Long-term clinical, radiological, and histological follow-up after complex ventral incisional hernia repair using urinary bladder matrix graft reinforcement: a retrospective cohort study

Background

Complex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12–70 months of follow-up.

Methods

A single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed.

Results

64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12–70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan–Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12–70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115.

Conclusion

In 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia.

Rhino-orbitocerebral mucormycosis in a patient with idiopathic crescentic glomerulonephritis

Mucormycosis, caused by mucorales, is an acute, rapidly progressive infection associated with high mortality. Rhino-orbitocerebral infection is the most common variant and is generally seen in association with immune deficiency syndromes. Prompt medical treatment of this infection and debridement decreases the mortality rate. We describe a 47-year-old man with crescentic glomerulonephritis on maintenance prednisolone therapy. He had earlier received steroid and cyclophosphamide pulse therapies. Renal functions improved following immunosuppressive treatment. In the third month of maintenance therapy, he presented to us with left-sided facial swelling and bloody nasal discharge. He had high blood sugar and acidic blood pH (ketoacidosis), probably due to steroid therapy. Magnetic resonance imaging of the head and sinuses showed inflammation and mass in the ethmoid sinus and nose with partial septal destruction, proptosis, global destruction of the left eye, brain infarction and carotid artery obliteration. Endoscopic biopsy of the sinuses revealed severe tissue necrosis. Samples of nasal discharge and biopsy tissue showed aseptate hyphae on light microscopy and culture, compatible with Rhizopus. The patient was treated with amphotericin B and multiple wound debridements along with ethmoidectomy and enucleation of the left eye. He was discharged in good general condition but with mild right hemiparesis. On follow-up examination at one year, there were no signs of fungal infection or renal dysfunction.

Monitoring of intraocular pressure and its correlation with systemic parameters before and after hemodialysis

INTRODUCTION

End-stage renal disease and hemodialysis affect intraocular pressure (IOP). This study aimed to evaluate the effects of a one session of hemodialysis on IOP.

MATERIALS AND METHODS

In this study, the IOP of 130 eyes of 65 hemodialysis patients (38 men and 27 women) was measured before and every 1 hour after the initiation of hemodialysis therapy. Patients with any glaucomatous conditions were excluded. Demographic information including age, gender, underling systemic or ocular diseases, hemodialysis duration and frequency, KT/V, and levels of blood pressure, body weight, blood urea, serum sodium, serum potassium, blood glucose before and after hemodialysis were recorded.

RESULTS

The mean age of the patients was 60.3 +/- 16.7 years. The mean predialysis and postdialysis IOPs were 13.50 +/- 4.09 mm Hg and 12.73 +/- 4.07 mm Hg, respectively (P = .02). The mean IOP at the first and second hours (12.32 mm Hg and 11.83 mm Hg, respectively) of hemodialysis were significantly lower than the mean predialysis IOP (P < .001 for each). In nondiabetics, the mean IOP significantly decreased after hemodialysis. The mean predialysis and postdialysis blood glucose levels were significantly different between diabetics and nondiabetics, but were not significant in each group of diabetics and nondiabetics. There was a significant inverse relationship between IOP and blood glucose changes after hemodialysis (r = -0.180, P = .040).

CONCLUSIONS

Increased blood glucose levels significantly decreases IOP in hemodialysis patients without glaucomatous features. Changes in other metabolic parameters do not affect IOP during hemodialysis.

Impact of hemodialysis on visual parameters in patients with end-stage renal disease

INTRODUCTION

Patients with end-stage renal disease who receive hemodialysis are prone to visual disturbances. The aim of this study was to evaluate the effects of metabolic changes on visual parameters during hemodialysis sessions.

MATERIALS AND METHODS

Demographic information including history of underlying diseases, wearing eyeglasses, any ocular diseases or surgeries, and hemodialysis duration and frequency were recorded in 65 hemodialysis patients. The best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution and spherical equivalent (SE) per diopter were measured before and after hemodialysis. Other systemic and metabolic parameters including systolic blood pressure, body weight, KT/V, and blood levels of glucose, urea, and sodium were recorded.

RESULTS

A total of 130 eyes of 38 men and 27 women with ages ranged from 24 to 90 years (mean, 60.3 ± 16.7 years) were enrolled. The mean BCVA changed significantly after hemodialysis (0.29 ± 0.48 increased to 0.31 ± 0.49; P < .001). The mean SE changes were significant as well (-0.33 ± 0.31 D decreased to -0.40 ± 0.12 D; P < .001). There was a weakly positive correlation between the BCVA and blood glucose changes (P = .05, r = 0.166). There were significant associations between diabetic retinopathy and wearing of eyeglasses with BCVA and SE (P < .001 for both).

