Tehran University Medical Journal

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Among the 708 patients who were admitted in the pediatric intensive care unit (PICU) of the children's hospital medical center, there were 100 patients with hyponatermia (Na<130 mEq/L). 62% of these patients had hyponatermia at the beginning of admission and 38% during hospitalization in PICU. According to the classification of hyponatermia in comparison to body fluid, this study revealed 7% pseudohyponatermia, 40% euvolemic hyponatermia, 34% hypovolemic hyponatermia and 10% hypovolemic hyponatermia. In conclusion, the most perevalent causes of hyponatermia in this study were syndrome of inappropriate antidiuretic hormone secretion (SIADH) (27%), water intoxication (22%) and extrarenal losses (20%)

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Between 1990-97 two hundered children referred to our department with end-stage renal disease (ESRD) for renal replacement therapy. The ages of these children were 1-14 years (mean 8.14). There was no significant difference in incidence of ESRD between two sexes. We evaluated these children for the causes of ESRD. The most common causes were: Pylonephritis and congenital anomalies of urinary tract (35.5%), glomerular diseases (22.5%) and hereditary kidney diseases (13.5%).

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Background: Cyclosporin A (CsA) is now commonly used in the management of children with steroid-dependent and steroid resistant nephoitic syndrome. It has been reported to be effective in maintaining remission in 70-100 percent of patients with SDNS but somewhat SRNS 0-100 percent. The aim of this study was to evaluate the efficacy of long-term (CsA) in children with refractory nephrotic syndrome (RNS) and steroid dependent nephrotic syndrome (SDNS).

Materials and Methods: The long-term effect of (CsA) in 91 Iranian children aged 3 months to 11 years (54 with RNS and 37 with SDNS) was assessed between 1984 and 1999. Eighty of 91 children received renal biopsy prior to introduction of (CsA), and the other 11 patients had not consent for kidney biopsy. If the patients did not show remission aftre receiving 3-6 months of (CsA), the medication was discontinued.

Results: All patient were treated with (CsA) in combination with low dose alternate day prednisolone. In children with RNS and SDNS, therapy with (CsA) induced, remission in 25 of 54 (46.2 percent) and 27 of 37 (73 percent) respectively (P<0.02). Of the 32 patients with minimal change disease (MCD), 23 (72 percent) responded to therapy, compared with 4 of 18 (22 percent) with focal segmental glomerulosclerosis (FSGS) (P<0.005). Twenty-four (48 percent) of 50 who entered complete remission, had relapse 1-12 months after cessation of (CsA). The duration between the onset of nephrotic syndrome (NS) and administration of (CsA) and sexuality of patients had no effect in result of treatment. Side effects occurred in 25 patients (27.4 percent). No patients exhibited raised transaminases, 8 (8.7 percent) of the children developed hirsutism, 7 (7.6 percent) hypertension, 7 (7.6 percent) gingival hyperplasia, (2.2 percent) neurological toxicity and 1 (1 percent) increase in serum creatinine.

Conclusion: Our findings suggest that (CsA) can be used to induce a complete remission in a significant proportion of patients with RNS and SDNS, and patients with SDNS have areasonable potential for remission than children with RNS. Resistant to steroid and cyclophosphamid.

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Background: Urinary tract infection is a common bacterial infection in children and may lead to irreversible renal damage. TC 99-m Dimercaptosuccinic acid renal scintigraphy is the most sensitive method for diagnosing acute pyelonephritis. We designed a study to evaluate the ability of DMSA scan and ultrasonography to detect renal paranchymal lesion.

Materials and Methods: 62 children 1 month to 12 years of age with the first episode of acute pyelonephritis were prospectively studied with DMSA scan and ultrasonography during acute phase of infection. A Voiding Cystourethrogram was performed in 60 children when urine culture became negative. Children with renal paranchymal changes were older at the time of acute pyelonephritis (P=0.04) but no difference was found between the groups with regard to levels of CRP, ESR (P>0.05).

