Management of oxidative stress for cell therapy through combinational approaches of stem cells, antioxidants, and photobiomodulation

Over the recent decades, stem cell-based therapies have been considered as a beneficial approach for the treatment of various diseases. In these types of therapies, the stem cells and their products are used as treating agents. Despite the helpful efficacy of stem cell-based therapies, there may be challenges. Oxidative stress (OS) is one of these challenges that can affect the therapeutic properties of stem cells. Therefore, it seems that employing strategies for the reduction of OS in combination with stem cell therapy can lead to better results of these therapies. Based on the available evidence, antioxidant therapy and photobiomodulation (PBM) are strategies that can regulate the OS in the cells. Antioxidant therapy is a method in which various antioxidants are used in the therapeutic processes. PBM is also the clinical application of light that gained importance in medicine. Antioxidants and PBM can regulate OS by the effect on mitochondria as an important source of OS in the cells. Considering the importance of OS in pathologic pathways and its effect on the treatment outcomes of stem cells, in the present review first the stem cell therapy and effects of OS on this type of therapy are summarized. Then, antioxidant therapy and PBM as approaches for reducing OS with a focus on mitochondrial function are discussed. Also, a novel combination treatment with the hope of achieving better and more stable outcomes in the treatment process of diseases is proposed.

The effect of varying concentrations of chicken plasma egg yolk and glycerol on the viability of canine sperm following short and long-term preservation

Background

Plasma egg yolk (PEY), due to simple preparation and easier access, could be a suitable alternative to raw egg yolk for preserving canine semen.

Aims

The present study investigated suitable concentrations of PEY and glycerol for preservation of canine semen.

Methods

Semen was collected by digital manipulation (seven replicates from four dogs). Following initial raw semen evaluation, the semen was diluted in a tris-based extender supplemented with varying concentrations of chicken PEY (0, 20, and 40% v/v) and glycerol (3%; v/v). After cooling the specimen to 4°C within 1 h, the specimens were diluted with an equal volume of freezing extender consisting of similar concentrations of chicken PEY and 0 and 7% glycerol to reach the final glycerol concentration of 1.5 and 5% for short-term storage of canine semen. Samples with different concentrations of PEY and 5% glycerol were frozen. The sperm viability parameters including total motility, progressive forward motility, plasma membrane integrity, and live percentage of sperm were assessed following short and long-term storage.

Results

Sperm viability parameters of semen extended in an extender supplemented with 20 or 40% chicken PEY with either 1.5 or 5% glycerol remained superior until 72 h after semen collection compared to the specimen that did not receive any PEY (P<0.05). Post-thaw sperm viability was also greater in samples extended in extender supplemented with either 20 or 40% PEY compared to 0% PEY.

Conclusion

Tris-based extender supplemented with either 20% chicken PEY could be suitable for short and long-term preservation of canine semen.

