Congratulations
to
Pusat Hemodialisis Suria
(Owned by Kumar Urology & Stone Centre Sdn Bhd)
37-G & 37-1, Kompleks Al-Azim
Bandar Bukit Baru,
75150 Melaka
on the commencement of your services
Best Wishes & Warmest Regards
from
MalaysianKidneySPA
Thursday, August 26, 2010
Tuesday, August 24, 2010
Acute liver failure.....
Acute liver failure following hemodialysis arteriovenous graft placement: a case report
Zachary Z Brener1, Augusto D Paiusco1 and Michael Bergman2
1 Department of Medicine, Beth Israel Medical Center, New York, 10003, NY, USA
2 Department of Medicine, Hasharon-Golda, Rabin Medical Center, Petah-Tikva, 19632, Israel
Journal of Medical Case Reports 2010, 4:261doi:10.1186/1752-1947-4-261
Abstract
Introduction
Severe high-output cardiac failure is a serious complication of high-flow vascular access requiring immediate intervention. Ischemic hepatitis is defined as a massive increase in serum transaminase levels due to an imbalance between hepatic oxygen supply and demand in the absence of other acute causes of liver damage. It is typically preceded by hypotension, hypoxemia, or both, and occurs mostly in elderly patients with right-sided congestive heart failure.
Case presentation
We report a fatal case of acute liver failure in an 84-year-old Caucasian man with high-output cardiac failure due to arteriovenous hemodialysis access. The chronological sequence of acute liver failure in the context of vascular access created two days before suggests that ischemic hepatitis was the result of high-output cardiac failure due to vascular access.
Conclusions
A thorough cardiac assessment should be performed in patients with severe cardiac disease prior to placing an arteriovenous access, and arteriovenous fistula should be the preferred vascular access.
Read full text here
Zachary Z Brener1, Augusto D Paiusco1 and Michael Bergman2
1 Department of Medicine, Beth Israel Medical Center, New York, 10003, NY, USA
2 Department of Medicine, Hasharon-Golda, Rabin Medical Center, Petah-Tikva, 19632, Israel
Journal of Medical Case Reports 2010, 4:261doi:10.1186/1752-1947-4-261
Abstract
Introduction
Severe high-output cardiac failure is a serious complication of high-flow vascular access requiring immediate intervention. Ischemic hepatitis is defined as a massive increase in serum transaminase levels due to an imbalance between hepatic oxygen supply and demand in the absence of other acute causes of liver damage. It is typically preceded by hypotension, hypoxemia, or both, and occurs mostly in elderly patients with right-sided congestive heart failure.
Case presentation
We report a fatal case of acute liver failure in an 84-year-old Caucasian man with high-output cardiac failure due to arteriovenous hemodialysis access. The chronological sequence of acute liver failure in the context of vascular access created two days before suggests that ischemic hepatitis was the result of high-output cardiac failure due to vascular access.
Conclusions
A thorough cardiac assessment should be performed in patients with severe cardiac disease prior to placing an arteriovenous access, and arteriovenous fistula should be the preferred vascular access.
Read full text here
Tuesday, August 17, 2010
Lighter Moments.....
WHAT is confidence all about?
TWENTY CEOs of IT companies, each from a different country, board an
airplane and are told that the flight that they are about to take is
the first-ever to feature pilotless technology: It is a completely
unmanned aircraft.
Each one of the CEOs is then told, privately, that his company's
software is running the aircraft's Automatic Pilot System. ONE by one,
nineteen of the CEOs leave the aircraft, each offering a different
excuse, some lame and laughable. Now that is obviously lack of
confidence.
The Malaysian CEO alone remains on board the jet, smiling and sipping his tea.
Asked why he is so certain his software will run the totally
computer-controlled plane, he replies :
"This plane will never take off !"
...That , my friend, is confidence!!!
TWENTY CEOs of IT companies, each from a different country, board an
airplane and are told that the flight that they are about to take is
the first-ever to feature pilotless technology: It is a completely
unmanned aircraft.
Each one of the CEOs is then told, privately, that his company's
software is running the aircraft's Automatic Pilot System. ONE by one,
nineteen of the CEOs leave the aircraft, each offering a different
excuse, some lame and laughable. Now that is obviously lack of
confidence.
The Malaysian CEO alone remains on board the jet, smiling and sipping his tea.
