Long-term outcome of kidney transplantation in patients with a urinary conduit: a case–control study

Purpose

To study the short- and long-term outcomes of kidney transplantation in patients with a bladder augmentation or urinary diversion compared to patients with a kidney transplantation in a normal functional bladder.

Patients and methods

Between January 2000 and March 2011, 13 patients received 16 grafts into a reconstructed urinary tract. We performed a retrospective case–control study and matched each patient to 4 controls for donor and recipient gender and year of transplantation.

Results

Short- and long-term complications of kidney transplantation occurred in 12 patients, varying from urinary tract infections to medical hospitalization with or without surgical or radiological intervention. In 5 patients, a percutaneous nephrostomy (PCN) was placed followed by surgical re-intervention. In three patients, the grafts failed as a result of chronic rejection and were re-transplanted. There was no graft loss as a result of surgical complications or the reconstructed urinary tract. One-year patient and graft survival was 100 %. After five years, all patients were alive and seven of nine grafts (77.8 %) were functioning. Mean follow-up time was 4.3 years. Among the controls, 55 grafts were transplanted in 52 patients. Ten patients received a PCN. Five patients needed surgical re-intervention. In three patients, transplantectomy was performed for ongoing rejection. Three patients were re-transplanted. One patient had a failing graft 7.5 years post-transplantation and became dialysis dependent.

Conclusion

Kidney transplantation in patients with a reconstructed urinary tract has an increased complication rate. Nevertheless, the long-term results are comparable to patients with a normal urinary bladder.     

Robotic-assisted paraesophageal hernia repair—a case–control study

Aims

The da Vinci® telemanipulation system offers a wide range of precise movements and 3D visualization with depth perception and magnification effect. Such a system could be useful for improving minimally invasive procedures—as in the case of large hiatal hernia with paraesophageal involvement (PEH) repair. Studies reporting on the robotic-assisted PEH repair are scarce, and a comparison to the standard operation techniques is lacking. Therefore, we decided to investigate the feasibility and safety of robotic-assisted surgery (RAS) compared to conventional laparoscopic (CLS) and open surgery (OS) for the first time.

Methods

We investigated 42 patients for the perioperative outcome after PEH repair. Twelve patients were operated on with RAS, 17 with CLS, and 13 with OS. Operating time, intraoperative blood loss, intra- and postoperative complications, mortality, and duration of hospital stay were analyzed in each method.

Results

On average, operating time in the RAS group was 38 min longer, and the intraoperative blood was loss 217 ml lower compared to OS. Both results were similar to the CLS group. The intraoperative complication rate was similar in all groups. The postoperative complication rate in the RAS group was significantly lower than the OS group, though again similar to the CLS group. The hospital stay was 5 days shorter in the RAS group than the OS group and once again similar to the CLS group.

Conclusion

The results show that RAS is feasible and safe. It appears to be an alternative to OS due to lower intraoperative blood loss and potentially fewer postoperative complications, as well as shorter hospital stay. Though, RAS is not superior to CLS.     

Cardiovascular autonomic function in patients with hemodynamic instability at induction of capnoperitoneum: a case–control study

Background This study hypothesized that patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum have an underlying autonomic cardiovascular dysfunction.Methods A case–control study was conducted to examine the baseline autonomic function of patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum. The control group consisted of patients who maintained normal cardiac rhythm and blood pressure during the same procedure. Two groups of tests were performed: bedside stress tests of cardiovascular autonomic function (response graded 1 (normal) to 4 (severely abnormal) and heart rate variability analysis (spectral and time domain components).Results The study evaluated 6 patients in the bradycardia group and 10 in the control group. The group in whom bradycardia had developed scored significantly worse on the bedside stress tests than the control group (for grades I to IV: ² = 6.5, p = 0.022; for trend: ² = 5.6, p = 0.018). In contrast, both groups had similar baseline autonomic tone, as measured by heart rate variability.Conclusions Patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum have cardiovascular autonomic dysfunction, which is identifiable by bedside stress tests of autonomic function.     

Phosphate homeostasis in Bartter syndrome: a case–control study

Background

Bartter patients may be hypercalciuric. Additional abnormalities in the metabolism of calcium, phosphate, and calciotropic hormones have occasionally been reported.