Results: Changes on the DMSA scan were found in 106 (85.5 percent) kidneys of 62 children but ultrasonography showed renal changes in 19.4 percent (sensitivity=20 percent, specificity=83 percent) (Kappa=0.06). Vesicoureteric reflux was found in 14 children (23.3 percent) but 83 percent of the affected kidneys were drained by non-refluxing ureters.

Conclusion: It is concluded that DMSA scan is more sensitive than ultrasonography in detecting renal paranchymal changes in acute pyelonephritis and we found out that renal paranchymal changes after acute pyelonephritis is common, even in those without VUR.

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The nephrotic syndrome is the most common chronic renal disease of childhood.
Materials and Methods: In this study the clinical course, risk factors for relapse and the predictors of long-term outcome of 502 patients (median age 5 years)with primary nephrotic syndrome were followed for an average of 60 months (3.5 to 240 months) from 1981 to 2000.
Results: Among the 502 patients 5 (1%) achieved spontaneous remission and 313 children were initial responder. One hundred eighty four patients received at least 1 kidney biopsy (78 prior and 106 after initiation of treatment). Of 104 children with frequently relapsing steroid sensitive and steroid dependent nephrotic syndrome, levamisole induced prolong remission in 33 ( 31.7%) of patients. Cyclophosphamid and cyclosporine A induced prolong remission in 49 (50%) of 98 and 28 (41.3%) of 68 patients respectively. At the time of the final clinical evaluation, 73 patients (14.5%) were on remission 301 (59.9%) had relapsing 43 (8.6%) had persistent nephrotic syndrome 33 (6.6%) of patients evolving to end-stage renal disease (ESRD) and 6 (1.2%) of them with chronic renal failure died (infection and cardio respiratory were the cause of death in 5 and 1 patient respectively). Young age (1-5 y) at onset of disease and atopy were identified as an independent risk factors for relapse (P0.05). Patients with steroid dependent nephrotic syndrome (SDNS) or MCNS had better response to cyclophosphamide or cyclosporin than children with steroid resistance nephrotic syndrome (SRNS) or FSGS (P0.05). Persistent proteinuria, hypertension, microscopic or macroscopic hematuia, glucosuria were associated with progression to chronic renal failure (PO.05).
Conclusion: Steroid dependency and histopathology of MCNS in patients with nephrotic syndrome were significantly associated with good long-term prognosis. In contrast persistent proteinuria, histopatholoy of FSGS, hypertension, macroscopic or microscopic hematuria, and glucosoria were significantly correlated with unfavorable long-term outcome. Additionally our study showed a positive correlation between young age and atopy with higher rate of relapse.

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The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on post-operative bleeding and need for allogeneic transfusion.
Materials and Methods: In a prospective, randomized study, 200 patients undergoing CABG allocated into two groups:
□ AT group = 100 patients received 1-2 units (300-450cc) autologous blood after termination of CPB D TX group = 100 patients received tranexamic acid, 15mg/kg before the injection of heparin and 15mg/kg after protamin injection Postoperative bleeding, transfusions, complications, ICU stay and hospital stay were recorded.
Results: The postoperative bleeding was lower in TX group (600 ml) than in AT group (1100 ml) (P <0.001). The rates of transfused patients in AT and TX groups were 72% and 65%. Patients in the AT group received more whole blood (2.82 units per patient vs. 1.93 units in TX group) (P<0.01). The numbers of FFP units administered per patient in AT and TX groups were 3.08 and 2.38 (P <0.01). In TX group, ICU stays and hospital stays were 0.8, 5.4 days (vs. 1.2s, 6.7days in AT group). In AT group, there were 2 transient renal dysfunctions and two re-operations. There was no difference between all groups regarding to neurological dysfunction and coagulopathy. There is no hospital mortality in all groups.
Conclusion: Tranexamic acid in comparison with intra-operative autotransfusion effectively reduces postoperative complications and allogeneic transfusions in CABG. In addition this technique due to shorter ICU and hospital stay is cost- effective.

