Recurrent rhabdomyolysis and glutaric aciduria type I: a case report and literature review.

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Qian, Gu-Ling; Hong, Fang; Tong, Fan; Fu, Hai-Dong; Liu, Ai-Min

2016-08-01

Glutaric acidemia type I (GA-I) is a rare metabolic disorder caused by mutation of the glutaryl- CoA dehydrogenase (GCDH) gene. The occurrence of rhabdomyolysis with GA-I is extremely rare. We reported a child with recurrent rhabdomyolysis and undiagnosed glutaric acidemia type I (GA-I). And a literature review was performed. A 4.5-year-old girl was admitted to our hospital due to recurrent rhabdomyolysis for 3 times within three years. At the third admission, she was diagnosed with GA-I by biochemical testing and mutation analysis. The girl was found to have a serine to leucine replacement mutation of the GCDH gene in exon 8 at position 764. Other three patients with rhabdomyolysis and GA-I were discovered by literature searching. This report highlights that patients with GA-I may have an increased risk of rhabdomyolysis.

Perspectives on Exertional Rhabdomyolysis.

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Rawson, Eric S; Clarkson, Priscilla M; Tarnopolsky, Mark A

2017-03-01

Exertional (exercise-induced) rhabdomyolysis is a potentially life threatening condition that has been the subject of research, intense discussion, and media attention. The causes of rhabdomyolysis are numerous and can include direct muscle injury, unaccustomed exercise, ischemia, extreme temperatures, electrolyte abnormalities, endocrinologic conditions, genetic disorders, autoimmune disorders, infections, drugs, toxins, and venoms. The objective of this article is to review the literature on exertional rhabdomyolysis, identify precipitating factors, and examine the role of the dietary supplement creatine monohydrate. PubMed and SPORTDiscus databases were searched using the terms rhabdomyolysis, muscle damage, creatine, creatine supplementation, creatine monohydrate, and phosphocreatine. Additionally, the references of papers identified through this search were examined for relevant studies. A meta-analysis was not performed. Although the prevalence of rhabdomyolysis is low, instances still occur where exercise is improperly prescribed or used as punishment, or incomplete medical history is taken, and exertional rhabdomyolysis occurs. Creatine monohydrate does not appear to be a precipitating factor for exertional rhabdomyolysis. Healthcare professionals should be able to recognize the basic signs of exertional rhabdomyolysis so prompt treatment can be administered. For the risk of rhabdomyolysis to remain low, exercise testing and prescription must be properly conducted based on professional standards.

Rhabdomyolysis featuring muscular dystrophies.

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Lahoria, Rajat; Milone, Margherita

2016-02-15

Rhabdomyolysis is a potentially life threatening condition of various etiology. The association between rhabdomyolysis and muscular dystrophies is under-recognized in clinical practice. To identify muscular dystrophies presenting with rhabdomyolysis at onset or as predominant feature. We retrospectively reviewed clinical and laboratory data of patients with a genetically confirmed muscular dystrophy in whom rhabdomyolysis was the presenting or main clinical manifestation. Thirteen unrelated patients (males=6; females=7) were identified. Median age at time of rhabdomyolysis was 18 years (range, 2-47) and median duration between the first episode of rhabdomyolysis and molecular diagnosis was 2 years. Fukutin-related protein (FKRP) muscular dystrophy (n=6) was the most common diagnosis, followed by anoctaminopathy-5 (n=3), calpainopathy-3 (n=2) and dystrophinopathy (n=2). Four patients experienced recurrent rhabdomyolysis. Eight patients were asymptomatic and 3 reported myalgia and exercise intolerance prior to the rhabdomyolysis. Exercise (n=6) and fever (n=4) were common triggers; rhabdomyolysis was unprovoked in 3 patients. Twelve patients required hospitalization. Baseline CK levels were elevated in all patients (median 1200 IU/L; range, 600-3600). Muscular dystrophies can present with rhabdomyolysis; FKRP mutations are particularly frequent in causing such complication. A persistently elevated CK level in patients with rhabdomyolysis warrants consideration for underlying muscular dystrophy. Copyright © 2015 Elsevier B.V. All rights reserved.

Diagnostic evaluation of rhabdomyolysis.

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Nance, Jessica R; Mammen, Andrew L

2015-06-01

Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. Clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. Muscle Nerve 51: 793-810, 2015. © 2015 Wiley Periodicals, Inc.

[Ultrasound findings in rhabdomyolysis].

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Carrillo-Esper, Raúl; Galván-Talamantes, Yazmin; Meza-Ayala, Cynthia Margarita; Cruz-Santana, Julio Alberto; Bonilla-Reséndiz, Luis Ignacio

Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis. A case is presented on the ultrasound findings in a patient with rhabdomyolysis. To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings, and review the literature. A 30 year-old with post-traumatic rhabdomyolysis of both thighs. Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer (5-10MHz), in low-dimensional scanning mode (2D), in longitudinal and transverse sections at the level of both thighs. The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas. Ultrasound is a useful tool in the evaluation of rhabdomyolysis. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment

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Torres, Patrick A.; Helmstetter, John A.; Kaye, Adam M.; Kaye, Alan David

2015-01-01

Background Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. Methods This review focuses on the epidemiology, pathophysiology, causes, presentation, diagnosis, complications, management, and anesthetic considerations related to rhabdomyolysis. Results Any form of muscle damage––and by extension any entity that causes muscle damage––can initiate rhabdomyolysis. One of the most important treatment goals when rhabdomyolysis is suspected is avoiding acute kidney injury. Conclusion All clinicians should be aware of common causes, diagnosis, and treatment options. PMID:25829882

Bench-to-bedside review

DEFF Research Database (Denmark)

Afshari, Arash; Schrenzel, Jacques; Ieven, Margareta

2012-01-01

ABSTRACT: Among critically ill patients, the diagnosis of bloodstream infection poses a major challenge. Current standard bacterial identification based on blood culture platforms is intrinsically time-consuming and slow. The continuous evolvement of molecular techniques has the potential of prov...

Drug induced rhabdomyolysis

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Hohenegger, Martin

2012-01-01

Rhabdomyolysis is a clinical condition of potential life threatening destruction of skeletal muscle caused by diverse mechanisms including drugs and toxins. Given the fact that structurally not related compounds cause an identical phenotype pinpoints to common targets or pathways, responsible for executing rhabdomyolysis. A drop in myoplasmic ATP paralleled with sustained elevations in cytosolic Ca2+ concentration represents a common signature of rhabdomyolysis. Interestingly, cardiac tissue is hardly affected or only secondary, as a consequence of imbalance in electrolytes or acid–base equilibrium. This dogma is now impaired by compounds, which show up with combined toxicity in heart and skeletal muscle. In this review, cases of rhabdomyolysis with novel recently approved drugs will be explored for new target mechanisms in the light of previously described pathomechanisms. PMID:22560920

Bedside teaching in medical education: a literature review.

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Peters, Max; Ten Cate, Olle

2014-04-01

Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession, but its use is declining. A literature review was conducted to reveal its strengths, the causes of its decline and future perspectives, the evidence with regard to learning clinical skills and patient/student/teacher satisfaction. PubMed, Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching. Articles regarding the above-mentioned subjects were included. Bedside teaching has shown to improve certain clinical diagnostic skills in medical students and residents. Patients, students/residents and teachers all seem to favour bedside teaching, for varying reasons. Despite this, the practice of bedside teaching is declining. Reasons to explain this decline include the increased patient turnover in hospitals, the assumed violation of patients' privacy and an increased reliance on technology in the diagnostic process. Solutions vary from increasingly using residents and interns as bedside teachers to actively educating staff members regarding the importance of bedside teaching and providing them with practical essentials. Impediments to bedside teaching need to be overcome if this teaching modality is to remain a valuable educational method for durable clinical skills.

Rhabdomyolysis Secondary to Bee Sting

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Okhan Akdur

2013-01-01

Full Text Available Insect stings belonging to Hymenoptera defined as wasps, yellow jackets, bees, or hornets by human usually result in unserious clinical pictures that go with pain. Rhabdomyolysis following a bee sting is a rare condition. This paper emphasizes “rhabdomyolysis” as a rare complication of this frequently observed envenomation. Rare but severe clinical results may occur due to multiple bee stings, such as intravascular hemolysis, rhabdomyolysis, acute renal insufficiency, and hepatic dysfunction. In bee stings as in our case, clinicians should be alert for rhabdomyolysis in cases with generalized body and muscle pain. Early onset alkaline diuresis and management in patients with rhabdomyolysis are vital in protecting the renal functions and preventing morbidity and mortality.

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

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Scalco, Renata S; Snoeck, Marc; Quinlivan, Ros; Treves, Susan; Laforét, Pascal; Jungbluth, Heinz; Voermans, Nicol C

2016-01-01

Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed.

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

Science.gov (United States)

Scalco, Renata S; Snoeck, Marc; Quinlivan, Ros; Treves, Susan; Laforét, Pascal; Jungbluth, Heinz; Voermans, Nicol C

2016-01-01

Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed. PMID:27900193

Fenofibrate monotherapy-induced rhabdomyolysis in a patient with hypothyroidism: A rare case report and literature review.

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Wang, Dawei; Wang, Yanqiu

2018-04-01

Fenofibrate is a fibric acid derivative indicated for use in hypertriglyceridemia and mixed dyslipidemia treatment among adults. Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation, which is the most serious and fatal side effect of fenofibrate. The objective of this paper is to discuss fatal side effect of fenofibrate and keep safe medication. A patient with hypothyroidism who presented with rhabdomyolysis during fenofibrate monotherapy for hypertriglyceridemia was reported. Fenofibrate Monotherapy Induced Rhabdomyolysis. Fenofibrate was stopped. Adequate fluid resuscitation, mannitol diuresis, myocardium protection, hepatoprotection and urine alkalinization with sodium bicarbonate were performed. Blood tests were normal and the patient was good and discharged 2 weeks later. 13 cases associated with fenofibrate monotherapy-induced rhabdomyolysis were reviewed, which had been published in the English literature. The severity of fenofibrate muscle toxicity may be the result of the combination of two rhabdomyolysis enhancers, such as hypothyroidism and female gender. To avoid it, strict clinical and laboratory monitoring should be maintained, particularly hypothyroidism. Patients should be informed of possible potentially irreversible effects after taking fibrates.

Increasing Incidence and Unique Clinical Characteristics of Spinning-Induced Rhabdomyolysis.

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Cutler, Todd S; DeFilippis, Ersilia M; Unterbrink, Michelle E; Evans, Arthur T

2016-09-01

To compare outcomes of spinning-induced rhabdomyolysis to those with exertional rhabdomyolysis from other physical activities. Retrospective cohort study. Academic medical center, single-center. A retrospective chart review was conducted on patients evaluated from December 2010 through November 2014. Patients were selected by ICD-9 code for rhabdomyolysis. Patients were included if the reason for admission was rhabdomyolysis caused by exertion. Cases of rhabdomyolysis caused by trauma or drugs were excluded. Muscle group involvement, admission, and peak creatine kinase levels, time from activity to hospitalization, length of hospital stay, and incidence of complications. Twenty-nine cases were reviewed with 14 admissions secondary to spinning. Median admission creatine kinase (73 000 IU/L vs 29 000 IU/L, P = 0.02) and peak creatine kinase levels were significantly higher in the spinning group (81 000 IU/L vs 31 000 IU/L, P = 0.007). Hospital admissions for spinning-induced rhabdomyolysis increased over time. Health care providers should be aware of the potential dangers of spinning-related rhabdomyolysis especially in otherwise healthy young people.

Rhabdomyolysis

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... this page: //medlineplus.gov/ency/article/000473.htm Rhabdomyolysis To use the sharing features on this page, please enable JavaScript. Rhabdomyolysis is the breakdown of muscle tissue that leads ...

Rhabdomyolysis induced by antiepileptic drugs: characteristics, treatment and prognosis.

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Jiang, Wei; Wang, Xuefeng; Zhou, Shengnian

2016-01-01

Rhabdomyolysis syndrome refers to a variety of factors that affect the striated muscle cell membrane, the membrane channels and its energy supply. Most cases of rhabdomyolysis are due to direct trauma. However, infection, toxins, drugs, muscle ischemia, electrolyte imbalance, metabolic diseases, genetic diseases and abnormal body temperature can also lead to rhabdomyolysis. Epilepsy is one of the most common chronic neurological diseases. The primary long-term treatment is antiepileptic drugs (AEDs), which may cause rhabdomyolysis. This article summarizes the characteristics, treatment methods and prognosis of patients with rhabdomyolysis that is induced by antiepileptic drugs. This review is based on PubMed, EMBASE and MEDLINE searches of the literature using the keywords "epilepsy", "antiepileptic drugs","status epilepticus","rhabdomyolysis", and "antiepileptic drugs and rhabdomyolysis syndrome" as well as extensive personal clinical experience with various antiepileptic drugs. Potential relationships between antiepileptic drugs and rhabdomyolysis are discussed. Worldwide, there are approximately 50 million epilepsy patients, most of whom are treated with drugs. Reports have indicated that the majority of antiepileptic drugs on the market can cause rhabdomyolysis. Although rhabdomyolysis induced by antiepileptic drugs is a rare condition with a low incidence, this condition has serious consequences and merits attention from clinicians.

Rhabdomyolysis Secondary to Clenbuterol Use and Exercise.

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Grimmer, Nicole M; Gimbar, Renee Petzel; Bursua, Adam; Patel, Meet

2016-02-01

The literature regarding rhabdomyolysis secondary to illicit drug use is sparse. Clenbuterol is a bronchodilator approved for veterinary use, which in high doses can increase protein deposition and lipolysis similarly to anabolic steroids, and is thereby abused for bodybuilding and weight loss effects. Clenbuterol has previously been described in case reports to be cardiotoxic, with patient presentations similar to overdoses of sympathomimetic substances, but reports of rhabdomyolysis are limited to a single case series in horses. We report the first case of rhabdomyolysis secondary to clenbuterol in a human. Our patient used clenbuterol for muscle-building effects in addition to exercise for multiple days prior to presentation. The patient's chief complaint at Emergency Department (ED) presentation was discolored urine. Workup for rhabdomyolysis was initiated, and an initial creatine kinase was measured at 122,933 units/L. Our patient's rhabdomyolysis was successfully treated with supportive therapy, and the patient was eventually discharged to home with no identifiable disability. The patient's kidney function remained at baseline, and no acute kidney injury was experienced secondary to rhabdomyolysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients presenting to the ED may have been unintentionally exposed through cutting of illicit substances or through intentional use in bodybuilding. Clenbuterol has well-described cardiotoxic effects, and we report the additional toxicity of rhabdomyolysis with its use. Copyright © 2016 Elsevier Inc. All rights reserved.

[Acute rhabdomyolysis: a case report and literature review].

Science.gov (United States)

Mrsić, Viviana; Nesek Adam, Visnja; Grizelj Stojcić, Elvira; Rasić, Zarko; Smiljanić, Aleksandra; Turcić, Ivica

2008-07-01

Acute rhabdomyolysis is a syndrome characterized by the lesion of skeletal muscle resulting in subsequent release of intracellular contents into the circulatory system, which can cause potentially lethal complications. These contents include myoglobin, creatine phosphokinase, potassium, aldolase, lactate dehydrogenase and glutamic-oxaloacetic transaminase. There are numerous causes that can lead to acute rhabdomyolysis and many of patients present with multiple causes. The most common potentially lethal complication of rhabdomyoloysis is acute renal failure. In this article we present a case of a patient that developed clinical signs of acute rhabdomyolysis after consumption of heroin and alcohol. After approximately nine hours of alcohol and heroin induced coma he had acute compartment syndrome of the right arm, and clinical and laboratory signs of acute rhabdomyolysis with acute renal failure as a complication of rhabdomyolysis. Acute rhabdomyolysis developed in the patient as the result of acute compartment syndrome, with direct toxic activity of alcohol and diamorphine. During the period of coma, due to lying in particular position over a long period of time, pressure upon the certain part of the body caused muscle compression and capillary occlusion in fascial compartments, which led to ischemia. Upon pressure relief and beginning of tissue recovery, post ischemic compartment syndrome occurred with subsequent rhabdomyolysis. Getting out of coma the patient started to complain of severe pain in the right arm, which clinically worsened on passive stretching of the limb, with the loss of sensation and weakness. Laboratory findings showed high levels of creatine phosphokinase as the most sensitive marker of muscular damage. The peak of creatine phosphokinase level can be predictive for the development of acute renal failure because myoglobin level may return to normal within 6 hours after muscle injury. The peak of creatine phosphokinase (186.080 U/L; normal range

Missing Links Between Genetically Inherited Molecules in Split Cord Malformation and Other Anomaly: A Bench to Bedside Approach.

Science.gov (United States)

Barik, Mayadhar; Mishra, Pravash R; Mohapatra, Ashok Kumar

2018-01-01

Split cord malformation (SCM) is associated with extensive vertebral fusions (Klippel-Feil anomaly). In light of previous embryological theories and recent research findings, we attempt to document the origin of split cord, and vertebral fusions involvement of spectrum of genes is necessary to know better the etiopathogenesis of SCM and its associated diseases. We used the various databases such as PubMed/MEDLINE, Cochrane Review, Hinari, and Google Scholar for the recently published medical literature. The women had been living and still born infants had SCM. The relative risk (RR) and possible molecular mechanism are described details of major genes and its variants in details. Although molecular genetics involvement including with recent advances of study add an evidence of both Mendelian and Non-Mendelian fashion is discussed with all genetic components. We mentioned our earlier experience and responsibility of SCM and its associated diseases. Although different mechanisms are suggested for the development of SCM observed in our experience, there is a midline lesion bisecting the neuroepithelium and the notochordal plate, which is responsible for complete splitting of the cervical cord with anterior bony defect. The localized disturbance of cervical neural tube closure accounts for SCM with partial dorsal splitting of the cord with posterior vertebral defect and associated diseases. According to the best of our knowledge, this report is the first one to be documented by wider spectrum of variants from (experimental studies to human subject). This add a complex interaction of mutant variants drive toward an additional second-hit alterations for the SCM. The up-to-date information, documented in proper order, derived the bench-to-bedside approach to overcome this burden of SCM, which is globally noticed with other additional diseases.

Increased frequency of rhabdomyolysis in familial dysautonomia.

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Palma, Jose-Alberto; Roda, Ricardo; Norcliffe-Kaufmann, Lucy; Kaufmann, Horacio

2015-11-01

Familial dysautonomia (FD; OMIM # 223900) is an autosomal recessive disease with features of impaired pain and temperature perception and lack of functional muscle spindles. After 3 FD patients presented with rhabdomyolysis in a short time span, we aimed to determine the frequency of rhabdomyolysis is this population. This study was a retrospective chart review of 665 FD patients. Eight patients had at least 1 episode of rhabdomyolysis. Two patients had 2 episodes. The average incidence of rhabdomyolysis in FD was 7.5 per 10,000 person-years. By comparison, the average incidence with statins has been reported to be 0.44 per 10,000 person-years. Mean maximum creatine kinase (CK) level was 32,714 ± 64,749 U/L. Three patients had hip magnetic resonance imaging showing gluteal hyperintensities. Patients with FD have an increased incidence of rhabdomyolysis. We hypothesize that this may result from a combination of absent functional muscle spindles and muscle mitochondrial abnormalities. © 2015 Wiley Periodicals, Inc.

Proton Pump Inhibitors and Risk of Rhabdomyolysis.

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Duncan, Scott J; Howden, Colin W

2017-01-01

Proton pump inhibitors (PPIs) have been associated with a variety of adverse events, although the level of evidence for many of these is weak at best. Recently, one national regulatory authority has mandated a change to the labeling of one PPI based on reports of possible associated rhabdomyolysis. Thus, in this review we summarize the available evidence linking PPI use with rhabdomyolysis. The level of evidence is insufficient to establish a causal relationship and is largely based on sporadic case reports. In general, patients with suspected PPI-associated rhabdomyolysis have not been re-challenged with a PPI after recovery. The mechanism whereby PPIs might have been associated with rhabdomyolysis is unclear but possibly related to interaction with concomitantly administered drugs such as HMG-CoA reductase inhibitors (statins). For patients with rhabdomyolysis, a careful search must be made for possible etiological factors. In patients who recover from an episode of possible PPI-related rhabdomyolysis but do not have a genuine requirement for PPI treatment, the PPI should not be re-introduced. For those with a definite indication for ongoing PPI treatment, the PPI can be re-introduced but should preferably not be administered with a statin.

Rhabdomyolysis Related to Dyskinesia in Parkinson’s Disease

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Hesna Bektaş

2014-04-01

Full Text Available Rhabdomyolysis is a life threatening syndrome. It accounts for an estimated 8% to 15% of cases of acute renal failure and is associated with a mortality rate of 5%. In movement disorders, various causes of rhabdomyolysis have been reported including status dystonicus, myoclonus, generalized chorea and parkinsonism-hyperprexia syndrome in Parkinson’s disease (PD. Levodopa-induced dyskinesia leading to rhabdomyolysis is a very rare phenomenon in PD. We report a case of 76 years old PD patient with dyskinesia and rhabdomyolysis.

Pregnancy predisposes to rhabdomyolysis due to hypokalemia

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Muthukrishnan Jayaraman

2010-01-01

Full Text Available Increased predilection for hypokalemia-induced rhabdomyolysis has been noted in pregnant women. We managed a woman with distal renal tubular acidosis (RTA with persistent hypokalemia who presented with recurrent rhabdomyolysis in her consecutive pregnancies despite adequate potassium citrate therapy.

Acute Renal Failure due to Non-Traumatic Rhabdomyolysis

Directory of Open Access Journals (Sweden)

Nagehan Aslan

2016-04-01

Full Text Available Rhabdomyolysis is a musculoskeletal clinical and biochemical syndrome which is seen associated with traumatic and non-traumatic causes and is known as muscular dystrophy. Rhabdomyolysis which develops following crush-type trauma (Crush syndrome is rarely seen but is a well-known clinical event in the etiology of acute renal failure. Non-traumatic rhabdomyolysis is rare. The case is here presented of a patient who was diagnosed with rhabdomyolysis on presentation with acute renal failure and to whom repeated dialysis was applied.

Rare acute kidney injury secondary to hypothyroidism-induced rhabdomyolysis.

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Cai, Ying; Tang, Lin

2013-01-01

Acute kidney injury (AKI) caused by hypothyroidism-induced rhabdomyolysis is a rare and potentially life-threatening syndrome. The aim of this study was to investigate the clinical characteristics of such patients. We retrospectively analyzed five patients treated at the Second Affiliated Hospital of Chongqing Medical University with AKI secondary to hypothyroidism- induced rhabdomyolysis from January 2006 to December 2010. Of the five cases reviewed (4 males, age range of 37 to 62 years), adult primary hypothyroidism was caused by amiodarone (1 case), chronic autoimmune thyroiditis (1 case), and by uncertain etiologies (3 cases). All patients presented with facial and lower extremity edema. Three patients presented with weakness, while two presented with blunted facies and oliguria. Only one patient reported experiencing myalgia and proximal muscle weakness, in addition to fatigue and chills. Creatine kinase, lactate dehydrogenase, and renal function normalized after thyroid hormone replacement, except in two patients who improved through blood purification. Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis. Moreover, further investigation into the etiology of the hypothyroidism is warranted.

Freebie Rhabdomyolysis: A Public Health Concern. Spin Class-Induced Rhabdomyolysis.

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Brogan, Maureen; Ledesma, Rudrick; Coffino, Alan; Chander, Praveen

2017-04-01

Rhabdomyolysis is a pathologic condition in which intracellular muscle constituents leak into the blood circulation. It is usually caused by muscle trauma. "Spinning" is an indoor form of cycling where participants use a special stationary exercise bicycle with a weighted flywheel and undergo high-intensity cycling classes focusing on endurance. There have been several case reports in the literature of exertional rhabdomyolysis following spin class. Our nephrology practices have diagnosed a number of cases of symptomatic patients presenting to our emergency departments following their first spin classes, with histories and creatinine phosphokinase levels diagnostic of exertional rhabdomyolysis. We present 3 unusual cases of exertional rhabdomyolysis, each occurring after a first spin class. In the first case, rhabdomyolysis developed following 15 minutes of spin class. In the second case, it occurred in a young individual who exercises regularly. In the third case, the patient developed biopsy-proved acute kidney injury secondary to exertional rhabdomyolysis and required hemodialysis. The high-intensity exercise associated with "spin class" comes with significant risks to newcomers. Copyright © 2016 Elsevier Inc. All rights reserved.

Rhabdomyolysis caused by the moderate CYP3A4 inhibitor fluconazole in a patient on stable atorvastatin therapy: a case report and literature review.

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Hsiao, S-H; Chang, H-J; Hsieh, T-H; Kao, S-M; Yeh, P-Y; Wu, T-J

2016-10-01

Rhabdomyolysis is a severe potential adverse drug reaction of statin therapy. We report a case of rhabdomyolysis due to drug-drug interaction (DDI) between atorvastatin and fluconazole and review the literature. A 70-year-old woman received atorvastatin for hyperlipidaemia without any problem for 4 years. When intravenous fluconazole was added for treating a fungal infection, rhabdomyolysis developed 2 weeks later. Removal of atorvastatin led to the resolution of her rhabdomyolysis. Our case demonstrates that in some subjects even a moderate CYP3A4 inhibitor such as fluconazole may lead to rhabdomyolysis in subjects receiving a statin. © 2016 John Wiley & Sons Ltd.

Russula subnigricans Poisoning: From Gastrointestinal Symptoms to Rhabdomyolysis.

Science.gov (United States)

Lin, Shide; Mu, Maoyuan; Yang, Fangwan; Yang, Chunfei

2015-09-01

Wild mushroom poisoning is often reported to cause acute liver or renal failure. However, acute rhabdomyolysis caused by wild mushroom poisoning has rarely been reported. We describe 7 patients of 1 family with Russula subnigricans Hongo poisoning. Their clinical manifestations varied from gastrointestinal symptoms to rhabdomyolysis, with 1 fatality. Our report provides supporting evidence that rhabdomyolysis may result from ingestion of R subnigricans mushrooms. A key to survival for patients with rhabdomyolysis caused by R subnigricans poisoning may be early recognition and intensive supportive care. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review

Science.gov (United States)

2014-01-01

Rhabdomyolysis, a clinical syndrome caused by damage to skeletal muscle and release of its breakdown products into the circulation, can be followed by acute kidney injury (AKI) as a severe complication. The belief that the AKI is triggered by myoglobin as the toxin responsible appears to be oversimplified. Better knowledge of the pathophysiology of rhabdomyolysis and following AKI could widen treatment options, leading to preservation of the kidney: the decision to initiate renal replacement therapy in clinical practice should not be made on the basis of the myoglobin or creatine phosphokinase serum concentrations. PMID:25043142

Bioprosthetic Valve Fracture During Valve-in-valve TAVR: Bench to Bedside.

Science.gov (United States)

Saxon, John T; Allen, Keith B; Cohen, David J; Chhatriwalla, Adnan K

2018-01-01

Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) has been established as a safe and effective means of treating failed surgical bioprosthetic valves (BPVs) in patients at high risk for complications related to reoperation. Patients who undergo VIV TAVR are at risk of patient-prosthesis mismatch, as the transcatheter heart valve (THV) is implanted within the ring of the existing BPV, limiting full expansion and reducing the maximum achievable effective orifice area of the THV. Importantly, patient-prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR. Bioprosthetic valve fracture (BVF) is as a novel technique to address this problem. During BPV, a non-compliant valvuloplasty balloon is positioned within the BPV frame, and a highpressure balloon inflation is performed to fracture the surgical sewing ring of the BPV. This allows for further expansion of the BPV as well as the implanted THV, thus increasing the maximum effective orifice area that can be achieved after VIV TAVR. This review focuses on the current evidence base for BVF to facilitate VIV TAVR, including initial bench testing, procedural technique, clinical experience and future directions.

Statin-Induced Rhabdomyolysis: A Comprehensive Review of Case Reports

OpenAIRE

Mendes, Polyana; Robles, Priscila Games; Mathur, Sunita

2014-01-01

Purpose: To identify case reports of statin-induced rhabdomyolysis and summarize common predisposing factors, symptoms, diagnostic findings, functional outcomes, characteristics, treatment, and rehabilitation. Method: MEDLINE, CINAHL, SCOPUS, and PEDro databases were searched (1990–2013) for relevant case reports using the search terms “Statins,” “Rhabdomyolysis,” “Myalgia,” “Muscle damage,” “Muscle injury,” and “Myopathy.” Relevance (based on title and abstract) was assessed by one investiga...

[Exercise-induced rhabdomyolysis - a new trend?

Science.gov (United States)

Fardal, Hilde; Gøransson, Lasse G

2016-10-01

The purpose of this study was to investigate whether or not there has been an increase in the number of admissions for exercise-induced rhabdomyolysis at Stavanger University Hospital (SUS) in recent years. The study is a retrospective review of patients discharged over the period January 2010 to March 2015 with a diagnosis of exercise-induced rhabdomyolysis and with maximum creatine kinase (CK) levels more than ten times the upper reference limit. A total of 33 patients, 21 women and 12 men, with a median age of 28 years (18 - 68), were included in the study. Of the 33 patients, three quarters (25) were admitted in 2014 - 15, compared with eight over the period 2010 - 13. One patient developed kidney failure that required dialysis. The treatment depended more on the attending physician and department than on the patient's clinical condition and CK-level, but this did not seem to affect the rate of complications. The incidence of exercise-induced rhabdomyolysis at SUS increased from autumn 2014, and this coincided with increased media attention and a new exercise trend. We recommend standardising the treatment of exercise-induced rhabdomyolysis, as current treatment recommendations are based on rhabdomyolysis triggered by causes other than exercise.

Acute rhabdomyolysis

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Pascale de Lonlay

2015-01-01

Full Text Available Rhabdomyolysis results from the rapid breakdown of skeletal muscle fibers, which leads to leakage of potentially toxic cellular contents into the systemic circulation. Acquired causes by direct injury to the sarcolemma are the most frequent. The inherited causes are: metabolic with failure of energy production, including mitochondrial fatty acid ß-oxidation defects, LPIN1 mutations, inborn errors of glycogenolysis and glycolysis, more rarely mitochondrial respiratory chain deficiency, purine defects and peroxysomalα-Methylacyl-CoA-racemase defect (AMACR; dystrophinopathies and myopathies; calcic causes with RYR1 mutations; inflammatory with myositis. Irrespective of the cause of rhabdomyolysis, the pathophysiologic events follow a common pathway, the ATP depletion leading to an increased intracellular calcium concentration and necrosis. Most episodes of rhabdomyolysis are triggered by an environmental stress, mostly fever. This condition is associated with two events, elevated temperature and high circulating levels of pro-inflammatory mediators such as cytokines and chemokines. We describe here an example of rhabdomyolysis related to high temperature, aldolase deficiency, in 3 siblings with episodic rhabdomyolysis without hemolytic anemia. Myoglobinuria was always triggered by febrile illnesses. We show that the underlying mechanism involves an exacerbation of aldolase A deficiency at high temperatures that affected myoblasts but not erythrocytes. Thermolability was enhanced in patient myoblasts compared to control. The aldolase A deficiency was rescued by arginine supplementation in vitro. Lipid droplets accumulated in patient myoblasts relative to control and this was increased by cytokines. Lipotoxicity may participate to myolysis. Our results expand the clinical spectrum of aldolase A deficiency to isolated temperature-dependent rhabdomyolysis, and suggest that thermolability may be tissue specific. We also propose a

A case of gabapentin-induced rhabdomyolysis requiring renal replacement therapy.

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Choi, Min Seok; Jeon, Howook; Kim, Hyo Suk; Jang, Bo Hyun; Lee, Yoon Hee; Park, Hoon Suk; Kim, HyungWook; Jin, Dong Chan

2017-01-01

Gabapentin is commonly used for controlling convulsions, restless pain syndrome, and pain in diabetic neuropathy. Common side effects include dizziness, somnolence, ataxia, peripheral edema, and confusion; gabapentin-induced rhabdomyolysis is rarely reported. To date, the reported cases of gabapentin-induced rhabdomyolysis have been associated with patients with multiple underlying diseases and assuming multiple medicines for various reasons. In this report, we describe a case of gabapentin-induced rhabdomyolysis in a 32-year-old woman with no medical history. We also review related literature and discuss the possible mechanism and the association with other factors. This case shows that gabapentin can induce rhabdomyolysis in healthy patients and that clinicians must consider the possible association between gabapentin and rhabdomyolysis. © 2016 International Society for Hemodialysis.

A Case of Rhabdomyolysis Induced by Lipid Lowering Agent

Energy Technology Data Exchange (ETDEWEB)

Koh, Eun Mi; Lee, Tae Won; Ihn, Chun Gyoo; Kim, Kwang Won; Kim, Myung Jae; Choi, Young Kil [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

1990-03-15

Bezafibrate is a lipid-lowering agent and one of the fabric acid derivatives. It is relatively safe and well tolerated and adverse reactions to bezafibrate have largely been restricted to gastrointestinal disturbances. But a few cases of rhabdomyolysis after bezafibrate administration have been reported and recently we experienced bezafibrate-induced rhabdomyolysis in patients with chronic renal failure. So we report this case with the bone scan finding and the literature review. We believe that this is the first case report of bezafibrate-induced rhabdomyolysis in Korea.

A Case of Rhabdomyolysis Induced by Lipid Lowering Agent

International Nuclear Information System (INIS)

Koh, Eun Mi; Lee, Tae Won; Ihn, Chun Gyoo; Kim, Kwang Won; Kim, Myung Jae; Choi, Young Kil

1990-01-01

Bezafibrate is a lipid-lowering agent and one of the fabric acid derivatives. It is relatively safe and well tolerated and adverse reactions to bezafibrate have largely been restricted to gastrointestinal disturbances. But a few cases of rhabdomyolysis after bezafibrate administration have been reported and recently we experienced bezafibrate-induced rhabdomyolysis in patients with chronic renal failure. So we report this case with the bone scan finding and the literature review. We believe that this is the first case report of bezafibrate-induced rhabdomyolysis in Korea.

Bench-to-bedside review: human subjects research--are more standards needed?

Science.gov (United States)

Huang, David T; Hadian, Mehrnaz

2006-01-01

There are many controversial issues surrounding ethics in study design and conduct of human subjects research. In this review we briefly touch on the origin of ethics in clinical research and how the current regulations and standards came into practice. We then discuss current controversies regarding informed consent, conflicts of interest, institutional review boards, and other relevant issues such as innovative procedures and quality improvement projects. The question of whether we need more standards is a very important yet challenging one to which there is no simple answer. We address this question by reviewing and commenting on relevant literature. We conclude that what is needed are not more standards per se, but rather refinement and uniformity of current standards, and their interpretation and application both to protect human subjects and to advance medicine.

Acute renal failure secondary to rhabdomyolysis

International Nuclear Information System (INIS)

Kim, S.H.; Han, M.C.; Kim, S.; Lee, J.S.

1992-01-01

MR imaging of the kidney was performed in 6 patients with acute renal failure (ARF) secondary to rhabdomyolysis caused by snake bite (n = 4), crush injury (n = 1), and carbon monoxide poisoning (n = 1). A test for urine myoglobin was positive in all 6 patients and MR imaging was done 6 to 18 days after the causative event of the rhabdomyolysis. MR images in all 6 patients showed globular swelling of the kidneys, preserved corticomedullary contrast on T1-weighted images, and obliteration of corticomedullary contrast on T2-weighted images. Unlike other medical renal diseases in which corticomedullary contrast is lost on T1-weighted images, preservation of the corticomedullary contrast on T1-weighted MR images with globular renal swelling was a constant finding in patients with ARF secondary to rhabdomyolysis. (orig.)

Rhabdomyolysis Related to Dyskinesia in Parkinson’s Disease

OpenAIRE

Bektaş, Hesna; Deniz, Orhan; Temel, Şadiye; Keklikoğlu, Hava Dönmez; Akyol, Şener

2014-01-01

Rhabdomyolysis is a life threatening syndrome. It accounts for an estimated 8% to 15% of cases of acute renal failure and is associated with a mortality rate of 5%. In movement disorders, various causes of rhabdomyolysis have been reported including status dystonicus, myoclonus, generalized chorea and parkinsonism-hyperprexia syndrome in Parkinson’s disease (PD). Levodopa-induced dyskinesia leading to rhabdomyolysis is a very rare phenomenon in PD. We report a case of 76 years old PD patient ...

When exercise causes exertional rhabdomyolysis.

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Furman, Janet

2015-04-01

Exertional rhabdomyolysis is a clinical condition caused by intense, repetitive exercise or a sudden increase in exercise in an untrained person, although rhabdomyolysis can occur in trained athletes. In many cases, the presentation of early, uncomplicated rhabdomyolysis is subtle, but serious complications such as renal failure, compartment syndrome, and dysrhythmias may arise if severe exertional rhabdomyolysis is undiagnosed or untreated. Management is further complicated by the lack of concrete management guidelines for treating rhabdomyolysis and returning patients to activity.

Clinical spectrum of rhabdomyolysis presented to pediatric emergency department

Science.gov (United States)

2013-01-01

Background Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The aim of the work is to analyze the clinical spectrum and to evaluate the prevalence of various etiologies in children, who present to the emergency department (ED) with rhabdomyolysis. Methods During a 6-year study period, we retrospectively analyzed the medical charts of patients, aged 18 years or younger, with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase (CK) levels greater than 1000IU/L. We analyzed the clinical spectrum and evaluated the potential risk factors of acute renal failure (ARF). Results Thirty-seven patients (mean age = 10.2 ± 5.5 years), including 26 males and 11 females, were enrolled in the study. Two of the most common presented symptoms in these 37 patients were muscle pain and muscle weakness (83.8% and 73%, respectively). Dark urine was reported in only 5.4% of the patients. The leading cause of rhabdomyolysis in the 0- to 9-year age group was presumed infection, and the leading cause in the 10- to 18-year age group was trauma and exercise. The incidence of ARF associated with rhabdomyolysis was 8.1 % and no child needed for renal replacement therapy (RRT). We did not identify any reliable predictors of ARF or need for RRT. Conclusions The classic triad of symptoms of rhabdomyolysis includes myalgia, weakness and dark urine are not always presented in children. The cause of rhabdomyolysis in younger age is different from that of teenager group. However, the prognosis of rhabdomyolysis was good with appropriate management. PMID:24004920

Clearing up the hazy road from bench to bedside: A framework for integrating the fourth hurdle into translational medicine

Directory of Open Access Journals (Sweden)

John Jürgen H

2008-09-01

Full Text Available Abstract Background New products evolving from research and development can only be translated to medical practice on a large scale if they are reimbursed by third-party payers. Yet the decision processes regarding reimbursement are highly complex and internationally heterogeneous. This study develops a process-oriented framework for monitoring these so-called fourth hurdle procedures in the context of product development from bench to bedside. The framework is suitable both for new drugs and other medical technologies. Methods The study is based on expert interviews and literature searches, as well as an analysis of 47 websites of coverage decision-makers in England, Germany and the USA. Results Eight key steps for monitoring fourth hurdle procedures from a company perspective were determined: entering the scope of a healthcare payer; trigger of decision process; assessment; appraisal; setting level of reimbursement; establishing rules for service provision; formal and informal participation; and publication of the decision and supplementary information. Details are given for the English National Institute for Health and Clinical Excellence, the German Federal Joint Committee, Medicare's National and Local Coverage Determinations, and for Blue Cross Blue Shield companies. Conclusion Coverage determination decisions for new procedures tend to be less formalized than for novel drugs. The analysis of coverage procedures and requirements shows that the proof of patient benefit is essential. Cost-effectiveness is likely to gain importance in future.

Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review.

Science.gov (United States)

Kertscher, Berit; Speyer, Renée; Palmieri, Maria; Plant, Chris

2014-04-01

Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of oropharyngeal dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify oropharyngeal dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.

A Rare Cause of Acute Renal Failure: Fenofibrate-Induced Rhabdomyolysis

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Ferhat Icme

2013-08-01

Full Text Available Fibrates are derivative of fibric acid and broad spectrum drugs which are commonly used in the treatment of dyslipidemia and hypertriglyceridemia. Side effects are often related with striated muscles, kidney and liver. Rhabdomyolysis developing with striated muscle destruction is potentially the most lethal of these side effects. Although several case reports of rhabdomyolysis have been reported due to the combination of statin and fenofibrate, fenofibrate alone rarely causes rhabdomyolysis. The purposes of this paper are to present a patient whom we diagnosed with acute renal injury due to use of fenofibrate in order to emphasize the importance of questioning drugs which have been used, and to review management of rhabdomyolysis due to fenofibrate use. [Cukurova Med J 2013; 38(4.000: 800-804

Exertional Rhabdomyolysis after Spinning.

Science.gov (United States)

Jeong, Youjin; Kweon, Hyuk-Jung; Oh, Eun-Jung; Ahn, Ah-Leum; Choi, Jae-Kyung; Cho, Dong-Yung

2016-11-01

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24-48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered.

Rhabdomyolysis in Critically Ill Surgical Patients.

Science.gov (United States)

Kuzmanovska, Biljana; Cvetkovska, Emilija; Kuzmanovski, Igor; Jankulovski, Nikola; Shosholcheva, Mirjana; Kartalov, Andrijan; Spirovska, Tatjana

2016-07-27

Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1 st till December 31 st 2015 was performed. Patients medical records were screened for available serum creatine kinase (CK) with levels > 200 U/l, presence of myoglobin in the serum in levels > 80 ng/ml, or if they had a clinical diagnosis of rhabdomyolysis by an attending doctor. Descriptive statistical methods were used to analyze the collected data. Out of totally 1084 patients hospitalized in the ICU, 93 were diagnosed with rhabdomyolysis during the course of one year. 82(88%) patients were trauma patients, while 11(12%) were surgical non trauma patients. 7(7.5%) patients diagnosed with rhabdomyolysis developed acute kidney injury (AKI) that required dialysis. Average values of serum myoglobin levels were 230 ng/ml, with highest values of > 5000 ng/ml. Patients who developed AKI had serum myoglobin levels above 2000 ng/ml. Average values of serum CK levels were 400 U/l, with highest value of 21600 U/l. Patients who developed AKI had serum CK levels above 3000 U/l. Regular monitoring and early detection of elevated serum CK and myoglobin levels in critically ill surgical and trauma patients is recommended in order to recognize and treat rhabdomyolysis in timely manner and thus prevent development of AKI.

Using Targeted Virotherapy to Treat a Resistant Ewing Sarcoma Model: From the Bedside to the Bench and Back

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Hesham Abdelbary

2014-01-01

Full Text Available Metastatic Ewing sarcoma (EWS is often resistant to current multimodal chemotherapeutic regimens. Oncolytic virus therapy (OV is a novel therapeutic platform whereby viruses can selectively infect as well as replicate in and kill tumor cells, while sparing normal tissues. The purpose of this study is to investigate the efficacy of the biotherapeutic oncolytic agent, vesicular stomatitis virus (VSVΔM51, to kill EWS cells that are resistant to conventional therapy. Our hypothesis is that systemic delivery of VSVΔM51 can demonstrate tumor-specific killing of resistant EWS cells, as well as a significant decrease of tumor burden in EWS bearing mice. Methods. A biopsy sample was obtained from a patient with metastatic EWS and was used to establish a novel EWS cell line. In vitro assays evaluated the oncolytic effect of vesicular stomatitis virus (VSVΔM51 on this cell line. EWS xenograft mice model bearing either lung or subcutaneous tumors was established to evaluate the antitumor specific oncolytic effect of VSVΔM51 after local and systemic delivery. Results. The established EWS cell line shared similar molecular and genetic traits to the patient’s original tumor specimen. VSVΔM51 effectively infected and killed EWS cells in vitro. In vivo, VSVΔM51 selectively infected and killed EWS and led to significant delay in tumor growth. Conclusion. This study has been designed to implement a translational link between the bedside and the bench, where a specific challenging clinical scenario guided this basic science research. This research demonstrated that a sarcoma, which is resistant to current conventional standard therapies, is still susceptible to an alternative therapeutic platform, such as OV. Adding OV to the armamentarium of sarcoma treatment can enhance the future therapeutic approach towards these cancer patients.

Malignant hyperthermia susceptibility in patients with exertional rhabdomyolysis: a retrospective cohort study and updated systematic review.

Science.gov (United States)

Kraeva, Natalia; Sapa, Alexander; Dowling, James J; Riazi, Sheila

2017-07-01

Two potentially fatal syndromes, malignant hyperthermia (MH), an adverse reaction to general anesthesia, and exertional rhabdomyolysis (ER) share some clinical features, including hyperthermia, muscle rigidity, tachycardia, and elevated serum creatine kinase. Some patients with ER have experienced an MH event and/or have been diagnosed as MH susceptible (MHS). In order to assess the relationship between ER and MH further, we conducted a retrospective cohort study summarizing clinical and genetic information on Canadian patients with ER who were diagnosed as MHS. In addition, a systematic literature review was performed to compile further evidence on MH susceptibility and RYR1 and CACNA1S variants associated with rhabdomyolysis. Demographic, clinical, and genetic information was collected on Canadian MHS patients who presented with rhabdomyolysis. In addition, we performed a systematic review of the literature published during 1995-2016 on genetic screening of the RYR1 and CACNA1S genes in patients with ER. Retrospective data on Canadian MHS patients with ER showed that ten out of 17 patients carried RYR1 or CACNA1S variants that were either known MH-causative mutations or potentially pathogenic variants. The systematic review revealed 39 different rare RYR1 variants, including 13 MH-causative/associated mutations and five rare potentially deleterious CACNA1S variants in 78% of patients with ER. Findings from the Canadian patient cohort and the systematic review all signal a potential association between MH susceptibility and ER. The presence of MH-causative mutations and putative deleterious RYR1 variants in ER patients without a history of adverse anesthetic reactions suggests their possible increased risk for MH.

Rhabdomyolysis with different etiologies in childhood

Science.gov (United States)

Alaygut, Demet; Torun Bayram, Meral; Kasap, Belde; Soylu, Alper; Türkmen, Mehmet; Kavukcu, Salih

2017-01-01

AIM To investigate different etiologies and management of the rhabdomyolysis in children. METHODS Eight pediatric rhabdomyolysis cases who applied to the Dokuz Eylul University Faculty of Medicine Department of Pediatric Nephrology with different etiologies between January 2004 and January 2012 were evaluated in terms of age, gender, admission symptoms, physical examination findings, factors provoking rhabdomyolysis, number of rhabdomyolysis attacks, laboratory results, family history and the final diagnosis received after the treatment. RESULTS Average diagnosis ages of eight cases were 129 (24-192) ± 75.5 mo and five of them were girls. All of them had applied with the complaint of muscle pain, calf pain, and dark color urination. Infection (pneumonia) and excessive physical activity were the most important provocative factors and excessive licorice consumption was observed in one case. In 5 cases, acute kidney injury was determined and two cases needed hemodialysis. As a result of the further examinations; the cases had received diagnoses of rhabdomyolysis associated with mycoplasma pneumoniae, sepsis associated rhabdomyolysis, licorice-induced hypokalemic rhabdomyolysis, carnitine palmitoyltransferase II deficiency, very long-chain acyl-CoA dehydrogenase deficiency, congenital muscular dystrophy and idiopathic paroxysmal rhabdomyolysis (Meyer-Betz syndrome). CONCLUSION It is important to distinguish the sporadic and recurrent rhabdomyolysis cases from each other. Recurrent rhabdomyolysis cases should follow up more regardful and attentive. PMID:29184760

Bench-to-bedside review: Human subjects research – are more standards needed?

Science.gov (United States)

Huang, David T; Hadian, Mehrnaz

2006-01-01

There are many controversial issues surrounding ethics in study design and conduct of human subjects research. In this review we briefly touch on the origin of ethics in clinical research and how the current regulations and standards came into practice. We then discuss current controversies regarding informed consent, conflicts of interest, institutional review boards, and other relevant issues such as innovative procedures and quality improvement projects. The question of whether we need more standards is a very important yet challenging one to which there is no simple answer. We address this question by reviewing and commenting on relevant literature. We conclude that what is needed are not more standards per se, but rather refinement and uniformity of current standards, and their interpretation and application both to protect human subjects and to advance medicine. PMID:17184560

Exertional Rhabdomyolysis after Spinning

OpenAIRE

Jeong, Youjin; Kweon, Hyuk-Jung; Oh, Eun-Jung; Ahn, Ah-Leum; Choi, Jae-Kyung; Cho, Dong-Yung

2016-01-01

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24?48 hours after attending a spi...

[Rhabdomyolysis secondary to simvastatin and phenofibrate].

Science.gov (United States)

Forcadell-Peris, M J; de Diego-Cabanes, C

2014-01-01

Statins, which are used as first-line drugs in the prevention of cardiovascular disease, are usually safe, but in some cases there may be muscular toxicity. Statin-associated myopathy, can present as myalgia, myositis or rhabdomyolysis. Only 0.44 per 10,000 treated and per year, develop rhabdomyolysis. There are many risk factors associated with the patient and with the pharmacological treatment. A risk of muscle injury of 1-5% has been reported with some statins combined with fibrates. The fibrate with the highest risk of myopathy in combination with statins is gemfibrozil, while phenofibrate seems to be the safest. The case is presented of a 60 year-old woman with clinical symptoms and laboratory findings that suggested rhabdomyolysis secondary to a combination of simvastatin and phenofibrate. This case reminds physicians of the need to closely monitor these patients, in addition to alert them to the onset of muscle pain or weakness. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Severe Rhabdomyolysis Associated with Staphylococcus aureus Acute Endocarditis Requiring Surgery.

