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Review of oncological emergencies in small animal patients.

Oncological emergencies can occur at any time during the course of a malignancy and need to be recognized promptly to maximize successful outcomes. Emergencies are characterized as chemotherapy-induced, paraneoplastic syndromes, or directly related to the neoplasm. Prompt identification with treatment of these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This review aims to educate the reader on the pathophysiology, clinical presentation and treatment of some of these emergencies, and to review the current veterinary literature to help

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… Current recommendations for management of AKI in humans include the discontinuation of nephrotoxic drugs, haemodynamic support with intravenous fluids, monitoring of UOP and, in cases of oliguria/anuria, vasoactive drugs (Keir & Kellum 2015 ). … When oliguria/anuria and/or fluid overload is suspected, the placement of an indwelling urinary catheter is recommended to measure UOP. …

Diuretics for preventing and treating acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) is a well-known complication of critical illnesses, significantly affecting morbidity and the risk of death. Diuretics are widely used to ameliorate excess fluid accumulation and oliguria associated with AKI. Their popularity stems from their ability to reduce the energy demands of renal tubular cells by inhibiting transporters and flushing out intratubular casts. Numerous studies have assessed the effects of diuretics in the context of AKI prevention and treatment. However, a comprehensive systematic review addressing this topic has yet to be conducted. …

Study on the therapeutic effect of glucocorticoids on acute kidney injury in rats exposed to diquat.

AIMS: To preliminarily explore, whether glucocorticoids have a therapeutic effect on diquat-induced acute kidney injury in rats. METHOD: 15 … , most rats in DQ group, DQ+L-GC group, DQ+M-GC group and DQ+H-GC group showed shortness of breath, oliguria, diarrhea, yellow hair and other symptoms. No symptoms and related signs were observed in Ctrl group and GC group. (2) The weight of rats in the Ctrl group and the GC group increased slowly during the test. the body weight of the rats in the DQ, DQ+ …

Spontaneous Tumor Lysis Syndrome.

Tumor lysis syndrome (TLS) is a hemato-oncological emergency characterized by metabolic and electrolyte imbalances which are associated with disintegrating tumor cells. The syndrome is frequently observed when starting cytotoxic treatment of hematological malignancies, while the incidence of spontaneous tumor lysis prior to the start of tumor therapy is rare. Here, we present a case of spontaneous TLS in a male patient who was referred with unspecific symptoms and suspected metastatic malignancy. He developed acute renal failure before the diagnosis of a high-grade B-cell lymphoma (double hit

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… There are also predisposing tumor-independent factors, such as advanced age, pre-existing renal dysfunction, oliguria, anuria, hyperuricemia, dehydration, deviations from normal urine pH value (low pH value: risk of urate nephropathy; high pH value: risk of calcium phosphate precipitation [ 22 ]), and … Absolute dialysis indications are severe oliguria or anuria, therapy-resistant hyperkalemia and hyperphosphatemia, and symptomatic hyperphosphatemia-induced hypocalcemia [ 7 , 22 , 34 ]. Conclusion Spontaneous TLS is a rare hemato-oncological emergency situation. …

A multicenter prospective study of 515 febrile neutropenia episodes in Argentina during a 5-year period.

For better management of patients with febrile neutropenia, our study investigated the epidemiologic, microbiologic, and clinical characteristics of adult inpatients with febrile neutropenia and their mortality-associated factors. To this end, we carried out a prospective, observational, multicenter study in 28 Argentinian hospitals between 2007 and 2012. We included 515 episodes of febrile neutropenia from 346 patients, median age 49 years. Neutropenia followed chemotherapy in 77% of cases, half of the cases due to hematological malignancies. Most episodes were classified as high-risk accordi

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… Prior use of antimicrobials | 161 (31,3%) | Bacterial prophylaxis | 63 (12.2%) | Prior infection at the onset of FNE | 98 (19%) No antibiotics | 354 (68.7%) Physical examination at the onset of FNE | Hypotension | 85 (16.5%) Tachycardia | 179 (34.8%) Dehydration | 64 (12.4%) Tachypnea | 152 (29.5%) Oliguria … Tachycardia and tachypnea, followed by hypotension, dehydration, and oliguria were the most frequent alterations seen on physical examination at the onset of FNEs ( Table 1 ). …

Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm.

