Acute kidney failure after intra-articular use of gentamicin sponge.

An 83-year-old man developed acute kidney failure after intra-articular use of gentamicin sponges for a periprosthetic hip infection. Haemodialysis was necessary for clearance of gentamicin, and for kidney function replacement. It is important to be aware that there is a risk of renal toxicity due to gentamicin when using a locally applied sponge.

Life-threatening hypokalaemic paralysis associated with distal renal tubular acidosis.

A 56-year-old woman developed acute respiratory failure requiring mechanical ventilation due to acute hypokalaemic paralysis. There was no gastrointestinal potassium loss nor was she taking diuretics. Additional analyses revealed a normal anion gap metabolic acidosis with a positive urine anion gap. An acid-load test revealed a renal urine acidification defect, leading to the diagnosis of distal renal tubular acidosis. Normalisation of serum potassium level was established with oral bicarbonate supplementation and temporary potassium supplementation.

Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation.

Retroperitoneal fibrosis (RPF) is a rare disorder of unknown etiology. Its incidence is unknown, and the insidious and nonspecific nature of symptoms may contribute to considerable diagnostic delay. We conducted the current study to assess the incidence and clinicoradiologic characteristics of idiopathic RPF. For this, we evaluated prospectively 53 consecutive patients with a diagnosis of idiopathic RPF at our tertiary care referral center from April 1998 through January 2008.Calculated annual incidence of RPF was 1.3/100,000 inhabitants. Mean age was 64 +/- 11.1 (SD) yr; male-female ratio was 3.3:1.0. Median duration of symptoms was 6.0 mo (IQR 3.0-12.0). Abdominal, flank, and/or back pain and discomfort were the major symptoms, with visual analogue scale scores of 49 +/- 27.2 mm and 43 +/- 29.4 mm for pain and discomfort, respectively. Female patients had higher erythrocyte sedimentation rate (ESR), higher white blood cell count, and lower hemoglobin content than male patients at presentation. Computed tomography-documented maximal mass thickness amounted to 35 +/- 16.6 mm; craniocaudal length amounted to 137 +/- 48.8 mm. RPF mass extension up to or above the level of the renal vessels was noted in 3 patients (6%). Six patients (11%) presented with atypical RPF localization and/or bulky mass. Localized lymphadenopathy adjacent to the RPF mass was observed frequently (25%). Patients with hydronephrosis (56%) presented earlier than patients without hydronephrosis, with higher creatinine and greater mass thickness but similar pain severity. Patients were typically at high cardiovascular risk with increased-often aneurysmal-infrarenal aortic diameter (25.0 mm, IQR 22.0-30.0). RPF mass distribution was similar in patients with or without aneurysmal dilation. Occupational asbestos exposure (20%) and asbestos-related pleural changes (17%) were frequent among males. Previous or concurrent chronic inflammatory disease and/or autoimmune disease was noted in 8 patients (15%). Multivariate analysis revealed an independent association of ESR values with severity of pain and discomfort. Smoking was independently associated with infrarenal aortic diameter.In summary, annual RPF incidence is higher than previously assumed. Age at diagnosis and male-female ratio seem to have changed over time. RPF typically affects patients at high cardiovascular risk, including increased aortic diameter. Clinical presentation is influenced by sex, severity of inflammation and presence of hydronephrosis. Prolonged asbestos exposure and asbestos-related pleural changes were frequent among males. Localized lymphadenopathy adjacent to the RPF mass occurs frequently and should not confuse RPF diagnosis.

[A localized reaction to sublingual immunotherapy]. / Een lokale bijwerking van sublinguale immunotherapie.

An otherwise healthy 31-year-old woman with allergic rhinoconjunctivitis developed considerable swelling of the floor of her mouth after sublingual allergen-specific immunotherapy with the hyposensitization product 'Slit One grass pollen'. After discontinuation, complaints disappeared and she was successfully put on a regimen of subcutaneous immunotherapy. Despite a lack of reports of serious adverse reactions in clinical trials, the Inspectorate of Health Care and The Netherlands Pharmacovigilance Centre Lareb received several reports of sometimes serious localized reactions to oral and sublingual allergen-specific immunotherapy. Under-reporting is likely since local reactions are more or less expected. Caution should be exercised with allergen treatment, even in the case of non-invasive administration.