CONCLUSIONS

Hemodialysis could influence on visual parameters such as BCVA and refractive status by means of changes in blood glucose or possibly other systemic parameters.

The effect of exercise on urinary gamma-glutamyltransferase and protein levels in elite female karate athletes

PURPOSE

Post exercise proteinuria and increased urinary Gamma-Glutamyl transferase (GGT) levels can be indicative of exercise-induced renal damage. The aim of this investigation is to study the effect of one session of intensive training on renal damage markers and compare their values to those 6 hours after training.

METHODS

In this cross-sectional study with pre- and post-test design, 10 elite volunteer female athletes were selected and participated in one training session (2 hours). Urine samples were collected before training, one hour after training, and 6 hours after training. Urinary protein (Pr), creatinine (Cr), and GGT values were measured through laboratory methods and then Pr/Cr and GGT/Cr ratios were computed.

RESULTS

There were significant differences between values of protein, GGT and Creatinine in the three sampling phases (P<0.05). However, no significant differences were observed between values for GGT/Cr and Pr/Cr ratio. There were significant differences between the mean values of Creatinine, protein and GGT within pre-exercise and 1 hour post-exercise and within 1 hour post-exercise and 6 hours post-exercise (P<0.05).

CONCLUSION

It seems that a session of karate training does not result in renal damage and athletes can continue training after 6 hours.

A biomechanical study comparing plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to cyclic loading

The use of bicortical screws to fix metacarpal fractures has been suggested to provide no added biomechanical advantage over unicortical screw fixation. However, this was only demonstrated in static loading regimes, which may not be representative of biological conditions. The present study was done to determine whether similar outcomes are obtained when cyclic loading is applied. Transverse midshaft osteotomies were created in 20 metacarpals harvested from three cadavers. Fractures were stabilised using 2.0 mm mini fragment plates fixed with either bicortical or unicortical screw fixation. These fixations were tested to failure with a three-point bending cyclic loading protocol using an electromechanical microtester and a 1 kN load cell. The mean load to failure was 370 N (SD 116) for unicortical fixation and 450 N (SD 135) for bicortical fixation. Significant differences between these two constructs were observed. A biomechanical advantage was found when using bicortical screws in metacarpal fracture plating.

Acute renal failure as an initial manifestation of multiple endocrine neoplasia (MEN) type 1

Multiple endocrine neoplasia (MEN) is a group of heritable syndromes characterized by aberrant growth of benign or malignant tumors in a subset of endocrine tissues. There are three major syndromes: MEN1, 2A and 2B. We describe a 60-year-old woman who initially manifested acute renal failure due to hypercalcemia and dehydration and, finally, was diagnosed as a sporadic MEN1 case.

An unusual presentation of antineutrophil cytoplasmic antibody-associated vasculitis: discrepancy between histopathology and clinical presentation

A 60-year-old man was admitted to our clinic with dyspnea, hemoptesis, anuria, nephritic syndrome, and a positive myeloperoxidase antineutrophil cytoplasmic antibody titer. He was diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis due to Wegener granulomatosis, microscopic polyangiitis, or drug induction. Unexpectedly, histopathologic examination of the kidney biopsy specimen revealed the diagnosis of noncrescentic and nonnecrotizing glomerulonephritis. We report this case because of the unusual histologic type of renal involvement.

Subacute thyroiditis following ginger (Zingiber officinale) consumption

A woman with subacute thyroiditis following ginger consumption is presented. The diagnosis was confirmed by physical examination and laboratory tests, in two distinct episodes. The patient was cured and recommended to refuse ginger consumption.

Effects of intradialytic aerobic training on sleep quality in hemodialysis patients

INTRODUCTION

Sleep disorders are common in hemodialysis patients. They can affect their quality of life. The purpose of this study was to evaluate the effects of aerobic training on sleep quality, inflammatory status, and serum leptin levels in hemodialysis patients.

MATERIALS AND METHODS

Twenty-eight men in the age range of 28 to 74 years who were on maintenance hemodialysis and had sleep problems were enrolled in this study. They were randomly assigned into control and training groups (14 patients in each group). Patients in the training group performed a 10- to 30-minute stationary cycling, 3 times a week, during the 1st two hours of every dialysis session, for 8 weeks. The Pittsburgh Sleep Quality Index and the Baecke questionnaire on physical activity were filled out for all participants. To assess serum leptin and C-reactive protein levels, blood samples were drawn before the beginning and at the end of the eighth week.

