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ABSTRACT: Results from recent trials and advances in the fields of medicine and technology have altered the spectrum of indications for use of therapeutic plasma exchange. In this article we analyze changes in indications for therapeutic plasma exchange that have occurred during 27 years in Croatia. We retrospectively analyzed the database of the Department of Dialysis at the University Hospital Center, Zagreb (678 patients; 6596 procedures), for changes in indications for therapeutic plasma exchange from 1982 to 2008. The number of patients and procedures increased several-fold during the follow-up period, but the mean number of procedures per patient per year did not change significantly. Neurological disorders constituted the largest group of indications for therapeutic plasma exchange (66% of all indications), followed by hematological (16%), nephrological (6%), and rheumatological disorders (6%). Myasthenia gravis was the most frequent indication during the entire follow-up period, but the pattern of other indications changed, with the most frequent at the beginning of follow-up becoming the least frequent at the end of follow-up. The five most frequent indications represented 62.2% of all indications at the beginning of follow-up, whereas during the 1990s, this percentage increased to more than 90% of all indications. Since the year 2000, the spectrum of indications has grown, and the percentage of the five most common indications decreased to 79.9%. Despite changes in indications for therapeutic plasma exchange, this procedure is still applicable in various medical fields, either traditional or newly created with the development of medicine and technology.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 12/2011; 15(6):587-92. · 1.39 Impact Factor
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MEDIX (medix@ct-poslovneinformacije.hr); Vol.11 No.58.
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ABSTRACT: A 59-year-old Caucasian male started intermittent hemodialysis in March 1995 for the treatment of end-stage renal disease of unknown etiology. In December 2002, he started receiving parenteral iron sucrose, 100 mg every two weeks, for iron deficiency. He did not receive erythropoietin. One month later he experienced severe pruritus. Blood analysis revealed erythrocytosis. Iron therapy was discontinued immediately, and four venepunctures were performed to avoid thrombosis of AV fistula. Malignant disease was excluded. It was decided to apply an angiotensin convertase enzyme inhibitor (ACEi), ramipril, in a dose of 2.5 mg/day. However, the patient developed severe cough as a side effect of ramipril and was switched to an angiotensin receptor type II antagonist (AAR), losartan, in a dose of 25 mg/day. While the patient was prone to hypotension during the dialysis sessions, losartan was administered every evening at bedtime. One month after the introduction of AAR, a stable hemoglobin level was achieved. On control MSCT six months later, there was no sign of malignant disease. Oral ACEi and AAR are appropriate treatment in the control of erythrocytosis in dialysis patients.
Acta Clinica Croatica; Vol.43 No.4.
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ABSTRACT: Anderson-Fabry disease is an X-linked recessive glycolipid storage disease caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. Numerous mutations are responsible for development of the disease. Clinical manifestations include acroparesthesia from childhood, corneal dystrophy, angiokeratomas, hypohidrosis, hearing loss and, with aging, development of cardiovascular and renal disease. Renal failure typically begins in the third decade of life. A young male patient presents with proteinuria and impaired urinary concentrating ability, or reaches end-stage renal disease of unknown origin without prior supervision of nephrologist. Polyuria and nicturia are the first signs of disease caused by urinary concentration defect. Proteinuria begins in the second decade of life, and is usually below the nephrotic level. Urinalysis is characterized by hematuria and lipiduria. Urinary sediment contains lipid globules and characteristic .Maltese crosses.. Enzyme replacement therapy has recently become available. Two formulations of alpha-galactosidase A have received marketing authorization. It seems possible to halt and probably even reverse the progression of Fabry disease before the irreversible organ damage has set in. Clinical trials have proved the efficacy and safety of treatment with agalsidase alpha or beta. Besides its beneficial effect on renal function, enzyme replacement therapy improves cardiac parameters and quality of life in patients with Anderson-Fabry disease. The main disadvantage of enzyme replacement therapy is the very high cost of treatment, posing a challenge even to the most industrialized countries in the world.
Acta Clinica Croatica; Vol.44 No.1.
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ABSTRACT: Osteopetroses are disorders of bone remodeling resulting in increased bone mass. Osteopetrosis abnormalities can include changes in osteoclast lineage, bone marrow microenvironment, or both. Little is known about the mechanisms that regulate the activity of different bone cell types. Various agents act on bone in a complicated web of interactions, with either synergistic or diverse effects. Advances in molecular biology have enabled studies in knockout or transgenic animals, providing an insight into the mechanism of bone remodeling.
Acta Clinica Croatica; Vol.40 No.1.
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ABSTRACT: A 57-year-old male was started on hemodialysis in 1998 because of end-stage renal disease caused by IgA nephropathy. He received an allograft in April 2002 and was treated with cyclosporine, mycophenolate mofetil and steroids. Graft function was optimal, without episodes of acute rejection. A red intradermal painless nodule was observed in the left preauricular region in September 2004. Immunohistochemical staining showed perinuclear expression of cytokeratin 20 and synaptophysin as well as the presence of neuron-specific enolase and chromogranin, characteristic of Merkel cell carcinoma. Radical re-excision with a median margin of 2 cm was necessary. The patient received adjuvant radiotherapy in a total dose of 55 Gy in 20 cycles. Immunosuppressive therapy was reduced. Merkel cell carcinoma is a rare aggressive cancer that may be misdiagnosed as an indolent skin disease. In immunocompromised host it is more likely to occur, at a younger age and probably assuming a more aggressive course than in the general population.
Acta Clinica Croatica; Vol.46 No.3.
