Zahedan Journal of Research in Medical Sciences
Volume:16 Issue: 1, Jan 2014

Cognitive impairment can emerge in the earliest phases of multiple sclerosis. It strongly impacts different aspects of multiple sclerosis (MS) patients'' lives, like employment, social relationships and the overall quality of life; thus, its on-time recognition and treatment is mandatory. This paper discusses issues, diagnostic methods and treatment options for cognitive dysfunctions in MS. This paper is a descriptive review of the related studies in the recent 10 years, performing a keyword search in the main databases. Cognitive impairment mostly involves aspects of information processing, memory and executive functioning in MS. Neuropsychological tests like MACFIMS and BRB-N are recommended for its assessment. Still, there is no fully efficient treatment for cognitive impairment. Researchers have shown some positive effects, using disease-modifying therapies and cognitive rehabilitation. Depression, pain, fatigue and other factors influencing cognitive functions must be paid attention to. Recognizing cognitive impairment as a major symptom for MS, makes studying this subject one of the priorities in dealing with the disease. Therefore, a consecutive research for identification and management of this part of quality of life in MS patients is obligatory.

Using opioids along with local analgesic increase anesthesia duration and provide appropriate postoperative analgesia. However, intrathecal injection of opioids is associated with upsetting side effects including pruritus. Ondansetron (5-HT3 receptor agonist) has anti-pruritus effects. Therefore, we conducted a double blind randomized case-control study to evaluate prophylactic effects of ondansetron for preventing intrathecal fentanyl-induced pruritus. Two hundred seven patients with ASA status I, II or III, who were candidate for pelvic or lower extremity surgery with spinal anesthesia (SA) using bupivacaine hyperbaric (10-15 mg) and fentanyl (25 µg) were included in the study. Patients were randomly assigned to two groups of case (ondansetron 8mg IV) and control (4 ml normal saline IV). Patients’ hemodynamic indexes and side effects were evaluated at 5, 10, 30, 60 minutes and then hourly up to 6 hours after SA. Pruritus presence, degree, and site were evaluated after two and six hours. Data were analyzed using Kolmogorov-Smirnov test, student t-test, Mann–Whitney U, χ2, Fisher exact test, and Spearman linear correlation coefficient. The pruritus incidence was 60% in control and 34% in case group. Severe pruritus was observed in 18% of control group and 6% of case group. Ninety four percent of patients with pruritus in control group expressed it in above T6 dermatomes and 74% of patients with pruritus in case group had pruritus in T6-L1 dermatomes. The incidence of pruritus in L1-lower dermatomes was similar in two groups. Headache and nausea after anesthesia were more common in control group (p=0.035). Ondansetron decrease incidence and degree of intrathecal fentanyl-induced pruritus. This reduction was more significant around injection area T6-L1 dermatomes. Ondansetron injection does not influence systolic blood pressure, duration of anesthesia and analgesia, and does not induced urinary retention and back pain.

CRP (C-reactive protein) is one of the known inflammatory markers in the body. Studies claim that the level of this marker in patients with migraine is higher than normal peoples. Despite the result of various studies, even the relation between serum CRP and migraine is not detected thoroughly and is in a halo of ambiguity, therefore in this study, we intended to assess the relation between migraine and serum CRP levels. The present study was performed as a case-control on 47 migraine suffers that presented Besat hospital on year 2011, at intervals between their attacks and 50 normal individuals. Serum CRP level was measured at interval between attacks or at least 72 hour after the completion of the last attack and was compared with obtained results from normal population. The comparison of CRP level in two groups, indicated that the median CRP at case group was 16.40 mg/dl and at control group 9.76 mg/dl (p≤0.05). The comparison of CRP median between the sufferers of classic migraine, migraine without aura and individuals without migraine, indicated that the CRP median difference at without aura migraine sufferers and normal population was not meaningful, but classic migraine suffers had higher serum CRP level than the other two groups. Finally, we should stay that the present study demonstrate that CRP inflammatory marker was higher at migraine suffers in comparison with normal general population and could explained the role of inflammation in creation and progression of this type of headache.

