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Introduction Since infammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifer of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. Objective and methods We investigated the efect modifcation by systemic infammation (serum CRP) on the relationship between a surrogate of the flling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantifed by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. Results At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r=0.23, P

Objective: The aim of the report was to sum up all the results from the project that was conducted in three phases during a three-years period, to present the correlation and influence of dietary habits during pregnancy and the cardiovascular development in new-borns. Materials and methods: It was designed as a cohort study, including pregnant women (n=43) selected by random selection from a total number of pregnant women examined in private clinics in Mostar, Sarajevo and Komiža (Croatia). Results: Newborns from mothers with unhealthy eating habits - foods that caused a tooth decay - had significantly higher values of the right carotid artery intimamedia thickness (p=0.046). There was a statistically significant difference in the diameter of the descending aorta, with larger diameters in children whose mothers had poor eating habits (p=0.021). New-borns from mothers with fibre-rich, lower-fat eating habits had higher pulmonary artery flow rate (p=0.039). Oral health was examined with the Decay-missing-filled index (DMF). Ejection fraction (FS%) was significantly higher in the group of new-borns whose mothers had a larger DMF index (p=0.03). Conclusion: Dietary habits and oral health during pregnancy significantly affect the diameter of blood vessels and the flow rate.

Si les études portant sur le genre et la migration ont donné lieu à de nouvelles perspectives d’analyse, rares sont les recherches qui interrogent la façon dont, en situation de mobilité, se pense la relation de maternité/paternité. Cet ouvrage contribue ainsi à enrichir cette approche en s’intéressant à la transformation des rapports sociaux de sexe induits par les migrations dans l’exercice de la parentalité. Il offre un regard inédit et innovant sur les façons différenciées d’être père ou mère et questionne la relation souvent implicite entre proximité physique et unité familiale.

Introduction Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vasculopathy of small blood vessels characterized by the deposition of calcium deposits in intimal arterioles with the consequent proliferation of intima, fibrosis and thrombosis. Aim The aim was to show the significance of recognition of calciphylaxis relies on heightened clinical awareness of the presence of atypical skin nodules or ulcers that occur in patients with hemodialysis dependence and to characterize features of calciphylaxis or components of treatment that may lead to improved outcome. Case report We present the case of 84-year-old woman with chronic kidney disease and diabetes mellitus as well as severely painful, firm, indurated plaques on the lower extremities. The plaques progressed to involve larger areas with associated local ulceration and necrosis. Laboratory testing revealed hyperparathyroidism and incisional skin biopsy confirmed calciphylaxis. Wound microbiology confirmed Staphylococcus aureus. Conclusion The diagnosis can be based on clinical grounds, supported by histological analysis if possible. The laboratory workout must cover all the possible implications of chronic kidney disease with special attention to Ca+ and P+ values and evidence of skin or systemic infection. Calciphylaxis must be known by dermatologist as early diagnosis and proper management can be decisive for better prognosis.

Background and Aims Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications. Method A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two groups: Group 1 (27 patients) received combined treatment of HD with hemoperfusion (HP) in this regimen: HD 2 times a week with HD+HP once a week two times in a row, then after two weeks, and afterwards once a month as a maintenance treatment. Group 2 (27 patients) was only undergoing maintenance HD 3 times a week. The clinical and laboratory properties of both groups were followed up for 18 months, whereas the primary outcomes included normal clinical data, high sensitive C-reactive protein (hsCRP), immunoreactive parathyroid hormone (iPTH), phosphorus (P04), calcium (Ca), albumin, iron (Fe), total iron binding capacity (TIBC), hemoglobin, Epo doses and types of hypertensive drugs. Results At the end of the 18-month observation, the serum concentration of albumin, P04, hsCRP, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower with Group 1 than with Group 2 (p Conclusion HD+HP was superior to HD in regularly eliminating middle and large molecule uremic toxins accumulated in the body which is mostly shown through reducing the values of iPTH and hsCRP. These findings suggest a potential role for HD+HP in the treatment of inflammation and renal osteodystrophy as well, because lowering these values of iPTH leads to a normalization of other minerals which is expected and therefore leads to a stabilization of this long-term uremic complications, which can improve the overall general condition of the MHD patient.

