Medical Journal Of the Islamic Republic of Iran
Volume:20 Issue: 2, Summer 2006

Cytokines play a major role in both acute and chronic inflammatory processes, including those produced by Sulfur Mustard. This study describes the cytokine level six months after exposure to a single dose of sulfur mustard, defined by IL-1β, IL-6, IL-9, IL-12, TGFβ and TNF-α. The cytokine levels of Broncho-Alveolar Lavage (BAL) and seraof twenty male rats exposed to sulfur mustard were measured and compared with the control group. The rats in the test group were exposed to a single dose of sulphur mustard (inhalation) and left for up to 6 months. After six months the animals were anesthetised, blood samples were obtained from their heart using 5-mL syringes and serum was kept at -20ºC. Their BAL was collected by lavage. BAL fluid was centrifuged and left at -20ºC until assay. Cytokine assay was performed employing the ELISA Method (Bender Med Systems). The results showed significant differences (p<0.001) between the control and exposed groups in terms of all cytokine (IL-9, γIFN, TGFβ, IL-6, IL-1β, IL-12 and TNFα) productions in both the BAL fluid and serum. The most noticeable increase in cytokine release was seen in IL-9, which was 615.93% and 321.88% for the BAL fluid and serum, respectively (p<0.001). After IL-9 the highest increase was demonstrated for TGF-β and IL-6 in the BAL fluid which was 200.85% and 125.50% respectively. From data presented here, it is possible to suggest that verproduction of IL-6, IL-9 and TGFβ might be involved in the late outcome oflung injury after six months exposure to sulfur mustard.

The incidence of early wound related complications is assessed in laparoscopic versus open abdominal surgeries. Complications of surgical wounds (esp. wound infections) are considered as a major problem in surgery wards. Complications of surgical wounds are classified as early and late. Common and early complications are hematoma, seroma and wound infection. The medical records of 104 elective laparoscopic (A) and 106 diagnosis matched open surgeries (B) including appendectomy, cholecystectomy, ventral hernia repair, and bariatric surgery were prospectively reviewed. Study data included patients` sex, age, wound class, type of operation, and occurrence of early wound related complications. Surgical wounds were evaluated for presence of early complications during the post-op period and 10 to 15 days after the operation. The two groups were not different regarding age, sex and woundclasses. No patients in group A and 7 patients in group B developed wound infection (p<0.05). Incidence of hematoma was similar in the two groups; one case in each. No patient in the two groups experienced seroma nor wound dehiscence. Gender, age and wound classes were not associated with higher rates of wound complications. Laparoscopic surgery significantly reduced the incidence of early wound complications, especially wound infection, and is a safe and effective alternative to conventional open procedures.

Life-threatening infections caused by the encapsulated fungal pathogen Cryptococcus neoformans have been increasing steadily over the past 10 years. Cryptococcus neoformans is recognized as the most frequent fungal infection of the central nervous system (CNS) in immunocompetent as well as immunocompromised patients. We report the development of a semi-nested- PCR-based assay for the detection of C. neoformans in less than 100 yeast cells per ml of cerebrospinal fluid (CSF).

In patients with cervical spondylosis, cord compression and impingement of cord vessels as well as the vertebral artery may be accompanied by vertigo. We evaluated improvement of vertigo in these patients after surgical and medical treatment. In this prospective study we reviewed 16 patients with vertigo suspected of cervical spondylosis, admitted to our hospital between 1999 and 2004. Before orthopedic examination, other causes of vertigo related to the field of ENT and neurologic problems had been ruled out. Dynamic angiography and /or Doppler sonography were performed in patients during flexion and extension and rotation of the cervical spine. Operations such as laminectomy and foraminotomy and resection of osteophytes were performed in patients who did not improve by conservative treatment. There were ten males and six females, with a mean age of 62.5 years. Twelve patients had cervical canal stenosis, and four patients also had vertebral artery stenosis. In two patients angioplasty of the vertebral artery was performed. Operations were performed in twelve patients and conservative treatment was used in four patients. Surgical treatment gave good relief of symptoms and was satisfactory in eight patients and not satisfactory in four patients. Conservative treatment improved symptoms in one patient, and was not satisfactory in three patients (p <.05). Vertigo occurs in patients with cervical spondylosis, especiallyin old patients with spondylosis. In most cases we had improvement of vertigo by surgical decompression of the cervical cord and arteries.

The purpose of this study is to investigate the rate of fertility andresults of pregnancy among KTP women, and the assessment of the function oftransplanted kidneys during pregnancy among those who have received kidneys inGolestan Hospital from 1996 to 2003. All the transplanted women in child bearing age who were interested in accepting pregnancy were involved in this study. After pregnancy, all the patientswere visited twice a month until the 32nd week of pregnancy and their histories weretaken and regular clinical examination and necessary paraclinical assessments werecarried out. After the 32nd week, they were visited weekly and other necessaryassessments were done in addition to previous measures. Taking immunosuppressivedrugs was continued with a minor dose reduction and consumption of harmful drugslike some antihypertensives was prohibited. 16 out of 48 women who were at child bearing age and were interested in pregnancy got pregnant and totally 22 cases of pregnancy occurred. Four cases resulted in spontaneous or therapeutic abortion and 3 out of 18 remaining cases ha intrauterine fetal death and the others had successful pregnancy. The most commoncomplication was LBW and following that premature labor. Maternal complicationswere no more than the general population and the function of the transplanted kidneyhad no decline in most of the cases. Based on what was mentioned, it is concluded that successful KTPcan increase the chance of pregnancy and in order to improve the results of pregnancy,it is necessary to prepare ideal conditions especially for the transplanted kidney beforepregnancy, while pregnancy does not produce any decline in the function of thetransplanted kidney.

