Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Purpose — to evaluate mid-term outcomes of primary hip replacement in patients with end-stage chronic renal disease and to develop an algorithm for selection of surgical tactics and perioperative treatment.Materials and Methods. The authors evaluated outcomes of primary hip replacement in 45 patients receiving renal substitution therapy and 47 patients without chronic renal disease. Patients with end-stage chronic renal disease (CRD) were divided into two groups: group I included 30 (66.6%) patients receiving chronic hemodialysis (CH) and group II included 15 (33.4%) patients after renal transplantation (RT). Group III of 47 (51.1%) patients without any signs of CRD who underwent hip arthroplasty within relevant period of time was established to evaluate the effectiveness of primary hip replacement. Blood serum Ca2+ and P5+ levels as well as levels of parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D were measured to determine the rate of calcium- phosphoric metabolism disturbance. Multi-spiral CT scans of hip joint were performed to identify bone mineral density and the mean Hounsfield (Hu) value was calculated for which the data was obtained from five various points on the proximal femur and acetabulum. Beta-2 microglobulin (B2M) blood test was performed to confirm amyloid bone disease.Results. The authors did not observe statistically significant differences for arthroplasty outcomes in patients of group II and III. Patients receiving long-term hemodialysis demonstrated significantly lower parameters of Harris score and Barthel’s index of social adaptation after hip replacement as compared to groups II and III: patients of group I demonstrated outcomes improvement at 19.55%, in group II — at 13.03%, in group III — at 10.15% as compared to preoperative status. Decrease of 1.25-dihydroxyvitamin D below 20,0 mcg results in resorption of cancellous bone in proximal femur and acetabulum along with myopathy of gluteus muscles. Sharp increase of parathyroid hormone level (over 600 pcg/ml) was accompanied by inhibition of osteoblasts proliferation and differentiation resulting in substantial impairment of mineralization.Conclusion. According to the algorithm suggested by the authors the key parameters that need to be evaluated in preoperative period are parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D. Five-fold increase of PTH (>600 pcg/ml) demands parathyroidectomy as the first stage of treatment to decrease risk of early aseptic loosening of hip prosthesis and development of periprosthetic fracture.

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Comment to the Article „Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease“

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2019-25-2-55-58 ◽

2019 ◽

Vol 25 (2) ◽

pp. 55-58

Author(s):

V. Yu. Murylev ◽

G. L. Sorokina

Keyword(s):

Renal Disease ◽

Hip Replacement ◽

Chronic Renal Disease ◽

End Stage ◽

Primary Hip Replacement

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Wound Healing: An Endpoint for Complex Peripheral Angioplasty

Journal of Endovascular Therapy ◽

10.1177/152660289500100112 ◽

1994 ◽

Vol 1 (1) ◽

pp. 88-91 ◽

Cited By ~ 1

Author(s):

John R. Crew ◽

Marilyn Thuener

Keyword(s):

Wound Healing ◽

High Risk ◽

San Francisco ◽

Wound Management ◽

Group Iii ◽

High Risk Patients ◽

Group I ◽

Risk Patients ◽

Group Ii ◽

End Stage

Purpose: The standard endpoint for lower limb revascularization is long-term patency; however, in high-risk patients with end-stage ischemia, healing of chronic ulcerations has been proposed as an acceptable endpoint. To evaluate if today's minimally invasive interventions, in combination with comprehensive wound healing procedures, can resolve nonhealing wounds, we performed a retrospective review of chronic ulceration patients treated at the San Francisco Wound Care Center. Methods: Eight-five patients with 96 limbs at risk due to nonhealing ulcers were treated with a variety of endovacular procedures: 7 patients (group 1) received PalmazR stents for unilateral iliac occlusions; 42 limbs (group II) in 39 patients were treated with balloon angioplasty for superficial femoral and popliteal lesions; and 47 extremities in 39 patients (group III) underwent rotational atherectomy for tibioperoneal lesions. Comprehensive wound management techniques, including the application of growth factors, were used. Results: All group I wounds healed, although 6 of 7 patients required additional procedures to address outflow lesions. In groups II and III, primary patencies were similar (64% and 70%, respectively), and nine treated sites reoccluded in each group. Restenotic lesions were retreated in both groups (three in group II and four in group III); secondary patencies were 71% and 78%, respectively. There were more amputations in group III patients (five) compared to group II (one). In both groups after 5 months, 90% of wounds had healed in group II and 72% in group III. Conclusion: The use of endovascular procedures appears to play an important role in the healing of chronic lower extremity ulcerations in high-risk patients with end-stage ischemia.

