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1.
Neth J Med ; 76(3): 125-128, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29667588

RESUMO

The Netherlands Pharmacovigilance Centre Lareb has received two reports of cholesterol crystal embolisms associated with the use of a direct oral anticoagulant (DOAC). The European pharmacovigilance database contains several other cases concerning this association, and one report was published in the scientific literature. Cholesterol crystal embolisms were described in association with the use of several other antithrombotic drugs, although the role as an independent risk factor is not conclusive. The case series described in this article, indicates the possibility of an adverse drug reaction when a patient develops cholesterol crystal embolisms while using a DOAC.


Assuntos
Anticoagulantes/efeitos adversos , Antitrombinas/efeitos adversos , Embolia de Colesterol/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Bases de Dados Factuais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Masculino , Países Baixos , Farmacovigilância
2.
Ned Tijdschr Geneeskd ; 162: D2077, 2018.
Artigo em Holandês | MEDLINE | ID: mdl-29519257

RESUMO

BACKGROUND: Infected joint replacements can be treated with gentamicin-containing materials for implantation. This may lead to side effects, especially in patients with impaired renal function. CASE DESCRIPTION: A 74-year-old woman underwent two surgeries for an acutely infected hip replacement. Gentamicin sponges (Garacol) were implanted during both interventions. The day after the second operation, her serum gentamicin levels had risen to toxic values. This confirmed the suspicion that she had a kidney impairment which was probably caused by the implanted gentamicin-containing sponges. In order to limit kidney damage, the patient received continuous venovenous haemodiafiltration (CVVHD). Outpatient check-up 3 months later found that the creatinine levels in the serum of the patient had normalised. CONCLUSION: Locally administered gentamicin sponges for implantation can cause therapeutic serum levels leading to systemic side effects. It is advisable to check kidney function before using the sponges. If this is reduced, it is recommended to be cautious when using these sponges for implantation. In case of toxic elevated values, CVVHD can limit kidney damage - which is reversible, given time - by accelerating gentamicin excretion.


Assuntos
Antibacterianos/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Gentamicinas/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Insuficiência Renal/induzido quimicamente , Idoso , Animais , Antibacterianos/administração & dosagem , Implantes de Medicamento/efeitos adversos , Feminino , Gentamicinas/administração & dosagem , Humanos , Infecções Relacionadas à Prótese/cirurgia , Tampões de Gaze Cirúrgicos
4.
Clin Nephrol ; 69(3): 219-20, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18397722

RESUMO

A hemodialysis patient is described who was suffering from headache during his dialysis sessions. This was due to a neovascular glaucoma causing an increase in intraocular pressure (IOP) during dialysis sessions. After several months his headache decreased but his IOP measurements remained high with almost similar pre- and post dialysis values. Headache during hemodialysis may be due to glaucoma, but this can disappear with time, along with a disappearance in the increase in IOP during dialysis sessions.


Assuntos
Glaucoma Neovascular/complicações , Cefaleia/etiologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Idoso de 80 Anos ou mais , Seguimentos , Glaucoma Neovascular/fisiopatologia , Humanos , Pressão Intraocular , Falência Renal Crônica/complicações , Masculino , Remissão Espontânea , Fatores de Tempo
6.
Neth J Med ; 59(1): 35-8, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11438198

RESUMO

A patient is described with the tubulointerstitial nephritis with uveitis syndrome. The diagnosis can be difficult since it has to be differentiated from sarcoidosis, or infections like tuberculosis and toxoplasmosis. Our patient showed prompt recovery of fever, ocular symptoms and renal function after starting corticosteroids.


Assuntos
Eosinofilia/complicações , Nefrite Intersticial/complicações , Tireoidite/complicações , Uveíte/complicações , Adulto , Feminino , Humanos
7.
Ann Rheum Dis ; 60(7): 699-701, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11406527

RESUMO

Three patients are described with severe systemic atherosclerosis, including aortic occlusion, in the presence of a spectrum of risk factors, including hypercholesterolaemia, hypertension, a positive family history of cardiovascular problems, and hyperhomocysteinaemia. In all three patients high levels of anticardiolipin antibodies were found. The possible pathogenic role of antiphospholipid antibodies in atherosclerosis in the context of hyperhomocysteinaemia in these patients is discussed.