22 Comparing Three Extenders: Hashi, Green Buffer and INRA 96, for Chilled Storage of Bactrian Camel Semen

Semen preservation remains challenging in the camel industry. The objective of the present study was to compare 3 different extenders for chilled storage of Bactrian camel semen. Semen (n = 9 ejaculates) was collected from camel bulls (n = 2) manually using artificial vagina. Good neat semen, as far as mass vibration concerns, was equally distributed into 3 double-wall vessels filled with 35°C water. The 3 extenders used in the present study were Hashi, Green buffer (IMV, L’Aigle, France), and INRA 96 (IMV). The Hashi extender consisted of Tris, 2.6%; citric acid, 1.35%; glucose, 0.9%; fructose, 0.9%; penicillin G sodium, 1000 IU mL−1; streptomycin sulfate, 1000 mg mL−1 supplemented with 20% plasma egg yolk and 20% camel skim milk; osmolality of 330 and pH of 6.9). Green buffer was supplemented with 20% plasma egg yolk (osmolality of 335 and pH of 6.9). The osmolality and pH of INRA 96 were 310 and 7, respectively. Extenders at a ratio of 1:3 were added to semen followed by pipetting 10 times with an automatic pipettor. The water-jacketed extended specimen was covered with foam and transferred to individual vaccine carrier equipped with 4 ice packs. This system of cooling not only allows the specimen to cool down slowly and reach 4°C after 7 h, but also reduces the viscosity of camel semen. The assessment was carried out 7 and 24 h after semen dilution, when the specimen reached 4°C. Semen viability parameters were assessed after short-term semen preservation in different extenders. Total motility and progressive forward motility were examined subjectively by single operator using Sperm Track (ISAS, Proiser, Spain) after diluting the specimen to achieve 25 × 106 sperm mL−1. Live percentage of sperm was estimated using Eosin B Fast Green staining method. Plasma membrane integrity was assessed using the hypo-osmotic swelling (HOS) test. Following arcsin transformation, data were analysed by GLM procedure followed by Tukey test in SAS (SAS Institute Inc., Cary, NC, USA). At 7 and 24 h, there were no differences among the 3 extenders in total motility of sperm (Hashi: 73 and 67.4%; Green buffer: 71.6 and 62.1%; INRA 96: 70 and 66.2%; P > 0.05), live percentage of sperm (Hashi: 76 and 73%; Green buffer: 70.5 and 65.6%; INRA 96: 77.8 and 70.7%; P > 0.05), or HOS test (Hashi: 52.4 and 45.2%; Green buffer: 49.6 and 40.6%; INRA 96: 57.3 and 51.1%; P > 0.05). However, at the same times, progressive forward motility was similar between Hashi (47.7 and 28.6%) and Green buffer (40 and 23.5%; P > 0.05) but was different between Hashi and INRA 96 (23.6 and 16.7%; P < 0.05). In conclusion, Hashi and Green buffer could be considered suitable extenders to preserve Bactrian camel semen under chilled condition. Further studies with a larger number of bulls and ejaculates are warranted.

Comparing three superovulation protocols in dromedary camels: FSH, eCG-FSH and hMG

The objective of this study was to compare three superovulation protocols in dromedary camels. Follicular waves of dromedary camel donors (n=6) were synchronized using two GnRH injections. Superovulation was initiated 2 days after the second injection (day 0 of experiment). The experiment was conducted using change over design, where all females received three superovulation treatments one after the other with a resting period of one month in between. Superovulation was carried out for all donors using 390 mg FSH, 1000 IU eCG and 330 mg FSH, or 16.5 ampule hMG (75 i.u. FSH and 75 i.u. LH per ampoule). FSH and hMG were injected twice daily, indecreasing doses, over 5.5 days. Thirty-six h after the last FSH or hMG injection, donors were mated once and received an intravenous injection of the GnRH analogue. The diameter and number of ovarian follicles ≥4 mm on day 4 after superovulation and the total number of corpora lutea and follicles ≥9 mm on day 7.5 after mating were evaluated by ultrasound examinations. No significant differences were found between the total number of corpora lutea among FSH (13.8 ± 2.65), eCG-FSH (15 ± 2.60) and hMG (10.8 ± 2.30) and the number of expanded hatched blastocysts in FSH (5.7 ± 2.32), eCG-FSH (8.8 ± 2.10) and hMG (5.8 ± 2.40) treated donors. This study showed that all three superovulatory protocols could be used successfully and interchangeably in dromedary camels.

Protective effects of Cornus mas fruit extract on carbon tetrachloride induced nephrotoxicity in rats

