مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتادم شماره 8 (پیاپی 140، آبان 1391)

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.

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.

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.

In this study, we found no significant differences between Aspirin, Plavix or their combination on the survival of random skin flaps.

It is generally accepted that the selective adenosine triphosphate-dependent potassium channel openers (KATP openers) have a dramatic role in the treatment of some cardiovascular disorders. The aim of this study was to investigate the effects of diazoxide, a potent ATP-related potassium channel opener, on spontaneously beating isolated rat atria to achieve more accurate approaches to treat cardiovascular diseases, such as atrial related disorders including atrial arrhythmias.

After induction of anesthesia, we exsected the heart and isolated the atria of 48 male Wistar rats. Later, we recorded the beating and contractile force of the atria by a physiograph. Subsequently, we studied the effects of diazoxide (2 to 100 µg/mL) on beating and contractile force of the isolated atria 5, 10, 15 and 20 minutes after applying the drug onto the atria.

Diazoxide administration (2 to 100 µg/mL) showed a significant decrease (7% to 49% depending on concentration) in atrial beatings (P≤0.001) and in contractile force (1.5% to 67% depending on concentration), (P≤0.001). The effects began several minutes after applying the drug onto the tissues.

This study revealed that diazoxide has a direct concentration-dependent effect on cardiac performance and leads to reduction in beating rates and contractile force of the heart. This effect seems to be related to the activation of mitochondrial or sarcolemmal KATP channels. Since the inhibitory action of diazoxide on the heart was very remarkable and prompt, this agent may also exhibit antiarrhythmic properties.

Measurements of mitral valve area (MVA) are essential to determine the severity of mitral stenosis (MS) and adopt the best management strategies. The aim of the present study was to compare MVA determined by two-dimensional (2D) planimetry to MVA measured by continuity equation (CE) in patients with moderate to severe MS.

We evaluated 73 consecutive patients with the diagnosis of MS scheduled for balloon mitral valvuloplasty or with moderate to severe rheumatic MS admitted at the echocardiography clinic of Imam Khomeini Hospital in 2010. Using 2D images of mitral valve obtained from paraesternal short axis view, 2D planimetry of the mitral orifice area was performed by an experienced cardiologist. MVA by CE was calculated from aortic forward stroke volume divided by transmitral time-velocity integral.

The mean value of MVA by 2-D planimetry was 1.0±0.3 cm2. The average values of MVA measured by PHT and CE were 1.0±0.3 cm2 and 0.9±0.4 cm2, respectively. The MVA determined by planimetry correlated well with CE (r=0.832, standard error of estimation [SEE]= 0.166, P<0.001). The mean values of MVA calculated by CE highly correlated with those calculated by 2-D planimetry in patients presenting with both non-significant (r=0.701) and significant (r=0.761) AIs.

When planimetry is not feasible, such as in severe calcification of mitral valve or after percutaneous balloon valvuloplasty, CE could be an alternative method for MVA measurement in comparison with PHT.

Lung separation is the basis of thoracic anesthesia, which is performed by different instruments. Checking probable malpositioning of tracheal tube needs fiberoptic bronchoscopy. The aim of this study was to compare respirator suggested compliance with fiberoptic findings in detecting major tracheal tube malpositioning. A total of 256 patients undergoing thoracic surgery with double-lumen tracheal tube insertion in Imam Khomeini Hospital, Tehran, Iran, during 2010-11 were divided into three groups (n=86). We used left-sided double-lumen tube (DLT) for left or right-sided surgeries (groups 1 and 2), and right-sided DLT for left-sided surgeries (group 3). The position of the tubes was evaluated and compared using bag compliance versus fiberoptic bronchoscopy. The mean age of the study population was 44.7±13.4 (16-73) years, while 155 (59.9%) were male. The sensitivity, specificity, positive and negative predictive values, and the accuracy of bag compliance test for left-sided DLT in supine position were 40% (95% CI: 20-60%), 99% (95% CI: 96-99%), 84% (95% CI: 54-94%) 92% (95% CI: 88-95%) and 92% (95% CI: 87-95%), respectively. The above-mentioned variables for lateral decubitus position respectively were 27%, 98%, 76%, 89%, and 88%. Malpositioning was more prevalent in right-sided DLTs (P=0.02). Based on the results of this study, and the high specificity, positive predictive value, and accuracy of bag compliance test, its use is encouraged as an alternative to fiberoptic bronchoscopy for checking DLT position, specially, in emergent surgeries or when fiberoptic bronchoscopy is unreachable due to lack of expertise or personnel.

Patent ductus arteriosus (PDA) is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited; hence, we compared the effects of two different doses of ibuprofen in this interventional study.

In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups.

Thirty (100%) patients in 15-mg/kg group and 23 (76.7%) patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference (P=0.011) and the highest response to treatment was seen within the first 24 hours of treatment.

We may conclude that higher doses of ibuprofen (15 and 2×7.5 mg/kg) would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.

