The effect of skeletal muscle area and attenuation in patients with sternum fracture due to blunt chest trauma

OBJECTIVE

This study aims to retrospectively investigate the imaging features of patients with sternum fracture (SF) and concomitant organ injuries. We also aimed to evaluate the potential prognostic effect of skeletal muscle area (TMA) and muscle attenuation (MuA) values.

PATIENTS AND METHODS

Computed tomography (CT) images of patients with SF were re-evaluated by two observers (Observer-1 and 2). Observer-3 has measured TMA and MuA values. Observer-1 has repeated the measurements blindly to the first measurement results to evaluate the inter-observer agreement. The length of hospital stay, death, hemiplegia, or quadriplegia were investigated from the archives. Mann-Whitney U-test or Student's t-test was used to investigate the relationship between linear variables. The intraclass correlation coefficient (ICC) score was used to evaluate the interobserver agreement. Logistic regression analysis was used to estimate the relative effect of variables by calculating unadjusted odds ratios (ORs) for categorical outcomes.

RESULTS

Sixty-five patients had SF and 53 patients had SF and concomitant organ injuries. The most common injuries accompanying SF were rib fracture (73.58%) and lung contusion (60.38%). Manubrium fracture was the most common fracture location (52.3%), and 18 patients (27.7%) had displaced SF. Eight patients (15.1%) were discharged with plegia and five (9.4%) died. Hemothorax, displaced SF and decreased MuA were predictors of prolonged hospital stay, and the presence of cardiac contusion, displaced SF, hemothorax, and vertebra body fracture were independent factors for death.

CONCLUSIONS

The presence of a displaced SF and decreased MuA value are important prognostic factors in patients with SF.

Is there any difference regarding atopy between children with familial Mediterranean fever and healthy controls?

INTRODUCTION

There are only a few studies regarding the prevalence of atopy in Familial Mediterranean fever (FMF) patients, and their results are conflicting.

METHODS

In this study children with the diagnosis of FMF were evaluated for the presence of atopy by comparing with controls. One hundred and eighteen children diagnosed as FMF and 50 healthy age and sex matched controls were enrolled. They were evaluated for the presence of rhinitis, atopic dermatitis, urticaria and asthma. Laboratory assessment was done by measuring IgA, IgM, IgG, IgE levels, total eosinophil count and by performing skin prick test (SPT) panels for common allergens to children with FMF and healthy controls.

RESULTS

One hundred and eighteen children (61girls and 57 boys) diagnosed as FMF with a median age of 120±47 months (range 36-204 months) were compared with 50 healthy controls (31 girls and 19 boys) having a median age of 126±37 (range 48-192 months). The mean percentage of total eosinophil count of patients was similar to that of the control group. The mean level of IgE was significantly higher in children with FMF than controls (136±268, 87±201, respectively; p values <0.05). The percentage of skin prick test positivity was similar for both patients and controls (13% and 8.2%, respectively; p>0.05). The prevalences of atopic dermatitis, allergic rhinitis, and asthma in the patient group were 5.08%, 28.8%, and 15.25%, respectively, while the control group had the prevalences of 0%, 36%, and 14% respectively.

CONCLUSION

Children with FMF did not show an increase of atopic dermatitis, allergic rhinitis and asthma with respect to controls.

Nonsurgically Treated Sigmoid Volvulus in a Young Patient 3 Days After Renal Transplant

Sigmoid volvulus is a rare clinical condition in young individuals. It should be accurately diagnosed and treated in a rapid manner. Surgical and nonsurgical conservative methods are used for the treatment of sigmoid volvulus. Patients having no signs of perforation or peritonitis should be primarily treated by colonoscopic detorsion. A delay in the diagnosis and treatment of this condition may cause significant morbidity and mortality in an immunosuppressed patient with newly performed renal transplant and diffuse abdominal pain. This paper reports a young patient who was diagnosed with sigmoid volvulus during admission with sudden-onset abdominal pain and distension after having undergone renal transplant from a living donor 3 days previously. The patient avoided the burden of a second surgical intervention by a bedside endoscopic detorsion procedure.

