Relationship between Renal Function and Bone Mineral Density in Postmenopausal Women

Renal insufficiency is a risk factor for osteoporosis and can increase risk of fracture. It may be a result of an age-related decline in renal function or chronic kidney disease. In patients with CKD, accurate diagnosis of osteoporosis or CKD-MBD is important for determining the most appropriate treatment. This was a cross sectional study was done at Institute of nuclear medicine and Allied Sciences, BSMMU, Dhaka from 1st January 2014 to 31st December 2014. Study population was total 69 postmenopausal women age over 50 years. Women with Bilateral hip replacement or bilateral hip pins or screws, metallic rods in spine, Carrying out BMD scan within the week after other radiological investigation using contrast media e.g. Barium meals or enema, IVPs were excluded from study. Clinical variables were- age (years), height (cm), weight (kg), BMI. Laboratory variables were- serum creatinine and BMD (Dexa). Estimated GFR was determined by using the serum Creatinine by MDRD formula. Renal function test and Bone mineral density (BMD) were done in all of these patients. Majority (43.4%) of the patients were in 6th decade. The mean weight was found 57.4±11.2kg. Majority 41(59.4%) patients belonged to T score at hip (-1 to -2.5) and their mean T score at hip was found (-1.1±1.1). Osteopenia and osteoporosis were found in 59.4% and 4.3% respectively according to BMD. High serum creatinine level was found in 10.1% cases. Renal function impairment was found in 79.6% of patient. Majority (50.7%) patients had mild decrease of eGFR (60-89 ml/min/1.73m²), There was Pearson's correlation (r=0.156; p=0.200) but not significant was found between age with T score at hip of the patients. Positive Pearson's correlation (r=0.112; p=0.361) was found but not significant between age and serum creatinine level. A significant negative Pearson's correlation (r= -0.274; p=0.023) was found between T score at hip and serum creatinine level of the patients. A significant negative Spearman correlation (r=-0.278; p=0.021) was found between BMD and serum creatinine of the patients. A significant positive Spearman correlation (r=0.580; p=0.001) was found between BMD and estimated GFR of the patients. This study was undertaken to evaluate the relationship between renal function and bone mineral density in postmenopausal women. Majority of the postmenopausal women were in 6th decade and most of them were overweight and obese. Renal function impairment was found in 79.6% of patient. Osteoporosis was found in 04.3% and 20.3% cases according to T score at hip and T score at lumber spine respectively. Significant negative Pearson's correlation was found between T score at hip and serum creatinine level of the patients. Significant negative Spearman correlation was found between BMD and serum creatinine of the patients. Significant positive Spearman correlation was found between BMD and estimated GFR of the patients.

Evaluation of the Patient Profile and Current Pattern of Care with Docetaxel Based Adjuvant Regimen in Operable Breast Cancer

Background: Early stage breast cancer can often be cured with surgery alone though there are chances of recurrent disease and decrease in survival. Adjuvant poly-chemotherapy with docetaxel-based regimens can improve both disease-free and overall survival in patients with operable breast cancer. Objective: This study was designed to evaluate the patient profile and current pattern of care with docetaxel based adjuvant regimen in operable breast cancer patients including the treatment outcome from clinical practice. Materials and method: This prospective, observational, non-comparative study planned to enroll newly diagnosed operable breast cancer patients with high risk of recurrence after surgery. Selection of docetaxel-based treatment strategy and dosage of therapy was at the discretion of individual oncologists as per routine clinical practice. Patient data were recorded during inclusion, each cycle of therapy, and follow-up at 1 year (+/- 1 month) after inclusion. Results: Between August 2008 and July 2011 a total of 85 patients with median age of 53 years (23-73 years) were enrolled and 53 (62.4%) patients were postmenopausal. Ductal carcinoma, the most common cancer type,was found in 73 (85.9%) patients. Receptor status was positive for estrogen, progesterone or Her2/neu/erbB2 in 65.9%, 47.1% and 5.8% patients, respectively. Mastectomy either partial or total was performed in 76 (89.4%) patients for the current disease. An average of 8 (range: 2-15) lymph nodes (LN) mostly in axilla were excised in 56 patients and average of 4 (range: 1-11) LN nodes were positive. Sentinel LNs were negative, excised in 4 patients. The mean tumor size was 5.5 cm and most (82.4%) patients were diagnosed at Stage II disease including some at Stage I and III (7.1%, 10.6%). Docetaxel (Taxotere®) was combined with cyclophosphamide alone or in addition with doxorubicin, epirubicin, 5 FU and trastuzumab either in combination or sequential regimen. Taxotere in combination with adriamycin and cyclophosphamide was planned for 63.5% patients. Trastuzumab as sequential therapy could be afforded by 1 patient only. Data regarding radiotherapy or hormone therapy was not recorded. At the end of four cycles, 83.5% of patients were found disease free and 5.9% had loco regional relapse. At 1 year 71 (93.4%) patients were alive, 63 (88.7%) were relapse-free and 8 (11.2%) had loco regional relapse. Nausea, vomiting, diarrhea, alopecia, anemia and neutropenia were most commonly reported adverse events classified as Grade 1 or Grade 2. Grade 3 neutropenia was reported in 5 patients and 2 patients reported grade 4 neutropenia. Grade 3 diarrhea was reported in 1 patient. Conclusion: Docetaxel as adjuvant chemotherapy offered one year survival in 93.4% (71/76) of the patients and 88.7% (63/71 patients) were disease-free. The safety profile of docetaxel based regimens was expected and manageable. Delta Med Col J. Jan 2019 7(1): 4-10