 

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Background: Chronic renal failure defines as progressive and irreversible dysfunction of kidneys that could eventually terminated to end stage renal disease (GFR< 10% NL). Because of therapeutic problem and high mortality and morbidity and it &aposs implication quality of life , ESRD is one of the important dilemma of pediatric medicine .

Materials and Methods: In our study 216 patients evaluated .

Results: Male to female ratio was 1.1 . The peak of the presenting age of ESRD was 10 years old (8-12 y). Congenital urological malformation (30%) , glomerulopathies (20%) , hereditary nephropathies (14.3%) , multisystem diseases (7%) and nephrolithiasis (6.2%) are the most common etiologies of ESRD . VUR in 21% and congenital obstructive disease in 8.5% are the etiology of ESRD. In patients with age five years old and lesser common causes of ESRD are congenital urologic malformation and glomerulopathies. In other age groups , urologic malformation is the most common cause of ESRD. In etiologic assessment of two separate 7 years interval , (1988-1993) and (1996-2003) , there was not any significant change in frequency of etiologies but frequency of congenital obstructive uropathy decreased from 10 % to 5.7%. Total amount of VUR (VUR ± Neuropathic bladder) has not any change but frequency of primary reflux nephropathy decreased from 14.2% to 8%. In this study , in 145 patients hemodialysis continued and 28 cases had unsuccessful renal transplant (13.8%) . 7.4 % of patients had successful renal replacement therapy (RRT) and mortality rate was 7.4% . B

Conclusion: Based on that the most common cause of ESRD is all ages in congenital urologic malformations , early diagnosis and appropriate management of these cases are effective in decreasing incidence of ESRD and with respect to few cases of renal transplant and unsuccessful results in 65% of RRT , the approach of this problem should be revised.

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Background: Despite several years of intensive investigation, relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is poor for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. As newer treatment modalities become available for patients with severe lupus nephritis, it become increasingly important to identify patients at risk for renal failure. The aim of this study was to evaluate the clinical course, histopathology, serologic features and prognostic significance of some parameters, to identify the risk factors for renal failure and mortality in children with lupus nephritis.

Materials and Methods: Retrospectively 30 children under 16 years of age with lupus nephritis from 1989 to 1999 were studied. All patients received renal biopsy and follow-up biopsies were performed in 3 children. Lupus nephritis was classified by the World Health Organization (WHO) criteria. The clinical and serologic parameters at the time of renal biopsy were recorded.

Results: All children underwent renal biopsy within 1 year of disease onset. There were 1 (3.3%) patients with class II, 5 (16.7%) with class III, 21 (%70) with class IV, and 3 (%10) with class V nephritis based on initial biopsy according to the WHO classification. The mean follow-up time was 60 months. Follow-up biopsies were histologically stationary in 2 patients and progressive in one. The overall renal and patient 5- year survival rates were 46.66% (14/30) and 93.33 %( 2/30) respectively. They were 47.61% (10/21) and 95.21 %( 20/21), respectively, of patients with class IV proliferative glomerulonephritis. Children with renal pathology (class V in the WHO classification system) at initial biopsy, were at high risk for renal failure 66.66% (2/3) or morality %33.33 (1/3) despite aggressive treatment. The results revealed that those with persistent hypertension, anemia, and decreased creatinine clearance rate, nephrotic proteinuria, at initial biopsy were more prone to develop renal failure (P<0.01).

Conclusion: The prognosis of children with class IV nephritis in our study was better than reported in other series in recent years. However, those with class V disease, persistent hypertension, anemia, low creatinine clearance and nephrotic proteinuria at the time of diagnosis are at increased risk for renal failure. The improved results may be due to initial histological classification, better supportive care and selective use of aggressive therapy such as methylprednisolone pulse therapy and intravenous cyclophosphamide for those with high risk factors.

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Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons.

Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons.

Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor <1 cm) was higher in the gynecologist oncologist group, than in the general gynecologist group (P<0.001). Repeated surgeries were required for a majority of patients in the general gynecologist group, while only a few patients in the gynecologist oncologist group needed a second operation (P<0.0001). The interval between the initial surgery and the beginning of chemotherapy was significantly longer in the gynecologist oncologist group compared to that of the general oncologist group (P=0.001). Overall survival and disease-free survival was considerably greater in the gynecologist oncologist group. Optimal cytoreductive surgery and stage of disease are prognostic factors in patients with ovarian cancer. We can therefore conclude that patients with ovarian cancer who are treated by gynecologist oncologists have a better outcome.

Conclusions: We suggest that patients requiring cytoreductive surgery for ovarian cancer be referred to a gynecologist oncologist rather than having a less specialized physician care for such cases.

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Background: Impairment in the function of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesico-ureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.

Methods: The research involved 133 children (11 boys, 122 girls), ranging in age from seven months to 14 years. Group A consisted of 78 children with a history of recurrent UTI, while Group B included 55 children with recurrent UTI and VUR. Urodynamic tests (cystometry) were performed on all the children.

Results: Abnormal functioning of the lower urinary tract was found in 98 children (73.1%) from Group A and 41 children (78.8%) from Group B. The most common dysfunction was detrusor-sphincter dyssynergia (DSD), which was found in 54% of all subjects, 46.2% of patients in Group A and 60% of patients in Group B (p<0.05). Unstable bladder was found in 42 (33%) children with no significant difference between the two groups. In 17 children (12.6%) DSD was accompanied by bladder instability. In both groups about 20% of the children did not present with symptoms indicative of urination dysfunction, where as 80% reported various symptoms, of which the most common were constipation and urinary urgency. In half of the children from Group A and one-fourth of the children from Group B there were several co-occurring symptoms: frequency, urgency, intermittent voiding, incontinence, dribbling and retention, and constipation.

Conclusions: The most common disturbance of lower urinary tract function in these children with recurrent UTI was DSD, which occurred more often in children with VUR.

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Background: The aim of this study was to estimate the prevalence, severity, and risk factors for diabetic retinopathy in diabetic cases admitted for non-ocular diabetic complications and to investigate the association between retinopathy and these complications.

Methods: In this cross-sectional study, 84 diabetic patients admitted to our university-affiliated hospital for non-ocular diabetic complications were fully evaluated for proliferative and nonproliferative diabetic retinopathy. Cases of nonproliferative retinopathy (NPDR) were graded as microaneurysm, mild, moderate or severe. To determine the association of retinopathy with the complications that caused hospitalization, statistical analysis was performed using SPSS ver. 11.5.

Results: The prevalence of diabetic retinopathy among our cases was 77.4% (65 patients), with proliferative diabetic retinopathy (PDR) present in 23 patients (35.4% of the retinopathy cases). Diabetic retinopathy was higher in patients who had been hospitalized for nephropathy than in patients with diabetic foot and diabetic ketoacidosis (DKA, p=0.001), and higher in those hospitalized for diabetic foot than for DKA (p=0.008). Among the 35 patients who had nephropathy and retinopathy, 16 subjects (45.7%) had PDR, and the other 19 subjects had NPDR. Twenty-seven patients had diabetic foot and retinopathy, six (22.7%) of whom had PDR, and 21 (77.8%) had NPDR. Factors significantly related to the occurrence of diabetic retinopathy were type 2 diabetes, presence of hypertension, elevated serum levels of creatinine, duration of diabetes and coexisting nephropathy or diabetic foot (all with p values <0.05). In the logistic regression model, diabetic duration had a slight association with PDR (p=0.06).

Conclusion: Our data suggest that diabetic retinopathy in our patients is common, especially in patients with nephropathy. In addition to glycemic control, lowering of serum cholesterol and triglycerides as well as blood pressure may be effective in lowering the prevalence of diabetic retinopathy.

