RESUMEN
A 43-year-old woman with a recurrent adenoid cystic carcinoma of the lacrimal gland was treated by orbital exenteration and reconstruction. Eight days later she developed symptoms of cerebral irritation and a computed tomogram showed intracerebral and subarachnoid air. She recovered with conservative treatment.
Asunto(s)
Carcinoma Adenoide Quístico/cirugía , Neoplasias del Ojo/cirugía , Enfermedades del Aparato Lagrimal/cirugía , Evisceración Orbitaria/efectos adversos , Neumocéfalo/etiología , Adulto , Femenino , HumanosRESUMEN
BACKGROUND: Renal failure is a frequent complication of sepsis with a high mortality. Tumor necrosis factor (TNF) has been suggested to be a factor in the acute renal failure in sepsis or endotoxemia. Recent studies also suggest involvement of nitric oxide (NO), generated by inducible NO synthase (iNOS), in the pathogenesis of endotoxin-induced renal failure. The present study tested the hypothesis that the role of TNF in endotoxic renal failure is mediated by iNOS-derived NO. METHODS: Renal function was evaluated in endotoxemic [Escherichia coli lipopolysaccharide (LPS), 5 mg/kg IP] wild-type and iNOS knockout mice. The effect of TNF neutralization on renal function during endotoxemia in mice was assessed by a TNF-soluble receptor (TNFsRp55). RESULTS: An injection of LPS to wild-type mice resulted in a 70% decrease in glomerular filtration rate (GFR) and in a 40% reduction in renal plasma flow (RPF) 16 hours after the injection. The results occurred independent of hypotension, morphological changes, apoptosis, and leukocyte accumulation. In mice pretreated with TNFsRp55, only a 30% decrease in GFR without a significant change in RPF in response to LPS, as compared with vehicle-treated mice, was observed. Also, the serum NO concentration was significantly lower in endotoxemic wild-type mice pretreated with TNFsRp55, as compared with untreated endotoxemic wild-type mice (260 +/- 52 vs. 673 +/- 112 micromol/L, P < 0.01). In LPS-injected iNOS knockout mice and wild-type mice treated with a selective iNOS inhibitor, 1400W, the development of renal failure was similar to that in wild-type mice. As in wild-type mice, TNFsRp55 significantly attenuated the decrease in GFR (a 33% decline, as compared with 75% without TNFsRp55) without a significant change in RPF in iNOS knockout mice given LPS. CONCLUSIONS: These results demonstrate a role of TNF in the early renal dysfunction (16 h) in a septic mouse model independent of iNOS, hypotension, apoptosis, leukocyte accumulation, and morphological alterations, thus suggesting renal hypoperfusion secondary to an imbalance between, as yet to be defined, renal vasoconstrictors and vasodilators.
Asunto(s)
Lesión Renal Aguda/metabolismo , Endotoxemia/complicaciones , Óxido Nítrico Sintasa/genética , Factor de Necrosis Tumoral alfa/metabolismo , Lesión Renal Aguda/etiología , Animales , Antígenos CD/farmacología , Apoptosis , Presión Sanguínea , Tasa de Filtración Glomerular , Hipertensión Renal/etiología , Hipertensión Renal/metabolismo , Riñón/irrigación sanguínea , Riñón/enzimología , Leucocitos , Lipopolisacáridos/toxicidad , Masculino , Ratones , Ratones Noqueados , Óxido Nítrico/sangre , Óxido Nítrico Sintasa/metabolismo , Óxido Nítrico Sintasa de Tipo II , Receptores del Factor de Necrosis Tumoral , Receptores Tipo I de Factores de Necrosis Tumoral , Vasoconstricción/fisiologíaRESUMEN
We performed a retrospective analysis of our institution's experience with the technique of delayed externalization of subcutaneously tunnelled peritoneal dialysis catheters. From 1993 to 1999, 49 catheters were implanted in 37 patients. Median age of the patients was 43.6 years; 70% were female; 32% had diabetes. Most of the catheters were midline, single-cuff, curled Quinton catheters without a swan neck. One patient underwent transplantation prior to catheter externalization. One catheter leaked prior to externalization and was removed. The remaining catheters were externalized a median of 40 days (range: 18-319 days) post implantation. At externalization, two leaks and one omental obstruction occurred, causing primary catheter failure. Total days of catheter follow-up were 17,895. One-year and two-year catheter survival rates were 70% and 40% respectively. Catheter failure occurred owing to infection in 7 cases and to mechanical complications in 10 cases. The rate of exit-site infection was 1 per 9.9 patient-months, and of peritonitis, 1 per 16.2 patient-months. Including primary failures, mechanical complications were 12 hernias, 6 leaks, and 4 instances of malposition. We conclude that delayed externalization of single-cuff catheters without a swan neck is associated with increased mechanical and infectious complications. These findings may warrant a change to a double-cuff catheter with a swan neck.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Diálisis Peritoneal/efectos adversos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Infecciones/etiología , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
We present a case of disseminated high-grade, T-cell-rich B-cell lymphoma in a 72-year-old white woman that presented as unilateral parotid swelling, and was initially diagnosed as xanthogranulomatous sialadenitis.