Comparative study of lung functions in women working in different fibre industries

A cross sectional work has been done on Bangladeshi females, working in different fibre industries, to study the effect of exposure to fibre dust on pulmonary functions. The ventilatory capacities were measured by VMI ventilometer in 653 apparently healthy women (160, 162 and 167 were jute, textile and garment industry workers, respectively). For the controls 164 females were recruited who never worked in any fibre industry. The observed FVC, FEV1 and PEFR were lower in all groups of fibre industry workers than those of the control. Among the industry workers, the jute mill workers had the lowest ventilatory capacities and garment industry workers had the highest values. The jute and textile mill workers had also significantly lower FEV1 and PEFR than those of garment industry workers. The FEV1 and PEFR were significantly lower in jute mill workers than those of textile ill workers. The low ventilatory capacities were almost proportionate with the length of service of the workers. Thus, the present study indicates that the fibre dust, on regular exposure for longer duration, may limit the lung functions.

Impact of prostate-specific antigen level and prostate volume as predictors of efficacy in photoselective vaporization prostatectomy: analysis and results of an ongoing prospective multicentre study at 3 years

In a multicentre study from the USA, 3-year results of the high-power KTP laser prostatectomy are presented. The authors used preoperative PSA level as a marker of prostate volume and assessed its potential predictive value on the level of clinical efficacy for treating symptomatic BPH. They found that the overall results from the technique were positive and durable, and suggested that there was a significant difference in efficacy between patients presenting with a total PSA of <6 or >6 ng/mL. Many patients who have had a radical prostatectomy are followed for a prolonged period and several observations are presented from an Italian study of urinary incontinence. The authors present their detailed results, finding a considerable trend in incontinence and anastomotic stricture, which decreased over time.

OBJECTIVE

To report the 3-year results and analyse whether total prostate-specific antigen (tPSA) levels and prostate volume before treatment can predict the level of clinical efficacy of photoselective vaporization prostatectomy (PVP) for treating obstructive benign prostatic disease, as high-power potassium-titanyl-phosphate (KTP) laser prostatectomy was previously shown to be safe and to efficiently vaporize prostatic adenoma secondary to benign prostatic hyperplasia (BPH), with minimal bleeding and morbidity.

PATIENTS AND METHODS

From October 2001 to January 2003, 139 men (mean age 67.7 years, sd 8.7) diagnosed with obstructive lower urinary tract symptoms secondary to BPH, had PVP with an average 80 W of KTP laser energy, at six investigational centres. A subanalysis evaluating each patient for tPSA and prostate volume before PVP was conducted, with a long-term assessment of the primary efficacy outcomes at 3 years after PVP. Each patient was assigned to one of two subgroups according to the tPSA level (group 1, < or = 6.0 ng/mL; group 2 > or = 6.1 ng/mL) and evaluated separately. Each subgroup was assessed for changes from baseline in American Urological Symptom Index (AUA SI) score, quality of life (QoL) score, peak urinary flow rate (Q(max)), prostate volume, and postvoid residual urine volume (PVR) at 1, 2 and 3 years after PVP.

RESULTS

All tPSA subgroups had a sustained improvement in all efficacy outcomes maintained through the 3 years. There was a statistically significant difference in the level of improvement between groups 1 and 2 (P < 0.05) in AUA SI and Q(max) at 1, 2 and 3 years. The mean (sd) prostate volume for group 1 was 48.3 (16.7) mL (87 men), and was 83.1 (30.6) mL (52 men) in group 2. The mean percentage improvement in the AUA SI at 1, 2 and 3 years in group 1 and 2, respectively, was 86%, 92% and 85%, and 69%, 74% and 76%; the corresponding percentage improvement in Q(max) was 194%, 185% and 179%, and 124%, 145% and 139%, respectively. Overall treatment efficacy in all patients evaluated showed a mean 83%, 79%, 71% and 165% improvement in AUA SI, QoL, PVR and Q(max), respectively. Adverse events were minimal and the re-treatment rate was 4.3%.