RESULTS

At the end of the study, serum leptin and C-reactive protein levels were significantly reduced (P < .001 and P < .001, respectively). Furthermore, the Pittsburgh Sleep Quality Index scores of the training group declined significantly after 8 weeks (P < .001). There was a positive correlation between sleep quality and serum levels of leptin and C-reactive protein (P = .03 and P = .04, respectively).

CONCLUSIONS

Aerobic exercise with moderate intensity during the first two hours of a dialysis session could improve sleep quality and inflammatory status of hemodialysis patients, which predicts morbidity, mortality, and quality of life. However, additional research is needed to confirm these effects.

Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis

Physical function limitation is a common disorder in chronic hemodialysis (HD) patients, relating to increased morbidity and mortality. The aim of this study was to determine the effects of aerobic and resistance trainings on blood lipids and inflammation status in HD patients. Out of 30 volunteer males who had been undergoing conventional maintenance HD within an HD unit in Tehran, 21 subjects were enrolled. They were randomly assigned into aerobic exercise group - resistance training group undergoing an 8-week intradialytic exercise program (three times/week) and control group (n = 7, each). Training program consisted of 10-30 min stationary cycling at an intensity of 12-16 out of 20 at the rate of perceived exertion (RPE) of Borg scale in aerobic group and using ankle weights for knee extension, hip abduction and flexions at an intensity of 15-17 out of 20 at the RPE of Borg scale in resistance group. Fasting blood samples for serum biochemistry were drawn at baseline and 8 weeks. The age, HD duration, and physical activity score were 51.6±18.9yrs; 25.1±13.9 mo, and 19.2±7.6, respectively. Diabetes mellitus (43%), hypertension (28%), and obstructive uropathy (14%) were the most common underlying diseases. Aerobic and resistance exercises were correlated with serum creatinine (P< 0.0001 and P<0.001) and hs-CRP levels (P=0.005 and P=0.036) reduction so that aerobic exercise induced more reduction. These exercises had no influence on weight, Kt/V values, serum urea, albumin, hemoglobin, and lipid levels (P>0.05). Both intradialytic aerobic and resistance exercises showed beneficial effects on inflammation status without any influences on serum lipid levels probably due to short duration of the study which was not accompanied with body weight changes. Solute removal had no change during exercise programs. There is a need for more investigation on the role of exercise in HD patients.

Effect of intradialytic change in plasma volume on blood pressure in patients undergoing maintenance hemodialysis

BACKGROUND

Hypervolemia is a common complication in patients on hemodialysis (HD). To determine the effect of volume change on blood pressure in HD population, this cohort was conducted.

MATERIALS AND METHODS

The study population was composed of 60 non-diabetic patients on maintenance HD, with mean age of 59.95±15.28 years. They were divided into hypertensive group A (n=26) and normotensive group B (n=34). Data were collected by a questionnaire. Pre and post-dialysis blood levels of urea, sodium, total protein, and hemoglobin were measured and intradialytic change of plasma volume were calculated. Data analyses were performed by the SPSS v.16.

RESULTS

Out of 60 patients, 58.3% were male and 41.7% female. Post-dialysis systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly lower than pre-dialysis values in both groups (P=0.001, each). No correlation was found between intradialytic change in plasma volume or body weight and alterations of SBP or DBP during HD in the study groups (P>0.05, each). Intradialytic changes of body weight did not correlate to intradialytic changes of plasma volume (P=0.15).

CONCLUSION

HD effectively reduces blood pressure and volume expansion, however, intradialytic changes of plasma volume and body weight do not influence on SBP and DBP.

