effects of adenotonsillectomy on pulmonary arterial pressure by doppler echocardiography in children

Increeased upper-air way resistance resulting from hypertrophic tonsils and adenoids can cause intermittent airway obstruction, chronic alveolar hypoventilation, and even severe cardiopulmonary complications like pulmonary hypertension and corpulmonale. The aim of this study is to clarify whether tonsillectomy and adenoidectomy have any effect on mean pulmonary arterial pressure. This prospective study was approved by ethic committee. Thirty two randomly selected children [16 male, 16 female] aged between 3.5 and 13 [mean 7.06 +/- 1] with a diagnosis of upper airway obstruction or chronic infections from hypertrophied tonsils and adenoids were included in our study. Mean pulmonary arterial pressure [MPAP] was measured using Doppler echocardiography preoperatively and mean 4.25 +/- 0.46 months postoperatively in all subjects. Comparing preoperative and postoperative mean pulmonary arterial pressure showed a statistically significant decrease in mean pulmonary arterial pressure in these children [Preoperative mean PAP=19.37 +/- 0.82, postoperative mean PAP= 18.10 +/- 0.6]. [p=0.004]. 10 of the 32 subjects in the study group were pulmonary hypertensive preoperatively. MPAPs of 9 of these children decreased to normal range. [P=0.004]. This study showed that obstructive adenoid and tonsillar hypertrophy causes higher MPAP values in children that would be reversible by performing early adenotonsillectomy

[ comparative study of two treatment protocols in short course control of symptoms of allergic rhinitis patients]

Allergic rhinitis is the most common allergic disorder and its prevalence appears to be increasing. For writing prescription we have to consider some points: efficacy, safety and affordability of drugs and compliance of patient. According to the direct costs of allergic rhinitis, we selected two treatment protocols for comparison. 15 to 65 years-old patients suffered from clinical allergic rhinitis at least from one year ago [with annual not seasonal signs and symptoms] referred to Emam Reza hospital arranged in two treatment groups sequentially. After recording the first part of the questionnaire [about their symptoms] treatment started with two protocols. The first was less expensive one included first-generation antihistamine [Chlorpheniramin] and systemic decongestant [Pseudoephedrine] and the second more expensive one consisted of secondgeneration antihistamine [Loratadine] with inhaled corticosteroid [Beclomethasone]. After 45 days the second part of the questionnaire was completed. The patients who changed their jobs during this period were omitted from study. The two protocols were compared with each others by statistics software. Two protocols had similar efficacy on improvement of symptoms such as rhinorrhea, nasal or pharyngeal dryness and itching nasal congestion, PND and sneezing. According to the high price of second protocol and same efficacy of two protocols in some situations such as lack of drug affordability and patients' preference if there are no contraindications the first protocol could be a good alternative for second one

Nasopharyngeal tuberculosis: a case report presenting with neck mass

Tuberculosis is a common infectious disease. Nasopharyngeal involvement is a rare finding. We present a case [33-year old female] of known chronic renal failure with primary nasopharyngeal tuberculosis. The only manifestation of disease was bilateral cervical lymphadenopathy. There were no tuberculosis lesions in other organs. Diagnosis was made based on result of pathological examination of biopsy. Improvement was obtained by anti tuberculosis therapy. Tuberculosis must be considered in differential diagnosis of nasopharyngeal mass

[Bilateral pneumothorax due to jet ventilation, a case report]

Jet ventilation is one of the procedures that do not need intubation. Jet ventilation is used in difficult intubation, diagnostic laryngoscopy and micro laryngeal surgery, adult respiratory distress syndrome and bronchopleural fistulas. Jet ventilation has done by a thin cannula such as angiocath from oral or nasal route or cricothyroid membrane. Respiratory rate is 10-15/min in low frequency or 100-200/min in high frequency and tidal volume is 1-2 cc/kg to 5-10 cc/kg and O[2] pressure is 15-50 psi with high flow. Major complication is this procedure is cannula kink, hyperinflation, pneumothorax and sub cutaneous emphysema. In this patients for good exposure of the layrnx and immobility of the vocal cords, a nelaton cath was used from oral route into trachea and jet ventilation was done with 10-15/ min and 5cc/kg. Total IV anesthesia was done. Air-trapping and bilateral pneumothorax was caused due to pharyngeal obstruction and hemorrhage. Then the problem was resolved rapidly with bilateral chest tubes. The patient discharges after 3 days. Therefore when this procedure was used, we must be careful for expiration. Airway obstruction is treated rapidly and jet ventilation is stopped soon

Large giant cell tumor of the temporal bone presenting as mild conductive hearing loss

Giant cell tumor of bone or osteoclastoma is a relatively rare primary neoplasm of temporal bone. It usually involves the epiphyseal region of long bones. Primary involvement of bones of the skull appears to be uncommon. we report a case of giant cell tumor of temporal bone arising in a 33 years old man. The presenting symptom is only mild conductive hearing loss. A computed tomography [CT] scan showed a large well circumscribed mass within the right temporal bone, the posterior cranial fossa and the infratemporal fossa. Biopsy and subsequent resection showed a giant cell tumor of bone. Temporal bone tumor may be presented with symptoms such as mild hearing loss or aural fullness. So we always must be attention rare reasons of common symptoms

Evaluation of effect of topical phenytoin on wound healing [increasing wound tensile strength and collagen deposition] in rats

Background: Delyed healing and dehiscence of operative wounds represent a significant clinical problem. Sporadic reports indicate that phenytoin may significantly promote wound healing following topical application

Material and Methods: Ten male rats each received 4 dorsal skin incisions and were sutured immediately on proliferative and early maturation phase. The incisions were infiltrated with phenytoin or normal saline for controls randomly. The wounds were harvested 18 days after wounding and were assessed by tensiometric measurement and microscopic examination. Data was expressed as mean [sd] and were analysed using student's paired T test

Results: Application of phenytoin, in both proliferative and maturation phases, resulted in a significant increase in wound tensile strength [34.16[8.15] N and 32.18 [7.43] N in treated wound versus 28.58 N and 26.7[4.93] N controls respectively, n = 20; P<0.01]. Application of phenytoin in these two phases had no difference. The rise in wound tensile strength was associated with increase in wound collagen deposition