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https://www.readbyqxmd.com/read/28223040/red-blood-cell-exchange-as-an-approach-for-treating-a-case-of-severe-tacrolimus-overexposure
#1
Valentina Spallanzani, Lucia Bindi, Irene Bianco, Arianna Precisi, Paolo DeSimone, Alessandro Mazzoni, Gianni Biancofiore
Immunosuppressive medication dosing errors are not unfrequent and may present a number of challenges to transplant clinicians. Tacrolimus (TAC) is a widely used immunosuppressant with a narrow therapeutic index and potential severe side effects, including neurotoxicity and kidney injury. We herein report a case of 60-year-old woman who underwent deceased-donor liver transplantation at our center and due to inadvertent TAC overexposure was admitted to the Intensive Care Unit because of severe neurologic impairment, kidney injury and arterial hypotension...
February 2, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28213687/ofatumumab-for-the-treatment-of-childhood-nephrotic-syndrome
#2
Chia-Shi Wang, Rochelle Schmidt Liverman, Rouba Garro, Roshan Punnoose George, Anastacia Glumova, Alana Karp, Stephanie Jernigan, Barry Warshaw
BACKGROUND: Ofatumumab is a humanized anti-CD20 monoclonal antibody that has recently garnered interest as a potential therapeutic agent for nephrotic syndrome. We report our center's experience in administering ofatumumab to five pediatric patients with idiopathic nephrotic syndrome. METHODS: Between March 2015 and November 2016, five patients were treated with ofatumumab. One patient had post-transplant recurrent focal segmental glomerulosclerosis (FSGS) which had been resistant to plasmapheresis and numerous immunosuppressive agents...
February 17, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28205445/severe-hypertriglyceridemia-induced-by-sirolimus-treated-with-medical-management-without-plasmapheresis
#3
Kazuhiko Kido, Rickey A Evans, Anil Gopinath, Jeremy D Flynn
: Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28203129/plasmapheresis-for-refractory-pruritus-due-to-drug-induced-cholestasis
#4
Hasan Al-Azzawi, Ruchi Patel, Gagan Sood, Sumit Kapoor
Pruritus can be a distressing symptom seen in various cholestatic disorders. It is treated with medications like bile acid sequestrants. Drug-induced cholestasis usually resolves with withdrawal of the causative medication. We describe a case of refractory pruritus due to drug-induced cholestasis, not improved with withdrawal of the drug, managed effectively with multiple sessions of plasmapheresis.
September 2016: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28193112/longitudinal-outcomes-in-the-2014-acute-flaccid-paralysis-cluster-in-canada
#5
Carmen Yea, Ari Bitnun, Joan Robinson, Aleksandra Mineyko, Michelle Barton, Jean K Mah, Jiri Vajsar, Susan Richardson, Christoph Licht, Jason Brophy, Megan Crone, Shalini Desai, Juliette Hukin, Kevin Jones, Katherine Muir, Jeffrey M Pernica, Robert Pless, Daniela Pohl, Mubeen F Rafay, Kathryn Selby, Sunita Venkateswaran, Geneviève Bernard, E Ann Yeh
We describe the presenting features and long-term outcome of an unusual cluster of pediatric acute flaccid paralysis cases that occurred in Canada during the 2014 enterovirus D68 outbreak. Children (n = 25; median age 7.8 years) presenting to Canadian centers between July 1 and October 31, 2014, and who met diagnostic criteria for acute flaccid paralysis were evaluated retrospectively. The predominant presenting features included prodromal respiratory illness (n = 22), cerebrospinal fluid lymphocytic pleocytosis (n = 18), pain in neck/back (n = 14) and extremities (n = 10), bowel/bladder dysfunction (n = 9), focal central gray matter lesions found in all regions of the spinal cord within the cohort (n = 16), brain stem lesions (n = 8), and bulbar symptoms (n = 5)...