Genotoxic effects of some antituberculosis drugs and mixtures in rats

In this study*, it was aimed to observe, genotoxic effects of antituberculosis drugs and combinations on rats. Animals were treated with 31.5 mg/kg isoniazid (INH), 54 mg/kg rifampicin (RIF), 189 mg/kg pyrazinamide (PYR), 100 mg/kg etham-butol(ETA), INH+RIF+PYR (MIX1) and INH+RIF+PYR+ETA (MIX2) mixtures applied via gavage for 90 days. At the end of the study, blood, liver and kidney samples were taken and evaluated by Comet and Micronucleus techniques. Compared to control group, head intensity decreased, tail intensity and tail migration increased on experiment groups in blood samples. Head intensity of PYR and mixture groups decreased, tail intensity of PYR and mixture groups increased and tail migration of PYR, ETA and mixture groups increased in liver samples. Head intensity decreased and tail intensity increased of INH, RIF, ETA and MIX1 group; tail migration increased of MIX1 group in kidney samples. Compared to control group, micronucleus rate of ETA, RIF and MIX 2 groups increased in experiment groups. In conclusion antituberculosis drugs and their mixtures applied for 90 days causes to double strand break of DNA damage at different degrees in blood, kidney and liver cells in rats.

Correlation between iron stores and QTc dispersion in chronic ambulatory peritoneal dialysis patients

AIM

We aimed to investigate the QT dispersion and corrected QT (QTc) dispersion which are suggested as the signals of ventricular arrhythmias, in patients on maintenance CAPD and to evaluate the correlation between iron stores and these electrocardiographic parameters.

MATERIALS AND METHOD

Fifty-eight patients on maintenance CAPD and 19 healthy age- and sex-matched adults without cardiac disease were included. The PD patients were divided into two groups according to whether their computerized measurements of QTc dispersion were longer than 65 ms.

RESULTS

Although QT interval was statistically significantly shorter in control group (34 ± 28 vs. 43 ± 34 ms; p < 0.05), there was no significant difference in regards to the QTc, QT dispersion and QTc dispersion between two groups. PD patients with QTc dispersion longer than 65 ms had higher levels of serum ferritin (p = 0.038) and transferrin saturation (TSAT; p = 0.022) than the others. QTc dispersion were positively correlated with ferritin (r = 0.469, p < 0.01) and TSAT (r = 0.430, p < 0.01) in CAPD patients.

CONCLUSION

Although prolonged QTc, QT dispersion and QTc dispersion were suggested as the markers of ventricular arrhythmias we did not find any significant difference in regards to these parameters between control patients and CAPD patients. But the high body iron stores in these patients increase the risk of increased QT dispersion. The concern over iron overload in dialysis patients is not only because of its oxidative toxicity, but also its precipitation of arrhythmias, which may be measured by the surrogate marker of QTc dispersion.

Cefpodoxime proxetil-related hemolysis and acute interstitial nephritis

OBJECTIVE

We report a case of acute interstitial nephritis (AIN) and immune hemolytic anemia (IHA) associated with cefpodoxime therapy.

CASE SUMMARY

A patient with a recent history of cefpodoxime proxetil treatment presented with elevated serum creatinine, oliguria, nausea, vomiting, and dyspnea. Evidence of renal failure, abnormal urinalysis, and renal biopsy with inflammatory infiltrate in the interstitium confirmed a diagnosis of AIN. The patient subsequently developed IHA, which was confirmed by peripheral blood smear results and positive Coombs' test. The patient recovered after dialysis therapy and 2 days of intravenous methylprednisolone (500mg/day) followed by oral prednisolone (60 mg/day), which was rapidly tapered and stopped within 3 weeks.

CONCLUSIONS

To our knowledge, cefpodoxime-induced AIN and IHA are unprecedented. Physicians should be aware that drug-induced AIN and hemolysis can be associated with cefpodoxime proxetil.

The Effect of Alendronate, Risedronate, and Raloxifene on Renal Functions, Based on the Cockcroft and Gault Method, in Postmenopausal Women

BACKGROUND

Oral alendronate, risedronate, and raloxifene are effective treatment options in the management of postmenopausal osteoporosis. There is little previously reported about the renal safety profiles of these three agents in osteoporosis. We aimed to assess the risk of renal toxicity associated with oral alendronate, risedronate, and raloxifene in the treatment of osteoporosis, prospectively.