In this study, the existing challenge about the association of construal level and temporal distance was examined. Doing so, the effect of two types of educational intervention on progress of decision making stages in students with premenstrual syndrome (PMS) was studied, based on theoretical concepts of construal level. The present study is a randomized field trial research conducted on 1578 high school students. A total of 255 students in the second stage of the precaution adoption process model were chosen randomly. They then went through educational intervention based on either low or high construal levels of relaxation method. Subjects in the intervention group showed a higher decision-making stage progression than in control group (p<0.001). The two-stage progression was significantly salient in low construal level-based intervention group (p=0.012). None of the demographic, premenstrual, and premenstrual syndrome severity characteristics were related to this progression. Inducing low construal level causes an individual shift toward desired action more rapidly. That is, there is a correlation between construal level and temporal distance. To accelerate the adoption of any health behavior, temporal distance can be taken as a basic and essential topic.

An increased serum homocysteine level was accepted as an important risk factor for vascular disease, including coronary atherosclerosis. However, there was no data about the importance of glycemic control on homocysteine levels in type 2 diabetic patients without CVD. The aim of this study was to investigate association between serum homocysteine concentrations and glycemic control in type 2 diabetic patients without CVD. Out of 100 diabetic patients, 50 were good glycemic control and 50 patients were poor glycemic control. Also we tested fifty healthy volunteers as controls. Degree of glycemic control in diabetic patients was evaluated by HbA1c concentration measurements. Serum homocysteine level was measured in patients with good or poor glycemic control, and healthy controls. The correlation of HbA1c and homocysteine concentrations was investigated. The results indicated HbA1c concentration and total serum levels of homocysteine in patients as whole are significantly higher than healthy subjects. HbA1c concentration is significantly higher in subgroup with poor glycemic control compared to subgroup with good glycemic control and healthy control group. However, there is no significant difference in homocysteine serum levels of patients with good and poor glycemic control. The findings suggest elevation of serum homocysteine level in patients with type 2 diabetes, however there is not significant correlation between homocysteine concentrations and glycemic control in type 2 diabetes patients.

Penoscrotal diseases and inguinal hernia are abnormalities that are often not diagnosed in childhood because most parents do not know the normal anatomy of this region. We designed a cross-sectional study in order to determine the prevalence of inguinal hernia and penoscrotal abnormalities in the elementary school boys in Zahedan city. We studied 3100 elementary-school boys, aged 7-12 years, who underwent clinical examination of the groin and genitalia in 2008. Abnormalities were detected in 167 children (5.38%). The most frequent anomaly was indirect inguinal hernia, seen in 81 children (2.6%). The other abnormalities were undescended testis in 39 boys (1.2%), hydrocele in 25 boys (0.8%), hypospadiasis in 11 boys (0.3%), epispadiasis in 1 boy (0.03%), varicoceles in 3 boys (0.09%) and micropenis in 7 boys (0.2%). Since these abnormalities are most common disorder in children, education of the public and medical staff about these abnormalities and screening system are needed to improve the outcome.

Sclerotherapy is a safe mode of hemorrhoid treatment with minimum costs and side effects. The expensive present sclerosants reduce our tendency to use this technique, so we conducted this study in a try to replace them. This is a prospective study on 170 hemorrhoid cases visited at Imam Ali and Khatam clinics during a year. Patients were randomly divided into case and control groups. After sedation and proctoscopy 3 ml of “50% glucose” and “phenol in olive oil” solutions were injected in each hemorrhoid pile of case and control groups respectively. Patients were assessed 1 week and 3 months thereafter. Data was analyzed via SPSS-17 software, using χ2 and t-student tests. Out of 71 cases and 73 controls, 55.6% were female. The most common chief complaint was bleeding (51.4%). Two groups were even regarding gender, age and chief complaint. (p-value respectively 0.412, 0.876, 0.146). Bleeding after one week and 3 months and response rate didn’t show a significant statistical difference between 2 groups. (p-value respectively 0.914, 0.731, 0.422). Finally 19 patients didn’t respond to any treatment (13.2%). In an even sample sclerotherapy with 50% glucose can be as efficient as phenol in olive oil solution. Regarding cultural characteristics, we hope that evolving non surgical techniques may encourage patients to seek early treatments.

