The protective effect of diabetes mellitus against prostate cancer: role of sex hormones.

BACKGROUND: Diabetes mellitus (DM) has been associated with decreased risk of prostate cancer (PC) in several reports. Hormonal environment of diabetic patients is believed to be an important contributing factor in this regard. METHODS: Using data from a multi-center case-control study in Iran, base line testosterone, sex hormone binding globulin (SHBG), estradiol, and albumin levels as well as thorough demographic and medical characteristics of 194 newly diagnosed prostate cancer patients were determined. There were 317 ethnicity-matched men with no cancer as controls as well. Data was analyzed for hormones of interest in DM patients regarding their cancer status. RESULTS: Of 511 enrolled patients, twenty-one cases and 63 controls were diagnosed as DM. Patients with DM were significantly less likely to have PC (OR: 0.44, P = 0.003). Time since DM diagnosis was also inversely correlated with the risk of cancer (P trend < 0.0001). Control patients had significantly higher testosterone, estradiol, and testosterone/SHBG ratio (P < 0.05). As time since DM diagnosis increased by quartiles, testosterone significantly increased (P trend < 0.05). The risk of PC also significantly declined (P trend < 0.0001) following an initial remarkable increase early after DM diagnosis. After including the hormones in the logistic regression model, there was a weak, yet significant inverse association of testosterone/SHBG and DM duration with the risk of PC. CONCLUSIONS: Based on our results DM duration is inversely correlated with the risk of prostate cancer. Our results do not support the hypothesis that sex hormones, including testosterone, play a major role in the protective effect of DM against PC.

Concentration of blood and seminal plasma elements and their relationships with semen parameters in men with spinal cord injury.

The relationship of calcium, magnesium, zinc (Zn) and copper (Cu) concentrations in blood and seminal plasma on sperm parameters of spinal cord-injured (SCI) men and of normal controls was determined. The study included 93 SCI men and 145 neurologically intact men. Colorimetric and flame atomic absorption spectrophotometers were used. Seminal Zc and Cu had a relationship with sperm motility in SCI men.

Severity of Mitral Regurgitation before and after Kidney Transplantation.

BACKGROUND: Perivalvular and valve involvement are prevalent in patients with end-stage renal disease (ESRD), especially in younger patients compared with normal population. Kidney transplantation improves the prognosis of these patients. Patients with cardiac valvular disease is also be improved following kidney transplantation. OBJECTIVE: To evaluate the impact of renal transplantation on the severity of mitral regurgitation (MR). METHODS: We studied 95 kidney transplantation candidates in Sina Hospital. The patients underwent echocardiography preoperatively and at the 3rd, 6th, and 12th months post-operatively. RESULTS: Pre-operatively, the average MR fraction was 30%; MR volume 30 mL/beat; mitral valve mean gradient 1.8 mm Hg; mitral valve area 4.6 cm2; and mitral annular size 3 cm. No significant difference was observed among the measurements made at the 3rd, 6th, and 12th months post-operatively. CONCLUSION: There was no significant association between the variables measured pre- and post-operatively. The reason might be the fact that patients with ESRD in Iran do not have to expect long transplant waiting lists and dialysis cannot affect their heart adversely.

Does donor nephron mass have any impact on graft survival?

OBJECTIVES: Functioning nephron mass namely, the number of nephrons in the grafted kidney, is one of the nonimmunologic factors that may have some impact on long-term graft survival. The aim of this study was to assess the impact of donor nephron mass on graft outcome in the recipient. MATERIALS AND METHODS: From 1989 to 2005, 1000 renal transplants were performed at our center. The 217 studied cases were followed for an average of 8 years. All patients received grafts from living donors. The weight of the grafted kidney (donor nephron mass) as well as the recipient's body mass index (BMI) were measured at the time of operation. Nephron mass index (NMI) was defined as the ratio of donor nephron mass to recipient BMI. Associations between variables were tested by logistic regression and Pearson correlation using the SAS system and S-plus statistical software. To evaluate graft function, we determined serum creatinine values, acute rejection episodes and chronic nephropathy. RESULTS: Mean NMI was 8.07 +/- 0.2 and mean creatinine level was 1.43 +/- 0.4 mg/dL. There were 32 cases (14.7%) of acute rejection, who were managed successfully with antithymocyte globulin (ATG) in 28 cases. Four patients lost their grafts. There were 15 cases (7%) of graft loss due to chronic rejection. Using Pearson correlation, we observed no association between NMI and mean serum creatinine level. Logistic regression showed a significant relation between NMI and acute rejection (P<.05) with an odds ratio of 2.0. There was no significant correlation between NMI and chronic rejection. CONCLUSIONS: The lower the NMI, the greater the short-term graft loss. However, in the long term, no significant correlation was found between graft survival and NMI. Also, mean creatinine level was not significantly different among patients regardless of NMI.

Microchimerism and renal transplantation: doubt still persists.

