Tehran University Medical Journal

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In order to understand the function of mammalians serotonin system, we have to know the anatomical structure, because physiological changes are influenced through the anatomical changes. A number of thalamic nuclei are associated with functions known to be influenced by serotonergic input in brainstem, among them mediodorsal thalamic nucleus has relationship with limbic system and prefrontal cortex. The precise topographical projections of mesencephalic raphe nuclei to the MD nucleus of thalamus were identified in the rat using horseradish peroxidase (HRP) retrograde tracing substance. Injection of HRP in MD labeled a large number of neurons in rostral to caudal part of dorsal raphe nucleus. It exhibited a strong number of neurons in ipsilateral part of DR and a few cells in its contralateral part. Numerously labeled cells were also observed ipsilateral in rostral and medial part of MnR (86%) and a few cells in it's contralateral part. The present study has provided that the MD innervation by DR is more greater in density than that observed at the MnR. Upon these results and previous study, mesencephalic raphe nuclei are involved in several specific functions of thalamus as limbic system behavioral mechanism. A much more detailed knowledge is needed to show topographic relationships between mesencephalic raphe nuclei and forebrain.

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One of the common problems in children and specially in infants is gasteroesophageal reflux (G.E.R). Present study was performed to compare diagnostic value of lower esophageal sonography with barium swallow. This study was conducted on 50 patients 1 month to 15 years age in center of pediatric clinic of Tehran, during the years 1999-2000. Patients suspected to have G.E.R studied with lower esophageal sonography and barium swallow and at the end, their results were compared with esophageal PH monitoring as a standard test. In this study sensevity of sonography was 90 percent against 50 percent for barium swallow but specifity of two test was the same 35 percent. We can concluded that sonography is a non invasive, low cost, with less side effects than barium swallow. We recommend sonography in place of barium swallow in diagnosis of G.E.R.

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Background: Abnormal uterine bleeding (AUB) is a common presenting symptom indicative of abnormal menstrual bleeding patterns that may occur in anovulatory or ovulatory women.There are different ways to diagnose AUB, all requiring much time and energy. The purpose of this study was to evaluate and compare the value of endometrial biopsy, transvaginal ultrasonography with dilation and curettage (D&C) which is the current gold standard procedure.

Methods: A prospective-descriptive study was conducted on fifty patients referred to our center for refractory abnormal uterine bleeding who were candidates for hysterectomy. All patients underwent endometrial biopsy and transvaginal ultrasonography , followed by D&C as a Gold standard procedure in operating room just before surgery.

Results: Mean age of patients was 46.62 years. Transvaginal utrasonography offered a sensitivity of 70% and specificity of 68% demonstrating the lowest numbers compared to D&C. Endometrial biopsy had a sensitivity of 70% and specificity of 75% that was better than sonography alone.

Conclusion: D&C was the most useful and valuable procedure and addition of endometrial biopsy with transvaginal ultrasonography will not be of high value in diagnosis.

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Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications the most important is laryngo-tracheal injuries.                   

Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia.

Results: Fifty-seven patients (44 male mean age, 23.014.7 years) were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%). Head trauma was responsible for most cases of intubation (72.4%). The most common types of tracheal and laryngeal lesions were tracheal (56.9%) and subglottic (55.2%) stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001) but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS). Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%). No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS). Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS).

Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation period were greater in tracheal and subglottic lesions.

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Background: The aim of this study was to review the frequency, histopathology and outcome in children with tumors of the liver.
Methods: Included in this retrospective/descriptive study were 30 children treated for liver tumors from 1375-1384 (ca. 1996-2005), at Children’s Hospital Medical Center, Tehran, Iran. We included the clinical, radiologic, and pathologic data of our patients, focusing on the frequency, etiology and outcome.
Results: Patient ages ranged from three months to 12 years (median 3.8 years), with 18 males (60%) and 12 females (40%). Of these, 17 patients had hepatoblastoma (55.66%), including 13 males and four females, with an age range of six months to five years. Four cases (13.33%) had neuroblastoma. Hepatocellular carcinoma (HCC) was found in three cases (10%), all of whom were carriers of hepatitis B. Two cases (6.66%) were diagnosed with mesenchymal hamartoma, two cases (6.66%) with hemangioendothelioma and two cases (6.66%) with rhabdomyosarcoma and leiomyosarcoma of the biliary tract. Abdominal swelling and hepatomegaly were seen in all of patients. Jaundice was observed in two cases. Serum alpha-fetoprotein levels greater than 500 ng/ml were seen in 17 cases (56.66%). All patients were receiving specific treatment. The three-year survival rate was 65% for hepatoblastoma and 2% for HCC
Conclusion: With the introduction of specific treatment, the survival rate for children with tumors of the liver has significantly increased. Further improvement can be achieved using diagnostic biopsy for hepatoblastoma, although it may result in complications, and preoperative chemotherapy followed by complete surgical excision (per International Society of Pediatric Oncology guidelines), yielding an outstanding survival rate of 80%.

