فهرست مطالب

  • Volume:5 Issue:4, 2013
  • تاریخ انتشار: 1392/08/28
  • تعداد عناوین: 20
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  • Zohreh Rostami Pages 855-857
  • Orcun Celik, Selcuk YÜcel Pages 858-861
    The classical etiology of erectile dysfunction (ED) comprises aging and vascular, neurogenic, psychological and hormonal components. Recent studies have shown that ED can be the forerunner of serious cardiovascular disturbances. It has also been reported that peripheral neuropathy and microvascular injuries caused by pathophysiological changes in patients with diabetes and obesity lead to ED in a significant number of such cases. These patients develop clinically significant ED and comprise a significant portion of the patient group which do not respond to PDE-5 inhibitors. Testosterone has been shown to increase the expression of PDE-5. This function of testosterone supports its effect on the regulation of erection and increasing the sexual libido. In view of the complexity of ED, as well as the effect of testosterone on erection, it is concluded that PDE-5 inhibitors in combination with testosterone replacement would be a better therapy alternative in the management of erectile dysfunction in hypogonadal patients..
    Keywords: Testosterone, Erectile Dysfunction, Therapeutics
  • Hamid Tayebi Khosroshahi, Bohlul Habibi Asl, Afshin Habibzadeh, Parastoo Chaichi, Amin Ghanbarpour, Amir Hossein Badie Pages 862-865
    Background
    The most common complications during dialysis are hypotension and muscle cramps. There are many strategies to prevent and treat these complications..
    Objectives
    The aim of this study is to evaluate effects of vitamin E and L-carnitine supplementation alone and in combination on intradialytic complications.. Patients and
    Methods
    In a prospective study, 20 patients with end stage renal disease on chronic hemodialysis that had intradialytic complications such as hypotension, muscle cramp, nausea, vomiting and headache were studied. These patients were studied in four 45 day periods, beginning with no treatment (step 1), receiving vitamin E (200 IU/d) (step 2), receiving L-carnitine (500 mg/d) (step 3) and their combination (step 4). Intradialytic complications were recorded in each step and compared between treatments..
    Results
    All three treatments significantly reduced frequency of muscle cramps in comparison to baseline values. Vitamin E alone and in combination with L-carnitine reduced the frequency of muscle cramps more effectively. Hypotension was significantly lower in combination therapy in comparison to baseline values and vitamin E treatment..
    Conclusions
    Vitamin E and L-carnitine both have comparative effects on intradialytic complications. As the combination use of vitamin E and L-carnitine could more effectively reduce the intradialytic complications, it is recommended for daily use in hemodialysis patients..
    Keywords: Renal Dialysis, Kidney Failure, Chronic, Vitamin E Carnitine
  • Chukwudi Ogonnaya Okorie Pages 866-869
    Background
    Most contemporary series on urethral prolapse report either on the use of excisional or conservative treatment approaches..
    Objectives
    To introduce a modified ligation over a Foley catheter treatment method for urethral prolapse that addresses most of the previously reported complications..Patients and
    Methods
    Five consecutive patients with urethral prolapse treated between 2003 and 2011, all using the ligation method on an outpatient basis were studied prospectively. Maintaining the inflated balloon of the Foley catheter with timed removal of the catheters among other modifications to the original technique is further described in the article. The main outcome measures were to evaluate for recurrence, post-operative appearance of the urethral orifice and satisfaction of parents. Secondarily the actions of the parents of the patients and those of the receiving physicians were also recorded..
    Results
    The mean age of the patients was 6 years old (ranging from 3 to 8 years). All parents suspected sexual molestation and in two cases, the suspected perpetrators were verbally threatened of dire consequences of their actions if proven. None of the receiving medical personnel were aware of this condition. Maximum length of catheterization was for 4 days. The post treatment urethral openings appeared normal and there were no complications..
    Conclusions
    The ligation method with attention to the modifications described further in the article is a simple, safe and cost effective option for the management of urethral prolapse. Maintaining the inflated balloon of the Foley catheter with timed catheter removal especially adds predictability to this technique.
    Keywords: Catheters, Ligation, Prolapse, Urethra
  • Baratali Asghari, Mansour Babaei, Bijan Pakroshan, Alireza Vaziriniya, Abdolreza Babamahmoodi Pages 870-873
    Background
    Kidney transplantation from living donors has been increased recently. Preoperative evaluation of living donor is important to select the appropriate kidney for transplantation and to decrease donor surgical complications..
