Single-centre review of radiologically guided percutaneous nephrostomy using "mixed" technique: success and complication rates.

AIM: A review of complication and success rates of the "mixed" technique in percutaneous nephrostomy using both the Seldinger and one-step techniques in dilated and non-dilated systems. MATERIALS AND METHODS: We retrospectively analysed 500 percutaneous nephrostomies in dilated an non-dilated systems in 353 patients from 2006 to 2007 (208 males (range 19-95 years), 127 females (range 27-91 years) and 21 children (range 3 months-16 years: 6 females, 15 males)). Percutaneous nephrostomy was considered successful if catheter was placed in renal pelvis and drained urine spontaneously. Successful percutaneous nephrostomies were classified as primary (renal system drained instantly) or postponed (drainage achieved within 24h after initial failure). Number of complications was registered. RESULTS: All of the 500 nephrostomies were successful within 24h (96.2% primary; 3.8% postponed). The success rate of primary nephrostomy in dilated and non-dilated systems was 98.2% and 82%, respectively. Major complications occurred in 0.45% and minor complications in 14.2%. CONCLUSION: Percutaneous nephrostomy using the "mixed" technique is very successful in dilated systems, is not superior to other PCN techniques in non-dilated systems and has a very low rate of major complications.

Computed tomography scans of intra-abdominal fat, anthropometric measurements, and 3 nonobese metabolic risk factors.

The present cross-sectional study of 46 adult Danish white men and women aimed to evaluate association between intra-abdominal obesity, 4 anthropometric measurements of obesity, and combinations of 3 nonobese metabolic risk factors: systolic blood pressure of 130 mm Hg or higher, serum triglyceride concentration of more than 1.7 mmol/L, and fasting capillary blood glucose concentration of 5.6 mmol/L or more. For 80% of the subjects, intra-abdominal fat on a computed tomography scan of the abdomen using a cutoff limit of more than 144 cm(2) gave a correct classification of combinations of at least 2 of the 3 metabolic risk factors. Body mass index and waist circumference were better markers of intra-abdominal obesity than waist-to-hip ratio in receiver operating characteristic analyses (P = .0035). Body mass index of more than 26 kg/m(2) and waist circumference of more than 0.92 m classified 76% and 74% of the subjects correctly regarding combinations of the 3 nonobese metabolic risk factors. Intra-abdominal obesity was significantly stronger associated with the combinations than a raised waist-to-hip ratio (P = .016). Both body mass index and waist circumference may be used as markers of intra-abdominal obesity, whereas waist-to-hip ratio was significantly inferior. Correspondingly, both body mass index and waist circumference were better than waist-to-hip ratio to indicate combinations of the 3 nonobese metabolic risk factors.

Fibrinogen and other coronary risk factors.

The association between plasma fibrinogen concentration and other coronary risk factors diverged in previous studies, and the impact from complex lipoprotein patterns has not been studied. Our research involved 24 healthy subjects without coronary heart disease (control) and 22 patients who had survived having acute myocardial infarction before the age of 41 years (cases), overall 40 men and 6 women with age range of 34 to 54 years. In multiple linear regression analyses concerning control subjects, family disposition, social class, a score based on serum triglyceride and high-density lipoprotein (HDL) cholesterol concentrations, and fasting capillary blood glucose concentration were significantly associated with plasma fibrinogen concentration (P < .00005, R2 = 0.81). For case subjects, the ratio between serum low-density lipoprotein cholesterol and high-density lipoprotein cholesterol concentrations was significantly associated with plasma fibrinogen concentration (P = .0018, R2 = 0.39). Thus, for healthy subjects, 4 coronary risk factors explained three quarters of the variation of plasma fibrinogen concentration, and for patients with a previous acute myocardial infarction, another coronary risk factor explained one third of the variation. In conclusion, the pattern of coronary risk factors associated with plasma fibrinogen concentration differed between those without coronary heart disease and those with a previous acute myocardial infarction.

Plasminogen activator inhibitor 1 activity and other coronary risk factors.

Because only some coronary risk factors have been evaluated for an association with plasma plasminogen activator inhibitor 1 (PAI-1) activity, this cross-sectional study examined the association between 27 coronary risk factors and PAI-1 in 24 healthy persons without coronary heart disease (control persons) and 22 patients who had survived myocardial infarction (cases). The coronary risk factors included major coronary risk factors such as age, anthropometric measures such as intraabdominal fat, and biochemical analytes such as serum concentration of triglyceride and plasma von Willebrand factor activity. The associations were analyzed in univariate and multiple linear regression analyses. For the control persons, triglyceride and von Willebrand factor were significantly associated with PAI-1 activity (p=0.0002, R(2)=0.55). In contrast for the 24 cases, age and intraabdominal adipose tissue were significantly associated with PAI-1 (p=0.0011, R(2)=0.51). Coronary risk factors explained more than half the variation of PAI-1 activity for both study groups. However, healthy persons and patients with previous myocardial infarction differed regarding coronary risk factors associated with PAI-1.

Smoking, low density lipoprotein cholesterol, fibrinogen and myocardial infarction before 41 years of age: a Danish case-control study.

BACKGROUND: Of major coronary risk factors, smoking and total cholesterol were significant in a previous Danish case-control study of myocardial infarction at a young age. OBJECTIVE: To determine whether smoking was an important coronary risk factor in the context of new and major anthropometric and biochemical risk factors for myocardial infarction in individuals less than 41 years of age. METHODS: A prevalence hospital-based matched case-control study of young individuals. We selected 22 Caucasian cases and 24 Caucasian controls without coronary heart disease matching for age and gender and studied a series of major coronary risk factors and newer anthropometric and biochemical variables. RESULTS: In conditional univariate logistic regression analyses, the following factors were significantly associated with the coronary risk: family history, social class, smoking, intraabdominal adipose tissue area as percentage of total abdominal adipose tissue area on a CT scan, glycosylated haemoglobin level, systolic blood pressure, total cholesterol, low density lipoprotein (LDL) cholesterol, homocysteine, and fibrinogen levels (P < 0.05). However, in multiple conditional logistic regression analyses, only smoking, LDL cholesterol, and fibrinogen levels remained significant. Ten cases (46%) and none of the 24 controls were smokers with a LDL cholesterol level 4.5 mmol/l and a fibrinogen level 3.7 g/l (P = 0.0003, Fisher's exact test). CONCLUSION: Out of a series of major and newer coronary risk factors in young Western Caucasians, smoking, and levels of LDL cholesterol, and fibrinogen were independent significant coronary risk factors. The findings need to be validated in prospective studies.