RESUMO
Encapsulating peritoneal fibrosis (EPF) is a serious, uncommon complication of chronic peritoneal dialysis. However, it is rare in hemodialysis patients. EPF is characterized by peritoneal membrane inflammation followed by peritoneal membrane fibrosis and encapsulation. The etiology is unclear, but inflammation of the deteriorated peritoneum causes peritoneal fibrosis. We present a case of EPF that occurred in a 29-year-old man with hepatitis B-associated liver cirrhosis with ascites that was treated solely with hemodialysis. We managed this patient surgically and then medically with prednisolone. To our knowledge, this is the first such case in Korea, so we report this case with a literature review.
Assuntos
Adulto , Humanos , Ascite , Fibrose , Hepatite , Inflamação , Coreia (Geográfico) , Cirrose Hepática , Membranas , Diálise Peritoneal , Fibrose Peritoneal , Peritônio , Prednisolona , Diálise RenalRESUMO
Formic acid or formate is a common industrial compound used in the production of ensilage, disinfectants, decalcifying agents and mainly as a precursor in industrial chemical synthesis. It is also a well-known toxic metabolite produced in methanol poisoning. Thus, formate is a potential source of both accidental and deliberate poisoning. Very few reports have been published thus far, on the toxicology of direct formic acid poisoning. Here, we report a case of a 74-year-old man without a history of depression, who ingested about 30 gm of formic acid. The patient presented with profound high anion gap metabolic acidosis, acute renal failure and esophageal stricture. The patient was successfully treated with hemodialysis and supportive measures. But permanent esophageal stricture was complicated by formic acid burns in the gastrointestinal tract. We discuss the pathophysiology and treatment of this case.
Assuntos
Idoso , Humanos , Equilíbrio Ácido-Base , Acidose , Injúria Renal Aguda , Queimaduras , Depressão , Desinfetantes , Estenose Esofágica , Formiatos , Trato Gastrointestinal , Metanol , Diálise Renal , ToxicologiaRESUMO
BACKGROUND: Because of the rate of infection, NKF-K/DOQI guidelines recommended that uncuffed catheter (UC) should be used for no longer than 3 weeks. However, from data of the Dialysis Outcomes and Practice Patterns Study (DOPPS), it was recognized that 48% of new HD patients in US and 75 % in Europe use UC as temporary access. ALT has been recommended as a prevention of CRB in these patients. We prospectively evaluated the efficacy of catheter-restricted filling with Antibiotic Lock Solution in preventing CRB. METHODS: One hundred twenty new hemodialysis patients requiring temporary catheter while waiting for placement and maturation of an arteriovenous fistula were enrolled. Patients were excluded if they had clinical or microbiological evidence of infection or already received antibiotics. Patients with uncuffed, right internal jugular vein catheter were randomly assigned to receive either antibiotic-heparin lock solution (cefazolin 10 mg/mL, gentamicin 5 mg/ mL, heparin 1, 000 unit/mL) or heparin lock solution (heparin 1, 000 unit/mL) as a catheter lock solution during interdialytic period. The end point of the trial was CRB. RESULTS: CRB developed in seven (11.7%) patients receiving heparin lock solution (S. aureus 2, S. epidermidis 5) whereas one patient receiving ALT had S. aureus bacteremia. CRB rates per 1, 000 catheter-days were 0.44 in the ALT group versus 3.12 in the heparin lock solution group (p=0.031). Kaplan-Meier analysis also showed CRB-free catheter survival is longer in ALT group. CONCLUSION: These results showed that ALT could be an effective strategy for the reduction of CRB rate in hemodialysis patients with UC.
Assuntos
Humanos , Antibacterianos , Fístula Arteriovenosa , Bacteriemia , Catéteres , Diálise , Europa (Continente) , Gentamicinas , Heparina , Veias Jugulares , Estimativa de Kaplan-Meier , Estudos Prospectivos , Diálise RenalRESUMO
PURPOSE: The increased prevalence and incidence of end-stage renal disease (ESRD) in the elderly has become a worldwide phenomenon. New cases of ESRD are growing faster among people aged older than 70 years. We studied in order to investigate the survival rate, technical survival rate, causes of death and the predictors of death in patient starting hemodialysis aged over 70 years. METHODS: We analyze 34 patients who started hemodialysis as an initial replacement therapy for chronic renal failure in Kangnung Asan Hospital between July 1996 and July 2001. Demographic and clinical characteristics, including diabetes mellitus and laboratory findings at the beginning of hemodialysis were retrospectively analyzed. All subjects were followed up until the point of assessment, the time of death or withdrawal from dialysis. The survival rate was calculated by Kaplan-Meier method. In order to determine independent predictors of death, we used Cox proportional hazard model. RESULTS: The median age of the patients was 74.5 years and sex ratio was 2.4:1 (M:F). The most common cause of ESRD was diabetes (35.5%) and obstructive uropathy was second. The mean follow-up period was 18.6+/-2.5 months and cardiac problems were major causes of death (37.5%). The survival rate of 34 patients was 84.9% at 1 year, 72.8% at 2 year and 56.6% at 5 years. The technical survival rate of 34 patients was 54.7% at 1 year, 48.6% at 2 year and 30.1% at 4 years. The predictors of death were found to be (i) age starting hemodialysis (RR=1.685, p=0.018) (ii) female (RR=18.5, p=0.028) (iii) low initial hemoglobin level (RR 0.233, p=0.009). CONCLUSION: Very elderly ESRD patients on dialysis have a relatively good outcome and age is not barrier to dialysis. Measures to improve quality of life of elderly hemodialysis patients may favorably influence their survival.
Assuntos
Idoso , Feminino , Humanos , Causas de Morte , Diabetes Mellitus , Diálise , Seguimentos , Incidência , Falência Renal Crônica , Prevalência , Modelos de Riscos Proporcionais , Qualidade de Vida , Diálise Renal , Estudos Retrospectivos , Razão de Masculinidade , Análise de Sobrevida , Taxa de SobrevidaRESUMO
Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.