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Background: Nephrotic syndrome is one of the most remarkable diseases in childhood. The majority of patients have prompt response to corticosteroids.

Methods: In this study, we retrospectively evaluate the outcome of patients with steroid-responsive nephritic syndrome. Medical records from January 1996 to September 2006 were reviewed to identify all children with steroid sensitive nephrotic syndrome at the Pediatric Medical Center, Tehran, Iran. Initial steroid therapy was 60 mg/m² per day for four weeks. Levamisole, a steroid-sparing agent, was prescribed at a dose of 2.5 mg/kg on alternate days in conjunction with alternate-day prednisolone. If no benefit was observed by three months, levamisole was discontinued and immunosuppressive therapy with cyclophosphamide at a dose of 3 mg/kg daily for 8 weeks, or cyclosporin A at a dose of 3-5 mg/kg was prescribed.  

Result: Of 745 children with steroid sensitive nephrotic syndrome, 63.1% of patients were male. The most common causes were minimal change disease (98/324, 30.2%) and focal segmental glomerulosclerosis (81/324, 25%). At presentation, microscopic hematuria was found in 22.6% of the patients. During follow-up, 9.2% had no relapse at any time, while 15.8% were frequent relapsers. The remission period ranged from 3.5 to 168 months. At the last follow-up, 57.6% of the patients were in remission, 37.7% relapsed and 29 children developed chronic renal failure. The outcome of nephrotic syndrome was not associated with age or gender. The end clinical status of patients correlated with duration of remission, number of subsequent relapses and response to cytotoxic agents.

Conclusions: Steroid-responsive nephrotic syndrome in children should be followed over a long period, especially patients with early relapse. Relapse was seen in more than 90% of patients. Documentation of histopathology by renal biopsy may be helpful to identify those at increased risk for a poor outcome.

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Background: Childhood nephrotic syndrome is frequently characterized by a relapsing course. Due to their adverse effects, the use of corticosteroids for the management of frequently relapsing nephrotic syndrome is limited. Levamisole, a steroid sparing agent, has been found to have low toxicity. This study was conducted to evaluate the efficacy of levamisole in steroid-sensitive nephrotic syndrome (SDNS). 

Methods: In this retrospective study from January 1988 to September 2006, we included data from 305 pediatric SDNS patients at the Children's Medical Center clinics in Tehran, Iran. Nephrotic syndrome was diagnosed using classic criteria. None of the patients had any signs or symptoms of secondary causes of nephrotic syndrome. All had received prednisolone 60 mg/m²/day. After remission, prednisolone administration was reduced to every other day and the steroid was tapered over the next three months. With every recurrence, prednisolone was prescribed with the same dosage, but after remission it was continued at a lower dosage for another six months or longer if there was risk of recurrence. Levamisole was administered to all patients at a dose of 2 mg/kg every other day.         

Results: Patients ranged in age from 1 to 20 years (mean±SD: 4.84 ±3.1) and 70.8% were male. At the last follow up, 84 (27.5%) were in remission, while 220 (72.1%) patients had relapsed or needed a low dose of steroid. Levamisole was effective in reducing the prednisolone dosage and long-term remission in 68 (22.3%) and 90 (29.5%) cases, respectively. A comparison of before vs. after levamisole treatment revealed a had significant decrease in the number of relapses (2.05±0.88 vs. 1.1±1.23 P<0.0001) and the prednisolone dosage (0.74±0.39 vs. 0.32±0.38 mg/kg/day P<0.0001). Only one patient developed levamisole-induced neutropenia.

Conclusions: In childhood steroid-dependent nephrotic syndrome, levamisole is an efficacious, safe initial therapy in maintaining remission while decreasing steroid dose, in addition to reducing the rate of relapse.

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Background: Medical induction abortion is an acceptable alternative to surgical abortion for pregnancy termination. Misoprostol is an inexpensive PGE1 analogue that can be used easily and safely as a single agent for first- and second-trimester pregnancy termination. The objective of this study was to evaluate the efficacy of two different doses of vaginal misoprostol for pregnancy termination with gestational age up to 16 weeks.