Methods

The metabolism of calcium, phosphate, and calciotropic hormones was investigated in 15 patients with Bartter syndrome and 15 healthy subjects.

Results

Compared to the controls, Bartter patients had significantly reduced plasma phosphate {mean [interquartile range]:1.29 [1.16–1.46] vs. 1.61 [1.54–1.67] mmol/L} and maximal tubular phosphate reabsorption (1.16 [1.00–1.35] vs. 1.41 [1.37–1.47] mmol/L) and significantly increased parathyroid hormone (PTH) level (6.1 [4.5–7.7] vs. 2.8 [2.2–4.4] pmol/L). However, patients and controls did not differ in blood calcium, 25-hydroxyvitamin D, alkaline phosphatase, and osteocalcin levels. In patients, an inverse correlation (P?P?P?Conclusions The results of this study demonstrate a tendency towards renal phosphate wasting and elevated circulating PTH levels in Bartter patients.     

Vitamin D in nephrotic syndrome remission: a case–control study

Background

Vitamin D deficiency may contribute to osteoporosis in nephrotic syndrome (NS).

Methods

A cross-sectional case–control study was performed to investigate 25 hydroxycholecalciferol [25(OH)D] status in 40 patients with NS in remission and 40 healthy controls. Serum levels of 25(OH)D, calcium, phosphate, alkaline phosphatase (ALP), and intact parathyroid hormone (PTH) were assayed. NS patients were segregated by age at onset, current age, type and duration of NS, months since relapse and current drug therapy.

Results

Levels of 25(OH)D showed a positive correlation with months elapsed since last NS relapse (r _s?=?+0.4, p?=?0.012) and were lower in NS patients within 3 months of relapse but similar to that of controls in patients in remission for >3 months [median 14.23 (interquartile range 12.19–17.63) vs. 19.75 (14.04–28.38) ng/ml, respectively; p?=?0.039]. There was no correlation of 25(OH)D levels with other disease characteristics or drug therapy. ALP levels were also lowest after relapse (r _s?=?+0.34, p?=?0.036). Overall, 25(OH)D levels of <20 ng/ml occurred in 62.5 % of NS patients + controls, and correlated negatively with age (r _s?=??0.24, p?=?0.037) but showed no significant correlation with calcium, phosphate, or PTH levels.

Conclusions

In our patients with NS, vitamin D stores remained low for 3 months after NS relapse but showed an increase with longer remission time to control levels. Vitamin D stores were not influenced by disease characteristics or therapy. Longitudinal studies are required to confirm these findings and evaluate the effect of vitamin D on bones, particularly in frequent relapsers.     

Thirty-month follow-up of coronary artery calcification in hemodialysis patients: different roles for inflammation and abnormal calcium-phosphorous metabolism?

BACKGROUND: Cardiovascular disease is the leading cause of death in hemodialysis (HD) patients. Coronary artery calcification (CAC) is considered a marker of atherosclerosis and coronary artery disease (CAD). The CAC progression and factors that influence it were evaluated during a 30-month period. METHODS: Forty HD patients without a history of CAD were enrolled into the study. CAC score was assessed with conventional CT repeated every six months. The circulating factors of phosphorous, calcium, calcium-phosphorous product, intact parathyroid hormone, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, lipoprotein-alpha, albumin, high sensitivity C-reactive protein, and fibrinogen were measured monthly. Hypertension and calcium intake during the study period were taken into account as well. RESULTS: At baseline, CAC score was correlated with age and duration of HD therapy. From all evaluated factors, CAC initiation was influenced only by older age and C-reactive protein. CAC, when it was started, was aggravated continuously and was influenced only by elevated serum phosphorous and calcium-phosphorous product. Hypertension, lipid profile, and calcium intake did not affect CAC initiation or progression. CONCLUSIONS: Once CAC progression starts, it is an uninterrupted process. The roles of inflammation and abnormal calcium-phosphorous metabolism in CAC differ. Inflammation is the major factor that contributes in CAC initiation. Elevated serum phosphorous and calcium-phosphorous product accelerates CAC progression.     

