Mortality predictors in acute kidney injury patients who underwent continuous venovenous hemodiafiltration: A retrospective, single-center study

Continuous renal replacement therapy (CRRT) is an increasingly preferred treatment that is easier to use in patients with hemodynamic impairment and can be applied in critical care settings. There are various subtypes of CRRT, one of which is continuous venovenous hemodiafiltration (CVVHDF). In this study, we examined the general characteristics of intensive care patients who underwent CVVHDF. Methods. The clinical and biochemical data of 123 patients who underwent CVVHDF in the intensive care units of our center between February 2012 and November 2014 were analyzed retrospectively. Patients who died during the course of therapy were compared with those who survived. Results. The study included 123 patients, 73 males (59.3%) and 50 females (40.7%). The mean age was 64.4 years. Eighty-eight patients (71.5%) died during CVVHDF while 35 patients survived (28.5%). Hemodynamic parameters such as systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse pressure were significantly lower in patients who died compared to survivors (p<0.001). Mean lactic acid level was significantly higher in the deceased group than in the surviving group (8.54 mmol/L vs. 3.68 mmol/L, p<0.001, chi-square test). Conclusions. Low bicarbonate level, low systolic arterial blood pressure, and older age were significant independent predictors of mortality in this study. Mortality rates were significantly higher among patients with lactic acidosis and those over 66 years of age. Lactic acid levels can be used to predict mortality in patients undergoing CVVHDF

Assesment of flow volume and anastomosis diameter in native arteriovenous fistulas using doppler ultrasound

Nativ hemodiyaliz arteriyovenöz fistüllü (AVF) hastalarda brakiyal arter akım volümü ile AVF anastomoz çapı arasındaki ilişkiyi araştırmak. Toplam 16 nativ AVF'li hasta değerlendirildi.16 hastanın 11'inde AVF üst kolda (brakiyobazilik ya da brakiyosefalik) 5'inde ise ön kolda (radiyosefalik) yer almaktaydı. OrtalamaAVF süresi 24 aydı.16 hastanın 12'si semptomsuzdu. 4 hastada ise üst ekstremitede ödem mevcuttu. Doppler ultrasonografi ile AVF' lerde brakiyal arter akım volümü ve AVF anastomoz genişliği ölçüldü. Üst ekstremitede ödem bulunan 4 hastanın 3'üne fistülografi yapılarak ödem etiyolojisi araştırıldı. 16 hastanın 14'ünde brakiyal arter volümü 2000ml/dk altında ölçüldü. Bu hastalardaAVF anastomoz genişliği ortalama 3.6 mm idi. Brakiyal arter akım volümü 2000ml/dk üzerinde ölçülen 2 hastada (4400ml/dk, 6000ml/dk) AVF anastomoz genişliği sırasıyla 6.9mm ve 10mm idi. Fistülografi yapılan 3 hastanın 2'sinde sunklavyan vende tromboz, 1'inde darlık saptandı. Doppler ultrasonografi ile AVF'lerde akım volümü hesaplanabilir. Bizim çalışmamızda, yüksek akım volümüne sahipAVF'lerde anastomoz genişliği normal volümlü hastalara göre daha fazla idi. Artmış anastomoz genişliği yüksek akım volümünün sebebi olabilir.The aim of this study was to evaluate flow volume and anastomosis diameter of native arteriovenous fistulas(AVF). 16 patients with native AVF were evaluated using Doppler Ultrasound. Eleven of 16 patients had upper arm AVF (bachiocephalic or brachiobasillic) and 5 of 16 patinets had forearm AVF (radiocephalic). Twelve of 16 patients had not symptoms. There was edema of upper extremity in 4 patients.Brachial artery flow volume andAVF anastomosis diameter were calculated using Doppler ultrasound. Fistulography was performed on 3 of the 4 patients who had upper extremity edema. The brachial artery flow volume was calculated to be less than 2000ml/min in 14 of the 16 patients. The mean AVF anastomosis diameter was 3.6 mm in these patients. Whose flow volume of brachial artery were 4400ml/min and 6000ml/min. The diameters of AVF anastomosis were 6.9 mm and 10 mm in the 2 patients. Whose fistulography showed subclavian vein thrombosis in 2 patients and subclavian vein stenosis in 1 patient. In this study, diameter ofAVF anastomosis with high flow volume was greater than diameter ofAVF anastomosis with normal flow volume. Increased diameter of AVF anastomosis may be responsible for an increased flow volume ofAVF

Exenatide-Induced Acute Renal Failure: A Case Report

Exenatide is a glucagon-like peptide-1 receptor agonist that is commonly used in the treatment of type II diabetes mellitus for its effects on the incretin system. The use of exenatide is also related to weight loss and it has reportedly been known to induce acute renal failure (ARF) according to clinical reports. We observed ARF and severe weight loss two months after beginning the treatment with exenatide in a 59-year-old female patient with type II diabetes mellitus. We present this case in which ARF was considered to be a rare adverse effect of exenatide use. In conclusion, renal functions should be closely monitored, especially in patients prescribed nephrotoxic agents and for those with a high risk of nephropathy and dehydration due to their treatment with exenatide. The usage of this drug should also be carefully planned in these patients. Turk Jem 2013; 17: 68-7

Actinomycosis of the Tongue in Non-Hodgkin Lymphoma

A non-Hodgkin’s Iymphoma case with actinomycosis of the tongue in a forty-three years old male patient is described in this article. The patient hospitalized because of NHL relapse and ifosphamide, methotrexate, bleomycin, prednisolone and intrathecal methotrexate were given as chemotherapy. In the course of the hospital stay, fungemia has been documented and an isolated lesion has emerged in the tongue. Wedge biopsy was performed yielding the diagnosis of actinomycosis. The case is reported from the point of its rare localization and clinical presentation, diagnostic methods, differential diagnosis and treatment. Actinomycosis should be beared in mind in immunocompromised patients with oral lesions