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We studied the prevalence and the risk factor among the patients of gout in Mexico. Research was conducted in the National Institute of Cardiology and in our private practice. Prevalence of hiperuricemia and gout in the Institute of Cardiology was of 1% (970 out of nearly 100,000 patients). We divided those cases of two subgroups: Reumatology patients (333) and Cardiovascular patients (529). In the first group primary gout was (96.3), and (50.32% in the second. Risk factor was quite different too: nephropathy 9.9%, lithiasis 9.3%, pyelonephritis 2.7%, cardioangiosclerosis 12.9%, aortosclerosis 6.6%, coronary insufficiency 6.3%, myocardial infarction 0.9%, arterial hypertension 24.6% obesity 56.1% and diabetes 9.9% in the Reumatology group; in the Cardiovascular one, nephropathy 14.3%, lithiasis 12.2%, pyelonephritis 7.1%, cardioangiosclerosis 62.7%, aortosclerosis 31.7%, coronary insufficiency 24.9%, myocardial infarction 29%, arterial hypertension 51%, obesity 54.8% and diabetes 20.4%. Among the private practice patients prevalence was of 10.1% (961). In an early age (39 years) in men and a later one for women (53 years). Other characteristics of epidemiology and risk factor are: primary gout 89%, atherosclerosis 5%, coronary disease 4.6%, lithiasis 4.7%, nephropathy 2%, pyelonephritis 1%, obesity 43%, and diabetes 4.6%. In an small group of patients of our private practice we made an exhaustive study of risk factor and the metabolic disorder of lipids. We found the following frequency: 9.3 of nephropathy, 31.2% of lithiasis, 18.7% of pyelonephritis, 68.9% of cardioangiosclerosis, 46.8% de coronary insufficiency, 9.3% of myocardial infarction, 68.7% of arterial hypertension, 68.7% of obesity and 18.7% of diabetes. In the lipid profile we found an increase in triglicerids and prebeta lipoprotein. We have amply discussed the relation between hiperuricemia and pathology considered as a risk factor from the genetic point of view as well as the metabolic and circumstancial aspect. From all that we concluded that risk is multifactorial.
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PMID:[Various epidemiological aspects of hyperuricemia and gout in Mexico: incidence and the cardiovascular risk factor]. 72 44

Levels of R proteins, immunoglobulins A, M, and G, natural anti-sheep erythrocyte antibodies, active oxygen (superoxide) were measured in the neutrophilic leukocytes in pregnant females at a risk for late gestosis. The examinees were found to have high levels of R proteins, IgA, IgM, natural anti-sheep erythrocyte antibodies, neutrophils capable to restore NST, and low levels of IgG. Teen-agers, old-year primiparas, pregnant females with a history of pyelonephritis, obesity, neuropathy in the prior labour, and hypertensive vegetovascular dystonia constituted a gestosis-risk group. The R-protein test should be considered to be the most informative indicator of a gestosis risk.
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PMID:[Immunity indices in the diagnosis of pretoxicosis in women with an increased risk for the development of late toxicosis]. 165 May 37

The long-term results of surgical and specific drug therapy were compared in a group of 57 patients with primary aldosteronism (PA) (46 with aldosterone-producing adenoma (APA), 11 with idiopathic hyperaldosteronism (IHA) and bilateral adrenal hyperplasia). Unilateral adrenalectomy completely normalized blood pressure (BP) in 77.1% of surgically treated APA, evidently improving hypertension in remaining 22.9%. No recurrence of the adenoma in the remaining adrenal was seen in any of the surgical APA cases. In 19 of the non-surgical patients (11 with APA, 8 with IHA) monotherapy with spironolactone reduced blood pressure in 73%, though total BP normalization was an exception. The treatment normalized hypokalemia, low total exchangeable potassium, tendency to hypernatremia, and high total exchangeable sodium. Surgical as well as conservative therapy increased to normal or above-normal levels plasma renin activity suppressed prior to treatment. Pre-operatively high urine and plasma aldosterone levels normalized in all adrenalectomized patients, but remained above the normal range during spironolactone therapy in spite of a small decline in its absolute values. The disturbances of maximum renal concentrating capacity due to impaired nephron responsiveness to sufficiently high endogenous vasopressin concentrations were completely eliminated after kaliopenic nephropathy had been repaired. The other renal functions remained within normal values. Echocardiographically diagnosed left ventricular hypertrophy was seen less often than in the other types of arterial hypertension, tending to regress after APA management. Our longitudinal study (2-16 years) showed primary aldosteronism as a well curable, albeit rare, cause of hypertension. As regards BP and laboratory tests normalization, better results were achieved in surgical APA cases than in patients treated with spironolactone. Older age, longer history of hypertension and more frequent incidence of obesity, nephrosclerosis and pyelonephritis may be responsible for hypertension persisting after surgical treatment.
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PMID:Long-term results of surgical and conservative treatment of patients with primary aldosteronism. 345 May 33