Kidney transplantation is the best treatment option for kidney failure. Major medical progress has been made in the field of renal transplantation over the last 40 years. The surgical procedure has been standardized and the complication rate is low. Overall, the outcome of renal transplantation is excellent and has improved over time. Vascular complications after renal transplantation are the most frequent type of complication following urological complications. Renal artery spasm (RAS) following manipulation of renal artery is a common problem during live donor nephrectomy (LDN). The aim of this study was to determine whether or not it is necessary to wait for reverse of RAS and resumption of urinary flow before nephrectomy. In this clinical trial 16 cases of LDN who developed RAS during surgery received intra-arterial injection of 40 mg papaverine. In 8 cases surgery continued towards nephrectomy and in other 8 cases we waited for reverse of RAS. All analyses were performed using SPSS-11. In both groups urinary flow started a few minutes (Mean, 12 min) after declamping of transplanted kidney and normal renal consistency and color were achieved. There was no significant difference between urinary volume during 12 h after transplantation in two groups. The results showed that it might not be necessary to wait for reverse of RAS before LDN. Both patient (less anesthesia complications) and hospital (less expenses) will benefit from this time saving.

Coronary atherosclerosis is a common disorder of the arteries and may block the arteries and cause heart disease. Recently several studies have indicated a role of infectious agents in atherosclerosis and obstructive coronary artery disease. Candida species are normal flora of the human oral cavity and can enter in the blood stream and damage inner walls of coronary arteries by several mechanisms. Thus this study was done to compare the oral candida flora in healthy people and patient with coronary atherosclerosis. In this study, we compared oral candida flora in 90 patients with coronary atherosclerosis and 90 healthy people. All specimens were obtained from oral cavity by swab and cultured on CHOROMagar Candida medium. Identification of isolated colonies was done by RapID yeast plus system. The data were analyzed using the chi-square test. In this study 55.4% (N=61) of patient and 44.6% (N=49) of control group had candida colonization in their oral cavity. Candida albicans was the most common species isolated in both groups. Candida glabrata, Candida krusei, Candida tropicalis and Candida parapsilosis were the most common non albicans species. Although no significant difference was observed between candida colonization in patients and controls, the differences between isolated colony numbers in patient and healthy group were significant (p=0.001). Hypercolonization of candida species in oral cavity may lead to invasion and enter the organism in the blood stream and damage the coronary arteries.

Obstructive sleep apnea (OSA) is partial or complete recurrent upper airway obstructions during sleep. Reduction in blood flow of the optic nerve head is an important causative factor in glaucoma. The objective of this study is to determine the prevalence of primary open angle glaucoma (POAG) in OSA patients. From September 2009 to January 2010 in this descriptive-analytic cross sectional study, 90 cases of patients with OSA referred to Yazd Shahid Sadoughi hospital were collected and studied by polysomnography, blood gas analysis and ocular examination including measurement of intra ocular pressure, gonioscopy, fondoscopy and automated perimetry. Statistical analysis was performed by SPSS software. Thirty-one patients had mild OSA, 30 patients had moderate OSA and 29 patients had severe OSA. The prevalence of POAG in this group of patients was 10% (95% CI: 4-16). It is higher than the general population in the same age group (p=0.017). There was no significant correlation between the presence of glaucoma and apnea hypopnea index (AHI), mean saturation arterial O2 (MSaO2), body mass index (BMI), sex and age. A significant correlation between AHI with IOP and cup/disc ratio was not documented. According to our founding, the prevalence of POAG in OSA patients was higher than the general population in the same age group. Thus we recommend screening of glaucoma in OSA patients. This Study suggests that AHI, MSaO2, BMI, sex or age are not important risk factors for glaucoma in OSA patients.

Diabetes Mellitus (DM) is a major health care problem. The relationship between DM and zinc has frequently been reported in various research. The present study aims to investigate serum zinc level in patients with type 1 (IDDM) and type 2 (NIDDM). Association between glyaceted hemoglobin and level of zinc is also evaluted. This cross-sectional study was conducted on 60 subjects with DM (Type l: N=30; Type 2: N=30) who met inclusion criteria of the study. Patients’ serum zinc level and HbA1c were measured. Data were analyzed using t-test and Mann-Withney U test. Seventy five percent of the subjects were female. The average age of the IDDM was 15.36±5.28 years and that of NIDDM was 48.70±11.45 years. The average HbA1c of subjects was 8.06±1.64%. The average serum level of zinc in IDDM group was 95.82±14.51 mg/dl and that of NIDDM was 97.47±32.36 mg/dl, no significant difference was found between the two groups. Serum zinc difficiency was detected in 20% of the patients with NIDDM and 16.6% of the patients with IDDM. However, no significant correlation between HbA1c and serum level of zinc was detected in this study. Zinc deficiency was detected among a significant percentage of IDDM and NIDDM patients, but no significant correlation between serum zinc level and HbA1c was detected.

