To provide data on the distribution of intraocular pressure (IOP) in an Iranian population. Metho... more To provide data on the distribution of intraocular pressure (IOP) in an Iranian population. Methods: Through a population based, cross sectional study, 4565 Tehran citizens were studied in the Tehran Eye Study. The findings from the participants (n = 3834) aged 10 years and older free of glaucoma diagnosis or suspicion who had undergone applanation tonometry examination are presented. All participants received a standardised protocol including applanation tonometry, fundus examination, demographic data, and an interview. IOP measurement was used to evaluate its distribution by age, sex, and some eye parameters. Results: Mean (SD) IOP was 14.5 (2.6) mm Hg in the total population, 14.4 (2.7) in men, and 14.5 (2.5) in women. Mean (SD) IOP in people >40 years was 15.1 (2.9) mm Hg. IOP increased significantly with age and cup:disc ratio except for a fall in old age. This relation was also observed when individuals without diabetes or hypertension history were analysed. IOP increased with darker eye pigmentation except for blue/grey eyes. There was a non-linear increase in IOP from emmetropic to high myopic eyes. Conclusion: Age, iris colour, and cup:disc ratio were related to IOP but not to sex. The distribution of IOP in this study was different from various other studies in different geographical regions and it seems advisable to employ a geographical approach to normal IOP interpretation.
Background: The aim of this study was to provide data, on the distribution or intraocular pressur... more Background: The aim of this study was to provide data, on the distribution or intraocular pressure (IOP) in Tehran population. Materials and Methods: Through a population-based, cross-sectional study, a total of 4565 Tehran citizens were studied in the Tehran Eye Study. The findings of the participants (n=3834) 10 years and older free of glaucoma diagnosis or suspicion who had undergone applanation tonometry examination are presented. All participants received a standardized protocol included applanation tonometry, and some other ocular measurements, fundus examination, demographic data and an interview. IOP measurement was used to evaluate its distribution by age, sex, and some eye parameters. Results: Mean ± SO IOP was 14.5±2.6 in the total population, 14.4±2.7 in men, and 14.5±2.5 in women. Normal range (mean±2SD) of IOP was determined to be 9.3 - 19.7 mmHg. IOP increased significantly with age and cup-disc ratio except for a fall in old ages. This relationship was also observed when we analyzed individuals without diabetes or hypertension history. IOP increased with darker eye pigmentation except for blue/gray eyes. There was a non-linear increase of IOP from emmetropic to high myopic eyes. Conclusion: Mean and/or normal range of IOP and their associations have been reported with wide differences in various studies. It is wise that studies evaluate IOP distribution or associations in healthy people and glaucoma people separately and also report the prevalence of IOP risk factors in their population to allow for a logical comparison of studies.
*Corresponding Author: Mehrnaz Rasolinejad Iranian Research Center for HIV/AIDS, School of Medici... more *Corresponding Author: Mehrnaz Rasolinejad Iranian Research Center for HIV/AIDS, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Tel: +98 21 66581598, Fax: +98 21 66581598, E-mail: [email protected] ... Evaluation of Depression in ...
PURPOSE To determine the number of percutaneous nephrolithotomy (PCNL) operations which are requi... more PURPOSE To determine the number of percutaneous nephrolithotomy (PCNL) operations which are required to achieve competence or excellence. MATERIALS AND METHODS One hundred and five consecutive PCNL operations performed by a fellow in endourology, with no previous experience in performing solo PCNL, were studied. Operation duration, stone extraction percent, stone-free rate, number of access, tubeless cases, and complications were studied in sequential groups of 15 patients as the surgeon gained experience. RESULTS Operation duration decreased from the mean of 95.4 minutes in the first to 15th patients to 78.3 minutes in the 31st to 45th patients, and then remained unchanged. Minor complications were only observed in the first to 45th patients. Stone extraction percent increased from the mean of 88.3% in the first to 15th patients to 99.3% in 91st to 105th patients. Percentage of patients with no residual fragments decreased from 53% in the first to 15th patients to 6.7% in the 91st ...
