Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients

Introduction

Pulse pressure (PP) has been reported as an independent predictor of cardiovascular mortality in hemodialysis patients. In this study, we aimed to investigate association of PP with echocardiographic and vascular structural changes such as atherosclerosis and arterial calcifications in HD patients.

Patients and methods

In this cross-sectional study, 108 chronic hemodialysis patients (49 male, 59 female, mean age: 46?±?13?years) were included. Biochemical analyses, echocardiographic and high-resolution carotid Doppler examinations were done. Aortic wall and coronary artery calcifications were measured with electron beam computed tomography. The degree of carotid artery stenosis was measured at four different sites (communis, bulbus, interna and externa) in both carotid arteries.

Results

PP was strongly correlated with systolic (r: 0.82) and diastolic (r: 0.33) blood pressure, left ventricular mass index (r: 0.58), left ventricle end diastolic diameter (r: 0.38) and weakly correlated with aortic wall calcification score (r: 0.26) and carotid plaque score (r: 0.27), but not with coronary artery calcification score. Patients with carotid plaque had higher PP than patients without plaque (50?±?16?mmHg versus 44?±?14?mmHg, P?=?0.05). Patients were divided into three groups according to aortic wall calcification score. PP was significantly higher in patients with higher aortic wall calcification (54?±?16?mmHg) than patients with lower aortic wall calcification (44?±?15?mmHg, P?=?0.04). However, on multivariate linear regression analysis for predicting PP, the only significant factor retained was left ventricle end diastolic diameter.

Conclusion

PP was weakly associated with large vessel calcification and atherosclerosis in hemodialysis patients. The bulk of the effect on PP seems to be due to hypervolemia.     

Nonresectable esophageal cancer.

Esophageal cancer is a devastating illness that has often metastasized before diagnosis. Diagnostic options include barium x-ray and endoscopy. Staging is most accurate using endoscopic ultrasonography. Treatment modalities that are widely used include radiotherapy, chemotherapy, dilatation, prosthesis placement, neodymium-yttrium-aluminum-garnet laser and combinations thereof. Photodynamic therapy is a treatment currently used on an experimental basis that offers selective ablation of cancerous cells. Nursing support for these patients is critically important and must be ongoing. Education for patients and families is continuous throughout the course of treatment.     

Congenital coronary anomalies in adults: comparison of anatomic course visualization by catheter angiography and electron beam CT.

The objective of this study was to compare the anatomic course of anomalous coronary arteries by axial and three-dimensional volume-rendered electron beam computed tomography (EBCT) angiography and X-ray catheter angiography (CAG). We performed a blinded study where patients who previously underwent CAG with (n = 14) and without (n = 14; age- and gender-matched controls) anomalous coronary anatomy were studied with EBCT coronary angiography. Forty to 50 EKG-triggered 3 mm overlapping axial slices were acquired with 2 mm table movement within one breath hold during the i.v. injection of 140 cc of nonionic iodinated contrast (4 ml/sec). The axial source images and volume-rendered three-dimensional reconstructions were evaluated for the presence, type, and course of coronary anomalies and the results were compared to those of CAG. All normal and anomalous coronary arteries were identified by both modalities in all subjects. Identified anomalies include single coronary artery (n = 3), left-sided right coronary artery (n = 3), right-sided left main coronary artery (n = 3), anterior descending coronary artery (n = 2), circumflex coronary artery (n = 2), and separate left-sided ostia for left anterior descending and circumflex coronary arteries (n = 1). In five cases, there was discrepancy in the course of the anomalous vessels between the two modalities. Consensus reading among cardiologist and radiologists favored the interpretation of EBCT over catheter angiography. Noninvasive EBCT coronary angiography compares well with CAG in identifying anomalous coronary arteries and may provide confirmatory evaluation of their precise anatomic relationships to the heart and great vessels.     

Changes in coagulation and fibrinolysis during laparoscopic cholecystectomy

BACKGROUND: The influence of laparoscopic cholecystectomy on coagulation and fibrinolysis is debatable. There have been a few but controversial studies and the need for routine antithrombotic prophylaxis is unclear. MATERIALS AND METHODS: In this prospective study we investigated changes in coagulation and fibrinolysis parameters in laparoscopic cholecystectomy. Blood samples taken before, during, and after surgery from 38 consecutive patients were analyzed. Measured parameters included the international normalized ratio, prothrombin time, partial thromboplastin time, antithrombin III activity, platelet count, mean platelet volume, fibrinogen, and D-dimers. RESULTS: Statistically significant changes included increased perioperative international normalized ratio and D-dimers, and postoperative antithrombin III, fibrinogen, and D-dimers, as well as decreased perioperative antithrombin III and fibrinogen and postoperative international normalized ratio, platelet count, and mean platelet volume. Values of partial thromboplastin time had no statistically significant changes. CONCLUSION: Reduced coagulation activity and increased fibrinolytic activity occur during and after laparoscopic cholecystectomy.     

Tuberculous spondylitis: abscess drainage after failure of anti-tuberculous therapy

Spinal tuberculous abscesses usually respond to anti-tuberculous drugs. The purpose of this study was to evaluate the results of surgical drainage after failure of first-line anti-tuberculous drugs. Patients with spinal instability or vertebral collapse were excluded from the study. The authors retrospectively reviewed 11 patients. The operation was successful in all patients. Anterior/posterior spinal fusion or curettage was not performed. Drains were removed after two to three days. None of the patients required a second operation. Complications, such as spinal instability, vertebral collapse, or death did not occur.     

Pancreatic transplantation in the rat. Long-term study following different methods of management of exocrine drainage

A major problem in pancreas transplantation is the management of exocrine drainage. Isotransplantation has been performed in streptozotocin-induced diabetic rats using a microsurgical technique, and four methods of exocrine drainage have been compared over a nine-month period. The duct system was ligated, left open to drain into the peritoneal cavity, or obliterated with latex or with Ethibloc I occlusion gel. Biochemical follow-up included determinations of serum glucose concentration, intravenous and oral glucose tolerance tests (GTTs), and insulin assays. Histological studies were performed at 1 and 9 months posttransplant. All animals became normoglycemic after the operation. Although 25 out of 28 remained normoglycemic throughout the period of study, oral GTTs performed at six months indicated impaired endocrine function in some of the ligated, freely draining, and Ethibloc I-obliterated animals. Latex-obliterated grafts showed normal oral GTTs up to 9 months postoperatively. Intravenous GTTs showed impairment of endocrine function in all groups, but this was least evident in the latex-obliterated rats. These changes were supported by the peak serum insulin levels during the GTTs. Histologically, long-term ligated, freely draining, and Ethibloc I-obliterated pancreas grafts showed similar degrees of exocrine degeneration, fibrosis, and disruption of islets of Langerhans. In contrast, long term latex-obliterated pancreas grafts demonstrated minimal exocrine tissue and intact islets.     

Enteral nutrition is feasible in pediatric stem cell transplantation patients

We aimed to demonstrate whether enteral nutrition (EN) is feasible in daily practice of hematopoietic stem cell transplantation (HSCT).Nutritional records of 100 patients were evaluated. Patients with poor oral intake were fed by EN with tube. A total of 79 patients required nutritional support. Of them, 71 were fed by EN only. Five were fed by EN plus parenteral nutrition (PN),three were fed by PN only. Median duration of EN was 21 days. In the EN only group, 68% gained or maintained their weight. EN should be considered as a feasible option for nutrition support in children undergoing HSCT. Pediatr Blood Cancer 2012; 59: 1327–1329. © 2012 Wiley Periodicals, Inc.