Assuntos
Anticorpos Anticardiolipina/análise , Arteriosclerose/complicações , Hiper-Homocisteinemia/complicações , Adulto , Aortografia , Arteriosclerose/diagnóstico por imagem , Arteriosclerose/imunologia , Artéria Celíaca/diagnóstico por imagem , Feminino , Humanos , Hiper-Homocisteinemia/diagnóstico por imagem , Hiper-Homocisteinemia/imunologia , Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Hipertensão/imunologia , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Fumar
8.
Clin Nephrol ; 55(3): 227-32, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11316243

RESUMO

AIM: Many patients with end-stage renal disease are eligible for renal transplantation. To enable a patient to choose between transplantation or to remain on dialysis comparable data on morbidity and mortality should be available. METHODS: Data were collected retrospectively from the medical records of all patients on the waiting list for renal transplantation and of transplanted patients during the period January 1, 1990, to January 1, 1997. All patients were dialyzed in the Kennemer Gasthuis and renal transplantation was performed in the Leiden University Medical Center (LUMC). Morbidity and mortality in both groups were compared. Morbidity was assessed by studying number, length and cause of hospital admissions. RESULTS: During the study period 102 patients had been on the waiting list and 54 patients had been transplanted in the LUMC. Mean length of stay on the waiting list before transplantation was 37 months. During the follow-up period 11 patients (10.8%) died on the waiting list and 6 patients (11.1%) died after renal transplantation. The mean length of stay on the waiting list of these two groups was much longer, being 55 months and 62 months, respectively. Length of hospitalization was significantly different between both patient groups during the first 6 months of treatment (13.24 days for those on the waiting list versus 40.75 days transplanted patients) and after 6 months (32.4 days for those on the waiting list versus 13.1 days transplanted patients). The number of hospital admissions did not differ significantly. Dialysis-related admissions constituted 47% of the total of admissions in the waiting list group and transplantation-related admissions were 43% in the transplanted group. CONCLUSION: In the present study we revealed no difference in overall mortality. However, mortality was influenced by length of stay on the waiting list. Morbidity was increased during the first 6 months after transplantation. Therapy modality greatly influenced the specific cause of morbidity.


Assuntos
Transplante de Rim/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Renal/efeitos adversos , Feminino , Sobrevivência de Enxerto , Hospitalização , Humanos , Falência Renal Crônica/terapia , Transplante de Rim/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua/mortalidade , Diálise Renal/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Listas de Espera
10.
Gut ; 46(3): 385-9, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10673301

RESUMO

BACKGROUND: It has been suggested that the incidence of acute pancreatitis in patients with end stage renal failure is increased. AIMS: To assess the risk of acute pancreatitis in patients on long term peritoneal dialysis and long term haemodialysis compared with the general population, to evaluate its clinical course and outcome, and to identify possible aetiological factors. PATIENTS: All patients who were maintained on long term peritoneal dialysis and/or haemodialysis (total dialysis time more than six weeks) from January 1989 to March 1998 in a large general hospital in The Netherlands. METHODS: Retrospective cohort study. Standardised ratios (as an approximate relative risk) between the incidence of acute pancreatitis in haemodialysis or peritoneal dialysis and the general population were calculated. Possible risk factors were identified. Patients with and without acute pancreatitis were compared. RESULTS: In 269 patients on haemodialysis (total of 614 person years), one patient developed an attack of acute pancreatitis. Patients on haemodialysis did not show an increased risk for acute pancreatitis compared with the general population (standardised ratio 11; 95% confidence interval (CI) 0.275 to 60.5). In 128 patients on peritoneal dialysis (total of 241 person years), seven patients had nine attacks of acute pancreatitis. Patients on peritoneal dialysis had a significantly and highly increased risk for acute pancreatitis (standardised ratio 249; 95% CI 114 to 473). Mortality in this series of nine attacks was 11%. No single aetiological risk factor could be identified. CONCLUSIONS: The risk of acute pancreatitis in patients on long term peritoneal dialysis is significantly and highly increased compared with the general population. The underlying causal mechanisms remain to be elucidated.


Assuntos
Falência Renal Crônica/complicações , Pancreatite/complicações , Diálise Renal/efeitos adversos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
11.
Eur J Gastroenterol Hepatol ; 10(8): 717-20, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9744704

RESUMO

Beta2-microglobulin (A beta2M) amyloidosis is a relatively new secondary amyloidosis associated with renal failure and haemo- and peritoneal dialysis. Although beta2-microglobulin depositions are systemic, clinical manifestations are limited to articular and para-articular disease in most cases. A very limited number of patients have been reported with extra-articular manifestations including those of the gastrointestinal tract. We report on a patient who was treated with haemodialysis for 23 years and developed colonic pseudo-obstruction due to A beta2M amyloidosis.