Purpose: Evidence suggests that androgens can be involved in the pathogenesis of renal stones. Th... more Purpose: Evidence suggests that androgens can be involved in the pathogenesis of renal stones. This study aimed at investigating coding region polymorphisms and CAG repeats in androgen receptor (AR) and their association with active renal calcium stone disease. Materials and Methods: Male patients with calcium kidney stones ( N = 106) with at least two episodes of stone recurrence or size increase during the past 5 years (ASF) were enrolled from December 2008 to April 2009. Control individuals were recruited after matching for age and gender from healthy individuals without current stone or history of stone disease. Genetic sequencing and single strand conformational polymorphism (SSCP) were used to determine AR polymorphisms in the patients and controls. Results: Two polymorphisms were identified in the AR gene: Silent G to A polymorphism in the first exon of the AR gene and C to G polymorphism in intron 4. CAG repeats ranged from 12 to 37. The C/G polymorphism in intron 4 and CAG ...
Background Open trigonoplasty antireflux operation has been associated with promising results. Ho... more Background Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. Methods All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Pre-Operative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients’ DRNCs were used to judge for reflux relapse. Results Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and pat...
Background: We aimed to compare the efficacy of a new bedside screening test named acromioaxillos... more Background: We aimed to compare the efficacy of a new bedside screening test named acromioaxillosuprasternal notch index (AASI) with modified Mallampati (MMP). Methods: A total of 603 adult patients, who were candidates for tracheal intubation in elective surgery, were enrolled in this prospective study. Preoperative airway assessment was carried out with AASI and MMP. The new AASI score is calculated based on the following measurements: (1) using a ruler, a vertical line is drawn from the top of the acromion process to the superior border of the axilla at the pectoralis major muscle (line A); (2) a second line is drawn perpendicular to line A from the suprasternal notch (line B); and (3) the portion of line A that lies above the point where line B intersects it is line C. AASI is calculated by dividing the length of line C by that of line A (AASI ¼ C/A). After induction of anesthesia, the laryngeal view was recorded according to the CormackeLehane grading system. Receiver operating characteristic curve analysis was employed to compare between AASI and MMP. Results: Difficult visualization of larynx (DVL, CormackeLehane III and IV) was observed in 38 (6.3%) patients. The best cutoff point for DVL was defined at AASI > 0.49. AASI had a lower false negative rate and higher predictive values (sensitivity, positive predictive value, and accuracy) in comparison with MMP. Conclusion: AASI was associated with higher predictive values than MMP and could be used for estimation of DVL.
Introduction: In this study the full sequence of the calcitonin receptor gene (CALCR) in a group ... more Introduction: In this study the full sequence of the calcitonin receptor gene (CALCR) in a group of Iranian males suffering from recurrent calcium urinary stones was compared with that of a control group. Methods: Serum and urinary biochemistry related to urolithiasis were evaluated in 105 males diagnosed with recurrent kidney calcium stones and 101 age-matched healthy control males. The polymerase chain reaction single-strand conformation polymorphism method was used to detect new polymorphisms in the CALCR. Results: Nine polymorphisms were detected; seven were in the non-coding and two in the coding region. The T allele associated with the 3′UTR+18C>T polymorphism was observed exclusively in the stone formers. The exact odds ratio for the T allele in this locus for those at risk of stone formation was 36.72 (95% CI 4.95-272.0) (p < 0.001). The mean (standard deviation) urine calcium concentration was 117 (60) mg/l in patients with the C allele and 152 (72) mg/l in those with...
Introduction: This study was designed to evaluate factors contributing to failure in Gil-Vernet a... more Introduction: This study was designed to evaluate factors contributing to failure in Gil-Vernet antireflux operation. Materials and Methods: 96 patients (150 refluxing units; median (range) age, 60 (12–180) months; M/F, 11/85) with primary vesico-ureteral reflux were included. Trigonoplasty was done according to a modified Gil-Verent procedure. Relapse was diagnosed on the postoperative direct radionuclide cystography (DRNC) 3 or 6 months after operation. Demographic and intraoperative data were used to assess factors contributing to failure. Results: Resolution of reflux in postoperative DRNC was observed in 87 patients (90.6%) and in 138 refluxing units (92.0%). In patients who were followed 3–6 months, one relapse occurred (3%) versus 8 relapses in those who were followed 24–39 months (12%). Relapse in refluxing units was related to the history of voiding symptoms (30 vs. 3%, p < 0.001), history of breakthrough infections (20 vs. 3%, p = 0.001), golf or stadium like ureteral o...
