Tehran University Medical Journal

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In the past, coronary artery bypass grafting was the treatment of choice for patients with symptomatic multi vessel coronary artery disease, but in recent years per cutaneous transluminal coronary angioplasty (PTCA) accepted as an alternative approach to revascularization. To assess the initial success and in hospital results of coronary angioplasty of more than one lesion per procedure in patients with multi vessel coronary artery disease, a retrospective analysis of patients who underwent selective coronary angioplasty at Imam Khomeini medical center from 1994-1997 were peformed. From 1994 to 1997 per cutaneous transluminal coronary angioplasty (PTCA) were done in 257 patients, that 201 (78.2 percent) were male and their age range 23-73 years. The numbers of patients with multi vessel coronary artery disease were 98 (38.13 percent), that complete revascularization (PTCA of more than one lesion per procedure) underwent in 34 (13.58 percent) of them (27 men, 7 women, age: mean±SD 48±9.8 range 30-70). A total of 71 lesions were tried, that 22 (31 percent) were type A, 45 (63.4 percent) were type B, and 4 (5.6 percent) were type C. Among patients 21 (61.8 percent) had unstable angina and 13 (38.2 percent) had stable angina. Procedures were successful in 68 (95.8 percent) of lesions and 31 (91.2 percent) patients were discharged fro procedural complications included 3 (8.8 percent) non-Q wave myocardial infarction and no mortality. Without any complication, (success defined as residual stenosis <50 percent). As a conclusion, in selected patients with multi vessel coronary artery disease PTCA of more than one lesion per-procedure is effective and safe.

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In recent years off-pump coronary artery bypass surgery (OPCAB) has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG), we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery.
Materials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB.
Results: Of 150 OPCAB cases, 146 (97.3 percent) were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6). Total 595 distal grafts anastomosed to LAD (140) diagonals (140), right coronary artery (145), left circumflex (164). Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein.
Conclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

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This study was conducted to show the comparison of efficacy and survival of amniotic membrane grafts and homologous dura grafts.
Methods and Materials: In this study, ten dogs (age 6-9 months & weight 15 lo 20 kg) have been chosen. The study was a single blind clinical trial. The dogs have been assigned into two groups by random allocation method. The amniotic membrane (A.M) was taken from a placenta belonging to a 38 weeks fetus delivered in a cesarean section surgery. In one group the graft was a peace of dura mater and in the other one the graft was a homologous dura graft. Maintenance of all cases was the same. Forty-five days later, another surgeon who was not aware of the assignment, conducted the second exploratory surgery for evaluation of the results.
Results: None of cases in two groups had any infection, abscess formation, fistula, CSF leakage or any toxic status. The healing process was normal in both groups.
Conclusion: There seems to be no difference between the (A.M) grafts and homologous dura in the repairmen of dura mater. This is expected to occur only if the pregnant woman is carefully tested for the presence of certain clinical conditions and the preparation of A.M is contemplated in an ideal environment.

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Background: Dialysis access procedures and complications are important causes of morbidity and hospitalization for chronic hemodialysis patients. Ideally, any patient undergoing hemodialysis should receive an autogenous fistula that can be accessed throughout the patient's life. In patients with primarily unsuitable or secondarily surgically-exhausted veins, a prosthetic graft can be performed. Several recently published studies report the outcome of prosthetic grafts. The conclusions of these studies differ dramatically. The aim of this prospective study was to determine the patency, infection and thrombosis rates using Poly-tetrafluoroethylene (PTFE) in grafts for vascular access in hemodialysis patients.
Methods: During this three-year prospective study, 84 patients underwent placement of vascular access graft at the Vascular Surgery Department of Sina Trauma and Surgery Research Center in Tehran. Demographics, complications, and subsequent treatment were recorded. Primary patency rates were estimated using the Kaplan-Meier method. Logrank tests were used to evaluate the statistical differences in survival distribution.
Results: The mean patient age was 55 years (±12 years). Hypertension, diabetes and smoking were considered to be risk factors for atherosclerosis in 45, 26 and 19 cases, respectively. The patients were followed up for at least 24 months. The primary patency rates were 78%, 63.3% and 54.9% at 6, 12 and 18 months, respectively. There were 39 (46.4%) access failures, which were related to infection in five cases (6%), thrombosis in 30 cases (35.7%) and bleeding in two cases (2.4%). The patency rate in patients without hypertension and with hypertension were 62.2% and 29.7%, respectively (P<0.03). Patency rates for upper extremity and lower extremity grafts were 60% and 26%, respectively (P<0.05).
Conclusion: A PTFE vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, good care and educating patients can further decrease the rate of complication and morbidity, thereby resulting in a better patency rate.

