Young population bladder neoplasms.

OBJECTIVE: Bladder urothelial carcinoma is a rare condition that primarily affects the elderly and is rare in people under 40 years of age. There is no definitive information about the prognosis and clinical behavior of bladder cancer in young individuals. In our study, we aimed to investigate the prognosis and clinicopathological features of bladder tumors in patients under 40. PATIENTS AND METHODS: A retrospective analysis was performed on patients diagnosed with urothelial neoplasia who underwent bladder surgery between January 2008 and December 2020. The patient's medical records in our cancer database were collected. The study included stage, grade, multifocality, smoking habits, recurrence, and survival. The cases were divided into two groups: those under 40 (Group 1) and those over 40 (Group 2). The clinical and pathological features of young and old patients were compared. RESULTS: 17 patients (14 men and 3 women) under 40 were identified. The age ranged between 19 and 40, and the average was 30.6. One infiltrating urothelial carcinoma (pT1), twelve papillary urothelial carcinomas (pTa), two papillary urothelial neoplasias with low malignant potential, and two urothelial papillomas were all identified by pathology. Dysuria was the primary symptom that initially manifested. Recurrence occurred in two of 12 patients with low-grade papillary urothelial carcinoma in the young patient group. In a similar group of patients over 40, recurrence was detected in 7 out of 10 patients. Patients with urothelial carcinoma under the age of 40 have been noted to have single, small tumors, unlike older patients. No tumor progression was detected in young patients. All young patients are still alive and have not experienced any recurrences. In the group of older patients, tumor progression was observed in 11 patients (16.4%). CONCLUSIONS: Patients under 40 typically have low-grade and low-stage bladder urothelial cancer. Because urothelial tumors in young people frequently have a good prognosis and seldom recur, transurethral excision is the preferred treatment method for bladder tumors.

Pentraxin-3, endothelin-1, some biochemical parameters and hematology in bovine respiratory disease complex.

Abstract. Background: Infectious bovine respiratory disease complex (BRDC) is one of the world's major livestock problems. Aims: The study aimed to determine the diagnostic importance of pentraxin-3, endothelin-1, clinical biochemistry, and hematological parameters in infectious BRDC. Methods: Animals in this study were Simmental breed, 1-7 years old, untreated, and healthy and BRDC cattle (40 cattle with BRDC in the disease group, and 10 healthy cattle in the control group). Clinical findings such as general posture, respiratory rate per minute, rectal temperature, heart rate per minute, and mental posture of the diseased cattle were recorded. Blood samples were taken from the jugular vein only once from all cattle. Complete blood count from blood samples was measured in an automatic complete blood count device, biochemical parameters in an autoanalyzer, and pentraxin-3 and endothelin-1 were measured by ELISA method. Results: Rectal temperature, respiratory and pulse rates per minute, total leukocyte count, gamma-glutamyl transferase, urea, total bilirubin, lactate dehydrogenase, creatine kinase, pentraxin-3 and endothelin-1 concentrations were found to be statistically higher in BRDC group than those in the control group (P<0.001). Conclusion: Pentraxin-3 and endothelin-1 levels were statistically significantly higher in the BRDC group compared to the control group. As a result, pentraxin-3 and endothelin-1 were found to be diagnostically important in cattle diagnosed with BRDC.

Heritability of advertisement call properties of the Japanese quail / Herdabilidade de propriedades de chamada de anúncio da codorna japonesa

Abstract The objective of this study was to investigate genetic variances and covariances among features of the male Japanese quail advertisement call. Duration of the first, second and third syllable, the length of interval 1 (between the first and the second syllable), interval 2 (between the second and the third syllable) and damping (extension of the third syllable) were measured as temporal properties of the call. Spectral properties were peak frequencies of each syllable and the damping component. In this study, 1730 calls were recorded from 488 male Japanese quail. The restricted maximum likelihood procedure for repeated measurements was applied to estimate (co)variance components and genetic parameters for the examined traits. Heritability estimates of call parameters of the male Japanese quail ranged from low to high values (0.04-0.65) and they were generally higher for temporal properties than for spectral properties. Among the temporal properties of the call, the highest genetic correlation was between the first and the second syllable (0.96±0.251) while the lowest genetic correlation was between the first and the third syllable (0.03±0.231). Significant genetic correlations were generally high and positive among peak frequencies of the syllables. Despite the lack of apparent pattern, interval lengths tended to have positive correlation with spectral properties of the call, but the correlation of syllable lengths with spectral properties of the call was negative.