Objectives: We evaluated the impact of sleep position on the effectiveness of shock wave lithotri... more Objectives: We evaluated the impact of sleep position on the effectiveness of shock wave lithotripsy (SWL) in renal calculi. Patients and Methods: Patients (n = 120) with a single radiopaque renal stone who were candidates for SWL were enrolled. For studying patients’ position during sleep, a novel sleep position recorder was designed. Group 1 (n = 60) consisted of patients who slept preferentially on the ipsilateral side of the stone; group 2 (n = 60) comprised patients who slept preferentially on the contralateral side. Treatment effectiveness was defined as the absence of residual stones >3 mm up to 3 months after SWL. Results: The mean (range) percent of sleep on the ipsilateral side of the stone was 61.5% (51–78) and on the contralateral side it was 62.4% (51–81) in groups 1 and 2, respectively (p > 0.05). The overall success rate of SWL was 88.3% (77.4–95.2) and 70.0% (56.8–81.2) in groups 1 and 2, respectively (p = 0.01). Stone clearance increased with an increasing per...
Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, ... more Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position. Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure. The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%. Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.
The aim of this study was to evaluate the postoperative serum sodium changes after percutaneous n... more The aim of this study was to evaluate the postoperative serum sodium changes after percutaneous nephrolithotomy (PCNL) with half-strength saline irrigation. PCNL operations from June to August 2008 were included. PCNL was performed according to the standard prone position with fluoroscopic guidance. Patients received 0.3% saline-3.3% dextrose by intravenous infusion in the first 24 h after operation. Serum sodium was measured before the operation and at 6, 24 and 48 h after the operation. 96 patients were included. Serum sodium slightly decreased from preoperative 140.3 ± 2.8 mEq/l to 140.1 ± 3.6, 139.1 ± 3.4 (p \ 0.01) and 139.3 ± 2.7 (p \ 0.05) at 6, 24 and 48 h after the operation, respectively. Half-strength saline irrigation does not result in considerable change in the postoperative serum sodium in simple PCNL operations. The use of intravenous solutions with hypotonic sodium is discouraged in PCNL patients with the possibility of high volume absorption of hypotonic irrigation fluid.
The purpose of this study was to evaluate the impact of vitamin D receptor (VDR) gene polymorphis... more The purpose of this study was to evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active renal calcium stone formation. Male active renal calcium stone formers (ASF, final N = 106) with two episodes of stone relapse in the past 5 years were enrolled from December 2008 to April 2009. Controls (N = 109) were selected from age range-and gender-matched individuals who had no evidence or history of stone disease. Sequencing and single-strand conformational polymorphism were used to determine VDR polymorphisms in the patients and controls. Three polymorphisms were identified in the VDR gene: (1) start codon polymorphism (rs2228570T[C; p.M1T); (2) C/T polymorphism in the second intron (NT-029419.12: g.10416049C[T); (3) a silent polymorphism in exon 9 (rs731236T[C; p.I352I). Start codon polymorphism was the only one that was associated with the status of calcium stone formation (p \ 0.05). We performed a complete coding genome analysis of VDR gene and observed that only start codon polymorphism was related to the status of active calcium stone formation.
Long-term effects of percutaneous nephrolithotomy (PCNL) on renal function have been evaluated in... more Long-term effects of percutaneous nephrolithotomy (PCNL) on renal function have been evaluated in many studies but there are little data on the renal effects of PCNL immediately after surgery in human patients. The aim of this study was to evaluate estimated glomerular filtration rate (GFR) during the first few days after PCNL. From July to September 2008, we gathered preoperative and postoperative serum creatinine data of all the patients who underwent PCNL at our center. Children and patients who received transfusion during surgery were excluded. Creatinine clearance was estimated by Cockcroft-Gault equation and was used to estimate GFR. 94 patients met the inclusion criteria. The mean ± SD of creatinine clearance by Cockcroft-Gault equation was 87.5 ± 32.2 cc/min before operation. It decreased to 85.5 ± 29.4 cc/min, 77.0 ± 26.8 cc/min and 75.9 ± 25.0 cc/min at 6, 24 and 48 h after operation and then increased slightly to 81.9 ± 26.4 cc/min 72 h after operation. Renal GFR decreases immediately after PCNL reaches a nadir 48 h after operation, and then, increases slowly. It seems advisable to avoid factors that can bear a negative influence on renal function during the early postoperative period such as nephrotoxic drugs, contrast agents, shock wave lithotripsy and Re-PCNL.
