Introduction: Many techniques are available for inserting peritoneal dialysis (PD) or continuous ambulatory peritoneal dialysis (CAPD) catheters, with varying possible complications. We report a case of bladder perforation that was managed with catheter salvage. Case report: A 48-year-old man with end-stage renal disease (ESRD) underwent CAPD catheter placement percutaneously, with tip in the pelvis. On the 3 rd day after placement, the patient complained of increase in urinary volume with PD flushing. Urine analysis showed 3(+) glucose and absent creatinine. Cystogram showed the catheter abutting the bladder wall. CT of the abdomen showed the catheter piercing the bladder and exiting through the posterior wall. The PD catheter was repositioned under fluoroscopy. Discussion: The complications surrounding insertion of CAPD catheter can be either mechanical or infectious. Peritoneo-vesical fistula or placement of the PD catheter into the urinary bladder is a very rare complication. The possibility of catheter salvage should be entertained while discussing management options.

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BACKGROUND: Thyroid abnormalities are common in chronic heart failure. Severity of heart failure rises by several fold in patients with thyroid dysfunction. OBJECTIVES: The purpose of this cross sectional comparative study is to determine the correlation between low T3 syndrome and chronic heart failure & predicting the severity of chronic heart failure. METHODS: In this descriptive, cross sectional study, all patients who presented to the Department of medicine with chronic heart failure during this study period of 12 months from January 2010-December 2011 in K.R.Hospital, Mysore were included. Patients were grouped into Low T3 chronic heart failure (10); hypothyroid chronic heart failure (29) and chronic heart failure (11) were included. RESULTS: Mean age of low T3 chronic heart failure patients was higher [60.50±6.15(SD) years], Higher number of hypertensives were seen in low T3 chronic heart rate patients, Cardiomyopathy was most common etiology for chronic heart failure patients (42%) and was common in the age group of 55-60 years (38%) in present study, idiopathic etiology was common in the age group of 60-65 years (63%), hypertensive heart disease as etiology was common with age group of 45-50 years (42.8%), IHD etiology was common with age group of 55-60 years (36.3%). Idiopathic etiology was common etiology with low T3 chronic heart rate patients (60%) and all patients was seen in the age group of 55-65 years. Mean pulse rate was higher in low T3 chronic heart failure group [104±6.9 (SD) beats/min]. Systolic blood pressure was high in low T3 chronic heart rate group [131±20.8 (SD) mm of Hg]; diastolic blood pressure was higher in low T3 chronic heart rate groups [84.6±12.4 (SD) mm of Hg]. S3 heart sound was present in more number of patients with low T3 chronic heart rate (60%), Systolic dysfunction on 2D Echo was more in low T3 chronic heart failure group (20%), Diastolic dysfunction on 2D Echo was more in low T3 chronic heart failure group (30%), Global hypokinesia was seen in more number of patients with low T3 chronic heart failure (30%).Segmental hypokinesia was seen in more number of patients with low T3 chronic heart failure (3%). Mean ejection fraction was seen in more number of patients with low T3 chronic heart failure [36.78±5.08 (SD) %].Mean ejection fraction was lower in low T3 chronic heart failure [34.8±3.293 (SD) %].The high pulmonary artery systolic pressure was seen in more number of patients in low T3 chronic heart failure (70%). CONCLUSION: There is significant percentage of chronic heart failure patients having low T3 alone as biochemical parameter. It is important to recognize patients with chronic heart failure as it is associated with increased severity of heart failure. KEYWORDS: chronic heart failure, low T3 syndrome, systolic blood pressure, diastolic blood pressure and PR interval.

Introduction: Acute cholangitis is a serious and life-threatening illness that results from sepsis and obstruction. Patients with acute cholangitis are susceptible to exposure to acute kidney injury(AKI) due to sepsis, which can lead to a poor prognosis. We aim to investigate the association of acute cholangitis and AKI with clinical outcomes. Methods: We retrospectively evaluated the medical records of patients who were diagnosed with acute cholangitis from January 2011 to December 2016 in our institution. We compared laboratory finding between patient's baseline and at the time of hospitalization to assess AKI. We divided groups into AKI group and normal renal function group, The primary endpoints was incidence of AKI, and secondary endpoints were all cause of death and risk factors. Patients were classified according to AKI criteria according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Patients were excluded if they were chronic kidney disease stage 5, only visited the emergency room, or could not confirm the baseline blood test. Results: A total of 1683 patients were evaluated, a mean age was 69.52AE13.675 years old. 211 patients(12.5%) developed AKI and the average estimated glomerular filtration rate(eGFR) of AKI group was 50.85AE31.60(ml/min/1.73m2) wereas non-AKI group was 99.14AE31.08(ml/min/1.73m2). There was a statistically significant increase in all cause of death in the AKI group(24.5%, 10.0% p<0.001). In AKI group, Systemic Inflammatory Response Syndrome(SIRS)(34.8% vs 8.7% p<0.001), blood urea nitrogen to albumin ratio(11.7 vs 4.1 p<0.001), which were related to death, were significantly higher than non-AKI group. The presence of CBD stone (50.7%, 52.8%, p¼0.561) and obstruction (11.5%, 10.7%, p¼0.726) were not significantly different between the two groups. Conclusions: Acute cholangitis can be accompanied by AKI due to sepsis, which leads to poor prognosis. All cause of death increases due to AKI, and prognosis can be assessed through SIRS score and blood urea nitrogen to albumin ratio.

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