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Background: While excellent organ quality and ideal transplant conditions eliminate many of the known factors that compromise initial graft function (IGF), slow graft function (SGF), still occurs after living donor kidney transplantation (LDKT). The aim of our current study is determination SGF frequency and its risk factors in LDKT 

Methods: In this prospective study, between April 2004 and March 2006, data were collected on 340 LDKT, in Baghiyattallah Hospital, Tehran. Recipients were analyzed in two groups based on initial graft function (IGF): Creatinine <3 mg/dl 5 day after transplantation, SGF: Creatinine ≥ 3 mg/dl 5 day after transplantation with out dialysis in the first week. Donors' and recipients' characteristics and recipient lab. data were compared in two groups by chi-square, Mann-whitney & independent samples T-test.

Results: The incidence of SGF was 22 (6.2%) and IGF 318 (89.8%), Recipients' BMI in IGF were 22.1±3.9 and in SGF were 25.3±3.8 (P=0.001 95% Cl 1.097-1.401 OR= 1.24). SGF relative frequency in female donors is more than male donors. A multivariate analysis model confirms this significant difference. (P=0.044 95% Cl 1.028-7.971 OR= 2.862). SGF relative frequency in PRA (Panel Reactive Antibody) positive recipients are more than negative ones. A multivariate analysis model confirms this significant difference. (P=0.007 95%Cl 1.755-35.280 OR= 7.849). Recipients' age and donors' BMI are significant in univariate analysis (P=0.002 & P=0.029 respectively) but multivariate analysis model dose not confirm those significance. Serum ca & P & PTH levels don't have significant difference between IGF & SGF. Using calcium channels blockers have not a protective effect.

Conclusions: We conclude that negative PRA and lower recipient BMI have protective effects on SGF. Recipients with female donors have higher chance to develop SGF. We recommend recipients reduce their BMI before transplantation. The male donors are preferred to female ones.

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Background: The Ross procedure has been known as a good method for aortic valve replacement. Pulmonary allograft postoperative stenosis subsequent to the Ross procedure has been noted as an important disadvantage of this technique, although risk factors related to this complication are not clearly recognized. In this study we evaluate the risk factors of pulmonary allograft stenosis after Ross procedure.
Methods: This retrospective cohort study was carried out on 42 patients who underwent the Ross procedure. Left ventricular outflow tract obstruction was repaired using pulmonary allografts 22.7±2.5 mm in diameter. Echocardiographic and clinical examinations were performed for all patients at six and 12 months after surgery. Echocardiographic data as well as data related to the allografts were recorded.
Results: The mean age of the patients was 28.5±10 years. Postoperative pulmonary valve stenosis was detected in 13 patients (31%). Nine patients (21.4%) had mild stenosis and four patients (9.5%) had moderate stenosis. No relationship was detected between the degree of stenosis and the size of allograft (p=0.08). There was a significant correlation between postoperative pulmonary stenosis and donor age (p=0.04). Predictive variables of pulmonary allograft stenosis after the Ross procedure were low donor and recipient age (p=0.03 and 0.05, respectively).
Conclusions: This study shows that the Ross procedure has a rather low incidence of postoperative stenosis and is a suitable substitute for aortic valve replacement. Low donor age is associated with pulmonary allograft stenosis formation, perhaps due to greater viability of tissue cells from younger donors.

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Background: Several therapeutic modalities have been cited for patients with microtia. Recently there are several reports about using cadaveric homograft cartilage for some other purposes. The aim of this study was to assess the results of auricular reconstruct-tion in 10 patients (12 ears) with congenital atresia using homograft rib cartilage from the Iranian Tissue Bank.

