Nima Baradaran

The protective effect of diabetes mellitus against prostate cancer: Role of sex hormones

Diabetes mellitus (DM) has been associated with decreased risk of prostate cancer (PC) in several reports. Hormonal environment of diabetic patients is believed to be an important contributing factor in this regard.

Effect of Pelvic Floor Interferential Electrostimulation on Urodynamic Parameters and Incontinency of Children With Myelomeningocele and Detrusor Overactivity

OBJECTIVES To evaluate safety and efficacy of transcutaneous interferential (IF) electrostimulation on voiding symptoms and urodynamic variables in children with myelomeningocele (MMC)-induced refractory neurogenic detrusor overactivity. METHODS Thirty MMC children (18 girls, 12 boys; mean age 5.6 +/- 2.7) with moderate to severe intractable incontinency, detrusor overactivity, and high maximal detrusor end-fill pressure were enrolled and then randomly allocated to treatment (IF stimulation, 20 children) and control (sham stimulation, 10 children) groups. They underwent urodynamic study (UDS) before and after IF and 6 months later, with attention to mean maximal detrusor pressure (MMDP), maximum bladder capacity (MBC), mean detrusor compliance (MDC), postvoiding residue (PVR), and detrusor sphincter dyssynergia (DSD). Daily incontinence score, voiding frequency, and enuresis were also assessed. Eighteen courses of pelvic floor IF electrostimulation for 20 minutes 3 times per week were performed with low-frequency current, duration of 250 microseconds, and repetition time of 6.6 seconds. RESULTS Of the UDS parameters in the treatment group immediately after IF implication, MMDP, PVR, and DSD significantly improved compared with sham stimulation and pretreatment measures (P < .05). In the treatment group, 78% patients gained continence immediately after IF therapy and 60% had persistent continence for 6 months (P < .05). Immediately after IF treatment, urinary frequency and enuresis also improved (P < .05), with a statistically significant difference between the 2 groups. CONCLUSIONS This study demonstrated that noninvasive IF therapy is effective in improving voiding symptoms including incontinence and UDS parameters of MMC children with neurogenic detrusor overactivity. The clinical beneficial implication of this modality is yet to be determined in larger studies.

Cytomegalovirus Infection and Disease Following Renal Transplantation: Preliminary Report of Incidence and Potential Risk Factors

BACKGROUND Cytomegalovirus (CMV) infection and disease are major causes of morbidity and mortality after renal transplantation. However, the incidence and potential risk factors are different in developing countries. We sought to determine the incidence and potential risk factors for CMV infection and disease in our center. We also sought to identify groups of recipients who may benefit from preemptive therapy. MATERIALS AND METHODS Forty renal transplant recipients were monitored regularly for CMV infection within 6 months after transplantation using CMV immunoglobulin (Ig) M and IgG titers, pp65 antigenemia, and CMV DNA by polymerase chain reaction (PCR). Thorough laboratory and physical examinations were performed to detect CMV disease. We evaluated the role of various factors in CMV infection and disease development using Cox regression and Kaplan-Meier statistical models. RESULTS CMV infection and disease were detected in 33 (82.5%) and 10 (25%) subjects, respectively. Average time to infection and disease development was 4.7 and 11 weeks, respectively. PCR was the most accurate method of diagnosis in 22 (67%) cases. By comparison to other recipients, patients who received antithymocyte globulin (ATG) showed a significant decrease in time to disease development (P = .009). Upon multivariate survival analysis, ATG therapy remained an independent risk factor for CMV disease (odds ratio: 6.8; P = .02). CONCLUSION Due to the low rate of progression from CMV infection to disease, it does not seem reasonable to perform preemptive therapy in all infected cases. ATG therapy was an independent risk factor for CMV disease. Recipients of this treatment would be proper candidates to receive preemptive therapy.

