Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones

This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography [MRCP] and intra-operative cholangiography [IOC] methods in patients suspicious to gall stones. According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography. In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared. The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods. According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients

Benefits and complications of the new single hole chest tube: study of 100 cases

Chest tube is indicated in many situations and can be life saving in certain patients. Some of the chest tube complications are related with the number of its holes. Tube length is associated with other complications. The present study was performed with the aim of comparing two types of chest tubes, one with several holes and the other with a single hole. A randomized clinical trial was performed on 100 patients in Imam Hossein Hospital. Patients were randomly divided into two groups, and each group used one type of tube, one with several holes and the other with a single hole. Radiographic pattern, duration of use, complications, and need for a second tube were compared in the two groups. There was no significant difference between the two groups regarding age, sex, duration of use, reason for tube insertion, clinical findings and laterality of chest tube placement. Hemothorax was significantly observed more frequently in radiographs obtained 1 hour and one-day later. In the 3[rd] day, two groups were similar in terms of hemothorax. Inadequate drainage was a complication observed in those with single hole tubes. Kinking was a complication seen in patients with multiple hole tubes. None of the patients needed second tube placement. There was no significant difference between the two tubes regarding their function but hemothorax occurred more frequently in those with multiple hole [conventional] tubes. Thus, we recommend the use of single holes tubes. Mass production of these tubes is cost effective considering less production costs and similar function

BCG vaccination and active tuberculosis prevention: a three-year study

Six to eight million people are infected with tuberculosis [TB] annually throughout the world, out of which 2 to 3 million die. BCG vaccination and its efficacy are always used in tuberculosis control planning. There are different rates of BCG vaccination efficacy in the world from 0 to 80%. BCG vaccine has different efficacy in endemic and non-endemic areas. The prevalence of tuberculosis in Iran is high; therefore it was necessary to perform a study in this regard. This was a case-control descriptive study conducted from 2001- 2003. There were 50 cases of active pulmonary tuberculosis [according to WHO definitions], and 100 controls without tuberculosis admitted for other reasons. Vaccination was done in 10 [20%] people in the case group and 36 [36%] people in the control group [OR: 43%].Thus vaccine efficacy was calculated to be 57% in this study from the equation VE=1-OR [CI: 95% between 0.04-0.81]. Twenty percent of vaccinated people have been protected from active tuberculosis in this study. In this study vaccine efficacy was 57% [CI: 95% between 4-81%], and protection rate of vaccinated people against active tuberculosis was 20%. The effectiveness of BCG vaccine is not constant in all situations and old age and past history of contact with TB patients are confounding factors causing the low efficacy of the vaccine. While case control studies have limitations; thus, similar studies should be planned in different parts of our country for more accurate results

Frequency of Infectious skin lesions in kidney transplant recipients

This study was performed to evaluate the frequency of skin lesions in kidney transplant recipients. A total of 681 kidney transplant recipients were followed at Shaheed Labbafinejad transplant center in Tehran, Iran. Skin lesions were evaluated, and diagnoses were made clinically and confirmed by lesion smear, tissue biopsy, tissue culture, and serologic examinations, as indicated. Skin lesions were found in 54 patients [7.9%], and their frequencies were as follows: dermatomal herpes zoster [18 patients, 2.6%, 13 men and 5 women], herpes simplex infection of face and lips [15 patients, 2.2%, 5 men and 10 women], chickenpox [6 patients, 0.9%, 5 men and 1 woman], Kaposi's sarcoma [5 patients, 0.7%, 3 men and 2 women], warts [4 women, 2 of whom had genital warts], pyoderma gangrenosum [1 man, 0.14%], multiple fungal abscesses of the leg [1 man, 0.14%], mucormycosis [1 man, 0.14%], and molluscum contagiosum [1 man, 0.14%]. Moreover, 2 women [0.3%] had generalized herpes simplex lesions. Frequencies of herpes zoster [3.5%], herpes simplex [2.5%], and human papillomavirus [0.6%] infections in our kidney transplant recipients were low. We recommend that all kidney transplant candidates be evaluated and immunized for herpes zoster virus before transplantation, all herpetic-form lesions of these patients be reported to physicians [even mild lesions], and finally, that all human papillomavirus lesions be diagnosed and treated promptly to prevent more serious lesions such as malignancies