Resumo O objetivo deste estudo foi investigar as variâncias e covariâncias genéticas entre as características do canto de anúncio de codornas japonesas. A duração da primeira, segunda e terceira sílaba, o comprimento do intervalo 1 (entre a primeira e a segunda sílaba), o intervalo 2 (entre a segunda e a terceira sílaba) e o amortecimento (extensão da terceira sílaba) foram medidos como propriedades temporais da chamada. As propriedades espectrais foram as frequências de pico de cada sílaba e o componente de amortecimento. Neste estudo, 1730 chamadas foram registradas de 488 codornas japonesas masculinas. O procedimento de máxima verossimilhança restrita para medidas repetidas foi aplicado para estimar componentes de (co) variância e parâmetros genéticos para as características examinadas. As estimativas de herdabilidade dos parâmetros de chamada das codornas japonesas masculinas variaram entre valores baixos e altos (0,04-0,65) e foram geralmente mais elevadas para as propriedades temporais do que para as propriedades espectrais. Dentre as propriedades temporais da chamada, a maior correlação genética foi entre a primeira e a segunda sílaba (0,96 ± 0,251), enquanto a menor correlação genética foi entre a primeira e a terceira sílaba (0,03 ± 0,231). Correlações genéticas significativas foram geralmente altas e positivas entre as frequências de pico das sílabas. Apesar da falta de padrão aparente, os comprimentos de intervalo tenderam a ter uma correlação positiva com as propriedades espectrais da chamada, mas a correlação dos comprimentos das sílabas com as propriedades espectrais da chamada foi negativa.

Heritability of advertisement call properties of the Japanese quail.

The objective of this study was to investigate genetic variances and covariances among features of the male Japanese quail advertisement call. Duration of the first, second and third syllable, the length of interval 1 (between the first and the second syllable), interval 2 (between the second and the third syllable) and damping (extension of the third syllable) were measured as temporal properties of the call. Spectral properties were peak frequencies of each syllable and the damping component. In this study, 1730 calls were recorded from 488 male Japanese quail. The restricted maximum likelihood procedure for repeated measurements was applied to estimate (co)variance components and genetic parameters for the examined traits. Heritability estimates of call parameters of the male Japanese quail ranged from low to high values (0.04-0.65) and they were generally higher for temporal properties than for spectral properties. Among the temporal properties of the call, the highest genetic correlation was between the first and the second syllable (0.96±0.251) while the lowest genetic correlation was between the first and the third syllable (0.03±0.231). Significant genetic correlations were generally high and positive among peak frequencies of the syllables. Despite the lack of apparent pattern, interval lengths tended to have positive correlation with spectral properties of the call, but the correlation of syllable lengths with spectral properties of the call was negative.

Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation.

BACKGROUND: Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers. METHODS: This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal. RESULTS: For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding. CONCLUSIONS: There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.

Heritability of advertisement call properties of the Japanese quail

Abstract The objective of this study was to investigate genetic variances and covariances among features of the male Japanese quail advertisement call. Duration of the first, second and third syllable, the length of interval 1 (between the first and the second syllable), interval 2 (between the second and the third syllable) and damping (extension of the third syllable) were measured as temporal properties of the call. Spectral properties were peak frequencies of each syllable and the damping component. In this study, 1730 calls were recorded from 488 male Japanese quail. The restricted maximum likelihood procedure for repeated measurements was applied to estimate (co)variance components and genetic parameters for the examined traits. Heritability estimates of call parameters of the male Japanese quail ranged from low to high values (0.04-0.65) and they were generally higher for temporal properties than for spectral properties. Among the temporal properties of the call, the highest genetic correlation was between the first and the second syllable (0.96±0.251) while the lowest genetic correlation was between the first and the third syllable (0.03±0.231). Significant genetic correlations were generally high and positive among peak frequencies of the syllables. Despite the lack of apparent pattern, interval lengths tended to have positive correlation with spectral properties of the call, but the correlation of syllable lengths with spectral properties of the call was negative.

