Previous studies have reported a 4%-50% incidence of acute renal failure (ARF) following the use of radiocontrast media in patients with preexisting chronic renal insufficiency. In these studies, ARF was defined as a rise of the serum creatinine of at least 1 mg/dl above baseline. Using the same criteria, we studied 214 patients undergoing various intravascular radiocontrast media procedures. Patients were infused with a specially prepared cocktail solution (NSMF) containing 1000 ml half-normal saline, 12.5 g of mannitol (M), I ampule NaHCO3, and 200 mg of furosemide (F) at 100 ml/h from one hour prior to two hours after the procedure. Urinary output was replaced with normal saline for at least 6 h after the procedure. Seven percent of the patients developed acute renal insufficiency. Only 3% of the patients had a rise in serum creatinine greater than 2 mg/dl. No patient required dialysis therapy after the procedure. There was one unrelated death caused by acute myocardial infarction postangioplasty. Risk factors for development of ARF despite cocktail administration included the presence of diabetes mellitus and angiotensin converting enzyme (ACE) inhibitor therapy. We concluded that the properly administered NSMF solution protects against radiocontrast dye induced renal failure. In select patients with chronic renal insufficiency, consideration should be given to withholding ACE inhibitor therapy for 24-48 h prior to administration of intravenous radiocontrast dye. A large controlled trial will be required to establish whether the NSMF solution offers benefit beyond that of saline hydration alone.
The election of Barack Obama to the presidency of the United States brought forth torrents of emotions and expressions from across the racial spectrum, but especially so among African Americans. However, amidst the euphoria of this historic event is a disturbing reaction circulating among African Americans which has implications for the struggle against racism in America. Since Barack Obama's election, many African Americans across the nation are saying "now blacks have no more excuses," in effect evoking old discredited theories that eschewed racism as a factor in African American life and blamed victims of this racism for their resulting situations. We assess this development.
In patients receiving peritoneal dialysis, fungal peritonitis is generally impossible to eradicate with previously available therapy in the absence of catheter removal. Corbella et al. described a patient with fungal peritonitis treated with fluconazole without catheter removal. We studied this drug's effectiveness in the treatment of 5 patients with peritonitis secondary to Candida species. Patients received a loading dose of 200–400 mg fluconazole, followed by 50–200 mg fluconazole daily. Patients Improved initially after therapy with fluconazole. Abdominal pain and fever abated, dialysis returns cleared, cell counts decreased, and, in four cases, cuitures were sterilized. Dialysate fluconazole levels were adequate. However, despite maintenance of fluconazole therapy, all patients had recurrent peritonitis within 1 month. Complete cure did not occur unless the Tenckhoff catheter was removed. When the catheter was removed, tip cuitures grew pure Candida species, and microscopic examination of catheter sections revealed abundant yeast. Although there may be continued isolated reports of successful eradication of fungal peritonitis without catheter removal, we conclude that in the vast majority of cases catheter removal is required.
This essay uses ethnographic research conducted among Haitian Protestants in the Bahamas in 2005 and 2012 plus internet resources to document the belief among Haitian Protestants (Haitians who practice Protestant forms of Christianity) that Haiti supposedly made a pact with the Devil (Satan) as the result of Bwa Kayiman, a Vodou ceremony that launched the Haitian Revolution (1791-1803). Vodou is the syncretized religion indigenous to Haiti. I argue that this interpretation of Bwa Kayiman is an extension of the negative effects of the globalization of American Fundamentalist Christianity in Haiti and, by extension, peoples of African descent and the Global South.
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