scholarly journals A case of peritoneal-pericardial leak in a 19-year-old patient on peritoneal dialysis

2021 ◽  
Vol 4 (2) ◽  
pp. 129-135
Author(s):  
Meryem Birrou ◽  
Mina Agrou ◽  
Hasnae Guerrouj ◽  
Rabia Bayahia ◽  
Loubna Benamar
Keyword(s):  
Peritoneal Dialysis ◽  
Progressive Increase ◽  
Great Abundance ◽  
Pericardial Drainage ◽  
Glucose Levels ◽  
Fluid Analysis ◽  
History Of ◽  
Glucose Plasma ◽  
Radio Tracer

We report a case of a peritoneal-pericardial leak in peritoneal dialysis.A 19-year-old patient, with no history of heart disease, with unkown chronic kidney disease, treated with continuous ambulatory peritoneal dialysis (CAPD) for 10 months. complained of chest pain and tachycardia, revealing pericardial effusion of great abundance. Pericardial drainage was necessary. The fluid analysis was a transudate with glucose levels 5 times higher than glucose plasma levels. A peritoneal scintigraphy was performed and showed a distribution of the radio-tracer in the peritoneal cavity without any image of a leak. With clinical and especillay biological arguments, the patient was diagnosed with a peritoneal-pericardial leak.After pericardial drainage and temporary switch to hemodialysis, automated peritoneal dialysis was resumed with progressive increase in volumes, without recurrence of the leak after a 6 months follow-up.

False Elevation of Blood Glucose Levels Measured by GDH-PQQ-BASED Glucometers Occurs during all Daily Dwells in Peritoneal Dialysis Patients Using Icodextrin

2010 ◽  
Vol 30 (3) ◽  
pp. 329-335 ◽  
Author(s):  
Chiu-Yeh Tsai ◽  
Su-Chu Lee ◽  
Chi-Chih Hung ◽  
Jia-Jung Lee ◽  
Mei-Chuan Kuo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Glucose ◽  
Glucose Dehydrogenase ◽  
Serum Glucose ◽  
Monitoring Systems ◽  
Self Monitoring ◽  
Glucose Levels ◽  
Follow Up Study ◽  
Blood Glucose Levels

♦ ObjectiveFalse elevation of blood glucose levels measured by glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ)-based glucose self-monitoring systems; glucometer) in peritoneal dialysis (PD) patients using icodextrin solution has been well documented. However, adverse hypoglycemic events caused by misreadings for blood glucose are still being reported. We aimed to study blood glucose levels measured simultaneously using different methods in PD patients with switching of icodextrin, and throughout daily exchanges either using icodextrin or not.♦ DesignWe recruited 100 PD patients, including 40 using icodextrin; 128 hemodialysis patients served as a reference. Fasting serum glucose was measured using our laboratory reference method (LAB) and 2 glucose self-monitoring systems based on glucose dehydrogenase nicotinamide adenine dinucleotide (GDH-NAD) and GDH-PQQ respectively. 80 PD patients had a second follow-up study. A time course study was performed in 16 PD patients through measuring fingertip glucose using the 2 glucose self-monitoring systems during daily exchanges.♦ ResultThe differences in measured serum glucose levels in (PQQ minus LAB) versus (NAD minus LAB) were markedly increased in PD patients using icodextrin compared to other patient groups, and was further confirmed by the follow-up study in patients that switched to icodextrin. The high serum glucose levels measured by the GDH-PQQ-based glucose self-monitoring system were present throughout all exchanges during the day in patients using icodextrin solution.♦ ConclusionsFalse elevation of blood glucose measured by GDH-PQQ-based glucose self-monitoring systems exists in patients using icodextrin. To avoid misinterpretation of hyperglycemia and subsequent over-injection of insulin, GDH-PQQ-based glucose self-monitoring systems should not be used in PD patients.

scholarly journals A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection

2016 ◽  
Vol 8 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Cláudia Borbinha ◽  
João Pedro Marto ◽  
Sofia Calado ◽  
Miguel Viana-Baptista
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Vascular Events ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Varicella Zoster Infection

Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.

Delayed forebrain syndrome due to presumptive traumatic intranasal meningoencephalocele in a cat

2019 ◽  
Vol 7 (3) ◽  
pp. e000910
Author(s):  
Theophanes Liatis ◽  
Alberta De Stefani ◽  
Panagiotis Mantis ◽  
Giunio Bruto Cherubini
Keyword(s):  
Epileptic Seizures ◽  
Final Diagnosis ◽  
Neurological Signs ◽  
Fluid Analysis ◽  
Cerebral Mri ◽  
Long Term Follow Up ◽  
Postural Reaction ◽  
History Of ◽  
The Right

