Fetuin-A and cardiovascular morbidity in hemodialysis patients

Serum fetuin-A is levels are reduced in patients with end-stage renal disease [ESRD] and this predisposes to increased vascular and valvular calcification. The aim of this study is to demonstrate the role of fetuin-A deficiency in the pathogenesis of cardiovascular disease in hemodialysis patients. Our study included 50 patients on regular hemodialysis; they were divided in to two groups. Group A, included 25 patients who had angina or myocardial infarction. Group B, included 25 patients with no significant cardiovascular disease. They were compared with 20 age and sex matched controls. Serum fetuin-A was significantly lower in group A than group B and was significantly lower in group B than controls, Its level was significantly lower in patients with mitral annular calcification and it showed significant negative correlation with left ventricular mass index. Fetuin-A deficiency in ESRD patients on regular hemodialysis can be regarded as an important cardiovascular risk factor

Laparoscopic evaluation of two different anti-reflux techniques of uretero-intestinal anastomosis: metabolic impact

Split-nipple [n=10] and the submucosal tunnel [n=10] antireflux uretero-intestinal anastomotic techniques were performed employing 12 female pigs with average weight ranging from 35 to 40 kg. Preoperative intestinal preparation, both chemical and mechanical, was achieved 48 hours prior to surgery. Renal panel was also performed for all animals pre- and postoperatively. A 5-port trans-peritoneal technique was employed. The procedure comprised bilateral dissection of the ureters, hemicystectomy, isolation of a 20 cm ileal segment, ureter-intestinal anastomosis and ileo-cystoplasty. Animals were followed up for a period ranging from two weeks to three months. Bilateral antireflux uretero-ileal anastomoses were completed in all 10 animals with average total operative time of 4.5 hours and mean blood loss of 40 ml. All technical maneuvers could be performed completely intracorporealy using laparoscopic techniques. Mean pre- and postoperative serum creatinine was 1.1 and 1.2 mg%, respectively. All animals were non refluxing, however, two of the split-nipple uretero-ileal anastomosis had ureteral strictures. There were no significant metabolic effects of using intestinal segments in this procedure