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Cytoreduction with Hyperthermic Intraperitoneal Chemotherapy and Renal Insufficiency Related to Diabetes Mellitus: An Anesthetic Challenge

Abstract

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves the prognosis in selected patients with peritoneal surface malignancies but it is an extensive procedure predisposing to major complications. Among them renal toxicity was reported. Severe renal insufficiency is considered a contraindication for this complex procedure. We present a patient with diabetic nephropathy with renal insufficiency KDOQI 3 and peritoneal metastasis from sigmoid adenocarcinoma with a good clinical outcome after CRS with HIPEC, highlighting the anesthetic precautions considered for this particular clinical case.

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Toxic Epidermal Necrolysis - A Case Report

Abstract

Toxic epidermal necrolysis (TEN) is an acute, life-threatening muco-cutaneous disease, often induced by drugs. It is characterized by muco-cutaneous erythematous and purpuric lesions, flaccid blisters which erupt, causing large areas of denudation. The condition can involve the genitourinary, pulmonary and, gastrointestinal systems. Because of the associated high mortality rate early diagnosis and treatment are mandatory.

This article presents the case of a sixty-six years old male patient, known to have cirrhosis, chronic kidney failure, and diabetes mellitus. His current treatment included haemodialysis. He was hospitalized as an emergency to the Dermatology Department for erythemato-violaceous, purpuric patches and papules, with acral disposition, associated with rapidly spreading erosions of the oral, nasal and genital mucosa and the emergence of flaccid blisters which erupted quickly leaving large areas of denudation. Based on the clinical examination and laboratory investigations the patient was diagnosed with TEN, secondary to carbamazepine intake for encephalopathic phenomena. The continuous alteration in both kidney and liver function and electrolyte imbalance, required him to be transferred to the intensive care unit. Following pulse therapy with systemic corticosteroids, hydro-electrolytic re-equilibration, topical corticosteroid and antibiotics, there was a favourable resolution of TEN.

The case is of interest due to possible life-threatening cutaneous complications, including sepsis and significant fluid loss, in a patient with associated severe systemic pathology, highlighting the importance of early recognition of TEN, and the role of a multidisciplinary team in providing suitable treatment.

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Statins as Pleiotropic Modifiers of Vascular Oxidative Stress and Inflammation

oxide synthase function in human vessels. Circulation. 2013;127:2209-21. 7. Antonopoulos AS, Margaritis M, Coutinho P, et al. Adiponectin As A Link Between Type 2 Diabetes Mellitus And Vascular NADPH-Oxidase Activity In The Human Arterial Wall: The Regulatory Role Of Perivascular Adipose Tissue. Diabetes. 2014. doi: 10.2337/db14-1011 [Epub ahead of print] 8. Channon KM and Guzik TJ. Mechanisms of superoxide production in human blood vessels: relationship to endothelial dysfunction, clinical and genetic risk factors. J Physiol Pharmacol

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Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

, bilateral internal mammary artery grafting, the complexity of procedures, the use of intra-aortic balloon pumps, lack of adequate antibiotic prophylaxis [ 10 ], as well as oesophageal perforations, and oropharyngeal infections such as para-pharyngeal abscess and odontoid process with epidural abscess of a descending necrotizing nature [ 11 ]. These triggering conditions are more aggressive if associated with factors such as age, smoking, chronic pulmonary disease, diabetes mellitus, chronic kidney failure, immunosuppression treatment with corticosteroids, and generalised

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Critical Care Aspects of Gallstone Disease

. Patients with diabetes mellitus have an increased risk of gangrenous cholecystitis [ 43 ], and patients with chronic haemolysis, i.e., hereditary spherocytosis or sickle cell disease, may develop pigment stones due to the accumulation of bilirubin in bile, and are more at risk of becoming symptomatic [ 22 ]. Native Americans [ 44 ], as well as patients with large gallbladder adenomas [ 45 ], pancreatic ductal draining into the common bile duct, porcelain gallbladder, or choledochal cysts, Caroli’s disease, or carrying S. thyphi [ 46 ], are at increased risk of

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