American journal of kidney diseases : the official journal of the National Kidney Foundation
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Review Case Reports
Pulmonary mucormycosis in diabetic renal allograft recipients.
Renal allograft recipients are prone to opportunistic infections due to their need of immunosuppression to prevent rejection. Mucormycosis is a rare opportunistic infection caused by a fungi of the order Mucorales. Risk factors predisposing to this disease include prolonged neutropenia, chelation therapy for iron or aluminum overdose, diabetes, and patients who are immunosuppressed. ⋯ Early diagnosis and prompt aggressive therapy is imperative to achieve an improved outcome. We present two cases of pulmonary mucormycosis in diabetic renal allograft recipients who were treated successfully with amphotericin B and surgical resection of the lesions with preservation of their allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in our transplant population.
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Review Case Reports
Paradoxical cerebral air embolism from a hemodialysis catheter.
Air embolism is a rare complication of the use of central venous catheters as vascular access for hemodialysis. We report a patient with an intracardiac shunt who had a paradoxical air embolism following manipulation of her hemodialysis catheter that resulted in transient hemiplegia. This case illustrates the potentially devastating consequences of even a small air leak into the circulation if it gains access to the arterial system.
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Review Case Reports
Pseudopulmonary embolism: acute respiratory distress in the syndrome of heparin-induced thrombocytopenia.
A 73-year-old man with myasthenia gravis was treated with daily plasmapheresis. During the course of treatment, the patient developed progressive thrombocytopenia and an episode of severe acute respiratory distress suggesting pulmonary embolism. ⋯ The time frame of clinical events suggests a heparin-mediated mechanism for both the thrombocytopenia and respiratory compromise. We conclude that acute respiratory distress may be the presenting manifestation of the syndrome of heparin-associated thrombocytopenia in patients treated with dialysis or apheresis.
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Offering financial incentives to families of brain-dead individuals has been proposed as a way to increase the supply of organs for transplantation. However, such incentives may lead to weakening of altruism and exploitation of poor families. We investigated dialysis patient attitudes toward the potential benefits and problems of incentives. ⋯ Subjects thought financial incentives would greatly increase donation by poor families while having little impact on rich families. In conclusion, even though dialysis patients are likely to benefit from increasing the supply of kidneys, many of them want to maintain altruism and protect poor families even if that means fewer kidneys. These concerns should be addressed in proposals to modify the transplant system.