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Background: Infectious diseases are usually treatable however, infectious disease is one of the most common causes of mortality in hospitals. Furthermore, an apparent functional stagnation around the weekends in hospitals can increase the mortality rate. The goal of this study is to describe the causes and predisposing factors of mortality and to evaluate the role of holidays on patient mortality in infectious disease wards.

Methods: In this retrospective descriptive-analytic study, we examined the files of patients who had expired while hospitalized in the infectious disease ward of Imam Khomeini Hospital from 2002 to 2004. All of the information was gathered from patient files and the mortality committee of Imam Khomeini Hospital. Patient mortality rates were determined for each year. Mortality rates for the various days of the week were estimated and compared for 2004.

Results: The total number of patients included in this study was 3979. Of these, 216 cases had expired, 143 of whom were male (66%). The common causes of mortality were sepsis (26%) bacterial pneumonia (22%) and tuberculosis (19%). The mortality rates were 5.08%, 5.31% and 5.84% in 2002, 2003 and 2004, respectively. In 2004, mortality rates were 9.21%, 10.21% and 4.56% for holidays, pre-holidays and other days of week, respectively. A significantly higher rate of mortality was observed for holidays and pre-holidays compared to the other days of week. (P value <0.05).

Conclusions: Fortunately, the mortality rate of 5.43% in this infectious disease ward was not high. Since sepsis, bacterial pneumonia and tuberculosis were the most common causes of mortality, extra care of patients with these diseases is necessary. As a result of the findings of this study, we recommend increasing expert hospital staff and improving the quality of diagnostic and treatment services during holidays and pre-holidays.

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Background: Resulting from the rough flow of air through the nose and throat during sleep, snoring can arise from transitory obstruction at various levels, rendering the sufferer feeling sleep deprived. A relatively new method using radiofrequency technology, called palatoplasty (somnoplasty), can be used to reduce the size of obstructive tissues in the nose and throat. In this study, we assess radiofrequency palatoplasty in the treatment of snoring.

Methods: This nonrandomized prospective quasi-experimental study included 28 patients who snored at a level considered bothersome to their bed partner. Snoring and drowsiness were each subjectively scored using 20-point visual analogue scales before and after treatment. Radiofrequency energy was delivered to the soft palate either at the midline or in the lateral soft palate 21 patients were treated once and seven patients twice with an interval of at least seven weeks.

Results: The mean age of the patients was 47 (SD=10.7) years, with a range of 25-65 years, 57% were men, and the mean body mass index was 29 (SD=4.5). Sleep apnea in these patients was subjectively rated mild to moderate. After seven weeks of treatment, snoring was improved in 71.4% of patients (p<0.005). The tongue versus pharyngeal size was improved in 34.4% (p<0.005). The mean patient snoring score was significantly improved from 17.39 (SD=3.02) to 11.50 (SD=6.46) (p<0.005). The mean drowsiness score was also significantly reduced from 6.8 (SD=6.9) to 3.93 (SD=4.19) (p<0.005). No persistent negative impact was observed in speech or swallowing. Pain and bleeding was limited.

Conclusions: Radiofrequency palatoplasty is effective in the treatment of snoring and its consequent drowsiness.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Coronary Artery Disease (CAD) is a major cause of death worldwide including Iran.  The risk of developing disease in patients without symptoms is assessed in part by factors that are associated with disease. Among these factors family history points to the significance of genetic component in the risk of CAD. The identification of the genetic variants that confer risk for CAD is essential for detecting high-risk individuals, so preventative life style and therapeutic action can be taken before overt disease develops. So far more than 100 genes have been reported with possible role in developing risk for CAD. Matrix- Gla Protein (MGP) is one of these genes that association of its single nucleotide polymorphism (SNP) with CAD has been reported.  Among the polymorphisms, there are two promoter SNPs at position -7 & -138 that their association with CAD has been reported before. Here we investigated the association of these SNPs with CAD in Iranian population.
Methods: 150 cases and 150 controls were selected on the basis of their clinical assessments and angiographic reports. DNA was extracted from blood samples. The genotypes for both SNPs were determined using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method with size fractionation on Polyacrylamide gel.
Results: The comparison of allele & genotype frequencies between patients and controls showed that there is an excess of A allele at position -7 and T allele at position -138 among patients, although these differences were not significant (p<0.2, and p<0.5 respectively).
Conclusions: This study suggests no association of these SNPs with CAD in Iranian population. Confirmation of this finding needs independent repeat of similar studies.
Keywords: Coronary Artery Disease (CAD), Matrix Gla Protein (MGP), Single Nucleotide Polymorphism (SNP).