The aim of this study is to investigate the serum levels of parathyroid hormone (PTH), calcitonin... more The aim of this study is to investigate the serum levels of parathyroid hormone (PTH), calcitonin, 1,25 (OH) 2 vitamin D3, estradiol and testosterone in male patients with active renal calcium stone disease compared with controls and investigate their relationship with serum/ urinary biochemistry. Male active renal calcium stone formers (ASF) were enrolled from December 2008 to April 2009. Controls were selected from age and sex matched individuals. Two 24-h urine samples and a blood sample were withdrawn from each participant while they were on free diet. Serum 1,25 (OH) 2 vitamin D3 levels in the ASF and control groups were 127 ± 40 and 93 ± 35 pmol/l (p \ 0.001). Serum levels of PTH, calcitonin, estradiol and testosterone were not statistically different between the ASF and control groups (all p [ 0.05). Serum 1,25 (OH) 2 vitamin D3 was associated with higher urinary excretion of calcium and phosphorus in ASF patients. Serum levels of calcitonin were related to less urinary excretion of calcium in the control group. Serum testosterone was related to higher urinary excretion of uric acid in ASF patients and to higher urinary excretion of oxalate in the control group. 1,25 (OH) 2 Vitamin D3 is an important hormone in the pathogenesis of recurrent renal calcium stone disease and could increase renal stone risk by increasing the urinary excretion of calcium and phosphorus. There is a possibility of testosterone involvement in the pathogenesis of renal stones through higher urinary uric acid and oxalate excretion.
To evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active ren... more To evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active renal calcium stone formation. METHODS: Male active renal calcium stone formers (ASF, final Nϭ106) with 2 episodes of stone relapse in the past five years were enrolled from December 2008 to April 2009. Controls (Nϭ109) were selected from age range and gender matched individuals who had no evidence or history of stone disease. Sequencing and Single strand conformational polymorphism were used to determine VDR polymorphisms in the patients and controls. RESULTS: Three polymorphisms were identified in the VDR gene: 1) Start codon polymorphism (M1T) 2) C/T polymorphism in intron 2 at nucleotide position 10416049. 3) A silent polymorphism in exon 9 (I352I). Start codon polymorphism was the only polymorphism that was associated with the status of calcium stone formation (pϽ0.05). CONCLUSIONS: We performed a complete coding genome analysis of VDR gene and observed that only start codon polymorphism was related to the status of active calcium stone formation.
To evaluate the safety and cost-effectiveness of Hem-o-lok and metallic titanium clips for both r... more To evaluate the safety and cost-effectiveness of Hem-o-lok and metallic titanium clips for both renal arterial and venous control in laparoscopic nephrectomies. All patients who underwent laparoscopic nephrectomy from June 2000 to March 2011 in our center were included. Before July 2005, we used three medium-large titanium clips for safe control of renal vessels. After July 2005, we used two clips for renal artery control (one 10 mm Hem-o-lok clip and one medium-large titanium clip) and two clips for renal vein control (12 mm and 10 mm Hem-o-lok clips) in all cases. To prevent possible complications, we placed vascular clips 2 to 3 mm away from the aortic root of the renal artery underneath lumbar vessels. Episodes of clip failure were defined as intraoperative or postoperative hemorrhage or exploration because of clip failure. This study included 1834 laparoscopic nephrectomies (1423 donor nephrectomies, 214 simple nephrectomies, and 197 radical nephrectomies). All arteries and renal veins were controlled by titanium and Hem-o-lok clips. One complication that was probably related to vascular clips (titanium and Hem-o-lok), however, involved a delayed hemorrhage from a pseudoaneurysm at the aortic root of the renal artery, which was repaired at exploration. No complication was clearly related to vascular clips. Using Hem-o-lok and titanium clips instead of vascular staplers resulted in $670 savings per operation. Hem-o-lok and metallic vascular clips applied properly by trained surgeons according to published safety measures provide a safe and considerable cost-saving option for vascular control in laparoscopic nephrectomy.