    Objectives
    The aim of this study was to compare the accuracy of the use of multidetector computed tomography (MDCT) to evaluate vascular anatomy in living kidney donors with traditional angiography.. Patients and
    Methods
    A total number of 60 living kidney donors who underwent open surgical approach for transplantation were selected: Kidney anatomy of donors evaluated by CT angiography (group 1) or traditional angiographic examination (group 2). Renal vessels anatomy was compared with surgical findings in both groups..
    Results
    The accuracy for detecting number of main renal arteries were not different in both groups which were 96.7% in CT angiography group and 90% in traditional angiography group (P = 0.15). The accuracy for detection of main renal veins were 100% in group 1 and 96.7% in group 2 (P = 0.31)..
    Conclusions
    MDCT has the same accuracy as traditional angiography to detect renal abnormalities in living kidney donors..
    Keywords: Kidney Transplantation, Multidetector Computed Tomography, Tissue Donors
  • Maliheh Keshvari Shirvan, Mohammad Reza Darabi Mahboub, Hamid Reza Rahimi, Ali Seyedi Pages 874-878
    Background
    Urinary stone incidence in pregnancy has been reported in a wide range, from 1 in 200 to 1 in 2000 cases..
    Objectives
    The aim of this study was to investigate the efficacy and safety of ureteroscopic treatment and its results and complications for pregnant women with urinary stones..Patients and
    Methods
    From 2003 till 2011, 113 pregnant patients with symptomatic urolithiasis were admitted to the urology emergency clinic at Imam Reza hospital. All patients were initially treated conservatively, resulting in spontaneous passage of the calculi in 69 patients. Forty-four patients with symptomatic urolithiasis were included in the study. Post-operative follow ups, including maternal and fetal health was performed by a gynecologist consult fetal heart rate assessment and urine analysis and culture and renal and urethral ultrasonography..
    Results
    The mean age of the patients was 23 years ± 2 (19-34) and the mean gestational age was 24 ± 3 weeks. The overall and pneumatic lithotripsy success rate was 100%. All patients from the interventional group delivered at term with no fetal or maternal complications. There was no morbidity during and after the operation..
    Conclusions
    In conditions, medical management of urinary stones and consequent renal colic in pregnant women cannot improve patients’ symptoms, choosing of a surgical method like setting of a DJ catheter or URS and pneumatic lithotripsy can be a safe and effective way for the health of both the mother and fetus. Of course, more research is needed to establish this approach as the standard method in pregnancy urinary stones..
    Keywords: Urinary Calculi, Urolithiasis, Lithotripsy
  • Majid Ali-Asgari, Farid Dadkhah, Alireza Ghadian, Mohammadhossein Nourbala Pages 878-883
    Background
    Urologic complications are of the most important complications after kidney transplantation which increases mortality and morbidity significantly..
    Objectives
    We designed this study to evaluate the association between ureteral length and postoperative complications..Patients and
    Methods
    We recorded the length of the transplanted ureter during the operation. Ureter-to-bladder anastomosis was performed using modified Lich-Gregoir method on the ureteral stent. Complications like urine leakage and increased creatinine were evaluated. We used both univariate and multivariate analyses and survival analysis according lengths of ureter. It means that the main variable is ureteral length and other variables are studied based on it..
    Result
    A total of 395 patients with the mean age of 37 years (range, 18 to 68 years) were enrolled in the study, twenty six graft lost during the follow-up period. The Mean age of recipients was 37 ± 13 years. Urinary stenosis was seen in 6 patients (1.5%) and urinary leakage in 4 (1%) patients. The complication rate was not significantly different between these groups (P = 0.67). We found that there were no significant difference among complication (P = 0.25), hospitalization (P = 0.31) and survival (P = 0.84) at 5.5 cm length cut off..
    Conclusions
    The length of transplanted ureter does not affect the postoperative urologic complications (including urinary fistula and ureter-to-bladder anastomosis stricture), and it seems that decreased rate of complication frequency during the recent years is due to technical improvement, surgeon’s skillfulness and development in use of immunosuppressant’s postoperatively..
