Acta medica Indonesiana
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Acta medica Indonesiana · Jul 2012
ReviewUpdate on the role of intrapleural fibrinolytic therapy in the management of complicated parapneumonic effusions and empyema.
A parapneumonic effusion is the collection of exudative fluid in the pleural space associated with a concurrent pulmonary infection. Parapneumonic effusions account for approximately one-third of all effusions, and about 40% of patients with pneumonia develop a concomitant effusion. Patients with pneumonia who develop an effusion have an increased risk of morbidity and mortality. ⋯ Several investigators have studied the efficacy and safety of intrapleural fibrinolytics in the treatment of pleural effusion and empyema. Intrapleural instillation of fibrinolytic agents is undertaken to dissolve fibrinous clots and membranes, to prevent fluid sequestration, and hence to improve drainage. Recombinant deoxyribonuclease has been reported to improve drainage in a single patient who did not respond to fibrinolytic therapy.
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The kidney has a remarkable capacity to withstand insults for an extended period of time. The sensitivities of individual renal cells to injury vary depending on their type, position in the nephron, local vascularization, and the nature of injury. The resulting kidney injury is a product of the interplay between cell dysfunction, cell death, proliferation, inflammation, and recovery. ⋯ Ideal biomarker for AKI should be affordable, quick and measurable, precise and accurate, with prognostic ability to define severity of renal dysfunction, specific for renal, increase in the early stage dysfunction, with high sensitivity and specificity. Efforts to detect AKI in the earlier stage has resulted in some promising biomarkers such as KIM-1, NGAL, IL-18, Clusterin, etc. Cystatin C is a biomarker for glomerular filtration function, while 2-microglobulin, 1-microglobulin, NAG, RBP, IL-18, NGAL, Netrin-1, KIM-1, Clusterin, Sodium Hydrogen Exchanger Isoform and Fetuin A are biomarkers for tubular reabsorption function.
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Acta medica Indonesiana · Jul 2012
Serum bile acid: an alternative liver function marker in the obstructive jaundice patient.
to confirm the role of bile acid value as single marker for liver function test as compared to the conventional liver function tests on obstructive jaundice patients. ⋯ the sBA level follow the pattern of changes of classic liver function markers. Serum bile acid could be considered to be used as alternative marker to evaluate liver function, which is simple and applicable.