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Objective: To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL)., Materials and Methods: In this prospective study, 40 patients with diffuse FIL and 50 normal healthy adults who served as control group underwent hepatic vein (HV) Doppler ultrasonography. The patients with the diagnosis of FIL were 23 men (57.5%) and 17 women aged 30-62 years (mean age +/- S.D., 42 +/- 12 years). Subjects in the control group were 27 men (54%) and 23 women aged 34-65 years (mean age +/- S.D., 45 +/- 14 years). The diagnosis of FIL was confirmed with computed tomography density measurements. The waveforms of HV were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. Etiological factors for FIL were diabetes mellitus (DM), hyperlipidemia and obesity (body mass index > 25). Serum lipid profile was obtained from all the patients with FIL., Results: Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant (P < 0.001). No differences were found in the behaviour of the hepatic vein Doppler waveform in relation to the different etiologic factors for FIL (P > 0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern (P = 0.60)., Conclusion: Patients with fatty liver has a high rate of an abnormal hepatic vein Doppler waveform pattern which can be biphasic or monophasic. We could not find a relation between the etiological factors for FIL and the occurrence of an abnormal HV Doppler waveform.

Background/aims: This study investigates the possible relationship between inflammation and cardiac valve calcification (VC) in patients on hemodialysis (HD), and identifies risk factors for VC in this patient group., Methods: Seventy-nine patients on HD (mean age, 52.2 +/- 13.6 years; mean HD duration, 46.8 +/- 34.3 months) were assessed echocardiographically for the presence of VC. Systolic and diastolic blood pressure (BP) values were determined. The blood parameters studied in each case were hemoglobin, blood urea nitrogen, creatinine, calcium, phosphate, calcium-phosphorous (Ca x P) product, albumin, alkaline phosphatase, intact parathyroid hormone, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride, lipoprotein(a), fibrinogen, and C-reactive protein (CRP). The number of patients receiving vitamin D and calcium-containing phosphate binder was determined from records, and presence of diabetes mellitus was noted., Results: Cardiac VC was detected in 36 patients (46%). Five of these patients (6%) had mitral VC, 11 (14%) had aortic VC, and 20 (25%) had calcification of both valves. The patients with VC were significantly older than those without VC (60 +/- 11 vs. 43 +/- 15 years, respectively; P=.001). Compared with the group without VC, the group with calcification had significantly higher systolic (145.1 +/- 14.7 vs. 124.3 +/- 20.7 mmHg, P=.001) and diastolic BP (91.3 +/- 10.3 vs. 75.09 +/- 14.9 mmHg, P=.001); significantly higher phosphate (5.1 +/- 1.4 vs. 4.5 +/- 1.4 mg/dL, P=0.04), CaxP product (48.6 +/- 16.2 vs. 39.8 +/- 11.8, P=.01), lipoprotein(a) [28 (15, 45) vs. 16 (5,42) mg/dL, P=.04], fibrinogen (4.2 +/- 1.2 vs. 3.5-0.9, P=.005), and CRP levels [9 (4, 19) vs. 5 (3, 11) mg/L, P=.05]; and significantly longer HD duration [49 (27, 99) vs. 26 (17, 52) month, P=.01). Apart from age, duration of HD, systolic and diastolic BP, and Ca x P product, VC was associated with CRP (odds ratio, 1.151; P=.007) and fibrinogen (odds ratio, 1.119; P=.005)., Conclusions: The results confirm well-known risk factors for cardiac VC in HD patients, such as older age, longer HD duration, elevated BP, and high Ca x P product. In addition, they suggest that elevated levels of CRP and fibrinogen were associated with VC in the HD population.

