SESARAM - Nef - Nefrologia
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Browsing SESARAM - Nef - Nefrologia by Author "Barbas, José"
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- Fungal peritonitis in peritoneal dialysis patients: is previous antibiotic therapy an essential condition?Publication . Guimarães Rosa, Nuno; Silva, Sónia; Lopes, José António; Branco, Patrícia; de Almeida, Edgar; Ribeiro, Carlos; Abreu, Fernando; Barbas, José; Martins Prata, M.The aim of this study was to analyse the clinical and microbiological features of fungal peritonitis, in chronic peritoneal dialysis patients, focusing on non-traditional risk factors for this feared complication. From 2001 to 2004, five episodes of fungal peritonitis were diagnosed in five different patients, accounting for 4.5% of all peritonitis cases seen during this period. Candida spp. were the most frequent isolates. In all cases, peritoneal dialysis catheter removal and switching to haemodialysis were necessary. In these five cases of fungal peritonitis only one was preceded by antibiotic use, within the previous 3 months, the classical risk factor for fungal peritonitis. Identifying predisposing factors usually not taken into account, may lead to an early diagnosis and to a better understanding of fungal peritonitis pathogenesis.
- Homozygous C677T mutation of the 5,10-methylenetetrahydrofolate reductase gene with hyperhomocysteinaemia associated with lupus anticoagulant in a chronic peritoneal dialysis patient with cerebral venous thrombosis- Case ReportPublication . Guimaraes, Nuno; Silva, Sónia; Branco, Patrícia; Almeida, Edgar de; Canhão, Patrícia; Barbas, José; Gomes da Costa, A.; Prata, M. MartinsWe report a case of a cerebral venous thrombosis (CVT) in a chronic kidney disease patient with three CVT predisposing conditions. A 53 year-old woman on chronic peritoneal dialysis presented to the emergency department with acute headache and vertigo. The neurological examination and head CT scan performed at the emergency department were normal but, three days later, a lateral gait deviation and a horizontal nystagmus were identified. A brain MRI and MRI-venogram confirmed a left lateral sinus thrombosis. Hormonal replacement therapy (HRT), a positive lupus anticoagulante and a homozygous mutation on the methylenetetrahydrofolate reductase gene, with hyperhomocysteinaemia, were the three well-known prothrombotic conditions identified in this patient. HRT was discontinued, the patient started anticoagulation with warfarin and folic acid supplementation and was discharged, 10 days after admission, complaining of a mild vertigo. After six months of therapy the patient had vertigo improvement and maintained a positive lupus anticoagulant. The head MRI and MRI-venography showed a thrombus reduction.
- Iliac artery false aneurysm twelve years after allograft nephrectomyPublication . Guimarães Rosa, Nuno; Silva, Sónia; Jorge, Sofia; Branco, Patricia; Inácio, João; Barbas, José; Gomes da Costa, A; Martins Prata, MWe report a case of a non-infected right external iliac artery false aneurysm. The patient was a 44 year-old woman on chronic peritoneal dialysis had had an allograft nephrectomy 12 years before and who presented with acute abdominal pain. Ultrasound and CT-scan showed a saccular aneurysm arising from the right external iliac artery. A large false aneurysm was identified during surgery, from donor arterial vessel remaining in situ after graft nephrectomy. Resection of the false aneurysm, with ligation of the right external iliac artery and interposition of a femorofemoral graft was successfully performed, with an uneventful post-operative recovery. False aneurysms after renal allograft nephrectomy are very rare. To our knowledge, this is the longest reported period of time between na nephrectomy and clinical evidence of a false aneurysm.