Tranexamic Acid Treatment of Life-Threatening Hematuria in Polycystic Kidney Disease

A 41-year-old woman with autosomal dominant polycystic kidney disease had chronic kidney disease class IV. She presented 10 days postpartum with a 4-day history of severe hematuria, left flank pain, and anemia, hemoglobin 62 g/L. CT scan showed massively enlarged kidneys with multiple cysts; several cysts bilaterally had high attenuation consistent with hemorrhage. Hematuria persisted over several days despite intensive conservative measures that included vitamin K1, 4 units of plasma, transfusion of 10 units of packed RBCs, Darbopoeitin, and DDAVP. Antifibrinolytic therapy was given with tranexamic acid 1000 mg p.o. t.i.d for one day then OD. The hematuria stopped within 24 hours and did not recur after tranexamic acid therapy ended. Over the next 4 years there were 3 hospitalizations each with severe gross hematuria requiring blood transfusion for acute anemia. The hematuria responded well to further treatment with tranexamic acid. Tranexamic acid produces antifibrinolytic effects via complex interactions with plasminogen, displacing plasminogen from the fibrin surface. Chronic renal impairment is considered a relative contraindication to use of tranexamic acid due to reports of ureteric clots and acute renal failure from cortical necrosis. We conclude that tranexamic acid can be used safely in some patients with CKD and polycystic kidney disease to treat severe hematuria

Extrahepatic cholangiocarcinoma with prolonged survival: a case report

Abstract Background Cholangiocarcinoma has poor prognosis and short term-survival. Here, we report the case of a patient with unusually prolonged survival. Case presentation Our patient was a 56-year-old Arab man with a 6-month history of obstructive jaundice. A computed tomography scan of his abdomen revealed a mass at the confluence of the hepatic ducts with suspected malignant strictures on endoscopy. A positive tissue diagnosis was achieved more than 18 months after commencement of his symptoms. He remained functional throughout this period despite recurrent episodes of cholangitis. Conclusions Cholangiocarcinoma is a presumably fatal disease, especially because patients tend to present late with unresectable disease. Many patient-related and disease-related factors may alter survival

Colobronchial Fistula Presenting with Persistent Pneumonia in a Patient with Crohn\u27s Disease: A Case Report

Colobronchial fistula is an uncommon complication of Crohn\u27s Disease. It is also rarely diagnosed on first presentation. We describe a case of colobronchial fistula and recurrent pneumonia in a patient with Crohn\u27s Disease. A 52-year-old gentleman with a history of Crohn\u27s Disease presented with cavitating left lower lobe pneumonia that did not resolve despite a one month course of antibiotics. A computed tomography of the thorax confirmed the presence of a cavitating left lower lobe pneumonia. A subsequent abdominal computed tomography revealed a fistulous communication between the colon at the splenic flexure and the left bronchial space. The patient underwent surgery and a fibrous tract was visualized from the splenic flexure to the left lung. Medical treatment was continued with a six week course of antibiotics and the patient was doing well 12 weeks after surgery. There have been few case reports of colobronchial fistula with a clinical picture similar to this case

Digestive Symptoms in Older Adults: Prevalence and Associations with Institutionalization and Mortality

BACKGROUND: Digestive symptoms are common in adults. However, little is known about their prevalence in older adults and the association of digestive symptoms with institutionalization and mortality in community-dwelling older adults