March 2017: Journal of Child Neurology
https://www.readbyqxmd.com/read/28188006/changes-in-hemostasis-caused-by-different-replacement-fluids-and-outcome-in-therapeutic-plasma-exchange-in-pediatric-patients-in-a-retrospective-single-center-study
#6
REVIEW
Volker Witt, Herbert Pichler, Elisabeth Beiglboeck, Friedrich Kursten, Lisa Weidner
BACKGROUND: Therapeutic plasma exchange (TPE) is a generally accepted and frequently performed procedure for numerous therapeutic indications in adults. Slowly, TPE is also becoming more and more popular in the treatment of pediatric patients. Although, we know that TPE is safe in pediatric patients, the outcome of children treated with TPE is rarely reported. Furthermore, there are only general recommendations regarding the plasma replacement fluid for children and these are adopted from adults...
January 19, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28184378/relapse-of-hcv-genotype-1b-infection-after-sofosbuvir-ledipasvir-treatment-presenting-as-de-novo-cryoglobulinemic-vasculitis
#7
Mohammad Qasim Khan, Alan D Moreno, Nora Joseph, George Kim, Claus J Fimmel
Relapse of hepatitis C virus (HCV) genotype 1 infection after combination therapy with sofosbuvir and ledipasvir is unusual. We report a treatment-naïve, non-cirrhotic patient in whom the relapse of genotype 1b HCV infection was accompanied by de novo cryoglobulinemic vasculitis and glomerulonephritis, requiring hemodialysis for acute renal failure. Sequence analysis revealed several resistance-associated variants in the HCV NS5a gene but not in NS3/4A. The patient's vasculitis was successfully treated with immunosuppression and plasmapheresis, followed by retreatment of HCV with a combination of sofosbuvir, simeprevir, and ribavirin...
2017: ACG Case Reports Journal
https://www.readbyqxmd.com/read/28182045/thrombotic-microangiopathy-an-unusual-cause-of-renal-failure-in-rheumatoid-arthritis
#8
R Sakthirajan, J Dhanapriya, T Dineshkumar, N Gopalakrishnan, S Murugan, T Balasubramaniyan
Rheumatoid arthritis (RA) is one of the commonest rheumatological diseases. Renal involvement is not common but can occur as a result of chronic inflammation as part of disease process or drug toxicity. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure of variable severity. Only a few cases of TMA in patients with RA were reported to date. We describe a 45-year-old female patient with RA who presented with oliguria and edema. Renal biopsy showed TMA with patchy cortical necrosis...
January 2017: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/28180010/extreme-thrombocytosis-presenting-in-anti-neutrophil-cytoplasmic-autoantibodies-associated-crescentic-glomerulonephritis-with-immune-complex-deposits-a-case-report
#9
Zhang Xuemei, Diao Yongshu, Zhang Ling, Yang Yingying, Fu Ping
INTRODUCTION: We describe a female patient with extreme reactive thrombocytosis (RT) in anti-neutrophil cytoplasmic autoantibodies (ANCA)-associated crescentic glomerulonephritis (CGN) with immune complex deposits, which has never been reported before. CASE PRESENTATION: A female adolescent with symptoms of oliguria and gross hematuresis had serious renal function impairment (crescent formation and immune complex deposits in renal pathology examination with positive serum ANCA) and extreme thrombocytosis...
October 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/28176474/monoclonal-gammopathy-of-renal-significance-triggering-atypical-haemolytic-uraemic-syndrome
#10
REVIEW
Usman Mahmood, Nicole Isbel, Peter Mollee, Andrew Mallett, Sridevi Govindarajulu, Ross Francis
Haemolytic uraemic syndrome is a rare condition with an overall incidence of one to two cases in a population of 100 000 and approximately 10% of these cases are classified as atypical. Atypical haemolytic uraemic syndrome (aHUS) is a thrombotic microangiopathy (TMA) characterized by microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and acute kidney injury. aHUS can be genetic, acquired or idiopathic (negative genetic screening and no environmental triggers). We describe a case of aHUS triggered by monoclonal gammopathy of renal significance (MGRS) successfully treated with plasmapheresis and a bortezomib-based chemotherapy regimen, resulting in marked improvement in renal function and other markers of haemolysis...
