Relationship Between Inflammation and Sex Hormone Profile in Female Patients Receiving Different Types of Renal Replacement Therapy

Background

Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients.

Methods

The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)–36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction.

Results

Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2–35), 22.4 (4–34), 18.35 (2–34), and 29.6 (2–35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (β = −0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = −0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001).

Conclusions

Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.     

Lower vitamin D level is associated with poor coronary collateral circulation

Objectives. Vitamin D regulates calcium and bone homeostasis, and parathyroid hormone (PTH) secretion. Cross-sectional associations between lower vitamin D levels and cardiovascular diseases have been reported, but the relationship between vitamin D levels and collateral arteries in stable coronary artery disease (CAD) has not been reported before. Design. Two hundred and fourteen patients with above 95% stenosis in at least one epicardial coronary artery were consecutively recruited after coronary angiography (CAG) during the winter season. The coronary collateral circulation (CCC) was graded using Rentrop classification. Poor CCC group included patients with Rentrop Grade 0–1 CCC and control group included patients with Rentrop Grade 2–3 CCC. Vitamin D and PTH levels were measured on the day of CAG. Results. In the poor CCC group, vitamin D levels were lower (34 ± 25 pmol/L vs. 49 ± 33 pmol/L; p = 0.01) and the prevalence of vitamin D deficiency (< 37 pmol/L) was higher (67% vs. 43%; p = 0.01) compared to the controls. PTH levels, calcium, and phosphate levels were not significantly different between the groups. Female gender, lower HDL cholesterol, and lower vitamin D levels were independently correlated with poor CCC in the study population. Conclusion. Lower vitamin D levels may be associated with poor collateral development in patients with stable CAD.     

Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective,randomized trial

The treatment techniques for pilonidal disease are either associated with high recurrence rates or complex procedures. This prospective randomized study compared the outcome of excision and marsupialization technique with sinus excision technique. A total of 40 consecutive patients with limited, chronic pilonidal sinus disease were operated with either excision and marsupialization technique (Group 1, n=20) or sinus excision technique (Group 2, n=20). The demographics, perioperative data, complications and recurrences were recorded. Patient satisfaction was evaluated with a specific questionnaire 16–18 weeks after surgery. Demographic data, preoperative symptoms and the acute disease history were similar between the groups. Operation time, hospital stay and work-off periods were significantly shorter and the number of out-patient procedures was significantly more in Group 2. Although satisfaction scores were similar between the groups, the patients who had no complaint, were “completely satisfied” or would “absolutely recommend the operative technique to other patients” were significantly more in Group 2. In conclusion, the sinus excision technique requires a shorter operation time, hospital stay and work-off period than excision and marsupialization in the treatment of limited, chronic pilonidal disease. The sinus excision technique can be performed as an out-patient procedure in most cases, and seems to be associated with better patient satisfaction. Received: 15 September 2002 / Accepted: 5 October 2002     

Adaptive radiation therapy of breast cancer by repeated imaging during irradiation

Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide. A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery, radiation therapy (RT) and systemic treatment. RT composes an integral part of breast conserving treatment, and is typically used after breast conserving surgery to improve local control. Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery. Adaptive radiation therapy (ART) is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation. In the context of breast cancer, ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed. Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation. Herein, we provide a concise review of ART for breast cancer in light of the literature.     

Skin graft storage in platelet rich plasma (PRP)

Storage of skin grafts for later use is one of the standard applications in surgery. It is the most preferred method to maintain at +4°C in refrigeration after wrapping the surplus grafts into sterile gauze pad moistened with saline. Although there are many studies on the storage of skin grafts, less is known about storing skin grafts with PRP. Twenty‐five pieces of 1 × 1 cm² partial thickness skin graft were harvested from 12 patients during the reduction mammoplasty operation. Twenty‐four grafts were divided into 4 groups, and each group consisted of 6 grafts, 1 graft was analyzed as Day 0. Grafts in Group 1, 2, and 3 were wrapped by sterile gauze pad moistened by either saline (Group 1) or Hartman (Group 2) or PRP (Group 3). Grafts were analyzed macroscopically and microscopically. There were no significant differences between media for the first 10 days. Decrease in viability was less in saline and PRP wrapped grafts at 20 day, viability decreased significantly in all environments after 20 days. Although there was no significant difference in saline or PRP storage, it was observed macroscopically that the grafts stored in the PRP appeared better.