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Introduction: Idiopathic hypercalciuria (IH) has been recognized as a common disorder in childhood and is an important and common factor in formation of renal stones. Recurrent urinary tract infection is a clinical presentation of hypercalciuria. Regarding that Hydrochlorothiazide is effective in hypercalciuria treatment, therefore in this study we assessed the efficacy of Hydrochlorothiazide in preventing recurrent UTI in hypercalciuric girl patients. Materials & Methods: This research was a single blind randomized clinical trial. 100, 1 to 12 years old girls, who were followed by pediatric nephrology outpatient clinic in Vali-Asr and Amir Kabir hospitals, with the diagnosis of idiopathic hypercalciuria and at least two urinary tract infections in year, were included in study. Patients were randomly divided into two equal groups. First group received a general preventive treatment consisted of a liberal fluid , urination every 2 hours , reducing dietary salt intake , washing genitalia from front to back , wearing cotton loose underwear and complete urination. In second group, in addition to the general treatment, Hydrochlorothiazide was used with initial dose of 1mg/kg/day in a morning dosage.Then, urinary tract infection recurrence in two groups was assessed by student T test. Results: All patients who received Hydrochlorothiazide were normocalciuric. In each group, incidence of UTI non recurrence was 34% (17 cases), that was not significantly different. Conclusion: This study rejected the presence of hypercalciuria treatment effect in preventing recurrent urinary infection. Therefore, the association between UTI and IH needs to be closely studied with the attention to eliminate confounding factors.

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Introduction: Benign Prostatic Hyperplasia (BPH) is the most common benign tumor in men. Due to the side effects of chemical drugs, phytotherapy has become a treatment method in BPH since 1990s. Prostatan is a plant extract widely available in Iran. In this study, we evaluated the therapeutic effects of Prostatan drop in combination with Prazosin in alleviating BPH symptoms. Materials and Methods: In a single blind randomized clinical trial , 66 men over 50 years with BPH symptoms who were visited in Vali-e-Asr hospital of Arak were randomly divided in two groups and treated with either Prostatan (40 drop,TDS) plus Prazosin (1mg, BD)or Prazosin (1mg, BD)alone . AUA symptom score, PSA (prostate-specific antigen) levels, Prostate volume, post voidal residue (PVR) by sonograms and uroflowmetry results were determined before and 12 weeks after treatment. Data was analyzed by T and Man- Whithey u tests. Results: Before treatment there were no significant differences in age, PSA, PVR, AUA symptom score, Prostate volume and uroflowmetry between the two groups. After treatment the mean of PSA levels, Prostate volume and PVR did not differ between the two groups. In the Prostatan plus Prazosin group, the mean of AUA symptom score was 3.3 less (p<0.0001) and the mean of maximal urine flow rate was 2.7 ml/s more than the Prazosin group (p<0.0001). Conclusion: Regarding results, it seems that adding Prostatan to Prazosin against Prazosin alone enhances its effects on controlling BPH symptoms and increases urine flow rates.

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Introduction: Hydronephrosis in infancy and childhood is a frequent urinary malformation. We were unable to find any reports concerning rate and causes of hydronephrosis in Iranian children therefore, we decided to evaluate it, in under 12 years old children. Materials and Methods: This was a descriptive study done in a 9-month period starting from Novemger 2004. All children under 12 years old who had visited Amir Kabir hospital of Arak for UTI or FTT were enlisted and an ultrasonography was requested. If hydronephrosis was detected, then a VCUG was performed. For those with normal VCUG results, if hydronephrosis persisted in the follow up sonography, the next step was an IVP or DTPA scan. Results: 65 patients (39 girls and 26 boys) were evaluated for hydronephrosis. 18.5% presented with FTT , 75.4% with UTI and 6.1% with FTT+UTI. The most prevalent causes of hydronephrosis were VUR (40%) and UPJO (23.5%). Grade I hydronephrosis was the most prevalent form (65%), however when VUR was present , it was mostly grades III or IV (27% and 19% respectively). 70% of girls and 31% of boys had VUR and the average age at the time of diagnosis was 2-3 years. Conclusion: Vesicouretero reflux and UPJO are the most prevalent causes of hydronephrosis and must be evaluated in children with hydronephrosis.

