Tehran University Medical Journal

Background: Necrotizing soft tissue infections are one of the most dreaded infections in human and result in a very high rate of mortality. The treatment of these infections must be very aggressive and consists of radical debridement of all necrotic tissue accompanied by appropriate antibiotics.

Materials and Methods: This study was undertaken to assess the mortality rate, the time from diagnosis to cure, and some of the parameters which may affect mortality in our patients. In this descriptive, retrospective study first files from patients attended by necrotizing soft tissue infections including Fournier's gangrene or disease, gas gangrene, hemolytic streptococcal infections, myonecrosis, necrotizing fascitis and related subjects in Sina and Amir-Alam hospitals from 1989 to 1999 were studied. Data were extracted and analyzed by SPSS.

Results: The total number of cases was 36. The median age was 47.69 years. Seven of the patients were female. The median time from onset to cure was 10 days. The most common site affected was the perineum and the most common etiology was perianal abscess. Diabetes mellitus was the underlying disease mostly observed. Half of the patients had received inappropriate treatments. In this group mortality was higher.

Conclusion: It is crucial that general practitioners be acquainted with the diagnosis of necrotizing soft tissue infections so that patients are referred immediately to surgical centers. In our referral center the mortality was acceptable but it can be lowered further. The sex, sites of infection, underlying disease and etiologies in our patients were similar to patient in other countries except for alcoholism. It appears that data in foreign texts can be attributed to Iranian patients.

Background: Random pattern flap is a common reconstructive surgery procedure but its necrosis is a challenging problem. A lot of pharmacological agents and surgical procedures have been examined for the prevention of this complication to maximize the length to width ratio of these surgical flaps. Therefore, we designed an experimental study to evaluate the effects of aspirin, clopidogrel bisulfate (Plavix) and their combination on random skin flap survival in rats.
Methods: Forty male rats were randomly assigned to four equal groups. Surgery was done under general anesthesia. A random, rectangular 3×11 cm dorsal skin flap was designed, elevated and sutured back into its primary site. In group one, 100 mg/kg Aspirin and in group two, 25 mg/kg Plavix were administered orally for 7 days postoperatively. Aspirin and Plavix were co-administered in the third group for the same period of time while the control group received no medication. After 7 days, the total surface of flaps, the viable and also the necrotic parts were measured by Image J software. Mean standard deviation and analysis of variance were calculated to compare the results.
Results: The mean area of flap survival was 62.49% in the control, 64.04% in Aspirin, 65.09% in Plavix and 64.06% in combination groups. No statistically significant differences were found between treatment groups and control rats.
Conclusion: In this study, we found no significant differences between Aspirin, Plavix or their combination on the survival of random skin flaps.

Background: Scaphoid non::::union:::: remains a challenging problem for hand surgeons. In this study, we assessed the functional outcome of scaphoid non::::union:::: treatment and the influence of a number of variables on it.
Methods: In this study we recruited 24 patients with scaphiod non::::union:::: by consecutive sampling at Dr. Ali Shariati Teaching Hospital, in Tehran, Iran in 2008-2011. We examined the patients by antero-posterior (AP) and lateral view radiographies and wrist MRIs. Functional outcome of surgery was scaled according to Mayo wrist and Quick DASH scoring systems.
Results: Among 10 cases with osteonecrosis, there were 7 (70%) cases of radiological ::::union::::. In 13 (92%) out of 14 cases who had no signs of osteonecrosis, we radiologically confirmed scaphoid ::::union:::: after the treatment. The total ::::union:::: rate was estimated to be 83% at the end of 24 months follow up (P<0.05).
Conclusion: The results showed that patients with scaphoid non::::union:::: have improved function after surgical treatment.

Background: Cooling is one of the main processes in bone temperature decrement, while drilling. this experiment was conducted for examination of alcohol effect as cooler in prevention of thermal necrosis.

Conclusion: Due to obtained data from examination, utilization alcohol can have an important influence on final bone temperature decreasing. The way of using alcohol was in the style of attrition soaked gauze onto wire while insertion.

Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine produced by a variety of cells, including hematopoietic and non-hematopoietic cells, malignant cells, macrophages, B lymphocytes, T lymphocytes, natural killer cells, neutrophils, astrocytes, endothelial cells, and smooth muscle cells. TNF-α is a homo-trimeric molecular whose individual subunits are composed of antiparallel beta-sheets, forming a regular triangular prism shape. TNF-α binds to three receptor molecules through its receptor-binding sites, which are at the base of its pyramid structure. Biological responses to TNF-α are mediated through two different receptors: TNFR1 and TNFR2. These receptors are transmembrane glycoproteins with extracellular domains containing multiple cysteine-rich repeats that are structurally and functionally homologous, and the intracellular domains that are discrete and transduce their signals through both overlapping and distinct pathways. However, though TNF-α was initially discovered as an anti-tumor agent, it has been revealed that TNF-α and other ligands of this family are involved in some diseases like cancer, neurological, pulmonary, cardiovascular and autoimmune diseases and metabolic disorders. In general, TNF-α activates the control systems involved in cell proliferation, differentiation, inflammation and cell death, and the regulation of immune system. Although a normal level of TNF-α is very important for the regulation of immune responses, the persistence of the immune response as a result of inappropriate and excessive production of TNF-α can cause some inflammatory or autoimmune diseases. Accordingly, either neutralization TNF-α or blockade of its receptors using TNF-α inhibitors can be an effective therapeutic strategy to prevent or treat such inflammatory diseases. Several methods have been used to inhibit TNF-α, including the production of chimeric or fully human antibodies, soluble TNF-α receptors, or anti-TNF-α small molecules. The two previous agents are mostly capable of inhibiting the binding of TNF-α to its associated receptors, while anti-TNF-α small molecules, in addition to the above, inhibit the biosynthesis of TNF-α by blocking TNF-α mRNA biosynthesis, through the inhibition of its post-translational processing, or by blocking TNF-α receptors. Therefore, in this review article, we discuss the structure and characteristics of TNF-α and its related receptors: TNF-α signaling, TNF-α-mediated inflammatory diseases as well as TNF-α inhibition strategies.