The implications of the foot health status in Parkinson patients: A case–control study

Parkinson's disease (PD) is a neurodegenerative disorder that affects both health of the feet, as to gait patterns. This study aimed to find out about foot problems and their impact on self-perceived quality of life and related to foot health in Parkinson's patients compared to a group of healthy subjects and to measure it with Spanish Podiatry Health Questionnaire (PHQ-S). It is about a case–control study in a sample of Parkinson's patients n = 62, healthy controls n = 62. The PHQ-S was reported, it describes perception the subject has in each of podiatric 6 dimensions consulted, assessing appreciation of health status of interviewee's feet and a self-rated the foot health score on the visual analog scale (VAS). There were statistically significant differences (P < 0.05) in the dimensions that assessed problems with walking and moving, nail trimming, concern feet state, and affectation of quality of life related foot health. Regarding the self-perception of state of their feet, Parkinson's patients perceive a worse state of health of their feet than healthy subjects. The mean value was 4.8 (SD 2.2) for Parkinson's patients and 3.8 (SD 2.3) for healthy subjects. In conclusion, patients with PD have problems in walking or moving, foot pain, difficulties in foot hygiene and in cutting for their nails, as well as the concern they suffer from deterioration in state of their feet affect them and decrease their quality of life. Podiatric problems in Parkinson's patients have a great impact in reducing quality of life related to foot health.     

Oxalobacter formigenes reduce the risk of kidney stones in patients exposed to oral antibiotics: a case–control study

International Urology and Nephrology - This is the first prospective study to investigate the association between kidney stones, bone mineral density, serum testosterone, colon cancer and O....     

Association of macroalbuminuria with oxidized LDL and TGF-β in type 2 diabetic patients: a case–control study

The pathogenesis of diabetic nephropathy, mainly characterized by macroalbuminuria, is still poorly understood, but it is reported that transforming growth factor-β (TGF-β) plays a key role. In vitro evidence suggests that administration of oxidized LDL (ox-LDL) can lead to upregulation of TGF-β by human glomerular mesangial cells. This study aimed to evaluate the association between macroalbuminuria, ox-LDL, and TGF-β in diabetic patients. A total of 77 type 2 diabetic patients with macroalbuminuria (albumin excretion rate: AER ≥ 300 mg/24 h) and 66 patients with normoalbuminuria (AER ≤ 30 mg/24 h) were recruited. Fasting blood samples were obtained and serum levels of ox-LDL and TGF-β were determined. Ox-LDL and TGF-β were significantly higher in patients with macroalbuminuria than in those with normoalbuminuria (98.93 ± 3.99 vs. 72.45 ± 2.48 U/l; P < 0.001 and 6.46 ± 0.74 vs. 2.49 ± 0.39 ng/ml; P < 0.001, respectively). In patients with macroalbuminuria, there was a significant correlation between Ox-LDL and TGF-β (r = 0.376; P < 0.01). AER was significantly correlated to ox-LDL (r = 0.302; P < 0.05) and TGF-β (r = 0.306; P < 0.05) in macroalbuminuric patients. This association remained significant after adjustment for potential confounders. Adjustment for TGF-β (ox-LDL), attenuated the association of ox-LDL (TGF-β) with AER. In conclusion, this study demonstrated the association of TGF-β and ox-LDL with albuminuria in macroalbuminuric type 2 diabetic patients, and suggested that this relationship is highly mediated through the correlation between TGF-β and ox-LDL.     

Nephrectomy as a cause of chronic kidney disease in the treatment of urolithiasis: a case–control study

Objective

To analyze the clinical course of nephrectomized patients due to complications related to nephrolithiasis and ascertain the prevalence of chronic kidney disease (CKD) in this population.

Methods

From 2005 to 2010, 658 patients were treated with urolithiasis. Among these, 30 (4.6%) were nephrectomized. For each case, a control was selected and matched to the case by age, sex and disease duration. All data were collected from medical records, which contained the clinical, laboratory evaluation and diagnostic imaging.