To provide data on the distribution of intraocular pressure (IOP) in an Iranian population. Metho... more To provide data on the distribution of intraocular pressure (IOP) in an Iranian population. Methods: Through a population based, cross sectional study, 4565 Tehran citizens were studied in the Tehran Eye Study. The findings from the participants (n = 3834) aged 10 years and older free of glaucoma diagnosis or suspicion who had undergone applanation tonometry examination are presented. All participants received a standardised protocol including applanation tonometry, fundus examination, demographic data, and an interview. IOP measurement was used to evaluate its distribution by age, sex, and some eye parameters. Results: Mean (SD) IOP was 14.5 (2.6) mm Hg in the total population, 14.4 (2.7) in men, and 14.5 (2.5) in women. Mean (SD) IOP in people >40 years was 15.1 (2.9) mm Hg. IOP increased significantly with age and cup:disc ratio except for a fall in old age. This relation was also observed when individuals without diabetes or hypertension history were analysed. IOP increased with darker eye pigmentation except for blue/grey eyes. There was a non-linear increase in IOP from emmetropic to high myopic eyes. Conclusion: Age, iris colour, and cup:disc ratio were related to IOP but not to sex. The distribution of IOP in this study was different from various other studies in different geographical regions and it seems advisable to employ a geographical approach to normal IOP interpretation.
Background: The aim of this study was to provide data, on the distribution or intraocular pressur... more Background: The aim of this study was to provide data, on the distribution or intraocular pressure (IOP) in Tehran population. Materials and Methods: Through a population-based, cross-sectional study, a total of 4565 Tehran citizens were studied in the Tehran Eye Study. The findings of the participants (n=3834) 10 years and older free of glaucoma diagnosis or suspicion who had undergone applanation tonometry examination are presented. All participants received a standardized protocol included applanation tonometry, and some other ocular measurements, fundus examination, demographic data and an interview. IOP measurement was used to evaluate its distribution by age, sex, and some eye parameters. Results: Mean ± SO IOP was 14.5±2.6 in the total population, 14.4±2.7 in men, and 14.5±2.5 in women. Normal range (mean±2SD) of IOP was determined to be 9.3 - 19.7 mmHg. IOP increased significantly with age and cup-disc ratio except for a fall in old ages. This relationship was also observed when we analyzed individuals without diabetes or hypertension history. IOP increased with darker eye pigmentation except for blue/gray eyes. There was a non-linear increase of IOP from emmetropic to high myopic eyes. Conclusion: Mean and/or normal range of IOP and their associations have been reported with wide differences in various studies. It is wise that studies evaluate IOP distribution or associations in healthy people and glaucoma people separately and also report the prevalence of IOP risk factors in their population to allow for a logical comparison of studies.
*Corresponding Author: Mehrnaz Rasolinejad Iranian Research Center for HIV/AIDS, School of Medici... more *Corresponding Author: Mehrnaz Rasolinejad Iranian Research Center for HIV/AIDS, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Tel: +98 21 66581598, Fax: +98 21 66581598, E-mail: [email protected] ... Evaluation of Depression in ...
PURPOSE To determine the number of percutaneous nephrolithotomy (PCNL) operations which are requi... more PURPOSE To determine the number of percutaneous nephrolithotomy (PCNL) operations which are required to achieve competence or excellence. MATERIALS AND METHODS One hundred and five consecutive PCNL operations performed by a fellow in endourology, with no previous experience in performing solo PCNL, were studied. Operation duration, stone extraction percent, stone-free rate, number of access, tubeless cases, and complications were studied in sequential groups of 15 patients as the surgeon gained experience. RESULTS Operation duration decreased from the mean of 95.4 minutes in the first to 15th patients to 78.3 minutes in the 31st to 45th patients, and then remained unchanged. Minor complications were only observed in the first to 45th patients. Stone extraction percent increased from the mean of 88.3% in the first to 15th patients to 99.3% in 91st to 105th patients. Percentage of patients with no residual fragments decreased from 53% in the first to 15th patients to 6.7% in the 91st ...