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A Comparative Study between Radiocephalic and Brachiocephalic Arteriovenous Fistula in End Stage Renal Disease

Cardiovascular Journal ◽

10.3329/cardio.v14i1.55373 ◽

2021 ◽

Vol 14 (1) ◽

pp. 44-49

Author(s):

Md Nazmus Sabah ◽

SM Parvez Ahmed ◽

Md Saif Ullah Khan ◽

Rakibul Hasan ◽

Md Fidah Hossain ◽

...

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Color Doppler ◽

Maturation Time ◽

Doppler Study ◽

Group I ◽

Group Ii ◽

The Difference ◽

Stage Renal Disease ◽

End Stage

Background: Chronic Kidney Disease (CKD) is a major health issue all over the world. Patients with deteriorating renal function and end-stage renal disease require vascular access for hemodialysis. Studies suggest that Arterio-Venous fistula (AVF) constructed judiciously using autologous conduit give the best outcome in this regard. Objective of the study was to compare the outcomes of Radiocephalic and Brachiocephalic AVF in end stage renal disease (ESRD). Methods: It was a quasi-experimental study carried out at the Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The study was conducted from June 2019 to May 2020. Patients suffering from ESRD underwent AVF creation surgery for hemodialysis access. A total of 60 (Sixty) patients were included in this study. The patients were divided into two groups; Group I included 30 patients who underwent Radiocephalic AVF operation and Group II included 30 patients who had Brachiocephalic AVF operation. Results: In Group I, (Radiocephalic AVF) 60% were male and 40% were female. On the other hand, in Group II (Brachiocephalic AVF) 73.3% were male and 26.7% were female. Calculated volume flow (Q max) was significantly higher in Group II compared with Group I (769.11±101.54 ml/min vs 626.37±55.81) ml/min) with the difference being statistically significant (P=0.001). Maturation time was significantly less in Group II compared with Group I )37.78±1.93 vs 43.33±2.12 days) with the difference between the two group being statistically significant (P=0.001). Complication was more in Group I than Group II (16.7% vs 3.3%). Conclusion: The present study shows that Brachiocephalic AVF gives significantly better outcome in terms of shorter maturation time and less complications compared with Radio-Cephalic AVF. Color Doppler study is an essential tool for preoperative vessel evaluation which guides the selection of suitable AVF construction site. Cardiovasc j 2021; 14(1): 44-49

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The influence of acute and chronic hypercalcemia on the parathyroid hormone response to hypocalcemia in rabbits

Acta Endocrinologica ◽

10.1530/eje.0.1460411 ◽

2002 ◽

pp. 411-418 ◽

Cited By ~ 6

Author(s):

S Bas ◽

E Aguilera-Tejero ◽

JC Estepa ◽

B Garfia ◽

I Lopez ◽

...

Keyword(s):

Parathyroid Hormone ◽

Elevated Level ◽

Renal Mass ◽

Hormone Response ◽

Group Iii ◽

Surgical Reduction ◽

Group I ◽

Group Ii ◽

Acute Hypercalcemia ◽

Stimulation Of

OBJECTIVE: To investigate the influence of acute and chronic hypercalcemia on the parathyroid hormone (PTH) response to hypocalcemia. DESIGN: The PTH response to hypocalcemia has been evaluated in three groups of rabbits: Group I, normal rabbits, Group II, normal rabbits subjected to an acute hypercalcemic clamp (induced by CaCl(2) infusion) and Group III, rabbits with chronic hypercalcemia (due to surgical reduction of renal mass). RESULTS: In Group I (baseline Ca(2+)=1.69+/-0.02 mM), hypocalcemia resulted in stimulation of PTH secretion which reached a maximum (PTHmax) of 91.7+/-6.4 pg/ml. In rabbits from Group II, which also had normal baseline Ca(2+) (1.70+/-0.02 mM), plasma Ca(2+) was maintained at an elevated level for 2 h, at around 2.05 mM. The PTH response to hypocalcemia in Group II was attenuated and the PTHmax in these rabbits was 45.6+/-7.4 pg/ml. In rabbits from Group III, baseline Ca(2+) was elevated (2.06+/-0.06 mM) for 1 month. The PTH response to hypocalcemia in Group III was esentially the same as in Group I and PTHmax reached levels of 94.8+/-9.9 pg/ml. CONCLUSIONS: A difference in PTH response to hypocalcemia has been found in rabbits after exposure to either acute or chronic hypercalcemia. After acute hypercalcemia, an attenuated PTH response to hypocalcemia has been identified. Chronic hypercalcemia, however, did not influence the PTH response to hypocalcemia.

