OBJECTIVETo summarize our experience in the management of adipsic central diabetes insipidus(ADI) accompanied with intracranial calcification.

METHODThe clinical data of one ADI patient accompanied with intracranial calcification who was treated in our hospital since December 2011 were retrospectively summarized.

RESULTSThe 24-hour urine volume was 800 ml. She didn't feel thirsty even with increased plasma sodium concentration(153 mmol/L) and blood osmotic pressure(333 mmol/L) . Combined water deprivation and vasopressin test revealed the diagnosis of central diabetes insipidus. The high intensity signal(on T1-weighted magnetic resonance imaging) in the posterior lobe of pituitary gland was found. Computed tomography showed calcifications in the bilateral basal ganglia.Serum cytomegalovirus IgG was positive. She was treated with desmopressin and asked for regular water intake regardless of the adipsia. The plasma sodium concentration was still below 150 mmol/L during the 4-month follow-up.

CONCLUSIONSRoutine adipsia evaluation and combined water deprivation and vasopressin test are critical for the diagnosis and treatment of ADI. Past insidious intracranial cytomegalovirus infection may explain the cause of ADI and calcification.

Brain Diseases ; complications ; Calcinosis ; complications ; Child ; Cytomegalovirus ; Diabetes Insipidus, Neurogenic ; complications ; diagnosis ; etiology ; Drinking ; Female ; Humans ; Sodium ; blood

OBJECTIVE: The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. MATERIALS AND METHODS: Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. RESULTS: Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p < 0.01). The grade of HR was not significantly associated with BAC (p > 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were > or = 60 years old. CONCLUSION: The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.
Adult ; Age Factors ; Aged ; Arteries/pathology ; Breast/*blood supply ; Calcinosis/*complications ; Female ; Humans ; Hypertension/*complications ; Mammography ; Middle Aged ; Retinal Diseases/*complications

BACKGROUNDThis study was to investigate the relationship among aortic artery calcification (AAC), cardiac valve calcification (CVC), and mortality in maintenance hemodialysis (MHD) patients.

METHODSAll MHD patients in Shanghai Ruijin Hospital in July 2011 were included. To follow up for 42 months, clinical data, predialysis blood tests, echocardiography, and lateral lumbar X-ray plain radiography results were collected. Plasma FGF23 level was measured using a C-terminal assay.

RESULTSTotally, 110 MHD patients were involved in this study. Of which, 64 (58.2%) patients were male, the mean age was 55.2 ± 1.4 years old, and the median dialysis duration was 29.85 (3.0-225.5) months. About 25.5% of the 110 MHD patients had CVC from echocardiography while 61.8% of the patients had visible calcification of aorta from lateral lumbar X-ray plain radiography. After 42 months follow-up, 25 (22.7%) patients died. Kaplan-Meier analysis showed that patients with AAC or CVC had a significant greater number of all-cause and cardiovascular deaths than those without. In multivariate analyses, the presence of AAC was a significant factor associated with all-cause mortality (hazard ratio [HR]: 3.149, P = 0.025) in addition to lower albumin level and lower 25-hydroxy Vitamin D (25(OH)D) level. The presence of CVC was a significant factor associated with cardiovascular mortality (HR: 3.800, P = 0.029) in addition to lower albumin level and lower 25(OH)D level.

CONCLUSIONLateral lumbar X-ray plain radiography and echocardiography are simple methods to detect AAC and CVC in dialysis patients. The presence of AAC and CVC was independently associated with mortality in MHD patients. Regular follow-up by X-ray and echocardiography could be a useful method to stratify mortality risk in MHD patients.

Aortic Diseases ; blood ; complications ; Calcinosis ; blood ; complications ; China ; Female ; Fibroblast Growth Factors ; blood ; Follow-Up Studies ; Heart Valve Diseases ; blood ; complications ; Heart Valves ; pathology ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Renal Dialysis ; mortality

OBJECTIVETo investigate the testicular blood flow in patients with testicular microlithiasis (TM) and its correlation with the seminal profile in infertile men.

METHODSWe selected 88 infertile men and examined them by testicular color Doppler and routine seminal tests.

RESULTSTesticular microlithiasis was found in 19 (19.3%) of the patients, classic testicular microlithiasis (CTM) in 7 (8.0%), and limited testicular microlithiasis (LTM) in 10 (11.3%). No significant differences were observed in the age of onset, bilateral testicular volume, resistance index (RI) of bilateral testicular arteries, semen amount and the rate of teratospermia. The bilateral testicular peak systolic velocity (PSV), sperm count and sperm motility were significantly lower in the CTM than in the LTM group (P < 0.05), but showed no statistically significant difference between the LTM and the non-calcification group.

