scholarly journals Case Report: Hyponatremia Secondary to Desmopressin Administration Prior to Percutaneous Kidney Biopsy: A Case-Based Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Alexandra Vornicu ◽  
Bogdan Obrişcă ◽  
Bogdan Cotruta ◽  
Adriana Octaviana Dulămea ◽  
Nicu Caceaune ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Kidney Biopsy ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Spot Urine ◽  
Recurrent Vomiting ◽  
Bleeding Prophylaxis ◽  
Life Threatening ◽  
History Of ◽  
The One

Bleeding remains the most clinically relevant complication of kidney biopsy and several prophylactic approaches were proposed, including desmopressin administration. We present the case of a 60-year-old man with a history of liver transplantation, admitted for the evaluation of a renal dysfunction. As part of our department protocol, desmopressin 60 μg was administered orally, 2 h before the percutaneous kidney biopsy. The patient developed acute, severe, symptomatic hyponatremia (i.e., headache and recurrent vomiting), followed by a life-threatening upper gastrointestinal bleeding due to a Mallory-Weiss syndrome. Although it is often used as bleeding prophylaxis prior to kidney biopsy, data regarding the efficacy and safety of desmopressin in this setting are inconsistent. Accordingly, we performed a thorough literature review of the use of desmopressin as bleeding prophylaxis prior to kidney biopsy, focusing on the incidence of hyponatremia. The reported incidence of hyponatremia (<130 mmol/l) was 7–11%, probably because serum sodium was monitored in few studies. Nevertheless, hyponatremia was rarely symptomatic but, in some cases, like the one presented here, its complications could be severe. Pre-biopsy low serum sodium and estimated glomerular filtration rate as well as high spot urine sodium and non-restricted fluid intake were reported to be associated with hyponatremia incidence. However, the current evidence cannot clearly establish which patients benefit the most from desmopressin use with respect to bleeding complications. We propose that when desmopressin is used for bleeding prophylaxis prior to kidney biopsy, measurements of serum sodium levels, before and every 6 h after, should complement ultrasound and hemoglobin as part of the patient post-procedural monitoring. Also, water intake should be restricted in the day of biopsy. However, this proposed approach should be adequately evaluated in a clinical trial.

Infant Apnea: Polygraphic Studies and Follow-up Monitoring

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 731-736 ◽  
Author(s):  
Carol Lynn Rosen ◽  
James D. Frost ◽  
Gunyon M. Harrison
Keyword(s):  
Ph Monitoring ◽  
Home Monitoring ◽  
Seizure Disorders ◽  
Eeg Abnormalities ◽  
Subsequent Episode ◽  
Life Threatening ◽  
History Of ◽  
Polygraphic Recordings ◽  
Prolonged Apnea ◽  
The One

Twenty-six infants with unexplained and apparently life-threatening apnea were evaluated clinically, underwent eight- or 12-hour polygraphic recordings during sleep, and were then observed on home monitors. The one exception was an infant who was treated with theophylline and not monitored at home. Clinical evaluation revealed a history of vomiting in 19 infants, gastroesophageal reflux (GER) on esophagram in 19, and subtle neurologic abnormalities in ten. Polygraphic studies revealed questionable EEG abnormalities in nine infants, abnormal rapid eye movement (REM) time in four, prolonged apnea in one, and increased frequency of brief mixed (central and obstructive) and obstructive apneas in five. Of the 11 infants who underwent pH monitoring during their polygraphic sleep studies, seven had at least one recorded episode of GER, but the episodes were not accompanied by apnea or bradycardia. Thirteen infants had a subsequent episode of apnea that required stimulation, and in eight infants, cardiopulmonary resuscitation was given. There was two deaths. Two infants subsequently developed seizure disorders. Three of the five infants who underwent surgical fundoplication had recurrent apneic episodes. GER commonly occurred in these infant apnea patients but did not correlate with the clinical outcome. Although subtle abnormalities may be detected by sophisticated polygraphic monitoring studies, they are not predictive of recurrent apnea or death. Home monitoring may be useful in detecting the infant at risk for recurrent life-threatening apnea and in providing some safeguard for that infant.