Resumo O objetivo deste estudo foi investigar as variâncias e covariâncias genéticas entre as características do canto de anúncio de codornas japonesas. A duração da primeira, segunda e terceira sílaba, o comprimento do intervalo 1 (entre a primeira e a segunda sílaba), o intervalo 2 (entre a segunda e a terceira sílaba) e o amortecimento (extensão da terceira sílaba) foram medidos como propriedades temporais da chamada. As propriedades espectrais foram as frequências de pico de cada sílaba e o componente de amortecimento. Neste estudo, 1730 chamadas foram registradas de 488 codornas japonesas masculinas. O procedimento de máxima verossimilhança restrita para medidas repetidas foi aplicado para estimar componentes de (co) variância e parâmetros genéticos para as características examinadas. As estimativas de herdabilidade dos parâmetros de chamada das codornas japonesas masculinas variaram entre valores baixos e altos (0,04-0,65) e foram geralmente mais elevadas para as propriedades temporais do que para as propriedades espectrais. Dentre as propriedades temporais da chamada, a maior correlação genética foi entre a primeira e a segunda sílaba (0,96 ± 0,251), enquanto a menor correlação genética foi entre a primeira e a terceira sílaba (0,03 ± 0,231). Correlações genéticas significativas foram geralmente altas e positivas entre as frequências de pico das sílabas. Apesar da falta de padrão aparente, os comprimentos de intervalo tenderam a ter uma correlação positiva com as propriedades espectrais da chamada, mas a correlação dos comprimentos das sílabas com as propriedades espectrais da chamada foi negativa.

Applications of external cavity diode laser-based technique to noninvasive clinical diagnosis using expired breath ammonia analysis: chronic kidney disease, epilepsy.

An external cavity laser (ECL)-based off-axis cavity-enhanced absorption spectroscopy was applied to noninvasive clinical diagnosis using expired breath ammonia analysis: (1) the correlation between breath ammonia levels and blood parameters related to chronic kidney disease (CKD) was investigated and (2) the relationship between breath ammonia levels and blood concentrations of valproic acid (VAP) was studied. The concentrations of breath ammonia in 15 healthy volunteers, 10 epilepsy patients (before and after taking VAP), and 27 patients with different stages of CKD were examined. The range of breath ammonia levels was 120 to 530 ppb for healthy subjects and 710 to 10,400 ppb for patients with CKD. There was a statistically significant positive correlation between breath ammonia concentrations and urea, blood urea nitrogen, creatinine, or estimated glomerular filtration rate in 27 patients. It was demonstrated that taking VAP gave rise to increasing breath ammonia levels. A statistically significant difference was found between the levels of exhaled ammonia (NH3) in healthy subjects and in patients with epilepsy before and after taking VAP. The results suggest that our breath ammonia measurement system has great potential as an easy, noninvasive, real-time, and continuous monitor of the clinical parameters related to epilepsy and CKD.

Does the inhibition of renin-angiotensin system decrease inter-dialytic weight gain in anuric hemodialysis patients?

