ABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a clinical radiologic syndrome which is characterized by reversible neurological and radiological findings. It is associated with an abrupt and severe increase in blood pressure, eclampsia, chronic kidney disease with hypertension and using various immunosupressive drugs. Patient with chronic kidney disease could be especially vulnerable to this syndrome because they are frequently exposed to several possible causes as uremia, hypertension, or electrolyte imbalance. We report a case of posterior reversible encephalopathy syndrome in a patient having continuous ambulatory peritoneal dialysis.
Subject(s)
Female , Humans , Pregnancy , Blood Pressure , Eclampsia , Hypertension , Kidney Failure, Chronic , Peritoneal Dialysis, Continuous Ambulatory , Posterior Leukoencephalopathy Syndrome , Renal Insufficiency, Chronic , UremiaABSTRACT
A 53-year-old male was hospitalized with abdominal pain and turbid peritoneal fluid. He was diagnosed with hypertension, diabetic nephropathy and started continuous ambulatory peritoneal dialysis (CAPD) 4 years ago. Initial peritoneal fluid analysis demonstrated CAPD peritonitis. As initial antibiotic therapy, ceftazidime/vancomycin were injected intraperitoneally. But drug sensitivity test revealed these regimens were ineffective. On sixth hospital day, Brevundimonas vesicularis (B. vesicularis) was cultured from peritoneal fluid, this strain was susceptible to imipenem, piperacillin and resistant to ceftazidime. Accordingly we changed the antibiotics to imipenem, which was administered for 14 days, but analysis of peritoneal fluid was seldom improved. Finally, CAPD catheter was removed, and hemodialysis was started. After CAPD catheter removal, peritonitis improved rapidly. B.vesicularis is a rare opportunistic organism in CAPD peritonitis. Because this peritonitis may not improve in spite of medical treatment with susceptible antibiotics, CAPD catheter must be removed finally.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Anti-Bacterial Agents , Ascitic Fluid , Catheters , Ceftazidime , Diabetic Nephropathies , Hypertension , Imipenem , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Piperacillin , Pseudomonas , Renal Dialysis , Sprains and StrainsABSTRACT
STUDY DESIGN: This study reviewed prospectively 15 patients with chronic persistent low back pain who were treated with disc excision and posterior lumbar interbody fusion(PLIF). Outcomes of treatment were evaluated by a follow-up interview and x-ray studies. OBJECTIVES: To evaluate the efficacy of surgical treatment of patients with chronic persistent low back pain resulting from internal disc derangement (IDD) that does not respond to conservative treatments. SUMMARY OF LITERATURE REVIEW: Chronic persistent low back pain resisting to all known modalities of conservative treatments represents a difficult problem. The efficacy of any specific treatment methods for this group of patients is controversial. MATERIALS AND METHODS: Between 1994 and 2000, 15 patients were treated with disc excision and PLIF at Keimyung University Hospital from 1994 to 2000. The clinical outcomes were evaluated by postoperative follow-up interviews, and the fusion results were evaluated by x-ray studies. RESULTS: All patients responded properly to the follow-up evaluation. 66.6% of the patients had satisfactory results(13.3% excellent, 53.3% good, 26.7% fair, 6.7% poor), and a successful fusion was obtained in all of the patients. CONCLUSION: These results suggest that disc excision and PLIF for IDD patients is effective modality in treatment of IDD.