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]

causes, prevention and management of post spinal backache: an overview

Back pain is one of humanity's most frequent complaints, a common reason for physician visits and a major psychological, physical and economical burden. Although the frequency of backache is as high as 46% even after general anaesthesia, it was the major cause for 13.4% patients refusing spinal anaesthesia. Multiple factors are involved in the pathogenesis of postoperative back pain and include type and duration of surgery, duration of immobilization, and the position of the patient during spinal puncture. Diagnosis of back pain is not simple; contributing factors may include needle trauma, surgical positioning, and injection of saline or local anaesthetic into the interspinous ligaments, development of a supraspinous hematoma, excessive stretching of ligaments after relaxation of paraspinal muscles and localized trauma to the intervertebral disc. Its relationship with various types and sizes of spinal needle is yet to be confirmed. Some preventive aspects have been discussed. Acute post spinal backache usually resolves within 7 days without any treatment but the possibility of epidural abscess or epidural hematoma must be ruled out. Counselling, hot and cold massage, mild analgesics like paracetamol or topical NSAIDs ointments may be prescribed

Administration of local anaesthetics through epidural needle before catheter insertion does not improve the quality of anaesthesia or reduce catheter related complications

The objective of this study was to compare the effect of injecting local anaesthetics through epidural needle and catheter on quality of anaesthesia and catheter related complications. We randomized 60 patients into 2 equal groups; in the Needle Group [n=30], catheters were inserted after injection of a full dose of local anesthetic through the needle. In the Catheter Group [n=30], the catheters were inserted immediately after identification of the epidural space; local anesthetic was then injected via the catheter. The groups were compared for paresthesias, inability to advance the catheter, intravenouos or subarachnoid catheter placement; sensory and motor block were assessed 20 min after the injection of local anesthetic. Statistical analysis was performed by SPSS for Windows [version 10.0] Patient characteristics were analyzed using the t-test for independent groups. Block height, perioperative anesthesia quality and incidences of catheter related complications were analyzed using chi square test. Thoracic level sensory block and motor block was comparable in both the groups. Frequency of paresthesia during catheter placement was comparable; [23.3% versus 13.3% P=0.3]. Intra-vascular catheterization occurred in 23.3% versus 10% of patients in the catheter and needle groups, respectively [P=0.166]. Excellent surgical conditions were statistically similar in both the groups. Injecting local anaesthetic through the epidural needle before catheter placement does not reduce catheter-related complications or improve the qualityof epidural anesthesia