Report of a documented case of encapsulating peritoneal sclerosis in Iran

Encapsulating peritoneal sclerosis [EPS] is a rare, acquired condition that has been described interchangeably with peritoneal encapsulation [PE] as well as abdominal cocoon. EPS causes complications for peritoneal dialysis [PD] patients. In EPS, the small intestine is covered by a fibrotic and inflammatory peritoneal capsule that either partially or completely encases the bowel. For EPS, there is no agreement in the literature as to whether the treatment of choice should be surgery or conservative therapy. However in the obstructive phase the treatment of choice is surgery due to the impossibility of conservative treatment. Here, we report the case of a 64-year-old woman who presented with several episodes of intestinal obstruction and peritonitis. Computed tomography [CT] of the abdomen did not show significant characteristic features of EPS. Exploratory laparotomy was performed, freeing the small bowel of adhesions and encapsulation. For EPS, adequate clinical knowledge and a high degree of suspicion are crucial for a correct diagnosis and appropriate management

Role of dipstick in detection of haeme pigment due to rhabdomyolysis in victims of Bam earthquake

Avoiding life-threatening complications of rhabdomyolysis depends on early diagnosis and prompt management. The aim of this study was to evaluate the role of urinary dipstick test in the detection of haeme pigment in patients who were at risk of acute renal failure [ARF] due to rhabdomyolysis after suffering injury in the Bam earthquake. Serum creatine phosphokinase [CPK] level was used as the gold standard for prediction of ARF. ARF developed in 8 [10%] of 79 patients studied. We found no significant differences in the sensitivity, specificity and accuracy of dipstick urine and serum CPK tests for identifying patients who were at risk of ARF. However, dipstick urine test is an easy test that can be performed quickly at an earthquake site

Serum cystatin C as a new marker of glomerular filtration rate [GFR]

Cystatin C is a 13 KD basic protein that is a member of the cystatin super-family of cysteine protease inhibitors. The cystatin C gene seems to be a house keeping gene, which is compatible with a stable production rate of cystatin C by most cells. This protein is freely filtered through the glomerulus and almost completely reabsorbed and catabolized by proximal tubular cells. Because of these characteristics cystatin C is assumed to be a better marker of glomerular filtration rate than other markers. 115 new cases of renal disease aged between 14 and 88 years and 121 healthy subjects, aged between 11 and 78 years were studied. In all of the subjects serum cystatin C and creatinine were determined and creatinine clearance was determined only in patients. Cystatin C was determined by a particle-enhanced turbidimetric assay and creatinine was measured by Jaffe's method. In addition, to assess the diagnostic efficiency of serum cystatin C in comparison to that of serum creatinine and creatinine clearance in predicting changes in GFR, we performed Tc99m - DTPA clearance on 53 subjects including controls and patients. A linear relationship was found between Tc99m - DTPA clearance and Y serum cystatin C [r= 0.712, p-value <0.001], 1/serum creatinine [r= 0.709, p-value< 0.001] and creatinine clearance [r= 0.777, p- value <0.001]. Diagnostic accuracy in the identification of reduced GFR measured as area under the receiver-operating characteristic plot was 0.878 +/- 050 [Mean +/- SE] for Scystatin C, 0.866 +/- 0.051 for creatinine and 0.866 +/- 0.051 for creatinine clearance. The serum cystatin C reference values [mean +/- 1.96 SD] determined was 0.83 -0.88 mg/L. A cutoff cystatin C concentration of 0.82 mg/L had 92% sensitivity and 79% specificity for detecting abnormal GFR. There was no significant correlation between cystatin C and age [p- value <0.219] and weight [p- value <0.193]. This study demonstrates that serum cystatin C has an increased diagnostic accuracy for reduced GFR when compared with serum creatinine and creatinine clearance. Hence, cystatin C seems to be an alternative for the estimation of GFR