Heterogeneity of the prognostic significance of B-type natriuretic peptide levels on admission in patients hospitalized for acute heart failure syndromes.

Background: We hypothesized that variation in baseline characteristics of patients with acute heart failure syndromes (AHFS) affects the prognostic significance of B-type natriuretic peptide (BNP) levels because of heterogeneity of this patient population. We evaluated the association of elevated BNP levels on admission with an increased risk of adverse clinical outcomes in subgroups of patients hospitalized for AHFS.

Methods: This study included patients from the acute decompensated heart failure syndromes (ATTEND) study, a multicenter prospective cohort of 4501 AHFS patients with BNP data on admission.

Clinical presentation and outcome by age categories in acute heart failure: results from an international observational cohort.

Aims: To assess, according to age groups, patients' characteristics according to region of origin, the chronic therapeutic management, prognostic utility of clinical variables, and natriuretic peptides.

Methods And Results: The GREAT registry consisted of patients identified as presenting with acute heart failure at the emergency department. Four groups of patients were defined according to age: the young patient group (<65 years); 'middle-old' (65-74 years), 'old-old' (75-84 years) and the 'oldest-old' (85-94 years).

Incidence and predictors of in-hospital non-cardiac death in patients with acute heart failure.

Background: Patients with acute heart failure (AHF) commonly have multiple co-morbidities, and some of these patients die in the hospital from causes other than aggravated heart failure. However, limited information is available on the mode of death in patients with AHF. Therefore, the present study was performed to determine the incidence and predictors of in-hospital non-cardiac death in patients with AHF, using the Acute Decompensated Heart Failure Syndromes (ATTEND) registry Methods: The ATTEND registry included 4842 consecutive patients with AHF admitted between April 2007-September 2011.

Relation of left ventricular ejection fraction and clinical features or co-morbidities to outcomes among patients hospitalized for acute heart failure syndromes.

The aim of this study was to evaluate the heterogeneity of the association of a preserved or reduced ejection fraction (EF) with the increased risk of outcomes among patients with acute heart failure syndromes. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry in Japan, 4,720 patients were evaluated to investigate the association of EF and clinical features or co-morbidities with all-cause mortality after admission. The median follow-up period after admission was 519 (388 to 781) days.

Prevalence of intracranial artery calcification in hemodialysis patients--a case-control study.

Background: Intracranial artery calcification has been reported to be an independent risk factor for ischemic stroke. Also, existence of a positive correlation has been reported between the presence of arterial calcification and that of ischemic changes in the area supplied by such arteries. While intracranial artery calcification has frequently been observed on computed tomographic (CT) images of the brain in hemodialysis patients, its prevalence has not been reported previously.

[Morphological analysis of bone dynamics and metabolic bone disease. A case report of recurrent renal hyperparathyroidism].

A 39-years-old chronic hemodialysis patient who developed recurrent hyperparathyroidism after total parathyroidectomy with immediate autotransplantation (PTX-AT) is now reported. The patient had undergone bilateral nephrectomy due to bilateral renal cell carcinoma at 4 and 5 years after the initiation of dialysis, followed by the treatment with interleukin-2 administration. Secondary hyperparathyroidism was treated by PTX-AT, followed by confirmation of reduced bone turnover.

Increased osteocyte death and mineralization inside bone after parathyroidectomy in patients with secondary hyperparathyroidism.

In order to gain insight into the mechanisms underlying the dynamic changes in bone metabolism and bone quality after parathyroidectomy (PTX) in secondary hyperparathyroid patients with high levels of parathyroid hormone (PTH), we performed bone histomorphometric analysis with tetracycline labeling in iliac bone biopsy specimens taken before and after PTX, with special attention paid to osteocytes. At 2 to 4 weeks after PTX, PTH concentrations decreased markedly with evident reductions in bone turnover markers. Histomorphometry revealed that at 2 to 4 weeks following PTX, the osteoclast surface decreased to nearly 0%, with a substantial increase in osteoid volume and a reduction in fibrosis volume.

Impact of cinacalcet hydrochloride on bone histology in patients with secondary hyperparathyroidism.

Serum parathyroid hormone (PTH) levels are effectively decreased by cinacalcet hydrochloride (HCl) in patients with secondary hyperparathyroidism. We assessed the impact of cinacalcet HCl on bone histology in these patients. Four hemodialysis patients with secondary hyperparathyroidism (intact PTH > or = 300 pg/mL) were treated with cinacalcet HCl with low-doses of vitamin D sterols as well as calcium-based phosphate binders for 52 weeks.