Oxidative damage is implicated in the pathogenesis of kidney injury. Cornus mas is used for in renal aliments traditionally in Iran. The present study was aimed to investigate the antioxidant activity of C. mas fruit extract (CMFE) on carbon tetrachloride (CCl₄) treated oxidative stress in Wistar albino rats. Forty two male albino rats were divided into seven groups. Group I served as a sham; Group II served as a normal control; Group III served as a toxic control, with CCl₄ (1 ml/kg body weight; 80% in olive oil); Groups IV and V received CMFE at doses of 300 and 700 mg/kg before CCl₄ injection; Groups VI and VII received extract at same doses orally at 2, 6, 12, 24 and 48 h after CCl₄ intoxication. CCl₄ injection produced a significant rise in serum markers of oxidative stress and lipid peroxidation product malondialdehyde along with the reduction of antioxidant enzymes such as superoxide dismuta, catalase and glutathion peroxidase. Serum creatinine, urea and uric acid concentrations were increased whereas level of protein and albumin were reduced. Treatment of rats with different doses of fruit extract (300 and 700 mg/kg) significantly (P < 0.05) ameliorated the alterations induced with CCl₄ in lipid peroxidation, antioxidant defenses, biochemical and renal lesions. Based on these results, we conclude that CMFE protects kidney from oxidative stress induced by CCl₄.

Experience of cyclone Gonu in the Islamic Republic of Iran: lessons learned

Gonu, the second tropical cyclone of the 2007 northern Indian ocean cyclone season, affected Oman, Pakistan, the United Arab Emirates and the Islamic Republic of Iran. This report examines the effects of cyclone Gonu in the Islamic Republic of Iran where it approached on its path on 6 June 2007 and reviews the actions taken before, during and after the cyclone. The incident highlighted the need for a special protocol to be prepared for all types of natural disasters. Responsible organizations should train their personnel according to the prepared protocols and service packages. Among the important lessons learned were the need for early warning, proper community involvement, access to essential data for risk analysis, special attention to safety of infrastructures, coordination and command integrity.

The role of fibular fixation in the treatment of tibia diaphysis distal third fractures

INTRODUCTION

Combined fractures of the distal third of tibia diaphysis and fibula diaphysis are a common orthopedic injury. There is an ongoing debate about the necessity of fibular fixation when associated to distal third tibial fracture. This study aims at evaluating the role of fibular fixation in the treatment of distal third tibial fractures.

HYPOTHESIS

We hypothesized that fixation of the fibula increases the stability of fixation in distal third tibial and fibular fractures.

MATERIALS AND METHODS

In a randomized clinical trial, 53 patients with concomitant fractures of tibia and ipsilateral fibula at distal third level were recruited in this study during a 23-month period. Patients were randomized in two groups: patients with fibular fixation (case group) and without fibular fixation (control group). The patients were followed up for at least 6 months postoperatively.

RESULTS

There were seven cases exhibiting malalignment on immediate postoperative radiographs. Six of them were in group II (control group) and one was in group I (case group) (P=0.084). We didn't find nonunion in group I and we found three patients in group II (P=0.141). Infection was one in group I and two in group II on gustillo II injuries (P=0.516).

CONCLUSION

Despite its low count of patients, our study didn't show any advantage to fix the fibula fracture associated to distal third of tibia diaphysis fracture. It didn't show either an increase of complication after fibula open reduction and internal fixation.

LEVEL OF EVIDENCE

Level III. Randomized prospective study.

Impact of trauma dispatch algorithm software on the rate of missions of emergency medical services

BACKGROUND

Trauma still stands atop of the list of emergencies. Transfer of these patients via Emergency Medical Services (EMS) dispatch is critical with regard to importance of timing. This aspect has achieved greater importance due to population increase and telephone triage.

OBJECTIVES

We aimed to decrease unnecessary Emergency Medical Services (EMS) missions via a computer program designed for an algorithmic approach for trauma care by nurses involved in EMS, to help them evaluate the case more accurately. We named our program "Trauma Dispatch Algorithm".

MATERIALS AND METHODS

First, the most common chief complaints regarding traumatic events were chosen from searching all the calls in December 2008 recorded in Tehran, Iran's EMS center; and then an algorithm approach was written for them. These algorithms were revised by three traumatologists and emergency medicine specialists, after their approval the algorithms were evaluated by EMS dispatch center for their practicality. Finally all data were turned into computer software. The program was used at the Tehran EMS center; 100 recorded calls assessed with each system were selected randomly. They were evaluated by another traumatologist whether it was necessary to send a team to the site or not.

