Prosthetic Aortic Valve Stenosis in End-Stage Renal Failure

Although renal failure is one of the known comorbidities associated with rapid progression of aortic stenosis, it is unclear whether hemodialysis alters the progression of prosthetic aortic valve stenosis. We describe a 79-year-old female who underwent bioprosthetic aortic valve replacement 8 years ago with stable prosthetic valve area for the initial 6 years. In the last two years, coinciding with the initiation of maintenance hemodialysis, she developed progressive prosthetic valve stenosis to the point of clinical decompensation. She underwent a second prosthetic aortic valve replacement with symptom resolution. This case suggests that circulating milieu in end-stage renal failure and dialysis can accelerate the progression of prosthetic aortic valve stenosis. More frequent clinical followup and surveillance echocardiogram for dialysis patients with bioprosthetic aortic valve may facilitate timely management of valvular stenosis

Immune-complex deposits in “pauci-immune” glomerulonephritis: a case report and brief review of recent literature

Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis is considered a “pauci-immune” disease, characterized by absent or mild glomerular tuft staining for immunoglobulin and/or complement. We describe a 72-year-old man with progressive renal failure over five months who was found to have P-ANCA associated crescentic glomerulonephritis. Renal biopsy also revealed immunofluorescence staining for Immunoglobulin G and C3. Treatment comprised corticosteroids, cyclophosphamide, and plasmapheresis but unfortunately kidney function did not recover, likely due to substantial interstitial fibrosis at diagnosis. This case illustrates that serologic evaluation for ANCAs should not be discounted when immune deposits are present. Prompt diagnosis is warranted

Navigating venous access: A guide for hospitalists

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112219/1/jhm2335.pd

Holocene salt-marsh sedimentary infilling and relative sea-level changes in West Brittany (France) using foraminifera-based transfer functions

International audienceIn order to reconstruct the former sea-levels and to better characterize the history of Holocene salt-marsh sedimentary infillings in West Brittany (western France), local foraminifera-based transfer functions were developed using Weighted-Average-Partial-Least-Squares (WA-PLS) regression, based on a modern dataset of 26 and 51 surface samples obtained from salt-marshes in both the bay of Tressseny and the bay of Brest. Fifty cores were retrieved from Tresseny, Porzguen, Troaon and Arun salt-marshes, which were litho- and biostratigraphicaly analyzed in order to reconstruct palaeoenvironmental changes. A total of 26 AMS 14C age determinations were performed within the sediment successions. The Holocene evolution of salt-marsh environments can be subdivided into four stages: (1) a development of brackish to freshwater marshes (from c. 6400 to 4500 cal. a BP); (2) salt-marsh formation behind gravel barriers in the bay of Brest (from 4500 to 2900 cal. a BP); (3) salt-marsh erosion and rapid changes of infilling dynamics due to the destruction of coastal barriers by storm events (c. 2900-2700 cal. a BP); (4) renewed salt-marsh deposition and small environmental changes (from 2700 cal. a BP to present). From the application of transfer functions to fossil assemblages, 14 new sea-level index points were obtained indicating a mean relative sea-level rise around 0.90±0.12 mm a-1 since 6300 cal. a BP