CONCLUSIONS

These results suggest that there is a significant difference in efficacy in patients with a tPSA of < or = 6.0 ng/mL or > or = 6.1 ng/mL before PVP. However, the overall results achieved with PVP were very positive and durable to 3 years, irrespective of tPSA level and prostate volume.

PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA: 12-MONTH RESULTS FROM THE FIRST UNITED STATES MULTICENTER PROSPECTIVE TRIAL

PURPOSE

We report the 1-year efficacy and safety of photoselective vaporization of the prostate (PVP) for symptomatic and obstructive benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

A prospective clinical trial was performed in 139 men clinically diagnosed with symptomatic bladder outlet obstruction secondary to BPH who were enrolled and treated with a high power, 80 W, quasicontinuous wave potassium-titanyl-phosphate laser at 6 American medical centers across the country. Efficacy parameters were mean and percent changes from baseline in the American Urological Association Symptom Index (AUA-SI) score, quality of life score (QOL), peak urinary flow rate (Qmax), post-void residual urine volume (PVR) and transrectal ultrasound prostate volume measurement. Patients were evaluated 1, 3, 6 and 12 months following treatment. At each followup evaluation side effects were elicited.

RESULTS

Significant improvements in AUA-SI score, QOL score, Qmax and PVR were noted as early as 1 month after PVP treatment. At 12 months the mean AUA-SI score decreased from 23.9 to 4.3 (p <0.0001) and the QOL score decreased from 4.3 to 1.1 (p <0.0001), while mean Qmax increased from 7.8 to 22.6 ml per second (p <0.0001). PVR decreased from 114.3 to 24.8 ml (p <0.0001), while the transrectal ultrasound volume reduction went from 54.6 ml at baseline to 34.4 ml. There was no significant blood loss or fluid absorption during or immediately after PVP. Complications consisted of transient hematuria, dysuria and urinary retention in 12 (8.6%), 13 (9.3%) and 7 (5%) patients, respectively.

CONCLUSIONS

PVP is a unique, safe and effective outpatient modality that provides immediate symptomatic and urodynamic relief of bladder outlet obstruction secondary to BPH. Long-term followup is needed to validate further the maintenance of clinical efficacy beyond 1 year.

Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia

PURPOSE

To study the safety and efficacy of a new high-power potassium-titanyl-phosphate laser (KTP/532; Niagara PV trade mark laser system; Laserscope, San Jose, CA) for transurethral photoselective vaporization of benign obstructive prostate tissue.

PATIENTS AND METHODS

The KTP/532 laser energy at 80 W was delivered by a 6F side-firing fiber through a 23F continuous-flow cystoscope. Photoselective vaporization of the prostate (PVP) using sterile water irrigation was performed under spinal anesthesia on an outpatient basis in 10 patients with a preoperative mean prostate volume of 41.37 +/- 18.5 cc (range 24-76.3 cc). The mean lasing time was 19.8 +/- 4.9 minutes.

RESULTS

Two patients experienced 1 to 7 days of mild dysuria, and one who was taking warfarin had mild transient hematuria, but none had urinary retention or other complications. The mean catheterization time was 17.2 +/- 9.6 hours (range 0-28 hours). At 1 year, the outcomes, which had showed significant improvement sustained throughout the follow-up, were as follows: mean American Urological Association Symptom Score decreased from 23.2 +/- 4.7 to 2.6 +/- 0.5 (88.8%), the mean quality of life score improved from 4.3 +/- 0.7 to 0.4 +/- 0.5 (90.7%), the mean peak urinary flow rate increased from 10.3 +/- 1.4 mL/sec to 30.7 +/- 5.8 mL/sec (198.1%), and the mean postvoiding residual volume decreased from 137.6 +/- 112.2 mL to 3.0 +/- 4.8 mL (97.8%). The mean prostate volume decreased by 27%.

CONCLUSIONS

This pilot study indicates that PVP with the new 80 W KTP/532 laser is a simple, safe, and efficacious outpatient procedure for the treatment of obstructive BPH.