Efficacious and Safe Use of Recombinant Activated Factor VII (rFVIIa) in Patients with Enoxaparin (ENOX)-Induced Bleeding and Pre-Existing Hypercoagulable States.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1054-1054 ◽  
Author(s):  
K. Firozvi ◽  
P. Acs ◽  
S. Baidas ◽  
R. Deveras ◽  
C. M. Kessler
Keyword(s):  
Kidney Biopsy ◽  
Ex Vivo ◽  
Factor Vii ◽  
Bleeding Complications ◽  
Prior History ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Intravenous Bolus ◽  
History Of ◽  
Antifactor Xa

Abstract Introduction: rFVIIa has been touted as a pancoagulant to reverse untoward hemorrhage in various clinical situations. We describe 3 hypercoagulable patients with enox-induced bleeding treated successfully and safely with rFVIIa. Case Summaries: Patient 1, a 58 year old female, received enox 60mg SQ q12 h for a left femoral DVT. On day 2, a bleeding right femoral pseudoaneurysm was detected. On day 3, the patient’s hematocrit fell from 37.5% to 22%, as swelling and pain ensued in the right thigh 4h after receiving her AM dose of enox. The concurrent PT, INR and aPTT were 18.1, 1.72 and 34.2 sec respectively. rFVIIa (20μg/kg) was administered intravenously with rapid cessation of bleeding. Patient 2, a 42 year old male, with a history of SLE, antiphospholipid antibody syndrome, and a distant history of a distal DVT was admitted for acute renal failure (creatinine of 4.2) secondary to lupus nephritis. One day after a kidney biopsy, the patient was placed on coumadin 5mg and continuous infusion of unfractionated heparin which was then changed to enox 70 mg SQ q 12. Both coumadin and enox were held after 4 d, once his PT, INR and aPTT reached 30, 3.97 and 56.2 sec respectively. The next day, a CT scan to evaluate a new abdominal pain revealed a large bleed at the kidney biopsy site. Despite transfusions of 6 bags of red blood cells, 4 bags of fresh frozen plasma, and 10mg of SQ vitamin K1, his hematocrit dropped to 19% and his PT, INR, and aPTT remained elevated at 28, 3.49, and 60.8 sec respectively. Thromboembolization was achieved to terminate bleeding from 2 of his 3 renal biopsy sites, the last of which was technically inaccessible. rFVIIa (30μg/kg) was administered as an intravenous bolus with immediate cessation of active bleeding. The next day, the antifactor Xa level was 0.12 anti-Xa U/ml and the PT, INR, and aPTT were 13.7, 1.09 and 45.1 sec, respectively and remained at these levels for the next 4 days. Patient 3, a 56 year old female with a prior history of multiple PEs and proximal DVTs due to protein S deficiency, was admitted for total knee arthroplasty. Admission labs were all within normal limits. Enox 80mg sq was initiated 24 h post-operatively for DVT prophylaxis. Four h later, brisk bleeding developed acutely from the surgical site. The simultaneous antifactor Xa level was 0.49 anti-Xa U/ml. rFVIIa (20μg/kg) was administered as an intravenous bolus and bleeding from the JP drain ceased instantly. All 3 patients stabilized within hours following administration of rFVIIa for their acute bleeding events; all required multiple transfusions of FFP and packed RBCs before rFVIIa; and all resumed anticoagulation without further bleeding. Discussion: Many clinicians fear that the rare untoward hemorrhage associated with any low molecular weight heparin (LMWH) preparation cannot be efficiently or rapidly reversed as there is no specific or reliable antidote. rFVIIa concentrate has reversed the anti-Xa properties of LMWH in ex vivo plasma-spiking experimental models but experience with use of rFVIIa to reverse LMWH-induced bleeding in vivo is lacking. Conclusion: This report suggests that rFVIIa administered in low doses (20–30μg/kg) reverses clinically significant LMWH-induced bleeding complications effectively, rapidly, and safely and should be considered as an adjunct in the treatment of LMWH-induced bleeding in patients with either hypercoagulable conditions or acute VTE. Clinical trials are needed to confirm the effectiveness of rFVIIa in this clinical scenario.

Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review

1996 ◽  
Vol 41 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Gb Meterissian
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Features ◽  
Prior History ◽  
Extrapyramidal Side Effects ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
The One

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. Methods: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. Results: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. Conclusions: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.

scholarly journals Performing an Ultrasound-Guided Percutaneous Needle Kidney Biopsy: An Up-To-Date Procedural Review

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2186
Author(s):  
Antonio Granata ◽  
Giulio Distefano ◽  
Francesco Pesce ◽  
Yuri Battaglia ◽  
Paola Suavo Bulzis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Kidney Biopsy ◽  
Left Kidney ◽  
Renal Involvement ◽  
Observation Time ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Renal Diseases ◽  
Safe Procedure ◽  
Ultrasound Guided

Ultrasound-guided percutaneous renal biopsy (PRB) has revolutionized the clinical practice of nephrology in the last decades. PRB remains an essential tool for the diagnosis, prognosis, and therapeutic management of several renal diseases and for the assessment of renal involvement in systemic diseases. In this study, we examine the different applications and provide a review of the current evidence on the periprocedural management of patients. PRB is recommended in patients with significant proteinuria, hematuria, acute kidney injury, unexpected worsening of renal function, and allograft dysfunction after excluding pre- and post-renal causes. A preliminary ultrasound examination is needed to assess the presence of anatomic anomalies of the kidney and to identify vessels that might be damaged by the needle during the procedure. Kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, whereas in patients with obesity, the supine antero-lateral position is preferred. After preparing a sterile field and the injection of local anesthetics, an automatic spring-loaded biopsy gun is used under ultrasound guidance to obtain samples of renal parenchyma for histopathology. After the procedure, an ultrasound scan must be performed for the prompt identification of potential early bleeding complications. As 33% of complications occur after 8 h and 91% occur within 24 h, the ideal post-procedural observation time is 24 h. PRB is a safe procedure and should be considered a routine part of the clinical practice of nephrology.

