1/4. Bacterial meningitis--complication from a dialysis catheter.Various infective complications associated with dialysis catheter infection have been reported in the literature previously. We report a case of a hemodialysis patient presented with confusion and dysarthria secondary to staphylococcus aureus septicemia and meningitis originating from a tunneled catheter used for providing dialysis. Blood cultures from the periphery, central venous catheter and culture of the line tip grew methicillin-sensitive staphylococcus aureus. Lumbar puncture after CT brain confirmed staphylococcus aureus. He was treated with high dose of an appropriate parenteral antibiotic and also removal of the infected line. In spite of optimal treatment, he died 15 days following his admission. The ideal option will be to use a definitive access like a fistula or AV graft, but in practice a significant proportion of hemodialysis patients is dialyzed with temporary or tunneled catheters all over the world, and infection poses a serious threat to dialysis patients resulting in significant mortality and morbidity. In patients with dialysis catheter-related sepsis, removal of the infected catheters and appropriate antibiotic treatment will prevent serious metastatic complications. Planning definitive access well ahead in chronic kidney disease patients and minimizing the use of temporary access is the only way forward.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/4. Acute cerebral symptomatology, a rare presentation of scleromyxedema.A 65 year old male with the entity, scleromyxedema, experienced exacerbation of the disease in which the main clinical features involved the central nervous system. He presented with clouded sensorium, disorganized thinking, combative behavior, headache, unsteady gait and grand mal seizures. A few days after hospital admission the symptoms abated. After a 6 day hiatus, the symptoms suddenly recurred, continuing for another week. The symptomatology again suddenly ceased with complete clearance of mental status. During the full-blown delirium, the electroencephalogram had demonstrated diffuse slowing while lumbar puncture, brain scan, E.M.I. scan and cerebral arteriogram failed to contribute to the understanding of the clinical presentation. scleromyxedema rarely involves the central nervous system. This case illustrates a very unusual manifestation of scleromyxedema, prominent central nervous system involvement presenting as an acute organic brain syndrome. It is the only case which includes formal mental status examination, cerebrospinal fluid findings and electroencephalogram results.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/4. Behavioral change in a cancer patient following intrathecal beta-endorphin administration.A patient with a disseminated malignancy received 3 mg of synthetic beta-endorphin administered intrathecally by lumbar puncture. A marked behavioral syndrome characterized by confusion, hypomanic/manic behavior, and psychosis followed drug administration and persisted for more than 2 days.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/4. Pharmacokinetic and clinical studies in patients with cimetidine-associated mental confusion.15 cases of cimetidine-associated mental confusion have been reported. In order that this syndrome might be investigated changes in mental status (M.S.) were correlated with serum concentrations and renal and hepatic function in 36 patients, 30 patients had no M.S. change on cimetidine and 6 had moderate to severe changes. These 6 patients had both renal and liver dysfunction (P less than 0.05), as well as cimetidine trough-concentrations of more than 1.25 microgram/ml (P less than 0.05). The severity of M.S. changes increased as trough-concentrations rose, 5 patients had lumbar puncture. The cerebrospinal fluid: serum ratio of cimetidine concentrations was 0.24:1 and indicates that cimetidine passes the blood-brain barrier; it also raises the possibility that M.S. changes are due to blockade of histamine H2-receptors in the central nervous system. patients likely to have both raised trough-concentrations and mental confusion are those with both severe renal and hepatic dysfunction. They should be closely observed and should be given reduced doses of cimetidine.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |