Evaluation of caspase 3 enzyme and TNF-alpha as biomarkers in ureteropelvic junction obstruction in children- a preliminary report

Objective: To determine the applicability of urinary caspase 3 enzyme and TNF-alpha as biomarkers in children with ureteropelvic junction obstruction [UPJO]

Methods: In this study, 31 unilateral UPJO patients and 33 age- and sex-matched healthy childrens were enrolled. The patients with UPJO consisted of 11 female and 20 male children between the ages of 2 to 62 months old. All participants were evaluated regarding anterior-posterior[AP] diameter and cortical thickness of affected kidney by ultrasonography. Technetium DTPA renal scan and voiding cystourethrogram[to assess vesicoureteral reflux] were performed, pre-operatively. Also, urinary levels of TNF-alpha and caspase 3 enzyme were checked. Follow-ups included measurement of aforementioned indices in patients: AP diameter and cortical thickness of the affected kidney, as well as TNF-alpha and caspase 3 levels in urine, three and six months after pyeloplasty

Results: The results showed highly significant decrease in urinary TNF-alpha and caspase 3 enzyme [P values < 0.01], approaching the level measured in children without UPJO after six months. Significant decrease in AP diameter and increase in cortical thickness were also noticed [P values < 0.01]

Conclusion: The results of this study strongly support that TNF-alpha and caspase 3 levels in urine can be used for improvement monitoring in follow-up of UPJO patients after pyeloplasty and can also be potentially used as determining indices for surgical plan but more studies, especially in patients who are not surgical candidates are needed to confirm our observaitons

Efficacy of dexamethasone on postoperative analgesia in children undergoing hypospadias repair

Background and Objective: Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery

Methods: In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg [n=23] or placebo [normal saline] [n=19] during the operation. Penile block was performed in both groups using Bupivacaine 0.5% [1mg/kg] at the end of the procedure. By the end of the operation, FLACC [Face, Leg, Activity, Cry, Consolability] pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea /vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours

Results: The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different [P<0.000]. The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different [z= 4.57, p<0.000]. The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption [Chi2= 31.4, p<0.000]

Conclusion: Single dose of intravenous dexamethasone [0.5 mg/kg] in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone

Analgesic effects and safety of desmopressin, tramadol and indomethacin in patients with acute renal colic; a randomized clinical trial

Objective: To compare the efficacy of desmopressin [DDAVP], tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis

Methods: This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including 120 patients [70 men and 50 women, mean age 38.2 +/- 5.8 years] referring to emergency room of Shahid Faghihi hospital with renal colic caused by urolithiasis without any previous treatment. The patients were randomly assigned to three groups: groupAreceived tramadol 50mg intramuscularly [n=40], groupBreceived desmopressin 40 [micro]g intranasally [n=40] and group C received indomethacin 100mg rectally [n=40]. The pain was assessed both on admission and 30 minutes after the intervention. The pain intensity and the side effects were compared between two study groups

Results: There was no significant difference between two study groups regarding the baseline characteristics. The intensity of pain of presentation was almost similar in all groups. In group A, 30 patients [75%], in group B, 15 patients [37.5%] and in group C, 19 patients [47.5%] had complete pain relief. The pain intensity decreased significantly after the intervention within all three groups [p<0.001]

Conclusion: According to the results of the current study, rectal indomethacin, intramuscular tramadol and intranasal desmopressin are effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis. Tramadol was the most effective agent in controlling the pain

Stereological Comparison of the Effects of Pentoxifylline, Captopril, Simvastatin, and Tamoxifen on Kidney and Bladder Structure After Partial Urethral Obstruction in Rats

PURPOSE: Limited studies have shown antifibrotic effects of pentoxifylline, captopril, simvastatin, and tamoxifen. No comparisons are available of the effects of these drugs on prevention of renal and bladder changes in partial urethral obstruction (PUO). MATERIALS AND METHODS: The rats were divided into six groups (n=7). The sham-operated rats (group I) only underwent laparotomy and did not receive any treatments. The PUO groups (group II-VI) received normal saline (PUO+NS), pentoxifylline (100 mg/kg/d; PUO+PEN), captopril (35 mg/kg/d; PUO+CAP), simvastatin (15 mg/kg/d; PUO+SIM), or tamoxifen (10 mg/kg/d; PUO+TAM) by gavage for 28 days. Then, the volume and/or length of the kidney components (tubules, vessels, and fibrous tissue) and the bladder components (epithelial and muscular layers, fibrous tissue, fibroblast and fibrocyte number) were quantitatively evaluated on the microscopic sections by use of stereological techniques. RESULTS: The volume of renal and bladder fibrosis was significantly ameliorated in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. Also, the volume and length of the renal tubules and vessels and bladder layers were more significantly protected in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. CONCLUSIONS: Treatment of PUO with PEN was more effective in the prevention of renal and bladder fibrosis and in the preservation of renal and bladder structures.

Which Patients Are at Higher Risk for Residual Valves After Posterior Urethral Valve Ablation?

