[Pseudotumor cerebri after kidney transplantation]

Pseudotumor cerebri is defined by the increase of intracranial pressure. It has different atiologies but, many of its causes are idiopathic and typically present on young obese females. Cerebrospinal fluid [CSF] analysis was normal in this case study and there was no evidence of intracranial mass, venous sinus thrombosis, or obstruction in CSF stream. In this study, we have reported a case of Pseudotumor cerebri presented 7 years after a successful kidney transplant, under treatment by Cyclosporine, Methylprednisolon and Azathioprine[AZT]. The patient was a 17-year old obese female with a body mass index of 30kg/m2 having Pseudotumor cerebri 7 years after a successful kidney transplant. Brain imaging like CT scan and MRA [Magnetic Resonance Angiography] were normal. CSF analysis was normal, but the increase in CSF pressure had been detected. Repetitive lumber punctures were performed with simultaneous Acetazolamid administration. But her headaches were treated even after the continuation of Cyclosporine and Methylprednisolon, anemia, and renal failure. For patients with kidney transplant and headaches, it is necessary to rule out Pseudotumor cerebri as a differential diagnosis. Neurotoxicity of Cyclosporine is not rare and we have to pay close attention to neurologic side effect of this drug as well. After diagnosing Pseudotumor cerebri in such patients, it is necessary to limit the progression of symptoms and avoid the decrease in patient's visual acuity

Cost benefit of the routine urinalysis

In the present health care environment, cost-benefit analysis is extremely important. In this screening program, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. The process of screening was similar to all the studies. The minimal cost utilizing 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. Initial abnormal urinalysis was found in 4.7% [76/1601] of patients. Upon retesting 1.37% [22/1601] of patients were calculated to have a persistent abnormality. The calculated cost was 1/530/000 Rials [164.5 $] to initially screen all 1601 patients with a dipstick urinalysis or 850 Rials [0.09 $] per patient. The calculated cost to evaluate the 22 patients with any persistent abnormality on repeat dipstick urinalysis was 246/840 Rials [26.5 $] or 11.220 Rials [1.2 $] per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. Multiple screening dipstick urinalysis in asymptomatic pediatric are costly and should be discontinued. We purpose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years old, in all asymptomatic children

Evaluation of clonidine, insulin, L-Dopa, exercise tests on growth hormone in short children

Growth hormone stimulation tests have been used to assess the growth hormone reserve of the pituitary gland in both children and adults. We have assessed the effect of clonidine, insulin, L-Dopa and exercise on growth hormone secretion in 261 short children. The results found in this study revealed that there are no significant differences in these stimulation tests [P=0.28]