Shiraz Emedical Journal
Volume:2 Issue: 4, Oct 2001

Halitosis is defined as any detectable offensive smell carried on the breath. It is a frequent complaint which is estimated to be found in around 50%-60% of the general population. Etiologically, it may arise from gastrointestinal or respiratory systems which maybe local (such as gum infection) or systemic (such as cirrhosis). Treatment is pointed toward the underlying cause.

Identifying tuberculosis in body fluids (Pleura, pericardium, peritoneum and cerebrospinal fluid) is still a common clinical problem with multiple pitfalls. The AIDS epidemic has reminded us of the importance of identifying tuberculosis and treating it. Since 1978 ADA has been used in the diagnosis of tuberculous effusions, which is simple and inexpensive. Other causes of increase in ADA activity in body fluids include: bacterial infections, rheumatologic diseases and lymphoproliferative disorders. Determination of ADA isoenzymes (ADA-2) helps in differentiation of tuberculosis and other causes. Although ADA isoenzymes do not detect tuberculosis in all cases, its specificity and sensitivity is much higher than traditional diagnostic tests such as skin test, smear, culture and so on. Difference between ADA levels in different studies is probably due to different methods of ADA measurement, presence of other diseases and TB epidemiology. ADA is the best test for early TB detection where TB is endemic or other diagnostic means are expensive. This article reviews the ADA measurement in pleuritic, pericardial, cerebrospinal and ascitic fluids.

Although heparin remains the standard therapy for pulmonary emboli with stable hemodynamics, thrombolytic therapy is the treatment of choice for recent pulmonary embolism (maximally 14 days) and recommended in hemodynamically compromised patients. However, in deep vein thrombosis of the lower limbs, therapeutic thrombolysis is still controversial because it depends on the age and organization and localization of the thrombus. Direct intrapulmonary infusion of fibrinolytics needs lower doses than intravenous administration. Except for a few carefully selected patients with severe obstruction, thrombolytic therapy after venous thrombosis should be avoided. Right atrial or ventricular thrombi in patients with pulmonary embolism are emboli in transit and are a medical emergency because they are associated with a high mortality rate when treated conservatively with anticoagulation. Finally it should be stressed that for cases of thrombosis or emboli, careful selection should be made for thrombolytic therapy.

Despite normalization of renal function after a successful renal transplantation, problems related to bone mineral metabolism often persist. These are secondary to metabolic disorders, which are either already present at the time of transplantation or induced by immunosuppressive therapies. Hypercalcemia is frequently seen in the early post transplant period. The incidence is between 8.5% and 53% in transplanted patients, among whom 1.6% to 17% will later undergo a parathyroidectomy(1,2). It is generally regarded as benign and transient, but may be prolonged in about 50% of these patients, depending on the degree of secondary hyperparathyroidism before transplantation(3). A persistent hypercalcemia is usually due to sustained tertiary hyperparathyroidism (THP). However, hypercalcemia occurring after more than 2 years post transplant should raise the suspicion of an underlying malignant lesion or granulomatous disease.