Methods: We enrolled 10 patients with microtia who were referred to the Imam Khomeini Hospital from September 2006 to July 2007 for auricular reconstruction. The reconstruction was performed using a pre-shaped homograft(s) of each patient's ear(s) made by the Iranian Tissue Bank from the 6th, 7th and 8th costal cartilage according to the method of Marquette. In six patients, the second stage of reconstructive surgery was performed three months after the first stage. The patients were followed regarding the ear appearance, the dimensions of cartilage and tissue reaction.

Results: The mean age of the patients was 11.08 (SD=5.57) years and the average duration of follow-up was 6.29 (SD=3.12) months. Eight cases had unilateral involvement (six right and two left), in addition to two cases of bilateral involvement. During the follow-up period, the appearance of the helix was satisfactory in 11 ears and the lobule in 10 ears. The height and width of the reconstructed auricles was an average of 1-2 millimeters different from the opposite ear. Erythema was the most common early complication. Late complications, including cartilage exposure and infection, were observed in one patient.

Conclusion: Auricular reconstruction using homograft costal cartilage in patients with microtia has promising results. The short term resorption can be ignored and significant early or late complications are infrequent.

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Background: The usage of pericardium of patient himself, for support of anastomosis lines may carry benefits in patients undergoing aortic valve replacement with pulmonary autograft (Ross). The aim of the present study was to compare the short term results of aortic valve replacement with pulmonary autograft with routine and offered methods.

Methods: In a non-randomized clinical trial, 64 patients who referred to cardiac surgery ward of Imam Khomeini hospital Tehran Iran from December 2002 to December 2006 for aortic valve replacement with pulmonary autograft with two different methods. In the first two years of this study all of the patients were operated with routine procedure (group A, n=28) and during the next two years, all of them were operated with authors' offered method in which the patient`s pericardium was used for support of anastomosis lines (group B, n=36). Some of clinical parameters and outcome were compared between two groups.

Results: There were no significant differences between mean of age, sex, pathology, preoperative and postoperative EF in two groups. In group B, the mean pump time was significantly lower than group A (144.09±26 vs. 179.64±25 min). The mean Cross-clamp time was significantly lower in group B (118.5±22 vs. 136.93±19 min) Need for blood transfusion in ICU was significantly lower in group B (35.71% vs. 68.57%). Mean ICU Stay and Postoperative Hospital Stay were significantly lower in group B (1.3±0.3 vs. 1.9±0.7 and 5.2±0.9 vs. 5.9±1.5 days respectively). Overall mortality was four death (6.25%) which was not significant between two groups.

Conclusions: The usage of patient's pericardium for support of anastomosis lines in patients undergoing aortic root replacement with pulmonary autograft carry advantages to routine procedure and its utilization is advocated in other centers.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Trauma is the 2nd cause of mortality in Iran, after cardiovascular diseases. In traumatic patients, head and neck and face skeletal fracture is common. The most common facial fracture is mandible fracture and the least common is frontal fracture. Complications due to orbital fracture are more devasting than the other fractures in face.
Methods: These descriptive cross sectional studies are designed on 92 patients with orbital fractures in a referral educational trauma center, Imam Khomeini hospital, Tehran, Iran. Sample size was the patients who referred to this hospital with orbital fracture during the ten years period (1986-2000).
Results: In this study 74 patients were male and 18 patients were female. Mean age of patients was 30 years. The most common cause of orbital fracture was motor vehicle accident which was seen in 38 patients.46 patients had fracture in left orbit and 44 patients in right. Isolated orbital fracture was seen in 38 patients and 54 patients had concomitant trauma and fracture in the other organs. Management of orbital fracture was reduction of displaced bone fragment and fixation for osteosynthesis. The most common methods for osteosynthesis was fixation with miniplate which used in 53 patients and then reconstruction of orbital floor and roof with autologus bone graft. The most common complications due to orbital fracture was related to eyes that were seen in 20 patients.
Conclusion: Face fractures are a piece of all problems in multiple trauma patients as the tip of iceberg. Concomitant injuries are the concealed part of this iceberg. Early detection of orbital fracture and immediate treatment that prevent the future complications and deformities due to orbital fractures.