OBJECTIVE: Knowledge about the inhibition of centrally located angiotensin-I (AT-I) receptors by highly lipophilic AT-I receptor blockers and its' effect are limited with experimental studies. Thus, we aimed to investigate the effect of Telmisartan on Inter-dialytic weight gain (IDWG) % and echocardiographic measurements in anuric hemodialysis (HD) patients. PATIENTS AND METHODS: A total of forty-one anuric HD patients with ≥ 6 months maintenance on HD were included in this prospective, randomized and self-controlled study. Four weeks prior the study, angiotensin converting enzyme blockers and AT-I receptor blocker drugs were stopped. Patients were assessed three times during the study protocol. These are baseline, three months later (without Telmisartan period) and three months after Telmisartan therapy. RESULTS: IDWG % was significantly decreased in the period of with Telmisartan compared to period without Telmisartan (5.6 ± 1.0% vs 5.3 ± 1.0%, p = 0.03). After the administration of Telmisartan left ventricule end-diastolic diameter (LVEDD) (p = 0.001) and inferior vena cava diameter (IVCD) (19.1 ± 3.8 mm vs 17.3 ± 4.2 mm, p = 0.001) were significantly decreased compared to the period of without Telmisartan. Despite of significantly changes observed in IVCD and LVEDD measurements in a period without Telmisartan, there was no significantly difference in left ventricular mass index (LVMI) measurements in this period. However, LVMI was significantly regressed after the administration of Telmisartan (269.3 ± 82.7 g vs 256.3 ± 70.3 g, p = 0.003 respectively). CONCLUSIONS: Treatment of anuric HD patients with Telmisartan at a dose of 40 mg a day reduces IDWG%, LVEDD and IVCD measurements. Further studies investigating the long-term effect of these beneficial effects on clinical outcomes are necessary.

The effects of allopurinol on metabolic acidosis and endothelial functions in chronic kidney disease patients.

BACKGROUND: Hyperuricemia and metabolic acidosis have emerged as important risk factors for progression of kidney disease. In this study, we aimed to investigate the effects of allopurinol on metabolic acidosis and endothelial functions in hyperuricemic stage 2-4 chronic kidney disease (CKD) patients. METHODS: Thirty patients with stage 2-4 CKD and serum uric acid levels over 5.5 mg/dl were included in the study group. They were prescribed 300 mg/day per oral allopurinol treatment for three months. Age- and gender-matched CKD patients (n = 30) with similar clinical characteristics were taken as the control group and were not given allopurinol treatment. Endothelial functions were measured via flow-mediated dilatation (∆FMD %) over the forearm. pH and HCO3 levels in venous blood, Cr clearance and proteinuria levels were calculated in all patients at baseline and in the third month. RESULTS: Serum uric acid levels significantly decreased in the study group from 7.9 ± 1.6 to 6.4 ± 1.7 (p < 0.001). Cr clearance (from 43.4 ± 20.1 to 51.4 ± 24.9, p = 0.011), serum bicarbonate levels (from 21.4 ± 3.4 to 23.0 ± 3.4, p = 0.007) and ΔFMD % values (from 5.8 ± 2.5 to 6.2 ± 2.7, p = 0.006) increased significantly in the allopurinol group. There were no significant changes except for ∆FMD % values (decreased from 6.27 ± 1.62 to 5.71 ± 1.90, p = 0.005) in the control group. ∆FMD % variations within the two groups were clearly significant in the repeated ANOVA general linear model. CONCLUSION: We assume that decreasing uric acid levels with allopurinol treatment seems to be helpful in restoring endothelial functions, preventing metabolic acidosis and slowing down the progression of CKD.

Associations between serum hepcidin level, FGF-21 level and oxidative stress with arterial stiffness in CAPD patients.

BACKGROUND: Patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. Atherosclerosis is associated with increased arterial stiffness (AS), endothelial dysfunction and elevated oxidative stress (OS) and inflammation. We aimed to investigate the relationship between oxidative stress status, arterial stiffness, hepcidin and fibroblast growth factor-21 (FGF-21) levels in CAPD patients. METHODS: As a prospective observational study, we analyzed 56 CAPD patients, aged between 30 and 63 years. Serum hepcidin, FGF-21 levels, OS status and AS were determined. Arterial stiffness was measured by flow-mediated dilatation (FMD). Oxidative stress status was determined by total antioxidant status, total oxidant status (TOS) and oxidative stress index (OSI). RESULTS: FMD was negatively correlated with TOS, OSI, hepcidin and FGF-21 (r: -0.313, p: 0.020; r: -0.0331, p: 0.014; r: -0.498, p < 0.001; r: -0.403, p: 0.002, respectively). OSI was positively correlated with hepcidin, parathormone and negatively correlated with FMD (r: 0.278, p: 0.040; r: 0.462, p < 0.001; r: -0.0331, p: 0.014, respectively). CONCLUSION: There are many factors affecting arterial stiffness in CAPD patients. In our study, higher levels of OS status, hepcidin and FGF-21 were independent determinants of arterial stiffness in PD patients. Therefore, definition and improvement of these new parameters will be helpful to reduce the cardiovascular disease risk and mortality in CAPD patients.

Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis.

Wegener's granulomatosis (WG) is an uncommon systemic vasculitis, which involves the upper and lower respiratory tracts and the kidneys. Because the patients generally present with clinical manifestations that are similar to common diseases, WG may be initially misdiagnosed as infection or malignancy. We report the case of a 55-year-old male presenting with weight loss, cough, hemoptysis, low-grade fever, and pulmonary nodules detected on the thoracic CT scan. Malignancy was initially suspected, so a PET/CT was performed. It demonstrated intense FDG uptake in the upper and lower respiratory system. The diagnosis of WG was based on PET findings, elevated serum levels of inflammatory markers, and the presence of c-ANCA. We consider that the knowledge of FDG-PET/CT findings may help to make an easier and earlier diagnosis of WG.

Generalized Aggressive Periodontitis in a Patient With Nephrotic Syndrome Associated With Primary Renal Amyloidosis: A Case Report.

INTRODUCTION: Renal amyloidosis may lead to renal disease, and then nephrotic syndrome may develop. To the best of the authors' knowledge, this is the first case report in which a patient presents with generalized aggressive periodontitis (GAgP) and nephrotic syndrome in conjunction with renal amyloidosis. CASE PRESENTATION: An 18-year-old male presented to the periodontology department for generalized gingival recessions. He was diagnosed as having primary renal amyloidosis by his physician. The patient presented with severe gingival inflammation and alveolar bone loss. Biochemical tests were within normal limits except for serum albumin level. No amyloid deposition was found in a gingival biopsy, and the patient was diagnosed as having GAgP. Non-surgical periodontal treatment, in combination with antibiotic treatment, was performed. After 3 years, his systemic and periodontal conditions showed deterioration. CONCLUSIONS: The effects of systemic factors related to nephrotic syndrome in conjunction with renal amyloidosis and deterioration in oral hygiene may play a significant role in the progression of periodontal disease. Even if there is no amyloid deposition in periodontal tissues, clinicians should consider that nephrotic syndrome associated with systemic amyloidosis may provide an important contribution to the periodontal breakdown by the modifying conditions that affect the host response to the accumulation of dental biofilm.

The upper extremity musculoskeletal complications in dialysis patients: comparison between hemodialysis and peritoneal dialysis.

OBJECTIVES: The aim of this study was to compare the upper extremity musculoskeletal complications in the patients who had been receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). MATERIAL AND METHODS: The patients who had been receiving HD (n=17) or CAPD (n=15) were included to the study. The age, gender, duration of dialysis were recorded. The physical findings related to musculoskeletal system in the upper extremity were researched. The cervical, shoulder, hand standard radiographies and shoulder magnetic resonance imaging were investigated. RESULTS: The mean duration of HD and CAPD were 53.60 ± 36.03 and 49.17 ± 33.14 months, respectively (p=0.720). Only 6.3% of the CAPD group had signs of carpal tunnel syndrome (CTS). There were not any differences in the frequency of cervical destructive spondyloarthropathy, decreased height of vertebral corpus in the examination of cervical radiography (p=0.579) and also in the frequency of erosions in the humeral head and bones of hand, cyst in the clavicula, erosive osteoarthropathy and osteoporosis detected in the bones of hands (p> 0.005). In the examination of shoulder MR imaging, 80% of the HD group and 47.1% of the CAPD group had supraspinatus tendinitis (p=0.059). The frequency of subscapularis, biceps and infraspinatus tendinitis were not different in HD and CAPD groups (p> 0.05). CONCLUSION: The musculoskeletal system complications of the upper extremity were common in the patients undergoing dialysis therapy. The most common complications were osteoporosis of the hand region and supraspinatus tendinitis. LEVEL OF EVIDENCE: Prospective, Level 2b.