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Background: Data mining as a multidisciplinary field is rooted in the fields such as statistics, mathematics, computer science and artificial intelligence and has been gaining momentum in scientific, managerial, and executive applications in health care. Data mining can be defined as the automated extraction of valuable, practical and hidden knowledge and information from large data. Applying data mining in medical records and data is of utmost importance for health care givers and providers and brings vital and valuable outcomes. Data mining can help doctors come up with better recommendations and plans for treatment which actually in many respects have significant impact on patients’ life and satisfaction In this paper we have proposed and utilized data mining methods to extract hidden information in medical records of pelvis stone patients with ureteral stone. We have tried to design a decision support system model to be applicable for selecting type of treatment for these groups of patients.
Methods: We gathered needed information from Shahid Hashemi Nejad hospital. In this research we have used decision tree as a data mining tool, for selecting suitable treatment for patients with ureteral stone. This model can predict probability of success of each treatment. 
Results: In this research we extracted effective attributes in selecting type of treatment for patients with ureteral stone.
Conclusions: By using this model we can have eight percent improvement in number of patients who have stone free output after treating. In fact, this model has a better functionality than expert system of hospitals.

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Background: Ureteral obstruction has been shown to induce renal oxidative stress, suppressed energy metabolism and defected acid excretion. This study was aimed to examine the improving effects of L-carnitine, a facilitating cofactor for mitochondrial oxidation of fatty-acids as well as a scavenger of free-radicals, and -tocopherol as the most potent antioxidant on these renal disorders at early hours following release of unilateral ureteral obstruction.
Methods: The left ureter was ligated in 60 anaesthetised rats, L-carnitine, -tocopherol, or their vehicles (normal saline and olive oil, respectively) were injected (i.p.) in four groups. Each rat was re-anesthetized and cannulated, and ureteral legation was released at exactly 24h after UUO-induction. A 30-min clearance period performed to separately collect urine from both kidneys. The collected urine and arterial blood samples were given to pH-gas analyzer and autoanalyzer, and malondialdehyde (MDA), ATP and ADP levels were assessed in preserved kidneys. There were also sham and control groups (n=8-10 in each).
Results: In the post-obstructed kidney of vehicle-treated groups with respect to the equivalent kidney of sham group, there were increases in MDA (p<0.001), ADP (p<0.01), urinary pH (p<0.001), absolute (p<0.05) and fractional bicarbonate excretions (p<0.01), but decreases in ATP, ATP/ADP (both p<0.001), and urinary PCO2 (p<0.01). -tocopherol could normalize MDA level but did not affect the altered amounts of energy metabolic indices and acid-base excretions, while L-carnitine improved all of them except of decreased urinary PCO2.
Conclusions: Increased bicarbonate-excretion in post-obstructed kidney is due to defected acid-secretion at collecting duct, which is not related to ureteral obstruction-induced renal oxidative stress and suppressed energy metabolism.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Recombinant antibodies are new versions of monoclonal antibodies that are produced by recent molecular biology techniques. These antibodies can be isolated by phage display technology from immune or non-immune libraries. Recombinant antibodies are applied to treatment of some diseases and also are increasingly used for diagnosis and detection of many antigens. In the latter case, the presence of antigen-antibody complexes has to be detected by further approaches. The aim of current research was to stain an anti-K99 phage antibody with two different protein dyes and to apply them directly for detection of E. coli K99 fimbriae.
Methods: In order to stain above antibody, a phagmid vector carrying the anti-K99 single-chain Fv (scFv) antibody was isolated, purified and transformed into TG1 strain of E. coli. Afterward, the antibody was expressed in this cell as phage-scFv antibody. Phage antibodies were subsequently eluted, purified and stained with Disperse Red dye 60 and Coomassie Brilliant Blue. Finally, the binding activity of coloured phage antibodies towards the purified K99 fimbriae was verified by immunoblotting.
Results: The results showed that anti-K99 phage antibody was stained with both dyes and the coloured phages were able to recognize the corresponding antigen.
Conclusions: These protein stains that they usually do not alter the protein structure can be used for staining phage antibodies. The coloured phage antibodies retain their binding affinity for the antigens, and therefore can be applied to detection of relevant antigens.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Salmonellosis is a bacterial gasteroenteritis caused by different serovars of Salmonella. In the recent years, Salmonella enterica subspecies. Enterica serovar enteritidis is a major cause of gastroenteritis and food poisoning in the worldwide.  Different genus of salmonella is increasingly being resistant to common antibiotics. The aim of this study was to determine the frequency and the antibiotic resistance patterns of Salmonella enterica isolated from medical health centers in Tehran.