Plasma LH and FSH levels in azoospermia and in normal male and female human subjects

Immunoassay of human plasma LH and FSH level was carried out in the Institute of Nuclear Medicine, Bangladesh. Apparently normal male and female volunteers and subjects having primary sterility were studied. Plasma LH and FSH levels of normal males ranged from 1.9 to 20.48 (mean 7.3) and 1.17 to 6.75 (mean 3.30) m IU/ml respectively. Corresponding values for females were 0.99 to 38.92 (mean 17.94). Level of LH and FSH in azoospermic males were found higher than normal ones with the mean value of 17.0 and 5.67 m IU/ml respectively. The study gives an impression about the plasma LH and FSH levels in azoospermia and normal population in Bangladesh.

Crystal structure of aristoserratine

The crystal structure of the alkaloid aristoserratine,* C20H24N2O, has been determined by single-crystal X-ray diffraction methods at 295 K, the structure being refined to a residual of 0.034 for 1107 independent 'observed' reflections. Crystals are monoclinic, P21, a 14.836(5), b 8.568(3), c 6.633(3) �, β 98.05(3)�, Z 2. The relative configuration is established and, by inference, by comparison of the circular dichroism spectrum with that of aristoteline, the absolute configuration is assigned.

Effects of prostaglandin F2 alpha and its synthesis inhibitor indomethacin on corporaluteal functions in pseudopregnant rats

The effects of PGF2 alpha and its synthesis inhibitor indomethacin on corporaluteal (CL) functions were studied in adult pseudopregnant rats. The CL functions were assessed by studying the duration of pseudopregnancy and histological changes in the ovary. Administration of PGF2 alpha (4 mg/kg BW) significantly (P less than 0.001) shortened the duration of pseudopregnancy. Histological examination of ovaries revealed regressed CL. Administration of indomethacin, on the other hand, significantly (P less than 0.001) prolonged the duration of pseudopregnancy. Histological examination of ovaries revealed large and well formed CL, the diameters of which were significantly (P less than 0.05) increased. Administration of indomethacin and PGF2 alpha simultaneously, however, keeps the duration of pseudopregnancy within normal limit. Further, the shortening in the duration of pseudopregnancy by PGF2 alpha alone was completely reversed by exogenous administration of progesterone. Since PGF2 alpha shortens and indomethacin (an inhibitor of PGF2 alpha synthesis) prolongs the duration of pseudopregnancy, it is concluded that PGF2 alpha acts as a luteolytic agent in rats. The mechanism of luteolysis is most likely to be due to decrease plasma progesterone level. An estimation of blood progesterone level after administration of PGF2 alpha to pseudopregnant rats is therefore, suggested.

Surgical management of major renal trauma: a review of 102 cases treated by conservative surgery

A review is presented of 102 patients with significant renal trauma seen in the last 5 years. All patients underwent exploratory laparotomy for abdominal trauma and had associated urologic injuries, which were managed by conservative surgery. Forty-eight patients had non-expanding retroperitoneal hematoma and were treated expectantly. Nine patients needed exploration and drainage only, while 18 had some form of renorrhaphy. Four patients underwent repairs of renal pelvic injuries, 12 underwent partial nephrectomy and 11 underwent repairs of renal pedicle injuries. A conservative approach to renal trauma is emphasized.

Influence of prehydration on the changes in renal tissue composition induced by water diuresis in the rat

1. The composition of renal tissue was determined in rats before and immediately after intravenous infusion of dextrose (2.5 g/100 ml.) in amounts sufficient to administer a positive fluid load of 4% body weight over 2 hr. The rats were classified into three groups, according to the preinfusion urine osmolality: hydropaenia, normal and moderately diuretic (over 2400, 800-1500 and below 800 mu-osmoles/g H(2)O, respectively).2. In non-infused rats, the steepness of the corticomedullary osmolal gradient varied, due to differences in both water and solute (sodium and urea) contents, and was related to urinary osmolality. Whereas differences in medullary and papillary solute contents occurred between all three groups, papillary water content was significantly higher only in the moderately diuretic animals.3. Dextrose infusion caused the induction of water diuresis, the lowest urinary osmolalities being produced in the previously moderately diuretic animals.4. Dextrose infusion caused a considerable reduction in the steepness of the corticomedullary osmolal gradient in all rats, particularly in the previously hydropaenic animals, due to changes in both solute (sodium and urea) and water contents. Whereas reductions in medullary and papillary solute contents occurred in all three groups, there was no further increase in papillary water content from the already high values seen in the noninfused diuretic animals.5. Thus, dextrose infusion largely abolished any previous differences in tissue water content, whereas significant, though small, differences in osmolal (particularly urea) content persisted.6. These data are discussed in terms of changes and differences in endogenous antidiuretic hormone (A.D.H.) release.7. Changes in the magnitude and direction of the urinary-papillary urea concentration difference are discussed in terms of passive transport, with probable A.D.H.-induced changes in nephron urea permeability.

