Tehran University Medical Journal

---

AVNRT, (Atrioventricular nodal reentry tachycardia), atrial tachycardia and atrial flutter are 3 kinds of supraventricular tachycardia, which their mechanism are explained based on reentry. A 60-years-old man is presented with all of the above-mentioned arrhythmias, responsive to intravenous injection of adenosine. Radiofrequency ablation of the slow pathway territories cured all of them. Therefore, we suggest that there was a common pathway among all kinds of these arrhythmias, which were ablated with single RF lesion.

---

Background: Reflex Sympathetic Dystrophy Syndrome (RSDS) is a rarely described complication which characterized by pain, edema, movement and vasomotor disorders, trophic changes in the skin and patchy demineralization of bone in extremities. There are numerous risk factors such as trauma, surgery, myocardial infraction and drugs. Cyclosporine (CsA) is one of the drugs which can induce RSDS.

Case report: Herein we described a 33- years old man (known case of ALL) with severe painful and edematous extremities, which was being treated with cyclosporine because of Graft Versus Host Disease (GVHD) after bone marrow transplantation. His laboratory tests were normal except for AST and ALT. With impression of Reflex Sympathetic Dystrophy Syndrome triple-phase bone scan was done, Increased uptake and delayed wash-out in vascular and bony phase is considered typical for RSDS. Due to clinical and triple-phase bone scan findings the diagnosis was established. Symptoms of RSDS improved when CsA was discontinued.

Conclusion: According to this case report and the other ones, Cyclosporine should be considered as the etiology of Reflex Sympathetic Dystrophy Syndrome.

---

Background: The relationship between Coronary Artery Disease (CAD) and the prevalence of Renal Artery Stenosis (RAS) has been demonstrated. Despite high incidence of heart diseases and high frequency of CAD risk factors among Iranian population, this relation has not been clearly determined. This study estimated the prevalence of RAS and its determinants in Iranian angiographic candidates. We also tried to find which risk factors of atherosclerosis are associated more frequently with renal artery stenosis.

Methods: In a cross-sectional study that was performed at the Tehran Heart Center, in Tehran, Iran, 146 patients who were candidate for angiography with suspected CAD were consecutively included. Selective renal angiography was performed following coronary angiography in all patients with established coronary artery stenosis and the presence and severity of RAS was evaluated.

Results: Prevalence of RAS in study patients was 25.3% (men, 13.7% and women 47.1%, (p<0.001). We found that only 6.2% of the patients had bilateral R.A.S. Also, RAS≥50% was found in 17.1% of patients. Regarding number of defected coronary vessels, two- and three-vessel diseases were found in 30.0% and 39.0% of participants, respectively. No significant relationship was found between the number of involved coronaries and the severity as well as side of RAS (p=0.716) Significant multivariate predictors of RAS were female gender (p=0.001), advanced age, (p=0.046) duration of hypertension (p=0.032) and baseline serum creatinine concentration (p=0.018).

Conclusions: Routine angiographic assessment of renal arteries following coronary angiography is recommended especially in women as well as those with long-term duration of hypertension or renal dysfunction.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Neutrophil Gelatinase Associated Lipocalin (NGAL) is a new biomarker which can predict acute kidney injury (AKI) in critically ill patients. Usefulness of NGAL in the early diagnosis of all types of AKI is under question. We hypothesized NGAL is an early predictive biomarker of contrast-induced nephropathy (CIN).
Methods: In this process evaluation study, we enrolled 122 patients (Mean age 59.7±10.8 years) undergoing elective angiography/angioplasty with contrast media during April to September 2009. Serial urine samples were analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay. CIN was defined as a 25% increase in baseline serum creatinine. 
Results : The prevalence of CIN was 30.3%. Significant elevations in urinary NGAL concentrations were noted within 12-h and 24-h after the procedure in patients with CIN. NGAL concentrations after 12 hours was 90.62±105.63 vs. 27.6±45.8 ng/ml in patients with and without CIN, respectively P=0.0001, and 79.78±117.7 vs. 30.92±52.84 ng/ml, 24 hours afterwards P=0.002. Some patients had AKI after five days of exposure rather than the second day (P=0.0001). We found using a cut-off point of 8 ng/ml with a sensitivity, specificity, negative predictive value and area under the ROC curve 94%, 25%, 91% and 0.75 respectively are good for the prediction of CIN in 12-h urinary NGAL and a cut-off point of 5.5 ng/ml with respective values of 97%, 24%, 95% and 0.70 for 24-h urinary NGAL.
Conclusion: Urine NGAL may represent a sensitive early biomarker of acute AKI after angiography/angioplasty. We recommend the routine measurement of NGAL in high risk patients receiving contrast agents.