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Acute-on-chronic liver failure (ACLF) is a condition that may develop in up to one third of patients with chronic liver disease who exhibit clinical signs of acute decompensation, i.e. ascites, gastrointestinal bleeding, hepatic encephalopathy or bacterial infection. ACLF implies the combination of acute hepatic decompensation with organ failure in kidney, brain, liver, lungs, circulation and/or coagulation. The prognosis worsens with the number of failing organs, renal involvement, advanced age and elevated leukocyte blood count. ACLF is caused by a systemic inflammation. Cultures from blood, urine and ascites should be drawn, and rapid antibiotic treatment is essential to prevent ACLF development. Renal function must be monitored and renal failure treated promptly. Acute alcoholic hepatitis may be considered a specific case of ACLF, which may be treated with corticosteroids in cases having high score in prognostic indices (GAHS, MELD or ABIC), and after bacterial infections have been ruled out or treated. © 2016, Swedish Medical Association. All rights reserved. Source

Unge C.,Karolinska Universitetssjukhuset
Lakartidningen | Year: 2014

Glucose-6-phosphate dehydrogenase deficiency is the most common human enzyme defect and may cause episodes of hemolytic anemia triggered by exogenous agents, such as certain drugs, intake of fava beans or physical stress. Normal levels of enzyme activity may be present during episodes of hemolysis in patients with glucose-6- phosphate dehydrogenase deficiency. We present a case concerning a man with hemolytic anemia where the diagnosis was made only after repeated analysis of enzyme activity. Source

Colombo N.,Istituto Europeo di Oncologia | Mangili G.,Ospedale San Raffaele | Mammoliti S.,Azienda Ospedaliera San Martino | Kalling M.,Gynekologisk Onkologklinik Universitetssjukhuset | And 4 more authors.
Gynecologic Oncology | Year: 2012

Objective: The recombinant fusion protein, aflibercept binds and neutralizes vascular endothelial growth factor (VEGF) A, B and placental growth factor (PlGF). Aflibercept inhibits ascites formation and reduces tumor burden in an ovarian cancer model. This open-label, single-arm, multicenter phase II study assessed the efficacy and safety of aflibercept in patients with advanced chemo-resistant epithelial ovarian cancer and symptomatic malignant ascites. Methods: Patients who required ≥ 3 previous paracenteses at 1-4 paracenteses per month received intravenous aflibercept 4 mg/kg every 2 weeks. The primary endpoint was repeat paracentesis response rate (RPRR), with response defined as at least a two-fold increase in time to repeat paracentesis compared with the baseline interval. Results: Ten out of 16 enrolled patients achieved a response; the RPRR was 62.5% (95% CI 35.4%-84.8%). Aflibercept was considered effective based on a hypothesis that the RPRR was ≥ 60%. Median time to repeat paracentesis was 76.0 (95% CI 64.0-178.0) days, which was 4.5 times longer than the baseline interval (16.8 days). Median progression-free survival was 59.5 (95% CI 41.0-83.0) days. Twelve patients experienced adverse events considered related to aflibercept treatment including hypertension (7 patients), headache, anorexia, and dysphonia (3 patients each). Two patients experienced Grade 3/4 treatment-related adverse events (Grade 3 hypertension and weight loss in one patient, Grade 3 intestinal perforation in one patient). Conclusion: Aflibercept 4 mg/kg every 2 weeks was effective at controlling malignant ascites, reducing the interval between repeat paracenteses. The safety profile was consistent with that reported for anti-VEGF agents. © 2012 Elsevier Inc. All rights reserved. Source

Cardiovascular calcification is a common phenomena in patients with end-stage renal disease. The etiology of vascular calcification is multifactorial in the toxic uremic mileu and include not only hyperphosphatemia but also adynamic bone disease, inflammation, dyslipidemia and oxidativ stress. Recent studies indicate that also subclinical deficiency of vitamin K may promote the vascular calcification process via less activation of the vitamin K dependent protein matrix Gla protein (MGP). As vitamin K inhibitors (such as warfarin) not only inactivate coagulation factors but also the carboxylation of MGP evidence suggests that they may also promote the vascular calcification process in susceptible indviduals. As retrospective studies indicate that warfarin is rather associated with increased risk for stroke the relative roles of warfarin versus novel oral anticoagulants need further studies in this calcification prone patient group. Source

Rosenborg S.,Karolinska Universitetssjukhuset
Lakartidningen | Year: 2013

Kidney function should be regarded when dosing and prescribing. We assessed the prescribing information available in the Summary of Product Characteristics (SmPC) for the 253 drug substances on the Stockholm County Formulary for the year 2010 (a.k.a. "The Wise List"). More than half of the 253 drug substances (58%) were excreted by the kidneys by more than 20%. 61% of them had some remark or regarding renal function. Different eGFR methods were recommended for different drugs and clar definitions of the GFR limit for dose adjustment were often lacking. Future recommendations in the SmPCs should be improved on dose adjustment in renal impairment, e.g. clarifying which eGFR method to use and at what GFR the dose should be adjusted. Source

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