Outcomes of two different polytetrafluoroethylene graft sizes in patients undergoing maintenance hemodialysis

Arteriovenous access creation is mandatory for maintenance hemodialysis. If native fistula placement was not possible or failed, a prosthetic conduit would be the best substitute. The purpose of this prospective study was to compare outcomes of two different sizes of polytetrafluoroethylene (PTFE) grafts, in hemodialysis patients, at the Mustafa Khomeini Hospital in Iran. The study population consisted of 586 end-stage renal disease referrals for vascular access construction (January 2003 to January 2007) of which eventually 102 subjects were candidates for PTFE graft who were followed for one year. Data were collected by a questionnaire and analyzed using the SPSS, life table, Kaplan- Meier and Log-Rank tests. Out of 102 PTFE implantation candidates (mean value of age 51.7 +/- 17.06 yrs), 56% were male and 44% female. PTFE grafts of 8 mm and 6 mm sizes were randomly placed in 57 and 45 subjects, with distribution of 83%, 12% and 5% in arm, forearm and thigh. The most underlying diseases were hypertension and diabetes. There was a significant difference in complication rates between patients with and without underlying diseases [42% vs. 10% (P = 0.03)]. One-year patency rates were 42.2% and 36.5% for 6 mm and 8 mm grafts and 28.2% vs. 52% in patients with and without underlying diseases respectively. Despite more complication frequency in 8 mm grafts, the patency and complication rates of two graft groups did not significantly differ. Hypertension and diabetes could have contributory roles in graft complication rate, which may be preventable. Non-tapered grafts of 6 mm and 8 mm sizes have not significant different outcomes. Further research is recommended with larger sample size and longer duration.

Hematological profile of chronic kidney disease (CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis

Anemia is a common sequealae of chronic kidney disease (CKD), associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodialyzed, 46 pre-dialyzed). Data including, complete blood count, BUN, creatinine, creatinine clearance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%), hypochromic-microcytic (15%) and macrocytic (5%). The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL) were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001). The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL) in 5%, moderate in 70% and severe (Hgb < 7 g/dL) in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.

Survey of medical students of Shahed University in Iran about attitude and willingness toward organ transplantation

BACKGROUND

Transplantation is a successful procedure that prolongs the lives of people suffering from debilitating diseases. The purpose of this study was to assess medical students' attitude toward organ donation.

METHODS

The study population consisted of 262 medical students with a mean age of 22.1 +/- 2.5 years who were surveyed using a reliable questionnaire that examined their attitudes and willingness. All data analyses were performed using Chi-square and analysis of variance tests with SPSS.

RESULTS

The medical students had highly positive attitude toward organ donation (mean score 4.34 +/- 0.46) and a great willingness. Participants were more willing to donate their own organs than those of a deceased relative (85% vs 49.2%) to help others more than to develop science (91.2% vs 8.8%). The greatest willingness among students was kidney (84%) donation. There was no correlation between age, gender, education levels, and attitude toward organ donation.

CONCLUSION

These findings necessitate an organized education program of medical students in all aspects of organ and tissue donation.

Recurrent septicemia in a renal transplant recipient

The incidence of infection is significantly elevated in renal transplant recipients,but native kidney infection is an uncommon event in these patients. We describe a 52-year-old renal transplant recipient with infection of the native kidneys that had atypical clinical presentation and a unusual course.

Urinary sodium and potassium excretion following karate competitions

INTRODUCTION

Exercise induces renal hemodynamic alterations and stimulates electrolytes excretion. The purpose of this study was to assess urinary excretion of sodium and potassium in karate practitioners, following competitions.

MATERIALS AND METHODS

The study population composed of 18 healthy men, aged 18 to 21 years, with similar physical characteristics. They were professional karatekas with a history of at least 7 years of karate training. The participants competed in 3 rounds of about 3 minutes in duration with 10 minutes resting intervals between them. The 24-hour urine samples were collected before (while trainings were stopped) and after the match and their sodium and potassium concentrations were measured. Also, blood samples were obtained before and after the match for measurement of these electrolytes in the participants' sera.

RESULTS

Before the match, the mean values of urinary sodium and potassium were 200.3 +/- 89.3 mEq/L/d and 68.5 +/- 12.9 mEq/L/d, respectively. After the match, they changed into 206.9 +/- 74.7 mEq/L/d and 67.1 +/- 14.4 mEq/L/d, respectively. No significant alterations were observed in urinary sodium and potassium excretion following karate match (P = .94 and P = .96, respectively). Serum sodium levels were 136.7 +/- 3.1 mEq/L and 136.3 +/- 2.9 mEq/L, before and after the match, respectively (P = .11), serum potassium levels were 4.2 +/- 0.3 mEq/L and 4.1 +/- 0.2 mEq/L, respectively (P = .16).

CONCLUSIONS

With regard to short duration and anaerobic nature of karate, it seems that a Karate match does not contribute to excessive urinary electrolytes excretion.