The relationship of amelogenesis imperfecta and nephrocalcinosis syndrome.

AIM: To analyze the prevalence and associated oral findings of nephrocalcinosis in a group of patients affected with amelogenesis imperfecta (AI). The relationship between types of AI and nephrocalcinosis were also evaluated. DESIGN: This study examines patients who were referred to Pediatric Dentistry Department of SDU between the years of 2002-2007 and who, upon clinical and radiological examination, were diagnosed with AI and treated. Patients were offered information about the possibility of nephrocalcinosis syndrome. Patients who agreed to have tests carried out on their renal system were advised to visit the department of nephrology at the clinic. RESULTS: Suspicious radiopacity was observed during renal ultrasonography of a controlled number of patients with hypoplastic type AI. Laboratory results revealed low Ca values (100-300 mg/days) and normal P values (0.4-1.3 g/days). Delayed eruption, gingival hyperplasia, pulp stones and orthodontic problems were also observed in the same patient groups. CONCLUSION: Although renal findings were observed in a few patients, pediatric dentists are the doctors who are the first to have early contact with this patient group. Because of the potential risk of nephrocalcinosis, early diagnosis may offer good prognosis.

Comparison of sleep quality between hemodialysis and peritoneal dialysis patients.

AIM: Sleep disorders are common in patients with end-stage renal disease. Although studies have been conducted on the type and frequency of sleep disturbances in hemodialysis and peritoneal dialysis patients, there has been no study comparing the sleep quality between these two groups. Therefore, we aimed to compare sleep quality between hemodialysis and peritoneal dialysis patients. METHODS: A total of 102 patients (52 hemodialysis and 50 peritoneal dialysis) were included in the study. The Pittsburgh sleep quality index (PSQI) was used for the assessment of sleep quality. Two groups were compared for seven components of the PSQI questionnaire and global score as well as for clinical and laboratory findings. We also assessed the independent predictors of sleep quality. RESULTS: There were 51 male and 51 female patients (29 male and 23 female in hemodialysis group versus 22 male and 28 female in peritoneal dialysis group). The mean age was 55.5+/-14.6 years in the hemodialysis and 51.5+/-18.1 years in the peritoneal dialysis group. The median dialysis duration was 36 (77.0) months. The sleep quality was poor in 88.5% of the hemodialysis patients and 78.0% of the peritoneal dialysis patients. However, this difference in sleep quality was not significant between the two groups (P>0.05). There was a significant association between the sleep quality and the age, presence of diabetes mellitus, and serum albumin. Among these variables, only age was found to be an independent predictor of sleep quality. CONCLUSIONS: Hemodialysis and peritoneal dialysis patients had a similar high rate of poor sleep quality. Further studies are necessary to investigate the causes of poor quality of sleep and to investigate methods to improve sleep quality in this population.

The effect of serum albumin level on iron-induced oxidative stress in chronic renal failure patients.