Loeys–Dietz syndrome pathology and aspects of cardiovascular management: A systematic review

Vascular ◽  
2020 ◽  
pp. 170853812093458 ◽  
Author(s):  
Rizwan Iqbal ◽  
Samiha Alom ◽  
Jalal BinSaeid ◽  
Amer Harky
Keyword(s):  
Autosomal Dominant ◽  
Genetic Disorder ◽  
Aortic Aneurysms ◽  
Current Evidence ◽  
Medical Subject Headings ◽  
Genetic Studies ◽  
Mesh Terms ◽  
Life Threatening ◽  
History Of ◽  
Systemic Manifestations

Loeys–Dietz syndrome is an autosomal dominant genetic disorder which is associated with significant and often crucial vascular manifestations. This review is aimed to examine current evidence on pathophysiology and management of Loeys–Dietz syndrome in current era. A comprehensive electronic search was done to identify the articles that discussed all the aspects of Loeys–Dietz syndrome, combined key words and Medical Subject Headings (MeSH) terms were used. Relevant articles have been summarized in each relevant section. Loeys–Dietz syndrome is an autosomal dominant genetic disorder which has combined and multi-systemic manifestations. The increased breakdown of extracellular matrix predisposes an individual to developing aneurysms in the aortic tree which is undoubtedly the most significant complication of this disorder. Understanding the pathophysiology and natural history of Loeys–Dietz syndrome and regular surveillance is important to plan prophylactic interventions to prevent life-threatening aortic emergencies which can be fatal. Loeys–Dietz syndrome is an aggressive genetic condition that predisposes an individual to the development of life-threatening aortic aneurysms. Our understanding of Loeys–Dietz syndrome remains ever-changing and it is likely that the knowledge regarding its diagnosis and treatment will become more clearly defined in the coming years with deeper genetic studies.

The Tempo and mode(S) of Prebiotic Evolution

1997 ◽  
Vol 161 ◽  
pp. 419-429 ◽  
Author(s):  
Antonio Lazcano
Keyword(s):  
Origin Of Life ◽  
Organic Compounds ◽  
Biological Evolution ◽  
Current Evidence ◽  
Early Diversification ◽  
Time Period ◽  
The Galaxy ◽  
History Of ◽  
Widespread Phenomenon ◽  
The Origin Of Life

AbstractDifferent current ideas on the origin of life are critically examined. Comparison of the now fashionable FeS/H2S pyrite-based autotrophic theory of the origin of life with the heterotrophic viewpoint suggest that the later is still the most fertile explanation for the emergence of life. However, the theory of chemical evolution and heterotrophic origins of life requires major updating, which should include the abandonment of the idea that the appearance of life was a slow process involving billions of years. Stability of organic compounds and the genetics of bacteria suggest that the origin and early diversification of life took place in a time period of the order of 10 million years. Current evidence suggest that the abiotic synthesis of organic compounds may be a widespread phenomenon in the Galaxy and may have a deterministic nature. However, the history of the biosphere does not exhibits any obvious trend towards greater complexity or «higher» forms of life. Therefore, the role of contingency in biological evolution should not be understimated in the discussions of the possibilities of life in the Universe.

Misreading Egypt

2018 ◽  
Author(s):  
Jesse Schotter
Keyword(s):  
New Media ◽  
Narrative Form ◽  
Experimental Film ◽  
Tower Of Babel ◽  
Avant Garde ◽  
Sergei Eisenstein ◽  
History Of ◽  
The One ◽  
The Relationship ◽  
Modern Technologies

The first chapter of Hieroglyphic Modernisms exposes the complex history of Western misconceptions of Egyptian writing from antiquity to the present. Hieroglyphs bridge the gap between modern technologies and the ancient past, looking forward to the rise of new media and backward to the dispersal of languages in the mythical moment of the Tower of Babel. The contradictory ways in which hieroglyphs were interpreted in the West come to shape the differing ways that modernist writers and filmmakers understood the relationship between writing, film, and other new media. On the one hand, poets like Ezra Pound and film theorists like Vachel Lindsay and Sergei Eisenstein use the visual languages of China and of Egypt as a more primal or direct alternative to written words. But Freud, Proust, and the later Eisenstein conversely emphasize the phonetic qualities of Egyptian writing, its similarity to alphabetical scripts. The chapter concludes by arguing that even avant-garde invocations of hieroglyphics depend on narrative form through an examination of Hollis Frampton’s experimental film Zorns Lemma.