Allergic asthma: a tale of many T cells

Asthma is a common immune-mediated disorder characterized by reversible airway inflammation, mucus production, and variable airflow obstruction with airways hyperresponsiveness (AHR). In most cases the airway inflammation characteristic of asthma is thought to result from an allergic-type reaction to an inhaled substance from the environment (so-called allergic asthma). In allergic asthma, allergen exposure stimulates eosinophilic inflammation of the airways associated with infiltration of T cells. Although the recruitment of eosinophils into the airways is an important component in the pathogenesis of asthma, the trafficking of T lymphocytes into the airways is now believed to establish and orchestrate the asthmatic inflammatory response. This review explores the roles of various T cell subsets in the pathogenesis of allergic airway inflammation and highlights the contributions of these cells in regulating asthma.

Assessment of nutritional status in patients undergoing maintenance hemodialysis: a single-center study from Iran

Malnutrition is a relatively common problem in patients on hemodialysis (HD) and is associated with increased morbidity and mortality in affected patients. With the aid of subjective global assessment (SGA), a semi-quantitative scale for estimating nutritional status, the malnutrition score (MS), has been developed. The MS incorporates advantages of the SGA while extending the reliability and precision. This study was performed to assess the nutritional status in patients on HD at the Mostafa Khomeini Hospital, Tehran, Iran. Based on the MS, which consists of seven components--weight change, dietary intake, gastrointestinal (GI) symptoms, functional capacity, comorbidity, subcutaneous fat, and muscle wasting--we conducted a cross-sectional descriptive-analytic study on 54 HD patients (35 males, 19 females) with age range of 18 to 82 years (mean 44.2 +/- 19.8 years). Each component of the MS has a score from one (normal) to five (very severe). Anthropometric measurements including triceps skin-fold thickness (TSF), mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC) were taken on all patients. Also, the body mass index and TSF/MAC ratio were calculated. Relevant laboratory parameters were checked. The duration of HD of the study patients ranged between 5 and 36 months (mean 19.5 +/- 1.5 months). Data analysis was carried out using the SPSS, Pearson correlation, 't' test and regression. Based on the MS, 40.7% of patients had malnutrition (mean score 13.8 +/- 2.8). There were statistically significant correlations between TSF (p < 0.01), MAC (p = 0.02), MAMC (p = 0.01), TSF/MAC ratio (p < 0.001), BMI (p = 0.028), serum albumin concentration (p = 0.021) and MS. No statistically significant correlation was found between the MS and urea reduction ratio, protein catabolic rate, age, gender, or duration of dialysis. After 1 year, 20.4% of patients died because of dialysis-related complications. The mortality rate did not show significant correlation with age, presence of diabetes mellitus, biochemical parameters, and anthropometric measures. A significant correlation was found between the protein catabolic rate (nPCR) and the mortality rate (regression analysis, p = 0.016); lower values of nPCR were associated with increased mortality. Our study suggests that the MS is a reliable, precise, and rapid method for estimating the nutritional status in patients on HD. The nPCR can be used as a predictor of increased mortality. Further studies with larger sample size and longer duration are required to confirm this observation.

Epidemiology of chronic renal failure in Iran: a four year single- center experience

Chronic renal failure (CRF) is a major public health problem. Early diagnosis and proper management have important roles in prevention of CRF progression to end-stage renal disease (ESRD). For this purpose, determining the etiology of CRF may be helpful. This study was conducted in the nephrology department at the Mostafa Khomeini Hospital in Tehran, Iran from March 2001 to March 2005, to determine the etiology of CRF in adult Iranian patients. A total of 1200 patients with a diagnosis of CRF were involved in the study. Relevant data were collected using a reliable questionnaire. All data analyses were carried out using SPSS and the chi2 test. Of the 1200 patients, 61% were males and 39% females. The most frequent age group was 61-75 years (38.3%) and the mean age of the study patients was 51.6 +/- 17 years. The etiology of CRF in our series included: diabetes mellitus in 26.8%, hypertension in 13.5%, obstructive uropathy in 12%, cystic and congenital disorders in 10.3%, glomerulonephritis in 6.5%, urinary tract infections in 4%, vasculitis in 2%, tubulo-interstitial nephritis and pregnancy related in 0.8% each and unknown causes in 29.5% of the patients. Laboratory and ultrasonographic assessment at initiation of the study revealed blood urea nitrogen> 100 mg/dl in 57.8% of the patients, serum creatinine> 10 mg/dl in 40.3%, glomerular filtration rate (GFR) < 10 ml/min in 61.3%, hemoglobin < 10 g/dl in 65.8% and kidney size lesser than 8 cm in 46% of the cases. There was a significant statistical relationship between kidney size and duration of hypertension greater than five years (P = 0.017). The high frequency of CRF of unknown etiology in this study may be attributed to diagnostic limitations prevailing in our country. A GFR of < 10 ml/min in 61.3% of the cases at presentation suggests late diagnosis and/or referral. Aggressive screening and treatment strategies to prevent ESRD are recommended.

