Relationship of salusin-alpha and salusin-beta levels with atherosclerosis in patients undergoing haemodialysis

INTRODUCTION@#In patients undergoing haemodialysis, cardiovascular mortality and morbidity, characterised by accelerated atherosclerosis and increased inflammation, are elevated. Salusins are newly defined molecules in the atherosclerotic processes, and while salusin-alpha (Sal-α) acts as an antiatherogenic factor, salusin-beta (Sal-β) has a proatherogenic role. Their roles are as yet undefined in patients undergoing haemodialysis.@*METHODS@#In this cross-sectional study, salusin levels, carotid intima-media thickness (CIMT) from the common carotid artery and pulse wave velocity (PWV) were measured for 180 patients undergoing haemodialysis and 90 healthy controls.@*RESULTS@#Mean Sal-α and Sal-β levels in patients undergoing haemodialysis (Sal-α: 726.4 ± 578.7 pg/mL; Sal-β: 1,080.4 ± 757.1 pg/mL) and healthy controls (Sal-α: 325.8 ± 303.7 pg/mL; Sal-β: 268.1 ± 409.0 pg/mL) were determined. Negative correlation was observed between Sal-α levels and CIMT (patients undergoing haemodialysis: r = -0.330, p < 0.0001; healthy controls: r = -0.223, p = 0.035) and PWV (patients undergoing haemodialysis: r = -0.210, p = 0.005; healthy controls: r = -0.378, p < 0.0001) in both groups. In patients undergoing haemodialysis, positive correlation was observed between Sal-β/Sal-α ratio and CIMT (r = 0.190, p = 0.012) and PWV (r = 0.155, p = 0.041). On subgroup analysis, Sal-α levels were found to be low in patients with diabetes mellitus.@*CONCLUSION@#Patients undergoing haemodialysis have higher Sal-β and Sal-α levels, and their higher Sal-β/Sal-α ratio, in comparison with healthy controls, might have cardiovascular risk implications.

association of vitamin D status and vitamin d replacement therapy with glycemic control, serum uric acid levels, and microalbuminuria in patients with type 2 diabetes and chronic kidney disease

Objective: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid [SUA] levels, and microalbuminuria [MAU] in patients with type 2 diabetes [T2DM] and chronic kidney disease [CKD]

Subjects and Methods: A total of 1,463 patients with T2DM and CKD [aged 14-88 years], 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25[OH]D, level, SUA, hemoglobin [Hb]A1[c], creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio [UACR] were obtained from the medical records. The Mann-Whitney U test, the chi[2] test, the Mantel-Haenszel test, and linear regression models were used for data analysis

Results: Vitamin D deficiency and insufficiency were evident in 770 [52.0%] and 357 [24.0%] patients, respectively. Median HbA1[c] levels [7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01] were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR [beta -0.01; 95% CI -0.01 to -0.001; p = 0.017] and HbA1[c] [beta -1.1; 95% CI -1.6 to -0.6; p < 0.001], but with low levels of SUA [beta 1.3; 95% CI 0.5-2.2; p = 0.002]. Vitamin D replacement was associated with a significantly low level of HbA1[c] [7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]

Conclusion: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1[c], and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management

Gynecologic pathologies in our appendectomy series and literature review / 대한외과학회지

PURPOSE: Appendectomy applied from the diagnosis of acute appendicitis is one the most common operations in surgery. The rates of negative appendectomy are still high. The rates of negative appendectomy in males and females differ and are higher in females. In our study, these differences, particularly in females, were studied and possible solutions were discussed. METHODS: Between October 2002 and October 2009, among women receiving urgent appendectomies, those whose primary cause was gynecological pathology were studied retrospectively. All our women subjects were examined by preoperative gynecologists. After gynecological consultation, the patients were evaluated by a general surgeon due to lack of urgent ultrasonography, computed tomography (CT) and diagnostic laparoscopy and the patient received appendectomy due to acute appendicitis. RESULTS: In our series of 1,969 appendectomies, the rate of female/male is 811/1,158. It was determined that the primary cause in 47 (47/811; 5.8%) women with applied appendectomy was gynecological pathology. As a gynecological pathology, it was observed that the most common cause was ovarian cyst ruptures at a rate of 72.3%. The negative appendectomy rate in males was found to be 14.94% (173/1,158), and in females it was 22.56% (183/811). The difference between them is significant (P < 0.01). Of these women, 5.8% were gynecologically-induced and 16.76% were unrelated to gynecological causes. CONCLUSION: We believe that gynecological consultation before appendectomy in women is necessary, but not sufficient. It is also important that at least one of the facilities, such as us, CT, magnetic resonance imaging, and diagnostic laparoscopy should be available in surgical use for the diagnosis of negative appendicitis.

