[ prediction's trend of graft survival in renal transplantation with chronic allograft dysfunction]

Clinically chronic allograft dysfunction [CAD] is characterized by a progressive decline in glomerular filtration rate [GFR] over time, the pattern of disease progression determined by the five-stage model. In this paper, we used Erlang and hypo-exponential distributions as phase- type distributions to describe hazard of kidney failure at over time in RTR with Cad. In a single-center retrospective study, 214 patients with RTR with Cad were investigated at the Emam hospital of Urmia University of medical sciences from 1997 to 2005. Kidney function at each visit assessed with GFR and categorized based on NKF and KCOQI staging system. The estimated hazard rates of disease progression from stage 1 to 2, 0.0378; from stage 2 to 3, 0.04; from stage 3 to 4, 0.0458; and from stage 4 to 5; 0.0541 were respectively based on each expected month. This estimates yield a mean waiting time of disease progression from stage 1 to kidney failure or dialysis 91.63 month. The 18th, 58th, 118th and 155th months of death-censored graft survival were 0.99, 0.75, 0.25 and 0.10 respectively. The findings of this study are compatible with hyperfiltration theory in chronic kidney disease and give us more detailed information about the dynamic process of disease which would help to manage it effictevliy

[Prognostic value of serum T-lymhocyte cytokines for prediction of early acute rejection of renal transplants]

Acute rejection is one of the most important complications after renal transplantation which influences transplant prognosis and survival. This study was conducted to determine the prognostic value of Th1/ Th2 cytokines in acute renal rejection [AR]. This was a cross-sectional study and included 60 kidney transplant recipients [40 male, mean age 38.82], who had received their transplants from live donors. Serum levels of Th-1 dependent cytokines [interleukin- [IL] 2 and interferon-gamma] and Th-2 dependent cytokines [IL-4, IL-10] were measured on the day before, 7th and 14th days post transplantation using ELISA. All the patients received Immunosupressive agents including cyclosporine, mychofenolate mofetile and prednisolon. Acute rejection was defined as a more than 50 percent rise in serum creatinin in the first 20 days after transplantation. Data were introduced into SPSS soft ware and analyzed by means of independent T-test. Among 60 patients, 40 were male. The mean age of the patients were 38.82 years. In our study we diagnosed twelve cases of AR [20% of the cases]. There was no significant relation between the serum levels of IL2, IL4, IL10 and IFN zeta in the patients with acute rejection of the transplant and those without. These data showed that there is no correlation between Th1/ Th2 serum cytokines profile and early AR episodes in kidney transplantation and these cytokines can not be used as prognostic factors in acute renal rejection

[ evaluation of total antioxidant capacity and related markers in patients with chronic peritoneal dialysis]

Oxidative stress due to overproduction of reactive oxygen species and impairment in antioxidant defense mechanisms have been suggested as possible factors contributing to the pathogenesis of atherosclerosis in patients with end- stage renal disease. The aim of this study was to evaluate antioxidant markers of oxidative stress including glutathione and glutathione related enzymes [i.e. glutathione peroxidase [GPx] and glutathione reductase [GR]] as well as total antioxidant capacity in peritoneal dialysis [PD] patients. Twelve PD patients and 17 healthy controls [age range: 25-60 and 22-53 years respectively] were selected. Erythrocyte glutathione levels and plasma activities of GPx, GR and total antioxidant capacity were determined spectrophtometrically. Glutathione levels and GPx activity were significantly lower in the patients group than in controls [1.17 +/- 0.28 vs. 1.42 +/- 0.25 micro mol/ml and 57.1 +/- 21.8 vs. 142.5 +/- 31.7 U/L; p<0.05, respectively]. Higher levels of GR activity and total antioxidant capacity were noted in patient group [57.5 +/- 16.4 U/L and 0.60 +/- 0.09 micro mol/ml; respectively] in comparison to control group [32 +/- 9.4 U/L and 0.47 +/- 0.11 micro mol/ml; p<0.05, respectively]. Decreased glutathione levels and alteration in the activities of its related enzymes imply increased oxidative stress and disturbances of antioxidant defense systems in peritoneal dialysis patients. This condition may contribute to the development of accelerated cardiovascular disease and its morbidity and mortality in these patients

[ case report of ruptured spontaneous heterotopic pregnancy]

Heterotopic pregnancy refers to the simultaneous occurrence of pregnancy intrauterine and outside of uterine corpus. It is most often manifested in women who have undergone artificial reproductive technology [ART] but rarely occurs spontaneously. Heterotopic pregnancy still remains as a diagnostic and therapeutic challenge to practitioners. In this situation physicians should have high suspicion for diagnosis and intrauterine pregnancy protection. This study reported a case of ruptured spontaneous heterotopic pregnancy. A 32 year-old woman with abdominal pain, nausea, vomiting and hypovolumic shock in 1386 referred to emergency department in Sanandaj hospital. She reported one previous cesarean section. On examination, the patient's abdomen was distended. She had generalized tenderness and rebound tenderness in abdomen. The ultrasonographic examination revealed large amount of fluid in pelvic and abdominal cavity with a large hematoma in right adnex but there was intrauterine pregnancy at 7 weeks with normal fetal heart activity. She underwent laparotomy for heterotopic pregnancy and ruptured tube with tubal pregnancy removed. Intrauterine pregnancy continued without problem and led to birth of a healthy female neonate. Physicians should be quite cautious of heterotopic pregnancy in woman at reproductive age. Any abnormality on physical examination or ultrasonography of a patient with intrauterine pregnancy and abdominal pain should heighten the clinician's suspicion for heterotopic pregnancy

[ report of a schizophrenic patient with several dysmorphophobic complaints and somatic delusions]

Dysmorphophobia means fear of deformity and is characterized by a subjective feeling of ugliness or physical defect. It may by itself be a separate entity or may be a symptom of an underlying disorder, like schizoprenia. We report a case of schizophrenia who presented with several dysmorphophobic complaints including disturbance in the knees, teeth irregularity, nose deformity etc. His dysmorphophobic complaints were secondary to primary somatic delusions. Several unnecessary surgical and medical procedures were done for him. It is suggested that when physicians encounter patients who place unusual medical and surgical demands should get assured of the patient's mental health before initiating any treatment