RESULTS

The age average was 26 years in both groups. The "trauma dispatch algorithm" was significantly effective in reducing the unnecessary missions of EMS by 16% (from 42% to 26%) (P = 0.005).

CONCLUSIONS

This program was effective in reducing unnecessary missions. We propose the usage of this system in all EMS centers.

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy

Background

Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time.

Objectives

The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method.

Materials and Methods

In this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis.

Results

All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery).

Conclusions

Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.

Evaluation of intrapleural contrast-enhanced abdominal pelvic CT-scan in detecting diaphragm injury in stable patients with thoraco-abdominal stab wound: a preliminary study

BACKGROUND

Many of the patients with thoraco-abdominal stab wound remain asymptomatic; in this regard, previous studies reported that 7-48% of asymptomatic patients had diaphragm injury (DI). Thoracoscopy or multidetector computed tomography (MDCT) scan is the best method to detect DI. We aimed to evaluate the role of CT scan with intrapleural contrast to rule out DI in stable thoraco-abdominal stab wounds.

METHOD

In a prospective study, we evaluated all haemodynamically stable patients with thoraco-abdominal stab wound, from October 2009 to 2010. Exclusion criteria included patients who needed emergency thoracotomy or laparotomy, those who were haemodynamically unstable and those with blunt trauma or gunshot injury. In the CT-scan department, 500 cc of diluted meglumine diatrozate was transfused into the pleural space via a chest tube and the CT scan was performed from the dome of the diaphragm to the pelvic cavity. In the second step, all patients were taken for thoracoscopy within 24h after admission. The CT-scan slide was considered positive if one of the following signs was found: (1) the diaphragm was obviously injured as seen in CT-scan slides and (2) contrast agent was seen in the peritoneal cavity. Sensitivity and specificity were calculated for CT scan and thoracoscopy.

RESULTS

Four out of 40 patients had DI according to thoracoscopy. CT scan with intrapleural contrast predicted diaphragmatic injury correctly in all four patients. Considering thoracoscopy as the gold-standard method, the CT scan had two false-positive cases. The sensitivity of the intrapleural-contrast CT scan was 100% and its specificity was 94.4%.

CONCLUSION

Our study showed that CT scan with intrapleural contrast can be an acceptable approach to rule out DI and limit the use of thoracoscopy for final diagnosis and repair of DI in cases with suspicious or positive CT-scan results, especially in trauma centres with high load of trauma patients and little accessible equipment.

Comparison of the efficacy of two local haemostatic agents

Background:

In modern life, the incidence of traumatic injuries increases daily. In accidents which lead to trauma, massive bleeding is the main cause of death. Nowadays, many different chemical and herbal agents are available for quick control of bleeding.

Objectives:

In this study, we compare the effectiveness of two different types of chemical agents for control of bleeding in an animal model.

Materials and Methods:

This research was done comparing two hemostaticagents- ”Chitohem” and “Quikclot”. Ten healthy IR Iranian sheep were chosen and were blindly divided into two different groups. In each of the groups, one of the aforementioned agents was to be applied. First, four main limb arteries of the sheep were dissected linearly and after measuring the volume of bleeding in the first 60 seconds, the chemical agent was applied to the site of bleeding. After that, the duration of bleeding, the volume of bleeding and the secondary blood pressure were measured and compared.

Results:

There were no significant differences between the primary features of the animals in two groups (Weight, Baseline Systolic Blood Pressure and Pre-treatment Blood loss). In dependent quantities such as the volume of bleeding after the usage of chemical agents, secondary systolic blood pressure, the results were in favor of “Quick Clot” (P < 0.001 for volume of bleeding, P = 0.008 for secondary blood pressures and P < 0.001 for the necessary time for the bleeding to stop).

