Skin Perfusion Pressure Is a Prognostic Factor in Hemodialysis Patients

Peripheral arterial disease (PAD) is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP) in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events) and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients

Determination of Porto-Azygos shunt anatomy in dogs by computed tomography angiography

Objective: To describe the morphology of porto-azygos shunts in a large series of dogs using computed tomography (CT) angiography. Study Design: Retrospective study. Animals: Dogs (n=36) with porto-azygos shunts. Methods: CT angiography was performed in dogs subsequently proven to have a porto-azygos shunt. The origin and insertion of the shunts were assessed on native images. The diameter of the porto-azygos shunt and the portal vein, cranial and caudal to the shunt origin, were measured. The porto-azygos shunt anatomy was studied on three-dimensional images. Results: All porto-azygos shunts originated either in the left gastric vein (33 left gastro-azygos shunts) or the right gastric vein (3 right gastro-azygos shunts). Two left gastro-azygos shunts had concurrent caval-azygos continuation and 2 right gastro-azygos shunts had a caudal splenic loop. All shunts crossed the diaphragm through the esophageal hiatus. The majority of porto-azygos shunts (32) followed a straight pathway after traversing the diaphragm, although 4 shunts followed a tortuous route. All shunts terminated in the thoracic part of the azygos vein, perpendicular to the aorta. The shunt diameter at insertion was only 3 mm on average. The insertion site was consistently the narrowest part of the shunt. Conclusion: CT angiography was well suited to provide anatomic details of porto-azygos shunts and comprehensively documented that all porto-azygos shunts had a thoracic terminus, after crossing the diaphragm through the esophageal hiatus. Different shunt types existed with minor variations

Clinical features and surgical treatment of inflammatory colorectal polyps in miniature dachshunds: 40 cases (2002-2015)

The medical records of 40 client-owned miniature dachshunds were reviewed to analyze the clinical features of miniature dachshunds with inflammatory colorectal polyps (ICRPs) and to evaluate the therapeutic effects of surgical treatment involving the mucosa-submucosal pull-through technique. All the dogs underwent a physical examination, digital rectal examination, complete blood count, serum chemistry, colonoscopy, endoscopic ultrasound, radiography, abdominal ultrasonography, surgical treatment (with the mucosa-submucosal pull-through technique), and postoperative care, including non-steroidal anti-inflammatory drugs (NSAIDs). Typical clinical signs included hematochezia (100%), tenesmus (75%), and large intestinal diarrhea (70%). Colonoscopies revealed that the lesions were located only in the rectum in 18 cases (45%), involved the descending colon in 21 cases (52.5%), and involved the transverse colon in 1 case (2.5%). Endoscopic ultrasounds showed that the lesions were located within the mucosal layer in all dogs. The mucosa-submucosal pull-through technique was feasible in all cases without intraoperative complications. Short-term complications were observed; however, they rapidly resolved. No long-term complications were noted. Most dogs were prescribed NSAIDs and mesalazine for long-term postoperative medical management. The mortality rate was 0%; the recurrence rate was 12.5%. Our study described the clinical features of ICRPs in miniature dachshunds and revealed that the lesions were located in the mucosa-submucosal layer even in cases of adenocarcinoma. Our findings suggest the mucosa-submucosal pull-through technique improves the prognosis of miniature dachshunds with ICRPs

Correlation between renal function and common risk factors for chronic kidney disease in a healthy middle-aged population: a prospective observational 2-year study.

Age, proteinuria, metabolic syndrome, and hyperuricemia are the reported risk factors for chronic kidney disease (CKD) and cardiovascular disease (CVD). However, the best predictor of changes in renal function in the early stages of renal disease in a healthy middle-aged population is still unknown. Our study evaluated the correlation between changes in renal function and common risk factors to determine such a predictor.In total, 2,853 healthy persons aged ≤50 years participated in the study. They had no proteinuria and were not on medications for hypertension, diabetes mellitus, hyperlipidemia, or hyperuricemia. Over 2 years, participants underwent annual health screening. The relationship between changes in estimated glomerular filtration rate (eGFR) and changes in risk factors for CKD was evaluated using univariate and multivariate linear regression analyses.Over 2 years, eGFR showed a significant decrease. Univariate regression analysis revealed that changes in fasting plasma glucose (FPG), total cholesterol, LDL-cholesterol, serum uric acid levels, and hemoglobin showed a significant negative correlation with changes in eGFR. Multiple regression analysis confirmed that changes in FPG, serum uric acid levels, in particular, and hemoglobin had a significant negative correlation with changes in eGFR.The changes in eGFR and other variables over 2 years were small and could be within expected biologic variation. A longer observational study is needed to elucidate whether FPG, serum uric acid and hemoglobin represent the earliest markers of eGFR decline