- Volume:1 Issue:1, 2009
- تاریخ انتشار: 1388/05/11
- تعداد عناوین: 14
Conventional Interferon Alpha Therapy of Chronic Hepatitis C in Patients with End Stage Renal Disease, Six versus Twelve Months? A Meta-AnalysisPage 4Too many small studies have evaluated efficacy of standard interferon (IFN) in hemodialysis patients, however their findings are heterogeneous and absolute guideline for therapy is still unclear. In current review, we aim to determine which of 24 or 48 week of treatment has greater value in treatment of end stage renal disease in pre-transplantation patients.
We required that studies report HCV RNA results at least 6 months after treatment cessation. Ninety-five percent confidence intervals (CI) of SVRs were calculated using the approximate normal distribution model. 95% CI of pooled SVR was computed by random effects models. Data manipulation and statistical analyses were undertaken using STATA 8.0.
The pooled SVR for 24 and 48 weeks of standard IFN monotherapy was 38.2% (95% CI=28.9%-47.5%) and 36.9% (95% CI=24.3%-49.4%), respectively. Pooled dropout rate was 24.2% (95% CI=9.5%-38.9%) and 26.9% (95% CI=10.6%-43.3%) in 24 and 48 weeks of IFN monotherapy, respectively.
Standard IFN is still the drug of choice in treatment of HCV in dialysis individuals and 6 months seems to be equal to one-year duration of therapy.Keywords: Hepatitis C, Hemodialysis, Interferon
Page 14Chyluria,recognized as a urological manifestation of lymphatic system abnormality has been a curious entity since long. With varied options for management, this tropical, debilitating disease is known for recurrence.The article provides an in-depth review into the subject with the author''s experience in the field along with the recent advances in management. This article also describes the entity from its historical background, etiopathogenesis,investigative and management protocols including complications. Recent treatment modalities reported in literature are reviewed with author''s innovative contributions in the form of applying MR scan for diagnosing and robotics for treating chyluria.Keywords: Chyluria, Laparoscopy, Recurrence, Sclerotherapy, Surgery
Does N-Acetyl Cysteine Have a Dose-Dependent Effect on Plasma Homocysteine Concentration in Patients Undergoing Hemodialysis?Page 27High homocysteine (Hcy) levels in hemodialyzed patients are associated with coronary disease. On the other hand, different effects were reported for impact of N-Acetyl Cysteine (NAC) on plasma Hcy levels in patients undergoing hemodialysis. The current study was conducted to evaluate the effect of oral NAC on plasma Hcy values in hemodialysis patients, comparing to placebo.
This double blind randomized clinical trial study was done on 99 ESRD subjects undergoing hemodialysis with hyperhomocysteinemia at three dialysis centers in 2008. The effect of one month consumption of 3 different doses of oral NAC (600, 1200 and 1800 mg daily) were assessed on plasma Hcy concentration. Each group was randomly divided into two sub-groups of drug (n=15, 19 and 14, respectively) and placebo (n=18, 19 and 14, respectively).
There were significant differences between groups 2 (1200 mg daily) and 3 (1800 mg daily) of NAC within the study (P=0.000 and 0.004, respectively). Furthermore, there was a relation between the rate of reducing plasma Hcy concentrations and the higher doses of NAC (P=0.000), it means that the effect of drug was dose-dependent. On the other hand, highest dose of drug (1800 mg per day) caused GI disterbance in 5 patients without further effect than 1200 mg daily dose of NAC (P=0.6).
The current study showed that oral NAC in dialysis patients for normalization of the plasma Hcy level has been successful and appeared to be dose-dependent.Keywords: Homocysteine, N, Acetyl Cysteine, ESRD, hemodialysis
Page 33Immunosuppression increases the incidence of cancer and promotes the growth of neoplasm in kidney transplant recipients. There have been few reports on the incidence of gastrointestinal (GI) and liver cancers from transplant registries.
In the current study, we collected data from 8 kidney transplant centers in Iran between 1984 and 2008, to detect the incidence, type, and outcome of GI and liver cancers after kidney transplantation. Only histologically confirmed tumors that occurred after renal transplantation were included in the analysis. We also compared their data with 3028 kidney recipients of two transplant centers.
50 years of age) and the total time on immunosuppression. Patient and graft survival rates from the time of GI and liver cancers onset were poor.
