3 research outputs found
POSEBNOST DIJALIZE u STARIH I VRLO STARIH BOLESNIKA ā DILEME
The global increase in the proportion of older population contributes to the increasing number of patients with renal insufficiency. This disorder particularly involves the old (age 70-75) and very old (over 80) population groups. The number of comorbidities is increasing and life expectancy reduced with aging. Cross-sectional analysis of ten-year survival showed a rate of 33.9% in patients treated at the Hemodialysis Center, 23.81% in transplanted patients and 19.35% in dialyzed patients. In patients having started hemodialysis (HD) at the age of ā„70, the mean survival was 20.27Ā±18.62 months, in those that died 15.54Ā±17.35 months, and in survivors 30.29Ā±17.85 months. Among HD treated patients, 35% survived for up to one year, 18% for two years and 8% for ā„3 years. Karnofsky index was below 50% in all patients that survived, while the Malnutrition Inflammation Score and Subjective Global Assessment indicated malnutrition. In Croatia, the number of HD patients is constantly increasing as the result of population aging, better, accessible and equal health care that prolongs life span, easier access to substitution methods, more accesses to the vascular system, development of the national transplant network and good immunosuppressive therapy. All this provides biological, economic and normative space for replacement therapy. Old age, comorbidities and poor nutritional status influence high mortality, poor functional status and impaired quality of life. Survival results correspond to reports in the literature.U svijetu je ubrzan porast broja starijih bolesnika koji trebaju lijeÄenje dijalizom. Ti se izvjeÅ”taji poklapaju iz raznih zemalja. Problemi koje nosi starija dob su viÅ”estruki. RazliÄiti su stavovi za stratifikaciju dobnih granica. Bilo kako bilo, dobne granice su produžene i porast starije populacije sa svim prateÄim komorbiditetima je neizbježan. KroniÄna bubrežna bolest ima puno veÄu incidenciju u meÄu starom negoli meÄu mlaÄom populacijom i u stalnom je porastu u svijetu bilo kao bolest, komorbiditet ili posljedica raznih stanja. Ova Äinjenica nameÄe pitanja fiziologije i patofiziologije starenja i promjena u glomerularnoj filtraciji (GF). Ima li jasnih stavova o normalnim laboratorijskim vrijednostima prilagoÄenim dobnoj granici? U kojem stupnju je GF fizioloÅ”ka varijanta za konkretnu dob? Produžava li lijeÄenje hemodijalizom životni vijek vrlo starih osoba? Odgovori nisu uvijek precizni. Stara populacija Äesto je izložena odlukama lijeÄnika, obitelji ili skrbnika mimo svoje želje, bilo zbog nedostatka komunikacije ili zbog nepoznavanja postupaka. Procedure mogu na bolesnika ostaviti psihiÄke i fiziÄke posljedice (patnje), bez obzira na to Å”to su sve napravljene profesionalno, oni Äesto kažu āda sam znao Å”to me Äeka, ne bih pristaoā. Zbog toga je nužno poÅ”tivati odluku bolesnika. Analizom vlastitih podataka vidljiva je prisutnost veoma stare populacije s velikim brojem pridruženih komorbiditeta te visokim stupnjem pothranjenosti (MIS) i Karnofskyjeva skora. U Centru je viÅ”e od 49,23% populacije starije od 70 godina, s velikom zastupljenoÅ”Äu privremenog ili trajnog centralnog venskog katetera kao pristupa za dijalizu (42,35%). NajviÅ”e preživjelih do 1, 2 i 3 godine bilo je u skupini od 76-80 godina, a u skupini starijih od 80 godina nitko nije preživio 4 ili 5 godina. Kod preživjelih bolesnika visoke dobi sposobnost za samostalno funkcioniranje je veoma mala. Karnofskyjev zbir za preživjele 6 mjeseci i viÅ”e bio je u prosjeku 50%
Generalizirana ateroskleroza, metaboliÄki sindrom i rezistentna hipertenzija - uzroci i posljedice
e components of metabolic syndrome lead to generalized atherosclerotic changes
and micro- and macrovascular complications with damage to systems and organs. Consequently,
patientsā treatment with the resulting changes in the target organs is costly, complicated, and unpredictable.
We present a 65-year-old patient with diabetes diagnosed with hyperlipidemia, unregulated
arterial hypertension in the presence of other metabolic syndrome components and who consequently
developed complications of generalized atherosclerosis. Despite detailed, individually tailored therapy,
in line with current recommendations, we suggest that treatment success is very closely related
and dependent on dietary measures, healthy living habits, and patient cooperation.Komponente metaboliÄkog sindroma dovode do generaliziranih aterosklerotskih promjena te mikro i makrovaskularnih
komplikacija s oÅ”teÄenjem sustava i organa. Slijedom toga, lijeÄenje bolesnika s posljedicama promjena na ciljnim organima
vrlo je skupo, složeno i nepredvidljivo. Predstavljamo 65-godiÅ”njeg pacijenta, dijabetiÄara, kojem je dijagnosticirana hiperlipidemija,
neregulirana arterijska hipertenzija u prisutnosti drugih komponenata metaboliÄkog sindroma i posljediÄno razvijene
komplikacije generalizirane ateroskleroze. UnatoÄ detaljnoj, individualno prilagoÄenoj terapiji, u skladu s trenutnim
preporukama, smatramo da je uspjeh lijeÄenja vrlo usko povezan i ovisi o prehrambenim mjerama, zdravim životnim navikama
i suradnji pacijenta
High-volume post-obstructive choleresis (biliary hyperproduction) with acute kidney injury after choledochotomy, gallstones extraction, and T-tube drainage, successfully treated with octreotide - Report of a case
Only several cases of postprocedural choleresis (biliary hyperproduction) were reported, and guidance
on management is scarce, although an application of octreotide was anecdotally described.
We herein present a rare post-obstructive choleresis complicated with acute kidney injury due to
dehydration, successfully treated with an off-label application of octreotide. A 58-year-old female,
following cholecystectomy and choledochotomy with numerous stones extraction, developed excessive bile
loss via a T-tube complicated with acute kidney injury. Despite aggressive fluid replacement, the patient
continued to deteriorate, prompting a trial of subcutaneous octreotide 0.1 mg three times per day over five
days. Therapy yielded a rapid decline in bile production with improved diuresis and normalizing kidney
function. The patient was discharged with a ligated T-tube, which we removed a month later. The followup was unremarkable, with normalized laboratory findings and symptom-free.
Early use of octreotide could help resolve complicated biliary hyperproduction; however, further
research is required to determine the risks and benefits of such an approach