ABSTRACT
Although radiocephalic arteriovenous fistula (AVF) is the method of choice for hemodialysis (HD) vascular access, it continues to have a high incidence of early failure due to delayed or failed venous maturation. Here we report an unusual case of delayed maturation of AVF due to radial artery obstruction in a patient receiving radiocephalic AVF. A 53-year-old woman had received radiocephalic AVF operation for hemodialysis. Venous maturation of the AVF did not occur 2 months after the operation. Fistulography via brachial artery approach demonstrated non- visualization of radial artery, anastomosis of radial side of palmar arch and cephalic vein and mild stenosis of the anastomosis site at left wrist area. We thought that we could not use the AVF for HD due to inadequate arterial blood flow and decided to make new vascular access. The patient received brachial-basilic AVF operation again. Adequate maturation of the AVF was successfully made 1 month after the operation. Therefore, we think that radial artery obstruction may be a possible cause of delayed maturation of AVF.
Subject(s)
Female , Humans , Middle Aged , Arteriovenous Fistula , Brachial Artery , Constriction, Pathologic , Incidence , Radial Artery , Renal Dialysis , Veins , WristABSTRACT
Extended-spectrum beta-lactamase (ESBL) producing bacterial infection causes delayed response to antibiotic treatment and consequently results in serious problem, because it can hydrolyze the majority of beta-lactam antibiotics. Here we report a case of multiple renal abscess by ESBL producing Escherichia coli in a patient with diabetes mellitus who had a history of repetitive urinary tract infection. A 49-year old woman was admitted to our hospital because of intermittent fever, left flank pain, and vomiting. She had been diagnosed as acute pyelonephritis and treated with the first and third cephalosporin for 1 month at a clinic. At admission, urinary bacterial culture revealed Escherichia coli resistant to both the first and third cephalosporin such as cefotaxime, ceftriaxone, and ceftazidime. Double disk synergy test confirmed ESBL. Abdominal computed tomography demonstrated multiple renal abscess. After treatment of imipenam for 4 weeks, she discharged with improved condition.
Subject(s)
Female , Humans , Middle Aged , Abscess , Anti-Bacterial Agents , Bacterial Infections , beta-Lactamases , Cefotaxime , Ceftazidime , Ceftriaxone , Diabetes Mellitus , Escherichia coli , Escherichia , Fever , Flank Pain , Pyelonephritis , Urinary Tract Infections , VomitingABSTRACT
Fibromuscular dysplasia (FMD) is an uncommon hyperplastic disorder affecting medium-sized arteries. It can lead to renovascular hypertension, sometimes associated with dissection. But it rarely causes renal infarction. We here report a case of recurrent renal infarction due to FMD. A previously healthy 29- year-old man presented with acute onset of right flank pain. He had been treated for the same symptom 8 years ago. Abdominal CT scan showed renal infarction at upper pole of right kidney. Renal arteriography demonstrated string of bead, consistent with FMD. It showed also old renal infarction at lower pole of right kidney. To our knowledge, recurrent renal infarction due to FMD has not been previously reported.