Purpose: Evidence suggests that androgens can be involved in the pathogenesis of renal stones. Th... more Purpose: Evidence suggests that androgens can be involved in the pathogenesis of renal stones. This study aimed at investigating coding region polymorphisms and CAG repeats in androgen receptor (AR) and their association with active renal calcium stone disease. Materials and Methods: Male patients with calcium kidney stones ( N = 106) with at least two episodes of stone recurrence or size increase during the past 5 years (ASF) were enrolled from December 2008 to April 2009. Control individuals were recruited after matching for age and gender from healthy individuals without current stone or history of stone disease. Genetic sequencing and single strand conformational polymorphism (SSCP) were used to determine AR polymorphisms in the patients and controls. Results: Two polymorphisms were identified in the AR gene: Silent G to A polymorphism in the first exon of the AR gene and C to G polymorphism in intron 4. CAG repeats ranged from 12 to 37. The C/G polymorphism in intron 4 and CAG ...
Background Open trigonoplasty antireflux operation has been associated with promising results. Ho... more Background Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. Methods All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Pre-Operative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients’ DRNCs were used to judge for reflux relapse. Results Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and pat...
Background: We aimed to compare the efficacy of a new bedside screening test named acromioaxillos... more Background: We aimed to compare the efficacy of a new bedside screening test named acromioaxillosuprasternal notch index (AASI) with modified Mallampati (MMP). Methods: A total of 603 adult patients, who were candidates for tracheal intubation in elective surgery, were enrolled in this prospective study. Preoperative airway assessment was carried out with AASI and MMP. The new AASI score is calculated based on the following measurements: (1) using a ruler, a vertical line is drawn from the top of the acromion process to the superior border of the axilla at the pectoralis major muscle (line A); (2) a second line is drawn perpendicular to line A from the suprasternal notch (line B); and (3) the portion of line A that lies above the point where line B intersects it is line C. AASI is calculated by dividing the length of line C by that of line A (AASI ¼ C/A). After induction of anesthesia, the laryngeal view was recorded according to the CormackeLehane grading system. Receiver operating characteristic curve analysis was employed to compare between AASI and MMP. Results: Difficult visualization of larynx (DVL, CormackeLehane III and IV) was observed in 38 (6.3%) patients. The best cutoff point for DVL was defined at AASI > 0.49. AASI had a lower false negative rate and higher predictive values (sensitivity, positive predictive value, and accuracy) in comparison with MMP. Conclusion: AASI was associated with higher predictive values than MMP and could be used for estimation of DVL.
Introduction: In this study the full sequence of the calcitonin receptor gene (CALCR) in a group ... more Introduction: In this study the full sequence of the calcitonin receptor gene (CALCR) in a group of Iranian males suffering from recurrent calcium urinary stones was compared with that of a control group. Methods: Serum and urinary biochemistry related to urolithiasis were evaluated in 105 males diagnosed with recurrent kidney calcium stones and 101 age-matched healthy control males. The polymerase chain reaction single-strand conformation polymorphism method was used to detect new polymorphisms in the CALCR. Results: Nine polymorphisms were detected; seven were in the non-coding and two in the coding region. The T allele associated with the 3′UTR+18C>T polymorphism was observed exclusively in the stone formers. The exact odds ratio for the T allele in this locus for those at risk of stone formation was 36.72 (95% CI 4.95-272.0) (p < 0.001). The mean (standard deviation) urine calcium concentration was 117 (60) mg/l in patients with the C allele and 152 (72) mg/l in those with...
Introduction: This study was designed to evaluate factors contributing to failure in Gil-Vernet a... more Introduction: This study was designed to evaluate factors contributing to failure in Gil-Vernet antireflux operation. Materials and Methods: 96 patients (150 refluxing units; median (range) age, 60 (12–180) months; M/F, 11/85) with primary vesico-ureteral reflux were included. Trigonoplasty was done according to a modified Gil-Verent procedure. Relapse was diagnosed on the postoperative direct radionuclide cystography (DRNC) 3 or 6 months after operation. Demographic and intraoperative data were used to assess factors contributing to failure. Results: Resolution of reflux in postoperative DRNC was observed in 87 patients (90.6%) and in 138 refluxing units (92.0%). In patients who were followed 3–6 months, one relapse occurred (3%) versus 8 relapses in those who were followed 24–39 months (12%). Relapse in refluxing units was related to the history of voiding symptoms (30 vs. 3%, p < 0.001), history of breakthrough infections (20 vs. 3%, p = 0.001), golf or stadium like ureteral o...
