Obesity as a Risk Factor for Radiographic Contrast-Induced Nephropathy.

Contrast-induced nephropathy (CIN) is common. Risk factors include preexisting renal impairment, diabetes, elderly age, and dehydration. In a single-centre prospective study, we investigated which factors are implicated for CIN in patients with peripheral arterial disease due for angiography. Serum creatinine was measured before, 1, 2, and 7 days post-angiography. We also considered the chronic kidney disease stage of the patients at admission and 48 hours post-contrast. All patients received 500 mL normal saline pre- and post-angiography and a low-osmolality contrast medium. 6 of 94 patients developed CIN: 1 required dialysis and 1 died partly due to renal failure. Only 2 factors were associated with CIN: body mass index (BMI; P = .019) and kidney function (P = .001); 4 of 6 patients with CIN were obese (BMI ≥30) and only 2 were nonobese (P = .0092). Diabetes, contrast volume, and age were not significant risk factors. Our results confirm renal impairment raises the risk of CIN. To our knowledge, we report for the first time that obesity may be a risk factor for CIN. Pending confirmatory studies and given the rising prevalence of obesity, this finding could help identify at-risk patients and hence reduce the burden of CIN.

Contamination of heavy metals in poultry eggs: a study presenting relation between heavy metals in feed intake and eggs.

This study aims to quantify heavy metals (Ni, Pb, Zn, Mn, Cr, Cu and Se) in eggs obtained from poultry farms and backyard raised hens by comparing the concentration of metals in their feed intake. Overall, 90 samples of egg and 12 samples of poultry feed (6 each with food and water) were collected from 3 different poultry farms and backyards located in peri-urban areas of Lahore. A di-acid digestion method was adopted for digestion, after which digested samples were analyzed under atomic absorption spectrophotometer. Results showed that the concentration of Pb, Cr and Se in egg white (Pb = 0.6578, Cr = 0.18 and Se = 0.2161), egg yolk (Pb = 0.7011, Cr = 0.2617 and Se = 0.2656), feed (Pb = 2.585, Cr = 1.3039 and Se = 0.9411) and water (Pb = 0.5483, Cr = 0.1006 and Se = 0.3461) were above permissible limits in both poultry farms (study group 1) and backyards (study group 2). The concentration of metals such as Pb, Mn, Cr, Cu and Se in poultry farms eggs were higher than backyard hen eggs, which may be due to the intake of contaminated feed. So, the current study concluded that the higher concentration of metals in eggs has a positive correlation with the intake of feed contaminated with heavy metals.

Stomal varices: a rare cause of stomal hemorrhage. A report of three cases.

Stomal varices secondary to portal hypertension are a rare but potentially fatal cause of hemorrhage. Management, determined by the site of the bleeding, centers on preventing additional bleeds and may include providing local pressure, applying silver nitrate, injection sclerotherapy, suture ligation of the bleeding point, and/or the placement of transjugular intrahepatic portosystemic shunts and refashioning the stoma. Two patients (60- and 69-year-old women) had panproctocolectomy for inflammatory bowel disease and presented at the authors' hospital with bleeding from the ileostomy 1 and 19 years, respectively, following the creation of their stomas. A third patient (a 72-year-old man) bled from an end colostomy following an abdominoperineal resection for Duke's C rectal adenocarcinoma performed 3 years previous. All three patients had recurrent admissions for stomal bleeding and stomal varices secondary to portal hypertension and were initially treated with local measures (pressure, silver nitrate, and suture ligation). Two had undergone revision of their stomas prior to current treatment. One patient responded to local treatment but later died due to liver failure, one stopped bleeding after transjugular portosystemic shunt placement, and one died from metastatic cancer. Clinicians should maintain a high index of suspicion of stomal varices in patients with underlying liver disease who present with recurrent stomal bleeds and provide appropriate treatment to stop active bleeding and reduce portal venous pressure.

Metastatic prostate cancer masquerading clinically and radiologically as a primary caecal carcinoma.

BACKGROUND: Prostatic carcinoma is the second most common cause of cancer-related deaths in males in the West. Approximately 20% of patients present with metastatic disease. We describe the case of a patient with metastatic prostate cancer to the bowel presenting clinically and radiologically as a primary caecal cancer. CASE PRESENTATION: A 72 year-old man presented with abdominal discomfort and a clinically palpable caecal mass and a firm nodule on his thigh, the latter behaving clinically and radiologically as a lipoma. Computed tomographic (CT) scan showed a luminally protuberant caecal mass with regional nodal involvement. The patient was being treated (Zoladex) for prostatic cancer diagnosed 6 years previously and was known to have bony metastases. On admission his PSA was 245.4 nmol/ml. The patient underwent a right hemicolectomy. Histology showed a poorly differentiated adenocarcinoma which was PSA positive, confirming metastatic prostatic adenocarcinoma to the caecum. The patient underwent adjuvant chemotherapy and is free from recurrence a year later. CONCLUSION: Metastasis of prostatic carcinoma to the bowel is a very rare occurrence and presents a challenging diagnosis. The diagnosis is supported by immunohistochemistry for PSA. The treatment for metastatic prostate cancer is mainly palliative.