Results

Age of the study group was 51.5 ± 10.4 years and the control group 47.1 ± 5.2 years. There were 17 (85%) women and three men in each group. Patients from the study group reported 3 (range, 1–5) episodes of acute renal colic before nephrectomy. Urinary tract infection and hematuria was detected in 70% of cases before surgery. In addition, half of the patients had at least one previous urological procedure. The control group showed higher urinary levels of calcium (216.1 ± 114.3 vs. 130.9 ± 72.2), uric acid (530.2 ± 197.4 vs. 424 ± 75.2) and citrate (755 ± 533 vs. 380.2 ± 260.7), p < 0.01, 0.03 and 0.01, respectively. The creatinine clearance was lower in the study group, 52.5 ± 18.8 ml/min vs. 92.9 ± 24.2 ml/min in the control group (p < 0.001).

Conclusions

There was a decrease in kidney function in nephrectomized patients compared to a control group of stone-forming patients with both kidneys. Prospective studies are needed to assess the incidence of CKD in patients with nephrolithiasis submitted to nephrectomy.     

Rheumatoid arthritis and incident fracture in women: a case–control study

Background

To examine fracture incidence in women with rheumatoid arthritis (RA) for an entire geographical region of south-eastern Australia.

Methods

Women aged 35 years and older, resident in the Barwon Statistical Division (BSD) and clinically diagnosed with RA 1994–2001 were eligible for inclusion as cases (n?=?1,008). The control population (n?=?172,422) comprised the entire female BSD population aged 35 years and older, excluding those individuals identified as cases. Incident fractures were extracted from the prospective Geelong Osteoporosis Study Fracture Grid. We calculated rate ratios (RR) and 95% confidence intervals (CI) to compare the age-adjusted rate of fracture between the RA and non-RA populations, and used a chi-square test to compare proportions of fractures between women with and without RA, and a two-sided Mann–Whitney U-test to examine age-differences.

Results

Among 1,008 women with RA, 19 (1.9%) sustained a fracture, compared to 1,981 fractures sustained by the 172,422 women without RA (1.2%). Fracture rates showed a trend for being greater among women diagnosed with RA (age-adjusted RR 1.43, 95%CI 0.98-2.09, p?=?0.08). Women with RA sustained vertebral fractures at twice the expected frequency, whereas hip fractures were underrepresented in the RA population (p?<?0.001). RA status was not associated with the likelihood of sustaining a fracture at sites adjacent to joints most commonly affected by RA (p?=?0.22).

Conclusion

Given that women with RA have a greater risk of fracture compared to women without RA, these patients may be a suitable target population for anti-resorptive agents; however, larger studies are warranted.     

Frequencies of apolipoprotein E alleles in depressed patients undergoing hemodialysis – a case-control study

Abstract

Objective: To explore the relation between the frequencies of apolipoprotein E (ApoE) alleles and the occurrence of depression in patients undergoing hemodialysis in a Chinese population. Methods: We examined the ApoE alleles in a sample of 288 subjects: 72 patients with depression under hemodialysis, 74 patients without depression under hemodialysis, 75 patients with depression under nondialytic treatment and 67 patients without depression under nondialytic treatment. The depression state was assessed using the Center for Epidemiological Studies Depression (CES-D) scale. Associations between the occurrence of depression and the frequencies of ApoE alleles were examined using multinomial logistic regression models with adjustment of relevant covariates. Information about sociodemographics, clinical data, vascular risk factors and cognitive function was also collected and evaluated. Results: The frequencies of ApoE-?2 were significantly different between depressed and non-depressed patients irrespective of dialysis (p?<?0.05), but no significant difference was found in the frequencies of ApoE-?4 (p?>?0.05). Serum ApoE levels were significantly different between depressed and non-depressed patients in the whole sample (p?<?0.05). Multinomial logistic regression models showed significant association between the frequency of ApoE-?2 and the occurrence of depression in the Chinese population after control of relevant covariates, including age, sex, educational level, history of smoking and drinking, vascular risk factors and cognitive function. Conclusions: No association between the frequency of ApoE-?4 and the occurrence of depression was found in patients undergoing hemodialysis. Further research is needed to find out if ApoE-?2 acts as a protective factor in Chinese dialysis population since it might decrease the prevalence of depression and delay the onset age.     

Identification of intrinsic and reflexive contributions to trunk stabilization in patients with low back pain: a case–control study

European Spine Journal - The goal of this study was to assess differences in low back stabilization and underlying mechanisms between patients with low back pain (LBP) and healthy controls. It has...     

