University of Iowa Hospitals and Clinics

About: University of Iowa Hospitals and Clinics is a healthcare organization based out in Iowa City, Iowa, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 7201 authors who have published 9476 publications receiving 276995 citations. The organization is also known as: University of Iowa Hospitals & Clinics.

Craniovertebral junction database analysis: incidence, classification, presentation, and treatment algorithms

Abstract: Introduction The initial treatment of bony lesions at the craniocervical junction consisted of posterior decompression with enlargement of the foramen and removal of the posterior arch of the atlas and axis vertebra. This was regardless of the site of compression. Needless to say, the results were poor when an irreducible ventral lesion at the craniocervical junction caused compression of the cervicomedullary area. It was predictable that an adverse outcome would occur in approximately 35–40% of patients treated with dorsal decompression with a fixed anterior abnormality at the craniovertebral junction. Thus, it became essential to identify the causes of failure and recognize the pathology as well as attempt to improve the treatment. The need to identify natural history led to a prospective database. This database now lists 5,300 patients who were analyzed. Of these, 2,000 were children and this has been reviewed here.

Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment.

Abstract: Anemia is a complication that affects a majority of individuals with advanced CKD. Although relative deficiency of erythropoietin production is the major driver of anemia in CKD, iron deficiency stands out among the mechanisms contributing to the impaired erythropoiesis in the setting of reduced kidney function. Iron deficiency plays a significant role in anemia in CKD. This may be due to a true paucity of iron stores (absolute iron deficiency) or a relative (functional) deficiency which prevents the use of available iron stores. Several risk factors contribute to absolute and functional iron deficiency in CKD, including blood losses, impaired iron absorption, and chronic inflammation. The traditional biomarkers used for the diagnosis of iron-deficiency anemia (IDA) in patients with CKD have limitations, leading to persistent challenges in the detection and monitoring of IDA in these patients. Here, we review the pathophysiology and available diagnostic tests for IDA in CKD, we discuss the literature that has informed the current practice guidelines for the treatment of IDA in CKD, and we summarize the available oral and intravenous (IV) iron formulations for the treatment of IDA in CKD. Two important issues are addressed, including the potential risks of a more liberal approach to iron supplementation as well as the potential risks and benefits of IV versus oral iron supplementation in patients with CKD.

Primary ovarian sarcoma: Analysis of prognostic variables and the role of surgical cytoreduction

Abstract: BACKGROUND Data regarding the value of cytoreduction and cell histology in ovarian sarcomas are limited. The goal of this study was to assess the value of surgical cytoreduction, preoperative CA 125 levels, stage, histology, and platinum-based chemotherapy in the primary treatment of ovarian sarcomas. METHODS A retrospective analysis of 47 women with primary ovarian sarcomas was performed. RESULTS Forty-one patients (87%) presented with advanced stage disease (International Federation of Gynecology and Obstetrics Stage III or IV). Optimal surgical cytoreduction ( 35 U/mL) in 93% of patients with ovarian sarcomas. A preoperative CA 125 level < 75 U/mL was significantly associated with better survival (P = 0.01). In univariate analysis, other significant predictors of improved survival were early stage (P = 0.04), homologous tumors (P < 0.05), and optimal surgical cytoreduction (P < 0.001). In multivariate analysis of various prognostic variables, optimal surgical cytoreduction (P < 0.001) was the most significant factor, followed by histologic subtype (P < 0.02). CONCLUSIONS Ovarian sarcomas are rare malignancies with a poor prognosis. All women with suspected ovarian carcinoma or sarcoma should have a preoperative CA 125 level taken. Surgical cytoreduction to a residual tumor burden of ≤1 cm improves outcome and should be the goal of surgery. Although the optimal consolidation chemotherapy regimen remains unknown, platinum should be included as part of the regimen. Cancer 1998;82:1731-7. © 1998 American Cancer Society.

Factors affecting the pullout strength of self-drilling and self-tapping anterior cervical screws.

Abstract: STUDY DESIGN: A biomechanical comparison of 12-, 14-, and 16-mm self-tapping and self-drilling screws in cadaveric cervical spines was performed. OBJECTIVE: This study compared self-drilling and self-tapping screw designs used in anterior cervical locking plates in terms of insertion torque and pullout strength. In addition to screw design, the effects of screw length (12, 14, and 16 mm) and bone mineral density were examined. METHODS: A total of 201 screws were implanted and tested. Nineteen cadaver spine specimens (C2 through C7) were radiographed and their bone mineral density measured. In each vertebral level, two screws of the same length were implanted and their insertion torque measured. One of each screw design (self-drilling or self-tapping) was randomly placed in each vertebra for side-by-side comparison. Vertebrae then were individually potted and mounted on an MTS machine for accurate measurement of maximum pullout strength. RESULTS: Pullout strength was strongly related to screw length ( = 0.0002). There was no significant difference in pullout strength between the self-drilling and self-tapping screw designs at any length ( = 0.9352). A significant correlation (

Connexin mutations and hearing loss

Abstract: Kelsell et al.1 provide convincing evidence that mutations in the gene encoding the gap-junction protein connexin 26 (Cx26) are responsible for autosomal recessive non-syndromic hearing loss at the DFNB1 locus on chromosome 13q12. They also report a small family with apparent autosomal dominant congenital hearing loss and autosomal dominant palmoplantar keratoderma (PPK) in which two siblings with profound hearing loss are heterozygous for a single base-pair substitution resulting in a methionine-to-threonine (ATG-to-ACG) change in codon 34 (M34T) of Cx26 (12). The authors conclude that the M34T change is the genetic basis of profound hearing loss in this family and suggest, on this basis, that the Cx26 gene is responsible for autosomal dominant non-syndromic hearing loss (ADNSHL) at the DFNA3 locus chromosome 13q12 (ref. 3). We have identified a family in which the M34T variant is not associated with hearing loss, suggesting that this conclusion might be premature.