ABSTRACT
Wernicke encephalopathy, due to the depletion of thiamine, can be a complication of chronic hemodialysis. We report a 43 years old diabetic male in chronic hemodialysis, who two weeks after an infra-condyleal amputation of his left leg, was admited to the hospital due to an episode of vomiting and abdominal pain lasting 5 days, where confusion and ocular motor signs appeared. Parenteral thiamine administration was started and the confusional state abated. Dialysis can be a predisposing factor for Wernicke encaphalopathy and this diagnosis must be considered in confuse patients
Subject(s)
Humans , Male , Adult , Wernicke Encephalopathy/etiology , Renal Dialysis/adverse effects , Thiamine/administration & dosage , Thiamine Deficiency/complications , Diabetes Mellitus/complications , Hypertension/complicationsABSTRACT
Patients and methods: Thirty four patients with more than one year after the transplantation, with stable renal function and receiving triple immunosuppression were studied. Conventional cyclosporine was changed to the microemulsion form maintaining the same daily dose. Drug serum levels, serum creatinine and blood pressure were measured within two to eight months after the conversion. Doses of microemulsion cyclosporine were adjusted to achieve serum levels of 150 ñ 40 ng/ml. Results: Microemulsion cyclosporine induced a slight initial increase in blood cyclosporine levels. Afterwards, levels were more stable than with conventional cyclosporine (165-185 and 145-210 ng/ml respectively) and the dispersion of values were lower (standard deviations of 70 and 100 ng/ml respectively). Twenty three patients did not require dose adjustments, in four it was reduced and in five it was increased. There were no changes in serum creatinine or blood pressure after the conversion. Conslusion: More stable serum levels without adverse reactions were obtained with microemulsion cyclosporine. Doses of cyclos porine need not to be changed during the conversion
Subject(s)
Humans , Male , Female , Kidney Transplantation/rehabilitation , Cyclosporine/pharmacokinetics , Ketoconazole/pharmacokinetics , Azathioprine/administration & dosage , Prednisone/administration & dosage , Nitrendipine/administration & dosage , Follow-Up Studies , Immunosuppression Therapy/methodsABSTRACT
The purpose of this prospective study was to determine whether the course and prognosis of acute renal failure (ARF) in patients with and without sepsis are different. 252 (8 percent) of 3086 consecutive patients admited to a medical surgical intensive care unit (ICU) developed ARE. One hundred forty-nine (59 percent) were septic and 103 (41 percent) were non-septic. No differences were founded between groups regarding the incidence of oliguria, hyperkalemia, hypercatabolism, gastrointestinal bleeding, duration of oliguria and renal deficit, severity of azotemia, dialysis requirements and duration of stay in the hospital. There were statistically significant differences between septic and non septic patients with respect to hyponatremia (67.8 vs 54.4 percent, p<0.04), respiratory failure (68 vs 54 percent, p<0.04), and thrombocytopenia (64 vs 48 percent, p<0.02). Mortality in septic patients was higher than in non-septics (56 vs 42.7 percent, p<0.009). Factors associated with increased mortality in ARF septic patients were respiratory failure, metabolic acidosis and oliguria while in the non-septics they were hepatic dysfunction, hyperkalemia, respiratory failure and infection acquired during the course of renal failure. We conclude that ARF developing in septic patients has a higher mortality than that of non-septic patients, whereas the incidence of hypercatabolism and oliguria was not different between both groups
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Sepsis/complications , Acute Kidney Injury/complications , Sepsis/physiopathology , Acute Kidney Injury/physiopathologyABSTRACT
Se realizó una encuesta con preguntas dirigidas a evaluar una serie de aspectos en relación con los trasplantes de órganos, a un total de 83 médicos pertenecientes al Hospital Gustavo Fricke (primer semestre de 1993), de diversos servicios. Se recopilan los datos, comparando posteriormente los resultados entre los distintos servicios clínicos. Se concluye, entre otras cosas, que es necesario implementar programas específicos para la procura de órganos; que la mayoría de los médicos desconoce los téminos legales que se refieren a trasplantes y a muerte cerebral en Chile, y que, aunque la gran mayoría de ellos está dispuesto a donar sus órganos una vez fallecido, un ínfimo porcentaje ha realizado el trámite notarial respectivo
Subject(s)
Humans , Brain Death/diagnosis , Tissue and Organ Procurement , Organ Transplantation/psychology , Tissue Donors , Attitude of Health Personnel , Medical Staff, Hospital/psychology , Ethics, MedicalABSTRACT
Se presentan 50 casos de aneurismas cerebrales que requirieron clipaje temporal para su tratamiento, ingresados en el lapso entre abril de 1989 a abril de 1993 al Servicio de Neurocirugía del Hospital C. Van Buren, e intervenidos por el autor principal, L.Q. Se exponen las principales causas para utilizar clipaje temporal, entre las que destacan los aneurismas gigantes, la cirugía precoz y las cúpulas aneurismáticas de paredes delgadas y tensas adheridas a los tejidos o vasos sanguíneos vecinos. Se discute el plan de protección cerebral durante el clipaje temporal, nominado Cocktail de Valparaíso, utilizando etomidato, nimodipina y manitol, haciendo énfasis en que ningún paciente sufrió deterioro de su estado neurológico previo a la cirugía, como consecuencia del clipaje temporal. Se revisan en detalle las bases fisiopatológicas y farmacológicas para aplicar el Cocktail de Valparaíso como método de protección cerebral
Subject(s)
Adult , Middle Aged , Intracranial Aneurysm/surgery , Premedication , Etomidate/therapeutic use , Mannitol/therapeutic use , Nimodipine/therapeutic use , Surgical Procedures, OperativeABSTRACT
Se estudiaron 25 pacientes con insuficiencia renal en los que se utilizó un catéter de Uldall para hemodiálisis. De 32 catéteres usados la vía venosa de acceso fue yugular interna en 10, sublavia en 2 y femoral en 1 paciente. 9 catéteres se infectaron (28%). Los catéteres infectados tuvieron un tiempo de permanencia mayor (15 vs 13 días) (NS) y un mayor número de hemodiálisis (7 vs 5) (NS). En relación con la vía venosa de acceso, el catéter subclavio respecto del yugular interno fue más estable (16 vs 7 días) (p < 0.05) y se infectó menos (10% vs 20%) NS). Esta experiencia sugiere que al utilizar el catéter de Uldall para hemodiálisis es recomendable usar la vena subclavia y que el tiempo de permanencia del catéter no debería superar los 12 días