Clipping of ruptured intracranial aneurysms in a hybrid room environment—a case-control study

Background

Hybrid room treatment (HRT) provides the surgeon immediate intraoperative angiography control of aneurysm occlusion and vessel patency. Since it is relatively resource demanding, in clinical routine HRT is reserved for elective cases. However, since its introduction in our department in 2008, several random cases of ruptured intracranial aneurysms (IAs) have been treated in the HR. This study aims to compare the clinical and radiological outcomes of these cases with cases treated conventionally using a matched pair analysis.

Methods

Twenty (20%) consecutive patients with ruptured IA treated by microsurgical clipping in the HR between 2009 and 2015 were retrospectively matched with “conventionally” (C) treated patients (overall n = 101). Clinical and radiological outcome variables were assessed and compared.

Results

Despite a trend in favor of the HR group, no significant difference between both matched groups (HR vs. C) could be demonstrated regarding the functional outcome (upper/lower good recovery 16/20 vs. 17/20, p > 0.05), frequency of clipping-related vascular insults on CT scans (0/20 vs. 3/20, p > 0.05), aneurysm remnant rate on postoperative angiography (1/20 vs. 4/20, p > 0.05) and retreatment rate (0/20 vs. 1/20, p > 0.05). When cumulating all outcome events by a scoring system, however, the HR cohort showed a significantly lower occurrence of events (p < 0.05). In three cases co-treatment by an endovascular approach was performed in the HR cohort.

Conclusion

In this relatively small cohort, a matched pair analysis revealed a discrete but not significant tendency toward a lower frequency of aneurysm remnants and clipping-related vascular insults in the HR cohort. However, HR cohort patients benefited from direct endovascular co-treatment in selected cases.

     

Oral health-related quality of life in Iranian patients with spinal cord injury: A case–control study

IntroductionThe study aimed to compare the oral health variables, general, and oral health-related quality of life (QoL), depression, and anxiety between spinal cord injury (SCI) patients and healthy controls and also to determine the key factors related to the oral health-related quality of life (OHRQoL) in the SCI patients.MethodsA total of 203 SCI patients and 203 healthy controls were enrolled. Patients and healthy adults were invited to attend a dental clinic to complete the study measures and undergo oral clinical examinations. OHRQoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14), and the general health-related quality of life (GHRQoL) was evaluated by SF-36. In SCI patients, depression and anxiety were recorded using the Hospital Anxiety and Depression Scale (HADS), while Functional Assessment Measure (FAM) was used to assess dependence and disability. All the subjects were examined for caries which was quantified using the decayed, missing, and filled Teeth (DMFT) index, gingival bleeding index (GI), plaque index, and periodontal status by community periodontal index (CPI).ResultsThe analysis of covariance (ANCOVA) revealed significant differences between the two groups in terms of oral health expressed in DMFT, oral hygiene, and periodontal status, controlled for age, gender, family income, and occupational status (p < 0.001). Using the hierarchical linear regression analyses, in the final model, which accounted for 18% of the total variance (F(126.7), p < 0.01), significant predictors of OHRQoL were irregular tooth brushing (β = 1.23; 95% CI = 1.06; 1.41), smoking (β = 0.82; 95% CI = 0.66; 0.97), dry mouth (β = 0.37; 95% CI = −0.65 to 0.10) functional and motor functioning (β = 0.32; 95% CI = −0.45 to 0.17), DMFT (β = 0.06; 95% CI = 0.02; 0.09), CPI (β = 0.22; 95% CI = 0.04; 0.04), physical component measure of GHRQoL (β = −0.275; 95% CI = −0.42 to 0.13), lesion level at the lumbar–sacral (β = −0.18; 95% CI = −0.29 to −0.06) and thoracic level (β = −0.09; 95% CI = −0.11 to −0.06).ConclusionSCI patients had poor oral hygiene practices, greater levels of plaque, gingival bleeding, and caries experience than the healthy controls. In addition, more number of SCI patients had periodontal pockets and dry mouth than the comparative group. SCI patients experienced more depression and anxiety, poor GHRQoL, and OHRQoL than the healthy control group. The factors that influenced OHRQoL in SCI patients were age, toothbrushing frequency, smoking, oral clinical status, depression, physical component of GHRQoL, and level of lesion.