◽  
Duodenal Ulcer ◽  
Fatty Liver ◽  
Obese Woman ◽  
Abdominal Ultrasound ◽  
Drug Discontinuation ◽  
Computed Tomography Scan ◽  
Case Summary ◽  
Receptor Blockers ◽  
Tomography Scan

OBJECTIVE: To report a case of hepatitis induced by two histamine (H2)-receptor blockers, famotidine and cimetidine. CASE SUMMARY: A 51-year-old obese woman with a duodenal ulcer developed symptomatic, famotidine-induced hepatitis. Other causes for hepatitis were ruled out. Famotidine was discontinued and the patient took omeprazole for a month without incident. Cimetidine therapy was then initiated and shortly thereafter, the patient developed another episode of symptomatic hepatitis that resolved upon drug discontinuation. Two abdominal ultrasound examinations six months apart and an abdominal computed tomography scan obtained later showed what appeared to be a stable, fatty liver. DISCUSSION: This appears to be the first reported case of clinical hepatitis related to famotidine and the first reported case where clinical hepatitis followed the administration of two different H2-receptor blockers. The fatty liver probably was secondary to obesity and incidental to the hepatitis episodes. CONCLUSIONS: Famotidine can cause clinical hepatitis, and druginduced hepatitis can occur after the administration of two different H2-receptor blockers.

Incidental Splenic Cyst Simulating A Supernumerary Kidney

Ultrasound ◽  
2009 ◽  
Vol 17 (2) ◽  
pp. 90-92
Author(s):  
Andrew Christie
Keyword(s):  
Computed Tomography ◽  
Renal Failure ◽  
Left Kidney ◽  
Splenic Cyst ◽  
Computed Tomography Scan ◽  
Splenic Cysts ◽  
Us Findings ◽  
Tomography Scan ◽  
Collecting System

This case represents an incidental splenic cyst misinterpreted as a supernumerary kidney, resulting in a computed tomography scan to confirm the ultrasound (US) findings. A 55-year-old man presenting with renal failure had an US examination which showed a mass adjacent to the left kidney. It resembled a kidney with a dilated collecting system rather than a spleen. Supernumerary kidneys are extremely rare in the published literature. Splenic cysts are more common, but are still relatively unusual. The possible diagnoses and US findings in splenic cysts are discussed.

scholarly journals Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Mestet Yibeltal Shiferaw ◽  
Tsegazeab Laeke T/Mariam ◽  
Abenezer Tirsit Aklilu ◽  
Yemisirach Bizuneh Akililu ◽  
Bethelhem Yishak Worku
Keyword(s):  
Cerebral Edema ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Midline Shift ◽  
Subdural Hygroma ◽  
Case Summary ◽  
The Status ◽  
History Of ◽  
Type 1 Dm

Abstract Background While both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma. Case summary This study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment. Conclusion DKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

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