Objectives: We evaluated the impact of sleep position on the effectiveness of shock wave lithotri... more Objectives: We evaluated the impact of sleep position on the effectiveness of shock wave lithotripsy (SWL) in renal calculi. Patients and Methods: Patients (n = 120) with a single radiopaque renal stone who were candidates for SWL were enrolled. For studying patients’ position during sleep, a novel sleep position recorder was designed. Group 1 (n = 60) consisted of patients who slept preferentially on the ipsilateral side of the stone; group 2 (n = 60) comprised patients who slept preferentially on the contralateral side. Treatment effectiveness was defined as the absence of residual stones >3 mm up to 3 months after SWL. Results: The mean (range) percent of sleep on the ipsilateral side of the stone was 61.5% (51–78) and on the contralateral side it was 62.4% (51–81) in groups 1 and 2, respectively (p > 0.05). The overall success rate of SWL was 88.3% (77.4–95.2) and 70.0% (56.8–81.2) in groups 1 and 2, respectively (p = 0.01). Stone clearance increased with an increasing per...
Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, ... more Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position. Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure. The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%. Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.
The aim of this study was to evaluate the postoperative serum sodium changes after percutaneous n... more The aim of this study was to evaluate the postoperative serum sodium changes after percutaneous nephrolithotomy (PCNL) with half-strength saline irrigation. PCNL operations from June to August 2008 were included. PCNL was performed according to the standard prone position with fluoroscopic guidance. Patients received 0.3% saline-3.3% dextrose by intravenous infusion in the first 24 h after operation. Serum sodium was measured before the operation and at 6, 24 and 48 h after the operation. 96 patients were included. Serum sodium slightly decreased from preoperative 140.3 ± 2.8 mEq/l to 140.1 ± 3.6, 139.1 ± 3.4 (p \ 0.01) and 139.3 ± 2.7 (p \ 0.05) at 6, 24 and 48 h after the operation, respectively. Half-strength saline irrigation does not result in considerable change in the postoperative serum sodium in simple PCNL operations. The use of intravenous solutions with hypotonic sodium is discouraged in PCNL patients with the possibility of high volume absorption of hypotonic irrigation fluid.
The purpose of this study was to evaluate the impact of vitamin D receptor (VDR) gene polymorphis... more The purpose of this study was to evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active renal calcium stone formation. Male active renal calcium stone formers (ASF, final N = 106) with two episodes of stone relapse in the past 5 years were enrolled from December 2008 to April 2009. Controls (N = 109) were selected from age range-and gender-matched individuals who had no evidence or history of stone disease. Sequencing and single-strand conformational polymorphism were used to determine VDR polymorphisms in the patients and controls. Three polymorphisms were identified in the VDR gene: (1) start codon polymorphism (rs2228570T[C; p.M1T); (2) C/T polymorphism in the second intron (NT-029419.12: g.10416049C[T); (3) a silent polymorphism in exon 9 (rs731236T[C; p.I352I). Start codon polymorphism was the only one that was associated with the status of calcium stone formation (p \ 0.05). We performed a complete coding genome analysis of VDR gene and observed that only start codon polymorphism was related to the status of active calcium stone formation.
Long-term effects of percutaneous nephrolithotomy (PCNL) on renal function have been evaluated in... more Long-term effects of percutaneous nephrolithotomy (PCNL) on renal function have been evaluated in many studies but there are little data on the renal effects of PCNL immediately after surgery in human patients. The aim of this study was to evaluate estimated glomerular filtration rate (GFR) during the first few days after PCNL. From July to September 2008, we gathered preoperative and postoperative serum creatinine data of all the patients who underwent PCNL at our center. Children and patients who received transfusion during surgery were excluded. Creatinine clearance was estimated by Cockcroft-Gault equation and was used to estimate GFR. 94 patients met the inclusion criteria. The mean ± SD of creatinine clearance by Cockcroft-Gault equation was 87.5 ± 32.2 cc/min before operation. It decreased to 85.5 ± 29.4 cc/min, 77.0 ± 26.8 cc/min and 75.9 ± 25.0 cc/min at 6, 24 and 48 h after operation and then increased slightly to 81.9 ± 26.4 cc/min 72 h after operation. Renal GFR decreases immediately after PCNL reaches a nadir 48 h after operation, and then, increases slowly. It seems advisable to avoid factors that can bear a negative influence on renal function during the early postoperative period such as nephrotoxic drugs, contrast agents, shock wave lithotripsy and Re-PCNL.