Assuntos
Amiloidose/complicações , Pseudo-Obstrução do Colo/etiologia , Diálise Renal , Microglobulina beta-2 , Idoso , Amiloidose/diagnóstico , Amiloidose/patologia , Colo/patologia , Pseudo-Obstrução do Colo/diagnóstico por imagem , Pseudo-Obstrução do Colo/patologia , Feminino , Histocitoquímica , Humanos , Radiografia , Fatores de Tempo
12.
Neth J Med ; 53(1): 45-6, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9718943

RESUMO

A patient with rhabdomyolysis and transient renal failure due to auto injection of the procaine containing drug "Gerovital" is described. This case illustrates the hazards of self-regulated alternative treatment.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Procaína/efeitos adversos , Rabdomiólise/induzido quimicamente , Idoso , Humanos , Injeções Intramusculares , Masculino , Procaína/administração & dosagem
18.
Neth J Med ; 43(1-2): 71-3, 1993 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8232698

RESUMO

A 36-year-old patient, euthyroid under methimazole treatment, was admitted because of an active Graves' ophthalmopathy and found to have a transient granulocytopenia. Forty-five days after this episode she developed classical agranulocytosis because of which the methimazole was stopped. The agranulocytosis occurred more than 20 months after the initiation of antithyroid drug therapy. Other causes for the initial phase of granulocytopenia were not found.


Assuntos
Agranulocitose/induzido quimicamente , Granulócitos , Doença de Graves/tratamento farmacológico , Metimazol/efeitos adversos , Adulto , Agranulocitose/sangue , Monitoramento de Medicamentos , Feminino , Humanos , Contagem de Leucócitos , Fatores de Tempo
19.
Scand J Clin Lab Invest ; 53(5): 499-506, 1993 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8210973

RESUMO

Twenty nine stable renal transplant recipients, 10 receiving cyclosporin, 10 cyclosporin-prednisolone and nine azathioprine-prednisolone were supplemented in a double blind randomization cross-over study with fish oil and corn oil for a period of 4 months each. Erythrocyte deformability was reduced in the cyclosporin-treated patients and returned to normal values after supplementation of either oil. The oil supplementation resulted in an increased polyunsaturated fatty acid content in the plasma phospholipids. An increased erythrocyte membrane polyunsaturated fatty acid content might correct the lower erythrocyte deformability in cyclosporin treated patients. Therefore, it is probable that these changes are membrane-related. The oil supplementation had no effect on glomerular filtration rate, effective renal plasma flow, filtration fraction or blood pressure, which does not exclude effects of the cyclosporin-induced rigidified erythrocytes in the acute phase of renal transplantation. Decreased erythrocyte deformability could play a role in the cyclosporin-induced deterioration of renal haemodynamics. This may enhance the effects of endothelin, as these patients also had elevated endothelin levels.


Assuntos
Óleo de Milho/farmacologia , Ciclosporina/farmacologia , Endotelinas/sangue , Deformação Eritrocítica/efeitos dos fármacos , Óleos de Peixe/farmacologia , Transplante de Rim , Rim/efeitos dos fármacos , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos/sangue
20.
Acta Diabetol ; 30(2): 89-92, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8219264

RESUMO

A lower erythrocyte deformability, which causes impairment of the microcirculation, is postulated to contribute to diabetic organ complications. Erythrocyte deformability was measured in four groups of type 1 (insulin-dependent) diabetic subjects and 30 controls by filtration and ektacytometry. Twenty-five patients without organ complications, 21 with microalbuminuria, 13 with overt nephropathy and 12 with leg ulceration were studied. No decreased erythrocyte deformability was found in any of the diabetic groups with either technique, and neither did the total group of 71 diabetic subjects have a lower erythrocyte deformability when compared with the controls. In order to imitate local conditions in the kidney, erythrocyte deformability was also measured in hyperosmolar solutions. Again no differences were found between the diabetic groups separately or as a whole and the controls. Furthermore no correlation was found between erythrocyte deformability and the plasma glucose or glycosylated haemoglobin level.


Assuntos
Diabetes Mellitus Tipo 1/sangue , Deformação Eritrocítica , Adulto , Albuminúria , Glicemia/metabolismo , Nefropatias Diabéticas/sangue , Feminino , Filtração/métodos , Hemoglobinas Glicadas/análise , Humanos , Úlcera da Perna/sangue , Úlcera da Perna/complicações , Masculino , Rotação Ocular , Valores de Referência
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