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Background: Kidney transplantation had been evaluated in some researches in Iran mainly with clinical approach. In this research we evaluated graft survival in kidney recipients and factors impacting on survival rate. Artificial neural networks have a good ability in modeling complex relationships, so we used this ability to demonstrate a model for prediction of 5yr graft survival after kidney transplantation.
Methods: This retrospective study was done on 316 kidney transplants from 1984 through 2006 in Isfahan. Graft survival was calculated by Kaplan-meire method. Cox regression and artificial neural networks were used for constructing a model for prediction of graft survival.
Results: Body mass index (BMI) and type of transplantation (living/cadaver) had significant effects on graft survival in cox regression model. Effective variables in neural network model were recipient age, recipient BMI, type of transplantation and donor age. One year, 3 year and 5 year graft survival was 96%, 93% and 90% respectively. Suggested artificial neural network model had good accuracy (72%) with the area under the Receiver-Operating Characteristic (ROC) curve 0.736 and appropriate results in goodness of fit test (κ2=33.924). Sensitivity of model in identification of true positive situations was more than false negative situations (72% Vs 61%).
Conclusion: Graft survival in living donors was more than cadaver donors. Graft survival decreased when the BMI increased at transplantation time. In traditional statistical approach Cox regression analysis is used in survival analysis, this research shows that artificial neural networks also can be used in constructing models to predict graft survival in kidney transplantation.

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Background: Studies of the association between post operative AF and Plasma level of NT- Pro BNP have reported conflicting findings. The aim of the present study was evaluation of the association between post coronary bypass graft- Atrial Fibrillation (AF) and Plasma level of NT- ProBNP as an independent risk factor of AF development in patients undergoing coronary artery bypass graft.

Methods: In a cohort study, 79 patients with sinus rhythm who admitted in Imam Khomeini Hospital in Tehran, Iran, during February 2009 and February 2010 for CABG are included the study and followed for developing post operative AF rhythm.

Results: Post operative AF was found in 17.7% of patients. The peak time from the operation to the first AF episode was in second post op day in ten patients (71.4%). The serum level of ProBNP in patients with AF was significantly higher (1624± 647 versus 221± 238 pg/ml, p< 0/0001). Increased age, Increased LA size and high plasma level of ProBNP were associated with increased risk for post op AF. After adjustment of risk factors, plasma level of ProBNP was the most important risk factor with odds ratio of 15.34 with CI 95% 1.77-132.95 and then LA diameter with odds ratio of 6.11 with CI 95% 0.99-37.42 was independently correlated with post op AF. Correlation between plasma level of ProBNP with age and LA size was seen too (LA size r = 0.0281, p= 0.012). Between age and ProBNP (r= 0.337, p= 0.002). The best cut off point for plasma ProBNP as a predictor of post op AF was 854 pg/ml.

Conclusion: Increased level of preoperative ProBNP levels could be an independent predictor of post operative Atrial Fibrillation.

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Background: Atrial fibrillation is the most common but benign arrhythmia following cardiac surgery. Although this arrhythmia is often self-limited and vanishes in about 24 hours upon surgery a number of arrhythmias might ensue among which some might be really life-threatening. A multitude of therapeutic modalities have been proposed for the prevention of this arrhythmia and one of them is posterior pericardiotomy. This method has not been fully accepted by the peers yet and more studies are needed to prove its efficacy and benefits to the patients. Methods: In this single-blind randomized clinical trial, done over a 2-year period from February 2009 to January 2011, the effects of posterior pericardiotomy were evaluated in 174 patients (87 the case and 87 the control groups) undergoing elective coronary artery bypass grafting (CABG). The case group underwent CABG with posterior pericardiotomy while the control group underwent CABG-only operation. The postoperative incidence of arrhythmia, especially atrial fibrillation, was assessed for a week using statistical methods. Results: The prevalence of postoperative atrial fibrillations were fewer in the group undergoing CABG with posterior pericardiotomy compared with the CABG-only group (P<0.004). Conclusion: Posterior pericardiotomy seems to reduce the incidence of atrial fibrillation following elective CABG therefore, its application is suggested for elective CABGs

