[Frequency and pattern of diabetes insipidus following hypophyseal adenectomy in Baqyiatallah hospital, 1991-2001]

Adenoma is one of the most common pituitary tumors, with diabetes Insipidus [DI] being one of the most common complications. This study was conducted with the following aims: a] determination of relative frequency of DI following hyphophyseal adenectomy, b] assessment of correlation between DI and some variables, c] study the clinical course of DI development after surgery of hyphophyseal adenoma. Matherials and This prospective study was conducted between 1991-2001 in Baqyiatallah Hospital, Tehran, 50 Patients with pituitary adenoma without diabetes underwent trans-Sphenoidal [n = 35] or trans-cranial adenectomy [n = 15]. Development, time of onset, duration of DI, and need to use Minirin was assessed in patients. DI was categorized to Immediate DI [IDI, day 10]. DI occurred in 15 cases [30%], of which, 10 had IDI [67%] and 5 cases had DDI [33%]. DI developed in 5 [33.3%], 7 [46.6%], and 1 [6.6%] subjects, on days 1, 2 and 7 following their operation, respectively. DI was not correlated with sex, age and kind of surgery [p>0.05]. DDI was seen more after trans-Cranial surgery than after trans-Sphenoid surgery [26.6% vs 2.8%, p=0.024]. Of 15 cases of DI, 5 [33%] did not need Minirin, 5 [33%] needed it just for one day, and 5 [33%] received it for 4-180 days [4, 11, 15, 62 and over 180 days]. This study reported the relative frequency of hypophyseal adenectomy to be 33%. According to this study, one third of patients have self-limited DI and do not need drug therapy. However, we recommend that in patients with DI after these surgeries, early and routine prescription of Minirin should be avoided and treatment should be based on fluid replacement. This study also reported trans-Sphenoid surgery to be less frequently accompanied by DI, which seems to be an important factor in the selection of operation techniques for these surgeries

[Role of surgery for diagnosis and treatment of tuberculosis]

There are few recent prospective studies regarding role of surgery for the treatment and diagnosis of tuberculosis [TB]. We conducted this study in our department and the results are presented. From 20 February 2003 to 21 September 2003, patients who underwent surgery for diagnosis or treatment of TB at the Department of Surgery, Masih Daneshvary Hospital were enrolled in the study. We designed a data form and details of history, radiology, laboratory, bacteriology, operation, complications, histologic studies, as well as results of surgery were recorded. Clinical follow up was scheduled prospectively. Statistical analysis of the data forms were done at the end of the study. During the study period, [7 month] 18 patients enrolled in the study. There were 7 females and 11 males with mean age of 34.16 [range: 12-76 years]. Twenty six operations were performed on 18 patients which are listed below: Thoracotomy 6, surgical bronchoscopy 6, lymph node biopsy 4, laparatomy 2, video assisted thoracoscopy [VATS] 2, chest tube insertion 2, chest wall resection 1, insertion of stent in the right main bronchus 1. Goals of surgery were: diagnosis in 8, diagnosis and treatment in 6, and treatment alone in 4. In all patients goals of surgery were successfully achieved. There was no mortality, but 3 major complications occurred [persistent air leakage in one patient, severe bleeding after right pneumectomy in one patient and occlusion of the stent by granulation tissue in one. All complications resolved with appropriate treatment. Diagnosis of TB was based on histological findings of surgical specimens or isolation of Mycobacterium TB or both. Whenever indicated, surgery has a definite role in the treatment and diagnosis of TB. Results of surgery are good with few complications

Imaging in 100 patients of thoracic hydatid disease including unusual imaging appearances