Can fruit seeds and undigested plant residuals cause acute appendicitis

<p><b>OBJECTIVE</b>To investigate the relation between fruit seeds, plants residuals and appendicitis.</p><p><b>METHODS</b>Among cases that underwent appendectomy, the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively. Also, histopathological features, age, sex, and parameters of morbidity and mortality were used.</p><p><b>RESULTS</b>Fruit seed was found in one case (0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases (0.35%). It was determined that there were appendix inflammation in 2 of the plant residuals cases, while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases. No mortality was observed.</p><p><b>CONCLUSIONS</b>The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.</p>

rare cause of small bowel transection: metastatic lung cancer

To present a case of small bowel perforation due to metastatic lung cancer. A 78-year-old male patient, who had been diagnosed with lung cancer 3 months earlier, presented to our clinic with acute abdominal pain. He underwent emergency laparotomy. At surgery, there was a circumferential lesion encompassing the ileum with complete transection. There was no obvious macroscopic appearance of metastatic disease. The involved bowel segment was resected and an ileostomy was performed. Postoperative pathologic analysis confirmed metastatic squamous cell carcinoma metastasis to the ileum, arising from the patient's lung cancer. This case report showed that small bowel metastases should always be considered in the differential diagnosis of lung cancer patients presenting with acute abdominal pain

Is repair of incisional hernias by polypropylene mesh a safe procedure?

The aim of our study was to evaluate the safety of the intraperitoneal mesh repair procedure and to assess the complications that develop after the procedure. We reviewed the records of 25 patients who underwent intraperitoneal mesh repair procedures. Data on age, sex, size and cause of the hernia, postoperative mortality, and morbidity with special attention to complications were obtained from the medical records. Of the 25 patients [7 males, 18 females], the original operation was cholecystectomy in 15 cases [60%], gynaecological surgery in 2, gastric surgery in 2, and umbilical hernia in 2. Incisions were midline in 20 cases [80%], transverse in 2 and laparoscopic port sites in 3 patients. The average size of the hernia was 150 cm[2]. Local complications occurred in 4 [16%] patients. Postoperative complications included wound infection in 3 patients and haematoma in 1 patient. Postoperative hospital stay ranged from 3 to 25 days with a mean of 6 days. No recurrence developed during 28-month follow-up. The tension-free repair of incisional hernia with polypropylene mesh in intraperitoneal position is a safe and easy procedure with acceptable morbidity and no recurrence

Small bowel tumors: insidious and important abdominal problems for surgeons

To evaluate the major clinical symptoms, etiology and presentation of small bowel tumors so that they can be diagnosed. Retrospective study. Izmir Bozyaka Teaching and Research Hospital, Turkey. Forty-five patients with 46 small bowel tumors over a 15-year period were included in the study. Biopsy or small bowel resection. The data obtained from the medical records including clinical features, diagnostic workup, operative procedures and pathologic diagnosis. The male to female ratio was 1.4:1 with a median age at presentation of 53 years [range, 30 - 83 years]. Thirty [66.7%] patients presented with abdominal emergencies such as bowel obstruction [40%], bowel perforation [24.4%] and intestinal bleeding [2.3%]. Non-urgent presentations were found in 15 [33.3%] patients. The preoperative diagnosis of small bowel tumor was positive in nine [20%] of the elective cases. The tumors were located in the ileum in 68.8%, the jejunum in 26% and the duodenum in 6.6% of patients. Thirty-eight [82.6%] malignant and eight [17.4%] benign tumors were identified. In addition, patients with malignant tumors more commonly presented with bowel obstruction and perforation. Segmental resection was done in 41[91%] patients. These observations suggest that small bowel tumors are difficult to diagnose because of delayed presentations and vague symptoms. Clinicians must have a high degree of suspicion and should perform early laparotomy without hesitation

double deep gluteal muscles

During routine dissections on a 65-year-old male cadaver, we encountered double piriformis, double gemelli superior and inferior, double quadratus femoris muscles in the left gluteal region. The sciatic nerve passed between the lower piriformis and the upper superior gemelli muscles [infrapiriform foramen] as usual. No other variation was found in the region. This rare variation may be of importance in the radiology and surgery of this region