CRC was the most common GI tumor following kidney transplantation and was predominant in male. GI and liver malignancies have poor prognosis and early diagnosis and prompt treatment of the post- transplant malignancies is essential.Keywords: Kidney Transplantation, Gastrointestinal Neoplasm, Liver, Colorectal Carcinoma
Page 39Mucormycosis is an extremely rare and potentially fatal complication after kidney transplantation. Limited data are available on mucormycosis following living donor kidney transplantation. The aim of this study was to determine the incidence of mucormycosis and to identify the clinical presentation and mortality rate in renal allograft recipients.
We conducted a retrospective survey of 7132 Iranian renal transplant recipients to find those with Mucormycosis in eight transplant centers from January 1990 to June 2008. A total of 22 patients had received kidneys from living donors were complicated with Mucormycosis. Mean follow up period after diagnosis was 9±13(1-60) months.
No significant differences were found between infection occurrence and gender (P=0.6). Patients with mucormycosis were older than those who had no infection (p=0.02) with the mean age at diagnosis 48 ± 13 years. The diagnosis time since transplantation ranged from 1-84 (Median: 12) months. Mucormycosis was most likely to occur within 1 year after renal transplantation (n=13). The major form of disease in population studied was rhino-cerebral (n =11), followed by pulmonary (n=8), cutaneous (n=2), and disseminated (n=1). In addition, 9 patients have had the history of steroid pulse therapy. Diabetes mellitus was seen in 6 recipients with mucormycosis.
To our knowledge, the current study is the largest sample of renal recipients with ormycosis in living donor renal transplantation. Augmented immunosuppression, especially with corticosteroids, older age and PTDM were the predisposing factors for the infection.Keywords: Renal Transplantation, Mucormycosis, Living Donor, Multicenter Study
Page 45Successful transplantation of allografts with multiple renal arteries (MRAs) is one of the challenges and requires investigation of its impact on post-transplant graft and patient outcome. The aim of this study was to determine the impact of kidneys with MRAs on graft and patient survival rates.
We retrospectively reviewed the medical records of 90 grafts with MRAs that were performed between June 1995 and June 2008. Recipients were divided into 3 groups: group I (n =230) single renal artery, group II (n =83) with double renal arteries and group III (n =7) with triple renal arteries. The aspects analyzed were number of kidney''s arteries, donor type, vascular reconstruction technique, surgical complications, as well as patient and graft survival.
No significant differences were noted in the sex of the recipients, donor source, body mass index (BMI) at the time of transplantation, causes of ESRD, occurrence of complications, vascular reconstruction technique, warm ischemic times, number of transplantation and immunosuppression regimen. The mean cold ischemic time in MRAs group was significantly higher than the control group (P<0.05). One year patient survival rates were 97%, 97% and 71% in groups I, II and III, respectively (I vs. II, P=0.7, HR=1.26; I vs. III, P=0.004, HR=0.09 and II vs. III, P=0.01, HR=0.07). The graft survival rates at one year were 95% in group I; 95% in group II; and 71% in group III (I vs. II, P= 0.4, HR=0.69; I vs. III, P=0.001, HR=0.11 and II vs. III, P=0.007, HR=0.15).
These findings indicate that kidney transplantation using grafts with MRAs are safe and result in acceptable patient and allograft outcome.Keywords: Renal Transplantation, Complication, Survival
Can use the NMP22 BladderChek Decrease the Frequency of Cystoscopy in the Follow up of Patients with Bladder Carcinoma ?Page 51Bladder cancer is one of the most common cancers. Its diagnosis,management and follow up represent a burden in urology practice. "NMP22 BladderChek" is a urine test that measures levels of NMP22 (nuclear matrix protein 22), which is a protein found in both normal and cancerous cells of the bladder. However, levels of NMP22 are usually elevated in the presence of bladder cancer. To assess the accuracy of urinary NMP22 qualitative assay for the detection of recurrence of transitional cell carcinoma (TCC) during follow up period compared to the radiological investigations, urine cytology and check cystoscopy; and if it can be relied upon for the follow up to decrease the frequency of check cystoscopy.
38 patients known to have bladder cancer, undergoing surveillance, were subjected to abdominal- pelvic ultrasonography, NMP22 BladderChek test; urine cytology followed by check cystoscopy and biopsy if indicated. The accuracy of these tools was compared by their sensitivity and specificity as well as diagnostic likelihood ratio in detecting recurrence of bladder cancer.