BACKGROUND: Intravenous iron (IVIR) administration is widely used to treat anemia in chronic renal failure (CRF) patients and causes oxidative stress. Despite the fact that proteins are extremely susceptible to oxidative stress, there have been no studies investigating the relationship between the severity of iron-induced acute oxidative stress and serum albumin. Therefore, we wanted to investigate the relation between the severity of iron-induced acute oxidative stress and serum albumin level in CRF patients. METHODS: A total of 68 patients (22 on hemodialysis, 24 on continuous ambulatory peritoneal dialysis and 22 predialytic CRF) with absolute iron deficiency were included to the study. Patients with acute inflammatory status, serum ferritin level > or = 100 ng/mL, transferrin saturation > or = 20%, hemoglobin level > or = 12 g/dL or serum C-reactive protein (CRP) level > or = 10 mg/dL were excluded. Serum direct 8-isoprostoglandin F2 alpha (IsoPG-F2 alpha) level was used as an oxidative stress marker. After baseline sampling, 100 mg ferric sucrose was infused within 30 minutes. Blood samples were drawn to assess changes in oxidative stress marker at the end of the IVIR infusion and at 240 minutes. Patients with serum albumin level <4 g/dL were defined as hypoalbuminemic and > or = 4 g/dL as normoalbuminemic. RESULTS: There were 34 hypoalbuminemic and 34 normoalbuminemic patients. Serum IsoPG-F2 alpha level increased in all patients after the administration of IVIR. The severity of iron-induced acute oxidative stress was more prominent in patients with a low serum albumin level. Serum albumin level, presence of diabetes mellitus (DM) and hemoglobin level were found as significant predictors of time-dependent changes in serum IsoPG-F2 alpha level. When the analyses were repeated in nondiabetic patients, serum albumin level was similarly found to be a significant predictor of time-dependent changes in serum IsoPG-F2 alpha level. CONCLUSION: This study demonstrated a negative interaction between iron-induced acute oxidative stress and serum albumin level in CRF patients. Because CRF patients with low serum albumin level are at greater risk for iron-induced acute oxidative stress, new strategies are necessary in this population.

The prognostic importance of trauma scoring systems for blunt thoracic trauma.

BACKGROUND: Early identification and aggressive management of blunt thoracic trauma are essential to reduce the significant rates of morbidity and mortality. The aim of this study was to evaluate the independent predictive value of 5 different trauma scoring systems (Revised Trauma Score [RTS], Trauma and Injury Severity Score [TRISS], Injury Severity Score [ISS], Lung Injury Scale [LIS], and Chest Wall Injury Scale [CWIS]) with respect to prognostic factors such as tube thoracostomy duration, the need for mechanical support and thoracotomy, the length of hospital and ICU stay, morbid conditions, and deaths of patients with blunt thoracic trauma. METHODS: The records of 152 patients with blunt thoracic trauma were reviewed and data consisting of the patients' age and gender, blood pressure and respiratory rate on admission, the extent of chest wall and intrathoracic injury, types of associated injuries, Glasgow Coma Scale (GCS) scores, the need for mechanical support and thoracotomy, tube thoracostomy duration, length of hospital and ICU stay, morbid conditions, and deaths were collected. The relations between the trauma scoring systems and prognostic factors were evaluated by multivariate analysis. RESULTS: The analysis showed that only TRISS was an independent predictor of mortality and only LIS was an independent predictor of morbidity, the need for thoracotomy, and tube thoracostomy duration. TRISS and LIS were independent predictors of the length of ICU stay. ISS, CWIS, and LIS were independent predictors of the need for mechanical support. RTS, TRISS, ISS and LIS were independent predictors of the length of hospital stay. CONCLUSIONS: The LIS grade appeared to correlate with the severity of blunt thoracic injury and was found to be the most useful scoring system in predicting the outcomes of these patients.

Blunt and penetrating traumatic ruptures of the diaphragm.

BACKGROUND: The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality. METHODS: Fourteen patients with TDR were treated in our hospital between January 2000 and June 2005. They have been investigated retrospectively. RESULTS: The study identified 9 men (64 %) and 5 women (36 %), with ages ranging from 19 to 65 years (mean 35.3 years). Rupture of the diaphragm was left-sided in 10 (71 %) and right-sided in 4 (29 %) of the patients. Blunt trauma accounted for the injuries of 11 patients (79 %). Early diagnosis was obtained in 9 patients (64 %). The diagnosis was established preoperatively in 8 patients (57 %), and intraoperatively in 4 (29 %). The diagnosis was missed in 2 (14 %) patients in the first operation. Multiple associated injuries were observed in 12 patients (85 %). Postoperative complications were encountered in five patients (35 %), and the overall mortality was 7 %. CONCLUSIONS: Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.

Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients.

PURPOSE: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. MATERIAL AND METHODS: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n=40) were compared with those of the anatomical landmark method (n=40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared. RESULTS: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. CONCLUSION: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.