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

Outcomes of kidney transplantation in patients with systemic lupus erythematosus: a single-center study

This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus [SLE] and a matched control group of non-SLE kidney recipients. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. In each group, 12 patients [36.4%] received a kidney from a deceased donor, 15 [45.4%] from a living unrelated donor, and 6 [18.2%] from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 +/- 18.1 days in the SLE group, while it was 13.0 +/- 7.3 days in the controls [P = .006]. One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients [P = .17]. One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls [P = .26]. Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications [P = .59]. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys

Primary realignment of posterior urethral rupture

We report the results of treatment of posterior urethral rupture [PUR] by primary realignment with some modifications of the technique. In this prospective study, 25 patients [mean age, 33.5 years; range, 18 to 70 years] in whom PUR had been proved underwent primary urethral realignment. All patients were evaluated postoperatively for urinary incontinence, erectile dysfunction, and urethral stricture. They were followed for a mean of 20 months [range, 9 to 27 months]. In 20 of 25 patients [80%], posterior urethral rupture was associated with pelvic fractures and in 2 [8%], bladder rupture was also present. None of the patients had urinary incontinence. Six patients [24%] had evidence of postoperative stricture that required urethral dilatation and/or direct vision internal urethrotomy in 2 or 3 procedures under local anesthesia. Erectile dysfunction was reported by 4 patients [16%] as a decreased quality of erection, all of whom responded to sildenafil. We believe that primary realignment of PUR is a simple procedure associated with low morbidity. It is recommended for patients who are stable and have no other significant intra-abdominal and pelvic organ injuries