Theodor W. Adorno

2018 ◽  
Author(s):  
Colby Dickinson
Keyword(s):  
The Other ◽  
History Of Thought ◽  
History Of ◽  
The One

In his somewhat controversial book Remnants of Auschwitz, Agamben makes brief reference to Theodor Adorno’s apparently contradictory remarks on perceptions of death post-Auschwitz, positions that Adorno had taken concerning Nazi genocidal actions that had seemed also to reflect something horribly errant in the history of thought itself. There was within such murderous acts, he had claimed, a particular degradation of death itself, a perpetration of our humanity bound in some way to affect our perception of reason itself. The contradictions regarding Auschwitz that Agamben senses to be latent within Adorno’s remarks involve the intuition ‘on the one hand, of having realized the unconditional triumph of death against life; on the other, of having degraded and debased death. Neither of these charges – perhaps like every charge, which is always a genuinely legal gesture – succeed in exhausting Auschwitz’s offense, in defining its case in point’ (RA 81). And this is the stance that Agamben wishes to hammer home quite emphatically vis-à-vis Adorno’s limitations, ones that, I would only add, seem to linger within Agamben’s own formulations in ways that he has still not come to reckon with entirely: ‘This oscillation’, he affirms, ‘betrays reason’s incapacity to identify the specific crime of Auschwitz with certainty’ (RA 81).

Sea Urchins and Circuses: The Modernist Natural Histories of Jean Painlevé and Alexander Calder

2018 ◽  
Vol 13 (2) ◽  
pp. 187-211
Author(s):  
Patricia E. Chu
Keyword(s):  
New Media ◽  
Sea Urchins ◽  
Life Sciences ◽  
Three Dimensional ◽  
Machine Age ◽  
Avant Garde ◽  
History Of ◽  
And Performance ◽  
The One ◽  
Natural Historian

The Paris avant-garde milieu from which both Cirque Calder/Calder's Circus and Painlevé’s early films emerged was a cultural intersection of art and the twentieth-century life sciences. In turning to the style of current scientific journals, the Paris surrealists can be understood as engaging the (life) sciences not simply as a provider of normative categories of materiality to be dismissed, but as a companion in apprehending the “reality” of a world beneath the surface just as real as the one visible to the naked eye. I will focus in this essay on two modernist practices in new media in the context of the history of the life sciences: Jean Painlevé’s (1902–1989) science films and Alexander Calder's (1898–1976) work in three-dimensional moving art and performance—the Circus. In analyzing Painlevé’s work, I discuss it as exemplary of a moment when life sciences and avant-garde technical methods and philosophies created each other rather than being classified as separate categories of epistemological work. In moving from Painlevé’s films to Alexander Calder's Circus, Painlevé’s cinematography remains at the forefront; I use his film of one of Calder's performances of the Circus, a collaboration the men had taken two decades to complete. Painlevé’s depiction allows us to see the elements of Calder's work that mark it as akin to Painlevé’s own interest in a modern experimental organicism as central to the so-called machine-age. Calder's work can be understood as similarly developing an avant-garde practice along the line between the bestiary of the natural historian and the bestiary of the modern life scientist.

Ion Channel Remodelling in Atrial Fibrillation

2011 ◽  
Vol 7 (2) ◽  
pp. 97 ◽  
Author(s):  
Niels Voigt ◽  
Dobromir Dobrev ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ion Channel ◽  
Antiarrhythmic Drugs ◽  
Current Knowledge ◽  
Bleeding Complications ◽  
Large Size ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
Life Threatening ◽  
Underlying Mechanisms

Atrial fibrillation (AF) is the most common arrhythmia and is associated with substantial cardiovascular morbidity and mortality, with stroke being the most critical complication. Present drugs used for the therapy of AF (antiarrhythmics and anticoagulants) have major limitations, including incomplete efficacy, risks of life-threatening proarrhythmic events and bleeding complications. Non-pharmacological ablation procedures are efficient and apparently safe, but the very large size of the patient population allows ablation treatment of only a small number of patients. These limitations largely result from limited knowledge about the underlying mechanisms of AF and there is a hope that a better understanding of the molecular basis of AF may lead to the discovery of safer and more effective therapeutic targets. This article reviews the current knowledge about AF-related ion-channel remodelling and discusses how these alterations might affect the efficacy of antiarrhythmic drugs.

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