Search

Multifactorial disorders in mineral metabolism and bone structure occur early in the course of chronic kidney disease. The new term of ‘chronic kidney disease – mineral and bone disorders’ has been used to encompass a broad syndrome in which various abnormalities in bone and mineral metabolism are present in patients with chronic kidney disease. Brown tumors are an uncommon type of bone lesions that represent a focal manifestation of high-turnover bone disease. In our report, we describe a patient with chronic kidney disease on chronic hemodialysis that presented with multiple osseous lesions of the right elbow, right scapula and ribs. This case illustrates the importance of taking brown tumor in consideration in differential diagnosis and management of patients with an osseous mass and chronic kidney disease, where a failure to establish an accurate diagnosis can lead to unnecessary further diagnostic procedures and even extensive surgery, increasing the morbidity of these patients. Prevention, early diagnosis and treatment of secondary hyperparathyroidism are important in reducing the prevalence of high-turnover bone disease and consequential bone lesions including brown tumors., Multifaktorijalni poremećaji mineralnog metabolizma i koštane strukture javljaju se rano u razvoju kronične bubrežne bolesti. Novi pojam „kronična bubrežna bolest – mineralni i koštani poremećaji“ rabi se kako bi obuhvatio širok sindrom različitih abnormalnosti mineralnog i koštanog metabolizma koje nalazimo kod bolesnika s kroničnom bubrežnom bolešću. Smeđi tumori su rijetki koštani poremećaji koji predstavljaju žarišnu manifestaciju bolesti prekomjerne koštane pregradnje. Prikazan je slučaj bolesnice s kroničnom bubrežnom bolešću na programu kronične hemodijalize, koja je primljena s višestrukim koštanim lezijama u području desnog lakta, desne lopatice i rebara. Rad ukazuje na važnost razmatranja smeđeg tumora u diferencijalnoj dijagnostici bolesnika s koštanim masama i kroničnom bubrežnom bolešću, kada propust u postavljanju ispravne dijagnoze može dovesti do nepotrebnih dodatnih dijagnostičkih postupaka, pa čak i do opsežnih operativnih zahvata, povećavajući tako pobol. Prevencija, rana dijagnostika i liječenje sekundarnog hiperparatiroidizma je važno za smanjivanje učestalosti bolesti pretjerane koštane pregradnje i posljedičnih koštanih bolesti uključujući smeđi tumor.

Tissue hypoperfusion with concomitant hypoxia is a leading sign of septic shock. Despite increased DO2 after volume administration, VO2 remains low. Our hypothesis was that in this setting, lower CO2 output would also occur. We calculated anaerobic output of CO2 and found its small proportion to complete CO2 output.

Dyspnea and tachypnea are the leading signs of pulmonary dysfunction in sepsis. With regards to present knowledge of pathophysiology and pathogenesis of the pulmonary dysfunction, the real reasons for this phenomena are still not researched enough. It is our assumption that one of the underlying causes is in the increased ventilation of the physiological dead space due to the mismatch of the pulmonary ventilation and perfusion. In sepsis, equal to change in systemic, there are changes in pulmonary circulation, often with pulmonary hypotension and decreased pulmonary vascular resistance. To investigate this we used a simple test to measure the ventilation of the dead space using the Vd/Vt test.

The oxygen uptake and carbon dioxide production were measured in 21 patients in sepsis during conventional hemodynamic resuscitation. We assumed that in the state of low oxygen delivery, carbon dioxide is increasingly eliminated from the body. We hypothesized that this condition can be recognized from the VCO2/VO2 relationship. VO2 and VCO2 were measured by analysis of expired gas by metabolic monitor; hemodynamics was monitored by pulmonary artery catheter. Cardiac output was determined by thermodilution, oxygen transport variables were gauged according to standard formulas using samples from peripheral arterial and mixed venous blood from pulmonary artery. The patients were monitored for 6 hours. Lower values of VO2 were followed with higher values of VCO2. There was a high coefficient of negative correlation between cardiac index and respiratory quotient (r = -0.85; P = 0.002). The similar correlation, as expected, was found between oxygen delivery and respiratory quotient (r = -0.75; P = 0.01). The positive correlation was detected between respiratory quotient and venous–arterial CO2 difference (v–aDCO2) (r = 0.79; P = 0.016). Our preliminary conclusion was that cardiovascular instability in patients with sepsis can be recognized from variations in VO2 and respiratory quotient.