Tehran University Medical Journal

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Background: The aim of this study was to minimize edema and ecchymosis following rhinoplasty through a closed drainage system to address concealed hemorrhage.
Methods: This study was designed as a prospective، double blinded, randomized contr-olled study. Fifty one patients who underwent septorhinoplasty were included in this study and divided in two groups. In group A, a closed drainage system was applied in the most dependent posterior septal area following septal harvesting. Concealed bloody secretions were drained out of mouth in a vacutaner tube during three concecutive post operative days. In control group, group B, exactly the same classic rhinoplasty opera-tion by the same surgeon was done as for study group except omitting the closed drainage system. Degree of supra-tip and eyelid edema was evaluated on post operative days through photographic and software image analysis. Edema and ecchymosis rating of eyelids and ecchymosis of paranasal and cheek area done based on photographic analysis by independent plastic surgeons using a defined grading system.
Results: Eyelid ecchymosis was reduced significantly on post operative day 14 in the study group (P=0.03). Ecchymosis of paranasal and check was reduced considerably likewise on days 7 and 14 in group A using Mann-Whitney test (P=0.03). There was no significant deference regarding supra tip edema on post operative days. The same hold true for the eyelids edema.
Conclusion: Significant decrement observed in eyelids ecchymosis on day 14 and para-nasal and cheek ecchymosis on postoperative days 7 and 14 in study group. There were no positive effects regarding supra tip and eyelid edema reduction using closed drainage system to evacuate concealed haemorrhage in posterior septum space. There could be different etio-pathologies for two common morbidities following rhinoplasty that should be addressed separately.

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Background: Tramadol is a synthetic drug which is prescribed in moderate and severe pain. Tramadol overdose can induce severe complications such as consciousness impairment and convulsions. This study was done to determine the convulsions incidence after tramadol use until one week after hospital discharge. Methods: This prospective study was done in tramadol overdose patients without uncontrolled epilepsy and head injury history. All cases admitted in Loghman and Rasol Akram Hospitals, Tehran, Iran from 1, April 2011 to 1, April 2012 were included and observed for at least 12 hours. Time interval between tramadol intake and first seizure were record. Then, patients with second drug-induced seizure were recognized and log time between the first and second seizure was analyzed. The patients were transferred to the intensive care unit (ICU) if clinical worsening status observed. One week after hospital discharge, telephone follow-up was conducted. Results: A total of 150 patients with a history of tramadol induced seizures (141 men, 9 women, age: 23.23±5.94 years) were enrolled in this study. Convulsion was seen in 104 patients (69.3%). In 8 out of 104 patients (7.6%) two or more convulsion was seen. Time interval between tramadol use and the onset of the first and second seizure were 0.93±0.17 and 2.5±0.75 hours, respectively. Tramadol induced seizures are more likely to occur in males and patients with a history of drug abuse. Finally, one hundred forty nine patients (99.3%) were discharged with good condition and the only one patient died from tramadol overdose. Conclusion: The results of the study showed tramadol induced seizure most frequently occurred within the first 4 hours of tramadol intake. The chance of experiencing a second seizure exists in the susceptible population. Thus, 4 hours after drug intake is the best time for patients to be hospital discharged.

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Background: Since high plasma level for C-reactive protein (CRP) is a risk factor for cardiovascular disease, thereby decrease in the level of high- sensitivity C-reactive protein (hs-CRP) in acute coronary syndrome (ACS) patients through anti-inflammatory drugs can reduce mortality and the incidence of heart failure. Accordingly, this research aims to investigate the effect of hs-CRP on ACS patients before and after treatment with astatines.

Methods: This cross-sectional and cohort study was performed for the population of 90 patients with acute coronary syndrome (ACS) martyrs at the Mustafa Khomeini University Hospital in the Ilam city, Iran, From July to September, 2014. Blood samples were collected at admission and demographic and clinical symptoms, echocardiography and electrocardiography were recorded. At admission, the questionnaire including demographic information and medical history of patients was filled by the researchers and echocardiography and physical examination was carried out by cardiologist. The obtained data are further explored and analyzed via SPSS software, ver. 19 (Chicago, IL, USA).

Results: The sample under study was 52.2% and 48.8% men and women, respectively. Phi correlation coefficient of 73% and positive Cramer's V of 0.879 was observed between re-admission and arrhythmia admission for the group received 40 mg atorvastatin. It means that we have more re-admission when arrhythmia increases. Only 4% correlation coefficient and very low positive Cramer's V of 0.293 was seen for the group who receive 80 mg atorvastatin. It indicates that no significant correlation exists between eject fraction of admission and re-admission (P=0.18). The results showed that hs-CRP of the group that received 80 mg atorvastatin was 0.179 which is lower than 0.37 for the group who received 40 mg atorvastatin.

Conclusion: By increasing the astatine dose, the amount of hs-CRP and consequently the risk of subsequent cardiovascular events were reduced. Hence, high starting dose of atorvastatin at preliminary stages of hospitalizing can reduce re-admission and cardiovascular consequents.

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Background: In recent years the use of diced cartilage grafts in reconstructive surgery particulary rhinoplasty have been considered by most plastic surgeons. However, long-term resorption usually occurs. Stem cells are a powerful tool for reconstructive surgery to rebuild and maintain tissue with reduced complications. Since the adipose tissue-derived stem cells (ADSCs) can rebuild a wide variety of tissues such as skin, fat, bone and cartilage are used, this is a very good chance for cosmetic surgery. The aim of this study was to examine the effects of adipose-derived stem cells on the viability of diced cartilage grafts.

Methods: This interventional study was performed on May 2014 in animal laboratory of Hazrat Fatima Hospital on 10 New Zealand white male rabbits, weighing 2000-2500 grams, approximately 12 to 16 weeks of age. Stem cells was harvested from inguinal adipose tissue of each rabbits. After completely removing the skin and perichondrium, cartilage became divided into two equal pieces using a scalpel. Then place the ear amputation was restored by nylon 4 zero. After weighing cartilages, on either side of the center line on the back of each rabbits, left and right, subcutaneous pocket created equal weight and each piece of cartilage was placed in an envelope. Stem cells were injected in one side and the other side was control. The cartilage weights were recorded both before implantation and after explantation. Evaluation of living chondrocytes was conducted 12 weeks after implantation.

Results: The mean difference of cartilage weights was varied between two groups (intervention and control sides), So that the average was significantly higher in stem cell side than that in the control side (P= 0.021). The average number of live chondrocytes was significantly higher in the intervention side than the control side (P< 0.001).

Conclusion: Despite the unclear mechanism, these results suggest that adipose-derived stem cells can maintain the viability of diced cartilage. Because adipose-derived stem cells are autologous and easy to harvest, they can be use to improve the long-term outcomes of diced cartilage grafting.