Tehran University Medical Journal

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Intestinal obstruction is a significant disease specially in patients with previous surgery. Patients symptoms and signs usually are abdominal pain, vomiting, abdominal distention and obstipation. Adhesion bands secondary to previous abdominal surgery is the most common cause of small bowel obstruction and in USA up to 70% of small bowel obstruction is caused by adhesions. In our study adhesion is also the most common cause but 23% of patients have obstruction secondary to adhesion. In the literature colorectal cancers are the most common cause of colonic obstruction and volvulus is the third common cause of colonic obstruction after obstruction from compressive effect of other primary abdominal or pelvic tumors. In our study vuvulus was the most common cause of colonic obstruction and colorectal cancer was the second most common cause. The most common previous surgery that lead to obstruction in our study was appendectomy. From 112 patients 75% of patients had complete and 25% had partial obstruction. Frequency of mortality was six from 112 patients or 5.3%. Seventy percent of our patients had small bowel obstruction and 30% had colonic obstruction. Patients with hypertension before surgery for obstruction had greater risk of mortality in the postoperative period than other patients. Patients with intestinal gangrene had greater risk of postoperative complication and morbidity than other patients.

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Background: A plan for management of infected arterial pseudoaneurysm has evolved from our experience with forty two cases of such aneurysms treated between 1378 and 1382.
Methods: Clinical data of 42 patients with femoral pseudoaneurysm resulting from addictive drug injection who presented in emergency department of Sina Hospital between 1378 and 1383 were retrospectively reviewed.
Results: All patients were men with the mean age of 36.9 years. Twenty eight patients were referred from other medical centers. The mean time of delay in presentation was 17.3 days. The mean duration of drug injection was 14 months. Primary repair and emergent vascular bypass were performed in 3(7.1%) and 2(4.8%) patients, respectively. 5(11.9%) patients undergone delayed revascularization. Thirty two (76.2%) patients returned to their normal lifestyle without any vascular bypass. One patient required amputation and one patient died due to sepsis and acute renal insufficiency.
Conclusion: Management of infected femoral pseudoaneurysms is simple ligation of the external iliac or femoral artery. When Doppler is not available “Operation Room and postoperative Direct Observation” is recommended in such patients to avoid unnecessary revascularization surgery.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Dendritic Cell (DC) is an important antigen-presenting cell that present tumor antigen to CD8⁺ and CD4⁺ T- Lymphocytes and induce specific anti-tumor immunity. In order to induce effective anti-tumor response, an option is increasing the efficiency of antigen presentation of dendritic cells and T cell activation capacity. The aim of the present study was to investigate the effect of dendritic cell maturation with protein components of toxoplasma gondii on cytotoxic T lymphocyte activity and their infiltration in to the tumor.
Methods: For DC generation, bone marrow cells were cultured in the presence of GM-CSF and IL-4 for five days. After that, LPS, protein components and whole extract of toxoplasma gondii were added to the culture media and incubated for another two days for DC maturation. To generate tumor, mices were injected subcutaneously with WEHI-164 cell line. For immunotherapy 10⁶ DCs matured with different compounds were injected around the tumor site. Infiltration of CD8⁺ T cells were determined by flow cytometry and cytotoxic activity was measured by LDH detection kit.
Results: Immunotherapy with DCs treated with protein components of toxoplasma gondii led to a significant increase in the activity of cytotoxic T cells and infiltration of CD8⁺ T cells in to the tumor. Immunotherapy using protein components of toxoplasma gondii significantly improved the survival of the mice compared with other groups (p<0.0001).
Conclusion: Protein components of toxoplasma are able to increase DC capability in induction of CTL-mediated anti-tumor response and increase infiltration of these cells in to the tumor.

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Background: Cupping is one of the most common traditional medical procedures in Iran, which is widely used and prescribed from long time ago. Putting a cup on the skin with induction of negative pressure, causes an artificial inflammation with collection of some body fluids under the skin which can be extracted by scarification. Different mechanisms and effects are attributable to cupping based on several assumptions and theories. Regarding to the vast use of this traditional therapeutic method and relatively different point of views about the effects of cupping, this study was performed to systematically assess published studies in this field and also to find probable indications of cupping.

Methods: In this systematic review, according to search via Google Scholar, PubMed, Scopus databases and Iranian databases (IranMedex and SID), 99 different scientific articles about cupping and it`s positive and negative effects were assessed. Different diseases categorized in 19 groups according to the pathophysiology and organ similarities for better presentation Results: More than 50 different disorders have been studied in randomized or nonrandomized clinical trials. 84.9% of reviewed papers have reported significant positive effects of cupping. The most common disorders studied in the reviewed papers were musculoskeletal, pain and skin disorders, especially low back pain has been studied more with positive results of cupping.

Conclusion: In Iran the prevalence of cupping performance is really high. The reported positive effects and also complications especially infection were also dramatic. It seems performing systematic studies on cupping effects in different disorders and designing and implementing an active surveillance system for cupping in our country is essential. According to the type of studies, authors concluded that cupping have been reported as an effective intervention for some diseases such as musculoskeletal and skin disorders, but further methodologically elaborated studies with larger sample sizes should be considered for recommending this intervention scientifically.

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Results: The mean and standard deviation (SD) of the patients' age was 50/4±11/8 years.  The average time of incidence of skin lesion after transplantation has been 8/1 ± 5/7 weeks. The most common types of non-melanoma cancers were squamous cell carcinoma (2%) and Kaposi's sarcoma (4%) and there was no significant difference between men and women (p>0.05). Sixty-six percent of the patients had skin infections and the most common skin infections were wart (34%) and tinea versicolor (11%). The relative frequency of skin infections was significantly higher in male patients than in females (p=0.004). Considering all other confounding variables including smoking, hypertension, diabetes and other infectious diseases, the only noteworthy finding was the higher relative frequency of tinea versicolor in diabetic compared with non-diabetic patients (p=0.046). Conclusion: This study showed that skin complications including various neoplastic (Sarcoma and Carcinoma), infectious (fungal and viral), and other (Acne and Hypertrichosis) diseases are common in patients with kidney transplantation who are taking immunosuppressive drugs. Informing these patients and medical staff about skin problems leads to an early referral of patients and increases their life expectancy and improves their quality of life.

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Results: The challenges of teaching medical ethics from the participant's point of view are classified into three themes: 1- Hidden curriculum 2- Necessity of completing medical ethics education program 3- Executive and managerial macro factors. The results showed that medical ethics training courses are not effective for changing students' behavior and their moral decision-making. There are substantial shortcomings in the current curriculum in terms of content, format, and implementation that make it unresponsive to ethical needs and concerns. Teaching medical ethics should be turned into a longitudinal theme. The duties and missions of the Department of Medical Ethics at the university are not well understood. The Department does not act as a strong executor and supervisor of medical ethics in interaction with higher authorities to pursue the requirements of effective ethics education and to ensure the implementation of ethical codes. There is no effective mechanism for evaluating the ethical performance of activists and students and giving feedback to them. There is insufficient organizational support for students' complaints and reports about the misconduct and unethical behavior of faculty or staff.

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