Intravenous pamidronate for refractory lymphedema

Based on beneficial reports of pamidronate use for reflex sympathetic dystrophy in reduction of pain and swelling, this drug can be studied as a novel treatment for refractory lymphedema. This study aims to determine the effectiveness of pamidronate on lymphedema and its possible side effects. Twelve cases of lower limb refractory lymphedema were enrolled. They received intravenous pamidronate monthly for 3 consecutive months and were followed by measuring any discomfort with visual analog scale [VAS] and physician global assessment, based on objective signs of limb volume and circumference. The limb volume, circumference, and satisfaction of the patients improved significantly. Pamidronate when is added to conservative treatments may reduce lymphedema and improve the patient's comfort

[Comparison of sedative effect of midazolam and propofol in patients with renal failure]

Peritoneal dialysis [PD] is a form of dialysis which is used mostly in children. Insertion of PD devices catheter needs a sedation and midazolam and fentanyl usually are used for this purpose. In some studies propofol also used as a sedative in renal failure patients, hospitalized in intensive care units [ICU]. No study has been conducted so far on comparison of midazolam with propofol in patients. Therefore, this study was aimed to compare the sedative effect of midazolam and propofol in the patients with renal failure, used PD device. In this clinical trial study, a total of 44 patients aged ranged 18-65 years, with physical condition of class III and IV [based on ASA classification] and with chronic renal failure who needed peritoneal dialysis catheter were randomly designated into two groups of 22 individuals. The first group was injected with propofol [50 mg/kg] and fentanyl and the second one with midazolam [50 mg/kg] and fentanyl. Then, using Ramsay score, sedation score and vital markers, before and after the intervention, were evaluated. The required clinical symptoms were obtained using an appropriate questionnaire and using Man-Whitney and t test, the data were analyzed. According to the results of this study propofol induced a higher sedation level than that of midazolam [P<0.001]. There was no significant difference in O2 saturation between the two groups. Blood pressure and pulse rate in the group received propofol were [P<0.001] decreased whereas in the group received midazolam were increased [P<0.05]. The mean of pain, based on visual analog scale [VAS], in the groups received propofol and midazolam was 2.68 +/- 0.49 and 3.64 +/- 0.4, respectively [P<0.05]. Durations of recovery in the groups received propofol and midazolam were 25.86 +/- 2.98 and 31.68 +/- 3.12, respectively [P<0.01]. Based on the results, the patients received propofol had more relief and less pain than those received midazolam. Thus, propofol is suggested to be used in the patients with renal failure who need PD catheterization

Fasciotomy versus amputation in patients with compartment syndrome in Bam earthquake victims

Compartment syndrome following the injuries in earthquake is a big problem and may cause amputation and psychological problems. The aim of this study was evaluation of the effects of fasciotomy on the prognoses of these patients, especially for the function of the limbs and the function of the kidneys. In a clinical trial all patients referred to Alzahra hospital in Isfahan city from the Bam earthquake area, were taken part in this study. The compartment pressure were measured and following suitable liquid therapy, they were fasciotomized. Then, the bloodshed, infections, fever and the prognoses of the operation especially the need for amputation were recorded. The kidney function was also evaluated by measuring the creatinin. Twenty patients out of 255 patients referred to Alzahra hospital, from the Bam earthquake had compartment syndrome in 26 limbs. This patients were fasciotomized. The average of their age was 36.1 years and 55% of them were female. 1.1 cases had pulses in their limbs. However, all of them had hardness and inflammations in their limbs, without any function. Before surgery, 5 patients had increased blood creatinin. 2 months after surgery, all patients had normal kidney function. 3 patients had amputation. Fasciotomy in patients with compartment syndrome may rescue patients limbs, without any significant adverse effects on their kidney function, and is recommended for all patients with this particular problem