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OBJECTIVE: Folic acid and vitamin B complex administration in uremic patients has been reported to lower plasma total homocysteine (tHcy) levels, but whether or not this has a beneficial effect on the inflammatory state is not clear. METHODS: We conducted a randomized open labeled study to determine the effects of folic acid (5 mg daily) and vitamin B complex administration on plasma tHcy levels as well as inflammatory (serum high-sensitivity C reactive protein, hs-CRP) and nutritional (serum albumin) markers in patients on maintenance hemodialysis. Treatment was given for 3 consecutive months to 61 patients on maintenance hemodialysis. Another 60 patients, all age-, sex-, hemodialysis duration-matched served as control group. MAIN OUTCOME MEASURES: Plasma tHcy, serum hs-CRP, albumin, creatinine (Cr), post-dialysis body weight (BW), and normalized protein catabolism rate (nPCR). RESULTS: After 3 months, levels of plasma tHcy and serum hs-CRP, Cr, and nPCR were significantly decreased while levels of serum albumin, vitamin B(12), folate, and BW were significantly increased. The dialytic dose (KT/V) and dietary intake remained unchanged. However, correlations between the magnitude of reduction of tHcy & hs-CRP, tHcy & Cr, and Cr & nPCR were statistically significant. CONCLUSIONS: Folic acid and vitamin B complex co-administration effectively lowers tHcy and hs-CRP levels and increases albumin levels in stable hemodialysis subjects, underscoring their potential benefit to attenuate the state of inflammation and possibly improve the nutritional status in patients on hemodialysis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the neurovascular structures at risk during placement of glenohumeral arthroscopy portals using an outside-in technique., Type of Study: Anatomic cadaveric study., Methods: Five fresh-frozen cadaveric specimens were used in this study. Each shoulder was mounted on a custom-designed apparatus allowing shoulder arthroscopy in a lateral decubitus position. The following portals were established using an outside-in technique and marked using an 18-gauge spinal needle: posterior, posterolateral, anterior, 5-o'clock, anterosuperolateral, and Port of Wilmington. Each specimen was carefully dissected after the procedure, and the distance from each portal site to the adjacent relevant neurovascular structures (axillary nerve, musculocutaneous nerve, lateral cord of the brachial plexus, cephalic vein, and axillary artery) was measured using a precision caliper., Results: Except for the cephalic vein, all of the neurovascular structures were more than 20 mm away from all the portals evaluated. When creating either an anterior portal or a 5-o'clock position portal, the mean distance from the portal to the cephalic vein was 18.8 mm and 9.8 mm, respectively. In one anterior portal, a direct injury to the cephalic vein occurred., Conclusions: Our study suggests that shoulder arthroscopy portals placed in an outside-in fashion are unlikely to produce neurologic injury. However, the cephalic vein is at risk during placement of an anterior or 5-o'clock position portal, although probably with minimal subsequent patient morbidity. Placing portals in an outside-in fashion guarantees the correct angle of approach, with minimal risk to adjacent neurologic structures., Clinical Relevance: This study shows the safety of standard and accessory glenohumeral arthroscopy portals.