Case Report Rhabdomyolysis and Acute Renal Failure after Gardening

Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed

Henoch-Schönlein purpura in the third trimester of pregnancy

Henoch-Schönlein purpura (HSP) is an IgA-mediated small vessels’ vasculitis that affects the skin, intestines and kidneys. Pregnancy has been reported as an exacerbating factor. We present the case of a 24-year-old primigravida with HSP that occurred in the third trimester and lasted up to the end of the successful delivery. She had pruritic maculopapular exanthema on her legs. Biopsy of a cutaneous lesion was performed for histopathologic features and direct immunofluorescence (DIF) for the presence of perivascular IgA deposition. Histopathology of the cutaneous lesion confirmed leukocytoclastic vasculitis. A DIF examination of the skin lesion confirmed deposits of fibrinogen in the small blood vessel walls. Six weeks following delivery, the skin lesions almost completely disappeared. Control laboratory findings were normal. This case of HSP might have been primarily associated with a preceding respiratory infection but this should first be carefully investigated due to a possible severe immunological disease in the patient’s background requiring special attention since nephrotic symptoms may occur

Frequency of factor II G20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphism in patients with venous thromboembolism: Croatian case-control study

Introduction: Venous thromboembolic disease is one of the leading causes of morbidity and mortality in the developed world. Identification of hereditary factors of thrombophilia is contributing to a better understanding of the etiology and disease prevention. The aim of this study was to assess the prevalence of factor IIG20210A, factor V Leiden, MTHFR (methylenetetrahydrofolate reductase) C677T and PAI-1 (plasminogen activator inhibitor-1) 5G/4G polymorphisms in healthy Croatian subjects and patients with thromboembolism. Materials and methods: This prospective study included 100 thromboembolic patients consecutively admitted to the Intensive Care Unit, Sestre Milosrdnice University Hospital and 106 healthy subjects. Genotyping of factor IIG20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphisms was done using melting curve analysis on Light Cycler 1.2 analyzer. Results: Heterozygotes for Factor V Leiden polymorphism were more frequent in the group of patients with the thromboembolic disease (16%) than in the control healthy subjects (2.9%), OR (95% CI) = 6.41 (1.81-22.8); P = 0.004. Allele and genotype frequencies of other studied polymorphisms did not differ between cases and controls. Conclusion: This study confirmed the association of factor V Leiden polymorphism with the thromboembolic disease in Croatian population

Frequency of factor II G20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphism in patients with venous thromboembolism: Croatian case-control study

Introduction: Venous thromboembolic disease is one of the leading causes of morbidity and mortality in the developed world. Identification of hereditary factors of thrombophilia is contributing to a better understanding of the etiology and disease prevention. The aim of this study was to assess the prevalence of factor IIG20210A, factor V Leiden, MTHFR (methylenetetrahydrofolate reductase) C677T and PAI-1 (plasminogen activator inhibitor-1) 5G/4G polymorphisms in healthy Croatian subjects and patients with thromboembolism. Materials and methods: This prospective study included 100 thromboembolic patients consecutively admitted to the Intensive Care Unit, Sestre Milosrdnice University Hospital and 106 healthy subjects. Genotyping of factor IIG20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphisms was done using melting curve analysis on Light Cycler 1.2 analyzer. Results: Heterozygotes for Factor V Leiden polymorphism were more frequent in the group of patients with the thromboembolic disease (16%) than in the control healthy subjects (2.9%), OR (95% CI) = 6.41 (1.81-22.8); P = 0.004. Allele and genotype frequencies of other studied polymorphisms did not differ between cases and controls. Conclusion: This study confirmed the association of factor V Leiden polymorphism with the thromboembolic disease in Croatian population

Rhabdomyolysis and Acute Renal Failure after Gardening

Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed

Fatal aspiration of iodine oral contrast

We report on a case of massive iodine oral contrast aspiration with consequential cardiorespiratory arrest. The patient was successfully resuscitated and treated with mechanical ventilatory support and an urgent bronchoscopy toilet with only modest success. Instead of esophagography, the X-ray image showed an almost classical “bronchography.” A few hours later, the chest X-ray was indicative of acute noncardiogenic pulmonary edema. Respiratory status additionally deteriorated due to bilateral pleural effusions, severe exacerbation of chronic obstructive pulmonary disease, and heart failure, and the patient died of multiorgan failure 8 days after admission to the Intensive Care Unit. The incidence of fatal complications of oral iodine contrast aspiration is very rare but can be even lower if fully cooperative, and well-instructed patients are selected. Special attention should be paid to those with any kind of swallowing difficulties

Interrogating and Quantifying In Vitro Cancer Drug Pharmacodynamics via Agent-Based and Bayesian Monte Carlo Modelling

The effectiveness of chemotherapy in cancer cell regression is often limited by drug resistance, toxicity, and neoplasia heterogeneity. However, due to the significant complexities entailed by the many cancer growth processes, predicting the impact of interference and symmetry-breaking mechanisms is a difficult problem. To quantify and understand more about cancer drug pharmacodynamics, we combine in vitro with in silico cancer models. The anti-proliferative action of selected cytostatics is interrogated on human colorectal and breast adenocarcinoma cells, while an agent-based computational model is employed to reproduce experiments and shed light on the main therapeutic mechanisms of each chemotherapeutic agent. Multiple drug administration scenarios on each cancer cell line are simulated by varying the drug concentration, while a Bayesian-based method for model parameter optimisation is employed. Our proposed procedure of combining in vitro cancer drug screening with an in silico agent-based model successfully reproduces the impact of chemotherapeutic drugs in cancer growth behaviour, while the mechanisms of action of each drug are characterised through model-derived probabilities of cell apoptosis and division. We suggest that our approach could form the basis for the prospective generation of experimentally-derived and model-optimised pharmacological variables towards personalised cancer therapy