Catheter associated infections in hemodialysis patients

Hemodialysis catheter related infections (HCRI) are one of the major causes of increasing mortality, morbidity and cost of therapy in hemodialysis patients. Prevention of HCRI requires the identification of predisposing risk factors. To determine the frequency of HCRI risk factors, we studied 116 patients (54% male, mean age of 49.5+/-16 years) patients with HCRI between 2003-2004. Forty one percent of the patients were diabetic. There was a history of previous catheter placement and infection in 41% and 32% of patients, respectively. Pathogenic organisms isolated from blood cultures included Staphylococcus-aureus 42%, Coagulase-negative Staphylococci 20%, E. Coli 19%, Enterococci 7%, Streptococcus D 7%, Pseudomonas aeruginosa 4%, and Klebsiella 1%. Bacterial resistance to vancomycin and amikacin was present in 7% and 4% of the cases, respectively. Hemodialysis catheter related blood borne infections comprised 67% of the total blood-borne infections in our hospital. No significant statistical association was found between HCRI and age, gender, diabetes mellitus, serum albumin level <30 g/L, leukocyte count, erythrocyte sedimentation rate, anatomical location of catheter, mean duration of antibiotic therapy, mean catheter duration, frequency of hemodialysis sessions, pathogenic organisms, and history of previous catheter infection. We conclude that the prevalence of pathogenic organisms of HCRI were similar to previous studies. However, bacterial resistance to antibiotics was low. The mean duration of catheter usage was longer than previously reported.

Fungal abdominal wall abscess in a renal transplant recipient

The incidence of fungal infection is significantly higher in patients with endstage renal disease and renal transplant recipients than in normal individuals. Candidia Albicans is an uncommon cause of abdominal wall abscess. We describe a 37 year-old renal transplant recipient with such an infection. He presented with atypical clinical manifestations and an insidious course, but was successfully treated with antifungal therapy.

One-year efficacy of expanded polytetrafluoroethylene vascular graft in eighty-three hemodialysis patients

INTRODUCTION

Our aim was to evaluate the patency and efficacy of expanded Polytetrafluoroethylene (ePTFE) vascular graft in hemodialysis patients.

MATERIALS AND METHODS

In a prospective study from January 1999 to January 2001 at Sina hospital 41 patients underwent implantation of 6-mm vascular grafts and 42 underwent implantation of 8-mm grafts in order to make vascular assess for hemodialysis. They were followed up to 12 months, observing the complications.

RESULTS

Mean patients' age was 52.2 years. Thirty-seven of them were females and 46 were males. Over a 12 months period of follow-up, 12 cases of graft infection (14.5%), 21 cases of thrombosis (25.3%), 7 cases with both complications (8.4%), and 1 case of pseudoaneurism (1.2%) were observed. One-year patency rate was 34.9%. Diabetes was the only factor associated with lower patency rate (27% versus 57%, p<0.05).

CONCLUSION

ePTFE vascular graft seems to be an appropriate substitute for arteriovenous fistula as a vascular assess in hemodialysis patients. Educating patients and good care can decrease the rate of infection, thrombosis, and other complications, resulting in a better patency and lower morbidity rate.

Protein phosphatase X interacts with c-Rel and stimulates c-Rel/nuclear factor kappaB activity

Nuclear factor kappaB (NF-kappaB) and the Rel family of proteins are pleiotropic transcription factors that play central roles in the immune and inflammatory responses, as well as apoptosis. Here, we identified a serine/threonine protein phosphatase X (PPX; also called protein phosphatase 4 (PP4)) that specifically associated with c-Rel, NF-kappaB p50, and RelA. The amino acid sequences of human and mouse PPX are 100% identical, and the PPX gene was mapped to human chromosome 16 p11.2. Overexpression of PPX, but not catalytically inactive PPX mutants, stimulated the DNA-binding activity of c-Rel and activated NF-kappaB-mediated transcription. These results suggest that PPX is a novel activator of c-Rel/NF-kappaB.