The transverse rectus abdominis musculocutaneous (TRAM) flapremains the gold standard for postmastectomy reconstruction either immediate ordelayed. However, transfer of TRAM flap can be associated with donor sitemorbidities and complications in flap. A successful reconstruction consists of carefulpatient selection, surgical technique and meticulous preoperative planning. This studywas designed to evaluate outcome and complications of breast reconstruction withTRAM flap in association with patient conditions and risk factors, prospectively. Breast reconstruction was performed in 44 women consecutively, using the TRAM flap during a 3-year period, 1999–2002. Modified radical mastectomyaccompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy. The mean age of the patients was 40.41±4.43 years. Thirty (68.18%)patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAMflaps were used in 26(59.09%) and 14(31.81%) reconstructions, respectively. Theabdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18%)patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%),partial flap loss (13.64%), etc. Satisfaction rates were excellent in 10 (22.72%), goodin 25 (56.82%), moderate in five (11.36%), and poor in four (9.09%) patients. Themean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 inpatients with contralateral and ipsilateral flaps, respectively (p>0.05). A significantassociation was observed between overall complications and comorbidities. Partialflap loss and fat necrosis was associated with smoking, and abdominal hernia wasassociated with obesity marginally

The pancreatojejunostomy has notoriously been known to carry a high rate of operative complications, morbidity and mortality, mainly due to anastomotic leak and ensuing septic complications. In order to decrease anastomotic leak and its attendant morbidityand mortality in operations requiring a pancreato-jejunal anastomosis, and also in order to simplify the operation, a new technique was developed by the author and subsequently termed “JEMI”, i.e., Jejunal Eversion Mucosectomy and Invagination. This method consists of preparation of a Roux-en-Y jejunal limb,eversion of the limb end to expose the jejunal mucosa, submucosal saline injection, and mucosectomy of a 2 cm cuff of mucosa saving the submucosal vessels and a seromuscular cuff of jejunum. The pancreatic remnant is next prepared to accept the prepared limb by freeing 2 cm of pancreatic tissue. This is followed by suturing the edge of the mucosa to the edge of the pancreatic capsule via 3/0 vicryl or PDS, pulling the mucosectomized cuff over the pancreatic remnant, and suturing the edge of the seromuscular cuff onto thepancreatic capsule via 3/0 vicryl or silk. 18 patients underwent a pancreatojejunal anastomosis after pancreatic resection during a 4 year period by the author. No case of pancreatic fistula or leak was observed in any of the cases, and all cases were discharged from the hospital on PO day 6, except for one patient who was discharged on PO day 12 due to delayed gastric emptying, and one early post operative death due to extensive myocardial infarction. This technique appears promising and is gaining popularity in our institution, and is therefore recommended as a choice method for any operation requiring a pancreatojejunal anastomosis.

Human blood and blood products is the source of a wide range of medicinal products used for the treatment and prevention of a variety of injuries and disease. Despite stringent routine measures and filters employed, residual pathogen infectivity remains an important challenge in the field of blood transfusion. In this article various measures and technologies that can be applied in order to reduce the residual risk are reviewed.

Spinal anesthesia for cesarean section is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Forty-four preeclamptic parturients undergoing cesarean section were randomized in two groups of 22 patients. Group A received a spinal anesthetic of bupivacaine 6 mg plus fentanyl 20 μg, and group B received 12 mg bupivacaine. Hypotension was defined as a 30% decrease in systolic and diastolic pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 2.5-5 mg up to maximum 50 mg. All patients had satisfactory anesthesia. Five of 22 patients in group A required ephedrine, a single dose of 5 mg. Seventeen of 22 patients in group B required vasopressor support of blood pressure. The lowest recorded systolic, diastolic and mean blood pressures as fractions of the baseline pressures were 71.2%, 64.5% and 70.3% versus 59.9%, 53.5% and 60.2% respectively for group A versus group B. A “minidose” of 6 mg bupivacaine in combination with 20 μg fentanyl may provide satisfactory spinal anesthesia for cesarean section in the preeclamptic patient. The minidose combination caused dramatically less hypotension than 12 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.

One of the best reliable markers of hepatitis B virus infection is antibodies to the core antigen (Anti-HBc). A first-time blood donor with HBsAg positivity was identified as an HBVcarrier that was anti-HBc negative. The patient was followed for 24 months in order to investigate the evolution of his HBV serological profiles and HBVDNA (PCR).In the follow-up for 24 months, HBsAg, HBeAg and HBV-DNA (PCR) were positive but all the time anti-HBc remained negative. HBV DNA viral load was 3.4×106 copies per mL. In the immunohistochemical study on the needle liver biopsy, the hepatocytes were positive for HBcAg and HBsAg. For this immunological situation, the most probable hypothesis is animmunotolerance to HBV due to an in utero HBV infection. This situation does not impose a risk of HBV transmission by blood transfusion, because HBsAg positive donations are excluded and discarded by HBsAg screening tests.