Clinical consequences of intermittent elevation of C-reactive protein levels in hemodialysis patients

An elevated C-reactive protein (CRP) level has been associated with malnutrition, with erythropoietin resistance during hemodialysis (HD) therapy, and with a higher risk of chronic transplant rejection. Meanwhile, the clinical consequences of intermittent elevations of CRP levels observed among a large group of HD patients are unclear. We sought to compare the inflammatory and nutritional parameters as well as the erythropoietin requirements for HD patients with persistent or intermittent CRP elevations versus subjects with CRP levels in the normal range. The 6-month retrospective clinical and laboratory data of 100 HD patients (age 48.4 +/- 14.3 years, HD duration 69.3 +/- 49.0 months) were divided into three groups on the basis of at least six monthly values of CRP: for persistent (group 1) or intermittent high (at least one level of CRP >/=10 mg/L); (group 2) versus normal CRP levels (group 3). We compared the estimates of fibrinogen, ICAM-1, VCAM-1, albumin, prealbumin, normalized protein catabolic rate (nPCR), interdialytic weight gain (IDWG), and rhuuEpo/kg/Htc. Significant differences, were observed in fibrinogen, albumin, prealbumin, ICAM-1, nPCR, IDWG, and rHUuEpo/kg/wk values. Like group 1, group 2 patients seemed to show inflammation and malnutrition, namely decreased albumin levels, nPCR, and rHUEpo resistance, when compared with group 3. Finally, intermittent elevations of CRP must be considered to reflect a state of chronic inflammatory response associated with malnutrition and erythropoietin resistance similar to that observed among hemodialysis patients with persistently high CRP levels.

The effect of cisapride on gallbladder contractility in type II diabetic patients

BACKGROUND/AIMS

To investigate whether diabetics have altered gallbladder motility, and whether cisapride has any effect on gallbladder motility in these patients. The factors associated with abnormal gallbladder contractility, and with the effects of cisapride on gallbladder contractility in diabetics were also evaluated.

METHODOLOGY

The gallbladder contractility parameters of 20 diabetics and 20 controls were assessed by real time ultrasonography. The same measurements were made after cisapride treatment in diabetics.

RESULTS

Fasting gallbladder volume and residual gallbladder volume were statistically higher in the diabetic group than in the controls (P = 0.018 and P = 0.022, respectively). Multivariate analysis also showed a significant association between fasting gallbladder volume and existing diabetes (P = 0.0002). There was a significant positive correlation between level of hemoglobin A1c and fasting gallbladder volume (r = 0.48, P = 0.031). Responders to cisapride treatment had significantly higher hemoglobin A1c levels than nonresponders (6.6 +/- 1.3 vs. 9.1 +/- 1.8, respectively; P = 0.004). Logistic multiple regression analysis revealed that hemoglobin A1c level was the only independent factor that was predictive for efficacy of cisapride treatment.

CONCLUSIONS

This study demonstrates that diabetics have impaired gallbladder contractility, and that control of diabetes is predictive for gallbladder contractility and response to cisapride therapy in these patients.

Unusual case of metastatic thyroid nodule: nonpalpable breast mass as origin

OBJECTIVE

To document a case of thyroid cancer metastatic from the breast.

METHODS

We present the clinical, laboratory, radiologic, and biopsy findings in our patient and review the related literature.

RESULTS

A 47-year-old female patient was referred to our clinic because of dyspnea and generalized bone pain. Physical examination revealed a diffusely enlarged nodular goiter, and fine-needle aspiration biopsy demonstrated intrathyroidal anaplastic cells. Total thyroidectomy was done, and the histopathologic diagnosis was anaplastic carcinoma. Unexpected rapid progression of the disease with cervical and intrathoracic lymphadenopathies and osteoblastic metastatic lesions without radioiodine uptake prompted us to attempt to rule out a primary nonthyroidal malignant lesion metastatic to the thyroid gland. The plasma level of CA 15-3 was profoundly increased (388 U/mL). Detailed reassessment of the patient disclosed a small mass in the right mammary gland with histopathologic features similar to those of the thyroidectomy material. Reevaluation of the thyroid specimens resulted in a final diagnosis of primary breast carcinoma in conjunction with metastatic carcinoma of the thyroid.

CONCLUSION

Thorough systemic clinical assessment of a patient with a thyroid nodule and careful study of biopsy specimens should be done to ascertain whether the nodule is a primary or a metastatic lesion.