Effect of vitamin D supplementation on endothelial dysfunction in hemodialysis patients.

INTRODUCTION: Patients with chronic kidney disease (CKD) commonly experience 25-hydroxyvitamin D3 (25-OH-D3) deficiency, and these patients have a higher incidence of cardiovascular diseases (CVDs) due to endothelial dysfunction (ED). The aim of our study was to investigate the effect of 25-OH-D3 deficiency and its supplementation on ED in patients with CKD. METHODS: Twenty-nine uremic patients on dialysis and 20 healthy controls were evaluated for ED by high-resolution Doppler ultrasonography of the brachial artery. In addition, 25-OH-D3-deficient patients (25-OH-D3 < 30 nmol/L) with CKD and healthy controls were evaluated for ED before and after 8 weeks of oral vitamin D (cholecalciferol, 50,000 units) treatment. All subjects were evaluated for percent flow-mediated dilatation (%FMD), percent endothelium-independent nitroglycerin-induced vasodilatation (%NID), and bilateral carotid intima-media thickness (CIMT). FINDINGS: Patients on dialysis had lower %FMD and %NID 6.11 [2.27-12.74] and 10.96 [5.43-16.4], respectively, than controls 15.84 [8.19-22.49] and 21.74 [12.49-29.4], respectively (P < 0.05). Patients on dialysis had higher left and right CIMT (0.79 ± 0.15 and 0.78 ± 0.14, respectively) than controls (0.60 ± 0.09 and 0.59 ± 0.09, respectively; P < 0.05). In 25-OH-D3-deficient patients with CKD, after vitamin D treatment, %FMD was significantly increased in dialysis patients (10.25 [7.8-12.8]) compared to before supplementation (5.4 [2.77-6.15]; P < 0.001). DISCUSSION: These results indicated that dialysis patients had significantly lower blood 25-OH-D3 levels and higher CIMT than healthy subjects. In addition, vitamin D supplementation improved ED and increased %FMD in dialysis patients. Our findings suggest that vitamin D supplementation in dialysis patients might prevent CVD.

Ultrasonographic evaluation of peritoneal membrane thickness and comparison with the effectiveness and duration of CAPD.

BACKGROUND: The few studies on the morphology and functions of CAPD and peritoneum have tended to use histological and histomorphometrical methods. However, such methods are known to require biopsy, which is an invasive method. The present study aims to determine the morphological changes established by ultrasonography in CAPD patients, as well as achieving a comparison between these changes and the functional properties of peritoneum in CAPD. We aim to determine the effects of the duration of CAPD upon peritoneal thickness. METHODS: The study included 42 CAPD patients. Twenty-four of them had peritoneal dialysis (PD) duration of less than 24 months (Group 1) and 18 of them had PD duration of longer than 48 months (Group 2). Patients with a history of surgery involving the peritoneum and abdomen and with a history of peritonitis in the last 3 months were excluded. We examined the parietal peritoneum by trans-abdominal ultrasonography. RESULTS: There was a statistically significant positive correlation between PD duration and peritoneal thickness of each quadrant. There was a statistically significant negative correlation between membrane thickness and creatinine clearance (CrCl), peritoneal Kt/V (pKt/V) and normalized protein catabolic rate. There was a positive significant correlation between membrane thickness and dialysate/plasma creatinine ratio. There was a statistically significant difference between the two groups according to their peritoneal membrane thickness. CrCl and pKt/V values were better in Group 1 than in Group 2. CONCLUSION: Our study revealed that increased PD duration may have a relation with increased peritoneal membrane thickness, and this can be associated with less effective PD. Ultrasound imaging has an important role for evaluating peritoneal membrane thickness without using an invasive method such as biopsy and can be performed easily in dialysis clinics.

Assessment of genetic risk factors for thromboembolic complications in adults with idiopathic nephrotic syndrome.

AIMS: Nephrotic syndrome (NS) may occur with acquired hypercoagulability, however, the fact that it is accompanied by an underlying hereditary thrombophilia, especially combined hereditary thrombophilia would lead to thrombotic events. In this study, we aimed to evaluate the contribution of genetic thrombophilia to development of thrombotic events in adult patients with NS. MATERIAL AND METHODS: Factor V Leiden (FVL), prothrombin, and methylenetetrahydrofolate reductase (MTHFR) gene mutation were studied in 51 newly diagnosed idiopathic NS patients and age- and gender-matched 20 healthy control subjects included in the study. Renal vein Doppler ultrasound was conducted in order to investigate the prevalence of subclinical renal vein thrombosis. RESULTS: Of 51 patients, 6 (11.8%) were established to have thromboembolic (TE) complications at the time of diagnosis (4 symptomatic, 2 subclinical), and no recurring thrombotic episode was observed. Genetic mutation was established in all patients that were found to have TE complications. Acquired hypercoagulability factors were similar in patients without and with TE complication. CONCLUSIONS: The coexistence of inherited thrombophilia in NS may facilitate thromboembolic complications. If the cause of thrombosis cannot be explained by the usual factors attributed to the occurrence of thrombosis in NS, screening for the other factors, such as FVL, MTHFR, and prothrombin gene mutation, may be beneficial.

Evaluation of the renal resistive index and pulsatility index in patients with pleural effusion by duplex Doppler ultrasonography.

