One of the causes of hyperkalemia in patients with impaired renal function includes the excessive consumption of foods containing large amounts of potassium. We report the case of an 81-year-old man with chronic kidney disease brought by ambulance for weakness and difficulty walking. The patient has a history of congestive heart failure and hypertension; he was taking a potassium-sparing diuretic, along with an angiotensin II receptor blocker and a calcium channel blocker for hypertension. At presentation he was found to be hyperkalemic and was given life-saving emergency hemodialysis. It was found that the patient had consumed more than 500 g of sweet potatoes and two bananas on a daily basis starting one week before. The patient was educated not to consume too much of either food, as both contain large amounts of potassium, and he was discharged five days after initial presentation. Since this time, there have been no signs of hyperkalemia. Practitioners should exercise caution when administering drugs for chronic kidney disease patients who may have high potassium levels. Such patients should be instructed to refrain from excessive intake of foods with high potassium content.
Isolated Left Ventricular Non-Compaction (LVNC) is a rare congenital anomaly LVNC is commonly associated with congenital heart disease. Patients with LV non compaction also manifest with typical symptoms of heart failure, arrhythmias and thromboembolism, we report a 22-year-old male with LVNC and patent ductus arteriosus. After careful reviewing of the literature we found that this is the tenth reported case to have such a rare association between left ventricular non compaction cardiomyopathy and patent ductus arteriosus.
Learning Objectives: LV non compaction is a rare type of cardiomyopathy that can be easily misdiagnosed by echocardiographers. This case highlights the importance of echocardiography in diagnosing LV non compaction .it also presents a rare association between LV non compaction and patent ductus arteriosus which is the least common congenital heart disease known to be associated with LV non compaction.
Burkitt’s Lymphoma is historically recognized as a difficult to treat disease especially in the elderly cohort of patients and this necessitates close follow-up with vigilance for relapse. We report a case of an elderly lady who was treated aggressively for Burkitt’s Lymphoma and followed up clinic with with regular imaging every 6 months. During her follow up note was made of increased uptake in the cervical area with strong suspicion of disease relapse but which was discordant with her clinical signs and symptoms and therefore a tissue biopsy was performed which revealed granulomatous infection and no evidence of Lymphoma. Subsequently she was found to have toxoplasmosis with high levels toxoplasma IgG titer with reactive IgM levels. She had no history of direct exposure to cats and was treated conservatively. This case report provides us with a reminder that we should think of a wider differential for positive PETCT findings when the clinical picture doesn’t fit.
In Obstructive Uropathy normal urine flow is impeded because of structural and functional urinary tract abnormalities. Sustained obstruction decreases renal blood circulation and glomerular filtration rate accompanied by atrophy and apoptosis of the renal tubules resulting in irreversible kidney damage, inflammation and oxidative stress with progression to end-stage renal disease (ESRD) which requires dialysis therapy. The latter can also induce oxidative stress from mechanical stress exerted by the interaction of the blood with the dialysate across the dialyzer membrane. The effect of oxidative stress on biomolecules including DNA can occur via oxidation. As genetic damage studies on cases with uropathy and associated complications have not come to attention, peripheral blood of a 15 y-old male on hemodialysis presenting with chronic obstructive uropathy and ESRD was investigated for basal and oxidative DNA damage using the comet assay. Basal (2.35x) as well as oxidative DNA damage (~12x) was higher compared to levels in an age-matched healthy male. Lipid peroxidation assessed as Malondialdehyde (MDA) levels was also increased (3.64x) as were triglyceride levels. These findings on genetic damage and oxidative stress in obstructive uropathy and kidney disease mark early lesions which can translate to malignancy if unrepaired.
The objective of this study is to report a 41-year-old female TDH patient with a 16-year history with mainly upper left back pain radiating to the ipsilateral chest area. Concomitant spinal magnetic resonance imaging (MRI), computed tomography (CT), and physical examination confirmed a T7-8 and T8-9 disc herniation. Ultimately, the diagnostic measures ruled the source of the pain derived from T7-8 that was consistent with patient’s self-reported areas of pain associated with T7-8 myotome and dermatome distribution. The patient and surgeons chose percutaneous endoscopic thoracic discectomy (PETD) as the treatment intervention. After removal of the herniation mass and posterior marginal osteophyte that compressed right anterior-lateral surface of the spinal cord, the preoperative visual analog scale (VAS) pain rating decreased from 6 to nearly 0, which was further confirmed by postoperative MRI and CT imaging. And the 3-dimensional CT findings suggested structural recovery at T7-8. To date, there are minimal published studies exploring the treatment effect of PETD on TDH, regardless the median or high thoracic level. Here, this study provides support that PETD can be used as an effective and safe therapy for median thoracic disc herniation.