Science.gov (United States)

Ravry, Céline; Fedou, Anne-Laure; Dubos, Maria; Denes, Éric; Etchecopar, Caroline; Barraud, Olivier; Vignon, Philippe; François, Bruno

2015-12-01

Rhabdomyolysis has multiple etiologies with unclear mechanisms; however, rhabdomyolysis caused by Staphylococcus aureus infection is rare. A case report of severe rhabdomyolysis in a patient who presented with endocarditis caused by methicillin-susceptible S. aureus and review of relevant literature. The patient had a history of cardiac surgery for tetralogy of Fallot. He was admitted to the hospital because of fever and digestive symptoms. Respiratory and hemodynamic status deteriorated rapidly, leading to admission to the intensive care unit (ICU) for mechanical ventilation and vasopressor support. Laboratory tests disclosed severe rhabdomyolysis with a serum concentration of creatine kinase that peaked at 49,068 IU/L; all blood cultures grew methicillin-susceptible S. aureus. Antibiotic therapy was amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin initially and was changed subsequently to oxacillin, clindamycin, and gentamicin. Transesophageal echocardiography showed vegetation on the pulmonary valve, thus confirming the diagnosis of acute endocarditis. Viral testing and computed tomography (CT) scan ruled out any obvious alternative etiology for rhabdomyolysis. Bacterial analysis did not reveal any specificity of the staphylococcal strain. The patient improved with antibiotics and was discharged from the ICU on day 26. He underwent redux surgery for valve replacement on day 53. Staphylococcal endocarditis should be suspected in cases of severe unexplained rhabdomyolysis with acute infectious symptoms.

Adolescent with Rhabdomyolysis due to Undiagnosed Hypothyroidism

Directory of Open Access Journals (Sweden)

Raquel Farias Moeller

2011-01-01

Full Text Available Exercise-induced rhabdomyolysis has been described in military recruits, trained athletes and daily runners. Statin use, quail ingestion, infection by Epstein-Barr virus (EBV, and hypothyroidism, though rare, are risk factors for the development of rhabdomyolysis. We describe the case of a 15-year-old female who presented with myalgias, weakness, and pigmenturia following marching band practice. Laboratory tests confirmed an elevated creatine kinase (CK level as well as a profound hypothyroid state. Muscle biopsy revealed severe muscle necrosis and myositis. Treatment with levothyroxine resulted in obtaining an euthyroid state and regain of muscle strength as well as decrease in CK levels. Although rare, hypothyroidism should be considered as a potential cause of rhabdomyolysis in pediatric patients undergoing a myopathy workup.

Rhabdomyolysis detected by bone imaging

International Nuclear Information System (INIS)

Sanders, J.A.

1989-01-01

Rhabdomyolysis involves necrosis of skeletal muscle and may arise from multiple conditions both traumatic and nontraumatic. Bone imaging with Technetium-99m phosphates is a very sensitive indicator of acute muscle damage and may be used to visualize the extent of rhabdomyolysis and its resolution. A case of alcohol-induced rhabdomyolysis is presented

[Severe rhabdomyolysis secondary to severe hypernatraemic dehydration].

Science.gov (United States)

Mastro-Martínez, Ignacio; Montes-Arjona, Ana María; Escudero-Lirio, Margarita; Hernández-García, Bárbara; Fernández-Cantalejo Padial, José

2015-01-01

Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity. The laboratory tests highlighted severe metabolic acidosis, hypernatraemia and pre-renal kidney failure (Sodium [Na] plasma 181 mEq/L, urine density> 1030). He was managed in Intensive Care Unit with gradual clinical and renal function improvement. On the third day, slight axial hypotonia and elevated cell lysis enzymes (creatine phosphokinase 75,076 IU/L) were observed, interpreted as rhabdomyolysis. He was treated with intravenous rehydration up to 1.5 times the basal requirements, and he showed a good clinical and biochemical response, being discharged 12 days after admission without motor sequelae. Severe hypernatraemia is described as a rare cause of rhabdomyolysis and renal failure. In critically ill patients, it is important to have a high index of suspicion for rhabdomyolysis and performing serial determinations of creatine phosphokinase for early detection and treatment. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Rhabdomyolysis Associated with Parainfluenza Virus

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Miltiadis Douvoyiannis

2013-01-01

Full Text Available Influenza virus is the most frequently reported viral cause of rhabdomyolysis. A 7-year-old child is presented with rhabdomyolysis associated with parainfluenza type 2 virus. Nine cases of rhabdomyolysis associated with parainfluenza virus have been reported. Complications may include electrolyte disturbances, acute renal failure, and compartment syndrome.

Adolescent with Rhabdomyolysis due to Undiagnosed Hypothyroidism

OpenAIRE

Farias Moeller, Raquel; Zecavati, Nassim; Sherafat-Kazemzadeh, Rosa; Aleinikoff, Shoshana; Rennert, Wolfgang

2011-01-01

Exercise-induced rhabdomyolysis has been described in military recruits, trained athletes and daily runners. Statin use, quail ingestion, infection by Epstein-Barr virus (EBV), and hypothyroidism, though rare, are risk factors for the development of rhabdomyolysis. We describe the case of a 15-year-old female who presented with myalgias, weakness, and pigmenturia following marching band practice. Laboratory tests confirmed an elevated creatine kinase (CK) level as well as a profound hypothyro...

Postoperative rhabdomyolysis following robotic renal and adrenal surgery: a cautionary tale of compounding risk factors.

Science.gov (United States)

Terry, Russell S; Gerke, Travis; Mason, James B; Sorensen, Matthew D; Joseph, Jason P; Dahm, Philipp; Su, Li-Ming

2015-09-01

This study aimed at reviewing a contemporary series of patients who underwent robotic renal and adrenal surgery by a single surgeon at a tertiary referral academic medical center over a 6-year period, specifically focusing on the unique and serious complication of post-operative rhabdomyolysis of the dependent lower extremity. The cases of 315 consecutive patients who underwent robotic upper tract surgery over a 6-year period from August 2008 to June 2014 using a standardized patient positioning were reviewed and analyzed for patient characteristics and surgical variables that may be associated with the development of post-operative rhabdomyolysis. The incidence of post-operative rhabdomyolysis in our series was 3/315 (0.95%). All three affected patients had undergone robotic nephroureterectomy. Those patients who developed rhabdomyolysis had significantly higher mean Body Mass Index, Charlson Comorbidity Index, and median length of stay than those who did not. The mean OR time in the rhabdomyolysis group was noted to be 52 min longer than the non-rhabdomyolysis group, though this value did not reach statistical significance. Given the trends of increasing obesity in the United States and abroad as well as the continued rise in robotic upper tract urologic surgeries, urologists need to be increasingly vigilant for recognizing the risk factors and early treatment of the unique complication of post-operative rhabdomyolysis.

Rhabdomyolysis Complicating Typhoid Fever in A Child and Review of the Literature.

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Snelling, Peter James; Moriarty, Paul; Vaska, Vikram L; Levitt, David; Nourse, Clare

2017-09-01

Typhoid fever is an important cause of morbidity and mortality in the developing world, particularly in children, but is infrequently observed in the developed world and can occur in patients without a significant travel history. Rhabdomyolysis as a complication has rarely been reported, and never in a child. A child with Salmonella enterica serovar Typhi septicemia, complicated by rhabdomyolysis, encephalopathy and pancreatitis is described and all 15 reported cases to date are summarized.

Acute rhabdomyolysis and inflammation.

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Hamel, Yamina; Mamoune, Asmaa; Mauvais, François-Xavier; Habarou, Florence; Lallement, Laetitia; Romero, Norma Beatriz; Ottolenghi, Chris; de Lonlay, Pascale

2015-07-01

Rhabdomyolysis results from the rapid breakdown of skeletal muscle fibers, which leads to leakage of potentially toxic cellular content into the systemic circulation. Acquired causes by direct injury to the sarcolemma are most frequent. The inherited causes are: i) metabolic with failure of energy production, including mitochondrial fatty acid ß-oxidation defects, LPIN1 mutations, inborn errors of glycogenolysis and glycolysis, more rarely mitochondrial respiratory chain deficiency, purine defects and peroxysomal α-methyl-acyl-CoA-racemase defect (AMACR), ii) structural causes with muscle dystrophies and myopathies, iii) calcium pump disorder with RYR1 gene mutations, iv) inflammatory causes with myositis. Irrespective of the cause of rhabdomyolysis, the pathology follows a common pathway, either by the direct injury to sarcolemma by increased intracellular calcium concentration (acquired causes) or by the failure of energy production (inherited causes), which leads to fiber necrosis. Rhabdomyolysis are frequently precipitated by febrile illness or exercise. These conditions are associated with two events, elevated temperature and high circulating levels of pro-inflammatory mediators such as cytokines and chemokines. To illustrate these points in the context of energy metabolism, protein thermolability and the potential benefits of arginine therapy, we focus on a rare cause of rhabdomyolysis, aldolase A deficiency. In addition, our studies on lipin-1 (LPIN1) deficiency raise the possibility that several diseases involved in rhabdomyolysis implicate pro-inflammatory cytokines and may even represent primarily pro-inflammatory diseases. Thus, not only thermolability of mutant proteins critical for muscle function, but also pro-inflammatory cytokines per se, may lead to metabolic decompensation and rhabdomyolysis.

Frequent rhabdomyolysis in anti-NMDA receptor encephalitis.

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Lim, Jung-Ah; Lee, Soon-Tae; Kim, Tae-Joon; Moon, Jangsup; Sunwoo, Jun-Sang; Byun, Jung-Ick; Jung, Keun-Hwa; Jung, Ki-Young; Chu, Kon; Lee, Sang Kun

2016-09-15

The aim of this study was to analyze the clinical presentation and provocation factors of rhabdomyolysis in anti-NMDAR encephalitis. Among the 16 patients with anti-NMDAR encephalitis in our institutional cohort, nine patients had elevated CK enzyme levels and clinical evidence of rhabdomyolysis. Rhabdomyolysis was more frequent after immunotherapy. The use of dopamine receptor blocker (DRB) increased the risk of rhabdomyolysis. None of the patients without rhabdomyolysis received DRBs. Rhabdomyolysis is a frequent complication in anti-NMDAR encephalitis and more common after immunotherapy and the use of DRBs increases the risk. Therefore, DRBs should be administered carefully in patients with anti-NMDAR encephalitis. Copyright © 2016 Elsevier B.V. All rights reserved.

Levofloxacin-induced rhabdomyolysis: a case report.

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John, Febin; Oluronbi, Ruby; Pitchumoni, C S

2016-08-24

Rhabdomyolysis secondary to quinolones is not frequent. There are scarce reports in the literature associating rhabdomyolysis to levofloxacin. We describe a case of levofloxacin-induced rhabdomyolysis. A 52-year-old African-American man presented with muscle tightness after taking three doses of levofloxacin. He had elevated creatine kinase without acute kidney injury. His symptoms resolved after discontinuation of levofloxacin and supportive care. It is fascinating that our patient has a prior history of rhabdomyolysis, likely from levofloxacin. Our case highlights the need to be mindful of this potentially life-threatening complication of levofloxacin.

Rhabdomyolysis due to Trimethoprim-Sulfamethoxazole Administration following a Hematopoietic Stem Cell Transplant

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Alexander Augustyn

2015-01-01

Full Text Available Rhabdomyolysis, a syndrome of muscle necrosis, is a life-threatening event. Here we describe the case of a patient with chronic myeloid leukemia who underwent a haploidentical stem cell transplant and subsequently developed rhabdomyolysis after beginning trimethoprim-sulfamethoxazole (TMP/SMX prophylaxis therapy. Rechallenge with TMP/SMX resulted in a repeat episode of rhabdomyolysis and confirmed the association. Withdrawal of TMP/SMX led to sustained normalization of creatine kinase levels in the patient. A high index of suspicion is necessary to identify TMP/SMX as the cause of rhabdomyolysis in immunocompromised patients.

Great expectations - Epigenetics and the meandering path from bench to bedside

DEFF Research Database (Denmark)

Häfner, Sophia J; Lund, Anders H

2016-01-01

Making quick promises of major biomedical breakthroughs based on exciting discoveries at the bench is tempting. But the meandering path from fundamental science to life-saving clinical applications can be fraught with many hurdles. Epigenetics, the study of potentially heritable changes of gene...... function without modification of the underlying DNA sequence, has dominated the biological research field during the last decade and encountered a large public success. Driven by the unfolding of molecular biology and recent technological progress, the term has evolved significantly and shifted from....... However, while exciting reports of biological phenomena involving DNA methylation and histone modifications fill up the scientific literature, the realistic clinical applications of epigenetic medicines remain somewhat blurry. Here, we discuss the state of the art and speculate how epigenetics might...

Sepsis: from bench to bedside

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Eliézer Silva

2008-01-01

Full Text Available Sepsis is a syndrome related to severe infections. It is defined as the systemic host response to microorganisms in previously sterile tissues and is characterized by end-organ dysfunction away from the primary site of infection. The normal host response to infection is complex and aims to identify and control pathogen invasion, as well as to start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to both anti-inflammatory and proinflammatory responses. The chain of events that leads to sepsis is derived from the exacerbation of these mechanisms, promoting massive liberation of mediators and the progression of multiple organ dysfunction. Despite increasing knowledge about the pathophysiological pathways and processes involved in sepsis, morbidity and mortality remain unacceptably high. A large number of immunomodulatory agents have been studied in experimental and clinical settings in an attempt to find an efficacious anti-inflammatory drug that reduces mortality. Even though preclinical results had been promising, the vast majority of these trials actually showed little success in reducing the overwhelmingly high mortality rate of septic shock patients as compared with that of other critically ill intensive care unit patients. Clinical management usually begins with prompt recognition, determination of the probable infection site, early administration of antibiotics, and resuscitation protocols based on "early-goal" directed therapy. In this review, we address the research efforts that have been targeting risk factor identification, including genetics, pathophysiological mechanisms and strategies to recognize and treat these patients as early as possible.

High risk of rhabdomyolysis and acute kidney injury after traumatic limb compartment syndrome.

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Tsai, Wei-Hsuan; Huang, Shih-Tsai; Liu, Wen-Chung; Chen, Lee-Wei; Yang, Kuo-Chung; Hsu, Kuei-Chang; Lin, Cheng-Ta; Ho, Yen-Yi

2015-05-01

Rhabdomyolysis often occurs after traumatic compartment syndrome, and high morbidity and mortality have been reported with the acute kidney injury that develops subsequently. We focused on the risk factors for rhabdomyolysis and acute kidney injury in patients with traumatic compartment syndrome. We also analyzed the relation between renal function and rhabdomyolysis in these patients. A retrospective chart review was conducted from January 2006 to March 2012. Inpatients with traumatic compartment syndrome were included. We evaluated patients' demographics, history of illicit drugs use or alcohol consumption, mechanism of injury, symptoms, serum creatine kinase levels, and kidney function. A total of 52 patients with a mean age of 40.9 years were included; 23 patients had rhabdomyolysis (44.2%), of which 9 patients developed acute kidney injury (39.1%). Significant predictive factors for rhabdomyolysis were history of illicit drugs or alcohol use (P=0.039; odds ratio, 5.91) and ischemic injury (P=0.005). We found a moderate correlation between serum creatine kinase levels and serum creatinine levels (R=0.57; PRhabdomyolysis was a predisposing factor for acute kidney injury (P=0.011; odds ratio, 8.68). Four patients with rhabdomyolysis required a short period of renal replacement therapy. A high percentage of patients with traumatic compartment syndrome developed rhabdomyolysis (44.2%). Patients with rhabdomyolysis had a higher possibility of developing acute kidney injury (39.1%), and rhabdomyolysis was correlated to renal function. Early diagnosis, frequent monitoring, and aggressive treatment are suggested once compartment syndrome is suspected. The overall prognosis is good with early diagnosis and proper treatment.

An increase in the number of admitted patients with exercise-induced rhabdomyolysis.

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Aalborg, Christian; Rød-Larsen, Cecilie; Leiro, Ingjerd; Aasebø, Willy

2016-10-01

Rhabdomyolysis may lead to serious complications, and treatment is both time-consuming and costly. The condition can be caused by many factors, including intense exercise. The purpose of this study was to investigate whether the number of hospitalisations due to exercise-induced rhabdomyolysis has changed in recent years. We describe the disease course in hospitalised patients, and compare disease course in individuals with exercise-induced rhabdomyolysis and rhabdomyolysis due to other causes. The study is a systematic review of medical records from Akershus University Hospital for the years 2008 and 2011 – 14. All hospitalised patients with diagnostic codes M62.8, M62.9 and T79.6 and creatine kinase levels > 5 000 IU/l were included. The cause of the rhabdomyolysis was recorded in addition to patient characteristics and the results of various laboratory tests. Of 161 patients who were hospitalised with rhabdomyolysis during the study period, 44 cases (27  %) were classified as exercise-induced. In 2008 there were no admissions due to exercise-induced rhabdomyolysis; in 2011 and 2012 there were six and four admissions respectively, while in 2014 there were 22. This gives an estimated incidence of 0.8/100 000 in 2012 and 4.6/100 000 in 2014. Strength-training was the cause of hospitalisation in 35 patients (80  % of the exercise-induced cases). Three patients (7  % of the exercise-induced cases) had transient stage 1 kidney injury, but there were no cases with stage 2 or stage 3 injury. By comparison, 52  % of patients with rhabdomyolysis due to another cause had kidney injury, of which 28  % was stage 2 or 3. The number of persons hospitalised with exercise-induced rhabdomyolysis has increased four-fold from 2011 to 2014, possibly due to changes in exercise habits in the population. None of the patients with exercise-induced rhabdomyolysis had serological signs of kidney injury upon hospital discharge.

No association between hyponatremia and rhabdomyolysis in rats.

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Peled, Michael; Dolkart, Oleg; Finn, Talya; Amar, Eyal; Zeltser, David

2014-10-01

Rhabdomyolysis is an uncommon complication of hyponatremia, reported previously only in case reports and small retrospective studies, and its underlying mechanism is controversial. Some studies support the hypothesis that the rapid correction of hyponatremia is responsible for rhabdomyolysis, whereas others emphasize the severity of the hyponatremia as a predisposing factor for rhabdomyolysis. To test the association between hyponatremia and rhabdomyolysis and to demonstrate a causal association. Hyponatremia was induced by administration of water and desmopressin acetate in rats during 3 days, followed by its rapid correction, using animal models established for the evaluation of central pontine myelinolysis. The plasma creatine phosphokinase levels, a marker for rhabdomyolysis, were monitored, and hematoxylin and eosin sections of the quadriceps and gastrocnemius muscles were evaluated for signs of rhabdomyolysis. The induction of hyponatremia and its correction were accompanied by the previously reported neurological sequelae, including signs of central pontine myelinolysis. However, no increase in plasma creatine phosphokinase levels was found, and histopathological examination of the quadriceps and gastrocnemius muscles revealed no sign of rhabdomyolysis. The present study, which is the first to test the association between hyponatremia and rhabdomyolysis in an animal model, does not support any causal association between hyponatremia and rhabdomyolysis. Thus, other factors might be necessary for an association between hyponatremia and rhabdomyolysis, such as genetic factors or convulsions that are known to be associated with both hyponatremia and rhabdomyolysis. Further research in this important physiologic and clinical question is needed. Copyright © 2014 Elsevier Inc. All rights reserved.

[Rhabdomyolysis in a Bipolar Adolescent. Analysis of Associated Factors].

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Restrepo, Diana; Montoya, Pablo; Giraldo, Laura; Gaviria, Génesis; Mejía, Catalina

2015-01-01

To describe a case of rhabdomyolysis associated with the use of quetiapine and lamotrigine in an adolescent treated for bipolar disorder. Description of the clinical case, analysis of the associated factors and a non-systematic review of the relevant literature. An 18 year old male, with bipolar disorder and treated pharmacologically with quetiapine and lamotrigine, after two weeks of physical activity presents with rhabdomyolysis. Quetiapine and exercise have been associated with rhabdomyolysis. The mediator mechanism of this association has not been found, although it has been established that there is neuromuscular dysfunction and an increase in sarcomere permeability. This clinical case allowed the complex interaction between antipsychotic agents and increased physical activity to be observed in a psychiatric adolescent patient, as well as the appearance of a potentially lethal medical complication. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

A Klebsiella pneumoniae liver abscess presenting with myasthenia and tea-colored urine: A case report and review of 77 cases of bacterial rhabdomyolysis.

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Deng, Lihua; Jia, Rong; Li, Wei; Xue, Qian; Liu, Jie; Miao, Yide; Wang, Jingtong

2017-12-01

Rhabdomyolysis is a well-known syndrome in clinical practice, although rhabdomyolysis caused by a liver abscess is rarely reported and the patient may lack symptoms that are associated with a primary site of infection. Early recognition of this possibility is needed to avoid diagnostic delay and facilitate treatment. We report the case of a 71-year-old woman with a Klebsiella pneumoniae (KP) pyogenic liver abscess who presented with myasthenia and tea-colored urine and also review the 77 reported cases of bacterial rhabdomyolysis. The patient was 71 years old and presenting with a 7-day history of myasthenia and a 3-day history of tea-colored urine, but without fever or abdominal pain. Laboratory testing in our case revealed rhabdomyolysis, and blood culture revealed KP. Abdominal ultrasonography revealed a hypoechoic enclosed mass, and computed tomography (CT) revealed an enclosed low-density mass (8.3 × 6.6 × 6.1 cm). The main diagnoses were a pyogenic liver abscess with rhabdomyolysis. Empirically intravenous piperacillin-sulbactam and intravenous potassium treatment, as well as fluid infusions and other supportive treatments were provided after admission. After the diagnosis was confirmed and susceptibility test results were available, we adjusted the antibiotics to cefoperazone and sulbactam, which were maintained for 6 weeks. The patient's symptoms relieved and the abnormal laboratory parameters corrected. Follow-up abdominal ultrasonography at 24 months after her discharge revealed that the abscess had disappeared. Early recognition and careful consideration of the underlying cause of rhabdomyolysis are critical to improving the patient's prognosis. Thus, physicians should carefully consider the underlying cause in elderly patients who present with rhabdomyolysis, as they may lack symptoms of a primary infection. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Recurrent rhabdomyolysis in a child. Case presentation.

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Ertuğrul, Sabahattin; Yolbaş, İlyas; Aktar, Fesih; Yılmaz, Kamil; Tekin, Recep

2016-06-01

Viral myositis associated with infections rarely may cause rhabdomyolysis. There is no any pediatric case with severe recurrent rhabdomyolysis triggered by infections in the literature. We reported a two-year-old boy who was hospitalized three times due to severe rhabdomyolysis associated with viral myositis in the winter months. This is the first child case presentation with severe rhabdomyolysis triggered by infections. Prednisolone and intravenous immunoglobulin treatments were ineffective in this case. Sociedad Argentina de Pediatría.

Rhabdomyolysis and acute kidney injury in the injured war fighter.

Science.gov (United States)

Elterman, Joel; Zonies, David; Stewart, Ian; Fang, Raymond; Schreiber, Martin

2015-10-01

Rhabdomyolysis is a recognized complication of traumatic injury. The correlation of an elevated creatine kinase (CK) level and the development of acute kidney injury (AKI) has been studied in the civilian population. We sought to review the prevalence of rhabdomyolysis in injured war fighters and determine if peak CK levels correlate with AKI. This is a retrospective cohort study of patients admitted at a US military treatment facility from January to November 2010. Inclusion criteria were active duty patients transported after explosive, penetrating, or blunt injury. Patients with burns or non-trauma-related admissions were excluded. Rhabdomyolysis was defined as a CK level greater than 5,000 U/L. AKI was defined using the Kidney Disease: Improving Global Outcomes classification. Mann-Whitney U-tests were used to determine the significance for continuous data. Correlations were determined using Spearman's ρ. Significance was set at p Rhabdomyolysis developed in 79 patients (24.8%). The median peak CK for all patients was 4,178 U/L and ranged from 208 U/L to 120,000 U/L. Stage 1, 2, and 3 AKI developed in 56 (17.6%), 3 (0.9%), and 7 (2.2%) patients, respectively. There was a weak but statistically significant correlation between peak CK and AKI (r = 0.26, p rhabdomyolysis in combat casualties and would allow for standardized comparisons in future work. Epidemiologic/prognostic study, level III.

Low-Intensity Repetitive Exercise Induced Rhabdomyolysis

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Mina Tran

2015-01-01

Full Text Available Rhabdomyolysis is a rare condition caused by the proteins of damaged muscle cells entering the bloodstream and damaging the kidneys. Common symptoms of rhabdomyolysis are muscle pain and fatigue in conjunction with dark urine; kidney damage is a common symptom among these patients. We present a case of a 23-year-old woman who displayed myalgia in the upper extremities caused by low-intensity and high-repetition exercise. She was successfully diagnosed and treated for exertional rhabdomyolysis. This patient had no significant medical history that would induce this condition. We urge the emergency medical community to observe and monitor patients that complain of myalgia to ensure they are not suffering from rhabdomyolysis even in atypical cases.

Rhabdomyolysis and Renal Insufficiency Due to Synthetic Cannabinoid Intoxication

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Semiha Orhan

2017-12-01

Full Text Available Bonsai is the street name of synthetic marijuana, which is a psychoactive substance. Since synthetic cannabinoids are easily accessible and cheap, their use is becoming widespread day by day. It can cause not only various clinical symptoms but also severe rhabdomyolysis. In this case, with severe rhabdomyolysis, we tried to discuss the treatment challenges of the patient examined in intensive care unit with the history of bonsai use.

Brugada sign in a patient with hyperkalemia due to rhabdomyolysis in hypothermia.

Science.gov (United States)

Tomcsányi, Kristóf; Tomcsányi, János

The Brugada sign may appear as an indication of severe hyperkalemia. This phenomena has recently been called as the "Brugada phenocopy". Hyperthermia and hypothermia may lead to rhabdomyolysis. Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. We present a case where rhabdomyolysis-related delayed hyperkalemia showed Brugada sign on the ECG mimicking ventricular tachycardia. Copyright © 2016 Elsevier Inc. All rights reserved.

Nutrition in cachexia: from bench to bedside.

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Konishi, Masaaki; Ishida, Junichi; von Haehling, Stephan; Anker, Stefan D; Springer, Jochen

2016-05-01

As malnutrition is often present in cachexia, nutritional intervention has been one of the widely accepted strategies. A literature review of cachexia models with dietary interventions in the present issue of this journal pointed out that the majority of nutrient intervention studies were of n-3 fatty acid, mainly eicosapentaenoic acid and docosahexaenoic acid. Effect on protein catabolism and anti-inflammation are most pronounced benefits of n-3 fatty acid. The effectiveness of n-3 fatty acid may depend on control diet or even be attributed to the polyunsaturated fatty acid deficiency inadvertently produced in control group. However, there is not enough clinical evidence to support a benefit of n-3 fatty acid substitution in patients with cachexia. The second important result from this review is that the majority of studies did not provide information about dietary design or did not standardize design, content, source, and overall composition. To guide dietary design for researchers in preclinical studies, a model has been proposed in this review, which may be useful to predict the efficacy of new dietary intervention in cachexia science. From a clinical point of view, the limited effectiveness of nutritional support in cachexia may partly be explained by the multifactorial nature of this condition. Cachexia differs from malnutrition inasmuch as malnutrition can be reversed by adequate nutrition and/or by overcoming problems of absorption or utilization of nutrients, but cachexia cannot be successfully treated by nutrition alone. Multidisciplinary approach including the assessment and intervention in feeding, appetite, swallowing, exercise, psychosocial, and psychological issue may be needed to improve nutrition in patients with cachexia.

Rhabdomyolysis following acute alcohol intoxication.

OpenAIRE

Hewitt, S M; Winter, R J

1995-01-01

The case of a fit young man who developed rhabdomyolysis after a short period of immobilization following acute alcohol intoxication is described. Rhabdomyolysis should be considered in an intoxicated patient presenting with muscle tenderness, particularly after immobilization.

Nuclear medicine imaging in rhabdomyolysis

International Nuclear Information System (INIS)

Cornelius, E.A.

1982-01-01

A case of severe rhabdomyolysis is reported in which, some seven and one-half weeks after its occurrence, a gallium scan was strongly positive, due to abscess formation in the damaged muscle. A bone scan was weakly positive in the same area, due to gallium photons. A review of the the reported cases reveals that bone scans are a very sensitive indicator of acute muscle damage and are useful to monitor its repair

Characteristic MR image finding of squatting exercise-induced rhabdomyolysis of the thigh muscles.

Science.gov (United States)

Yeon, Eung K; Ryu, Kyung N; Kang, Hye J; Yoon, So H; Park, So Y; Park, Ji S; Jin, Wook

2017-04-01

To describe the characteristic MRI appearance of squatting-induced rhabdomyolysis involving the thigh muscles. This study consisted of 10 cases obtained at 3 institutions from 2005 to 2015. A retrospective review was performed to obtain clinical information and MR scans for rhabdomyolysis of the thigh muscles. MRI was analyzed according to the distribution and degree of muscle involvement; the degree was assessed and graded as normal, mild or prominent. The mean patient age was 20.2 years (range, 15-24 years), and 7 of the 10 patients were male. All patients had history of excessive squatting action, suffered clinically from bilateral thigh pain and were confirmed to have rhabdomyolysis through analysis of serum creatine kinase (CK) levels. All of the patients (10/10) exhibited diffuse mild to prominent degree involvement of the anterior thigh muscles according to fluid-sensitive MR sequences. Among the anterior thigh muscles, the rectus femoris was spared in 8 patients (8/10) and mild degree involved in 2 patients (2/10). Thus, no cases exhibited prominent degree involvement of the rectus femoris muscle. Preservation of the rectus femoris muscle on MRI in squatting-induced rhabdomyolysis may be useful for differentiating rhabdomyolysis from other aetiologies. Advances in knowledge: Preservation of rectus femoris on MRI is distinguishable finding in squatting-induced rhabdomyolysis and reflects the functional anatomy of anterior thigh muscles.

Rhabdomyolysis-Induced Acute Renal Failure Following Fenofibrate Therapy: A Case Report and Literature Review

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Ramazan Danis

2010-01-01

Full Text Available Fenofibrate, a fibric acid derivative, is used to treat diabetic dyslipidemia, hypertriglyceridemia, and combined hyperlipidemia, administered alone or in combination with statins. Rhabdomyolysis is defined as a pathological condition involving skeletal muscle cell damage leading to the release of toxic intracellular material into circulation. Its major causes include muscle compression or overexertion; trauma; ischemia; toxins; cocaine, alcohol, and drug use; metabolic disorders; infections. However, rhabdomyolysis associated with fenofibrate is extremely rare. Herein we report a 45-year-old female patient who was referred to our department because of generalized muscle pain, fatigue, weakness, and oliguria over the preceding 3 weeks. On the basis of the pathogenesis and clinical and laboratory examinations, a diagnosis of acute renal failure secondary to fenofibrate-induced rhabdomyolysis was made. Weekly followups for patients who are administered fenofibrate are the most important way to prevent possible complications.

Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review

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Jooyoung Kim

2016-09-01

Full Text Available Exercise-induced rhabdomyolysis (exRML, a pathophysiological condition of skeletal muscle cell damage that may cause acute renal failure and in some cases death. Increased Ca2+ level in cells along with functional degradation of cell signaling system and cell matrix have been suggested as the major pathological mechanisms associated with exRML. The onset of exRML may be exhibited in athletes as well as in general population. Previous studies have reported that possible causes of exRML were associated with excessive eccentric contractions in high temperature, abnormal electrolytes balance, and nutritional deficiencies possible genetic defects. However, the underlying mechanisms of exRML have not been clearly established among health professionals or sports medicine personnel. Therefore, we reviewed the possible mechanisms and correlated prevention of exRML, while providing useful and practical information for the athlete and general exercising population.

Rhabdomyolysis Associated with Fenofibrate Monotherapy in a Patient with Chronic Myelogenous Leukemia

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Kazuya Kato

2011-08-01

Full Text Available Rhabdomyolysis associated with fenofibrate monotherapy is extremely rare. Here, we report a rare case of rhabdomyolysis of the psoas muscle in an 82-year-old man with chronic myelogenous leukemia (CML. He was prescribed fenofibrate because of a hypertriglyceridemia. The patient reported generalized muscle pain and right abdominal pain while receiving fenofibrate monotherapy. An abdominal computed tomography scan and an abdominal ultrasound showed a large and low attenuation and high echogenicity, respectively, in the right middle abdominal area. Laboratory values included a serum creatine concentration of 4.1 mg/dl and a creatinine phosphokinase concentration of 5,882 IU/l. During laparotomy, a large hematoma and necrotic mass was identified in the right psoas muscle. Histological examination revealed that the resected specimens were of the psoas muscle with irregular fiber sizes, degenerating fibers surrounding the inflammatory reaction, and fiber necrosis that is typical for polymyositis. Based on these findings and the clinical history, a diagnosis of fenofibrate-induced rhabdomyolysis was made. To the best of our knowledge, no patient has ever been diagnosed with fulminant psoas rhabdomyolysis due to a fenofibrate monotherapy. This report details the rare case of rhabdomyolysis in a patient with CML associated with fenofibrate monotherapy and offers a review of the literature.

Development of rhabdomyolysis in a child after norovirus gastroenteritis.

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Nishio, Tomohiro; Yonetani, Ryoko; Ito, Eisuke; Yoneta, Makiko; Maruo, Yoshihiro; Yoshida, Tokiko; Sugimoto, Tohru

2016-11-04

In children, the most significant cause of rhabdomyolysis or muscle breakdown is viral infection. However, there are no reports that norovirus, a gastroenteric virus that commonly infects children, specifically causes rhabdomyolysis. Here, we report the first pediatric case of norovirus-associated rhabdomyolysis. The patient, a 2-year-old boy with fever, diarrhea, and vomiting, was referred to our hospital with dysstasia and transaminitis. He was diagnosed with rhabdomyolysis. Additionally, norovirus genogroup GII was detected from stool samples by real-time quantitative reverse transcription Polymerase Chain Reaction, and thereafter, the norovirus GII.4 variant was identified. However, the association between rhabdomyolysis and the isolated norovirus variant was not clarified. After treatment the patient recovered without renal failure or disseminated intravascular coagulation. Rhabdomyolysis is a disease for which there is a need for early detection and treatment. If abnormal posture or muscle weakness is observed during the course of gastroenteritis, blood and urinary tests should be performed to rule out rhabdomyolysis.

Tourniquet-induced rhabdomyolysis after total knee replacement.

Science.gov (United States)

Palmer, S. H.; Graham, G.

1994-01-01

A case is described of a patient who developed rhabdomyolysis and acute renal failure after the use of an intraoperative tourniquet for elective orthopaedic surgery. A review of the literature revealed four similar cases in the last 20 years. The clinical features and management of such patients are discussed. PMID:7702328

Rhabdomyolysis and acute renal failure after strenuous exercise and alcohol abuse: case report and literature review

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Elizabeth De Francesco Daher

Full Text Available CONTEXT: Rhabdomyolysis is a severe and life-threatening condition in which skeletal muscle is damaged. Acute renal failure due to rhabdomyolysis has been widely described and its main pathophysiological mechanisms are renal vasoconstriction, intraluminal cast formation and direct myoglobin toxicity. OBJECTIVE: To report on a case of acute renal failure (ARF induced by rhabdomyolysis due to strenuous exercise and alcohol abuse and to describe the pathophysiology of this type of ARF. CASE REPORT: A 39-year-old man arrived at the hospital emergency service with swollen legs and lower extremity compartment syndrome. He was oliguric and had serum creatinine and urea levels of 8.1 mg/dl and 195 mg/dl, respectively. The diagnosis of rhabdomyolysis was made through clinical and laboratory findings (creatine kinase activity of 26320 IU/l. The initial treatment consisted of fluid replacement and forced diuresis. The specific treatment for compartment syndrome, such as fasciotomy, was avoided in order to prevent infection. Partial recovery of renal function was recorded, after ten hemodialysis sessions. Complete recovery was observed after two months of follow-up.

Acute renal dysfunction in a patient presenting with rhabdomyolysis due to Hypothyroidism attributed to Hashimoto's Disease

OpenAIRE

Nikolaidou, C; Gouridou, E; Ilonidis, G; Boudouris, G

2010-01-01

We describe a patient with rhabdomyolysis and acute renal dysfunction due to hypothyroidism, attributed to Hashimoto's disease. Though rhabdomyolysis could be life-threatening, it is a rare complication of hypothyroidism, especially when other precipitating factors, such as exercise, alcohol, medications or renal failure, are absent. Nevertheless, hypothyroidism can be an authentic cause of rhabdomyolysis and should always be considered when elevated creatine kinase (CK) and other muscle enzy...

[A Case of Rhabdomyolysis Related to SOX Therapy for Liver Metastasis of Gastric Cancer].

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Sato, Kei; Akiyama, Hirotoshi; Kogure, Yuu; Suwa, Yusuke; Momiyama, Masashi; Ishibe, Atsushi; Endo, Itaru

2017-04-01

We report a case of rhabdomyolysis related to S-1 plus oxaliplatin(SOX)therapy for liver metastasis of gastric cancer. A 76- year-old man who had received SOX therapy for metastatic gastric cancer was admitted to our hospital for a chief complaint of fatigue and weakness. He diagnosed with rhabdomyolysis related to SOX therapy because of his symptoms and because his laboratory studies showed significant elevation of his serum creatine kinase(CK)level. The symptoms disappeared and the CK level normalized following large-volume transfusions. Rhabdomyolysis following SOX therapy is a very rare, but severe adverse event. This is the first detailed case report of rhabdomyolysis related to SOX therapy.

Rapid onset of rhabdomyolysis after switching to a raltegravir-based antiretroviral regimen.

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Tsai, Wan-Jung; Lee, Susan Shin-Jung; Tsai, Hung-Chin; Sy, Cheng-Len; Chen, Jui-Kuang; Wu, Kuang-Sheng; Wang, Yung-Hsin; Chen, Yao-Shen

2016-04-01

Raltegravir is the first integrase inhibitor antiretroviral agent that has been demonstrated to have antiviral efficacy and safety. However, the US Food and Drug Administration has recommended use with caution in patients with risk factors for rhabdomyolysis, based on four case reports of rhabdomyolysis in patients with identifiable risk factors. We present a 32-year-old Asian man with human immunodeficiency virus (HIV), but without other underlying diseases, who developed rapid-onset, raltegravir-associated rhabdomyolysis and hyperlactatemia. Our patient lacked predisposing factors for rhabdomyolysis, and the rapid onset time of 4 days was the shortest reported. Therefore, clinicians should exercise caution when using raltegravir and closely monitor all patients for the symptoms of muscle pain and weakness. This case has been reported to the National Adverse Drug Reactions Reporting System of the Department of Health in Taiwan. Copyright © 2013. Published by Elsevier B.V.

Spinning: an arising cause of rhabdomyolysis in young females.

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Kim, Y H; Ham, Y R; Na, K R; Lee, K W; Choi, D E

2016-09-01

'Spinning' is an indoor cycling regimen. The number of case reports of spinning-induced rhabdomyolysis (SIR) has increased since 2004 in South Korea. The aim of this study is to evaluate the clinical characteristics of SIR and compare it with other causes of rhabdomyolysis. Patients who were diagnosed with rhabdomyolysis from 1 September 2011 to 30 April 2015 were included. We analysed the incidence of rhabdomyolysis, biochemical parameters and forced hospitalisation, which was defined as the days from admission to creatinine phosphokinase rhabdomyolysis in young, unfit females, which is typically severe. A graded exercise programme is advised at the first session. © 2016 Royal Australasian College of Physicians.

Nurses' Perceived Barriers to Bedside Handover and Their Implication for Clinical Practice.

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Tobiano, Georgia; Whitty, Jennifer A; Bucknall, Tracey; Chaboyer, Wendy

2017-10-01

Bedside handover during the change of shift allows nurses to visualize patients and facilitate patient participation, both purported to improve patient safety. But, bedside handover does not always occur and when it does, it may not involve the patient. To explore and understand barriers nurses perceive in undertaking bedside handover. A cross-sectional survey was administered to 200 nurses working on medical wards, recruited from two Australian hospitals, one private and one public. As part of the survey, there was one open-ended question asking about perceived barriers to bedside handover. Content analysis was used to analyze data. Barriers were assessed using a determinant framework. The open-ended question was answered by 176 (88%) participants. Three categories were identified. First, censoring the message showed nurses were concerned about patients and third-parties hearing sensitive information. In the second category, disrupting the communication flow, nurses perceived patients, family members, other nurses and external sources, interrupted the flow of handover and increased its duration. Finally, inhibiting characteristics demonstrated that individual patient and nurse views or capabilities hindered bedside handover. Barriers to bedside handover were determined to relate to individual nurse factors, patient factors, social, political and legal factors, and guideline factors. Suggestions for enhancing bedside handover include debunking nurses' misconceptions, reflecting on nurses' viewpoints, using active educational approaches, and promotion of legal requirements to heighten nurses' confidence dealing with sensitive information. Regular patient rounding, and standardized handover may enable patient involvement in handover. Finally, reviewing the local context to ensure organizational processes support bedside handover is recommended. © 2017 Sigma Theta Tau International.

Successful reintroduction of statin therapy after statin-associated rhabdomyolysis.

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Simons, Janet E; Holbrook, Anne M; Don-Wauchope, Andrew C

2015-01-01

The case report demonstrates the successful use of an alternative statin after a statin-related episode of rhabdomyolysis. Statin-associated rhabdomyolysis is a serious adverse event with a very low incidence and is considered the most severe of the muscle-related side effects of the statins. Rechallenge with statins is not a recommended practice after rhabdomyolysis. The patient experienced a myocardial infarct 1 y after the episode of rhabdomyolysis. He used alternative lipid-lowering therapy for 2 y. His low-density lipoprotein cholesterol was not meeting typical secondary prevention targets. An alternative statin was introduced and the patient has been followed for 4 years without recurrence of the rhabdomyolysis. This case suggests it may be time to reconsider the accepted practice of permanently avoiding statin therapy after rhabdomyolysis. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Rhabdomyolysis and Acute Renal Failure after Gardening

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Zeljko Vucicevic

2015-01-01

Full Text Available Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed.

Rhabdomyolysis in a Patient with Severe Hypothyroidism.

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Salehi, Nooshin; Agoston, Endre; Munir, Iqbal; Thompson, Gary J

2017-08-22

BACKGROUND Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients with hypothyroidism who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. CASE REPORT We report a case of a 52-year-old Hispanic woman with a history of hypothyroidism, hypertension, and type 2 diabetes mellitus who presented with fatigue, severe generalized weakness, bilateral leg pain, and recurrent falls. She reported poor medication compliance for the preceding month. Initial laboratory testing showed elevated thyroid stimulating hormone (TSH) and creatine kinase (CK) levels, indicating uncontrolled hypothyroidism with associated rhabdomyolysis. Supportive treatment with intravenous fluids and intravenous levothyroxine were initiated and resulted in dramatic clinical improvement. CONCLUSIONS We report a case of rhabdomyolysis, which is a rare but potentially serious complication of hypothyroidism. Screening for hypothyroidism in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment of hypothyroidism is essential to prevent rhabdomyolysis and its consequences.

Acute renal failure secondary to rhabdomyolysis; MR imaging of the kidney

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Kim, S.H.; Han, M.C.; Kim, S.; Lee, J.S. (Dept. of Radiology and Dept. of Internal Medicine, Seoul National Univ., Coll. of Medicine (Korea, Republic of))

1992-11-01

MR imaging of the kidney was performed in 6 patients with acute renal failure (ARF) secondary to rhabdomyolysis caused by snake bite (n = 4), crush injury (n = 1), and carbon monoxide poisoning (n = 1). A test for urine myoglobin was positive in all 6 patients and MR imaging was done 6 to 18 days after the causative event of the rhabdomyolysis. MR images in all 6 patients showed globular swelling of the kidneys, preserved corticomedullary contrast on T1-weighted images, and obliteration of corticomedullary contrast on T2-weighted images. Unlike other medical renal diseases in which corticomedullary contrast is lost on T1-weighted images, preservation of the corticomedullary contrast on T1-weighted MR images with globular renal swelling was a constant finding in patients with ARF secondary to rhabdomyolysis. (orig.).

Rhabdomyolysis in a Patient with Severe Hypothyroidism

Science.gov (United States)

Salehi, Nooshin; Agoston, Endre; Munir, Iqbal; Thompson, Gary J.

2017-01-01

Patient: Female, 52 Final Diagnosis: Hypothyroidism induced rhabdomyolysis Symptoms: Bilateral leg pain • fatigue Medication: Levothyroxine • Calcitriol • Calcium Gluconate Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients with hypothyroidism who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. Case Report: We report a case of a 52-year-old Hispanic woman with a history of hypothyroidism, hypertension, and type 2 diabetes mellitus who presented with fatigue, severe generalized weakness, bilateral leg pain, and recurrent falls. She reported poor medication compliance for the preceding month. Initial laboratory testing showed elevated thyroid stimulating hormone (TSH) and creatine kinase (CK) levels, indicating uncontrolled hypothyroidism with associated rhabdomyolysis. Supportive treatment with intravenous fluids and intravenous levothyroxine were initiated and resulted in dramatic clinical improvement. Conclusions: We report a case of rhabdomyolysis, which is a rare but potentially serious complication of hypothyroidism. Screening for hypothyroidism in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment of hypothyroidism is essential to prevent rhabdomyolysis and its consequences. PMID:28827517

Nutrition in cachexia: from bench to bedside.

OpenAIRE

Konishi, Masaaki; Ishida, Junichi; von Haehling, Stephan; Anker, Stefan D.; Springer, Jochen

2016-01-01

As malnutrition is often present in cachexia, nutritional intervention has been one of the widely accepted strategies. A literature review of cachexia models with dietary interventions in the present issue of this journal pointed out that the majority of nutrient intervention studies were of n-3 fatty acid, mainly eicosapentaenoic acid and docosahexaenoic acid. Effect on protein catabolism and anti-inflammation are most pronounced benefits of n-3 fatty acid. The effectiveness of n-3 fatty aci...

Massive pericardial effusion and rhabdomyolysis secondary to untreated severe hypothyroidism: the first report.

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Zare-Khormizi, M R; Rahmanian, M; Pourrajab, F; Akbarnia, S

2014-10-01

Hypothyroidism is an endocrine disease with various clinical manifestations. It is a rare cause for rhabdomyolysis and massive pericardial effusion. We describe a case of severe hypothyroidism secondary to autoimmune hashimoto thyroiditis with massive pericardial effusion and rhabdomyolysis. Improvement of mentioned complications after hypothyroidism treatment and rule out of other possible causes are supportive clues that hypothyroidism is the main cause of patient's rare presentation. With the best of our knowledge, it is the first report of rhabdomyolysis and massive pericardial effusion coincidence in a patient of adult population with primary uncontrolled hypothyroidism for years.

From bench to bedside: editorial | Pettengell | South African ...

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Cerivastatin, Genetic Variants, and the Risk of Rhabdomyolysis

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Marciante, Kristin D.; Durda, Jon P.; Heckbert, Susan R.; Lumley, Thomas; Rice, Ken; McKnight, Barbara; Totah, Rheem A.; Tamraz, Bani; Kroetz, Deanna L.; Fukushima, Hisayo; Kaspera, Rüdiger; Bis, Joshua C.; Glazer, Nicole L.; Li, Guo; Austin, Thomas R.; Taylor, Kent D.; Rotter, Jerome I.; Jaquish, Cashell E.; Kwok, Pui-Yan; Tracy, Russell P.; Psaty, Bruce M.

2011-01-01

Objective The withdrawal of cerivastatin involved an uncommon but serious adverse reaction, rhabdomyolysis. The bimodal response--rhabdomyolysis in a small proportion of users-- points to genetic factors as a potential cause. We conducted a case-control study to evaluate genetic markers for cerivastatin-associated rhabdomyolysis. Methods The study had two components: a candidate gene study to evaluate variants in CYP2C8, UGT1A1, UGT1A3, and SLCO1B1; and a genome-wide association (GWA) study to identify risk factors in other regions of the genome. 185 rhabdomyolysis cases were frequency matched to statin-using controls from the Cardiovascular Health Study (n=374) and the Heart and Vascular Health Study (n=358). Validation relied on functional studies. Results Permutation test results suggested an association between cerivastatin-associated rhabdomyolysis and variants in SLCO1B1 (p = 0.002), but not variants in CYP2C8 (p = 0.073) or the UGTs (p = 0.523). An additional copy of the minor allele of SLCO1B1 rs4149056 (p.Val174Ala) was associated with the risk of rhabdomyolysis (OR: 1.89, 95% CI: 1.40 to 2.56). In transfected cells, this variant reduced cerivastatin transport by 40% compared with the reference transporter (p rhabdomyolysis (OR: 0.48; 95% CI: 0.36 to 0.63). Conclusion We identified modest genetic risk factors for an extreme response to cerivastatin. Disabling genetic variants in the candidate genes were not responsible for the bimodal response to cerivastatin. PMID:21386754

Severe Statin-induced Rhabdomyolysis following Cholestatic Hepatitis induced by Amoxicillin-clavulanate

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Rachele Rapetti

2014-05-01

Full Text Available We report the case of an 86-year-old man with a past history of coronary disease admitted to our internal medicine department for severe asthenia and weakness due to rhabdomyolysis. Three days earlier, he had been discharged from a gastroenterology unit with a diagnosis of amoxicillin–clavulanate-induced acute cholestatic hepatitis. A review of his drugs revealed that he had taken atorvastatin 10 mg daily in the previous six years, without clinical or laboratory signs of myopathy. Atorvastatin was therefore stopped, with gradual improvement of the rhabdomyolysis. All concomitant drug therapy needs to be reassessed in elderly patients, especially when they become acutely ill.

