Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice.

OBJECTIVES: To evaluate the safety and efficacy of low-dose desmopressin in elderly men with and without nocturnal polyuria (NP) in real-life practice. METHODS: Patients with lower urinary tract symptoms (LUTS)/ benign prostate hyperplasia (BPH) who were≧ 65 years old with refractory nocturia were enrolled in this study. We retrospectively analysed elderly men treated with adding desmopressin to current medications for nocturia according to category of the baseline nocturnal urine volume. The 48-h frequency volume chart (FVC), International Prostate Symptom Score (IPSS) and quality of life (QoL) were initially assessed and re-evaluated 12 weeks later. Serum sodium level was checked 1 week, 4 weeks, and 12 weeks after initiation of desmopressin therapy or suspected hyponatremia event. The mean change in numbers of nocturnal voids was evaluated for efficacy of treatment. RESULTS: A total of 136 patients were included with 55 in non-NP group and 81 in NP group. Hypertension was more common in NP group in regard of comorbidities. During treatment period, there were significant reductions of nocturnal voids from 4.22 ± 1.38 to 2.31 ± 0.98 (p < 0.001) in non-NP group and from 4.52 ± 1.23 to 2.07 ± 0.89 (p < 0.001) in NP group. The reduction in nocturnal voids was more significant in NP group (2.44 ± 1.15 vs. 1.91 ± 1.48, p = 0.003). The mean decrease in serum sodium levels were 3.89 ± 1.22 mmol/l (p < 0.001) in non-NP group and 4.69 ± 3.5 mmol/l (p < 0.001) in NP group at the extreme value. CONCLUSIONS: Long-term treatment with low-dose desmopressin is safe and effective for nocturia with or without NP in elderly patients with LUTS/BPH during real-life practice. Patients should be well informed about the disease and are closely followed.

Diagnostic performance of serum cystatin C and serum creatinine in the prediction of chronic kidney disease in renal transplant recipients.

BACKGROUND: Chronic kidney disease (CKD) has adverse impacts on mortality and morbidity of renal transplant recipients. Serum cystatin C (sCysC) is a novel marker in predicting the CKD. We therefore compare sCysC and serum creatinine (sCr) with the aim of improving the detection of CKD in renal transplant recipients. METHODS: We enrolled 106 renal transplant recipients and estimated glomerular filtration rates (GFR) using the Cockcroft-Gault (GFR(CG)) and the abbreviated Modification of Diet in Renal Disease (GFR(aMDRD)) formulae. We defined CKD as the presence of structural or functional kidney damage, irrespective of the diagnosis. Comparisons of sCysC and sCr in detecting CKD were analyzed. RESULTS: sCysC correlates with sCr significantly (r = 0.87; P < .001). The receiver operating characteristic curve demonstrates that sCysC has a better specificity and area under the curve, but less sensitivity than sCr in predicting CKD in renal transplant recipients if GFR is estimated by GFR(CG). Additionally, if GFR was estimated by GFR(aMDRD), the role of sCysC or sCr in prediction of CKD was comparable. CONCLUSION: sCysC may be better than sCr to detect CKD in renal transplant recipients using the GFR(CG).

Sonographic assessment of the vaginal vault following hysterectomy.

OBJECTIVE: A prospective study to determine the sonographic appearance of the vaginal vault following hysterectomy. METHODS: A transvaginal sonographic examination of the vaginal vault on the third postoperative day. Follow-up to determine the incidence of postoperative morbidity. RESULTS: An accurate sonographic examination of the vaginal vault was possible in 66/71 cases (92.9%). Fluid collections were visible in 28/66 cases (42.4%), and measured up to 41.1 cm2 in the transverse plane and 30.2 cm2 in the sagittal plane. There was no correlation between the presence of a collection and indices of postoperative morbidity. CONCLUSION: Collections of fluid at the vaginal vault are common after hysterectomy, but do not usually contribute to postoperative morbidity.

Clinical evaluation of glass ionomer-silver cermet restorations in primary molars: one year results.

Using the half mouth technique, 33 silver amalgam (Dispersalloy) and 40 glass ionomer (Ketec silver) restorations were placed in the primary molars of children aged five to seven years. After one year, 73 restorations were evaluated. The amalgam restorations rated 90-100 per cent alpha for anatomic form and margins with no recurrent caries or fractures. The glass ionomer restorations rated 35 to 55 per cent alpha for anatomic form and margins with 40 per cent being replaced due to fracture of the material. Within the guidelines of this study, glass ionomer silver cermet was not a suitable material for the restoration of interproximal cavities in primary molars.