Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients

BACKGROUND: Pulmonary hypertension (PHT) is a recently recognized complication of chronic kidney disease. In this study, we investigated the association between PHT, peripheral vascular calcifications (VCs), and major cardiovascular events. METHODS: In this retrospective study, we included 172 end-stage renal disease (ESRD) patients undergoing dialysis [hemodialysis (HD)=84, peritoneal dialysis=88]. PHT was defined as an estimated pulmonary artery systolic pressure >37 mmHg using echocardiography. The Simple Vascular Calcification Score (SVCS) was measured using plain radiographic films of the hands and pelvis. RESULTS: The prevalence of PHT was significantly higher in HD patients (51.2% vs. 22.7%). Dialysis patients with PHT had a significantly higher prevalence of severe VCs (SVCS> or =3). In multivariate analysis, the presence of severe VCs [odds ratio (OR), 2.68], mitral valve disease (OR, 7.79), HD (OR, 3.35), and larger left atrial diameter (OR, 11.39) were independent risk factors for PHT. In addition to the presence of anemia, severe VCs, or older age, the presence of PHT was an independent predictor of major cardiovascular events in ESRD patients. CONCLUSION: The prevalence of PHT was higher in HD patients and was associated with higher rates of major cardiovascular events. Severe VCs are thought to be an independent risk factor for predicting PHT in ESRD patients. Therefore, in dialysis patients with PHT, careful attention should be paid to the presence of VCs and the occurrence of major cardiovascular events.

Comparison of Laparoscopic and Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: Advancements in technology and surgical skill have extended the applications of minimally invasive surgery, and various studies have suggested that laparoscopic adrenalectomy (LA) might lead to better clinical outcomes compared to open surgery. We reviewed our experience in order to evaluate the clinical outcomes of laparoscopic and open adrenalectomy (OA). METHODS: We retrospectively analyzed the clinical records of 41 patients who underwent surgery for adrenal lesions between 1998 and 2006. Outcome measurements included gender, age, diagnosis, lesion size, operative time, intraoperative blood loss, procedure-related complications, time to first oral intake, and postoperative hospital stay. RESULTS: There were 19 LAs and 22 OAs. There were no significant differences in gender, age, lesion location (right or left), comorbidity, complications, or postoperative hospital stay. The mean operative time was longer in the LA group than in the OA group (OA 215, LA 273 min, P=0.048). Resumption of oral intake occurred at 3.4 days in the OA group and at 1.9 days in the LA group (P<0.001), and the incidence of bleeding that required transfusion was 58% in the OA group and 21% in the LA group (P=0.018). We divided the LA group into 14 pure LAs (pLA) and 5 conversions from laparoscopic procedures to open adrenalectomy (CA). Significant postoperative complications occurred in the OA, pLA, and CA groups at rates of 18%, 14%, and 80%, respectively (OA vs pLA, P=0.569 pLA vs CA, P=0.017 OA vs CA, P=0.017), and postoperative hospital stays were 11.1, 5.7, and 19.6 days for each group, respectively (OA vs pLA, P=0.005 pLA vs CA, P<0.001 OA vs CA, P=0.025). CONCLUSION: Patients who underwent pLA had similar postoperative complications, but shorter hospital stays and shorter times to first oral intake compared to OA. Patients in the CA group had longer operative times, longer postoperative hospital stays, and significantly higher rates of variable complications compared to the pLA and OA groups. Careful preoperative selection of patients for LA is important to avoid unnecessary CA.

Traumatic Isolated SMA Dissecting Aneurysm Associated with Burst Fractures of Lumbar Spines

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.

Traumatic Isolated SMA Dissecting Aneurysm Associated with Burst Fractures of Lumbar Spines

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.