Thromboangiitis obliterans - case report.

Thromboangiitis obliterans (Buerger'€™s disease) represents an inflammatory disease of limbs'€™ small arteries and veins causing vascular thrombosis, and partial or total obstruction. It affects mostly male gender aged 40 years old. The peculiarity of our case is underlined by presenting a 62 years, chronic tobacco user and not compliant female patient known with thromb oangiitisobliterans for almost 15 years. The arteriographic and clinical features with concomitant and sever affected upper and lower limbs are highly suggestive, emphasizing the possibility of Buerger'€™s disease development even in female patients.

Giant condyloma acuminatum - Buschke-Lowenstein disease - a literature review.

AIM: Buschke-Lowenstein disease or giant condyloma acuminatum represents a rare, sexually transmitted disorder, with a slow evolution and the tendency to infiltrate in the adjacent tissues; untreated, the outcome is unfavorable. The hallmark is the development of one or various prominent-sized vegetant tumors that usually ulcerate. MATERIAL AND METHODS: The present article summarizes both the etiopathogenic features and the current approach of treatment management. RESULTS: Minimally invasive surgery along with local and systemic therapy is adequate in patients with small-sized lesions or high intraoperative risk. The main treatment remains extensive surgery with wide resection and often reinterventions to complete the excision. CONCLUSIONS: giant condyloma acuminatum represents a continuous surgical challenge, because of the need of exhaustive surgical procedures that should consider both the oncological principles and a better anatomical resolution. No standard treatment protocol can be established, because of the infrequency of the disease. Radical surgery including full thickness excision of the affected areas represents the "gold standard" therapy. Other known forms of treatment present unsatisfactory results without statistical significance, the studies having been conducted on small groups of patients. An adequate, long-term follow-up of Buschke-Lowenstein patients is highly recommended, because of the increased recurrence rate.

A rare case of watermelon stomach in woman with continuous ambulatory peritoneal dialysis and systemic lupus erythematosus.

We report a case of a 42-year-old woman with systemic lupus erythematosus and chronic kidney disease stage 5 undergoing continuous ambulatory peritoneal dialysis, presenting asthenia, dizziness, abdominal pain and small efforts dyspnea. After a complete physical and clinical examination, including laboratory tests, esophagogastroduodenal endoscopy and gastric lesions biopsy, she was diagnosed with gastric antral vascular ectasia. We are facing a rare case of antral vascular ectasia in a patient associating both chronic kidney disease and autoimmune disease.

Calcific uremic arteriolopathy in hemodialyzed patients.

In the present article, we discuss the case of 67-year-old female patient diagnosed with inferior limbs calciphylaxis and hemodialyzed since 2006. The clinical manifestations and pathological lab findings are typical for this rare and extremely severe complication in chronic hemodialyzed individuals. The favorable treatment response to sodium thiosulfate, not often used as elected therapy in international studies, represents the particularity of the case.

Oral treatment of metabolic acidosis in hemodialyzed patients and the implications on the hemodynamic status.

UNLABELLED: Metabolic acidosis slowly develops during renal impairment natural evolution towards ESRD and represents an important contributing factor of CKD progression. Although, several clinical and experimental trials reported the major impact of metabolic acidosis on CKD evolution, the pathophysiology mechanism remains a matter of debate. Furthermore, international guidelines do not impose a specific treatment scheme for metabolic acidosis in CKD patients, and metabolic acidosis is not fully compensated once hemodialysis starts. Therefore, the aim of our study was to determine an adequate follow-up of metabolic acidosis therapy benefits and risks in HD patients. PATIENTS AND METHODS: 164 HD patients were evaluated according to the following protocol: bioumoral laboratory tests, the measure of different important parameters (residual diuresis, UF, BP, LVMI, volemia status). The assessed data were statistic analyzed using non-paired Student's t-test for continuous variables and chi-square (χ²) test for qualitative parameters (p-value <0.05 was considered statistically significant). RESULTS: HD individuals were followed-up depending on their predialysis-alkaline reserve value. After therapy started, predialysis-alkaline reserve mean level increased from 19.4 mEq/L to 22.6 mEq/L (p<0.001). Furthermore, we observed a significant decrease of nitrogenous waste products values (T=10.87<1.66) and intradialytic hypotension events (p<0.001). CONCLUSIONS: Our findings emphasize the beneficial effects of correcting metabolic acidosis using the proposed treatment scheme with direct impact on hemodynamic status improvement.