Vesicoureteral Reflux and Primary Bladder Neck Dysfunction in Children: Urodynamic Evaluation and Randomized, Double-Blind, Clinical Trial on Effect of α-Blocker Therapy

PURPOSE Primary bladder neck dysfunction has been under diagnosed as a treatable cause of vesicoureteral reflux. We evaluated the effect of prazosin administration on vesicoureteral reflux resolution and urodynamic parameters in children with idiopathic primary reflux and primary bladder neck dysfunction. MATERIALS AND METHODS A total of 62 children (mean ± SD age 7.9 ± 2.4 years) with documented vesicoureteral reflux and urodynamics proved primary bladder neck dysfunction were randomized to receive either 0.025 mg/kg α-blocker (prazosin, 40 patients) or placebo (22) nightly for 1 week with a subsequent increase to 2 divided doses. Patients were followed for 12 months with clinical evaluation and uroflowmetry performed every 2 months, and each patient underwent complete urodynamic study at 6-month intervals. RESULTS In the placebo group no uroflowmetry or urodynamic parameter changed significantly at 1-year followup. A 60% decrease in reflux grade was observed in the treatment group compared to 17% in the placebo group. Mean maximal detrusor pressure, post-void residual and opening time were significantly decreased in both followup sessions in the prazosin group (p <0.05). Average flow rate improved from 4.30 to 12.80 ml per second at 6 months and to 13.10 ml per second at 12 months (both p <0.05). CONCLUSIONS Special attention should be given to secondary causes of vesicoureteral reflux (such as primary bladder neck dysfunction, an underdiagnosed entity in children), since conventional treatment will most likely fail if these conditions are not addressed promptly. In this study prazosin was effective therapy for children with vesicoureteral reflux and primary bladder neck dysfunction.

Role of Resistive Index Measurement in Diagnosis of Acute Rejection Episodes Following Successful Kidney Transplantation

OBJECTIVE This study was performed to evaluate the role of resistive index (RI) in the diagnosis of rejection episodes following successful kidney transplantation. MATERIALS AND METHODS One hundred and one unrelated living first kidney allograft adult recipients (75 males and 26 females) of overall mean age of 39 years were enrolled and prospectively followed for 6 months. The measurement of RI by Doppler ultrasonography was performed in all patients on days 3 and 7 as well as at months 1, 3, and 6 in addition to when there was graft dysfunction. We determined serum creatinine and cyclosporine levels. RESULTS Twenty-seven patients (26.7%) experienced 33 acute rejection episodes during the follow-up. There were significant differences between mean RI among patients with normal function vs rejection: 0.606 +/- 0.065 vs 0.866 +/- 0.083 (P < .05), respectively. Overall, elevated levels of cyclosporine, ischemic acute tubular necrosis (ATN), and renal artery thrombosis were observed in 8, 5, and 3 patients, respectively. No association was observed between these factors and RI. CONCLUSIONS RI was significantly higher in patients with acute rejection episodes. It had no association with ATN or cyclosporine toxicity. Hence, RI may be useful to diagnose acute renal allograft rejection following renal transplantation.

Risk factors associated with occipital encephalocele: a case-control study. Clinical article.

OBJECT An encephalocele is characterized by congenital herniation of the brain tissue and/or meninges through a skull defect. The underlying cause is complex and not fully understood, but environmental agents are suspected. The authors aimed to determine the known risk factors for encephaloceles. METHODS Potential risk factors were studied in 31 children with encephaloceles who had been referred to the outpatient clinic. At the same time, 31 children with non-CNS anomalies were randomly selected from the same hospital as a control group. Both cohorts were assessed in person through interviews with the mothers. RESULTS Most children with encephaloceles were female. There was no significant risk factor in the case group as compared with controls, although the families of patients with encephaloceles had a better economic status (p=0.03) and the fathers had a higher mean age. CONCLUSIONS Although the authors of this study could not identify any significant risk factors for encephaloceles, environmental factors can still be mentioned as probable etiological elements. Additional studies with larger sample sizes and more comprehensive evaluations are required to confirm the role of environmental or genetic factors to prevent the occurrence of encephaloceles.

TH1/TH2 cytokines and soluble CD30 levels in kidney allograft patients with donor bone marrow cell infusion.

