Multifocal cranial plasmablastic lymphoma as a rare manifestation of posttransplant lymphoproliferative disorder.

We present an unusual case of a young woman who developed multiple cranial masses and unilateral facial palsy 10 years after a successful living-unrelated kidney transplant. She was diagnosed with diffuse large B-cell plasmablastic differentiated lymphoma, a rare form of posttransplant lymphoproliferative disorder. She responded to 5 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy with resolution of all cranial masses. However, her facial palsy did not resolve, and she died 6 months after diagnosis with pneumonia and sepsis.

Simvastatin ameliorates gentamicin-induced renal injury in rats.

Gentamicin nephrotoxicity is one of the most common causes of acute renal failure. Simvastatin is one of the antioxidative drugs, which has anti-inflammatory and anabolic effects and modulates the immune system. The present study was conducted to assess the effect of simvastatin on ameliorating the gentamicin-induced renal injury in 87 Sprague-Dawley rats, which were allocated randomly to 11 study groups: (A) and (B) groups with only gentamicin in 2 dosages; (C), (D), and (E) gentamicin 50 mg/kg/day and simvastatin with different dosage; (F), (G), and (H) gentamicin 80 mg/kg/day and simvastatin with different dosage; (I) only simvastatin; (J) Injected normal saline; (K) control (no gentamicin and no simvastatin) group. Our study intervention period for injection of drugs was 12 days. Serum creatinine level and clearance were measured in all groups. At the end of the study, the rats were killed and both kidneys were removed and processed for histopathologic examination using the standard methods. The 50 mg/kg/day dose was utilized because it induces a mild form of renal toxicity, whereas the 80 mg/kg/day dose cause a more severe degree of renal injury. Morphologic examination of specimens from all rats was qualitatively assessed with blindness to treatment groups and proximal tubular profiles that were presented in each file were counted. The results demonstrated amelioration of gentamicin-induced renal toxicity in rats by simvastatin due to its antioxidant drug dose-related effect.

Practical strategies to reduce morbidity and mortality of natural catastrophes: a retrospective study based on Bam earthquake experience.

BACKGROUND: Critical analysis of shortcomings of emergency medical management of earthquake casualties will provide an invaluable insight to improve outcomes for future events. Using a critical analysis methodology to evaluate the quality of emergency medical management after Bam earthquake, we suggest a practical strategic approach to decrease morbidity and mortality after such events. METHODS: We designed a questioner to register the basic demographic data and the key biologic parameters of all rescued victims arriving in hospitals. Based on that questioner a data bank was created and used for different analyses. In addition, published official reports and on the scene observations of our nephrologist colleagues were other sources of our data. RESULTS: Bam earthquake was publicly announced more than six hours after its occurrence. The earliest time when local and international rescue teams arrived at the scene was 12 hours after the disaster. Fifty-four percent of hospital inpatients had been admitted on the second or third day after the earthquake. The mean time of being under the rubble was 4.8+/-4.9 hours. The mean time between extrication and initiation of intravenous fluid infusion was 18.9 hours (min: 10 minutes, max: 96 hours). CONCLUSION: Problems encountered in the aftermath of the Bam earthquake were related to the lack of prepared action plan and data management system. Here, we present a specifically designed earthquake chart. By following the chart, rescue paramedic personnel and emergency medical teams will be able to recognize high-risk victims, in order to provide timely medical management.

Epidemiologic aspects of the Bam earthquake in Iran: the nephrologic perspective.

BACKGROUND: Acute renal failure is a serious, preventable, and potentially reversible midterm complication after mass disasters. In 2003, an earthquake struck Bam, Iran. This article studies the epidemiologic aspects of the earthquake from a nephrologic perspective. METHODS: A questionnaire was sent to the reference hospitals. The resulting database of 2,086 traumatized patients hospitalized in the first 10 days was analyzed. RESULTS: Mean age was 29.0 +/- 15.6 years. Compared with the resident population, the percentage of patients was lower among children and teenagers younger than 15 years and higher among young and middle-aged adults (P < 0.001). There was no significant difference between mean ages of patients with acute renal failure and other patients. Time under the rubble was longer for patients with acute renal failure (6.2 +/- 4.1 versus 2.1 +/- 3.9 hours; P < 0.001). These patients were hospitalized later (3.1 +/- 2.8 versus 1.5 +/- 1.7 days after the disaster; P < 0.001) and longer (16.7 +/- 12.8 versus 12.5 +/- 11.3 days; P < 0.001). Sepsis (11.6% versus 0.5%), disseminated intravascular coagulation (7.3% versus 0.3%), adult respiratory distress syndrome (9.1% versus 1.4%), fasciotomy (38.9% versus 1.9%), amputation (6.1% versus 0.5%), and death (12.7% versus 1.9%) were markedly more frequent among patients with acute renal failure (P < 0.001 for all). CONCLUSION: Hospitalized patients were mostly young and middle-aged adults. Patients with acute renal failure were entrapped longer and hospitalized later and for longer periods. Medical complications, surgical procedures, and mortality were greater in the latter group. Early extrication and quick hospitalization with appropriate multidisciplinary care are cornerstones to prevent acute renal failure and its subsequent mortality in earthquake conditions.

Noscapine suppresses angiotensin converting enzyme inhibitors-induced cough.

BACKGROUND: Dry cough is a common side-effect of the angiotensin converting enzyme inhibitors (ACEI) and is a major limiting factor of their use. It has been suggested that ACEI cause this side-effect by potentiation of the bradykinin effect. Previous work in our laboratory has shown that noscapine, an antitussive drug, inhibits the effect of bradykinin. METHODS: To investigate the effect of noscapine on ACEI-induced cough, 611 hypertensive patients who were being treated with ACEI were evaluated for the incidence of persistent dry cough. RESULTS: A cough had developed in 65 (10.6%) patients, two (3.1%) of whom also had severe respiratory distress that required hospitalisation and immediate discontinuation of the ACEI. Forty-two (64.6%) patients had developed a mild cough and 21 (32.3%) patients had developed a moderate to severe cough. The patients with moderate to severe cough received 15 mg of noscapine, orally three times daily, while they continued ACEI. Noscapine effectively resolved the cough in 19 (90%) patients within 4-9 days of starting treatment. CONCLUSION: Noscapine, possibly by inhibition of bradykinin synthesis, eliminates ACEI-induced cough in the majority of patients and allows them to continue with ACEI therapy.

Reversible acute renal failure associated with hypothyroidism: report of four cases with a brief review of literature.

We present four adult cases of acute renal failure associated with hypothyroidism. All patients presented with symptoms suggestive of moderate to severe hypothyroidism, such as cold intolerance, constipation, muscle weakness, and lower extremity oedema. Initial serum creatinine levels ranged between 115 and 203 micromol/L (1.3 and 2.3 mg/dL), with creatinine clearances (CrCl) ranging between 0.58 and 0.97 mL/s (34.5 and 58 mL/min). After 6-12 weeks of treatment with levothyroxin, serum creatinine levels decreased to the range of 80 and 124 micromol/L (0.9 and 1.4 mg/dL) and CrCl increased to 0.74-1.64 mL/s (44-98 mL/min). One patient had proteinuria of 800 mg/day, which decreased to the normal range (<200 mg/day) after levothyroxin treatment. One patient developed acute gouty arthritis before normalization of thyroid-stimulating hormone (TSH), which was successfully managed with prednisone therapy. All of our patients had increased creatine kinase (CK), ranging between 1000 and 2360 U/L (normal range, 22-165 U/L), which normalized after 6 weeks of levothyroxin treatment.