Rhabdomyolysis without detectable myoglobulinuria due to severe hypophosphatemia in diabetic ketoacidosis

Clinical signs of hypophosphatemia, even when severe, are rare in diabetic ketoacidosis despite their high frequency in this condition. This article presents a patient with rhabdomyolysis due to severe hypophosphatemia, where the level of serum phosphorus was observed to be as low as 0.42 mg/dL on the 16th hour of ketoacidosis treatment. The patient developed acute tubular necrosis due to rhabdomyolysis, but there was no blood reaction in the urine, and the creatine kinase increased to 1200 U/L. The patient was treated without dialysis and was cured after a polyuria period of 2 months after the oliguric period.     

The primary patency of drug-eluting balloon versus conventional balloon angioplasty in hemodialysis patients with arteriovenous fistula stenoses

Objective

The aim of this article is to assess and compare the rate of primary patency achieved by drug-eluting balloon angioplasty (DEBA) and conventional balloon angioplasty (CBA) in hemodialysis arteriovenous fistula stenoses.

Methods

This retrospective study consists of 52 patients with significant arteriovenous fistulas stenoses who were treated with DEBA (n = 26) or CBA (n = 26) between January 2013 and January 2015. Only those patients with postprocedural technical and clinical success of 100 % were selected from the database. Primary patency rates of fistulas at 6 and 12 months were evaluated with Doppler ultrasonography as well as clinically. The Kaplan-Meier method was used to compare the primary assisted patency rates for the two groups.

Results

The type of AVFs were 41 (78.8 %) radiocephalic and 11 (21.2 %) brachiocephalic. Primary patency rates between the DEBA and CBA group had a statistically significant difference at 12 months (p < 0.05). However there was no statistically significant difference at the 6-month follow-up period (p = 0.449). There was no statistically significant difference among the patient age, patient gender and fistula type of the two groups (p > 0.05).

Conclusion

Drug-eluting balloon angioplasty proved to be an effective treatment of hemodialysis AVFs stenosis, with a high primary patency rate at 12 months.

     

Is the preoperative MPV value related to early thrombus formation in microvascular anastomosis?

Objective: One of the most common encountered problems in free flap surgeries is anastomotic thrombosis. The mean platelet volume (MPV) may indicate the concentration of intra-platelet proactive substances and the thrombogenic potential of the platelets. MPV is used as a clinical monitoring index in routine blood counts, it has not yet been effectively used in free flap surgery.

Methods: This study evaluates the relationship between the preoperative MPV value and anastomotic thrombus formation during the postoperative 48?hours in 32 free flap operations from September 2013 to September 2014. The mean patient age was 36.75 years. The preoperative MPV value, which was obtained from the complete blood count, was recorded and correlation of MPV and postoperative thrombus formation was investigated.

Results: Four anastomotic thrombus were encountered in 34 free flaps during the postoperative 48?hours. Two of them were salvaged by performing thrombectomy and/or administration of i.v. heparin. There was no statistical relationship between MPV value and postoperative thrombus formation during 48?hours follow-up (p?=?0.925).

Conclusion: Even though this study didn’t find a correlation between preoperative MPV value and postoperative early anastomotic thrombus, it would be helpful to validate the results using multi-centre and comprehensive studies with larger patient cohorts.     

Effects of captopril,telmisartan and bardoxolone methyl (CDDO‐Me) in ischemia‐reperfusion‐induced acute kidney injury in rats: an experimental comparative study

Renal ischemia‐reperfusion (IR) injury is one of the most common causes of acute kidney injury. This study investigated the effects of captopril (CAP), telmisartan (TEL) and bardoxolone methyl (BM) in animals with renal IR injury. Adult male Wistar–Albino rats were divided into six groups: control, vehicle, IR, IR with CAP, IR with TEL and IR with BM. Before IR was induced, drugs were administered by oral gavage. After a 60‐min ischemia and a 120‐min reperfusion period, bilateral nephrectomies were performed. Serum urea, creatinine, neutrophil gelatinase‐associated lipocalin (NGAL) levels, tissue total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), asymmetric dimethylarginine (ADMA) levels, superoxide dismutase (SOD) activity and glutathione peroxidase (GSH‐Px) activity were measured. Tissue mRNA expression levels of peroxisome proliferator‐activated receptor‐? (PPAR‐?), nuclear factor erythroid 2‐related factor 2 (Nrf2) and nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB) were analyzed. In addition, renal tissues were evaluated histopathologically and immunohistochemically. All tested drugs reduced renal damage, apoptosis, urea, creatinine, NGAL, TOS, nitric oxide (NO) and ADMA levels, NF‐κB, inducible nitric oxide synthase (iNOS) and endothelin‐1 (ET‐1) expressions (P < 0.001). All tested drugs increased SOD activity, GSH‐Px activity, TAS levels, TT levels, endothelial nitric oxide synthase (eNOS) expression, dimethylarginine dimethylaminohydrolases (DDAHs) expression, Nrf2 expression and PPAR‐? expression (P < 0.001, P < 0.003). These results suggest that CAP, TEL and BM pretreatment could reduce renal IR injury via anti‐inflammatory, antioxidant and anti‐apoptotic effects.     

Value of <Superscript>18</Superscript>F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma

Purpose  

We assessed the role of the maximum standardized uptake value (SUV_max) of bone marrow and the extramedullary lesion with the highest SUV_max in positron emission tomography/computed tomography (PET/CT) of newly diagnosed multiple myeloma (MM) patients in predicting overall survival (OS).