The time course of changes in renal tissue composition duruig water diuresis in the rat

1. The time course and extent of changes in the composition of renal tissue slices in water diuresis were determined by sacrificing groups of rats before and during the intravenous infusion of dextrose (2.5 g/100 ml.) in amounts sufficient to administer over 2 hr, and subsequently to maintain for up to 7(1/2) hr, a positive fluid load of 4% body weight.2. The corticomedullary osmolal gradient characteristic of the nondiuretic rats was progressively dissipated until, at 7(1/2) hr, only papillary tip concentrations were higher than those of other segments.3. The changes in individual constituents followed different time courses: (i) an increase in water content in all segments, particularly the papilla, was almost complete by 1 hr, preceding the maximal increases in urine flow; (ii) a marked decrease in papillary and medullary urea content in the first hour was followed by a slower, progressive decrease leading to an almost complete dissipation of the urea gradient by 7(1/2) hr; (iii) small, non-significant decreases in sodium content occurred in all segments in the first hr, followed by a further small, progressive decrease in papillary sodium content; (iv) changes in ammonium and potassium concentrations were mainly related to those in water content, since the contents of these solutes showed only small changes.4. By 2 hr, differences in the rates of decline of osmolal and urea concentrations in urine and papilla led to urinary concentrations significantly lower than papillary values. The steep papilla-urine urea concentration difference became smaller, but remained significant even at 7(1/2) hr.5. The findings are discussed in terms of changes in countercurrent mechanisms, particularly as influenced by anti-diuretic hormone.6. The development of papilla/urine urea concentration ratio greater than unity is also considered in terms of passive transport with changes in membrane permeability.

The time course of changes in renal tissue composition during mannitol diuresis in the rat

1. The time course and extent of changes in the composition of renal tissue slices in osmotic diuresis were determined by sacrificing groups of rats before and during the intravenous infusion of mannitol (15 g/100 ml.) for up to 7(1/2) hr.2. Very rapid changes in tissue water and solute contents occurred within 15 min, preceding the times of maximal diuresis, with little subsequent change even up to 7(1/2) hr.3. The main changes were:(a) an increase in water content in all slices, particularly the papilla; (b) a very profound decrease in papillary and medullary urea content in the first 15 min, with a small, but significant, further decrease, subsequently; (c) a small, but significant, rapid decrease in papillary sodium, and small non-significant increases in the outer medulla and cortex. Subsequent changes in any segment were small and non-significant; (d) apart from small changes in the first 15 min ammonium and potassium contents remained fairly constant.4. The rates of change in papillary and urinary urea concentrations were similar, so that after 30 min, any differences between tip and urinary concentrations were small and non-significant.5. The findings are discussed in terms of factors influencing counter-current mechanisms. It is concluded that altered medullary blood flow is mainly responsible for the rapid changes in medullary composition.6. The relation between papillary and urinary urea concentrations is explicable in terms of passive handling, with equilibration across a freely permeable collecting duct membrane.

Effects of water diuresis and osmotic (mannitol) diuresis on urinary solute excretion by the conscious rat

1. The time course and extent of changes in urinary flow and in the outputs of urea, Na(+), K(+), and NH(4) (+) over a period of 7(1/2) hr in conscious rats during water and osmotic (mannitol) diuresis were determined, and compared with spontaneous changes in non-diuretic animals.2. In non-diuretic rats, a morning rise and subsequent decline in urinary osmolal, sodium, potassium and ammonium outputs occurred, possibly attributable to circadian rhythms.3. Water diuresis was accompanied by (i) a rapid increase in urea excretion during the phase of increasing urine flow, followed by a fall in later periods to values similar to those in non-diuresis, (ii) a slower increase in sodium output, continuing after the establishment of the constant water load, (iii) unchanged potassium excretion, but slightly increased ammonium outputs.4. Mannitol diuresis was accompanied by (i) a rapid increase in urea outputs which subsequently fell but remained significantly higher, (ii) a steep rise in sodium and potassium outputs to values which remained far higher than those in non-diuretic and water diuretic animals.5. The changes in mannitol diuresis are considered to result mainly from decreased tubular reabsorption, due to the lowered intraluminal sodium, potassium and urea concentrations and increased intratubular fluid flow. Some of the acute increase in urea excretion may be due to washout of medullary urea into the tubular fluid.6. In water diuresis, some of the changes in solute excretion may similarly result from altered tubular reabsorption, perhaps influenced by suppression of anti-diuretic hormone (A.D.H.). In addition, the slower changes in sodium output may be related to several consequences of change in body fluid volume.