Methods: This clinical trial included 100 pregnant women with gestational age up to 16 weeks requesting legal termination of pregnancy. The subjects were randomized in two equal groups, and received either 200 (group 1) or 400 µg (group 2) misoprostol vaginally every 6 hours with a maximum of four doses. Response to treatment was defined as complete or incomplete abortion within 48 hours after initial dose. Curettage was performed for patients with heavy bleeding or incomplete abortion. The abortion outcome and side-effects were assessed.

Results: The groups were similar in maternal age, gestational age, parity and obstetrical history and indication for pregnancy termination. The side effects in group 2 were significantly higher than in group 1 (P<0.05). There were no statistically significant differences between the two groups regarding completeness of the abortion and mean time to abortion induction.

Conclusions: In the termination of pregnancies up to 16 weeks, the 200 µg per dose regimen of misoprostol was as effective as the 400 µg regimen however, side-effects were more common with the higher dose.

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Background: Early diagnosis of renal parenchymal involvement in children with acute pyelonephritis (APN) using isotope scan and early treatment may decrease or prevent development of renal parenchymal lesions. We designed this study to assess the diagnostic value of certain biologic parameters in children with first- episode of acute pyelonephritis (APN) documented by 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy.
Methods: We compared the laboratory findings of leukocyte count, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels with the results of the DMSA scans obtained within three days of admission. One hundred-two children (93 girls and 9 boys aged 1 month–12 years (mean 2.85±2.92 years) were enrolled in the study. Of these patients, 203 renal units, were investigated using scintigraphy. Voiding cystourethrography (VCUG) was performed in 98 children (195 renal unit) when urine culture became negative.
Results: In all children one or both of kidneys had parenchymal involvement on scintigraphy. Changes on the DMSA scan were found in 178(88%) renal units during the acute phase. The extent of changes in DMSA scan were mild in 113/178(55.7%) renal units, moderate in 40/178(19.7%) and severe in 25/178(12.3%). When inflammatory markers were correlated with the development of the severe renal lesions, as assessed with DMSA scan, a highly significant correlation with both ESR (p=0.007) and leukocyte counts (p=0.02) were found.
conclusions: We conclude that the incidence of renal parenchymal involvement in Iranian children with APN is very high. Although increased ESR and leucocytosis may be valuable markers for determination of severe renal parenchymal involvement, but these parameters and also CRP, were inadequate in distinguishing mild to moderate renal parenchymal involvement.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Neck lymph node metastasis has the prognostic role in SCC of the tongue and the importance of the biologic markers in tumor invasion and metastasis has been stated in the medical literature. The aim of this study was to evaluate the relationship between two biomarkers, p53 and EGFR (which had the main role in cell proliferation) and two other biomarkers, CD44 and E-cadherin, in lymph node metastasis.
Methods: In an analytic descriptive study fifty three patients with SCC (Squamous Cell Carcinoma) of the tongue who underwent the resection of tumor and dissection of neck lymph nodes were assessed during the year of 2002-2009. Histological samples from 53 patients were immunohistochemically stained and the analysis of these markers were performed due to clinicopathological variable and metastasis of the neck lymph nodes.
Results: The result showed that among the clinicopathological factors, the relationship between Age (p=0.01), history of having risk factors (p=0.002), clinical lymphadenopathy (p=0.002), the size of the tumor (p=0.001), decreasing of CD44 (p=0.02) and lymph node metastasis of the neck were statistically significant. No significant relationship were found between sex and other biomarkers including p53, EGFR, E-cadherin.
Conclusion: CD44 is an important indicator of prognostic markers that can also be used as an indicator of clinocopathological markers.

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Background: Vascular complications, as the most common complications of diagnostic catheterization and percutaneous coronary intervention (PCI), are important factors in the morbidity of patients undergoing such procedures thus, this study was done to evaluate the prevalence of these complications and their related factors.