To evaluate the chest radiography and CT scan characteristics of pulmonary hydatid disease [PHD]. One hundred patients [59 males and 41 females, age ranged from 9 to 80 years] with surgically proven pulmonary hydatid cysts were studied. We reviewed clinical and imaging findings including PA and LAT chest roentgenograms and conventional CT of the chest. Only 82 patients had CT scan in their files, but all had CXR. The radiological features [localization, diameter, architecture, density and other radiological signs and appearances] were determined. On CXR, 124 cysts were determined. In evaluation of 82 available CT scans, a total of 112 cysts were detected. No cysts was detected on 5 CT scans. No discrete cyst was detected on 10 CXRs: 4 patients. only consolidation; and 6 patients, only hydropneumothorax. The most frequent site of involvement was RLL [29.6%]. Fifteen hydatid cysts appeared as solid masses on CT. Fifty-seven cysts were ruptured cysts and 25 patients with ruptured cysts had hemoptysis [43.9%]. Thirty-eight percent of cysts had thin walls and 62% had thick walls. Sixty-four cysts were round in shape [55.7%]. Single cysts were seen in 63 patients while multiple cysts were seen in 37. Median CT density of the cysts was 24 Hounsfeild Units [HU] [-18 to 84]. There were 16 giant cysts [diameter >/= 10 cm] on CT. Mean maximum and minimum dimensions of cysts were 5 cm and 4 cm on CT and 6.8 cm and 5.7 cm on CXR, respectively. On CT and CXR, "water lily sign" was seen in 18 and 22 patients, 'air-fluid level" in 12 and 17 patients, and "crescent sign" in 11 and 5 of patients, respectively. Inverse crescent sign and calcification were not observed on CXRs, but each was reported on 4 CT scans. On CT' 90% of cysts were smooth, 74 cysts were uniloculated and 9 were multiloculated. Nineteen percent of cysts were infected. Other imaging findings included mediastinal shift, atelectasis, infiltration. pericystic lung reaction, chest wall involvement, and rib destruction. CXR is helpful with diagnosis of intact cysts but fails to define entire morphology of complicated cysts. CT imaging recognizes certain details not visible on radiography. In endemic regions like Iran, atypical imaging presentations of complicated pulmonary hydatid disease, such as solid masses, should be considered in differential diagnosis of pulmonary lesions

[How postintubation tracheal stenosis could be prevented?]

Although it is assumed that appropriate care of endotracheal tubes and airway might prevent postintubation airway stenosis [PIAS], but this concept has not been investigated adequately. The purpose of the study was to investigate practical ways for prevention of PIAS in intubated patients. The study was implemented in 3 phases. First we collected information about methods of caring for airways and tubes in intensive care units in Tehran and other cities [control group] and data collection based on filling 10-20 questionnaires in each intensive care unit. Then we assessed patients who had PIAS and had been treated by us during a 6 year period [1994-2000] [study group]. In the final phase, collected data were analyzed and we looked for important pitfalls in caring for airways in intensive care units in our country and also looked for the practical measures to prevent PIAS. In phase I, 341 questionnaires were filled out in 18 intensive care units [12 in Tehran, 6 in other cities]. There were 133 females and 208 males aged 3 month to 98 years [mean 46.1]. Head injury was the commonest cause of intubations in 24%. of patients. Out of 356 tracheal tubes which had been used in these patients, 318 were high volume low pressure types [new tubes], and 32 were high pressure low volume types [old tubes]. In 179 patients [52.4%], there was not any type of care for tubes and airways by attending physicians, in 140 patients [41%] there was some kind of care although not organized or sufficient and in only 21 patients [6.1%] the care was organized and sufficient. Mean time of intubation was 8 days [1-45 days]. Tracheotomy had been undertaken without any established criteria and mostly by junior staff with low experience [usually junior residents]. In phase II, 120 patients were treated for PIAS [36 females, 84 males aging 1-83 years, mean 25.9 years]. Head injury was the cause of intubation in 78 [65%] patients, the site of stenosis was tracheal in 88 and laryngotracheal in 32 patients. More than half of the patients were intubated by inappropriate old tubes. Direct cause of stenosis was the cuff in 92, tip of the tubes in 15 and stoma in 10 patients. In 3 patients more than one factor were the causes. Mean time of intubation was 14.9 days [1-90] and mean length of stenosis was 3.2 cm [1-7]. Caring of tubes and airways was inappropriate and inorganized in all patients. Factors which were statistically different in study and control group were: time of intubation [14.9 day vs 8 days, P=0.000], suicide attempts [12 vs 5, P=0.000], head injuries [65% vs 24% P=0.000], Age [25.9y Vs 46y, P=0.05], using old tubes [50% vs 9% P=0.000], organized caring of tubes and airways [0.0%vs6.1%P=0.000]. The following measures are effective in decreasing the PIAS: decreasing time of intubation, using appropriate tubes, [including PVC tubes], continuous care of airway and tube, cuff monitoring and daily recording of information about tubes and cuff pressure, and special care for intubated young patients who had sustained head injury or had attempted suicide