Brucella glomerulonephritis.
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Brucellosis↗
Biomedical subjects
Fahim Zaman
Publications and source records attributed to Fahim Zaman.
Post transplant lymphocele: a single centre experience.
The occurrence of post renal transplant lymphocele is variable and the best approach to treatment is not well defined. The purpose of this study was to find out the incidence of post transplant lymphocele at our centre, identify demographic or surgical factors that may have influenced lymphocele formation, and distinguish the best approach to treatment. The charts of 138 consecutive renal transplant recipients from 1996 to 2001 were retrospectively reviewed. The demographic characteristics, comorbid illnesses, occurrence of lymphocele and its treatment modality were recorded. A total of 36 (26%) patients developed lymphoceles. There was a significant relationship between an increased body mass index (BMI) and lymphocele occurrence (P > 0.01). The recurrence rate with drainage alone was 33%, which decreased to 25% with sclerotherapy. In comparison, both laparoscopic and open surgical marsupialization had a much lower but similar recurrence rate of 12%. The laparoscopic method had less morbidity, a shortened hospital stay, and less infection than open surgery.
Adult↗
Native quadruple-valve endocarditis caused by Enterococcus faecalis.
We report the case of a patient with postoperative, hospital-acquired, quadruple-valve endocarditis caused by Enterococcus faecalis on presumed normal native valves. During a cervical laminectomy, the patient had a non-ST-elevation myocardial infarction that was treated conservatively. In the intensive care unit, the patient became febrile and developed a new 2/6 systolic murmur. Blood cultures grew E. faecalis, and the patient was given antibiotics. Postoperative transthoracic echocardiography and transesophageal echocardiography revealed vegetations on all 4 heart valves. Subsequently, the patient was moved to another facility and died. No autopsy was performed. E. faecalis is the third-most-common cause of bacterial endocarditis overall; however, it is rarely found in multiple-valve, hospital-acquired endocarditis. Although transthoracic echocardiography is a powerful diagnostic tool, transesophageal echocardiography increases the sensitivity and specificity to about 90%. In our patient, the diagnosis of native quadruple-valve endocarditis would not have not been made without the use of transesophageal echocardiography.
Cross Infection↗
Successful orthotopic liver transplantation after trimethoprim-sulfamethoxazole associated fulminant liver failure.
Trimethoprim-sulfamethoxazole (TMP-SMZ) is one of the most commonly used antibiotics. Although many of its adverse effects are well recognized, TMP-SMZ related hepatotoxicity is considered rare and is usually characterized by cholestasis or mixed hepatocellular-holestatic reactions. In this study, we describe the case of a previously healthy young man with acute fulminant liver failure caused by TMP-SMZ. The patient presented with complaints of 'flu-like' symptoms with myalgia and fever after taking TMP-SMZ for 7 d for otitis externa. The patient subsequently developed fever, worsening jaundice, and a rash on his neck and chest. Liver enzymes peaked on day 3 with alanine aminotransferase (ALT) 11,549, aspartate aminotransferase (AST) 23,289, alkaline phosphatase 245, and total bilirubin 10.3 mg/dL, with a conjugated bilirubin of 8.3 mg/dL, prothrombin time (PT) 60.5 s, partial normalized ratio (PTT) 49 s, and international normalized ratio (INR) 7.5. Of note, acetaminophen level on admission was undetectable. Serology for hepatitis A, B, C, cytomegalovirus, HIV, toxoplasmosis, and blood cultures were all negative. The patient developed hepatic encephalopathy with hallucination on day 4. Laboratory tests revealed a serum ammonia level of 190 U, serum creatinine kinase (CK) 10,466 (42 on admission), serum creatinine 8.2 mg/dL (1.2 on admission), and significant metabolic acidosis. Renal ultrasound was unremarkable. The patient was started on hemodialysis for acute renal failure. Meanwhile, liver transplantation assessment was also initiated. On day 8 post-admission (15 d after taking TMP-SMZ), the patient received a successful orthotopic liver transplant.
Adult↗
Severe hypermagnesemia as a result of laxative use in renal insufficiency.
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Acute Kidney Injury↗
Salvage of poorly developed arteriovenous fistulae with percutaneous ligation of accessory veins.