Acute kidney injury (AKI) is a common clinical condition among patients admitted in the hospitals. The condition is associated with both increased short-term and long-term mortality. With the development of a standardized definition for AKI and the acknowledgment of the impact of AKI on patient outcomes, there has been increased recognition of AKI. Two advances from past decades, the usage of computer decision support and the discovery of AKI biomarkers, have the ability to advance the diagnostic method to and further management of AKI. The increasingly widespread use of electronic health reco

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… Introduction Acute kidney injury (AKI) is a highly complicated clinical disorder that is widely characterized by rapid rate of reduced rate of glomerular filtration (GFR), demonstrated by a rise in serum creatinine (SCr) concentration or oliguria, or both [ 1 , 2 , 3 , 4 , 5 ]. … Biomarkers of Acute Kidney Injury (AKI) SCr level does not detect AKI promptly and increased SCr and oliguria may not occur for several hours after the onset of an acute decline in GFR [ 1 ]. …

Adverse Events of Oncologic Immunotherapy and Their Management.

Over the past two decades, immunotherapy has emerged as a promising treatment option for patients with cancer. However, newer versions of immunotherapy, such as checkpoint inhibitors, may be associated with unusual adverse effects (AEs) that can range in severity from mild to life-threatening. Unlike common AEs of conventional chemotherapy, which have a predictable nadir or cyclic pattern after administration, AEs of these newer immunotherapies are variable, depending on the type of immunotherapy, route of administration, and mechanism of action. The onset and resolution of these AEs may be pr

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… mouth • Increased liver enzymes • Arthralgia • Myalgia • Asthenia • Flu-like symptoms • Diarrhea • Chills • Vomiting • Rash • Bilirubinemia • Thrombocytopenia • Nausea • Confusion • Increased serum creatinine • Capillary leak syndrome (peripheral edema, hypotension, pleural effusion, dyspnea, ascites, oliguria … , and hyperbilirubinemia.[ 10 , 23 ] In a retrospective analysis of 243 patients with advanced melanoma who received high-dose IL-2, the following AEs were reported: oliguria (14%–58%), hypotension (14%–39%), and tachycardia (10%–21%).[ 50 ] Given that these AEs can be severe or life-threatening, most …

Fulminant hepatitis and multi-organ failure following varicella zoster virus infection in an adult with G6PD deficiency: a case report.

BACKGROUND: Varicella zoster virus (VZV) infection in adults can lead to severe complications, particularly in those with underlying comorbidities. This case report presents a rare instance of VZV-associated fulminant hepatitis progressing to multi-organ failure in a 27-year-old female with glucose-6-phosphate dehydrogenase (G6PD) deficiency. CASE PRESENTATION: The patient presented with a generalized rash and rapidly developed acute liver failure, coagulopathy, and renal dysfunction. Despite aggressive management, including intravenous immunoglobulin therapy and supportive care, the patient'

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… During the progression of her condition, the patient developed oliguria as part of the evolving acute kidney injury (AKI) associated with multi-organ failure. … Renal replacement therapy (RRT) was not initiated, as the oliguria was managed conservatively with aggressive intravenous hydration and close monitoring of fluid balance. …

Proteasome inhibitors related thrombotic microangiopathy: a systematic and comprehensive review.

Proteasome inhibitors (PIs) are crucial in treating multiple myeloma but carry a risk of thrombotic microangiopathy (TMA), especially with carfilzomib use. This systematic review includes 44 studies with 115 cases of PI-induced TMA, where carfilzomib was implicated in 101 cases. Treatment approaches varied: 28 patients received supportive care, 43 underwent therapeutic plasma exchange (TPE), 9 were treated exclusively with eculizumab (ECU), and 13 received both TPE and ECU. Notably, eculizumab significantly improved outcomes for patients unresponsive to initial TPE, achieving complete remissio

