Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: A systematic review and meta-analysis

The general management for chronic kidney disease (CKD) includes treating reversible causes, including obesity, which may be both a driver and comorbidity for CKD. Bariatric surgery has been shown to reduce the likelihood of CKD progression and improve kidney function in observational studies. We performed a systematic review and meta-analysis of patients with at least stage 3 CKD and obesity receiving bariatric surgery. We searched Embase, MEDLINE, CENTRAL and identified eligible studies reporting on kidney function outcomes in included patients before and after bariatric surgery with comparison to a medical intervention control if available. Risk of bias was assessed with the Newcastle-Ottawa Risk of Bias score. Nineteen studies were included for synthesis. Bariatric surgery showed improved eGFR with a mean difference (MD) of 11.64 (95%CI: 5.84 to 17.45, I² = 66%) ml/min/1.73m² and reduced SCr with MD of ?0.24 (95%CI ?0.21 to ?0.39, I² = 0%) mg/dl after bariatric surgery. There was no significant difference in the relative risk (RR) of having CKD stage 3 after bariatric surgery, with a RR of ?1.13 (95%CI: ?0.83 to ?2.07, I² = 13%), but there was reduced likelihood of having uACR >30 mg/g or above with a RR of ?3.03 (95%CI: ?1.44 to ?6.40, I² = 91%). Bariatric surgery may be associated with improved kidney function with the reduction of BMI and may be a safe treatment option for patients with CKD. Future studies with more robust reporting are required to determine the feasibility of bariatric surgery for the treatment of CKD.     

Lyme carditis: complete AV dissociation with episodic asystole presenting as syncope in the emergency department.

We report a case of Lyme carditis in an otherwise-healthy young male who presented to the Emergency Department (ED) with syncope and a possible seizure. This patient, without documented history of Lyme disease, acutely developed third-degree atrioventricular (AV) block with episodic asystole, which required placement of a transvenous pacemaker in the ED and resolved only after the patient had been placed on ceftriaxone. We discuss the significance of Lyme carditis and its increasing prevalence, and review the current literature. We also recommend appropriate screening modalities for patients with known Lyme disease, or an atypical profile for cardiac abnormalities.     

Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings.

OBJECTIVE: The purpose of this study was to review surgical histologic findings in women with lobular carcinoma in situ (LCIS) at percutaneous breast biopsy. MATERIALS AND METHODS: Retrospective review was performed of 1315 consecutive lesions that underwent percutaneous breast biopsy. Percutaneous biopsy yielded LCIS in 16 (1.2%) lesions. Subsequent surgical biopsy was performed in 14 lesions in 13 women. Histologic findings were reviewed. RESULTS: In five of the 14 lesions, percutaneous biopsy yielded LCIS and a high-risk lesion (radial scar in three and atypical ductal hyperplasia in two); in one (20%) of these five lesions, surgery revealed ductal carcinoma in situ (DCIS). In four of the 14 lesions, the LCIS in the percutaneous biopsy had features that overlapped with those of DCIS; in two (50%) of these four lesions, surgery revealed DCIS (n = 1) or infiltrating lobular carcinoma (n = 1). In the remaining five of the 14 lesions, surgery revealed no DCIS or infiltrating carcinoma. Five (38%) of 13 women with LCIS lesions had synchronous or metachronous infiltrating carcinoma (three ductal, one lobular, one mixed) in the ipsilateral (n = 1) or contralateral (n = 4) breast. CONCLUSION: Surgical excision was warranted in lesions in which LCIS was found at percutaneous breast biopsy when the percutaneous biopsy histologic features overlapped with those of DCIS, when a high-risk lesion was present, or when there was imaging-histologic discordance. LCIS without these factors was not shown to require surgical excision in our small series, but a larger study is needed. Diagnosis of LCIS at percutaneous biopsy is a marker for women who are at increased risk of ductal or lobular carcinoma in either breast.     

Trichorrhexis invaginata and ichthyosiform erythroderma in netherton syndrome

Trichorrhexis invaginata and ichthyosiform erythroderma are pathognomic for Netherton Syndrome.     

A field investigation of the acute respiratory effects of metal working fluids. II. Effects of airborne sulfur exposures

An investigation of the acute respiratory effects of workers exposed to metal working fluids (MWF) was conducted in an automobile parts manufacturing facility. After observing an association between cross-shift decline in forced expiratory volume in the first second (FEV₁) and aerosol mass concentration, improved characterization of the exposure was sought through investigation of four elements of a priori interest (Cl, Cr, Ni, S). Of these, only sulfur showed an association with cross-shift FEV₁ decrement. The relative risk of 5% cross-shift FEV₁ decrement was 2.7 (95% confidence interval = 1.0–6.0) comparing those with >4.4 μg/m³ to those with <2.5 μg/m³ sulfur exposure. Because the concentrations of sulfur in this environment were relatively low and other respiratory irritants were present, sulfur is more likely to be an indicator of more irritating conditions than the sole agent responsible for the observed acute respiratory effects. Am. J. Ind. Med. 31:767–776, 1997. © 1997 Wiley-Liss, Inc.