Although being equal in short-term efficacy and overall tolerability our results suggest a better gastrointestinal tolerability for iron sucrose. Larger trials are mandatory to prove a possible advantage of iron sucrose in short- and long-term efficacy as well as in tolerability over iron sulfate in the management of IDA in IBD.
With real-time sonography, 120 nondialyzed uremic patients prior to hemodialysis, 108 patients on maintenance hemodialysis and 9 patients postdialysis after successful homotransplantation were examined for the presence of renal cysts. Even in incipient renal failure, multiple cysts were demonstrable in some patients (at a serum creatinine of 3 mg/dl in 22% of patients), particularly in patients with analgesic nephropathy. When hemodialysis was started (serum creatinine approximately 10 mg/dl), 35% of the patients had multiple cysts. On hemodialysis, the prevalence, number and size of cysts rose progressively with time. After 8 years of hemodialysis, 92% of the patients had multiple cysts. However, enlargement of the kidneys was observed in only 2/108 patients. No major clinical complications were noted with the possible exception of 1 case of renal cell carcinoma. No correlation was noted between hematocrit and presence or extent of cystic transformation, but the 2 patients with cystic enlargement of the kidneys were polyglobulic. In 8/9 patients after transplantation, cysts were demonstrable in the patient’s own kidneys after a median follow-up of 16 months. On light microscopy, cysts were lined by cuboidal or columnar epithelial cells with frequent papillary or adenomatous proliferations. The cyst lumen was filled with amorphous or lamellated organic material, which exhibited microfibrillar structure on electron microscopy. One kidney examined after ex vivo perfusion fixation showed multiple interconnected cavities on scanning electron microscopy. Ultrastructural studies showed epithelia with either the characteristics of proximal tubular cells (i.e. numerous microvilli, interdigitations and abundant lysosomes or mitochondria) or distal tubular cells (i.e. highly interdigitating processes) or finally collecting duct cells (i.e. no interdigitations and few microvilli).
Background: Adequate bowel preparation is essential for
accurate colonoscopy. Both oral sodium phosphate (NaP) and
polyethylene glycol-based lavage (PEG-ELS) are used predominantly
as bowel cleansing modalities. NaP has gained popularity due to
low drinking volume and lower costs. The purpose of this
randomized multicenter observer blinded study was to compare
three groups of cleansing (NaP, NaP + sennosides, PEG-ELS +
sennosides) in reference to tolerability, acceptance, and
cleanliness. Patient and Methods: 355 outpatients between 18 and
75 years were randomized into three groups (A, B, C) receiving NaP =
A, NaP, and sennosides = B or PEG-ELS and sennosides = C.
Gastroenterologists performing colonoscopies were blinded to the
type of preparation. All patients documented tolerance and adverse
events. Vital signs, premedication, completeness, discomfort, and
complications were recorded. A quality score (0–4) of cleanliness
was generated. Results: The three groups were similar
with regard to age, sex, BMI, indication for colonoscopy, and
comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP
(P = .005). Discomfort from
ingested fluid was recorded in A = 39.8% (versus C: P = .015),
B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were
statistically not significant. No differences in adverse events
and the cleanliness effects occurred in the three groups (P = .113).
The cleanliness quality scores 0–2 were calculated in A:
77.7%, B: 86.7%, and C: 85.2%. Conclusions:
These data fail to demonstrate significant differences in
tolerability, acceptance, and preparation quality between the
three types of bowel preparation for colonoscopy. Cleansing with
NaP was not superior to PEG-ELS.
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