CONCLUSIONTM may be one of the causes of poor sperm function in infertile men.

Adult ; Blood Flow Velocity ; Calcinosis ; complications ; physiopathology ; Humans ; Infertility, Male ; complications ; physiopathology ; Male ; Middle Aged ; Regional Blood Flow ; Semen ; cytology ; Sperm Count ; Sperm Motility ; Testicular Diseases ; complications ; physiopathology ; Testis ; blood supply ; pathology

Lp (a) and coronary artery calcification (CAC) have recently been reported as predictors of plaque instability, but this is surrounded by much controversy. We investigated the influence of Lp (a) and CAC compared other acute coronary syndrome (ACS) risk factors. 698 patients diagnosed with at least minimal coronary artery obstructive disease from a coronary angiography were randomly selected using SPSS. Lp (a), other lipid profiles and past histories were checked, and CAC semi quantitatively graded on stored fluoroscopic images. The prevalence of CAC was significantly higher in the ACS than the non-ACS group (38.0% vs. 29.9%, p=0.026). The serum level of Lp (a) (26.89 +/- 30.64 vs. 20.85 +/- 21.63, p < 0.01) and prevalence of positive Lp (a) (> 35 mg/dl) was higher in the ACS group (24% vs. 15.7%, p < 0.01). The risk of ACS was higher in the patients with both CAC and elevated an Lp (a) than in those with only one (OR: 2.16, p=0.009, 95% CI; 1.213 - 3.843 vs. OR: 1.79, p < 0.001, 95% CI; 1.300 - 2.456). The risk of ACS was increased 1.451 times (p=0.040, 95% CI; 1.071- 2.071) in patients with CAC and 1.648 times (p=0.014, 95% CI; 1.107- 2.455) in patients with a Lp (a) > 35 mg/dl. In the younger patients (< 60 years), the Lp (a), but not the CAC, was an independent risk factor for ACS (OR=2.248, p=0.005, 95% CI; 1.281-3.943). In the older patients (> 60 years), CAC, but not the Lp (a), was an independent risk factor (OR=1.775, p=0.021, 95% CI; 1.090 - 2.890). Both the Lp (a) and CAC were risk factors for ACS, and they had a synergistic effect on its development. In the younger Lp (a), and the older CAC, was the more potent risk factor for ACS, respectively.
Acute Disease ; Age Factors ; Aged ; Aging/*blood ; Calcinosis/blood/*complications ; Coronary Arteriosclerosis/blood/*etiology ; Coronary Vessels/*pathology ; Female ; Human ; Lipoprotein (a) /*blood ; Male ; Metabolic Diseases/complications ; Middle Aged ; Risk Factors ; Support, Non-U.S. Gov't ; Syndrome

Although the treatment of aortic coarctation in adults with the use of stents has shown favourable results and reduced complications, there have been few studies involving elderly patients. We highlight the clinical challenges faced in the management of such patients, with attention to severe calcification at the coarctation site. The midterm results were good in our patient, showing an improvement in blood pressure control and maintenance of stent patency.
Aged ; Aortic Coarctation ; therapy ; Blood Pressure ; Calcinosis ; complications ; Cardiology ; methods ; Female ; Geriatrics ; methods ; Hemodynamics ; Humans ; Magnetic Resonance Angiography ; methods ; Myocardial Infarction ; therapy ; Stents ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Troponin I ; blood

DKK1 modulates Wnt signaling, which is involved in the atherosclerosis. However, no data exist regarding the usefulness of measuring serum DKK1 concentration in predicting coronary atherosclerosis. A total of 270 consecutive patients (62.8 +/- 11.2 yr; 70% male) were included. A contrast-enhanced 64-slice coronary MDCT was performed to identify the presence of atherosclerotic plaques. Agatston calcium scores (CS) were calculated to quantify the coronary artery calcification (CAC). DKK1 concentrations were measured by enzyme-linked immunosorbent assay. For each subsequent DKK1 quartile, there was a significant increase in CAC (P = 0.004) and the number of segments with coronary atherosclerosis (P < 0.001). In addition, DKK1 concentration was significantly higher in patients with atherosclerotic plaques, regardless of plaque composition (P = 0.01). Multivariate analysis identified DKK1 as an independent risk factor for the presence of coronary atherosclerotic plaque. The adjusted odds ratio for coronary atherosclerotic plaque was 4.88 (95% CI, 1.67 to 14.25) for highest versus lowest quartile of the DKK1 levels. Furthermore, patients with DKK1 concentrations > or = 68.6 pg/mL demonstrated coronary atherosclerotic plaques even when they had low CS. Serum DKK1 concentrations correlate with the coronary atherosclerosis and play an independent role in predicting the presence of coronary atherosclerosis.
Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Calcinosis/blood/complications/radiography ; Coronary Artery Disease/blood/complications/*diagnosis/radiography ; Female ; Humans ; Intercellular Signaling Peptides and Proteins/*blood ; Male ; Middle Aged ; Odds Ratio ; Plaque, Atherosclerotic/blood/*diagnosis ; Predictive Value of Tests ; Risk Factors ; Severity of Illness Index ; Tomography, X-Ray Computed

