Hamed Jalaeian

Effect of Zinc Supplementation on Triglyceride, Cholesterol, LDL, and HDL Levels in Zinc-Deficient Hemodialysis Patients

Introduction. Zinc deficiency is known to occur in widely diverse areas of world. It has now been recognized in many disease states, such as ESRD patients on maintenance hemodialysis (HD). The purpose of this research was to study the effects of zinc supplementation on the concentration of serum zinc, total cholesterol, triglyceride, and cholesterol fractions (HDL, LDL) in HD patients. Patients and Methods. In a double blind trial, the effects of oral zinc supplementation on the serum concentration of zinc, total cholesterol, HDL and LDL cholesterol, and triglyceride in HD patients were evaluated. Results. After 42 days, the mean serum zinc concentration among participants in the zinc-supplemented group increased. There was a significant elevation in the serum total cholesterol and also in mean the serum LDL and HDL cholesterol and serum triglyceride for the subjects in the zinc-supplemented group. Discussion. A suboptimal level of the serum total cholesterol concentration is a factor associated with malnutrition and morbidity in the HD patients. Maintenance HD patients with both low serum zinc and low serum total cholesterol concentrations may benefit from zinc supplementation. Therefore, it is advisable to obtain baseline measurement of the serum zinc and total cholesterol concentrations in maintenance HD patients.

Ruptured Meckel's Mesodiverticulum and Meckel's Diverticulum following Blunt Abdominal Trauma

Objectives: To present a case of simultaneous rupture of Meckel’s diverticulum and mesodiverticulum with abdominal pain following a blunt trauma to the abdomen, sustained during an automobile accident. Clinical Presentation: Following a head-on automobile collision a 36-year-old man was referred to the emergency room with abdominal pain, guarding and rigidity and was taken to the operating theater with a preoperative impression of peritonitis due to rupture of a hollow viscus. Upon abdominal exploration, ruptured Meckel’s diverticulum (from the base) and ileum with active bleeding from mesodiverticulum was found. Intervention: The ileum was repaired in two layers: a segmental bowel resection including Meckel’s diverticulum and the gastrointestinal tube anastomosed without any tension. The patient has a normal postoperative course. Conclusion: This case shows that a blunt abdominal trauma can tear the mesodiverticulum and rupture the Meckel’s diverticular base simultaneously, resulting in hemoperitoneum and chemical peritonitis. Diagnosis and management of this type of injury are basically the same as those of acute surgical abdomen following trauma.

Ischemic Preconditioning Protects the Dog Kidney from Ischemia-Reperfusion Injury

Objective: To evaluate the effects of unilateral ischemic insult and ischemic preconditioning (IPC) on renal histology in a canine model. Methods: 30 dogs were randomized into 4 groups. In group A (5 male controls) and group B (5 female controls), ischemia was induced by clamping both left renal arteries for 40 min. Dogs in group C (10 male cases) or group D (10 female cases) underwent 5 min of arterial clamping and 10 min of declamping prior to the final 40-min ischemia induction. Renal biopsy was prepared 48 h later and microscopically examined. Results: The control groups (A and B) developed 40% frank necrosis, 60% moderate injury, and there was no intact renal tissue in this group with no difference between sexes. The IPC groups (C and D) revealed 55% moderate injury and 45% normal pathology; however, there was no frank necrosis among them. Better IPC protection in the female group was not statistically significant. Conclusion: An IPC schedule of 5-min ischemia and 10-min reperfusion improves ischemia-reperfusion injury from subsequent prolonged ischemia in a canine model.

Management of infrarenal duplicated inferior vena cava during living related kidney transplantation.

Congenital anomalies of the inferior vena cava (IVC) arerelatively rare pathologies, usually with an asymptomaticcourse.During open donor nephrectomy, we incidentallyfound two left infrarenal duplicated IVCs (Fig. 1):In the first case, left infrarenal IVC was sacrificed. Leftkidney was harvested with a normal length renal vein(Fig. 2a). The recipient had uneventful post-op course.Only mild edema was seen in his donor, around pelvisgirdle and proximal left thigh, persisting for 2 weeks.In second donor, we divided left renal vein more prox-imally with an acceptable short renal vein to preserve thecontinuity of left IVC (Fig. 2b). Both donor and recipienthad good renal function and no surgical complication onfollow-ups was seen.DiscussionCongenital anomalies of IVC are usually diagnosed bychance during surgery. From bioptic material their inci-dence has been estimated to be 2–3% [1]. The frequencyof accidental intraoperative finding in different series var-ies between 0.2% and 0.6%. Caval duplication and a leftpositioned vena cava are the most common incidentalanomalies [2]. They are known to be associated with var-ious urogenital tract anomalies such as horseshoe kidneysand circum-aortic renal collar [3,4].Nowadays, in many transplant centers, helical CT angi-ography and MR angiography have replaced conventionalangiography. They give a better view of the renal paren-chyma and the computer reconstruction shows the arter-ial anatomy as well. Ureteric and renal anomalies are alsoseen well with these methods; the accuracy is 95% andthey are quicker and cheaper [5].Up to now, few cases with complete duplication ofIVC have been reported to be found during live donornephrectomy (LDN) [6,7]. In previous literature, onlyone case with infrarenal duplicated IVC was found thatwas managed as the first case in this report [8]. They didnot mention any complication in post-op course. How-ever, as we mentioned earlier, due to ligation of left IVC,our first case suffered from edema. In complete duplica-ted IVC, usually each kidney drains to the ipsilateral IVCand nephrectomy has no effect on limb drainage. How-ever, infrarenal duplicated IVC is totally different, as ipsi-lateral limb drains partially or totally to renal vein andligation of this vein compromises drainage of limb, atleast early in post-op. So, it seems reasonable to take thesecond surgical technique.We advise to perform imaging technique in LDN. Ifthe donor has duplicated IVC, it is essential to carefullyconduct advance imaging techniques to investigate otherpossible anomalies and blood flow of the renal vein.Although it is preferred to use kidney with longer renalvein, the graft must be carefully selected so it is not dis-advantageous to the donor.Hamid Reza Davari, Seyed Ali Malek-Hosseini,Heshmatollah Salahi, Ali Bahador, Saman Nikeghbalian,