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Background: One of the most common orthopedic complaints is direct or indirect trauma to the knee with torn anterior cruciate ligament (ACL). Reconstruction of the torn ACL is emphatically offered in active individuals as by this operation, we prevent osteoarthritis, knee instability and injury to the meniscus. There are numerous methods for graft fixation in the femoral tunnel in ACL reconstruction. If the graft proves to be stable after the operation, patients would not complain of giving way knee joints. In this clinical trial, we compared transfemoral pinning with endobutton fixation of hamstring graft in arthroscopic ACL reconstruction by examining knee stability and use of other relevant functional tests. Methods: Fourteen Patients who had undergone arthroscopic ACL reconstruction in Shariati Hospital during the years 2008-2009 and were being followed up were evaluated at least 15 months post-operatively by physical examination and the use of an arthrometer made by the Faculty of Mechanics of Sharif Technical University. Results: The results showed that two out of seven patients in which their ACL had been reconstructed by hamstring graft fixation by endobutton technique, and in one out of seven patients who had undergone ACL reconstruction by hamstring graft fixation through transfemoral pinning, Lachmann test (in 25 position) was greater than 5 mm but there were not any complaints of giving way knee joints. Conclusion: The clinical results of ACL reconstruction by transfemoral pinning technique seems to be superior to the reconstruction by endobutton technique.

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Background: Despite advances in cancer diagnosis and treatment, survival rate of patients suffering from glioblastoma multiform (GBM) has not been significantly improved. Therefore, novel therapeutic adjuncts to routine therapies have been suggested over time. Inhibition of angiogenesis by antiangiogenic drugs is one of the new approaches to inhibit the growth of malignant cells. Microvessel density (MVD) assay is a technique performed by counting immunohistochemically-stained blood vessels. Nowadays, athymic nude mice are widely used for the establishment of xenograft tumor models in cancer research. The aim of this study was to evaluate the MVD of autochthonous xenograft models of GBM isolated from Iranian patients for use in pharmaceutical research on antiangiogenic drugs.Methods: Fresh tumor samples of GBM were obtained from three patients in Cancer Institute of Tehran University of Medical Sciences in Fall of 2010 and Winter of 2011. After preliminary processing, minced tumor samples were implanted heterotopically on flanks of athymic nude mice. Two months later, the animals were sacrificed and the xenograft tumor samples were sent to the pathology laboratory. After establishing the proof of the xenograft tumor type, MVD-CD34, an endothelial cell marker, was assessed by counting hot spot areas in 22 samples.Results: The mean number of microvessels in these xenograft tumor models was 30±2.1. Conclusion: These autochthonous xenograft models of GBM can be used in preclinical settings for research on antiangiogenic drugs regarding a pharmacogenomics-based treatment regimen for the Iranian population. Moreover, such models can be used in future studies for determining the sensitivity or resistance to antiangiogenic drugs in individualized cancer therapy.

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Background: Anterior cruciate ligament (ACL) reconstruction is a first choice treatment for ACL-deficient knees, and arthroscopic single-bundle reconstruction has been widely accepted around the world in this regard. Although, such single-bundle reconstructions result in sufficient knee stability in most cases, but some patients have not been satisfied with postsurgical results in both short-term and long term clinical studies. One of the reasons for these unsatisfactory results could be related to the fact that normal function of the native ACL has not been restored by the traditional ACL reconstruction which uses only a single-bundle graft. The natural ACL consists of a 3-dimensional structure with multibundle fascicles, which can be anatomically divided into 2 main bundles, the anteromedial (AM) and the posterolateral (PL) bundles named for the orientation of their tibial insertions. The purpose of the present study was to compare double-bundle and single-bundle ACL reconstruction.
Methods: Twenty-two patients with anterior cruciate ligament tear who were candidates for ACL reconstruction were enrolled in the study undertaken in Shariati Hospital from 2009 to 2010. Fourteen patients underwent single-bundle and 8 patients double-bundle ACL reconstruction. The patients were evaluated by arthrometer and physical examination in postoperation follow up visit at least 9 months after the operations.
Results: Four out of 14 patients with single-bundle reconstruction had knee joint translation greater than 5 mm but nobody had knee translation more than 5 mm in the double-bundle reconstruction group.
Conclusion: Double-bundle ACL reconstruction seems to be more stable than single-bundle ACL reconstruction.