OBJECTIVE: We sought to study microchimerism in a group of kidney transplant recipients. MATERIALS AND METHODS: In this study, the peripheral blood microchimerism (PBM) after renal transplantation was retrospectively evaluated in 32 male-to-female recipients of living unrelated or cadaveric donor renal transplants. Using a nested polymerase chain reaction (PCR) amplification specific for SRY region of the Y chromosome, microchimerism was detected with a sensitivity of 1:1,000,000. Recipients were compared according to the presence of PBM, acute and chronic rejection episodes, type of allotransplant, recipient and donor age at transplantation, previous male labor or blood transfusion, allograft function (serum creatinine level), and body mass index. RESULTS: Among 32 recipients, 7 (21.9%) were positive for PBM upon multiple testing at various posttransplant times. All microchimeric recipients had received kidneys from living unrelated donors. No significant difference was observed with regard to other parameters. In addition the acute rejection rate in the microchimeric group was 3 (42%) versus 4 (16%) in the nonmicrochimeric recipients (not significant). CONCLUSION: Our results suggested better establishment of microchimerism after living donor kidney transplantation. However, doubt persists concerning the true effect of microchimerism after renal transplantation. It seems that microchimerism alone has no major protective role upon renal allograft survival.

Does renal transplantation improve erectile dysfunction in hemodialysed patients? What is the role of associated factors?

OBJECTIVE: To assess the effect of successful renal transplantation on improvement of erectile function in hemodialysis (HD) patients and the relationship between the degree of patient response and other factors. MATERIALS AND METHODS: From September 2002 to November 2005, erectile function of 64 patients on HD for at least 6 months was evaluated pretransplantation and 6 months posttransplantation by International Index of Erectile Function, version 5 (IIEF-5). Sixty four age-matched persons without renal impairment were enrolled as control group to compare erectile dysfunction (ED) prevalence with the HD group. We evaluated duration of HD, age, and site of arterial anastomosis. In an attempt to find predictors of improvement of ED, after kidney transplantation, we performed linear regression analysis with a backward method. RESULTS: The prevalence of ED in HD patients was 87.5%. Although there were some differences in the prevalence of ED between patients older versus younger than 50 years, the difference was not statistically significant. There was no relationship between the duration of dialysis and the severity of ED in HD group. Compared to the pretransplant IIEF-5 score (13.59), there was significant improvement (19.16). In an attempt to find predictors of ED improvement, we used a linear regression analysis with backward method. Pretransplant IIEF-5 score, age at the time of transplant, and anastomosis to the common iliac artery showed significant associations with improvement, but the duration of dialysis and anastomosis to internal iliac or external iliac artery did not. CONCLUSION: The incidence of ED among hemodialyzed patients is high. Kidney transplantation is the key treatment for this complaint. ED has a major negative impact on the quality of life and family relations. Its treatment is associated with improvement of psychogenic factors. ED is a sensitive topic and many patients will not spontaneously discuss it with their physician, so better to include potency evaluation in posttransplantation list evaluations.

Pelvic nerve neuropathy after kidney transplantation.

OBJECTIVES: We examined the relation of various age, gender, diabetes, hypertension, and graft function with the prevalence of femoral and lateral cutaneous nerves sensory and/or motor disturbances after kidney transplantation. MATERIALS AND METHODS: Among 129 patients who underwent kidney transplantation from April 2001 to March 2002. We excluded, 10 due to preoperative sensory disturbances. We evaluated the prevalence of sensory and/or motor disturbances preoperatively by physical examination and postoperatively by both physical and electromyography examinations. The clinical findings were correlated with the following risk factors: age, gender, preoperative dialysis duration, background diseases. (e.g., diabetes, hypertension), graft weight, nephron mass index, operative and retraction time, and rejection episodes. RESULTS: At 1 to 9 days postoperatively, 31 ng (26%) patients, suffered neuropathy of the lateral cutaneous nerve and 4 (3.3%), femoral neuropathy. No meaningful relation was detected between the incidence of neuropathy and these risk factors. The probability of neuropathy was greater among diabetics, hypertensives, women, and those with graft rejection episodes. All of these complaints were temporary. CONCLUSIONS: Post-kidney transplant femoral and/or lateral cutaneous nerve neuropathy is a prevalent complication particularly in diabetic, hypertensive, and female patients. Neuropathy is also more evident after graft rejection.

Comparison of transdermal electromotive administration of verapamil and dexamethasone versus intra-lesional injection for Peyronie's disease.

To compare the efficacy of transdermal electromotive administration and intra-lesional injection of verapamil plus dexamethasone for the treatment of Peyronie's disease. Patients with Peyronie's disease of less than 2-year duration were randomized into two groups of transdermal electromotive administration and intra-lesional injection of verapamil plus dexamethasone. During the 6-week therapy period, a single weekly dose of 10 mg verapamil and 4 mg dexamethasone solution was administered to 30 patients in each group either by transdermal electromotive method or via the conventional injection method by a syringe connected to a 25 G needle. Evaluations of plaque length, width, and volume, penile curvature, erectile dysfunction and penile deviations were carried out before and after 1 and 3 months of the interventions. Erectile pain was reduced in the electromotive group from a mean of 5.1-1.0 in scale of 10 and from 5.4 to 3.6 in the injection group (p = 0.006). Regarding plaque length, plaque width, penile curvature plaque volume and erectile dysfunction, the electromotive administration group showed better results which, however, were not statistically significant. (p > 0.05). Transdermal electromotive drug administration yielded comparable results as against current conventional intra-lesional injection technique and fared better in controlling erectile pain.

