[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 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