In contrast to the majority of renal calculi, in situ extracorporeal shock wave lithotripsy (ESWL) for upper ureteral stones is still controversial. Some centers recommend retrograde mobilization of the calculus into the renal pelvis prior to ESWL as a routine procedure (UC + ESWL). To evaluate the efficiency of in situ ESWL for upper ureteric stones, we initiated a prospective clinical trial. From July 1985 to January 1986, 122 patients presented with upper ureteral calculi, necessitating a total of 146 different procedures: 88 in situ ESWL; 31 UC + ESWL; 15 antegrade ureteroscopies (URS); 6 retrograde URS; 2 open surgery (ureterolithotomy, nephrectomy), and 4 patients were managed conservatively. Of all 99 patients treated at the lithotripter, 80 patients received in situ ESWL (no emergency case, no location problems): in 60 patients (75%) the stone could be disintegrated in one session; 8 patients (10%) required a second ESWL session due to partial fragmentation. Retrograde mobilization using a ureteral catheter or URS was necessary in 9 patients due to failure of in situ ESWL (11%) and, in only 3 patients, we had to remove the stone by antegrade URS (4%). In conclusion, 96% of all upper ureteric stones suitable for primary ESWL could be treated by a noninvasive (in situ ESWL) or minimally invasive (UC + ESWL) procedure. Therefore we recommend in situ ESWL for these calculi. Primary retrograde mobilization is only indicated in case of location problems (stone close to the spine, obesity, skeleton deformation) or emergency cases (colic, hydronephrosis). Antegrade URS should be performed if retrograde mobilization fails or in emergency cases (acute pyelonephritis, following percutaneous nephrostomy, after clinical stabilization). The rate of open surgery is below 2%.
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PMID:Efficacy of in situ extracorporeal shock wave lithotripsy for upper ureteral calculi. 354 48

This study was performed at University Medical Center, Lubbock, Texas, from July 1989 to June 1990. We obtained serum gentamicin peak and trough levels in 23 pregnant women with pyelonephritis. The patients were given a loading dose of 2 mg/kg gentamicin, followed by 1.5 mg/kg gentamicin adjusted for obesity every 8 hours. Peak levels were obtained 1 hour after the fifth dose and trough levels were drawn 30 minutes before the sixth dose. Statistical analysis was performed using chi 2 analysis. The mean (+/- SD) peak gentamicin level was 2.7 +/- 1.4 micrograms/mL and the mean trough level was 0.5 +/- 0.3 micrograms/mL. Twenty-two of 23 (96%) patients had peak levels 5 micrograms/mL and 1 of 23 (4%) patients had peak levels between 5 and 10 micrograms/mL. The mean peak gentamicin level in pregnancy is significantly less than in puerperal women (2.70 versus 5.78; P < 0.000001). We conclude that the majority of pregnant women treated for pyelonephritis with standard doses of gentamicin do not achieve therapeutic levels. Also, peak gentamicin levels are significantly below that reported for puerperal women.
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PMID:Gentamicin levels in pregnant women with pyelonephritis. 815 10

The authors analyzed obesity in 1173 persons aged 75+. They were all inhabitants of the same section of the town of Brno, CSFR, 721 of them were diabetic and 452 non-diabetics. The authors concentrated on the internal analysis of both groups regarding obesity; they found it to occur much more frequently among the diabetics (p = 0.005). The difference in obesity occurrence between men and women was found to be significantly higher among diabetic women (p = 0.005). The authors also analyzed the relation of obesity to the occurrence of coronary heart disease, hypertension, cerebrovascular incidents, and chronic pyelonephritis. Higher values were found for both hypertension in obese non-diabetics (p = 0.005) and cerebrovascular incidents in obese diabetics (p = 0.025); other differences were not statistically significant. The authors compared cholesterol levels of both groups; the results are unfavorable for the obese diabetics (Table 2); only the difference between non-obese diabetics and the obese non-diabetics was not statistically significant. The authors also compared treatment regimens for obese and non-obese diabetics. A significant difference was found for diet, by which the non-obese diabetics were more frequently treated (p = 0.05).
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PMID:[Obesity and diabetes in the aged--correlation and relation to some chronic diseases]. 821 99

Simultaneous operations on different organs and cavities, including urgent and scheduled operations, always are associated with high risk of operative and postoperative periods. The case of simultaneous operation of aortocoronary shunt and panhysterectomy is presented in the paper. In the case of our patient despite the severe condition: occlusion of left anterior descending coronary artery (rest and effort angina) and endometrium malignant tumor worsened by concomitant pathologies including bronchial asthma, hypothyreosis, pyelonephritis and obesity, the surgical intervention was completed successfully without complications at operational and postoperational periods.
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PMID:[Case of simultaneous operations of aortocoronary shunt and panhysterectomy]. 1690 99