February 2017: Nephrology
https://www.readbyqxmd.com/read/28176463/severe-chronic-norovirus-diarrheal-disease-in-transplant-recipients-clinical-features-of-an-under-recognized-syndrome
#11
Robin K Avery, Bonnie E Lonze, Edward S Kraus, Kieren A Marr, Robert A Montgomery
BACKGROUND: Norovirus (NV) infection has been reported as a cause of severe chronic diarrhea in transplant recipients, but this entity remains under-recognized in clinical practice, leading to diagnostic delays. Transplant clinicians should become familiar with this syndrome in order to facilitate early detection and management. METHODS: Demographic, clinical, and outcomes variables were summarized from a series of transplant recipients with positive stool NV reverse transcription polymerase chain reaction (RT-PCR) assays at Johns Hopkins in 2013-2014...
February 7, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28163432/early-primary-graft-failure-after-a-pediatric-heart-transplant-and-successful-rescue-with-plasmapheresis-immunoglobulins-and-alemtuzumab
#12
Shashi Raj, Phillip Ruiz, Paolo Rusconi
Early primary graft failure after pediatric orthotopic heart transplantation (OHT) has a high mortality rate and can occur due to several causes including but not limited to prolonged graft ischemia time, suboptimal preimplant myocardial preservation, hyperacute rejection, and maladaptation of the graft to the host's hemodynamic status. Mechanical circulatory support with either extracorporeal membrane oxygenation (ECMO) or ventricular assist device has been used for the rescue of primary graft failure in pediatric patients after heart transplant...
January 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28162168/-analysis-of-clinical-characteristics-and-outcomes-of-mechanically-ventilated-patients-with-anti-n-methyl-d-aspartate-receptor-encephalitis
#13
Y Zhang, Y Y Su, D Q Gao, H Ye
Objective: To explore the clinical characteristics and long-term outcomes of mechanically ventilated patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Methods: In this observational study, patients with anti-NMDAR encephalitis were enrolled, who were admitted into Xuanwu Hospital of Capital Medical University from Jan 2012 to Jun 2015.All patients accepted tumor screening, symptomatic therapy, and immunotherapy.Outcomes were assessed by modified Rankin Scale (mRS) after immunotherapy every 6 months, and mRS 0-2 was defined as favorable outcome...
January 17, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28154283/postpartum-anti-n-methyl-d-aspartate-receptor-encephalitis-a-case-report-and-literature-review
#14
Tadashi Doden, Yoshiki Sekijima, Junji Ikeda, Kazuki Ozawa, Nobuhiko Ohashi, Minori Kodaira, Akiyo Hineno, Naoko Tachibana, Shu-Ichi Ikeda
We describe a 24-year-old woman with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis that developed 3 weeks after normal delivery. She was treated with methylprednisolone, intravenous immunoglobulin, and plasmapheresis, in addition to teratoma excision. However, her recovery was slow, and dysmnesia and mental juvenility persisted even two years after onset. To date, five patients with postpartum anti-NMDAR encephalitis have been reported. All of those patients showed psychotic symptoms and were suspected of having postpartum psychosis in the early period of the encephalitis...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28152224/effect-of-plasmapheresis-on-the-antifactor-xa-activity-of-enoxaparin-in-an-obese-adolescent-patient
#15
K W Rahawi, K L Higgins, C Noda, J S Stultz
To our knowledge, the effect of plasmapheresis on the antifactor Xa activity of enoxaparin has never been reported. We describe a 13-year-old, obese (92-kg) adolescent female who was treated with enoxaparin for a pulmonary embolism while receiving plasmapheresis for suspected autoimmune encephalitis, and experienced clinically significant reductions in antifactor Xa activity following plasmapheresis. She received five courses of plasmapheresis, with the final two during treatment with enoxaparin. Her antifactor Xa concentrations were highly variable, and we hypothesized that plasmapheresis was affecting these levels...