PURPOSE: To find patients at high risk of obstructive remnant leaflets after valve ablation among boys with posterior urethral valve (PUV), we evaluated any possible relationship between preoperative findings in our patients and residual obstructive leaflets after valve ablation. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 55 patients with PUV that was treated by the same surgeon between 2008 and 2012. Of these, 37 patients (67.3%) had no obstructive remnant leaflets (group A) and 18 patients (32.7%) had obstructive remnant leaflets (group B) in follow-up cystoscopy. Preoperative clinical and radiological findings were evaluated and compared between the groups. RESULTS: Among all the preoperative data we examined, the analysis revealed that age at the time of surgery (median age: group A, 15 months; group B, 7 months; p=0.017), echogenicity of kidneys (p<0.05), presence of vesicoureteral reflux (p<0.05), and grade of reflux (p<0.05) were significantly different between the groups. Method of valve ablation, anterior-posterior diameters of the renal pelvis, renal cortical thickness, bladder wall thickening, and scarring on the dimercaptosuccinic acid scan showed no significant differences between the two groups. CONCLUSIONS: In our patients, younger age at surgery time, hyperechogenicity of renal parenchyma, presence of vesicoureteral reflux, and grade 4 or 5 reflux before surgery had a significant relationship with residual valves. More studies may result in enhanced management of patients at high risk of residual valves after PUV ablation, because the sooner the obstruction is resolved entirely, the better the outcome.

Catheter related bladder discomfort comparison of ketamine and tolterodine; for reduction of catheter related bladder discomfort

Bladder discomfort is a common side effect after surgical procedures that involve either extensive bladder dissection or prolonged postoperative catheter drainage. Various treatments have been tried with varying degrees of success for managing this adverse effect. In this study we compared the efficacy of ketamine and tolterodine in prevention of catheter induced bladder discomfort. Three hundred patients who were scheduled for open prostatectomy or transurethral resection of prostate [TURP] were randomized into three groups. The first group received placebo, the second one received tolterodine before operation, and the third group received ketamine 250 ig/kg IV, just before the anesthesia induction. Bladder discomfort was assessed by anesthesiologist who was unaware of the type of medication. The assessment was done on arrival in the post anesthesia care unit [PACU] and then at 0, 1, 2 and 6 hours after patient's consciousness. Severity of discomfort was recorded as none, mild, moderate, or severe. The absence or presence of adverse effects were recorded. The data were analyzed using SPSS and Pearson chi-squared and ANOVA tests were applied for further statistical evaluations. Both the incidence rate of bladder discomfort and its severity in the control group was significantly higher compared with ketamine and tolterodine groups [P<0.001]. Comparing the ketamine and tolterodine groups, tolterodine had lead to lesser degree of bladder discomfort at 0, 1, 2 hours, while ketamine was more effective at 6 hours. Pretreatment with either ketamine or tolterodine is effective in decreasing the incidence and severity of catheter related bladder discomfort in patients under going open prostatectomy or TURP

Age specific reference levels of serum prostate-specific antigen, prostate volume and prostate specific antigen density in healthy Iranian men

It is relevant to highlight that there is not a precise and perfect report on either 95 percentile value [upper limit of normal range] or on appropriate reference intervals for serum PSA in Iranian population. To determine age-specific reference ranges for serum prostate-specific antigen [PSA] concentration and PSA density [PSAD] and prostate volumes in a population of healthy Iranian men. Nine-hundred and thirteen healthy Iranian men, aged 50-79 years, underwent a detailed clinical evaluation including a digital rectal examination, a serum PSA determination [DRE] and transrectal ultrasound [TRUS]. PSA test was performed on 666 of the subjects and TRUS was done on 633 of them. None of the subjects had any evidence of prostate cancer by any one of the three diagnostic tests and had no history of Lower Urinary Tract Symptoms [LUTS]. Age specific ranges for PSA levels, PSA density and prostate volume were determined. The serum PSA concentration correlated directly with the subjects' age [r=0.280; p < 0.001] and prostatic volume [r=0.327; p < 0.001]. Also prostatic volume was directly proportional to age [r = 0.197; p < 0.001].The serum PSA ranges [95th percentile] for each age range in Iranian men were: 0.00-2.61 ng/ml for 50-59 years; 0.00-3.59 ng/ml for 60-69 years; and 0.00-4.83 ng/ml for 70-79 years. The respective prostate volumes were: 14-59, 16-66 and 18-73ml. Also respective PSA densities were: 0.00-0.076, 0.00-0.10 and 0.00-0.14 ng/ml/ml. The present study confirms earlier reports that serum PSA levels and prostate volume and PSAD are age- and race- dependent, so it is appropriate to have age- specific reference ranges for these variables in various communities around the world. This will increase the positive predictive value of PSA estimation in the diagnosis of prostate cancer in different communities

[Detection of staphylococcus aureus enterotoxin type C isolated from healthy carriers by PCR]

Staphylococcus aureus is a pathogen which can cause food poisoning under certain conditions though growth in nutrients and producing enterotoxin. Only some strains are capable of producing enterotoxin and causing food poisoning and their presence can be detected by DNA amplification and gene sequence specification. Therefore, this research was conducted to detect type C enterotoxinproducing staphylococcus aureus. 95 staphylococcus aureus strains were isolated from 150 nasal carriers using sterilized swabs and were confirmed by biochemical tests. Then primers were designed and the PCR was used to amplify amplify the staphylococcal enterotoxin C gene [sec] in order to detect type C enterotoxogenic strains. DNA amplification fragments of 397 bp for staphylococcal nuclease and those of 271 bp for type C gene were confirmed by enzymatic digestion. Only 9.5% of the isolated strains contained sec gene. Specificity and sensitivity were also evaluated and its sensitivity was found to be 125 cells. This technique is a rapid, sensitive, specific, inexpensive and different alternative to conventional biochemical and serologic assays and it can be used to detect the agent producing type C staphylococcal enterotoxin