Rapid Diagnosis of Rhabdomyolysis with Point-of-Care Ultrasound.

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Nassar, Alicia; Talbot, Richard; Grant, Ashley; Derr, Charlotte

2016-11-01

It is important to rapidly diagnosis and treat rhabdomyolysis in order to decrease morbidity and mortality. To date there are no reports in the emergency medicine literature on the use of point-of-care ultrasound in the diagnosis of rhabdomyolysis. This unique case describes how ultrasound was used in the emergency department (ED) to quickly diagnose and treat rhabdomyolysis prior to confirmation with an elevated serum creatine kinase. When coupled with a high index of suspicion, ultrasound can be one of the most portable, readily available, low cost, and minimally invasive techniques for making a rapid diagnosis of rhabdomyolysis in the ED.

Laxative-induced rhabdomyolysis

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Alfonso Merante

2010-03-01

Full Text Available Alfonso Merante1, Pietro Gareri2,3, Norma Maria Marigliano2, Salvatore De Fazio2, Elvira Bonacci1, Carlo Torchia1, Gaetano Russo1, Pasquale Lacroce1, Roberto Lacava3, Alberto Castagna3, Giovambattista De Sarro2, Giovanni Ruotolo11Geriatrist, Geriatric Unit “Pugliese-Ciaccio” Hospital, Catanzaro, Italy; 2Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University Magna Graecia of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy; 3Geriatrist, Operative Unit Elderly Health Care, Catanzaro, ItalyAbstract: The present study describes a case of laxative-induced rhabdomyolysis in an elderly patient. An 87-year-old woman was hospitalized for the onset of confusion, tremors, an inability to walk, and a fever that she had been experiencing for 36 hours. She often took high dosages of lactulose and sorbitol syrup as a laxative (about 70 g/day. During her physical examination, the patient was confused, drowsy, and she presented hyposthenia in her upper and lower limbs, symmetric and diffuse moderate hyporeflexia, and her temperature was 37.8°C. Laboratory tests revealed severe hyponatremia with hypokalemia, hypocalcemia, hypochloremia, and metabolic alkalosis. Moreover, rhabdomyolysis markers were found. The correction of hydroelectrolytic imbalances with saline, potassium and sodium chlorure, calcium gluconate was the first treatment. During her hospitalization the patient presented acute delirium, treated with haloperidol and prometazine chloridrate intramuscularly. She was discharged 12 days later, after resolution of symptoms, and normalized laboratory tests. Over-the-counter drugs such as laxatives are usually not considered dangerous; on the other hand, they may cause serum electrolytic imbalance and rhabdomyolysis. A careful monitoring of all the drugs taken by the elderly is one of the most important duties of a physician since drug interactions and

Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants.

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O'Connor, Ayrn D; Padilla-Jones, Angie; Gerkin, Richard D; Levine, Michael

2015-06-01

Synthetic cathinones have emerged as popular drugs of abuse and produce sympathomimetic toxicity. It is unknown if rhabdomyolysis occurs more frequently following the use of synthetic cathinones compared to other stimulants. This retrospective study sought to determine the prevalence of rhabdomyolysis in patients with sympathomimetic toxicity and compare rates among patients using specific agents. Patients greater than 14 years of age with sympathomimetic toxicity and detection of a stimulant agent in urine via gas chromatography-mass spectroscopy (GC-MS) were included. Patients were excluded if clinical sympathomimetic toxicity was not present, a serum creatine kinase (CK) was not measured, or urine GC-MS was not performed. Rhabdomyolysis and severe rhabdomyolysis were defined as CK > 1000 and 10,000 IU/L, respectively. Prevalence of rhabdomyolysis and severe rhabdomyolysis were reported. Logistic regression was performed to determine the relative effect in single-agent exposures of a synthetic cathinone compared to other sympathomimetics on rhabdomyolysis. A secondary outcome, a composite endpoint defined as need for mechanical ventilation, renal replacement therapy, development of compartment syndrome, or death, was also analyzed. One hundred two subjects met inclusion criteria; median age (IQR) was 32 (25-42) years with a range of 14-65 years; 74 % were male. Rhabdomyolysis occurred in 42 % (43/102) of subjects. Patients whose sympathomimetic toxicity could be ascribed to a single agent were considered for further statistical analysis and placed into four groups: methamphetamine (n = 55), synthetic cathinone (n = 19), cocaine (n = 9), and other sympathomimetic (n = 6). In 89 subjects with single stimulant exposure, the prevalence of rhabdomyolysis was as follows: synthetic cathinone, 12/19 (63 %); methamphetamine, 22/55 (40 %); cocaine, 3/9 (33 %); and other single agent, 0/6 (0 %). The occurrence of severe rhabdomyolysis (CK > 10

Rhabdomyolysis case based on hypothyroidism

OpenAIRE

Bilal Katipoglu; Ihsan Ates; Fatih Acehan; Ayşenur Meteris; Nisbet Yılmaz

2016-01-01

Summary Hypothyroidism is a wide clinical spectrum disorder and only a few cases in literature show this. Rhabdomyolysis and acute renal impairment can be seen concurrently in a hypothyroid state. We report a case of severe hypothyroidism with poor drug compliance leading to rhabdomyolysis and acute kidney injury. Learning points: Hypothyroidism is a rare cause of acute kidney injury. In this case report, we studied a rare occurrence of acute renal impairment due to hypothyroidism with poor d...

An ignored cause of red urine in children: rhabdomyolysis due to carnitine palmitoyltransferase II (CPT-II) deficiency.

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Melek, Engin; Bulut, Fatma Derya; Atmış, Bahriye; Yılmaz, Berna Şeker; Bayazıt, Aysun Karabay; Mungan, Neslihan Önenli

2017-02-01

Carnitine palmitoyltransferase II (CPT-II) deficiency is an autosomal recessively inherited disorder involving the β-oxidation of long-chain fatty acids, which leads to rhabdomyolysis and subsequent acute renal failure. The clinical phenotype varies from a severe infantile form to a milder muscle form. Here, we report a 9-year-old boy referred to our hospital for the investigation of hematuria with a 2-day history of dark urine and malaise. As no erythrocytes in the microscopic examination of the urine and hemoglobinuria were present, myoglobinuria due to rhabdomyolysis was the most probable cause of dark urine. After excluding the other causes of rhabdomyolysis, with the help of metabolic investigations, the patient was suspected to have CPT-II deficiency, the most common cause of metabolic rhabdomyolysis. Our aim in presenting this case is to emphasize considering rhabdomyolysis in the differential diagnosis of dark urine in order to prevent recurrent rhabdomyolysis and renal injury.

Rapid Diagnosis of Rhabdomyolysis with Point-of-Care Ultrasound

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Alicia Nassar

2016-11-01

Full Text Available It is important to rapidly diagnosis and treat rhabdomyolysis in order to decrease morbidity and mortality. To date there are no reports in the emergency medicine literature on the use of point-of-care ultrasound in the diagnosis of rhabdomyolysis. This unique case describes how ultrasound was used in the emergency department (ED to quickly diagnose and treat rhabdomyolysis prior to confirmation with an elevated serum creatine kinase. When coupled with a high index of suspicion, ultrasound can be one of the most portable, readily available, low cost, and minimally invasive techniques for making a rapid diagnosis of rhabdomyolysis in the ED.

Recurrent rhabdomyolysis in a teenager with psychosis-intermittent hyponatremia-polydipsia syndrome.

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Shenoi, Asha N; Stockwell, Jana

2015-04-01

To report a case of recurrent hyponatremia and rhabdomyolysis in a teenager with psychogenic polydipsia. A 16-year-old boy was admitted with recurrent episodes of hyponatremia and rhabdomyolysis secondary to psychogenic polydipsia. He was treated with hypertonic saline, intravenous fluids, and supportive care. Psychogenic polydipsia is a condition characterized by compulsive drinking. Severe hyponatremia is a rare, but serious complication in patients with psychogenic polydipsia. Failure in cell volume regulatory mechanisms, defective osmoregulation, defective urinary dilution, and enhanced secretion of vasopressin are believed to play a role in the development of hyponatremia. Rhabdomyolysis can complicate severe hyponatremia, although the exact mechanism is not known. Antipsychotic drugs are also implicated in rhabdomyolysis. Severe hyponatremia and rhabdomyolysis can complicate psychogenic polydipsia. Patients receiving antipsychotic drugs with concomitant severe hyponatremia need to be monitored for rhabdomyolysis.

MR imaging of rhabdomyolysis

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Zagoria, R.J.; Karstaedt, N.; Koubek, T.D.

1986-01-01

The use of magnetic resonance (MR) imaging in two cases of rhabdomyolysis, one resulting from prolonged muscle compression and one from electrical burns, is described. The involved muscles were clearly demonstrated with MR. Recognition and assessment of the extent of rhabdomyolysis are important since life-threatening sequelae including severe metabolic disorders are possible. In one case, spin-echo and inversion-recovery MR imaging provided greater detail of muscle abnormalities than did 99mTc-pyrophosphate radionuclide scanning. Both cases illustrate the usefulness of MR in evaluation of skeletal muscle disorders

Two Cases of CrossFit®-Induced Rhabdomyolysis: A Rising Concern

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Madhur Rathi

2015-10-01

Full Text Available ackground: The author reports the cases of two adult males who presented with severe rhabdomyolysis following identical CrossFit® workouts performed on the same day, at the same time and at the same location. Results: For both cases, symptoms of rhabdomyolysis disappeared upon discontinuation of the regime and within three days of aggressive hydration and rest. Patients made a complete recovery upon discharge. Conclusion: The rhabdomyolysis was attributed to the same excruciating workout both men underwent. Exertional rhabdomyolysis exemplified by the cases presented highlights a rising concern over the health consequences of the popular training program. CrossFit®-induced rhabdomyolysis is underrecognized and should be considered in patients presenting with signs and symptoms of rhabdomyolysis.

Mitochondrial trifunctional protein deficiency with recurrent rhabdomyolysis

NARCIS (Netherlands)

Scheuerman, Oded; Wanders, Ronald J. A.; Waterham, Hans R.; Dubnov-Raz, Gal; Garty, Ben-Zion

2009-01-01

Rhabdomyolysis is an important clinical diagnosis. The differential diagnosis is extensive and includes various etiologies, such as infection, inflammation, trauma, endocrinopathies, and congenital muscular and metabolic disorders. Reported here is the case of an infant with recurrent rhabdomyolysis

Hypokalemia causing rhabdomyolysis in a patient with short bowel syndrome.

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Balhara, Kamna S; Highet, Bridget; Omron, Rodney

2015-04-01

Rhabdomyolysis, usually in the setting of trauma or drug use, is frequently seen in the emergency setting, and often leads to hyperkalemia at presentation. Hypokalemia, however, is a potentially underrecognized cause of rhabdomyolysis. We present a case of rhabdomyolysis likely due to hypokalemia in the setting of short bowel syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although less common, hypokalemia can be a significant cause of rhabdomyolysis via its effects on muscle. This scenario should be considered in the differential diagnosis of patients at risk for hypokalemia who present with weakness. Rapid recognition of this relationship and rapid correction of hypokalemia may prove very important in preventing the deleterious effects of rhabdomyolysis. Copyright © 2015 Elsevier Inc. All rights reserved.

Rhabdomyolysis during envenomation by Physalia sp envenomation in New Caldonia.

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Maldonado, E; Maillaud, C; Barguil, Y; Labadie, M

2017-02-01

We report the first case of rhabdomyolysis following envenomation by a Physalia sp in New Caledonia. Systemic envenomation by this marine hydrozoan is well known, including myalgia as a commonly reported clinical feature. Nonetheless, a related increase in muscle enzymes, featuring rhabdomyolysis, has not previously been described. In this case report, we describe a patient with rhabdomyolysis and acute renal failure. Rhabdomyolysis should be checked in case of systemic physalia envenomation.

Rhabdomyolysis associated with cytomegalovirus infection in kidney transplant recipients.

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Jung, H-Y; Kim, K-H; Park, S-C; Lee, J-H; Choi, J-Y; Cho, J-H; Park, S-H; Kim, Y-L; Kim, H-K; Huh, S; Kim, C-D

2014-12-01

Rhabdomyolysis is a pathological syndrome caused by skeletal muscle cell damage that affects the integrity of the cellular membrane and leads to the release of toxic intracellular constituents into the bloodstream. Although cytomegalovirus (CMV) has rarely been reported as a cause of rhabdomyolysis, CMV infection could be considered as a possible cause because of its clinical significance in kidney transplant recipients (KTRs). We report 2 cases of rhabdomyolysis associated with CMV infection in KTRs. A 64-year-old woman (Case 1) and a 65-year-old man (Case 2), who had each received a kidney from a living unrelated donor, were admitted with complaints of weakness in both legs and myalgia. Laboratory findings revealed highly increased creatine phosphokinase and myoglobinuria. In both cases, no recent alterations of medications had occurred, and other causes of rhabdomyolysis--such as trauma, alcohol, drugs, and electrolyte abnormalities - were excluded. CMV pp65 antigen was positive, and patients were diagnosed with rhabdomyolysis associated with CMV infection. Both patients recovered without complications after ganciclovir treatment. In conclusion, CMV infection should be considered as a possible cause of rhabdomyolysis in KTRs. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Therapeutic Effects of Procainamide on Endotoxin-Induced Rhabdomyolysis in Rats.

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Chih-Chin Shih

Full Text Available Overt systemic inflammatory response is a predisposing mechanism for infection-induced skeletal muscle damage and rhabdomyolysis. Aberrant DNA methylation plays a crucial role in the pathophysiology of excessive inflammatory response. The antiarrhythmic drug procainamide is a non-nucleoside inhibitor of DNA methyltransferase 1 (DNMT1 used to alleviate DNA hypermethylation. Therefore, we evaluated the effects of procainamide on the syndromes and complications of rhabdomyolysis rats induced by lipopolysaccharide (LPS. Rhabdomyolysis animal model was established by intravenous infusion of LPS (5 mg/kg accompanied by procainamide therapy (50 mg/kg. During the experimental period, the changes of hemodynamics, muscle injury index, kidney function, blood gas, blood electrolytes, blood glucose, and plasma interleukin-6 (IL-6 levels were examined. Kidneys and lungs were exercised to analyze superoxide production, neutrophil infiltration, and DNMTs expression. The rats in this model showed similar clinical syndromes and complications of rhabdomyolysis including high levels of plasma creatine kinase, acute kidney injury, hyperkalemia, hypocalcemia, metabolic acidosis, hypotension, tachycardia, and hypoglycemia. The increases of lung DNMT1 expression and plasma IL-6 concentration were also observed in rhabdomyolysis animals induced by LPS. Treatment with procainamide not only inhibited the overexpression of DNMT1 but also diminished the overproduction of IL-6 in rhabdomyolysis rats. In addition, procainamide improved muscle damage, renal dysfunction, electrolytes disturbance, metabolic acidosis, hypotension, and hypoglycemia in the rats with rhabdomyolysis. Moreover, another DNMT inhibitor hydralazine mitigated hypoglycemia, muscle damage, and renal dysfunction in rhabdomyolysis rats. These findings reveal that therapeutic effects of procainamide could be based on the suppression of DNMT1 and pro-inflammatory cytokine in endotoxin-induced rhabdomyolysis.

Therapeutic Effects of Procainamide on Endotoxin-Induced Rhabdomyolysis in Rats.

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Shih, Chih-Chin; Hii, Hiong-Ping; Tsao, Cheng-Ming; Chen, Shiu-Jen; Ka, Shuk-Man; Liao, Mei-Hui; Wu, Chin-Chen

2016-01-01

Overt systemic inflammatory response is a predisposing mechanism for infection-induced skeletal muscle damage and rhabdomyolysis. Aberrant DNA methylation plays a crucial role in the pathophysiology of excessive inflammatory response. The antiarrhythmic drug procainamide is a non-nucleoside inhibitor of DNA methyltransferase 1 (DNMT1) used to alleviate DNA hypermethylation. Therefore, we evaluated the effects of procainamide on the syndromes and complications of rhabdomyolysis rats induced by lipopolysaccharide (LPS). Rhabdomyolysis animal model was established by intravenous infusion of LPS (5 mg/kg) accompanied by procainamide therapy (50 mg/kg). During the experimental period, the changes of hemodynamics, muscle injury index, kidney function, blood gas, blood electrolytes, blood glucose, and plasma interleukin-6 (IL-6) levels were examined. Kidneys and lungs were exercised to analyze superoxide production, neutrophil infiltration, and DNMTs expression. The rats in this model showed similar clinical syndromes and complications of rhabdomyolysis including high levels of plasma creatine kinase, acute kidney injury, hyperkalemia, hypocalcemia, metabolic acidosis, hypotension, tachycardia, and hypoglycemia. The increases of lung DNMT1 expression and plasma IL-6 concentration were also observed in rhabdomyolysis animals induced by LPS. Treatment with procainamide not only inhibited the overexpression of DNMT1 but also diminished the overproduction of IL-6 in rhabdomyolysis rats. In addition, procainamide improved muscle damage, renal dysfunction, electrolytes disturbance, metabolic acidosis, hypotension, and hypoglycemia in the rats with rhabdomyolysis. Moreover, another DNMT inhibitor hydralazine mitigated hypoglycemia, muscle damage, and renal dysfunction in rhabdomyolysis rats. These findings reveal that therapeutic effects of procainamide could be based on the suppression of DNMT1 and pro-inflammatory cytokine in endotoxin-induced rhabdomyolysis.

Great expectations – Epigenetics and the meandering path from bench to bedside

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Sophia J. Häfner

2016-06-01

Full Text Available Making quick promises of major biomedical breakthroughs based on exciting discoveries at the bench is tempting. But the meandering path from fundamental science to life-saving clinical applications can be fraught with many hurdles. Epigenetics, the study of potentially heritable changes of gene function without modification of the underlying DNA sequence, has dominated the biological research field during the last decade and encountered a large public success. Driven by the unfolding of molecular biology and recent technological progress, the term has evolved significantly and shifted from a conceptual framework to a mechanistic understanding. This shift was accompanied by much hype and raised high hopes that epigenetics might hold both the key to deciphering the molecular underpinning of complex, non-Mendelian diseases and offer novel therapeutic approaches for a large panel of pathologies. However, while exciting reports of biological phenomena involving DNA methylation and histone modifications fill up the scientific literature, the realistic clinical applications of epigenetic medicines remain somewhat blurry. Here, we discuss the state of the art and speculate how epigenetics might contribute to prognostic and therapy approaches in the future.

Stem cell therapy: From bench to bedside

International Nuclear Information System (INIS)

Tamarat, R.; Lataillade, J. J.; Bey, E.; Gourmelon, P.; Benderitter, M.

2012-01-01

Several countries have increased efforts to develop medical countermeasures to protect against radiation toxicity due to acts of bio-terrorism as well as cancer treatment. Both acute radiation injuries and delayed effects such as cutaneous effects and impaired wound repair depend, to some extent, on angiogenesis deficiency. Vascular damage influences levels of nutrients, oxygen available to skin tissue and epithelial cell viability. Consequently, the evolution of radiation lesions often becomes uncontrolled and surgery is the final option-amputation leading to a disability. Therefore, the development of strategies designed to promote healing of radiation injuries is a major therapeutic challenge. Adult mesenchymal stem cell therapy has been combined with surgery in some cases and not in others and successfully applied in patients with accidental radiation injuries. Although research in the field of radiation skin injury management has made substantial progress in the past 10 y, several strategies are still needed in order to enhance the beneficial effect of stem cell therapy and to counteract the deleterious effect of an irradiated tissue environment. This review summarises the current and evolving advances concerning basic and translational research based on stem cell therapy for the management of radiological burns. (authors)

From bench to bedside and to health policies (and back: ethics in translational research

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Carlo Petrini

2014-03-01

Full Text Available INTRODUCTION: The medical aim of translational research is to smooth the transition of discoveries made through basic research from the laboratory bench to their diagnostic or therapeutic applications for patients. These applications may be extended to current clinical practice and to health policies. AIM: The converse is also important: health policies should provide a point of departure when identifying research priorities. Translational research poses the same ethical problems as trials with human subjects - albeit in different ways. One of the more significant problems is the risk for participants in trials: it is thus necessary to ensure that the risks to which these subjects are exposed are not out of proportion to the expected benefits. DISCUSSION: Translational research does not require new ethical principles, but existing biomedical principles need to be adjusted to the specific context. The well-being of participants should always be the primary objective; these persons should never be considered as means for the advancement of knowledge or for the improvement of applications.

Resistance exercise-induced rhabdomyolysis: Need for immediate intervention and proper counselling.

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Khalil, Maysaa A; Saab, Basem R

2016-12-01

Rhabdomyolysis results from damage to skeletal muscle. Improper resistance training may result in rhabdomyolysis, which can cause acute kidney injury, serious metabolic abnormalities, compartmental syndrome and even death. Proper counselling for athletes may prevent this condition. We present two patients with unilateral swelling after resistance exercise. The workup revealed rhabdomyolysis. We highlight the importance of counselling to prevent rhabdomyolysis secondary to resistance exercise. Trainers and primary care physicians need to be educated about the main features of rhabdomyolysis and urgently refer trainees suspected of having this condition. Treatment consists mainly of hydration and correction of metabolic abnormalities. Primary care physicians need to counsel patients on ways to prevent rhabdomyolysis. Trainers and primary care physicians should instruct novice trainees who are performing resistance exercise to start low and gradually increase the load. Training with loads of 60-70% of one repetition maximum for 8-12 repetitions and use of one to three sets per exercise is recommended.

Exertional and CrossFit-Induced Rhabdomyolysis.

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Meyer, Michelle; Sundaram, Sneha; Schafhalter-Zoppoth, Ingeborg

2017-07-14

Few publications of exercise-induced rhabomyolysis currently exist in the medical literature besides case reports. However, this condition can be severe, resulting in hospitalization and IV fluid administration to prevent serious sequelae. This report describes a case of exercise-induced rhabdomyolysis caused by a CrossFit workout. A 31-year-old female presented with 2 days of bilateral upper extremity pain and soreness, which began 2 days after she completed a CrossFit workout. Workup revealed an elevated creatine phosphokinase (CPK) of 18 441 U/L, consistent with exercise-induced rhabdomyolysis, and elevated liver function tests and elevated D-dimer, although her renal function was normal. She was hospitalized for 2 days and treated with IV fluids. This case report demonstrates that CrossFit exercises can lead to rhabdomyolysis, highlighting a condition that may be underdiagnosed and underreported.

Hypokalemia-associated catastrophic rhabdomyolysis in ulcerative colitis

International Nuclear Information System (INIS)

Tzvetanov, G.

2009-01-01

A case of catastrophic hypokalemia-associated rhabdomyolysis in patient with ulcerative colitis (UC) is reported. A 60-year-old man presented with an exacerbation of UC and hypokalemia due to long-term diarrhea. While in the hospital, rhabdomyolysis developed in association with worsening hypokalemia. The hypokalemia was refractory to treatment and progressive course. Patient developed painful cramps of the masticatory and facial musculature associated with a moderated weakness in distal muscle groups. The weakness extended to intercostals and diaphragm muscles and led to respiratory deficiency. Serum concentration of creatine kinase was highly increased. Patient died from advancing and insurmountable cardiovascular deficiency. The causative role of hypokalemia for muscle involvement and rhabdomyolysis in patients with inflammatory bowel diseases was discussed. (author)

New onset diabetes complicated by haemolysis and rhabdomyolysis: a case report and review of the literature

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Galtrey Clare M

2008-05-01

Full Text Available Abstract Introduction Previously undiagnosed glucose-6-phosphate dehydrogenase (G6PD deficiency can be unmasked by a diabetic crisis and both can be associated with rhabdomyolysis. The relationship between diabetes and G6PD deficiency is discussed and the possible triggers for haemolysis as outlined in this case report. The incidence of G6PD deficiency is 10% in African-American males and up to 35% in parts of Africa so an increased awareness of G6PD deficiency is important when treating diabetes in these populations. Case presentation A 54-year-old Kenyan man presented with a 3-day history of reduced appetite, weakness and reduced level of consciousness as a result of a hyperglycaemic diabetic crisis with both hyperosmolarity and ketoacidosis. The patient then developed haemolysis and a raised creatine kinase level. A diagnosis of G6PD deficiency and rhabdomyolysis was made. Conclusion This case highlights the importance of simple laboratory investigations in the early identification of the rarer complications of diabetic crisis such as haemolysis secondary to G6PD deficiency and rhabdomyolysis.

Incidence, Etiology, and Outcomes of Rhabdomyolysis in a Single Tertiary Referral Center

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Park, Jae-Seok; Seo, Min-Sook; Gil, Hyo-Wook; Yang, Jong-Oh; Lee, Eun-Young

2013-01-01

We have encountered numerous cases of rhabdomyolysis associated with acute pesticide intoxication; however, the cause, incidence, and treatment outcomes of rhabdomyolysis have not been studied. The current study involved 2,125 patients hospitalized with acute chemical poisoning. Based on clinical and laboratory parameters and treatment outcomes, we found that overall incidence of rhabdomyolysis in our hospital was 0.06% (93 of 143,830 patients admitted), but the incidence associated with acute pesticide intoxication was 1.8% (33 of 1,793 cases). The incidence of rhabdomyolysis after pesticide intoxication was significantly higher in men than in women (P = 0.010). The amount of pesticide ingested was significantly higher in rhabdomyolysis patients than that in those who did not develop rhabdomyolysis (mean ± SD, 114.1 ± 79.5 mL vs 74.1 ± 94.2 mL, P = 0.010). Our results show that pesticide intoxication is a frequent cause of rhabdomyolysis and is more common among men than women. The volume of pesticide ingested, and not the degree of human toxicity, is the main factor influencing the incidence of rhabdomyolysis. PMID:23960447

Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism

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N. D. B. Ehelepola

2017-01-01

Full Text Available Statins and hypothyroidism, independently, can rarely cause rhabdomyolysis. The combination of them especially with concurrent intake of drugs such as diltiazem increases the risk of rhabdomyolysis. Hashimoto’s encephalopathy is a rare condition associated with Hashimoto’s thyroiditis and some patients with that can present with a stroke like picture. An elderly male who has been on atorvastatin for three years and on diltiazem for a week presented with sudden onset inability to walk and confusion. On examination muscle tenderness was noticed and creatine kinase levels indicated rhabdomyolysis which we attributed to atorvastatin. Patient developed a seizure and myoclonus of masseters. Considering this, his confusion and his neutrophilia and high C-reactive protein levels, empirical antibiotics with dexamethasone were started and the patient responded to that. His cerebrospinal fluid and blood culture reports that arrived later did not show sepsis. After going home also his CK (creatine kinase levels remained high; TSH (thyroid-stimulating hormone level test was done and hypothyroidism was diagnosed. His antithyroid peroxidase antibody levels were also very high. We retrospectively think he had Hashimoto’s encephalopathy as well. His lipid profile and TSH and CK values returned to normal in that order after a few months of levothyroxine therapy.

Exercise-induced rhabdomyolysis - a patient series.

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Tazmini, Kiarash; Schreiner, Christoffer; Bruserud, Sidsel; Raastad, Truls; Solberg, Erik Ekker

2017-11-14

No guidelines are available for the treatment and follow up of exercise-induced rhabdomyolysis. The purpose of this study was to describe the treatment, complications and follow-up of patients with exercise-induced rhabdomyolysis at Diakonhjemmet Hospital. A retrospective observational study from 2011 up to and including 2015 of patients with exercise-induced rhabdomyolysis ≥ 18 years and with creatine kinase > 5 000 IU/l. We registered a total of 42 patients and obtained informed consent from 31. Twenty were treated as inpatients with a median hospitalisation time of 2.5 (1–6) days. Median creatine kinase was 36 797 (17 172–53 548) IU/l upon admission and 16 051 (11 845–26 505) IU/l at discharge. Median intravenous fluid volume was 6 000 (1 000–27 700) ml. Eleven patients underwent urinary alkalinisation. None developed severe kidney injury or other serious complications such as electrolyte imbalance, compartment syndrome or disseminated intravascular coagulation, either during hospitalisation or in the course of the study period. Healthy persons with exercise-induced rhabdomyolysis have a very low risk of complications. Our patients are treated as outpatients or considered for discharge with creatine kinase < 40 000 IU/l measured at least three days after their workout, and if they have no risk factors or other complications.

Exertional Rhabdomyolysis in a 21-Year-Old Healthy Woman: A Case Report.

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McKay, Brianna D; Yeo, Noelle M; Jenkins, Nathaniel D M; Miramonti, Amelia A; Cramer, Joel T

2017-05-01

McKay, BD, Yeo, NM, Jenkins, NDM, Miramonti, AA, and Cramer, JT. Exertional rhabdomyolysis in a 21-year-old healthy woman: a case report. J Strength Cond Res 31(5): 1403-1410, 2017-The optimal resistance training program to elicit muscle hypertrophy has been recently debated and researched. Although 3 sets of 10 repetitions at 70-80% of the 1 repetition maximum (1RM) are widely recommended, recent studies have shown that low-load (∼30% 1RM) high-repetition (3 sets of 30-40 repetitions) resistance training can elicit similar muscular hypertrophy. Incidentally, this type of resistance training has gained popularity. In the process of testing this hypothesis in a research study in our laboratory, a subject was diagnosed with exertional rhabdomyolysis after completing a resistance training session that involved 3 sets to failure at 30% 1RM. Reviewed were the events leading up to and throughout the diagnosis of exertional rhabdomyolysis in a healthy recreationally-trained 21-year-old woman who was enrolled in a study that compared the acute effects of high-load low-repetition vs. low-load high-repetition resistance training. The subject completed a total of 143 repetitions of the bilateral dumbbell biceps curl exercise. Three days after exercise, she reported excessive muscle soreness and swelling and sought medical attention. She was briefly hospitalized and then discharged with instructions to take acetaminophen for soreness, drink plenty of water, rest, and monitor her creatine kinase (CK) concentrations. Changes in the subject's CK concentrations, ultrasound-determined muscle thickness, and echo intensity monitored over a 14-day period are reported. This case illustrates the potential risk of developing exertional rhabdomyolysis after a low-load high-repetition resistance training session in healthy, young, recreationally-trained women. The fact that exertional rhabdomyolysis is a possible outcome may warrant caution when prescribing this type of resistance

A Case Report of Salmonella muenchen Enteritis Causing Rhabdomyolysis and Myocarditis in a Previously Healthy 26-Year-Old Man.

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Chapple, Will; Martell, Jon; Wilson, Joy S; Matsuura, Don T

2017-04-01

This case report examines an unusual presentation of a non-typhoidal Salmonella serovar with limited prevalence in the literature. This is the first case report to associate specifically the Salmonella muenchen serovar with rhabdomyolysis and myocarditis. This case report reviews the diagnostic criteria for myocarditis and explores the diagnostic dilemma of troponin elevation in the setting of rhabdomyolysis. It demonstrates that Salmonella muenchen has the ability to present in a broad range of individuals with complications extending beyond classical gastrointestinal symptoms. This report also concludes that diagnosis of the many possible complications from non-typhoidal Salmonella infections can be difficult due to patient comorbidities, variability in the severity of the illnesses, laboratory test limitations, and imaging limitations. When a patient presents with elevated troponins in the setting of rhabdomyolysis a careful workup should be done to evaluate for ischemic causes, myocarditis, or false elevation secondary to rhabdomyolysis.

Acute Compartment Syndrome Which Causes Rhabdomyolysis by Carbon Monoxide Poisoning and Sciatic Nerve Injury Associated with It: A Case Report.

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Ji, Jung-Woo

2017-09-01

Rhabdomyolysis is most frequently caused by soft tissue injury with trauma to the extremities. Non-traumatic rhabdomyolysis may be caused by alcohol or drug abuse, infection, collagen disease, or intensive exercise, but incidence is low. In particular, rhabdomyolysis resulting from carbon monoxide poisoning is especially rare. If caught before death, carbon monoxide poisoning has been shown to cause severe muscle necrosis and severe muscle damage leading to acute renal failure. In cases of carbon-monoxide-induced rhabdomyolsis leading to acute compartment syndrome in the buttocks and sciatic nerve injury are rare. We have experience treating patients with acute compartment syndrome due to rhabdomyolysis following carbon monoxide poisoning. We report the characteristic features of muscle necrosis observed during a decompression operation and magnetic resonance imaging findings with a one-year follow-up in addition to a review of the literature.

Rhabdomyolysis in a Patient with Severe Hypothyroidism

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Salehi, Nooshin; Agoston, Endre; Munir, Iqbal; Thompson, Gary J.

2017-01-01

Patient: Female, 52 Final Diagnosis: Hypothyroidism induced rhabdomyolysis Symptoms: Bilateral leg pain ? fatigue Medication: Levothyroxine ? Calcitriol ? Calcium Gluconate Clinical Procedure: ? Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare...

MR findings of acute rhabdomyolysis: case report

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Jung, Kum Chae; Kwon, Soon Tae; Cho, Kang Hee; Kang, San Kyong; Kim, Jin Man [Chungnam National University College of Medicine, Taejon (Korea, Republic of)

2003-08-01

Rhabdomyolysis is an acute disorder resulting from skeletal muscle injury in which intracellular contents are released into extracellular space and plasma. The condition may result from drug or alcohol overdose, infection, crush injuries, collagen disease, or intensive exercise. We report two cases of acute rhabdomyolysis resulting from CO poisoning and alcohol overdose, and discuss the MRI and ultrasonographic findings.

MR findings of acute rhabdomyolysis: case report

International Nuclear Information System (INIS)

Jung, Kum Chae; Kwon, Soon Tae; Cho, Kang Hee; Kang, San Kyong; Kim, Jin Man

2003-01-01

Rhabdomyolysis is an acute disorder resulting from skeletal muscle injury in which intracellular contents are released into extracellular space and plasma. The condition may result from drug or alcohol overdose, infection, crush injuries, collagen disease, or intensive exercise. We report two cases of acute rhabdomyolysis resulting from CO poisoning and alcohol overdose, and discuss the MRI and ultrasonographic findings

Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes.

Science.gov (United States)

Koubar, Sahar H; Estrella, Michelle M; Warrier, Rugmini; Moore, Richard D; Lucas, Gregory M; Atta, Mohamed G; Fine, Derek M

2017-07-17

The Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014. A retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI. Three hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5-10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40-2.99]), infection (OR 5.48 [95% CI 2.65-11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03-1.45]). Rhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality.

Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis.

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Non, Lemuel R; Patel, Rupa; Esmaeeli, Amir; Despotovic, Vladimir

2015-11-01

Hemophagocytic lymphohistiocytosis (HLH) and rhabdomyolysis are rare complications of typhoid fever from Salmonella enterica serovar Typhi. Herein, we describe the clinical features in a 21-year-old female from India who presented to the intensive care unit with fever, severe pancytopenia, and rhabdomyolysis. © The American Society of Tropical Medicine and Hygiene.

Rhabdomyolysis Complicating Unrecognized Hypophosphatemia in an Alcoholic Patient

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Deepali Kumar

1999-01-01

Full Text Available Rhabdomyolysis occurring as a complication of hypophosphatemia has been infrequently described. A 58-year-old male with a history of daily alcohol consumption presented with two generalized tonic clonic seizures secondary to hypovolemic hyponatremia. He was volume-resuscitated, and antiepileptic medication was administered. After three days of hospitalization, the patient developed severe rhabdomyolysis despite the absence of further seizure activity. Serum phosphate levels were depressed. He was treated with intravenous mannitol, alkaline diuresis, and intravenous and oral phosphate supplementation. He recovered uneventfully. Hypophosphatemia can potentially lead to multisystem organ dysfunction including severe rhabdomyolysis. It is, therefore, important to maintain a low threshold for measuring serum phosphate levels in patients admitted to hospital.

Modulating NAD+ metabolism, from bench to bedside.

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Katsyuba, Elena; Auwerx, Johan

2017-09-15

Discovered in the beginning of the 20 th century, nicotinamide adenine dinucleotide (NAD + ) has evolved from a simple oxidoreductase cofactor to being an essential cosubstrate for a wide range of regulatory proteins that include the sirtuin family of NAD + -dependent protein deacylases, widely recognized regulators of metabolic function and longevity. Altered NAD + metabolism is associated with aging and many pathological conditions, such as metabolic diseases and disorders of the muscular and neuronal systems. Conversely, increased NAD + levels have shown to be beneficial in a broad spectrum of diseases. Here, we review the fundamental aspects of NAD + biochemistry and metabolism and discuss how boosting NAD + content can help ameliorate mitochondrial homeostasis and as such improve healthspan and lifespan. © 2017 The Authors.

Rhabdomyolysis After Performing Blood Flow Restriction Training: A Case Report.

Science.gov (United States)

Tabata, Shogo; Suzuki, Yukio; Azuma, Koichiro; Matsumoto, Hideo

2016-07-01

Tabata, S, Suzuki, Y, Azuma, K, and Matsumoto, H. Rhabdomyolysis after performing blood flow restriction training: a case report. J Strength Cond Res 30(7): 2064-2068, 2016-Rhabdomyolysis is a serious and potentially life-threatening condition related to resistance training. Despite numerous reports of low-intensity blood flow restriction (BFR) training inducing muscle hypertrophy and increasing strength, few reports of rhabdomyolysis related to BFR training have been published. Here, we report a 30-year-old obese Japanese man admitted to our hospital the day after his first BFR training session with complaints of severe muscle pain in his upper and lower extremities, high fever, and pharyngeal pain. He was diagnosed with acute rhabdomyolysis based on a serum creatine phosphokinase level of 56,475 U·L and a urine myoglobin level of >3,000 ng·ml, and with acute tonsillitis based on a white blood cell count of 17,390 and C-reactive protein level of 10.43 mg·dl. A number of factors are suspected to be related to the onset and exacerbation of rhabdomyolysis, including excessive muscular training with BFR, bacterial infection, and medication. After 10 days of hospitalization with intravenous fluids and antibacterial drugs, he recovered without complications. This case indicates that BFR training should be conducted with careful consideration of the physical condition and strength of the individual to prevent serious complications, such as rhabdomyolysis.

Acute Alcohol Intoxication Exacerbates Rhabdomyolysis-Induced Acute Renal Failure in Rats.

Science.gov (United States)

Tsai, Jen-Pi; Lee, Chung-Jen; Subeq, Yi-Maun; Lee, Ru-Ping; Hsu, Bang-Gee

2017-01-01

Traumatic and nontraumatic rhabdomyolysis can lead to acute renal failure (ARF), and acute alcohol intoxication can lead to multiple abnormalities of the renal tubules. We examined the effect of acute alcohol intoxication in a rat model of rhabdomyolysis and ARF. Intravenous injections of 5 g/kg ethanol were given to rats over 3 h, followed by glycerol-induced rhabdomyolysis. Biochemical parameters, including blood urea nitrogen (BUN), creatinine (Cre), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and creatine phosphokinase (CPK), were measured before and after induction of rhabdomyolysis. Renal tissue injury score, renal tubular cell expression of E-cadherin, nuclear factor-κB (NF-κB), and inducible nitric oxide synthase (iNOS) were determined. Relative to rats in the vehicle group, rats in the glycerol-induced rhabdomyolysis group had significantly increased serum levels of BUN, Cre, GOT, GPT, and CPK, elevated renal tissue injury scores, increased expression of NF-κB and iNOS, and decreased expression of E-cadherin. Ethanol exacerbated all of these pathological responses. Our results suggest that acute alcohol intoxication exacerbates rhabdomyolysis-induced ARF through its pro-oxidant and inflammatory effects.

Rhabdomyolysis induced acute renal failure secondary to statins

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R Ram

2013-01-01

Full Text Available Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation. We report a patient with chronic kidney disease who had deterioration of renal function due to combination of risk factors like hypothyroidism and interaction of amlodipine and clopidogrel with statins.

Update: Exertional rhabdomyolysis, active component, U.S. Armed Forces, 2012-2016.

Science.gov (United States)

2017-03-01

Among active component service members in 2016, there were 525 incident diagnoses of rhabdomyolysis likely due to physical exertion and/or heat stress ("exertional rhabdomyolysis"). The crude incidence rate in 2016 was 40.7 cases per 100,000 person-years. Annual rates of incident diagnoses of exertional rhabdomyolysis increased 46.2% between 2013 and 2016, with the greatest percentage change occurring between 2014 and 2015. In 2016, relative to their respective counterparts, the highest incidence rates of exertional rhabdomyolysis affected service members who were male; younger than 20 years of age; and black, non-Hispanic. During the surveillance period, annual incidence rates were highest among service members of the Marine Corps, intermediate among those in the Army, and lowest among those in the Air Force and Navy. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or the Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain or swelling, limited range of motion, or the excretion of dark urine (possibly due to myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.

Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular Sonography

Science.gov (United States)

2010-05-01

worldwide. Peer Reviewed Title: Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular Sonography Journal Issue: Western...Preferred Citation: Thompson D, Stanescu C, Pryor P, Laselle B. Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular...nontrauamtic retrobulbar hematoma associated with warfarin toxicity. The application and limitations of focused bedside ocular sonography for this

Rhabdomyolysis-Induced Acute Kidney Injury Under Hypoxia and Deprivation of Food and Water

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Jingwen Wang

2013-10-01

Full Text Available Background: To investigate the renal pathophysiologyin rhabdomyolysis-induced acute kidney injury (AKI in rats under hypoxia and deprivation of food and water (HDFW, thus broadening the knowledge about rhabdomyolysis-induced AKI in massive earthquake. Methods: Male Wistar rats weighing 200-230g were randomized into control, rhabdomyolysis (R, HDFW and rhabdomyolysis in combination with HDFW (R/HDFW group. Experimental rhabdomyolysis rat model was established through clamping hind limb muscles, HDFW model rats were kept in 10% hypoxic chamber unavailable to food and water. At 1, 3, 5, 7, 9, 11d after treatment, serum creatinine (Scr level, renal index, renal structural changes and cell apoptosis were analyzed. Results: After R, HDFW, R/HDFW treatment, the animals showed significantly higher Scr levels than the control group. Renal index in R and R/HDFW groups elevated remarkably compared with that in control and HDFW group. The results of histopathology, ultra-structure and apoptosis assay suggested that rhabdomyolysis caused renal tubular injury, HDFW treatment resulted in renal vascular dilation, tissue congestion and tubular cell damage. In addition, more severe renal lesion appeared in R/HDFW. Conclusions: We conclude that the association of experimental rhabdomyolysis with HDFW results in a different functional and histological pattern. The rhabdomyolysis-HDFW combination causes more severe renal injury.

Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality.

Science.gov (United States)

Stewart, Ian J; Faulk, Tarra I; Sosnov, Jonathan A; Clemens, Michael S; Elterman, Joel; Ross, James D; Howard, Jeffrey T; Fang, Raymond; Zonies, David H; Chung, Kevin K

2016-03-01

Rhabdomyolysis has been associated with poor outcomes in patients with traumatic injury, especially in the setting of acute kidney injury (AKI). However, rhabdomyolysis has not been systematically examined in a large cohort of combat casualties injured in the wars in Iraq and Afghanistan. We conducted a retrospective study of casualties injured during combat operations in Iraq and Afghanistan who were initially admitted to the intensive care unit from February 1, 2002, to February 1, 2011. Information on age, sex, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), mechanism of injury, shock index, creatine kinase, and serum creatinine were collected. These variables were examined via multivariate logistic and Cox regression analyses to determine factors independently associated with rhabdomyolysis, AKI, and death. Of 6,011 admissions identified, a total of 2,109 patients met inclusion criteria and were included for analysis. Rhabdomyolysis, defined as creatine kinase greater than 5,000 U/L, was present in 656 subjects (31.1%). Risk factors for rhabdomyolysis identified on multivariable analysis included injuries to the abdomen and extremities, increased ISS, male sex, explosive mechanism of injury, and shock index greater than 0.9. After adjustment, patients with rhabdomyolysis had a greater than twofold increase in the odds of AKI. In the analysis for mortality, rhabdomyolysis was significantly associated with death until AKI was added, at which point it lost statistical significance. We found that rhabdomyolysis is associated with the development of AKI in combat casualties. While rhabdomyolysis was strongly associated with mortality on the univariate model and in conjunction with both ISS and age, it was not associated with mortality after the inclusion of AKI. This suggests that the effect of rhabdomyolysis on mortality may be mediated by AKI. Prognostic and epidemiologic study, level III.

A translational study "case report" on the small molecule "energy blocker" 3-bromopyruvate (3BP) as a potent anticancer agent: from bench side to bedside.

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Ko, Y H; Verhoeven, H A; Lee, M J; Corbin, D J; Vogl, T J; Pedersen, P L

2012-02-01

The small alkylating molecule, 3-bromopyruvate (3BP), is a potent and specific anticancer agent. 3BP is different in its action from most currently available chemo-drugs. Thus, 3BP targets cancer cells' energy metabolism, both its high glycolysis ("Warburg Effect") and mitochondrial oxidative phosphorylation. This inhibits/ blocks total energy production leading to a depletion of energy reserves. Moreover, 3BP as an "Energy Blocker", is very rapid in killing such cells. This is in sharp contrast to most commonly used anticancer agents that usually take longer to show a noticeable effect. In addition, 3BP at its effective concentrations that kill cancer cells has little or no effect on normal cells. Therefore, 3BP can be considered a member, perhaps one of the first, of a new class of anticancer agents. Following 3BP's discovery as a novel anticancer agent in vitro in the Year 2000 (Published in Ko et al. Can Lett 173:83-91, 2001), and also as a highly effective and rapid anticancer agent in vivo shortly thereafter (Ko et al. Biochem Biophys Res Commun 324:269-275, 2004), its efficacy as a potent anticancer agent in humans was demonstrated. Here, based on translational research, we report results of a case study in a young adult cancer patient with fibrolamellar hepatocellular carcinoma. Thus, a bench side discovery in the Department of Biological Chemistry at Johns Hopkins University, School of Medicine was taken effectively to bedside treatment at Johann Wolfgang Goethe University Frankfurt/Main Hospital, Germany. The results obtained hold promise for 3BP as a future cancer therapeutic without apparent cyto-toxicity when formulated properly.

Pheniramine Maleate-Induced Rhabdomyolysis and Aki: Is it Fatal?

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Venugopal, K; Reddy, M Mallikarjun; Bharathraj, M Y; Jaligidad, Kadappa; Kushal, D P

2014-01-01

Pheniramine maleate is an easily accessible, over-the-counterantihistaminic, which is frequently involved in overdoses. Pheniramine has antimuscarinic effect causing tachycardia, dilated pupils, urinary retention, and dry flushed skin, and decreased bowel sounds, confusion, mild increase in body temperature, cardiac arrhythmias, and seizures at lethal doses. It has not been implicated as an important cause of rhabdomyolysis and acute kidney injury (AKI). Rhabdomyolysis causing AKI is rarely reported in the literature. This case report emphasizes the occurrence of nontraumatic rhabdomyolysis in pheniramine maleate overdose which required hemodialysis. Since there is a lack of a specific antidote, treatment is mainly symptomatic and supportive. We report a fatal case of a young male with a very high dose of consumption of pheniramine maleate (4.077 g), which was complicated by seizures, respiratory depression, nontraumatic rhabdomyolysis, and AKI. Despite hemodialysis, ventilator support, and other intensive supportive care, patient could not survive and death ensued due to multiorgan dysfunction syndrome.

Exercise induced rhabdomyolysis

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Ružič Maja

2009-01-01

Full Text Available Introduction. Rhabdomyolysis is a potentially life threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. Case report. A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. Conclusion. Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis.

Specific macrophage subtypes influence the progression of rhabdomyolysis-induced kidney injury.