Asked why he is so certain his software will run the totally
computer-controlled plane, he replies :
"This plane will never take off !"
...That , my friend, is confidence!!!
Sunday, August 15, 2010
Read Recommendation
We would like to recommend the book entitled "The Secret of Change" by Dr Victor SL Tan to all. The book comprises 50 beautifully written messages in the form of poems enticing people to change. This book is powerful and empowering in its messages of change, should not be missed.
The book is available at MPH Bookstore. Checkout his other books too. Happy reading.
The book is available at MPH Bookstore. Checkout his other books too. Happy reading.
Thursday, August 12, 2010
Haemodiafiltration effect on skin hyperpigmentation....
The quantitative evaluation of online haemodiafiltration effect on skin hyperpigmentation
Nephrology Dialysis Transplantation - Advance Access
published online on August 9, 2010
http://ndt.oxfordjournals.org/cgi/content/abstract/gfq479
Masanori Shibata1, Kojiro Nagai2, Kazumasa Usami3, Hideo
Tawada1 and Shinkichi Taniguchi4
1 Department of Haemodialysis, Koujukai Rehabilitation
Hospital, Aichi, Japan
2 Department of Nephrology, Course of Biological
Medicine, School of Medicine, The University of
Tokushima, Tokushima, Japan
3 Department of Internal Medicine, Taigenkai Hospital,
Aichi,Japan
4 Department of Dermatology, Wakayama Medical University,
Wakayama,Japan
Submitted by Mr CS Shoong
Abstract
Background. Skin pigmentation is a common problem for dialysis patients, but little is known about the factor responsible for the colour intensity. Middle-molecular-weight (MMW) substances have been suggested to be responsible for the skin colour. Several papers have reported that β2-microglobulin (β2-MG) correlates with the skin colour, and haemodiafiltration (HDF) is effective to reduce the skin hyperpigmentation. However, a quantitative skin colour follow-up on patients treated with online haemodiafiltration (online HDF) has not been performed.
Methods. Sixty-one patients were enrolled in this study. Quantification of skin colour was done using a reflected light colorimeter. Among them, 51 patients were under haemodialysis (HD), and the other 10 patients were under online HDF. Follow-ups to estimate the skin colour change were performed for 6 months. Among 10 patients under online HDF, four patients were also investigated by crossover way between HD and online HDF.
Results. Compared with controls, patients treated with HD had darker skin. The colour value was well correlated with age, haematocrit, sex, diabetes and β2-MG but not with Kt/V. The skin colour got worse under HD treatment as well as the values of β2-MG, but online HDF improved the hyperpigmentation and the β2-MG values.
Conclusions. Our data show the effectiveness of online HDF on skin colour and suggest that HD patients’ skin colour can be improved by modality change.
Nephrology Dialysis Transplantation - Advance Access
published online on August 9, 2010
http://ndt.oxfordjournals.org/cgi/content/abstract/gfq479
Masanori Shibata1, Kojiro Nagai2, Kazumasa Usami3, Hideo
Tawada1 and Shinkichi Taniguchi4
1 Department of Haemodialysis, Koujukai Rehabilitation
Hospital, Aichi, Japan
2 Department of Nephrology, Course of Biological
Medicine, School of Medicine, The University of
Tokushima, Tokushima, Japan
3 Department of Internal Medicine, Taigenkai Hospital,
Aichi,Japan
4 Department of Dermatology, Wakayama Medical University,
Wakayama,Japan
Submitted by Mr CS Shoong
Abstract
Background. Skin pigmentation is a common problem for dialysis patients, but little is known about the factor responsible for the colour intensity. Middle-molecular-weight (MMW) substances have been suggested to be responsible for the skin colour. Several papers have reported that β2-microglobulin (β2-MG) correlates with the skin colour, and haemodiafiltration (HDF) is effective to reduce the skin hyperpigmentation. However, a quantitative skin colour follow-up on patients treated with online haemodiafiltration (online HDF) has not been performed.
Methods. Sixty-one patients were enrolled in this study. Quantification of skin colour was done using a reflected light colorimeter. Among them, 51 patients were under haemodialysis (HD), and the other 10 patients were under online HDF. Follow-ups to estimate the skin colour change were performed for 6 months. Among 10 patients under online HDF, four patients were also investigated by crossover way between HD and online HDF.