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… The clinical manifestations commonly associated with PI-related TMA included oliguria or anuria in about half of the patients, gastrointestinal symptoms in 41.9%, neurological symptoms in 28.1%, and fever or infections in 37.7%. … 12.2) Other | – | 5 (6.7) Clinical presentation, n (%) | Gastrointestinal symptom | 31/74 (41.9) | 26/60 (43.3) Neurological symptom | 18/64 (28.1) | 12/50 (24.0) Skin symptom | 5/53 (9.4) | 2/42 (4.8) Fever/Infection | 20/53 (37.7) | 20/44 (45.4) Hypertension | 27/46 (58.7) | 25/43 (58.1) Anuria or oliguria …

Atypical Hemolytic Uremic Syndrome in the Setting of Acute Clostridium difficile Colitis.

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS can be secondary to multiple etiologies such as infections, medications, and immune processes. A rare, yet significant, etiology of HUS includes acute Clostridium difficile colitis. Here, we present a case of atypical HUS secondary to acute C. difficile colitis, successfully treated with hemodialysis and systemic corticosteroids. It is imperative that clinicians are cognizant of C. difficile-associated HUS given the overall rising incidence of acute C. difficile

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… The severity of acute kidney injury ranges from hematuria and proteinuria to severe renal failure and oliguria. …

From the nephrologist's point of view: diversity of causes and clinical features of acute kidney injury.

Acute kidney injury (AKI) is a clinical syndrome with multiple entities. Although AKI implies renal damage, functional impairment or both, diagnosis is solely based on the functional parameters of serum creatinine and urine output. The latest definition was provided by the Kidney Disease Improving Global Outcomes (KDIGO) working group in 2012. Independent of the underlying disease, and even in the case of full recovery, AKI is associated with an increased morbidity and mortality. Awareness of the patient's individual risk profile and the diversity of causes and clinical features of AKI is pivo

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… Septic AKI is often characterized by oliguria and results in an increased mortality, morbidity and prolonged hospitalization mainly by impairment of other organ systems with special focus on the lung [ 21 ]. … On the other hand, patients already suffering from AKI triggered by other factors than sepsis are endangered to systemic infections with oliguria, higher fluid accumulation and need for renal replacement therapy among others being predictors for development of sepsis [ 22 ]. …

Ига Ассоциированный Васкулит, вызывающий острый брюшной синдром у старшего пациента.

Васкулит, связанный с васкулитом (IgaV), хотя и относительно необычный для взрослых, часто ассоциируется с повышенной строгостью васкулита. Внезапная боль в брюшной полости и кровавый диарей являются обычными проявлениями ИГАВ у детей. У пожилых пациентов клинические проявления болезни могут быть типичными, но преклонный возраст и сходство могут сделать окончательный диагноз неожиданным. СЛУЧАЙ СЛЕДУЮЩЕЕ СООБЩЕНИЕ: 67-летний мужчина с множественными основными медицинскими заболеваниями, включая сахарный диабет и артериальную гипертонию, был допущен с острой болью в животе. Базовая оценка выяви

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… Laboratory tests revealed typical biochemical features of acute kidney injury accompanied by oliguria. Serum creatinine and urea levels increased to 381.7 μmol/L and 37.1 mmol/L, respectively. …

Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants.

BACKGROUND: Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to … uality evidence). There was a statistically significant reduction in the proportion of infants with oliguria in the ibuprofen group (6 studies, 576 infants; typical RR 0.28, 95% CI 0.14 to 0.54; typical RD -0.09, 95% CI -0.14 to -0.05; NNTB 11, 95% CI 7 to 20; I2 = 24% for RR and I2 = 69% for RD; moderate-quality evidence). The serum/plasma creatinine leve …

Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants.

BACKGROUND: A patent ductus arteriosus (PDA) complicates the clinical course of preterm infants, increasing their risks of developing chroni … o indomethacin in closing a PDA was found. Ibuprofen compared with indomethacin reduces the risk of oliguria and is associated with lower serum creatinine levels following treatment. Pulmonary hypertension has been observed in three infants after prophylactic use of ibuprofen and one infant receiving ibuprofen for treatment in this review developed pulmona …

Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants.