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Introduction: Children with reflux who fail prophylaxis management or reflux which do not resolve spontaneously are candidates for sugery. Delay in surgery increases the development of new renal scars. Finding a modal factor for prediction of reflux resolution likelihood can decrease complications of treatments. Regarding that sacral bone anomalies have a direct influence on the final function of urinary and bowel systems, this study is done to investigate the relationship between sacral ratio and reflux. Materials and Methods: This is a case-control study. The case group included 76 children less than 9 years old refered to Vali-e-Asr and Amir Kabir hospital clinics with urinary tract infection and according to voiding cystouretrograply (VCUG) results, children with III, IV and V grade vesicoureteral reflux (VUR) entered the study. The control group included 76 children with previous urinary tract infection and normal VCUG. Sacral ratio in the two groups was measured and was compared by student t, Chi square and Mann Whitney tests. Results: The case group included 24 males and 52 females with average age of 2.7 years old and the control group included 23 males and 53 females with the average age of 3 years. The percent of sacral ratio abnormality were 40% and 23.7% in the case and control groups respectively, which was significantly different (p=0.001). The difference between the mean sacral ratio in case group with the value of 80% and the control group with the value of 84% was not different. The ratio distribution pattern in the two groups was not different. Conclusion: The percent of sacral ratio abnormality in children with vesicoureteral reflux were more than children without reflux.

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Introduction: Oral Ketamine is used as a low side effect analgesic in comparison with opioids, in different pain syndromes. This study is designed to evaluate the effect of oral Ketamine in renal colic treatment. Materials and Methods: In this clinical trial study 104 patients with renal colic, hospitalized in emergency department, were divided in to two groups by Random block design. Group B received Pethidine (1 mg/kg up to 100 mg) and placebo, and group A received Pethidine with the same dose and Ketamine (0.5 mg/kg). All patients were assessed for pain by using VAS chart, for nausea by a 0-3 scale and for the number of vomiting at baseline and 1, 2 and 3 hours after taking drug. The results were analyzed by t-test. Results: Average pain score and vomiting in all times and nausea score in one and three hours after receiving drugs were reduced significantly in patients who took Pethidine and Ketamine comparing patients who took Pethidine and placcbo(p < 0.05). Conclusion: Regarding the significant effect of Ketamine in reduction of pain, nausea and vomiting without side effects, it is possible to use Ketamine as an adjuvant drug in treatment of renal colic and to reduce narcotic dosage.

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Background: Pyelonephrities is the urinary tract infection. Using supplemental dugs may decrease duration of treatment and hospitalization. We studied the effect of vitamin C on the recovery of symptoms due to pyelonephrities Methods and Materials: In this clinical trial, double blind, study, 64 patients with uncomplicated pyelonephrities were assessed in 2 groups randomly. Case group took vitamin C capsules, and control group took placebo capsules. In both groups, primary treatment was ceftriaxon capsules during hospitalization and they took ciprofloxacin capsules for 14 days after discharging. Symptoms and Urinary analysis were assessed in the first day of administration and then on the 7th and 14th days after discharging. Data were analyzed with Chi-Square test. Results: Mean of fever duration in vitamin C group (1.130.34 SD day) and placebo group (1.560.62 SD day) significantly decrease (p=0.001). There was a significant difference in dysuria duration in vitamin C group 2.191.06 SD day with placebo group (2.971.06 SD day) (p =0.007). In flank pain, nausea and vomiting duration difference was not significantly (p≥ 0.05). Conclusion: It seems vitamin C, as a supplemental drug improves some pyelonephrities symptoms, such as fever and dysuria, decreases of the hospitalization period

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Background: Studies in different species indicate that a variety of different inhibitors may influence myometrium during pregnancy and withdrawal of one or more of them leads to the onset of labor pain. Hence, this study was done to investigate the association between parathyroid hormone-related peptide1-34 (PTH-rp1-34) and labor pain. Materials and Methods: This study was a case-control one. Plasma PTH-rp1-34, PTH, total calcium, phosphorous, magnesium, and alkaline phosphatase concentrations were quantified for 152 normal pregnant women at term (76 women at the onset of labor pain, as the case group and 76 women without labor pain, as the control group). The subjects had no pregnancy related complications. Results: The mean of plasma PTHrp concentrations in the group with labor pain (12.36±0.60 ng/ml) did not differ from that in the group without labor pain (13.57±0.63 ng/ml). The means of plasma PTHrp concentration amounts in the group with labor pain and the group without labor pain were 28.92±1.66 pg/ml and 31.88±1.64 pg/ml, respectively and there was no significant difference between the two groups. There were no significant difference in plasma calcium, phosphorus, magnesium, and alkaline phosphatase concentrations in the two groups too. Conclusion: In this study, the endocrinal role of PTHrp and the onset of labor pain was not confirmed.