Results. Compared with controls, patients treated with HD had darker skin. The colour value was well correlated with age, haematocrit, sex, diabetes and β2-MG but not with Kt/V. The skin colour got worse under HD treatment as well as the values of β2-MG, but online HDF improved the hyperpigmentation and the β2-MG values.
Conclusions. Our data show the effectiveness of online HDF on skin colour and suggest that HD patients’ skin colour can be improved by modality change.
Wednesday, August 11, 2010
Dressing CVC sites....
Dressing CVC sites for infection-fighting success
Harwood, L., Wilson, B., et al. (2008).
Predictors of hemodialysis central venous catheter exit-site infections. The Canadian Association of Nephrology Nurses and Technologists Journal, 18(2), 26-35.
Modern Medicine: Publish date: Nov 1, 2008
Treating hemodialysis catheter-related bacteremia can cost as much as $45,000. More importantly, these infected sites are a significant cause of morbidity and mortality for hemodialysis patients. But researchers have studied these infected, tunneled hemodialysis CVC exit sites in hope of cleaning them up.
The study compared dressing types, cleansing agents, and number of dressing changes. Typically, dressings are either a dry gauze-type or a semi-permeable transparent dressing. Cleansers included a 2% chlorhexidine gluconate agent, which was tested against 10% povidone-iodine or 70% alcohol. Results indicated that the most infection-free sites were cleansed with 2% chlorhexidine gluconate and dressed with dry gauze.
As for the frequency of dressing changes, more is not better. Sites with negative exit-site cultures were more likely to have dressings changed weekly instead of daily or during each hemodialysis treatment.
Harwood, L., Wilson, B., et al. (2008).
Predictors of hemodialysis central venous catheter exit-site infections. The Canadian Association of Nephrology Nurses and Technologists Journal, 18(2), 26-35.
Modern Medicine: Publish date: Nov 1, 2008
Treating hemodialysis catheter-related bacteremia can cost as much as $45,000. More importantly, these infected sites are a significant cause of morbidity and mortality for hemodialysis patients. But researchers have studied these infected, tunneled hemodialysis CVC exit sites in hope of cleaning them up.
The study compared dressing types, cleansing agents, and number of dressing changes. Typically, dressings are either a dry gauze-type or a semi-permeable transparent dressing. Cleansers included a 2% chlorhexidine gluconate agent, which was tested against 10% povidone-iodine or 70% alcohol. Results indicated that the most infection-free sites were cleansed with 2% chlorhexidine gluconate and dressed with dry gauze.
As for the frequency of dressing changes, more is not better. Sites with negative exit-site cultures were more likely to have dressings changed weekly instead of daily or during each hemodialysis treatment.
Wednesday, August 4, 2010
Stabilizing Effects of Cool Dialysate ......
Stabilizing Effects of Cool Dialysate Temperature on Hemodynamic Parameters in Diabetic Patients Undergoing Hemodialysis
Asghar Ghasemi1, Morteza Shafiee2, Karim Rowghani2
1 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Hemodialysis, 15 Khordad Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
Abstract
To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3 ± 7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 o C) temperature dialysate solution. During the study, all the dialysis conditions were maintained the same except cooling the dialysate from 37 o C to 35°C. Hemodynamic parameters including SBP, DBP, and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic, and mean arterial pressure decreased significantly during standard temperature compared to cool dialysis. Maximum decrease of systolic, diastolic, and mean arterial pressure was observed during the third hour of dialysis and the magnitude of decrease was 18, 17, and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59 ± 5 vs. 37 ± 4, and 63 ± 7 vs. 41 ± 5, µmol/L respectively, P< 0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients.
Read full text here
Asghar Ghasemi1, Morteza Shafiee2, Karim Rowghani2
1 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Hemodialysis, 15 Khordad Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
Abstract
To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3 ± 7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 o C) temperature dialysate solution. During the study, all the dialysis conditions were maintained the same except cooling the dialysate from 37 o C to 35°C. Hemodynamic parameters including SBP, DBP, and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic, and mean arterial pressure decreased significantly during standard temperature compared to cool dialysis. Maximum decrease of systolic, diastolic, and mean arterial pressure was observed during the third hour of dialysis and the magnitude of decrease was 18, 17, and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59 ± 5 vs. 37 ± 4, and 63 ± 7 vs. 41 ± 5, µmol/L respectively, P< 0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients.
Read full text here
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