Background. To evaluate the benefits of dialyzer reuse for hemodialysis (HD) (NT $7,834,257.60). The annual cost of hollow fiber was reduced by $540.48 U.S. dollars (NT $17,565.60) in one patient with dialyzer reuse. The mortality rates in dialyzer reuse and single use groups were 3.1% and 10.9% within one year (p < 0.0001). Multiple logistic regressions showed that single use compared with reuse was associated with higher mortality after adjusting co-morbid conditions including age, diabetes mellitus, etc. Conclusions. We concluded that the benefits of dialyzer reuse included safety in our center and reduction in cost during a 12-month period. Dialyzer reuse may be a safe alternative.

Dysregulation of the neuroendocrine system is a frequent complication after traumatic brain injury (TBI). Symptoms of these hormonal abnormalities might be subtle and thus easily ignored. Hyponatremia usually indicates underlying disorders that disrupt fluid homeostasis. In most patients with TBI, hyponatremia is a feature of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion due to pituitary dysfunction after head injury. Usually TBI-associated hyponatremia is transient and reversible. We report the case of a 48-year-old man with TBI-associated hyponatremia with delayed recovery and recurrent hyponatremia precipitated by subsequent surgery. In this report, we emphasize the importance of identifying patients with slow recovery of the injured brain, which could complicate with SIADH and acute hyponatremia. Differentiating TBI-associated SIADH from other important causes of hyponatremia such as cerebral salt wasting, and hypocortisonism are also reviewed. Prevention of its recurrence by avoiding further risk is mandatory in managing patients with TBI. KEY H yponatremia is a common disorder encountered in various settings. 1 In most cases, hyponatremia manifests as an underlying disease and degree of hyponatremia usually indicates severity of etiology, and can even correlate with patient outcome. 2 Clinical features of hyponatremia are confined to most neurological manifestations, but vary with severity and rate of progression. Hyponatremia is one of the clues for diagnosing disease that might not be detected directly. Moreover, in certain circumstances, hyponatremia can even provide significant prognostic implications. 1 Traumatic brain injury (TBI) may severely impair brain function. In addition to structural damage, neuroendocrine dysfunction is an important complication. 3 The pituitary insult can manifest with any hormone dysregulation involving either the anterior or posterior pituitary gland. 4,5 Most TBI-associated hyponatremia is mild and asymptomatic, and lasts only a short time. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) commonly underlies acute hyponatremia in these patients. 6 Because the neurological manifestations of hyponatremia and acute brain injury are quite similar, differentiation may be difficult. Furthermore, unresolved recurrent hyponatremia with obvious clinical manifestations has rarely been described. We report here a patient with recurrent symptomatic hyponatremia after head injury. Case ReportA 48-year-old man was sent to our emergency department because of an accidental fall, and head injury 4 days before admission. He had originally been admitted to a local hospital where brain computed tomography revealed no intracranial hemorrhage or skull fracture. However, he developed progressive headaches, deteriorated consciousness, and vomiting that were refractory to medical treatment. Repeated brain computed tomography at our institution disclosed minimal bilateral frontal subdural hematoma. Biochemical examination found a rapid drop ...

182F.-R. Chuang et al.Background. Nephropathy associated with contrast medium exposure is a well-known complication of IVP. However, it is uncertain whether iso-osmolar non-iodinated contrast medium (iodixanol) is less nephrotoxic than low-osmolar contrast medium (iohexol). Materials and Methods. In this singlecenter, double-blind, prospective study, 50 patients undergoing IVP were randomized into two groups receiving different contrast medium: iodixanol and iohexol. Patients in high risk for contrast nephropathy were included, 28 with renal insufficiency and 19 with diabetes mellitus. We compared the nephrotoxic effect (contrast nephropathy), complement and cytokines profile between the iodixanol and iohexol groups. The mean volume of contrast medium in each IVP procedure was 0.8 mL/kg. Results. The incidence of contrast nephropathy was 4 percent among all patients (one iodixanol and one iohexol). We found no significant differences in contrast nephropathy and allergic reactions between the two groups. There was no significant difference in cytokine profiles in both groups (p > 0.05).The incidence of allergic reaction was 16 percent among all patients. Twelve percent (3/25) had late reaction after iohexol exposure compared to four percent (2/25) with iodixanol (p = 1.0). One patient had severe skin rash due to late adverse reaction after iodixanol. No mortality was found. Conclusions. New iodixanol and iohexol contrast medium for routine IVP examination are safe and have low nephrotoxicity profile, especially in elderly or high-risk patients. Iodixanol contrast medium has an increased risk to induce severe late adverse reaction compared to iohexol. Allergic reaction may be the main adverse effect after contrast medium infusion.