Two daytime icodextrin exchanges decrease brain natriuretic peptide levels and improve cardiac functions in continuous ambulatory peritoneal dialysis patients

Aim: Peritoneal dialysis patients with ultrafiltration failure frequently have fluid overload. It is known that the increase in the ultrafiltration is associated with decrease in the left ventricle (LV) dysfunction. This study was designed to examine the potential effects of serum brain natriuretic peptide (BNP) on cardiac functions and to determine the relationship between BNP and cardiac parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with ultrafiltration failure. Methods: Twenty‐eight patients with high or high‐average membrane permeability as indicated by the peritoneal equilibration test were enrolled and randomized to receive either once or twice daily icodextrin. Serum BNP levels and echocardiographic measurements were evaluated at baseline and at the end of the eighth week. The correlations between the percentage changes of parameters from baseline were also studied. Results: In both groups there was a significant decrease in serum BNP, LV mass, heart rate (HR) and cardiothoracic index (CTI) and an improvement in ejection fraction (all P < 0.05). However, the percentage of change in all these parameters was significantly better in the twice daily compared with once daily group (all P < 0.05). Furthermore, the percentage decrease in BNP was positively correlated with the percentage decrease in HR, LV mass and BP. Conclusion: Twice daily icodextrin treatment might be useful in hypervolaemic CAPD patients for the improvement of cardiac functions. BNP monitoring may be useful to follow up these patients.     

Transition zone biopsy and prediction of extraprostatic extension at radical prostatectomy

BACKGROUND: There is limited data in the literature that suggests that transition zone (TZ) biopsy might be useful for the prediction of extraprostatic extension (EPE) in clinically localized prostate cancer. We studied the role of TZ biopsy in the prediction of EPE. METHODS: Transition zone biopsies were performed in addition to systematic peripheral zone (PZ) biopsies between November 1995 and December 1999. During this period, 59 patients underwent radical prostatectomy for clinically localized disease. Final pathological results were compared with preoperative clinical and biopsy findings. RESULTS: Of the 59 patients who underwent radical prostatectomy, 46 had cancer only in the PZ cores and 13 had cancer both in the PZ and the TZ cores at the biopsy. Final histopathological results revealed EPE in 19 (32%) patients and positive surgical margins in 22 (37%). In univariate analysis of age, prostate-specific antigen (PSA), mean percentage of positive PZ cores, mean biopsy Gleason score and positive TZ biopsy, there was a significant difference for serum PSA levels (P = 0.021), presence of positive TZ cores (P = 0.018) and percentage of positive PZ cores in patients with and without EPE (P < 0.001). In multivariate analysis, the single independent predictor of EPE was the percentage of positive PZ biopsy cores (P = 0.0227). There was agreement between the side of positive TZ biopsy and EPE in seven of eight patients. CONCLUSION: Taking two TZ cores in addition to peripheral sextant biopsy did not result in better prediction of EPE. The relationship between TZ involvement and the presence of EPE can be investigated further in radical prostatectomy specimens.     

Intrapericardial Instillation of Recombinant Tissue Plasminogen Activator: A Case Report

On the 43rd day after open heart surgery, pericardial effusion developed in a patient and resulted in cardiac tamponade. Since the drainage could not be obtained by subxiphoid window technique due to location of fluid and presence of fibrinous adherence and a thrombus in pericardial space, transcatheter intrapericardial recombinant tissue plasminogen activator (tPA) was instilled in the patient. Thus, the intrapericardial fibrinous adherence and the thrombus disappeared, and the effusion was drained efficiently.     

Radioisotope synovectomy with rhenium186 in haemophilic synovitis for elbows, ankles and shoulders

Summary. We have performed 221 radioisotope synovectomy (RS) in more than 150 children and young adults with haemophilia, age ranging 3–30 years (mean 15) in Ege Hemophilia Center, Izmir, Turkey for last 7 years. We always preferred to use Yttrium 90 (Y⁹⁰) for knees; however, since 2005, we started using rhenium 186 (Re¹⁸⁶) for medium‐sized joints with respect to safety. In this article, we have evaluated long‐term experience ranging from 6 months to 3 years (mean 18 months) with Re¹⁸⁶ for elbows (n = 35), ankles (n = 26) and shoulders (n = 2) in total of 63 RS procedures for 49 patients. Their age range was 3–30 years and mean age was 15.5. Two mCi of Re¹⁸⁶ intra‐articularly injected for treating target joints and chronical synovitis. After RS, joint bleedings were decreased for all patients. The best results were obtained for all joints in patients with grade‐II synovitis as like earlier experience with Y⁹⁰. Excellent rates (no bleeding) were observed in grade‐II synovitis in 81% and 46% for elbows vs. 86% and 57% for ankles after 6 months and after 1 year follow‐up of patients, respectively. In grade‐III synovitis, excellent rates were 53% and 25% for elbows and 44% and 29% for ankles, respectively. In five joints for five patients, repeated injections were needed for better outcome. No adverse events such as radioisotope leakage, local inflamatory reactions or malignancy development were observed during and after RS. For medium‐sized joints, RS with Re¹⁸⁶ seems to be either effective or safe treatment method. Our results confirm those previously published by others on the value of Re¹⁸⁶ synoviorthesis in medium‐sized joints in haemophilia patients. After this experience, we changed our protocol and we use Re¹⁸⁶ for all medium‐sized joints for treating chronical synovitis.     

Decrease in cell proliferation by an matrix metalloproteinase inhibitor,doxycycline, in a model of immune‐complex nephritis

Aim: Renal expression of matrix metalloproteinases (MMP) and tissue inhibitors of MMP (TIMP) contribute to the development of tubulointerstitial fibrosis characteristic of progressive forms of primary glomerulonephritis (GN). The aim of this study was to investigate the therapeutic effect of MMP inhibitor, doxycycline, administration in an experimental rat model of immune‐complex nephritis (ICN). Methods: The induction of immune‐complex glomerulonephritis was carried out by the administration of an i.v. dose of 2 mg bovine serum albumin (BSA) daily for 28 days after 8 weeks of s.c. immunization with 1 mg of BSA in complete Freund's adjuvant. Doxycycline (30 mg/kg) was given daily (in groups 2 and 4) by gavage for 28 days. Results: Animals treated with doxycycline showed significant reduction in glomerular area and cell proliferation than non‐treated controls. Glomerular deposition of immunoglobulin (Ig)G and C3 was less intense in treated rats than non‐treated controls. Although not statistically significant, interstitial inflammation was less intense in treated rats than non‐treated controls. Glomerular expression of MMP‐9 by immunoflourescence was significantly inhibited in the treated group. In addition pro‐MMP‐2 on gelatin zymography was importantly suppressed by doxycycline in ICN. Conclusion: Doxycycline, in addition to its antibiotic property, may, following further investigation, provide a possible survival benefit in proliferative glomerulonephritis.     

Chronic Cough and Tachycardia‐Induced Cardiomyopathy in a Patient with Idiopathic Frequent,Monomorphic Premature Ventricular Contractions

A 70‐year‐old woman presented with a 1‐year history of dry cough. Extensive work‐up ruled out common causes of chronic cough. She was found to have very frequent, monomorphic premature ventricular contractions (PVCs) and mild‐to‐moderate left ventricular systolic dysfunction. Propafenone 450 mg/day resulted in complete resolution of her cough and disappearance of PVCs within 24 hours of initiation. One month after the initiation of propafenone therapy, left ventricular ejection fraction normalized and her chronic cough resolved completely. (PACE 2013; 36:e156–e158)