Background and Aims The occurance of mid- and longterm uremic complications is related to the low clearance rate of middle and large molecule uremic toxins when hemodialysis (HD) alone is adopted. As the uremic toxins and their corresponding biological effects become increasingly clear, blood purification treatment that aims to remove these toxins, has developed from a stage of life-sustaining to improving the quality of life. The objective of this study was to evaluated demographic, clinical and laboratory data in patients who underwent the combination of maintenance hemodialysis with hemoperfusion (HP) and in those who recieved HD alone and to investigate whether this combination could improve the clearance rate of middle and large molecule uremic toxins. Method A total of 26 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into three groups: Group 1 (7 patients) received combined treatment of HD with HP biweekly (HD 2 times a week with HD+HP once a week), whereas Group 2 (10 patients) was given HD with high flux dialyzer and Group 3 (9 patients) was given HD with low flux dialyzer 3 times a week. This study was followed for 4 months. Before and after the observational period demographic and clinical data were taken from the medical history and blood samples were taken for hemoglobin (Hb), iron (Fe), total iron binding capacity (TIBC), albumin (Alb), calcium (Ca), phosphorus (P04) and parathyroid hormone (PTH). Results This study included 13 female and 13 male patients with a mean age of 41, 62 + 11.12 and a mean dialysis duration of 62, 78+53, 33 months. When it comes to baseline characteristics, patients of the group 3 were significantly older than patients in other groups (p=0.001). At the end of the four months observation period, the same difference according to age was noticed (p=0.01). Also, HD+HP group had significantly higher values of TIBC (p=0.006) and significantly lower serum levels of P04 (p=0.001). EPO doses were very similar in group 1 and 2, but in group 3 there were noticeably lower than in those two groups but without a significant difference. The serum levels of albumin were higher in group 3 compared to the other two groups but also without statistical difference. No statistical difference between groups after the follow up period was observed in terms of Hb, Fe, PTH, Ca, BMI, duration of dialysis treatment and vascular access. When groups are viewed individually, in the HD+HP group serum P04 levels were significantly lower after the 4 months off the follow up period than it was at the beginning (p=0.031) and also TIBC was significantly higher (p=0.018). In group 2 the values of TIBC were significantly lower after the follow up period than it was at the beginning (p=0.025). No significant difference was noticed in group 3 but serum PTH levels tends to decrease after 4 months compared to baseline measurement. Conclusion This combination treatment of HD with HP was superior to HD in reducing levels of phosphorus. These findings suggests a potential role of reducing the risk of cardiovascular events in this population especially when it is known that hyperphosphatemia has been pointed out as the primary culprit in the process of cardiovascular calcification. Also, patients who underwent the combined treatment showed higher values of TIBC but unfortunately no difference was noticed between Hb levels and EPO doses. These results eventually demonstrates their role in the improvement of renal disease anemia, which opens up the possibility of further research on a larger sample and over a longer period of time.

A 40-year old female presented with a 3-month history of multiple, blue-grayish, thickly clustered, 1–3 mm in diameter macules increasing progressively in number and involving almost the whole left pectoral region. She revealed color change of a preexisting nevus on left areola, from light brown into black over the past two years (Fig. 15.1).

A 74-year-old female patient presented to our clinic for dark brown irregular pigmented plaque in the area of the right eyelid margin. She gave history of a light brown macula in the same location since her young age. Over time, the lesion increased slightly and during the last year she reported progressive growth and color variegation.

A 66-year-old man presented with a non-healing, eroded plaque involving the bottom of a toe on the left foot, which started 6 years ago.

Serbokroatisk har i modsætning til dansk nulsubjekter ved topicsammenhæng, dvs. når subjektet i en sætning er koreferentielt med subjektet i en forudgående sætning. Et pronominelt subjekt tolkes derfor i reglen som signal om topicskift og som koreferentielt med et andet led end subjektet i en tidligere sætning. Ved hjælp af en self-paced reading test blev 10 serbokroatiske indvandrere som var kommet til Danmark efter at de var fyldt 15 år, og som havde boet mindst 23 år i Danmark, sammenlignet med 10 danskere med dansk som førstesprog. Forsøgsdeltagerne læste en helsætning med en final adverbiel ledsætning med et pronominelt subjekt som ud fra ledsætningens slutning skulle tolkes som koreferentielt med enten subjektet eller det oblikke led i oversætningen. Resultaterne viste det forventede mønster: Deltagerne med serbokroatisk baggrund læste det relevante område af sætningen signifikant langsommere når pronomenet skulle tolkes som koreferentielt med oversætningens subjekt, end når det skulle tolkes som koreferentielt med det oblikke led i oversætningen. Kontrolgruppen viste en tendens til det omvendte mønster. I konklusionen peges der på betydningen af bevidsthed om de typologiske forskelle mellem dansk og de sprog som tales af voksne flygtninge og indvandrere som skal lære dansk.