In hypothyroidism and hyperthyroidism, disturbance of oxidant/antioxidant balance leads to reactive oxygen species (ROS) generation. The aim of this study is assaying total antioxidant capacity and superoxide dismutase and catalase activities in patients with hypo-and hyperthyroidism in order to control the progression of its pathology and health care. This case-control study was performed on 85 patients with hypothyroidism, 66 patients with hyperthyroidism and 74 normal individuals as control that referred to the clinic of the Research Institute for Endocrine Sciences of Shahid-Beheshti University in year 2010. Serum enzymatic activity of catalase, superoxide dismutase and total antioxidant capacity was measured in the fasting state. Data was described as mean±SD and data means of the two groups was compared by independent t-test. Data was analyzed by SPSS-18 application. The total antioxidant capacity in individuals with hyperthyroidism decreased compared to healthy controls, but individuals with hypothyroidism compared to the healthy control group showed no significant difference. Catalase and superoxide dismutase activity in hypo-and hyperthyroidism were significantly increased compared with healthy controls (p=0.005). Decreasing of antioxidant capacity in hyperthyroid patients is probably because of increased production of free radicals. There was not observed significant difference in total antioxidant capacity in hypothyroid patients. Also in hypo-and hyperthyroidism patients, increasing of enzymes activity is probably due to increasing of the production of ROS.

Worldwide non communicable diseases are increasingly recognized as a major cause of morbidity and mortality. The metabolic syndrome is a common metabolic disorder that results from the increasing prevalence of obesity.The disorder is defined in various ways. This study determine the comparison of indicators of metabolic syndrome in Iranian smokers population. A total of 1,024 Iranian subjects aged 30 to 70 participated in this cross sectional study. Standard questionnaire was completing regarding smoking habits, medications, past medical history, physical activity, blood pressure, fasting blood suger, total cholestrol HDL and triglycerides. The diagnosis of metabolic syndrome was based on the IDF criteria. As defined by the modified IDF criteria, (45.9%) had the MS at baseline assessment. The risk of incidence of the metabolic syndrome among smokers was significantly (p<0.008) greater than nonsmokers. Among men without the MS at entry, body weight gain, compared with never smokers, was significantly (p<0.007) higher in smokers who had quit smoking. It is important for the prevention of the MS not only to quit smoking but also to prevent weight gain after smoking cessation. Although many cardiovascular diseases (CVDs) can be treated or prevented many people die from CVDs. Reducing the rate of cigarette smoking, body weight, blood pressure, blood cholesterol, and blood glucose all have a benefit impact on major biological cardiovascular risk factors. Behaviors such as stopping smoking, taking regular physical activity and eating a healthy diet promote health and have no known harmful effects.

Sacral stress fracture is a rare but severe fracture that can be fixed by screw insertion. However, location and number of screws have been remained controversial. The goal of the present paper is to examine the efficiency of three fixation systems (1S-sup, 1S-inf and 2S) which vary in number and insertion location. A 3D precious model of sacrum based on CT images, fractured from zone 2, was undergone to L5-S1 joint forces after the screws inserted in three fixation systems. Finite element method was used for the present research to evaluate stress distribution within the models and find the interfragmentary motion at the sacral fracture line. Stress is concentrated in vicinity to the fracture gap on the screws. Maximum stress was determined for 1S-inf system, considerably greater than two other systems. Although 1S-sup and 2S systems received similar maximum stress values, the relative displacement between the fragments was more limited in 2S system. Screw fixation can be an efficient technique to fix the sacral fracture. By considering one screw to be inserted, superior location to the first foramina is more effective. Two-screw fixation system (2S) noticeably reduced the relative displacement between the fragments and prepared proper situation for fracture healing.

