Endothelial dysfunction and secondary hyperparathyroidism in end stage renal disease [ESRD]

Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease. Endothelial dysfunction represents an obligatory, prodromal phase in the atherosclerosis process. Secondary hyperparathyroidism is an integral component of the uremic syndrome. The aims is to study endothelial dysfunction in patients with uremia in relation to secondary hyperparathyroidism. Two groups of patients were studied: a group of 40 patients on regular hemodialysis 3 times/ week, 4 hours/ session, and a group of 30 patients with chronic kidney disease on conservative management. They were compared to 30 healthy age and sex matched normal controls. Measurement of flow-mediated [FMD] and nitroglycerine-induced vasodilatation [NMD] were done, in addition to routine laboratory investigation including intact PTH assay. Both flow-mediated vasodilation [8.52+/- 2.9% in hemodialysis patients and 13.33 +/- 1.44% in CKD patients] and flow-independent vasodilation [nitroglycerine mediated] [15.93 +/- 3.4% in HD group and 17.06 +/- 2.02% in CKD] were compromised when compared to controls [FMD 16.02 +/- 2.9% and NMD 20.76 +/- 4.3%] [p < 0.05]. FMD was significantly compromised in HD versus CKD group [p < 0.05] but this was not the case for NMD. Both FMD and NMD were significantly negatively correlated with serum createnine and PTH. Control of PTH levels in different stages of kidney disease may be part of the strategy to reduce the burden of atherosclerosis associated with CKD and PTH levels could be useful to identify patients at higher risk of future cardiovascular events

new four in one stabilizing operation for anterior recurrent dislocation of the shoulder joint

A preliminary study of a new surgical technique included eight male patients with recurrent anterior dislocation of the shoulder, all managed operatively after failure of the rehabilitation program. The new surgical technique included four main steps done in one operation, namely imbrication of the redundant capsule, anterior bone block by using the coracoid process, muscular dynamic buttress for anterior and inferior capsule and finally imbrication of the upper half and lower half of the subscapularis muscle. Our average age 27.88 years ranged from 22 - 40 years. All achieved satisfactory results [excellent to good]. Bony union of the transferred coracoid process has occurred in all patients. No recurrence of dislocation has happened after an average follow up period of 3.15years ranged from 8 months to 6 years