Evaluation of effective factors in treatment outcome of diabetic foot in diabetic patients referring to Taleghany hospital - Tehran from 2008-2009

Foot problems are a leading cause of hospitalization for the patients who have been identified as having diabetes mellitus. The aim of this study was to investigate the outcome of different factors on treatment of patients with diabetic foot referring to Taleghani hospital from 2007 - 2009. Diabetic patients fulfilling our inclusion criteria entered the study. In addition to their physical and clinical characteristics, laboratory findings and other information regarding their life style and habits, etc were also collected through a questionnaire. The collected information was recorded in their medical files and was further analyzed using t2 and x2 tests by SPSS software. Out of 80 patients, 58.75% were male and 75% of patients were above 50 years of age. 67.5% of patients were under graduated. 68.75% of these patients suffered diabetes for more than 10 years. 26 patients injected insulin while the rest used oral drugs to control their hyperglycemia. 48 patients were smokers [mainly cigarette]. Alcohol drinking was also considered in this study. Conservative treatments were advised for 43% of patients and for 36% of cases finger amputation and for 11 patients foot amputation was the treatment employed. Analysis of data reveal that there is significant relation [P<0.05] between the level of education and knowledge of patients regarding their illness and its sequelae, presence of distal palpation, control of diabetes and smoking. t2 test indicates that patients' age among those with good knowledge about the diabetes is significantly lower than patients without enough knowledge about diabetes mellitus [P<0.05]. Foot involvement among patients who are negligent about their condition happens quicker. There is no significant correlation between alcohol drinking, drugs consumed to lower blood sugar and duration of diabetes [P> 0.05]

[Patient with mirizzi syndrome in 501 hospital]

Background: mirizzi syndrome is a rare complication of prolonged cholelithiasis with presence of large, impacted gallstone into the Hartman's pouch, causing chronic extrinsic compression of common bile duct [CBD]. Fistula formation between the CBD and the gallbladder may represent the outcome of that condition; representing a diagnostic challenge

Case report: a 72 year old woman referred to 501 hospital complaining of epigastric and right upper quadrant pain with repeated cholangitis. Laboratory and radiologic investigations revealed biliary obstruction, presence of gall stone and common hepatic duct fistula. The definitive diagnosis was made intra-operatively. Patient underwent partial cholecystectomy, choledochoplasty and removal of stone from biliary duct. The patient was discharged from hospital in good condition

Discussion: it is important to identify Mirizzi syndrome and fistula formation because of morbidity and mortality as a sequence of the condition. Treatment is equally important as the chronic biliary tree inflammation and subsequent bile ducts anatomic alterations necessitate a meticulous surgical approach. Our patient suffered mirizzi syndrome type III. Type III is stenosis at the confluence of the cystic duct and the hepatic duct due to a stone as was in the present case

Evaluation of specific and non-specific cellular immune responses in amoebiasis patients

Specific and non- specific cellular immune responses were studied in 20 amoebiasis cases and 10 controls. All the study cases and controls were Indians living in Varanasi, India. Ten amoebic liver abscess cases were patients admitted to University hospital. Ten non-invasive intestinal amoebiasis cases constituted the second study group. Non-specific immune responses were studied using E-rosette technique. Specific cellular immune response was evaluated by measuring tritiated thymidine uptake by transformed lymphocytes using crude amoebic extract prepared from axenically grown Entamoeba histolytica NIH: 200 and two of its chromatographed fractions, i.e. fraction I [FI] and fraction II [FII] as well as a mitogen, i.e. Phyto Haemagglutinin-A [PHA]. Results show those crude antigens followed by FI and FII are able to induce blastoid transformation of lymphocytes prepared from different cases. Moreover, it was shown that specific cellular immune response was greatly depressed in amoebic liver abscess cases [P<0.001]. While the CPM [count per minute] of different groups on using PHA for stimulation did not vary significantly