twelve-year experience in the management of calciphylaxis resulting in penile gangrene

To analyze the mode of presentation of patients with calciphylaxis induced penile gangrene and the outcome of management of the disease Prospective study [1998 - 2010] Urology Unit, Mubarak Hospital, Kuwait Patients presenting with penile gangrene secondary to calciphylaxis were analyzed. Intervention[s]: Patients with moderate to severe penile gangrene had penile amputation Main Outcome Measure[s]: Etiological factors, mode of presentation, patient characteristics and the outcome of management Eleven patients were managed in the 12-year period. All patients [100%] had end stage renal failure [ESRF] and nine patients [81.8%] were on chronic dialysis at presentation. Poorly controlled diabetes mellitus was a co-morbidity in 10 patients [90.9%]. Areas of gangrene were limited to the glans penis in nine patients [81.8%] and extending to the scrotum in two patients [19.2%]. All patients had generalized calcified blood vessels on plain X-ray of the abdomen and pelvis. Eight patients [72.7%] required partial or total amputation of the penis. Three patients were successfully managed by debridement while one of them was too ill for surgical intervention. Seven patients [63.6%] were dead within three months of the diagnosis of penile gangrene. Penile gangrene due to calciphylaxis is a rare disease seen mostly in patients with ESRF on chronic dialysis. Poorly controlled diabetes is a risk factor for the onset of penile gangrene. The disease has a high mortality in older patients with other co-morbid medical diseases. Immediate penile amputation may result in a satisfactory outcome in less than 50% of all patients

Reference intervals for important serum sex steroid hormones, prostate specific antigen, insulin like growth factor 1 and IGF binding protein 3 concentration in a normal Kuwaiti adult male population

The purpose of this study was to determine the age-specific reference ranges for some important male sex steroid hormones, prostate-specific antigen [PSA], insulin-like growth factor-1 [IGF-1], and IGF binding protein-3 [IGFBP-3], for the Kuwaiti population. Blood samples were taken from 398 consenting, fasting, healthy Kuwaiti males aged 15-80 years between 8.00 a.m. and 12.00 noon. The serum concentrations of total testosterone [TT], dehydro-epiandrosterone sulfate [DHEAS], androstenedione [ADT], sex hormone binding globulin, luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin, PSA, IGF-1 and IGFBP-3 were determined. A distribution curve was plotted and age-specific reference levels were determined for each analyte. The reference interval for parameters with a normal distribution [Gaussian] was mean +/- 2 SD, while for the non-normal distribution [non-Gaussian], it was 2.5-97.5 percentile. The reference intervals for the analytes obtained from this study were compared with those suggested by the kit manufacturers and currently used by the Ministry of Health, Kuwait Laboratories [MOHKL]. Serum IGFBP-3 and ADT had normal distribution while other analytes had non-normal distribution. The reference intervals from this study, manufacturers kit and MOHKL were as follows: TT 3-31, 9-60, 8-35 nmol/l; DHEAS 0.9-11, 1.0-7.3, 2.2- 15.2 micro mol/l; ADT 0.5-4.3, 0.8-2.8, 2.0-9.2 nmol/l; LH 1-11, 0.8-7.6, 0.4-5.7 mIU/l; FSH 0.5-11, 0.7-11.1, 1.1-13.5 mIU/l; prolactin 42-397, 53-360, 80-230 nmol/l; IGF-1 41-542, 78-956, 71-261 ng/ml; IGFBP-3 88- 2,090, 900-4,000, 900-4,000 ng/ml, and PSA 0-3.1, 0-4, 0-4 ng/ml, respectively. These data indicate that for Kuwaitis lower reference ranges must be used for serum TT, DHEAS, ADT, IGFBP-3 and PSA. There is no need to change the currently used reference interval for FSH whereas higher values must be used for LH, prolactin, and IGF-1