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Effect of parathyroid hormone on renal excretion of sodium and hydrogen ions

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y77-086 ◽

1977 ◽

Vol 55 (3) ◽

pp. 628-638 ◽

Cited By ~ 3

Author(s):

Hubert Hermkens ◽

Tewfik Nawar ◽

Claude Caron ◽

Gerard E. Plante

Keyword(s):

Parathyroid Hormone ◽

Renal Plasma Flow ◽

Extracellular Volume ◽

Phosphate Transport ◽

Left Renal Artery ◽

Group Iii ◽

Titratable Acid ◽

Group I ◽

Group Ii ◽

The Right

The contribution of parathyroid hormone (PTH) to the renal adjustment of phosphate transport has been extensively investigated, whereas the action of this hormone on bicarbonate and hydrogen excretion has not received as much attention.Nineteen dogs were studied before and during a 2-h infusion of PTH in the left renal artery (8 mU/min per kilogram) under slight expansion of extracellular volume (fractional sodium excretion = U/FNa = 3.8 ± 0.3%). Group I (n = 7) was studied under normal acid–base condition while group II (n = 6) was studied during metabolic acidosis. Bicarbonate titration curves were obtained from group III (n = 6) in which the right kidney was used as control. In all studies, plasma pCO2 was kept constant.[Formula: see text] rose from 4.2 ± 1.1 to 15.6 ± 3.0% and from 3.8 ± 0.4 to 25.0 ± 3.5% in groups I and II, respectively. U/FNa was unchanged in both groups. [Formula: see text] rose from 5.8 ± 0.6 to 10.1 ± 0.7% in group I but remained at 1.0 ± 0.2% in group II during PTH. Urinary titratable acid and ammonium were not influenced by PTH in group II. In group III, plasma HCO3 was progressively increased from 15 to 40 mM/litre. For all plasma values exceeding 22 mM/litre, HCO3 reabsorption was 1 mM/litre of filtrate lower in the left than in the right kidney. Glomerular filtration and renal plasma flow remained constant during PTH.The results indicate that PTH affects sodium and hydrogen excretion in a very modest fashion. Bicarbonaturia obtains whenever plasma HCO3 exceeds 22 mM/litre during PTH. This phenomenon is associated with a demonstrable reduction in tubular HCO3 reabsorption per unit of filtrate.

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A case of extrapulmonary tuberculosis in a patient with end-stage renal disease with elevated parathyroid hormone–related protein

SAGE Open Medical Case Reports ◽

10.1177/2050313x20926421 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2092642

Author(s):

Shreya Podder ◽

Katarina Fleckenstein ◽

Zehra Gaudiano

Keyword(s):

Parathyroid Hormone ◽

Renal Disease ◽

End Stage Renal Disease ◽

Extrapulmonary Tuberculosis ◽

Signs And Symptoms ◽

Related Protein ◽

Dihydroxyvitamin D ◽

Parathyroid Hormone Related Protein ◽

Stage Renal Disease ◽

End Stage

The diagnosis of extrapulmonary tuberculosis in patients with end-stage renal disease can be challenging as the signs and symptoms are often non-specific. In this study, we present a case of extrapulmonary tuberculosis in an Ethiopian woman with end-stage renal disease who had subcarinal and right hilar lymphadenopathy, moderate sized right pleural effusion, hypercalcemia, and elevated parathyroid hormone–related protein in the setting of an elevated 1,25-dihydroxyvitamin D. After being started on appropriate tuberculosis treatment, patient’s parathyroid hormone–related protein level decreased and calcium level normalized. Our literature review showed that the elevation of parathyroid hormone–related protein in extrapulmonary tuberculosis has not been well studied, and it is our aim to explore the role of parathyroid hormone–related protein in extrapulmonary tuberculosis.

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Cytokine Signature in End-Stage Renal Disease Patients on Hemodialysis

Disease Markers ◽

10.1155/2017/9678391 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Danyelle Romana Alves Rios ◽

Melina Barros Pinheiro ◽

Wander Valadares de Oliveira Junior ◽

Karina Braga Gomes ◽

Andréa Teixeira Carvalho ◽

...

Keyword(s):

Renal Disease ◽

Vascular Access ◽

The Body ◽

T Helper ◽

T Helper 1 ◽

Group I ◽

Group Ii ◽

Inflammatory Profile ◽

Stage Renal Disease ◽

End Stage

Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I) and 46 patients had previously presented this complication (group II). Plasma levels of cytokines including interleukin (IL-) 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γwere measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II) had higher levels of the IL-2, IL-4, IL-5, and IFN-γwhen compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication.