Combined Use of Growth Hormone and Gonadotropin-Releasing Hormone Analogue in Short Normal Adolescent Girls: A Survey from Iran

Combined therapy with gonadotropin‐releasing hormone (GnRH) analogue and growth hormone (GH) has been used to increase the height of adolescents who are not GH deficient and who have normally timed puberty. Its use, however, is still controversial. For 2 years simultaneously, we treated eight healthy girls with very low predicted adult height (PAH < 145 cm) who were entering into normally timed puberty. The GnRH analogue triptorelin pamoate (Decapeptyl, 100 μg/kg intramuscularly every 4 weeks) and GH (0.1 IU/kg/day subcutaneously, 6 days/week) were administered. The mean chronologic age (CA) of our patients was 11.01 ± 0.95 years, and mean bone age (BA) was 12.25 ± 1.13 years. With a height of 131.50 ± 5.83 cm (−2.37 ± 0.35 SD below the mean) and PAH of 140.87 ± 3.53 cm, they were all in Tanner stage 2‐3 of puberty (except one patient in stage 4). In all cases, GH and thyroid hormone deficiency were ruled out before the study began. Height and BA were measured immediately after discontinuation of therapy. PAH was determined before and at the end of therapy. Combined treatment resulted in a 4.13 ± 1.19 cm increase in PAH (p < 0.01). Height increased significantly to 142.66 ± 3.54 cm at the end of treatment (p < 0.01). Height standard deviation score for CA increased from −2.37 ± 0.35 to −2.32 ± 0.67, showing no significant improvement (p = 0.5). Height age (HA)/BA ratio and BA/CA ratio both demonstrated significant growth during the treatment (p < 0.03 and p < 0.01, respectively), whereas HA/CA ratio did not improve significantly (p < 0.32). During treatment, puberty was completely suppressed in all cases. Combination therapy with GnRH analogue and GH resulted in significant improvement in height and PAH during therapy. Additional, and perhaps more long‐term, studies are required to show whether this kind of treatment is effective in improving final adult height. The cost‐benefit of such therapies should also be taken into account.

Extravesical seromuscular ureteroneocystostomy: an effective and simple operation for treatment of vesicoureteral reflux

Purpose: To evaluate the success rate of extravesical seromuscular ureteroneocystostomy in the treatment of children with vesicoureteral reflux (VUR). Patients and Methods: In a prospective study from August 2005 to January of 2006, 15 patients (11 girls, 4 boys), median age of 9.5 years (range: 1–24 years), with high-grade VUR underwent operation. Urinary tract ultrasonography and voiding cystoureterography (VCUG) were the main diagnostic tools to detect VUR before the operation and at 3 months after the operation. Results: No VUR was detected at evaluation of 3-month postoperative VCUGs (14 cases, 93%). However, one child (7%) still had persistent VUR. This patient underwent reoperation and the length of the seromuscular tunnel was increased more with a favorable result. The overall success rate of this technique was about 93%. Conclusion: Extravesical seromuscular ureteroneocystostomy is simple and effective method for the treatment of VUR in children.

Influence of atopic history on cord blood IgE.

eosinophilia, interstitial lung disease, necrotic nodule), and serositis (pleural effusion, pericarditis, pleuropericarditis, myocarditis).2 Respiratory pathologies generally arise after diagnosis of IBD. However, they may arise simultaneously or previously.9 Abnormalities of PFT in IBD are not so common. Obstructive and restrictive disorders and bronchial hyperreactivity can be observed.2,4,10,11,12 These findings become obvious especially in the activation period of the disease. A restrictive disorder was present in only one (5%) of our patients. However, the majority (64%) of our patients were in a remission period. Bronchial hyperreactivity in the range of 17% to 45% was detected in different studies.13,14 We detected hyperreactivity in 29% of our cases. Abnormalities such as bronchiectasis, air-trapping, tree-in-bud appearance, and ground glass opacity may be observed in HRCT even when there is no respiratory symptoms in IBD.4,9,10 Songur et al found no relationship between HRCT pathologies and PFT.7 Our study also yielded no correlation between HRCT pathologies and PFT. Alveolitis may be lymphocytic, neutrophilic, or eosinophilic according to the presence of bronchiectasis, associated granulomatous disorders, drug usage and smoking.4,15,16 Our study demonstrated lymphocytic and neutrophilic alveolitis in 40% and 6.6%, respectively. Ground glass opacity, neutrophilic alveolitis, and restrictive-type PFT were observed all together in one patient. Tracheobronchial involvement has been defined in tracheal mucosa biopsies of patients with Crohn’s disease.6 Tracheobronchitis may be an extraintestinal manifestation of Crohn’s disease and it responds very well to inhaled budesonide therapy. Camus et al have shown an intense infiltration of lymphocyte and plasma cells in mucosa biopsies.9 Karadag et al have identified lymhocyte infiltration, fibrosis and thickening in alveolar septas.4 Submucosal inflammatory cell infiltation was identified in 2 of our cases. In conclusion, there was no relationship between the radiological and hystopathological findings of the respiratory system in IBD patients. In our study, this may be due to the small number of cases. However, even in the absence of respiratory symptoms, cases with IBD should be evaluated for pulmonary involvement because extraintestinal involvement is frequently observed in IBD.