A 3-year-old male neutered domestic shorthair cat was referred with 1-month history of three generalised tonic-clonic epileptic seizures and left-sided thoracic limb knuckling. Nine months previously, the cat was bitten on the right upper palpebral region without manifesting neurological signs. On admission, physical and neurological examination revealed left-sided postural reaction deficits and absent menace response. Thus, a right-forebrain neurolocalisation was reached. Haematology, biochemistry, bile acid stimulation test, infectious diseases serology and cerebrospinal fluid analysis were unremarkable. Cerebral MRI revealed extension of brain and meninges into the right frontal sinus. Final diagnosis of a right-sided traumatic frontoethmoidal meningoencephalocele was made. The cat remained seizure free under phenobarbital treatment with residual left-sided postural reaction deficits at 9 months follow-up. This is the first report of presumptive traumatic meningoencephalocele in a cat, which emphasises the importance of complete neurological investigation and regular long-term follow-up checks in patients with historical head trauma despite the absence of initial neurological signs.

Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

2015 ◽  
Vol 40 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Liping Xiong ◽  
Li Fan ◽  
Qingdong Xu ◽  
Qian Zhou ◽  
Huiyan Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
History Of ◽  
The Relationship

Background: There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. Results: During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. Conclusion: Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.

Prevalence and risk factors of exit-site infection in incident peritoneal dialysis patients

2020 ◽  
Vol 40 (2) ◽  
pp. 164-170
Author(s):  
Jianxiong Lin ◽  
Hongjian Ye ◽  
Jianying Li ◽  
Yagui Qiu ◽  
Haishan Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Mechanical Stress ◽  
Laboratory Data ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Increased Risk ◽  
History Of

Background: Exit-site infection (ESI) is a common complication in peritoneal dialysis (PD) patients. Clearly understanding the risk factors may be useful for the prevention of ESI. This study was to explore the prevalence and risk factors of ESI in incident PD patients. Methods: We evaluated ESI in incident PD patients who had catheter insertion in our center between 1 January 2009 and 31 December 2013, with follow-up for 1 year. We collected data on demographics, clinical features, and nursing care methods of the exit site (ES). Results: We recruited 1133 incident PD patients (687 male (60.6%); mean age 47.0 ± 15.1 years), and 245 (21.6%) had diabetes. Median follow-up was 12.0 months. One hundred and thirty-one patients had 139 episodes of ESI with a rate of 92.8 patient-months per episode (0.13 episodes per year). Coagulase-negative staphylococcus was the main pathogen, accounting for 33.8% of the ESIs. Gram-positive rods, Staphylococcus aureus, Pseudomonas, fungi, and other organisms accounted for 23.0%, 15.8%, 1.4%, 1.4%, and 2.9%, respectively. No bacterial growth was found in 15.1%. There were no differences in demographic and laboratory data (age, gender, primary kidney disease, hemoglobin, white blood cell, serum albumin, blood urea nitrogen, serum creatinine, and C-reactive protein) between the ESI and non-ESI groups. Poor competency of ES care, poor catheter immobilization, history of catheter-pulling injury, and mechanical stress on the ES were significantly associated with increased risk of ESI. Conclusions: The prevalence of ESI was 0.13 episodes per year. Poor competency of ES care, catheter mobilization, history of catheter-pulling injury, and mechanical stress by waist belt or the protective bag of PD on ES were risk factors for ESI.

scholarly journals Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

2018 ◽  
pp. bcr-2018-225252
Author(s):  
Michelle Herberts ◽  
Bradley Hicks ◽  
Muhammad Rizwan Sohail ◽  
Anil Jagtiani
Keyword(s):  
Hepatic Cirrhosis ◽  
Fluid Collection ◽  
Abdominal Ultrasound ◽  
Pelvic Abscess ◽  
Ct Guided ◽  
Bacterial Peritonitis ◽  
Fluid Analysis ◽  
Abdominal Ct Scan ◽  
History Of

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

scholarly journals Vision Impairment After Iron Chelating Agent in a Patient Under Peritoneal Dialysis

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Chi-Feng Huang
Keyword(s):  
Peritoneal Dialysis ◽  
Vision Loss ◽  
Ferritin Level ◽  
Chelating Agent ◽  
Olmesartan Medoxomil ◽  
Vision Disorders ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

A 54-year-old female patient had a history of end-stage renal disease (ESRD) under continuous automatic peritoneal dialysis (CAPD) therapy for 6 years. She had underlying hypertension history under oral hypertensives (olmesartan medoxomil). She was admitted to the ward for iron chelating agent therapy due to high ferritin level (5480 ng/ml). Deferoxamine 1 gram was prescribed with intravenous drip for 24 hours for 5 days. On the fifth day, she complained about vision problems, i.e. central halo pattern vision loss. A deferoxamine-related macula edema was diagnosed. After discontinuing the medication, her vision gradually improved. After 3 months of follow up, her vision disorders recovered.Although we reduced the dose of iron chelating agent, vision side effects also occurred in this ESRD patient.This case taught us to perform a careful detection of vision problems before, during, and after deferoxamine therapy in order to prevent irreversible vision disorders.

scholarly journals Plasma creatine kinase and all-cause mortality in patients on peritoneal dialysis: a multi-center retrospective study