Methods: In this descriptive cross- sectional study from April to December 2008, 1950 fecal specimens from children with diarrhea were cultivated to identify Salmonella enteritidis. We used Clinical and Laboratory Standard Institute (CLSI) protocol to determine resistance patern of the isolates to 16 different antibiotics.

Results: In this study, out of 26 isolates 14(54%) were S. enteritidis, 2(8%) S. para B, 6(23%) S. para C, 3(11%) S. arizonea and 1(4%) S. para A. all of them were sensitive to ceftazidime, cephalexin, cefotaxime, ceftiraxone, ciprofloxacin, imipenem, meropenem, gentamicin and colistin sulfate. All of the isolates were resistant to nitrofurantoin whereas 71.4% of them were resistant to nalidixic acid.

Conclusions: The most prevalent isolated salmonella was S.enteritidis. According to high sensivity of these isolates to cephalosporin and flourqouinolon family, they can used as infective treatment for salmonellosis infections.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma.
Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site.
Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group p=0.415).
Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis.

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Background: Bickerstaff's brainstem encephalitis (BBE) is a very uncommon central nervous system disease with unknown etiology. As it is usually responsive to treatment, the diagnosis this disease is important. It seems There is no reported Bickerstaff's brainstem encephalitis case in Iran.
Case presentation: An 83 year old woman presented with vertigo, ataxia and dysarthria from a week prior to admission. Her T2 weighted MRI revealed high intensity lesions in the pons area. She received treatment with impression of ischemic stroke. After few days, lower extremities became weak symmetrically and deep tendon reflexes depressed. Deep sensory loss was noted too. The EMG-NCV studies showed acute polyneuropathy and in CSF examination increased protein content was noted. The patient improved after IVIG and corticosteroid therapy with impression of Bickerstaff's brainstem encephalitis.
Conclusion: In spite of severe initial presentation, Bickerstaff's brainstem encephalitis has a good prognosis if it diagnosed and treated properly. Although clinical features is too important, but paraclinical work up are necessary to diagnose this syndrome.

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Background: Sinus surgeries are usually associated with bleeding, thus can result in hemodynamic instability. This study investigated the hemodynamic changes induced by remifentanil plus isoflurane administration in comparison with propofol plus remifentanil in patients undergoing sinus surgery.
Methods: In this randomized clinical trial study, 96 patients were divided into two groups of isoflurane (1.2 MAC) plus remifentanil (44 patients, group A) and propofol (100 μg/kg/min) plus remifentanil (52 patients, group B). Twenty-two patients in group A and 23 in group B were male. The remifentanil dosage (0.1 μg/kg/min) was equal in both groups and all received 500 ml isotonic solution during the operation too.  Premedications and anesthetic inductions of both groups were similar. The variables included age, BMI, blood loss during surgery, systolic and diastolic blood pressures, pulse rate and mean arterial blood pressure.
Results: The mean age, BMI, amount of blood loss, mean systolic (30 minutes before and after the intervention) and diastolic blood pressures (60 minutes before and after the intervention), pulse rate (30 and 60 minutes before and after the intervention), mean arterial blood pressure (60 minutes before and after the intervention) were similar in both groups. The average mean arterial blood pressure, 30 minutes after the intervention (p=0.027) and the mean diastolic blood pressure, 30 minutes after the intervention (p=0.011) in the case group had statistically significant differences with the controls.
Conclusion: Based on this study, the combination of isoflurane plus remifentanil could better maintain the hemodynamic stability during sinus surgeries.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Staphylococcus aureus infection pervasively occurs in communities and hospitals and observing related guidelines is essential in preventing development of antibiotic resistance in Hospitals. In this study we tried to determine the prevalence of Methicillin and vancomycine resistant staphylococcus aureus (MRSA & VRSA) and find the most suitable diagnostic tool and treatment in affected patients.
Methods: This study was performed on hospitalized patients in Sina Hospital in Tehran, Iran during 2009-2010. Eighty-five staphylococcus aureus samples were evaluated for resistance to oxacillin and vancomycine by both disc diffusion and E-test methods.
Results: The study population included 46 male and 39 female patients. The mean age of the participants was 51.46±19.21 years. The MRSA frequency was 50%. 67 (78.8%) patients had hospital-acquired staphylococcus infection. The rate of hospital-acquired MRSA was 93%. Length of hospital stay, undergoing invasive methods, history of antibiotic use three months prior to hospitalization and its kind were recognized as MRSA risk factors. There were no reports of VRSA except one case of vancomycine-intermediate S. aureus (VISA). The results of disk effusion and E-test methods were consistent.
Conclusion: Considering the prevalence of methicillin resistance in hospital-acquired infections, it seems that oxacillin should not be used as the first-line option for empiric therapy against S. aureus till antibiogram results are available. Disc diffusion can also be reliably used instead of the more expensive E-test.