Bone formation by minimodeling is more active than remodeling after parathyroidectomy.

Bone formation using the process known as minimodeling forms only lamellar bone in the absence of prior bone resorption even in uremic patients. In patients undergoing parathyroidectomy for secondary hyperparathyroidism, we compared the contribution of minimodeling to remodeling during the change in bone volume. Iliac bone biopsies were used to measure parameters related to minimodeling and remodeling before, at 3 to 4 weeks and 10 to 12 weeks after parathyroidectomy.

Minimodeling reduces the rate of cortical bone loss in patients with secondary hyperparathyroidism.

Background: Secondary hyperparathyroidism often causes progressive cortical thinning because of increased bone resorption at the endocortical surface and increases cortical porosity because of increased resorption at the intracortical surface. Because bone formation by minimodeling has not yet been reported in cortical bone, we investigated the effects of cortical minimodeling on the decrease in rate of bone loss.

Methods: Thirty-five patients with secondary hyperparathyroidism were enrolled.

[Two cases of hemodialysis patients with absolute hypoparathyroidism or normal parathyroid function who were suffering from prostate carcinoma].

In recent years, the incidence of prostate carcinoma in patients with renal failure is increasing. But it is difficult to diagnose the occurrence of this neoplasm because of decrease of urinary volume in these patients. Two hemodialysis patients (age: 64, 68 years, the duration of hemodialysis: 10, 8 years) suffering from prostate carcinoma were treated with androgen deprivation therapy, which accelerates bone resorption.

[Diagnosis and classification of renal osteodystrophy].

Bone histomorphometry is essential to diagnosis of renal osteodystrophy. Sherrard et al classified renal osteodystrophy into the 5 groups according to Fb.V/TV, OV/BV and BFR/TV of cancellous bone (Osteitis fibrosa, Mixed uremic osteodystrophy, Osteomalacia, Mild lesion, Aplastic disease).

Changes of bone remodeling immediately after parathyroidectomy for secondary hyperparathyroidism.

Background: Successful parathyroidectomy for secondary hyperparathyroidism alleviates bone pain and is followed by the development of hypophosphatemia and hypocalcemia, as well as an increase in bone mineral density. An increase in osteoblast surface (Ob.S/BS) is not observed several months after surgery.

Development of low-turnover bone diseases after parathyroidectomy and autotransplantation.

Parathyroidectomy and immediate autotransplantation (PTX-AT) has been shown to decrease bone pain and increase bone mineral density. However, adynamic bone disease (ABD) has been predicted to develop if the serum intact parathyroid hormone (i-PTH) level remains lower than normal for a long period of time. Therefore, we investigated the bone histology of patients whose serum i-PTH levels did not increase over 70 pg/mL for 1 year after PTX-AT.

Early changes of bone histology and circulating markers of bone turnover after parathyroidectomy in hemodialysis patients with severe hyperparathyroidism.

Aims: There have so far been no reports on the changes in bone histology in the early period after parathyroidectomy and autografting (PTX-AG). We investigated the effects of PTX-AG on bone histology during the initial 12 weeks after undergoing these surgical procedures.

Materials And Methods: We performed bone histomorphometry 3 times (before as well as 4 and 12 weeks after PTX-AG) in 6 patients and 2 times (before and 4 weeks after PTX-AG) in 3 hemodialysis patients.

Successful surgical treatment for hepatic encephalopathy caused by a pancreatic siphon: report of a case.

We report herein the case of a 39-year-old man with cirrhosis of the liver who developed hepatic encephalopathy and progressive diabetes caused by a pancreatic siphon after undergoing a distal splenorenal shunt (DSRS) for a variceal hemorrhage. Radiologic occlusion was judged to be inappropriate because of the extensive DSRS. The DSRS was surgically closed 6 years after the operation to restore portal perfusion.

[A case of hyperammonemia in chronic renal failure successfully treated with the infusion of NaHCO3].

The present report describes a rare of a 77-year-old woman who developed encephalopathy and metabolic acidosis associated with hyperammonemia, at the introduction of hemodialysis by chronic renal failure. With the intravenous infusion of HCO3-, levels of acidosis and hyperammonemia decreased rapidly. Concomitantly the disturbance of consciousness was improved.