ABSTRACT
Nephrocalcinosis is defined as calcium deposition in the renal interstitium. One of the major causes of neonatal nephrocalcinosis is the use of calcium and phosphor supplements for premature neonates. This study aims at assessing the effects of calcium and phosphor supplementation in neonatal nephrocalcinosis by renal ultrasonography. In this randomized controlled trial, 37 premature neonates with birth weights <1500 g or a gestational age of <34 weeks were considered. Two different doses of calcium 75 vs. 230 mg/kg/day and phosphor 50 vs. 110 mg/kg/day were prescribed and laboratory and sonographic data were then documented and evaluated. The incidence of nephrocalcinosis was 47.8% in group 1 and 28.6% in group 2. There was a significant association between NC and positive family history of renal stones, shorter duration of TPN and NICU stay. The amount of calcium dosage, gestational age, birth weight, sex, use of surfactants, and mechanical ventilation did not have any significant association with NC. In this study, the neonates with NC were mostly the white flake type [8 cases] and the majority of the lesions were 1-2 mm. All the lesions were located in the pyramid and papilla areas, acoustic shadows were not prevalent and stones were not observed in any of the patients
ABSTRACT
In patients who undergo median sternotomy to treat congenital heart diseases, a thymectomy is performed to yield better access to the cardiac system. In this study we have used MRI to evaluate the changes in size, shape and location of the thymus after midsternatomy. This case-control study was performed during 2011-2012 in Shiraz, Iran. Eligible participants between 5-17 years of age were divided into case and control groups [n=13 per group]. Each participant underwent a median sternotomy at least one year prior to study entry. Participants were initially examined by a cardiologist and then referred for MRI. A radiologist examined all MRI images. The thymus was observed in all control group patients and in only 7 [53.8%] patients in the case group. There was a significant relationship noted in terms of mean age in the group whose thymus was visible and the group in which the thymus was not visible. We have observed no significant difference in thymic visibility between these two groups based on the mean age at midsternatomy. In pediatric patients undergoing cardiac surgery the possibility of remaining or regenerated thymic tissues may be evaluated by MRI. The remaining portion of the thymus may have any shape, size or location. Therefore, it can be misinterpreted as a mass if a patient's previous surgical history and age at the time of surgery are not taken into consideration
ABSTRACT
A number of pharmacological methods are being used for preserving the function of the transplanted kidney; however, their effects on the future performance of these kidneys remain controversial. We aimed to compare the effects of different methods of induced diuresis on the function of transplanted kidneys. This randomized, controlled, double-blind trial was conducted among 140 candidates of renal transplantation. They were randomly assigned into four equal groups of 35 patients each: control group [receiving furosemide and mannitol], group receiving dopamine, group receiving aminophylline, and group receiving a hyperosmolar solution containing dextrose and sodium bicarbonate [forced diuresis group]. To assess renal function, urine volume, creatinine clearance, urinary sodium excretion, and serum creatinine were measured. Data were analyzed using SPSS software. Pearson correlation and analysis of variance [ANOVA] tests were used as appropriate. Age and gender distribution of kidney graft recipients and donors of transplanted kidneys had no statistically significant difference among the four studied groups. During the first postoperative day, creatinine clearance was significantly higher in the groups receiving either dopamine or forced diuresis compared with other groups. Likewise, in the first 2 hours after surgery the mean urinary output and creatinine clearance were significantly higher in the groups receiving either dopamine or forced diuresis. The stimulation of transplanted kidneys by dopamine and using forced diuresis were the best methods in increasing the surrogate markers of renal function, i.e. urinary output, and creatinine clearance. They may be suggested as methods of choice for supporting the function of transplanted kidneys
ABSTRACT
Laryngoscopy and endotracheal intubation is usually associated with hemodynamic changes increases in blood pressure and heart rate. We aimed to compare the hemodynamic effects of combined use of low dose thiopentone and propofol during induction of anesthesia with conventional dose of thiopentone and propofol separately. This trial was conducted prospectively among 90 candidates, American Society of Anaesthesiologists grade-l [ASA-I], scheduled for elective surgery, with an age range of 20-50 years. Selected patients were randomly assigned to three equal groups. Thiopentone was used in group 1, propofol in group 2, and a combination of low dose thiopentone and propofol in group 3 as an induction agent. Heart rate and blood pressures were measured non-invasively at five different times: prior to the injection of study drugs, three minutes after the last injection of induction drug and immediately before the laryngoscopy and endotracheal intubation, as well as at the first, third and fifth minutes after endotracheal intubation. The adjusted mean values of systolic blood pressure, diastolic blood pressure, and heart rate were assessed by paired comparisons, by considering the variable of time; all changes were significantly different between Groups 1 and 2. Moreover, changes in systolic and diastolic blood pressures were significantly different between Groups 1 and 3. They were not significant for heart rate. No significant difference was documented between Groups 2 and 3; showing that in these groups the hemodynamic changes were small during drug injection, laryngoscopy, and intubation as well as until five minutes after endotracheal intubation. The combined use of low dose thiopentone and propofol for anesthetic induction caused less hemodynamic changes than the higher dose of either alone. This modality of anesthesia induction may have clinical importance for the elderly patients as well as those with high blood pressure and heart diseases
ABSTRACT
Heparin is the only widely used pharmacologic agent for anticoagulation during coronary artery bypass graft surgery [CABG]. Failure of adequate and prompt heparin reversal by protamine sulfate can result in hemodynamic instability. Protamine has various side effects. Clemastine as an H1 receptor blocking agent shows positive inotropic effect but not some side effects of non-sedative antihistamines such as cardiac arrhythmia. The aim of this study was to evaluate the effect of clemastine on several hemodynamic responses after protamine sulfate administration in patients subjected to CABG. In a prospective randomized controlled trial, 60 patients aged 34-87, with the ASA class II to IV and cardiac ejection fraction >/= 50% who subjected to elective CABG were enrolled to two equal groups. Patients in group 1 received normal saline [2ml] intravenously as placebo before the operation was completed. Patients in group 2 received clemastine 2 mg [2ml] intravenously at the same time as group 1. After the operation all patients received slowly infusion of protamine sulfate within 7 minutes, through peripheral vein. Change of MAP in 5 minutes after protamine administration was clinically significant in group 1. No drop in MAP in 5 and 10 minutes after protamine administration was seen in group 2. There was a significant increase in heart rate in 5 and 10 minutes after protamine administration in group 1. There was no significant rise in heart rate before and after protamine administration in group 2. Clemastine can prevent MAP decrease after protamine administration in patients subjected to coronary artery bypass graft surgery