Shiraz Emedical Journal
Volume:4 Issue: 1, Jan 2003

Caustic ingestion can produce a progressive and devastating injury to the esophagus and stomach. If the patient survives the acute effects, the reparative response can result in esophageal and/or gastric stenosis and an increase incidence of esophageal cancer. Management of the problem is complicated because the individuals most susceptible to injury are the very young, psychotic, suicidal, and alcoholic. Alkaline or acidic injuries to the upper GI is classified as first degree (superficial with edema and erythema of the mucosa), second degree (penetration occurs into the muscularis layer and third degree (associated with perforation). The most common involved organ in the upper GI is esophagus. Treatment modalities include: neutralization of caustics, corticosteroids, collagen synthesis inhibitors, antibiotics, nutritional considerations, esophageal dilation and stenting, and surgery. Complications are: perforation, internal bleeding, sepsis, esophageal stricture and stenosis, esophageal cancer and carcinoma of the stomach. Thanks to better diagnostic and therapeutic approaches, today; the mortality rate is decreased from 20% to 1 4%.

The history of medical treatment of echinococcosis is intimately related to development and use of benzimidazole carbamates (e.g., mebendazole, albendazole, etc.) as a safe and effective class of ant parasitic drugs. The most important side effects include abnormality in liver enzymes, hair loss, drug allergy, bone marrow suppression and etc. Factors predicting the cyst�s response to treatment are size, site and dosage and method of use of the drug. Relapses occur in 3-25% of patients, the majority occurs within first two years. There are a few contraindications to the medical therapy of hydatid cyst, including: pregnancy, bone marrow suppression, liver diseases, diabetes mellitus and some cyst characteristics such as size and location of some of cysts. Another nonsurgical therapy mode of treatment is ultrasound guided percutanous drainage and treatment (PAIR =Puncture of the cyst, rapid Aspiration of the cyst contents, Injection of a scolicidal agent to cavity and Reaspiration of cyst contents). Due to complications of this method (e.g., rapture, anaphylaxis, etc.) a few premedications are needed such as antibiotics, corticosteroids and antihistamines. Main side effects of percutanous drainage include: allergic reaction, fever and infection, dissemination and local recurrence, biliary fistulas, biliary rapture and obstruction and caustic sclerosing cholangitis. Contraindications to PAIR are: inaccessible or superficially located hepatic cysts, inactive or calcified cysts, pulmonary cysts, cysts with dominant nondrainable material and those cysts with communications with biliary tree or with multiple septations (relative). Percutanous drug injection without aspiration is the most recent modality, which is under investigation.

Deep vein thrombosis and pulmonary embolism is seen in 29% to 43% and 3%of neurosurgical patients respectively, however, only 10% to 17% of cases of DVT in neurosurgical patients produce clinical symptoms. A strong correlation between brain tumors and thromboembolic complications exists. Risk factors include leg paresis, age, tumor size and chemotherapy, pathology of glioblastoma multiforme and operation time longer than four hours. Preventive measures include Sequential compression devices (SCDs) (e.g. calf compression boots), heparin, and combination method; however, the preventive choice is controversial. In this article different studies regarding prevention of thromboembolic complication of the neurosurgical patients is reviewed.

The patient has common type AVNRT that started after a premature atrial contraction. So verapamil was administrated and arrhythmia resolved completely.

Brucellosis is a zoonosis occasional transmitted from mother to fetus through the placenta. Brucella infection in pregnant women causes maternal bacteremia, spontaneous abortion and intrauterine fetal death. Proper antibiotic therapy shortens the course of the disease. The combination of TMP-SMZ and rifampin is the regimen of choice for treatment of brucellosis in pregnant women

The patient has massive ischemic infarction of right cerebral hemisphere, which was confirmed by MRI.Several correct answers were received, and Dr. Kazem Nezam was selected as the winner. His prize will be sent for him.

The patient has common type AVNRT that started after a premature atrial contraction. So verapamil was administrated and arrhythmia resolved completely.