Erectile dysfunction is an important problem in men and an organic cause is found in about 50% of cases. When a vasculogenic etiology is suspected, imaging assessments are of great help. Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in men with impotency. We employed CT cavernosography as a novel technique for demonstrating penile venous anatomy and leaking veins. In the present case series study, we recruited 45 patients with erectile dysfunction by convenient sampling at Hazrat Rasoul Akram Hospital in Tehran, Iran, during one year (1390). The patients had previously been diagnosed with venous incompetency by Doppler study. After intracavernosal injection of prostaglandin E1, we injected sterile normal saline into the corpora cavernosa to achieve penile erection. Later, we injected contrast media into the corpus cavernosum, which was followed by CT scan of the penis and pelvic area to show the venous anatomy and leakage sites. The mean age of the patients was 35.8±8.9 years. 36 (80%) patients had venous leakage in crural veins, 27 (60%) in cavernosal veins, 27 (60%) in circumflex veins, 24 (52.3%) in urethral veins, 21 (46.7%) in deep dorsal vein, 3 (6.7%) in para-arterial veins and 3 (6.7%) in corpus spongiosum. The results of this study show the high prevalence of venous leakage in patients referring for erectile dysfunction. Moreover, CT cavernosography was shown to be a useful method for evaluating penile venous system and its related leakage sites which are important for surgical planning.

Several studies have suggested higher incidence of osteoporosis in patients with idiopathic scoliosis in comparison with the normal population. The aim of this study was to assess the prevalence of low bone mass among adolescent girls with idiopathic scoliosis. In this cross-sectional study performed in shafa Hospital in Tehran, Iran during 2011-2012, we recruited fifty-seven 12- to-20-year old girls with idiopathic scoliosis and compared them with 100 age-matched healthy girls. The patients had no other diseases including neuromuscular disorders, congenital vertebral anomalies or a history of spinal surgery. Bone mineral densities (BMD) of the hip and spine were evaluated and compared in all 157 participants using dual X-ray absorptiometry (DXA). Standard BMD (sBMD) was also calculated at the lumbar spine. Analysis of the data revealed that hip BMD was significantly (P=0.004) lower in patients with idiopathic scoliosis versus the controls. Moreover, BMD and sBMD of the Spine were also significantly lower in the patients (respectively, P=0.030 and P=0.030). Curve location had no effect on the values of hip BMD, spine BMD or spine sBMD (respectively, P=0.061 and P=0.274 and P=0.208).Finally, with more severe curves a lower bone mass was detected for sBMD and spine BMD (respectively, P=0.017 and P=0.016), but it was not significant for hip BMD (P=0.069). Adolescent girls with idiopathic scoliosis had lower bone mass compared with their healthy peers. The lower bone mass was correlated with the severity of the curve but not its location.

Laryngeal videostroboscopy is an important noninvasive diagnostic tool in patients with dysphonia. More than 50% of patients with dysphonia have a benign laryngeal lesion on vocal fold examination. The aim of this study was to evaluate patients with benign laryngeal lesions by videostroboscopy. This cross-sectional study was done on 159 patients with dysphonia in Amiralam Hospital in Tehran, Iran during 2006-2007. All the patients underwent stroboscopic examination of the vocal folds, including their movement. We also evaluated the patients for mucosal status, mucosal wave and patterns of glottal closure. Eighty-two patients participating in the study were female and 77 were male. Reflux laryngitis and muscle tension dysphonia were the most observed disorders in the patient population. Patients with sulcus vocalis and intracordal cysts had the worst mucosal wave patterns. Laryngeal videostroboscopy is a useful tool for the diagnosis and treatment planning in patients with benign laryngeal lesions.

Choledochal cyst is a congenital disease of hepatobiliary system. Patients with the disease differ in terms of gender and symptoms. In this study, we aimed to evaluate the patients from clinical signs and symptoms, diagnostic methods and treatment perspectives. In this retrospective study, we evaluated the data from the medical records of patients with choledochal cyst admitted in Ghaem and Omid hospitals affiliated to Mashhad University of Medical Sciences in Mashhad, Iran during 1994 to 2011. The medical records of 23 (18 women and 5 men) patients were evaluated. The mean age of the patients was 24.6 years. The most common type of the disease was choledochal cyst type 1. The most common type of surgery performed in the patients, respectively was resection of biliary cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. No mortality was observed during the hospital stay or follow-up period. Surgical complications were minor and patients recovered by conservative measures. Regarding the favorable results of surgical treatment of choledochal cysts, timely and definite diagnosis of this congenital anomaly and proper planning for its surgery are of special importance.

True umbilical cord knot is one of the abnormalities of the umbilical cord. Active fetal movements create cord knotting. True umbilical cord knots are rare but may be associated with fetal distress and stillbirth. True umbilical cord knots are capable of impeding blood flow to the fetus. A 26-year old primigravid woman was first treated for genital herpes simplex virus (HSV type 2) at 36 weeks of gestational age. She received oral acyclovir (400 mg three times daily for 10 days). At the gestational age of 38 weeks and 5 days, fetal activity decreased and NST was nonreactive. She was delivered by cesarean section and a true umbilical cord knot was found. Four years later, in her second pregnancy, another true knot was seen. Excessively long umbilical cords are more likely to be associated with true knots. Genetics has an important role in determining cord length and occurrence of true knots.