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Ultrastructural Lesions Produced by Alcohol and Sucrose in the Heart and Liver of C57BL Mice

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100068035 ◽

1970 ◽

Vol 28 ◽

pp. 208-209

Author(s):

K.K. SEKHRI ◽

C.S. ALEXANDER ◽

H.T. NAGASAWA

Keyword(s):

Osmium Tetroxide ◽

Male Mice ◽

Alcohol Group ◽

Group Iii ◽

Group I ◽

C57bl Mice ◽

Group Ii

C57BL male mice (Jackson Lab., Bar Harbor, Maine) weighing about 18 gms were randomly divided into three groups: group I was fed sweetened liquid alcohol diet (modified Schenkl) in which 36% of the calories were derived from alcohol; group II was maintained on a similar diet but alcohol was isocalorically substituted by sucrose; group III was fed regular mouse chow ad lib for five months. Liver and heart tissues were fixed in 2.5% cacodylate buffered glutaraldehyde, post-fixed in 2% osmium tetroxide and embedded in Epon-araldite.

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Heterogeneity and Immunochemical Properties of Anti-β2-glycoprotein I Autoantibodies

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615218 ◽

1998 ◽

Vol 80 (09) ◽

pp. 393-398 ◽

Cited By ~ 33

Author(s):

V. Regnault ◽

E. Hachulla ◽

L. Darnige ◽

B. Roussel ◽

J. C. Bensa ◽

...

Keyword(s):

Fluid Phase ◽

Anticardiolipin Antibodies ◽

Dual Reactivity ◽

Group Iii ◽

Important Group ◽

Epitope Specificity ◽

Glycoprotein I ◽

Group I ◽

Group Ii ◽

Sufficient Concentration

SummaryMost anticardiolipin antibodies (ACA) associated with antiphospholipid syndrome (APS) are directed against epitopes expressed on β2-glycoprotein I (β2GPI). Despite a good correlation between standard ACA assays and those using purified human β2GPI as the sole antigen, some sera from APS patients only react in the latter. This is indicative of heterogeneity in anti-β2GPI antibodies. To characterize their reactivity profiles, human and bovine β2GPI were immobilized on γ-irradiated plates (β2GPI-ELISA), plain polystyrene precoated with increasing cardiolipin concentrations (CL/β2GPI-ELISA), and affinity columns. Fluid-phase inhibition experiments were also carried out with both proteins. Of 56 selected sera, restricted recognition of bovine or human β2GPI occurred respectively in 10/29 IgA-positive and 9/22 IgM-positive samples, and most of the latter (8/9) were missed by the standard ACA assay, as expected from a previous study. Based on species specificity and ACA results, IgG-positive samples (53/56) were categorized into three groups: antibodies reactive to bovine β2GPI only (group I) or to bovine and human β2GPI, group II being ACA-negative, and group III being ACA-positive. The most important group, group III (n = 33) was characterized by (i) binding when β2GPI was immobilized on γ-irradiated polystyrene or cardiolipin at sufficient concentration (regardless of β2GPI density, as assessed using 125I-β2GPI); (ii) and low avidity binding to fluid-phase β2GPI (Kd in the range 10–5 M). In contrast, all six group II samples showed (i) ability to bind human and bovine β2GPI immobilized on non-irradiated plates; (ii) concentration-dependent blockade of binding by cardiolipin, suggesting epitope location in the vicinity of the phospholipid binding site on native β2GPI; (iii) and relative avidities approximately 100-fold higher than in group III. Group I patients were heterogeneous with respect to CL/β2GPI-ELISA and ACA results (6/14 scored negative), possibly reflecting antibody differences in terms of avidity and epitope specificity. Affinity fractionation of 23 sera showed the existence, in individual patients, of various combinations of antibody subsets solely reactive to human or bovine β2GPI, together with cross-species reactive subsets present in all samples with dual reactivity namely groups III and II, although the latter antibodies were poorly purified on either column. Therefore, the mode of presentation of β2GPI greatly influences its recognition by anti-β2GPI antibodies with marked inter-individual heterogeneity, in relation to ACA quantitation and, possibly, disease presentation and pathogenesis.

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Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

The Heart Surgery Forum ◽

10.1532/hsf.1325 ◽

2015 ◽

Vol 18 (3) ◽

pp. 098

Author(s):

Cem Arıtürk ◽

Serpil Ustalar Özgen ◽

Behiç Danışan ◽

Hasan Karabulut ◽

Fevzi Toraman

Keyword(s):

Body Temperature ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Extracorporeal Circulation ◽

Group Iii ◽

Oxygen Fraction ◽

Arterial Blood ◽

Group I ◽

Group Ii

Background: The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery.Methods: After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO2 adjustment strategies applied to the patients in the groups were as follows: FiO2 levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).Results: Mean PaO2 was significantly higher in Group I than in Group II at T2 and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4 (P = .0001 for all). Conclusion: Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.

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