METHODS

One hundred and twenty-seven patients with osteoporosis and osteopenia according to lumbar or femoral-neck bone mineral density t score were enrolled in the study. The patients were randomized to alendronate 70 mg once weekly (n = 47), risedronate 35 mg once weekly (n = 44), or raloxifene 60 mg per day (n = 36) for one year. Preliminary screening included medical history, physical examination, lumbar and femoral bone mineral densitometry measurement, and blood biochemical tests, including renal function tests. The biochemical markers were then assessed at the end of 12 months.

RESULTS

There was no significant difference between basal and final renal function parameters of each group. Also these parameters did not differ between the three groups after 12 months of treatment period.

CONCLUSIONS

These results demonstrate that alendronate, risedronate, and raloxifene are all safe drugs for renal functions in the treatment of osteoporosis.

Persistent hypercalcemia is a significant risk factor for graft dysfunction in renal transplantation recipients

Hypercalcemia is a common problem in renal transplant recipients, although in most cases, spontaneous resolution occurs within 1 year after renal transplantation. This condition may persist in some patients producing effects on renal function which are not well understood. In this study, we sought to analyze the effect of persistent hypercalcemia in the posttransplantation period on the function of renal transplants. A total of 121 recipients (31 women, 90 men; mean age, 34.1 +/- 9.9 years) underwent renal transplantation between 1999 and 2002. All patients underwent prospective evaluation of their serum calcium levels at 6-month intervals. A sustained corrected mean serum calcium level higher than 10.2 mg/dL was defined as "persistent hypercalcemia." Patients who had a gradual increase in their serum creatinine levels to >2 mg/dL or a 50% rise above the baseline were considered to display chronic allograft dysfunction (CAD). Among 121 recipients, 52 patients (43%) developed CAD and 37 patients (30.6%) had persistent hypercalcemia. Among the CAD patients, 22 suffered persistent hypercalcemia, while the other 15 patients were without CAD, a difference that was statistically significant (42.3% vs 21.7%, P = .01). The mean calcium levels were lower among patients without than with CAD, a difference that did not reach statistical significance (9.9 +/- 0.4 mg/dL vs 10.1 +/- 0.6 mg/dL, P = .1). In conclusion, persistent hypercalcemia in the posttransplantation period may significantly contribute to the development of chronic allograft nephropathy.

Peritoneal Transport Status Influence on Atherosclerosis/Inflammation in CAPD Patients

OBJECTIVE

Peritoneal transport status is one of the main determinants of dialysis adequacy and dialysis-related complications in end-stage renal disease patients receiving continuous ambulatory peritoneal dialysis (CAPD). In this study we aimed to investigate the relationship between peritoneal transport characteristics and known promoters of atherosclerosis in a group of patients receiving CAPD for a minimum of 36 months.

DESIGN AND PARTICIPANTS

We performed a cross-sectional study of a cohort of 84 patients with end-stage renal disease (37 men, 47 women; age, 44.0 +/- 15.7 years; dialysis duration, 40.3 +/- 8.1 months) who were receiving CAPD for minimum 36 months. Peritoneal transport characteristics were identified after a peritoneal equilibration test (PET) determined at the third month of CAPD using Dialysate/Plasma (D/P) reference values. Patients were classified according to one of four peritoneal transport types: high (H), high-average (HA), low-average (LA), and low (L). After PET, patients were grouped as high (H/HA group, n = 51) or low (L/LA group, n = 33) transporters. The patient groups' clinical and laboratory data before dialysis and after initiation of the CAPD were collected retrospectively. The patients' follow-up data were retrieved for the diagnosis of any atherosclerosis-related event after the initiation of CAPD. The following events were collected, including myocardial infarction, having been diagnosed as having coronary artery disease by angiography or myocardium scintigraphy, cerebrovascular accident, and development of clinically evident peripheral arterial disease.