The sensitivity and positive likelihood ratio of NMP22 BladderChek were superior to urine cytology (95% and 8.5 vs 50% and 4.5, respectively), while both diagnostic modalities were equal in terms of specificity (88.9%).
NMP22 BladderChek is a simple in-office test which proved in the current study to be highly sensitive in detecting recurrence, it can change the classical regimen for follow up of bladder cancer cases; reducing the number of check cystoscopies for these patients.Keywords: Bladder Cancer, Tumor Markers, Nuclear Matrix Protein 22
Page 56:To analyze endoscopic management of foreign body urinary tract, its outcome and complications.
A retrospective study of 11 cases of foreign body urinary bladder and urethra was performed from Jan, 2001 to June, 2008. Diagnosis was confirmed by X-Ray and ultrasound and removal was done by endoscopic and open surgery.
Total numbers of patients were 11, out of which 8 were male and 3 female. Eight patients have foreign body in bladder and 3 in urethra. Lower urinary tract symptoms, hematuria, pyuria and urinary retention were the main symptoms. Endoscopic removal was successful in 9 out of 11 patients.Psychiatric disorder was present in 4 patients while two inserted these for autoerotic stimulation. Urethral stricture was the main complication.
Foreign bodies in urinary tract are rare. Radiological evaluation is mandatory to ascertain exact size, shape, site, and type of object. Endoscopic removal is usually successful in expert heads with little complications. A psychiatric evaluation is recommended for self inflicted foreign bodies.Keywords: Foreign Body, Urethra, Bladder, Cystoscopy
Quality Assessment of Abstracts of the Xth Congress of the Middle East Society for Organ Transplantation: Does It Need Improvement?Page 61As all submitted abstracts, are not published as full articles in every meeting, therefore a published abstract is often the only source to earn the methodology and results of a study. The current study was designed to evaluate the abstracts quality of Xth congress of the Middle East Society for Organ Transplantation (MESOT) held November 2006.
Quality assessment checklist, which was developed by Timmer et al, was used to evaluate abstract quality. One hundred and fifteen abstracts of total 449 abstracts were selected by cluster random sampling. From oral and poster presentations we examined study type, study design, country of study, number of au- thors, organ type and quality score for each study. Evaluation was done by a reviewer.
0.5. Human observational studies with 0.69±0.11 quality score had highest score. The highest quality was related to object description and design evident had the lowest quality.
published abstract at Xth MESOT congress had good quality score and design evident of researches must be improved in the future.Keywords: Quality assessment, Research design, Congresses, Scoring Methods
Page 65Renal squamous cell carcinoma (RSCC) is a rare malignancy of the upper urinary tract characteristically presenting with advanced stage. Most patients have a history of chronic urolithiasis, renal infection or abuse of analgesics. A 52-year-old male patient presented to our emergency department with left flank pain and the signs of acute renal failure. He had a history of untreated renal calculi. After appropriate conservative management and two sessions of hemodialysis, extensive investigations demonstrated splenic hematoma extending to the superior surface of the enlarged left kidney without a remarkable mass size. Percutaneous renal biopsy revealed squamous cell carcinoma of the left kidney. Herein we report a case of RSCC presenting with intracapsular hematoma of the spleen, thought to be the invasion of the tumor at the left kidney. The possibility of malignancy should always be kept mind when identifying controversial clinical signs and subtle imaging findings in patients with long standing untreated urolithiasis.Keywords: Kidney, Squamous Cell Carcinoma, Spleen, Hematoma, Urolithiasis
Page 69Lamivudine has been successfully used in the treatment of acute hepatitis B virus (HBV) infection and HBV-associated polyarteritis nodosa. There are few such reports in patients with HBV-related nephropathy. We report our experience with a patient with acute glomerulonephritis and HBV infection. Lamivudine therapy resulted in the complete resolution of renal disease and subsequently the remission of viral infection.Keywords: Glomerulonephritis, Chronic Hepatitis B, Lamivudine
Page 72Bladder leiomyomas are rare benign mesenchymal tumors which account for less than 0.43 % of all bladder tumors with approximately 200 cases described in the literature. A case of urinary bladder leiomyoma is presented that was initially diagnosed to have bladder carcinoma on account of one week history of gross painless hematuria. The clinical presentation, imaging findings and management of this rare benign tumor is described.Keywords: Leiomyoma, Urinary Bladder, Benign Neoplasm