The aim of this study is to investigate the serum levels of parathyroid hormone (PTH), calcitonin... more The aim of this study is to investigate the serum levels of parathyroid hormone (PTH), calcitonin, 1,25 (OH) 2 vitamin D3, estradiol and testosterone in male patients with active renal calcium stone disease compared with controls and investigate their relationship with serum/ urinary biochemistry. Male active renal calcium stone formers (ASF) were enrolled from December 2008 to April 2009. Controls were selected from age and sex matched individuals. Two 24-h urine samples and a blood sample were withdrawn from each participant while they were on free diet. Serum 1,25 (OH) 2 vitamin D3 levels in the ASF and control groups were 127 ± 40 and 93 ± 35 pmol/l (p \ 0.001). Serum levels of PTH, calcitonin, estradiol and testosterone were not statistically different between the ASF and control groups (all p [ 0.05). Serum 1,25 (OH) 2 vitamin D3 was associated with higher urinary excretion of calcium and phosphorus in ASF patients. Serum levels of calcitonin were related to less urinary excretion of calcium in the control group. Serum testosterone was related to higher urinary excretion of uric acid in ASF patients and to higher urinary excretion of oxalate in the control group. 1,25 (OH) 2 Vitamin D3 is an important hormone in the pathogenesis of recurrent renal calcium stone disease and could increase renal stone risk by increasing the urinary excretion of calcium and phosphorus. There is a possibility of testosterone involvement in the pathogenesis of renal stones through higher urinary uric acid and oxalate excretion.
To evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active ren... more To evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active renal calcium stone formation. METHODS: Male active renal calcium stone formers (ASF, final Nϭ106) with 2 episodes of stone relapse in the past five years were enrolled from December 2008 to April 2009. Controls (Nϭ109) were selected from age range and gender matched individuals who had no evidence or history of stone disease. Sequencing and Single strand conformational polymorphism were used to determine VDR polymorphisms in the patients and controls. RESULTS: Three polymorphisms were identified in the VDR gene: 1) Start codon polymorphism (M1T) 2) C/T polymorphism in intron 2 at nucleotide position 10416049. 3) A silent polymorphism in exon 9 (I352I). Start codon polymorphism was the only polymorphism that was associated with the status of calcium stone formation (pϽ0.05). CONCLUSIONS: We performed a complete coding genome analysis of VDR gene and observed that only start codon polymorphism was related to the status of active calcium stone formation.
To evaluate the safety and cost-effectiveness of Hem-o-lok and metallic titanium clips for both r... more To evaluate the safety and cost-effectiveness of Hem-o-lok and metallic titanium clips for both renal arterial and venous control in laparoscopic nephrectomies. All patients who underwent laparoscopic nephrectomy from June 2000 to March 2011 in our center were included. Before July 2005, we used three medium-large titanium clips for safe control of renal vessels. After July 2005, we used two clips for renal artery control (one 10 mm Hem-o-lok clip and one medium-large titanium clip) and two clips for renal vein control (12 mm and 10 mm Hem-o-lok clips) in all cases. To prevent possible complications, we placed vascular clips 2 to 3 mm away from the aortic root of the renal artery underneath lumbar vessels. Episodes of clip failure were defined as intraoperative or postoperative hemorrhage or exploration because of clip failure. This study included 1834 laparoscopic nephrectomies (1423 donor nephrectomies, 214 simple nephrectomies, and 197 radical nephrectomies). All arteries and renal veins were controlled by titanium and Hem-o-lok clips. One complication that was probably related to vascular clips (titanium and Hem-o-lok), however, involved a delayed hemorrhage from a pseudoaneurysm at the aortic root of the renal artery, which was repaired at exploration. No complication was clearly related to vascular clips. Using Hem-o-lok and titanium clips instead of vascular staplers resulted in $670 savings per operation. Hem-o-lok and metallic vascular clips applied properly by trained surgeons according to published safety measures provide a safe and considerable cost-saving option for vascular control in laparoscopic nephrectomy.
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Papers by Amir H Kashi