Conclusions:

In this study, it seems that activity of “Quikclot” in cessation of bleeding of large arterial vessels was slightly better than “Chitohem”. Due to limitations which we had in this study, further studies are necessary to show the actual differences between these agents and their side effects.

Designing a model for trauma system management using public health approach: the case of Iran

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

A novel robotic tactile mass detector with application in clinical breast examination

This paper presents a novel tactile sensing robot designed to detect breast lesions with minimum invasiveness to the tissue while providing exact documentation to make therapeutic and surgical decisions. The robot named "Robotic Tactile Breast Mass Identifier (Robo-Tac-BMI) consists of an indentation probe controlled by a robotic system and a visualization interface to manipulate the end-effecter. Geometrical maps of the test points with related tension-relaxation curves are provided during clinical examinations. Utilizing the curves, three functional stiffness parameters are extracted locally for each test point. These parameters are employed to provide objective information to facilitate the surgeon's task in the diagnostic procedure. Computational analysis is proposed for a real breast tissue model to study the capability of artificial tactile sensing in the mass detection. Indications of the mass existence are determined and employed as the basis of the Robo-Tac-BMI design and construction. Clinical trials are executed by the Robo-Tac-BMI on 161 cases. The results show that the robot has the potential to provide tissue mechanical properties unlike the conventional screening modalities carried out either by the surgeon or the imaging techniques which are not quantitative and lack documentation. Sonography with and without mammography is chosen as the "gold standard" tests.

Trauma care system in Iran

OBJECTIVE

The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.

METHODS

The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.

RESULTS

Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.

CONCLUSIONS

It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

Survival after In-Hospital Cardiopulmonary Resuscitation in a Major Referral Center during 2001-2008

Despite efforts to save more people suffering from in-hospital cardiac arrest, rates of survival after in-hospital cardiopulmonary resuscitation (CPR) are no better today than they were more than a decade ago. This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing CPR by the code blue team at our center during 2001 to 2008. Data were collected retrospectively from adult patients (n=2262) who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated using binomial and tests. Of the patients included (n=2262), 741 patients (32.8%) had successful CPR. The number of male patients requiring CPR was more than females in need of the procedure. The majority of patients requiring CPR were older than 60 years (56.4±17.9). The number of successful CPR cases in long-day shift (7:00 to 19:00) was more than that in the night shift (19:00 to 7:00). Furthermore, 413 (18.4%) cases were resuscitated on holidays and 1849 (81.7%) on the working days. The duration of CPR was 10 min or less in 710 (31.4%) cases. Cardiopulmonary resuscitations which lasted less than 10 minutes were associated with better outcomes. The findings of the present study indicate that some manageable factors including the duration of CPR, working shift, working day (holiday or non-holiday) could affect the CPR outcomes. The findings might also be taken as evidence to suggest that the allocation of more personnel in each shift especially in night shifts and holidays, planning to increase the personnel's CPR skills, and decreasing the waste time would result in the improvement of CPR outcome.

Assessment and outcome of 496 penetrating gastrointestinal warfare injuries

AIM

The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes.

METHODS

The medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed.

RESULTS

There were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals.

CONCLUSION

Penetrating abdominal injuries were common in Iranian victims of war often causing multiple organ injuries. The colon and small intestine were the more commonly injured organs and carried the most postoperative complications. Mortality at 1st line hospitals was more than double that of 2nd line hospitals; the complication rate was also greater as was the number of missed injuries. Adherence to the standard surgical protocols, prompt evaluation, proper triage and management are factors which may lower patient morbidity and complications.

A medical tactile sensing instrument for detecting embedded objects, with specific application for breast examination

BACKGROUND

In this paper, having considered the tactile sensing and palpation of a physician in order to detect abnormal masses in the breast, we simplified and then modelled the tissue containing a mass and used contact elements to analyse the tactile sensor function.

