Tehran University Medical Journal

Background: Multislice computed tomography (MSCT) is a noninvasive method of detecting coronary artery disease (CAD). The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64-MSCT) in daily practice, without patient selection.

Methods: Sixty-four consecutive suspected CAD patients underwent both 64-MSCT and quantitative coronary angiography (QCA). The CT system The mean time span between MSCT and QCA was 7.2±3.9 days. For the 64-MSCT, detection or exclusion of CAD, defined as one or more areas of >50% stenosis within major epicardial coronary arteries, the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) were evaluated both per patient and per segment.

Results: Sixty-one of the 64 coronary CT angiograms (95%) were of diagnostic image quality. QCA showed significant CAD in 64% (39/61) of the patients, with the other 36% (22/61) showing nonsignificant disease or no disease. Sensitivity, specificity, accuracy, PPV, and NPV of 64-MSCT per patient were 92%, 86%, 90%, 92% and 96%, respectively. By the per-segment analysis, 695 of 791 coronary artery segments were assessable (88%). Of these, 64-MSCT showed a sensitivity of 80%, specificity of 92%, accuracy of 90%, PPV of 65%, and NPV of 96%, respectively, in detecting CAD.

Conclusions: Both per patient and per segment analyses for coronary 64-MSCT showed a higher diagnostic accuracy than QCA. This suggests 64-MSCT should primarily be used for risk stratification on a per patient basis as a noninvasive gate-keeper diagnostic method.

Background: Because of eventual side effects of chemical drugs, the efficacy of natural wound healing accelerators in long-term diseases and some situations is demanded to practitioners. The initial aim of our study was to assess full thickness excisional skin wound healing and inflammation diminution, Morphometrically and Histopathologically, after topical application of dried extract of Echinacea purpurea aerial part in rats, compared with zinc oxide.

Methods: Sixty wistar rats received four full thickness excisional wounds with the aim of surgical punch on the back skin under surgical anesthesia. All rats were randomly divided into groups 1, 2 and 3, of Echinacea purpurea, zinc oxide and control, respectively. All of them were treated topically once a day for 21 uninterrupted days. Healing of the wounds was daily measured by taking digital photographs and analysis. Histopathologic assessment was carried out in the 0th, 3rd, 7th, 14th, and 21st days of treatment period as well, and wound healing was assessed using 1 to 6 healing grades.

Results: According to Morphometric findings, the wound contraction rate in group 1 after 21 days of skin punching, with wound size of 0.18±0.03 mm² in contrast with group 2, 2.81±0.21mm², was much higher than that in other groups. Group 1 with wound contraction rate of 2.5 times in the day 7 and 3 times in the day 14 more than group 2, had the best wound contraction (p<0.01). histopathologic assessment revealed that, overall healing rate in the group 1 was highest (p<0.01).

Conclusion: Echinacea purpurea dried herbal extract could be a new capable remedy to accelerate skin wound healing because of its potential anti-phlogosis and wound healing stimulatory properties.

Background: Pain associated with IV injection of propofol is seen in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with ephedrine and lidocaine for the prevention of propofol-induced pain.

Methods: One hundred and twenty adult patients, ASA physical status I-II, undergoing elective surgery were randomly assigned into six groups (20 each). Normal saline group received normal saline, lidocaine group received lidocaine 2% (40 mg), and ephedrine (E 30) group received 30 µg/kg ephedrine, ephedrine (E 70) group received 70 µg/kg ephedrine, ephedrine (E 100) group received 100 µg/kg ephedrine, ephedrine (E 150) group received 150 µg/kg ephedrine. All pretreatment drugs were made in two mL. Pain was assessed by a 100-point scale of visual analogue (VAS) (0= no pain, 100= the most severe pain) and (VRS) verbal rating scale at the time of propofol injection. Noninvasive mean arterial blood pressure (MAP) and HR were recorded before induction, just before intubation, and 1, 2, and 3 min after intubation, respectively.

Results: The mean of pain scorel during propofol injection was significantly more in Normal Saline group compared to lidocaine and ephedrine (E30, E70, E100, E150) groups but there was no significant difference between lidocaine and ephedrine (E30, E70, E100, E150) groups (80.9vs 59.6 and 56.2, 51.05, 52.8, 57.45) Kruskal- wallis P=0.009. The incidence of pain was also significantly more in Normal Saline group compared to lidocaine group and ephedrine's groups but there was no significant difference between lidocaine and different dose levels of ephedrine. A small dose of ephedrine (30 and 70 µg/kg) could prevent propofol induced pain before intubation and did not produce significant hemodynamic changes compared with the other groups after intubation.

Conclusions: Pretreatment with ephedrine (specially low dose) effectively attenuated pain intensity, and frequency with propofol injection without undesired complications.

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: The ability of a specific test to predict a difficult intubation is decreased by the variability of definitions of difficult intubation/laryngoscopy. The Mallampati classification system is a widely utilized approach for evaluating patients in the preoperative setting. Zero class of Mallampati is a new class of airway view that to add to the four modified Mallampati classes. This study estimates the incidence of class zero airway and determines the ability of Mallampati score, age and sex on the prediction of the larangoscopy grade.
Methods: This is a cross sectional study in which 376 patients aged 7-18 years and A.S.A physical status I or II were enrolled. They were scheduled for surgery under general anesthesia All the airway assessments were done in the sitting position, with the patient's head in neutral position, mouth fully open, tongue fully extended and without phonation. After induction of general anesthesia, laryngoscopy grade was assessed in sniffing position using the Cormak & Lehame grading scale.
Results: Class zero airways occurred in 0.3% of patients, and the patients with class zero airway had a grade I laryngoscopy. 49.5% of patient had class I, 37.2% class II, 13% of patient had class III and there found no patient with class IV airway. Grade II and III laryngoscopy were more frequent in females than in males but this correlation was not statistically significant. 
Conclusions: Assessment of airway by Mallampati scoring system and attention to the age can be an important factor in the prediction of high laryngoscopy grade.

Background: In molar pregnancy, when hydatidiform changes are local and some embryonic components are observed, the term of partial mole is used. The risk of persistent trophoblastic tumor after partial mole is much lower than complete mole. In this persistent cases almost all are non metastatic. The aim of this study is to report a case of uterine rupture following incomplete molar pregnancy.
Case presentation: The patient was a 26 year old woman with obstetric history of an abortion and one molar pregnancy and no child. She was referred to emergency unit in Ghaem University Hospital, Mashhad, Iran in May 2011. She had an evacuation curettage following molar pregnancy three months before and without any follow up visit. The patient was referred to emergency unit with hemorrhagic shock. She immediately underwent laparotomy. The uterine fundal rupture was repaired and evacuation curettage performed. In post operative evaluation, she had a nine millimeter metastatic nodule in base of right Lung. As a patient in low risk stage III, she received weekly intramuscular methotrexate (40mg/m2) for six courses. In follow up visit -hCG titer was negative (<10miu/ml) at 5th week.
Conclusion: In cases of in complete molar pregnancy risk of metastasis is very low. Serial beta-hCG titer is the most accurate method for detection of persistent gestational trophoblastic disease (GTN). In neglected cases like this case preservation of ruptured uterus in GTN is possible.