    Keywords: Ureter, Kidney Transplantation, Complications
  • Nepton Soltani, Mehdi Nematbakhsh, Fatemeh Eshraghi-Jazi, Ardeshir Talebi, Farzaneh Ashrafi Pages 884-891
    Background
    Cisplatin (CP) therapy as the most common potent chemotherapeutic process is accompanied by nephrotoxicity. The diabetic state may protect rat kidney against this toxicity, and magnesium (Mg) on the other hand may reduce the glucose level in diabetic animals..
    Objectives
    Current study was planned to investigate the effect of oral administration of magnesium supplementation on CP-induced nephrotoxicity in normal and Streptozocin (STZ)-induced diabetic rats..
    Materials And Methods
    Male Wistar rats were divided into seven groups and underwent two experiment protocols. As protocol 1, group 1 was considered as the sham group. Group 2 (CP group) received CP (2 mg/kg/d) for five consecutive days. Group 3 (CP + Mg group) received magnesium sulphate (MgSO4, 10 g/L added to the drinking water) for 10 days and then treated with CP from sixth day. As protocol 2, animals received a single dose of STZ (65 mg/kg i.p.). Three days after diabetes induction, animals were divided into four groups; Groups 4 (D group), 5 (D + CP group), and 7 (D + Mg + CP group) followed the same manner as groups 1 to 3, respectively; and group 6 (D + Mg group) was treated with MgSO4 alone for 10 days. Finally, blood samples were obtained, and all animals were killed for kidney tissue investigation..
    Results
    CP administration in normoglycemic rats significantly elevated the serum levels of blood urea nitrogen (BUN) and creatinine (Cr) (P < 0.05). However, coadministration of CP and Mg statistically increased the serum levels of BUN and Cr in both normoglycemic and diabetic animals when compared to the rats treated with CP alone (P < 0.05), while the serum level of Mg was significantly increased in nondiabetic groups (P < 0.05). No significant changes were observed in serum and kidney levels of nitrite; as well as the testis weight between all normoglycemic groups, whereas Mg decreased kidney levels of nitrite in diabetic groups when accompanied by CP (P < 0.05). The kidney and serum levels of malondialdehyde (MDA) enhanced significantly in nondiabetic rats treated with Mg and CP (P < 0.05). Kidney tissue damage score (KTDS), kidney weight, and body weight loss were significantly different among normoglycemic groups (P < 0.05), and Mg promoted the KTDS in diabetic animals treated with CP..
    Conclusions
    Oral Mg supplementation did not protect the CP induced nephrotoxicity in diabetic rats..
    Keywords: Cisplatin, Streptozocin, Diabetes Mellitus, Magnesium, Dietary Supplements
  • Rizna Abdul Cader, Halim Abdul Gafor, Rozita Mohd, Wei Yen Kong, Norazimah Arshad, Norella Kong Pages 891-896
    Background
    Coupled plasma filtration adsorption (CPFA) is a novel extracorporeal blood purification therapy for sepsis which adsorbs both proinflammatory and anti-inflammatory mediators from filtered plasma, thereby achieving early haemodynamic stability and a reduction in inotropic support requirement..
    Objectives
    The main objective was to review our centers'' experience with CPFA in septic patients..Patients and
    Methods
    A retrospective chart review of all septic patients who received CPFA was performed. All patients were initially treated according to the ‘surviving sepsis care bundle’ with fluid resuscitation, antibiotics, and inotropes as required. CPFA was started as soon as possible after a nephrologists’ assessment..
    Results
    Twenty five patients with sepsis received CPFA (15 M, 10 F, mean age 49.60 ± 18.97 years). Comorbidities included hypertension (n = 10, 40%), diabetes mellitus (n = 6, 24%), ischemic heart disease (n = 6, 24%), and an immunosuppressed state (n = 10, 40%). All patients received one cycle of CPFA with median duration of 5 (1-10) hours. CPFA was well tolerated but we encountered technical problems, especially filter clotting as CPFA was performed heparin free. 14 (56%) patients died within 28 days of treatment. CRP correlated with PCT (P = 0.040) and had an inverse trend with albumin (P = 0.066). Serum albumin was a strong predictor of mortality..
    Conclusions
    The high prevalence of fungaemia and mortality could be attributed to many patients on chronic immunosuppressive therapy. Nonetheless, CPFA albeit expensive, does add to our armamentarium of extracorporeal treatment for severe sepsis. Regional citrate anticoagulation with CPFA may overcome problems with filter clotting..
