[Post transplant erythrocytosis and the effect of treatment with enalapril]

Post transplant erythrocytosis [PTE], defined as a hematocrit level of above 51 percent, is a multifactorial condition common in renal transplant recipients. Traditional therapies include repeated phlebotomies, bilateral native nephrectomies, and anticoagulant therapy. The aim of this study was to evaluate the efficacy of ACE inhibitor on PTE. This analytic outcome study was done on all transplant patients referred to Shaid Rahnemoon hospital [Yazd, Iran]. Hematocrit [HCT] and hemoglobin were assessed in two blood samples taking from the patients. Patients with HCT >51 were selected and studied for other causes of polycythemia. Not finding other causes, the patients were diagnosed as PTE and received Enalapril tab [5 mg /daily]. Blood pressure, HCT and Hb of these patients were recorded during next 3 months [30, 60, 90th post-treatment days]. Among 126 referred patients, 47 patients had erythrocytosis [37 males [86%] and 6 females [14%]] that shows a higher prevalence in comparison with other studies. All patients responded to Enalapril treatment. Before treatment, mean hemoglobin and hematocrit were 18.35 +/- 0.59 gr/l and 55.96 +/- 1.90mm respectively, while after 3 months treatment with Enalapril, hemoglobin and hematocrit decreased to 16.7 +/- 0.5 mg/l and 48.73 +/- 1.42 mm respectively. Enalapril is an effective treatment of PTE and can prevent the need for phlebotomy or nephrectomy in these patients

[Measurement of anterior-posterior diameter of IVC by ultrasonography: a non invasive method for estimation of central venous pressure]

The assessment of intravascular volume in severely traumatized patients or patients admitted in ICU is very essential. At present the accurate method for estimating the intravascular volume requirement is by measuring the CVP which is an invasive method. The measurement of IVC diameter by ultrasound has been suggested as an easily available and simple method for measuring the intravascular volume status. The purpose of this study was to compare the results of IVC diameter measurement by ultrasonography and CVP measurement for calculating the intravascular volume in ICU admitted patients. This was a descriptive and prospective stud]' including 50 patients admitted in ICU with a central Venous catheter placed for any reason whatsoever and no signs of increased right atrial pressure. CVP was measured in supine position by CVP manometer. The anterior- posterior IVC diameter was assessed by ultrasonography during inspiration and expiration. Data analysis was performed by SPSS and evaluated statistically with Pearsons regression and linear correlation test. The mean CVP at inspiration and during expiration was 11.35 +/- 5.53, 12.20 +/- 5.65 cm H2O, respectively. The mean of inspiratory and expiratory IVC diameter was 7.71 +/- 3.5, 11.37 +/- 3.28 mm, respectively. There was significant correlation between CVP and IVC diameter both during inspiration [r= 0.64, p-value= 0.001] and expiration [r=0.495, p-value=0.001] The result of this study suggests that IVC diameter measurement by ultrasound can be used as a reliable and non- invasive method for estimating the intravascular volume