The effect of anemia and left ventricular geometric patterns on renal disease progression in type 2 diabetic nephropathy.

BACKGROUND: Left ventricular (LV) geometric patterns have never been evaluated as independent risk factors for renal disease progression (RDP). We investigated the risk factors for RDP in type 2 diabetic nephropathy patients, especially focusing on the effects of LV geometric patterns. METHODS: This was a single-center retrospective cohort study. Type 2 diabetic nephropathy patients who underwent echocardiography for routine checkup were recruited. Baseline laboratory data within 1 month from the time of echocardiography and clinical and follow-up laboratory data were collected by retrospective reviews. RESULTS: A total of 150 patients (90 men, mean age 62.9 years) were enrolled. Distributions of the patients according to LV geometric patterns were as follows: normal 21 (14.0%), concentric remodeling 18 (12.0%), concentric hypertrophy 70 (46.7%) and eccentric hypertrophy 41 (27.3%). During the study period (30.1 ± 19.4 months), RDP developed in 53 of 150 patients (35.3%). On univariate analysis, use of erythropoiesis-stimulating agent, hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, log-transformed 24-hour urine protein, LV mass index and eccentric hypertrophy were strong predictors of renal outcomes. RDP-free survival was significantly decreased in the eccentric hypertrophy group (p=0.001, vs. other groups) according to Kaplan-Meier analysis. On multivariate analysis, eGFR, eccentric hypertrophy and hemoglobin levels were significant predictors of renal outcome. CONCLUSION: Anemia and eccentric hypertrophy may be considered as important risk factors for RDP. Multicenter prospective trials should be needed to validate the effect of LV geometric patterns on RDP.

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary artery disease and diabetic nephropathy: a single center experience.

BACKGROUND: Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. METHODS: The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed. RESULTS: The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046). CONCLUSIONS: The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.

[The short term prognosis in alcoholic liver disease with metabolic acidosis].

BACKGROUND/AIMS: Alcoholic liver disease with metabolic acidosis may have possible causes such as alcoholic ketoacidosis, diabetic ketoacidosis, lactic acidosis. Salicylate, methanol, and ethylene glycol intoxication should also be considered. The aim of this study was to investigate the short-term prognostic factors in patients with alcoholic liver disease with metabolic acidosis. METHODS: Clinical data related to twenty-nine patients with alcoholic liver disease and metabolic acidosis was analysed retrospectively. Patients were divided into two groups according to the outcome (survival or death). Past medical history, and physical, laboratory and radiologic data at admission were compared. RESULTS: The amount of daily alcohol intake differed significantly between the two groups (P=0.034), but duration and total amount of alcohol intake did not differ significantly between the two groups (P=0.128; P=0.360). The presence of ascites differed significantly between two the groups (P=0.019). On laboratory testing, the following differed significantly: base excess (P=0.038), hemoglobin (P=0.019), platelet (P=0.040), total bilirubin (P=0.007), albumin (P=0.012), creatinine (P=0.014), phosphorus (P=0.021), chloride (P=0.010), ammonia (P=0.003), prothrombin time (P=0.033), fibrinogen (P=0.011) and D-dimer (P=0.024). Review of the medical history of the patients showed diabetes (10/29), cirrhosis (10/29), and hepatocellular carcinoma (1/29). Combined conditions at admission were sepsis (8/29), pneumonia (7/29), acute renal failure (6/29), rhabdomyolysis (5/29), gastrointestinal hemorrhage (4/29), acute pancreatitis (3/29), acute respiratory distress syndrome (2/29), and acute myocardial infarction (1/29). CONCLUSIONS: The amount of daily alcohol intake, base excess, hemoglobin, platelet, total bilirubin, albumin, creatinine, phosphorus, chloride, ammonia, prothrombin time, fibrinogen and D-dimer seemed to be useful parameters in predicting short-term prognosis of patients with alcoholic liver disease with metabolic acidosis. Further study is needed to define the significance of these factors.

[Comparison of midazolam versus midazolam/meperidine during colonoscopy in a prospective, randomized, double-blind study].

BACKGROUND/AIMS: Colonoscopy is a painful procedure. Therefore conscious sedation is often used. However, the value of adding analgesics to sedatives has not been well evaluated. METHODS: The double blind, randomized controlled trial was carried out to compare patients' and endoscopist' assessments in both groups of patients: MP (Midazolam/Placebo) group (n=49) received midazolam plus placebo and MM (Midazolam/Meperidine) group (n=51) received midazolam plus meperidine. RESULTS: There was no significant difference of baseline characteristics except previous operation history. There were no significant difference of grade of tolerance, pain and willingness to another colonoscopy between the two groups. In endoscopist' satisfaction, the degree of difficulty was higher in MP group than in MM group (39.0 vs. 31.7,p<0.05). After the colonoscopy, systolic blood pressure, oxygen saturation, and pulse rate were significantly decreased (p<0.05) in both groups. However, there was no difference in the degree of decrease between the two groups. The incidence of adverse effect was not different in the two groups. However, one case of orthostatic hypotension with presyncope was noted in MM group. CONCLUSIONS: Adding meperidine to the midazolam before the colonoscopy does not seem to bring more beneficial effect to patients, whereas endoscopist favored the use of both medications.

A Case of Primary Gastric Choriocarcinoma Presenting with Amenorrhea.

Primary gastric choriocarcinomas are very rare, and their prognosis is extremely poor. A 37-year-old woman presented with amenorrhea, vaginal spotting and severe nausea, which mimicked a pregnancy and gestational trophoblastic disease. The serum level of the beta-subunit of human chorionic gonadotrophin (beta-hCG) was significantly increased. An endoscopic biopsy of the stomach mass showed the features of a choriocarcinoma, with marked anaplasia and necrosis. Immunohistochemical staining for beta-hCG showed positive results in the choriocarcinoma. Chemotherapy for the choriocarcinoma was administered, but she died 8 months following diagnosis.