    Keywords: Plasma Filtration, Mortality, Sepsis
  • Vajihe Biniaz, Ali Tayybi, Eghlim Nemati, Mehdi Sadeghi Shermeh, Abbas Ebadi Pages 897-900
    Background
    Fatigue, a common symptom reported by patients receiving dialysis, is a multidimensional and subjective experience which is readily understood by individuals but difficult to measure..
    Objectives
    This study was performed to identify the prevalence of differential aspects of fatigue among patients receiving maintenance dialysis..Patients and
    Methods
    The cross-sectional study was conducted in two hemodialysis wards in Tehran with a sample of 163 participants. In this study, the multidimensional fatigue inventory was used to determine the level of fatigue. Demographic data were also collected with self-report survey. To analyze data with SPSS statistical software, test Chi square, T-test, and ANOVA were used. P- Value less than 0.05 was considered significant..
    Results
    All the patients experienced degrees of fatigue and 50 (30.7%) of the participants experienced a high level of fatigue. Fatigue scores arrangement was founded for physical fatigue followed by reduced activity and general fatigue. Lower levels of fatigue were reported for mental fatigue and reduced motivation. There was no diversity in this study in the levels of fatigue in respects of gender and marital status and employment status. Participants with diabetic nephropathy were the most fatigued..
    Conclusions
    People with chronic kidney disease regardless of their age, gender, state of health, and duration of hemodialysis experience high levels of fatigue; it is particularly important for health providers to understand this level of fatigue which affects the daily life of patients..
    Keywords: Renal Insufficiency, Chronic, Kidney Failure, Chronic, Fatigue, Renal Dialysis
  • Zohreh Rostami, Behzad Einollahi, Mahboob Lessan-Pezeshki, Azam Soleimani Najaf Abadi, Susan Mohammadi Kebar, Heshmatollah Shahbazian, Atieh Makhlough, Khadijeh Makhdoomi, Mahmood Salesi, Mojgan Jalalzadeh Pages 901-912
    Background
    The effectiveness of health care and health policy developments are often determined by health-related quality of life (HRQOL) assessment..
    Objectives
    The objective of this study was to explore the potential corresponding factors and traditional biomarkers of HRQOL in a large number of Iranian hemodialysis patients.. Patients and
    Methods
    A total of 6,930 chronic hemodialysis (HD) patients enrolled. KDCS-SF version 1.3 questionnaire was used to assess the health related quality of life (HRQOL). We pooled PCS, MCS and KDCS scores with random effect model from 19 similar studies performed between 1996 and 2010.
    Results
    The mean age was 54.4 ± 17.1 years. Mean PCS, MCS and KDCS scores obtained for the study cohort were 40.79 ± 20.10, 47.79 ± 18.31 and 57.97 ± 11.70, respectively; the total score of SF-36 plus KDCS was 51.12 ± 13.41 as well. The most common primary known disease was hypertension (31.9%) and the second etiology was diabetes (25.5%). In multilevel logistic regression, Kt/V between 1 and 1.2 and PCS, KDCS more than 50 were considered as a significant reduction in the risk of hospitalization..
    Conclusions
    This study showed that PCS and MCS score were slightly more than overall results while KDCS was slightly less than overall results. In addition, dialysis adequacy with Kt/V between 1 and 1.2 is associated with lower rate of hospitalization..
    Keywords: Quality of Life, Renal Dialysis, Mental Status Schedule, Kidney Diseases
  • Omid Sedighi, Atieh Makhlough, Ghasem Janbabai, Mohammad Neemi Pages 913-917
    Background
    Functional iron deficiency (FID) may cause erythropoietin resistance in patients under hemodialysis (HD). Since the role of chronic inflammation or oxidative stress in its pathogenesis is unclear, controversy remains to whether intravenous iron or intravenous ascorbic acid (an antioxidant) can improve this anemia due to decreased iron availability..
    Objectives
    The current study compared the effect of intravenous iron versus intravenous ascorbic acid in the management of FID in HD patients..Patients and
    Methods
    Forty HD patients with hemoglobin (Hb) ≤ 11 g/dL, serum ferritin ≥ 500 ng/mL and transferrin saturation (TSAT) ≤ 25% were randomly divided into two groups. 20 patients received 100 mg of intravenous (IV) iron (group I), and 20 patients received 300 mg of IV ascorbic acid (group II) postdialysis, twice a week for 5 consecutive weeks. Hb and iron metabolism indices were measured before the onset of the study and after 12 weeks following therapy..