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Background: Urolithiasis is one of the causes of renal colic. The annual incidence of this disease is 1-2/1000 people. Due to the severity of pain, adverse effects of routine treatments and incomplete pain relief, more effective methods of treatment have always been sought for. Alhagi Pseudalhagi distillate is a traditional herbal medication used for urolithiasis. Due to its wide availability and no previous report of adverse effects, we decided to evaluate its impact on ureteral stone expulsion. Materials and Methods: In this single-blind randomized clinical trial, 100 renal colic patients whom visited in Arak Vali-asr Hospital or its clinics were divided into two groups. Group1 received Thiazide, Tamsulosin, and analgesics and group 2 received Alhagi Pseudalhagi distillate in addition to aforementioned drugs. The patients were followed upto 4 weeks and the stone expulsion rates and their times were compared. Results: The average stone sizes for groups 1 and 2 were 4.66 and 4.32 mm, respectively (p=0.128). Stones in both groups were mostly located in lower ureter (p=0.551). Expulsion occurred in 40% of group 1 and 66% of group 2 patients (p=0.009). The mean expulsion times for groups 1 and 2 were 11 and 9 days, respectively (p= 0.291). Conclusion: Alhagi Pseudalhagi distillate had a significant effect on the rate of stone expulsion and it is likely to decrease the time needed for the passage of Urolithiasis stones.

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Background: Nowadays, the use of inflammatory biomarkers in the diagnosis of appendicitis is on the rise. On the other hand, the role of oxygen free radicals in various inflammatory states has been verified. Noticing the high prevalence of negative appendectomy (9.3-22.2%), the aim of this study was to investigate the level of blood total antioxidant capacity (TAC) as a biomarker for early diagnosis of acute appendicitis. Materials and Methods: In this prospective analytical trial, over a one-year period, 407 patients, with preoperative diagnosis of acute appendicitis who had undergone operation, were studied. After measuring the TAC level, data were analyzed through the analytic ROC curve and parametric mean comparison tests. Results: Of all the patients, 298 were identified with appendicitis. TAC levels in adult female and male groups were respectively 663.9±164.75 and 752.58±167.37 µm/L which revealed a significant difference (p<0.0001). Also, in children, the mean of TAC level in perforated appendicitis sub-group was significantly greater than those in gangrenous and suppurative groups. Conclusion: TAC level can be used as a predictive factor for the diagnosis of perforated appendicitis in children however, it cannot be used as a biomarker for the diagnosis of appendicitis. Because of the significant difference existing between the level of TAC in male and female patients, further studies are suggested to investigate the level of inflammatory biomarkers with respect to menstrual cycle in women.

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Background: Diagnosis of acute appendicitis is one of the challenges that surgeons face in the emergency ward. Although Alvarado score has been recommended in the diagnosis of acute appendicitis, this criterion has some limitations in terms of age, sex, and race. The aim of this study was to evaluate the effectiveness of Alvarado score in the diagnosis of acute appendicitis based on the age and gender. Materials and Methods: In this cross-sectional study, 407 patients who underwent operation with the preoperative diagnosis of acute appendicitis from June 2008 to August 2009 were included in the study. The patients’ data were recorded by the investigators. The data were compared by parametric tests. The sensitivity and specificity were determined by the optimal cut-off point on ROC curve using MedCalc software version 10.2.0.0. Results: The optimal cut-off point for women was lower than men (6 and 7, respectively). The rate of negative appendectomy in the group with Alvarado scores 9 and 10 was 11.8%, while the negative appendectomy rate in the other two groups with Alvarado scores 7 and 8 and 5 and 6 were 29.9% and 52.8%, respectively. Conclusion: The diagnostic value of Alvarado score of 8 and less in physical examination is lower than the abdominal tenderness exam alone. Also, the cut-off point for the diagnosis of acute appendicitis in women should be considered lower than that in men. On the other hand, the cut-off point in adolescents and children is higher than adults.