NDT plus
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A 19-year-old female presented with bilateral severe loin pain associated with recurrent macroscopic haematuria. A provisional diagnosis of loin pain haematuria syndrome was made; the severity and frequency of pain led to referral to the pain management service. ⋯ Although previous reports of obstruction of the left renal vein have not described pain of this severity, magnetic resonance angiography was performed; it showed obstruction of the left renal vein as it passed between the superior mesenteric artery and aorta, i.e. the nutcracker phenomenon. Both pain and haematuria resolved fully after autotransplantation.
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Lanthanum carbonate is a nonaluminum, noncalcium phosphate-binding agent, which is widely used in patients with end-stage chronic kidney disease. Until now, no significant side-effects have been described for the clinical use of lanthanum carbonate, and there are no available clinical data regarding its tissue stores. Here we report the case of a 59-year-old patient who was admitted with confusional syndrome. ⋯ The results of our study confirm that, in our case, the lanthanum carbonate did cross the blood-brain barrier (BBB). Although lanthanum carbonate seems a safe drug with minimal absorption, this work reveals the problem derived from the increase of serum levels of lanthanum carbonate, and the possibility that it may cross the BBB. Further research is required on the possible pathologies that increase serum levels of lanthanum carbonate, as well as the risks and side-effects derived from its absorption.
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Corrigan's secret door describes a metaphorical escape route for busy physicians. The term was derived from the successful and exceptionally busy professional life of Irish physician Dominic John Corrigan (1802-80). It is claimed that Corrigan's outpatient clinic was so busy that he required a secret door in his consulting rooms to escape from the ever-growing queue of eager patients. ⋯ My own escape is through classical music and the violoncello, in particular. As the name implies, my own secret door is normally invisible to colleagues and patients. This little article is about a patient who found me out, and a reflection on the role of classical music and the cello in my professional life.