    Results
    Twenty one percent of all HD patients, exhibited high serum ferritin, low TSAT and sufficient data for analysis. Both Group I (n = 20) and Group II (n = 20) patients showed a significant increase in Hb, serum iron, and TSAT (P < 0.001). There were no significant differences between both groups in increasing Hb (P = 0.076), serum iron (P = 0.589), serum ferritin (0.725), and TSAT (P = 0.887)..
    Conclusions
    This study showed that both IV iron and IV ascorbic acid can improve FID in HD patients. A larger randomized trial is warranted to determine the optimal management of FID in HD patients..
    Keywords: Renal Dialysis, Anemia, Iron, Deficiency, Ascorbic Acid
  • Farzaneh Ashrafi, Mehdi Nematbakhsh, Hamid Nasri, Ardeshir Talebi, Sayed Mohsen Hosseini, Mehdi Ashrafi Pages 918-920
    Background
    Nephrotoxicity is characterized and scored by many parameters such as vacuolization, dilatation, hyaline cast, debris or degeneration in injured renal tissue. In this short report, we attempt to find, the most correlated parameters with kidney tissue pathology damage score (PDS) in Cisplatin-induced nephrotoxicity..
    Method
    A total of 207 normal and toxic rats’ kidney tissue (induced by Cisplatin) were evaluated for toxicity intensity by two methods. In the first method, the tissue damage was scored from 0 to 4, and in the second method the percentage of vacuolization, dilatation, hyaline cast, debris or degeneration were determined. The data was analyzed using stepwise discriminant function and regression analysis..
    Results
    The variables having the higher discriminant function coefficient were hyaline cast, dilatation, and degeneration. The linear regression model and the prediction function to determine the kidney tissue PDS were generated as below. PDS = 0.445 + 0.035 × hyaline cast + 0.013 × dilatation + 0.020 × degeneration.
    Conclusion
    According to this finding it is suggested that presence of hyaline cast and dilatation, and then degeneration in the sample of toxic renal tissue are the most important item to score the damage intensity..
    Keywords: Dilatation, Hyaline, Degeneration, Kidney Failure, Chronic
  • Behzad Feizzdeh Kerigh, Ghodratolah Maddah Pages 921-923
    Rectus sheath hematoma usually occurs unilateral but rare cases of bilateral hematoma have been reported. Herein we report the first case of spontaneous bilateral Rectus Sheath Hematoma in the kidney transplanted patient..
    Keywords: Hematoma, Kidney Transplantation, Bilateral
  • Fatemeh Beiraghdar, Zohreh Rostami, Yunes Panahi, Behzad Einollahi, Mojtaba Teimoori Pages 924-927
    Subjectives: Prevalence of benign joint hypermobility syndrome (BJHMS) without systemic disease seems to be high in children. Little literature is currently available related to urinary tract diseases in patients with BJHMS. Here, we report an association between the urinary tract disease and BJHMS..
    Methods
    We conducted a prospective case series study of 62 pediatric patients with musculoskeletal pain to detect urinary tract diseases in Tehran, Iran from October 2009 to October 2010. The Brighton criteria score was used to diagnose BJHMS. The collected data included age, gender, grading of vesicoureteral reflux (VUR), ultrasonography findings, urodynamic results and biochemical tests. Voiding cystourethrography was used for detection and grading of VUR..
    Results
    VUR was observed in 60% of patients with BJHMS. However, sonography was normal in 66.7% of patients. The most common grading of reflux was grade II of VUR (37.5%). Seventy percent of patients with BJHMS and neurogenic bladder had failure to thrive..
    Conclusion
    Our findings showed an increased frequency of VUR in patients with BJHMS. We suggest that Infants and children with BJHMS should be screened for VUR..
    Keywords: Hypermobility syndrome, Pediatrics, Vesico, Ureteral Reflux, Urologic Diseases, Urinary Tract Infections
  • Eduardo Moran Pascua Pages 928-929
  • Paraskevi Theofilou Page 931
  • Akihiko Kato Page 932