Search

Acid-base balance is maintained by kidney excretion of titratable acids and bicarbonate reabsorption. Metabolic alkalosis is uncommon in dialysis-treated patients. The aim of this retrospective study was to assess the rate of metabolic alkalosis in pediatric patients treated with peritoneal dialysis.Medical records of children treated with peritoneal dialysis in Shaare Zedek Medical Center from January 2000 to June 2021 were reviewed and compared with young adults currently treated with peritoneal dialysis. Demographic, clinical, and peritoneal dialysis characteristics were extracted from the medical records.Thirty chronic peritoneal dialysis patients were included in our study, seven under 2 years, 13 between 2 and 18 years, and 10 adults. 90.3% of the measurements in infants showed metabolic alkalosis compared to 32.3% in the 2-18-year group and none in the adult group. Higher size-adjusted daily exchange volume, lack of urine output, and high lactate-containing dialysate were associated with metabolic alkalosis. Alkalosis was not explained by vomiting, diuretic therapy, or carbonate-containing medications. High transport membrane, low dietary protein, and malnutrition, all previously reported explanations for metabolic alkalosis, were not found in our study.Metabolic alkalosis is common in infants treated with peritoneal dialysis as opposed to older children and adults. High lactate-containing dialysate is a possible explanation. Higher size-adjusted daily dialysate exchange volume, which may reflect higher bicarbonate absorption, is another independent predictor of alkalosis. Acid-base status should be closely followed in infants, and using a dialysis solution with lower bicarbonate or lactate level should be considered. A higher resolution version of the graphical abstract is available as Supplementary Information.

Introduction Since infammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifer of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. Objective and methods We investigated the efect modifcation by systemic infammation (serum CRP) on the relationship between a surrogate of the flling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantifed by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. Results At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r=0.23, P

Several previous studies have reported an increase in Hounsfield unit density of the renal papillae in patients with nephrolithiasis compared with controls. Kidney stone formers (KSF) were found to have higher papillary and cortical density in both kidneys, irrespective of which side had calculi, and it was proposed that this might be related to the presence of underlying hypercalciuria. The current study was designed: (1) to determine whether recurrent KSF do have higher papillary density compared with healthy controls; (2) to test an association between higher renal papillary density and the presence of hypercalciuria in KSF. This retrospective case-matched controlled study was carried out at the Royal Free Hospital, London, UK. We investigated 111 patients, 57 of whom were KSF and 54 healthy controls. The CT attenuation values were measured within a 0.2 cm(2) area of the renal papilla in the upper, middle, and lower segments of each kidney, and were compared between KSF and non-stone formers, and between KSF with and without hypercalciuria. There were no significant differences in age and sex between groups. Papillary density was significantly higher in KSF by both crude and adjusted analyses (p 0.001). However, there was no association between higher papillary density and hypercalciuria in KSF. The papillary density measured by CT is a useful, non-invasive tool to differentiate between KSF and healthy controls. The absence of any correlation between papillary density and hypercalciuria suggests that the presence of clinically significant underlying renal stone disease, rather than urinary metabolic abnormalities, correlates with radiologically detectable increased papillary density.

Enoxaparin, a low molecular weight heparin, has been shown to be a safe and effective anticoagulant to prevent clotting in the extracorporeal circulation during hemodialysis. Enoxaparin also possesses antiproliferative properties, and reduces neointimal proliferation following vascular injury in animals. Use of enoxaparin during hemodialysis may be associated with decreased myointimal proliferation and diminished vascular access stenosis or failure.The aim of our study was to test the efficacy of enoxaparin to reduce the incidence of recurrent vascular access stenosis in chronic hemodialysis patients.Twenty-nine hemodialysis patients who suffered from recurrent arteriovenous (A-V) access stenosis were studied retrospectively to compare the incidence of vascular access procedures before and during enoxaparin administration. Enoxaparin was administered intravenously as a single bolus at the start of hemodialysis.Twenty-eight patients (14 male) were analyzed. Ten required a new fistula during the study period. Observed treatment times (years/patient) were 1.20 ± 0.87 for unfractionated heparin (UFH) and 3.04 ± 2.19 for enoxaparin (P = 0.0001). Angiographic procedure rates (procedures/year) were 1.76 ± 0.92 in the UFH group and 1.30 ± 1.01 in the enoxoparin group (P = 0.0786). There were no significant differences in time to first stenosis between the two groups (P = 0.5315). One patient receiving enoxaparin developed upper gastrointestinal bleeding and a second patient sustained a subdural hematoma after a fall.Our study demonstrated a trend toward a decreased number of angiographic procedures for maintaining A-V access patency in selected chronic hemodialysis patients treated with enoxaparin in comparison with UFH as anticoagulant during dialysis.

The risk of second malignancies among female breast cancer patients has been studied for decades. In contrast, very little is known about second primary tumors in men. Risk factors for breast cancer in men, including genetic, hormonal and environmental factors, provide parallels to the etiology of breast cancer in women. This review considers the literature related to the risk of developing a second cancer in patients with male breast cancer.A systematic review of the literature between 1966 and 2007 was conducted and acceptable articles used for analysis. All retrieved articles were screened to identify any papers that had been missed. Studies were included if they discussed the risk of subsequent malignancy in patients with male breast cancer.Patients with history of male breast cancer have an increased risk of a second ipsilateral, or contralateral breast cancer (standardized incidence ratio 30-110). The risk of subsequent contralateral breast cancer was highest in men under 50 years of age at the time of the diagnosis of the initial cancer. The data on non-breast second primary cancers is diverse. One study has suggested an increased incidence of cancers of the small intestine, prostate, rectum and pancreas, and of non-melanoma skin cancer and myeloid leukaemia. Other investigators did not find an increase in the overall risk of subsequent cancer development in men diagnosed initially with primary breast cancer. Although sarcoma, lung and esophageal cancers are well recognized complications of radiation therapy for female breast cancer, there is no evidence for the association of these cancers following radiation therapy in male breast cancer.Although the incidence of second primary cancer in patients with primary male breast cancer requires further study, male breast cancer survivors should probably undergo periodic screening for the early detection of second breast cancers and other adverse health effects.

A 63-year-old man presented to the Otolaryngology department with severe dysphagia. On laryngoscopy, a whitish nodule 3 cm in size exiting from the posterior commissurae of the larynx, and almost obstructing the hypopharyngeal space, was observed. The excision biopsy specimen was diagnosed as moderately differentiated squamous cell carcinoma of the hypopharynx. A staging procedure with positron emission tomography-computer tomography (PET-CT) was recommended. The day before the procedure, the patient experienced chills, and his temperature increased up to 38.9 C. He was evaluated in the emergency department (ED) of our hospital. The plain film of the chest X-ray study revealed a small infiltrate in the right lower lobe (arrows Fig. 1a, b) and the patient was discharged on oral antimicrobial therapy to manage his pneumonia. The patient’s wife had been hospitalized with pneumococcal pneumonia 2 days earlier. The day after his ED visit, the patient underwent the previously arranged ambulatory PET-CT that revealed a significant increase of fluorine-18-fluorodeoxyglucose (F18-FDG) uptake in the hypopharyngeal mass (thick arrow Fig. 1a), diffuse uptake in the bone marrow of the spine, ribs, and pelvis without underlying bone lesions on a computed tomography (CT scan) (black arrows Fig. 2a–c), and an increased uptake in the right lower lobe consolidation consistent with pneumonia (white arrows Fig. 2b, c). The diagnosis of pneumonia was supported by significant