OBJECTIVETo investigate the association of fetuin-A with residual renal function and carotid artery calcification in patients with chronic kidney disease (CKD).

METHODSBlood examples were collected form 60 CKD patients in stages CKD3 to CKD5 (20 patients per stage) for measurement of serum fetuin-A, albumin, calcium, phosphorus and parathyroid hormone, cholesterol, triglycercide, low-density lipoprotein, and high-density lipoprotein. MDRD equation was used to calculate the estimated glomerular filtration rate (eGFR), and ELISA was used to detect serum fetuin-A. Color Doppler ultrasound was performed to measure carotid intima-media thickness (CIMT).

RESULTSAs the eGFR decreased, serum fetuin-A significantly decreased in CKD5 stage compared with that in CKD4 stage (P<0.05); compared with that in CKD3 stage, serum fetuin-A level was significantly lowered in CKD4 stage (P<0.05). Linear regression analysis suggested a significant positive correlation between fetuin-A and eGFR. The rate of carotid artery calcification was the highest in CKD5 stage. Rank correlation analysis showed a negative correlation between fetuin-A and cIMT, and logistic regression analysis identified decreased serum Fetuin-A as a risk factor of carotid artery calcification.

CONCLUSIONSerum fetuin-A decreases following the decrease in eGFR, and decreased serum Fetuin-A level is a risk factor of carotid artery calcification in CKD patients.

Adult ; Calcinosis ; etiology ; Carotid Artery Diseases ; etiology ; Carotid Intima-Media Thickness ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Renal Insufficiency, Chronic ; blood ; complications ; physiopathology ; Risk Factors ; alpha-2-HS-Glycoprotein ; metabolism

This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio), a marker of LV diastolic function. The E/E' ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Aorta, Abdominal ; Blood Flow Velocity ; Blood Pressure ; Calcinosis/*etiology ; Cardiovascular Diseases/*complications ; Disease-Free Survival ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/*complications/mortality ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Renal Dialysis ; Risk Factors ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left/complications/*physiopathology

We evaluated the risk of coronary-artery disease in patients with chronic renal failure (CRF) by measuring the coronary-artery calcium scores with electron beam CT (EBCT). A total of 81 CRF patients were divided into three groups; pre-dialysis (group I, n=35), hemodialysis (group II, n=31) and peritoneal dialysis (group III, n=15). The several serum biochemical markers and calcium score levels by EBCT were determined. The Ca x P products were significantly higher in groups II (p<0.05) and III (p<0.01) than in group I. The serum calcium levels were significantly higher in group III than in both group I (p<0.01) and II (p<0.05). The serum calcium level in 15 patients with a calcium score > 400 was significantly higher than the 66 patients with a score < or =400 (p<0.01). The calcium score was significantly higher in the 15 patients with cardiovascular complications than in the 66 patients without cardiovascular complications (628.9+/-904.8 vs. 150.4+/-350.9, p<0.01). EBCT seemed to be a good diagnostic tool for evaluating the risk of coronary-artery disease ''noninvasively'' in CRF patients who are at increased risk of cardiovascular morbidity and mortality.
Adolescent ; Adult ; Aged ; Calcinosis/etiology/metabolism/*radiography ; Calcium/blood/*metabolism ; Coronary Arteriosclerosis/etiology/metabolism/radiography ; Coronary Vessels/*metabolism ; Female ; Humans ; Kidney Failure, Chronic/complications/metabolism/*radiography/therapy ; Male ; Middle Aged ; Peritoneal Dialysis ; Renal Dialysis ; Research Support, Non-U.S. Gov't ; Risk Factors ; Tomography, X-Ray Computed