Objective: To determine the incidence of pericatheter sleeve formation, thrombus formation, and stenosis of the central veins in hemodialysis patients with temporary catheters., Methods and Material: In this prospective study, 57 patients (40 males, 17 females) with temporary dialysis catheters had catheter venography by pulling back the catheter just before removal. Patient's age range was 25-87 years (mean age, 51 years). The venographic studies were evaluated for pericatheter sleeve formation, thrombus formation, and stenosis of the brachiocephalic vein (BCV) and the superior vena cava (SVC). The IJV could only be evaluated if there was adequate filling during contrast administration. In a subgroup of patients who had had only right IJV or only right SCV catheters, impact of these catheters on the central veins was compared., Results: The catheter location was right internal jugular vein (IJV) in 26 cases, right subclavian vein (SCV) in 27 cases, left IJV in 1 case, and left SCV in 3 cases. Thirty-two patients (56%) had had only one temporary catheter and the rest had had more than one inserted. The mean dwell time for the catheters was 21 days (range 7-59 days). A pericatheter sleeve was detected on venography in 32 (56%) patients and thrombus formation was noted in 16 patients (28%). A total of 41 patients (72%) exhibited pericatheter sleeve and/or thrombus formation. While 19 of the 32 patients (59%) without previous catheterization had a sleeve around the catheter, only 13 (52%) of 25 patients who had had multiple catheters inserted had a sleeve (P > 0.005). Of the eight patients (14%) with BCV stenosis, two had >50% stenosis. Only one patient (2%) had mild stenosis of the SVC. Three patients out of 15 (20%) who had diagnostic venography for the IJV had severe stenosis of the vein. Pericatheter sleeve formation was more frequent in women (P < 0.005). However, there were no statistical differences with respect to pericatheter sleeve formation, luminal filling defect and BCV stenosis when patients were grouped according to age, dwell time of the catheter, number of catheters inserted, and diameter of the SVC. Forty-two of the fifty-seven patients had had only right IJV (n =16) or right SCV (n = 26) catheters. There were no differences between these groups with respect to rates of pericatheter sleeve formation, thrombus formation, or BCV stenosis., Conclusion: This study showed that even short-term catheters result in significantly high rates of pericatheter sleeve and thrombus formation which are two of the important causes of catheter malfunction. The IJV route is known to be much safer than the SCV route with respect to stenosis formation in the vein in which the catheter is inserted; however, the result showed no differences between the two routes with respect to frequencies of pericatheter sleeve formation, thrombus formation, and BCV stenosis. These findings remind us again that we should avoid unnecessary catheter insertion even for short-term in these chronically ill patients.

The aims of this study were to determine the incidence rates of genital calcification in male hemodialysis patients based on ultrasonography findings and to identify risk factors for this condition. Twenty-three male end-stage renal disease (ESRD) patients (mean age, 51.4 +/- 12.1 years) who were on maintenance hemodialysis underwent penile and scrotal ultrasonography. For each case, we recorded the underlying renal disease and measured serum levels of phosphorus, intact parathormone, and calcium x phosphorus product. Patients were also questioned about erectile dysfunction. The control group consisted of 22 consecutive patients (mean age, 51 years) with type 2 diabetes mellitus with normal renal function who underwent penile and scrotal ultrasonography for various reasons. In the ESRD group, ultrasound revealed calcification of the tunica albuginea of the corpora cavernosa in 15 patients (65%) and calcification of the epididymis in 16 patients (70%; 14 bilateral and 2 unilateral cases). Twenty patients (87%) showed calcification of the epididymis and/or the tunica, and 10 (43%) showed calcification of both these tissues. The rates of epididymal and penile calcification in the ESRD patients and the controls were significantly different (P <.001 for both). There were no significant differences between patients with and without penile and epididymal calcification with respect to age, hemodialysis duration, frequencies of elevated serum phosphorus, elevated serum intact parathormone, elevated calcium x phosphorus product, and frequency of erectile dysfunction (ED) (P >.05 for all). Ultrasonography revealed high rates of penile (tunica albuginea of the corpora cavernosa) and epididymal calcification (65% and 70%, respectively) in the ESRD patients studied, but no association was found between risk factors such as age, underlying renal disease, hemodialysis duration, frequencies of elevated serum phosphorus, elevated serum intact parathormone, and elevated calcium x phosphorus product.

In recent years a characteristic subcapsular and periligamentous fatty infiltration of the liver has been reported in diabetic patients on intraperitoneal insulin treatment by continuous ambulatory peritoneal dialysis. The finding is unique to these patients on continuous ambulatory peritoneal dialysis and has not been defined in diabetics using subcutaneous insulin. We present characteristic US and CT findings in two such patients with focal subcapsular fatty infiltration of the liver.

Objective: To describe a case of cefoperazone-induced acute interstitial nephritis (AIN) in which the diagnosis was supported by renal biopsy., Case Summary: A 35-year-old woman presented to our hospital with decreased urine output and no past history of renal problems. Fifteen days prior to presentation, she had started treatment with intramuscular cefoperazone 1 g/day for a scalp infection. On day 12 of therapy, the patient noted decreased urine output, anorexia, and weakness, but she continued taking cefoperazone for 3 more days. Hemodialysis and oral prednisolone 1 mg/kg (30 mg twice daily) were started. Renal function returned to normal after 2 months of prednisolone treatment., Discussion: Although AIN has been linked with other cephalosporins, as of June 18, 2004, to our knowledge, this is the first report of a cefoperazone-induced case. We based our diagnosis on the features of acute-onset renal failure, abnormal urinalysis findings, eosinophilia, inflammatory infiltrate in the interstitium, and recovery from renal failure after initiation of corticosteroid treatment. Application of the Naranjo probability scale indicated a probable relationship between the acute renal failure secondary to the possible AIN and cefoperazone therapy in this patient., Conclusions: This case indicates that cefoperazone, like other cephalosporins, can cause AIN. We recommend close monitoring of renal function in patients who are prescribed this drug.