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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: 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.

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Background: The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. Methods: In this study, fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG, were selected by convenience sampling method. Se-quentially, they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups, using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure, brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0.05 was considered as significant. Results: The mean age of patients was (65.3±9.9). The patients included %16 (n.8) of women and %84 (n.42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization (P=1), duration of ventilator use (P=0.4), duration of need to hospitalization (P=0.11), duration of a patients stay in the Intensive Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

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Thymoglobulin is a purified polyclonal immunoglobulin that has been used widely over the last decades in the prevention and treatment of rejection following renal transplantation. This immunoglobulin works against human thymocytes. Since thymoglobulin does not contain the nephrotoxic properties therefore it can be used in induction therapy especially in patients with higher risk of graft rejection such as patients who receive graft from cadavers. Recent research showed also its beneficial role in cross-match-positive transplantation, a role that is mediated through conjunction with inhibitors of terminal complement activation. This immunoglobulin has also been used for treatment of rejection following renal transplantation. Thymoglobulin can have various effects on various Immune system cells including T cells, B cells and also plasma cells. Thymoglobulin also affects the Tcell surface antigens, natural killer-cell antigens, B cell antigens, plasma cell antigens, adhesion molecules and chemokine receptors. Diverse effects of thymoglobulin on the immune system includes: T cell depletion, induce apoptosis in B cell lineage and interference with dendritic cell functional properties. Thymoglobulin can cause acute complications, delayed complications as well as infectious complications. Acute reaction events includes: anaphylaxis, fever, chills, dyspnea, nausea, vomiting and diarrhea. Thymoglobulin also induces cytokine release syndrome manifested by high grade fevers and chills and treated by steroid therapy. Delayed reactions events usually present as serum sickness and infections. Infectious complications are more important and include cytomegalovirus (CMV) infection, sepsis, candidiasis, herpes simplex and urinary infections. Thymoglobulin can also induce cytokine release syndrome. It has been thought that thymoglobulin increases the risk of post-transplant lymphoproliferative disorder (PTLD), however, debate still exists whether such an association is present when lower dosing regimens are used. In this review, we aimed to present first a brief history of thymoglobulin development and its mechanism of action and then assess the most recent published data regarding the role of thymoglobulin in following issues: immunological tolerance, ischemia-reperfusion injury, delayed graft function, prevention and treatment of acute allograft rejection, live donor transplantation, graft and patient survival and posttrans-plant lymphoproliferative disorder. This review can help specialist in transplant domain to appropriately used thymoglobulin in transplant patients.

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Background: Graft survival has been considered the major problem in reconstructive surgery. Clinical studies have helped us to understand the role of PRP in increasing skin survival. Our goal in this study was to examine the treatment effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on autologous full thickness skin graft survival in male rats.

Methods: This experimental study was performed on 36 rats of Sprague-Dawley race with weighing approximately 250 to 300 gr on May 2015 in animal laboratory of Hazrat Fatima Hospital. After anesthesia, rats were divided into 3 groups. We injected platelet-rich plasma (PRP) in the first group, platelet-rich fibrin (PRF) in the second and saline in the third group after removing the skin. Microscopic analysis was performed with camera (Canon powershot SX200, Tokyo, Japan) on days 7, 14, 21 and 28 after surgery. We used image analysis system (ImageJ, ver. 1.45) to examine necrosis and survival rate. Samples were studied with H&E staining on day 28 microscopically for histological analysis of vascular density and angiogenesis.

Results: Our findings showed the area of necrosis in animals injected with PRP on days 7 and 14, was meaningfully less than control group (P= 0.0001). There was no meaningful difference between control and PRP groups (P> 0.05). The area of necrosis in animals injected with PRF did not have any significant difference with control group from beginning to 21st day (P< 0.0001). there was no meaningful difference in vascular density between control and PRP group, whereas in animals injected with PRF the vascular density was significantly less than control group (P= 0.002).

Conclusion: According to our results in this study, we can conclude that using autologous PRP can enhance the process of healing soft tissue injury and be affective at increasing graft survival. This method is suggested to be conducted for patients highly at risk of graft loss and also for those who are in need of early treatments.