The Randomized Controlled Study of Low-Level Laser Therapy, Kinesio-Taping and Manual Lymphatic Drainage in Patients With Stage II Breast Cancer-Related Lymphedema.

Objective: To compare the effects of low-level laser therapy, kinesio-taping and manual lymphatic drainage (MLD) on the affected arm volume, quality of life, arm function, neuropathic pain and shoulder mobility in patients with stage II breast cancer-related lymphedema. Materials and Methods: Forty-five breast cancer patients with stage II lymphedema were included. The patients were randomized to three groups and treated with MLD, kinesio-taping or low-level laser therapy. After these different therapeutic modalities, all patients received multilayer compression bandaging, lymphedema remedial exercises, skin care, and a patient education program by the same lymphedema therapist. All treatments were applied 5-days a week for three weeks. The lymphedema compression garments were prescribed to all patients and follow-up visits were planned at the end of the treatment, and at four and 12 weeks. The efficacy of the treatments was evaluated by volumetric calculations based on circumferential measurements using the formula for a truncated cone, in addition to goniometric assessments for shoulder joint ROM, and questionnaires: Quick-disability of arm, shoulder and hand for arm disability; pain-detect for neuropathic pain; and quality of life for arm lymphedema (LYMQOL-arm). Results: The baseline patient and disease characteristics, and outcome measures were similar between groups. All treatment modalities were found to be effective in decreasing arm volume, and improving quality of life, upper extremity disability and neuropathic pain. The percentage of decreased arm volume or treatment success was better in kinesio-taping group than in the MLD group at the end of the treatment, and at four and 12 weeks after treatment (p = 0.009, p = 0.039, and p = 0.042, respectively). Conclusion: Kinesio-taping led to better results than MLD and was similarly effective compared with low-level laser in stage II breast cancer-related lymphedema at the twelfth week of follow-up. Kinesio-taping and low-level laser should be considered as alternative treatments in early-moderate stages of lymphedema. After these modalities, multi-layer compression and compression bandaging remain cornerstones of lymphedema treatment.

Demographic and clinical characteristics of primary glomerular diseases in Turkey.

BACKGROUND: The aim of our study was to delineate the demographic and clinical properties of primary glomerular diseases of adult population in our country in the light of global knowledge. METHODS: All over the country, a total of 25 centers entered data between May 2009 and July 2012 to the database created by 'Glomerulonephritis Study Group' of Turkish Society of Nephrology. Demographic and clinical characteristics, specific diagnoses of glomerular diseases and biopsy findings recorded to the database were analyzed. RESULTS: Among the 1,274 patients, who had renal biopsy within the defined time period, 55 % were male and 45 % were female. The mean age was 40.8 ± 14.6 years. The most frequent indication for biopsy was nephrotic syndrome (57.8 %), followed by nephritic syndrome including rapidly progressive glomerulonephritis (16.6 %) and asymptomatic urinary abnormalities (10.8 %). The most frequent primary glomerular disease was membranous nephropathy (28.8 %), followed by focal segmental glomerulosclerosis (19.3 %) and IgA nephropathy (17.2 %). CONCLUSION: The presented study displayed important data about the epidemiology of primary glomerular diseases among adults in our country. The predominance of membranous nephropathy in contrast to other countries, in which the most frequent etiology is IgA nephropathy, seems to be due to differences in the indications for renal biopsy.

Urinary tuberculosis: ten years' experience.

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18-71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.

Bone marrow amyloidosis with erythropoietin-resistant anemia in a patient undergoing chronic hemodialysis treatment.

The resistance to erythropoietin, which is used to treat normochromic, normocytic anemia in chronic renal failure, can develop in patients with conditions such as iron deficiency, aluminum toxicity, hyperparathyroidism, chronic inflammatory diseases, and primary hematological disorders. We found amyloidosis in the bone marrow of a woman without any other etiology for erythropoietin resistance who was undergoing chronic hemodialysis. Her anemia did not improve, despite 6 months of erythropoietin therapy. Bone marrow amyloidosis was found to be the reason for erythropoietin-resistant anemia in our patient with chronic renal failure and renal anemia. We present the case of bone marrow amyloidosis because it is a very rare cause of erythropoietin resistance.