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Belliere, Julie; Casemayou, Audrey; Ducasse, Laure; Zakaroff-Girard, Alexia; Martins, Frédéric; Iacovoni, Jason S; Guilbeau-Frugier, Céline; Buffin-Meyer, Bénédicte; Pipy, Bernard; Chauveau, Dominique; Schanstra, Joost P; Bascands, Jean-Loup

2015-06-01

Rhabdomyolysis can be life threatening if complicated by AKI. Macrophage infiltration has been observed in rat kidneys after glycerol-induced rhabdomyolysis, but the role of macrophages in rhabdomyolysis-induced AKI remains unknown. Here, in a patient diagnosed with rhabdomyolysis, we detected substantial macrophage infiltration in the kidney. In a mouse model of rhabdomyolysis-induced AKI, diverse renal macrophage phenotypes were observed depending on the stage of the disease. Two days after rhabdomyolysis, F4/80(low)CD11b(high)Ly6b(high)CD206(low) kidney macrophages were dominant, whereas by day 8, F4/80(high)CD11b(+)Ly6b(low)CD206(high) cells became the most abundant. Single-cell gene expression analyses of FACS-sorted macrophages revealed that these subpopulations were heterogeneous and that individual cells simultaneously expressed both M1 and M2 markers. Liposomal clodronate-mediated macrophage depletion significantly reduced the early infiltration of F4/80(low)CD11b(high)Ly6b(high)CD206(low) macrophages. Furthermore, transcriptionally regulated targets potentially involved in disease progression, including fibronectin, collagen III, and chemoattractants that were identified via single-cell analysis, were verified as macrophage-dependent in situ. In vitro, myoglobin treatment induced proximal tubular cells to secrete chemoattractants and macrophages to express proinflammatory markers. At day 30, liposomal clodronate-mediated macrophage depletion reduced fibrosis and improved both kidney repair and mouse survival. Seven months after rhabdomyolysis, histologic lesions were still present but were substantially reduced with prior depletion of macrophages. These results suggest an important role for macrophages in rhabdomyolysis-induced AKI progression and advocate the utility of long-term follow-up for patients with this disease. Copyright © 2015 by the American Society of Nephrology.

Do Bedside Visual Tools Improve Patient and Caregiver Satisfaction? A Systematic Review of the Literature.

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Goyal, Anupama A; Tur, Komalpreet; Mann, Jason; Townsend, Whitney; Flanders, Scott A; Chopra, Vineet

2017-11-01

Although common, the impact of low-cost bedside visual tools, such as whiteboards, on patient care is unclear. To systematically review the literature and assess the influence of bedside visual tools on patient satisfaction. Medline, Embase, SCOPUS, Web of Science, CINAHL, and CENTRAL. Studies of adult or pediatric hospitalized patients reporting physician identification, understanding of provider roles, patient-provider communication, and satisfaction with care from the use of visual tools were included. Outcomes were categorized as positive, negative, or neutral based on survey responses for identification, communication, and satisfaction. Two reviewers screened studies, extracted data, and assessed the risk of study bias. Sixteen studies met the inclusion criteria. Visual tools included whiteboards (n = 4), physician pictures (n = 7), whiteboard and picture (n = 1), electronic medical record-based patient portals (n = 3), and formatted notepads (n = 1). Tools improved patients' identification of providers (13/13 studies). The impact on understanding the providers' roles was largely positive (8/10 studies). Visual tools improved patient-provider communication (4/5 studies) and satisfaction (6/8 studies). In adults, satisfaction varied between positive with the use of whiteboards (2/5 studies) and neutral with pictures (1/5 studies). Satisfaction related to pictures in pediatric patients was either positive (1/3 studies) or neutral (1/3 studies). Differences in tool format (individual pictures vs handouts with pictures of all providers) and study design (randomized vs cohort) may explain variable outcomes. The use of bedside visual tools appears to improve patient recognition of providers and patient-provider communication. Future studies that include better design and outcome assessment are necessary before widespread use can be recommended. © 2017 Society of Hospital Medicine

Nelarabine Associated Myotoxicity and Rhabdomyolysis

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Mahnur Haider

2015-01-01

Full Text Available Nelarabine (ara-G; Arranon; compound 506U78 is an antineoplastic purine analog used for the treatment of refractory or relapsed T-cell acute lymphoblastic leukemia (T-ALL and T-cell lymphoblastic lymphoma (T-LBL. The drug was granted accelerated approval in October 2005 by the US Food and Drug Administration (FDA given the efficacy (induction of complete responses noted in 2 single-arm trials (one in pediatric setting and one in adult patient population. The main spectra of toxicities that have been reported in these clinical trials and subsequent studies are hematological and neurological. Nelarabine induced rhabdomyolysis and increased creatinine phosphokinase (CK; CPK levels apparently have been reported and this side effect has been added as an adverse reaction in the product monograph from the drug company during postmarketing surveillance. However, the true extent and incidence of the myotoxicity from the drug are unclear. In this paper we report a grade IV CK elevation and rhabdomyolysis in a patient with T-ALL treated with nelarabine. Given the reported finding, we examined the literature further for myotoxicity, increased CK, and/or rhabdomyolysis associated with the use of the nelarabine and report our findings.

Ischemic neuropathy and rhabdomyolysis as presenting symptoms of postpartum cardiomyopathy

NARCIS (Netherlands)

Helmich, Rick C. G.; van Laarhoven, Hanneke W. M.; Schoonderwaldt, Hennie C.; Janssen, Mirian C. H.

2009-01-01

Rhabdomyolysis and peripheral neuropathy are two distinct disease entities which are rarely encountered in combination. We present a woman with rhabdomyolysis and peripheral neuropathy 3 weeks postpartum. Her symptoms were caused by bilateral femoral artery thrombosis due to postpartum

Pneumococcusuria: From bench to bedside.

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Krishna, S; Sanjeevan, K V; Sudheer, A; Dinesh, K R; Kumar, A; Karim, S

2012-01-01

The present study highlights six cases of pneumococcusuria during the time period of May 2008 to May 2010. All the patients had a co-existing predisposing factor with the isolation of Streptococcus pneumoniae in urine. Five of the six patients having signs and symptoms of urinary tract infections (UTI) were treated and cured of the same. It becomes essential to consider pneumococcal UTI in the presence of clinical signs and symptoms associated with urinary tract abnormalities like hydronephrosis and renal stones. S. pneumoniae may be regarded as an emerging pathogen in UTI. Precise microbiological diagnosis must correlate with the clinical signs and symptoms for the administration of appropriate antibiotic therapy.

Rhabdomyolysis in DOMS

International Nuclear Information System (INIS)

Martinez Carsi, C.; Ruiz Hernandez, G.; Sanchez Marchori, C.; Munoz Moliner, J.

1999-01-01

A 26-year-old man with a previous history of external twin bursitis was remitted to our Department for a bone scintigraphy. Before the study, the patient performed an elevated number of intense sprints. Bone scintigraphy showed a bilaterally increased activity in both anterior rectum muscles suggesting rhabdomyolysis. Biochemical studies and MRT confirmed the diagnosis. (orig.) [de

Rhabdomyolysis-Associated Acute Kidney Injury With Normal Creatine Phosphokinase.

Science.gov (United States)

Kamal, Faisal; Snook, Lindsay; Saikumar, Jagannath H

2018-01-01

Rhabdomyolysis is a syndrome characterized by the breakdown of skeletal muscle and leakage of intracellular myocyte contents, such as creatine phosphokinase (CPK) and myoglobin, into the interstitial space and plasma resulting in acute kidney injury (AKI). Elevated CPK of at least 5 times the upper limit of normal is an important diagnostic marker of Rhabdomyolysis. We present a case of rhabdomyolysis with severe AKI with a normal CPK at presentation. A 32-year-old man presented with acute respiratory failure and AKI after an overdose of recreational drugs. Urinalysis at presentation showed trace amounts of blood, identified as rare red blood cells under microscopy. CPK was 156 U/L at presentation. Workup for glomerulonephritis and vasculitis was negative. He was initiated on renal replacement therapy, and a kidney biopsy showed severe acute tubular injury with positive myoglobin casts. Supportive management and renal replacement therapy was provided, and renal function spontaneously improved after a few weeks. This is an uncommon clinical presentation of severe rhabdomyolysis complicated by AKI. This suggests that CPK alone may not be a sensitive marker for rhabdomyolysis-induced AKI in some cases. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Kidney transplantation from donors with rhabdomyolysis and acute renal failure.

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Chen, Chuan-Bao; Zheng, Yi-Tao; Zhou, Jian; Han, Ming; Wang, Xiao-Ping; Yuan, Xiao-Peng; Wang, Chang-Xi; He, Xiao-Shun

2017-08-01

Rhabdomyolysis in deceased donors usually causes acute renal failure (ARF), which may be considered a contraindication for kidney transplantation. From January 2012 to December 2016, 30 kidneys from 15 deceased donors with severe rhabdomyolysis and ARF were accepted for transplantation at our center. The peak serum creatinine (SCr) kinase, myoglobin, and SCr of the these donors were 15 569±8597 U/L, 37 092±42 100 μg/L, and 422±167 μmol/L, respectively. Two donors received continuous renal replacement therapy due to anuria. Six kidneys exhibited a discolored appearance (from brown to glossy black) due to myoglobin casts. The kidney transplant results from the donors with rhabdomyolysis donors were compared with those of 90 renal grafts from standard criteria donors (SCD). The estimated glomerular filtration rate at 2 years was similar between kidney transplants from donors with rhabdomyolysis and SCD (70.3±14.6 mL/min/1.73 m 2 vs 72.3±15.1 mL/min/1.73 m 2 ). We conclude that excellent graft function can be achieved from kidneys donors with ARF caused by rhabdomyolysis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Two cases of serious rhabdomyolysis during linezolid treatment.

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Lechner, Arno M; Past, Eva; Porsche, Ulla; Kern, Jan M; Hoppe, Uta; Pretsch, Ingrid

2017-08-01

Linezolid is an oxazolidinone antibiotic with activity against gram-positive organisms, particularly methicillin-resistant Staphylococcus aureus (MRSA). To the best of our knowledge, there are only two case reports on rhabdomyolysis in patients treated with linezolid. Here, we describe two cases of serious rhabdomyolysis: one in a patient with septic community-acquired (CA)-MRSA pneumonia and a second case in a patient with suspected catheter-related blood stream infection.

Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management.

Science.gov (United States)

Cervellin, Gianfranco; Comelli, Ivan; Benatti, Mario; Sanchis-Gomar, Fabian; Bassi, Antonella; Lippi, Giuseppe

2017-08-01

Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Clinical usefulness of scintigraphy with 99mTechnetium phosphates in rhabdomyolysis

International Nuclear Information System (INIS)

Aizawa, Nobuyuki; Hara, Yoshikuni; Suzuki, Yutaka; Akashi, Tsunehiro; Kamei, Tetsumasa; Uchiyama, Fujio; Mitsui, Tamito; Yamazaki, Yuki.

1990-01-01

We performed bone scans with 99m Technetium phosphates in 15 cases of clinically suspected rhabdomyolysis admitted to Chigasaki Tokushukai Hospital. Whole body scans were performed within 5 days from the onset of illness or admission. Accumulation of the radioactivity in the skeletal muscle was revealed in 13 of the 15 cases and the involved muscle groups were visualized vividly. Etiologies of rhabdomyolysis were diverse, ranging from malignant syndrome to sepsis. Myocardial concentration was absent in all of the cases. Renal concentration of the isotope was seen in cases where the degree of rhabdomyolysis was higher and renal impairment was present. We conclude that 99m Technetium phosphate bone scan is useful in clinically suspected rhabdomyolysis as a diagnostic test and as a test to localize and quantitate the muscular involvement. (author)

"Back to Bedside": Residents' and Fellows' Perspectives on Finding Meaning in Work.

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Hipp, Dustin M; Rialon, Kristy L; Nevel, Kathryn; Kothari, Anai N; Jardine, Lcdr Dinchen A

2017-04-01

Physician burnout is common and associated with significant consequences for physicians and patients. One mechanism to combat burnout is to enhance meaning in work. To provide a trainee perspective on how meaning in work can be enhanced in the clinical learning environment through individual, program, and institutional efforts. "Back to Bedside" resulted from an appreciative inquiry exercise by 37 resident and fellow members of the ACGME's Council of Review Committee Residents (CRCR), which was guided by the memoir When Breath Becomes Air by Paul Kalanithi. The exercise was designed to (1) discover current best practices in existing learning environments; (2) dream of ideal ways to enhance meaning in work; (3) design solutions that move toward this optimal environment; and (4) support trainees in operationalizing innovative solutions. Back to Bedside consists of 5 themes for how the learning environment can enhance meaning in daily work: (1) more time at the bedside, engaged in direct patient care, dialogue with patients and families, and bedside clinical teaching; (2) a shared sense of teamwork and respect among multidisciplinary health professionals and trainees; (3) decreasing the time spent on nonclinical and administrative responsibilities; (4) a supportive, collegial work environment; and (5) a learning environment conducive to developing clinical mastery and progressive autonomy. Participants identified actions to achieve these goals. A national, multispecialty group of trainees developed actionable recommendations for how clinical learning environments can be improved to combat physician burnout by fostering meaning in work. These improvements can be championed by trainees.

Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy

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Pyoung Ahn

2013-12-01

Full Text Available Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis.

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Gelpi-Hammerschmidt, Francisco; Tinay, Ilker; Allard, Christopher B; Su, Li-Ming; Preston, Mark A; Trinh, Quoc-Dien; Kibel, Adam S; Wang, Ye; Chung, Benjamin I; Chang, Steven L

2016-02-01

We evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis after extirpative renal surgery. We conducted a population based, retrospective cohort study of patients who underwent extirpative renal surgery with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade V), nonfatal major complications (Clavien grade III-IV), hospital readmission rates, direct costs and length of stay. The final weighted cohort included 310,880 open, 174,283 laparoscopic and 69,880 robotic extirpative renal surgery cases during the 10-year study period, with 745 (0.001%) experiencing postoperative rhabdomyolysis. The presence of postoperative rhabdomyolysis led to a significantly higher incidence of 90-day nonfatal major complications (34.7% vs 7.3%, p rhabdomyolysis (incidence risk ratio 1.83, 95% CI 1.56-2.15, p rhabdomyolysis (vs laparoscopic approach, OR 2.43, p rhabdomyolysis (p rhabdomyolysis developing. Our study confirms that postoperative rhabdomyolysis is an uncommon complication among patients undergoing extirpative renal surgery, but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities, obesity, prolonged surgery (more than 5 hours) and a robotic approach appear to place patients at higher risk for postoperative rhabdomyolysis. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Severe hypokalaemic paralysis and rhabdomyolysis due to ingestion of liquorice

NARCIS (Netherlands)

A.E. van den Bosch (Annemien); J.M. van der Klooster; D.M. Zuidgeest; R.J.T. Ouwendijk (Rob); A. Dees

2005-01-01

textabstractChronic ingestion of liquorice induces a syndrome with findings similar to those in primary hyperaldosteronism. We describe a patient who, with a plasma K+ of 1.8 mmol/l, showed a paralysis and severe rhabdomyolysis after the habitual consumption of natural liquorice.

A Rare Case of Acute Renal Failure Secondary to Rhabdomyolysis Probably Induced by Donepezil

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Osman Zikrullah Sahin

2014-01-01

Full Text Available Introduction. Acute renal failure (ARF develops in 33% of the patients with rhabdomyolysis. The main etiologic factors are alcoholism, trauma, exercise overexertion, and drugs. In this report we present a rare case of ARF secondary to probably donepezil-induced rhabdomyolysis. Case Presentation. An 84-year-old male patient was admitted to the emergency department with a complaint of generalized weakness and reduced consciousness for two days. He had a history of Alzheimer’s disease for one year and he had taken donepezil 5 mg daily for two months. The patient’s physical examination revealed apathy, loss of cooperation, and decreased muscle strength. Laboratory studies revealed the following: urea: 128 mg/dL; Creatinine 6.06 mg/dL; creatine kinase: 3613 mg/dL. Donepezil was discontinued and the patient’s renal function tests improved gradually. Conclusion. Rhabdomyolysis-induced acute renal failure may develop secondary to donepezil therapy.

Exertional Rhabdomyolysis: What Is It and Why Should We Care?

Science.gov (United States)

Thomas, David Q.; Carlson, Kelli A.; Marzano, Amy; Garrahy, Deborah

2012-01-01

Exertional rhabdomyolysis gained increased attention recently when 13 football players from the University of Iowa developed this condition after an especially demanding practice session and were hospitalized. Exertional rhabdomyolysis may lead to severe kidney stress, kidney failure, and even sudden death. Anyone who does physical exercise at a…

Clinical Features of and Risk Factors for Rhabdomyolysis Among Adult Patients with Dengue Virus Infection

Science.gov (United States)

Huang, Shi-Yu; Lee, Ing-Kit; Liu, Jien-Wei; Kung, Chia-Te; Wang, Lin

2015-01-01

Among 1,076 dengue patients, 9 patients with rhabdomyolysis and 1,067 patients without rhabdomyolysis (controls) were retrospectively analyzed. Of nine patients with rhabdomyolysis, the most commonly reported symptom other than fever was myalgia; dengue hemorrhagic fever (DHF) was found in seven cases, and acute kidney injury was found in six cases. Furthermore, one (11.1%) patient died. The median duration from hospital admission to rhabdomyolysis diagnosis was 3 days. Patients with rhabdomyolysis had higher age, proportion of men, prevalence of hypertension, frequency of myalgia, and incidences of DHF, pleural effusion, and acute kidney injury than controls. Multivariate analysis showed that hypertension (odds ratio [OR] = 14.270), myalgia (OR = 20.377), and acute kidney injury (OR = 65.547) were independent risk factors for rhabdomyolysis. Comparison of cytokine/chemokine concentrations in 101 DHF patients, including those with (N = 4) and without (N = 97) rhabdomyolysis, showed that interleukin-6 and tumor necrosis factor-α levels were significantly increased in the former. PMID:25349377

Outcomes of exertional rhabdomyolysis following high-intensity resistance training.

Science.gov (United States)

Huynh, A; Leong, K; Jones, N; Crump, N; Russell, D; Anderson, M; Steinfort, D; Johnson, D F

2016-05-01

High-intensity resistance training (HIRT) programmes are increasingly popular amongst personal trainers and those attending gymnasiums. We report the experience of exertional rhabdomyolysis (ER) at two tertiary hospitals in Melbourne, Australia. To compare the clinical outcomes of ER with other causes of rhabdomyolysis. Retrospective cross-sectional study of patients presenting with a serum creatine kinase (CK) of greater than 25 000 units/L from 1 September 2013 to 31 August 2014 at two tertiary referral hospitals in Melbourne, Australia. Records were examined to identify care measures implemented during hospital stay, clinical outcomes during admission and on subsequent follow up. Thirty four cases of rhabdomyolysis with a CK of greater than 25 000 units/L (normal range: 20-180 units/L) were identified during the 12-month study period. Twelve of the 34 cases (35%) had ER with 10 of 12 related to HIRT. No acute kidney injury, intensive care admission or death were seen among those with ER. All cases were managed conservatively, with 11 admitted and 9 receiving intravenous fluids only. In contrast, patients with rhabdomyolysis from other causes experienced significantly higher rates of intensive care admission (64%, P = 0.0002), acute kidney injury (82%, P = 0.0001) and death (27%, P = 0.069). ER resulting from HIRT appears to have a benign course compared with rhabdomyolysis of other aetiologies in patients with a serum CK greater than 25 000 units/L. Conservative management of ER appears to be adequate, although this requires confirmation in future prospective studies. © 2016 Royal Australasian College of Physicians.

Rhabdomyolysis secondary to an accident with marine stingray (Dasyatis family

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AA Masson

2012-01-01

Full Text Available Whenever humans come in touch with the sea, they become vulnerable to risks, most frequently on account of invading a habitat that belongs to potentially harmful aquatic animals. World literature shows a growing number of incidents in recent years with marine stingrays, despite the fact that these animals only attack when harassed. This report describes an accident in which an amateur fisherman was injured by a marine stingray, probably of the Dasyatis family, on his left forearm. The puncture wound was highly painful and progressed to rhabdomyolysis. It is conjectured that lymphatic drainage, applied in an attempt to reduce edema and its complications, may have contributed to rebound increase in serum creatine kinase levels (CK and, thus, has exacerbated the intensity of rhabdomyolysis. Therefore, as a measure of caution, lymphatic drainage should not enter current treatment protocols for similar cases, until new studies are performed in order to clarify this issue.

Rhabdomyolysis in a Sickle Cell Trait Positive Active Duty Male Soldier.

Science.gov (United States)

Saxena, Pulkit; Chavarria, Christopher; Thurlow, John

2016-01-01

Exertional rhabdomyolysis is a complication of sickle cell trait (SCT) likely first reported in the military population over 40 years ago. Although commonly a benign condition, numerous studies and case reports have identified SCT positive patients to be at increased risk for rhabdomyolysis, compartment syndrome and sudden cardiac death. We report a recent case of an SCT positive African American active duty male Soldier who suffered exertional rhabdomyolysis following an Army Physical Fitness Test. His course was complicated by acute renal failure requiring hemodialysis, and he eventually recovered renal function. The diagnosis was significantly delayed despite a typical clinical presentation and available SCT screening results. The case highlights the importance of the recognition of SCT as a risk factor for severe rhabdomyolysis, and suggests more must be done for an effective SCT screening program for the active duty military population.

Clinical usefulness of scintigraphy with sup 99m Technetium phosphates in rhabdomyolysis

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Aizawa, Nobuyuki; Hara, Yoshikuni (Shonan Kamakura Hospital, Kanagawa (Japan)); Suzuki, Yutaka; Akashi, Tsunehiro; Kamei, Tetsumasa; Uchiyama, Fujio; Mitsui, Tamito; Yamazaki, Yuki

1990-08-01

We performed bone scans with {sup 99m}Technetium phosphates in 15 cases of clinically suspected rhabdomyolysis admitted to Chigasaki Tokushukai Hospital. Whole body scans were performed within 5 days from the onset of illness or admission. Accumulation of the radioactivity in the skeletal muscle was revealed in 13 of the 15 cases and the involved muscle groups were visualized vividly. Etiologies of rhabdomyolysis were diverse, ranging from malignant syndrome to sepsis. Myocardial concentration was absent in all of the cases. Renal concentration of the isotope was seen in cases where the degree of rhabdomyolysis was higher and renal impairment was present. We conclude that {sup 99m}Technetium phosphate bone scan is useful in clinically suspected rhabdomyolysis as a diagnostic test and as a test to localize and quantitate the muscular involvement. (author).

Peripheral T-cell lymphoma with unusual clinical presentation of rhabdomyolysis.

Science.gov (United States)

Liu, Zhiyu; Medeiros, L Jeffrey; Young, Ken H

2017-03-01

Primary extranodal lymphoma is known to occur in nose, gastrointestinal tract, skin, bone, and central nervous system. However, it is extremely rare for primary lymphoma to arise in skeletal muscle. We report a case of a 32-year-old man who presented initially with fever and fatigue. He had a history of alcohol abuse. Laboratory studies and computerized tomography scan showed results consistent with rhabdomyolysis, but the cause of the rhabdomyolysis was undetermined. After biopsy of abdominal skeletal muscle with histologic examination and T-cell receptor gamma chain gene rearrangement analysis, the diagnosis of peripheral T-cell lymphoma was established. After two cycles of the cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide regimen, the patient's symptoms greatly improved. This is the third reported case of peripheral T-cell lymphoma arising in skeletal muscle reported in the literature and which presented clinically with rhabdomyolysis. The alcohol abuse during the clinical course likely worsens the pathologic process of the rhabdomyolysis. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Test Bench Development for Femur Stability Assessment

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Samuel SANCHEZ-CABALLERO

2015-01-01

Full Text Available This paper shows the design and development of a test bench for humanfemurs. The main uses of this test bench will run from artificial femurs comparisonwith real femurs, to join stability assessment after bone a fracture repair. Amongthis uses is specially designed for condylar fractures testing. The test bench isdeveloped from a self-made existing tensile/compression testing machine. Thedesign procedure is supported by a literature review about the bone mechanicalbehavior and composition generally and the knee joint performance and repairparticularly. On the basis of this review, the machine was designed to simulate theadduction and abduction movements of the joint. The magnitudes to be measuredare: the compression force, the bone displacement (vertical and the knee jointrotation

A rare autopsy case of traumatic rhabdomyolysis associated with intermittent assault.

Science.gov (United States)

Chiba, Fumiko; Makino, Yohsuke; Motomura, Ayumi; Inokuchi, Go; Ishii, Namiko; Torimitsu, Suguru; Hoshioka, Yumi; Abe, Hiroko; Yamaguchi, Rutsuko; Hashimoto, Mari; Sakuma, Ayaka; Nagasawa, Sayaka; Saito, Hisako; Yajima, Daisuke; Iwase, Hirotaro

2016-05-01

Traumatic rhabdomyolysis generally occurs after severe blunt trauma and is acute in onset, associated with severe disease, and potentially lethal. Accordingly, diagnosis of traumatic rhabdomyolysis in patients without massive subcutaneous or intramuscular hemorrhage is difficult, especially in the postmortem period, which is limited in terms of the availability of biochemical examination tools and accurate history of illness. To the best of our knowledge, there are no previous reports of death from traumatic rhabdomyolysis among individuals who did not pursue medical consultation. A previously healthy man in his early sixties had been punched and kicked several times in the previous 2months, but he had not gone to a hospital. He suddenly lost consciousness at his workplace approximately 5days after the most recent assault, and cardiopulmonary arrest occurred when the emergency service arrived. He died the same day, and a medicolegal autopsy was performed. Although several sites of minor subcutaneous and muscle hemorrhage were observed, the cause of death was unclear upon macroscopic assessment. Immunohistochemical staining revealed acute renal failure caused by rhabdomyolysis. We herein report a rare case of fatal traumatic rhabdomyolysis, seemingly associated with minor and apparently nonlethal muscle injury. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Rhabdomyolysis following Acute Extended-Release Quetiapine Poisoning: A Case Report

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Antonios Liolios

2012-01-01

Full Text Available Background. During the past few years, there have been a number of case reports concerning rhabdomyolysis following quetiapine poisoning; however, there has been none concerning the medication in its extended-release form. Methods. We present the case report of a 48-year-old man presenting a major depressive disorder and borderline personality disorder, who after voluntary intoxication with 12000 mg of quetiapine extended-release developed signs of acute rhabdomyolysis. Results. The rhabdomyolysis was confirmed by the laboratory and the clinical findings, with elevated levels of creatinine, creatine phosphokinase, and CRP. Discussion. We would like to pinpoint the importance of this complication and our concern of prescribing it for psychiatric patients with chronic somatic comorbidities.

Rhabdomyolysis Syndrome in Alcohol, Psychotropic Drugs, and Illicit Substance Poisonings

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Seyed Kazem Taheri

2013-06-01

Full Text Available Background: Rhabdomyolysis is one of the major complications of poisoning causedby alcohol, narcotics, and psychotropic substances acute toxicity, which might lead toacute renal failure and even death. This study aimed to evaluate clinical and laboratoryfindings of rhabdomyolysis syndrome in poisoning patients who were admitted topoisoning ward of Farshchian Hospital of Hamadan, Iran.Methods: In this cross-sectional study, patients with acute toxicity by alcohol, narcotics,or psychotropic drugs who were admitted in poisoning ward of Farshchian Hospital ofHamadan were investigated during a 6-month period in 2012. Clinical and laboratorydata were collected by a standard questionnaire and analyzed by the SPSS softwareversion 16.Results: Eighty-two patients aged between 14 to 81 years were investigated. Twentytwocases developed rhabdomyolysis and narcotics related toxicity was the mostcommon cause. The most common clinical symptom in all patients was muscle pain(51cases, Laboratory studies showed some significant differences between serumcreatine kinase (CK, lactate dehydrogenase (LDH, serum creatinine, andaminotransferases (AST,ALT levels in rhabdomyolysis cases as compared to theothers (p<0.05.Conclusion: The results of this study revealed that the incidence of rhabdomyolysissyndrome in acute intoxication with alcohol and narcotics is significant and withoutproper treatment might cause serious complications such as acute renal failure andeven death. Classic clinical signs and symptoms of rhabdomyolysis are usually notpresent simultaneously, thus strong clinical suspicion and proper laboratory tests haveimportant role in early diagnosis and suitable treatment. Laboratory studies have animportant role in the diagnosis of this syndrome.

Exercise-induced rhabdomyolysis from stationary biking: a case report.

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Inklebarger, J; Galanis, N; Kirkos, J; Kapetanos, G

2010-10-01

There are several reports concerning exercise and rabdomyolysis. There has been no report in the English literature of exercise induced rabdomyolisis from a stationary bike.A 63-year-old female recreational athlete presented to our hospital seeking treatment for lower back, leg pain and stiffness after exercising on a stationary bicycle one day prior. Blood work showed a raised CK of 38,120 U/L, a myoglobin of 5330 and an AST 495 U/L with normal urea and electrolytes. Urinalysis remained negative. She was admitted for oral and intravenous hydration and fluid balance monitoringThis is a very rare case of rhabdomyolysis due to exercise. This study highlights the difficulties faced by accident and emergency teams in distinguishing delayed onset muscle soreness (DOMS) from exercise-induced rhabdomyolysis, and reinforces the concept that rhabdomyolysis can occur at any level of exercise intensity.

Rhabdomyolysis and truncular sciatic pain. MRI study of 2 cases

International Nuclear Information System (INIS)

Le Friant, G.; Brinquin, L.; Soulie, D.; Sarrazin, J.L.; Cosnard, G.; Cordoliani, Y.S.

1995-01-01

We report two cases of acute rhabdomyolysis in pelvic girdle muscles with sciatic palsy secondary to compression of the sciatic nerve trunk, with clinical and MRI correlation. The diagnosis of rhabdomyolysis is based on clinical and biological data, but diagnosis of compression complications secondary to swelling of the muscles, especially the compression of nerve trunk, is done by imaging. T2 weighted images give a definite anatomical evaluation. They show enlarged high signal intensity muscles and anatomic relationship with the sciatic nerve from its emergence out of pelvis, giving a good correlation between rhabdomyolysis and the compressed nervous trunk. It helps for planning a possible surgical fasciotomy. However, MRI provides only morphological informations, but not differentiates edema from necrosis in involved muscles. (authors). 7 refs., 2 figs

Single-dose-dexketoprofen-induced acute kidney injury due to massive rhabdomyolysis.

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Sav, Tansu; Unal, Aydin; Erden, Abdulsamet; Gunal, Ali Ihsan

2012-10-01

A 70-year-old male patient was admitted complaining of weakness and pain in his arms and lower limbs. His serum creatine kinase and serum creatinine were markedly elevated (36,248 IU/L and 2.8 mg/dL, respectively). He had taken dexketoprofen trometamol because of a common cold, which had developed the previous night. Acute kidney injury caused by dexketoprofen-induced rhabdomyolysis was diagnosed by ruling out other possible causes, such as dermato/polymyositis, myxedema, brucellosis, and hepatitis. Dexketoprofen administration was stopped. As diuresis did not restore spontaneously, the patient was treated with I.V. alkaline solutions and mannitol. Hemodialysis was performed because of anuria and severe metabolic acidosis. The patient's renal function later recovered. In conclusion, dexketoprofen may be a potential risk factor for acute kidney injury and rhabdomyolysis.

Allopurinol attenuates rhabdomyolysis-associated acute kidney injury: Renal and muscular protection.

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Gois, Pedro H F; Canale, Daniele; Volpini, Rildo A; Ferreira, Daniela; Veras, Mariana M; Andrade-Oliveira, Vinicius; Câmara, Niels O S; Shimizu, Maria H M; Seguro, Antonio C

2016-12-01

Acute kidney injury (AKI) is the most severe complication of rhabdomyolysis. Allopurinol (Allo), a xanthine oxidase inhibitor, has been in the spotlight in the last decade due to new therapeutic applications related to its potent antioxidant effect. The aim of this study was to evaluate the efficacy of Allo in the prevention and treatment of rhabdomyolysis-associated AKI. Male Wistar rats were divided into five groups: saline control group; prophylactic Allo (300mg/L of drinking water, 7 days); glycerol (50%, 5ml/kg, IM); prophylactic Allo + glycerol; and therapeutic Allo (50mg/Kg, IV, 30min after glycerol injection) + glycerol. Glycerol-injected rats showed markedly reduced glomerular filtration rate associated with renal vasoconstriction, renal tubular damage, increased oxidative stress, apoptosis and inflammation. Allo ameliorated all these alterations. We found 8-isoprostane-PGF 2a (F2-IsoP) as a main factor involved in the oxidative stress-mediated renal vasoconstriction following rhabdomyolysis. Allo reduced F2-IsoP renal expression and restored renal blood flow. Allo also reduced oxidative stress in the damaged muscle, attenuated muscle lesion/inflammation and accelerated muscular recovery. Moreover, we showed new insights into the pathogenesis of rhabdomyolysis-associated AKI, whereas Allo treatment reduced renal inflammation by decreasing renal tissue uric acid levels and consequently inhibiting the inflammasome cascade. Allo treatment attenuates renal dysfunction in a model of rhabdomyolysis-associated AKI by reducing oxidative stress (systemic, renal and muscular), apoptosis and inflammation. This may represent a new therapeutic approach for rhabdomyolysis-associated AKI - a new use for an old and widely available medication. Copyright © 2016 Elsevier Inc. All rights reserved.

Exertional Rhabdomyolysis after an Extreme Conditioning Competition: A Case Report

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Ramires Alsamir Tibana

2018-04-01

Full Text Available This case report describes an instance of exercise-induced rhabdomyolysis caused by an extreme conditioning program (ECP competition. A 35-year-old female presented with abdominal pain and soreness, which began one day after she completed two days of ECPcompetition composed of five workouts. Three days after competition, creatine kinase (CK was 77,590 U/L accompanied by myalgia and abnormal liver function tests, while renal function was normal and this resulted in a diagnosis of rhabdomyolysis. A follow-up examination revealed that her serum level of CK was still elevated to 3034 U/L on day 10 and 1257 U/L on day 25 following the ECP competition. The subject reported myalgia even up to 25 days after the ECP competition. Exertional rhabdomyolysis can be observed in ECP athletes following competition and highlights a dangerous condition, which may be increasing in recent years due to the massive expansion of ECP popularity and a growing number of competitions. Future research should investigate the causes of rhabdomyolysis that occur as a result of ECP, especially training methods and/or tasks developed specifically for these competitions.

Rhabdomyolysis and acute kidney injury in patients with traumatic spinal cord injury

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Galeiras, Rita; Mourelo, Mónica; Pértega, Sonia; Lista, Amanda; Ferreiro, Mª Elena; Salvador, Sebastián; Montoto, Antonio; Rodríguez, Antonio

2016-01-01

Background: Patients with acute traumatic spinal cord injuries (SCIs) exhibit factors that, in other populations, have been associated with rhabdomyolysis. Purpose: The aim of the study is to determine the incidence of rhabdomyolysis in patients with acute traumatic SCI admitted to the Intensive Care Unit (ICU), as well as the development of secondary acute kidney injury and associated factors. Study Design and Setting: This was an observational, retrospective study. Patient Sample: All adult patients admitted to the ICU with acute traumatic SCI who presented rhabdomyolysis, diagnosed through creatine phosphokinase (CPK) levels >500 IU/L. Outcome Measures: Incidence of rhabdomyolysis and subsequent renal dysfunction was calculated. Materials and Methods: Data about demographic variables, comorbidity, rhabdomyolysis risk factors, and variables involving SCI, severity scores, and laboratory parameters were obtained from clinical records. Multivariate logistic regression was used to identify renal injury risk factors. Results: In 2006–2014, 200 patients with acute SCI were admitted to ICU. Of these, 103 had rhabdomyolysis (incidence = 51.5%; 95% confidence interval [CI]: 44.3%–58.7%). The most typical American Spinal Injury Association classification was A (70.3%). The injury severity score was 30.3 ± 12.1 and sequential organ failure assessment (SOFA) score was 5.6 ± 3.3 points. During their stay, 57 patients (55.3%; 95% CI: 45.2%–65.4%) presented renal dysfunction (creatinine ≥1.2 mg/dL). In the multivariate analysis, variables associated with renal dysfunction were creatinine at admission (odds ratio [OR] = 9.20; P = 0.006) and hemodynamic SOFA score the day following admission (OR = 1.33; P = 0.024). Creatinine was a better predictor of renal dysfunction than the peak CPK value during the rhabdomyolysis (area under the receiver operating characteristic curve: 0.91 vs. 0.63, respectively). Conclusions: Rhabdomyolysis is a frequent condition in patients

[Acute rhabdomyolysis after spinal anesthesia for knee arthroscopy].

Science.gov (United States)

Bouché, P M; Chavagnac, B; Cognet, V; Banssillon, V

2001-08-01

We report an observation of acute rhabdomyolysis of gluteus maximum muscles occurring in a non-obese patient installed in supine position that underwent knee arthroscopy under spinal anaesthesia. The patient had insulin-dependent diabetes melitus with documented microangiopathy. The interest of this observation resides in the occurrence of the syndrome after a short period of time (one hour) of installation in the supine position in a patient that did not have any of the generally described risk factors of rhabdomyolysis.

Optimum polygenic profile to resist exertional rhabdomyolysis during a marathon.

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Del Coso, Juan; Valero, Marjorie; Salinero, Juan José; Lara, Beatriz; Gallo-Salazar, César; Areces, Francisco

2017-01-01

Exertional rhabdomyolysis can occur in individuals performing various types of exercise but it is unclear why some individuals develop this condition while others do not. Previous investigations have determined the role of several single nucleotide polymorphisms (SNPs) to explain inter-individual variability of serum creatine kinase (CK) concentrations after exertional muscle damage. However, there has been no research about the interrelationship among these SNPs. The purpose of this investigation was to analyze seven SNPs that are candidates for explaining individual variations of CK response after a marathon competition (ACE = 287bp Ins/Del, ACTN3 = p.R577X, CKMM = NcoI, IGF2 = C13790G, IL6 = 174G>C, MLCK = C37885A, TNFα = 308G>A). Using Williams and Folland's model, we determined the total genotype score from the accumulated combination of these seven SNPs for marathoners with a low CK response (n = 36; serum CK rhabdomyolysis. Yet other SNPs, in addition to exercise training, might also play a role in the values of CK after damaging exercise.

Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis

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Ayesha Farooq

2015-01-01

Full Text Available Introduction. Eosinophilic polymyositis (EPM is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

Cranberry for Urinary Tract Infection: From Bench to Bedside.

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Nabavi, Seyed Fazel; Sureda, Antoni; Daglia, Maria; Izadi, Morteza; Nabavi, Seyed Mohammad

2017-01-01

Urinary tract infections are common infectious diseases which can occur in any part of the urinary tract such as bladder, kidney, ureters, and urethra. They are commonly caused by bacteria that enter through the urethra. Urinary tract infections commonly develop in the bladder and spread to renal tissues. Up to now, there are different antimicrobial agents which have beneficial role on urinary tract infections. However, most of them cause different adverse effects and therefore, much attention has been paid to the search for effective therapeutic agents with negligible adverse effects. Cranberry is known as one of the most important edible plants, which possesses potent antimicrobial effects against the bacteria responsible for urinary tract infections. Growing evidence has shown that cranberry suppresses urinary tract infections and eradicates the bacteria. Therefore, the aim of this study is to critically review the available literature regarding the antimicrobial activities of cranberry against urinary tract infection microorganisms. In addition, we discuss etiology, epidemiology, risk factors, and current drugs of urinary tract infections to provide a more complete picture of this disease.

Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen: a case report.

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Sokolova, Alexandra; Chan, Onyee; Ullah, Waqas; Hamdani, Auon Abbas; Anwer, Faiz

2017-04-11

High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen. We report a case of a 21-year-old African-American man diagnosed with relapsed non-seminomatous germ cell tumor who received high-dose chemotherapy with carboplatin and etoposide following TIGER trial arm B off-protocol. His course was complicated by muscle pain and rhabdomyolysis after cycle 4 on day +12 after infusion of autologous stem cells. To the best of our knowledge, this complication has not been reported with this regimen. A differential diagnosis of sepsis and neutropenic fever along with side effects of high-dose chemotherapy were considered, but based on the timing of events, it was concluded that the etiology of rhabdomyolysis is high-dose chemotherapy. Rhabdomyolysis was successfully treated with hydration and did not recur during subsequent cycle 5. Delayed rhabdomyolysis after high-dose chemotherapy with paclitaxel, ifosfamide, carboplatin, and etoposide regimen has not been previously reported and needs to be considered for preventive strategy and prompt diagnosis and treatment to avoid renal complications. Physicians should have a low threshold to check creatine kinase enzymes in patients with unexplained muscle pain or renal insufficiency after high-dose chemotherapy.

[Rhabdomyolysis and severe hepatotoxicity due to a drug-drug interaction between ritonavir and simvastatin. Could we use the most cost-effective statin in all human immunodeficiency virus-infected patients?].

Science.gov (United States)

Bastida, Carla; Also, Maria Antonia; Pericas, Juan Manuel; Letang, Emili; Tuset, Montse; Miró, Josep Maria

2014-11-01

Drugs like statins may induce rhabdomyolysis. Simvastatin and lovastatin have a high hepatic metabolism and their potential toxicity could be increased by interactions with other drugs that reduce their metabolism. A case-report is presented of an HIV-infected patient treated with antiretroviral drugs who developed a rhabdomyolysis-induced renal failure and liver toxicity when simvastatin was substituted for atorvastatin. A literature review is also presented. The patient required hospital admission and showed a favorable response after hydration and urine alkalinization. There were 4 additional cases published of which there was one death. Drug-drug interactions can increase the risk of statin induced rhabdomyolysis. In order to evaluate them properly, physicians at all levels of clinical care should be aware of all drugs prescribed to their patients and the contraindicated combinations. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

STS-65 crewmembers participate in bench review at Boeing Building

Science.gov (United States)

1994-01-01

Attired in clean suits, STS-65 Payload Commander (PLC) Richard J. Hieb (left) and Payload Specialist Chiaki Mukai examine the contents of a stowage locker during a bench review at Boeing's Flight Equipment Processing Facility (FEPF) near the Johnson Space Center (JSC). In the background, Commander Robert D. Cabana inspects additional equipment to be carried aboard the Space Shuttle Columbia, Orbiter Vehicle (OV) 102, for the scheduled July flight of the second International Microgravity Laboratory (IML-2) mission. Mukai represents Japan's National Space Development Agency (NASDA). Photo taken by NASA JSC contract photographer Scott A. Wickes.

Bench, bedside, boardroom

DEFF Research Database (Denmark)

Addison, Courtney

2017-01-01

This article presents ethnographic material from a London-based group of gene therapists who received the opportunity to trial a device that, its makers claimed, would expedite and improve their cell work. The Vanguard cell processor elicits both enthusiasm and ambivalence from group members, whi...

Helicobacter pylori: From Bench to Bedside

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N Chiba

1997-01-01

Full Text Available With the exponential increase in research in the field of Helicobacter pylori a paradigm shift has occurred. It is now recognized that H pylori is a chronic infection of the stomach causing inflammation. Some patients remain asymptomatic, while others may develop dyspepsia, duodenal or gastric ulcer, gastric cancer or a mucosa-associated lymphoid tissue lymphoma. However, the role of H pylori in contributing to nonulcer dyspepsia or nonsteroidal anti-inflammatory drug gastropathy remains controversial. An effective vaccine against H pylori is years away. Major interest has focused on the questions "who should be investigated and therefore treated" and "what is the latest gold standard for eradication of H pylori"? In Europe, guidelines have been developed to help the practitioner answer these important questions. Canadian guidelines will soon be available. For persons with known peptic ulcer disease there should be unequivocal acceptance that the good clinical practice of eradicating H pylori will result in substantial savings in health care expenses. The original 'classical triple therapy' (bismuth, metronidazole and tetracycline [BMT] has now been surpassed by the combination of a proton pump inhibitor (PPI plus two antibiotics (metronidazole plus clarithromycin; amoxicillin plus clarithromycin; or amoxicillin plus metronidazole, each given twice a day for one week. In Canada, the regimen of omeprazole plus one antibiotic (amoxicillin or clarithromycin was approved recently but gives an eradication rate that is lower than the current target of 90%. According to the European (Mäastricht recommendations, if a single treatment attempt with PPI plus two antibiotics fails, PPI plus BMT is recommended.

Technological innovations: from bench to bedside.

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Robert, Glenn

2009-09-01

The NHS is perceived to be slower than other healthcare systems in adopting innovative technologies that can deliver patient benefits. This article summarises what is known about the role of nurses in assimilating such innovations into clinical care, and outlines the challenges facing nurse leaders.

Risk Factors for Acute Kidney Injury in Severe Rhabdomyolysis

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Rodríguez, Eva; Soler, María J.; Rap, Oana; Barrios, Clara; Orfila, María A.; Pascual, Julio

2013-01-01

Background Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction. Methods Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI. Results The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures. PMID:24367578

Severe rhabdomyolysis as a consequence of the interaction of fusidic acid and atorvastatin.

LENUS (Irish Health Repository)

Magee, Ciara N

2010-11-01

Rhabdomyolysis is a known complication of statin therapy and may be triggered by a pharmacokinetic interaction between a statin and a second medication. Fatal statin-induced rhabdomyolysis has an incidence of 0.15 deaths\\/million prescriptions. We describe 4 cases of severe rhabdomyolysis with the common feature of atorvastatin use and coadministration of fusidic acid. All cases involved long-term therapy with atorvastatin; fusidic acid was introduced for treatment of osteomyelitis or septic arthritis. Three cases occurred in the setting of diabetes mellitus, with 2 in patients with end-stage renal disease, suggesting increased susceptibility to atorvastatin-fusidic acid-induced rhabdomyolysis in these patient populations. Of the 4 patients in this series, 3 died. Fusidic acid is a unique bacteriostatic antimicrobial agent with principal antistaphylococcal activity. There have been isolated reports of rhabdomyolysis attributed to the interaction of statins and fusidic acid, the cause of which is unclear. Fusidic acid does not inhibit the cytochrome P450 3A4 isoenzyme responsible for atorvastatin metabolism; increased atorvastatin levels due to inhibition of the glucuronidation pathway may be responsible. Considering the low frequency of fusidic acid use, the appearance of 4 such cases within a short time and in a small population suggests the probability that development of this potentially fatal complication may be relatively high.

The role of myoglobin degradation in nephrotoxicity after rhabdomyolysis.

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Zorova, Ljubava D; Pevzner, Irina B; Chupyrkina, Anastasia A; Zorov, Savva D; Silachev, Denis N; Plotnikov, Egor Y; Zorov, Dmitry B

2016-08-25

The fate of myoglobin in renal cells was explored in an animal model of rhabdomyolysis known as the pathology highly related to oxidative stress resulting in impairment of renal functioning. The working hypothesis was that the proper degradation of myoglobin in rhabdomyolytic kidney can activate the reparative processes in the tissue. We found that incubation of myoglobin with kidney cells causes its accumulation in the cytoplasm. In rhabdomyolytic rats, the level of heme and free iron in cytoplasm and mitochondria of kidney cells is remarkably increased while inhibition of proteolysis results in further elevation of myoglobin content in the renal tissue. Heme oxygenase and ferritin levels were found to be increased in the kidney tissue at rhabdomyolysis and simulating conditions performed by i/v injection of myoglobin. In addition, the level of peroxidized lipids was high in rhabdomyolytic kidney and became even higher after inhibition of proteolysis by aprotinin. Elevated levels of carbonylated proteins were also observed after rhabdomyolysis, however, if prior to induction of rhabdomyolysis the injection of myoglobin was done, the level of carbonylated proteins dropped versus unprimed kidney tissue thus affording protection to the kidney against oxidative stress. Injection of myoglobin to the rat results in impairment of renal functioning and inhibition of myoglobin degradation in the rhabdomyolytic animal aggravates acute renal failure, demonstrating that degradation of myoglobin is somehow beneficial although it may result in undesired release of free iron which can participate in toxic redox cycling. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Psychotic Acute Episode and Rhabdomyolysis after Lovastatin Ingestion].

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Caamaño, Beatriz H; Díaz, Jairo M González; Bracho, Daniel Guerrero; Herrera, Harold; Samur, Manuel Castro

2012-09-01

Statins are the most prescribed drugs worldwide given the benefit and security they offer. However, they can cause severe neurological, gastrointestinal, renal and muscular side effects. To describe the clinical course of a female patient with adverse drug reaction to Lovastatin. Case report and literature review. 52-year old woman with sudden psychosis and rhabdomyolysis secondary to Lovastatin and ending after the drug suspension. The causal relationship was corroborated with a score of 6 (probable ADR) on Naranjo's Scale. The simultaneous manifestation of psychosis and rhabdomiolysis represents an atypical and unique case following Lovastatin ingestion. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Differences in gene expression profiles and signaling pathways in rhabdomyolysis-induced acute kidney injury.

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Geng, Xiaodong; Wang, Yuanda; Hong, Quan; Yang, Jurong; Zheng, Wei; Zhang, Gang; Cai, Guangyan; Chen, Xiangmei; Wu, Di

2015-01-01

Rhabdomyolysis is a threatening syndrome because it causes the breakdown of skeletal muscle. Muscle destruction leads to the release of myoglobin, intracellular proteins, and electrolytes into the circulation. The aim of this study was to investigate the differences in gene expression profiles and signaling pathways upon rhabdomyolysis-induced acute kidney injury (AKI). In this study, we used glycerol-induced renal injury as a model of rhabdomyolysis-induced AKI. We analyzed data and relevant information from the Gene Expression Omnibus database (No: GSE44925). The gene expression data for three untreated mice were compared to data for five mice with rhabdomyolysis-induced AKI. The expression profiling of the three untreated mice and the five rhabdomyolysis-induced AKI mice was performed using microarray analysis. We examined the levels of Cyp3a13, Rela, Aldh7a1, Jun, CD14. And Cdkn1a using RT-PCR to determine the accuracy of the microarray results. The microarray analysis showed that there were 1050 downregulated and 659 upregulated genes in the rhabdomyolysis-induced AKI mice compared to the control group. The interactions of all differentially expressed genes in the Signal-Net were analyzed. Cyp3a13 and Rela had the most interactions with other genes. The data showed that Rela and Aldh7a1 were the key nodes and had important positions in the Signal-Net. The genes Jun, CD14, and Cdkn1a were also significantly upregulated. The pathway analysis classified the differentially expressed genes into 71 downregulated and 48 upregulated pathways including the PI3K/Akt, MAPK, and NF-κB signaling pathways. The results of this study indicate that the NF-κB, MAPK, PI3K/Akt, and apoptotic pathways are regulated in rhabdomyolysis-induced AKI.

Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T

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Gro Egholm

2015-01-01

Full Text Available The essential role of cardiac troponin in the diagnosis of acute myocardial infarction has led to the development of high-sensitivity assays, which are able to detect very small amounts of myocardial necrosis. The high-sensitivity cardiac troponin T assay, however, is not entirely specific for myocardial injury. This case report describes a 48-year-old woman, who, two years after cardiac transplantation, presented with rhabdomyolysis. During the course of the disease, her troponin T level was elevated on repeated occasions, but other definitive evidence of myocardial injury was not found. Asymptomatic cardiac troponin T elevations during rhabdomyolysis may be due to either cardiac involvement or false positive results stemming from skeletal muscle injury.

[A case of rhabdomyolysis caused by saw palmetto of healthy foods].

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Hanaka, Minako; Yoshii, Chiharu; Yatera, Kazuhiro; Ito, Chiyo; Chojin, Yasuo; Nagata, Shuya; Yamasaki, Kei; Nishida, Chinatsu; Kawanami, Toshinori; Kawanami, Yukiko; Ishimoto, Hiroshi; Mukae, Hiroshi

2012-06-01

An 82-year-old man visited our hospital when he developed a fever of over 38 degrees C after having consumed 5 types of health foods. He had previously been treated for chronic obstructive pulmonary disease, hypertension and hyperuricemia. Blood examination on admission revealed renal dysfunction, marked elevation of C-reactive protein, and an elevated level of serum creatine kinase. According to the laboratory data and his clinical history, rhabdomyolysis complicated by acute renal failure was suspected, but his condition improved and his fever was reduced with fluid infusion. As a drug lymphocyte stimulation test was positive for only saw palmetto in the 5 health foods, we diagnosed the case as rhabdomyolysis induced by saw palmetto. We believe that this is the first case of a health food being the cause of rhabdomyolysis.

Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy

OpenAIRE

Ahn, Pyoung; Min, Hyun-Jun; Park, Sang-Hyun; Lee, Byoung-Mu; Choi, Myung-Jin; Yoon, Jong-Woo; Koo, Ja-Ryong

2013-01-01

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that ...

Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit - the role of buffers.

Science.gov (United States)

Gehlbach, Brian K; Schmidt, Gregory A

2004-08-01

The recognition and management of acid-base disorders is a commonplace activity for intensivists. Despite the frequency with which non-bicarbonate-losing forms of metabolic acidosis such as lactic acidosis occurs in critically ill patients, treatment is controversial. This article describes the properties of several buffering agents and reviews the evidence for their clinical efficacy. The evidence supporting and refuting attempts to correct arterial pH through the administration of currently available buffers is presented.

LPIN1 gene mutations: a major cause of severe rhabdomyolysis in early childhood

NARCIS (Netherlands)

Michot, Caroline; Hubert, Laurence; Brivet, Michèle; de Meirleir, Linda; Valayannopoulos, Vassili; Müller-Felber, Wolfgang; Venkateswaran, Ramesh; Ogier, Hélène; Desguerre, Isabelle; Altuzarra, Cécilia; Thompson, Elizabeth; Smitka, Martin; Huebner, Angela; Husson, Marie; Horvath, Rita; Chinnery, Patrick; Vaz, Frederic M.; Munnich, Arnold; Elpeleg, Orly; Delahodde, Agnès; de Keyzer, Yves; de Lonlay, Pascale

2010-01-01

Autosomal recessive LPIN1 mutations have been recently described as a novel cause of rhabdomyolysis in a few families. The purpose of the study was to evaluate the prevalence of LPIN1 mutations in patients exhibiting severe episodes of rhabdomyolysis in infancy. After exclusion of primary fatty acid

Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As a Presentation of Coeliac Disease

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Funda Sarı

2012-03-01

Full Text Available Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody.

Severe rhabdomyolysis and acute renal failure in an adolescent with hypothyroidism.

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Comak, Elif; Koyun, Mustafa; Kiliçarslan-Akkaya, Bahar; Bircan, Iffet; Akman, Sema

2011-01-01

Hypothyroidism has been reported rarely as the cause of rhabdomyolysis in adults and children. We present here a non-compliant adolescent with a diagnosis of hypothyroidism who developed rhabdomyolysis and acute renal failure with no additional predisposing factor. A 13-year-old girl with a previous history of hypothyroidism due to thyroid hypoplasia presented with generalized myalgia, malaise, vomiting, and oliguria lasting for three days. Neurological examination revealed bilateral marked weakness and tenderness of muscles of both lower and upper extremities. Urine had bloody appearance and urine analysis showed blood reaction with dipstick test, but there were no erythrocytes on microscopic examination. Serum creatine phosphokinase and myoglobin levels were elevated. Thyroid stimulating hormone (TSH) levels were high, and free thyroxine (T4) and triiodothyronine (T3) levels were low, compatible with uncontrolled hypothyroidism. Renal function tests showed acute renal failure. Other causes of rhabdomyolysis such as muscular trauma, drugs, toxins, infections, vigorous exercise, and electrolyte abnormalities were excluded. Hemodialysis was administered for 24 sessions. After L-thyroxine therapy, thyroid function tests normalized, muscle strength improved, serum muscle enzyme levels returned to normal levels, and renal function tests recovered. One must be aware that rhabdomyolysis may develop in a non-compliant patient with hypothyroidism.

Scintigraphic demonstration of a iatrogenic rhabdomyolysis im McArdle's syndrome

International Nuclear Information System (INIS)

Neumann, P.; Rumpf, K.W.; Kaiser, H.; Meinck, H.M.; Goebel, H.H.; Schicha, H.; Emrich, D.; Goettingen Univ.; Goettingen Univ.; Goettingen Univ.; Goettingen Univ.

1982-01-01

In a patient with late onset McArdle's disease local rhabdomyolysis and massive myoglobinuria were provoked by a routine diagnostic procedure - the forearm ischemic work test. Localisation and extent of rhabdomyolysis could be demonstrated by a conventional whole-body scanning technique using sup(99m)Tc methylenediphosphonate as a tracer. It is concluded that the forearm ischemic work test is not without risk in patients with McArdle's disease, and care should be taken to prevent myoglobinuric renal failure in these patients. (orig.) [de

Potential role of coenzyme Q10 in facilitating recovery from statin-induced rhabdomyolysis.

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Wang, L W; Jabbour, A; Hayward, C S; Furlong, T J; Girgis, L; Macdonald, P S; Keogh, A M

2015-04-01

Rhabdomyolysis is a rare, but serious complication of statin therapy, and represents the most severe end of the spectrum of statin-induced myotoxicity. We report a case where coenzyme Q10 facilitated recovery from statin-induced rhabdomyolysis and acute renal failure, which had initially persisted despite statin cessation and haemodialysis. This observation is biologically plausible due to the recognised importance of coenzyme Q10 in mitochondrial bioenergetics within myocytes, and the fact that statins inhibit farnesyl pyrophosphate production, a biochemical step crucial for coenzyme Q10 synthesis. Coenzyme Q10 is generally well tolerated, and may potentially benefit patients with statin-induced rhabdomyolysis. © 2015 Royal Australasian College of Physicians.

Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis - A case report.

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Dalbjerg, Sara Maria; Tsakiri, Anna; Frederiksen, Jette Lautrup

2016-07-01

Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis associated with Interferon-beta treatment. We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved. Clinicians should be aware of the possibility of rhabdomyolysis occurring during Interferon-beta-1-alpha therapy. In cases where patients complain of severe myalgia, and in particular if weakness is reported, creatine kinase activity should be measured to prevent irreversible rhabdomyolysis during Interferon-beta-1-alpha therapy in patients with multiple sclerosis. Copyright © 2016 Elsevier B.V. All rights reserved.

Distal clavicular osteolysis in adults: association with bench pressing intensity

International Nuclear Information System (INIS)

Nevalainen, Mika T.; Morrison, William B.; Zoga, Adam C.; Roedl, Johannes B.; Ciccotti, Michael G.

2016-01-01

To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity. From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests. The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p 1 x /week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney). High-intensity, but not low-intensity bench pressing is a risk factor for DCO. (orig.)

Update: Exertional rhabdomyolysis, active component, U.S. Army, Navy, Air Force, and Marine Corps, 2011-2015.

Science.gov (United States)

Armed Forces Health Surveillance Branch

2016-03-01

Among active component members of the U.S. Army, Navy, Air Force, and Marine Corps in 2015, there were 456 incident episodes of rhabdomyolysis likely due to physical exertion or heat stress ("exertional rhabdomyolysis"). Annual rates of incident diagnoses of exertional rhabdomyolysis increased 17% between 2014 and 2015. In 2015, the highest incidence rates occurred in service members who were male; younger than 20 years of age; black, non-Hispanic; members of the Marine Corps and Army; recruit trainees; and in combat-specific occupations. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain and swelling, limited range of motion, or the excretion of dark urine (e.g., myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.

A Case of Mushroom Poisoning with Russula subnigricans: Development of Rhabdomyolysis, Acute Kidney Injury, Cardiogenic Shock, and Death.

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Cho, Jong Tae; Han, Jin Hyung

2016-07-01

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.

Importance of MRI in the diagnosis and treatment of rhabdomyolysis

International Nuclear Information System (INIS)

Moratalla, Monica Ballesta; Braun, Petra; Fornas, Guillermina Montoliu

2008-01-01

Background: Rhabdomyolysis is a common disorder resulting from a large variety of causes. We describe the MRI features and their importance for diagnosis and treatment. Patients and methods: Between 2003 and 2006, four male patients (age range: 25-33 years) with rhabdomyolysis were studied via 1.5 T MRI (GE, Siemens). In all the patients, T1- and T2-weighted sequences with and without fat suppression, short tau inversion recovery (STIR) and gradient-echo sequences were obtained in axial, coronal and sagittal planes. In one patient, contrast material was given. Results: Two patients presented rhabdomyolysis due to drug abuse, one due to intense exercise and the last one due to long unconsciousness with compression of the paravertebral musculature. Two patients had acute kidney failure. The affected muscles showed an increased signal intensity on T2-weighted and STIR sequences and decreased on T1-weighted sequences. In one patient, intramuscular hemorrhage was observed on T1-weighted and gradient-echo sequences. In the patient with kidney failure, a globular swelling of the kidney with alteration of the corticomedullary differentiation on T2-weighted sequences with fat saturation and hypointensity of the renal medulla on T1-weighted contrast enhanced images was found. Discussion: Immediate recognition of rhabdomyolysis is important to prevent late complications. MRI is the method of choice to evaluate the distribution and extension of the affected muscles, especially when fasciotomy is considered for treatment. Even though the MRI findings are non-specific, the sensitivity in the detection of muscle involvement is higher than CT or US

Importance of MRI in the diagnosis and treatment of rhabdomyolysis

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Moratalla, Monica Ballesta [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)], E-mail: monica_ballesta@hotmail.com; Braun, Petra; Fornas, Guillermina Montoliu [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)

2008-02-15

Background: Rhabdomyolysis is a common disorder resulting from a large variety of causes. We describe the MRI features and their importance for diagnosis and treatment. Patients and methods: Between 2003 and 2006, four male patients (age range: 25-33 years) with rhabdomyolysis were studied via 1.5 T MRI (GE, Siemens). In all the patients, T1- and T2-weighted sequences with and without fat suppression, short tau inversion recovery (STIR) and gradient-echo sequences were obtained in axial, coronal and sagittal planes. In one patient, contrast material was given. Results: Two patients presented rhabdomyolysis due to drug abuse, one due to intense exercise and the last one due to long unconsciousness with compression of the paravertebral musculature. Two patients had acute kidney failure. The affected muscles showed an increased signal intensity on T2-weighted and STIR sequences and decreased on T1-weighted sequences. In one patient, intramuscular hemorrhage was observed on T1-weighted and gradient-echo sequences. In the patient with kidney failure, a globular swelling of the kidney with alteration of the corticomedullary differentiation on T2-weighted sequences with fat saturation and hypointensity of the renal medulla on T1-weighted contrast enhanced images was found. Discussion: Immediate recognition of rhabdomyolysis is important to prevent late complications. MRI is the method of choice to evaluate the distribution and extension of the affected muscles, especially when fasciotomy is considered for treatment. Even though the MRI findings are non-specific, the sensitivity in the detection of muscle involvement is higher than CT or US.

Rhabdomyolysis as a manifestation of clomipramine poisoning

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Nathalie Oliveira de Santana

Full Text Available CONTEXT: Tricyclic antidepressive agents are widely used in suicide attempts and present a variety of deleterious effects. Rhabdomyolysis is a rare complication of such poisoning. CASE REPORT: A 55-year-old woman ingested 120 pills of 25 mg clomipramine in a suicide attempt two days before admission. After gastric lavage in another emergency department on the day of intake, 80 pills were removed. On admission to our department, she was disoriented, complaining of a dry mouth and tremors at the extremities. An electrocardiogram showed a sinus rhythm with narrow QRS complexes. Laboratory results showed high creatine phosphokinase (CK = 15,094 U/l on admission; normal range = 26 to 140 U/l, hypocalcemia, slightly increased serum transaminases and mild metabolic acidosis. The patient's medical history included depression with previous suicide attempts, obsessive-compulsive disorder, hypothyroidism and osteoporosis. She presented cardiac arrest with pulseless electric activity for seven minutes and afterwards, without sedation, showed continuous side-to-side eye movement. She developed refractory hypotension, with need for vasopressors. Ceftriaxone and clindamycin administration was started because of a hypothesis of bronchoaspiration. The patient remained unresponsive even without sedation, with continuous side-to-side eye movement and a decerebrate posture. She died two months later. Rhabdomyolysis is a very rare complication of poisoning due to tricyclic drugs. It had only previously been described after an overdose of cyclobenzaprine, which has a toxicity profile similar to tricyclic drugs. CONCLUSIONS: Although arrhythmia is the most important complication, rhabdomyolysis should be investigated in cases of clomipramine poisoning.

Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

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Melody Ni

2014-12-01

Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

Improving nurse-physician teamwork through interprofessional bedside rounding.

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Henkin, Stanislav; Chon, Tony Y; Christopherson, Marie L; Halvorsen, Andrew J; Worden, Lindsey M; Ratelle, John T

2016-01-01

Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician-nurse teamwork are often suboptimal. To improve nurse-physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. From July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients' bedside. Based on stakeholder analysis and feedback, a checklist for key patient care issues was created and utilized during bedside rounds. To assess the effect of bedside rounding on nurse-physician teamwork, a survey of selected items from the Safety Attitudes Questionnaire (SAQ) was administered to participants before and after the implementation of bedside rounds. The number of pages to the general medicine teams was also measured as a marker of physician-nurse communication. Participation rate in bedside rounds across the four medicine teams was 58%. SAQ response rates for attendings, residents, and nurses were 36/36 (100%), 73/73 (100%), and 32/73 (44%) prior to implementation of bedside rounding and 36 attendings (100%), 72 residents (100%), and 14 (19%) nurses after the implementation of bedside rounding, respectively. Prior to bedside rounding, nurses provided lower teamwork ratings (percent agree) than residents and attendings on all SAQ items; but after the intervention, the difference remained significant only on SAQ item 2 ("In this clinical area, it is not difficult to speak up if I perceive a problem with patient care", 64% for nurses vs 79% for residents vs 94% for attendings, P=0.02). Also, resident responses improved on SAQ item 1 ("Nurse input is well received in this area", 62% vs 82%, P=0.01). Increasing face-to-face communication through

Hypothyroidism is a predisposing factor for fenofibrate-induced rhabdomyolysis--patient report and literature review.

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Satarasinghe, R L; Ramesh, R; Riyaaz, A A A; Gunarathne, P A K G; de Silva, A P

2007-01-01

A literature survey reveals that both lipid lowering drugs - statins and fibrates--and hypothyroidism are documented causes of muscle disorders including rhabdomyolysis leading to acute renal failure. We describe a case of fenofibrate monotherapy (Lipicard) induced dialysis dependent acute renal failure in an undiagnosed hypothyroid patient which is the first case to be reported from Sri Lanka. We strongly recommend that all patients who are receiving statins and/or fibrates should be screened for occult hypothyroidism which seems to aggravate the muscle damage due to the above drugs, with or without other risk factors.

Emerging hematological targets and therapy for cardiovascular disease: From bench to bedside

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Ana Villegas

2008-09-01

Full Text Available Ana Villegas, Fernando A Gonzalez, Leopoldo Llorente, Santiago RedondoService of Hematology and Hemotherapy, Hospital Clinico Universitario San Carlos, Madrid, SpainAbstract: Atherosclerotic cardiovascular disease is the leading cause of death and a major part of its pathophysiology remains obscure. Some hematological targets have been related to the development and clinical outcome of this disease, especially soluble cytokines, leukocytes, red blood cells, hemostatic factors and platelets, and bone-marrow vascular progenitors. These emerging factors may be modulated by current antiatherosclerotic pharmacotherapy, target-designed novel drugs or progenitor cell therapy. The aim of current review article is to comprehensively review the role of these antiatherosclerotic targets and therapy.Keywords: atherosclerosis, blood, progenitor cells, cytokines, therapy

Medical students' perceptions of bedside teaching.

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Gray, David; Cozar, Octavian; Lefroy, Janet

2017-06-01

Bedside teaching is recognised as a valuable tool in medical education by both students and faculty members. Bedside teaching is frequently delivered by consultants; however, junior doctors are increasingly engaging in this form of clinical teaching, and their value in this respect is becoming more widely recognised. The aim of this study was to supplement work completed by previous authors who have begun to explore students' satisfaction with bedside teaching, and their perceptions of the relationship with the clinical teachers. Specifically, we aimed to identify how students perceive bedside teaching delivered by junior doctors compared with consultants. We aimed to identify how students perceived bedside teaching delivered by junior doctors compared with consultants METHODS: A questionnaire was distributed to all third-year medical students at Keele University via e-mail. Responses were submitted anonymously. Forty-six students responded (37.4%), 73.3 per cent of whom said that they felt more comfortable having bedside teaching delivered by junior doctors than by consultants. Consultants were perceived as more challenging by 60 per cent of respondents. Students appeared to value feedback on their performance, trust the validity of taught information, and to value the overall educational experience equally, regardless of the clinical grade of the teacher. Student preference does not equate to the value that they place on their bedside teaching. Junior doctors are perceived as being more in touch with students and the curriculum, whereas consultants are perceived as having higher expectations and as being both stricter and more knowledgeable. The clinical teacher's approachable manner and enthusiasm for teaching are more important than clinical grade, as is the ability to deliver well-structured constructive feedback. © 2016 John Wiley & Sons Ltd.

Distal clavicular osteolysis in adults: association with bench pressing intensity

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Nevalainen, Mika T.; Morrison, William B.; Zoga, Adam C.; Roedl, Johannes B. [Sidney Kimmel Medical College at Thomas Jefferson University, Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Ciccotti, Michael G. [Sidney Kimmel Medical College at Thomas Jefferson University, Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, PA (United States)

2016-11-15

To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity. From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests. The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p < 0.001). Low-intensity bench pressing (1RM less than 1.5 times the body weight) was not a risk factor for DCO (OR = 0.6; 95 % CI = 0.4-0.8). High frequency (>1 x /week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney). High-intensity, but not low-intensity bench pressing is a risk factor for DCO. (orig.)

Bullous lesions, sweat gland necrosis and rhabdomyolysis in alcoholic coma

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Neelakandhan Asokan

2014-01-01

Full Text Available A 42-year-old male developed hemorrhagic bullae and erosions while in alcohol induced coma. The lesions were limited to areas of the body in prolonged contact with the ground in the comatose state. He developed rhabdomyolysis, progressing to acute renal failure (ARF. Histopathological examination of the skin showed spongiosis, intraepidermal vesicles, and necrosis of eccrine sweat glands with denudation of secretory epithelial lining cells. With supportive treatment and hemodialysis, the patient recovered in 3 weeks time. This is the first reported case of bullous lesions and sweat gland necrosis occurring in alcohol-induced coma complicated by rhabdomyolysis and ARF.

The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade

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Adam Goodman

2012-01-01

Full Text Available This review article discusses two clinical cases of patients presenting to the emergency department with pericardial effusions. The role of bedside ultrasound in the detection of pericardial effusions is investigated, with special attention to the specific ultrasound features of cardiac tamponade. Through this review, clinicians caring for patients with pericardial effusions will learn to rapidly diagnose this condition directly at the bedside. Clinicians will also learn to differentiate between simple pericardial effusions in contrast to more complicated effusions causing cardiac tamponade. Indications for emergency pericardiocentesis are covered, so that clinicians can rapidly determine which group of patients will benefit from an emergency procedure to drain the effusion.

Rhabdomyolysis and acute renal failure following prolonged surgery in the lithotomy position

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Adnane Guella

2013-01-01

Full Text Available Operative positions commonly used in urogenital surgeries when perineal exposure is required include the lithotomy and the exaggerated lithotomy positions (LPs, which expose patients to the risk of rhabdomyolysis. We report a patient with bladder outflow obstruction, benign prostatic hypertrophy and a very large bladder stone, which was removed with cystoscopy and cystolitholapaxy in the LP. The procedure was complicated by posterior bladder perforation and abdominal distention leading to prolonged surgery duration (5.5 h. The patient developed rhabdomyolysis and acute renal failure (ARF without compartmental syndrome. On the other hand, there was a potential role of glycine solution, used for bladder irrigation, in the appearance of ARF. Overall, our case shows that rhabdomyolysis and ARF can develop in operative positions, and duration of surgery is the most important risk factor for such complications.

MANAGEMENT OF ACUTE RENAL FAILURE WITH DELAYED HYPERCALCEMIA SECONDARY TO SARCOCYSTIS NEURONA-INDUCED MYOSITIS AND RHABDOMYOLYSIS IN A CALIFORNIA SEA LION (ZALOPHUS CALIFORNIANUS).

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Alexander, Amy B; Hanley, Christopher S; Duncan, Mary C; Ulmer, Kyle; Padilla, Luis R

2015-09-01

A 3-yr-old captive-born California sea lion (Zalophus californianus) developed Sarcocystis neurona-induced myositis and rhabdomyolysis that led to acute renal failure. The sea lion was successfully managed with fluid therapy, antiprotozoals, antibiotics, anti-inflammatories, antiemetics, gastroprotectants, and diuretics, but developed severe delayed hypercalcemia, a syndrome identified in humans after traumatic or exertion-induced rhabdomyolysis. Treatment with calcitonin was added to the management, and the individual recovered fully. The case emphasizes that animals with rhabdomyolysis-induced renal failure risk developing delayed hypercalcemia, which may be life threatening, and calcium levels should be closely monitored past the resolution of renal failure.

Rhabdomyolysis in a Patient Taking Both Oxandrolone for Bodybuilding and Methamphetamine.

Science.gov (United States)

Krzyzak, Michael; Elangovan, Natarajan

2017-11-13

Nonprescription drug use is increasingly prevalent in the United States. We report a case of a 31-year-old male who presented with hallucinations and was found to have rhabdomyolysis. He was consuming oxandrolone for six weeks and ingested methamphetamine the night prior to presentation. With supportive treatment, including intravenous hydration, the patient's mental status returned to baseline and rhabdomyolysis resolved. Our case illustrates the need to understand the interaction between different illicit substances. More research needs to be done to further understand the reactions between different medications as patients consume different combinations of substances.

[Visits of patients with exertional rhabdomyolysis to the Emergency Department at Landspítali, The National University Hospital of Iceland in the years 2008-2012].

Science.gov (United States)

Halldorsson, Arnljotur Bjorn; Benedikz, Elisabet; Olafsson, Isleifur; Mogensen, Brynjolfur

2016-03-01

Overexertion and too much training are among the -multiple etiologies of rhabdomyolysis. Creatine kinase (CK) and myo-globine, released from skeletal muscle cells, are useful for diagnosis and follow-up. Acute kidney injury is a serious complication of myoglobinemia. Literature on exertional rhabdomyolysis in the general population is scarce. The aim of this study was to investigate the epidemiology of exertional rhabdomyolysis among patients diagnosed at Landspítali The National University Hospital of Iceland in 2008-2012. The study was retrospective and observational. All patients presenting with muscle pain after exertion and elevated creatine kinase >1000 IU/L, during the period from 1 January 2008 to 31 December 2012, were included. Patients with CK elevations secondary to causes other than exertion were excluded. Variables included: patient number and gender, CK-levels, date of hospital admission, cause of rhabdomyolysis, location of injured muscle groups, length of hospital stay, complications and means of fluid replacement. Population figures of the capital region were gathered from Statistics Iceland and information on sport practice in the capital region from The National Olympic and Sports Association of Iceland. Exertional rhabdomyolysis was diagnosed in 54 patients, 18 females (33,3%) and 36 males (66,7%), or 8,3% of rhabdomyolysis cases from all causes in the study period (648 cases). Incidence in the capital region was 5,0/100.000 inhabitants per year in the study period. Median age was 28 years and median CK-level was 24.132 IU/L. CK-levels were higher among females but the difference between genders was not significant. Muscle groups of the upper and lower extremities were most frequently affected (89%). Thirty patients received intravenous fluids. They had significantly higher CK values than other patients. One patient developed acute kidney injury. Information on sport practice and physical training in the capital region was not available

Rhabdomyolysis and Acute Renal Impairment in a Patient with Hypothyroidism: A Case Report

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Arshi Naz

2014-01-01

Full Text Available We report the case of a 33-year-old male with hypothyroidism who developed acute renal impairment with rhabdomyolysis after strenuous physical activity (snow shoveling. His thyroid function test confirmed marked hypothyroidism. Severe elevation of serum CK consistent with rhabdomyolysis was noted and an elevated creatinine indicated acute renal impairment. Patient’s condition improved significantly after starting him on thyroid hormone replacement therapy and aggressive hydration. Acute renal impairment with rhabdomyolysis in patients with hypothyroidism is quite rare and we expect that this case report adds to the existing literature on this subject. We also emphasize that thyroid status should be evaluated in patients with unexplained acute renal impairment and presenting with the symptoms of muscle involvement.

Visualization of rhabdomyolysis with scintigraphy with Tc99m pyrophosphate: presentation of a clinical case

International Nuclear Information System (INIS)

Pruzzo C, Rossana; Amaral P, Horacio; Morales K, Barbara; Hurtado, Ester

2000-01-01

We present a case of secondary rhabdomyolysis due to vascular ischemia after dissection of the proximal aorta and obstruction of the left femoral artery after cocaine consumption. A Tc99m-pyrophosphate whole body scan demonstrated the presence of rhabdomyolysis in both lower extremities (Au)

ESPRESSO optical bench: from mind to reality

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Tenegi, F.; Santana, S.; Gómez, J.; Rodilla, E.; Hughes, I.; Mégevand, D.; Rebolo, R.; Riva, M.; Luis-Simoes, R.

2016-07-01

ESPRESSO [1] is a high-resolution spectrograph under development for the VLT telescope. In general, the Optical Bench (OB) structure can be considered as a 3D one, conformed by welding thin plates of Structural Steel (St-52) with a nickelplated surface treatment, combined for getting maximum stiffness and minimum weight, that will be finally re-machined to get stringent geometrical and dimensional tolerances at I/Fs positions. TIG conventional welding procedure has been selected to minimize the cost and facilitate the own welding process. This solution follows the inheritance from HARPS [2] due to its success to achieve the required performance for the bench. This paper contains an overview of the whole process of designing and manufacturing the Optical Bench of ESPRESSO, from the very first beginning with the specifications to the current status of the bench with its integration on the Spectrograph (including the Finite Element Models and the delivery of the final structure by the supplier) and lessons learned.

Pregabalin- and azithromycin-induced rhabdomyolysis with purpura: An unrecognized interaction: A case report.

Science.gov (United States)

Kato, Kazuya; Iwasaki, Yoshiaki; Onodera, Kazuhiko; Higuchi, Mineko; Kato, Kimitaka; Kato, Yurina; Tsutsui, Masato; Taniguchi, Masahiko; Furukawa, Hiroyuki

2016-01-01

Rhabdomyolysis associated with the use of pregabalin or azithromycin has been demonstrated to be a rare but potentially life-threatening adverse event. Here, we report an extremely rare case of rhabdomyolysis with purpura in a patient who had used pregabalin and azithromycin. We present the case of a 75-year-old woman with a history of fibromyalgia who was admitted with mild limb weakness and lower abdominal purpura. She was prescribed pregabalin (75mg, twice daily) for almost 3 months to treat chronic back pain. Her medical history revealed that 3days before admission, she began experiencing acute bronchitis and was treated with a single dose of azithromycin (500mg). She had developed rapid onset severe myalgia, mild whole body edema, muscle weakness leading to gait instability, abdominal purpura and tender purpura on the lower extremities. Laboratory values included a white blood cell count of 25,400/mL and a creatinine phosphokinase (CPK) concentration of 1250 IU/L. Based on these findings and the patient's clinical history, a diagnosis of pregabalin- and azithromycin-induced rhabdomyolysis was made. The long-term use of pregabalin and the initiation azithromycin therapy followed by a rapid onset of rhabdomyolysis is indicative of a drug interaction between pregabalin and azithromycin. We report an extremely rare case of rhabdomyolysis with purpura caused by a drug interaction between pregabalin and azithromycin. However, the mechanisms of the interactions between azithromycin on the pregabalin are still unknown. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Exercise Induced Rhabdomyolysis with Compartment Syndrome and Renal Failure

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Mary Colleen Bhalla

2014-01-01

Full Text Available Exertional rhabdomyolysis is sequela that is occasionally seen after strenuous exercise. The progression to compartment syndrome or renal failure is a rare complication that requires prompt recognition and treatment to prevent morbidity (Giannoglou et al. 2007. We present a case of a 22-year-old college football player who presented to the emergency department (ED after a typical leg workout as part of his weight conditioning. He was found to have rhabdomyolysis with evidence of renal insufficiency. His condition progressed to bilateral compartment syndrome and renal failure requiring dialysis. After bilateral fasciotomies were performed he had resolution of his compartment syndrome. He continued to be dialysis dependent and had no return of his renal function at discharge 12 days after admission.

Rhabdomyolysis in DOMS

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Martinez Carsi, C. [Hospital 9 d' Octubre, Valencia (Spain). Serveis de Medicina Nuclear; Ruiz Hernandez, G. [Hospital Clinic Universitari, Valencia (Spain). Serveis de Medicina Nuclear; Sanchez Marchori, C.; Munoz Moliner, J. [Hospital 9 d' Octubre, Valencia (Spain). Serveis de Traumatologia

1999-07-01

A 26-year-old man with a previous history of external twin bursitis was remitted to our Department for a bone scintigraphy. Before the study, the patient performed an elevated number of intense sprints. Bone scintigraphy showed a bilaterally increased activity in both anterior rectum muscles suggesting rhabdomyolysis. Biochemical studies and MRT confirmed the diagnosis. (orig.) [German] Ein 26jaehriger Mann mit vorausgehender M.-gastrocnemius-Bursitis wurde zur Skelettszintigraphie in unsere Abteilung ueberwiesen. Vor der Untersuchung fuehrte der Patient mehrere Kurzstreckensprints durch. Die Skelettszintigraphie ergab eine erhoehte Aktivitaet in beiden Mm. recti femoris, die auf eine Rhabdomyolyse hinweist. Biochemische Untersuchungen und MRT bestaetigten die Diagnose. (orig.)

Dasatinib-Induced Rhabdomyolysis in a 33-Year-Old Patient with Chronic Myeloid Leukemia

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Andrew Stevenson Joel Chandranesan

2018-01-01

Full Text Available Rhabdomyolysis is a life-threatening syndrome due to breakdown of the skeletal muscle. It can be caused by massive trauma and crush injuries or occur as a side effect of medications. Here, we describe a case of a 33-year-old male with human immunodeficiency virus (HIV and newly diagnosed chronic myeloid leukemia (CML with severe life-threatening rhabdomyolysis due to a rare offending agent.

Bedside Teaching in Undergraduate Medical Education: Issues, Strategies, and New Models for Better Preparation of New Generation Doctors

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Abdus Salam

2011-03-01

Full Text Available AbstractBedside teaching is a vital component of medical education. It isapplicable to any situation where teaching is imparted in thepresence of patients. In teaching in the patients’ presence, learnershave the opportunities to use all of their senses and learn thehumanistic aspect of medicine such as role modeling, which isvital but difficult to communicate in words. Unfortunately, bedsideteaching has been on the decline. To investigate the reasonsfor the decline in bedside teaching, its importance and its revival,a review of literature was carried out using PubMed and otherdata bases. The review revealed that the major concerns of bedsideteaching were time constraint, false preceptors’ concernabout patients’ comfort, short stay of patients in hospitals, learnerdistraction by technology, lack of experience and unrealistic facultyexpectation. Whatsoever the reasons, bedside teaching cannotbe replaced with anything else. There are newer approachesof effective bedside teaching, and the core focus of all such approachesis educational process. A bedside teacher must learnhow to involve patients and learners in the educational processes.Moreover, bedside teaching is the process through which learnersacquire the skills of communication by asking patients’ permission,establishing ground rules, setting time limit, introducing theteam, diagnosing learner, diagnosing patient, conducting focusedteaching, using simple language, asking patient if there is anyquestion, closing with encouraging thanks, and giving feedbackprivately. It is most important to ensure a comfortable environmentfor all participants, the learner, the patient and the bedsideteacher. Ongoing faculty development programs on educationalprocesses and realistic faculty expectations may overcome theproblems.

Subclinical Theileria Equi Infection and Rhabdomyolysis in Three Endurance Horses

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A. Muñoz1,2*, R. G. M. Rodríguez2, C. Riber1,2, P. Trigo2, M. Gómez-Díez2 and F. Castejon2

2013-04-01

Full Text Available Three well-trained endurance horses, competing over different distances, developed sudden and unexpected rhabdomyolysis at the onset of exercise. They were treated and afterwards they did not have any other bout of muscle damage. All of them were positive to Theileria equi (polymerase reaction chain. The possible reasons of the rhabdomyolysis could have been the direct effect of the parasite on the muscle and/or the result of the anemia and a limited oxygen supply to the exercising muscles. It is suggested that the horses were carriers of Theileria and they developed clinical signs because of the immune-suppression caused by prolonged submaximal exercise and/or transportation.

Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean.

Science.gov (United States)

Odolini, Silvia; Gobbi, Federico; Zammarchi, Lorenzo; Migliore, Simona; Mencarini, Paola; Vecchia, Marco; di Lauria, Nicoletta; Schivazappa, Simona; Sabatini, Tony; Chianura, Leonardo; Vanino, Elisa; Piacentini, Daniela; Zanotti, Paola; Bussi, Anna; Bartoloni, Alessandro; Bisoffi, Zeno; Castelli, Francesco

2017-09-01

Cases of undiagnosed severe febrile rhabdomyolysis in refugees coming from West Africa, mainly from Nigeria, has been observed since May 2014. The aim of this study was to describe this phenomenon. This was a multicentre retrospective observational study of cases of febrile rhabdomyolysis reported from May 2014 to December 2016 in 12 Italian centres. A total of 48 cases were observed, mainly in young males. The mean time interval between the day of departure from Libya and symptom onset was 26.2 days. An average 8.3 further days elapsed before medical care was sought. All patients were hospitalized with fever and very intense muscle aches. Creatine phosphokinase, aspartate aminotransferase, and lactate dehydrogenase values were abnormal in all cases. The rhabdomyolysis was ascribed to an infective agent in 16 (33.3%) cases. In the remaining cases, the aetiology was undefined. Four out of seven patients tested had sickle cell trait. No alcohol abuse or drug intake was reported, apart from a single reported case of khat ingestion. The long incubation period does not support a mechanical cause of rhabdomyolysis. Furthermore, viral infections such as those caused by coxsackievirus are rarely associated with such a severe clinical presentation. It is hypothesized that other predisposing conditions like genetic factors, unknown infections, or unreported non-conventional remedies may be involved. Targeted surveillance of rhabdomyolysis cases is warranted. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

A cola-induced hypokalemic rhabdomyolysis with electromyographic evaluation: A case report

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Davide Ferrazzoli

2017-02-01

Full Text Available Objective: To report a rare case of hypokalemic rhabdomyolysis induced by the heavy and prolonged ingestion of cola-based beverages, and its uneventful recovery after kalemia normalization. Methods: We report a 38-year-old Caucasian male presented in our emergency room with a recent and progressive weakness of the lower limbs proximal muscles. Results: A dietary history revealed a prolonged ingestion of cola-based beverages. Blood tests showed severe hypokalemia and marked increase in serum creatine phosphokinase. The analysis of cerebrospinal fluid resulted normal. Electromyography was suggestive for a myopathy. The clinical, laboratory and neurophysiological data were evocative for a cola-induced hypokalemic rhabdomyolysis. After kalemia normalization, the improvements of the electromyographic findings paralleled the clinical recovery. Conclusion: Chronic consumption of large amount of cola-based soft drinks may result in severe symptomatic hypokalemia, eventually leading in turn to myopathy. To our knowledge, this is the first description of the electromyographic findings of the cola-induced hypokalemic rhabdomyolysis. An early diagnosis and a prompt treatment appear to be crucial for a benign clinical course.

A cola-induced hypokalemic rhabdomyolysis with electromyographic evaluation: A case report.

Science.gov (United States)

Ferrazzoli, Davide; Sabetta, Annarita; Palamara, Grazia; Caremani, Luca; Capobianco, Marina; Balbi, Pietro; Frazzitta, Giuseppe

2017-01-01

To report a rare case of hypokalemic rhabdomyolysis induced by the heavy and prolonged ingestion of cola-based beverages, and its uneventful recovery after kalemia normalization. We report a 38-year-old Caucasian male presented in our emergency room with a recent and progressive weakness of the lower limbs proximal muscles. A dietary history revealed a prolonged ingestion of cola-based beverages. Blood tests showed severe hypokalemia and marked increase in serum creatine phosphokinase. The analysis of cerebrospinal fluid resulted normal. Electromyography was suggestive for a myopathy. The clinical, laboratory and neurophysiological data were evocative for a cola-induced hypokalemic rhabdomyolysis. After kalemia normalization, the improvements of the electromyographic findings paralleled the clinical recovery. Chronic consumption of large amount of cola-based soft drinks may result in severe symptomatic hypokalemia, eventually leading in turn to myopathy. To our knowledge, this is the first description of the electromyographic findings of the cola-induced hypokalemic rhabdomyolysis. An early diagnosis and a prompt treatment appear to be crucial for a benign clinical course.

Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers

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Nelson, D. Alan; Deuster, Patricia A.; Carter, Robert; Hill, Owen T.; Wolcott, Vickee L.; Kurina, Lianne M.

2016-01-01

Background Studies have suggested that sickle cell trait elevates the risks of exertional rhabdomyolysis and death. We conducted a study of sickle cell trait in relation to these outcomes, controlling for known risk factors for exertional rhabdomyolysis, in a large population of active persons who had undergone laboratory tests for hemoglobin AS (HbAS) and who were subject to exertional-injury precautions. Methods We used Cox proportional-hazards models to test whether the risks of exertional rhabdomyolysis and death varied according to sickle cell trait status among 47,944 black soldiers who had undergone testing for HbAS and who were on active duty in the U.S. Army between January 2011 and December 2014. We used the Stanford Military Data Repository, which contains comprehensive medical and administrative data on all active-duty soldiers. Results There was no significant difference in the risk of death among soldiers with sickle cell trait, as compared with those without the trait (hazard ratio, 0.99; 95% confidence interval [CI], 0.46 to 2.13; P = 0.97), but the trait was associated with a significantly higher adjusted risk of exertional rhabdomyolysis (hazard ratio, 1.54; 95% CI, 1.12 to 2.12; P = 0.008). This effect was similar in magnitude to that associated with tobacco use, as compared with no use (hazard ratio, 1.54; 95% CI, 1.23 to 1.94; Prhabdomyolysis. (Funded by the National Heart, Lung, and Blood Institute and the Uniformed Services University of the Health Sciences.) PMID:27518662

Bench-to-bedside review: Treating acid–base abnormalities in the intensive care unit – the role of buffers

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Gehlbach, Brian K; Schmidt, Gregory A

2004-01-01

The recognition and management of acid–base disorders is a commonplace activity for intensivists. Despite the frequency with which non-bicarbonate-losing forms of metabolic acidosis such as lactic acidosis occurs in critically ill patients, treatment is controversial. This article describes the properties of several buffering agents and reviews the evidence for their clinical efficacy. The evidence supporting and refuting attempts to correct arterial pH through the administration of currently available buffers is presented. PMID:15312208

Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position.

NARCIS (Netherlands)

Bocca, G.; Moorselaar, R.J.A. van; Feitz, W.F.J.; Staak, F.H.J.M. van der; Monnens, L.A.H.

2002-01-01

Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred

Microvesicles in Atherosclerosis and Angiogenesis: From Bench to Bedside and Reverse

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Lina Badimon

2017-12-01

Full Text Available Atherosclerosis (AT is a progressive chronic disease involving lipid accumulation, fibrosis, and inflammation in medium and large-sized arteries, and it is the main cause of cardiovascular disease (CVD. AT is caused by dyslipidemia and mediated by both innate and adaptive immune responses. Despite lipid-lowering drugs have shown to decrease the risk of cardiovascular events (CVEs, there is a significant burden of AT-related morbidity and mortality. Identification of subjects at increased risk for CVE as well as discovery of novel therapeutic targets for improved treatment strategies are still unmet clinical needs in CVD. Microvesicles (MVs, small extracellular plasma membrane particles shed by activated and apoptotic cells have been widely linked to the development of CVD. MVs from vascular and resident cells by facilitating exchange of biological information between neighboring cells serve as cellular effectors in the bloodstream and play a key role in all stages of disease progression. This article reviews the current knowledge on the role of MVs in AT and CVD. Attention is focused on novel aspects of MV-mediated regulatory mechanisms from endothelial dysfunction, vascular wall inflammation, oxidative stress, and apoptosis to coagulation and thrombosis in the progression and development of atherothrombosis. MV contribution to vascular remodeling is also discussed, with a particular emphasis on the effect of MVs on the crosstalk between endothelial cells and smooth muscle cells, and their role regulating the active process of AT-driven angiogenesis and neovascularization. This review also highlights the latest findings and main challenges on the potential prognostic, diagnostic, and therapeutic value of cell-derived MVs in CVD. In summary, MVs have emerged as new regulators of biological functions in atherothrombosis and might be instrumental in cardiovascular precision medicine; however, significant efforts are still needed to translate into

The evaluation of bedside teaching – an instrument for staff ...

African Journals Online (AJOL)

Bedside teaching is the core teaching strategy in the clinical study years of the medical undergraduate degree at the University of the Witwatersrand. ... evaluation questionnaire was developed, based on previously validated peer review questionnaires used in evaluating small group formal classroom-based lectures.

[Rhabdomyolysis after lifting IKEA bags in a man using sertraline].

Science.gov (United States)

Kummen, Ingvild; Jensen, Thomas Giver

2016-12-12

We present a case of a 28-year-old male, using sertraline, who experienced progressive oedema in both upper extremities after having lifted two IKEA bags weighing 20 kg each from his car up to the third floor. Blood creatine kinase (CK) level was measured 5,260 U/l, and the patient was admitted for oral rehydration with the diagnosis rhabdomyolysis. The MRI showed swelling in the triceps muscles and latissimus dorsi muscles resulting in compression of the brachial vein. We discuss the pathomechanism behind the increased CK level and the swelling, and the possible effect sertraline may have had on the development of rhabdomyolysis.

[Rhabdomyolysis in a well-trained woman after unusually intense exercise].

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Larsen, Christian; Jensen, Mogens Pfeiffer

2014-06-16

A 35-year-old woman was acutely hospitalized with oedema of the upper limbs, reduced force, severe movement reduction and muscle pain in both upper extremities. Her symptoms started after three days of intense exercise doing kayaking and a lot of pull-ups in crossfit. Rhabdomyolysis is a syndrome, characterized by muscle necrosis. Usually there is a marked elevation of creatine kinase (CK) concentration with symptoms as described and myoglobinuria (dark coloured urine). After hard muscular work there will often be asymptomatic, but significant elevations in CK concentration, and in rare cases life-threatening rhabdomyolysis with electrolyte imbalances and acute kidney failure.

Maternal rhabdomyolysis and twin fetal death associated with gestational diabetes insipidus.

Science.gov (United States)

Price, Joan T; Schwartz, Nadav

2013-08-01

Gestational diabetes insipidus is a rare, transient complication of pregnancy typically characterized by polyuria and polydipsia that may lead to mild electrolyte abnormalities. More severe sequelae of gestational diabetes insipidus are uncommon. We present a case of a 25-year-old woman at 23 weeks of gestation in a dichorionic-diamniotic twin pregnancy who developed severe symptomatic gestational diabetes insipidus complicated by rhabdomyolysis and death of both fetuses. Maternal rhabdomyolysis caused by gestational diabetes insipidus is extremely rare. Early recognition and treatment of gestational diabetes insipidus is necessary to prevent maternal and fetal morbidity and mortality.

Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation.

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Narula, Jagat; Chandrashekhar, Y; Braunwald, Eugene

2018-04-01

Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.

STEM CELL IMAGING: FROM BENCH TO BEDSIDE

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Nguyen, Patricia K.; Riegler, Johannes; Wu, Joseph C.

2014-01-01

Although cellular therapies hold great promise for the treatment of human disease, results from several initial clinical trials have not shown a level of efficacy required for their use as a first line therapy. Here we discuss how in vivo molecular imaging has helped identify barriers to clinical translation and potential strategies that may contribute to successful transplantation and improved outcomes, with a focus on cardiovascular and neurological diseases. We conclude with a perspective on the future role of molecular imaging in defining safety and efficacy for stem cell clinical implementation. PMID:24702995

[Rhabdomyolysis and anuric kidney failure induced by the treatment with a gemfibrozil-cerivastatin combination].

Science.gov (United States)

Sirvent, A E; Cabezuelo, J B; Enríquez, R; Amorós, F; González, C; Reyes, A

2001-01-01

A 67-year-old man treated with gemfibrozil for a year development rhabdomyolysis and anuric renal failure after addition of cerivastatin. The clinical features and serological studies ruled out other causes of rhabdomyolysis. Drugs were stopped and hemodialysis was carried on for 14 days until diuresis occurred. The renal function improved steadily to a serum creatinine of 1.2 mg/dl two months later. On the basis of its pharmacokinetic profile cerivastatin appears to have less interactions than other statins. There are only two reports of rhabdomyolysis and acute renal failure due to fibrates and cerivastatin combination. This patient shows the potential risk of a fibrates-cerivastatin combination. When this association is required it is necessary to avoid other nephrotoxic and myopathic factors and to monitor CK levels closely.

Neuroimaging in psychiatry: from bench to bedside

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David E Linden

2009-12-01

Full Text Available This perspective considers the present and the future role of different neuroimaging techniques in the field of psychiatry. After identifying shortcomings of the mainly symptom-focussed diagnostic processes and treatment decisions in modern psychiatry, we suggest topics where neuroimaging methods have the potential to help. These include better understanding of the pathophysiology, improved diagnoses, assistance in therapeutic decisions and the supervision of treatment success by direct assessment of improvement in disease-related brain functions. These different questions are illustrated by examples from neuroimaging studies, with a focus on severe mental and neuropsychiatric illnesses such as schizophrenia, depression and dementia. Despite all reservations addressed in the article, we are optimistic, that neuroimaging has a huge potential with regard to the above-mentioned questions. We expect that neuroimaging will play an increasing role in the future refinement of the diagnostic process and aid in the development of new therapies in the field of psychiatry.

A case of rhabdomyolysis after kidney transplantation successfully managed with intensive continuous dialysis.

Science.gov (United States)

Shahbazov, Rauf; Fox, Michael; Alejo, Jennifer L; Anjum, Malik A; Azari, Feredun; Doyle, Alden; Agarwal, Avinash; Brayman, Kenneth L

2018-04-01

Rhabdomyolysis is characterized by muscle cell death which can result in acute kidney injury from pigment nephropathy. We present a patient who developed rhabdomyolysis immediately after deceased donor kidney transplantation surgery and was managed with continuous renal replacement therapy that resulted in successful salvage of the kidney allograft. Patients who develop acute kidney failure requiring renal replacement therapy generally have a poor prognosis. It is worth noting that while continuous veno-venous hemofiltration (CVVHF) offers greater volume support and continuous clearance compared to hemodialysis (HD), recent studies have demonstrated no clinically significant improvement in clinical outcome between the two. Perhaps CVVHF is a better modality compared to HD in this setting to prevent further insult from pigment nephropathy to an allograft. A combination of early diagnosis and intensive continuous renal replacement therapy can be used for allograft salvage in a patient with rhabdomyolysis in the immediate post-kidney transplant period.

Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis

DEFF Research Database (Denmark)

Dalbjerg, Sara Maria; Tsakiri, Anna; Fredriksen, Jette Lautrup

2016-01-01

Background Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis...... associated with Interferon-beta treatment. Case presentation We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved...... Interferon-beta-1-alpha therapy in patients with multiple sclerosis....

Scintigraphic demonstration of a iatrogenic rhabdomyolysis im McArdle's syndrome

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Neumann, P.; Rumpf, K.W.; Kaiser, H.; Meinck, H.M.; Goebel, H.H.; Schicha, H.; Emrich, D.

1982-02-01

In a patient with late onset McArdle's disease local rhabdomyolysis and massive myoglobinuria were provoked by a routine diagnostic procedure - the forearm ischemic work test. Localisation and extent of rhabdomyolysis could be demonstrated by a conventional whole-body scanning technique using sup(99m)Tc methylenediphosphonate as a tracer. It is concluded that the forearm ischemic work test is not without risk in patients with McArdle's disease, and care should be taken to prevent myoglobinuric renal failure in these patients.

Epidemiology of exertional rhabdomyolysis susceptibility in standardbred horses reveals associated risk factors and underlying enhanced performance.

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Cajsa M Isgren

Full Text Available BACKGROUND: Exertional rhabdomyolysis syndrome is recognised in many athletic horse breeds and in recent years specific forms of the syndrome have been identified. However, although Standardbred horses are used worldwide for racing, there is a paucity of information about the epidemiological and performance-related aspects of the syndrome in this breed. The objectives of this study therefore were to determine the incidence, risk factors and performance effects of exertional rhabdomyolysis syndrome in Standardbred trotters and to compare the epidemiology and genetics of the syndrome with that in other breeds. METHODOLOGY/PRINCIPAL FINDINGS: A questionnaire-based case-control study (with analysis of online race records was conducted following identification of horses that were determined susceptible to exertional rhabdomyolysis (based on serum biochemistry from a total of 683 horses in 22 yards. Thirty six exertional rhabdomyolysis-susceptible horses were subsequently genotyped for the skeletal muscle glycogen synthase (GYS1 mutation responsible for type 1 polysaccharide storage myopathy. A total of 44 susceptible horses was reported, resulting in an annual incidence of 6.4 (95% CI 4.6-8.2% per 100 horses. Female horses were at significantly greater risk than males (odds ratio 7.1; 95% CI 2.1-23.4; p = 0.001 and nervous horses were at a greater risk than horses with calm or average temperaments (odds ratio 7.9; 95% CI 2.3-27.0; p = 0.001. Rhabdomyolysis-susceptible cases performed better from standstill starts (p = 0.04 than controls and had a higher percentage of wins (p = 0.006. All exertional rhabdomyolysis-susceptible horses tested were negative for the R309H GYS1 mutation. CONCLUSIONS/SIGNIFICANCE: Exertional rhabdomyolysis syndrome in Standardbred horses has a similar incidence and risk factors to the syndrome in Thoroughbred horses. If the disorder has a genetic basis in Standardbreds, improved performance in susceptible animals may be

Clinics in diagnostic imaging (179). Severe rhabdomyolysis complicated by myonecrosis.

Science.gov (United States)

Kok, Shi Xian Shawn; Tan, Tien Jin

2017-08-01

A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels and urine myoglobinuria were consistent with a diagnosis of rhabdomyolysis. Initial magnetic resonance imaging of the right lower limb revealed diffuse muscle oedema and features of myositis in the gluteal muscles and the adductor, anterior and posterior compartments of the thigh. Follow-up magnetic resonance imaging performed 11 days later showed interval development of areas of myonecrosis and haemorrhage. The causes, clinical presentation and imaging features of rhabdomyolysis are discussed. Copyright: © Singapore Medical Association.

Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis.

Science.gov (United States)

Higaki, Masato; Tanemoto, Masayuki; Shiraishi, Takeshi; Taniguchi, Kei; Fujigaki, Yoshihide; Uchida, Shunya

2015-01-01

Hypocalcemia is an important complication of rhabdomyolysis for which several pathogenic factors, including acute kidney injury (AKI), have been proposed. To gain insight regarding the hypocalcemic roles of AKI in rhabdomyolysis, we retrospectively examined patients with rhabdomyolysis. Of 28,387 patients admitted to the Department of Internal Medicine, 51 patients met the inclusion criteria for the study. Serum calcium was analyzed based on laboratory data including indicators of AKI, serum creatine kinase (CK) and serum inorganic phosphate (iP). Twenty-two patients (43%) had hypocalcemia. Compared with patients without hypocalcemia, they had a higher prevalence of AKI (82 vs. 55%; p = 0.046), higher levels of peak CK (39,100 ± 50,600 vs. 9,800 ± 11,900 IU/l; p = 0.003) and higher levels of peak iP (1.77 ± 1.10 vs. 1.10 ± 0.35 mmol/l; p = 0.007). Indicators of AKI were correlated with peak CK and peak iP and were not significant variables in the regression analysis for hypocalcemia. Peak CK and peak iP were not correlated with each other. Impaired phosphate use by muscle contributed to the increased iP. These findings indicate that muscle damage is the primary hypocalcemic factor in rhabdomyolysis. AKI facilitated hypocalcemia by exacerbating the hyperphosphatemic effects of muscle damage. Aggressive hydration, which could increase oxygen supply and subsequently repair phosphate use in muscle, might reduce the incidence of hypocalcemia in rhabdomyolysis. © 2015 S. Karger AG, Basel.

[Severe caffeine poisoning with rhabdomyolysis].

Science.gov (United States)

Wolter, J; Grün, D; Otto, S

2018-04-01

We report the case of a young man who took a large amount of caffeine powder dissolved in water in a suicide attempt. He was found comatose. The initial diagnosis was difficult. In hospital he suffered from rhabdomyolysis with renal failure and sepsis rapidly developed. After renal replacement treatment with hemodialysis, long-term artificial ventilation with tracheotomy and a 3‑week stay in the intensive care unit, the patient could be discharged to a rehabilitation center.

A Risk Prediction Score for Kidney Failure or Mortality in Rhabdomyolysis

Science.gov (United States)

McMahon, Gearoid M.; Zeng, Xiaoxi; Waikar, Sushrut S.

2016-01-01

IMPORTANCE Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring hemodialysis or continuous renal replacement therapy (RRT). OBJECTIVE To develop a risk prediction tool to identify patients at greatest risk of RRT or in-hospital mortality. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 2371 patients admitted between January 1, 2000, and March 31, 2011, to 2 large teaching hospitals in Boston, Massachusetts, with creatine phosphokinase levels in excess of 5000 U/L within 3 days of admission. The derivation cohort consisted of 1397 patients from Massachusetts General Hospital, and the validation cohort comprised 974 patients from Brigham and Women’s Hospital. MAIN OUTCOMES AND MEASURES The composite of RRT or in-hospital mortality. RESULTS The causes and outcomes of rhabdomyolysis were similar between the derivation and validation cohorts. In total, the composite outcome occurred in 19.0% of patients (8.0% required RRT and 14.1% died during hospitalization). The highest rates of the composite outcome were from compartment syndrome (41.2%), sepsis (39.3%), and following cardiac arrest (58.5%). The lowest rates were from myositis (1.7%), exercise (3.2%), and seizures (6.0%). The independent predictors of the composite outcome were age, female sex, cause of rhabdomyolysis, and values of initial creatinine, creatine phosphokinase, phosphate, calcium, and bicarbonate. We developed a risk-prediction score from these variables in the derivation cohort and subsequently applied it in the validation cohort. The C statistic for the prediction model was 0.82 (95% CI, 0.80–0.85) in the derivation cohort and 0.83 (0.80–0.86) in the validation cohort. The Hosmer-Lemeshow P values were .14 and .28, respectively. In the validation cohort, among the patients with the lowest risk score (10), 61.2% died or needed RRT. CONCLUSIONS AND

Collaborative Undergraduate HBCU Student Summer Prostate Cancer Training Program

Science.gov (United States)

2012-09-01

Addiction: From Bench to Khaled Moussawi, MD/PhD Student Bedside June 14 Hepatic Steatosis in a Growing World: The Impact Dr. Kenneth Chavin...Treatment of Cocaine Addiction: From Bench to TBA Bedside June 13 Hepatic Steatosis in a Growing World: The Impact Dr. Kenneth Chavin, MD, PhD

Exome sequencing in Jewish and Arab patients with rhabdomyolysis reveals single-gene etiology in 43% of cases.

Science.gov (United States)

Vivante, Asaf; Ityel, Hadas; Pode-Shakked, Ben; Chen, Jing; Shril, Shirlee; van der Ven, Amelie T; Mann, Nina; Schmidt, Johanna Magdalena; Segel, Reeval; Aran, Adi; Zeharia, Avraham; Staretz-Chacham, Orna; Bar-Yosef, Omer; Raas-Rothschild, Annick; Landau, Yuval E; Lifton, Richard P; Anikster, Yair; Hildebrandt, Friedhelm

2017-12-01

Rhabdomyolysis is a clinical emergency that may cause acute kidney injury (AKI). It can be acquired or due to monogenic mutations. Around 60 different rare monogenic forms of rhabdomyolysis have been reported to date. In the clinical setting, identifying the underlying molecular diagnosis is challenging due to nonspecific presentation, the high number of causative genes, and current lack of data on the prevalence of monogenic forms. We employed whole exome sequencing (WES) to reveal the percentage of rhabdomyolysis cases explained by single-gene (monogenic) mutations in one of 58 candidate genes. We investigated a cohort of 21 unrelated families with rhabdomyolysis, in whom no underlying etiology had been previously established. Using WES, we identified causative mutations in candidate genes in nine of the 21 families (43%). We detected disease-causing mutations in eight of 58 candidate genes, grouped into the following categories: (1) disorders of fatty acid metabolism (CPT2), (2) disorders of glycogen metabolism (PFKM and PGAM2), (3) disorders of abnormal skeletal muscle relaxation and contraction (CACNA1S, MYH3, RYR1 and SCN4A), and (4) disorders of purine metabolism (AHCY). Our findings demonstrate a very high detection rate for monogenic etiologies using WES and reveal broad genetic heterogeneity for rhabdomyolysis. These results highlight the importance of molecular genetic diagnostics for establishing an etiologic diagnosis. Because these patients are at risk for recurrent episodes of rhabdomyolysis and subsequent risk for AKI, WES allows adequate prophylaxis and treatment for these patients and their family members and enables a personalized medicine approach.

Bench-to-bedside review: leadership and conflict management in the intensive care unit.

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Strack van Schijndel, Rob J M; Burchardi, Hilmar

2007-01-01

In the management of critical care units, leadership and conflict management are vital areas for the successful performance of the unit. In this article a practical approach to define competencies for leadership and principles and practices of conflict management are offered. This article is, by lack of relevant intensive care unit (ICU) literature, not evidence based, but it is the result of personal experience and a study of literature on leadership as well on conflicts and negotiations in non-medical areas. From this, information was selected that was recognisable to the authors and, thus, also seems to be useful knowledge for medical doctors in the ICU environment.

Neurology at the bedside

DEFF Research Database (Denmark)

Kondziella, Daniel; Waldemar, Gunhild

This updated and expanded new edition takes neurology trainees by the hand and guides them through the whole patient encounter - from an efficient neurological history and bedside examination through to differential diagnosis, diagnostic procedures and treatment. At each step the expert authors......, as have new chapters including neurogenetics, neurorehabilitation, neurocritical care and heuristic neurological reasoning. In addition, this second edition now includes more than 100 unique case histories. Neurology at the Bedside, Second Edition is written for neurologists in all stages of training....... Medical students, general practitioners and others with an interest in neurology will also find invaluable information here....

Bedside teaching-making it an effective instructional tool.

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Khan, Ishtiaq Ali

2014-01-01

Bedside teaching is defined as any teaching in the presence of patient and is the core teaching strategy during the clinical years of a medical student. Although it is considered the most effective method to teach clinical and communication skills but its quality is deteriorating with the passage of time. The objective of this study is to explore faculty's perceptions about bedside teaching. This study was conducted in clinical disciplines of Ayub Medical College and hospital Abbottabad, Pakistan from January 2012 to July 2012. Pragmatic paradigm was selected to gather both quantitative and qualitative information. Data was collected sequentially to validate findings. Perceptions of all professors of clinical subjects about bed side teaching were recorded on a close-ended structured questionnaire. Then in-depth interviews were taken from 5 professors using an open ended questionnaire. Quantitative data was analysed using, SPSS-16. Qualitative research data was analysed through content analysis. Out of 20 professors of clinical departments 18 agreed to respond to the questionnaire assessing their perceptions about bed side teaching. Non-existence of bedside teaching curriculum, lack of discipline in students and faculty, lack of accountability, poor job satisfaction and low salary were identified as major factors responsible for decline in quality of bedside teaching. Most of them advocated that curriculum development, planning bedside teaching, implementation of discipline and accountability, improved job satisfaction and performance based promotions will improve quality of clinical teaching. Curriculum development for bedside teaching, institutional discipline, application of best planning strategies, performance based appraisal of faculty and good job satisfaction can make bedside teaching an effective instructional tool.

Rhabdomyolysis in pontocerebellar hypoplasia type 2 (PCH-2)

NARCIS (Netherlands)

Barth, Peter G.; Ryan, Monique M.; Webster, Richard I.; Aronica, Eleonora; Kan, Alex; Ramkema, Marja; Jardine, Philip; Poll-The, Bwee Tien

2008-01-01

Pontocerebellar hypoplasia type 2, an autosomal recessive neurodegeneration with prenatal onset, is characterised by progressive microcephaly and chorea/dystonia and has not previously been associated with muscular involvement. The gene associated with PCH-2 is unknown. An episode of rhabdomyolysis

Baking soda pica associated with rhabdomyolysis and cardiomyopathy in pregnancy.

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Scolari Childress, Katherine M; Myles, Thomas

2013-08-01

Pica is a commonly underappreciated disorder in pregnancy that can lead to several complications, including severe metabolic derangements and other adverse outcomes. We report a case of baking soda pica in pregnancy associated with both rhabdomyolysis and cardiomyopathy. A multigravid woman at 37 weeks of gestation presented with weakness and severe hypokalemia. She subsequently had development of rhabdomyolysis and presumed peripartum cardiomyopathy. After delivery, it was discovered that the patient had a long history of consumption of large quantities of baking soda. Her condition improved with cessation of the pica. Clinicians must have a high index of suspicion for pica in pregnancy because it can lead to complex diagnostic challenges and pregnancy complications. The diagnosis should be considered in a patient with unexplained metabolic abnormalities.

The evaluation of bedside teaching – an instrument for staff ...

African Journals Online (AJOL)

teaching during their undergraduate training, while 100% thought that bedside ... or no attention has been given to the evaluation of bedside teaching. Problem ... of this pilot study was to determine the quality of bedside teaching in one group ...

Rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery

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Sebastian John Baxter

2017-01-01

Full Text Available Rhabdomyolysis is the result of skeletal muscle tissue injury and is characterized by elevated creatine kinase levels, muscle pain, and myoglobinuria. It is caused by crush injuries, hyperthermia, drugs, toxins, and abnormal metabolic states. This is often difficult to diagnose perioperatively and can result in renal failure and compartment syndrome if not promptly treated. We report a rare case of inadvertent rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery. The presentation, differential diagnoses, and management are discussed. Hyperkalemia may be the first presenting sign. Early recognition and management are essential to prevent life-threatening complications.

Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

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Finsterer, Josef; Stöllberger, Claudia

2014-06-01

Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

Exceptionally High Creatine Kinase (CK) Levels in Multicausal and Complicated Rhabdomyolysis: A Case Report.

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Luckoor, Pavan; Salehi, Mashal; Kunadu, Afua

2017-07-04

BACKGROUND Rhabdomyolysis is a syndrome caused by muscle breakdown. It can be caused by traumatic as well as non-traumatic factors such as drugs, toxins, and infections. Although it has been initially associated with only traumatic causes, non-traumatic causes now appear to be at least 5 times more frequent. In rhabdomyolysis, the CK levels can range anywhere from 10 000 to 200 000 or even higher. The higher the CK levels, the greater will be the renal damage and associated complications. We present the case of a patient with exceptionally massive rhabdomyolysis with unusually high CK levels (nearly 1 million) caused by combined etiologic factors and complicated with acute renal failure. CASE REPORT A 36-year-old African American male patient with no significant past medical history and a social history of cocaine and alcohol abuse presented with diarrhea and generalized weakness of 2 days' duration. He was found to be febrile, tachycardic, tachypneic, and hypoxic. The patient was subsequently intubated and admitted to the medical ICU. Laboratory work-up showed acute renal failure with deranged liver functions test results, and elevated creatine kinase of 701,400 U/L. CK levels were subsequently too high for the lab to quantify. Urine legionella testing was positive for L. pneumophilia serogroup 1 antigen and urine toxicology was positive for cocaine. The patient had a protracted course in the ICU. He was initially started on CVVH, and later received intermittent hemodialysis for about 1 month. CONCLUSIONS In the presence of multiple etiologic factors, rhabdomyolysis can be massive with resultant significant morbidity. Clinicians should have a high index of suspicion for rhabdomyolysis in the presence of multiple factors, as early recognition of this diseases is very important in the prevention and active management of life-threatening conditions.

Recognizing Bedside Events Using Thermal and Ultrasonic Readings

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Danielsen Asbjørn

2017-06-01

Full Text Available Falls in homes of the elderly, in residential care facilities and in hospitals commonly occur in close proximity to the bed. Most approaches for recognizing falls use cameras, which challenge privacy, or sensor devices attached to the bed or the body to recognize bedside events and bedside falls. We use data collected from a ceiling mounted 80 × 60 thermal array combined with an ultrasonic sensor device. This approach makes it possible to monitor activity while preserving privacy in a non-intrusive manner. We evaluate three different approaches towards recognizing location and posture of an individual. Bedside events are recognized using a 10-second floating image rule/filter-based approach, recognizing bedside falls with 98.62% accuracy. Bed-entry and exit events are recognized with 98.66% and 96.73% accuracy, respectively.

Influence of bench angle on upper extremity muscular activation during bench press exercise.

Science.gov (United States)

Lauver, Jakob D; Cayot, Trent E; Scheuermann, Barry W

2016-01-01

This study compared the muscular activation of the pectoralis major, anterior deltoid and triceps brachii during a free-weight barbell bench press performed at 0°, 30°, 45° and -15° bench angles. Fourteen healthy resistance trained males (age 21.4 ± 0.4 years) participated in this study. One set of six repetitions for each bench press conditions at 65% one repetition maximum were performed. Surface electromyography (sEMG) was utilised to examine the muscular activation of the selected muscles during the eccentric and concentric phases. In addition, each phase was subdivided into 25% contraction durations, resulting in four separate time points for comparison between bench conditions. The sEMG of upper pectoralis displayed no difference during any of the bench conditions when examining the complete concentric contraction, however differences during 26-50% contraction duration were found for both the 30° [122.5 ± 10.1% maximal voluntary isometric contraction (MVIC)] and 45° (124 ± 9.1% MVIC) bench condition, resulting in greater sEMG compared to horizontal (98.2 ± 5.4% MVIC) and -15 (96.1 ± 5.5% MVIC). The sEMG of lower pectoralis was greater during -15° (100.4 ± 5.7% MVIC), 30° (86.6 ± 4.8% MVIC) and horizontal (100.1 ± 5.2% MVIC) bench conditions compared to the 45° (71.9 ± 4.5% MVIC) for the whole concentric contraction. The results of this study support the use of a horizontal bench to achieve muscular activation of both the upper and lower heads of the pectoralis. However, a bench incline angle of 30° or 45° resulted in greater muscular activation during certain time points, suggesting that it is important to consider how muscular activation is affected at various time points when selecting bench press exercises.

Mesenchymal stromal cell therapy in COPD: from bench to bedside

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Antunes MA

2017-10-01

Full Text Available Mariana A Antunes,1,2 José Roberto Lapa e Silva,3 Patricia RM Rocco1,2 1Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro (UFRJ, RJ, Brazil; 2National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil; 3Institute of Thoracic Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (UFRJ, Rio de Janeiro, RJ, Brazil Abstract: COPD is the most frequent chronic respiratory disease and a leading cause of morbidity and mortality. The major risk factor for COPD development is cigarette smoke, and the most efficient treatment for COPD is smoking cessation. However, even after smoking cessation, inflammation, apoptosis, and oxidative stress may persist and continue contributing to disease progression. Although current therapies for COPD (primarily based on anti-inflammatory agents contribute to the reduction of airway obstruction and minimize COPD exacerbations, none can avoid disease progression or reduce mortality. Within this context, recent advances in mesenchymal stromal cell (MSC therapy have made this approach a strong candidate for clinical use in the treatment of several pulmonary diseases. MSCs can be readily harvested from diverse tissues and expanded with high efficiency, and have strong immunosuppressive properties. Preclinical studies have demonstrated encouraging outcomes of MSCs therapy for lung disorders, including emphysema. These findings instigated research groups to assess the impact of MSCs in human COPD/emphysema, but clinical results have fallen short of expectations. However, MSCs have demonstrated a good adjuvant role in the clinical scenario. Trials that used MSCs combined with another, primary treatment (eg, endobronchial valves found that patients derived greater benefit in pulmonary function tests and/or quality of life reports, as well as reductions in systemic

Colchicine triggered severe rhabdomyolysis after long-term low-dose simvastatin therapy: a case report.

Science.gov (United States)

Frydrychowicz, Clara; Pasieka, Bastian; Pierer, Matthias; Mueller, Wolf; Petros, Sirak; Weidhase, Lorenz

2017-01-04

Rhabdomyolysis is a widely recognized yet rare complication in statin use. Rhabdomyolysis might be triggered by the prescription of high doses of statins or by statin accumulation due to interactions with concomitant medication. Muscle cell destruction as evidenced by myoglobin elevation can induce potentially life-threatening acute renal failure. We report a case of a 70-year-old obese white man with sudden onset of severe rhabdomyolysis with consecutive renal failure. His medication included low-dose simvastatin, which he had taken for 6 years up until the event. The statin was withdrawn immediately. After 3 days of veno-venous hemofiltration his renal function was completely restored. Clinicians in both primary and special care might be unaware that side effects of statins do occur even after a long uneventful statin medication; they should be advised not to exclude that possibility upfront, even if a patient has tolerated the medication for years.

Relationship of pectoralis major muscle size with bench press and bench throw performances.

Science.gov (United States)

Akagi, Ryota; Tohdoh, Yukihiro; Hirayama, Kuniaki; Kobayashi, Yuji

2014-06-01

This study examined the relationship of muscle size indices of the pectoralis major muscle with bench press and bench throw performances in 18 male collegiate athletes. The maximal cross-sectional area (MCSAMAx) and volume (MV) of the pectoralis major muscle were determined by magnetic resonance imaging. First, subjects were tested for their one repetition maximum bench press strength (1RMBP) using a Smith machine. At a later date, subjects performed bench throws using the Smith machine with several different loads ranging from 30.0 kg to 90% of 1RMBP. Barbell positions were measured by a linear position transducer, and bench throw power was calculated using a dynamic equation. Three trials were performed for each load. In all the trials, the maximal peak power was adopted as bench throw peak power (PPBT). The 1RMBP was significantly correlated with MCSAMAx. Similarly, the correlation coefficient between MV and PPBT was significant. In contrast to the y-intercept of the MV-PPBT regression line, that of the MCSAMAx-1RMBP regression line was not significantly different from 0. These results suggested that, although the dependence on pectoralis major muscle size is slightly different between bench press strength and bench throw power, the pectoralis major muscle size has a significant impact on bench press and throw performances. Greater muscle size leads to heavier body weight, which can be a negative factor in some sports. We therefore recommend that athletes and their coaches develop training programs for improving sports performance by balancing the advantage of increased muscle size and the potential disadvantage of increased body weight.

Bedside Teaching: Is it Effective Methods in Clinical Nursing Students Learning?

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Fatikhu Yatuni Asmara

2017-01-01

Full Text Available Introduction: Clinical learning is the centre of medical students education. Students not only learn about practical skills but also communication with patient and other health care givers which both competencies are useful for students when they come into working world (Spencer, 2003. There are variations of methods applied in clinical learning process; one of them is bedside teaching. The aim of this study was to observe the bedside teaching process which is held in group of students, teacher, and patient. Another aim was to know responses of students, teacher, and patients to the bedside teaching process. Method: The method which was applied in this study is observation in which bedside teaching process was observed related to the roles and function of each component of bedside teaching: students, teacher, and patient in each phase: preparation, process, and evaluation. Then it was continued by interview to know the responses of students, teacher, and patient related to bedside teaching process. Result: The result showed that both students and teacher felt that bedside teaching is an effective method since it helped students to achieve their competences in clinical setting and develop their communication skill. Furthermore teacher stated that bedside teaching facilitated her to be a good role model for students. As well as students and teacher, patient got advantage from the bedside teaching process that she got information related to her case; however the time to discuss was limited. During the observation, each component of bedside teaching did their roles and function, such as: during the preparation teacher asked inform consent from patient, and patient gave inform consent as well while students prepared the material. Discussions: Suggestion for next research is conducting a deeper study about perception of students, teacher, and patient about bedside teaching process and the strategies to develop it to be better method. Keywords: bedside

Acute Kidney Injury and Rhabdomyolysis as an Initial Presentation of Hashimoto’s Thyroiditis

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Deephak Swaminath

2013-03-01

Full Text Available The myopathy associated with hypothyroidism is usually mild and causes myalgia,stiffness, fatigability, and muscle weakness. Severe forms of myopathy, such as rhabdomyolysiswith acute kidney injury (AKI, have rarely been reported in hypothyroidpatients. We describe a young patient who presented with generalized body aches,cramps, and abdominal pain with vomiting after physical exercise. His laboratory studiesdemonstrated that he had rhabdomyolysis and AKI secondary to hypothyroidism;both resolved with thyroid hormone replacement. Hypothyroidism should be consideredin the differential diagnosis of rhabdomyolysis when common causes are excluded.

Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T

DEFF Research Database (Denmark)

Egholm, Gro; Pareek, Manan

2015-01-01

for myocardial injury. This case report describes a 48-year-old woman, who, two years after cardiac transplantation, presented with rhabdomyolysis. During the course of the disease, her troponin T level was elevated on repeated occasions, but other definitive evidence of myocardial injury was not found...

Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma?

Science.gov (United States)

Donmez, Halil; Tokmak, Turgut Tursem; Yildirim, Afra; Buyukoglan, Hakan; Ozturk, Mehmet; Yaşar Ayaz, Umit; Mavili, Ertugrul

2012-01-01

BACKGROUND.: Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma. METHODS.: In this prospective study, 240 hemithoraces of 120 consecutive patients with multiple trauma were evaluated with chest radiographs (CXR) and bedside thoracic US for the diagnosis of pneumothorax. CT examinations were performed in 68 patients. Fifty-two patients who did not undergo CT examinations were excluded from the study. US examinations were performed independently at bedside by two radiologists who were not informed about CXR and CT findings. CXRs were interpreted by two radiologists who were unaware of the US and CT results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR and US were calculated. RESULTS.: One hundred thirty-six hemithoraces were assessed in 68 patients. A total of 35 pneumothoraces were detected in 33 patients. On US, the diagnosis of pneumothorax was correct in 32 hemithoraces. In 98 hemithoraces without pneumothorax, US was normal. With US examination, there were three false-positive and three false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of US were 91.4%, 97%, 91.4%, 97%, and 97%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR were 82.7%, 89.7%, 68.5%, 95%, and 89.5%, respectively. CONCLUSIONS.: Bedside thoracic US is an accurate method that can be used in trauma patients instead of CXR for the detection of pneumothorax. Copyright © 2012 Wiley Periodicals, Inc.

Amine oxidases as important agents of pathological processes of rhabdomyolysis in rats.

Science.gov (United States)

Gudkova, O O; Latyshko, N V; Shandrenko, S G

2016-01-01

In this study we have tested an idea on the important role of amine oxidases (semicarbazide-sensitive amine oxidase, diamine oxidase, polyamine oxidase) as an additional source of oxidative/carbonyl stress under glycerol-induced rhabdomyolysis, since the enhanced formation of reactive oxygen species and reactive carbonyl species in a variety of tissues is linked to various diseases. In our experiments we used the sensitive fluorescent method devised for estimation of amine oxidases activity in the rat kidney and thymus as targeted organs under rhabdomyolysis. We have found in vivo the multiple rises in activity of semicarbazide-sensitive amine oxidase, diamine oxidase, polyamine oxidase (2-4.5 times) in the corresponding cell fractions, whole cells or their lysates at the 3-6th day after glycerol injection. Aberrant antioxidant activities depended on rhabdomyolysis stage and had organ specificity. Additional treatment of animals with metal chelator ‘Unithiol’ adjusted only the activity of antioxidant enzymes but not amine oxidases in both organs. Furthermore the in vitro experiment showed that Fenton reaction (hydrogen peroxide in the presence of iron) products alone had no effect on semicarbazide-sensitive amine oxidase activity in rat liver cell fraction whereas supplementation with methylglyoxal resulted in its significant 2.5-fold enhancement. Combined action of the both agents had additive effect on semicarbazide-sensitive amine oxidase activity. We can assume that biogenic amine and polyamine catabolism by amine oxidases is upregulated by oxidative and carbonyl stress factors directly under rhabdomyolysis progression, and the increase in catabolic products concentration contributes to tissue damage in glycerol-induced acute renal failure and apoptosis stimulation in thymus.

Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study.

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Despins, Laurel A

2017-12-01

This study examines what prompts the intensive care unit (ICU) nurse to go to the patient's bedside to investigate an alarm and the influences on the nurse's determination regarding how quickly this needs to occur. A qualitative descriptive design guided data collection and analysis. Individual semi-structured interviews were conducted. Thematic analysis guided by the Patient Risk Detection Theoretical Framework was applied to the data. Four specialty intensive care units in an academic medical center. ICU nurses go the patient's bedside in response to an alarm to catch patient deterioration and avert harm. Their determination of the immediacy of patient risk and their desire to prioritize their bedside investigations to true alarms influences how quickly they proceed to the bedside. Ready visual access to physiological data and waveform configurations, experience, teamwork, and false alarms are important determinants in the timing of ICU nurses' bedside alarm investigations. Copyright © 2017 Elsevier Ltd. All rights reserved.

CAV3 mutations causing exercise intolerance, myalgia and rhabdomyolysis: Expanding the phenotypic spectrum of caveolinopathies.

Science.gov (United States)

Scalco, Renata Siciliani; Gardiner, Alice R; Pitceathly, Robert D S; Hilton-Jones, David; Schapira, Anthony H; Turner, Chris; Parton, Matt; Desikan, Mahalekshmi; Barresi, Rita; Marsh, Julie; Manzur, Adnan Y; Childs, Anne-Marie; Feng, Lucy; Murphy, Elaine; Lamont, Phillipa J; Ravenscroft, Gianina; Wallefeld, William; Davis, Mark R; Laing, Nigel G; Holton, Janice L; Fialho, Doreen; Bushby, Kate; Hanna, Michael G; Phadke, Rahul; Jungbluth, Heinz; Houlden, Henry; Quinlivan, Ros

2016-08-01

Rhabdomyolysis is often due to a combination of environmental trigger(s) and genetic predisposition; however, the underlying genetic cause remains elusive in many cases. Mutations in CAV3 lead to various neuromuscular phenotypes with partial overlap, including limb girdle muscular dystrophy type 1C (LGMD1C), rippling muscle disease, distal myopathy and isolated hyperCKemia. Here we present a series of eight patients from seven families presenting with exercise intolerance and rhabdomyolysis caused by mutations in CAV3 diagnosed by next generation sequencing (NGS) (n = 6). Symptoms included myalgia (n = 7), exercise intolerance (n = 7) and episodes of rhabdomyolysis (n = 2). Percussion-induced rapid muscle contractions (PIRCs) were seen in five out of six patients examined. A previously reported heterozygous mutation in CAV3 (p.T78M) and three novel variants (p.V14I, p.F41S, p.F54V) were identified. Caveolin-3 immunolabeling in muscle was normal in 3/4 patients; however, immunoblotting showed more than 50% reduction of caveolin-3 in five patients compared with controls. This case series demonstrates that exercise intolerance, myalgia and rhabdomyolysis may be caused by CAV3 mutations and broadens the phenotypic spectrum of caveolinopathies. In our series, immunoblotting was a more sensitive method to detect reduced caveolin-3 levels than immunohistochemistry in skeletal muscle. Patients presenting with muscle pain, exercise intolerance and rhabdomyolysis should be routinely tested for PIRCs as this may be an important clinical clue for caveolinopathies, even in the absence of other "typical" features. The use of NGS may expand current knowledge concerning inherited diseases, and unexpected/atypical phenotypes may be attributed to well-known human disease genes. Copyright © 2016 Elsevier B.V. All rights reserved.

Returning to the bedside: using the history and physical examination to identify rotator cuff tears.

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Litaker, D; Pioro, M; El Bilbeisi, H; Brems, J

2000-12-01

To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT). Retrospective chart review Orthopedic practice limited to disorders of the shoulder 448 consecutive patients with suspected RCT referred for arthrography over a 4-year period Presence of partial or complete RCT on arthrogram 301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT. The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.

Curcumin, a component of golden spice: from bedside to bench and back.

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Prasad, Sahdeo; Gupta, Subash C; Tyagi, Amit K; Aggarwal, Bharat B

2014-11-01

Although the history of the golden spice turmeric (Curcuma longa) goes back thousands of years, it is only within the past century that we learned about the chemistry of its active component, curcumin. More than 6000 articles published within the past two decades have discussed the molecular basis for the antioxidant, anti-inflammatory, antibacterial, antiviral, antifungal, and anticancer activities assigned to this nutraceutical. Over sixty five clinical trials conducted on this molecules, have shed light on the role of curcumin in various chronic conditions, including autoimmune, cardiovascular, neurological, and psychological diseases, as well as diabetes and cancer. The current review provides an overview of the history, chemistry, analogs, and mechanism of action of curcumin. Published by Elsevier Inc.

Technetium-99m pyrophosphate imaging in acute renal failure associated with nontraumatic rhabdomyolysis

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Patel, R.; Mishkin, F.S.

1986-10-01

Technetium-99m pyrophosphate (Tc-PYP) imaging was performed in five patients with acute renal failure associated with nontraumatic rhabdomyolysis. Four patients had phencyclidine intoxication and one had viral pneumonia. During the acute phase, marked uptake of pyrophosphate was seen in all patients in several muscle groups, but always in the thigh adductors. The results show that phencyclidine intoxication can result in diffuse muscle uptake of Tc-PYP without overt evidence of muscle injury. Tc-PYP imaging may provide a clue to the cause of acute renal failure in patients with suspected rhabdomyolysis in whom elevations of serum creatine phosphokinase concentrations are equivocal.

Spinning-induced rhabdomyolysis: importance of MRI for patient’s outcome. A case report

Directory of Open Access Journals (Sweden)

P.G. Rabitti

2011-06-01

Full Text Available The first italian case of spinning-induced exertional rhabdomyolysis is presented here. The spinning is an expanding fitness activity which uses a stationary bike, that in some rare cases described in literature can induce rhabdomyolysis. In our patient, through magnetic resonance imaging, we detected a clear-cut temporal dissociation between clinical-biochemical healing and anatomical recovery. In fact we found that the improvement of magnetic resonance picture was much slower than the vanishing of myalgias and normalization of serum myoglobin and enzymes. This observation could be useful to understand the timing for exercise resumption without any risk for the patient.

Technetium-99m pyrophosphate imaging in acute renal failure associated with nontraumatic rhabdomyolysis

International Nuclear Information System (INIS)

Patel, R.; Mishkin, F.S.

1986-01-01

Technetium-99m pyrophosphate (Tc-PYP) imaging was performed in five patients with acute renal failure associated with nontraumatic rhabdomyolysis. Four patients had phencyclidine intoxication and one had viral pneumonia. During the acute phase, marked uptake of pyrophosphate was seen in all patients in several muscle groups, but always in the thigh adductors. The results show that phencyclidine intoxication can result in diffuse muscle uptake of Tc-PYP without overt evidence of muscle injury. Tc-PYP imaging may provide a clue to the cause of acute renal failure in patients with suspected rhabdomyolysis in whom elevations of serum creatine phosphokinase concentrations are equivocal

Cytokines and Biologics in non-infectious autoimmune uveitis: Bench to Bedside

Directory of Open Access Journals (Sweden)

Rupesh Agrawal

2014-01-01

Full Text Available Intraocular inflammatory eye disease is one of the important causes of ocular morbidity. Even though the prevalence of uveitis is less common in relation to diabetic retinopathy, glaucoma or age related macular degeneration, the complexity and heterogeneity of the disease makes it more unique. Putative uveitogenic retinal antigens incite innate immunity by the process of antigen mimicry and have been shown to be associated in patients with intraocular inflammatory disease by numerous experimental studies. Laboratory diagnostic tools to aid the etiologic association in intraocular inflammatory disease have evolved over the last two decades and we are entering into an era of molecular diagnostic tests. Sophisticated novel technologies such as multiplex bead assays to assess biological signatures have revolutionized the management of complex refractory uveitis. Nevertheless, there is still a long way to go to establish the causal relationship between these biomarkers and specific uveitic entities. Experimental studies have shown the supreme role of infliximab in the management of Behcet′s disease. Despite significant experimental and case control studies, the deficiency of randomized clinical trials using these biologic agents has handicapped us in exploring them as a front line therapy in severe refractory uveitis. Studies still need to answer the safety of these potentially life threatening drugs in a selected group of patients and determine when to commence and for how long the treatment has to be given. This review article covers some basic concepts of cytokines in uveitis and their potential application for therapy in refractory uveitis.

RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of skeletal muscle ryanodine receptor dysfunction.

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Voermans, N C; Snoeck, M; Jungbluth, H

2016-10-01

Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are associated with a wide spectrum of inherited myopathies presenting throughout life. Malignant hyperthermia susceptibility (MHS)-related RYR1 mutations have emerged as a common cause of exertional rhabdomyolysis, accounting for up to 30% of rhabdomyolysis episodes in otherwise healthy individuals. Common triggers are exercise and heat and, less frequently, viral infections, alcohol and drugs. Most subjects are normally strong and have no personal or family history of malignant hyperthermia. Heat intolerance and cold-induced muscle stiffness may be a feature. Recognition of this (probably not uncommon) rhabdomyolysis cause is vital for effective counselling, to identify potentially malignant hyperthermia-susceptible individuals and to adapt training regimes. Studies in various animal models provide insights regarding possible pathophysiological mechanisms and offer therapeutic perspectives. Copyright © 2016. Published by Elsevier Masson SAS.

Bedside examination for vestibular screening in occupational medicine

Directory of Open Access Journals (Sweden)

Ewa Zamysłowska-Szmytke

2015-04-01

Full Text Available Objectives: The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG oculomotor tests (central group and 43 subjects with normal VNG. Material and Methods: Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT, Dynamic Visual Acuity (DVA and gaze nystagmus assessment. Results: Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73% had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. Conclusions: The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes.

[Severe rhabdomyolysis syndrome in the course of alcohol withdrawal syndrome and hyponatremia].

Science.gov (United States)

Majewska, Magdalena; Tchórz, Michał; Szponar, Jarosław; Radoniewicz-Chagowska, Anna; Kołodziej, Małgorzata

2012-01-01

Rhabdomyolysis and associated kidney failure is a medical problem, often faced by doctors working in the centers of toxicology. Its most common cause is mechanical damage to the muscles, but predisposing factors include a big group of other pathologies and clinical conditions, including: electrolyte imbalance, immobility, infections, drug or psychoactive substances poisoning. The article presents an example of a patient with severe rhabdomyolysis syndrome caused by an alcohol withdrawal syndrome. Based on our experience and scientific studies of other clinical centres the paper presents various causes of muscle damage, including the iatrogenic effects of ethanol intoxication treatment. The article explains the importance of a proper and quick treatment which prevents damage of internal organs, including kidney failure.

Pathways of translation: deep brain stimulation.

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Gionfriddo, Michael R; Greenberg, Alexandra J; Wahegaonkar, Abhijeet L; Lee, Kendall H

2013-12-01

Electrical stimulation of the brain has a 2000 year history. Deep brain stimulation (DBS), one form of neurostimulation, is a functional neurosurgical approach in which a high-frequency electrical current stimulates targeted brain structures for therapeutic benefit. It is an effective treatment for certain neuropathologic movement disorders and an emerging therapy for psychiatric conditions and epilepsy. Its translational journey did not follow the typical bench-to-bedside path, but rather reversed the process. The shift from ancient and medieval folkloric remedy to accepted medical practice began with independent discoveries about electricity during the 19th century and was fostered by technological advances of the 20th. In this paper, we review that journey and discuss how the quest to expand its applications and improve outcomes is taking DBS from the bedside back to the bench. © 2013 Wiley Periodicals, Inc.

Comparison of bedside inoculation of culture media with ...

African Journals Online (AJOL)

Background: The yield of bacterial cultures from cerebrospinal fluid (CSF) at Kenyatta National Hospital (KNH) is very low. Bedside inoculation of culture media with CSF may improve yields. Objective: To compare the culture yield of CSF inoculated onto culture medium at the bedside to that of CSF inoculated onto culture ...

Acute kidney injury mediated by oxidative stress in Egyptian horses with exertional rhabdomyolysis.

Science.gov (United States)

el-Ashker, Maged R

2011-06-01

The present study was carried out to evaluate the role of oxidative stress in the pathophysiologic process of acute renal failure associated with exertional rhabdomyolysis (ER) in Egyptian horses. ER was tentatively diagnosed in 31 Baladi horses based on case history, physical examination findings and confirmed by elevation of plasma creatine kinase (CK) and urine myoglobin concentrations. According to severity of the condition, the diseased horses were categorized into two main groups; the first group included 18 horses with minimal clinical signs and plasma CK 100 000 IU/L). It was found that plasma creatol (CTL) was positively correlated (p Baladi horses with severe rhabdomyolysis.

Pharmacological Inhibition of Macrophage Toll-like Receptor 4/Nuclear Factor-kappa B Alleviates Rhabdomyolysis-induced Acute Kidney Injury.

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Huang, Rong-Shuang; Zhou, Jiao-Jiao; Feng, Yu-Ying; Shi, Min; Guo, Fan; Gou, Shen-Ju; Salerno, Stephen; Ma, Liang; Fu, Ping

2017-09-20

Acute kidney injury (AKI) is the most common and life-threatening systemic complication of rhabdomyolysis. Inflammation plays an important role in the development of rhabdomyolysis-induced AKI. This study aimed to investigate the kidney model of AKI caused by rhabdomyolysis to verify the role of macrophage Toll-like receptor 4/nuclear factor-kappa B (TLR4/NF-κB) signaling pathway. C57BL/6 mice were injected with a 50% glycerin solution at bilateral back limbs to induce rhabdomyolysis, and CLI-095 or pyrrolidine dithiocarbamate (PDTC) was intraperitoneally injected at 0.5 h before molding. Serum creatinine levels, creatine kinase, the expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6, and hematoxylin and eosin stainings of kidney tissues were tested. The infiltration of macrophage, mRNA levels, and protein expression of TLR4 and NF-κB were investigated by immunofluorescence double-staining techniques, reverse transcriptase-quantitative polymerase chain reaction, and Western blotting, respectively. In vitro, macrophage RAW264.7 was stimulated by ferrous myoglobin; the cytokines, TLR4 and NF-κB expressions were also detected. In an in vivo study, using CLI-095 or PDTC to block TLR4/NF-κB, functional and histologic results showed that the inhibition of TLR4 or NF-κB alleviated glycerol-induced renal damages (P rhabdomyolysis-induced AKI by the regulation of proinflammatory cytokine production and macrophage infiltration.

Rhabdomyolysis. The role of diagnostic and prognostic factors

Science.gov (United States)

Keltz, Eran; Khan, Fahmi Yousef; Mann, Gideon

2013-01-01

Summary Rhabdomyolysis, literally meaning the breakdown of muscle tissue, is a common syndrome with many causes, acquired ones such as exertion, trauma, infections, temperature extremes, drugs, toxins, electrolyte and endocrine abnormalities, and congenital ones such as myopathies and connective tissue disorders. All results in a common pathophysiologic pathway which ends with the dispersing of muscle tissue content into the circulation. Rhabdomyolysis has characteristic clinical, laboratory and radiologic features, but does require a high index of suspicion so that the diagnosis would not be missed. The sensitivity and specificity of the various characteristics, as well as clinical guidelines, are discussed in this paper. The syndrome may present with several complications, e.g. arrhythmias, electrolyte abnormalities, acute renal injury, acidosis, volume depletion, compartment syndrome and disseminated intravascular coagulation. The prognosis is highly variable and depends on the underlying etiologies and complications, but is in general considered as good. The milestone of treatment is vigorous fluid resuscitation. Treatment options, in practice and in research, are discussed in the following pages. PMID:24596694

Translational Antidote Research: A Bedside to Bench Tale

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Jeffrey Brent

2015-03-01

Full Text Available Although antidote development should proceed in an orderly fashion from observation, to experimental and safety studies, to clinical trials, this sequence is not always precisely followed. The development of fomepizole as an antidote for toxic alcohol and glycol poisoning is an example of how this may not be the case. Interest in the development of fomepizole was spurred in the 1960s. Shortly thereafter studies characterized by administration to humans commenced. The potential value of fomepizole as an antidote for methanol poisoning was highlighted by primate experiments. Simultaneously, the utility of fomepizole was shown in an experimental model of ethylene glycol poisoning. Further studies on humans showed effectiveness of fomepizole in the treatment of disulfiram-alcohol reactions and ethylene glycol poisoning. In addition, in primate experiments, the safety of fomepizole was established as the subjects tolerated serum fomepizole concentrations over 150 times higher than therapeutic target levels. Subsequent studies have validated the efficacy of fomepizole in the treatment of ethylene glycol and methanol poisonings. Fomepizole has been found to be associated with fewer complications than the alternative alcohol dehydrogenase inhibitor, ethanol. In serious cases of methanol toxicity, fomepizole has been shown to improve survival compared to that obtained with ethanol.

Intensive Sleep Re-Training: From Bench to Bedside

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Leon Lack

2017-03-01

Full Text Available Intensive sleep re-training is a promising new therapy for chronic insomnia. Therapy is completed over a 24-h period during a state of sleep deprivation. Improvements of sleep and daytime impairments are comparable to the use of stimulus control therapy but with the advantage of a rapid reversal of the insomnia. The initial studies have been laboratory based and not readily accessible to the patient population. However, new smart phone technology, using a behavioral response to external stimuli as a measure of sleep/wake state instead of EEG determination of sleep, has made this new therapy readily available. Technological improvements are still being made allowing the therapy to provide further improvements in the effectiveness of Intensive Sleep Re-training.

Bench-to-bedside translation of dendrimers: Reality or utopia? A concise analysis.

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Mignani, Serge; Rodrigues, João; Tomas, Helena; Roy, René; Shi, Xiangyang; Majoral, Jean-Pierre

2017-11-16

Nanomedicine, which is an application of nanotechnologies in healthcare is developed to improve the treatments and lives of patients suffering from a range of disorders and to increase the successes of drug candidates. Within the nanotechnology universe, the remarkable unique and tunable properties of dendrimers have made them promising tools for diverse biomedical applications such as drug delivery, gene therapy and diagnostic. Up-to-date, very few dendrimers has yet gained regulatory approval for systemic administration, why? In this critical review, we briefly focus on the list of desired basic dendrimer requirements for decision-making purpose by the scientists (go/no-go decision), in early development stages, to become clinical candidates, and to move towards Investigational New Drugs (IND) application submission. In addition, the successful translation between research and clinic should be performed by the implementation of a simple roadmap to jump the 'valley of death' successfully. Copyright © 2017 Elsevier B.V. All rights reserved.

Dashboard systems: implementing pharmacometrics from bench to bedside.

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Mould, Diane R; Upton, Richard N; Wojciechowski, Jessica

2014-09-01

In recent years, there has been increasing interest in the development of medical decision-support tools, including dashboard systems. Dashboard systems are software packages that integrate information and calculations about therapeutics from multiple components into a single interface for use in the clinical environment. Given the high cost of medical care, and the increasing need to demonstrate positive clinical outcomes for reimbursement, dashboard systems may become an important tool for improving patient outcome, improving clinical efficiency and containing healthcare costs. Similarly the costs associated with drug development are also rising. The use of model-based drug development (MBDD) has been proposed as a tool to streamline this process, facilitating the selection of appropriate doses and making informed go/no-go decisions. However, complete implementation of MBDD has not always been successful owing to a variety of factors, including the resources required to provide timely modeling and simulation updates. The application of dashboard systems in drug development reduces the resource requirement and may expedite updating models as new data are collected, allowing modeling results to be available in a timely fashion. In this paper, we present some background information on dashboard systems and propose the use of these systems both in the clinic and during drug development.

[Alpha-melanocyte-stimulating hormone. From bench to bedside].