2020 ◽  
Author(s):  
Yueqiang Wen ◽  
FenFen Peng ◽  
Xiaoran Feng ◽  
Niansong Wang ◽  
Xiaojiang Zhan ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Mortality Incidence ◽  
History Of ◽  
Comorbidity Index ◽  
Plasma Creatine Kinase

Abstract Background Higher plasma creatine kinase (CK) values are associated with the failure of antihypertensive treatment. However, an association between CK and all-cause mortality in peritoneal dialysis (PD) patients has received little attention.Methods In this retrospective multicenter study, 1382 incident PD patients with baseline CK values were enrolled from November 1, 2005, to February 28, 2017. All patients with oral statins were excluded and then were divided into four groups according to quartile range [Quartile 1 (<60 U/L), Quartile 2 (60-100 U/L), Quartile 3 (101-179 U/L), and Quartile 4 (>179 U/L)]. The primary endpoint was all-cause mortality. The association between plasma CK values and all-cause mortality was assessed with Cox regression and the Fine and Gray models.Results Of 1382 patients 298 (21.6%) patients died during a median 35-month (interquartile range=19-54 months) follow-up period. Patients in Quartile 4 were older (P<0.001), likely to be male (P<0.001), had a higher prevalence of diabetes (P=0.002), and a history of cardiovascular disease (P=0.005), and higher values of Charlson comorbidity index (P=0.031). All-cause mortality incidence was a significant difference among the four Quartiles (Quartile 1, 16.2%; Quartile 2, 22.2%; Quartile 3, 23.8%; Quartile 4, 24.1%; P=0.043). Cumulative all-cause mortality in the Quartile 4 was significantly higher compared with other groups (Log Rank=10.55, P=0.015). After adjusting for confounding factors, the highest CK quartile had a hazard ratio (HR) for all-cause mortality of 1.75 [95% confidence interval (CI) 1.34-3.20, P=0.041]. With kidney transplantation or hemodialysis as a competing risk, the Quartile 4 had an HR for all-cause mortality of 1.66 (95%CI 1.30-3.41, P=0.044), after adjusting for confounding factors.Conclusions Higher plasma CK levels at the commencement of PD may be a valuable biomarker for predicting the development of all-cause mortality in PD patients.

Mesalamine-induced eosinophilic pleural effusion

2020 ◽  
Vol 13 (4) ◽  
pp. e233886 ◽  
Author(s):  
Abdullah Al-abcha ◽  
Fazal Raziq ◽  
Shouq Kherallah ◽  
Ahmad Alratroot
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Symptomatic Improvement ◽  
X Ray ◽  
Fluid Analysis ◽  
Ct Angiogram ◽  
History Of ◽  
Chest X Ray ◽  
Eosinophilic Pleural Effusion

A 45-year-old woman with a medical history of ulcerative colitis (UC) presented with difficulty in breathing. The patient was diagnosed with UC a month prior to presentation and was started on mesalamine suppository. Chest x-ray (CXR) on presentation showed bilateral pleural effusion, which was confirmed on CT angiogram of the chest. Diagnostic and therapeutic thoracentesis was performed and 0.7 L of pleural fluid was removed from the left side. The pleural fluid analysis was consistent with exudative pleural effusion with eosinophilia. Symptomatic improvement was noted after thoracentesis. Mesalamine was stopped and repeat CXR was obtained on the follow-up visit, which showed no pleural effusion. The Naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was most probably secondary to adverse reaction from mesalamine.

scholarly journals 1399 Anorectal Melanoma: Can Be an Unexpected Diagnosis - A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Hagiga ◽  
M Shaaban ◽  
M Gultiaeva
Keyword(s):  
Digital Rectal Examination ◽  
Dentate Line ◽  
Progressive Increase ◽  
Incisional Biopsy ◽  
Anorectal Melanoma ◽  
Rare Tumour ◽  
History Of ◽  
Bleeding Per Rectum ◽  
Erectile Dysfunction Patient

Abstract Anorectal melanoma is a rare tumour. Few cases are reported in the literature. We report a case of 51 years old male complained of anal induration, itching and bloody and suppurative discharge. Patient had symptoms for 2 years. However, patient expected his symptoms are due to recurrence of haemorrhoids. Therefore, he presented late. Then, he had noticed a progressive increase in size, discharge and two opposing ulcers. Patient had no history of abdominal pain, change in bowel habits, bleeding per rectum, history of groin lumps, incontinence nor erectile dysfunction. Patient underwent haemorrhoidectomy about 11 years ago. On examination, there was a circumferential single ulcer eroding the anus extending deep to the dentate line reaching the rectum on digital rectal examination. Also, there was no inguinal lymphadenopathy detected on exam. Incisional biopsy of the ulcer showed anorectal melanoma. Patient had abdominoperineal resection (APR) with adjuvant radiotherapy. At 12 months follow up, there were no signs of recurrence.

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