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Background: Uterine environment and fetal period can profoundly affect health of the neonat. Hypoxia-inducible factor-1α (HIF-1α) is a transcription factor that regulates cellular stress responses and its activity is essential in both embryogenesis and postnatal life. The aim of the present study was to investigate the effects of maternal swimming on rat pups' HIF-1α levels as a key regulator of oxygen in lungs.

Methods: Sixteen female Wistar rats weighing 180- 200 grams were acclimated to a new environment consisting of equal light-darkness cycle and ad lib access to chow and adapted to the stress caused by water for two weeks. The rats were divided into two swimming and control groups. Swimming training began on the first day of pregnancy in a pool and continued for 3 weeks (1 h/day, 5 days/wk). Pups' lungs were removed two days after birth and their HIF-1α concentration was determined with enzyme-linked immunosorbent assay (ELISA). Statistical analysis of the data was done using independent t-test. A p-value smaller than 0.05 was considered statistically significant.

Results: Swimming lead to a significant (P<0.001) increase in the pups' lung HIF-1α levels compared with the control group. Although 3-wk period of swimming training, showed no significant increase in weight and also lung weight of newborns. Thus it can be concluded that swimming endurance training in pregnancy, can be considered as appropriate alternative in order to embryos development.

Conclusion: Our research suggests that HIF-1α level is an essential element for the development of the lungs of embryos. Moreover, further studies on the lung HIF-1α levels at post-natal period with different modes of exercise will provide more clear insight into the mechanisms of the findings resulting from this study.

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Background: Cognitive problems in patients with post-traumatic stress disorder (PTSD) include poor concentration and impaired memory. Prevalence of PTSD in all aspects of life is 8% in USA. Regarding the importance of memory in functional levels, this study was performed to review memory status in these patients.

Methods: Fifty male war veterans with PTSD and major depression and 50 male non-veterans with depression participated in this study performed at psychiatric outpatient ward in Baqiyatallah hospital during 2008-2009. The patients met the DSM-IV diagnostic criteria. Depression severity, sex, age, educational level, and marital status were matched in both groups. A psychologist completed demographic and Mississippi questionnaires, PTSD checklist (PCL), beck depression Inventory and wechsler memory scale. The collected data were analyzed using SPSS software (version 11.0). A P-value smaller than 0.05 was considered significant.

Results: The mean age of the veterans and non-veterans was 43.9±4.7 and 42±9.4 years, respectively. Memory status did not differ between the two groups (P>0.05). There was no statistically significant correlation between duration and severity of PTSD with memory impairment (P>0.05). A negative correlation was found between personal and general information with re-experiencing in the veterans (P<0.05). Impaired memory was correlated with age greater than 45, educational level lower than high school diploma, severity of depression and longer participation in war.

Conclusion: Although both PTSD and major depression affected memory, but memory status did not differ between patients with PTSD and depression and patients with chronic depression.

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Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.

Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.

Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).

Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.

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Background: Intracranial lipomas are rare benign neoplasms that comprise 1% of all primary brain tumors. Generally, occur in midline structure and usually identified incidentally on CT scans or in autopsies. The incidence of intracranial lipomas is about 0.08 to 0.46% on autopsies. These benign lesions are slow-growing, usually asymptomatic and rarely require surgery.

Case Presentation: We report a 20 years old male who complained of headache since two years ago. On CT examination, a quadrigeminal cistern lipoma without any pressure effect on neural structures demonstrated. His headache remitted with conservative measures. Here, we have a review on the literature and explain CT scan and MRI findings.

Conclusion: According to the literature and present case, it seems that direct surgical excision of tumor is not justified in the majority of cases and symptoms of patients greatly respond to conservative measures and, at most, in cases of hydrocephalus, CSF shunting relieves their symptoms.