OBJECTIVE We investigated the relevance of donor bone marrow cell infusion (DBMI) and serum levels of interferon-gamma (IFN-gamma), interleukin-10 (IL-10), and soluble CD30 (sCD30) in kidney recipients. PATIENTS AND METHODS We analyzed the allograft outcomes correlated with sCD30, IFN-gamma, and IL-10 levels using pre- and posttransplantation sera from 40 live donor renal transplants (20 patients with DBMI [2.1 x 10(9) +/- 1.3 x 10(9) mononuclear cells/body] and 20 controls). RESULTS Patients with acute rejection episodes (ARE)-3/20 DBMI and 6/20 controls-showed increased sCD30 and IFN-gamma as well as decreased IL-10 posttransplantation compared with nonrejectors. Significant differences were observed for sCD30 and IFN-gamma levels: 59.54 vs 30.92 ng/mL (P = .02) and 11.91 vs 3.01 pg/mL (P = .01), respectively. Comparison of pre- and posttransplant levels of IFN-gamma, IL-10, and sCD30 in ARE patients showed higher levels in posttransplant sera except for IFN-gamma in controls (6.37 vs 11.93; P = .01). Increased IFN-gamma and IL-10 were correlated with rejection (r = .93; P = .008). sCD30 correlated with serum creatinine among ARE patients in control and DBMI groups (r = .89; P = .019; and r = 1.00; P < .0001, respectively). CONCLUSIONS Higher levels of sCD30, IFN-gamma, and IL-10 posttransplantation in rejecting patients provided evidence for coexistence of cellular and humoral responses in ARE. There appeared to be a down-regulatory effect of infusion on alloresponses.

Cephalocele: Report of 55 Cases over 8 Years

Objective: Cephalocele is a central nervous system (CNS) birth defect. Various CNS and extra-CNS anomalies, as well as prognostic factors have been reported with cephalocele. The aim of this study was to discuss prognostic factors and current possible theories explaining associated anomalies seen in a series of 55 patients with cephalocele. Methods: A retrospective study was performed using the records of 55 children with cephalocele at the Children’s Hospital Medical Center in Tehran, Iran, from October 2000 through October 2008. Patients’ sex, age at the operation time, characteristics of the lesion including location, size, cerebrospinal fluid leakage, radiological assessments and intraoperative findings (sac contents), intracranial and extracranial associated anomalies, and the last situation of the children were reviewed. Conclusion: A genetic role can be proposed while a female predominance is seen in our results as well as in other reports. CNS and extra-CNS anomalies, as well as several genetic syndromes are not explicable as a causal consequence of cephalocele and the probability of a mere coincidence cannot be ruled out; therefore, we propose that the combination of these anomalies is rather a low-frequency association. Ventriculomegaly was the only poor prognostic determinant in our study, which can compel more severe neuroradiologic studies in such patients as a reasonable prognostic evaluation.

Nonneural congenital abnormalities concurring with myelomeningocele: report of 17 cases and review of current theories.

Objective: Meningomyelocele (MMC) is a common central nervous system birth defect. Various congenital and acquired abnormalities have been reported with MMC, some of which are secondary to the pathophysiology and some are morbidities of the underlying disease. The aim of this study was to discuss current possible theories explaining diverse anomalies/abnormalities seen in a series of 390 patients with MMC. Methods: A retrospective study was performed using the records of 390 patients with MMC at Children’s Hospital Medical Center in Tehran, Iran, from January 2001 to January 2007. A series of 17 cases of MMC with attributed organ anomalies, not explained by a causal effect of the underlying disorder, were compiled. There were 3 cardiac anomalies including ventricular septal defect, pulmonary artery atresia and tetralogy of Fallot, 4 musculoskeletal malformations, consisting of missing rib, polydactylia and complex distal limb anomaly, 4 urological anomalies such as bladder exstrophy, horseshoe kidney and dysplastic kidneys, 2 occipital encephaloceles, 2 congenital adrenal hyperplasia patients with ambiguous genitalia, 1 omphalocele, 1 albinism and 1 Klippel-Feil syndrome. A review of the literature and discussion explaining each of these observations, have been performed and some possible theories have been proposed.Conclusions: Although various organ anomalies with different embryological origin had been observed and reported with MMC, it is difficult to explain their development using one of the current theories of MMC formation. It could be attributed to a possible genetic defect or merely an incidental finding. A teratological insult during the embryogenic phase would be an alternative assumption.

Recurrent meningitis caused by cervico-medullary abscess, a rare presentation.

BackgroundRecurrent bacterial meningitis is usually a complication of cranial anatomical defect or the result of impaired humoral immunity, notably, defects of the complement system and agammaglobulinemia. It could present a diverse range of symptoms.DiscussionMeningitis as a presentation of intramedullary abscess is not common. Here we present a 7-year-old boy with recurrent meningitis as the first manifestation of an underlying upper cervical cord abscess.