OBJECTIVE: The aim of the study was to evaluate the renal resistive index (RI) and pulsatility index (PI) in patients with pleural effusion (PE). MATERIALS AND METHODS: We studied the mean renal RI and PI in 50 patients with PE and 30 healthy volunteers by Doppler sonography. We grouped effusion as unilateral and bilateral. Statistical analysis was done by independent t test and correlation coefficient analysis. RESULTS: The mean RI/PI in healthy volunteers and in PE patients was 0.58/0.93 and 0.72/1.35, respectively. We observed a significantly higher RI and PI in patients when compared with healthy volunteers (all p < 0.001). We found no difference between the renal RI or PI related to unilateral (0.71 or 1.34, respectively) or bilateral effusion (0.74 or 1.55, respectively) (p > 0.05). CONCLUSION: Pleural effusion might result in increased renal impedance as seen in cirrhosis, which is a rather complicated pathophysiological process, without causing any morphological changes in kidneys.

Acute and subacute effects of EV iron sucrose on endothelial functions in hemodialysis patients.

BACKGROUND: Iron support is an important component of treatment of anemia in hemodialysis (HD) patients. However, there are concerns about endovenous (EV) iron therapy that may cause endothelial dysfunction (ED) by increasing oxidative stress (OS) and lead to cardiovascular events. In this study, we aimed to evaluate the effects of high and repeated doses of EV iron sucrose on endothelial functions in acute and subacute phases. METHODS: We included 15 HD patients to our study. There were 16 patients with iron deficiency but normal kidney functions in control group. We also evaluated endothelium-dependent vasodilatation (EDV) and nitroglycerin-induced vasodilatation (NIV) from the brachial artery by ultrasonography at the beginning of the study, and then 200 mg EV iron sucrose was given initially to both groups for 1 h in 250 cc 0.9% saline and 4 h after the end of the infusion (acute phase) sonographic vasodilatation parameters were measured from brachial artery. These measurements and laboratory tests were repeated 1 week after the end of a total 1000 mg EV iron sucrose replacement (200 mg/week). RESULTS: There was a statistically significant increase in hemoglobin and ferritin levels after the EV iron sucrose therapy in both control and patient groups. EDV values in the HD group were significantly lower than that in the control group before therapy (6.25% vs. 10.53%, p < 0.05). EV iron sucrose therapy did not alter EDV and NIV values at the 4th hour and 6th week in both control and patient groups. CONCLUSION: According to our study, compared with the control group with normal kidney functions, HD patients had impaired endothelial functions. However, in HD patients, high and repeated doses of EV iron sucrose do not have deleterious effects on endothelial functions at acute and subacute phases and can be used safely in that patient group.

Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation.

The objective of this study is to investigate the efficacy of low-level laser therapy (LLLT) in patients with carpal tunnel syndrome (CTS). Sixty patients with CTS were included in this placebo-controlled and double-blind study and randomly assigned to three treatment groups: active laser with a dosage of 1.2 J/per painful point, active laser with a dosage of 0.6 J/per painful point, and placebo groups. A total of 5 points across the median nerve trace were irradiated with Gal-Al-As diode laser. All groups were treated 5 times per week for 3 weeks. Clinical assessments included pain intensity, grip strength, symptom severity score (SSS), functional status score (FSS), nerve conduction studies, and cross-sectional area (CSA) of the median nerve as measured by ultrasonography. Compared to baseline, post-treatment VAS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), grip strength (P < 0.05), SSS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), and FSS scores (P < 0.05) improved significantly in all groups. Only sensorial nerve velocity measurements on the palmar region showed a significant improvement in both active laser groups (P < 0.01). There was no significant difference in any of the outcome measures among the groups. With the chosen laser type and dose regimen, the results suggested that LLLT was no more effective than placebo in CTS.

A sign of arteriogenic insufficiency on penile Doppler sonography: retrograde flow in penile cavernosal-spongiosal communications.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of determining retrograde flow in the penile cavernosal-spongiosal communications (CSCs) with Doppler sonography. METHODS: Thirty-two consecutive men with erectile dysfunction (mean age, 40 years; range, 19-61 years) underwent penile color Doppler sonography. All patients were evaluated for flow direction in the CSCs. RESULTS: Eight of the 32 patients had normal Doppler sonographic findings; 8 had signs of veno-occlusive dysfunction; and 16 had arterial insufficiency. Doppler sonographic examinations of the patients with normal Doppler sonographic findings (100%) and veno-occlusive dysfunction (100%) showed a normal direction of flow in the CSCs. Thirteen of the 16 patients with arterial insufficiency had a normal direction of flow in the CSCs; however, reversal of the flow direction in the CSCs (from the urethral artery back to the cavernosal artery) was observed in the remaining 3 patients. CONCLUSIONS: Investigating the direction of flow in the cavernosal artery, CSCs, and urethral artery is not time-consuming and may help establish an accurate diagnosis of arteriogenic impotence, especially in patients with borderline peak systolic flow velocity values.

[Case report: Ovarian torsion in inguinal canal]. / Inguinal kanalda torsiyone over.

Inguinal and scrotal hernias are two most common congenital anomalies observed by clinicians. The possibility of ovarian torsion following recurrent inguinal hernia is well known. Ultrasound examination of the inguinal region of a female infant showed a spherical, enlarged ovary with multiple tiny cysts. After the diagnosis of ovarian torsion, the patient underwent oopherectomy. It is possible to diagnose inguinal emergencies by high resolution ultrasonography.