Many arteriovenous (AV) fistulae fail to achieve an adequate blood flow or size for successful cannulation because of accessory veins. We describe a simple technique to ligate accessory veins that does not require a surgical incision. In this retrospective study, 17 end-stage renal disease patients underwent ligation of accessory veins of poorly developed AV fistulae. There were 14 men and 3 women, and their average age was 50 +/- 13 years. There were 14 radiocephalic and 3 brachiocephalic fistulae. After identifying accessory veins with a fistulogram, two nonabsorbable 2-0 polypropylene (Prolene) sutures were placed percutaneously around each accessory vein in proximity to the AV fistula. Successful ligation was confirmed with a repeat fistulogram. This procedure was undertaken after 4 +/- 3 months following surgical placement. Successful maturation was defined as adequate blood flow to support effective hemodialysis and adequate caliber to allow for repeated cannulation with a 15G or 16G needle. Of 17 AV fistulae, 15 (88%) successfully matured 1.7 +/- 1 month (range, 0.3 to 6 months) after the procedure. The average number of accessory veins ligated was 1.7 +/- 0.8 (range, 1 to 3). All AV fistulae that matured after ligation of accessory veins were functioning at 44.5 +/- 12 weeks after first use. A technique for salvaging nonmaturing AV fistulae not requiring surgical cutdown for ligation of accessory veins is described. AV fistulae mature quickly after ligation of accessory veins. This is a rapid and safe procedure that can increase the prevalence of AV fistulae.
Arteriovenous Fistula↗
Isopropyl alcohol intoxication: a diagnostic challenge.
Isopropyl alcohol (IPA) is an ingredient of commonly used household solutions. Accidental and suicidal ingestion of IPA sometimes can be fatal if it goes unrecognized and untreated. There are few published reports on IPA intoxication. We describe a case of repeated IPA ingestion in a single individual, followed by a review of the literature on the subject. The differential diagnosis, diagnostic pitfalls, and therapeutic interventions in patients with IPA intoxications are discussed.
2-Propanol↗
Port catheter placement by nephrologists in an interventional nephrology training program.
We retrospectively reviewed all subcutaneous single- and double-lumen port catheters (PCs) inserted by interventional nephrologists at our institution to determine the success rate, immediate and late complications, and functional life. From January 2000 to August 2002, 187 PCs were placed in 187 patients (42% males, 51% Caucasians, mean age 50 +/- 14 years). There were no immediate complications related to the procedure such as hemorrhage, pulmonary embolism, or pneumothorax. There were a total of 35,078 catheter-days of follow-up. Sixteen catheters were removed during the observation period: three because of infection, seven after completion of chemotherapy, and six for other reasons. The remaining PCs are either functioning or the patients have died. The initial success rate was 100%. Kaplan-Meier analysis showed a 30-day survival of 97% and a 1-year survival of 92%. Interventional nephrologists, who have adequate training in central venous tunneled cuffed catheter placements, can successfully place PCs, with excellent success and minimal complications.
Catheters, Indwelling↗
Fluoroscopy-assisted placement of peritoneal dialysis catheters by nephrologists.
In the early 1950s and 1960s, peritoneal dialysis (PD) was used primarily to treat patients with acute renal failure. Continuous ambulatory peritoneal dialysis (CAPD) was introduced in 1976 and continues to gain popularity as an effective method of renal replacement therapy for patients with end-stage renal disease (ESRD). The PD catheter is inserted into the abdominal cavity either by a surgeon, interventional radiologist, or nephrologist. We have adopted a percutaneous approach with fluoroscopic guidance for PD catheter insertion that is easy, safe, and provides good patency and infection rate results. In this article we describe the technique and our results. From August 2000 to May 2003, 34 PD catheters out of 36 were successfully inserted using the percutaneous fluoroscopic technique in selected patients referred from the nephrology clinic. All the PD catheters were placed in our Interventional Nephrology Vascular Suite by nephrologists.
Catheterization↗
Retrieval of a fractured piece of Tessio catheter with a snare using a transcutaneous transvenous approach.
Approximately 20% of end-stage renal disease patients requiring hemodialysis have central dialysis catheters as their vascular access. The major cause of central dialysis catheters removal or revision is infection or occlusion. Catheter occlusions may occur as a result of thrombosis or fibrin sheath formation. However, the presence of a fractured dialysis catheter tip requiring immediate extraction to prevent serious complications is rare. Herein we present the case of a central dialysis catheter referred to us for malfunction. An incidental finding was a piece of catheter that had broken off the venous port and was seen in the right atrium. The retrieval and subsequent placement of a new central dialysis catheter are outlined.
Adult↗
Pancreatic transplantation: evaluation and management.
More than 2 million people in the United States have type 1 diabetes mellitus. Pancreatic transplantation has emerged as the single most effective means of achieving normal glucose homeostasis in this patient population. Newer immunosuppressive agents and surgical techniques continue to evolve, resulting in improved long-term graft and patient survival. Herein, an understanding of the evaluation, technical aspects, and perioperative management of pancreas transplantation is outlined.
Diabetes Mellitus, Type 1↗
Pretransplant bilateral hand-assisted laparoscopic nephrectomy in adult patients with polycystic kidney disease.
Laparoscopic procedures continue to gain popularity over traditional open procedures for a number of abdominal and pelvic surgeries. With increasing experience, the application of this technique is rising because it provides an alternative, less invasive, approach to various surgical procedures. Herein, we report our experience with adult patients with polycystic kidney disease, requiring bilateral laparoscopic nephrectomy before renal transplantation.
Adult↗