Brown tumor of the thoracic spine presenting with paraplegia in a patient with peritoneal dialysis

Secondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4 years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait and walking, and imaging studies showed an expansile mass lesion in the thoracic spine. She was operated for mass and diagnosed with brown tumor. After operation, she lost the ability of walking than become paraplegic and she underwent rehabilitation program. Preventive measures including calcitriol and cinacalcet may cause a modest decrease in parathyroid hormone levels but it should be remembered for the development of bone complications such as brown tumor formation in patients with moderate elevated PTH levels, especially those with tertiary hyperparathyroidism. Parathyroidectomy should be performed without delay in these cases

Hypoxia-inducible factors in arteriovenous fistula maturation: A prospective cohort study

Background Neointimal hyperplasia is the main cause of arteriovenous fistula (AVF) failure. Hypoxia-inducible factors (HIFs) factors are associated with neointimal hyperplasia. Thus, we investigated the association between HIF-2 alpha (HIF-2 alpha) and AVF maturation in end-stage kidney disease (ESKD) patients. Methods This prospective cohort study was conducted in 21 voluntary healthy subjects and 50 patients with ESKD who were eligible for AVF creation. Inclusion criteria were being ESKD patients without a history of AVF surgery and dialysis. Eight patients excluded from the study due to having unavailable veins six patients were excluded due to acute thrombosis after surgery. One patient lost to follow-up. A total of 35 patients were included in final analysis. The blood samples were collected a day before the AVF surgery for biochemical parameters and HIF-2 alpha measurement. HIF-2 alpha levels were measured by the ELISA method. Results Compared with healthy subjects, ESKD patients had a significantly higher level of HIF-2 alpha. [1.3 (1.0-1.9) vs 2.2 (1.6-3.0)] (P = .002). Patients were divided into two groups after the evaluation of AVF maturation, as the mature group (n = 19) and the failure group (n = 16). Serum HIF-2 alpha level was 1.7 (1.1-1.8) in the mature group; however, it was 3.1 (2.8-3.3 in failure group (P .001). Multiple logistic regression analyses showed that HIF-2 alpha independently predicted AVF maturation. The ROC curve analysis showed that HIF-2 alpha > 2.65 predicted AVF maturation failure with the 87% sensitivity and 94% specificity [AUC:0.947, 95% CI (0.815-0.994),P .001]. Conclusions HIF-2-alpha levels were higher in ESKD patients than healthy subjects. HIF-2-alpha could be a marker of AVF maturation failure

Changes in pre-dialysis blood pressure variability in the first year of dialysis associate with mortality in European hemodialysis patients: a retrospective cohort study on behalf of the MONDO Initiative

International audiencePre-hemodialysis systolic blood pressure variability (pre-HD SBPV) has been associated with outcomes. The association of a change in pre-HD SBPV over time with outcomes, and predictors of this change, has not yet been studied. Therefore, we studied this in a cohort of 8825 incident hemodialysis (HD) patients from the European Monitoring Dialysis Outcomes Initiative database. Patient level pre-HD SBPV was calculated as the standard deviation of the residuals of a linear regression model of systolic blood pressure (SBP) over time divided by individual mean SBP in the respective time periods. The pre-HD SBPV difference between months 1-6 and 7-12 was used as an indicator of pre-HD SBPV change. The association between pre-HD SBPV change and all-cause mortality in year 2 was analyzed by multivariate Cox models. Predictors of pre-HD SBPV change was determined by logistic regression models. We found the highest pre-HD SBPV tertile, in the first 6 months after initiation of HD, had the highest mortality rates (adjusted HR 1.44 (95% confidence intervals (95% CI): 1.15-1.79)). An increase in pre-HD SBPV between months 1-6 and 7-12 was associated with an increased risk of mortality in year 2 (adjusted HR 1.29 (95% CI: 1.05-1.58)) compared with stable pre-HD SPBV. A pre-HD SBPV increase was associated with female gender, higher mean pre-HD SBP and pulse pressure, and lower HD frequency

Medical imaging and facial soft tissue thickness studies for forensic craniofacial approximation: a pilot study on modern Cretans

Forensic cases may require craniofacial approximations for unidentifiable victims. The accuracy of these approximations is improved by using population-specific average soft tissue depths. This study used CT scans from 64 Cretan adults (32 male and 32 female) to produce three-dimensional models of each individual’s cranium and skin surface. Using the models, the soft tissue depths were measured at 36 craniofacial landmarks; the means and standard deviations were calculated for the general Cretan population, and for male and female Cretans separately. Cretan facial soft tissue depths were then compared to those of French, Slovak, and Korean adults. 16 of the 36 landmarks exhibited sex differences among Cretans, with males having consistently thicker depths than females. The facial soft tissue depths of Cretan adults also presented significant differences when compared to other populations. Overall, the average soft tissue depths obtained represent the first database for the craniofacial approximation of Cretan (Greek) adults