Relationship between asymmetric dimethylarginine [ADMA] and endothelial dysfunction in chronic renal failure patients

The aim of this study was to assess serum asymmetric dimethylarginine [ADMA]and their relation to endothelial dysfunction in chronic renal failure [CRF] patients. A total of 50 CRF patients were divided to 2 groups [25 CRF patients on conservative treatment with glomerular filtration rate [GFR] 41.04 +/- 10.5 ml/min/1.73 m[2], and 25 patients on regular hemodialysis [HD], in addition to 20 healthy controls were studied. GFR was estimated by Cockroft-Gault formula. ADMA was measured by an enzyme- linked immunosorbent assay. Endothelial dysfunction was measured by flow-mediated dilatation [FMD] in brachial artery using high-resolution ultrasound. In addition, C-reactive protein [C-RP], serum albumin, total protein, total cholesterol, low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], triglyceride and 24-h urinary proteins were performed. Compared with controls, CRF patients on conservative treatment as well as HD patients had higher levels of serum ADMA, brachial artery FMD was significantly lower among CRF patients on conservative treatment and HD patients, suggesting greater endothelial dysfunction, when CRF patients on conservative treatment were compared with HD patients, those HD patients had higher ADMA levels. Moreover, Serum ADMA levels did not change significantly after 4-hour dialysis in HD patients. In multivariate correlation, serum ADMA levels were correlated and independent predictor of FMD. serum ADMA levels were increased in CRF patients on conservative therapy and HD patients, and may be one of the contributing factors for the development of endothelial dysfunction in these patients

Relationship between asymmetric dimethylarginine [ADMA], proteinuria and endothelial dysfunction in chronic kidney disease

The aim of this study was to assess serum asymmetric dimethylarginine [ADMA] and their relation to endothelial dysfunction in chronic kidney disease [CKD] Patients with proteinuria. A total of 54 CKD Patients with normal glomerular filtration rate [GFR] were divided into three groups based on their urinary protein excretion in 24 h: 23 patients with nonnephrotic proteinuria [< 3.5 g/d], 17 patients with nephritic-range proteinuria, 14 patients with nephrotic-range proteinuria and secondary amyloidosis [SA] by renal biopsy, in addition to 18 healthy controls. Renal function was estimated with the Cockroft-Gault formula. ADMA was measured by high-performance liquid chromatography [HPLC], assessment of endothelial dysfunction by measuring flow-mediated dilatation [FMD] in brachial artery using high-resolution ultrasound. In addition, high sensitivity C-reactive protein [hsCRP], total cholesterol, triglycerides, high density lipoprotein cholesterol [HDL-C], low density lipoprotein cholesterol [LDL-C], serum albumin and insulin resistance were performed for all patients. The proteinuric patients had higher levels of serum ADMA. hsCRP and insulin resistance. Compared with controls, brachial artery FMD was significantly lower among proteinuric patients, suggesting greater endothelial dysfunction. When patients with secondary amyloidosis were compared with patients with glomerulonephritis who had similar levels of proteinuria, those with amyloidosis had higher ADMA levels and lower FMD measurements. Even after adjusting for confounders, ADMA level correlated with both proteinuria and the presence of secondary amyloidosis, and was an independent predictor of FMD. In conclusion, serum ADMA concentrations were increased in CKD, especially in secondary amyloidosis, and this may explain part of the mechanism by which proteinuria increases cardiovascular morbidity and mortality

Evaluation of serum fetuin-A: relationship with endothelial dysfunction in hemodialyzed patients

The aim of this study was to evaluate the association between serum fetuin-A concentrations and endothelial dysfunction in hemodialyzed [HD] patients. 85 patients on regular HD [55 males and 30 females] and 30 healthy controls [17 males and 13 females] were studied. We measurd serum fetuin-A by enzyme-linked immunosorbent assay. Assessment of endothelial dysfunction by measuring common carotid artery intima media thickness [CCA-IMT] and intima media thickness-inhomogeneity using high-resolution ultrasound. In addition, C-reactive protein [hsCRP], serum calcium, phosphate, intact parathyroid hormone [iPTH], albumin, total cholesterol, triglycerides, high density lipoprotein cholesterol [HDL-C], low density lipoprotein cholesterol [LDL -C] and fasting blood sugar were performed. Compared with controls, HD patients had a lower levels of serum fetuin - A, higher levels of CRP and 'iPTH, a greater CCA-IMT as well as CCA-IMT-inhomogeneity. Dialysis patients with cardiovascular disease [CVD] had a greater CCA-IMT and IMT-inhomogeneity compared with patients without CVD. IMT-inhomogeneity strongly correlated with IMT. In multiregression analysis, serum fetuin-A correlated with IMT-inhomogeneity but not with IMT, and hsCRP neither correlated with IMT-inhomogeneity nor with IMT. In conclusion, serum fetuin-A concentrations were decreased in HD patients and may be one of the contributing factors for the development of endothelial dysfunction in these patients

Endoscopic treatment of ejaculatory duct obstruction: value of intraoperative transrectal ultrasound guidance

To report our experience in the use of intraoperative transrectal ultrasound [TRUS] guidance for endoscopic treatment of patients with ejaculatory duct obstruction [EDO]. A total of 200 infertile men were evaluated for azoospermia with normal palpable testes, and 35 patients were found to have EDO. Diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, hormonal study, testicular biopsy and TRUS. Twenty-five patients underwent endoscopic management or treatment of their EDO under TRUS guidance in the form of resection in 20 cases and endoscopic extraction of calculi in five patients. In all of the 35 men, semen analyses showed the typical characteristics of complete EDO. TRUS revealed distended seminal vesicles [SV] and dilated ejaculatory ducts in 24 cases, fibrosed ejaculatory ducts in six cases, calculi obstructing ejaculatory ducts in five cases. Normal serum hormones, normal testicular biopsy and low ejaculate volume were found in all cases. The overall rates of improved semen values and paternity after endoscopic treatment were 52% [13/25] and 16% [4/25], respectively. Postoperative complications included urinary tract infection in 24%, haematuria in 16%, recurrent epididymitis in 12% and acute urinary retention in 8% of cases. TRUS provided useful information on the exact location of any cyst which was very helpful during transurethral resection of the ejaculatory ducts [TURED]. Intraoperative TRUS guidance facilitated and shortened operation time

Appendicular osteoid osteoma: percutaneous excision under computed tomography guidance using goaxial drill technique

Eleven cases of osteoitd osteomas of tubular bones were resected percutaneously under CT guidance. Diagnosis was made on the basis of clinical and radiological findings. Histopathological confirmation was obtained in 10 cases. Successful treatment was achieved in all patients. Because of the focal bone resection, no bone grafting was needed. Hospital stay lasted from 1 to 3 days. After 2-13 months of follow up, all patients were asymptomatic. We recommend percutaneous excision under CT guidance as the procedure of choice in the treatment of the appendincular osteoid osteoma