Lung cancer has wide variety of clinical presentations and different imaging features relating its subtypes. This study is focused on the role of CT scan in differentiating primary lung cancer subtypes including adenocarcinoma, squamous cell carcinoma and small cell carcinoma. This retrospective study is conducted on 55 pathologically diagnosed primary lung cancer patients. Several CT features including lung mass and pleural effusion and parenchymal nodule characteristics, mediastinal and hilar involvement, pericardial effusion and thickening, chest wall invasion, reticulation, superior vena cava (SVC) syndrome and encasement of main bronchus were checked. We enrolled 55 primary lung cancer patients including 29 adenocarcinomas, 19 squamous cell carcinomas and 7 small cell carcinomas, 36 males and 19 females with mean age of 60.3 years. Most common CT features of primary lung cancer were lung mass (94.5%) particularly located in hilum (51.9%) and irregular bordered (55.8%). Other prevalent findings included parenchymal nodules (60%), pleural effusion (41.8%), mediastinal adenopathy (47.3%), hilar adenopathy (42.9%), mediastinal invasion (43.6%) and reticulation (56.4%). Hilar adenopathy (47.4%), reticulation (48.3%) and parenchymal nodule (62.1%) in adenocarcinoma; hilar mass (57.9%) and parenchymal nodule (68.4%) in squamouos cell carcinoma; hilar and mediastinal involvement in small cell carcinoma were the most frequent findings. Comparing three subtypes, we found squamous cell and adenocarcinoma more similar regarding CT images parenchymal nodules, mass calcification and cavitation were more frequently seen in them compared to small cell lung cancer whereas hilar involvement, mediastinal involvement, irregular bordered mass and encasement of main bronchus were more prevalent in small cell carcinoma.

Oxidative stress and mild hyperhomocysteinemia are independent risk factors of vascular diseases and present in type 2 diabetes. Our aim in this study is to investigate role of hyperhomocysteinemia, oxidative stress and association of homocysteine level with oxidative stress in the development of diabetic retinopathy. Forty type 2 diabetic patients with retinopathy and sixty without retinopathy subjects were included to the study. Plasma homocysteine level, prooxidant-antioxidant balance and HbA1c concentration was measured in two groups, also we tested 50 healthy volunteers as control. HbA1c concentration in patients is significantly higher than healthy subject and positive correlation was found between HbA1c and retinopathy in diabetes patients. Plasma levels of homocysteine are significantly higher in diabetic patients compared to healthy individuals. However, there is no significant differentiate in homocysteine plasma levels in patients with and without retinopathy. Oxidative stress is higher in diabetic patient compared to healthy subjects; and also there is significant association between retinopathy and oxidative stress. Our data don’t show any significant correlation between HbA1c and homocysteine levels and homocysteine level with oxidative stress, however there is positive correlation between oxidative stress and HbA1c concentration. Our findings confirm elevation of homocysteine in diabetic patients; however there isn’t significant correlation between homocysteine levels and presence of diabetic retinopathy in type 2 diabetic patients. In agreement with previous data oxidative stress significantly associated with development of retinopathy.

The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its'' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. This study is based on clinical trial before and after rehabilitation. the exercise protocol lasted for one month, three times per week, each session lasting 1 hour, on 30 male patients in two groups in control (N=15) and experimental group (N=15) after CABG in the centre of rehabilitation in Javad-Alaeme Heart Hospital, Mashhad. The strength of lower limb by chair standing test, the static balance by standing on one leg and dynamic balance by time up and go (TUG) test, was evaluated before and after 1 month rehabilitation in training group and detraining in control group. Data were analyzed with SPSS-16 and used t-test analysis (p≤0.05). The strength of lower limb (p=0.001), static balance (p=0.023) and dynamic balance (p=0.037) increased significantly after one month of cardiac rehabilitation. The result of this study indicates that cardiac rehabilitation after coronary artery bypass surgery causes significant increase in strength of lower limb and balance in patients, the more muscle strength is associated with an increase in ability of performing daily activities and so it causes improved quality of life.

To assess the short term results of local methyl prednisolone acetate injection for the treatment of heel pain syndrome. This prospective study was carried out on 109 patients with plantar heel pain who were treated by local methyl prednisolone acetate injection. Reduction of pain and tenderness were the primary measurement outcome. Rest pain, walking pain and tenderness at 3 weeks was relived in 70 and 67 and 74 patients, and after 3 months in 72, 68 and 81 patients respectively. Mean patient''s pain score was 8.2±2.2 before injection, 4.1±1.5 at 3 weeks, and 3.9±1.4 at 3 months after injection. Local injection of methyl prednisolone acetate was associated with a fairly high satisfactory short term results in the treatment of heel pain.

Much of the vision loss from age-related eye disease can be prevented. The purpose of this study is to determine the prevalence of preventable causes of low vision. In this study, files of 204 patients were evaluated. Low vision was defined as best-corrected visual acuity in the better eye between 20/70 to 20/200. Diagnosis of anterior and posterior segment disease was based on the eye examination that performed with Topcon slit-lamp biomicroscope and direct and indirect ophthalmoscope examination. The prevalence of preventable causes of low was respectively: diabetic retinopathy, in 33 patients (16.18%), glaucoma in 6 patients (2.94%), and amblyopia in 2 patients (1%). The majority of cases have treatable and/or preventable causes; reduction of low vision or blindness can be achieved by appropriate screening strategies.