Functional status of chronic renal replacement therapy in elderly patients--comparison between hemodialysis and peritoneal dialysis.

UNLABELLED: Nowadays, nephrologists are confronted with an increasing number of elderly patients diagnosed with end-stage renal disease (ESRD) in need of dialysis. The benefits of renal replacement therapy are uncertain in this group of patients. Most studies show that the quality of life and survival of elderly dialyzed patients are worse than in younger patients because of multiple comorbidities. Functional status is an important aspect of the quality of life, a strong predictor of survival and a determinant of the health care systems costs. METHOD: In the present research, we compare the change in the functional status--appreciated with the MDS-ADL score--in a cohort of hemodialyzed versus peritoneal dialyzed elderly patients (> 65 years) during a period of 3 years after starting dialysis treatment. RESULTS: At the time of initiating dialysis, the median minimum data set of activities of daily living (MDS-ADL) score in hemodialysis (HD) elderly patients was 4.04 and in continuous ambulatory peritoneal dialysis (CAPD) group was 6.27 (the median MDS-ADL score at the moment of starting dialysis was statistically significant higher in peritoneal group than in hemodialysis elderly group). CONCLUSIONS: The results conclude that elderly treated with peritoneal dialysis have a better evolution of functional status than hemodialyzed elderly patients do.

Vascular calcifications in chronic kidney disease--clinical management.

Chronic kidney disease (CKD) patients could present various types of calcifications causing different pathological conditions that would contribute to the renal disease progression and high risk of mortality. Extra-skeletal calcifications represent a common consequence of mineral bone disorders in CKD patients. Vascular calcifications represent a complex systemic manifestation caused by phospho-calcium homeostasis disorders, by imbalance among promoters and inhibitors of calcification and the presence of various arterial diseases and other risk factors. Consequently, vascular calcification can be considered an active pathological process that resembles osteogenesis. Therefore, before starting a suitable therapy for the prevention or delay of vascular calcifications, our recommendations are: to perform lateral abdominal radiography or CT-based techniques in CKD stages 3-5 patients for an early vascular calcification detection, to assess thoroughly patients presenting hyperphosphatemia, hyperparathyroidism, vitamin D deficiency and to understand clearly the pathophysiology of arterial calcification and calciphylaxis.

Potassium level changes--arrhythmia contributing factor in chronic kidney disease patients.

UNLABELLED: As the renal function progressive decline is often correlated to diuresis impairment, potassium level changes represent a major pathophysiological factor in monitoring chronic kidney disease. Even more, potassium level imbalance could lead to life-threatening situations with the risk of severe rhythm disorders appearance. The aim of the study was to determine in which degree the serum potassium changes are implicated in arrhythmias development in CKD patients. PATIENTS AND METHODS: We included 678 CKD patients (predialysis and dialysed patients) to whom we recorded biohumoral and clinical features in correlations with the possibility of arrhythmias genesis. RESULTS: we noticed, in our predialysis group, an important correlation between hyper-/hypokalemia and arrhythmias appearance, more frequent during hypokalemia episodes (OR=4.04, respectively OR=7.5). The same situation was observed in chronic dialysis group. CONCLUSIONS: Hypokalemia is a stronger risk factor than hyperkalemia, but all together, any minimal changes in serum potassium levels could determine arrhythmia in CKD patients.

Correlation between albuminemia, natremia and survival rates in patients with hepatorenal syndrome.

A two years prospective study was developed, based on the monitoring of 84 patients with cirrhosis and elevated serum creatinine; 33 patients met the diagnostic criteria for the hepatorenal syndrome. In these 33 patients, survival rate has been studied in correlation with hepatorenal syndrome types, serum albumin and natremia.

Massive cortico-subcortical ischemic stroke with a consecutive hemorrhagic event: a case report.