Science.gov (United States)

Böhm, M; Luger, T A

2010-06-01

Alpha-melanocyte-stimulating hormone (alpha-MSH) is a tridecapeptide that is produced by the skin itself from the precursor proopiomelanocortin. It crucially mediates ultraviolet light-induced tanning after binding to melanocortin-1 receptors (MC-1R) expressed on the surface of epidermal melanocytes. The potent pigment-inducing and also cytoprotective actions of alpha-MSH are the rationale for the performance of first phase II clinical trials with Nle4-D-Phe7-alpha-MSH (NDP-alpha-MSH), a subcutaneously administered synthetic and superpotent alpha-MSH analogue, in patients with photodermatoses such as erythropoietic protoporphyria. Since alpha-MSH has shown promising anti-inflammatory and antifibrotic properties in numerous preclinical studies, it will be most interesting to evaluate these effects in further clinical pilot studies with NDP-alpha-MSH. In addition to alpha-MSH analogues, truncated tripeptides such as KDPT which do not bind to MC-1R but have sustained anti-inflammatory properties are currently emerging as another novel therapeutic strategy in dermatology.

Exertional Rhabdomyolysis in a Collegiate American Football Player After Preventive Cold-Water Immersion: A Case Report

Science.gov (United States)

Kahanov, Leamor; Eberman, Lindsey E.; Wasik, Mitchell; Alvey, Thurman

2012-01-01

Objective: To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive cold-water immersion. Background: A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated post-practice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45–260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal rhabdomyolysis. Treatment: The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). Uniqueness: The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. Conclusions: In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence. PMID:22488291

Severe Rhabdomyolysis Associated with the Cerivastatin-Gemfibrozil Combination Therapy

Science.gov (United States)

Lau, Theodore K.; Leachman, D. Richard; Lufschanowski, Roberto

2001-01-01

Cerivastatin is the new 3rd-generation of the synthetic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, the 1st drugs of choice for treating hypercholesterolemia. A potent inhibitor of HMG-CoA reductase, it possesses a high affinity for liver tissue and decreases plasma low-density lipoprotein cholesterol at microgram doses. Cerivastatin produces reductions in low-density lipoprotein cholesterol of 31.3% and 36.1% at doses of 0.3 and 0.4 mg/day, respectively. It is an uncomplicated agent with regard to its pharmacokinetic profile, low potential for interaction with other drugs, and suitability for use in those with impaired renal function. Most other statins have been implicated in causing rhabdomyolysis, either as mono-therapy or in combination with other agents. We report what to our knowledge is the most profound case yet in the literature of rhabdomyolysis in association with ceriva-statin-gemfibrozil combination therapy, in regard both to the extreme elevation in serum creatinine kinase and to the patient's near-paralytic weakness. PMID:11453128

Advances in cardiovascular fluid mechanics: bench to bedside.

Science.gov (United States)

Dasi, Lakshmi P; Sucosky, Philippe; de Zelicourt, Diane; Sundareswaran, Kartik; Jimenez, Jorge; Yoganathan, Ajit P

2009-04-01

This paper presents recent advances in cardiovascular fluid mechanics that define the current state of the art. These studies include complex multimodal investigations with advanced measurement and simulation techniques. We first discuss the complex flows within the total cavopulmonary connection in Fontan patients. We emphasize the quantification of energy losses by studying the importance of caval offsets as well as the differences among various Fontan surgical protocols. In our studies of the fluid mechanics of prosthetic heart valves, we reveal for the first time the full three-dimensional complexity of flow fields in the vicinity of bileaflet and trileaflet valves and the microscopic hinge flow dynamics. We also present results of these valves functioning in a patient-specific native aorta geometry. Our in vitro mitral valve studies show the complex mechanism of the native mitral valve apparatus. We demonstrate that the different components of the mitral valve have independent and synergistically complex functions that allow the valve to operate efficiently. We also show how valve mechanics change under pathological and repair conditions associated with enlarged ventricles. Finally, our ex vivo studies on the interactions between the aortic valve and its surrounding hemodynamic environment are aimed at providing insights into normal valve function and valve pathology. We describe the development of organ- and tissue-culture systems and the biological response of the tissue subjected to their respective simulated mechanical environment. The studies noted above have enhanced our understanding of the complex fluid mechanics associated with the cardiovascular system and have led to new translational technologies.

Integration of evidence-based practice in bedside teaching paediatrics supported by e-learning.

Science.gov (United States)

Potomkova, Jarmila; Mihal, Vladimir; Zapletalova, Jirina; Subova, Dana

2010-03-01

Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

NARCIS (Netherlands)

Scalco, R.S.; Snoeck, M.; Quinlivan, R.; Treves, S.; Laforet, P.; Jungbluth, H.; Voermans, N.C.

2016-01-01

Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild

New strategies to improve the efficacy of colorectal cancer vaccines: from bench to bedside.

Science.gov (United States)

Mocellin, Simone

2006-12-01

By exploiting a naturally occurring defense system, anticancer vaccination embodies an ideal non-toxic treatment capable of evoking tumor-specific immune responses that can ultimately recognize and kill colorectal cancer (CRC) cells. Despite the enormous theoretical potential of active specific immunotherapy, no vaccination regimen has achieved sufficient therapeutic efficacy necessary for clinical implementation. Nevertheless, several immunological advances have opened new avenues of research to decipher the biological code governing tumor immune responsiveness, and this is leading to the design of potentially more effective immunotherapeutic protocols. This review briefly summarizes the principles behind anti-CRC vaccination and describes the most promising immunological strategies that have been developed, which are expected to renew interest in this molecularly targeted anticancer approach.

Bedside examination for vestibular screening in occupational medicine.

Science.gov (United States)

Zamysłowska-Szmytke, Ewa; Szostek-Rogula, Sylwia; Śliwińska-Kowalska, Mariola

2015-01-01

The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG) oculomotor tests (central group) and 43 subjects with normal VNG. Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT), Dynamic Visual Acuity (DVA) and gaze nystagmus assessment. Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73%) had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report

International Nuclear Information System (INIS)

Lee, Susan C.; Geannette, Christian; Sneag, Darryl B.; Wolfe, Scott W.; Feinberg, Joseph H.

2017-01-01

This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed - and consequently scar tethered - the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy. (orig.)

Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report.

Science.gov (United States)

Lee, Susan C; Geannette, Christian; Wolfe, Scott W; Feinberg, Joseph H; Sneag, Darryl B

2017-08-01

This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed-and consequently scar tethered-the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy.

Establishment of a drug-induced rhabdomyolysis mouse model by co-administration of ciprofloxacin and atorvastatin.

Science.gov (United States)

Matsubara, Akiko; Oda, Shingo; Akai, Sho; Tsuneyama, Koichi; Yokoi, Tsuyoshi

2018-07-01

Rhabdomyolysis is one of the serious side effects of ciprofloxacin (CPFX), a widely used antibacterial drug; and occasionally, acute kidney injury (AKI) occurs. Often, rhabdomyolysis has occurred in patients taking CPFX co-administered with statins. The purpose of this study is to establish a mouse model of drug-induced rhabdomyolysis by co-administration of CPFX and atorvastatin (ATV) and to clarify the mechanisms of its pathogenesis. C57BL/6J mice treated with L-buthionine-(S,R)-sulfoximine (BSO), a glutathione synthesis inhibitor, were orally administered with CPFX and ATV for 4 days. Plasma levels of creatinine phosphokinase (CPK) and aspartate aminotransferase (AST) were significantly increased in the CPFX and ATV-co-administered group. Histopathological examination of skeletal muscle observed degeneration in gastrocnemius muscle and an increased number of the satellite cells. Expressions of skeletal muscle-specific microRNA and mRNA in plasma and skeletal muscle, respectively, were significantly increased. The area under the curve (AUC) of plasma CPFX was significantly increased in the CPFX and ATV-co-administered group. Furthermore, cytoplasmic vacuolization and a positively myoglobin-stained region in kidney tissue and high content of myoglobin in urine were observed. These results indicated that AKI was induced by myoglobin that leaked from skeletal muscle. The established mouse model in the present study would be useful for predicting potential rhabdomyolysis risks in preclinical drug development. Copyright © 2018 Elsevier B.V. All rights reserved.

From the bench to the bedside: emerging new treatments in multiple myeloma

Science.gov (United States)

Mitsiades, Constantine S.; Hayden, Patrick J.; Anderson, Kenneth C.; Richardson, Paul G.

2012-01-01

Within the last decade, several novel classes of anti-myeloma therapeutics have become available. The clinical successes achieved by thalidomide, lenalidomide, and the proteasome inhibitor bortezomib, and in particular the ability of these agents to lead to major clinical responses in patients resistant to conventional or high-dose chemotherapy, have highlighted the importance of expanding even further the spectrum of classes of agents utilized for the treatment of myeloma. Herein, we review the current state of the field of development of novel anti-myeloma agents, with emphasis on classes of therapeutics which have already translated into clinical trials or those in advanced stages of preclinical development. These include second-generation proteasome inhibitors (NPI-0052 and PR-171), heat shock protein 90 (hsp90) inhibitors, 2-methoxyestradiol, histone deacetylase (HDAC) inhibitors (e.g. SAHA, tubacin and LBH589), fibroblast growth factor receptor 3 (FGF-R3) inhibitors, insulin-like growth factor 1 receptor (IGF-1R) inhibitors, mTOR inhibitors, monoclonal antibodies, and agents targeting the tumor microenvironment, including defibrotide. PMID:18070720

[Rhabdomyolysis - may it be a metabolic myopathy? Case report and diagnostic algorithm].

Science.gov (United States)

Sebők, Ágnes; Pál, Endre; Molnár, Gergő Attila; Wittmann, István; Berenténé Bene, Judit; Melegh, Béla; Komoly, Sámuel; Hidvégi, Tibor; Balogh, Lídia; Szabó, Attila; Zsidegh, Petra

2017-11-01

We report the case of a 46-year-old female patient with recurrent rhabdomyolysis. In the background of her metabolic myopathy an inherited metabolic disorder of the fatty acid oxidation, very long-chain acyl-coenzyme A-dehydrogenase deficiency was diagnosed. The diagnosis was based on abnormal acyl-carnitine- and urine organic-acid profile in addition to low residual enzyme activity, and was confirmed by genetic testing. After introduction of dietotherapy metabolic crisis necessitating hospital admission has not occurred neither have fixed myopathic changes developed. We present here the differential diagnosis of rhabdomyolysis and exertional muscle complaints, with the metabolic myopathies in focus. The main features of fatty acid oxidation disorders are highlighted, acute and chronic managements of very long-chain acyl-coenzyme A-dehydrogenase deficiency are discussed. Metabolic myopathies respond well to treatment, so good quality of life can be achieved. However, especially in fatty acid oxidation disorders, a metabolic crisis may develop quickly and can be fatal, albeit rarely. Some of these disorders can be identified by newborn screening, but occasionally the symptoms may manifest only in adulthood. With the presentation of this case we would like to point out that in the differential diagnosis of recurrent rhabdomyolysis inherited metabolic disorders should be considered regardless of the patient's age. Orv Hetil. 2017; 158(46): 1873-1882.

A successfully treated case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis.

Science.gov (United States)

Wang, Yi-Chen; Gao, Li-Chao; Xu, Hui; Qu, Xiao-Zhang; Wang, Ye; Lou, Xiao-Qian; Guo, Hui

2015-05-01

This study aimed to report a rare case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis. Hypopituitarism is a clinical syndrome in which there is a deficiency in hormone production by the pituitary gland. It often leads to hypoglycaemia, but in this case the patient was complicated with hyperosmolar hyperglycaemic state. The patient received prompt medical treatment, which effectively prevented the occurrence of possible acute kidney failure and other complications. This is a complicated and rare case. Our report provides some indications for the timely diagnosis and the standardised treatments for a patient who has hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

High-Intensity Atorvastatin-Induced Rhabdomyolysis in an Elderly Patient With NSTEMI: A Case Report and Review of the Literature.

Science.gov (United States)

Huynh, Glen A; Lee, Audrey J

2017-12-01

A 91-year-old male was admitted to the hospital for worsening muscle weakness, muscle pain, and unexplained soreness for the past 10 days. Four months prior to his admission, the patient had experienced a myocardial infarction and was initiated on atorvastatin 80 mg daily. Although the provider had instructed the patient to decrease the atorvastatin dose to 40 mg daily 3 months prior to admission, the patient did not adhere to the lower dose regimen until 10 days prior to hospitalization. Upon admission, the patient presented with muscle weakness and pain, a serum creatinine phosphokinase of 18 723 U/L, and a serum creatinine of 1.6 mg/dL. The atorvastatin dose was held and the patient was treated with intravenous fluids. The 2013 American College of Cardiology and American Heart Association Blood Cholesterol Practice Guidelines recommend the use of moderate-intensity statins in patients older than 75 years to prevent myopathy. However, in clinical practice, aggressive statin therapy is often prescribed for significant coronary disease. Prescribing high-intensity statins for patients with advanced age, such as this case, may increase the risk of rhabdomyolysis and other complications. This case report suggests that providers should avoid or be cautious with initiating high-intensity atorvastatin in elderly patients over 75 years to minimize the risk of rhabdomyolysis.

MR manifestation of lower extremity rhabdomyolysis caused by crush injury in earthquake

International Nuclear Information System (INIS)

Li Zhengyan; Zou Ling; Song Bin; Liu Chang; Sun Jiayu; Zhang Weiwei; Zhang Cuiping

2008-01-01

Objective: Rhabdomyolysis (RM) is a common disorder resulting from a large variety of causes. Acute injury is one of the main reasons. The purpose is to describe the MRI manifestations of rhabdomyolysis caused by 5.12 Wenchuan earthquake in Sichuan province and to discuss their importance in diagnosis and treatment of rhabdomyolysison in clinic practice. Methods: Three patients with rhabdomyolysis caused by earthquake were studied via 1.5 T MRI. In all the patients, T 1 and T 2 weighted sequences with and without fat suppression, and short time inversion recovery (STIR) of both lower extremities were obtained in axial, coronal and sagittal planes. All patients were given contrast material during imaging, and MRA (magnetic resonance angiography) of both lower extremity vessels were performed. The MRI characteristics of damaged extremities in 3 cases were studied. Results: MRI showed swelling of the affected muscles and subcutaneous fat tissue on both T 1 and T 2 weighted images. The margins of involved muscles were blurred. On T 1 weighted images, swollen muscles showed equal or slightly decreased intensity with small patterns of increased intensity in some local areas. On T 2 weighted and STIR sequences, the affected muscles showed inhomogeneous increased signal intensity with clearer margin. Slight fluid collection in spatium intermusculare was observed. Contrast-enhanced scanning showed nonhomologous intensification of damaged muscles, the enhancement inside the muscles was decreased when compared with normal muscles. The locations of all these abnormal intensity were correlated with the injury history and clinic physical examinations. MRA showed no lower extremity vessels were affected. Conclusion: MRI has very high sensitivity in detecting the injury of muscles. It's very useful in evaluating the extent and severity of muscles affected in rhabdomyolysis caused by trauma. Also it's very valuable to evaluate the condition of blood vessels in involved extremity

Prospective implementation of an algorithm for bedside intravascular ultrasound-guided filter placement in critically ill patients.

Science.gov (United States)

Killingsworth, Christopher D; Taylor, Steven M; Patterson, Mark A; Weinberg, Jordan A; McGwin, Gerald; Melton, Sherry M; Reiff, Donald A; Kerby, Jeffrey D; Rue, Loring W; Jordan, William D; Passman, Marc A

2010-05-01

Although contrast venography is the standard imaging method for inferior vena cava (IVC) filter insertion, intravascular ultrasound (IVUS) imaging is a safe and effective option that allows for bedside filter placement and is especially advantageous for immobilized critically ill patients by limiting resource use, risk of transportation, and cost. This study reviewed the effectiveness of a prospectively implemented algorithm for IVUS-guided IVC filter placement in this high-risk population. Current evidence-based guidelines were used to create a clinical decision algorithm for IVUS-guided IVC filter placement in critically ill patients. After a defined lead-in phase to allow dissemination of techniques, the algorithm was prospectively implemented on January 1, 2008. Data were collected for 1 year using accepted reporting standards and a quality assurance review performed based on intent-to-treat at 6, 12, and 18 months. As defined in the prospectively implemented algorithm, 109 patients met criteria for IVUS-directed bedside IVC filter placement. Technical feasibility was 98.1%. Only 2 patients had inadequate IVUS visualization for bedside filter placement and required subsequent placement in the endovascular suite. Technical success, defined as proper deployment in an infrarenal position, was achieved in 104 of the remaining 107 patients (97.2%). The filter was permanent in 21 (19.6%) and retrievable in 86 (80.3%). The single-puncture technique was used in 101 (94.4%), with additional dual access required in 6 (5.6%). Periprocedural complications were rare but included malpositioning requiring retrieval and repositioning in three patients, filter tilt >/=15 degrees in two, and arteriovenous fistula in one. The 30-day mortality rate for the bedside group was 5.5%, with no filter-related deaths. Successful placement of IVC filters using IVUS-guided imaging at the bedside in critically ill patients can be established through an evidence-based prospectively

Influenza A (H3N2-induced rhabdomyolysis complicating anterior compartment syndrome: Serial changes in muscle MRI T2 fat suppression imaging

Directory of Open Access Journals (Sweden)

Tadanori Hamano

2017-06-01

Conclusions: Muscle MRI T2 fat suppression imaging is a useful method to monitor influenza A induced rhabdomyolysis. We should keep in mind the possibilities of rhabdomyolysis and ACS in patients with influenza A infection presenting serious muscle pain.

Rapid development of anterotibial compartment syndrome and rhabdomyolysis in a patient with primary hypothyroidism and adrenal insufficiency.

Science.gov (United States)

Muir, Paul; Choe, Michelle S; Croxson, Michael S

2012-06-01

Anterior compartment syndrome (ACS) and rhabdomyolysis are rare complications of hypothyroid myopathy. We report the case of a young man with rapid onset of ACS who presented with simultaneous primary hypothyroidism and adrenal insufficiency associated with acute renal failure, hyponatremia, and hyperkalemia. A 22-year-old man presenting with a one-month history of tiredness, hyperpigmentation, and cramps in his calves was found to have severe bilateral foot drop. Investigations revealed severe primary hypothyroidism and adrenal insufficiency, renal failure, and evidence of rhabdomyolysis with myoglobinuria. Abnormal biochemical findings included serum sodium of 110 mM, serum potassium of 6.9 mM, and serum creatine kinase (CK) of >25,000 IU/L. Magnetic resonance imaging (MRI) of his legs showed changes of myonecrosis confined to anterior tibial muscles typical of ACS. After treatment with intravenous fluids, potassium-lowering therapies, thyroxine, and hydrocortisone, his renal and metabolic function returned to normal, but irreversible bilateral foot drop persisted. A young man with primary hypothyroidism, adrenal insufficiency, hyponatremia, and hyperkalemia presented with severe myopathy, such that muscle necrosis, apparently confined to the anterior tibial compartment on MRI, led to rhabdomyolysis, acute renal failure, and irreversible bilateral peroneal nerve damage. It is possible that other patients with primary hypothyroidism and marked elevations of CK without widespread myopathy or rhabdomyolysis may demonstrate evidence of differential muscle effects in the anterior compartment when assessed by MRI, but that this patient also had adrenal insufficiency raises the possibility that this was a contributing factor. Severe thyroid myopathy and rhabdomyolysis may be associated with anatomic susceptibility to ACS, particularly in the presence of concomitant adrenal insufficiency. MRI examination reveals a distinctive appearance of myonecrosis confined to

Rhabdomyolysis and truncular sciatic pain. MRI study of 2 cases; Rhabdomyolyse et sciatique tronculaire. Deux cas etudies en IRM

Energy Technology Data Exchange (ETDEWEB)

Le Friant, G.; Brinquin, L.; Soulie, D.; Sarrazin, J.L.; Cosnard, G.; Cordoliani, Y.S. [Hopital des Armees du Val-de-Grace, 75 - Paris (France)

1995-02-01

We report two cases of acute rhabdomyolysis in pelvic girdle muscles with sciatic palsy secondary to compression of the sciatic nerve trunk, with clinical and MRI correlation. The diagnosis of rhabdomyolysis is based on clinical and biological data, but diagnosis of compression complications secondary to swelling of the muscles, especially the compression of nerve trunk, is done by imaging. T2 weighted images give a definite anatomical evaluation. They show enlarged high signal intensity muscles and anatomic relationship with the sciatic nerve from its emergence out of pelvis, giving a good correlation between rhabdomyolysis and the compressed nervous trunk. It helps for planning a possible surgical fasciotomy. However, MRI provides only morphological informations, but not differentiates edema from necrosis in involved muscles. (authors). 7 refs., 2 figs.

Exertional rhabdomyolysis in a collegiate american football player after preventive cold-water immersion: a case report.

Science.gov (United States)

Kahanov, Leamor; Eberman, Lindsey E; Wasik, Mitchell; Alvey, Thurman

2012-01-01

To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion. A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence.

Peer-assisted bedside teaching rounds.

Science.gov (United States)

Doumouras, Aristithes; Rush, Raphael; Campbell, Anthony; Taylor, David

2015-06-01

Although postgraduate trainees play a well-accepted role in medical education, little consideration has traditionally been given to senior undergraduate trainees as teachers. Recently, research has shown senior medical students (SMS) can play an effective teaching role for junior medical students (JMS) in non-clinical medical settings. The purpose of our study was to understand the perceptions of SMSs as teachers in a clinical environment for JMS. All students who participated in our peer-led bedside teaching programme from September 2010 to May 2012 were invited to complete a questionnaire following their teaching session. Fifty-six of 70 JMS (80%) and 15 of 15 SMS (100%) participated. Survey questions addressed learning, bedside experiences, teacher effectiveness and the overall usefulness of these sessions. The data collected were analysed for significance of the perceptions reported. We found students reported positive and statistically significant results in all domains examined. JMS reported that sessions were highly valuable learning, improved confidence and comfort at the bedside, had excellent teaching and were a valuable addition to their clinical skills training. SMS reported getting highly valuable learning through preparation and developing improved comfort in a teaching role. Little consideration has traditionally been given to senior undergraduate trainees as teachers Our findings demonstrate that peer-directed learning in undergraduate medical education can be effectively implemented in the clinical arena. © 2015 John Wiley & Sons Ltd.

Optimum polygenic profile to resist exertional rhabdomyolysis during a marathon.

Directory of Open Access Journals (Sweden)

Juan Del Coso

Full Text Available Exertional rhabdomyolysis can occur in individuals performing various types of exercise but it is unclear why some individuals develop this condition while others do not. Previous investigations have determined the role of several single nucleotide polymorphisms (SNPs to explain inter-individual variability of serum creatine kinase (CK concentrations after exertional muscle damage. However, there has been no research about the interrelationship among these SNPs. The purpose of this investigation was to analyze seven SNPs that are candidates for explaining individual variations of CK response after a marathon competition (ACE = 287bp Ins/Del, ACTN3 = p.R577X, CKMM = NcoI, IGF2 = C13790G, IL6 = 174G>C, MLCK = C37885A, TNFα = 308G>A.Using Williams and Folland's model, we determined the total genotype score from the accumulated combination of these seven SNPs for marathoners with a low CK response (n = 36; serum CK <400 U·L-1 vs. marathoners with a high CK response (n = 31; serum CK ≥400 U·L-1.At the end of the race, low CK responders had lower serum CK (290±65 vs. 733±405 U·L-1; P<0.01 and myoglobin concentrations (443±328 vs. 1009±971 ng·mL-1, P<0.01 than high CK responders. Although the groups were similar in age, anthropometric characteristics, running experience and training habits, total genotype score was higher in low CK responders than in high CK responders (5.2±1.4 vs. 4.4±1.7 point, P = 0.02.Marathoners with a lower CK response after the race had a more favorable polygenic profile than runners with high serum CK concentrations. This might suggest a significant role of genetic polymorphisms in the levels of exertional muscle damage and rhabdomyolysis. Yet other SNPs, in addition to exercise training, might also play a role in the values of CK after damaging exercise.

Kinematics and kinetics of the bench-press and bench-pull exercises in a strength-trained sporting population.

Science.gov (United States)

Pearson, Simon N; Cronin, John B; Hume, Patria A; Slyfield, David

2009-09-01

Understanding how loading affects power production in resistance training is a key step in identifying the most optimal way of training muscular power - an essential trait in most sporting movements. Twelve elite male sailors with extensive strength-training experience participated in a comparison of kinematics and kinetics from the upper body musculature, with upper body push (bench press) and pull (bench pull) movements performed across loads of 10-100% of one repetition maximum (1RM). 1RM strength and force were shown to be greater in the bench press, while velocity and power outputs were greater for the bench pull across the range of loads. While power output was at a similar level for the two movements at a low load (10% 1RM), significantly greater power outputs were observed for the bench pull in comparison to the bench press with increased load. Power output (Pmax) was maximized at higher relative loads for both mean and peak power in the bench pull (78.6 +/- 5.7% and 70.4 +/- 5.4% of 1RM) compared to the bench press (53.3 +/- 1.7% and 49.7 +/- 4.4% of 1RM). Findings can most likely be attributed to differences in muscle architecture, which may have training implications for these muscles.

An acute episode of rhabdomyolysis associated with everolimus and cabergoline intake in a postpartum kidney recipient

Directory of Open Access Journals (Sweden)

B. I. Yaremin

2017-01-01

Full Text Available Kidney transplantation is one of the most promising ways to ensure the onset and successful maintenance of pregnancy in patients with end-stage chronic renal disease. A multicomponent drug therapy in such patients creates risks for fetal development, primarily due to the teratogenicity of mTOR receptor inhibitors and mycophenolate. Moreover, the inhibitors of the proliferative signal may have potential drug interactions, which can result in additional complications.Rhabdomyolysis is one of them. The paper describes the clinical case of an acute episode of reversible rhabdomyolysis in a patient on everolimus therapy.

Cardiac Limited Ultrasound Examination Techniques to Augment the Bedside Cardiac Physical Examination.

Science.gov (United States)

Kimura, Bruce J; Shaw, David J; Amundson, Stan A; Phan, James N; Blanchard, Daniel G; DeMaria, Anthony N

2015-09-01

The current practice of physical diagnosis is dependent on physician skills and biases, inductive reasoning, and time efficiency. Although the clinical utility of echocardiography is well known, few data exist on how to integrate 2-dimensional screening "quick-look" ultrasound applications into a novel, modernized cardiac physical examination. We discuss the evidence basis behind ultrasound "signs" pertinent to the cardiovascular system and elemental in synthesis of bedside diagnoses and propose the application of a brief cardiac limited ultrasound examination based on these signs. An ultrasound-augmented cardiac physical examination can be taught in traditional medical education and has the potential to improve bedside diagnosis and patient care. © 2015 by the American Institute of Ultrasound in Medicine.

Bench press exercise: the key points.

Science.gov (United States)

Padulo, J; Laffaye, G; Chaouachi, A; Chamari, K

2015-06-01

The bench press exercise (BPE) is receiving increasing interest as a field testing, training/therapeutic modality to improve neuromuscular performance or to increase bone mass density. Several studies have been performed using BPE as a standard for increasing upper-limb strength. For this purpose, the position of the bar, the loads, the sets, the number of repetitions, the recovery time in-between sets, the movement speed, the muscular work and the use of the determination of the one repetition maximum (1-RM) are the classical tools investigated in the literature that have been shown to affect the BPE effect on neuromuscular. The goal of the present short review is to make a picture of the current knowledge on the bench press exercise, which could be very helpful for a better understanding of this standard movement and its effects. Based on the related literature, several recommendations on these key points are presented here.

Elective open bedside tracheostomy in the neurosurgical intensive care unit

Directory of Open Access Journals (Sweden)

Niran Maharjan

2015-09-01

Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11

Rhabdomyolysis with acute tubular necrosis following occupational inhalation of thinners.

Science.gov (United States)

Ngajilo, D; Ehrlich, R

2017-07-01

Thinners are mixtures of organic solvents commonly containing toluene, xylene, acetone, hexane, benzene and methyl isobutyl ketone. This report describes a case of rhabdomyolysis with acute tubular necrosis and renal failure, most likely attributable to toluene, following occupational exposure to thinners while cleaning a steel water tank. These adverse health effects have previously been reported following acute poisoning or intentional inhalation by drug abusers, but rarely in the occupational setting. Poor working conditions, lack of health and safety training and delayed treatment contributed to the onset and severity of the patient's complications. This case emphasizes the need for strict control measures, including adequate ventilation, training on working in confined spaces, appropriate personal protective equipment and emergency rescue procedures in such settings. In addition, rhabdomyolysis, acute tubular necrosis and renal failure should be added to safety data material as possible complications of excessive inhalation of thinners. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Statin-associated rhabdomyolysis triggered by drug-drug interaction with itraconazole

DEFF Research Database (Denmark)

Dybro, Anne Mette; Damkier, Per; Rasmussen, Torsten Bloch

2016-01-01

-associated rhabdomyolysis, probably caused by a drug-drug interaction between simvastatin and itraconazole. The patient made full recovery. Three commonly used statins-simvastatin, atorvastatin and lovastatin-are metabolised by the liver enzyme CYP3A4. Several potent inhibitors of this enzyme are known, for example, azole...

Bedside Ultrasonography: A Useful Tool For Traumatic Pneumothorax

International Nuclear Information System (INIS)

Mumtaz, U.; Zahur, Z.; Chaudhry, M. A.; Warraich, R. A.

2016-01-01

Objective: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax. Study Design: Analytical study. Place and Duration of Study: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015. Methodology: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CT chest was done for confirmation as gold standard. Result: Based on CT findings, sensitivity for ultrasonography and chest radiography was found to be 83.33 percentage and 54.76 percentage, respectively and specificity of 100 percentage for both modalities. Conclusion: Ultrasound can be used as a useful and suitable adjunct to CT in trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk. (author)

Neurology at the bedside

DEFF Research Database (Denmark)

Kondziella, Daniel; Waldemar, Gunhild

, as have new chapters including neurogenetics, neurorehabilitation, neurocritical care and heuristic neurological reasoning. In addition, this second edition now includes more than 100 unique case histories. Neurology at the Bedside, Second Edition is written for neurologists in all stages of training...

Blind bedside insertion of small bowel feeding tubes.

LENUS (Irish Health Repository)

Duggan, SN

2009-12-01

The use of Naso-Jejunal (NJ) feeding is limited by difficulty in feeding tube placement. Patients have traditionally required transfer to Endoscopy or Radiology for insertion of small bowel feeding tubes, with clear resource implications. We hypothesised that the adoption of a simple bedside procedure would be effective and reduce cost. Clinical nutrition and nurse specialist personnel were trained in the 10\\/10\\/10 method of blind bedside NJ insertion.

Bedside teaching with unwell patients: Can it ever be appropriate?

Science.gov (United States)

Jayakumar, Nithish

2017-03-01

Bedside teaching has seen a decline in its popularity since the heady days of Boerhaave and Osler; a number of hurdles have been noted in the literature including time constraints on senior clinicians. While organizing a bedside teaching course for final-year medical students, it was apparent that the availability of suitable patients was also a limiting factor. Often, we would be turned away from patients with physical signs because they were deemed to be too unwell for an examination. However, the benefits to medical students of examining unwell patients with physical signs cannot be underestimated. Identifying the unwell patient, and the associated physical signs relevant to the underlying diagnosis, should be a priority; although simulation is increasingly being used in teaching, it cannot fully replicate the learning experience gained in bedside teaching. As long as the patient is not under duress, bedside teaching with unwell patients should be encouraged.

Translating induced pluripotent stem cells from bench to bedside: application to retinal diseases.

Science.gov (United States)

Cramer, Alona O; MacLaren, Robert E

2013-04-01

Induced pluripotent stem cells (iPSc) are a scientific and medical frontier. Application of reprogrammed somatic cells for clinical trials is in its dawn period; advances in research with animal and human iPSc are paving the way for retinal therapies with the ongoing development of safe animal cell transplantation studies and characterization of patient- specific and disease-specific human iPSc. The retina is an optimal model for investigation of neural regeneration; amongst other advantageous attributes, it is the most accessible part of the CNS for surgery and outcome monitoring. A recent clinical trial showing a degree of visual restoration via a subretinal electronic prosthesis implies that even a severely degenerate retina may have the capacity for repair after cell replacement through potential plasticity of the visual system. Successful differentiation of neural retina from iPSc and the recent generation of an optic cup from human ESc invitro increase the feasibility of generating an expandable and clinically suitable source of cells for human clinical trials. In this review we shall present recent studies that have propelled the field forward and discuss challenges in utilizing iPS cell derived retinal cells as reliable models for clinical therapies and as a source for clinical cell transplantation treatment for patients suffering from genetic retinal disease.

Rhabdomyolysis in Ebola Virus Disease. Results of an Observational Study in a Treatment Center in Guinea.

Science.gov (United States)

Cournac, Jean Marie; Karkowski, Ludovic; Bordes, Julien; Aletti, Marc; Duron, Sandrine; Janvier, Frédéric; Foissaud, Vincent; Savini, Hélène; de Greslan, Thierry; Rousseau, Claire; Billhot, Magali; Gagnon, Nicolas; Mac Nab, Christine; Dubrous, Philippe; Moroge, Sophie; Broto, Helene; Cotte, Jean; Maugey, Nancy; Cordier, Pierre-Yves; Sagui, Emmanuel; Merens, Audrey; Rapp, Christophe; Quentin, Benoit; Granier, Hervé; Carmoi, Thierry; Cellarier, Gilles

2016-01-01

The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Migraine patients consistently show abnormal vestibular bedside tests.

Science.gov (United States)

Maranhão, Eliana Teixeira; Maranhão-Filho, Péricles; Luiz, Ronir Raggio; Vincent, Maurice Borges

2016-01-01

Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. Cross-sectional study including sixty individuals - thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

Using bench press load to predict upper body exercise loads in physically active individuals.

Science.gov (United States)

Wong, Del P; Ngo, Kwan-Lung; Tse, Michael A; Smith, Andrew W

2013-01-01

This study investigated whether loads for assistance exercises of the upper body can be predicted from the loads of the bench press exercise. Twenty-nine physically active collegiate students (age: 22.6 ± 2.5; weight training experience: 2.9 ± 2.1 years; estimated 1RM bench press: 54.31 ± 14.60 kg; 1RM: body weight ratio: 0.80 ± 0.22; BMI: 22.7 ± 2.1 kg·m(-2)) were recruited. The 6RM loads for bench press, barbell bicep curl, overhead dumbbell triceps extension, hammer curl and dumbbell shoulder press were measured. Test-retest reliability for the 5 exercises as determined by Pearson product moment correlation coefficient was very high to nearly perfect (0.82-0.98, p bench press load was significantly correlated with the loads of the 4 assistance exercises (r ranged from 0.80 to 0.93, p bench press load was a significant (R(2) range from 0.64 to 0.86, p Bench press load (0.28) + 6.30 kg, (b) Barbell biceps curl = Bench press load (0.33) + 6.20 kg, (c) Overhead triceps extension = Bench press load (0.33) - 0.60 kg, and (d) Dumbbell shoulder press = Bench press load (0.42) + 5.84 kg. The difference between the actual load and the predicted load using the four equations ranged between 6.52% and 8.54%, such difference was not significant. Fitness professionals can use the 6RM bench press load as a time effective and accurate method to predict training loads for upper body assistance exercises. Key pointsThe bench press load was significantly correlated with the loads of the 4 assistance exercises.No significant differences were found between the actual load and the predicted load in the four equations.6RM bench press load can be a time effective and accurate method to predict training loads for upper body assistance exercises.

Protective effect of coenzyme Q10 in simvastatin and gemfibrozil induced rhabdomyolysis in rats.

Science.gov (United States)

Farswan, Mamta; Rathod, S P; Upaganlawar, A B; Semwal, Arvind

2005-10-01

Administration of simvastatin (80 mg/kg, po. evening dose) and gemfibrozil (600 mg/kg, po twice) for 30 days produced significant decrease in the level of reduced glutathione, superoxide dismutase, catalase and increase in the level of lipid peroxidation and various serum parameters (creatine phosphokinase, lactate dehydrogenase, serum glutamate oxaloacetate transaminase, creatinine, urea and blood urea nitrogen). This suggested involvement of oxidative stress in rhabdomyolysis. Increase in the level of reduced glutathione, superoxide dismutase, catalase and decrease in the level of lipid peroxidation and serum parameters after administration of antioxidant CoQ10 (10 mg/kg.ip) proved the protective effect of CoQ10 in rhabdomyolysis.

Between Bedside and Budget

NARCIS (Netherlands)

J.L.T. Blank; E. Eggink

1998-01-01

Original title: Tussen bed en budget. The report Between bedside and budget (Tussen bed en budget) describes an extensive empirical study of the efficiency of general and university hospitals in the Netherlands. A policy summary recaps the main findings of the study. Those findings

Recreation Sports to host Sixth Annual Bench Press Competition March 17

OpenAIRE

Kropff, Catherine L.

2007-01-01

Music will blare, red and white lights will flash, and fans will cheer at the Sixth Annual Bench Press Competition to be held Saturday, March 17 at Virginia Tech. Participants will go to the bench to show their lifting skills beginning at 10 a.m. in War Memorial Gym.

Migraine patients consistently show abnormal vestibular bedside tests

Directory of Open Access Journals (Sweden)

Eliana Teixeira Maranhão

2015-01-01

Full Text Available Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs.Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls.Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls.Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity.Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

Bedside Ultrasound in the Emergency Department to Detect Hydronephrosis for the Evaluation of Suspected Ureteric Colic.

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Shrestha, R; Shakya, R M; Khan A, A

2016-01-01

Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist's in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the "gold standard" as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients.

Predictors and outcomes of increases in creatine phosphokinase concentrations or rhabdomyolysis risk during statin treatment

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van Staa, Tjeerd P; Carr, Daniel F; O’Meara, Helen; McCann, Gerry; Pirmohamed, Munir

2014-01-01

Aim The aim was to evaluate clinical risk factors associated with myotoxicity in statin users. Methods This was a cohort study of patients prescribed a statin in UK primary care practices contributing to the Clinical Practice Research Datalink. Outcomes of interest were creatine phosphokinase (CPK) concentrations and clinical records of rhabdomyolysis. Results The cohort comprised 641 703 statin users. Simvastatin was most frequently prescribed (66.3%), followed by atorvastatin (24.4%). CPK was measured in 127 209 patients: 81.4% within normal range and 0.7% above Rhabdomyolysis was recorded in 59 patients. Patients with concomitant prescribing of CYP3A4-interacting drugs had an increased odds ratio (OR) of rhabdomyolysis compared with controls (OR 3.71, 95% CI 1.18, 11.61) and >four times ULN CPK compared with normal CPK (OR 1.28, 95% CI 1.01, 1.60). Rosuvastatin users had higher risk of >four times ULN CPK (OR 1.62, 95% CI 1.22, 2.15) as did patients with larger daily doses of other statin types. A recent clinical record of myalgia was associated with an increased OR of >four times ULN CPK (OR 1.73, 95% CI 1.37, 2.18). In patients who were rechallenged to statins and had repeat CPK measurements after >four times ULN CPK abnormalities, 54.8% of the repeat CPK values were within normal range, 32.1% between one to three times and 13.0% >four times ULN. Conclusions The frequencies of substantive CPK increases and rhabdomyolysis during statin treatment were low, with highest risks seen in those on large daily doses or interacting drugs and on rosuvastatin. CPK measurements appeared to have been done in a haphazard manner and better guidance is needed. PMID:24602118

Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside

International Nuclear Information System (INIS)

Croisille, Pierre; Revel, Didier; Saeed, Maythem

2006-01-01

This review paper presents, in the first part, the different classes of contrast media that are already used or are in development for cardiac magnetic resonance imaging. A classification of the different types of contrast media is proposed based on the distribution of the compounds in the body, their type of relaxivity and their potential affinity to particular molecules. In the second part, the different uses of the extracellular type of T1-enhancing contrast agent for myocardial imaging is covered from the detection of stable coronary artery disease to the detection and characterization of chronic infarction. A particular emphasis is placed on the clinical use of gadolinium-chelates, which are the universally used type of MRI contrast agent in the clinical routine. Both approaches, first-pass magnetic resonance imaging (FP-MRI) as well as delayed-enhanced magnetic resonance imaging (DE-MRI), are covered in the different situations of acute and chronic myocardial infarction. (orig.)

CD163-Macrophages Are Involved in Rhabdomyolysis-Induced Kidney Injury and May Be Detected by MRI with Targeted Gold-Coated Iron Oxide Nanoparticles.

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Rubio-Navarro, Alfonso; Carril, Mónica; Padro, Daniel; Guerrero-Hue, Melanie; Tarín, Carlos; Samaniego, Rafael; Cannata, Pablo; Cano, Ainhoa; Villalobos, Juan Manuel Amaro; Sevillano, Ángel Manuel; Yuste, Claudia; Gutiérrez, Eduardo; Praga, Manuel; Egido, Jesús; Moreno, Juan Antonio

2016-01-01

Macrophages play an important role in rhabdomyolysis-acute kidney injury (AKI), although the molecular mechanisms involved in macrophage differentiation are poorly understood. We analyzed the expression and regulation of CD163, a membrane receptor mainly expressed by anti-inflammatory M2 macrophages, in rhabdomyolysis-AKI and developed targeted probes for its specific detection in vivo by MRI. Intramuscular injection of glycerol in mice promoted an early inflammatory response, with elevated proportion of M1 macrophages, and partial differentiation towards a M2 phenotype in later stages, where increased CD163 expression was observed. Immunohistological studies confirmed the presence of CD163-macrophages in human rhabdomyolysis-AKI. In cultured macrophages, myoglobin upregulated CD163 expression via HO-1/IL-10 axis. Moreover, we developed gold-coated iron oxide nanoparticles vectorized with an anti-CD163 antibody that specifically targeted CD163 in kidneys from glycerol-injected mice, as determined by MRI studies, and confirmed by electron microscopy and immunological analysis. Our findings are the first to demonstrate that CD163 is present in both human and experimental rhabdomyolysis-induced AKI, suggesting an important role of this molecule in this pathological condition. Therefore, the use of probes targeting CD163-macrophages by MRI may provide important information about the cellular composition of renal lesion in rhabdomyolysis.

Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge

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Laporta, Denny P; Burns, Judy; Doig, Chip J

2005-01-01

Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format. The results of the discussion are presented. In situations such as this, the ICU leader should first define the core problem, its complexity, its duration and its potential for reversibility. These factors often reside within workload and staff support issues. Some examples of core problems discussed that are frequently associated with poor retention and recruitment are a lack of a positive team culture, a lack of a favorable ICU image, a lack of good working relationships between staff and disciplines, and a lack of specific supportive resources. Several tools or individuals (typically outside the ICU environment) are available to help determine the core problem. Once the core problem is identified, specific solutions can be developed. Such solutions often require originality and flexibility, and must be planned, with specific short-term, medium-term and long-term goals. The ICU leader will need to develop an implementation strategy for these solutions, in which partners who can assist are identified from within the ICU and from outside the ICU. It is important that the leader communicates to all stakeholders frequently as the process moves forward. PMID:16277732

Addressing challenges of training a new generation of clinician-innovators through an interdisciplinary medical technology design program: Bench-to-Bedside.

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Loftus, Patrick D; Elder, Craig T; D'Ambrosio, Troy; Langell, John T

2015-01-01

Graduate medical education has traditionally focused on training future physicians to be outstanding clinicians with basic and clinical science research skills. This focus has resulted in substantial knowledge gains, but a modest return on investment based on direct improvements in clinical care. In today's shifting healthcare landscape, a number of important challenges must be overcome to not only improve the delivery of healthcare, but to prepare future physicians to think outside the box, focus on and create healthcare innovations, and navigate the complex legal, business and regulatory hurdles of bringing innovation to the bedside. We created an interdisciplinary and experiential medical technology design competition to address these challenges and train medical students interested in moving new and innovative clinical solutions to the forefront of medicine. Medical students were partnered with business, law, design and engineering students to form interdisciplinary teams focused on developing solutions to unmet clinical needs. Over the course of six months teams were provided access to clinical and industry mentors, $500 prototyping funds, development facilities, and non-mandatory didactic lectures in ideation, design, intellectual property, FDA regulatory requirements, prototyping, market analysis, business plan development and capital acquisition. After four years of implementation, the program has supported 396 participants, seen the development of 91 novel medical devices, and launched the formation of 24 new companies. From our perspective, medical education programs that develop innovation training programs and shift incentives from purely traditional basic and clinical science research to also include high-risk innovation will see increased student engagement in improving healthcare delivery and an increase in the quality and quantity of innovative solutions to medical problems being brought to market.

Baking soda pica: a case of hypokalemic metabolic alkalosis and rhabdomyolysis in pregnancy.

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Grotegut, Chad A; Dandolu, Vani; Katari, Sunita; Whiteman, Valerie E; Geifman-Holtzman, Ossie; Teitelman, Melissa

2006-02-01

We report a case of baking soda pica in a woman at 31 weeks of pregnancy causing severe hypokalemic metabolic alkalosis and rhabdomyolysis. A multigravida at 31 weeks of gestation presented with weakness and muscle pain. She was found to have severe hypokalemic metabolic alkalosis and rhabdomyolysis, with elevation in serum transaminases and hypertension. We initially thought the patient had an atypical presentation of preeclampsia until it was realized that she was ingesting 1 full box of baking soda (454 g sodium bicarbonate) per day. Symptoms and abnormal laboratory findings resolved with discontinuation of the patient's pica practices. Pica is a common but often overlooked practice that can potentially lead to life-threatening disorders. A thorough evaluation of a patient's dietary intake is extremely important, especially in the setting of atypical presentations of disease in pregnancy.

Teaching at the Bedside. Maximal Impact in Minimal Time.

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Carlos, William G; Kritek, Patricia A; Clay, Alison S; Luks, Andrew M; Thomson, Carey C

2016-04-01

Academic physicians encounter many demands on their time including patient care, quality and performance requirements, research, and education. In an era when patient volume is prioritized and competition for research funding is intense, there is a risk that medical education will become marginalized. Bedside teaching, a responsibility of academic physicians regardless of professional track, is challenged in particular out of concern that it generates inefficiency, and distractions from direct patient care, and can distort physician-patient relationships. At the same time, the bedside is a powerful location for teaching as learners more easily engage with educational content when they can directly see its practical relevance for patient care. Also, bedside teaching enables patients and family members to engage directly in the educational process. Successful bedside teaching can be aided by consideration of four factors: climate, attention, reasoning, and evaluation. Creating a safe environment for learning and patient care is essential. We recommend that educators set expectations about use of medical jargon and engagement of the patient and family before they enter the patient room with trainees. Keep learners focused by asking relevant questions of all members of the team and by maintaining a collective leadership style. Assess and model clinical reasoning through a hypothesis-driven approach that explores the rationale for clinical decisions. Focused, specific, real-time feedback is essential for the learner to modify behaviors for future patient encounters. Together, these strategies may alleviate challenges associated with bedside teaching and ensure it remains a part of physician practice in academic medicine.

Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside

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Lin, Ming-Feng; Lan, Chung-Yu

2014-01-01

Acinetobacter baumannii (A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrug-resistant A. baumannii (MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections. PMID:25516853

Clinical utility of asthma biomarkers: from bench to bedside

Directory of Open Access Journals (Sweden)

Vijverberg SJH

2013-08-01

Full Text Available Susanne JH Vijverberg,1,2,* Bart Hilvering,2,* Jan AM Raaijmakers,1 Jan-Willem J Lammers,2 Anke-Hilse Maitland-van der Zee,1,* Leo Koenderman2,* 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands; 2Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands *These authors contributed equally to this work Abstract: Asthma is a chronic disease characterized by airway inflammation, bronchial hyperresponsiveness, and recurrent episodes of reversible airway obstruction. The disease is very heterogeneous in onset, course, and response to treatment, and seems to encompass a broad collection of heterogeneous disease subtypes with different underlying pathophysiological mechanisms. There is a strong need for easily interpreted clinical biomarkers to assess the nature and severity of the disease. Currently available biomarkers for clinical practice – for example markers in bronchial lavage, bronchial biopsies, sputum, or fraction of exhaled nitric oxide (FeNO – are limited due to invasiveness or lack of specificity. The assessment of markers in peripheral blood might be a good alternative to study airway inflammation more specifically, compared to FeNO, and in a less invasive manner, compared to bronchoalveolar lavage, biopsies, or sputum induction. In addition, promising novel biomarkers are discovered in the field of breath metabolomics (eg, volatile organic compounds and (pharmacogenomics. Biomarker research in asthma is increasingly shifting from the assessment of the value of single biomarkers to multidimensional approaches in which the clinical value of a combination of various markers is studied. This could eventually lead to the development of a clinically applicable algorithm composed of various markers and clinical features to phenotype asthma and improve diagnosis and asthma management

Possible increased risk of rhabdomyolysis during concomitant use of simvastatin and gemfibrozil

NARCIS (Netherlands)

VanPuijenbroek, EP; DuBufVereijken, PWG; Spooren, PFMJ; VanDoormaal, JJ

1996-01-01

The occurrence of rhabdomyolysis is one of the rare side-effects of the cholesterol-lowering agent simvastatin. During the use of lovastatin, an agent related to simvastatin, the risk of this side-effect might be increased when cyclosporin or gemfibrozil are used concomitantly. It is possible that

CAR-T cell therapy in ovarian cancer: from the bench to the bedside.