RESULTS

A comparison of follow-up data revealed that the H/HA transport characteristic was associated with lower albumin (P < .01), higher C-reactive protein (CRP) (P < .0001) levels, and higher recombinant human erythropoietin (rHuEPO) needs (P < .001) when compared with the L/LA type. During follow-up, 28 patients showed an atherosclerosis-related event. Twenty-two of these were in the H/HA group (43.1%), whereas only six were in the L/LA group (18.1%, P < .01). Reanalysis of 18 patients with atherosclerosis-related events and high CRP levels (> 10 mg/L) showed that 15 were in the H/HA and 3 were in the L/LA group. Sixty-eight percent of the H/HA patients with atherosclerosis and 50% of the L/LA patients with an atherosclerotic event also had chronic inflammation (P < .001). A Pearson correlation analysis showed that there was a positive correlation between D/P creatinine levels and 36-month mean CRP levels (r = 0.608, P < .0001), and a negative correlation between D/P creatinine levels and 36-month mean albumin levels (r = -0.299, P < .005).

CONCLUSIONS

This study shows that the high transporter peritoneal membrane characteristic is a risk factor for inflammatory state in patients with end-stage renal disease. High-transporter patients are at an increased risk of atherosclerosis when compared with their low-transporter counterparts through chronic inflammation.

Interdialytic Weight Gain Is Less With the Mediterranean Type of Diet in Hemodialysis Patients

OBJECTIVE

Interdialytic weight gain is an important prognostic factor in dialysis patients. Different eating patterns may affect interdialytic weight gain. The goal was to assess the effect of the Mediterranean type of diet on interdialytic weight gain of chronic hemodialysis patients.

DESIGN

This study had a cross-sectional design.

SETTING

Four hospital-based satellite hemodialysis units in different cities in Turkey.

PATIENTS

A total of 702 patients (279 women, 423 men; mean age, 47.8 +/- 15.5 years) were included in the study. They were grouped according to the hemodialysis centers: Alanya-Izmir (group 1, n = 194) and Ankara-Adana (group 2, n = 508).

INTERVENTION

Group 1 patients were consuming a Mediterranean type of diet, whereas group 2 patients had a diet rich in protein and carbohydrates. All of the patients were under the same dialysis and treatment protocols. The demographic data, the medications, interdialytic weight gains, and laboratory data such as serum albumin, C-reactive protein, hemoglobin, hematocrit, serum iron binding capacity, ferritin, and parathyroid hormone during the last 3 months for each patient were recorded.

MAIN OUTCOME MEASURE

The interdialytic weight gain differences between the groups were compared using the Student t-test and the Mann-Whitney U test.

RESULTS

When the two groups were compared according to age, sex, blood pressure, serum albumin, hematocrit, and parathyroid hormone levels, there was no statistically significant difference. Mean interdialytic weight gain for group 1 and group 2 was 2.47 +/- 0.94 kg and 3.08 +/- 0.94 kg, respectively (P < .001). When the two groups were compared according to their iron requirements, group 1 showed an increased requirement for doses of iron and erythropoietin (P < .001 and P < .001, respectively).

CONCLUSIONS

A Mediterranean-type diet, rich in seafood and vegetables, was associated with less interdialytic weight gain compared with a diet rich in protein and carbohydrates. Although all of our patients had the same diet education and treatment protocols, the geographic region and culture influenced their compliance to diet and their therapeutic outcomes.

Angiotensin-Converting enzyme gene polymorphism significantly affects renal posttransplantation erythrocytosis