BACKGROUND: We report a case of a 78-year-old woman with a large cerebral infarction probably due to athermanous embolism following atrial fibrillation. CASE DESCRIPTION: The patient, known with atrial fibrillation, high blood pressure and heart failure, complained of headache and motor impairment on the left side of the body. CT imaging revealed a subacute ischemic lesion in the right fronto-occipital lobes, and an old ischemic lesion in the right fronto-parietal lobes. Anticoagulant treatment was conducted with careful monitoring of the coagulability status. After almost three weeks, suddenly the patient became comatose and died shortly after. Macroscopic and microscopic examination confirmed the cortico-subcortical ischemic lesions, but also identified a fresh hemorrhagic site in pons, distant from the initial lesion sites. An immunohistochemical study identified blood vessels in the ischemic sites completely isolated from any glial support. CONCLUSIONS: This is a rare case of a large cerebral infarction with a pontine hemorrhagic event.

New mediators of vascular damage in dialysed patients.

Cardiovascular events are the main causes of mortality in dialysed patients. Traditional risk factors such as hypertension, aging, smoking, diabetes, and abnormal lipid metabolism does not fully explain the high frequency of cardiovascular disease in renal patients, indicating that some other distinct pathogenesis may be involved. Vascular calcification have been associated with high cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. It is an active process that resembles osteogenesis, regulated by bone proteins and osteoblast-like cells. Elements involved in the pathogenesis are: the risk factors that initiates the process, the promoters released and overexpressed and the dysregulation of the inhibitor factors of extraskeletal calcifications. Although researches in the past decade have greatly improved our knowledge of the multiple factors and mechanisms involved in vascular calcification, many questions remain unanswered.

[The role of ultrasonography exam in orbital-ocular tumors]. / Rolul examenului ecografic în cazul tumorilor oculoorbitare.

Ophthalmology is one of the specialties that have particularly benefited from the contribution of ultrasonography exam as a method of investigation. Ultrasonography is very much essential for diagnostic to complement other clinical and laboratory investigations, providing images in real time. The basic principle of diagnostic ultrasound is to study and to interpret the changes they undergo when crossing ultrasonic waves diverse biological properties different sound, and such injuries can be traced in the dynamics or can be documented on photographic paper and thus can diagnose correct certain eye diseases. The indications for performing ultrasound consist in: measurement of distances and volumes, examine difficult or inaccessible case of opaque media; ophthalmoscopic view of a mass lesion, examine the orbit or optic nerve. The advantages of ultrasound for orbital-ocular tumors are represented by the fact that ultrasound is a noninvasive method, safe, well tolerated, less expensive that the advantage of determining the position and distance from structures ocular tumor. High frequency ultrasound provides excellent resolution of 0-1 to 0.01 mm, and serial scans allow tracking progress and measuring lesion diameters tumor while allowing monitoring and evaluation of stereotactic radiation treatments applied to small tumors. In conclusion ultrasound allows not only early diagnosis of eye tumors, but accurate assessment of the proposed therapy and of the evolution of detected mass lesions or tumors.

Chronic complications in hemodialysis: correlations with primary renal disease.

Although hemodialysis technique has improved in the last decades and the accessibility to this life-sustaining treatment modality increased rapidly, we are still concerned about the morbidity and mortality rates of dialysis patients. While technical advances are increasing the efficacy and safety of renal replacement therapies, latest studies are focused on other outcomes: increasing survival rates and the quality of life by an adequate management of the complications in chronic renal patients. This article reviews the complications of chronic hemodialysed patient with special considerations for the role of the primary renal disease that caused renal failure.

[Management of the chronic renal patient undergoing surgery]. / Managementul medico-chirurgical la bolnavii renali cronici.

Surgery in a chronic renal failure patient carries a substantial higher risk then in normal renal function individuals. This is due to more frequent bleeding and infectious complications, intravascular volume impairments, side effects of anesthesia and others. Development of dialysis technique increased the number of patients receiving treatment for end stage renal disease; their prolonged survival rates, as well as the high percentage of co-morbid conditions will continuously raise the need for surgery in patients with chronic renal failure. The complex and difficult management of these patients requires close cooperation of intensive care specialists and nephrologists, in order to reconcile their frequently opposing views.