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Zhu, Xinxin; Cai, Han; Zhao, Ling; Ning, Li; Lang, Jinghe

2017-09-08

Ovarian cancer (OC) is the most lethal gynecological malignancy and is responsible for most gynecological cancer deaths. Apart from conventional surgery, chemotherapy, and radiotherapy, chimeric antigen receptor-modified T (CAR-T) cells as a representative of adoptive cellular immunotherapy have received considerable attention in the research field of cancer treatment. CARs combine antigen specificity and T-cell-activating properties in a single fusion molecule. Several preclinical experiments and clinical trials have confirmed that adoptive cell immunotherapy using typical CAR-engineered T cells for OC is a promising treatment approach with striking clinical efficacy; moreover, the emerging CAR-Ts targeting various antigens also exert great potential. However, such therapies have side effects and toxicities, such as cytokine-associated and "on-target, off-tumor" toxicities. In this review, we systematically detail and highlight the present knowledge of CAR-Ts including the constructions, vectors, clinical applications, development challenges, and solutions of CAR-T-cell therapy for OC. We hope to provide new insight into OC treatment for the future.

Concise Review: Biomimetic Functionalization of Biomaterials to Stimulate the Endogenous Healing Process of Cartilage and Bone Tissue.

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Taraballi, Francesca; Bauza, Guillermo; McCulloch, Patrick; Harris, Josh; Tasciotti, Ennio

2017-12-01

Musculoskeletal reconstruction is an ongoing challenge for surgeons as it is required for one out of five patients undergoing surgery. In the past three decades, through the close collaboration between clinicians and basic scientists, several regenerative strategies have been proposed. These have emerged from interdisciplinary approaches that bridge tissue engineering with material science, physiology, and cell biology. The paradigm behind tissue engineering is to achieve regeneration and functional recovery using stem cells, bioactive molecules, or supporting materials. Although plenty of preclinical solutions for bone and cartilage have been presented, only a few platforms have been able to move from the bench to the bedside. In this review, we highlight the limitations of musculoskeletal regeneration and summarize the most relevant acellular tissue engineering approaches. We focus on the strategies that could be most effectively translate in clinical practice and reflect on contemporary and cutting-edge regenerative strategies in surgery. Stem Cells Translational Medicine 2017;6:2186-2196. © 2017 The Authors Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

Targeted alpha therapy for melanoma : from bench to bedside

International Nuclear Information System (INIS)

Allen, B.J.; Rizvi, S.M.A.; Li, Y.; Tsui, W.; Douglas, S.; Raja, C.; Graham, P.; Smart, R.; Butler, P.; Kearsley, J.; Thompson, J.

2001-01-01

Full text: The control of metastatic melanoma remains an elusive objective. Targeted alpha therapy (TAT) offers a new approach to the control of micrometastases and regression of tumours. The alpha emitting immunoconjugate (AIC) against malignant melanoma has been prepared by chelating Bi-213 to the anti-melanoma antibody 9.2.27, and injected locally at 2 d post-inoculation of 1.5 million melanoma cells, or intralesionally into skin tumours. Human subjects receive 50μCi intralesional dose, escalating to 1 mCi. The clearances from the tumour, kidneys and bladder are monitored by a NaI detector that detects the 440 keV gamma ray. Blood samples and tumour photographs are taken at O. 2 and 4 weeks; tumours are excised at 4 weeks. Isolated cancer cells and preangiogenic cell clusters in mice can be eliminated with 25 μCi local AIC injection, and intra-lesional injections of 100 μCi are sufficient to completely regress melanomas with volumes up to 300 mm 3 without side-effects. Systemic TAT with a single administration is less effective with 100% growth delay of tumours observed, and ∼20% complete inhibition. The clinical TAT trial for recurrent subcutaneous melanoma has been approved by the NSW Radiation Advisory Committee and the SES Human Ethics Committee. In a world first phase 1 study, the first 5 subjects have been treated by intralesional injection, 3 at 50 μCi, and 2 at 150 μCi. All subjects having unchanged blood profiles at 2 and 4 weeks post-therapy. Tumour volumes appear little changed. However, histology of a 3 cm melanoma shows that almost complete cell kill occurred at 150 μCi, with only a few small cell clusters surviving. Local TAT inhibits tumourogenesis and intralesional TAT completely regresses melanoma in mice. Intralesional TAT for melanoma in human subjects is non-toxic so far and appears to be a promising modality. The ultimate objective is to apply systemic TAT for the control of melanoma micrometastases. Copyright (2001) Australasian

Food addiction and obesity: evidence from bench to bedside.

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Liu, Yijun; von Deneen, Karen M; Kobeissy, Firas H; Gold, Mark S

2010-06-01

Obesity has become a major health problem and epidemic. However, much of the current debate has been fractious and etiologies of obesity have been attributed to eating behavior or fast food, personality issues, depression, addiction, or genetics. One of the interesting new hypotheses for epidemic obesity is food addiction, which is associated with both substance-related disorder and eating disorder. Accumulating evidences have shown that there are many shared neural and hormonal pathways as well as distinct differences that may help researchers find why certain individuals overeat and become obese. Functional neuroimaging studies have further revealed that good or great smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse. Many of the brain changes reported for hedonic eating and obesity are also seen in various forms of addictions. Most importantly, overeating and obesity may have an acquired drive like drug addiction with respect to motivation and incentive; craving, wanting, and liking occur after early and repeated exposures to stimuli. The acquired drive for great food and relative weakness of the satiety signal would cause an imbalance between the drive and hunger/reward centers in the brain and their regulation.

Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis

NARCIS (Netherlands)

Veenstra, J.; Smit, W. M.; Krediet, R. T.; Arisz, L.

1994-01-01

The incidence, causes and complications of severe rhabdomyolysis (creatine phosphokinase (CK) > or = 5000 U/l) were studied during a 7-year study period in a large university hospital population. This condition was present in 0.074% of all admitted patients. The mortality in the study group (n = 93)

Emerging therapies for Parkinson's disease: from bench to bedside.

Science.gov (United States)

Tarazi, F I; Sahli, Z T; Wolny, M; Mousa, S A

2014-11-01

The prevalence of Parkinson's disease (PD) increases with age and is projected to increase in parallel to the rising average age of the population. The disease can have significant health-related, social, and financial implications not only for the patient and the caregiver, but for the health care system as well. While the neuropathology of this neurodegenerative disorder is fairly well understood, its etiology remains a mystery, making it difficult to target therapy. The currently available drugs for treatment provide only symptomatic relief and do not control or prevent disease progression, and as a result patient compliance and satisfaction are low. Several emerging pharmacotherapies for PD are in different stages of clinical development. These therapies include adenosine A2A receptor antagonists, glutamate receptor antagonists, monoamine oxidase inhibitors, anti-apoptotic agents, and antioxidants such as coenzyme Q10, N-acetyl cysteine, and edaravone. Other emerging non-pharmacotherapies include viral vector gene therapy, microRNAs, transglutaminases, RTP801, stem cells and glial derived neurotrophic factor (GDNF). In addition, surgical procedures including deep brain stimulation, pallidotomy, thalamotomy and gamma knife surgery have emerged as alternative interventions for advanced PD patients who have completely utilized standard treatments and still suffer from persistent motor fluctuations. While several of these therapies hold much promise in delaying the onset of the disease and slowing its progression, more pharmacotherapies and surgical interventions need to be investigated in different stages of PD. It is hoped that these emerging therapies and surgical procedures will strengthen our clinical armamentarium for improved treatment of PD. Copyright © 2014 Elsevier Inc. All rights reserved.

A systematic review of surface electromyography analyses of the bench press movement task

Science.gov (United States)

Gołaś, Artur; Blazek, Dusan; Maszczyk, Adam; Wilk, Michał; Pietraszewski, Przemysław; Petr, Miroslav; Uhlir, Petr; Zając, Adam

2017-01-01

Background The bench press exercise (BP) plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The objective of this paper is to systematically review electromyography (EMG) studies performed on the barbell BP exercise to answer the following research questions: Which muscles show the greatest activity during the flat BP? Which changes in muscle activity are related to specific conditions under which the BP movement is performed? Strategy PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library were searched through June 10, 2016. A combination of the following search terms was used: bench press, chest press, board press, test, measure, assessment, dynamometer, kinematics and biomechanics. Only original, full-text articles were considered. Results The search process resulted in 14 relevant studies that were included in the discussion. The triceps brachii (TB) and pectoralis major (PM) muscles were found to have similar activity during the BP, which was significantly higher than the activity of the anterior deltoid. During the BP movement, muscle activity changes with exercise intensity, velocity of movement, fatigue, mental focus, movement phase and stability conditions, such as bar vibration or unstable surfaces. Under these circumstances, TB is the most common object of activity change. Conclusions PM and TB EMG activity is more dominant and shows greater EMG amplitude than anterior deltoid during the BP. There are six factors that can influence muscle activity during the BP; however, the most important factor is exercise intensity, which interacts with all other factors. The research on muscle activity in the BP has several unresolved areas, such as clearly and strongly defined guidelines to perform EMG measurements (e.g., how to elaborate with surface EMG limits) or guidelines for the use of exact muscle models. PMID

A systematic review of surface electromyography analyses of the bench press movement task.

Directory of Open Access Journals (Sweden)

Petr Stastny

Full Text Available The bench press exercise (BP plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The objective of this paper is to systematically review electromyography (EMG studies performed on the barbell BP exercise to answer the following research questions: Which muscles show the greatest activity during the flat BP? Which changes in muscle activity are related to specific conditions under which the BP movement is performed?PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL in the Cochrane Library were searched through June 10, 2016. A combination of the following search terms was used: bench press, chest press, board press, test, measure, assessment, dynamometer, kinematics and biomechanics. Only original, full-text articles were considered.The search process resulted in 14 relevant studies that were included in the discussion. The triceps brachii (TB and pectoralis major (PM muscles were found to have similar activity during the BP, which was significantly higher than the activity of the anterior deltoid. During the BP movement, muscle activity changes with exercise intensity, velocity of movement, fatigue, mental focus, movement phase and stability conditions, such as bar vibration or unstable surfaces. Under these circumstances, TB is the most common object of activity change.PM and TB EMG activity is more dominant and shows greater EMG amplitude than anterior deltoid during the BP. There are six factors that can influence muscle activity during the BP; however, the most important factor is exercise intensity, which interacts with all other factors. The research on muscle activity in the BP has several unresolved areas, such as clearly and strongly defined guidelines to perform EMG measurements (e.g., how to elaborate with surface EMG limits or guidelines for the use of exact muscle models.

A systematic review of surface electromyography analyses of the bench press movement task.

Science.gov (United States)

Stastny, Petr; Gołaś, Artur; Blazek, Dusan; Maszczyk, Adam; Wilk, Michał; Pietraszewski, Przemysław; Petr, Miroslav; Uhlir, Petr; Zając, Adam

2017-01-01

The bench press exercise (BP) plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The objective of this paper is to systematically review electromyography (EMG) studies performed on the barbell BP exercise to answer the following research questions: Which muscles show the greatest activity during the flat BP? Which changes in muscle activity are related to specific conditions under which the BP movement is performed? PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library were searched through June 10, 2016. A combination of the following search terms was used: bench press, chest press, board press, test, measure, assessment, dynamometer, kinematics and biomechanics. Only original, full-text articles were considered. The search process resulted in 14 relevant studies that were included in the discussion. The triceps brachii (TB) and pectoralis major (PM) muscles were found to have similar activity during the BP, which was significantly higher than the activity of the anterior deltoid. During the BP movement, muscle activity changes with exercise intensity, velocity of movement, fatigue, mental focus, movement phase and stability conditions, such as bar vibration or unstable surfaces. Under these circumstances, TB is the most common object of activity change. PM and TB EMG activity is more dominant and shows greater EMG amplitude than anterior deltoid during the BP. There are six factors that can influence muscle activity during the BP; however, the most important factor is exercise intensity, which interacts with all other factors. The research on muscle activity in the BP has several unresolved areas, such as clearly and strongly defined guidelines to perform EMG measurements (e.g., how to elaborate with surface EMG limits) or guidelines for the use of exact muscle models.

Pregabalin- and azithromycin-induced rhabdomyolysis with purpura: An unrecognized interaction: A case report

Directory of Open Access Journals (Sweden)

Kazuya Kato, MD

2016-01-01

Conclusion: We report an extremely rare case of rhabdomyolysis with purpura caused by a drug interaction between pregabalin and azithromycin. However, the mechanisms of the interactions between azithromycin on the pregabalin are still unknown.

From Bench to Bedside: Translating the Prolactin/Vasoinhibin Axis

Directory of Open Access Journals (Sweden)

Jakob Triebel

2017-12-01

Full Text Available The prolactin/vasoinhibin axis defines an endocrine system, in which prolactin (PRL and vasoinhibins regulate blood vessel growth and function, the secretion of other hormones, inflammatory and immune processes, coagulation, and behavior. The core element of the PRL/vasoinhibin axis is the generation of vasoinhibins, which consists in the proteolytic cleavage of their precursor molecule PRL. Vasoinhibins can interact with multiple different partners to mediate their effects in various tissues and anatomical compartments, indicating their pleiotropic nature. Based on accumulating knowledge about the PRL/vasoinhibin axis, two clinical trials were initiated, in which vasoinhibin levels are the target of therapeutic interventions. One trial investigates the effect of levosulpiride, a selective dopamine D2-receptor antagonist, on retinal alterations in patients with diabetic macular edema and retinopathy. The rationale of this trial is that the levosulpiride-induced hyperprolactinemia resulting in increased retinal vasoinhibins could lead to beneficiary outcomes in terms of a vasoinhibin-mediated antagonization of diabetes-induced retinal alterations. Another trial investigated the effect of bromocriptine, a dopamine D2-receptor agonist, for the treatment of peripartum cardiomyopathy. The rationale of treatment with bromocriptine is the inhibition of vasoinhibin generation by substrate depletion to prevent detrimental effects on the myocardial microvascularization. The trial demonstrated that bromocriptine treatment was associated with a high rate of left ventricular recovery and low morbidity and mortality. Therapeutic interventions into the PRL/vasoinhibin axis bear the risk of side effects in the areas of blood coagulation, blood pressure, and alterations of the mental state.

Comparison of concentric and eccentric bench press repetitions to failure.

Science.gov (United States)

Kelly, Stephen B; Brown, Lee E; Hooker, Steven P; Swan, Pamela D; Buman, Matthew P; Alvar, Brent A; Black, Laurie E

2015-04-01

Eccentric muscle actions (ECC) are characterized by muscle lengthening, despite actin-myosin crossbridge formation. Muscles acting eccentrically are capable of producing higher levels of force compared with muscles acting concentrically. The purpose of this study was to determine whether ECC bench press yields greater strength than concentric (CON) as determined by 1 repetition maximum (1RM). Additionally, a comparison was made examining differences in the number of repetitions to failure at different relative intensities of 1RM. Thirty healthy men (age = 24.63 ± 5.6 years) were tested for 1RM in CON and ECC bench press and the number of repetitions completed at 60, 70, 80, and 90% 1RM. For CON repetitions, the weight was mechanically lowered to the chest, and the participant pressed it up until the elbows were fully extended. The ECC bench press consisted of lowering a barbell from a fully extended elbow position to the chest in a continuous controlled manner for 3 seconds as determined by electronic metronome. Paired t-tests showed that ECC 1RM (115.99 ± 31.08 kg) was significantly (p ≤ 0.05) greater than CON 1RM (93.56 ± 26.56 kg), and the number of repetitions completed at 90% 1RM was significantly (p ≤ 0.05) greater in ECC (7.67 ± 3.24) as compared with CON (4.57 ± 2.21). There were no significant differences in number of completed repetitions during CON and ECC bench press at 60, 70, and 80% 1RM. These data indicate that ECC actions yield increased force capabilities (∼120%) as compared with CON in the bench press and may be less prone to fatigue, especially at higher intensities. These differences suggest a need to develop unique strategies for training eccentrically.

Severe rhabdomyolysis after excessive bodybuilding.

Science.gov (United States)

Finsterer, J; Zuntner, G; Fuchs, M; Weinberger, A

2007-12-01

A 46-year-old male subject performed excessive physical exertion during 4-6 h in a studio for body builders during 5 days. He was not practicing sport prior to this training and denied the use of any aiding substances. Despite muscle aching already after 1 day, he continued the exercises. After the last day, he recognized tiredness and cessation of urine production. Two days after discontinuation of the training, a Herpes simplex infection occurred. Because of acute renal failure, he required hemodialysis. There were absent tendon reflexes and creatine kinase (CK) values up to 208 274 U/L (normal: <170 U/L). After 2 weeks, CK had almost normalized and, after 4 weeks, hemodialysis was discontinued. Excessive muscle training may result in severe, hemodialysis-dependent rhabdomyolysis. Triggering factors may be prior low fitness level, viral infection, or subclinical metabolic myopathy.

Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Susan C.; Geannette, Christian; Sneag, Darryl B. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Wolfe, Scott W. [Hospital for Special Surgery, Hand and Upper Extremity, Department of Orthopedics, New York, NY (United States); Feinberg, Joseph H. [Hospital for Special Surgery, Physical Medicine and Rehabilitation, New York, NY (United States)

2017-08-15

This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed - and consequently scar tethered - the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy. (orig.)

Isolated Rhabdomyolysis of the Infraspinatus Muscle Following the CrossFit "Sissy Test": A Report of Two Cases.

Science.gov (United States)

Routman, Howard D; Triplet, Jacob J; Kurowicki, Jennifer; Singh, Neil

2018-01-01

Following the completion of a CrossFit-style challenge (the "Sissy Test"), 2 patients presented with severe pain and swelling over the posterior aspect of the scapula. Magnetic resonance imaging demonstrated isolated edema of the infraspinatus muscle in both patients; the compartments were compressible. Neurovascular checks and observation of range of motion were performed. The patients were treated nonoperatively and were discharged with the diagnosis of overuse syndrome with rhabdomyolysis of the infraspinatus muscle. With marked increase in the popularity of extreme fitness, monitoring for rhabdomyolysis and potential renal dysfunction is essential.

Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department.

Science.gov (United States)

Testa, Americo; Francesconi, Andrea; Giannuzzi, Rosangela; Berardi, Silvia; Sbraccia, Paolo

2015-12-01

The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets

Measurement of irradiation doses secondary to bedside radiographs in a medical intensive care unit

Energy Technology Data Exchange (ETDEWEB)

Boles, J M; Boussert, F; Manens, J P; Le Cam, B; Bellet, M; Garre, M

1987-01-01

The authors prospectively studied the radiation doses to radio-sensitive organs secondary to bedside radiographs in intensive care patients and in a control phantom. Dosimeters were taped on different organs during each bedside X-ray. The mean radiation doses, expressed in 10(-5) Gy (m-rad), for an ''average patient'' who was hospitalized 9 days and had 6 chest X-rays were respectively: 292 to the sternal bone marrow; 239 to the thyroid gland; 3 to the testes; 1 to the ovaries; 605 to the eye for 2 maxillary sinus X-rays. No diffused irradiation was measured during a 2-month period in the intensive care unit nor on dosimeters worn by four nurses.

Wide Spectrum of Traumatic Rhabdomyolysis in Earthquake Victims

Directory of Open Access Journals (Sweden)

Shahnaz Atabak

2009-12-01

Full Text Available In the natural disasters such as earthquake, based on severity of trauma, time under the rubble and quality/quantity of hydratation we will confront with a spectrum of traumatic rhabdomyolysis. In present study we evaluate victims of Bam earthquake to show different stage of muscle trauma, from minor trauma with almost normal level of muscle enzyme to those with moderate trauma leading to crush injury and finally to advanced crush syndrome. Questionnaire consisted of clinical, biochemical and demographic items was designed and completed by our research team retrospectively. We divided the patients to crush and non-crush and also crush injury and crush syndrome, and then compared aforementioned items between them. Clinical and laboratory data of 2962 hospitalized victims, with an average age of 28.4(SD14.2 years (range 1-90 were collected (40% female. 611 patients were affected with crush injury (20%. These were entrapped 2.2 hours longer than the others (P<0.001. Mean IV intake in first 5 days was 3.6(SD2.6 liters for these patients in compare with 2.5(SD1.4 liters for others (P<0.001. 200 cases showed complete feature of crush syndrome. Electrolyte imbalance and systemic complications were drastically increased in the worst patients with crush syndrome. In approach to crushed patients of natural disasters by attention to the wide spectrum of muscle damage and systemic problems, the stepwise management protocol based on severity of traumatic rhabdomyolysis is inevitable and warranted.

Effects of Early Acute Care on Autonomic Outcomes in SCI: Bedside to Bench and Back

Science.gov (United States)

2017-12-01

the current recommendations for acute SCI.15 Earlier in the course of this patient population, high-dose methylprednisolone was used at the discretion ...Principal component analysis: a review and recent developments. Philos Trans A Math Phys Eng Sci 2016;374: 20150202 CrossRef Medline 33. Linting M...grade 3 injury with super- imposed discrete foci of intramedullary T2 hypointensity attributed to the presence of macroscopic intramedullary

A thermolabile aldolase A mutant causes fever-induced recurrent rhabdomyolysis without hemolytic anemia.

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Asmaa Mamoune

2014-11-01

Full Text Available Aldolase A deficiency has been reported as a rare cause of hemolytic anemia occasionally associated with myopathy. We identified a deleterious homozygous mutation in the ALDOA gene in 3 siblings with episodic rhabdomyolysis without hemolytic anemia. Myoglobinuria was always triggered by febrile illnesses. We show that the underlying mechanism involves an exacerbation of aldolase A deficiency at high temperatures that affected myoblasts but not erythrocytes. The aldolase A deficiency was rescued by arginine supplementation in vitro but not by glycerol, betaine or benzylhydantoin, three other known chaperones, suggesting that arginine-mediated rescue operated by a mechanism other than protein chaperoning. Lipid droplets accumulated in patient myoblasts relative to control and this was increased by cytokines, and reduced by dexamethasone. Our results expand the clinical spectrum of aldolase A deficiency to isolated temperature-dependent rhabdomyolysis, and suggest that thermolability may be tissue specific. We also propose a treatment for this severe disease.

Lp25 membrane protein from pathogenic Leptospira spp. is associated with rhabdomyolysis and oliguric acute kidney injury in a guinea pig model of leptospirosis.

Science.gov (United States)

Abreu, Patrícia A E; Seguro, Antonio C; Canale, Daniele; Silva, Ana Maria G da; Matos, Larissa do R B; Gotti, Tatiane B; Monaris, Denize; Jesus, Denise A de; Vasconcellos, Sílvio A; de Brito, Thales; B Magaldi, Antonio J

2017-05-01

Acute kidney injury (AKI) from leptospirosis is frequently nonoliguric with hypo- or normokalemia. Higher serum potassium levels are observed in non-survivor patients and may have been caused by more severe AKI, metabolic disarrangement, or rhabdomyolysis. An association between the creatine phosphokinase (CPK) level and maximum serum creatinine level has been observed in these patients, which suggests that rhabdomyolysis contributes to severe AKI and hyperkalemia. LipL32 and Lp25 are conserved proteins in pathogenic strains of Leptospira spp., but these proteins have no known function. This study evaluated the effect of these proteins on renal function in guinea pigs. Lp25 is an outer membrane protein that appears responsible for the development of oliguric AKI associated with hyperkalemia induced by rhabdomyolysis (e.g., elevated CPK, uric acid and serum phosphate). This study is the first characterization of a leptospiral outer membrane protein that is associated with severe manifestations of leptospirosis. Therapeutic methods to attenuate this protein and inhibit rhabdomyolysis-induced AKI could protect animals and patients from severe forms of this disease and decrease mortality.

Rhabdomyolysis associated with human parvovirus B19 infection in a patient with Fukuyama-type congenital muscular dystrophy.

Science.gov (United States)

Ishikawa, Aki; Yoto, Yuko; Ohya, Kazuhiro; Tsugawa, Takeshi; Tsutsumi, Hiroyuki

2014-07-01

Patients with Fukuyama-type congenital muscular dystrophy sometimes experience transient exacerbations of muscle weakness. We took care of a 9-year-old boy with Fukuyama-type congenital muscular dystrophy who presented with acute respiratory failure and decreased exercise ability with marked elevation of serum creatine kinase indicating rhabdomyolysis. At that time, his younger sister suffered from erythema infectiosum. Although he had no particular symptoms, he was tested and proven to have acute human parvovirus B19 infection based on detection of anti-B19 IgM and parvovirus B19 DNA in his serum. His acute rhabdomyolysis was possibly triggered by human parvovirus B19 infection. © The Author(s) 2013.

Performance of Bedside Lung Ultrasound by a Pediatric Resident

DEFF Research Database (Denmark)

Zhan, Chen; Grundtvig, Natalia; Klug, Bent Helmuth

2017-01-01

OBJECTIVES: Recent studies suggest that lung ultrasound is a good, radiation-free alternative to chest radiography in children with pneumonia. We investigated how bedside lung ultrasound performed by a pediatric resident compared with chest radiography in children with suspected pneumonia. METHODS......: This was a prospective study comparing bedside lung ultrasound to chest radiography as the reference standard. Children aged 0 to 15 years with suspected pneumonia at a pediatric emergency department were included and underwent chest radiography and lung ultrasound. A pediatric resident with minimal practical ultrasound...

The clinical application of computed radiography in bedside photography of newborn

International Nuclear Information System (INIS)

Peng Sen; Guo Tianchang

2005-01-01

Objective: To evaluate the computed radiography in bedside photography of newborn, especially in chest radiography. Methods: Bedside CR images were selected in 100 cases randomly. The exposure parameters were optimized using the large latitude of CR. The details of images were post-processed and adjusted using spatial tuning technique. Then CR photography was compared with conventional X-ray photography. Results: The images acquired with CR had good contrast, high definition, and little distortion, in which the condemned image rate was 1%. While in conventional X-ray photography, the unsuccessful imaging rate is 9%. Conclusion: Bedside computed radiography of new-born, especially the chest imaging, is very helpful to improve image quality and positive rate of the diagnosis. (authors)

Rhabdomyolysis and Artifactual Increase in Plasma Bicarbonate Concentration in an Amazon Parrot (Amazona species).

Science.gov (United States)

Leissinger, Mary K; Johnson, James G; Tully, Thomas N; Gaunt, Stephen D

2017-09-01

A 7-year-old male Amazon parrot housed outdoors presented with acute collapse, marked lethargy, and open-mouth breathing. The patient had stiffness of the pectoral muscles, and petechiation and ecchymosis noted around the eyes and beneath the mandible. Laboratory data revealed markedly increased aspartate aminotransferase, creatine kinase, and lactate dehydrogenase activity consistent with rhabdomyolysis, as well as markedly increased plasma bicarbonate concentration. Marked clinical improvement and resolution of laboratory abnormalities occurred with fluid therapy, administration of a nonsteroidal anti-inflammatory medication, and husbandry modifications, including indoor housing and dietary alteration. A spurious increase in bicarbonate measurement as documented in equine and bovine cases of rhabdomyolysis also occurred in this avian patient and must be considered for accurate interpretation of acid-base status in exotic species presenting with consistent clinical signs.

Comparative study of bedside and laboratory measurements of hemoglobin.

Science.gov (United States)

Krenzischek, D A; Tanseco, F V

1996-11-01

The purpose of this study was to examine the effects of variations in technique on measurements of hemoglobin level done at the bedside and to compare these results with laboratory measurements of hemoglobin. In accordance with hospital policy, procedure, and protocol, various techniques were used to obtain samples of capillary and venous blood and of blood from arterial and central venous catheters. Levels of hemoglobin were measured at the bedside and in the laboratory, and the results were compared. The Johns Hopkins Hospital adult postanesthesia care unit. A total of 187 blood samples were obtained from 62 adults who had undergone general surgery. Group I comprised 20 subjects with capillary and venous blood samples. Group II comprised 21 subjects with arterial blood samples. Group III comprised 21 subjects with central venous blood samples. The results showed that the amount of blood to be discarded before obtaining samples of arterial and central venous blood need not be any larger than double the dead space of the catheter, and that shaking the blood sample for 10 seconds was sufficient to mix the sample before measurement of hemoglobin levels. Results of bedside and laboratory measurements of hemoglobin level were comparable. Bedside measurement of hemoglobin increases efficiency in patient care, decreases risk of blood-transmitted infection for staff, and decreases cost to the patient. However, the persons who perform the assay must be responsible in adhering to the standard of practice to minimize errors in the measurements.

Bariatric surgery, a risk factor for rhabdomyolysis.

Science.gov (United States)

García-García, M L; Campillo-Soto, A; Martín-Lorenzo, J G; Torralba-Martínez, J A; Lirón-Ruiz, R; Aguayo-Albasini, J L

2013-11-01

Rhabdomyolysis has been increasingly recognized as a complication of bariatric surgery. We report a case of this complication and its consequences, in a patient who had undergone bariatric surgery, with a very high creatine kinase (CK) concentration, and whose renal function failed. Obesity causes a range of effects on all major organ systems. Knowledge of these effects and issues specific to the intensive care unit care of bariatric patients can help to predict and manage this underestimated complication in this population in which early diagnosis can alter the outcome. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Bench to bedside molecular functional imaging in translational cancer medicine: to image or to imagine?

International Nuclear Information System (INIS)

Mahajan, A.; Goh, V.; Basu, S.; Vaish, R.; Weeks, A.J.; Thakur, M.H.; Cook, G.J.

2015-01-01

Ongoing research on malignant and normal cell biology has substantially enhanced the understanding of the biology of cancer and carcinogenesis. This has led to the development of methods to image the evolution of cancer, target specific biological molecules, and study the anti-tumour effects of novel therapeutic agents. At the same time, there has been a paradigm shift in the field of oncological imaging from purely structural or functional imaging to combined multimodal structure–function approaches that enable the assessment of malignancy from all aspects (including molecular and functional level) in a single examination. The evolving molecular functional imaging using specific molecular targets (especially with combined positron-emission tomography [PET] computed tomography [CT] using 2- [ 18 F]-fluoro-2-deoxy-D-glucose [FDG] and other novel PET tracers) has great potential in translational research, giving specific quantitative information with regard to tumour activity, and has been of pivotal importance in diagnoses and therapy tailoring. Furthermore, molecular functional imaging has taken a key place in the present era of translational cancer research, producing an important tool to study and evolve newer receptor-targeted therapies, gene therapies, and in cancer stem cell research, which could form the basis to translate these agents into clinical practice, popularly termed “theranostics”. Targeted molecular imaging needs to be developed in close association with biotechnology, information technology, and basic translational scientists for its best utility. This article reviews the current role of molecular functional imaging as one of the main pillars of translational research. -- Highlights: •Molecular functional imaging (MFI) gives insight into the tumor biology and intratumoral heterogeneity. •It has potential role in identifying radiomic signatures associated with underlying gene-expression. •Radiomics can be used to create a road map

CAR-T cell therapy in gastrointestinal tumors and hepatic carcinoma: From bench to bedside.

Science.gov (United States)

Zhang, Qi; Zhang, Zimu; Peng, Meiyu; Fu, Shuyu; Xue, Zhenyi; Zhang, Rongxin

2016-01-01

The chimeric antigen receptor (CAR) is a genetically engineered receptor that combines a scFv domain, which specifically recognizes the tumor-specific antigen, with T cell activation domains. CAR-T cell therapies have demonstrated tremendous efficacy against hematologic malignancies in many clinical trials. Recent studies have extended these efforts to the treatment of solid tumors. However, the outcomes of CAR-T cell therapy for solid tumors are not as remarkable as the outcomes have been for hematologic malignancies. A series of hurdles has arisen with respect to CAR-T cell-based immunotherapy, which needs to be overcome to target solid tumors. The major challenge for CAR-T cell therapy in solid tumors is the selection of the appropriate specific antigen to demarcate the tumor from normal tissue. In this review, we discuss the application of CAR-T cells to gastrointestinal and hepatic carcinomas in preclinical and clinical research. Furthermore, we analyze the usefulness of several specific markers in the study of gastrointestinal tumors and hepatic carcinoma.

Visualization of alcohol-induced rhabdomyolysis: a correlative radiotracer, histochemical, and electron-microscopic study

International Nuclear Information System (INIS)

Silberstein, E.B.; Bove, K.E.

1979-01-01

Technetium-99m diphosphonate was used to visualize the extent of alcohol-induced rhabdomyolysis and its resolution. Transient secondary hyperparathyroidism was documented. Histological and biochemical analyses of skeletal muscle obtained at biopsy 6 days postscan and 9 days after the onset of the illness did not show abnormal calcium content

Rhabdomyolysis in Patients with Hemoblastoses during Intensive Chemotherapy

Directory of Open Access Journals (Sweden)

A. V Lyanguzov

2009-01-01

Full Text Available Objective: to define the clinical significance of rhabdomyolysis in patients with hemoblastoses during intensive chemotherapy. Subjects and methods. The study included 63 hematoblastosis patients aged 20 to 71 years (median 42 years who received intensive chemotherapy that was referred as to grade 4 hematological toxicity. Serum myoglobin levels were monitored before and during chemotherapy, in the period of development of myelotoxic agranulocytosis and at the end of the treatment. Along with this, hematological shifts, biochemical parameters, and changes in acid-base and water-electrolytic balances were estimated. The condition was assessed using the APACHE II scale and organ dysfunctions were evaluated by the SOFA scale. The presence or absence of the systemic inflammatory response syndrome (SIRS was determined. Results. The study revealed a 16-fold increase in myoglobin levels along with significant changes in laboratory indices. Myoglobinemia was found to be associated with the incidence of SIRS. The level of myoglobulin directly correlates with the severity of the disease, by using the APACHE II scale, and the degree of the SOFA scale organ dysfunctions. Multivariate analysis was used to define a role of the elevated level of myoglobin as an additional indicator of a poor prognosis. Conclusion. The findings suggest that muscular tissue damage is a manifestation of multiple organ dysfunctions and may be one of the key links of the development of a vicious circle of the pathogenesis of multiple organ failures. The obtained results necessitate the elaboration of measures to prevent or diminish muscular tissue damage in patients with hemoblastoses. Taking into account muscle damages can improve a prognosis when multiple organ failures develop. Key words: myoglobin, rhabdomyolysis, hemoblastoses, systemic inflammation, severity scales, prognosis.

Hypertrophic scars and keloids in surgery: current concepts.

Science.gov (United States)

Song, Colin

2014-09-01

Hypertrophic scars and keloids remain a challenge in surgery. We appreciate that our understanding of the process at cellular and molecular level, profound as it is, when it comes to the clinical evidence much is left to be desired. Although the bench to bedside conundrum remains, the science of translational research calls for an even higher level of cooperation between the scientist and the clinician for the impetus to succeed.The clinicians alerted us to the possible theories in the pathogenesis of keloid formation, inter alia, the ischemia theory, mast cell theory, immune theory, transforming growth factor β interaction, mechanical theory, and the melanocyte stimulating hormone theory. All of the above presupposed a stimulus that would result in an uncontrolled upregulation of collagen and extracellular matrix expression in the pathogenesis of the keloid. This bedside to bench initiative, as in true science, realized more ponderables than possibilities.By the same token, research into the epidermal-mesenchymal signaling, molecular biology, genomics, and stem cell research holds much promise in the bench top arena. To assess efficacy, many scar assessment scores exist in the literature. The clinical measurement of scar maturity can aid in determining end points for therapeutics. Tissue oxygen tension and color assessment of scars by standardized photography proved to be useful.In surgery, the use of dermal substitutes holds some promise as we surmise that quality scars that arise from dermal elements, molecular and enzyme behavior, and balance. Although a systematic review shows some benefit for earlier closure and healing of wounds, no such review exists at this point in time for the use of dermal substitutes in scars.Adipose-derived stem cell, as it pertains to scars, will hopefully realize the potential of skin regeneration rather than by repair in which we are familiar with as well as the undesirable scarring as a result of healing through the inflammatory

Astrophysics on the Lab Bench

Science.gov (United States)

Hughes, Stephen W.

2010-01-01

In this article some basic laboratory bench experiments are described that are useful for teaching high school students some of the basic principles of stellar astrophysics. For example, in one experiment, students slam a plastic water-filled bottle down onto a bench, ejecting water towards the ceiling, illustrating the physics associated with a…

Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside.

Science.gov (United States)

Kimura, Bruce J

2017-07-01

The development of hand-carried, battery-powered ultrasound devices has created a new practice in ultrasound diagnostic imaging, called 'point-of-care' ultrasound (POCUS). Capitalising on device portability, POCUS is marked by brief and limited ultrasound imaging performed by the physician at the bedside to increase diagnostic accuracy and expediency. The natural evolution of POCUS techniques in general medicine, particularly with pocket-sized devices, may be in the development of a basic ultrasound examination similar to the use of the binaural stethoscope. This paper will specifically review how POCUS improves the limited sensitivity of the current practice of traditional cardiac physical examination by both cardiologists and non-cardiologists. Signs of left ventricular systolic dysfunction, left atrial enlargement, lung congestion and elevated central venous pressures are often missed by physical techniques but can be easily detected by POCUS and have prognostic and treatment implications. Creating a general set of repetitive imaging skills for these entities for application on all patients during routine examination will standardise and reduce heterogeneity in cardiac bedside ultrasound applications, simplify teaching curricula, enhance learning and recollection, and unify competency thresholds and practice. The addition of POCUS to standard physical examination techniques in cardiovascular medicine will result in an ultrasound-augmented cardiac physical examination that reaffirms the value of bedside diagnosis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

Directory of Open Access Journals (Sweden)

Jaspinder Kaur

2016-01-01

Full Text Available Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH, neuroleptic malignant syndrome (NMS, and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone.

TACLeBench: A benchmark collection to support worst-case execution time research

DEFF Research Database (Denmark)

Falk, Heiko; Altmeyer, Sebastian; Hellinckx, Peter

2016-01-01

-source programs, adapted them to a common coding style, and provide the collection in open-source. The benchmark collection is called TACLeBench and is available from GitHub in version 1.9 at the publication date of this paper. One of the main features of TACLeBench is that all programs are self-contained without...... any dependencies on standard libraries or an operating system....

Nontraumatic Exertional Rhabdomyolysis Leading to Acute Kidney Injury in a Sickle Trait Positive Individual on Renal Biopsy

Directory of Open Access Journals (Sweden)

Kalyana C. Janga

2018-01-01

Full Text Available A 26-year-old African American male with a history of congenital cerebral palsy, sickle cell trait, and intellectual disability presented with abdominal pain that started four hours prior to the hospital visit. The patient denied fever, chills, diarrhea, or any localized trauma. The patient was at a party at his community center last evening and danced for 2 hours, physically exerting himself more than usual. Labs revealed blood urea nitrogen (BUN level of 41 mg/dL and creatinine (Cr of 2.8 mg/dL which later increased to 4.2 mg/dL while still in the emergency room. Urinalysis revealed hematuria with RBC > 50 on high power field. Imaging of the abdomen revealed no acute findings for abdominal pain. With fractional excretion of sodium (FeNa > 3%, findings suggested nonoliguric acute tubular necrosis. Over the next couple of days, symptoms of dyspepsia resolved; however, BUN/Cr continued to rise to a maximum of 122/14 mg/dL. With these findings, along with stable electrolytes, urine output matching the intake, and prior use of proton pump inhibitors, medical decision was altered for the possibility of acute interstitial nephritis. Steroids were subsequently started and biopsy was taken. Biopsy revealed heavy deposits of myoglobin. Creatinine phosphokinase (CPK levels drawn ten days later after the admission were found to be elevated at 334 U/dl, presuming the levels would have been much higher during admission. This favored a diagnosis of acute kidney injury (AKI secondary to exertional rhabdomyolysis. We here describe a case of nontraumatic exertional rhabdomyolysis in a sickle cell trait (SCT individual that was missed due to findings of microscopic hematuria masking underlying myoglobinuria and fractional excretion of sodium > 3%. As opposed to other causes of ATN, rhabdomyolysis often causes FeNa < 1%. The elevated fractional excretion of sodium in this patient was possibly due to the underlying inability of SCT positive individuals

Rhabdomyolysis associated with polydipsia induced hyponatraemia.

LENUS (Irish Health Repository)

Bennett, Michael

2011-01-01

A 41-year-old white male with a history of alcoholism and depression was brought from prison into the emergency department (ED) after having had a witnessed tonic-clonic seizure lasting approximately 5 min. During the 24 h prior to admission, the patient\\'s cell mate reported that he was restless and had consumed 11 litres of water. The patient had also been taking regular escitalopram for his depression. On arrival to the ED, the patient was found to have a sodium level of 112 mmol\\/l. After correction of his hyponatraemia the patient developed rhabdomyolisis with a creatine kinase level of 65 064 IU\\/l. To prevent an acute kidney injury a high volume alkaline diuresis protocol was started. Once corrected, his sodium level remained normal and he was discharged home after making a full neurological recovery. Rhabdomyolysis has rarely been associated with the correction of hyponatraemia.

Arsenic trioxide induced rhabdomyolysis, a rare but severe side effect, in an APL patient: a case report.

Science.gov (United States)

He, Haiyan; An, Ran; Hou, Jian; Fu, Weijun

2017-06-01

Arsenic trioxide (ATO), a component of the traditional Chinese medicine arsenic sublimate, promotes apoptosis and induces leukemic cell differentiation. Combined with all-trans-retinotic acid (ATRA), ATO has become the first-line induction therapy in treating acute promyelocytic leukemia (APL). The most common side effects of ATO include hepatotoxicity, gastrointestinal symptoms, water-sodium retention, and nervous system damage. In this report, we present a rare side effect, rhabdomyolysis, in a 68-year-old female APL patient who was treated with ATO. After taking 10 mg ATO daily for 6 days, she presented shortness of breath, myodynia, elevated creatine kinase, and acute renal insufficiency. This report describes the first case of ATO-induced rhabdomyolysis.

Combined statin-fibrate therapy-induced rhabdomyolysis: Case report

Directory of Open Access Journals (Sweden)

Jozić Tanja L.

2014-01-01

Full Text Available Introduction Rhabdomyolysis is a rare, but serious and potentially fatal adverse reaction of the statin application that may be developed in any time of therapy. It is characterized by massive destruction of muscles associated with the large increase of creatine kinase (CK leading to myoglobinuria and potential acute renal failure. Combined statin-fibrate therapy increases the risk of rhabdomyolysis, especially in elderly and diabetic patients. Case report An 81-year-old male was admitted to Coronary Care Unit of the Emergency Center, Clinical Center of Serbia (CCS with the clinical picture and electrocardiogram of the acute anterior wall myocardial infarction complicated with pulmonary edema. Laboratory tests on admission showed higher elevated values of serum creatinine 179 μmol/L and BUN 9.2 mmol/L (eGFR 32 mL/min/1.73m2, CK 309 U/L (on day 2: 3476 U/L and mixed hyperlipidemia (total cholesterol 10.3 mmol/L, HDL 2.26 mmol/L, TG 4.85 mmol/L. The patient was treated with thrombolysis medication therapy (Alteplase, anticoagulant and dual antiplatelet therapy, diuretics, organic nitrates, angiotensin-converting enzyme (ACE inhibitors, antibiotics, and proton pump inhibitors. During seven days, his therapy included combined pravastatin 20 mg and fenofibrate (160 mg, which was discontinued due to pains and weakness of muscles and significantly elevated CC to 7080 U/L (upper limit 200 U/L, but no significant deterioration of renal function was observed. Discontinuation of therapy resulted in CC level normalization and improvement of clinical condition. Conclusion Combined statin and fibrate therapy requires strict clinical control and monitoring of CK i transaminases. Four-time or higher increase of CK requires discontinuation of therapy. In addition, patients are advised to report immediately any pains in muscles, sensibility, weakness or cramps.

Evaluating genomic tests from bench to bedside: a practical framework

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Lin Jennifer S

2012-10-01

Full Text Available Abstract The development of genomic tests is one of the most significant technological advances in medical testing in recent decades. As these tests become increasingly available, so does the need for a pragmatic framework to evaluate the evidence base and evidence gaps in order to facilitate informed decision-making. In this article we describe such a framework that can provide a common language and benchmarks for different stakeholders of genomic testing. Each stakeholder can use this framework to specify their respective thresholds for decision-making, depending on their perspective and particular needs. This framework is applicable across a broad range of test applications and can be helpful in the application and communication of a regulatory science for genomic testing. Our framework builds upon existing work and incorporates principles familiar to researchers involved in medical testing (both diagnostic and prognostic generally, as well as those involved in genomic testing. This framework is organized around six phases in the development of genomic tests beginning with marker identification and ending with population impact, and highlights the important knowledge gaps that need to be filled in establishing the clinical relevance of a test. Our framework focuses on the clinical appropriateness of the four main dimensions of test research questions (population/setting, intervention/index test, comparators/reference test, and outcomes rather than prescribing a hierarchy of study designs that should be used to address each phase.

The Virtual Liver Network: systems understanding from bench to bedside.

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Henney, Adriano; Coaker, Hannah

2014-01-01

Adriano Henney speaks to Hannah Coaker, Commissioning Editor. After achieving a PhD in medicine and spending many years in academic research in the field of cardiovascular disease, Adriano Henney was recruited by Zeneca Pharmaceuticals from a British Heart Foundation Senior Fellowship, where he led the exploration of new therapeutic approaches in atherosclerosis, specifically focusing on his research interests in vascular biology. Following the merger with Astra to form AstraZeneca, Henney became responsible for exploring strategic improvements to the company's approaches to pharmaceutical target identification and the reduction of attrition in early development, directing projects across research sites and across functional project teams in the USA, Sweden and the UK. This resulted in the creation of a new multidisciplinary department that focused on pathway mapping, modeling and simulation and supporting projects across research and development, which evolved into the establishment of the practice of systems biology within the company. Here, projects prototyped the application of mechanistic disease-modeling approaches in order to support the discovery of innovative new medicines, such as Iressa®. Since leaving AstraZeneca, Henney has continued his interest in systems biology, synthetic biology and systems medicine through his company, Obsidian Biomedical Consulting Ltd. He now directs a major €50 million German national flagship program – the Virtual Liver Network – which is currently the largest systems biology program in Europe.

RemBench: A Digital Workbench for Rembrandt Research

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Verberne, Suzan; Van Leeuwen, Rudie; Gerritsen, G.H.; Boves, Lou

2016-01-01

In this paper, we present RemBench, a search engine for research into the life and works of Rembrandt van Rijn. RemBench combines the data from four different databases behind one interface using federated search technology. Metadata filtering is enabled through faceted search. RemBench enables art

The rotator cuff: from bench to bedside. Developments in tissue engineering, surgical techniques and pathogenetic factors

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Longo, U.G.

2012-01-01

This thesis originates from the difficulties in the management of patients with rotator cuff tears. Since tendon healing rate is relatively slow compared with other connective tissues, we reviewed the available literature on tissue engineered biological augmentation for tendon healing, including

Elbow joint fatigue and bench-press training.

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Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2014-01-01

Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Controlled laboratory study. Motion research laboratory. A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Participants performed bench-press training until fatigued. Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.

Comparison of Myoelectric Activity of a Selection of Upper Extremity Muscles while Doing Bench Press in Two Training Methods of TRX and Barbell Bench Press

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Ahmad Reza Zibaei

2016-12-01

Conclusion: Considering these results it can be maintained that TRX bench press resistance training can be an alternative and effective practice for barbell bench press because, given the results, it can be appreciated that TRX bench press, dips low in the trunk, can lead to muscle activity close to the level of muscle activity during the barbell bench press drill.

From bench to bedside: the social orientation of research leaders

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van der Weijden, I.C.M.; Verbree, M.; van den Besselaar, P.A.A.

2012-01-01

This paper answers five questions about the societal impact of research. Firstly, we examine the opinions of research group leaders about the increased emphasis on societal impact, i.e. does it influence their research agenda, communication with stakeholders, and knowledge dissemination to

The status of bedside teaching in the United Kingdom: the student perspective

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Jones P

2015-06-01

Full Text Available Patrick Jones, Bhavan Prasad Rai Department of Surgery, Ninewells Hospital, Dundee, UK Purpose: Bedside teaching holds a strong tradition as a key-learning platform for clinical examination in the basic medical clerkship. There is a growing body of literature expressing concern for its witnessed decline in medical school curricula. However, the views of students toward this patient-centered cornerstone in surgical education remain under-reported. The purpose of this study was to gain a nationwide perspective on bedside teaching according to medical students in the United Kingdom. Materials and methods: An adapted Delphi method was employed to formulate the question series as part of a multi-step process including a pilot study, which was used to construct this survey. The target population was medical undergraduates in the United Kingdom and participants were recruited via social media. Outcomes assessed included exposure to bedside teaching, perceived benefits of clinical simulation, and junior doctors as clinical teachers. Barriers to clinical examination were also evaluated. Results: Overall, 368 completed surveys were received (completion rate 98.9%. Final year students were significantly more likely to report receiving insufficient bedside teaching (P<0.01. Seventy-eight percent of the study group agreed that clinical simulation is a good learning tool for clinical examination. Seventy percent of students felt junior doctors were as able as senior doctors to teach. Lack of confidence was identified as the commonest barrier to overcome when examining patients and two-thirds of students felt they burdened patients during bedside teaching. Conclusion: This prospective study confirms the exposure deficit, which medical students experience in bedside teaching. The junior doctor represents a dynamic clinical teacher in the face of working time directives. Peer learning is a novel solution to such pressures. Work is needed to re-establish the