METHODS

By using the finite element method, the effects of the mass existence appeared on the surface of the tissue. This was due to exerting mechanical load on the modelled tissue surface. Following this, a tactile sensing instrument called the 'tactile tumour detector' (TTD) was designed and constructed. This device is able to detect abnormal objects in the simulated models by making contact with model surfaces. In order to perform a series of precise experiments, a robot that could hold the tactile probe was used. The velocity of the linear movement of the probe is low enough to ensure that the tissue behaves in the linear elastic range, so that dynamic effects can be neglected.

RESULTS AND DISCUSSION

The maximum value of stresses was chosen as the comparison criterion. The variation of this criterion vs. the mass parameter changes was investigated and good agreements between numerical and experimental results were obtained. Moreover, the sensitivity and specificity of TTD and clinical breast examination (CBE) in the detection of breast masses, in comparison to sonography as the 'gold standard', were calculated by performing clinical trials on 55 cases.

The Outcome of Diverticulosis in Kidney Recipients With Polycystic Kidney Disease

INTRODUCTION

Diverticulosis is a common finding in autosomal-dominant polycystic kidney disease (ADPKD). To avoid the serious complications of diverticulosis after kidney transplantation, some policies have recommended aggressive actions, such as elective colectomy. These policies are not widely agreed upon. This controversy led us to investigate the serious complications and the outcome of diverticulosis in ADPKD kidney recipients to see whether such therapies are justified.

MATERIALS AND METHODS

From 2002 to 2006, we followed 18 ADPKD kidney recipient patients with barium enema-documented diverticulosis. All subjects were asymptomatic for diverticulosis at the time of transplantation. The mean value +/- SD of follow-up duration was 25.4 +/- 28.5 months. We documented demographic data, familial history of ADPKD, barium enema findings, and complications as well as graft and patient survivals.

RESULTS

Hepatic flexure was the most prevalent site for diverticula. The mean (SD) of diverticular count was 6 +/- 5.1. Patients with a familial history of ADPKD showed a higher number of diverticular (P=.01). Diverticulitis occurred in three patients, all of whom died.

CONCLUSION

Diverticulitis is a fatal and not rare complication in ADPKD patients. The rate of complications in our study was similar to previous findings, but we observed serious complications even among patients asymptomatic at the time of transplantation. The decision to take aggressive action such as elective colectomy is still a matter of debate that needs further evaluation.

Comparing presentation and diagnostic accuracy for conscripts and nonconscripts who have already been selected for appendectomy

BACKGROUND

The evaluation of acute appendicitis (AA), the most common cause of acute abdomen, in conscripts is important, specifically when it seems that the probability of malingering for secondary gains (such as exemption) is high, and surgeons may lose some cases of AA through this assumption.

METHODS

In this analytic cross-sectional study, 455 male conscripts with suspected AA were compared with 142 male individuals between 14 and 26 years of age who had already been selected for appendectomy.

RESULTS

The mean age (+/-SE) was 20.4+/-0.08 years. There were no statistically significant differences between the case and control groups in terms of age, rates of different symptoms and signs, quality and duration of pain, vital signs, and laboratory findings.

CONCLUSIONS

There was no significant difference between conscripts and others in terms of the presentation of AA and its accurate diagnosis. Therefore, it is recommended that military physicians approach conscripts with suspected AA like other patients.

[Costal echinococcosis. Report of one case and review of the literature (author's transl)]

Following the report of a case of costal echinococcosis, a review of the published literature showed that 32 identical cases have been the subject of publications in the Occident. A further 6 cases were found in the records of the University Hospitals in Teheran, which brings the total to 39 published cases, including our patient, known at the present time. It is important to make the diagnosis in these cases so that the surgeon can take the necessary precautions to avoid the anaphylactic shock which can follow dissemination of the parasite.

Prevention of hepatitis type B with specific immune serum globulin

In order to evaluate the preventive value of specific immune serum globulin against hepatitis type B, we have used this immune globulin in required doses in 12 patients (10 with AU antigen negative and 2 with AU antigen positive) with chronic renal failure who required maintenance hemodialysis for a period of 15 months, and we were able to prevent hepatitis type B in our dialysis patients.