[Electrocardiographic changes due to hyperkalemia in patients with acute and chronic renal failure undergoing chronic hemodialysis]

Hyperkalemia is a common disorder among renal failure patients and is considered as an important internal medicine emergency. On the other hand, considering the non-specific symptoms of hyperkalemia and its similarity to the underlying diseases' symptoms, the occurrence of dangerous side effects is probable. One of the most important effects is on myocardium. Considering the immature mechanism of potassium conformity in confrontation with hyperkalemia in Acute Renal Failure [ARF] patients, the toxic effects of hyperkalemia occurs in lower potassium levels. The aim of this study is comparing the EKG changes due to hyperkalemia in patients with acute and chronic renal failure undergoing chronic hemodialysis. The recent study was an analytic cross-sectional one performed on patients hospitalized in hemodialysis ward in Hashemi Nejad, Shohadaye-hafte- tir and Rasoul Akram hospitals, during 1382-1383. The serum electrolyte levels and EKG changes of 138 patients with End Stage Renal Disease [ESRD] who were under chronic hemodialysis and 91 patients with ARF, who were hospitalized in different wards, were measured and evaluated, using SPSS V.11 software and t and Chi Square tests Among 229 patients, 138 [60%] were ESRD patients who were under chronic hemodialysis and 91 [40%] had acute renal failure. The mean potassium level in ARF and ESRD patients were 5.66 +/- 1.2 and 5.77 +/- 0.91 mE/l which did not differ significantly [p=0.4]. In EKG evaluations, the mean height of T wave, R wave and T/R ratio in ARF patients were 6.3 +/- 2.4 mm, 5.7 +/- 2.1 mm and 1.3 +/- 0.9 mm respectively. These data in ESRD patients were 6 +/- 2.2 mm, 5.6 +/- 2.3 mm and 1.2 +/- 0.78 mm. No significant difference was seen among two groups [P = 0.3, 0.8 and 0.7]. In ARF and ESRD patients, there was a significant relationship between peaked tall T wave frequency and hyperkalemia severity [p<0.001]. In the simultaneous presence of hyperkalemia and hypocalcemia, peaked tall T wave frequency, mean of R wave height and T/R ratio in ARF and ESRD groups were not significantly different. On the other hand, in the coincidence of hyperkalemia and hyponatremia peaked tall T wave frequency and T/R ratio in ARF and ESRD groups were significantly different. [P <0.05] Severe hyperkalemia, hyperkalemia in the setting of ARF and the simultaneous presence of hyperkalemia and hyponatremia may increase the probability of cardiac changes. These groups of patients who undergo hemodialysis need vigorous care considering the cardiac complications

Assessment of ketamine effect as adjuvant to morphine in post- operative pain reduction in donor kidney transplanted

Morphine is a strong analgesic agent being used in acute pain but adverse effects may lead to its discontinuation before sufficient pain relief is obtained. Ketamine is an anti-nociceptive drug which blocks N-Methyl-D-Aspartate receptors and can modulate acute pain. In this study, ketamine effect as an adjuvant with morphine for post-operative pain management is evaluated. In a double blind randomized clinical trial, 50 kidney donors undergoing nephrectomy and receiving morphine as analgesics were enrolled. Patients were divided into two groups receiving ketamine [ketamine group] and saline serum [placebo group]. Post-operative pain was assessed by measuring cumulative morphine consumption and visual analog scale pain scores were assessed in 48 hours duration after surgery. Pain intensity and cumulative morphine consumption were lower and sedation score was higher in the ketamine group. Both groups were similar regarding the side effects. Regarding post-operative analgesia management, ketamine administration improved pain intensity and when its administration was continued for 48 hours post-operatively, there was a significant decrease in morphine consumption

Pulmonary langerhans cell histiocytosis presenting as simultaneous bilateral spontaneouse pneumothorax in a non-smoker patient

Pulmonary Langerhans Cell Histiocytosis [PLCH] is a rare idiopathic disorder that primarily affects young adult cigarette smokers. Affected patients often present with cough and dyspnea and about 20% of patients present with or later develop pneumothorax. It is striking that more than 90% of patients are smokers. We report a very unusual case of PLCH in a 20-year- old male patient with no smoking history in whom a life- threatening complication such as simultaneous bilateral pneumothorax was the presenting feature. The final diagnosis was made by open surgical biopsy and recurrent pneumothoraces necessitated surgical management with pleurodesis. We emphasize the early use of pleurodesis in managing patients with PLCH and spontaneous pneumothorax

Acute lupus peritonitis associated with massive ascites

Systemic lupus erythematosus [SLE] is an autoimmune disease with multiple organ involvements and abdominal pain as the most common gastrointestinal symptom. Herein, we describe a case of SLE presented with abdominal pain and massive ascites that had a good response to the high dose of prednisolone

Pulmonary metastases: results of surgical resection in 60 cases: treatment modalities other than surgery are needed

Pulmonary metastases occur in 30% of all oncology patients. Surgical resection of lung metastases is a widely accepted procedure but long-term results are disappointing with a 5-year survival rate of 20-40% and the results vary with the histologic type of the primary tumor. Due to unavailability of any study regarding pulmonary metastasectomy in Iran and emergence of new treatment modalities, reassessment of our current practices is essential. We performed a retrospective study of 60 cases of pulmonary metastasectomy during a 5-year period in one of the major thoracic surgery centers in Tehran [Imam Khomeini Hospital]. Bilateral metastases were present in 23% of cases, number of metastases in each patient ranged from 1-12. Average disease-free interval was 12 months, pneumonectomy rate was 21.7% mostly as a second or third attempt and finally, recurrence or death following initial metastasectomy occurred in 12-18 months in most patients. These results confirm that surgery remains unsuccessful in obtaining long-term survival or cure in most patients with pulmonary metastases and treatment strategies other than surgery, such as radiofrequency ablation are needed to avoid performing multiple operations in these patients and improving their quality of life

[Safety and efficacy of stenting in malignant esophageal obstruction: a prospective study]

Palliative procedures in esophageal cancer to restore swallowing are preferable to- major surgery in most cases. The aim of this prospective study was to provide further information on treatment techniques, complications, and survival in the patients with malignant esophageal obstruction undergoing endoscopic palliative therapy using Self-Expanding Metal Stents [SEMS]. Patients with obstruction of the esophagus secondary to carcinoma who referred for stenting with SEMS between October 2004 and July 2005 were studied. In all cases the tumor was considered non-respectable and the stage of the disease was III or IV. All patients had aphagia or severe dysphagia to liquids and saliva, due to which, stenting was indicated. A follow-up in 1-11 months was taken, with physical and laboratory examinations. Symptom relief, survival rate, and complications were analyzed using Wilcoxon signed ranks test and student t-test by SPSS software version 10.0. Results were considered statistically significant for p<0.05. Between October 2004 and July 2005 twenty two stents were placed under fluoroscopic guidance in 19 patients [13 males and 6 females with mean age of 65.5+/-12.6 years] with the obstruction of the esophagus secondary to carcinoma. Technical success rate was 100%. The dysphagia score improved significantly in a month after stenting [p=0.001]. During this time period, appetite score of the patients was not improved significantly [p=0.070]. Major immediate complications including severe pain occurred in two patients [10.5%]. Eight [42.1%] patients died. The survival rate was 68.4%, 63.2% and 57.9% for 3, 6 and 9 months, respectively. Our results suggest that self-expandable metallic stent placement is a simple, quick, safe and efficient method to palliate esophageal carcinoma obstruction and its implantation will efficiently palliate dysphagia. The major problem of these patients, however, seems to be loss of appetite due to the underlying disease