Methods: This is a descriptive study composed of 2097 consecutive patients who underwent percutaneous coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran from January 2008 to January 2009. Occurrence of vascular complications in course of hospitalization and the related factors leading to the complications were investigated.

Results: Out of 2097 patients, 1544 (73.6%) were male and 553 (26.4%) were female, and the mean age of the participants was 57±10 years. Vascular complications from the time of PCI to the time discharge were observed in 19 (0.9%) patients. The other complications included: hematoma in 10 cases (52.6%), pseudoaneurysm in five cases (26.3%), retroperitoneal hemorrhage and arteriovenous fistula in 2 (10.5%) patients each. The complications were significantly more common in female patients (P=0.003), in patients with a history of hypertension (P=0.02), people of shorter stature (P=0.004), and being on gp IIIa/IIb inhibitors (P=0.003).

Conclusion: The rate of vascular complications post-percutaneous coronary interventions is low and it is considered to be a good treatment option for patients with coronary stenosis provided that sufficient compression is applied on the vascular access point in the right time after removal of the arterial sheath. PCI is of fewer vascular complications, especially in female patients, history of hypertension, and higher anticoagulant concentrations.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Osteoma is a bony slow growing benign tumor in one of the sinuses. It is usually asymptomatic but clinical symptoms will occur by its overgrowth, occupation of sinus space and obstruction of ostia.
Methods : This descriptive, cross-sectional, retrospective study was done by accessing the medical records of 17 patients with paranasal sinuses osteomas admitted in Tehran Amir Alam Hospital during 1999-2008.
Results : The mean age of the participants was 33.9 years and 12 (70.6%) were male and 5 (29.4%) were female. No positive family histories existed for the lesions. The mean time interval between the onset of symptom and attending the hospital was 4.4 years.
Frontal followed by ethmoid sinus osteomas were more common in comparison to other sinuses. The most reported symptoms in frontal sinus osteomas were upper eyelid inflation and headache and proptosis, nasal congestions and diplopia in ethmoid sinus osteomas. Most patients had been endoscopically treated.
Conclusion: In small-to-medium-sized osteomas with no invasion into orbit or skull base, endoscopic surgery is the treatment of choice with minimum side-effects.

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Background: Isosorbide dinitrate has been broadly used in the treatment of various ischemic heart diseases. Isosorbide is a nitric oxide donor which increases blood flow to tumors through vasodilatation and consequently accelerates the access of chemo-drugs to them. Furthermore, this drug has inhibitory effects on angiogenesis, tumor growth and metastasis in vivo. Moreover, its ant-inflammatory effects have also been reported. In the present study we evaluated the effects of isosorbide on the proliferative activity of fibrosarcoma WEHI-164 cell line and peripheral blood mononuclear cells (PBMCs).

Methods: WEHI-164 fibrosarcoma cells and human PBMCs were cultured in complete Roswell Park Memorial Institute (RPMI) 1640 medium with 10% fetal bovine serum and 2×104 cells/mL for WEHI-164 and 2×105 cells/mL for PBMCs. The cells were then incubated at the exponential growth phase with different concentrations of isosorbide (4×10-6-1.6×10-3 M) for 24, 48 and 72 hours. Subsequently, isosorbide effects on proliferation of the cells were evaluated by trypan blue dye exclusion (TB) test and MTT assay. Statistical comparisons between groups were made by analysis of variance.

Results: The proliferative activity of WEHI-164 fibrosarcoma cells and human PBMCs treated with different concentrations of isosorbide, did not show any significant difference with untreated control cells.

Conclusion: The results of this study showed that isosorbide neither had any significant effects on the proliferative activity of fibrosarcoma WEHI-164 cells nor on human PBMCs. Our findings suggest that anti-tumoral effects of isosorbide reported by other investigators may be mediated through non-cytotoxic mechanisms.

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Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.
Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.
Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68).
Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.