Using cuffed and tunnelled central venous catheters as permanent vascular access for hemodialysis: a prospective study.

BACKGROUND: Adequate care of a hemodialysis patient requires constant attention to the need to maintain vascular access (VA) patency. VA complications are the main cause of hospitalization in hemodialysis patients. The native arteriovenous fistula (NAVF), synthetic arteriovenous grafts fistula (GAVF) and silastic cuffed central venous catheters (CVCs) are used for permanent vascular access (PVA). CVCs are primary the method of choice for temporary access. But using this access modality is increasing more and more for PVA in elderly hemodialysis patients and when other PVA is not possible. The primary aim of this study is to investigate survivals and complications of the CVCs used for long-term VA. METHODS: We prospectively looked at 92 CVCs (Medcomp Ash Split Cath, 14 FR x 28 cm (Little, M.A.; O'Riordan, A.; Lucey, B.; Farrell, M.; Lee, M.; Conlon, P.J.; Walshe, J.J. A prospective study of complications associated with cuffed, tunnelled hemodialysis catheters. Nephrol. Dial. Transplant. 2001, 16 (11), 2194-2200) with Dacron cuff) inserted in 85 (50 females, 35 males) chronic hemodialysis patients (the mean age: 56.6 +/- 14.1 years) from July 1999 to January 2002. The overall survival and complications were followed up. Furthermore, the patients were evaluated for demographic and clinical characteristics. Data were analysed by chi-square, Wilcoxon rank and Kaplan-Meier survival tests. RESULTS: The median duration of CVC survival was 289 days (range: 10-720). Eleven (11.9%) CVCs were removed due to complications. In 79 (92.9%) patients, 1, in 5 (5.8%) patients, 2 and in 1 patient, 3 CVCs were inserted. Of the 85 patients, 56 have CVCs functioning. In addition, 27 (31.76%) patients have CVCs functioning for over 12 months, 17 (20%) patients have CVCs functioning for 6 months. The total incidence of CVC related infections was 0.82 episodes/1000 catheter days. Besides, thrombosis was occurred in 10 (10.8%) CVCs. The most frequent indications for CVC removal were patient death (69.4%), thrombosis (16.6%) and CVC-related infections (13.8%). CONCLUSIONS: CVCs are primarily used for temporary access. But this study indicates that CVC may be a very useful alternative permanent vascular access for hemodialysis patients when other forms of vascular access are not available.

Familial Mediterranean fever.

BACKGROUND: The pathogenesis of familial Mediterranean fever (FMF) is unknown, and since no specific laboratory test is yet available, the diagnosis of FMF remains clinical. The purpose of this study was to review clinical characteristics of patients with FMF. METHODS: A total of 96 patients with FMF were evaluated either retrospectively (for those diagnosed before 1997) or prospectively (for those after 1997). RESULTS: The records of 54 male and 42 female patients were studied. All patients were Turks. Family history was positive in 72 patients (75%). Involved site was peritoneum in 73 (76%), joints in 65 (68%), and pleura in 16 (17%). Febrile myalgia occurred in 3 patients (3%), and erysipelas-like skin lesions were observed in 2 (2%). Fever was found in 93 patients (97%). Reactive systemic (AA) amyloidosis was found in 38 patients (40%). CONCLUSIONS: Diagnostic problems persist despite increased understanding of the pathogenesis of FMF. Amyloidosis, the most important complication of FMF, is often seen.

Microscopic polyangiitis in a pregnant woman.

Patients who have vasculitis in pregnancy generally have a grim prognosis. Vasculitis occurring during pregnancy may have a more aggressive course and require more aggressive treatment than vasculitis occurring at other times. A 29-year-old woman who presented in the 16th week of her third intrauterine pregnancy was diagnosed as having active microscopic polyangiitis. Therapy consisting of high-dose methylprednisolone and cyclophosphamide was instituted, but the patient died of pulmonary infection due to methicillin-resistant Staphylococcus aureus.