Death in the Eyes of the Beholder

The US Uniform Determination of Death Act provides two alternatives for determining death the circulatory criteria and the neurological criteriayet history and the public's current understanding of death in the US may mean that only brain death criteria can be relied upon without raising public suspicion that the medical profession is sacrificing the well-being of one group of patients [i.e., those dying after traumatic injury] to save another group [i.e., those in need of organs]. The problem is exacerbated by existing debate on the appropriate waiting time after which death is inevitable and when the brain should be actually considered dead through prolonged absence of autoresuscitation. Given the difficulty of definitive determina- tion of the time when brain function has ceased, two solutions are proposed: abandon the Dead Donor Rule or redefine death. Implementing the former would mean convincing the public to accept organ harvesting before the dying patient is completely brain dead through the writing of advance directives to permit organ harvest when death is inevitable though not confirmed. For the latter, reeducation would be necessary to persuade the public to accept the circulatory criteria for death as an independent determinant for death or the medical community would need to reconsider if the cessation of higher brain function is enough to be the basis for determining death. In conclusion, organ retrieval policies, no matter how medically sound, should seek to avoid the possibility of a public backlash that could result in fewer organs available for trans- plant

relative frequency, clinical and laboratory findings of adult glomerulonephritidies in Tehran

Renal diseases information is population-based and has great geographic variability. Due to the lack of national renal data registry system, there is no information on the prevalence rate, and clinical and laboratory features of various glomerulonephritidies [GNs] in Iran. In a retrospective cross sectional study, we analyzed 462 adult renal biopsies in Hashemi Nejad hospital, Tehran, Iran. We determined the prevalence rate and the frequency of different clinical and laboratory findings in patients with different GNs. We also compared our results with the reports from other countries. There were 267[57.8%] males and 195[42.2%] females. The mean age [ +/- SD] was 33.6 +/- 15.7 [range, 13-75] years old. After exclusion of 55 biopsies with pathologies other than GNs and in the remaining 407 biopsies, membranous glomerulopathy [MGN] was the most common GN [23.6%], followed by IgAN [13.5%], membranoproliferative GN [11.5%], systemic lupus nephritis [10.6%], focal segmental glomerulosclerosis [10.3%], and minimal change disease [9.8%]. These 6 GNs comprised the majority [79.4%] of all GNs. MGN is the most common form of GN, followed by IgAN, MPGN, SLE-GN, FSGS and MCD in adult patients in our study. The multi-center studies with a larger sample size are needed for more comprehensive data in Iranian population

Primary hyperoxaluria: report of four cases and review of the literature

In this paper we will present four cases of primary hyperoxaluria. All patients had a significant past medical history of polyuria [with or without microscopic hematuria] and polydypsia. All patients had a family history of their parents being cousins. Initial evaluation of all patients by ultrasound and plain abdominal films revealed nephrocalcinosis. Their clinical courses showed gradual loss of renal function over the follow-up years. We will also review primary hyperoxalurias and their management in this report

Management of severe hyperkalemia

A 22 year old male referred with palpitation. General appearance and physical exam impressed us in that the patient has Marfan syndrome. Cardiac catheterization showed diffuse arterial ectasia. We found no previous report of this generalized diffuse ectasia

Myotonic muscular dystrophy with bilateral uveitis and swan neck deformity of fingers

Myotonic muscular dystrophy [MMD] is a heredofamilial disease with multi-system involvement. In particular, it involves the skeletal muscles [as well as cardiac and smooth muscles], eye, cranial bones and the endocrine system, while other organs such as the gastrointestinal system,skin, and respiratory system are less frequently involved [1,2]. The disease is inherited in an autosomal dominant manner with complete penetrance and highly variable expression.It has a prevalence rate of 3-5/100,000 [2,4]. The symptoms appear from birth to 60 years of age [the majority in the second decade of life] [4,5]. In the large series of 67 cases presented by Pruzanski [1],males comprised 61% of the cases while in other series male to female ratios have been 1:5 [6] and 1:1 [7]. The patient reported below suffered from progressive HMD. In addition, during the course of his disease he developed bilateral uveitis and severe swan neck deformity of all fingers both of which have not been reported in English literature in association with MMD