Résumé
Central pontine myelinolysis (CPM) is a rare syndrome, especially in uremic patients undergoing dialysis. CPM induced by diabetic coma in hemodialysis patients or associated with rapid correction of hyponatremia in peritoneal dialysis patients have been reported. However, its pathogenesis has been unclear. We report a case of CPM in a 67-year-old female uremic patient undergoing continuous ambulatory peritoneal dialysis, who was admitted to our hospital for drowsy mentality. Sodium was normal (140 mEq/L) initially and throughout the entire clinical course. The fasting blood sugar level was 110 mg/dL, serum osmolality 312 mOsm/KgH2O and osmolar gap 9.47. The axial T2-weighted brain MRI showed high signal intensity in the basal pons.
Sujets)
Sujet âgé , Femelle , Humains , Glycémie , Encéphale , Coma diabétique , Dialyse , Jeûne , Hyponatrémie , Imagerie par résonance magnétique , Myélinolyse centropontine , Concentration osmolaire , Dialyse péritonéale , Dialyse péritonéale continue ambulatoire , Pont , Dialyse rénale , SodiumRésumé
Colorectal varix (CRV) is a rare cause of lower gastrointestinal bleeding and usually associated with portal hypertension from liver cirrhosis or portal venous obstruction. Idiopathic CRV have no identifiable underlying cause and can only be diagnosed after the cause of portal or mesenteric vein circulation have been excluded. We report a case of idioipathic CRV presented with rectal bleeding for a week. Colonoscopy revealed markedly dilatated tortuous, and bluish veins in the rectum as well as coexistent adenomatous polyp and internal hemorrhoid. Despite extensive investigation, there was no evidence of portal hypertension or any other cause. Family history was also negative. Although blood transfusions were required, the patient remained asymptomatic without further rectal bleeding.
Sujets)
Humains , Polypes adénomateux , Transfusion sanguine , Coloscopie , Hémorragie , Hémorroïdes , Hypertension portale , Cirrhose du foie , Veines mésentériques , Rectum , Varices , VeinesRésumé
Although central vein stenosis associated with vascular access is relatively common in a hemodialysis patient, innominate vein stenosis is very rare. We here report a case of innominate vein occlusion treated successfully by percutaneous transluminal angioplasty with endovascular stent in a hemodialysis patient. A 61-year-old woman on hemodialysis developed progressive swellingof and headache. She had an history of subclavian vein catheterization. Venography disclosed totally obstructed left innominate vein, multiple collaterals and retrograde flow into left internal jugular vein. Percutaneous transluminal angioplasty with endovascular stent was performed. Venography performed after this procedure showed complete resolution of collaterals and no residual stenosis and arm swelling and headache disappeared.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Angioplastie , Bras , Veines brachiocéphaliques , Cathétérisme , Cathéters , Sténose pathologique , Céphalée , Veines jugulaires , Phlébographie , Dialyse rénale , Endoprothèses , Veine subclavière , VeinesRésumé
Although excessive arteriovenous fistula blood flow may be a factor in the development of high-output cardiac failure, this diagnosis is easily over-looked. Surgical reduction of fistula blood flow can improve the condition. We here report a case of high-output cardiac failure due to excessive arterio-venous fistula blood flow in a hemodialysis patient. A 51-year-old man who had been treated with hemodialysis since 5 years ago was admitted for increasing cardiac failure. Echocardiographic evaluation of cardiac output and duplex measurement of the fistula confirmed the diagnosis of high-output cardiac failure due to excessive arteriovenous fistula blood flow. After surgical closure of the fistula, the signs and symptoms of cardiac failure subsequently subsided and both systolic and diastolic dimension of left ventricle much decreased.