Safety of carbon bead injection for incontinence in patients taking warfarin.

OBJECTIVES: To determine the safety of the use of Durasphere in patients receiving warfarin anticoagulation. METHODS: This case series included patients requiring long-term anticoagulation who also had intrinsic sphincteric deficiency or mixed urinary incontinence, and bladder outlets without hypermobility. All patients, with the exception of the 1 man in the study, were treated under local anesthesia with periurethral carbon bead injections, while receiving therapeutic doses of warfarin. RESULTS: Between 1999 and 2004, 20 such patients received carbon bead injections, on 36 different occasions, during therapeutic warfarin administration. Two complications related to the anticoagulation were encountered, one minor complication of a small periurethral hematoma and the other more severe, with a patient developing urinary retention and intravesical hemorrhage. CONCLUSIONS: In most cases, the injection of carbon beads under local anesthesia in patients receiving therapeutic warfarin anticoagulation can be safely performed without reversal of the anticoagulation.

Glomerular cell number in normal subjects and in type 1 diabetic patients.

BACKGROUND: The number of cells in glomeruli has been a challenging measure, especially in human kidneys, with only a small amount of tissue obtained by biopsy. However, the number of cells and their function are important determinants of renal function in health and disease. METHODS: Modern morphometric techniques have now provided the means to determine the numerical density (Nv) and number (with a measure of glomerular volume) of endothelial cells, mesangial cells, and podocytes in plastic-embedded renal tissue biopsied from nondiabetic subjects (N = 36) and type 1 diabetic patients (N = 46) over an extended age range from childhood through late adult. RESULTS: Nv values for all glomerular cells varied only slightly with age and did not change within the range of glomerular lesions of diabetes studied. Thus, the increase in glomerular volume during childhood to a steady level thereafter was the primary determinant of total glomerular cell number. The number of mesangial cells and endothelial cells increased with age, reflecting the increase in all cells, while the podocytes remained unchanged in number over all ages studied (10 to 69 years). Numbers of total glomerular cells, mesangial cells, and endothelial cells were not changed with diabetes, while podocytes were fewer in number in diabetic patients of all ages, with reduced podocyte numbers even in diabetes of short duration. CONCLUSIONS: The essentially constant glomerular cell density in nondiabetic and diabetic subjects under different circumstances possibly indicates an underlying propensity for the glomerulus to regulate its architecture to maintain a constant number of cells per volume, no matter the size of the glomerulus or the severity of diabetic nephropathy studied in this set of patients. The reductions in podocyte numbers in both younger and older diabetic patients indicate a significant risk for functional abnormalities as diabetic nephropathy progresses. Moreover, these observations do not support the suggestion of marked increases in glomerular cell number (and especially mesangial cells) with the development and progression of diabetic nephropathy.