BACKGROUND: Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to … uality evidence). There was a statistically significant reduction in the proportion of infants with oliguria in the ibuprofen group (6 studies, 576 infants; typical RR 0.28, 95% CI 0.14 to 0.54; typical RD -0.09, 95% CI -0.14 to -0.05; NNTB 11, 95% CI 7 to 20; I2 = 24% for RR and I2 = 69% for RD; moderate-quality evidence). The serum/plasma creatinine leve …

Case report and review: Angiosarcoma with thrombocytopenia after total hip arthroplasty.

Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee art

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… bleeding, hematoma of the left ankle Moderate to severe hypoxia due to alveolar hemorrhage | Day 53 | Melena and hemoptysis | Day 57 | Excision arthroplasty surgery: pseudotumor excision, removal of all components of left THA (Girdlestone situation) | Day 58 | Poor cognition, hypoxia, hypotension, and oliguria … A norepinephrine infusion was administered for hypotension, while furosemide was administered for oliguria. The patient developed moderate kidney insufficiency. Treatment with piperacillin–tazobactam was replaced with meropenem, while daptomycin was continued. …

Гипервискозный синдром, гиперкальцемия и острая ренальная недостаточность в качестве первоначальных проявлений множественной миеломы в октогенариане.

Множественная миелома (ММ) — гематологическая порча, характеризующаяся распространением аномальных плазменных клеток, часто сопровождаемая чрезмерной секрецией моноклонных иммуноглобулинов. Синдром гипервискоза (HVS) является редким, но угрожающим жизни осложнением, которое ведет к расстройству микроциркуляции и дисфункции органов. Кроме того, гиперкальцемия, обычно связанная с остеолитическим разрушением костей, может также привести к острым повреждениям почек и изменению сознания. ПРЕДСТАВЛЕНИЕ СЛУЧАИ: Мы описываем 80-year-old Мужчина, у которого была путаница, общая слабость, снижение мочи

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… He subsequently developed fever, confusion, and oliguria, leading to hospitalization. 3. Clinical Examination and Diagnosis Upon admission, a whole‐body computed tomography (CT) scan revealed multiple osteolytic lesions (Figure 1 ), raising suspicion of metastatic malignancy. …

Intractable right coronary artery spasm in the early postoperative period after heart transplantation: a case report.

Coronary artery spasm after heart transplantation is a very rare complication. In one observational study and many anecdotal reports, most cases of coronary artery spasm occurred more than 1 year after surgery and had good outcomes. However, cases of intractable coronary artery spasm during the early postoperative period resulting in fatality are limited. This report presents a case of two cardiac arrests caused by coronary artery spasms within a short period of time after heart transplantation.

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… After surgery, the recipient received supportive care, including immunosuppressants, inotropic agents, antibiotics, and continuous renal replacement therapy for oliguria in the intensive care unit. Fig. 1 Electrocardiogram (ECG) during hospitalization. (A) Normal ECG after cardiac transplantation. …

Myelomatous ascites and pleural effusion in relapsed multiple myeloma.

Extramedullary multiple myeloma is seen in advanced and aggressive disease and occurs due to plasma cell infiltration of sites other than the bone marrow. Myelomatous ascites or pleural effusion is seen in less than 1% of cases and can be differentiated from infectious etiologies based on fluid cytology.

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… He was hospitalized due to acute kidney injury with oliguria likely due to cast nephropathy in the setting of progressive MM. …

Spontaneous Tumor Lysis Syndrome due to Uterine Leiomyosarcoma with Lung Metastases.

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by a combination of metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia) caused by rapid turnover from cell destruction in certain cancers. These metabolic derangements can lead to seizures, cardiac arrhythmias, renal failure, and death. TLS is usually seen after the initiation of chemotherapy for hematologic malignancies. TLS occurring spontaneously, without initiation of chemotherapy, is rare and its occurrence in solid tumors is rarer still. We report a case of spontaneous TLS in a patien

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… In addition, clinical TLS was defined as laboratory TLS as mentioned above plus creatinine > 1.5 times the upper limit of normal, oliguria cardiac arrhythmias, neuromuscular irritability, seizures, and sudden death [ 4 ]. …