Relationship between Post-kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Complications.

BACKGROUND: Wound healing disorders are probably the most common post-transplantation surgical complications. It is thought that wound healing disturbance occurs due to antiproliferative effects of immunosuppressive drugs. On the other hand, success of transplantation is dependent on immunosuppressive therapies. Antihuman thymocyte globulin (ATG) has been widely used as induction therapy but the impact of this treatment on wound healing is not fully understood. OBJECTIVE: To investigate wound healing complications after ATG therapy in renal transplant recipients. METHODS: The medical records of 333 kidney transplant recipients were assessed for wound healing disorders. Among these patients, 92 received ATG and 5 doses of 1.5 mg/kg ATG along with the standard protocol of drugs. RESULTS: The mean age of patients was 38.9 years. Of 333 recipients, 92 (23.7%) received ATG; 21 (6.3%) developed wound healing complications. There was a significant relationship between ATG therapy and wound complications (p=0.034). Also, women were more likely to develop wound healing disorders than men (p=0.002). No statistical difference was observed between age and wound healing complication (p=0.28). There was no significant difference between the mean duration of hospitalization between ATG and Non-ATG group (p=0.9). CONCLUSION: ATG increases the risk of overall wound complications. It is needed to pay more attention to the patients treated with this immunosuppressant to avoid the risk of re-interventions, lessen the duration of hospitalization and decrease the impairment of graft function.

Plasma adiponectin concentration and insulin resistance: role of successful kidney transplantation.

Adiponectin (ADPN) has been reported to be inversely correlated with insulin resistance (IR) in uremic subjects and following kidney transplantation. Kidneys have been suggested to play a part in ADPN clearance. This study sought to evaluate this hypothesis. We enrolled 67 candidates with end-stage renal disease (ESRD) along with 30 healthy unrelated donors. Plasma ADPN, IR (based on the homeostasis model assessment for IR index), and glomerular filtration rates were compared between control and patient groups. The correlations of the aforementioned variables were also compared in the patient group 1 day before and 14 days following transplantation. The changes in measured parameters were also compared with control group values. The glomerular filtration rate was significantly decreased among recipients. ADPN levels were remarkably higher in the patient group before transplantation when compared with healthy subjects (P<.001) and remained significantly higher thereafter (P<.001). Insulin resistance was higher, albeit not significantly, among ESRD patients compared with controls (P>.05) and it increased following transplantation (P=.03). There was no correlation between ADPN, IR, and glomerular filtration rate in normal individuals or ESRD patients before or after transplantation. It is our assumption that mechanisms other than kidney function are probably involved in ADPN metabolism in ESRD patients and in the immediate phase following transplantation. It does not seem that ADPN substantially affects IR either in ESRD or transplantation patients.

Should post kidney transplantation hyperlipidemia considered a risk factor for graft function?

BACKGROUND: Hyperlipidemia is a common problem after kidney transplantation. OBJECTIVE: To uncover the real impact of post kidney transplantation hyperlipidemia on graft function and survival, and to determine whether it is just a biochemical phenomenon after using immunosuppressant or a part of disease pathology. METHODS: 330 kidney transplants were managed in Sina Hospital Kidney Transplantation Unit affiliated to Tehran University of Medical Sciences, Tehran, Iran from September 1994 till February 2010. The demographic characteristics of the patients, causes of chronic kidney diseases, history of pretransplantation dialysis, pretransplantation comorbidities (e.g., hypertension, diabetes mellitus [DM], hyperlipidemia and coronary artery disease), rejection episodes, status of infection with cytomegalous virus [CMV], post-transplantation DM, hyperlipidemia, ischemic heart disease [IHD], and graft and patient survival were recorded. A serum creatinine level >2 mg/dL was considered as "graft deterioration," and return to dialysis as "graft loss." According to the presence or absence of post kidney transplantation hypercholesterolemia (>200 mg/dL) or hypertriglyceridemia (>200 mg/dL), the patients were classified into "hyperlipidemic" or "non-hyperlipidemic." The presence of clinical or paraclinical coronary artery disease was also determined in both groups. RESULTS: The incidence of hyperlipidemia elevated from 8% to 50% before and after transplantation. 2.7% developed clinical IHD. 13% of hyperlipidemics and 22% of non-hyperlipidemics developed graft deterioration. Among hyperlipidemics with deteriorated grafts 40% had premorbid diseases, 68% had CMV infection and 82% had hypertension. Only 22% had previous acute rejection and 27% received deceased kidney transplant. CONCLUSIONS: post kidney transplantation hyperlipidemia is just an associated phenomenon secondary to the use of immunosuppressant medications, which have no obvious impact on renal graft function and can be easily controlled by instituting dietary modifications and use of modern antilipid medications. Post kidney transplantation CMV infection and hypertension are considered as the main threatening risk for renal graft-even more dangerous than acute or chronic rejections.