Abdominal Aortic Calcification in Living Kidney Donors.

OBJECTIVE: This study assesses the association between abdominal aortic calcification (AAC) and renal function of living kidney donors and evaluate AAC as a surrogate marker for nephrosclerosis. METHODS: Between January 2010 and March 2013, 287 donors who underwent living donor nephrectomy were enrolled. We analyzed computed tomography angiographies and quantified AAC scores by calculating the Agatston score for the abdominal aorta. The donors were stratified into the non-AAC group (AAC score = 0; n = 238) and the AAC group (AAC score >0; n = 49). The relationship between AAC and perioperative estimated glomerular filtration rate was analyzed. For the 180 donors consenting to implantation biopsy, the nephrosclerosis score was defined as the sum of abnormalities, including glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriosclerosis. RESULTS: The mean AAC score was 185.5 ± 263.3 in the AAC group. The AAC group was older than the non-AAC group (51.1 ± 6.1 vs 37.9 ± 11 years; P < .001). Perioperative renal function was not different between the 2 groups. However, among the AAC group, donors with an AAC score of >100 were associated with delayed renal function recovery (P = .035). Donors with AAC were more likely to have glomerulosclerosis (50.0% vs 29.1%; P = .022), tubular atrophy (62.5% vs 33.1%; P = .002), and a higher nephrosclerosis score (P = .002). CONCLUSIONS: Living donors with an AAC score of >100 require close observation because they have a higher probability of delayed renal function recovery after donation. AAC is associated with nephrosclerosis in healthy adults.

The prevalence of metabolic syndrome and its association with alanine aminotransferase in clozapine-treated Korean patients with schizophrenia.

Widely ranging prevalence rates for metabolic syndrome (MetS) in patients taking clozapine have been reported on the basis of various criteria, and most studies have been carried out in non-Asian countries. Therefore, we examined the prevalence of MetS in Korean patients using three commonly applied criteria with two waist-circumference cutoff values. The indirectly standardized prevalence ratio (ISPR) was estimated using data from the Fourth Korean National Health and Nutrition Examination Survey (KNHNES, 2007) to compare the prevalence of MetS in patients with that in the general population. In addition, we also examined whether serum alanine aminotransferase (ALT) and aspartate aminotransferase levels serve as biochemical markers for the identification of MetS. We reviewed the electromedical records of patients with schizophrenia who had taken clozapine as the sole antipsychotic for 3 months or more. The prevalence of MetS ranged from 34.5 to 46.9%, and the ISPR ranged from 2.4 to 2.8, given the three definitions of MetS and the two waist-circumference cutoff points for women. The ISPR for MetS among those aged 18-30 years was the highest and decreased with age in both men and women. After adjusting for age, patients with normal serum ALT levels who were in the top third were significantly more likely to have MetS compared with those who were in the bottom third. Logistic regression analysis showed that serum ALT levels and use of antidepressants were significantly related to the presence of MetS. Korean patients with schizophrenia who were receiving clozapine as the sole antipsychotic showed a high prevalence of MetS. Although we found substantial differences in the prevalence according to criteria, the ISPR indicated significantly higher rates of MetS in this group than in the general population. In the general population, younger patients had a much higher risk for MetS than older patients. Elevated levels of serum ALT that were in the normal range were associated with the presence of MetS, which suggests the possibility of using serum ALT level as an early indicator for MetS in patients treated with clozapine.

Relationship between prolactin levels and subjective endocrine-related adverse effects in patients with schizophrenia receiving long-term treatment with amisulpride.

INTRODUCTION: We have investigated the categorical prevalence of hyperprolactinemia and examined the relationship between prolactin levels and subjective endocrine-related adverse effects in schizophrenia patients treated with amisulpride during a 1-year period. METHODS: A total of 111 patients with schizophrenia who were either started on or switched to amisulpride were assessed for prolactin levels and endocrine-related adverse effects using 6 items derived from the Liverpool University neuroleptic side-effect rating scale (LUNSERS) at baseline, 8 weeks, and 1 year. RESULTS: 10 were antipsychotic-naïve, 23 were antipsychotic free for 1 month, 54 discontinued their medication during 1 month prior to study, and 24 maintained their antipsychotics at baseline. At 1 year, hyperprolactinemia was found in 75.9% of men and 85.7% of women. Significant increases in mean prolactin levels at week 8 in both sexes were found; this was followed by a significant decrease over 1 year only in women. The proportions of both sexes with hyperprolactinemia increased from baseline to week 8 but remained unchanged at 1 year. Scores on the endocrine-related items of the LUNSERS improved significantly from baseline to week 8 in both sexes and then remained consistent during maintenance treatment. Prolactin levels were significantly higher in the group with baseline hyperprolactinemia than in the group without baseline hyperprolactinemia at all assessment points. CONCLUSIONS: Amisulpride commonly induces hyperprolactinemia. Although the percentage of patients with hyperprolactinemia remained unchanged during maintenance treatment, serum prolactin levels significantly decreased among women. Self-reported endocrine-related side effects were not associated with prolactin elevation during amisulpride treatment.

A prospective evaluation of conventional cystography for detection of urine leakage at the vesicourethral anastomosis site after radical prostatectomy based on computed tomography.

AIM: To evaluate the diagnostic accuracy of conventional cystography for the detection of urine leakage at the vesicourethral anastomosis (VUA) site after radical prostatectomy based on computed tomography (CT) cystography. MATERIALS AND METHODS: Patients who underwent radical prostatectomies at a single tertiary cancer centre were prospectively enrolled. Conventional cystography was routinely performed on postoperative day 7. Non-enhanced pelvic CT images were obtained after retrograde instillation of the same contrast material for a reference standard of urine leakage at the VUA site. Urine leakage was classified as follows: none; a plication abnormality; mild; moderate; and excessive. RESULTS: One hundred and twenty consecutive patients were enrolled. Conventional cystography detected 14 urine leakages, but CT cystography detected 40 urine leakages, which consisted of 28 mild and 12 moderate urine leakages. When using CT cystography as the standard measurement, conventional cystography showed a diagnostic accuracy of 17.8% (5/28) for mild urine leakage and 75% (9/12) for moderate leakage. Of nine patients diagnosed with mild leakage on conventional cystography, four (44.4%) had complicated moderate urine leakages based on CT cystography, requiring prolonged catheterization. The sensitivity, specificity, positive and negative predictive values, and accuracy of conventional cystography were 35, 100, 100, 75.4, and 78.3%, respectively. CONCLUSIONS: Conventional cystography is less accurate than CT cystography for diagnosing urine leakage at the VUA site after a radical prostatectomy. The present results suggest that CT cystography is a good choice for diagnostic imaging of urine leakage after radical prostatectomy.

Discordant MRI/FDG-PET imaging for the diagnosis of borderline ovarian tumors.

The objective of this study was to assess the role of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) for the characterization of ovarian masses that were diagnosed as ovarian malignancies by magnetic resonance imaging (MRI). We performed a retrospective review of eight patients with pathologically confirmed borderline ovarian tumors (BOT) who underwent MRI and FDG-PET before surgical staging from August 2005 to March 2007. We assessed the PET imaging of the BOT, measured the FDG uptake and quantified the findings as a standardized uptake value (SUV). The FDG-PET scans, of all eight patients, showed uptake of FDG with a mean SUV of less than 2.0 in the solid portion of the masses evaluated. We conclude that the MRI-PET differences may help differentiate borderline from malignant ovarian tumors.