Pulmonary renal syndrome in a patient with vasculitis: case report and review of literature

Granulomatosis with polyangiitis [GPA] previously known as Wegner's granulomatosis, is a small vessel vasculitis that preferentially involves capillaries, arterioles and venules, presenting as multisystemic disease classically with alveolar haemorrhage and renal insufficiency. We report a case of GPA diagnosed on history, clinical findings and supported by imaging and very high levels of C-ANCA. Renal biopsy confirmed the typical histopathological findings. We discuss herein the management of the case and review of literature

Temporary hemodialysis; taurolidine lock to prevent catheter-related blood stream infections

Catheter related blood stream infections [CRBSI] in patients undergoing hemodialysis frequently results in significant morbidity and mortality. Attempts at prevention of CRBSI by catheter lock antibiotics, antibiotic combinations or solutions including Taurolidine have emerged over years. Objectives: To determine the role of taurolidine lock in presentation of Catheter related infection in hemodialysis. Design: Multicentre un-builded, r and omized controlled, non-inferiority trail. Period: Jul 2012 to Dec 2013. Setting: Department of Nephrology, Fatima Memorial Hospital UHS Lahore. Methods: It was a multicentre, un-blinded, r and omized controlled, non-inferiority trial. Results: Out of 95 patients, total of 38 patients were r and omized into two groups. In group A catheters were locked with Taurolidine 2% and Heparin [5000IU/ml] equal to the catheter volume according to the protocol. In group B [control] catheters were locked with Heparin alone. 36 patients completed the study protocol. For primary end point analysis [30 days] the mean duration of catheter days was 27.25 + 5.5 days [median 30 days]. During this period of follow up only one patient from Group B had CRBSI resulting in a point incidence of CRBSI of 2.7%. Conclusions: Catheter lock with Taurolidine 2% in combination with heparin compared to heparin alone had no additional benefit in prevention of CRBSI. This however needs to be evaluated in a larger study using non cuffed temporary vascular access [TVA]

Cerebral salt wasting: a report of three cases

Hyponatremia secondary to the Syndrome of Inappropriate Anti-Diuretic Hormone [SIADH] secretion is commonly observed in patients with various neurological disorders. Cerebral Salt Wasting [CSW] resulting in hyponatremia is also an infrequent occurrence in some patients with neurological disorders. Confusion in differentiating CSW from SIADH may arise since both results in similar electrolyte disturbances. Herein, we report three cases of CSW with intracranial afflictions. CSW was diagnosed on the basis of fractional excretion of urinary sodium and uric acid along with extremely low serum uric acid. Improvements in serum sodium levels after saline hydration and fludrocortisone administration further supported the diagnosis

Two stage brachio-basilic transposition fistula provides superior patency for chronic haemodialysis: our experience in SIMS/ SHL

Background: Adequate vascular access is of utmost importance for hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair cannulation and can cause significant complications and inconvenience for the technicians and patients

Objective: We intended to present the technique of superficialization [transposition] of the brachiobasilic fistula [BBF] and its clinical outcome regarding patency and complications

Materials and Methods: Twenty two brachiobasilic fistulas were fashioned in 20 patients between October 2010 to November 2011.The second stage superficialization [transposition] was carried out at a median of 59.1 days [range: 40-90 days] after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the antero-medial aspect of the arm and transposing it beneath skin

Results: During the study period 20 brachiobasilic fistulas [BBF] were fashioned in 20 patients. There were 8 [40%] males and 12 [60%] females. The mean age was 53.45years + 12.34 years [range: 21-70years]. The patency rates were 90% at 6 months. Surgical complications of transposition were infection in 2 [10%] patients and lymphocoele in 4 [20%] patients

Conclusion: Transposition of brachiobasilic fistulas is technically feasible and relatively safe procedure. Patency rates at 6 months are excellent

Renal involvement in acute gastroenteritis; Our population at presentation and its outcome with follow up for six months

Acute renal failure is one of the important complications of acute gastroenteritis. Early intervention and proper fluid replacement may lessen this risk. We conducted this observational study to see the renal involvement and its outcome in patients with acute gastroenteritis. Observational study. This study was done in three different hospitals which are tertiary care and teaching hospitals. May 2009 to September 2009. A total of 200 patients were included in this study who presented with acute gastroenteritis. All patients were assessed properly for their clinical examination and laboratory tests including renal functions, electrolytes and other routine tests were done and evaluated. These patients were treated either in Emergency department or indoor departments. Only those patients were included in our study who met our inclusion criteria which was set before conducting study. A total of 200 patients were included in our study, among them 160 were male patients and 40 were female patients. At presentation 32 [16%] patients had deranged renal functions, 18 [09%] patients had urea in range of 50-100 mg/dL and creatinine in the range of 1.4-2.0 mg/dl. 10 [05%] patients had urea in range of 101-150mg/dL and creatinine 2.1-3.Smg/dl. 04 [02%] patients had urea in range of 151-200 mg/dl and creatinine 3.6-7.0mg/dL. 12 patients were received in hypovolemic shock at presentation. After one week of follow up most of these patients improved but 04 patients were deteriorated and put on renal replacement therapy. Patients who had their renal functions in normal range were discharged from hospital and follow up of all these patients were continued for 6 months. lt was observed that those patients which presented late had more chances of renal involvement. Early referral and timely management with fluids and antimicrobials may reduce risk of renal failure in patients with acute gastroenteritis.

Need for chest tube after video assisted thoracoscopic [VATS] lung biopsy

To observe the effects of early removal of chest tube drain after video assisted thoracoscopic [VATS] lung biopsy. We prospectively evaluated the removal of chest tube drain at six hours or 24 hours after the VATS-lung biopsy in fifty consecutive patients with no evidence of air leak after the lung biopsy. Our results show that removal of chest tube drain at 6 hours was not associated with complications such pneumothorax, atelectasis or pleural effusion as compared to the 24 hours removal of the drain[p>0.05]. Early removal of chest tube drain is safe in patients where air leak has been documented to be absent. Since it was a non-randomized evaluation, further randomized study in our population is needed to confirm these findings