Relationship between Vessel Diameter and Time to Maturation of Arteriovenous Fistula for Hemodialysis Access.

Introduction. Native arteriovenous fistula (AVF) is the recommended vascular access for HD patients by the Dialysis Outcomes Quality Initiative (DOQI) guidelines. The aim of our study was to determine the correlation between diameter and maturation of vessels in radiocephalic AVF. Methods. A prospective cross-sectional study carried out during 2006-2007 on 96 hemodialysis patients from Hasheminejad Kidney Center with non probability selection, all of them with end to side native AVF. Results. In this population 62.5% had wrist (distal radial artery) AVF and 37.5% had antecubital (proximal radial artery) AVF. The mean diameter of artery was 2.57 mm (SD = 1.09) and the mean diameter of vein was 2.40 mm (SD = 0.79). The mean of maturation period was 38.60 days (SD = 42.13). There were no relationship between duration of maturation period and diabetes mellitus, sex, age, diameter of vein and artery (P > 0.05). Period of maturation showed some correlation with the diameter of vein (P = 0.04) in patients with distal radiocephalic fistulae. Conclusions. The maturation of fistula shows correlation with vein diameter, but no correlation was seen with diameter of the arteries. There is much discrepancy between times to maturation in various reports. The average time for fistula maturation was 38/6 days in our study.

Assessment of gynecologic malignancies: a multi-center study in Tehran (1995-2005).

OBJECTIVE: The observed differences in cancer incidence are mainly due to different individuals and social risk factors. This study aims to demonstrate the characteristics of female genital malignancies according to the pathological records in Tehran, Iran. MATERIALS AND METHODS: In this cross-sectional study, all records of pathological specimens categorized as ovarian, uterine corpus or uterine cervix cancers from 1995 to 2005, in five teaching hospitals in Tehran, were studied. Age, marriage, parity, menopausal status, smoking, oral contraceptive usage, pathological staging, and histological grading were reviewed by a trained general practitioner. SPSS 14 was used for statistical analysis. RESULT: Mean age (SD) at the time of diagnosis was 50 (15). Fifty-nine percent of ovarian, 33.9 and 47.7% of uterine corpus and uterine cervix malignant patients were premenopausal. About 90% of all were nonsmokers and 82.7% were multiparae. Various types of gynecologic malignancies included ovarian (55.5%), uterine corpus (24.9%), and uterine cervical cancers (19.6%) were diagnosed. In tumors of the uterine corpus and uterus cervix, the most frequent stage of diagnosis was stage IIA. CONCLUSION: Ovarian cancer was the most frequently occurring gynecologic tumor. Although distribution of age in ovarian cancer was similar to that mentioned in the literature, occurrence of the cancer was more frequent in the premenopausal state.

The effect of hemoglobin level on arteriovenous fistula survival in Iranian hemodialysis patients.

OBJECTIVE: End-stage renal disease (ESRD) poses steadily growing challenges to health care systems worldwide. Renal replacement therapy with hemodialysis (HD) or kidney transplantation is the only possibility for ESRD patient survival. A complete correction of anemia in HD patients may lead to an increased risk of vascular arteriovenous fistula (AVF) primary failure; some studies have demonstrated that decreased levels of hemoglobin (Hb) had adverse effects on cardiac and brain function. This study was designed to evaluate the impact of different risk factors, especially the Hb level on AVF survival. METHODS: Prospective observational data were analyzed from a non-randomized sample (n=100) of HD patients who were referred for first AVF creation between April 2005 and December 2006 with <1 month on HD. The relative risk (RR) of access primary failure was evaluated in four different groups of patients divided according to their Hb levels (<8, 8-10, 10-12, and >12 g/dL). Other factors possibly influencing vascular access (VA) survival were also considered including gender, age, smoking, diabetes, hypertension, parathyroid hormone levels, ACE inhibitor intake and triglyceride levels. The analyses were performed using SPSS v.11.5, Kaplan-Meier analysis, Cox's regression and log rank test. RESULTS: There was a statistically significant higher risk of AVF primary failure in patients with Hb <8 g/dL (RR=1.41; p=0.01), diabetes (RR=1.21; p=0.05), age>60 yrs (RR=1.41; p=0.06) were identified as predictive factors for AVF primary failure. ACE inhibitor intake (RR=0.45; p=0.01) was found to be protective. CONCLUSION: Correction of serum Hb level can lead to a better result in VA survival and ACE inhibitor intake was found to be a protective factor.