February 2, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28150184/thrombotic-thrombocytopenic-purpura-in-a-new-onset-lupus-patient
#16
Nery Sablón González, Noel Lorenzo, Yanet Parodis, Maria Belen Alonso Ortiz, Melek Kechida, Jose Carlos Rodriguez Perez
We are presenting a case of TTP with undetectable levels of ADAMTS 13 in a 39-year-old woman. Diagnosis of systemic lupus was evoked in the setting of thrombotic microangiopathy. The patient presented normal renal function but important neurological impairment. Treatment with daily plasmapheresis as well as Rituximab, cyclophosphamide as steroids was required to achieve clinical improvement.
February 2, 2017: Immunologic Research
https://www.readbyqxmd.com/read/28147928/pembrolizumab-induced-myasthenia-gravis-a-fatal-case-report
#17
Katherine L March, Michael J Samarin, Amik Sodhi, Ryan E Owens
Purpose Pembrolizumab, a monoclonal antibody which inhibits the programmed cell death 1 receptor, has been shown to efficaciously enhance pre-existing immune responses to malignancies. However, safety concerns must also be considered as pembrolizumab use has been associated with several life-threatening immune-related adverse events (irAEs). We report a fatal case of pembrolizumab-induced myasthenia gravis in a patient with no prior myasthenia gravis history. Case report A 63-year-old male presented with right eyelid drooping, puffiness, blurred vision, and shortness of breath two weeks after an initial infusion of pembrolizumab...
January 1, 2017: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/28141920/face-transplantation-partial-graft-loss-of-the-first-case-ten-years-later
#18
Emmanuel Morelon, Palmina Petruzzo, Jean Kanitakis, Stéphanie Dakpé, Olivier Thaunat, Valérie Dubois, Gabriel Choukroun, Sylvie Testelin, Jean-Michel Dubernard, Lionel Badet, Bernard Devauchelle
Ten years after the first face transplantation we report the partial loss of this graft. After two episodes of acute rejection (AR) occurred and completely reversed in the first post-transplantation year, ninety months post-transplantation the patient developed de novo class II-donor specific antibodies, without clinical signs of AR. Some months later she developed several skin rejection episodes treated with steroid pulses. Despite rapid clinical improvement, some months later the sentinel skin graft underwent necrosis...
January 31, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28133332/-multidisciplinary-treatment-for-high-risk-gist-of-the-stomach
#19
Tomo Ishida, Shigeyuki Tamura, Atsushi Takeno, Kohei Murakami, Yohei Nose, Ryota Mori, Yasuo Oneda, Ryuichi Kuwahara, Takuya Sakamoto, Atsushi Naito, Yoshiteru Katsura, Yoshiaki Ohmura, Yoshinori Kagawa, Yutaka Takeda, Takeshi Kato
A 59-year-old man underwent total gastrectomy(with D2 dissection)and cholecystectomy for gastric cancer and a submucosal tumor of the stomach. The specimen was immunohistochemically positive for c-kit, the Ki-67 label index was 10%, and the mitotic count was 20/HPF. Finally, the patient was diagnosed with high-risk gastrointestinal stromal cancer with normal type gastric cancer. After discharge from hospital, we started administration of TS-1 as adjuvant therapy for the gastric cancer. As multiple recurrences of the GIST in the abdomen developed, the patient underwent 3 radical local resections...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28131664/survival-and-outcomes-after-lung-transplantation-for-non-scleroderma-connective-tissue-related-interstitial-lung-disease
#20
Andrew M Courtwright, Souheil El-Chemaly, Paul F Dellaripa, Hilary J Goldberg
BACKGROUND: Patients with non-scleroderma connective tissue-related lung disease (NS-CTLD), including rheumatoid arthritis, idiopathic inflammatory myopathies, Sjögren syndrome, mixed connective tissue disease, and systemic lupus erythematosus, may be at risk for worse outcomes after lung transplantation because of immune dysregulation or extrapulmonary manifestations of their underlying disease. We compared survival, acute and chronic rejection, and extrapulmonary organ dysfunction after transplantation in patients with NS-CTLD and idiopathic pulmonary fibrosis (IPF)...
December 31, 2016: Journal of Heart and Lung Transplantation
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