Genetic mutations resulting in obesity and type 2 diabetes mellitus (T2D) are described for both inbred and outbred mice. However, no known mouse model completely recapitulates human T2D and its comorbidities. We identified a cohort of obese, male, outbred Swiss-Webster (SW) mice as polyuric, polydipsic, glucosuric, and hyperglycemic. Prevalence of glucosuria in the SW colony reached 60% (n=70) in males 8 weeks to 6 months of age. Despite severe obesity in some females, no females were diabetic. Pathologic findings in affected males included cachexia, dilated gastrointestinal tracts with poor muscular tone, pancreatic islet degeneration and atrophy with compensatory metaplasia and/or neogenesis, bacterial pyelonephritis, membranous glomerulopathy, and late-onset hepatic tumors with macrosteatosis, microsteatosis, and hydropic change in aged males. Serum insulin correlated with blood glucose in a nonlinear pattern, suggestive of islet exhaustion. Circulating leptin levels showed a weak inverse correlation with glucose. Diabetic males were bred with obese colony females to produce 20 male and 20 female offspring. Prevalence of diabetes in male offspring was 80% (16/20) with a median age of onset of 18 weeks. By contrast, no diabetic females were identified, despite being significantly more obese than males. Male predominance is likewise a feature of T2D in humans. To our knowledge, this is the first documentation of hepatocellular carcinoma and islet metaplasia and/or neogenesis in a spontaneous outbred mouse model of T2D. The SW availability and histopathologic features represent a promising new model for the study of T2D.
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PMID:Obesity and non-insulin-dependent diabetes mellitus in Swiss-Webster mice associated with late-onset hepatocellular carcinoma. 1866 86

Effective urolithiasis treatment, especially in overweight patients has a considerable medical and social implication. Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotripsy (PCNL) in prone position of the patient are standard treatment options for kidney and ureter stones. These interventions are not always effective in patients with concomitant obesity and are associated with technical difficulties and an increased risk of complications. The study included 175 patients with obesity. The first group consisted of 96 (54.8%) patients treated with transurethral contact lithotripsy. The 2nd group consisted of 54 (30.9%) patients who underwent PCNL in the supine position. The third group comprised 25 (14.3%) patients with multiple stones of kidney and ureter, who underwent combined transurethral and percutaneous intervention in the supine position. The 1st and 3rd group had a higher prevalence of patients with II degree of obesity, in the 2nd group--with I degree of obesity. The mean duration of surgery in 1st group was 43.4 min, in the 2nd--70.3 min and in the third--84.6 min. Method of kidney drainage depended mainly on the presence, location and size of residual stone fragments. The average duration of the kidney drainage stent in patients of the 1st group was 39 days (ureteral catheter--1.3 days). In all patients of the 2nd and 3rd groups, at the final stage of the operation a nephrostomy tube was placed for an average of 2.7 days. The average postoperative hospital stay was 2.9 days in the 1st group, 4.1 days in the 2nd group and 4.5 days in the third group. In the 1st group, the stone-free status was achieved in 81 (84.4%) patients. Another 10 (10.4%) patients later needed ESWL for the complete disposal of the stones. In the 2nd group, the complete clearance of kidney stones was achieved in 49 (90.7%) patients. Another 3 (5.6%) patients required added ESWL to achieve the stone-free status. In the third group of patients stone free status was reached in 22 (88%) cases. In the remaining patients residual stone fragments were not clinically important. The most prevalent postoperative complication in all groups was postoperative pyelonephritis. Taking into account high efficiency of transurethral lithotripsy and PCNL in the supine position, as well as their combinations we can recommend these interventions to treat patients with kidney and ureteral stones and concomitant obesity.
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PMID:[NEW OPTIONS OF ENDOSCOPIC TREATMENT FOR KIDNEY AND URETER STONES IN OBESE PATIENTS]. 2666 67

This study was conducted to determine the relationship between overweight/obesity and UTI in children. A comparison was made, in terms of overweight and obesity, between 135 children with UTI (case group) and 135 healthy children (control group). UTI was diagnosed through urine culture. Dimercaptosuccinic acid renal scanning (DMSA) was also used to distinguish between lower UTI and acute pyelonephritis. Overweight and obesity were determined based on standard body mass index (BMI) curves. There were 12 (8.8%) overweight and 26 (19.2%) obese children in the case group. Four (3.0%) overweight and five (3.7%) obese children were found in the control group. There was a significant difference between the two groups regarding overweight and obesity frequencies. However, no such difference existed between children with cystitis and acute pyelonephritis. This study showed a significant relationship between overweight/obesity and UTI. Therefore, overweight and obesity may play a role in the pathogenesis of UTI in children.
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PMID:The role of overweight and obesity in urinary tract infection in children. 2703 95


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