Posttransplantation erythrocytosis (PE) is a frequent problem in renal transplant patients. The pathogenesis and mechanisms of both the problem and therapy strategy are unknown. Since ACE and angiotensin 2 receptor inhibitors have been used to successfully manage PE, we speculated a relation between gene polymorphisms and this complication. Ninety-six ( 30 women, 66 men, age 34.4 +/- 11.0 years) renal transplant patients evaluated retrospectively, for gene polymorphisms of ACE, angiotensinogen, angiotensin 1 and 2 receptors (ATR1 and ATR2), as well as endothelial nitric oxide synthase (ecNOS). They were divided into two groups; patients with versus without PE, which was defined as >15 g/dL hemoglobin levels during the first year after renal transplantation. PE was found to be significantly more prevalent among D/D than I/I gene polymorphism of ACE genes (P <.04). The distribution of D/D, I/D, and I/I polymorphisms were 39.1%, 45.9%, and 7.6%, respectively. There was no difference between D/D and I/D polymorphisms. Comparing the I/D and I/I polymorphisms showed PE to be statistically more prevalent in the I/D polymorphism (P <.01). Logistic regression analysis revealed that D/D and I/D polymorphisms were significant risk factors for PE (P <.05, RR = 7.714 and P <.03, RR = 10.199, respectively). While previous studies revealed a relation between angiotensin II and PE, our study discovered the contribution of ACE gene polymorphism.

Angiotensin-converting enzyme genotype is a predictive factor in the peak panel-reactive antibody response

The presence of a high panel-reactive antibody (PRA) level represents an independent risk factor for early graft failure and chronic allograft dysfunction. It has also been reported that patients with the ACE-DD and AGT-AA genotypes display poorer chronic allograft function. We investigated the effects of gene polymorphisms of the renin angiotensin system (RAS) on anti-HLA antibody production among renal transplant candidates. Genotyping was performed on 133 dialysis patients for the ACE (I/D) and AGT (M235T) as well as the type 1 (A1166C) and type 2 (A1223G) angiotensin II receptor genes. Patients with a peak PRA >/= 30% were considered to be positive for anti-HLA antibody (40.6% of 133 patients). Genetic polymorphisms of the RAS were not associated with anti-HLA antibody production at this PRA level. Another analysis comparing the 29 patients with a peak PRA >/=50% with the 104 patients with a peak PRA <50% showed that previous transplants, the presence of ACE-DD genotype, history of blood transfusions, and dialysis duration were all associated with the high levels of antibody production by univariant analysis. A multivariate analysis using a logistic regression model revealed previous transplants, the presence of ACE-DD genotype, and history of blood transfusions to be predictors of anti-HLA antibody production. The ACE-DD genotype is an important risk factor for higher PRA levels. This study suggests that genetic control of RAS activity correlates with production of anti-HLA antibodies, possibly explaining the relationship to chronic allograft outcome.

Which method should be used to determine the obesity, in patients with coronary artery disease? (body mass index, waist circumference or waist-hip ratio)

OBJECTIVE

To determine body mass index (BMI), waist circumference and waist-hip ratio (WHR) in cases with angiographically established coronary artery disease (CAD) and to compare the obesity degrees established according to the ranges determined by the International Guidelines Committees for BMI, waist circumference and WHR.

DESIGN

Cross-sectional, observational study.

SUBJECTS

A total of 617 consecutive cases (516 males, mean age: 57.2+/-10.8 y) with CAD who underwent their first coronary angiography between January 2000 and May 2000.

MEASUREMENTS

Before coronary angiography, their heights, weights, waist and hip circumferences were measured. Waist circumferences, BMI and WHRs were compared both as a whole and also within stratified groups as for sexes and age groups categorized in decades above 40 y of age.

RESULTS

Overweight cases comprised approximately half of the patients in both sexes. In males, the percentages of obese cases with respect to BMIs were 15%, while males with action level 2 waist circumferences were detected to be 20%. Obese male patients whose WHRs were >or=0.95 were found to be 51%. In female cases, corresponding percentages of obesity were estimated to be 32, 72 and 86%, respectively.

CONCLUSION

In the same patient groups, the prevalence of obesity, defined by BMI, waist circumference and WHR, could vary three-fold. Thus, some patients may not display a diagnosis of obesity. To prevent this possibility the waist circumference is an easy method, which reflects central obesity more accurately.

Cyclical acute renal failure due to bilateral ureteral endometriosis

Endometriosis is a common disease but ureteral involvement is relatively rare. Ureteric endometriosis is mostly unilateral. Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. We present the cyclical acute renal failure associated with menstruation in a patient who developed severe bilateral ureteral obstruction due to endometriosis. Physicians should be aware of this uncommon but serious manifestation of endometriosis, especially if the clinical presentation is cyclical acute renal dysfunction in a premenopausal woman.