Diabetes is one of the most common endocrine disorder worldwide that due to high prevalence and chronic nature of diabetes imposes a heavy cost on health care system. Therefore this study aimed to assess prevalence of diabetes among patients with beta thalassemia major. This descriptive study was conducted on 364 patients with beta thalassemia major that received at least 100 blood bags. For evaluation of diabetes among these patients, fasting blood sugar and glucose tolerance test were done. Finally relationship between age, gender, age at beginning of transfusion and chelating therapy with occurrence of diabetes were analysis by SPSS-17 software. Among 364 patients with mean age of 17.7±4.9 years prevalence of diabetes was 15.1% (58 patients) that 37.9% (22 patients) were women and 62.1 (38 patients) were men. Due to high prevalence of diabetes in patients with beta thalassemia major, regular check up for endocrine disorders should be consider in these patients.

The purpose of this study was to determine the efficacy of applying postural restrictions after Epley maneuver on therapeutic success in patients with BPPV (Benign Paroxysmal Positional Vertigo). This randomized controlled clinical trial study was conducted in among 118 patients with BPPV at Khatam-al-Anbia hospital in Zahedan. First group treated with postural restrictions and the second with no restrictions. After one week the presence of BPPV examined and data were analyzed. In first group 84.7% did not show symptoms of vertigo, as well as 45 patients in second group. Results did not show any significant difference between two groups. This study showed that instructions had no significant effect on the patients’ treatment outcomes.

Color vision deficiency (CVD) is an X chromosome-linked recessive autosomal dominant. Determine the prevalence of color blindness in Qazvin population. In a cross sectional study color vision deficiency examined in 1853 individuals with age 10-25 years old who participated in private clinics and eye clinic of Bu-Ali hospital in Qazvin in 2010. The screening of color vision deficiency was performed using Ishihara test. Data were analyzed by SPSS-16 with χ2 test with p<0.05. Mean age of participant was 17.86±4.48 years. 59.5% of them were female. 3.49% of the total population had color vision deficiency that 0.93% and 2.56% were female and male respectively. color vision deficiency must be noticed by decision makers in health field for screen planning.

Langerhans cell histiocytosis (LCH) is the most common type of histiocytosis and characterized by abnormal proliferation and excess accumulation of inflammatory and langerhans cells at various tissue sites. Clinical manifestations are variable, ranging from spontaneously regressing single bone lesion to multisystem disease, life-threatening and refractory to treatment. Conventional chemotherapy has been shown to be effective in treatment of majority of patients with LCH. However, treatment of refractory disease or multiple reactivations is difficult. The aim of this study is to assess the efficacy of 2-CDA in relapsed or refractory LCH. Four patients with relapsed or refractory LCH that were treated with 2-chlorodeoxyadenosin (2-CDA) enrolled in this study. All patients had received at least one prior chemotherapy regimen. The dose and schedule of 2-CDA was 6 mg/m²/day for 5 days every 3-4 weeks. Median age at the time of treatment with 2-CDA was 9.7 years. Three patients had multisystem disease and one had multifocal bone lesions. All patients had multifocal bone lesions. None of them had risk organ involvement. Mean course of treatment with 2-CDA was 9.5. Radiologic evaluations revealed complete resolution of bone lesions in two (50%) patients. In one (25%) patient lesions regressed (partial response) and in another (25%) the disease remained stable. Drug related side effects were minimal. At the present time all patients are alive. Our study demonstrates that 2-CDA as a single agent is efficacious in treatment of multiple reactivations or refractory LCH and well-tolerated in children.

Intestinal obstruction caused by an anomalous congenital band is a very rare condition in adult and children. We report rare cause of acute non-post operative small bowel obstruction.A case of 21-year-old female with abdominal pain, while clinical and radiographic examinations were not diagnostic. After an open laparotomy a congenital band extending from antimesenteric wall of the jejunum to the root of mesentery was found that cause direct compression and entrapment of a segment of bowel loop.

IUD T380A is one of the most effective, reversible, long term methods of contraception all over the world based on the experience of World Health Organization and our own observation of women who continued to use the IUD beyond 10 years or even longer years. In this article one case of Intrauterine device removal after 22 years is reported without complications and pregnancy.